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Data from three NIH Environmental influences on Child Health Outcomes (ECHO) Program cohorts that collected the HOME‐Infant‐Toddler (HOME‐IT age 0–3 years) version were used to examine the reliability of a brief scale of caregiver support and cognitive stimulation. Participants with HOME‐IT data (N = 2518) were included in this analysis. Mean child age at HOME‐IT assessment was 1.51 years, 48% of children were female, and 43% of children identified as Black. A four‐stage analysis plan was used to evaluate item response theory assumptions, item response theory model fit, monotonicity, scalability, item fit, and differential item functioning. Results indicate the feasibility of developing a reliable 10‐item scale (reliability >0.7) with particularly high precision for children with lower levels of cognitive stimulation. [ABSTRACT FROM AUTHOR]

Background: Identifying modifiable risk factors of autism spectrum disorders (ASDs) may inform interventions to reduce financial burden. The infant/toddler gut microbiome is one such feature that has been associated with social behaviors, but results vary between cohorts. We aimed to identify consistent overall and sex-specific associations between the early-life gut microbiome and autism-related behaviors. Methods: Utilizing the Environmental influences on Children Health Outcomes (ECHO) consortium of United States (U.S.) pediatric cohorts, we gathered data on 304 participants with fecal metagenomic sequencing between 6-weeks to 2-years postpartum (481 samples). ASD-related social development was assessed with the Social Responsiveness Scale (SRS-2). Linear regression, PERMANOVA, and Microbiome Multivariable Association with Linear Models (MaAsLin2) were adjusted for sociodemographic factors. Stratified models estimated sex-specific effects. Results: Genes encoding pathways for synthesis of short-chain fatty acids were associated with higher SRS-2 scores, indicative of ASDs. Fecal concentrations of butyrate were also positively associated with ASD-related SRS-2 scores, some of which may be explained by formula use. Limitations: The distribution of age at outcome assessment differed in the cohorts included, potentially limiting comparability between cohorts. Stool sample collection methods also differed between cohorts. Our study population reflects the general U.S. population, and thus includes few participants who met the criteria for being at high risk of developing ASD. Conclusions: Our study is among the first multicenter studies in the U.S. to describe prospective microbiome development from infancy in relation to neurodevelopment associated with ASDs. Our work contributes to clarifying which microbial features associate with subsequent diagnosis of neuropsychiatric outcomes. This will allow for future interventional research targeting the microbiome to change neurodevelopmental trajectories. [ABSTRACT FROM AUTHOR]

Most research on the effect of father figures in the home on the incidence of child maltreatment has been cross-sectional and has focused on sexual abuse. This prospective study's purpose is to determine if the presence of a father surrogate in the home affects the risk of a subsequent child maltreatment report. In a longitudinal sample of at-risk children, North Carolina's Central Registry for Child Abuse and Neglect was used to determine the maltreatment history of children from birth to age 8 years. Children who had a father surrogate living in the home were twice as likely to be reported for maltreatment after his entry into the home than those with either a biological father (odds ratio = 2.6, 95 % confidence interval = 1.4-4.7) or no father figure in the home (odds ratio = 2.0, 95% confidence interval = 1.1-3.5).

Objective: To evaluate temporal changes in risk and patterns of hospital practice for acute myocardial infarction (AMI)., Design/patients: Retrospective analysis of age-related medical therapy and outcome of 342 consecutive patients (132 at least 70 years old and 210 younger than 70) with AMI between July 1, 1989, and June 30, 1990, and comparison with data from two previous analyses of AMI practice in 1987 (n = 207) and 1988-89 (n = 402)., Setting: Tertiary care medical centre., Interventions: No direct interventions; results of the two previous AMI practice pattern analyses, however, were propagated during the practice time of the most recent analysis., Results: In 1989-90, hospital mortality was higher (19%) among patients at least 70 years old compared with patients younger than 70 (8%) (P less than 0.01). Therapies proven by repeated clinical trials to be effective in reducing AMI risk were all used less frequently in patients aged at least 70 years: thrombolysis (20 versus 43%); beta-blockers (41 versus 62%); acetylsalicylic acid (71 versus 87%); and nitrates (86 versus 97%). Qualitatively, these age-specific patterns of AMI mortality and therapy were similar to previous studies. Quantitatively, however, comparing 1987 with 1989-90 demonstrated parallel and marked increases in the use of all proven medications in both age groups, ranging from 42 to 230% (P less than 0.01). There was also a significant overall decrease in mortality from the 1987 patient cohort (20%) to the 1989-90 cohort (13%) (P less than 0.05). The decrease in mortality was entirely due to decreased mortality within the group 70 years or older; 35% in 1987 versus 19% in 1989-90 (P less than 0.05). Mortality in the AMI patients younger than 70 years old remained unchanged from 1987 to 1989-90., Conclusions: Pattern of practice analyses were associated with, and may have contributed to, improved patient care and outcomes in AMI. Increased use of effective AMI medical therapy had a greater benefit in elderly higher risk AMI patients than lower risk younger patients. Persisting age-specific differences in AMI therapy may respond to more direct quality improvement measures, such as critical path management.