Recognition of child maltreatment in emergency departments in Europe: Should we do better?

Objectives To evaluate the different policies to recognize child maltreatment in emergency departments (EDs) in Europe in order to define areas of improvement. Methods A survey was conducted on the recognition of child maltreatment in EDs in European countries with a focus on screening methods, parental risk factors, training and hospital policies. The survey was distributed through different key members from the EUSEM, REPEM and the EuSEN. A summary score based on the NICE guideline (4 questions on child characteristics, 4 questions on parental characteristics and 5 questions on hospital policy) was calculated. Results We analysed 185 completed surveys, representing 148 hospitals from 29 European countries. Of the respondents, 28.6% used a screening tool, and 31.8% had guidelines on parental risk factors. A total of 42.2% did not follow training based on child characteristics, and 57.6% did not follow training on parental characteristics. A total of 71.9% indicated that there was a need for training. 50.8% of the respondents reported a standardized policy for the detection of child maltreatment. Translating the survey results to NICE summary scores of the EDs in Europe, we found that 25.6% (34/133) met most, 22.6% (30/133) met some and 51.9% (69/133) met few of the NICE guideline recommendations. More specifically, with respect to hospital policies, 33.8% (45/133) met most, 15.0% (20/133) met some and 51.1% (68/133) met few of the NICE guideline recommendations. Conclusion There is high variability regarding policies for child maltreatment detection and only a quarter of the EDs met most of the NICE guideline recommendations for child maltreatment. There is a need for the use of screening tools, training of ED staff and implementation of local hospital policies.

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Child Abuse Potential in Young German Parents: Predictors, Associations with Self-reported Maltreatment and Intervention Use

Child Psychiatry & Human Development ◽

10.1007/s10578-021-01157-y ◽

2021 ◽

Author(s):

Katrin Lang ◽

Christoph Liel ◽

Ulrike Lux ◽

Heinz Kindler ◽

Marc Vierhaus ◽

...

Keyword(s):

Risk Factors ◽

Early Childhood ◽

Child Abuse ◽

Child Maltreatment ◽

Abuse Potential ◽

Screening Tools ◽

Early Childhood Intervention ◽

Child Abuse Potential ◽

Childhood Intervention ◽

Abuse Risk

AbstractSince child maltreatment has highly negative effects on child adjustment, early identification of at-risk families is important. This study focuses on longitudinal risk factors for child maltreatment and associations between abuse risk and occurrence. It also examines whether abuse risk and involvement in early childhood intervention are associated. The sample comprises 197 German caregivers with children under 3 years of age. Data was collected in two waves. The Brief Child Abuse Potential Inventory assessed abuse risk. Socio-demographic, parent, child and family-related risk factors were measured using screening tools. The analysis revealed that parental characteristics (psychopathology, own maltreatment experiences etc.) were associated with concurrent abuse risk. Longitudinal changes in abuse risk were linked to caregiver education and child-related factors. Cumulative risk did not explain more variance than specific risk factors. Significant associations with caregiver-reported abuse were found, and data suggest that some burdened families cannot be reached by early childhood intervention.

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Prenatal Sociodemographic Factors Predicting Maltreatment of Children up to 3 Years Old: A Prospective Cohort Study Using Administrative Data in Japan

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18052505 ◽

2021 ◽

Vol 18 (5) ◽

pp. 2505

Author(s):

Aya Isumi ◽

Kunihiko Takahashi ◽

Takeo Fujiwara

Keyword(s):

Risk Factors ◽

Cohort Study ◽

Child Maltreatment ◽

Survey Data ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Characteristic Curve ◽

Risk Scores ◽

Prenatal Risk ◽

Prenatal Risk Factors

Identifying risk factors from pregnancy is essential for preventing child maltreatment. However, few studies have explored prenatal risk factors assessed at pregnancy registration. This study aimed to identify prenatal risk factors for child maltreatment during the first three years of life using population-level survey data from pregnancy notification forms. This prospective cohort study targeted all mothers and their infants enrolled for a 3- to 4-month-old health check between October 2013 and February 2014 in five municipalities in Aichi Prefecture, Japan, and followed them until the child turned 3 years old. Administrative records of registration with Regional Councils for Children Requiring Care (RCCRC), which is suggestive of child maltreatment cases, were linked with survey data from pregnancy notification forms registered at municipalities (n = 893). Exact logistic regression was used for analysis. A total of 11 children (1.2%) were registered with RCCRC by 3 years of age. Unmarried marital status, history of artificial abortion, and smoking during pregnancy were significantly associated with child maltreatment. Prenatal risk scores calculated as the sum of these prenatal risk factors, ranging from 0 to 7, showed high predictive power (area under receiver operating characteristic curve 0.805; 95% confidence interval (CI), 0.660–0.950) at a cut-off score of 2 (sensitivity = 72.7%, specificity = 83.2%). These findings suggest that variables from pregnancy notification forms may be predictors of the risk for child maltreatment by the age of three.

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Parental risk factors for congenital diaphragmatic hernia – a large German case-control study

BMC Pediatrics ◽

10.1186/s12887-021-02748-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Felicitas Schulz ◽

Ekkehart Jenetzky ◽

Nadine Zwink ◽

Charlotte Bendixen ◽

Florian Kipfmueller ◽

...

Keyword(s):

Risk Factors ◽

Confidence Interval ◽

Environmental Risk ◽

Odds Ratio ◽

Alcohol Intake ◽

Case Control Study ◽

Case Control ◽

Parental Risk Factors ◽

Healthy Control ◽

Control Study

Abstract Background Evidence for periconceptional or prenatal environmental risk factors for the development of congenital diaphragmatic hernia (CDH) is still scarce. Here, in a case-control study we investigated potential environmental risk factors in 199 CDH patients compared to 597 healthy control newborns. Methods The following data was collected: time of conception and birth, maternal BMI, parental risk factors such as smoking, alcohol or drug intake, use of hairspray, contact to animals and parental chronic diseases. CDH patients were born between 2001 and 2019, all healthy control newborns were born in 2011. Patients and control newborns were matched in the ratio of three to one. Results Presence of CDH was significantly associated with maternal periconceptional alcohol intake (odds ratio = 1.639, 95% confidence interval 1.101–2.440, p = 0.015) and maternal periconceptional use of hairspray (odds ratio = 2.072, 95% confidence interval 1.330–3.229, p = 0.001). Conclusion Our study suggests an association between CDH and periconceptional maternal alcohol intake and periconceptional maternal use of hairspray. Besides the identification of novel and confirmation of previously described parental risk factors, our study underlines the multifactorial background of isolated CDH.

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20 Risk factors for admission at three, urban emergency departments in england: a cross-sectional analysis of attendances over one month

Emergency Medicine Journal ◽

10.1136/emermed-2017-207308.20 ◽

2017 ◽

Vol 34 (12) ◽

pp. A875.1-A875

Author(s):

Ian Pope ◽

Sharif Ismail ◽

David McCoy ◽

Tim Harris

Keyword(s):

Risk Factors ◽

Emergency Departments ◽

Cross Sectional ◽

Cross Sectional Analysis ◽

Sectional Analysis

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Factors associated with physical, psychological and social frailty among community-dwelling older persons in Europe: a cross-sectional study of Urban Health Centres Europe (UHCE)

BMC Geriatrics ◽

10.1186/s12877-021-02364-x ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Lizhen Ye ◽

Liset E. M. Elstgeest ◽

Xuxi Zhang ◽

Tamara Alhambra-Borrás ◽

Siok Swan Tan ◽

...

Keyword(s):

Risk Factors ◽

Urban Health ◽

Cross Sectional Study ◽

Community Dwelling ◽

Household Composition ◽

European Countries ◽

Sectional Study ◽

Related Condition ◽

Cross Sectional ◽

Age Related

Abstract Background Frailty is an age-related condition resulting in a state of increased vulnerability regarding functioning across multiple systems. It is a multidimensional concept referring to physical, psychological and social domains. The purpose of this study is to identify factors (demographic characteristics, lifestyle factors and health indicators) associated with overall frailty and physical, psychological and social frailty in community-dwelling older people from five European countries. Methods This cross-sectional study used baseline data from 2289 participants of the Urban Health Center European project in five European countries. Multivariable logistic regression models were used to assess associations of the factors with overall frailty and the three frailty domains. Results The mean age was 79.7 (SD = 5.7). Participants who were older, were female, had secondary or equivalent education, lived alone, not at risk of alcohol use, were less physically active, had multi-morbidity, were malnourished or with a higher level of medication risk, had higher odds of overall frailty (all P < 0.05). Age was not associated with psychological and social frailty; sex was not associated with social frailty; smoking and migration background was not associated with overall frailty or any of its domains. There existed an interaction effect between sex and household composition regarding social frailty (P < 0.0003). Conclusions The present study contributed new insights into the risk factors for frailty and its three domains (physical, psychological and social frailty). Nurses, physicians, public health professionals and policymakers should be aware of the risk factors of each type of frailty. Furthermore, examine these risk factors more comprehensively and consider overall frailty as well as its three domains in order to further contribute to decision-making more precisely on the prevention and management of frailty. Trial registration The intervention of the UHCE project was registered in the ISRCTN registry as ISRCTN52788952. The date of registration is 13/03/2017.

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Development and validation of two SCORE-based cardiovascular risk prediction models for Eastern Europe: a multicohort study

European Heart Journal ◽

10.1093/eurheartj/ehaa571 ◽

2020 ◽

Vol 41 (35) ◽

pp. 3325-3333 ◽

Cited By ~ 2

Author(s):

Taavi Tillmann ◽

Kristi Läll ◽

Oliver Dukes ◽

Giovanni Veronesi ◽

Hynek Pikhart ◽

...

Keyword(s):

Risk Factors ◽

Prediction Models ◽

Validation Cohort ◽

European Countries ◽

Eastern European ◽

Risk Prediction Models ◽

Derivation Cohort ◽

Score Model ◽

Eastern European Countries

Abstract Aims Cardiovascular disease (CVD) risk prediction models are used in Western European countries, but less so in Eastern European countries where rates of CVD can be two to four times higher. We recalibrated the SCORE prediction model for three Eastern European countries and evaluated the impact of adding seven behavioural and psychosocial risk factors to the model. Methods and results We developed and validated models using data from the prospective HAPIEE cohort study with 14 598 participants from Russia, Poland, and the Czech Republic (derivation cohort, median follow-up 7.2 years, 338 fatal CVD cases) and Estonian Biobank data with 4632 participants (validation cohort, median follow-up 8.3 years, 91 fatal CVD cases). The first model (recalibrated SCORE) used the same risk factors as in the SCORE model. The second model (HAPIEE SCORE) added education, employment, marital status, depression, body mass index, physical inactivity, and antihypertensive use. Discrimination of the original SCORE model (C-statistic 0.78 in the derivation and 0.83 in the validation cohorts) was improved in recalibrated SCORE (0.82 and 0.85) and HAPIEE SCORE (0.84 and 0.87) models. After dichotomizing risk at the clinically meaningful threshold of 5%, and when comparing the final HAPIEE SCORE model against the original SCORE model, the net reclassification improvement was 0.07 [95% confidence interval (CI) 0.02–0.11] in the derivation cohort and 0.14 (95% CI 0.04–0.25) in the validation cohort. Conclusion Our recalibrated SCORE may be more appropriate than the conventional SCORE for some Eastern European populations. The addition of seven quick, non-invasive, and cheap predictors further improved prediction accuracy.

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Prevalence and risk factors of child maltreatment among migrant families in China

Child Abuse & Neglect ◽

10.1016/j.chiabu.2017.01.023 ◽

2017 ◽

Vol 65 ◽

pp. 171-181 ◽

Cited By ~ 11

Author(s):

Yunjiao Gao ◽

Sally Atkinson-Sheppard ◽

Xing Liu

Keyword(s):

Risk Factors ◽

Child Maltreatment ◽

Migrant Families

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The Epidemiology of Household Rodenticides Poisoning in Hong Kong and its Risk Factors for Developing Coagulopathy

Hong Kong Journal of Emergency Medicine ◽

10.1177/102490791402100601 ◽

2014 ◽

Vol 21 (6) ◽

pp. 339-345 ◽

Cited By ~ 1

Author(s):

N Othman ◽

Ck Chan ◽

Fl Lau

Keyword(s):

Risk Factors ◽

Hong Kong ◽

Emergency Departments ◽

Multiple Logistic Regression Analysis ◽

Case Series ◽

Female Ratio ◽

Intentional Ingestion ◽

Accident And Emergency ◽

Case Series Study ◽

Clinically Significant

Objective To (1) describe the epidemiology of household rodenticides poisoning in Hong Kong, (2) evaluate the proportion of patients who have develop coagulopathy after rodenticide poisoning, (3) identify the risk factors for developing coagulopathy in rodenticide poisoning. Design Case series study. Setting Sixteen accident and emergency departments in Hong Kong. Patients Patients with household rodenticide ingestion who presented to accident and emergency departments during the period from July 2008 to February 2012. Results 110 patients were reported to have rodenticide exposure during the study period. Eighty-seven patients were included in the final analysis. The mean age was 40.1 and the male-to-female ratio was 1.29:1 (49:38). Most patients (91%) took the rodenticide intentionally. Sixty-nine patients (79%) exposed to anticoagulants type of rodenticide based on history or laboratory findings. The ingredient of the rodenticide ingested in 18 patients (21%) was untraceable. The only clinically significant presentation reported after rodenticide exposure was coagulopathy. Thirty-one patients (36%) developed coagulopathy with an international normalised ratio greater or equal to 1.3. Clinical significant bleeding was only observed in one patient. Presence of coagulopathy in rodenticide poisoning was significantly associated with older patient, intentional ingestion, ingestion of warfarin, ingestion of more than one pack and presence of co-ingestion. Multiple logistic regression analysis showed that only two factors were independent predictor of coagulopathy: Ingestion of warfarin rodenticide (p=0.001, odds ratio [OR] = 18.20, 95% confidence interval [CI]=3.44-96.42), and ingestion of more than one pack of rodenticide (p=0.02, OR=10.01, 95% CI=1.43-69.87). Conclusions Clinically significant household rodenticide poisoning in Hong Kong is solely related to ingestion of anticoagulant type of rodenticide. Patients who have ingested warfarin rodenticide and higher ingestion dose are more likely in developing coagulopathy. (Hong Kong j.emerg.med. 2014;21:339-345)

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