Now showing items 1-20 of 13719

    • Petitions for Extreme Risk Protection Orders and Second Amendment Sanctuary Status in Colorado

      Knoepke, Chris; Barnard, Leonard; Batta, Nisha; McCarthy, Megan; Thies, Kimberly; Olivencia, Christian; Robinson, Caitlin; Kettering, Shalyn; Huss, Sheila; Betz, Marian (2024-04-01)
      IMPORTANCE Extreme risk protection orders (ERPOs) temporarily barindividuals adjudicated as being at risk of violence (including suicide) from buying or possessing firearms. In protest, many US jurisdictions have declared themselves “Second Amendment sanctuaries” (2A sanctuaries). Many 2A sanctuaries continue to use ERPOs in low numbers, suggesting a poorly defined risk threshold at which they are acceptable. OBJECTIVE To characterize circumstances under which ERPO s areused in 2A sanctuaries, highlighting their most broadly acceptable applications. DESIGN,SETTING, AND PARTICIPANTS This cross-sectional study of civil court documents analyzed petitions for ERPOs filed in Colorado from January 2020 to December 2022. All petitions during the study period were included following de-duplication. These include petitions filed by law enforcement and family members against adults allegedly at risk of firearm violence across the state. Data were analyzed on a rolling basis between January 2020 and June 2023. EXPOSURE ERPO petition filed in Colorado. MAIN OUTCOMES AND MEASURES Seventy-seven data elements defined apriori were abstracted from all petitions and case files, including respondent demographics, petitioner types (family or law enforcement), types of threats (self, other, mass violence, combination), violence risk factors, and case outcomes (granted, denied). RESULTS Of a total 338 ERPOs filed in Colorado, 126( 37.3%) occurredi n2A sanctuaries. Sixty-one of these 2A petitions were granted emergency orders, and 40 were full 1-year ERPOs after a hearing. Forty ERPOs (31.7%) were petitioned for by law enforcement. Petitions in non-2A counties were more likely to have been filed by law enforcement (138 of 227 [64.9%] vs 40 of 126 [31.7%]; P < .001) and to have had an emergency order granted (177 of 227 [78.0%] vs 61 of 126 [48.4%]; P < .001) than in 2A sanctuaries. Qualitative analysis of cases in 2A sanctuaries revealed common aggravating risk characteristics, including respondents experiencing hallucinations, histories of police interaction, and substance misuse. ERPOs have been granted in 2A sanctuaries against individuals threatening all forms of violence we abstracted for (themselves, others, and mass violence). CONCLUSIONS AND RELEVANCE In this examination of ERPO petitions across Colorado, more than a third of filings occurred in 2A sanctuaries. Nonetheless, law enforcement represent proportionately fewer petitions in these areas, and petitions are less likely to be granted. Serious mental illness, substance misuse, and prior interactions with law enforcement featured prominently in 2A sanctuary petitions. These case circumstances highlight dangerous situations in which ERPOs are an acceptable risk-prevention tool, even in areas politically predisposed to opposing them.
    • Progress Report: Women's Career Advancement

      Vinas, Keila; Lawler McHugh, Tina (2024-03)
    • Innovations in EAP

      Hammonds, Trina (2024-04-30)
      Employee Assistance Programs (EAPs) have played a crucial role in the lives of many employees. Traditionally, EAPs addressed an employee's work-related challenges. However, the programs have grown to offer robust assistance even to the employees' families. EAPs help employees deal with stressful situations in their life and work. These programs that EAPs provide include free and confidential counseling, legal and financial information and resources, work/ life solutions, and telephonic health coaching (Baskar et al., 2021). EAP services are free, available to employees and household members, and available 24 hours a day, seven days a week. There are many reasons why employees may contact the EAP services: for example, employees may need help with stress, anxiety, depression, relationship marital conflicts, parenting and children, grief and loss, job stress, substance use, and balancing work-life lifestyles (Baskar et al., 2021). As the EAP services continue to be valuable to employees, the future of EAP is shaped by modern trends and the ever-evolving work landscape. The evolving nature of the EAP shows a bright future with employees receiving more advanced help, hence improving their well-being.
    • EAPA Town Hall April 2024

      Fabsik-Swarts, Julie (2024-04-11)
    • Virtual Reality Experiences and Neural Responses: Unraveling the Dynamics of Empathy and Placebo Effects

      Clark, Jewel; Bellei-Rodriguez, Carmen-Edith; Shafir, Roni; Watson, Lakota; Wang, Yang; Colloca, Luana (2024-04-28)
    • Echogenicity Enhances Risk Assessment of Lesions on MP-MRI for Clinically Significant Prostate Cancer

      Wegner, Garret; Khan, Amir; Panagos, MIchael; Wang, Shu; Van Besien, Alexa J.; Naslund, Michael; Siddiqui, M. Minhaj; Panagos, Michael (2024-05-03)
      Multiparametric Magnetic Resonance Imaging (MP-MRI)/ ultrasound fusion guided biopsy (targeted biopsy) is emerging as an alternative diagnostic tool for Prostate cancer (PCa) in addition to historically used Transrectal Ultrasound-guided (TRUS) biopsy. Echogenicity observed during the fusion of MRI and ultrasound images may be associated with the detection of clinically significant prostate cancer in targeted biopsy of MP-MRI lesions.
    • Evaluating the Impact of the New CKD-EPI Creatinine Equation (2021) for eGFR on the Management of Muscle Invasive Bladder Cancer

      Khan, Amir; Siddiqui, M. Minhaj (2024-05-06)
      The estimated glomerular filtration rate (eGFR) equation had been historically calculated inclusive of a race coefficient. However, in September 2021, the NKF and the American Society of Nephrology Task Force announced a new race-free calculation for eGFR due to criticism around racial disparities. Aspects of treatment decisions for muscle-invasive bladder cancer (MIBC) such as cisplatin-based neoadjuvant chemotherapy (NAC) eligibility depend on eGFR due to potential nephrotoxic effects.
    • Virtual Reality for Procedure Pain in Pediatrics

      Wagner, Kendall (2024-05-07)
      Painful procedures are an inevitable aspect of pediatric hospitalization causing distress for patients. Recent research presents virtual reality (VR) as a promising alternative to mitigate procedural pain and anxiety. This synthesis examines the impact of VR distraction during painful procedures in hospitalized pediatric patients aged 6 to 18 years. A literature search identified five randomized controlled trials comparing VR to standard care. Findings consistently demonstrated reduced pain perception and anxiety with VR use. VR intervention presents minimal risks and aligns with patient-centered care principles. Future research should explore optimal VR programming, efficacy in younger age groups, and long-term outcomes.
    • Documenting Psychosocial Problems in Children’s Electronic Health Records

      Dubowitz, Howard; Kressly, Susan J. (American Medical Association (AMA), 2023-09-01)
    • Initial Medical Assessment of Possible Child Sexual Abuse: History, History, History

      Dubowitz, Howard; Finkel, Martin; Feigelman, Susan; Lyon, Thomas (Elsevier, 2024)
      Primary care professionals (PCPs) can play a valuable role in the initial assessment of possible child sexual abuse (CSA), an all too prevalent problem. PCPs, however, are often reluctant to conduct these assessments. The goal of this paper is to help PCPs be more competent and comfortable playing a limited but key role. This is much needed as there may be no need for further assessment and also because of a relative paucity of medical experts in this area. While some children present with physical problems, the child's history is generally the critical information. This article therefore focuses on practical guidance regarding history-taking when CSA is suspected, incorporating evidence from research on forensic interviewing. We have been mindful of the practical constraints of a busy practice and the role of the public agencies in fully investigating possible CSA. The approach also enables PCPs to support children and their families.
    • Validation of the Swedish version of the safe environment for every kid (SEEK) parent screening questionnaire

      Engström, Maria; Lindqvist, Sara; Janson, Staffan; Feldman, Inna; Dubowitz, Howard; Lucas, Steven (Springer Science and Business Media LLC, 2023-10-12)
      Background: Psychosocial risk factors in the home may impair children's health and development and increase the risk of maltreatment. The Safe Environment for Every Kid (SEEK) model was developed to provide pediatric primary care professionals with a structured way to identify common psychosocial problems. The SEEK model includes use of the Parent Screening Questionnaire (SEEK-PSQ) at routine preventive child health visits, discussion with parents about their responses and, when indicated, referral to relevant services. The SEEK-PSQ has not previously been available in Swedish. The aim of the present study was to evaluate the psychometric properties of an adapted Swedish version of the SEEK-PSQ (PSQ-S). Methods: This study is part of a cluster-randomised controlled trial of SEEK in the Swedish child health services. To validate the PSQ-S, parents (n = 852) with children 0-18 months of age were invited to complete a survey including the PSQ-S as well as evidence-based standardized instruments for the targeted psychosocial risk factors: economic worries, depressive symptoms, parental stress, alcohol misuse and intimate partner violence (IPV). Baseline data from 611 (72%) parents were analysed regarding sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for each risk factor. Results: As a whole, the PSQ-S had a sensitivity of 93%, specificity of 52%, PPV of 67% and NPV of 87%. For mothers and fathers combined, sensitivity was 80% for economic worries, 89% for depressive symptoms, 78% for parental stress, 47% for intimate partner violence (IPV) and 70% for alcohol misuse. Specificity was highest for IPV and alcohol misuse (91%) and lowest for depressive symptoms (64%). NPV values were high (81-99%) and PPV values were low to moderate (22-69%) for the targeted problems. Sensitivity was higher for mothers compared to fathers for economic worries, depressive symptoms and IPV. This difference was particularly evident for IPV (52% for mothers, 27% for fathers). Conclusion: The SEEK-PSQ-S demonstrated good psychometric properties for identifying economic worries, depressive symptoms, parental stress and alcohol misuse but low sensitivity for IPV. The PSQ-S as a whole showed high sensitivity and NPV, indicating that most parents with or without the targeted psychosocial risk factors were correctly identified.
    • Assessment of Adoption and Early Implementation Barriers and Facilitators of the Safe Environment for Every Kid (SEEK) Model

      Palinkas, Lawrence A.; Belanger, Rosemarie; Newton, Stacey; Saldana, Lisa; Landsverk, John; Dubowitz, Howard (Elsevier, 2023)
      Objective: Although the use of interventions for screening for social determinants of health of families in pediatric primary care clinics has increased in the past decade, research on the barriers and facilitators of implementing such interventions has been limited. We explored barriers, facilitators, and the mechanisms clarifying their roles in the adoption and implementation of the Safe Environment for Every Kid (SEEK) model, an approach for strengthening families, promoting children's health and development, and preventing child maltreatment. Methods: A total of 28 semistructured interviews were completed with 9 practice champions, 11 primary care professionals, 5 behavioral health professionals, and 3 nursing/administrative staff representing 12 pediatric primary care practices participating in a larger randomized control trial of implementing SEEK. Results: We identified several barriers and facilitators in the stages of SEEK's adoption and early implementation. Barriers associated with outer and inner setting determinants and poor innovation-organization fit declined in importance over time, while facilitators associated with SEEK characteristics increased in importance based on participants' responses. Barriers and facilitators were linked by mechanisms of comparison and contrast of burdens and benefits, and problem-solving to address limited capacity with available resources. Conclusions: Any screening for and addressing social determinants of health demands greater attention to adoption and implementation mechanisms and the processes by which primary care professionals assess and utilize facilitators to address barriers. This occurs in a context defined by perceived burdens and benefits of innovation adoption and implementation, the capacity of the practice, and changes in perception with experiencing the innovation.
    • Addressing Adverse Childhood Experiences in Primary Care: Challenges and Considerations

      Dubowitz, Howard; Finkelhor, David; Zolotor, Adam; Kleven, Jennifer; Davis, Neal (American Academy of Pediatrics (AAP), 2022-03-10)
      This article draws attention to the overlapping literature on social determinants of health and adverse childhood experiences, and the growing clinical interest in addressing them to promote children's and parents' health and well-being. We address important considerations and suggest solutions for leaders and practitioners in primary care to address social determinants of health/adverse childhood experiences. Priorities include: begin with a few prevalent conditions for which there are helpful resources; focus on conditions that are current or recent and where parents may be more apt to engage in services; focus initially on families with children aged <6 given the frequency of well-child visits and the especially strong relationships between primary care professionals and parents during this period; ensure training of primary care professionals and staff to help them play this role competently and comfortably; and have good referral processes to facilitate additional evaluation or help.
    • Neglect in Childhood, Problem Behavior in Adulthood

      Dubowitz, Howard; Roesch, Scott; Lewis, Terri; Thompson, Richard; English, Diana; Kotch, Jonathan B. (SAGE Publications, 2022-02-13)
      Few studies have reported problem behaviors in adulthood related to the timing of child neglect. The objective was to examine the relationship between classes of child neglect and later behavior. The sample included 473 participants from the prospective Longitudinal Studies of Child Abuse and Neglect (LONGSCAN); their mean age was 23.8 years. They completed an online survey regarding behaviors and experiences in early adulthood. Neglect was assessed via Child Protective Services (CPS) and self-reports of neglect. Latent class analysis (LCA) identified three classes: Late Neglect, Chronic Neglect, and Limited Neglect. There were significant differences between Limited and Late Neglect regarding later intimate partner aggression and violence (IPAV) and psychological distress, and among all classes for criminal behavior. High-risk youth experiencing neglect beginning in mid-adolescence appear especially vulnerable to later criminal behavior, psychological distress, and IPAV. Those working with such youth can help ensure that their needs are adequately met, to prevent or mitigate problems in adulthood.
    • Adolescent Neglect and Health Risk

      Kobulsky, Julia M.; Villodas, Miguel; Yoon, Dalhee; Wildfeuer, Rachel; Steinberg, Laurence; Dubowitz, Howard (SAGE Publications, 2021-10-19)
      This study examined relationships between adolescent neglect and abuse and later health risk in a sample of 1050 youth (53% female, 56% Black, and 24% White) from the Longitudinal Studies of Child Abuse and Neglect. At age 16, the youth reported any adolescent exposure to neglect and physical, sexual, and emotional abuse. At age 18, they reported risk behaviors (delinquency, substance use, and sexual behavior) and emotional and behavioral problems (externalizing and internalizing problems, suicidality). Control variables were childhood maltreatment (self-reports and early childhood child protective services reports), risk behaviors and emotional and behavioral problems at age 16, and demographics. Analysis confirmed a 5-factor model of adolescent neglect (Exposure to Risk, Inadequate Monitoring, Inattention to Basic Needs, Permitting Misbehavior, and Inadequate Support). Inadequate Support and Exposure to Risk were associated with more substances used; Exposure to Risk was also associated with delinquency and suicidality. Adolescent emotional abuse was associated with not using a condom use and internalizing and externalizing problems. Findings underscore the importance of preventing or addressing neglect during adolescence.
    • Social determinants of health, personalized medicine, and child maltreatment

      Lane, Wendy G.; Dubowitz, Howard (Springer Science and Business Media LLC, 2021)
      This review begins with a brief summary of the importance of child maltreatment as a major public health problem, given its prevalence and the substantial human and economic costs involved. The focus then shifts to consideration of personalized medicine and child maltreatment, including genetic and genomics factors, as well as the role of social determinants of health. Research on epigenetics related to child abuse and neglect is presented, followed by that pertaining to a few specific social factors, such as poverty, parental depression and substance use, and domestic (or intimate partner) violence. The review ends with a discussion of interventions to help address social determinants of health with brief descriptions of several model programs, and thoughts concerning the role of personalized medicine in addressing child maltreatment in the foreseeable future. IMPACT: This paper synthesizes knowledge on social determinants of health and advances in genetics and genomics related to the prevention of child maltreatment. It provides examples of model approaches to addressing the prevention of child maltreatment in primary care practices.