Adolescents and emerging adults who experience child maltreatment and involvement in the child welfare system have a higher risk for suicidal thoughts and behaviors (STBs; Dunn et al., 2013; Johnson et al., 2002). Selective prevention interventions, which target individuals or groups with elevated risk (Munoz et al., 1996), are critical to reduce suicide-related outcomes in youth with maltreatment exposure. This study provides preliminary qualitative data from youth providers (e.g., case workers and mental health clinicians) on challenges and opportunities for suicide prevention for youth who experience child maltreatment, in order to inform future preventive efforts. We collaborated with community organizations serving maltreated and system-involved youth (i.e., adolescents and young adults) to conduct three focus groups (N = 17) and 10 interviews (N = 10) with providers across two geographically different sites. Several themes emerged from our data regarding barriers for suicide prevention with youth with maltreatment histories, as well as opportunities and future directions for suicide prevention interventions. Research-practice partnerships can facilitate the development, implementation, acceptability, and feasibility of suicide prevention programs for youth with histories of maltreatment exposure.
ABO-incompatible (ABOi) heart transplantation, first performed in infants by West and colleagues in 1996, transformed pediatric heart allocation by challenging longstanding immunologic constraints. Early success of this approach leveraged the developmental immaturity of the neonatal immune system and has since shown comparable short- and long-term outcomes to ABO-compatible (ABOc) transplantation. Over three decades, increasing clinical experience and policy evolution, including broader ABOi eligibility criteria and relaxed titer thresholds, have expanded access to donor hearts and reduced waitlist mortality, particularly among blood group ABO-O candidates. Despite these advances, marked variability persists among centers in the measurement, interpretation, and reporting of ABO antibody titers, directly influencing candidate selection, perioperative management, and post-transplant surveillance. Most assays rely on manual hemagglutination techniques that are subject to significant inter-laboratory and intra-laboratory variability. Emerging single-antigen bead-based methods utilizing the Luminex™ platform may provide an opportunity for standardized, semi-quantitative assessment of graft-relevant anti-A and -B antibody levels. Perioperative strategies are individualized according to ABO antibody titer, with intraoperative plasma exchange or immunoadsorption typically employed when titers exceed a center-specific level. Standard immunosuppression regimens are generally sufficient, with anti-B cell therapies (e.g., rituximab) reserved for elevated or rebound titers. Long-term outcomes remain excellent, with most patients not producing donor-specific ABO antibodies after ABOi transplant. Most centers perform surveillance biopsies only when rising titers, an uncommon occurrence, are accompanied by graft dysfunction or biopsy-proven antibody-mediated rejection, managed with combinations of plasmapheresis, IVIG, and anti-B cell therapies as indicated. Future multicenter collaborations incorporating standardized reporting and longitudinal follow-up will be critical to optimize candidate selection, refine management algorithms, and further improve utilization and outcomes of ABOi heart transplantation.
BackgroundAdverse childhood experiences (ACEs) are associated with a wide range of negative health, behavioral, and developmental outcomes across the lifespan. However, many individuals demonstrate resilience, and protective factors play a critical role in buffering the effects of adversity. Yet most existing ACE measures overlook these protective experiences and rely primarily on retrospective adult self-reports. To address this gap, we developed the Child and Family Experiences Survey (CAFES), a caregiver-report tool designed to assess both adverse and protective experiences in early childhood across diverse settings.MethodsCaregivers (N = 157) from two counties in New York State completed the CAFES, which assessed adverse experiences, protective factors, and social determinants of health items. Summary scores were calculated for both adverse and protective experiences. Descriptive statistics, bivariate correlations, and principal components analysis (PCA) were conducted to evaluate item performance and inform item reduction.ResultsDescriptive analyses showed a range of endorsement across items related to adverse experiences, protective factors, and social determinants of health items. Correlations within protective and adverse experience items were moderate, supporting internal consistency. PCA was conducted for protective factors and social determinants of health items, and a four-component solution emerged for each. The CAFES was refined based on results from descriptive findings and the PCA.ConclusionsThe CAFES is a novel, caregiver-report tool designed to assess both adverse and protective childhood experiences, as well as family needs. Developed through a community-engaged process, CAFES addresses key limitations in existing ACE measures by incorporating protective factors and offering applicability across clinical, educational, and research settings. Future efforts will focus on refining the tool through qualitative feedback, improving data collection processes, and ensuring cross-cultural relevance, for example among underrepresented and immigrant populations, while also integrating appropriate supports to enhance its clinical implementation.
Introduction. Recent crises such as COVID-19, cyber-attacks on health care digital infrastructure, mass migration and war, highlight the crucial role of digital technology in service delivery. The establishment of the EU4 Health Programme in 2021, emphasized the need for an EU wide comprehensive enhancement of workforce digital skills with an emphasis on crisis resilience. At present there is almost no comparative EU wide workforce survey research in this area to inform effective policy implementation. Aim. To explore the use of digital technologies, the expressed training needs, the wellbeing and perception of organisational capacities referenced to digital technology across health care workforce in nine European Union states. Methods. A 36-item survey was developed focused on digital competencies, digital use, cybersecurity awareness, training needs, sense of wellbeing and perception of organisational readiness to implement digital change, utilising convenience sampling. For purposes of analysis workforce respondents were divided between clinical and non-clinical staff. Data was analysed using SPSS according to a pre-registered analysis plan. Results. After data cleaning, 2,028 respondents’ answers were analysed. Non-clinical staff demonstrated higher proficiency and usage rates in digital technologies. Significant differences between non-clinical and clinical staff were noted in security awareness, with clinical staff having significantly less knowledge/ awareness. All respondents perceived their organisations as only moderately ready to implement digital health care change. Conclusions. These exploratory results highlight need for policy development and interventions that enhance digital competencies across the EU health workforce. The results also suggest there is a need to address organisational capacities to support both training of the workforce and effective use of the workforce’s digital skills once these are acquired.
