Development of the Emergency Department Senior Abuse Identification (ED Senior AID) tool

Emergency departments (EDs) are an important health care setting for the identification of elder abuse (EA). Our objective was to develop an ED-based tool to identify EA. The initial tool included a brief cognitive assessment, questions to detect multiple domains of EA, and a physical examination. Refinement of the tool was based on input from clinical experts and nurse and patient feedback. The revised tool, which included 15 questions about EA, was then tested in an academic ED. We calculated the inter-rater reliability, sensitivity, and specificity of individual EA questions. Among ED patients age≥65 (N = 259), 17 (7%) screened positive for suspicion of EA. We identified a combination of six questions that cover the included domains of EA, demonstrated good or excellent inter-rater reliability, and had a sensitivity and specificity of 94% (95% confidence interval (CI) 71–100%) and 90% (95% CI 85–93%), respectively. These results inform a proposed screening tool for multisite validation testing.     

Making Civil Society Sustainable: The Legacy of USAID in Croatia

What makes civil society sustainable? This paper examines USAID “Legacy Mechanisms”—programs designed to support a stable civil society after USAID withdraws aid—in the context of post-war Croatia to reconceptualize civil society sustainability in terms of resilience. Rather than examine whether specific legacy mechanisms remained intact, this paper looks at how Croatian civil society organizations adopted, adapted, and dropped these legacy programs to respond to novel crises and a changing political and social environment once USAID exited Croatia. Drawing on archival data from USAID’s time in Croatia and interviews conducted between 2008 (the year after USAID withdrew) and 2016, this paper shows that the long-term impact USAID had on civil society lay not within the formal institutions and organizations it supported, but in the resilience, creativity, and cooperation it fostered in the civil society sector.     

Deconstructing Immigrant Illegality: A Mixed-Methods Investigation of Stress and Health Among Undocumented College Students

Research has established that being undocumented is a risk factor for mental and physical health conditions. Much of this work emphasizes undocumented immigrants’ chronic stress, yet key questions about pathways to health remain. The mere state of being undocumented is viewed as a general stressor, without considering actual levels of stress or identifying dimensions of documentation status that contribute to overall stress levels. Drawing on surveys and interviews with undocumented students at the University of California, we uncover the everyday manifestations of four dimensions of immigrant “illegality”: academic concerns, future concerns, financial concerns, and deportation concerns, and their association with reported stress levels and self-rated health. Survey data establish undocumented students’ high levels of stress and poorer health, in comparison to previous research on other national samples. In a structural equation model, we found academic and future concerns to be significantly associated with higher stress, which was in turn, associated with poorer self-rated health. Financial concerns were not associated with higher perceived stress but were directly associated with poorer self-rated health. Notably, deportation concerns did not have any significant independent associations with stress or health. We use our qualitative data to identify specific stressors embedded within these four dimensions. Our findings inform understandings of the health risks arising from documentation status.     

‘No,living well does not mean being rich’: Diverse understandings of well-being among 11–13-year-old children in three Ethiopian communities

Participatory research into how people living in material poverty define and experience well-being and ill-being is increasingly common in developed and developing countries. Such research highlights the importance of experiential aspects, such as being respected and able to preserve one's dignity, and having meaningful choices. Nevertheless, these findings rarely cover children's experiences and are often not contextualized or triangulated with other data. The paper will extend this exploration using data from qualitative research with a sub-sample of children aged 11–13 in three urban and rural communities, drawn from Young Lives, a long-term international research project investigating the changing nature of childhood poverty in four countries, including Ethiopia. Firstly, it addresses how understandings of a good life and what is needed to achieve one varies between communities and amongst children of different backgrounds living in those communities; for example, boys and girls and children from richer or poorer households. Secondly, the study examines how one's place in social relationships also contributes to how children perceive and understand what a good life is. The paper confirms the importance of allowing children to take at least a ‘partial role’ in measuring and monitoring their well-being (Ben-Arieh 2005, 575) and provides examples of how this might be done.     

Infants' Response to Maternal Mirroring in the Still Face and Replay Tasks

Infants' response to maternal mirroring was investigated in 4‐month‐old infants. Mother–infant dyads participated in the still face and replay tasks. Infants were grouped by those whose mothers did and did not mirror their behavior in the interactive phases of the tasks. In the still face task, infants with maternal mirroring showed more attention, smiling, and positive vocalizations across the phases, although both groups of infants demonstrated the still‐face effect with attention and smiling. Infants' social bidding to the mother during the still‐face phase correlated with mothers' mirroring behavior. In the replay task, infants with maternal mirroring demonstrated carryover effects with smiling; infants without maternal mirroring showed no awareness of change in their mothers' behavior. In both the still face and replay tasks, infants with maternal mirroring were more engaged with their mothers. Results suggest that maternal mirroring of infants' behavior affects infants' detection of, and response to, reciprocal interaction.     

Exploring the Ebbs and Flows of Community Engagement: The Pyramid of Engagement and Water Activism in Two Canadian Communities

In this article, we share results from a comparative study exploring the dynamics of community engagement surrounding local water advocacy organizations in two Canadian communities. Although emergent local issues and the perception of crisis triggered some short-term community engagement, social factors such as collective identity, a sense of community, and sense of efficacy appear to be more important for sustaining and deepening engagement. Drawing on the results, we show how the pyramid of engagement, by depicting activist engagement as a multilevel, developmental process, can serve as a useful tool for community engagement scholars and practitioners alike.     

The Indirect Effect of Child Maltreatment Severity on Adult PTSD Symptoms through Anxiety Sensitivity

Although the rate of posttraumatic stress disorder (PTSD) among survivors of child maltreatment is high, individuals differ in symptom severity and many do not experience clinically significant levels of psychopathology. The present study tested the indirect effects of child maltreatment severity on adult PTSD, suicidal ideations, and alcohol dependence via anxiety sensitivity. A sample of 336 participants (mean age of 22.81 years, SD = 8.93; 70.2% female) completed an online survey of child abuse and neglect, anxiety sensitivity, PTSD symptom severity, suicidal ideation severity, and alcohol dependence severity. The results revealed significant indirect effects of child maltreatment on PTSD symptom severity through cognitive and social concerns, but not physical concerns. No direct or indirect effects were demonstrated for suicidal ideations or alcohol dependence severity. These findings elucidate mechanisms in the robust relationship between child maltreatment and adult PTSD symptoms and can potentially inform future research on mechanisms of change in psychotherapy.     

Understanding end-user perspectives to enhance perceived value uptake of harm-minimization tools: considering gambler’s views of a pre-commitment system

Harm-minimization strategies reduce the experience of gambling-related harms for individuals and those close to them. Most policies and particularly discussions of tool design and implementation fail to involve end users and consider their concerns and needs. This study aimed to investigate the best way to introduce a harm-minimization tool for electronic gaming machines (EGMs) that will maximize the perceived value and subsequent uptake by the intended audience of gamblers. Focus groups were conducted with 31 Australian regular EGM gamblers experiencing a range of gambling problems. Participants were asked their perspectives of a pre-commitment system (features including accessing activity statements, setting limits, viewing dynamic messages, taking breaks), including concerns, and how to enhance perceived value and usefulness. Positive attitudes about the system were expressed; however, many gamblers saw the tool as relevant only for problem gamblers. Participants indicated that value could be enhanced by making the system flexible and customizable, but still easy to use. Design and implementation strategies such as incorporating flexibility in features, ease of use, appropriate terminology, and educational efforts may address gamblers’ concerns, particularly regarding privacy and potential stigma. This would enhance user perception of harm-minimization tools as relevant and may subsequently enhance effectiveness.     

Statistical modeling for Bayesian extrapolation of adult clinical trial information in pediatric drug evaluation

Children represent a large underserved population of “therapeutic orphans,” as an estimated 80% of children are treated off‐label. However, pediatric drug development often faces substantial challenges, including economic, logistical, technical, and ethical barriers, among others. Among many efforts trying to remove these barriers, increased recent attention has been paid to extrapolation; that is, the leveraging of available data from adults or older age groups to draw conclusions for the pediatric population. The Bayesian statistical paradigm is natural in this setting, as it permits the combining (or “borrowing”) of information across disparate sources, such as the adult and pediatric data. In this paper, authored by the pediatric subteam of the Drug Information Association Bayesian Scientific Working Group and Adaptive Design Working Group, we develop, illustrate, and provide suggestions on Bayesian statistical methods that could be used to design improved pediatric development programs that use all available information in the most efficient manner. A variety of relevant Bayesian approaches are described, several of which are illustrated through 2 case studies: extrapolating adult efficacy data to expand the labeling for Remicade to include pediatric ulcerative colitis and extrapolating adult exposure‐response information for antiepileptic drugs to pediatrics.