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Bystander-based sexual violence (SV) prevention trainings are offered on college campuses across the United States to meet federal Title IX requirements, as they have proven to be an effective strategy for violence prevention. Greek-affiliated students (fraternity and sorority members) are at a higher risk of sexual assault than their peers; however, few trainings consider the specific needs of this population, and program adaptations for this high-risk group may be needed. This scoping review identifies and describes the bystander trainings delivered to Greek-affiliated students in the US and Canada. An eight-database search was conducted following PRISMA-ScR guidelines. The review identified 81 unique sources, with 18 meeting the inclusion criteria. Eleven specific training programs were identified, encompassing qualitative, quantitative, and mixed-method studies. The thematic analysis revealed best practices, including the importance of peer leaders, interactive sessions, and tailored content to Greek culture, as well as barriers such as a lack of engagement and an inadequate session length. The review underscores the need for tailored interventions to effectively address the unique cultural characteristics and high-risk nature of Greek-affiliated students. These findings provide valuable insights for improving the design and implementation of bystander interventions to enhance their efficacy in preventing sexual violence within this population.

Background: Elevated mental illness prevalence complicates efforts designed to address the opioid crisis in Appalachia. The recovery community acknowledges that loneliness impacts mood and engagement in care factors; however, the predictive relationship between loneliness and retention in medication-assisted outpatient treatment programs has not been explored. Our objectives were to identify associations between mental health factors and retention in treatment and elucidate treatment retention odds. Data were collected from eighty participants ( n = 57 retained, n = 23 not retained) of a mindfulness-based relapse prevention (MBRP) intervention for individuals receiving medication for opioid use disorder (MOUD) in Appalachia. Loneliness, depression, and anxiety did not differ between the retained and not retained, nor did they predict not being retained; however, mindfulness was significantly lower among those not retained in treatment compared to those retained (OR = 0.956, 95% CI (0.912-1.00), and p < 0.05). Preliminary findings provide evidence for mindfulness training integration as part of effective treatment, with aims to further elucidate the effectiveness of mindfulness therapies on symptom reduction in co-occurring mental health disorders, loneliness, and MOUD treatment retention.

Introduction: Opioid addiction and opioid-related overdoses and deaths are serious public health problems nationally and in West Virginia, in particular. Medication-assisted treatment (MAT) is an effective yet underutilized treatment for opioid use disorder (OUD)., Purpose: Research examining factors that help individuals succeed in MAT has been conducted from provider and program perspectives, but little research has been conducted from the perspective of those in recovery., Methods: This study, co-developed with individuals in recovery, took place in West Virginia-based MAT programs using an exploratory sequential mixed methods approach. The survey was open February through August 2021. Data were analyzed late 2021 through mid 2022., Results: Respondents experienced many barriers to MAT entry and retention, including community bias / stigma, lack of affordable programming, and lack of transportation. Respondents sought MAT primarily for personal reasons, such as being tired of being sick, and tired of having to look for drugs every day. As one respondent shared, " I wanted to better my life, to get it under control.", Implications: Programs and policies should make it easy for individuals to enter treatment when ready, through affordable and accessible treatment options, reduced barriers to medications, focused outreach and education, individualized care, and reduced stigmatization., Competing Interests: Cover Page Footnote This study is a project of the West Virginia Alliance for Creative Health Solutions, an AHRQ-recognized Practice Based Research Network. Funding for the WVACHS and for this project was provided by the Claude Worthington Benedum Foundation, the Pew Charitable Trusts, the West Virginia Higher Education Policy Commission, and the West Virginia Primary Care Association. Supplemental biostatistics analysis was provided by the West Virginia Clinical and Translational Science Institute through funding from the National Institute of General Medical Sciences of the National Institutes of Health, Award Number 5U54GM104942-05 for which the content is sole responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Our deepest gratitude goes to the five Participant Advisors, the 225 people who responded to our survey, the practices that assisted in distribution of our survey, and our multiple advisors and reviewers., (Copyright © 2023 Adam D. Baus, Martha Carter, Jennifer Boyd, Erin McMullen, Trey Bennett, Alexandra Persily, Danielle M. Davidov, and Christa Lilly.)

This paper describes the prevalence of and factors associated with intimate partner violence (IPV) in the urgent care setting and an academic emergency department in Appalachia. A questionnaire assessing social support, mental and physical health status, substance use, and intimate partner violence was administered to 236 women seeking care in an academic emergency department or two affiliated urgent care clinics. Data collected were compared to IPV screening data from medical records. Separate logistic regression models were fit to estimate the association between sociodemographic and health-related factors and lifetime physical and sexual intimate partner violence, adjusted for the clinical setting. Of the 236 participating women, 63 were seen in the emergency department and 173 were seen in an urgent care clinic. Emergency department patients were significantly more likely to report lifetime threatened physical, physical, or sexual abuse. Based on medical records, over 20% of participants had not been screened for IPV by clinical staff during their healthcare visit. Of those that were screened, none disclosed IPV, despite a substantial proportion reporting IPV on the survey. Although survey reports of IPV were lower in the urgent care clinics, this remains an important location to introduce screenings and resources.

Mixed methods research is an approach that intentionally integrates both quantitative and qualitative research methods to answer a research question. The hallmark of mixed methods research is a focus on designing studies that integrate both quantitative and qualitative data, yielding greater results than either method could yield on its own. There are a number of fundamental concepts that are essential to conducting mixed methods research. These include a methodological approach that employs one of the three core study designs, involvement of a multidisciplinary team that includes both methodological and subject matter experts, and meticulous planning to ensure that the data collected can ultimately be integrated to yield findings that answer the original research question to the investigators' (and funders') satisfaction. In this article, we will discuss mixed methods research designs, data sources typically used in mixed methods research, and common data analysis and integration strategies. We will also provide examples of mixed methods research projects that have been used in vascular surgery. The intent of this article was to provide an overview of the field of mixed methods research, enabling the reader to critically assess mixed methods research studies in the literature and consider how this methodology might benefit their own research endeavors., (Copyright © 2022 Elsevier Inc. All rights reserved.)

This study examined the interrelationship of intimate partner violence (IPV), sexual assault (SA), and eating disorder (ED) symptomatology among a sample of college students ( n = 1,580). Students reporting a history of SA were 2.5 times more likely to screen positively for further ED assessment. A history of IPV also increased odds of having a positive ED screener. The model showed that 6% of the variance in ED symptomatology was explained by IPV and SA. Results did not differ based on gender. This study furthers our understanding of the relationship between IPV, SA, and ED to guide future prevention and treatment efforts. Specifically, the use of trauma-informed ED treatment could assist with full ED recovery and other comorbid mental health conditions., (© Copyright 2022 Springer Publishing Company, LLC.)

There is growing recognition that home visitation programs serving at-risk families may be an appropriate mechanism for detecting and reducing intimate partner violence (IPV). More research is needed about how home visitors assess and respond to IPV, especially in rural and underserved areas with unique social and geographic challenges. This study describes the qualitative, needs assessment phase of a larger mixed-methods evaluation of IPV assessment, referral processes, and safety planning with clients within a statewide home visitation program. Three focus groups were conducted with home visitors ( n = 16) in West Virginia's Home Visitation Program in May 2015. Home visitors represented four separate home visitation models and provided services across 12 of West Virginia's 55 counties. Guiding questions focused on home visitors' current protocol, experiences, barriers, and facilitators to (a) screening and assessment for IPV, (b) making referrals after disclosures of IPV, and (c) developing safety plans with IPV-exposed clients. Barriers identified by home visitors included the nature of assessment tools, issues with service availability and access in rural areas, and lack of education and training surrounding safety planning. Facilitators included building relationships and trust with clients, providing anticipatory guidance when making referrals, and tailoring safety plans to clients' unique situations. Participants also expressed a critical need to develop procedures for assuring home visitor safety when supporting IPV-exposed clients. These qualitative data highlight issues surrounding the management of IPV in home visitation and have the potential to inform future enhancements to programs that are specifically tailored to the needs of rural, disadvantaged communities.

The purpose of this qualitative study was to investigate factors influencing the adoption of an effective bystander-based sexual violence prevention intervention. High schools participating in a cluster-randomized controlled trial that found significant declines in sexual violence over time and with full implementation were invited to adopt this program (Green Dot) at no cost. Three emergent themes arose from interviews with 10 intervention implementers. These findings have implications for researchers, practitioners, and high school administrators and may facilitate future program marketing efforts and the development and testing of strategies for targeted dissemination of this and other bystander programs for violence.

An Exploratory Study on the Intergenerational Transmission of Dieting Proneness within an Eating Disorder Population (IRB Protocol Number: 160928271)., Purpose: Parents and families are not the sole factor in eating disorder (ED) development and their involvement in recovery is crucial. However, parents provide a social and environmental context for a child's eating and weight that cannot be completely discounted. The purpose of this study was to explore the intergenerational transmission of dieting behavior within an ED sample., Methods: Participants (N = 65) were recruited for this cross-sectional study through four distinct ED treatment sites. Participants completed a questionnaire that was developed previously to examine parental feedback as predictor variables, as well as completing the Eating Pathology Severity Index (EPSI) as an outcome variable. A total of 60 completed the questionnaire items of interest to be included in the analyses. SAS JMP ® 13.0 was used for descriptive analyses, correlations, and multivariable linear regressions., Results: Results of the multivariable linear regression showed that the amount of variance explained by the final model for eating pathology severity (via the EPSI) doubled when parental feedback was included (Model 1: R 2 = 0.09, Model 2: R 2 = 0.20). Additionally, there was a significant relationship between the "Negative Direct Parental Feedback Subscale" and EPSI total scores (ß = 14.1; SD = 7.0; p = 0.05)., Conclusion: These findings of increased eating pathology associated with direct parental feedback in a clinical population of ED participants even when controlling for parental ED history suggests greater attention is needed within the ED literature on social and environmental factors and their potential associations with eating pathology., Level of Evidence: Level V, descriptive study.

Background: Students with chronic absences tend to struggle academically and may not benefit fully from all school has to offer. A positive school climate has been shown to reduce absenteeism and promote academic success. In this study, we explored how a positive school climate and high satisfaction with school may influence absences and academic performance., Methods: We used mediated path analysis to describe relationships involving school climate, school satisfaction, absences, and grades among 6839 middle school (49% female, 82% white) and 7470 high school (51% female, 85.0% white) students from 26 West Virginia schools., Results: In the middle and high school samples, we found that a positive school climate and high satisfaction with school reduces school absenteeism. Findings also suggest students with more absences tend to perform less well academically; a positive school climate and school satisfaction may promote good grades., Conclusions: Missing a substantial amount of school days for any reason may hinder students academic success, but "skipping" may require added attention. Improving school climate and student satisfaction with school may contribute to better attendance and grades., (© 2020, American School Health Association.)

Child sexual abuse is a severely underreported crime in the United States. The consequences of child sexual abuse extend beyond physical injury, including an increased likelihood to develop chronic physical and mental diseases/disorders, including substance abuse and suicide. Care involves trauma-informed screening, assessment, and documentation, education of, and access to sexually transmitted infection prophylaxis and emergency contraception, safety interventions, and access to community resources. Medical providers should know the response process their facility, community, and state practices for victims of sexual abuse. Acknowledging and responding to victims of sexual abuse as a multidisciplinary team will ensure comprehensive care for the patient., Competing Interests: Disclosure The authors have nothing to disclose., (Copyright © 2020 Elsevier Inc. All rights reserved.)

There has been limited study of the syndemic link between HIV and intimate partner violence (IPV) among rural populations in the United States. We utilized the Revised Conflict Tactics Scale-2 to examine the past year prevalence, type (psychological aggression, physical assault, and sexual assault), and the impact of IPV on HIV clinical outcomes among men living with HIV in rural Appalachia. Approximately 39% of participants experienced some type of IPV in the preceding year, with 67% of those individuals experiencing more than 1 type of IPV. Approximately 77% of participants endorsing IPV exposure experienced psychological aggression. Most participants exposed to psychological aggression (70%) and/or physical assault (57%) were both victims and perpetrators, and those experiencing sexual assault reported being exclusively victims (65%). There were no significant differences in clinical outcomes including viral load and CD4 count, which may be secondary to small sample size derived from a clinic population with a high rate of virologic suppression (94%). This study demonstrates the need to assess IPV exposure in men living with HIV and further highlights the intricacies of relationship violence in these individuals.

Context: Emerging adults (aged 18-25 years) are increasingly seeking evaluation in acute-care clinics for sexual health-related concerns to receive treatment and education., Objective: To assess the sexual health knowledge of emerging adult patients by gender at acute-care health centers., Methods: A prospective, self-administered survey was distributed from August 2014 through May 2016 to patients aged 18 to 24 years who presented to 1 of 4 acute-care locations in a university town in a mid-Atlantic state. Analyses included descriptive statistics, as well as χ2 and Fisher exact test crosstabulations to determine differences between genders., Results: A total of 388 patients aged 18 to 24 years responded to the survey, with 81% of the sample identifying themselves as students and 64% identifying as female. Women were more likely than men to state that they sought sexual health advice at an urgent-care or walk-in clinic (70.3% vs 52.1%; P<.05). Human papillomavirus knowledge among women was significantly greater than among men (P<.0001). Open-ended responses were widespread and often incorrect, specifically with regard to the human papillomavirus vaccine and routine testing for sexually transmitted infections., Conclusion: Women were more knowledgeable about sexual health than men. However, both genders were not as knowledgeable overall on sexual health topics as hypothesized. A stronger emphasis on gender-specific programming for sexual health education via community- and school-based programs throughout adolescence, supplemented with greater emphasis on routine preventive health care during adolescence and emerging adulthood, is encouraged.

Purpose: There is a paucity of research exploring individuals' memories of parental dieting behavior, engagement in "fat talk", or criticism of weight or eating behavior in childhood. This exploratory study utilized a community sample to further characterize the retrospective report of parenting dieting behavior., Methods: A total of 507 participants (78.1% females; 20.7% males; and 1.2% transgender) were recruited to participate in an online, self-administered survey., Results: Forty percent (216) of participants reported maternal dieting in their family of origin and 34% (182) reported maternal fat talk, 24% (120) reported paternal dieting, and 11% recalled paternal 'fat talk' (58). Subgroup analyses suggest that both male and female participants had greater odds of remembering maternal rather than paternal weight or shape criticism and encouragement to diet (OR = 58.1; and OR = 3.12; p < 0.0001 for male and female participants, respectively). Retrospective report of indirect parental behaviors (e.g. parental dieting) also appears to be associated with direct parental behaviors (e.g. encouraging children to diet). Additionally, participants who recalled maternal encouragement to diet reported a significantly higher adult BMI (β = 1.31, SE = 0.32, p < 0.0001)., Conclusion: Results provide preliminary evidence that a sizeable percentage of both adult male and female participants recalled that their parents engaged in fat talk and dieting. In addition, participants recalled parental criticism of their own weight or eating behaviors, which was associated with recall of parental dieting and fat talk., Level of Evidence: Level V, Descriptive Study.

Background: Women with eating disorders are more likely to negatively react to finding out they are pregnant, although this difference in attitudes between women with eating disorders and controls disappears at 18-weeks' gestation. Those with anorexia also are twice as likely to have an unplanned pregnancy and those with bulimia have a 30-fold increased chance compared with healthy controls. Therefore, due to these considerations, pregnancy and the transition to motherhood can be an extremely challenging time for these women both psychologically and physically. The purpose of this qualitative descriptive study was to understand the intersection between eating disorders and pregnancy from the lived experience of women who have been pregnant or want to or do not want to become pregnant., Methods: A total of 15 women with a current or past history of an eating disorder were recruited, including nine women who have had previous pregnancies as well as six nonparous women. Interviews were the primary unit of data collection, in addition to document analysis of diaries or blogs. Data analysis was based on verbatim transcripts from audio recordings. NVIVO 11© was used to manage the data from these interviews and thematic analysis was then conducted for emergence of major and sub themes., Results: A total of six themes emerged from the iterative process of coding and categorizing. They were: Control, Disclosure to Others, Battle between Mothering & Eating Disorder, Fear of Intergenerational Transmission, Weight and Body Image Concerns, and Coping Strategies. One theme, Battle between Mothering & Eating Disorder also had three sub-themes: Decision to Have Child, Emotions Towards Pregnancy, and Focus on Child/Greater Good., Conclusions: It is hoped that quotes and themes derived from this study will help inform both prenatal and postnatal care and interventions, as well as addressing intergenerational transmission concerns among mothers with eating disorders.

Introduction: Emerging adults (18-25 years of age) are at increased risk for sexual assault. There is little Emergency Department (ED) data on sexual assaults that involve alcohol among this population. The purpose of this study was to analyze ED visits for sexual assault and determine if alcohol consumption by the patient was noted., Methods: This study was a retrospective chart review of patients aged 18-25 presenting to an ED in a college town over a four-year period. Extracted variables included age, gender, delay in seeking care, sexual assault nurse examiner (SANE) evaluation, and alcohol consumption by the patient. For analysis of alcohol use, cases were categorized as ages < 21 and ≥ 21., Results: There were 118 patients who presented to the ED from 2012 to 2015. The mean age of the cohort was 20 years, and almost 70% of visits were among those < 21. Of those aged < 21, 74% reported alcohol consumption, in contrast to 48% of those ≥ 21 (p = 0.055). Of those reporting alcohol use, 36% were evaluated on the day of the assault compared to 61% of those not reporting alcohol (p=0.035)., Conclusion: This study found that ED visits for sexual assault in emerging adults were more common in younger patients. Alcohol use occurred more frequently with patients under the legal drinking age, and presentation was also more likely to be delayed. The relationship between sexual assault and alcohol use should underscore primary prevention efforts in emerging adult populations., Competing Interests: Conflicts of Interest: By the WestJEM article submission agreement, all authors are required to disclose all affiliations, funding sources and financial or management relationships that could be perceived as potential sources of bias. No author has professional or financial relationships with any companies that are relevant to this study. There are no conflicts of interest or sources of funding to declare.

Cellphone use while driving has been recognized as a growing and important public health issue by the World Health Organization and U.S. Center for Disease Control and Prevention. Surveys typically collect data on overall texting while driving, but do not differentiate between various forms of cellphone use. This study sought to improve the survey indicators when monitoring cellphone use among young drivers. Experts and young drivers were recruited to propose behavioral indicators (cellphone use while driving behaviors) and consequential indicators (safety consequences of cellphone use while driving) in 2016. Subsequently, experts and young drivers selected the top indicators using the Delphi survey method. We enrolled 22 experts with published articles on cellphone use while driving nationally, and seven young drivers who were freshmen at a state university. Sending a text or e-mail on a handheld phone was picked as the top behavioral indicator by both groups. However, young drivers chose playing music on a handheld phone as the second most important behavioral indicator, which was overlooked by experts. Injury/death and collision were the top two consequential indicators. Experts and young drivers identified the important survey indicators to monitor cellphone use while driving.

The highly rural region of Appalachia faces considerable socioeconomic disadvantage and health disparities that are recognized risk factors for intimate partner violence (IPV). The objective of this study was to estimate the rate of IPV-related hospitalizations in Appalachia and the non-Appalachian United States for 2007-2011 and compare hospitalizations in each region by clinical and sociodemographic factors. Data on IPV-related hospitalizations were extracted from the State Inpatient Databases, which are part of the Healthcare Cost and Utilization Project. Hospitalization day, year, in-hospital mortality, length of stay, average and total hospital charges, sex, age, payer, urban-rural location, income, diagnoses and procedures were compared between Appalachian and non-Appalachian counties. Poisson regression models were constructed to test differences in the rate of IPV-related hospitalizations between both regions. From 2007-2011, there were 7,385 hospitalizations related to IPV, with one-third (2,645) occurring in Appalachia. After adjusting for age and rurality, Appalachian counties had a 22% higher hospitalization rate than non-Appalachian counties (ARR = 1.22, 95% CI: 1.14-1.31). Appalachian residents may be at increased risk for IPV and associated conditions. Exploring disparities in healthcare utilization and costs associated with IPV in Appalachia is critical for the development of programs to effectively target the needs of this population.

Background: Prescription medication abuse is an increasingly recognized problem in the United States. As more opioids are being prescribed and abused by adults, there is an increased risk of both accidental and intentional exposure to children and adolescents. The impact of pediatric exposures to prescription pain pills has not been well studied., Objectives: We sought to evaluate emergency department (ED) visits for poisoning by prescription opioids in pediatric patients., Methods: This retrospective study looked at clinical and demographic data from the Nationwide Emergency Department Sample (NEDS) from 2006 to 2012., Results: There were 21,928 pediatric ED visits for prescription opioid poisonings and more than half were unintentional. There was a bimodal age distribution of patients, with slightly more than half occurring in females. The majority of patients were discharged from the ED. More visits in the younger age group (0-5 years) were unintentional, while the majority of visits in the adolescent age group (15-17 years) were intentional. Mean charge per discharge was $1,840 and $14,235 for admissions and surmounted to over $81 million in total charges., Conclusion: Poisonings by prescription opioids largely impact both young children and adolescents. These findings can be used to help target this population for future preventive efforts., Competing Interests: of Interest: The authors are not aware of any personal or financial conflicts of interest that are associated with this study.

Background: Trauma was the seventh leading cause of death for persons 65 and older in West Virginia (WV) in 2010. In 2007, fatality rates for both accidental falls and motor vehicle crashes were higher in West Virginia than the nation as a whole. US Census Data from 2010 showed WV to have one of the oldest median ages in the nation (surpassed by Maine and Vermont) and currently 16% of the population of WV is over 65 years of age., Methods: This is a retrospective observational study of data extracted from the John Michael Moore Trauma Center (JMMTC) trauma registry for the time period of January 1, 2009 to December 31, 2014., Results: There were 3,895 patients, aged 65 years or older, treated at the Jon Michael Moore Trauma Center in Morgantown, WV during the study time period. Accidents accounted for 98.6% of the injuries. The elderly were most commonly injured in their place of residence (59.8%). The top two mechanisms of injury were falls (75.2%) and motor vehicular crashes (13.9%). Frequently, disposition from the Emergency Department was to a higher level of care: Intensive Care Unit (32.3%) and Step-down Unit (21.2%). The most common serious injuries were intracranial hemorrhage (40.0%), lower extremity fractures (38.1%), and spine fracture (26.0%). The average hospital stay was 5.6 days and the average ICU stay was 3.2 days. Hospital discharge dispositions frequently resulted in care out of the home; skilled nursing facility (22.0%), rehabilitation facility (15.5%), morgue/funeral home (6.6%), and long-term residential care facility (5.7%). The most common pre-existing medical conditions were hypertension (71.9%), diabetes mellitus (29.3%), chronic obstructive pulmonary disease (19.5%), and dementia (18.8%)., Conclusion: Elder West Virginians most frequently are injured in falls and motor vehicular crashes. Pre-existing medical conditions are very common. Trauma in the elderly creates a significant burden on the patient, their families, and on the health care system in West Virginia. Injury prevention interventions have the potential to diminish the impact of trauma on elder West Virginians.

Background: Prescription opioid abuse and overdose has steadily increased in the United States (US) over the past two decades, and current research has shown a dramatic increase in hospitalizations resulting from opioid poisonings. Still, much is unknown about the clinical and demographic features of patients presenting to emergency departments (EDs) for poisoning from prescription drugs., Objective: We sought to evaluate ED visits by adults for prescription opioids., Methods: This was a retrospective cohort study utilizing 2006-2011 data from the Nationwide Emergency Department Sample. Total number of admissions (weighted), disposition, gender, age, expected payer, income, geographic region, charges, and procedures performed were examined., Results: From 2006 through 2010, there were 259,093 ED visits by adults for poisoning by opioids, and 53.50% of these were unintentional. The overall mean age of patients was 45.5 years, with more visits made by females (52.37%). Patients who unintentionally overdosed were more likely to have Medicare (36.54%), whereas those who intentionally overdosed had private insurance (29.41%). The majority of patients resided in the South (40.93%) and came from lower-income neighborhoods. Approximately 108,504 patients were discharged, and 140,395 were admitted., Conclusions: There were over 250,000 visits to US EDs from 2006 through 2011 with a primary diagnosis of poisoning by a prescription opioid. Females made the majority of visits, and over half were admitted to the hospital, resulting in over $4 billion in charges. Future studies should examine preventative measures, optimal screening, and intervention programs for these patients., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Objectives: The objectives are to estimate the number of elderly patients presenting to emergency departments (EDs) in the United States from 2006 to 2011 for alcohol-related disorders and examine their demographic and clinical features., Methods: This study used 2006 to 2011 data from the Nationwide ED Sample, a stratified, multistage sample designed to give national estimates of US ED visits each year. Clinical Classifications Software 660 code ("alcohol-related disorders") was used. The clinical and demographic features that were examined were as follows: number of admissions, disposition, sex, age, expected payer, income, geographic region, charges, and primary diagnoses and procedures performed., Results: From 2006 to 2011, there were 1620345 ED visits for alcohol-related disorders in elderly patients. Roughly one-third were discharged from the ED, whereas 66% (1078677) were admitted to the hospital. Approximately 73% were male, and the mean age was 73 years. Most patients used Medicare (84%), resided in neighborhoods with the lowest median income national quartile (29%), and lived in the South (36.4%). The average charge for discharged patients was $4274.95 (4050.30-4499.61) and $37857.20 (36813.00-38901.40) for admitted patients. The total charges for all patients treated and released from the ED were $2166082965.40 and admitted was $40835690924.40., Conclusions: This study provided insight not only into the sociodemographic characteristics of this patient population but also the health care costs related to alcohol-related ED visits. These results may contribute to the development of future interventions targeted toward this population., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Purpose: The extent to which immigrant-specific factors influence the intergenerational transmission of family violence is unknown. The objectives of this paper are to examine the associations between immigrant generational status (IGS), child maltreatment (CM), intimate partner violence (IPV) and acculturation (i.e., the extent to which an individual adopts the values, language and attitudes of a new culture)., Methods: The sample was drawn from wave two of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC; n = 34,653), a nationally representative survey of United States (US) residents aged 20 years and older. Logistic regression was used to estimate the associations between IGS, CM history, IPV, and acculturation., Results: Compared to 3rd generation (or later) respondents, 1st generation immigrants were less likely to report a history of sexual (AOR = 0.74, CI0.95 = 0.62, 0.90) and emotional abuse (AOR = 0.69, CI0.95 = 0.55, 0.87), but were more likely to report physical neglect (AOR = 1.30, CI0.95 = 1.11, 1.52). After adjusting for covariates, IGS was not associated with IPV among respondents with or without a CM history. Among those without a CM history, highly acculturated 1st generation immigrants (AOR = 1.07, CI0.95 = 1.01, 1.13) were more likely to report perpetrating IPV, with highly acculturated 3rd generation respondents having lower odds of reporting IPV perpetration (AOR = 0.93, CI0.95 = 0.88-1.00)., Conclusion: IGS and acculturation are important factors in CM and IPV. Longitudinal studies are needed to clarify the influence of IGS, recency of immigration, acculturation and acculturative stress on the experiences and relationship between CM and IPV.

Background: Limited information exists about medical treatment for victims of intimate partner violence (IPV)., Objective: Our aim was to estimate the number of emergency department (ED) visits and subsequent hospitalizations that were assigned a code specific to IPV and to describe the clinical and sociodemographic features of this population., Methods: Data from the Nationwide Emergency Department Sample from 2006-2009 were analyzed. Cases with an external cause of injury code of E967.3 (battering by spouse or partner) were abstracted., Results: From 2006-2009, there were 112,664 visits made to United States EDs with an e-code for battering by a partner or spouse. Most patients were female (93%) with a mean age of 35 years. Patients were significantly more likely to reside in communities with the lowest median income quartile and in the Southern United States. Approximately 5% of visits resulted in hospital admission. The mean charge for treat-and-release visits was $1904.69 and $27,068.00 for hospitalizations. Common diagnoses included superficial injuries and contusions, skull/face fractures, and complications of pregnancy. Females were more likely to experience superficial injuries and contusions, and males were more likely to have open wounds of the head, neck, trunk, and extremities., Conclusions: From 2006 to 2009, there were approximately 28,000 ED visits per year with an e-code specific to IPV. Although a minority, 7% of these visits were made by males, which has not been reported previously. Future prospective research should confirm the unique demographic and geographic features of these visits to guide development of targeted screening and intervention strategies to mitigate IPV and further characterize male IPV visits., (Copyright © 2015 Elsevier Inc. All rights reserved.)

C-reactive protein (CRP) is an inflammatory biomarker of inflammation and may reflect progression of vascular disease. Conflicting evidence suggests CRP may be a prognostic biomarker of ischemic stroke outcome. Most studies that have examined the relationship between CRP and ischemic stroke outcome have used mortality or subsequent vascular event as the primary outcome measure. Given that nearly half of stroke patients experience moderate to severe functional impairments, using a biomarker like CRP to predict functional recovery rather than mortality may have clinical utility for guiding acute stroke treatments. The primary aim of this study was to systematically and critically review the relationship between CRP and long-term functional outcome in ischemic stroke patients to evaluate the current state of the literature. PubMed and MEDLINE databases were searched for original studies which assessed the relationship between acute CRP levels measured within 24 hours of symptom onset and long-term functional outcome. The search yielded articles published between 1989 and 2012. Included studies used neuroimaging to confirm ischemic stroke diagnosis, high-sensitivity CRP assay, and a functional outcome scale to assess prognosis beyond 30 days after stroke. Study quality was assessed using the REMARK recommendations. Five studies met all inclusion criteria. Results indicate a significant association between elevated baseline high sensitivity CRP and unfavorable long-term functional outcome. Our results emphasize the need for additional research to characterize the relationship between acute inflammatory markers and long-term functional outcome using well-defined diagnostic criteria. Additional studies are warranted to prospectively examine the relationship between high sensitivity CRP measures and long-term outcome., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Background: The use of alcohol by pediatric patients has not been thoroughly examined in the United States (US). Patients with complaints related to alcohol use frequently present to the Emergency Department initially., Objective: Our aim was to determine the number of pediatric patients (ages 17 years and younger) presenting to Emergency Departments (EDs) in the US from 2006 to 2008 for alcohol-related disorders and examine selected clinical and demographic features of this population., Methods: This was a retrospective cohort study using 3 years (2006-2008) of data from the Nationwide Emergency Department Sample. This database was used to identify patients younger than 18 years of age with an alcohol-related ED visit, and clinical and demographic features were examined., Results: From 2006 to 2008, a total of 218,514 pediatric patients presented to US EDs and received a subsequent diagnosis of an alcohol-related disorder. Mean age of patients was 15.61 years. Most patients were male and tended to be from higher-income communities., Conclusions: There were 218,514 visits to US EDs by patients younger than 18 years of age for alcohol-related disorders, accounting for >$850 million dollars in charges. ED-based brief alcohol interventions shown to work in adult populations should be explored for use in pediatric patients., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Objective: The purpose of this study was to examine the relationship between childhood maltreatment and alcohol use disorders (AUDs), treatment utilization, and barriers to treatment in a national sample of emerging adults. Multiple types of maltreatment were examined, including childhood emotional abuse and neglect., Method: The analyses are based on data from 18- to 25-year-olds (N = 4,468) who participated in the National Epidemiologic Survey on Alcohol and Related Conditions., Results: Adjusted for sociodemographic characteristics, we found that childhood maltreatment was associated with a greater likelihood of an AUD and a greater likelihood of accessing treatment, although these relationships were no longer significant once psychiatric comorbidities and other substance use disorders were included as control variables. We also found significant interaction effects for age; differences in the prevalence of AUDs among those who experienced physical abuse and multiple types of maltreatment were larger for the older age group. Finally, among those with AUDs, maltreatment was associated with specific perceived barriers to treatment., Conclusions: The current findings highlight childhood maltreatment, including emotional abuse and neglect, as important correlates of AUDs among emerging adults but indicate that these relationships may be accounted for by other psychiatric comorbidities. Barriers to treatment among individuals with AUDs may reflect maltreatment experiences and should be addressed in both policy and practice.

Background: Older adults represent a growing percentage of the United States (US) population living with human immunodeficiency virus (HIV). The Emergency Department plays an integral role in the identification and initial evaluation and treatment of patients with HIV., Objective: We sought to estimate the number of hospitalizations of older adults (age ≥ 50 years) with HIV in the United States from 2000 to 2006 and compare features of this population to younger adults with HIV. Clinical and demographic characteristics of the younger cohort (19-49 years) and two older cohorts (ages 50-64 and ≥ 65 years) were examined and compared., Methods: Data from the Nationwide Inpatient Sample was used to compare the three groups of HIV-positive patients. Comparisons between the most common discharge diagnoses and primary procedures were also made., Results: Older adults with HIV constitute almost one quarter of the hospitalizations of adults with HIV. Older adults with HIV were more likely to be male, have a significantly higher average hospital charge, and have a longer length of stay than younger adults with HIV. Pneumonia and fluid and electrolyte disorders were common diagnoses among all three age cohorts., Conclusions: Older HIV patients were more likely to die during hospitalization compared with younger adults with HIV and older adults without HIV. Admissions for older HIV patients almost doubled during the study period and future studies should examine whether this is due to aging of the current HIV population or new infections., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Objectives: To examine nurse home visitors' perspectives of and intentions to report children's exposure to intimate partner violence (IPV) in the context of the home visitation setting., Design and Sample: Cross-sectional study of 532 nurse home visitors in the Nurse-Family Partnership home visitation program., Measures: A web-based questionnaire assessing nurse home visitors' support for and attitudes toward mandatory reporting of children's exposure to IPV. Nurses' considerations of what levels of exposure constitute maltreatment and their intended reporting behaviors were also examined., Results: Variability and uncertainty were observed in participants' attitudes as well as in their determinations as to which situations constitute child maltreatment. Most of the sample believed reporting exposure to IPV can help the battered woman (67%) and can protect children (92%), while 56% indicated that reporting can negatively affect the nurse-client relationship. Nurses were more likely to endorse reporting children's exposure to IPV when the child was at greatest risk for being physically injured as a result of IPV., Conclusions: Training about maltreatment reporting procedures in home visitation programs should focus on the interpretation of child maltreatment laws as well as collaborations with local child protection service agencies to determine if children's exposure to IPV is reportable., (© 2012 Wiley Periodicals, Inc.)

In the United States, there is an ongoing debate about requiring health care professionals to report intimate partner violence (IPV) to law enforcement agencies. A comprehensive examination of the perspectives of those required to report abuse is critical, as their roles as mandated reporters often pose legal, practical, moral, and ethical questions. Even so, the perspective of health care professionals who are required to report is often overlooked and research is scarce on mandated reporters who work outside of clinical settings, such as nurses who engage in home visitation with clients. The purpose of this study was to examine nurse home visitors' perspectives regarding the mandatory reporting of IPV, specifically focusing on their attitudes toward reporting, perceived awareness of reporting requirements, and intended reporting behaviors. A web-based survey was administered to nurses in the Nurse-Family Partnership home visitation program across the United States. A total of 532 completed surveys were returned (response rate = 49%). In terms of support for reporting IPV, 40% of nurses indicated that they should "always" be required to report. Almost half of the sample indicated that they would report a case of IPV, yet less than one-third of participants were aware of a legal mandate. Attitudes and support toward reporting as well as the perception of a reporting requirement significantly predicted intention to report. Furthermore, 29% of participants did not know if they were required to report IPV perpetrated against their clients. Comprehensive information about mandatory reporting duties is needed for health care professionals in home visitation settings. The findings of the current study highlight the need to reduce variation among practitioners and establish consistent program practices that are grounded in the program's principals, supported by existing research, and compliant with existing state policies.

The mandatory reporting of intimate partner violence (IPV) is a controversial issue that is receiving increased attention. A related concern is whether children's exposure to IPV constitutes child maltreatment, making it reportable to child protective services. These issues have been relatively unexplored within the context of home visitation programs. A secondary analysis of qualitative data collected from community stakeholders, clients, and home visiting nurses in the Nurse-Family Partnership program was carried out. Participants' perceptions about mandatory reporting of IPV and reporting of children's exposure to IPV are highlighted. Emergent themes and implications for research, practice, and policy are discussed.

Background: Despite an increase in knowledge about the epidemiology of intimate partner violence (IPV), much less is known about interventions to reduce IPV and its associated impairment. One program that holds promise in preventing IPV and improving outcomes for women exposed to violence is the Nurse-Family Partnership (NFP), an evidence-based nurse home visitation program for socially disadvantaged first-time mothers. The present study developed an intervention model and modification process to address IPV within the context of the NFP. This included determining the extent to which the NFP curriculum addressed the needs of women at risk for IPV or its recurrence, along with client, nurse and broader stakeholder perspectives on how best to help NFP clients cope with abusive relationships., Methods: Following a preliminary needs assessment, an exploratory multiple case study was conducted to identify the core components of the proposed IPV intervention. This included qualitative interviews with purposeful samples of NFP clients and community stakeholders, and focus groups with nurse home visitors recruited from four NFP sites. Conventional content analysis and constant comparison guided data coding and synthesis. A process for developing complex interventions was then implemented., Results: Based on data from 69 respondents, an IPV intervention was developed that focused on identifying and responding to IPV; assessing a client's level of safety risk associated with IPV; understanding the process of leaving and resolving an abusive relationship and system navigation. A need was identified for the intervention to include both universal elements of healthy relationships and those tailored to a woman's specific level of readiness to promote change within her life. A clinical pathway guides nurses through the intervention, with a set of facilitators and corresponding instructions for each component., Conclusions: NFP clients, nurses and stakeholders identified the need for modifications to the existing NFP program; this led to the development of an intervention that includes universal and targeted components to assist NFP nurses in addressing IPV with their clients. Plans for feasibility testing and evaluation of the effectiveness of the IPV intervention embedded within the NFP, and compared to NFP-only, are discussed.