The document discusses the medical and mental health needs of children in foster care in Maine. It finds that children in foster care have high rates of chronic medical conditions, developmental delays, and behavioral disorders. Placement instability is also associated with worse health and mental health outcomes. A program called PREP provides comprehensive health assessments for children entering foster care. Data on thousands of children shows that those receiving PREP assessments have better health outcomes, lower rates of obesity, dental problems and use of psychotropic medications compared to children not receiving PREP assessments. PREP participants also have lower average monthly health care costs for the state Medicaid program.
Omega-3 Fatty Acid Supplementation in Children with ADHDAly Worf
Omega-3 fatty acid supplementation was studied in 5 clinical trials involving children with ADHD. The studies examined EPA, DHA, and ALA supplementation and their effects on ADHD symptoms using parent and teacher rating scales. The results were inconclusive, with some studies finding improvements in attention and behavior and others finding no significant effects. Larger and longer studies are still needed to make clinical recommendations due to limitations like small sample sizes and short treatment durations in the existing studies.
The document summarizes research on adverse childhood experiences (ACEs). It describes the original ACE study which found that two-thirds of participants reported at least one ACE. ACEs are interrelated and occur in clusters, with increased ACE scores correlated to higher risks of health problems, risky behaviors, and lower life potential. The document recommends promoting resilience and protective factors to reduce the prevalence and impact of ACEs.
Speaker Presentation from U.S. News Healthcare of Tomorrow leadership summit, Nov. 1-3, 2017 in Washington, DC. Find out more about this forum at www.usnewshot.com.
Case Management and Outcomes for Neglected Children: A 5 year follow up studyBASPCAN
This document summarizes a study examining case management and outcomes for 138 neglected children over 5 years. It finds that outcomes were often unstable, with 65% of returns to parents ending within 5 years and 48% of children being re-abused. Younger age at return, proactive case management, and placement in a changed household predicted stability. Barriers like late intervention, failure to address parental issues, and over-identification with parents hindered effectiveness. The conclusion calls for earlier intervention and addressing barriers to improve management of neglected children's cases.
This document provides an overview of Adverse Childhood Experiences (ACE) data from South Carolina. It discusses the Behavioral Risk Factor Surveillance System (BRFSS) as the data source for ACEs in SC. Some key findings include: 62% of SC residents report experiencing at least one ACE, with 14% experiencing 4 or more. There are associations between higher ACE scores and increased risk of health problems, mental illness, and risky behaviors. The data also show strong interrelationships between different types of ACEs - for example, those experiencing physical abuse were much more likely to also experience other forms of abuse and household dysfunction. The document demonstrates how ACE data can be applied to help various community efforts
Intergenerational pathways between child maltreatment, health and socioeconom...BASPCAN
PhD Candidate James Doidge, University of South Australia
Supervisors: Prof Leonie Segal, University of South Australia, A/Prof Paul Delfabbro, University of South Australia
This document summarizes a study that examined the relationship between physical activity, screen time, and subjective health complaints in Irish schoolchildren aged 10-17. The study found that a high percentage of children reported health complaints weekly or more, and that girls reported higher rates than boys. Children who met screen time recommendations of 2 hours or less per day had a higher risk of health complaints than those meeting physical activity guidelines. Children meeting neither guideline were at highest risk. The researchers concluded that targeting reductions in screen time may be particularly important for policies aimed at improving children's health and wellbeing.
Omega-3 Fatty Acid Supplementation in Children with ADHDAly Worf
Omega-3 fatty acid supplementation was studied in 5 clinical trials involving children with ADHD. The studies examined EPA, DHA, and ALA supplementation and their effects on ADHD symptoms using parent and teacher rating scales. The results were inconclusive, with some studies finding improvements in attention and behavior and others finding no significant effects. Larger and longer studies are still needed to make clinical recommendations due to limitations like small sample sizes and short treatment durations in the existing studies.
The document summarizes research on adverse childhood experiences (ACEs). It describes the original ACE study which found that two-thirds of participants reported at least one ACE. ACEs are interrelated and occur in clusters, with increased ACE scores correlated to higher risks of health problems, risky behaviors, and lower life potential. The document recommends promoting resilience and protective factors to reduce the prevalence and impact of ACEs.
Speaker Presentation from U.S. News Healthcare of Tomorrow leadership summit, Nov. 1-3, 2017 in Washington, DC. Find out more about this forum at www.usnewshot.com.
Case Management and Outcomes for Neglected Children: A 5 year follow up studyBASPCAN
This document summarizes a study examining case management and outcomes for 138 neglected children over 5 years. It finds that outcomes were often unstable, with 65% of returns to parents ending within 5 years and 48% of children being re-abused. Younger age at return, proactive case management, and placement in a changed household predicted stability. Barriers like late intervention, failure to address parental issues, and over-identification with parents hindered effectiveness. The conclusion calls for earlier intervention and addressing barriers to improve management of neglected children's cases.
This document provides an overview of Adverse Childhood Experiences (ACE) data from South Carolina. It discusses the Behavioral Risk Factor Surveillance System (BRFSS) as the data source for ACEs in SC. Some key findings include: 62% of SC residents report experiencing at least one ACE, with 14% experiencing 4 or more. There are associations between higher ACE scores and increased risk of health problems, mental illness, and risky behaviors. The data also show strong interrelationships between different types of ACEs - for example, those experiencing physical abuse were much more likely to also experience other forms of abuse and household dysfunction. The document demonstrates how ACE data can be applied to help various community efforts
Intergenerational pathways between child maltreatment, health and socioeconom...BASPCAN
PhD Candidate James Doidge, University of South Australia
Supervisors: Prof Leonie Segal, University of South Australia, A/Prof Paul Delfabbro, University of South Australia
This document summarizes a study that examined the relationship between physical activity, screen time, and subjective health complaints in Irish schoolchildren aged 10-17. The study found that a high percentage of children reported health complaints weekly or more, and that girls reported higher rates than boys. Children who met screen time recommendations of 2 hours or less per day had a higher risk of health complaints than those meeting physical activity guidelines. Children meeting neither guideline were at highest risk. The researchers concluded that targeting reductions in screen time may be particularly important for policies aimed at improving children's health and wellbeing.
The Buffer Zone: What Adverse Childhood Experiences (ACE) Study Teaches about...MFLNFamilyDevelopmnt
In an attempt to look at the association between childhood trauma and the risk for physical and mental illness in adulthood, Kaiser Permanente and the Centers for Disease Control and Prevention established the Adverse Childhood Experiences (ACE) Study which is one of the largest scientific research studies of its kind. This 90-minute webinar will provide participants with in-depth information on this study and its implications.
The main purpose of the present study was to determine the effect of regular home visits on the developmental indices of low birth weight infants. The present study was an on-site clinical investigation. 90 infants ranging between 1500 to 2500g born in Razi Hospital of Marand town having the entrance criteria to the present study were taken into consideration through the available sampling method and then they were divided into two intervention and control groups. The intervention group has received the whole routine cares since the first to fourth week and then they were visited at home for 45 minutes a week. The control group received the routine cares. The evolutionary indices of both groups were also completed monthly for three months by referring homes. The related data gathering tool was also subjected to the demographic information through registration list and the Persian version of the Low Weight Infant Inventory (LWII) (2 months) that have been completed by the researcher on the birthday, first, second and third months of the birth through the interview. SPSS-15 software and the application of the inferential and descriptive statistical tests (K2 and T-tests) were also applied in order to analyze the related data in this study. The significance level was considered as p<0.05.
More than half of these related research units of both groups had experience (61.5%) and control (55.8%) regarding all women in this study; the mean score of the low weight infants on the first month had not shown any statistical significant difference; but on the second months (p=0.04) and the third months (p=0.001), they had shown statistical significant difference progressively. The healthcare based on home-visit had influence on the recovery indices of the low weight infants. Hence, nurses and other health monitors of the infants should apply for the healthcare programs based on home-visit particularly in caring infants.
Four year follow-up of a randomized controlled trial of choline for neurodeve...BARRY STANLEY 2 fasd
Abstract
Background
Despite the high prevalence of fetal alcohol spectrum disorder (FASD), there are few interventions targeting its core neurocognitive and behavioral deficits. FASD is often conceptualized as static and permanent, but interventions that capitalize on brain plasticity and critical developmental windows are emerging. We present a long-term follow-up study evaluating the neurodevelopmental effects of choline supplementation in children with FASD 4 years after an initial efficacy trial
The document summarizes a study that measured health status in family practice patients using the EuroQol EQ-5D questionnaire. Over 2,000 patients were surveyed with an 83% response rate. The results showed that 73% of respondents reported at least a moderate problem in one or more health dimensions. The most commonly reported problems were pain (72.5%), mobility problems (46.7%), and problems with usual daily activities (52.7%). Having problems was more likely for females and increased with age. Patients with lower education reported more problems with daily activities, pain, mobility and self-care. The study concluded that family practice patients experience high rates of health problems that primary care teams need to address in addition to clinical symptoms
CUES ED. Children and Young People's National Conference 2017NHSECYPMH
- Approximately 20% of children under 16 experience significant anxiety, and 1 in 10 children aged 5-16 have a diagnosable mental health condition. Childhood emotional and behavioral issues increase vulnerability in adulthood.
- The document discusses a universal, evidence-based, 6-session program called "Who I Am and What I Can" that aims to improve emotional well-being and resilience in primary school children through engaging activities and CBT strategies.
- Evaluations found the program helped children understand their feelings better, develop coping strategies, and improved behavioral and emotional outcomes. It also reduced stigma around mental health by normalizing difficult experiences.
On April 6, 2019, the EveryLife Foundation for Rare Diseases and Genetic Alliance hosted a workshop to provide education about the process of adding rare genetic conditions to the federal Recommended Newborn Screening Panel. Presentations include insights from national newborn screening experts in biochemical sciences, genetics, and political advocacy.
This document summarizes a study that evaluated the effectiveness of an intervention to address intimate partner violence in primary care. The intervention consisted of screening women for intimate partner violence, notifying and training general practitioners (GPs) to respond, and inviting screened women for brief counseling with their GP. The study found that the intervention led to a decrease in depressive symptoms for women and increased safety discussions between GPs and women about themselves and their children. However, the intervention did not significantly improve women's quality of life. The study provides preliminary evidence that screening and training GPs can help address intimate partner violence in primary care, though the training requires resources and uptake of counseling was low.
Directors Meeting - Oct. 15, 2019
UofSC Division of Student Affairs and Academic Support
Featuring:
Christina Yao, Higher Education and Student Affairs program
Rebecca Caldwell, Student Health Services
Aimee Hourigan, Substance Abuse Prevention and Education
Dennis Pruitt, VP for Student Affairs
5.2 Services Optional: Using a Voluntary Services Approach
Speaker: Kathy Daniher
Programs increasing rely on voluntary services and harm reduction strategies to successfully work with vulnerable families and youth. This workshop will examine how providers have made the transition to a voluntary-services approach and how it has impacted their program outcomes.
Patricia Jennings, MEd, PhD - "Mindfulness-Based Approaches to Promoting Stud...youth_nex
The Youth-Nex Conference on Physical Health and Well-Being for Youth, Oct 10 & 11, 2013, University of Virginia
Patricia Jennings, MEd., Ph.D. - "Mindfulness-Based Approaches to Promoting Student Learning, Attention and Self-Regulation"
Jennings is a Research Assistant Professor in Human Development and Family Studies (HD FS) and affiliated with the Prevention Research Center at Penn State University.
Panel 4 — Mindfulness, Health and Well-Being: The Mind Body Connection.
Research with adults has found that contemplative practices such as mindfulness and yoga promote a variety of benefits for physical and emotional well-being. This panel will provide an overview of the growing body of research on such activities for youth that have been integrated into school settings and which are designed to affect students' attention, behavior, and academic achievement.
Website: http://bit.ly/YNCONF13
This document provides information on screening patients for domestic violence. It defines domestic violence and discusses its prevalence and health impacts. Screening all female patients is recommended to identify those experiencing intimate partner violence and refer them to support services. The document reviews screening tools like HARK and proper protocols for responding to positive screens while ensuring safety and confidentiality. Follow-up is important to provide ongoing support and review referral options. The overall goal is to integrate domestic violence screening into routine care to improve patient health and well-being.
The document summarizes a qualitative analysis of contraceptive use and barriers to access among Australian women based on surveys of 690 women across five surveys. It identifies several key themes in women's experiences with contraception over their reproductive lives, including side effects, lack of information, negative experiences with healthcare providers, contraceptive failure, and difficulty accessing contraception. These barriers were shown to have an important impact on women's mental and physical health. The analysis concluded that barriers to effective contraception persist throughout women's reproductive lives.
Transforming CYP Community Eating Disorders Services: Children and Young Peop...NHSECYPMH
The Durham and Darlington Eating Disorders Team shares with you our progress; reflecting on both successes and challenges, and offering the chance to share experiences. There are further developments and challenges ahead and we will consider what the future may hold.
Violence against women by their husband and postpartum depression finalChetkant Bhusal
The study aimed to determine the prevalence of violence against women by their husbands, postpartum depression, and the relationship between violence and depression in Nepal. The study found the incidence of postpartum depression was 19.4-22.2% and violence was 13.9-20.8%. No significant relationship was found between violence and depression, possibly due to small sample size. The study highlighted the need for further large-scale research on this topic in Nepal.
This document provides an overview of ADHD, including that it is the most common neurodevelopmental disorder, affecting approximately 5% of children and 2.5% of adults worldwide. It discusses the history of ADHD and evidence that it has been recognized as far back as the late 18th century. The document also summarizes research showing differences in brain activation patterns between those with and without ADHD. In addition, it outlines the diagnostic criteria for predominantly inattentive and hyperactive/impulsive presentations in the DSM-5 as well as high rates of comorbidity with conditions like depression, anxiety, substance abuse, and psychosocial dysfunction. The document concludes with a discussion of comprehensive treatment approaches including medication management, behavioral therapies
This document discusses the potential for using video games to promote health-related behavior change in children. It summarizes 27 articles on 25 video games that have been used experimentally to teach nutrition, increase physical activity, and address other health topics. Many of these games combine storytelling, interactivity, and behavior change techniques. The document argues that further research is needed to understand how best to design game stories, fantasy elements, interactivity, and behavior change features to maximize health impacts. It also notes the large amounts of time children spend playing video games, representing an opportunity to engage them around health through this entertaining medium.
Ethical and Legal Issues Related to Medical Genetics Rayhan Shahrear
Define ethics and bioethics.
State the major ethical issues related to medical genetics.
Outline the uniqueness of medical genetics.
Outline the relevant ethical principles in medicine.
Discuss some ethical dilemmas that arise in the genetic clinic.
Explain the ethical dilemmas and public interest.
Dr. Najnin Akhter
Phase-A, Year-2, Block-6
Guided by Prof. K M Shamim
The document provides best practices for using social media to build brand loyalty and share engaging content. It recommends being trustworthy, engaging, consistent and responsive on social media. It also suggests creating sharable content like contests, polls and blog posts using multimedia to leverage existing brand assets. Content should be unique, relevant and original to increase sharing and search engine optimization. The document advises pushing engaging content rather than passive commercials. Social media is for interaction, not monologues, so brands should respond to others, follow other pages and share their content to promote a two-way conversation like interactions at a cocktail party.
The Buffer Zone: What Adverse Childhood Experiences (ACE) Study Teaches about...MFLNFamilyDevelopmnt
In an attempt to look at the association between childhood trauma and the risk for physical and mental illness in adulthood, Kaiser Permanente and the Centers for Disease Control and Prevention established the Adverse Childhood Experiences (ACE) Study which is one of the largest scientific research studies of its kind. This 90-minute webinar will provide participants with in-depth information on this study and its implications.
The main purpose of the present study was to determine the effect of regular home visits on the developmental indices of low birth weight infants. The present study was an on-site clinical investigation. 90 infants ranging between 1500 to 2500g born in Razi Hospital of Marand town having the entrance criteria to the present study were taken into consideration through the available sampling method and then they were divided into two intervention and control groups. The intervention group has received the whole routine cares since the first to fourth week and then they were visited at home for 45 minutes a week. The control group received the routine cares. The evolutionary indices of both groups were also completed monthly for three months by referring homes. The related data gathering tool was also subjected to the demographic information through registration list and the Persian version of the Low Weight Infant Inventory (LWII) (2 months) that have been completed by the researcher on the birthday, first, second and third months of the birth through the interview. SPSS-15 software and the application of the inferential and descriptive statistical tests (K2 and T-tests) were also applied in order to analyze the related data in this study. The significance level was considered as p<0.05.
More than half of these related research units of both groups had experience (61.5%) and control (55.8%) regarding all women in this study; the mean score of the low weight infants on the first month had not shown any statistical significant difference; but on the second months (p=0.04) and the third months (p=0.001), they had shown statistical significant difference progressively. The healthcare based on home-visit had influence on the recovery indices of the low weight infants. Hence, nurses and other health monitors of the infants should apply for the healthcare programs based on home-visit particularly in caring infants.
Four year follow-up of a randomized controlled trial of choline for neurodeve...BARRY STANLEY 2 fasd
Abstract
Background
Despite the high prevalence of fetal alcohol spectrum disorder (FASD), there are few interventions targeting its core neurocognitive and behavioral deficits. FASD is often conceptualized as static and permanent, but interventions that capitalize on brain plasticity and critical developmental windows are emerging. We present a long-term follow-up study evaluating the neurodevelopmental effects of choline supplementation in children with FASD 4 years after an initial efficacy trial
The document summarizes a study that measured health status in family practice patients using the EuroQol EQ-5D questionnaire. Over 2,000 patients were surveyed with an 83% response rate. The results showed that 73% of respondents reported at least a moderate problem in one or more health dimensions. The most commonly reported problems were pain (72.5%), mobility problems (46.7%), and problems with usual daily activities (52.7%). Having problems was more likely for females and increased with age. Patients with lower education reported more problems with daily activities, pain, mobility and self-care. The study concluded that family practice patients experience high rates of health problems that primary care teams need to address in addition to clinical symptoms
CUES ED. Children and Young People's National Conference 2017NHSECYPMH
- Approximately 20% of children under 16 experience significant anxiety, and 1 in 10 children aged 5-16 have a diagnosable mental health condition. Childhood emotional and behavioral issues increase vulnerability in adulthood.
- The document discusses a universal, evidence-based, 6-session program called "Who I Am and What I Can" that aims to improve emotional well-being and resilience in primary school children through engaging activities and CBT strategies.
- Evaluations found the program helped children understand their feelings better, develop coping strategies, and improved behavioral and emotional outcomes. It also reduced stigma around mental health by normalizing difficult experiences.
On April 6, 2019, the EveryLife Foundation for Rare Diseases and Genetic Alliance hosted a workshop to provide education about the process of adding rare genetic conditions to the federal Recommended Newborn Screening Panel. Presentations include insights from national newborn screening experts in biochemical sciences, genetics, and political advocacy.
This document summarizes a study that evaluated the effectiveness of an intervention to address intimate partner violence in primary care. The intervention consisted of screening women for intimate partner violence, notifying and training general practitioners (GPs) to respond, and inviting screened women for brief counseling with their GP. The study found that the intervention led to a decrease in depressive symptoms for women and increased safety discussions between GPs and women about themselves and their children. However, the intervention did not significantly improve women's quality of life. The study provides preliminary evidence that screening and training GPs can help address intimate partner violence in primary care, though the training requires resources and uptake of counseling was low.
Directors Meeting - Oct. 15, 2019
UofSC Division of Student Affairs and Academic Support
Featuring:
Christina Yao, Higher Education and Student Affairs program
Rebecca Caldwell, Student Health Services
Aimee Hourigan, Substance Abuse Prevention and Education
Dennis Pruitt, VP for Student Affairs
5.2 Services Optional: Using a Voluntary Services Approach
Speaker: Kathy Daniher
Programs increasing rely on voluntary services and harm reduction strategies to successfully work with vulnerable families and youth. This workshop will examine how providers have made the transition to a voluntary-services approach and how it has impacted their program outcomes.
Patricia Jennings, MEd, PhD - "Mindfulness-Based Approaches to Promoting Stud...youth_nex
The Youth-Nex Conference on Physical Health and Well-Being for Youth, Oct 10 & 11, 2013, University of Virginia
Patricia Jennings, MEd., Ph.D. - "Mindfulness-Based Approaches to Promoting Student Learning, Attention and Self-Regulation"
Jennings is a Research Assistant Professor in Human Development and Family Studies (HD FS) and affiliated with the Prevention Research Center at Penn State University.
Panel 4 — Mindfulness, Health and Well-Being: The Mind Body Connection.
Research with adults has found that contemplative practices such as mindfulness and yoga promote a variety of benefits for physical and emotional well-being. This panel will provide an overview of the growing body of research on such activities for youth that have been integrated into school settings and which are designed to affect students' attention, behavior, and academic achievement.
Website: http://bit.ly/YNCONF13
This document provides information on screening patients for domestic violence. It defines domestic violence and discusses its prevalence and health impacts. Screening all female patients is recommended to identify those experiencing intimate partner violence and refer them to support services. The document reviews screening tools like HARK and proper protocols for responding to positive screens while ensuring safety and confidentiality. Follow-up is important to provide ongoing support and review referral options. The overall goal is to integrate domestic violence screening into routine care to improve patient health and well-being.
The document summarizes a qualitative analysis of contraceptive use and barriers to access among Australian women based on surveys of 690 women across five surveys. It identifies several key themes in women's experiences with contraception over their reproductive lives, including side effects, lack of information, negative experiences with healthcare providers, contraceptive failure, and difficulty accessing contraception. These barriers were shown to have an important impact on women's mental and physical health. The analysis concluded that barriers to effective contraception persist throughout women's reproductive lives.
Transforming CYP Community Eating Disorders Services: Children and Young Peop...NHSECYPMH
The Durham and Darlington Eating Disorders Team shares with you our progress; reflecting on both successes and challenges, and offering the chance to share experiences. There are further developments and challenges ahead and we will consider what the future may hold.
Violence against women by their husband and postpartum depression finalChetkant Bhusal
The study aimed to determine the prevalence of violence against women by their husbands, postpartum depression, and the relationship between violence and depression in Nepal. The study found the incidence of postpartum depression was 19.4-22.2% and violence was 13.9-20.8%. No significant relationship was found between violence and depression, possibly due to small sample size. The study highlighted the need for further large-scale research on this topic in Nepal.
This document provides an overview of ADHD, including that it is the most common neurodevelopmental disorder, affecting approximately 5% of children and 2.5% of adults worldwide. It discusses the history of ADHD and evidence that it has been recognized as far back as the late 18th century. The document also summarizes research showing differences in brain activation patterns between those with and without ADHD. In addition, it outlines the diagnostic criteria for predominantly inattentive and hyperactive/impulsive presentations in the DSM-5 as well as high rates of comorbidity with conditions like depression, anxiety, substance abuse, and psychosocial dysfunction. The document concludes with a discussion of comprehensive treatment approaches including medication management, behavioral therapies
This document discusses the potential for using video games to promote health-related behavior change in children. It summarizes 27 articles on 25 video games that have been used experimentally to teach nutrition, increase physical activity, and address other health topics. Many of these games combine storytelling, interactivity, and behavior change techniques. The document argues that further research is needed to understand how best to design game stories, fantasy elements, interactivity, and behavior change features to maximize health impacts. It also notes the large amounts of time children spend playing video games, representing an opportunity to engage them around health through this entertaining medium.
Ethical and Legal Issues Related to Medical Genetics Rayhan Shahrear
Define ethics and bioethics.
State the major ethical issues related to medical genetics.
Outline the uniqueness of medical genetics.
Outline the relevant ethical principles in medicine.
Discuss some ethical dilemmas that arise in the genetic clinic.
Explain the ethical dilemmas and public interest.
Dr. Najnin Akhter
Phase-A, Year-2, Block-6
Guided by Prof. K M Shamim
The document provides best practices for using social media to build brand loyalty and share engaging content. It recommends being trustworthy, engaging, consistent and responsive on social media. It also suggests creating sharable content like contests, polls and blog posts using multimedia to leverage existing brand assets. Content should be unique, relevant and original to increase sharing and search engine optimization. The document advises pushing engaging content rather than passive commercials. Social media is for interaction, not monologues, so brands should respond to others, follow other pages and share their content to promote a two-way conversation like interactions at a cocktail party.
Edwin R. Thiele - Daniel, esboço de estudosfabiofelippe
Apostila do livro bíblico de Daniel para estudo em curso de teologia elaborada pelo famoso professor e arqueólogo Edwin R. Thiele. Um ótimo material para quem quer se aprofundar no estudo do livro de Daniel.
The document discusses strategies for using social media, particularly Facebook and Twitter, for audience development, engagement, and revenue generation for a non-profit cycling organization. It provides tips on developing content calendars and "content banks" to regularly post engaging content to social media to stay active in users' news feeds. It also discusses using social media to promote events and develop brand partnerships with sponsors.
1. Dokumen tersebut membahas tentang pemodelan 3D dialog antara Putri dengan Raja di Unity
2. Terdapat penjelasan tentang pemodelan objek karakter, lingkungan, dan animasi untuk adegan dialog tersebut
3. Juga dijelaskan sistem AI sederhana untuk menentukan tingkat emosi Raja berdasarkan jawaban yang dipilih pemain untuk pertanyaan Raja
This document analyzes the organizational cultures of high-performing schools (HPS) and low-performing schools (LPS) in the state of Kedah, Malaysia. The study used Cameron and Quinn's Organizational Culture Assessment Instrument to measure four types of culture - clan, adhocracy, market, and hierarchy - in two HPS and two LPS with a total of 129 teachers. The findings showed that both HPS and LPS have dominant hierarchy cultures, with HPS scoring higher. Both practiced market culture equally. LPS practiced more clan culture while both practiced little adhocracy. Teachers in both schools preferred clan culture. HPS preferred market culture more than LPS. The study aims to identify cultural differences between
Este documento describe las agravantes y atenuantes establecidas en el Código Penal venezolano. Entre las agravantes se encuentran la alevosía, ejecutar el delito mediante precio o recompensa, y cometerlo usando medios que pueden causar grandes daños. Las atenuantes incluyen ser menor de edad al cometer el delito, no haber tenido intención de causar un daño grave, y haber sido provocado por la víctima. Finalmente, se definen conceptos legales como agravante, atenu
Conferencia de la Dra. Joanne Wolfe sobre Cuidados Paliativos Pediátricos, en...PrincipitoJuanPi
This document summarizes a presentation on pediatric palliative care given by Dr. Joanne Wolfe. It discusses the scope of pediatric palliative care needs, including common diagnoses, symptoms, and technologies used to treat children with life-threatening illnesses. It also describes the suffering experienced by patients and their families from physical, psychological, social, and existential distress. Additionally, it outlines the Boston Pediatric Palliative Care experience, including the interdisciplinary team approach, strategies used, and outcomes demonstrating improved symptom management, family satisfaction, and reduced healthcare utilization. Finally, it discusses adapting the pediatric palliative care model to low and middle income countries by assessing available resources and integration with local care providers.
Rosemary Frasso's presentation from the
Penn Urban Doctoral Symposium
May 13, 2011
Co-sponsored with Penn’s Urban Studies program, this symposium celebrates the work of graduating urban-focused doctoral candidates. Graduates present and discuss their dissertation findings. Luncheon attended by the students, their families and their committees follows.
Over one-third of children with developmental disabilities in foster care in this study were cared for by individuals over age 65. Specifically, 42% of children in kinship foster care and 26% of children in non-kinship foster care had caregivers over 65. The study examined 82 children and found that many factors like substance abuse, poverty, and family violence can result in grandparents and other relatives taking on caretaking roles. It concludes that more research is needed to determine if older caretakers are receiving sufficient support services.
Child-health practitioners in Iowa must find better ways to address family, neighborhood and economic factors that shape children' health and well being, according to CFPC executive director Charles Bruner and Debra Waldron, director and chief medical officer of the Child Health Specialty Clinics at the University of Iowa. They presented at the Iowa Governor's Conference on Public Health in Ames on April 5.
The document summarizes key outcomes of systems of care for children's mental health. It finds that systems of care are associated with:
1) Improved clinical outcomes like reduced behavioral and emotional problems, improved functioning, and fewer suicidal thoughts.
2) Cost savings from reduced use of restrictive care settings like inpatient hospitals and residential treatment centers. Savings are also seen from reduced juvenile justice involvement.
3) Better educational outcomes such as improved school attendance and fewer suspensions.
This document discusses trauma and its impacts on children in foster care. It provides an overview of PTSD and high rates of PTSD among children in foster care due to abuse, neglect, and family dysfunction. It also discusses the overuse of psychotropic medications in foster care and the need for trauma-informed treatment. Non-pharmacological interventions like TF-CBT are effective for treating trauma in children. Trauma-informed approaches are also needed within the criminal justice system given high rates of trauma among justice-involved individuals.
Do cognitive factors predict wellbeing in parents of children with profound a...Dr Fleur-Michelle Coiffait
This talk summarizes research examining whether cognitive factors predict the subjective well-being of parents who have children with profound and multiple intellectual disabilities. The study found that these parents had lower subjective well-being scores than the general population and other parents. An external parental locus of control predicted decreased well-being, but recognizing positive gains from parenting did not. The results suggest cognitions may impact parental adjustment, with implications for psychological support of these families.
This document provides an overview of behavioral health among youth in Georgia. It discusses that behavioral health encompasses both mental health and substance use disorders. Nearly half of US youth experience a behavioral health condition, and among Georgia youth, nearly 1 in 10 have been diagnosed with a behavioral health condition. The most prevalent conditions among Georgia youth are substance use disorders, anxiety, and depression. A variety of social factors can influence behavioral health, such as adverse childhood experiences, poverty, and access to healthcare and education. Over half of Georgia children have experienced at least one adverse childhood experience.
Research proposal emotional health and foster care adolescentsKaren McWaters
This document provides an overview of a proposed research study on the emotional health of adolescents in foster care. It discusses relevant literature showing common mental health issues like trauma, disorders, and behavioral problems among foster youth. The study aims to evaluate the impact of the South Carolina foster system through mixed methods. Focus groups and a standardized inventory will be used to assess emotions like depression, anxiety, anger, and self-concept among teen participants. The research seeks to identify ways to improve emotional care for adolescents and inform policies to support their well-being.
Epidemiological aspects of maternal and child healthnew 3Sinmayee Kumari
"maternal and child health refers to the promotive, preventive, curative and rehabilitative health care for mothers and children"
this topic is very essential for all the health care personnel
Capstone PowerPoint Grandparents raising grandchildren in Shreveport, laLish'a Bond Reed
Grandparents in Shreveport, Louisiana face challenges caring for their grandchildren. The document summarizes interviews with 15 grandparent caregivers who access services at a local health center. Most have low incomes and lack health insurance. Common reasons for taking in grandchildren include parental substance abuse or death. Grandparents desire resources to help with basic needs like food, clothing, bills and legal advice. A majority were unaware of existing support services and groups and expressed interest in informational materials and a resource center.
Emotional Health and Foster Care AdolescentsSarah Parks
This document proposes a research study to evaluate the impact of the foster care system in South Carolina on the emotional health of adolescents. It will use a mixed methods approach, including focus groups and the Beck Youth Inventory quantitative assessment. The focus groups will gather perspectives from males and females ages 13-18 across the state from different foster care situations. Questions will address emotional state, experiences impacting emotional health, and how the system maintains emotional well-being. The study aims to better understand how the system affects teens and identify opportunities for improvement.
Russell A. Barkley.
Clinical Professor of Psychiatry Medical University of South Carolina, Charleston SC, and Research Professor, Departament of Psychiatry Suny Upstate Medical University Syracuse, NY.
This study assessed behavioral problems among overweight school children in Tarrant County, Texas. Survey data on over 3,500 Caucasian and Hispanic children aged 0-14 was analyzed. Results showed that among Caucasian children, being overweight or obese was linked to behavioral issues like bullying others, exhibiting problematic social behaviors, and experiencing bullying. However, weight status did not significantly predict suspensions for Hispanic children. The study concludes that childhood obesity can negatively impact physical and mental health into adulthood, and suggests further research on academic and social development impacts.
This document summarizes issues related to pediatric adherence for HIV treatment in children and adolescents. It provides data on pediatric enrollment and adherence from ICAP programs in multiple countries. Key challenges to pediatric adherence are forgetting doses, staying away from home, and sleeping through doses. Developmental factors like age and disclosure status can also impact adherence. The document discusses strategies to support pediatric adherence, including education, reminders, involvement of caregivers, clinics that are child-friendly, and multidisciplinary teams. Country examples from South Africa, Kenya, and Ethiopia demonstrate approaches like appointment diaries, integration of services, and collaboration between medical and psychosocial teams to address children's developmental needs.
Dr. Roy Wade's Presentation from Childhood Adversity & Poverty: Creating a Co...SaintA
Dr. Roy Wade, a pediatrician from Children’s Hospital of Philadelphia, specializes in the connection between adverse childhood experiences and urban issues such as poverty, violence and health problems. This presentation was made during our community conversation on urban ACES and trauma informed care in Milwaukee.
This document summarizes a study on systems-level barriers that contribute to secondary conditions in individuals with fetal alcohol spectrum disorders (FASD). The study involved interviews and focus groups with parents of children with FASD and service providers.
The key findings were:
1) A pervasive lack of knowledge about FASD exists throughout multiple systems, including healthcare, education, and social services. This lack of knowledge contributes to barriers across different systems.
2) Systems-level barriers that interfere with preventing secondary conditions include delayed diagnosis of FASD, difficulty qualifying for and accessing services, poor implementation of services, and challenges maintaining services long-term.
3) Broad system changes are needed using a public
The document summarizes research on Adverse Childhood Experiences (ACEs) and their relationship to long-term health outcomes. It discusses two major studies - the ongoing CDC/Kaiser Permanente ACE study of over 17,000 patients, and the 2011 Oregon BRFSS survey where over 4,000 adults responded to ACE questions. Both studies found ACEs like abuse, neglect and household dysfunction to be common, and correlated with increased risk of health problems, disease, and unhealthy behaviors later in life. The document advocates for preventing ACEs through community programs that encourage safe relationships and healthy development for children and families.
Maternal and Child Mental Health_Senefeld CORE Group
The pilot project assessed maternal mental health and early childhood development in Kenya. It found high rates of perinatal depression (68%) and low social support (68%) among mothers. A follow-up study found elevated rates of anxiety (66.7%) and depression (66.7%) among primary caregivers, and negative correlations between caregiver depression and children's development. The project is providing family support and parenting programs, and referring children for developmental delays. Additional research is still needed on how interventions impact child outcomes.
2. Medical and Mental Health Needs of
Children in Entering Care in Maine
Stephen Meister MD, MHSA
Medical Director Edmund Ervin Pediatric Center
National Child Traumatic Stress Network
www.NCTSNet.org
3. Maine Child Traumatic Stress
1996
– Abusive Head Trauma
Inter-hemispheric hemorrhage
Seizure
Severe Neurologic Sequelae
– Parade of foster children
No medical records
No known medical history
4. Maine Child Traumatic Stress
1998 Needs of Children Entering Foster Care
– Conference in Augusta, Maine
Baylor Texas
– Sandy Hodges
– Mary Dionne
– Nancy Desisto
– Ann Marden
– Lisa Cavanaugh
5. Medical Needs of Children in
Foster Care
Szilagyi, M. The Pediatrician and the Child in Foster Care, Pediatrics in Review. 1998;19:39-
50
80% have at least one chronic medical condition
25% have three or more chronic problems
60% of preschool children in foster care have a
developmental disability
Nearly 40% of older children qualify for special
education services
Children in foster care tend to be underimmunized,
even compared with other poor children
6. Barriers to Care
1983 AAP Committee on Adoption reports
that children in foster care are not likely to
receive:
– Routine health care
– Immunizations
– Dental care
– Hearing or vision screening
7. Barriers to Care
Children move in and out of care
Move between foster homes and residential
facilities
Multiple providers may be involved
Diffusion of responsibility
A pattern of inadequate, fragmented,
sometimes redundant health care
8. Barriers to Care
Lack of Records/Information on entry to care
– Delayed identification of providers
– Difficulty acquiring consent to access
records
– Time to review and summarize records
– Delay in appropriate evaluations
9. Specialized Programs
1988 CWLA
– Standards for Health Care Services for Children
in Out-of-Home Care
– Initial screen for immediate health needs
– Comprehensive assessment within one month
– Developmental and mental health assessment
– Medical Passport
10. Specialized Programs
1994 Study showed little evidence the CWLA
recommendations were implemented
– Absence of clear State policies
– Medicaid managed care
– Lack of funding
1994 AAP Committee on Early Childhood,
Adoption and Dependant Care recommend a
comprehensive and coordinated treatment
approach
11. What is PREP?
Pediatric Rapid Evaluation Program
Centralized evaluations
Medical Home
Physical and Psychosocial Screening early in
foster care for abused/neglected children
Public/Private Collaboration: DHHS &
MaineGeneral Medical Center
12. What Does PREP Provide?
Medical, dental and psychosocial records
Physical examination
Psychosocial screening
Current problem list and recommendations
Behavioral and developmental guidance
Follow-up medical/psychosocial evaluation
13. Who Does PREP Serve?
Children in Temporary State Custody
Families providing the care
Primary Care and Mental Health Providers
Maine’s DHHS workers
Guardian Ad Litem
Court/District Attorney
Birth parents/Family
14. PREP Catchment Area
Somerset, Kennebec, Waldo,
Knox, Lincoln, Sagadahoc
Referrals by DHS Region:
Skowhegan 36%
Augusta 42%
Rockland 22%
16. PREP Data
1999 and 2006
996 children entered foster care
246 infants age 0-1
222 children age 2-5
285 children age 6-11
243 teens age 12-17
17. PREP Data
Placement Number
Children with first placement in an agency setting
were more than twice as likely to have placement
instability
25% of the children had 3 or more placements in a
year
42% of the teens had 3 or more placements in a
year
There was an association between placement
instability and PTSD
18. Placement Turnover for Maine Teens within
a Year of Entering State Care
243 Teens evaluated between 1999 and 2006
136 (56%) had one or 2 placements
60 (25%) had 4 or more placements
11 (4%) had 7 or more placements
19. PREP Data
Medical Problems
3 or more chronic medical problems
– 37% Age 12-17
– 27% Age 6-11
– 19% Age 2-5
Immunization delay (27%)
Obesity (20%)
Asthma (18%)
20. PREP Data
Behavioral and Developmental Problems
Developmental delay age 2-5
– 48% boys
– 31% girls
LD/MR age 12-17
– 21% boys
– 13% girls
Behavioral disorder
– 33% age 2-5
– 60% age 6-11
– 73% age 12-17
21. PREP Data
Behavioral and Developmental Problems
PTSD age 12-17
– Females (31%)
– Males (23%)
ADHD age 12-17
– Females (6%)
– Males (26%)
Depression age 12-17
– Females (24%)
– Males (12%)
22. PREP Data
Psychotropic Medication
Age 0-1 1%
Age 2-5 4%
Age 6-11 13%
Age 12-17 35%
Teens:
Boys: 21% stimulants, 13% SSRI, 8% antipsy
Girls: 8% stimulants, 23% SSRI, 11% antipsy
23. PREP Data
Obesity (>95%)
22% of the teens were >95% BMI, double the 10.9%
rate reported for Maine HS students
Adjusted for age & sex, depressed children were
twice as likely to be overweight
Children with PTSD and depression were 3 times
more likely to be overweight
SSRI use was not associated with overweight,
stimulant use was negatively associated with
overweight
24. PREP Data
Outcomes
Dental Problems
Exam 1 Exam 2
< Age 5 10% 10%
Age 5-9 50% 33%
Age 10-14 44% 22%
Age 15-17 44% 23%
25. PREP Data
Outcomes
Active Mental Health Problems
Exam 1 Exam 2
< Age 5 41% 37%
Age 5-9 79% 62%
Age 10-14 81% 60%
Age 15-17 88% 67%
26. PREP Data
Outcomes
Psychotropic Medications
Exam 1 Exam 2
< Age 5 2% 4%
Age 5-9 12% 28%
Age 10-14 23% 36%
Age 15-17 37% 47%
27. Medical Needs of Children in Foster
Care
Aggressive, reactive behavior
Secondary enuresis
Sleep deprivation
Attend to the threat, not school work
Constipation
Increased injuries
28. Adverse Childhood Experiences
ACE Study
Weight-loss program SD Kaiser-Permanente
Vincent Felitti, MD (Internist) notices relapse
– Patients with adverse childhood experiences
Health risk assessment 18,000+
– Partners with Centers for Disease Control
Ongoing series of studies correlating ACEs with
adult health and behavioral outcomes.
www.ACEstudy.org
29. Adverse Childhood Experiences
Exposure to Domestic Violence
Exposure to Parental Substance Abuse
Exposure to family member with Mental Illness
Neglect
Emotional Abuse
Physical Abuse
Sexual Abuse
Parent Incarceration
Loss of a parent
30. Mechanisms by Which Adverse Childhood
Experiences Influence Adult Health Status
Early Death
Disease & Disability
Adoption of Health-Risk Behaviors
Social, Emotional, and Cognitive Impairment
Adverse Childhood Experiences
Death
Birth
Felitti, VJ, et al, 2004
31. ACE Score vs.
Intravenous Drug Use
4
3.5
3
2.5
2
1.5
1
0.5
0
1 2 3 4+
ACE Score
% IVDA
32. % PREP Foster Children with
Adverse Childhood Experience
70
60
50
40
30
20
10
0
Sex Abuse Physical
Abuse
Substance
Abuse
Domestic
Violence
33. PREP Data
Adverse Childhood Events
882 (89%) neglect
635 (64%) exposed to domestic violence
445 (45%) physical abuse
Girls (32%) sexual abuse (Teens)
Boys(21%) sexual abuse (Teens)
52 ( 5%) parent death (10% Teens)
35% had >/= 4 adverse childhood events
34. Adult Health and Social Outcomes
of Children Who Have Been in Public
Care Viner Pediatrics 2005;115;894-899
British Cohort of 13,135 Children
343 had been in public care
More likely to have been homeless (2)
More likely to have a conviction (2.3)
More likely to be unemployed (2.6)
More likely to have psych morbidity (1.8)
More likely to be in poor health (1.6)
35. Newborns Experiencing Drug Withdrawal
Symptoms in Maine
13
27
38
79 83
124
158
180
215
0.1%
0.2%
0.3%
0.6% 0.6%
0.9%
1.2%
1.3%
1.6%
2.0
1.5
1.0
0.5
0.0
250
200
150
100
50
0
2000 2001 2002 2003 2004 2005 2006 2007 2008
% of discharges
# of discharges
Discharge Year
# of discharges % of discharges
36. Health Status, Service Use
and Costs among Maine
Children in Foster Care
Muskie School of Public Service
Prepared by: Erika Ziller, Tina Gressani, Catherine
McGuire & Kimberley Fox for the Improving Health
Outcomes for Children (IHOC) Program
37. Purpose
1. To inform IHOC program planning with baseline
data on the health care use and expenditures
of MaineCare children in the foster care
program.
2. To compare use and costs for foster care
children that receive comprehensive health
assessments through the Edmund N. Ervin
Pediatric Center’s Pediatric Rapid Evaluation
Program (PREP), and those that do not.
38. Design and Data
Study population: All children (age 0-17)
receiving foster care services in Maine between
January 1, 2007 and December 31, 2009.*
– PREP: N = 484
– Non-PREP: N = 3,566
Placement data source: Maine Office of Child
and Family Services Foster Care Placement List
Health care use and expenditure data:
MaineCare claims from MMDSS (MeCMS)
*To ensure that each child could be observed for at least 6 months, analyses include only foster
children that had a placement or PREP evaluation by 6/30/2009.
39. Child’s Age*
PREP Non-PREP
0-5 56.8% 43.4%
6-12 26.7% 25.5%
13-17 16.5% 31.1%
Average
6.2 years 8.4
Age (Boys)
Average
Age (Girls)
6.5 years 8.2
Average
Age (Total)
6.3 years 8.3 years
Children that participate in
PREP are, on average, 2
years younger than other
children in foster care
PREP children are more
likely to be aged 0-5 and
less likely to be teenagers.
*At first observed placement between 2007-2009 and/or at PREP evaluation date.
40. Average Monthly MaineCare Costs
Including PNMI (2007-2009)
PREP Non-PREP Based on all
$1,767
$2,925
MaineCare
expenditures, including
placement in private
non-medical institutions
(PNMI), children with
PREP evaluations cost
about $1,150 less per
month on average.
41. Percent of Children with High Costs
over 3 Years (2007-2009)
40%
$100K to < $500K
$500K to $1 million
60%
4%
15%
PREP Non-PREP
MaineCare costs for foster
care children are skewed,
with a small number having
extremely high costs
This is particularly true for
non-PREP children, of
whom 15% had costs of
more than $500 thousand
(compared to 4% of PREP
children)
42. Average Monthly MaineCare Costs
by Age (2007-2009)
$1,055
PREP Non-PREP One reason for the
$2,145
$3,406
$1,092
$3,100
$5,112
0-5 6-12 13-17
difference appears to be the
greater percent f young kids
(0-5) in PREP
Yet age does not appear to
explain the full difference in
costs because, within age
groups, PREP kids are
lower cost
43. Average Monthly MaineCare Costs
Excluding PNMI (2007-2009)
$823
PREP Non-PREP PNMI costs contribute
$1,767
$1,112
$2,925
Excluding PNMI Including PNMI
substantially to average
monthly costs (50-60% of
total costs)
When PNMI costs are
excluded, PREP participants
remain lower cost ($823
versus $1,112 for non-participants)
44. Average Monthly Costs,
by Placement Type (2007-2009)
Placement
Non-
PREP
Type
PREP
Adoption $302 $577
Bridge Homes* $7,869 $10,596
Congregate
$7,994 $11,104
Care (PNMI)
Foster Care $676 $721
Kinship Care $779 $891
Therapeutic
Foster Care
$3,246 $4,010
Unlicensed
Placements
$554 $813
Other $2,511 $3,750
Monthly costs vary
substantially based on
where a child is placed.
Within each placement type,
children receiving PREP
assessments have lower
costs than non-PREP
children.
*NOTE: Bridge Homes are no longer a placement
option
45. Percent of Children with Service Use,
by Service Type (2007-2009)
Service PREP
Non-
PREP
PNMI 31% 39%
Mental Health
59% 58%
Agency
Pharmacy 80% 86%
General Inpatient 5% 8%
Psychiatric
3% 7%
Inpatient
Physician 87% 82%
Speech Therapy 12% 9%
Occupational
11% 8%
Therapy
PREP children are less
likely to be placed in PNMIs,
have a prescription, or to
have general or psychiatric
inpatient stays
PREP children are more
likely to see a physician, and
to receive speech or
occupational therapy
46. Primary Diagnoses Associated with
Service Use (2007-2009)
Service
PRE
P
Non-
PRE
P
Upper resp. infection 43% 44%
Ear infection 27% 28%
Nutritional/metabolic 22% 21%
Adjustment disorder 39% 33%
Developmental
29% 35%
Disorders
Anxiety Disorder 30% 35%
Mood disorder 17% 28%
ADD/ADHD 30% 35%
Asthma 9% 12%
Medical diagnoses for PREP
and non-PREP children are
similar
Psychiatric diagnosis differ:
PREP children have fewer
diagnoses of anxiety,
developmental & mood
disorders or ADD/ADHD,
and are more likely to be
diagnosed with an
adjustment disorder
47. Adolescent Well-Care Visits (2007)
65.3%
58.6% 58.9%
PREP Non-PREP Total
Adolescents
participating in
PREP are more
likely to have a well-care
(preventive)
visit than are non-participants.
48. Well-Child Visits, Ages 3-6 (2007)
85.7%
71.4% 72.9%
PREP Non-PREP Total
Young children (3-6)
participating in
PREP are more
likely to have a well-child
(preventive)
care visit than are
non-participants.
49. Preliminary Findings
Children that have received PREP services
are generally lower cost than those that have
not; however, it is not clear whether this is
due to PREP, or to underlying differences
between the two populations.
MaineCare costs for foster care children are
skewed by a small number of extremely high
cost users, a group that is over-represented
in the non-PREP group.
50. Preliminary Findings
PREP children are somewhat younger than non-
PREP children (6.3 versus 8.3).
Age may explain some of the cost differences
between PREP participants and non-Participants.
Younger children are generally less costly than older
children, and teens are the most costly.
However, even within each age grouping, PREP
children continue to have lower costs (particularly
among the older age groups).
51. Preliminary Findings
PNMI expenditures are a sizeable proportion
of all MaineCare expenditures for children in
Foster Care and non-PREP children are
more likely to receive these services.
Yet, when PNMI costs are excluded, PREP
children’s MaineCare expenditures are about
25% lower than non-PREP ($823 per month
versus $1,112 per month)
52. Preliminary Findings
PREP children are more likely to see a
physician, and to receive speech or
occupational therapy.
Non-PREP children are more likely to have
received PNMI, pharmacy, and general or
psychiatric inpatient services
PREP participants and non-participants have
similar medical diagnoses, but psychiatric
diagnoses differ somewhat.
53. Preliminary Findings
Average monthly costs for children vary
substantially by placement type. However,
within placement types, PREP children were
generally lower cost than non-PREP children.
Children receiving PREP were also more
likely to have a well care, or preventive, visit
during 2007.
54. Limitations
Although PREP participation appears to be
generally associated with lower costs and better
access, the cross-sectional design limits ability
to make conclusions about causality.
We know that PREP children are somewhat
younger than non-PREP children, and that they
are limited to the 6-county area that PREP
serves. However, there may be other important,
unmeasured, differences between the groups
that are affecting costs.
55. Limitations
Finally, the relatively limited number of PREP
participants across the study period (n = 484)
meant that some estimates are based on
very small numbers.