Bullying is the most common form of youth aggression. Although 49 of all 50 states in the U.S. have an anti-bullying law in place to prevent bullying, little is known about the effectiveness of these laws. Our objective was to measure the effectiveness of Iowa's anti-bullying law in preventing bullying and improving teacher response to bullying.Sixth, 8th, and 11th grade children who completed the 2005, 2008 and 2010 Iowa Youth Survey were included in this study (n = 253,000). Students were coded according to exposure to the law: pre-law for 2005 survey data, one year post-law for 2008 data, and three years post-law for 2010 data. The outcome variables were: 1) being bullied (relational, verbal, physical, and cyber) in the last month and 2) extent to which teachers/adults on campus intervened with bullying. Generalized linear mixed models were constructed with random effects.The odds of being bullied increased from pre-law to one year post-law periods, and then decreased from one year to three years post-law but not below 2005 pre-law levels. This pattern was consistent across all bullying types except cyberbullying. The odds of teacher intervention decreased 11 % (OR = 0.89, 95 % CL = 0.88, 0.90) from 2005 (pre-law) to 2010 (post-law).Bullying increased immediately after Iowa's anti-bullying law was passed, possibly due to improved reporting. Reductions in bullying occurred as the law matured. Teacher response did not improve after the passage of the law.

Background

Listen Protect Connect (LPC), a school-based program of Psychological First Aid delivered by non-mental health professionals, is intended to support trauma-exposed children. Our objective was to implement LPC in a school setting and assess the effectiveness of LPC on improving psychosocial outcomes associated with trauma.

Methods

A pilot quasi-experiment was conducted with middle school children self-identified or referred to the school nurse as potentially exposed to stressful life experiences. LPC was provided to students by the school nurse, and questionnaires were administered at baseline, 2-, 4- and 8-weeks to assess life stressors, symptoms of post-traumatic stress disorder and depression, social support, and school connectedness. A total of 71 measurements were collected from 20 children in all. Although a small sample size, multiple measurements allowed for multivariable mixed effects models to analyze changes in the repeated outcomes over time.

Results

Students who received the intervention had reduced depressive and posttraumatic stress symptoms from baseline throughout follow-up period. Total social support also increased significantly from baseline through 8-weeks, and school connectedness increased up to 4-weeks post-intervention.

Conclusions

This study demonstrates the potential of LPC as a school-based intervention of Psychological First Aid. Future randomized trials of LPC are needed, however.

Histoplasmosis is often confused with other diseases leading to diagnostic delays. We estimated the incidence, length of, and risk factors for, diagnostic delays associated with histoplasmosis. Using data from IBM Marketscan, 2001-2017, we found all patients with a histoplasmosis diagnosis. We calculated the number of visits that occurred prior to the histoplasmosis diagnosis and the number of visits with symptomatically similar diagnoses (SSDs). Next, we estimated the number of visits that represented a delay using a simulation-based approach. We also computed the number of potential opportunities for diagnosis that were missed for each patient and the length of time between the first opportunity and the diagnosis. Finally, we identified risk factors for diagnostic delays using a logistic regression model. The number of SSD-related visits increased significantly in the 97 days prior to the histoplasmosis diagnosis. During this period, 97.4% of patients had a visit, and 90.1% had at least one SSD visit. We estimate that 82.9% of patients with histoplasmosis experienced at least one missed diagnostic opportunity. The average delay was 39.5 days with an average of 4.0 missed opportunities. Risk factors for diagnostic delays included prior antibiotic use, history of other pulmonary diseases, and emergency department and outpatient visits, especially during weekends. New diagnostic approaches for histoplasmosis are needed.