Child Abuse Pediatricians Assess a Low Likelihood of Abuse in Half of 2890 Physical Abuse Consults

2021 ◽  
pp. 107755952110419
Author(s):  
Katie L. Johnson ◽  
Emily C. B. Brown ◽  
Kenneth W. Feldman ◽  
Pingping Qu ◽  
Daniel M. Lindberg ◽  
...  
Keyword(s):  
Child Abuse ◽  
Injury Severity ◽  
Secondary Analysis ◽  
Descriptive Statistics ◽  
Regression Analyses ◽  
High Likelihood ◽  
Point Scale ◽  
Medical Centers ◽  
Race Ethnicity ◽  
Future Work

The aim of this study was to examine the frequency with which child abuse pediatricians (CAPs) assess consultations as low versus high likelihood of abuse. In this retrospective secondary analysis of data from the Examining Siblings to Recognize Abuse (ExSTRA) study, the likelihood of abuse score for 2890 consultations at 20 medical centers was collected. Descriptive statistics were used to examine the percentage of cases representing low versus high likelihood of abuse (i.e., score of 1–4 vs. 5–7 on a 7-point scale). Linear and logistic regression analyses were used to examine score variability between medical centers. Overall, fifty-three percent of cases were assessed as low likelihood of abuse, suggesting that CAPs were equally as likely to assess a high versus low likelihood of abuse. The percentage of cases representing low likelihood of abuse differed significantly ( P < .001) between medical centers after controlling for patient age, sex, race/ethnicity, twin/triplet status, injury types, and injury severity. The variability between CAP assessments at different medical centers is discussed, along with potential contributors to this variability and directions for future work.

Oral injuries and occult harm in children evaluated for abuse

2017 ◽  
Vol 103 (8) ◽  
pp. 747-752 ◽  
Author(s):  
Molly V Dorfman ◽  
James B Metz ◽  
Kenneth W Feldman ◽  
Reid Farris ◽  
Daniel M Lindberg
Keyword(s):  
Child Abuse ◽  
Physical Abuse ◽  
Prospective Observational Study ◽  
Secondary Analysis ◽  
Point Scale ◽  
Initial Examination ◽  
Occult Fractures ◽  
Level Of Concern ◽  
High Level ◽  
Retinal Haemorrhages

ObjectiveTo determine the frequency of occult trauma in children with oral injury evaluated for physical abuse.DesignThis was a retrospectively planned secondary analysis of a prospective, observational study.SettingEmergency departments supported by 20 US child abuse teams in the Examining Siblings to Recognize Abuse (ExSTRA) network.PatientsChildren <120 months old evaluated for physical abuse.InterventionsAnalysis of index children with oral injury on initial examination.Main outcome measuresRates of physician-recognised oral injury, as well as frequency and results of occult injury testing. Perceived abuse likelihood was described on a 7-point scale (7=definite abuse).ResultsAmong 2890 child abuse consultations, 3.3% (n=96) of children had oral injury. Forty-two per cent were 0–12 months old, 39% 1–3 years old and 18% >3 years old. Oral injury was the primary reason for evaluation for 32 (33%). Forty-three per cent (42/96) had frenum injuries. Skeletal surveys were obtained for 84% and 25% of these identified occult fractures. Seventy-five per cent had neuroimaging; 38% identified injuries. Forty-one per cent of children with oral injuries had retinal examinations; 24% of exams showed retinal haemorrhages. More occult injuries were found in children with oral injuries than other ExSTRA subjects. A high level of concern for abusive injury was present in 67% of children with oral injury versus 33% without.ConclusionsChildren with oral injury are at high risk for additional occult abusive injuries. Infants and mobile preschoolers are at risk. Young children with unexplained oral injury should be evaluated for abuse.

Evoking Issues of Race and Ethnicity in Research on Physiology and Interpersonal Communication

2020 ◽  
pp. 260-287
Author(s):  
Shardé M. Davis
Keyword(s):  
Interpersonal Communication ◽  
Race And Ethnicity ◽  
Communication Research ◽  
Interpersonal Interactions ◽  
The Past ◽  
Race Ethnicity ◽  
Diverse Groups ◽  
Future Work ◽  
Area Of Study

Investigating the role of physiology in communication research is a burgeoning area of study that has gained considerable attention by relational scholars in the past decade. Unfortunately, very few published studies on this topic have evoked important questions about the role of race and ethnicity. Exploring issues of ethnicity and race provides a more holistic and inclusive view of interpersonal communication across diverse groups and communities. This chapter addresses the gap in literature by considering the ways in which race and ethnicity matter in work on physiology and interpersonal interactions. More specifically, this chapter will first discuss the conceptual underpinnings of race, ethnicity, and other relevant concepts and then review extant research within and beyond the field of communication on race, ethnicity, interpersonal interactions, and physiology. These discussions set the foundation for this chapter to propose new lines of research that pointedly connect these four concepts and advance key principles that scholars should consider in future work.

Use of Damage Control and the Open Abdomen in Combat

2013 ◽  
Vol 79 (8) ◽  
pp. 747-753 ◽  
Author(s):  
Benjamin Bograd ◽  
Carlos Rodriguez ◽  
Richard Amdur ◽  
Fred Gage ◽  
Eric Elster ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Multivariate Regression ◽  
Injury Severity ◽  
Open Abdomen ◽  
Damage Control ◽  
Unit Length ◽  
Significant Risk ◽  
Hospital Length Of Stay ◽  
Study Cohort ◽  
Regression Analyses

Despite the well-documented use of damage control laparotomy (DCL) in civilian trauma, its use has not been well described in the combat setting. Therefore, we sought to document the use of DCL and to investigate its effect on patient outcome. Prospective data were collected on 1603 combat casualties injured between April 2003 and January 2009. One hundred seventy patients (11%) underwent an exploratory laparotomy (ex lap) in theater and comprised the study cohort. DCL was defined as an abbreviated ex lap resulting in an open abdomen. Patients were stratified by age, Injury Severity Score (ISS), Glasgow Coma Score (GCS), mechanism of injury, and blood product administration. Multivariate regression analyses were used to determine risks factors for intensive care unit length of stay (ICU LOS), hospital length of stay (HLOS), and the need for DCL. Mean age of the cohort was 24 ± 5 years, ISS was 21 ± 11, and 94 per cent sustained penetrating injury. Patients with DCL comprised 50.6 per cent (n = 86) of the study cohort and had significant increases in ICU admission ( P < 0.001), ICU LOS ( P < 0.001), HLOS ( P < 0.05), ventilator days ( P < 0.001), abdominal complications ( P < 0.05), but not mortality ( P = 0.65) compared with patients without DCL. When compared with the non-DCL group, patients undergoing DCL required significantly more blood products (packed red blood cells, fresh-frozen plasma, platelets, and cryoprecipitate; P < 0.001). Multivariate regression analyses revealed blood transfusion and GCS as significant risk factors for DCL ( P < 0.05). Patients undergoing DCL had increased complications and resource use but not mortality compared with patients not undergoing DCL. The need for combat DCL may be different compared with civilian use. Prospective studies to evaluate outcomes of DCL are warranted.

Factors of Dementia Caregiver Burden Differentially Contribute to Desire to Institutionalize

2021 ◽  
pp. 089198872110361
Author(s):  
John T. Martin ◽  
Kimberly R. Chapman ◽  
Christopher Was ◽  
Mary Beth Spitznagel
Keyword(s):  
Factor Analysis ◽  
Linear Regression ◽  
Factor Structure ◽  
Caregiver Burden ◽  
Living Arrangements ◽  
Regression Analyses ◽  
Loved One ◽  
Dementia Caregiver ◽  
Future Work ◽  
Made In

The experience of dementia caregiver burden is multidimensional. Little is known about how different aspects of burden contribute to the consideration of moving a loved one to a structured living facility. In the present study, caregiver burden (Zarit Burden Interview; ZBI) and consideration of structured living arrangements (Desire to Institutionalize Scale; DIS) were self-reported by 339 caregivers. Exploratory factor analysis was used to determine the ZBI factor structure; these factors were then examined via hierarchical linear regression for prediction of DIS. Factor analysis indicated a 4-factor ZBI solution: Impact on Life, Guilt, Embarrassment/Frustration, and Escape/Uncertainty. Regression analyses indicated that only Escape/Uncertainty ( p < .001) was associated with DIS. Of the 4 identified factors of caregiver burden, desire to escape the caregiving role was most related to consideration of structured living arrangements. Future work should explore longitudinal contribution of this factor to determine its role in actual changes made in living arrangements.

scholarly journals Do quality improvement initiatives for diabetes care address social inequities? Secondary analysis of a systematic review

BMJ Open ◽  
2018 ◽  
Vol 8 (2) ◽  
pp. e018826 ◽  
Author(s):  
Jacquie Boyang Lu ◽  
Kristin J Danko ◽  
Michael D Elfassy ◽  
Vivian Welch ◽  
Jeremy M Grimshaw ◽  
...  
Keyword(s):  
Systematic Review ◽  
Socioeconomic Status ◽  
Quality Improvement ◽  
Diabetes Care ◽  
Secondary Analysis ◽  
Place Of Residence ◽  
Disadvantaged Groups ◽  
Disadvantaged Populations ◽  
Patients With Diabetes ◽  
Race Ethnicity

BackgroundSocially disadvantaged populations carry a disproportionate burden of diabetes-related morbidity and mortality. There is an emerging interest in quality improvement (QI) strategies in the care of patients with diabetes, however, the effect of these interventions on disadvantaged groups remains unclear.ObjectiveThis is a secondary analysis of a systematic review that seeks to examine the extent of equity considerations in diabetes QI studies, specifically quantifying the proportion of studies that target interventions toward disadvantaged populations and conduct analyses on the impact of interventions on disadvantaged groups.Research design and methodsStudies were identified using Medline, HealthStar and the Cochrane Effective Practice and Organisation of Care database. Randomised controlled trials assessing 12 QI strategies targeting health systems, healthcare professionals and/or patients for the management of adult outpatients with diabetes were eligible. The place of residence, race/ethnicity/culture/language, occupational status, gender/sexual identity, religious affiliations, education level, socioeconomic status, social capital, plus age, disability, sexual preferences and relationships (PROGRESS-Plus) framework was used to identify trials that focused on disadvantaged patient populations, to examine the types of equity-relevant factors that are being considered and to explore temporal trends in equity-relevant diabetes QI trials.ResultsOf the 278 trials that met the inclusion criteria, 95 trials had equity-relevant considerations. These include 64 targeted trials that focused on a disadvantaged population with the aim to improve the health status of that population and 31 general trials that undertook subgroup analyses to assess the extent to which their interventions may have had differential impacts on disadvantaged subgroups. Trials predominantly focused on race/ethnicity, socioeconomic status and place of residence as potential factors for disadvantage in patients receiving diabetes care.ConclusionsLess than one-third of diabetes QI trials included equity-relevant considerations, limiting the relevance and applicability of their data to disadvantaged populations. There is a need for better data collection, reporting, analysis and interventions on the social determinants of health that may influence the health outcomes of patients with diabetes.PROSPERO registration numberCRD42013005165.

scholarly journals Adiposity, education and weight loss effort are independently associated with energy reporting quality in the Ontario Food Survey

2007 ◽  
Vol 10 (8) ◽  
pp. 803-809 ◽  
Author(s):  
Heather Ward ◽  
Valerie Tarasuk ◽  
Rena Mendelson
Keyword(s):  
Weight Loss ◽  
Food Insecurity ◽  
Multivariate Regression ◽  
Secondary Analysis ◽  
Primary Source ◽  
Reporting Quality ◽  
Personal Characteristics ◽  
Total Energy Expenditure ◽  
Regression Analyses ◽  
Men And Women

AbstractObjectivesTo examine the associations of adiposity, dietary restraint and other personal characteristics with energy reporting quality.Design/subjectsSecondary analysis of 230 women and 158 men from the 1997/98 Ontario Food Survey.MethodsEnergy reporting quality was estimated by ratios of energy intake (EI) to both basal metabolic rate (BMR) and total energy expenditure (TEE). Multivariate regression analyses were conducted to examine energy reporting quality between two dietary recalls and in relation to body mass index (BMI) with adjustment for potential confounders. Energy reporting quality was explored across categories of age, BMI, income, education, dieting status and food insecurity through analysis of variance (ANOVA).ResultsFrom the ANOVA, energy reporting quality was associated with BMI group, age category and weight loss for men and women, as well as with education among women (P < 0.05). The multivariate regression analyses indicated that energy reporting quality was positively associated with education and inversely associated with obesity and dieting. No associations were observed in relation to food insecurity or income (P>0.05). EI:BMR and EI:TEE on the first and second 24-hour recalls were positively related (P < 0.0001 for men and women). A higher proportion of variance in energy reporting quality was explained for women than for men (R2 = 0.19 and 0.14, respectively).ConclusionsStudies of diet and adiposity are probably hindered to some extent by BMI-related variation in energy reporting quality. Methods to address this issue are urgently needed if population surveys will continue to serve as the primary source of dietary intake data.

scholarly journals Do aggression and impulsivity dominate dark triad across genders?

2020 ◽  
Author(s):  
Anupriya Singh ◽  
Aisha Naeem ◽  
Komal Chandiramani
Keyword(s):  
Gender Differences ◽  
Standard Deviation ◽  
Pearson Correlation ◽  
Correlation Method ◽  
Dark Triad ◽  
T Test ◽  
Descriptive Statistics ◽  
Regression Analyses ◽  
Future Directions ◽  
Significant Relationships

The study investigated gender differences in Overall Dark Triad (Machiavellianism, Narcissism, and Psychopathy), Aggression, Impulsivity, and impact of Dark triad on Aggression and Impulsivity. Data was collected from 214 young adults. Analyses was done using descriptive statistics (mean and standard deviation). T-test was employed to analyze gender differences. Pearson Correlation Method and Multiple regression were used to assess the relation and prediction amongst the variables, respectively. T-test suggested significant gender differences in Machiavellianism, Psychopathy, and Overall Dark Triad, with females scoring high than males. No gender difference was observed in Aggression and Impulsivity. Correlation and regression analyses revealed several significant relationships between the above constructs. The research was concluded by briefly foregrounding some of the study’s implications and future directions.

White Matter Disruption in Pediatric Traumatic Brain Injury: Results from ENIGMA Pediatric Moderate to Severe Traumatic Brain Injury

Neurology ◽  
2021 ◽  
pp. 10.1212/WNL.0000000000012222
Author(s):  
Emily L Dennis ◽  
Karen Caeyenberghs ◽  
Kristen R Hoskinson ◽  
Tricia L Merkley ◽  
Stacy J Suskauer ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
White Matter ◽  
Behavioral Problems ◽  
Child Behavior Checklist ◽  
Injury Severity ◽  
Meta Analysis ◽  
Post Injury ◽  
Severe Tbi ◽  
Future Work

Objective:Our study addressed aims: (1) test the hypothesis that moderate-severe TBI in pediatric patients is associated with widespread white matter (WM) disruption; (2) test the hypothesis that age and sex impact WM organization after injury; and (3) examine associations between WM organization and neurobehavioral outcomes.Methods:Data from ten previously enrolled, existing cohorts recruited from local hospitals and clinics were shared with the ENIGMA (Enhancing NeuroImaging Genetics through Meta-Analysis) Pediatric msTBI working group. We conducted a coordinated analysis of diffusion MRI (dMRI) data using the ENIGMA dMRI processing pipeline.Results:Five hundred and seven children and adolescents (244 with complicated mild to severe TBI [msTBI] and 263 controls) were included. Patients were clustered into three post-injury intervals: acute/subacute - <2 months, post-acute - 2-6 months, chronic - 6+ months. Outcomes were dMRI metrics and post-injury behavioral problems as indexed by the Child Behavior Checklist (CBCL). Our analyses revealed altered WM diffusion metrics across multiple tracts and all post-injury intervals (effect sizes ranging between d=-0.5 to -1.3). Injury severity is a significant contributor to the extent of WM alterations but explained less variance in dMRI measures with increasing time post-injury. We observed a sex-by-group interaction: females with TBI had significantly lower fractional anisotropy in the uncinate fasciculus than controls (𝞫=0.043), which coincided with more parent-reported behavioral problems (𝞫=-0.0027).Conclusions:WM disruption after msTBI is widespread, persistent, and influenced by demographic and clinical variables. Future work will test techniques for harmonizing neurocognitive data, enabling more advanced analyses to identify symptom clusters and clinically-meaningful patient subtypes.

Central Venous Catheter Salvage in Ambulatory Central Line–Associated Bloodstream Infections

PEDIATRICS ◽  
2021 ◽  
Author(s):  
William J.H. Ford ◽  
David G. Bundy ◽  
Suzette Oyeku ◽  
Moonseong Heo ◽  
Lisa Saiman ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pediatric Patients ◽  
Secondary Analysis ◽  
Bloodstream Infections ◽  
Venous Catheter ◽  
Central Line ◽  
Type Number ◽  
Central Venous ◽  
Medical Centers ◽  
Associated Risk Factors

BACKGROUND Guidelines for treatment of central line–associated bloodstream infection (CLABSI) recommend removing central venous catheters (CVCs) in many cases. Clinicians must balance these recommendations with the difficulty of obtaining alternate access and subjecting patients to additional procedures. In this study, we evaluated CVC salvage in pediatric patients with ambulatory CLABSI and associated risk factors for treatment failure. METHODS This study was a secondary analysis of 466 ambulatory CLABSIs in patients &lt;22 years old who presented to 5 pediatric medical centers from 2010 to 2015. We defined attempted CVC salvage as a CVC left in place ≥3 days after a positive blood culture result. Salvage failure was removal of the CVC ≥3 days after CLABSI. Successful salvage was treatment of CLABSI without removal of the CVC. Bivariate and multivariable logistic regression analyses were used to test associations between risk factors and attempted and successful salvage. RESULTS A total of 460 ambulatory CLABSIs were included in our analysis. CVC salvage was attempted in 379 (82.3%) cases. Underlying diagnosis, CVC type, number of lumens, and absence of candidemia were associated with attempted salvage. Salvage was successful in 287 (75.7%) attempted cases. Underlying diagnosis, CVC type, number of lumens, and absence of candidemia were associated with successful salvage. In patients with malignancy, neutropenia within 30 days before CLABSI was significantly associated with both attempted salvage and successful salvage. CONCLUSIONS CVC salvage was often attempted and was frequently successful in ambulatory pediatric patients presenting with CLABSI.

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