Alcohol's involvement in recurrent child abuse and neglect cases

Aims This paper examined whether or not: (a) care‐giver ‘alcohol abuse’ is associated with recurrent child maltreatment; (b) other ‘risk factors’ affect this relationship; and (c) which of alcohol abuse or other drug abuse plays a stronger role. It also examined (d) how children and families where alcohol‐related child abuse was identified were managed by child protection services (CPS) in Victoria, Australia. Design, setting and participants Using anonymized data from Victorian CPS, repeat cases were examined involving 29 455 children identified between 2001 and 2005. Measurements Carer alcohol abuse, other drug abuse, mental ill‐health, carer experience of abuse as a child, child age and gender, family type, socio‐economic variables and level of child protection service intervention as recorded in the CPS electronic database were examined as risk factors for recurrence, using bivariate and multivariate techniques. Findings Almost one‐quarter of children in CPS experienced a recurrent incident of child maltreatment in a 5‐year period. Where carer alcohol abuse was identified children were significantly more likely to experience multiple incidents compared with children where this was not identified (P < 0.001), as were children where other family risk factors (including markers of socio‐economic disadvantage) were identified. The majority of children whose carers were identified with alcohol abuse experienced either repeat incidents or interventions (84%), although almost three‐quarters of these children were managed without resort to the most serious outcome, involving court orders. Conclusions Alcohol and drug abuse in carers are important risk‐factors for recurrent child maltreatment after accounting for other known risk factors; the increased risk appears to be similar between alcohol and drug abuse.     

Body mass index and all-cause mortality in a nationwide US cohort

OBJECTIVE: To investigate whether the nature of the relationship between body mass index (BMI (kg/m2)) and all-cause mortality is direct, J- or U-shaped, and whether this relationship changes as people age. DESIGN: Prospective nationwide cohort study of US radiologic technologists (USRT). SUBJECTS: Sixty-four thousand seven hundred and thirty-three female and 19 011 male certified radiation technologists. METHODS: We prospectively followed participants from the USRT study who completed a mail survey in 1983-1989 through 2000. During an average of 14.7 years of follow-up or 1.23 million person-years, 2278 women and 1495 men died. Using Cox's proportional-hazards regression analyses, we analyzed the relationship between BMI and all-cause mortality by gender and by age group (<55 years; > or = 55 years). We also examined risk in never-smokers after the first 5 years of follow-up to limit bias owing to the confounding effects of smoking and illness-related weight loss on BMI and mortality. RESULTS: Risks were generally J-shaped for both genders and age groups. When we excluded smokers and the first 5 year of follow-up, risks were substantially reduced in those with low BMIs. In never-smoking women under the age of 55 years (excluding the initial 5-year follow-up period), risk rose as BMI increased above 21.0 kg/m2, whereas in older women, risk increased beginning at a higher BMI (> or = 25.0 kg/m2). Among younger men who never smoked (excluding the initial 5-year follow-up period), risk began to rise above a BMI of 23.0 kg/m2, whereas in older men, risk did not begin to increase until exceeding a BMI of 30.0 kg/m2. CONCLUSIONS: In younger/middle-aged, but not older, women and men, mortality risks appear directly related to BMI. The more complicated relationship between BMI and mortality in older subjects suggests the importance of assessing whether other markers of body composition better explain mortality risk in older adults.     

Birthweight,lifetime body-mass Index,and physical function in mid-adulthood: evidence from a nationwide birth cohort study

Background

Physical functioning (PF) from mid-adulthood is important for maintaining independence and is linked to better health outcomes. Studies have linked obesity to poor PF; however, they have typically been cross-sectional, limited to two timepoints, or relied on retrospectively recalled height and weight. We aimed to establish associations between physical functioning at age 50 years and birthweight and body-mass index (BMI) across the life-course; BMI gains at specific life stages; and duration of obesity.

Breastfeeding and risk of food allergy: A nationwide birth cohort in Japan

BackgroundAlthough breastfeeding has been well-established as the preferred method for infant nutrition, its prophylactic effects on food allergy remain controversial. Infantile eczema has been linked to food allergy via percutaneous sensitization; however, this relationship has not been considered in previous studies. We aimed to uncover the prophylactic effects of breastfeeding on food allergy, focusing on eczema-mediated percutaneous sensitization.MethodsThis retrospective cohort study was based on 46,616 children from the Longitudinal Survey of Newborns in the 21st Century in Japan, begun in 2001. We classified participants into three groups based on infant feeding practices (exclusive breastfeeding, partial breastfeeding including only colostrum, and formula feeding only) and used information from at least one outpatient visit for food allergy during two observation periods (age 6–18 months and age 6–66 months) as health outcomes. We performed log-binomial regression analysis adjusted for potential confounders and stratified analysis according to infantile eczema status.ResultsCompared with formula feeding, partial breastfeeding including only colostrum reduced the risk of food allergy only in children with infantile eczema, (RR = 0.66, 95% CI: 0.46, 0.96 for age 6–66 months), whereas exclusive breastfeeding increased this risk in those without infantile eczema (RR = 2.41, 95% CI: 1.40, 4.15, age 6–66 months). The prophylactic effects of breastfeeding on food allergy in the infantile eczema group increased with shorter breastfeeding duration.ConclusionsOur results showed that breastfeeding, especially colostrum, had prophylactic effects on food allergy only among high-risk children with infantile eczema whereas prolonged breastfeeding increased the risk of food allergy.     

Hospitalization and mortality due to hepatitis A in Taiwan: a 15‐year nationwide cohort study

Hepatitis A virus (HAV) is the most common food‐borne hepatitis in the world. The study objectives were (i) to describe the epidemiology of HAV‐related hospitalizations during 1997–2011 in Taiwan, (ii) to examine the age effect on the length of stay (LOS) in hospital and (iii) to study the factors associated with death. The hospitalized cases were identified from the Taiwan National Health Insurance Research Database between 1997 and 2011 by ICD‐9‐CM code of 070.0/070.1. Patient sex, birthday, dates of hospitalization and death were analysed. A total of 3990 HAV‐hospitalized cases, males 2467 (62%), were identified. The LOS increased as patients’ age increased. The overall mortality rate was 16.8 per 1000 hospitalizations. Males had significantly higher case fatality rate than females (20.7 vs 10.5 per 1000 cases). The adjusted odds ratio (aOR) for death rose by age and increased rapidly over 40 years of age. The aOR and 95% confidence interval [95%CI] for aged 40–59 years and aged over 60 years were 7.89 (1.06–58.98) and 14.88 (2.02–109.40) compared to aged 0–19 years, respectively. Patients with chronic liver disease and cirrhosis had significantly higher risk of death (aOR=1.03 [1.01–1.04]), compared to those without liver disease. However, patients with liver disease, but no cirrhosis did not have higher risk of death (aOR=1.00 [0.99–1.01]). The aOR [95%CI] for LOS >9 day was 3.26 (1.96–5.40) compared to cases with LOS ≤9 days. Male sex, age over 40 years, cirrhotic liver and long LOS are significant factors associated with death in HAV‐hospitalized cases.     

Long-term mortality and recurrence in patients treated for colonic diverticulitis with abscess formation: a nationwide register-based cohort study

Purpose

The study aimed to investigate long-term mortality, recurrence, and death related to recurrence for patients admitted with acute diverticulitis with abscess formation (Hinchey stage Ib-II).

Methods

The cohort was identified by linking administrative registers for all Danish citizens in years 2000–2012. Patients were identified from ICD-10 discharge codes and stratified according to treatment (antibiotics, percutaneous abscess drainage, or surgery).

Results

From 6,641,672 persons, 3148 patients were identified with acute diverticulitis with abscess formation. Survival was comparable between treatment groups with a 1-year survival of 81–83% and a 5-year survival of 66–67% (p?=?0.66). Glucocorticoid usage prior to admission increased risk of mortality with hazard ratio 1.64 (95%CI 1.39–1.93), 1.77 (1.20–2.63), and 1.92 (1.07–3.44) for the antibiotics, drainage, and operative treatment group, respectively. Drainage treatment increased risk of recurrence with sub-distribution hazard (SDH) of 1.52 (1.19–1.95) and operative treatment decreased risk with a SDH of 0.55 (0.32–0.93), both compared with antibiotic treatment (p?=?0.0001). Recurrence occurred in 23.6% (18.5–30.1%) of patients in the drainage group, 15.5% (13.9–17.3%) in the antibiotics group, and 9.1% (5.1–16.1%) in the operative group. Recurrence-related mortality was 2.0% (0.9–4.4%) for the drainage group, 1.1% (0.7–1.8%) for the antibiotics group, and 0.6% (0.1–4.3%) for the operative group (p?=?0.24). Most recurrences and recurrence-related mortality occurred within the first year after primary admission.

Conclusions

This study with complete national data revealed a high mortality and recurrence rate after diverticular abscesses. Survival was comparable between treatment groups, but patients treated with drainage had significantly higher risk of recurrence.

     

Treatments and in-hospital mortality in acute myocardial infarction patients with rheumatoid arthritis: a nationwide retrospective cohort study in Japan

No previous study has examined the differences in treatments and outcomes after acute myocardial infarction (AMI) between patients with and without rheumatoid arthritis (RA) in a setting where coronary reperfusion therapy was readily available. This study aimed to examine whether coexisting RA affected likelihood of receiving coronary reperfusion therapy and in-hospital mortality among AMI patients in a Japanese nationwide setting where coronary reperfusion therapy was readily available. Using the Diagnosis Procedure Combination database, we retrospectively identified patients admitted with AMI between 2010 and 2014 and created a matched-pair cohort of patients with and without RA based on age, sex, hospital, and admission year at a maximum ratio of 1:5. We performed multivariable logistic regression analyses for associations of RA with likelihood of coronary reperfusion therapy and 30-day in-hospital mortality. There were no significant differences between the RA group (n = 938) and non-RA group (n = 3839) in the proportions of patients receiving coronary reperfusion therapy (on the day of admission 75.8% vs. 77.2%, P = 0.364; during hospitalization 87.1% vs. 87.3%, P = 0.913) and 30-day in-hospital mortality (5.9% vs. 5.9%, P = 1.000). Multivariable logistic regression analyses showed that RA was not significantly associated with either likelihood of receiving coronary reperfusion therapy during hospitalization (odds ratio 1.02; 95% confidence interval 0.82–1.27; P = 0.837) or 30-day in-hospital mortality (odds ratio 1.16; 95% confidence interval 0.81–1.65; P = 0.419). Coexisting RA did not affect likelihood of receiving coronary reperfusion therapy or in-hospital mortality among AMI patients in a setting where reperfusion therapy was readily available.