Long-term collateral effects of parent programs on child maltreatment proxies:Can administrative data provide useful insights?

Collecting child maltreatment data from participants is expensive and time-consuming, and often suffers from substantial attrition rates. Administrative population data may prove fruitful to overcome these barriers. The aim of this study was twofold: (1) to illustrate how administrative data may be used in evaluating long-term intervention effects; and (2) to examine collateral effects of three preventive early childhood interventions offered to families in the Netherlands (Supportive Parenting, VoorZorg, and Incredible Years). Using population data, four proxies of child maltreatment were assessed to examine collateral intervention effects: incidences of child protection orders, placements of children in residential care, crime victimization of children or their parents, and parental registrations as a crime suspect. The results revealed no significant differences between experimental and control conditions on any of these proxies, with very small effect sizes (ranging from Cramer's V = 0.01 to Cramer's V = 0.10). We conclude that the results do not provide support for collateral effects, but that studying other outcomes may provide this support. We further discuss that small sample sizes and low prevalences challenge studies using administrative data. Notwithstanding these limitations, we conclude that administrative data can strengthen the evidence base for collateral and direct intervention effects.</p

Differences and similarities between mothers’ and fathers’ risk factors for child maltreatment

Background: Parental risk factors play an important role in child maltreatment, however, little is known about the role of fathers’ risk factors. Objective: The current study aimed to compare fathers and mothers in terms of (1) the prevalence and impact of risk factors for perpetrating child maltreatment and (2) the interplay of risk factors. Participants: The Dutch sample consisted of 4090 mothers and 3973 fathers who had a newborn and received health-and developmental checks between October 2001 and November 2002. Methods: Risk factors were assessed using the Instrument for Identification of Parents at Risk for Child Abuse and Neglect (IPARAN) and child maltreatment was defined as a verified report at Child Protection Services in a period of 3-years following completion of the IPARAN. McNemar tests and network analyses were performed. Results: Results demonstrated that the majority of assessed risk factors were related to perpetrating future child maltreatment for both fathers and mothers. In general, risk factors were more prevalent in mothers than in fathers. Inability to ask for help was the risk factor that was most prevalent for both mothers (22.4%) and fathers (22%). The risk factors worries about raising the child, unhappy during pregnancy, and losing control when angry were more strongly related to future child maltreatment in mothers compared to fathers, whereas risk factors related to their own child maltreatment in the past and experiencing a lack of support were more impactful for fathers compared to mothers. For fathers and mothers, belief in physical punishment and risk factors related to their own history of child maltreatment were most central. Conclusions: Overall, these findings underscore the importance of considering the long-lasting, intergenerational effects of child maltreatment. Intergenerational trauma may put parents at a higher risk of becoming perpetrators; our network results confirm that these risk factors deserve an important spot in prevention efforts

Tumor mutational load, CD8+ T cells, expression of PD-L1 and HLA class I to guide immunotherapy decisions in NSCLC patients

Objectives: A minority of NSCLC patients benefit from anti-PD1 immune checkpoint inhibitors. A rational combination of biomarkers is needed. The objective was to determine the predictive value of tumor mutational load (TML), CD8+ T cell infiltration, HLA class-I and PD-L1 expression in the tumor. Materials and methods: Metastatic NSCLC patients were prospectively included in an immune-monitoring trial (NTR7015) between April 2016-August 2017, retrospectively analyzed in FFPE tissue for TML (NGS: 409 cancer-related-genes) and by IHC staining to score PD-L1, CD8+ T cell infiltration, HLA class-I. PFS (RECISTv1.1) and OS were analyzed by Kaplan–Meier methodology. Results: 30 patients with adenocarcinoma (67%) or squamous cell carcinoma (33%) were included. High TML was associated with better PFS (p = 0.004) and OS (p = 0.025). Interaction analyses revealed that patients with both high TML and high total CD8+ T cell infiltrate (p = 0.023) or no loss of HLA class-I (p = 0.026), patients with high total CD8+ T cell infiltrate and no loss of HLA class-I (p = 0.041) or patients with both high PD-L1 and high TML (p = 0.003) or no loss of HLA class-I (p = 0.032) were significantly associated with better PFS. Unsupervised cluster analysis based on these markers revealed three sub-clusters, of which cluster-1A was overrepresented by patients with progressive disease (15 out of 16), with significant effect on PFS (p = 0.007). Conclusion: This proof-of-concept study suggests that a combination of PD-L1 expression, TML, CD8+ T cell infiltration and HLA class-I functions as a better predictive biomarker for response to anti-PD-1 immunotherapy. Consequently, refinement of this set of biomarkers and validation in a larger set of patients is warranted

Pets as Sentinels of Human Exposure to Neurotoxic Metals

The idea that animals may be used as sentinels of environmental hazards pending over humans and the associated public health implications is not a new one. Nowadays pets are being used as bioindicators for the effects of environmental contaminants in human populations. This is of paramount importance due to the large increase in the worldwide distribution of synthetic chemicals, particularly in the built environment. Companion animals share the habitat with humans being simultaneously exposed to and suffering the same disease spectrum as their masters. Moreover, their shorter latency periods (due to briefer lifespans) enable them to act as early warning systems, allowing timely public health interventions. The rise on ethical constraints on the use of animals and, consequently, on the sampling they can be subjected to has led to the preferential use of noninvasive matrices, and in this case we are looking into hair. This chapter focuses in three non-essential metals: mercury, lead, and cadmium, due to their ubiquitous presence in the built environment and their ability of affecting the mammal nervous system. There is a fairly short amount of studies reporting the concentrations of these metals in pets’ hair, particularly for cats. These studies are characterized, and the metal concentrations corresponding to different parameters (e.g., age, sex, diet, rearing) are described in order to provide the reader with a general vision on the use of this noninvasive matrix on the studies conducted since the last two decades of the twentieth century.publishe