Child Maltreatment and Mortality in Young Adults
Leonie SegalJason M. ArmfieldEmmanuel S. GnanamanickamDavid B. PreenDerek S. BrownJames DoidgeHa Nguyen
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Child maltreatment (CM) is a global public health issue, with reported impacts on health and social outcomes. Evidence on mortality is lacking. In this study, we aimed to estimate the impact of CM on death rates in persons 16 to 33 years.A retrospective cohort study of all persons born in South Australia 1986 to 2003 using linked administrative data. CM exposure was based on child protection service (CPS) contact: unexposed, no CPS contact before 16 years, and 7 exposed groups. Deaths were observed until May 31, 2019 and plotted from 16 years. Adjusted hazard ratios (aHRs) by CPS category were estimated using Cox proportional hazards models, adjusting for child and maternal characteristics. Incident rate ratios (IRRs) were derived for major causes of death, with and without CPS contact.The cohort included 331 254 persons, 20% with CPS contact. Persons with a child protection matter notification and nonsubstantiated or substantiated investigation had more than twice the death rate compared with persons with no CPS contact: aHR = 2.09 (95% confidence interval [CI] = 1.62-2.70) to aHR = 2.61 (95% CI = 1.99-3.43). Relative to no CPS contact, persons ever placed in out-of-home care had the highest mortality if first placed in care aged ≥3 years (aHR = 4.67 [95% CI = 3.52-6.20]); aHR was 1.75(95% CI = 0.98-3.14) if first placed in care aged <3 years. The largest differential cause-specific mortality (any contact versus no CPS contact) was death from poisonings, alcohol, and/or other substances (IRR = 4.82 [95% CI = 3.31-7.01]) and from suicide (IRR = 2.82 [95% CI = 2.15-3.68]).CM is a major underlying cause of potentially avoidable deaths in early adulthood. Clinical and family-based support for children and families in which CM is occurring must be a priority to protect children from imminent risk of harm and early death as young adults.Recognizing that injuries and violence kill more than five million people worldwide annually and cause harm to millions more, the World Health Assembly (WHA) has repeatedly called on governments du...
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This study analysed the drinking patterns and motivation to change drinking behaviours among injury patients who acknowledged alcohol as a factor in their injuries. A cross-sectional study was conducted over 18 months at a Swedish emergency department. A total of 1930 injury patients aged 18 - 70 years were enrolled in the study (76.8% completion rate). Of those who reported drinking, 10% acknowledged alcohol as a factor in their injury. A patient was more likely to report a causal attribution of the injury to alcohol the higher the weekly intake and the higher the frequency of heavy episodic drinking. The motivation to change variables showed a similar pattern of increased likelihood of attributing a causal link of alcohol and injury with increasing discontent with drinking behaviours and increasing desire to change drinking behaviours. The findings suggest that the ability to measure causal attribution of alcohol to injuries could be a promising tool to help patients explore the association between their injuries and alcohol use and motivate patients to modify drinking behaviours in order to avoid future injuries.
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The risk of injury to children riding bicycles has been previously documented. However, the specific risk arising from the use of bicycles as a mode of transportation to and from school is unknown. This study examines the incidence of bicycle related injuries among school age children.A comprehensive prospective injury registration system was established in Stavanger, Norway. Data were obtained from this system to identify bicycle related injuries occurring from 1990-3 to children aged 10-15. The incidence of injuries was computed for two groups of children: (1) children cycling to school and (2) children cycling for other purposes.352 children received medical treatment for bicycle related injuries, 12.6/1000 bicycle riders; 108 (30%) of the 352 children were injured while cycling to or from school. The incidence of bicycle related injuries was significantly higher for boys than girls. Seventy seven per cent of the injuries occurred in a non-collision accident, 9% in a collision with another bicycle, and 14% in a collision with a motor vehicle. Twenty per cent of the injured children sustained upper head injuries and 13% required inpatient treatment. Average maximum abbreviated injury severity (MAIS) score was similar for the injuries sustained during travel to/from school and other injuries.Bicycle related injuries occurring during travel to or from school are a significant contributor to the total incidence of bicycle related injuries. Increased attention among parents, school officials, public health officials, and medical professionals should be paid to this health risk.
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Background Although most people with relapsing onset multiple sclerosis (R-MS) eventually transition to secondary progressive multiple sclerosis (SPMS), little is known about disability progression in SPMS. Methods All R-MS patients in the Cardiff MS registry were included. Cox proportional hazards regression was used to examine a) hazard of converting to SPMS and b) hazard of attaining EDSS 6.0 and 8.0 in SPMS. Results 1611 R-MS patients were included. Older age at MS onset (hazard ratio [HR] 1.02, 95%CI 1.01–1.03), male sex (HR 1.71, 95%CI 1.41–2.08), and residual disability after onset (HR 1.38, 95%CI 1.11–1.71) were asso- ciated with increased hazard of SPMS. Male sex (EDSS 6.0 HR 1.41 [1.04–1.90], EDSS 8.0 HR 1.75 [1.14–2.69]) and higher EDSS at SPMS onset (EDSS 6.0 HR 1.31 [1.17–1.46]; EDSS 8.0 HR 1.38 [1.19–1.61]) were associated with increased hazard of reaching disability milestones, while older age at SPMS was associated with a lower hazard of progression (EDSS 6.0 HR 0.94 [0.92–0.96]; EDSS 8.0: HR 0.92 [0.90–0.95]). Conclusions Different factors are associated with hazard of SPMS compared to hazard of disability progres- sion after SPMS onset. These data may be used to plan services, and provide a baseline for comparison for future interventional studies and has relevance for new treatments for SPMS RobertsonNP@cardiff.ac.uk
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Unintentional injury mortality trends in children and adolescents in Lithuania between 1971 and 2005
The objectives of the study were to estimate mortality rate trends due to road traffic, drowning and fire/burns in children aged 0–14 years and in adolescents aged 15–19 years in Lithuania between the years 1971–2005. The data were obtained from Statistics Lithuania and the Health Information Centre. Trends were estimated by linear and polynomial regression. The study revealed that the child and adolescent unintentional injury mortality rates show declining trends. For children, the significant decreasing trends of mortality rates due to road traffic, drowning and fire/burns were observed. For adolescents there were significant decreasing trends for drowning deaths, and insignificant decreasing tendencies for deaths from fire/burns. There was an insignificant increased road traffic mortality rate trend for adolescent girls. For the adolescent boys group and for boys and girls together from the beginning of the study period there were increasing trends, followed by declining trends. In the last years, the increase was observed again.
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The hazard ratio and median survival time are the routine indicators in survival analysis. We briefly introduced the relationship between hazard ratio and median survival time and the role of proportional hazard assumption. We compared 110 pairs of hazard ratio and median survival time ratio in 58 articles and demonstrated the reasons for the difference by examples. The results showed that the hazard ratio estimated by the Cox regression model is unreasonable and not equivalent to median survival time ratio when the proportional hazard assumption is not met. Therefore, before performing the Cox regression model, the proportional hazard assumption should be tested first. If proportional hazard assumption is met, Cox regression model can be used; if proportional hazard assumption is not met, restricted mean survival times is suggested.风险比（hazard ratio，HR）和中位生存时间是生存分析时的常规分析和报告指标。本文简要介绍了HR和中位生存时间的关系以及比例风险假定在这两者之间的作用，分析了检索出的58篇文献中的110对风险比和中位生存时间比的差异，并通过实例阐明了产生这种差异的原因。结果表明，在不满足比例风险假定时，Cox回归模型计算得到的风险比是不合理的，且与中位生存时间之比不等价。因此，在使用Cox回归模型前，应先进行比例风险假定的检验，只有符合比例风险假定时才能使用该模型；当不符合比例风险假定时，建议使用限制性平均生存时间。.
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Helmet use protects against head injury. Our objective was to assess whether parental knowledge of helmet safety is associated with helmet use in children, and whether a relationship exists between helmet ownership and other safety behaviors. Three hundred forty-one surveys were distributed to parents of third through fifth graders; 97% of parents believed that a helmet confers protection; 49% of parents reported that their child owns a helmet. Of the helmet owners, 27% reported that the child wears it more than 75% of the time. Seat belt usage was associated with helmet ownership (p=0.02) and frequency of wearing a helmet (p=0.04). Although parents are aware of the benefits, a barrier between helmet ownership and usage exists.
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"Water safety and drowning prevention." International Journal of Injury Control and Safety Promotion, 20(3), pp. 207–208
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