Child Abuse and the Otolaryngologist: Part I

2003 ◽  
Vol 128 (3) ◽  
pp. 305-310 ◽  
Author(s):  
C. D. Crouse ◽  
R. A. Faust
Keyword(s):  
United States ◽  
Risk Factors ◽  
Child Abuse ◽  
Mortality Rate ◽  
Emergency Room ◽  
Head And Neck ◽  
The United States ◽  
Infants And Children ◽  
Legal Obligations

Nearly 1 million infants and children are neglected and abused yearly in the United States, with a greater than 1% resulting mortality rate. One half of these children are seen by physicians for abuse-related injuries, and nearly 75% have injuries of the head and neck. Physicians, however, account for reporting only 11% of all cases. As experts trained in diseases and injuries of the head and neck, otolaryngologists are particularly well positioned to recognize abuse in the clinic and in the emergency room and during other consultations. We present an overview of child abuse definitions, risk factors, and legal obligations of the physician. We also review the manifestations of child abuse within the head and neck, with particular attention to the role of the otolaryngologist. We briefly discuss some conditions that may be mistaken for abuse and suggest a practical protocol for management of suspected cases in the clinic.

scholarly journals The Management of Hyponatremia

2015 ◽  
Vol 1 (1) ◽  
pp. napoc.2015.1473
Author(s):  
Norbert Lameire
Keyword(s):  
United States ◽  
Risk Factors ◽  
Correct Diagnosis ◽  
The United States ◽  
Plasma Sodium ◽  
Therapeutic Action ◽  
Electrolyte Disturbances ◽  
Present On Admission ◽  
Key Questions

A case of hyponatremia in a previously healthy 76-year-old woman is described with discussion revolving around key questions: 1. Is hyponatremia really hypotonic? 2. Is there an emergency present on admission necessitating acute therapeutic action to improve the electrolyte disturbances? 3. What is the best approach to obtaining a correct diagnosis? 4. What is the best approach to raise serum Na? 5. What are the risk factors, symptoms and pathophysiology of thiazide-induced hyponatremia? 6. What is the role of hypokalemia in the pathophysiology of hyponatremia? 7. What are the options for therapy to raise the plasma sodium in this patient? 8. How should the concomitant hypokalemia be treated, and is it an additional danger in the treatment of the hyponatremia? 9. What are the lessons from this case for the management of chronic “asymptomatic” or mildly symptomatic hyponatremic patients? 10. Would this patient be approached differently in Europe and the United States?

U.S. Center for SafeSport: Preventing Abuse in Sports

2020 ◽  
Vol 28 (1) ◽  
pp. 66-71 ◽  
Author(s):  
Nicole Johnson ◽  
Katie Hanna ◽  
Julie Novak ◽  
Angelo P. Giardino
Keyword(s):  
United States ◽  
Risk Factors ◽  
Sexual Abuse ◽  
Preliminary Data ◽  
The United States ◽  
Sport Organizations ◽  
The Many ◽  
And Training ◽  
The U.S

While society at large recognizes the many benefits of sport, it is important to also recognize and prevent factors that can lead to an abusive environment. This paper seeks to combine the current research on abuse in the sport environment with the work of the U.S. Center for SafeSport. The inclusion of risk factors unique to sport and evidence-informed practices provides framing for the scope and response to sexual abuse in sport organizations in the United States. The paper then explores the creation and mission of the U.S. Center for SafeSport, including the role of education in prevention and of policy, procedures, audit, and compliance as important aspects of a comprehensive safeguarding strategy. This paper provides preliminary data on the reach of the Center, established in 2017. This data captures the scope of education and training and the increase in reports to the Center from within the U.S. Olympic and Paralympic Movement.

Hide and Seek

2020 ◽  
pp. 75-82
Author(s):  
Purva Grover
Keyword(s):  
United States ◽  
Child Abuse ◽  
Patient Autonomy ◽  
The United States ◽  
Mandatory Reporting ◽  
Unintended Consequences ◽  
Adult Patients ◽  
Negative Effects ◽  
Legal Obligations ◽  
Mandated Reporters

The system of mandatory reporting was created in response to a growing recognition of devastation that child abuse was causing in the United States. All states designate people in certain professions as “mandated reporters.” This has led to discussion regarding unintended consequences or negative effects of mandatory reporting. What are our obligations toward adult patients who confide that they were abused as a child but are unsure if they want to report this now? Are we still the mandated reporters? How does patient autonomy factor into this? These laws and statutes are complex, and our legal obligations must be weighed against various ethical and practical considerations.

Epidemiology and primary prevention of feeding and eating disorders

2020 ◽  
pp. 1059-1064
Author(s):  
Katherine A. Halmi
Keyword(s):  
United States ◽  
Risk Factors ◽  
Eating Disorder ◽  
Mortality Rate ◽  
Age Groups ◽  
The United States ◽  
Lifetime Prevalence ◽  
The Past ◽  
Prevention Programmes ◽  
Standardized Mortality Rate

In the past 20 years, the incidence of anorexia nervosa (AN) in industrialized countries has remained stable at 4.2–7.7 new cases per 100,000 per year. During this period, the incidence of bulimia nervosa (BN) has decreased from 12.2 to 6.1 per 100,000. The lifetime prevalence of AN in females in the United States in the past decade was 0.9% and 0.3% in males, and that of BN was 0.88% in females and 0.12% in males in a European study. Binge eating disorder (BED) is the most common eating disorder (ED), with a lifetime prevalence of 3.5% in women in the United States and 2.0% in men. AN has the highest standardized mortality rate of 5.86, followed by BN with a standardized mortality rate of 2.29. Less than half of AN patients have a full recovery, compared to two-thirds of BN patients who recover. The prevalence of EDs is increasing in the Middle East and Asian countries, as well as among Latinos, African-Americans, and Asians in the United States. Body dissatisfaction and a family history of ED are consistent risk factors across all EDs. Perfectionism is a greater risk factor for restricting AN and conduct disorders, and substance abuse and sexual abuse are risk factors for BN and BED. ED prevention programmes have mainly targeted at-risk persons in specific age groups and environments. Both Internet-based and group session programmes have reduced ED-related symptoms. There are multiple issues concerning the implementation and maintenance of prevention programmes, including clinician training, costs, attrition rate, and effectiveness over time.

scholarly journals Outcomes of Hospitalized COVID-19 Patients by Risk Factors: Results from a United States Hospital Claims Database

2020 ◽  
Vol 7 (2) ◽  
pp. 165-175 ◽  
Author(s):  
Peter J. Mallow ◽  
Kathy W. Belk ◽  
Michael Topmiller ◽  
Edmond A. Hooker
Keyword(s):  
United States ◽  
Risk Factors ◽  
The United States ◽  
Hospital Length ◽  
Primary Objective ◽  
Hospital Length Of Stay ◽  
Improve Risk Stratification ◽  
Control And Prevention ◽  
Secondary Objective

Background/Objective: The primary objective was to quantify the role of the number of Centers of Disease Control and Prevention (CDC) risk factors on in-hospital mortality. The secondary objective was to assess the associated hospital length of stay (LOS), intensive care unit (ICU) bed utilization, and ICU LOS with the number of CDC risk factors. Methods: A retrospective cohort study consisting of all hospitalizations with a confirmed COVID-19 diagnosis discharged between March 15, 2020 and April 30, 2020 was conducted. Data was obtained from 276 acute care hospitals across the United States. Cohorts were identified based upon the number of the CDC COVID-19 risk factors. Multivariable regression modeling was performed to assess outcomes and utilization. The odds ratio (OR) and incidence rate ratio (IRR) were reported. Results: Compared with patients with no CDC risk factors, patients with risk factors were significantly more likely to die during the hospitalization: One risk factor (OR 2.08, 95% CI, 1.60–2.70; P < 0.001), two risk factors (OR 2.63, 95% CI, 2.00–3.47; P < 0.001), and three or more risk factors (OR 3.49, 95% CI, 2.53–4.80; P < 0.001). The presence of CDC risk factors was associated with increased ICU utilization, longer ICU LOS, and longer hospital LOS compared to those with no risk factors. Patients with hypertension (OR 0.77, 95% CI, 0.70–0.86; P < 0.001) and those administered statins were less likely to die (OR 0.54, 95% CI, 0.49–0.60; P < 0.001). Conclusions: Quantifying the role of CDC risk factors upon admission may improve risk stratification and identification of patients who may require closer monitoring and more intensive treatment.

Perioperative risk factors for puppies delivered by cesarean section in the United States and Canada

2000 ◽  
Vol 36 (4) ◽  
pp. 359-368 ◽  
Author(s):  
PF Moon ◽  
HN Erb ◽  
JW Ludders ◽  
RD Gleed ◽  
PJ Pascoe
Keyword(s):  
United States ◽  
Risk Factors ◽  
Mortality Rate ◽  
Cesarean Section ◽  
Survival Rates ◽  
The United States ◽  
Perioperative Risk ◽  
Factors Affecting ◽  
Section Data ◽  
Perioperative Risk Factors

The purpose of this study was to evaluate perioperative risk factors affecting neonatal survival after cesarean section. Data from 807 cesarean-derived litters (3,908 puppies) was submitted by 109 practices in the United States and Canada. Survival rates immediately, two hours, and seven days after delivery were 92% (n=3,127), 87% (n=2,951), and 80% (n=2,641), respectively, for puppies delivered by cesarean section (n=3,410) and were 86% (n=409), 83% (n=366), and 75% (n=283), respectively, for puppies born naturally (n=498). Maternal mortality rate was 1% (n=9). Of 776 surgeries, 453 (58%) were done on an emergency basis. The most common breed of dog was bulldog (n=138; 17%). The most common methods of inducing and maintaining anesthesia were administration of isoflurane for induction and maintenance (n=266; 34%) and administration of propofol for induction followed by administration of isoflurane for maintenance (n=237; 30%). A model of cesarean-derived puppies surviving to birth, between birth and two hours, and between two hours and seven days was designed to relate litter survival to perioperative factors. The following factors increased the likelihood of all puppies being alive: the surgery was not an emergency; the dam was not brachycephalic; there were four puppies or less in the litter; there were no naturally delivered or deformed puppies; all puppies breathed spontaneously at birth; at least one puppy vocalized spontaneously at birth; and neither methoxyflurane nor xylazine was used in the anesthetic protocol.

The risk of hepatocellular carcinoma in patients with previous malignancy

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 17075-17075
Author(s):  
A. B. Siegel ◽  
R. B. McBride ◽  
H. El-Serag ◽  
D. Hershman ◽  
L. Zablotska ◽  
...  
Keyword(s):  
United States ◽  
Risk Factors ◽  
Hepatocellular Carcinoma ◽  
Head And Neck ◽  
Kaposi's Sarcoma ◽  
Kaposi’S Sarcoma ◽  
The United States ◽  
Head And Neck Cancers ◽  
Second Primary ◽  
Primary Cancer

17075 Background: Hepatocellular carcinoma (HCC) is one of the most common malignancies in the world. Its incidence has doubled over the past 20 years in the United States. Determination of the pattern of occurrence of HCC as a second primary malignancy might give clues for new risk factors for HCC, or may reveal common genetic or environmental risks. Methods: We identified patients with a diagnosis of a second primary HCC between 1973 and 2002 using the Surveillance, Epidemiology, and End-Results Program (SEER) a compilation of population-based cancer registries in the United States, to calculate the observed to expected (O/E) frequency of second primary HCC after a different primary cancer. We stratified by ethnicity, latency from the year of diagnosis of primary cancer to HCC diagnosis, and period of diagnosis of primary cancer as early (1973–1987) or late (1987–2002). Results: We reviewed 1,931,911 subjects with cancer, and identified 1,185 second primary HCC cases. Overall, a second primary HCC after any primary cancer was less frequent than expected (O/E=0.82, 95% CI=0.77–0.87). We found positive associations with head and neck cancers (oral cavity/pharynx O/E=2.1, 95% CI=1.7–2.5), Kaposi's sarcoma (O/E=3.3, 95% CI=1.2–7.1) and Hodgkin's disease (O/E=2.3, 95% CI=1.2–4.0). Negative associations were seen for breast cancer (O/E=0.7, 95% CI=0.6–0.8), colorectal cancer (O/E=0.6, 95% CI=0.6–0.8), and prostate cancer (O/E=0.7, 95%CI=0.6–0.8). Overall, lower O/E ratios were seen in whites, while in African Americans and those of other races, the O/E ratios were close to one. Latency times were relatively short for head and neck cancers and Kaposi's sarcoma (most within 12–59 months), and greater than 120 months for most cases of HCC after Hodgkin's disease. All cases of Kaposi's sarcoma were seen in the later time period. Conclusions: These results highlight possible shared risk factors of alcohol ingestion and viral exposures which may predispose to second primary HCC after other primary malignancies. Providers should maintain heightened alertness for second primary HCC in these patients, especially those with head and neck cancers and HIV. No significant financial relationships to disclose.

scholarly journals Pain severity and e-cigarette health literacy: the moderating role of sex

2019 ◽  
Vol 13 ◽  
pp. 117822181989707 ◽  
Author(s):  
Tanya Smit ◽  
Hannah Olofsson ◽  
Pamella Nizio ◽  
Lorra Garey ◽  
Michael J Zvolensky
Keyword(s):  
United States ◽  
Risk Factors ◽  
Health Literacy ◽  
Interactive Effect ◽  
The United States ◽  
Pain Severity ◽  
Cigarette Use ◽  
Cigarette Dependence ◽  
Moderating Role

Although electronic cigarette (e-cigarette) use has increased among adults in the United States, there is still little knowledge of factors that may influence e-cigarette use or beliefs about use. Prior research suggests that health literacy plays an important role in e-cigarette beliefs, including perceived benefits and risks of e-cigarette use, as well as e-cigarette dependence. Yet, limited work has examined risk factors of poor e-cigarette health literacy. From a biopsychological perspective, sex and pain severity represent two constructs that may impact e-cigarette health literacy. To date, however, no research has investigated differences in e-cigarette health literacy across pain, sex, or their interrelation. Thus, the present study was conducted to evaluate the interactive effect of pain severity and sex on e-cigarette health literacy. Participants included 319 current, adult e-cigarette users (60.5% female, Mage = 36.82 years, SD = 10.62). Findings supported a significant pain by sex interaction, such that pain related to e-cigarette health literacy among women ( b = .10, SE = .03, P < .001), but not men ( b = .01, SE = .03, P = .60). The present findings suggest that pain may uniquely impact the degree to which women, but not men, seek and understand information on e-cigarettes.

scholarly journals Risk factors for penile fracture compared with a surgical control cohort in the United States: the role of substance abuse

2020 ◽  
Vol 0 (0) ◽  
pp. 0
Author(s):  
KatherineE Fero ◽  
Nathaniel Christian-Miller ◽  
AndrewT Lenis ◽  
Josef Madrigral ◽  
SriramV Eleswarapu ◽  
...  
Keyword(s):  
United States ◽  
Risk Factors ◽  
Substance Abuse ◽  
The United States ◽  
Control Cohort ◽  
Penile Fracture

scholarly journals Thrombosis and Mortality in Pregnant Patients with COVID-19

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 8-9
Author(s):  
Elizabeth Behrens ◽  
Surbhi Warrior ◽  
Joshua Thomas ◽  
Xavier Pombar ◽  
Sefer Gezer ◽  
...  
Keyword(s):  
United States ◽  
Risk Factors ◽  
Mortality Rate ◽  
Pregnant Women ◽  
Postpartum Period ◽  
The United States ◽  
Women Of Childbearing Age ◽  
Childbearing Age ◽  
Significant Difference ◽  
In Pregnancy

Background Coronavirus disease-2019 (COVID-19) has become a global pandemic causing respiratory compromise, coagulopathy and renal failure in severe cases. Studies demonstrate a high incidence of venous thromboembolism (VTE), up to 69% in patients with severe COVID-19 infection. Coagulopathy in COVID-19 patients is attributed to excessive inflammation and endotheliopathy. Pregnant patients have approximately a 4-fold increase of VTE incidence. This is in part due to an increase in clotting factors and fibrinogen and a decrease in fibrinolytic activity and protein S. Increased stasis and the presence of acquired and inherited thrombophilias can contribute to increased VTE incidence during pregnancy and postpartum period (PP). Risk factors for thrombosis in pregnancy include African American race, heart disease, diabetes, smoking, multiparity, age &gt;35 years, and obesity. Pregnancy/PP state and COVID-19 infection independently increase the risk of VTE which raises concern for an even higher incidence of thromboembolic events in pregnant/PP patients with COVID-19. Data pertaining to hypercoagulability in COVID-19 infected pregnant patients is currently limited. We conducted this study to evaluate the incidence of thrombosis and mortality in pregnant/PP COVID-19 positive patients. Methods A retrospective analysis was performed on all COVID-19 positive hospitalized patients between March 2020-June 2020 at our institution. Pregnant and PP patients were extracted from this cohort and individually chart reviewed by clinicians. Data from the Centers for Disease Control and Prevention on COVID-19 positive pregnant women in the United States from January 22-July 7, 2020 was utilized for comparison analyses. Statistical analysis was performed with chi-square testing. The incidences of thrombosis and mortality were compared between hospitalized COVID-19 positive pregnant/PP patients and hospitalized adult COVID-19 positive women of childbearing age (18-51 years). A subgroup analysis was performed to evaluate risk factors for thrombosis such as demographics, trimester of pregnancy, and single/multiple gestation (Table 1). Anticoagulation and COVID-19 related therapies administered in this cohort were also studied. Results Forty-three pregnant/PP COVID-19 positive patients were identified out of 1265 hospitalized COVID-19 positive patients at our institution. Thrombosis (DVT, PE, or stroke) incidence in our cohort was 0%, which was not significantly different compared to 6.12% incidence of thrombosis in hospitalized COVID-19 positive women of childbearing age (P = .097). The mortality rate of COVID-19 positive pregnant/PP patients was 0%, which was not significantly different compared to the mortality rate of 3.06% in hospitalized COVID-19 women of childbearing age (P = .25). Further, VTE incidence of 0% in hospitalized COVID-19 positive pregnant/PP patients was not significantly different from the 0.1% incidence of VTE in the non COVID-19 pregnant population in the United States (P=.84). Lastly, the 0% mortality rate in COVID-19 positive pregnant/PP patients at our institution was no different than the 0.0169% mortality rate of pregnant women without COVID-19 infections in the United States (P = .93). Conclusion Our study demonstrates no significant difference in incidence of thrombosis and mortality rate between hospitalized COVID-19 positive pregnant/PP patients and hospitalized COVID-19 positive women of childbearing age. There was also no difference in VTE incidence between hospitalized COVID-19 positive pregnant/PP patients and non COVID-19 pregnant women in the United States. The lack of significant difference in both thrombosis incidence and mortality rate in patients who are both COVID-19 positive and pregnant/PP is reassuring and may imply that pregnancy might play a role in decreasing the inflammatory response of COVID-19. During certain phases of pregnancy a high number of macrophages, natural killer cells, and T regulator cells in the decidua have been identified, which could indicate an overall increased systemic immune response, potentially decreasing the dysregulation of the cytokine storm seen in critically ill COVID-19 patients. However, the systemic immunologic changes in pregnancy and the postpartum period remain largely unknown and prospective studies are needed to further investigate the effects of COVID-19 on pregnant patients. Disclosures No relevant conflicts of interest to declare.

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