Longitudinal Pathways Research Articles

Ultrasound-guided needle knife release with different pathways for carpal tunnel syndrome: a randomized controlled trial

To evaluate the clinical efficacy of ultrasound-guided needle knife release with different pathways for carpal tunnel syndrome (CTS). Sixty CTS patients were randomly divided into a transverse group and a longitudinal group, with 30 patients in each group. The transverse group received the needle knife release under ultrasound above and below the median nerve along the short axis, while the longitudinal group received the needle knife release under ultrasound above the median nerve along the long axis. The patients' visual analogue scale (VAS) scores, Levine scores, and median nerve cross-section area (CSA) were assessed before treatment, on the 7th, 14th, and 30th days after treatment. The median nerve conduction indexes (motor conduction: latency [Lat], amplitude[Amp], motor conduction velocity [MCV]; sensory conduction: Lat, Amp, sensory conduction velocity [SCV]) were evaluated before treatment and on the 30th day after treatment. Compared before treatment, the VAS scores, Levine scores, and median nerve CSA were reduced in both groups on the 7th, 14th, and 30th days after treatment (P<0.05); the transverse group showed lower VAS and Levine scores and smaller CSA than those in the longitudinal group (P<0.05). On the 30th day after treatment, motor and sensory Lat was reduced (P<0.05), motor and sensory Amp was increased (P<0.05), and MCV and SCV were faster (P<0.05) in both groups. The transverse group had shorter Lat, higher Amp, and faster MCV and SCV than those in the longitudinal group (P<0.05). The ultrasound-guided needle knife release with transverse and longitudinal pathways could both effectively alleviate pain and improve median nerve conduction in CTS patients, with the transverse pathway showing superior efficacy to longitudinal pathway.

The contributions of language and inhibitory control to false belief reasoning over time

IntroductionThe role of language in false belief reasoning has been much debated for twenty-five years or more, especially the relative contributions of general language development, complement syntax, vocabulary, and executive function. However, the empirical studies so far have fallen short, in that they generally have too few participants for adequate statistical modeling; they do not include control variables; or they are cross-sectional rather than longitudinal, making inferences about causal direction much more tenuous.MethodsThe present study considers the role of these different variables in the development of false belief reasoning over several months of testing, with 258 children aged three to five years. The children are also from under-resourced communities, broadening the populations that generally contribute such data.ResultsA cross-sectional and a longitudinal regression analysis reveals the contribution of each variable to the children’s success on the false belief measures. Finally, a structural equation model tests the relative contribution of the different potential factors over time, how they interact, and change. The model is an excellent fit to the data. Inhibitory control, complement comprehension and vocabulary all have effects on false belief reasoning at the first time point (T1). However, at T3, the major proximal contribution is the child’s comprehension of complements, though the longitudinal pathways of vocabulary and inhibitory control also pave the way.DiscussionOur data confirm the specific contribution of complement syntax but also makes clear, as do training studies, that a certain amount of preparedness in vocabulary and in executive function skills is also necessary.

Longitudinal pathways linking peer victimization to academic efficacy in adolescence: Indirect effects via sleep

Although past research links greater peer victimization to poorer academic achievement, much less is known about if or how peer victimization contributes to adolescents’ academic efficacy, a potentially malleable predictor of academic success. Informed by the biopsychosocial framework of sleep that emphasizes the interplay of interpersonal dynamics and bioregulatory processes in shaping developmental outcomes, the current study investigated pathways from peer victimization to academic efficacy across adolescents’ first 2 years of high school, testing sleep as a potential underlying mechanism. Participants were 388 ninth-grade adolescents ( Mage = 14.05, SD = 0.41; 61% female) who completed five online assessments of peer victimization, sleep, and academic efficacy across ninth and 10th grades. Multilevel mediation models indicated that higher levels of peer victimization during ninth grade predicted increased daytime dysfunction and sleep disturbances at the beginning of 10th grade, which, in turn, predicted poorer academic efficacy by mid-year of 10th grade. No significant indirect effects were found for the models testing sleep duration and latency as mediators. The findings highlight specific dimensions of sleep as potential modifiable targets for interventions that could mitigate the harmful impact of peer victimization on adolescents’ academic efficacy.

Longitudinal pathways from emotional abuse to problematic gaming in adolescents: The role of psychoticism.

Problematic gaming (PG) has emerged as a major concern due to its potential impact on adolescents' everyday lives. Emotional abuse (EA) and psychoticism are considered factors influencing PG, but their long-term interactions have not been extensively studied. This research investigates these relationships over time using the Interaction of Person-Affect-Cognition-Execution (I-PACE) model. The study involved 1902 Italian adolescents (mean age=15.45, SD=1.10) in a three-wave longitudinal study. Surveys were conducted at the beginning (T1), after six months (T2), and after twelve months (T3). Structural equation modeling (SEM) was used to evaluate bidirectional relationships and mediation effects among the variables. The findings indicated that EA consistently predicted both psychoticism and PG, while psychoticism consistently predicted PG. However, psychoticism did not predict EA, and PG did not predict either EA or psychoticism. Significant mediation effects were found from EA at T1 to PG at T3 through EA at T2, psychoticism at T2, and PG at T2, as well as from psychoticism at T1 to PG at T3 through psychoticism at T2 and PG at T2. No significant indirect effect was observed from psychoticism at T2 to PG at T3 through EA at T2. The results suggest that adolescents experiencing EA are more prone to PG, with psychoticism worsening this effect. Effective interventions might include emotional support programs and therapies targeting psychoticism traits. Combining these approaches could improve treatment outcomes for adolescents with PG.

Distinct Ventral Hippocampus Network Properties inDissociated Cultures.

Extensive research has been focused in the past century on structural, physiological, and molecular attributes of the hippocampus. This interest was created by the unique involvement of the hippocampus in cognitive and affective functions of the brain. Functional analysis revealed that the hippocampus has divergent properties along its axial dimension to the extent that the dorsal sector (dorsal hippocampus, DH) has different connections with the rest of the brain than those of the ventral sector (VH). Still, longitudinal pathways connect the DH with the VH and dampen the functional differences between the sectors. To be able to identify the intrinsic functional difference between the DH and VH, we produced dissociated monolayer cultures from prenatal DH and VH and examined their properties at 10-20 days after plating by imaging the spontaneous activity of the network using Fluo-2 AM, a calcium indicator. Surprisingly, while DH and VH sectors produced dissociated cultures with similar morphological attributes, VH cultures were more active spontaneously than DH cultures. Furthermore, when stimulated to produce action potentials, VH neurons triggered network bursts in postsynaptic neurons more often than DH cultures. Finally, in both DH and VH cultures, electrical stimulation of single cells produced network bursts in response to a burst of action potentials rather than to single spikes. These experiments indicate that even in dissociated cultures, neurons of the VH are more excitable and sensitive to electrical stimulation than DH; hence, they are more likely to generate network bursts and epileptic seizures, as suggested for invivo brains.

Language abilities and metacognitive monitoring development: Divergent longitudinal pathways for native and non-native speaking children

BackgroundThe ability to accurately evaluate one's task performance (metacognitive monitoring) is crucial for children's learning and academic achievement, but mechanisms explaining monitoring development remain to be uncovered. AimWe investigated the role of language abilities for metacognitive monitoring in five to seven-year-old native and non-native speakers. SampleData stems from an ongoing German large-scale assessment (National Educational Panel Study) initiated in 2010 (N = 9167; 49.6 % male). MethodsWe computed cross-lagged panel models including measurements of children's language abilities and metacognitive monitoring (in math and science tasks) in kindergarten and grade one. ResultsEarlier language abilities predicted later metacognitive monitoring for native (β = −.21), but not for non-native speakers (β = −.07). Conversely, metacognitive monitoring predicted language abilities for non-native (β = .53), but not for native speakers (β = .03). ConclusionFundamentally different mechanisms appear to drive native and non-native speakers’ metacognitive monitoring development.

Pathway enrichment in genome-wide analysis of longitudinal Alzheimer's disease biomarker endophenotypes.

The genetic pathways that influence longitudinal heterogeneous changes in Alzheimer's disease (AD) may provide insight into disease mechanisms and potential therapeutic targets. Longitudinal endophenotypes from the Alzheimer's Disease Neuroimaging Initiative (ADNI) representing amyloid, tau, neurodegeneration (A/T/N), and cognition were selected. Genome-wide association analysis was performed using a linear mixed model (LMM) approach, followed by gene and pathway enrichment with significant and functionally relevant SNPs. A total of 33 and 19 statistically significant pathways were identified associating with the intercept and longitudinal trajectory, respectively. The longitudinal intercept pathways represent eight groups: immune, metabolic, cell growth and survival, DNA maintenance, neuronal signaling, RAS/MAPK/ERKsignalingpathways, vesicle and lysosomal transport, and transcription modification. Longitudinal trajectory pathways represented six groups: Immune, metabolic, cell signaling, cytoskeleton, and glycosylation. Longitudinal enrichment identified pathways that uniquely associate with trajectories of key AD biomarkers and cognition, providing new insight into AD course-related mechanisms and potential new therapeutic targets. A systematic genome-wide analysis with longitudinal AD biomarker endophenotypes was performed. Enriched pathways were identified with functionally derived SNP to gene analysis. Fifty-two pathways were associated with longitudinal trajectory and intercept. Many of the identified pathways are specific steps in larger pathways implicated in AD. The identified pathways may provide therapeutic targets and areas for further study.

Serum uric acid trajectories and the risk of cardiovascular disease: a longitudinal association and pathway analysis.

Age-specifically longitudinal associations and potential pathways between serum uric acid (SUA) and cardiovascular disease (CVD) remained unclear. This study aimed to explore SUA trajectories in different age populations and to determine their associations and potential pathways with incident CVD. This prospective cohort included 41,367 participants from the Kailuan study, including 30,938 participants aged <55 years and 10,419 participants aged ≥55. The SUA trajectories during year 2006-2012 were identified by latent class growth models. Three SUA trajectories were identified in the overall, aged <55 and aged ≥55 years participants, as "low-stable" (51.9%, 54.4%, and 43.3%), "moderate-stable" (39.0%, 36.9%, and 45.6%), and "high-stable" (9.1%, 9.7%, and 11.1%), respectively. During a median follow-up of 6.75 years, incident CVD occurred in 2302 participants (5.56%). Overall, a high-stable trajectory was independently associated with a higher risk of CVD (hazard ratio [HR], 1.23; 95% [confidence interval], 1.06-1.42). Notably, the associations differed by age, a significant association was only observed in participants aged ≥55 years (HR, 1.29; 95% CI, 1.05-1.58), rather than those aged <55 years (HR, 1.08; 95% CI, 0.89-1.33). The addition of SUA trajectories to a baseline risk model for CVD improved the integrated discrimination improvement value (P < 0.05) and category-free net reclassification improvement value (P < 0.05). Bayesian network showed the conditional probability of high CVD risk associated with aging, elevated SUA trajectories, blood pressure, glucose, and inflammation was 15.5%. High-stable SUA trajectories were independently associated with an elevated risk of CVD, which is mainly induced by hypertension, diabetes, and inflammation, especially in participants aged ≥55 years.

Conceptualization and teaching health advocacy in undergraduate medical education:a document analysis.

Health advocacy is considered to be a core competence for physicians, but it remains unclear how the health advocacy role, despite being described in overarching competency frameworks, is operationalized in undergraduate medical education (UME). This study aimed to identify how health advocacy is conceptualized and taught in undergraduate medical curricula. We performed a qualitative analysis of curriculum documents from all eight medical schools in the Netherlands, all of which offered competency-based UME. Thematic analysis was used to code all the documents and generate themes on health advocacy conceptualization and teaching. To categorize the emerging themes, we used the framework of Van Melle et al. for evaluating the implementation of competency-based medical educational programs. Health advocacy was mostly conceptualized in mission statements about social responsibility of future physicians, related to prevention and promoting health. We found key concepts of health advocacy to be taught mainly in public health and social medicine courses in the bachelor stage and in community-based clerkships in the master stage. Specific knowledge, skills and attitudes related to health advocacy were taught mostly in distinct longitudinal learning pathways in three curricula. Health advocacy is conceptualized mostly as related to social responsibility for future physicians. Its teaching is mostly embedded in public health and social medicine courses and community-based settings. A wider implementation is warranted, extending its teaching to the full width of medical teaching, with longitudinal learning pathways providing a promising route for more integrative health advocacy teaching.

Longitudinal pathways between parent depression and child mental health in families of autistic children

Abstract Autistic children and their parents are at risk for mental health problems, but the processes driving these connections are unknown. Leveraging three data cycles (spaced M = 11.76 months, SD = 2.77) on 162 families with autistic children (aged 6–13 years), the associations between parent–child relationship quality (warmth and criticism), child mental health problems, and parent depression symptoms were examined. A complete longitudinal mediation model was conducted using structural equation modeling. Father depression mediated the link between child mental health problems and father critical comments (β = −0.017, p = 0.018; CI [−.023 – −.015]). Father report of child mental health problems mediated the association between father depression and father critical comments (β = 0.016, p = 0.040; CI [0.003–0.023]) as well as the association between father positive remarks and father depression (β = −0.009, p = 0.032; CI [−0.010 – −0.009]). Additionally, father positive remarks mediated the connection between father depression and child mental health problems (β = 0.022, p = 0.006; CI [0.019–0.034]). No mediation effects were present for mothers. Findings highlight that the mental health of parents and autistic children are intertwined. Interventions that improve the parent–child relationship may reduce the reciprocal toll of parent and child mental health problems.

Pathways of Intergenerational Risk: Examining the Association Between Maternal Adverse Childhood Experiences and Child Socio-Emotional and Behavioral Concerns at 8 Years of Age.

Support has been found for the intergenerational transmission of risk from maternal adverse childhood experiences (ACEs) to child outcomes. Less research has focused on longitudinal psychosocial pathways that account for this transmission. In the current study, path analysis examined mediating pathways (i.e., maternal adult attachment insecurity, romantic relationship functioning, and maternal anxiety and depression symptoms) in the association between maternal ACEs and internalizing and externalizing concerns among their child at eight years of age. Participants included 1,994 mother-child dyads from a prospective longitudinal cohort sample. Maternal ACEs were significantly associated directly with child internalizing concerns (β = .06, p = .025) and indirectly via both maternal attachment anxiety and avoidance, lower romantic relationship functioning, and depression, (β = .002, p = .006; β = .003, p = .005, respectively). Maternal ACEs were directly associated with child externalizing concerns (β = .06, p = .018) and indirectly via both maternal attachment anxiety and avoidance, lower romantic relationship functioning, and depression, (β = .001, p = .008; β = .002, p = .010, respectively). This study identified several maternal risk factors that have implications for downstream internalizing and externalizing concerns among their children.

Mind the Gap: Understanding Palliative Care Clinician Attitudes Toward Mental Health Training.

Background: Palliative care (PC) clinicians provide mental healthcare to individuals with serious illnesses. Despite this, there is limited knowledge regarding their mental health training opportunities. Methods: To identify predictors of satisfaction with mental health training opportunities and assess the relationship between training opportunities and clinician comfort in managing mental health comorbidities, we conducted a secondary analysis of a nationwide survey involving 708 PC clinicians. Results: Satisfaction with mental health training was moderate (M = 2.75/5, SD = .915). Access to lectures/webinars was the most common training opportunity (54%). Significant predictors of satisfaction with training included access to lectures/webinars (β = .328, P <.001) and case discussions (β = .231, P = .007). Academic practice settings and satisfactory mental health referrals were associated with a greater number of different training opportunities. Clinicians in academic settings had higher odds of accessing various training opportunities, such as lectures/webinars (OR = 2.58, P <.001) and longitudinal training pathways (OR = 4.51, P <.001). A moderate, positive correlation was found between training satisfaction and comfort in managing mental health comorbidities (r = .30, P <.001). Discussion: This study is among the first to elucidate factors influencing PC clinicians' satisfaction with mental health training. Low-resource training opportunities, such as webinars and lectures, significantly predict satisfaction, suggesting the potential of these scalable solutions to enhance training. The findings underscore the importance of expanding evidence-based mental health training for PC clinicians to improve patient care.

A Four-Wave Cross-Lagged Study of Exposure to Violent Contexts, Cognitive Distortions, and School Bullying during Adolescence.

School bullying represents a widespread expression of violence in the peer context. Guided by the social-ecological model, this study investigated the longitudinal and transactional pathways linking domestic and neighborhood/community violence exposure (through direct victimization and witnessing), self-serving cognitive distortions (CDs), and school bullying perpetration. Furthermore, consistent with the previous literature, we tested the cognitive desensitization process that could develop in response to chronically violent contexts. Two four-wave cross-lagged panel mediation models were tested in a sample of 778 high school students (28.1% males; Mage [Time 1; T1] = 14.20, SD = 0.58). The results showed differential effects of multiple contexts and forms of violence exposure, with domestic violence victimization and community violence witnessing being associated with self-serving CDs and bullying perpetration over time. Moreover, significant associations between CDs and bullying perpetration over time were found, with bidirectional effects for each of these longitudinal patterns. Finally, self-serving CDs significantly mediated the relationships between both domestic violence victimization and community violence witnessing and school bullying perpetration. These findings highlight the need to consider school bullying as a social phenomenon stemming from a complex and bidirectional interplay between individuals and the environments they inhabit, confirming a basic postulate that "violence breeds violence".

Longitudinal pathways from harsh parenting to adolescent depression via internal working models: The moderating role of adolescent trait mindfulness

Theoretical and empirical research indicates that insecure attachment with parents may function as a mediator between aversive parenting and adolescent depression. However, no longitudinal research has differentiated the roles of internal representations of parental attachment, especially the roles of the two internal working models (i.e., the self-model and the other model) in the longitudinal relation from harsh parenting to adolescent depression and whether adolescent mindfulness can play a moderating role in such relationships. Six hundred and forty-five school children completed a paper-and-pencil questionnaire in school three times with two eight-month intervals (338 girls and 307 boys, mean age = 13.45), and data on harsh parenting, internal working models, and depression were collected at three time points, and mindfulness were collected only at Time 1. Results demonstrated that among adolescents low in mindfulness, harsh parenting could undermine positivity of the self-model, which could further elevate the risk of adolescent depression. In comparison, these predictive relations did not exist among highly mindful adolescents. To our knowledge, this study is the first one to differentiate the roles of the two elements of internal working models in a longitudinal research design, which highlights the significant role of the impaired self-model in the development of adolescent depression in the context of aversive parenting.

Understanding pathways from implementation to sustainment: a longitudinal, mixed methods analysis of promising practices implemented in the Veterans Health Administration

BackgroundThe Veterans Health Administration (VHA) is the United States largest learning health system. The Diffusion of Excellence (DoE) program is a large-scale model of diffusion that identifies and diffuses evidence-informed practices across VHA. During the period of 2016-2021, 57 evidence-informed practices were implemented across 82 VHA facilities. This setting provides a unique opportunity to understand sustainment determinants and pathways. Our objective was to characterize the longitudinal pathways of practices as they transition from initial implementation to long-term sustainment at each facility.MethodsA longitudinal, mixed-methods evaluation of 82 VHA facilities. Eighty-two facility representatives, chosen by leadership as points-of-contact for 57 DoE practices, were eligible for post-implementation interviews and annual sustainment surveys. Primary outcomes (implementation, sustainment), and secondary outcomes (institutionalization, effectiveness, anticipated sustainment) at four time-points were collected. We performed descriptive statistics and directed content analysis using Hailemariam et al.’s factors influencing sustainment.ResultsAfter approximately five years post-implementation (e.g., 2021 sustainment outcomes), of the 82 facilities, about one-third fully sustained their practice compared to one-third that did not fully sustain their practice because it was in a “liminal” stage (neither sustained nor discontinued) or permanently discontinued. The remaining one-third of facilities had missing 2021 sustainment outcomes. A higher percentage of facilities (70%) had inconsistent primary outcomes (changing over time) compared to facilities (30%) with consistent primary outcomes (same over time). Thirty-four percent of facilities with sustained practices reported resilience since they overcame implementation and sustainment barriers. Facilities with sustained practices reported more positive secondary outcomes compared to those that did not sustain their practice. Key factors facilitating practice sustainment included: demonstrating practice effectiveness/benefit, sufficient organizational leadership, sufficient workforce, and adaptation/alignment with local context. Key factors hindering practice sustainment included: insufficient workforce, not able to maintain practice fidelity/integrity, critical incidents related to the COVID-19 pandemic, organizational leadership did not support sustainment of practice, and no ongoing support.ConclusionsWe identified diverse pathways from implementation to sustainment, and our data underscore that initial implementation outcomes may not determine long-term sustainment outcomes. This longitudinal evaluation contributes to understanding impacts of the DoE program, including return on investment, achieving learning health system goals, and insights into achieving high-quality healthcare in VHA.

Maternal depression, parenting, and child psychological outcomes in the context of maternal pain.

Parental chronic pain is associated with adverse outcomes in children, but the mechanisms of transmission are largely untested. Mothers with chronic pain (N = 400, Mage = 40.3 years, 90.5% White) and their children (Mage = 10.33 years, 83.3% White, 50.2% female) were recruited in 2016-2018 to test longitudinal pathways of risk transmission from maternal chronic pain to children's psychological symptoms, examining roles of parenting, maternal depression, and child distress tolerance. Maternal pain was associated with positive (β = .28) and pain-specific (β = .10) parenting behaviors. Maternal depression was associated with lower child distress tolerance (β = -.03), which was associated with greater child psychological symptoms (β = -.62). Parenting and maternal pain were not prospectively associated with child outcomes. When considering the dual-generational impacts of chronic pain, physical and psychological functioning should be examined.

Aboriginal Children Placed in Out-of-Home Care: Pathways Through the Child Protection System

ABSTRACT The overrepresentation of Aboriginal and Torres Strait Islander (respectfully referred to hereafter as “Aboriginal”) children in the child protection system is a concern in Australia, with Aboriginal children placed in out-of-home care at a rate 11 times that of non-Aboriginal children. This study utilised linked administrative data to determine the longitudinal child protection pathways from birth to age 10 years for a cohort of 15,815 Aboriginal children born in Western Australia between 2000 and 2006. In total, 9,269 (59%) children did not have any contact with child protection between one year prior to birth and their 11th birthday. Conversely, 6,546 (41%) Aboriginal children were involved with child protection during the study period, with 1,405 (9%) children placed in out-of-home care. Infants who had a child protection notification were more likely than other age groups to have a substantiated notification of abuse and neglect and placed in out-of-home care. More than half (56%) of all children were predominantly placed in kinship care; however, only 22% had their first placement with kinship carers. Aboriginal-led strategies together with the support and commitment of all levels of government are required to reduce entry into care and improve outcomes for Aboriginal children in care. IMPLICATIONS Aboriginal-led strategies and wholistic responses can reduce the overrepresentation of Aboriginal children reported to child protection systems, and support families and communities. Infancy stands out as a key point of system involvement. This stage offers an opportunity where early intervention and family support strategies may prevent first time involvement with the child protection services and promote kinship placement, reunification with parents, and community-led supportive care.

Longitudinal Pathways From Maltreatment to Substance Use Through Delay Discounting During Adolescence and Into Young Adulthood

Children and adolescents exposed to maltreatment are at a greater risk for substance use disorders in adulthood. However, developmental processes that explain how maltreatment experiences may influence substance use behaviors remain unclear. We investigated whether delay discounting (ie, the preference for immediate over delayed rewards), a critical indicator of self-regulation, serves as a key mechanism linking maltreatment and substance use. We used a developmental cascade model with a dimensional approach to test the direct and indirect effects of neglect and abuse on substance use during adolescence and across the transition from adolescence to young adulthood. The present study includes 167 adolescents (53% male; mean age= 14 years at time 1) who provided data on delay discounting and cigarette, alcohol, and cannabis use frequency across 5 time points (ages 14-18, approximately 1 year between assessments). At ages 18 to 19, adolescents provided reports of their exposure to maltreatment during adolescence (across ages 13-17). Using structural equation modeling, developmental cascade models tested whether the effects of neglect and abuse on cigarette, alcohol, and cannabis use were mediated through delay discounting over time. Our results indicate that adolescents exposed to neglect may be especially vulnerable to cannabis use over time via elevated delay discounting. Neglect experiences predicted greater cigarette use over time. These findings underscore the critical role of delay discounting in prevention and intervention efforts aimed at mitigating the risks of substance use development among young people who have been exposed to neglect during adolescence.

Longitudinal pathways of maltreated young children: Family stress processes and adverse childhood experiences.

An important issue associated with at-risk families in the child welfare system is the impact of familial stress processes on child developmental outcomes. The present study used the family stress model (FSM) to examine the impact of economic hardship, economic pressure, caregiver emotional distress, caregiver/partner conflict, caregiver harsh parenting, and adverse childhood experiences (ACEs) on child's cognitive, behavioral, and social outcomes. Data from the National Survey on Child and Adolescent Well-Being II were utilized, and 1,363 children (709 male, 654 female) ages 2-18 months (at Wave 1) were included in the present study. Three waves of data were analyzed in the longitudinal structural equation model, with economic hardship and economic pressure at Wave 1, caregiver emotional distress, caregiver/partner conflict, and caregiver harsh parenting at Wave 2 predicting ACEs and child outcomes at Wave 3. Results were overall consistent with the FSM in that economic hardship led to economic pressure, and caregiver emotional distress and caregiver/partner conflict led to harsh parenting, which subsequently led to ACEs. ACEs led to negative child cognitive outcomes, and for female children only, ACEs led to internalizing/externalizing behaviors. The results demonstrate that over time, familial stress processes led to negative child developmental outcomes in this sample. Study results also highlight the inextricable connection between mild harsh parenting behaviors and more severe forms of maltreatment on child outcomes. The prevention of child maltreatment is emphasized, with a specific focus on increasing positive parenting behaviors and decreasing caregiver emotional distress and caregiver/partner conflict. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Identifying longitudinal healthcare pathways and subsequent mortality for people living with dementia in England: an observational group-based trajectory analysis

BackgroundThe number of people living with dementia (PLWD) continues to increase, particularly those with severe symptomatology. Severe symptoms and greater ill-health result in more acute care need. Early healthcare interventions can prove beneficial. Healthcare use has not been analysed as a holistic set of interlinked events. This study explores different healthcare pathways among PLWD, social or spatial inequalities in healthcare pathways and subsequent mortality risk.MethodsGroup-based trajectory models (GBTM) were applied to electronic healthcare records. We generated clusters of PLWD with similar five-year, post-diagnosis trajectories in rates of primary and secondary healthcare use. Potential social and spatial variations in healthcare use clusters were examined. Cox Proportional Hazards used to explore variation in subsequent mortality risk between healthcare use clusters.ResultsFour healthcare use clusters were identified in both early- (n = 3732) and late-onset (n = 6224) dementia populations. Healthcare use variations were noted; consistent or diminishing healthcare use was associated with lower subsequent mortality risk. Increasing healthcare use was associated with increased mortality risk. Descriptive analyses indicated social and spatial variation in healthcare use cluster membership.ConclusionHealthcare pathways can help indicate changing need and variation in need, with differential patterns in initial healthcare use post-diagnosis, producing similar subsequent mortality risk. Care in dementia needs to be more accessible and appropriate, with care catered to specific and changing needs. Better continuity of care and greater awareness of dementia in primary can enhance prospects for PLWD. Research needs to further illuminate holistic care need for PLWD, including health and social care use, inequalities in care, health and outcomes.