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          <h1>Documentation of drug abuse in the family or household of children admitted to the hospital for non-accidental trauma</h1>
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        <ul class="my-list">
          <li><a class="nav-link" href="#Abstract">Abstract</a></li>
          <div class="separator"></div>
          <li><a class="nav-link" href="#Introduction">Introduction</a></li>
          <div class="separator"></div>
          <li><a class="nav-link" href="#Commonly_Abused_Drugs">Commonly Abused Drugs</a></li>
          <div class="separator"></div>
          <li><a class="nav-link" href="#Section_Snippets">Section Snippets</a></li>
          <div class="separator"></div>
          <li><a class="nav-link" href="#References(5)">References(5)</a></li>
          <div class="separator"></div>
          <li><a class="nav-link" href="#Cited_by_(2)">Cited by (2)</a></li>
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        <section class="main-section" id="Abstract">
        <header>
          <h1>Abstract</h1>
        </header>
          <div>
            <h2>Background</h2>
            <p>Drug abuse in the family is known to increase the risk of child abuse, but its impact on outcomes of hospitalizations for non-accidental trauma (NAT) has not been characterized</p>
          </div>
          <h2>Objective</h2>
          <p>We aimed to identify how frequently drug abuse in the household was documented among children with known or suspected NAT, and to correlate drug abuse in the family with hospitalization outcomes.</p>
          <h2>Participants and setting</h2>
          <p>At our tertiary care hospital, we retrospectively queried hospital admissions of children ages 0–17 who had a Child Abuse and Neglect consultation ordered during an inpatient stay.</p>
          <h2>Methods</h2>
          <p>Case manager documentation and consult notes from the inpatient response team were used to determine suspected or confirmed presence of household substance abuse.</p>
          <h2>Results</h2>
          <p>We identified 185 children meeting inclusion criteria (59 % <1 year; 34 % 1−5 years; 7% 6–14 years of age). Drug abuse in the family was documented in 44 cases (24 %). Among 178 children surviving to discharge, drug abuse was associated with lower likelihood of discharge home (50 % vs. 70 % among children with no documented drug abuse, p = 0.018). After discharge, we found no statistically significant differences in rehospitalizations or emergency department visits according to documentation of drug abuse in the family.</p>
          <h2>Conclusion</h2>
          <p>Our study addresses the role of family drug abuse in outcomes of hospitalizations for NAT. Significantly, half of cases with suspected or known drug abuse had no prior CPS involvement, and drug abuse was associated with discharge outcomes after controlling for prior CPS involvement.</p>
      </section>
      <section class="main-section" id="Introduction">
        <header>
          <h1>Introduction</h1>
        </header>
        <p>n the United States (US), Child Protective Services (CPS) investigated over 3 million cases of child maltreatment in 2016, of which over 18 % involved physical abuse (US Department of Health & Human Services, 2016). In health care systems, many recent initiatives have sought to improve the identification of non-accidental trauma (NAT), provide appropriate treatment, and prevent its recurrence. While the literature has described the impact of the social environment on the risk of NAT extensively (Christian, 2015), little is known about social factors’ influence on the outcomes of children receiving care for known or suspected NAT. Most studies analyzing outcomes of health care use for NAT have relied on administrative databases, and therefore have only considered economic characteristics (e.g., the type of health insurance) as potentially predicting disposition at discharge or long-term health outcomes among children hospitalized for NAT (Boop, Axente, Weatherford, & Klimo, 2016; Nunez Lopez et al., 2018; Nuño et al., 2018; Sonderman, Wolf, Madenci, & Beres, 2018). Socioeconomic disadvantages are linked with higher risk of NAT and higher likelihood of adverse outcomes (e.g., long-term psychosocial complications), yet the specific mechanisms behind this association have not been elucidated (Nuño et al., 2018; Sonderman et al., 2018).

Drug abuse in the family or household is an especially relevant factor that is correlated with socioeconomic disadvantage, known to increase the risk of child abuse, and offers a clear target for intervention through clinical services (e.g., addiction treatment) and judicial systems (e.g., family drug courts). The connection between drug use and child maltreatment has received increasing attention in recent years in the wake of the US’s opioid crisis (Feder, Letourneau, & Brook, 2019). This relationship is especially salient in rural communities experiencing higher prevalence of drug use (Orsi, Yuma-Guerrero, Sergi, Pena, & Shillington, 2018). Given its contribution to the risk of child abuse (Freisthler, Wolf, Wiegmann, & Kepple, 2017; Kepple, 2018), drug abuse in the family could plausibly increase the risk of readmissions for NAT and decrease the likelihood of discharge home after a given hospitalization. However, family drug abuse is unlikely to be captured in multi-center databases recently used to study NAT incidence and outcomes (e.g., the Kids’ Inpatient Database), because analyses of these data are generally limited to identifying risk factors and comorbidities captured by International Classification of Disease (ICD) codes at participating institutions (Litz, Ciesla, Danielson, & Chandler, 2017; Nuño et al., 2018; Puls et al., 2018; Sonderman et al., 2018). As with other social determinants of health (SDH), drug abuse in the family is inconsistently mentioned in ICD coding of clinical encounters (Torres et al., 2017). Therefore, alternative strategies are needed to understand impact of family drug abuse on outcomes of NAT.

At our institution, evaluation and documentation of family drug abuse has been part of standard practice in cases of suspected child abuse. When victimization is suspected or reported for patients less than 18 years old who are admitted to the hospital, expert pediatricians trained in child abuse and neglect provide medical evaluation and coordinate care with other healthcare, legal, social service, law enforcement, and mental health services. Once a CPS report has been filed, the care team can make a referral to the child advocacy center for additional services. Leveraging this established practice of assessing family drug abuse, we conducted a single-center retrospective study to identify the proportion of admissions for NAT with family or household drug abuse mentioned in case manager or care team notes. Our secondary aim was to determine whether documentation of family or household drug abuse was associated with prolonged length of stay, intensive care unit (ICU) admission, or likelihood of hospital readmission.</p>
      </section>
      <section class="main-section" id="Commonly_Abused_Drugs">
        <header>
          <h1>Commonly Abused Drugs</h1>
        </header>
        <div>
          <div>
            <ul>
            <li>Alcohol</li>
            <li>Tobacco</li>
            <li>Marijuana</li>
            <li>Prescription Drugs</li>
            <li>Benzos</li>
            <li>Cocaine</li>
            <li>Stimulants</li>
            <li>Hallucinogen Drugs</li>
            <li>Methamphetamine</li>
            <li>Heroin</li>
            <li>Inhalants</li>
            <li>Steroids</li>
          </ul>
          </div>
          <p>These are commonly abused substances</p>
        </div>
      </section>
      <section class="main-section" id="Section_Snippets">
        <header>
          <h1>Section Snippets</h1>
        </header>
        <h2>Methods</h2>
        <p>The study was certified exempt by the Institutional Review Board at East Carolina University (ECU). We retrospectively queried inpatient admissions at James and Connie Maynard Children’s Hospital (MCH), a tertiary care hospital serving 29 counties in eastern North Carolina and affiliated with the ECU Brody School of Medicine. At MCH, the Child Abuse and Neglect consultation team is an inpatient response team led by specially trained pediatricians who work with ECU’s TEDI BEAR Children’s...</p>
        <h2>Results</h2>
        <p>We identified 185 children meeting inclusion criteria (59 % age <1 year; 34 % age 1−5 years; 7% age 6–14 years). Drug abuse was documented in 44 cases (24 %) and was known (rather than suspected) in 28 of those cases. Among the 44 cases with concern for drug abuse in the household, 30 had specific substances mentioned in the note. Common drugs of abuse included alcohol (n = 13), opioids (n = 7), marijuana (n = 5), cocaine (n = 4), and psychotropic medications (n = 4). Patient characteristics...</p>
        <h2>Discussion</h2>
        <p>Drug abuse is a well-known risk factor for child abuse and neglect, specifically physical abuse, but its impact on children admitted to the hospital due to child abuse is uncertain. In our study, known or suspected drug abuse in the household was documented for 24 % of children admitted for NAT. Drug abuse in the household was also associated with lower likelihood of discharge home, as opposed to discharge to other family or foster care. Significantly, half of cases with suspected or known drug...</p>
        <h2>Funding</h2>
        <p>This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors....</p>
        <h2>Acknowledgments</h2>
        <p>We are thankful for all the help and support received from ECU’s TEDI BEAR Children’s Advocacy Center....</p>
      </section>
      <section class="main-section" id="References(5)">
        <header>
          <h1>References(5)</h1>
        </header>
        <div class="ref">
          <p>N.J. Kepple</p>
          <p><a href="https://www.sciencedirect.com/science/article/pii/S0145213417303514">Does parental substance use always engender risk for children? Comparing incidence rate ratios of abusive and neglectful behaviors across substance use behavior patterns</a></p>
          <p>Child Abuse & Neglect
(2018)    </p>
        </div>
        <div class="ref">
          <p>C.N. Litz et al.</p>
          <p><a href="https://www.sciencedirect.com/science/article/pii/S0022346816303025">A closer look at non-accidental trauma: Caregiver assault compared to non-caregiver assault</a></p>
          <p>Journal of Pediatric Surgery
(2017)</p>
        </div>
        <div class="ref">
          <p>O. Nunez Lopez et al.</p>
          <p><a href="https://www.sciencedirect.com/science/article/pii/S0002961017310176">Sociodemographic determinants of non-accidental traumatic injuries in children</a></p>
          <p>American Journal of Surgery
(2018)</p>
        </div>
        <div class="ref">
          <p>M. Nuño et al.</p>
          <p><a href="https://www.sciencedirect.com/science/article/pii/S0145213418303302">Long-term impact of abusive head trauma in young children</a></p>
          <p>Child Abuse & Neglect
(2018)</p>
        </div>
        <div class="ref">
          <p>R. Orsi et al.</p>
          <p><a href="https://www.sciencedirect.com/science/article/pii/S0145213418303296">Drug overdose and child maltreatment across the United States’ rural-urban continuum</a></p>
          <p>Child Abuse & Neglect
(2018)</p>
        </div>
      </section>
      <section class="main-section" id="Cited_by_(2)"> 
        <header>
          <h1>Cited by (2)</h1>
        </header>
        <div class="ref">
          <p><a href="https://doi.org/10.1007/s10896-022-00383-9">Child fatality in families with prior CPS history: Do those with and without intimate partner violence differ?</a></p>
          <p>2023, Journal of Family Violence</p>
        </div>
        <div class="ref">
          <p><a href="https://doi.org/10.47391/JPMA.2419">The journey from drug addiction to drug recovery; a case report of an inpatient rehabilitation</a></p>
          <p>2022, Journal of the Pakistan Medical Association</p>
        </div>
      </section>
      </div>
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Technical Documentation Page - Build a Technical Documentation Page

A “code” element is a literal element.
They want you to add five code snippets using the code element:

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Thanks a lot , I got it

You’re most welcome @emmy27
Happy coding!

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