Research-to-Practice Brief: Promising Evidence that Early Head Start Can Prevent Child Maltreatment

This brief addresses two main questions in a sample of Early Head Start eligible children: 1) the number and type of maltreatment episodes and 2) the impact of Early Head Start on child and family involvement in the child welfare system. These findings are especially important given the lack of scalable and effective preventive interventions. In addition, they are also timely given the recent interest in fostering collaborations between early care and education programs and child welfare agencies, agencies responsible for overseeing child protection from maltreatment (OHS & ACYF, 2010; ACYF & OHS, 2011; ACYF & OCC, 2011). The current study represents a first look at the impact of Early Head Start on child maltreatment. We are continuing to collect data and will have more information in the upcoming years

It’s Not as Simple as it Sounds: Problems and Solutions in Accessing and Using Administrative Child Welfare Data for Evaluating the Impact of Early Childhood Interventions

In recent years, there has been increasing interest in using administrative data collected by state child welfare agencies as a source of information for research and evaluation. The challenges of obtaining access to and using these data, however, have not been well documented. This study describes the processes used to access child welfare records in six different states and the approach to combining and using the information gathered to evaluate the impact of the Early Head Start program on children’s involvement with the child welfare system from birth through age eleven. We provide “lessons learned” for researchers who are attempting to use this information, including being prepared for long delays in access to information, the need for deep understanding of how child welfare agencies record and code information, and for considerable data management work for translating agency records into analysis-ready datasets. While accessing and using this information is not easy, and the data have a number of limitations, we suggest that the benefits can outweigh the challenges and that these records can be a useful source of information for policy-relevant child welfare research

Apolipoprotein Proteomics for Residual Lipid-Related Risk in Coronary Heart Disease

BACKGROUND: Recognition of the importance of conventional lipid measures and the advent of novel lipid-lowering medications have prompted the need for more comprehensive lipid panels to guide use of emerging treatments for the prevention of coronary heart disease (CHD). This report assessed the relevance of 13 apolipoproteins measured using a single mass-spectrometry assay for risk of CHD in the PROCARDIS case-control study of CHD (941 cases/975 controls). METHODS: The associations of apolipoproteins with CHD were assessed after adjustment for established risk factors and correction for statin use. Apolipoproteins were grouped into 4 lipid-related classes [lipoprotein(a), low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglycerides] and their associations with CHD were adjusted for established CHD risk factors and conventional lipids. Analyses of these apolipoproteins in a subset of the ASCOT trial (Anglo-Scandinavian Cardiac Outcomes Trial) were used to assess their within-person variability and to estimate a correction for statin use. The findings in the PROCARDIS study were compared with those for incident cardiovascular disease in the Bruneck prospective study (n=688), including new measurements of Apo(a). RESULTS: Triglyceride-carrying ApoC1, ApoC3, and ApoE (apolipoproteins) were most strongly associated with the risk of CHD (2- to 3-fold higher odds ratios for top versus bottom quintile) independent of conventional lipid measures. Likewise, ApoB was independently associated with a 2-fold higher odds ratios of CHD. Lipoprotein(a) was measured using peptides from the Apo(a)-kringle repeat and Apo(a)-constant regions, but neither of these associations differed from the association with conventionally measured lipoprotein(a). Among HDL-related apolipoproteins, ApoA4 and ApoM were inversely related to CHD, independent of conventional lipid measures. The disease associations with all apolipoproteins were directionally consistent in the PROCARDIS and Bruneck studies, with the exception of ApoM. CONCLUSIONS: Apolipoproteins were associated with CHD independent of conventional risk factors and lipids, suggesting apolipoproteins could help to identify patients with residual lipid-related risk and guide personalized approaches to CHD risk reduction

Development and Validation of a Risk Score for Chronic Kidney Disease in HIV Infection Using Prospective Cohort Data from the D:A:D Study

Ristola M. on työryhmien DAD Study Grp ; Royal Free Hosp Clin Cohort ; INSIGHT Study Grp ; SMART Study Grp ; ESPRIT Study Grp jäsen.Background Chronic kidney disease (CKD) is a major health issue for HIV-positive individuals, associated with increased morbidity and mortality. Development and implementation of a risk score model for CKD would allow comparison of the risks and benefits of adding potentially nephrotoxic antiretrovirals to a treatment regimen and would identify those at greatest risk of CKD. The aims of this study were to develop a simple, externally validated, and widely applicable long-term risk score model for CKD in HIV-positive individuals that can guide decision making in clinical practice. Methods and Findings A total of 17,954 HIV-positive individuals from the Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) study with >= 3 estimated glomerular filtration rate (eGFR) values after 1 January 2004 were included. Baseline was defined as the first eGFR > 60 ml/min/1.73 m2 after 1 January 2004; individuals with exposure to tenofovir, atazanavir, atazanavir/ritonavir, lopinavir/ritonavir, other boosted protease inhibitors before baseline were excluded. CKD was defined as confirmed (>3 mo apart) eGFR In the D:A:D study, 641 individuals developed CKD during 103,185 person-years of follow-up (PYFU; incidence 6.2/1,000 PYFU, 95% CI 5.7-6.7; median follow-up 6.1 y, range 0.3-9.1 y). Older age, intravenous drug use, hepatitis C coinfection, lower baseline eGFR, female gender, lower CD4 count nadir, hypertension, diabetes, and cardiovascular disease (CVD) predicted CKD. The adjusted incidence rate ratios of these nine categorical variables were scaled and summed to create the risk score. The median risk score at baseline was -2 (interquartile range -4 to 2). There was a 1: 393 chance of developing CKD in the next 5 y in the low risk group (risk score = 5, 505 events), respectively. Number needed to harm (NNTH) at 5 y when starting unboosted atazanavir or lopinavir/ritonavir among those with a low risk score was 1,702 (95% CI 1,166-3,367); NNTH was 202 (95% CI 159-278) and 21 (95% CI 19-23), respectively, for those with a medium and high risk score. NNTH was 739 (95% CI 506-1462), 88 (95% CI 69-121), and 9 (95% CI 8-10) for those with a low, medium, and high risk score, respectively, starting tenofovir, atazanavir/ritonavir, or another boosted protease inhibitor. The Royal Free Hospital Clinic Cohort included 2,548 individuals, of whom 94 individuals developed CKD (3.7%) during 18,376 PYFU (median follow-up 7.4 y, range 0.3-12.7 y). Of 2,013 individuals included from the SMART/ESPRIT control arms, 32 individuals developed CKD (1.6%) during 8,452 PYFU (median follow-up 4.1 y, range 0.6-8.1 y). External validation showed that the risk score predicted well in these cohorts. Limitations of this study included limited data on race and no information on proteinuria. Conclusions Both traditional and HIV-related risk factors were predictive of CKD. These factors were used to develop a risk score for CKD in HIV infection, externally validated, that has direct clinical relevance for patients and clinicians to weigh the benefits of certain antiretrovirals against the risk of CKD and to identify those at greatest risk of CKD.Peer reviewe

Das Muster der Tugend, An Seiner im Leben höchstliebgewesenen Gemahlin, Constantia Concordia Perpetva Wolte Nebst dem durch deren allzufrühzeitige Abforderung, Welche Den 26. Julii Anno 1724. erfolgete ... Durch folgende ... Worte ... vorstellen Dero Betrübtester Ehemann Hanß Adam Freyherr von Ende

Trauerrede auf Konstanze Konkordia Perpetua von Ende, geb. von Danckelmann, Ehefrau des Regierungsrats im Herzogtum Magdeburg, Domherrn zu Halberstadt u. Erb- u. Gerichtsherr auf Alt-Jeßnitz Hans Adam von Ende, 1697-1724Vergl. Stolberg. Leichenpr. 8094Autopsie nach Ex. der ULB Sachsen-AnhaltVorlageform des Erscheinungsvermerks: Halle, druckts Christian Henckel, Univ. Buchdr

Schuldigstes Ehren- und Denckmahl : Welches Bey dem Absterben Des Hoch-Wohlgebohrnen Herrn, Herrn Hans Adam von Ende, Weyland Königl. Preußischen hochbestallten Obristen und Ambts-Hauptmanns zu Rosenburg, auf Trinum und Alt-Jeßnitz Erb-Herrns. Aus mehr als kindlicher Pflicht Und zu derselben steter Bezeugung hiemit abstattet Dessen hinterlassener Bruders Sohn Hans Adam von Ende

Fingerprint nach Ex. der HAB Wolfenbüttel und der ULB Sachsen-AnhaltVorlageform des Erscheinungsvermerks: Halle, Druckts Christian Henckel, Univers. Buchdr.In Fraktu

Die Gerechtsame der Thränen : Bey dem Grabe Der Hoch-Wohlgebohrnen Frauen, Frauen Johannen von Dießkau, gebohrner Löserin, Des Hoch-Wohlgebohrnen Herrn, Herrn Carl von Dießkau, Zu Dießkau, Lochau und Bruckdorff Erb- und Gerichts-Herrns, Sr. Königl. Majestät in Preussen Höchst-meritirten Geheimten, wie auch Regierungs- und Krieges-Raths, [et]c. [et]c. Hertzgeliebtesten Frau Gemahlin, Welche Den 4. Junii 1715. Durch ein exemplarisch seeliges Ende die Zeitlichkeit gesegnete

Wolte Mit höchst-verbundener Feder etlicher massen entwerffen Hanß Adam Frey-Herr von Ende, Königlicher Preuß. Regierungs-Rath im Hertzogthum Magdeburg, wie auch Dom-Herr des hohen Stiffts zu HalberstadtAutopsie nach Ex. der SBBVorlageform des Erscheinungsvermerks: Magdeburg, Gedruckt bey Christ. Salfelds, Kön. Pr. Reg. Buchdr. nachgel. Wittw

The Effect of Early Head Start on Child Welfare System Involvement: A First Look at Longitudinal Child Maltreatment Outcomes

The high societal and personal costs of child maltreatment make identification of effective early prevention programs a high research priority. Early Head Start (EHS), a dual generational program serving low-income families with children prenatally through age three years, is one of the largest federally funded programs for infants and toddlers in the United States. A national randomized trial found EHS to be effective in improving parent and child outcomes, but its effectiveness in reducing child maltreatment was not assessed. The current study used administrative data from state child welfare agencies to examine the impact of EHS on documented abuse and neglect among children from seven of the original seventeen programs in the national EHS randomized controlled trial. Results indicated that children in EHS had significantly fewer child welfare encounters between the ages of five and nine years than did children in the control group, and that EHS slowed the rate of subsequent encounters. Additionally, compared to children in the control group, children in EHS were less likely to have a substantiated report of physical or sexual abuse, but more likely to have a substantiated report of neglect. These findings suggest that EHS may be effective in reducing child maltreatment among low-income children, in particular, physical and sexual abuse

Pathways to Prevention: Early Head Start Outcomes in the First Three Years Lead to Long-Term Reductions in Child Maltreatment

While there is growing evidence that early childhood prevention programs can have positive outcomes for children and families, research has tended to focus on short-term outcomes, with fewer studies of long-term benefits. In addition, evaluations of such programs rarely go beyond the question, “does the program work?” despite numerous calls over the past decade for more research that can help understand how these programs have their effects. Using longitudinal, experimental data from the Early Head Start (EHS) Research and Evaluation Project (EHSREP) linked to child welfare agency records for 2794 children, we examined the effectiveness of EHS birth-to-three services in preventing child maltreatment during children’s first 15 years of life. Following this, we assessed whether changes in specific child and family outcomes at ages 2 and 3 acted as mediators for later maltreatment prevention. Results showed that EHS has a long-term impact on the likelihood of child welfare system involvement that is driven by earlier impacts on parenting behaviors, family well-being, and child developmental status. By children’s second birthday, families randomly assigned to participate in EHS had lower family conflict and parenting distress, and more positive parent-child interactions; these impacts, in turn, led to later reductions in the likelihood of children being involved with the child welfare system through age fifteen years. Furthermore, at age three, children in EHS were more attentive and engaged in play with their parents and had higher scores on cognitive development assessments compared to controls; these outcomes were similarly associated with long-term reductions in the likelihood of child maltreatment. These findings suggest that early two-generational programs, like EHS, that are able to successfully decrease family conflict and stress and support positive, emotionally responsive parenting and child development, may reduce the likelihood of abuse and neglect later in life