Child abuse and cot deaths

A search was made of the Child Protection Register for children with siblings who died of SIDS. The Child Health Department in Southern Derbyshire Health Authority (population 522,000; 7,100 births per year) undertakes confidential inquiries into all child deaths and registered SIDS deaths are noted. This study looked at all children born between January 1, 1984 and June 30, 1988 whose names appeared on the Child Protection Register as victims of abuse or who were considered to be at risk for abuse. From a cohort of 288 children on the Child Protection Register, one in 30 of the children on the Register had a sibling whose death was registered as caused by SIDS. In Southern Derbyshire there is an association between child abuse and about 10% of deaths of children diagnosed as SIDS.     

剖宫产与母儿安全性分析

目的 :分析剖宫产对母儿的影响 ,以评估剖宫产的安全性。方法 :对泰州市人民医院 2 0 0 0年 1月 - 1 2月全年剖宫产病例的手术指征 ,产后出血量 ,新生儿出生后Apgar评分等资料进行了综合分析。结果 :全年剖宫产 5 5 4例 ,占分娩总数 3 6 42 %,其中 :剖宫产后大出血2 7例 ,占 4 87%,新生儿窒息 (Apgar <7分 ) 6 0例 ,占 1 0 83 %。结论 :为了真正提高产科质量 ,必须严格掌握剖宫产指征 ,才能提高母儿的安全性。     

The incidence of severe physical child abuse in Wales

OBJECTIVES: The purposes of this study were: (1) to ascertain the incidence and nature of severe physical child abuse in Wales; (2) to ascertain the incidence of all physical abuse in babies under 1 year of age; and (3) to determine whether child protection registers (CPR) accurately reflect the numbers of children who are physically abused. METHODS: This is a population-based incidence study based in Wales, UK, for 2 years from April 1996 through March 1998. Children studied were under the age of 14 with severe physical abuse consistent with the criminal law level of Grievous Bodily Harm. This included seven categories of injury (death; head injury including subdural hemorrhage; internal abdominal injury; physical injury in Munchausen Syndrome by Proxy including suffocation; fracture; burn or scald; adult bite). Cases were ascertained by a pediatrician surveillance reporting system (WPSU). A criterion for inclusion was multidisciplinary agreement that physical abuse had occurred (at case conference, strategy meeting, or Part 8 Review). The incidence of all babies under 1 year of age with physical abuse was also studied. Ascertainment of babies under the age of 1 year was undertaken from CPR as well as the WPSU. RESULTS: Severe abuse is six times more common in babies [54/100,000/year (95% CI +/- 17.2)] than in children from 1 year to 4 years of age [9.2/100,000 (95% CI +/- 3.6)]. It is 120 times more common than in 5- to 13-year-olds [0.47/100,000 (95% CI +/- 0.47)]. This is mainly because two types of serious abuse (brain injury including subdural hemorrhage and fractures) are more common in babies under the age of 1 year than older children. Using data from two sources (the WPSU and CPRs), the incidence of physical abuse in babies is 114/100,000 (CI 114 +/- 11.8) per year. This equates to 1 baby in 880 being abused in the first year of life. The largely rural Health Authority area in Wales had incidence figures for abuse in babies that were 50% of the three other predominantly urban Health Authority areas. Boys throughout the series were more at risk of being severely abused than girls (p < .025). Only 29% of the babies under 1 year of age on the CPR had actually been injured. Thirty percent of abused babies under the age of 1 year and 73% of severely abused children over the age of 1 year had caused previous concern to health professionals regarding abuse or neglect. Conclusions: Physical abuse is a significant problem in babies under the age of 1 year. Very young babies (under 6 months old) have the highest risk of suffering damage or death as a result of physical abuse. Severe abuse, in particular subdural hematoma and fracture, is much more common in babies than in older children. There is evidence of failure of secondary prevention of child abuse by health professionals, with a greater need to act on concerns regarding abuse and neglect. Interagency child protection work in partnership with parents should focus more on protecting babies under age 1 year from further abuse than on maintenance of the infant within an abusive home. The CPR is not intended as an accurate measure of children suffering abuse. It is a record of children requiring a child protection plan and must not be used as a measure of numbers of abused children.     

Fatal child maltreatment in England, 2005-2009

Objective

This paper presents comprehensive and up-to-date data covering 4 years of Serious Case Reviews into fatal child maltreatment in England.

Methods

Information on all notified cases of fatal maltreatment between April 2005 and March 2009 was examined to obtain case characteristics related to a systemic classification of 5 broad groups of maltreatment deaths (severe physical assaults; covert homicide/infanticide; overt homicide; extreme neglect/deprivational abuse; deaths related to but not directly caused by maltreatment).

Results

A total of 276 cases were recorded giving an incidence of 0.63 cases per 100,000 children (0-17) per year. 246 cases could be classified based on the data available. Of these the commonest specific group was those children who died as a result of severe physical assaults. Apparently deliberate overt and covert homicide was less common, while deaths as a direct consequence of neglect were rare. In contrast, some evidence of neglect was found in at least 40% of all cases, though not the direct cause of death.

Conclusions

Class characteristics differ between the different categories of death and may suggest the need for different strategies for prevention.     

Child homicide and neglect in France: 1991–2008

The aim of this study is to investigate epidemiological characteristics of the victims and the offenders in children homicide cases and to propose preventive measures. We retrospectively investigated homicides and deaths by neglect involving children aged 15 or less, which have been autopsied in the Department of Pathology and Legal Medicine of the Raymond Poincaré Hospital, Garches, France, during the 18-year period from 1991 to 2008. Cases included were analyzed for victims’ age and gender, victim-assailant's relation, death cause and scenery, and offender's motivation. For the purposes of the study, victims were divided into four age groups: new born; infants (1–23 months); young children (2–5 years); and children (6–15 years). During the study period, 70 victims of homicide or fatal neglect were identified, which equates to a child homicide prevalence of 0.56 per 100,000 children per year. Slightly more than half of the victims (51.4%) were less than 1 year old. Neonaticide prevalence was 0.12 per 100,000 births with an equal distribution between genders. Neonates were most likely to be killed by their mothers while fathers were the most frequent assailants in both infants and children groups. Stepparents were involved in only one case. Familicide cases where children and spouses are killed were perpetrated only by fathers. The leading cause of death was blunt trauma (especially head trauma). In the neonaticide group, half of the victims died from passive neglect whereas gunshots were predominant in the children groups.     

低龄小儿先心病术后呼吸系统监护15例体会

[目的]确保低龄小儿先心病术后最高的成功率 [方法]用纽邦E 200型呼吸机监护、小儿气管内插管、小儿吸痰管的应用,对15例低龄小儿先心病术后呼吸系统监护管理的方法及护理 [结果]根据各低龄小儿的情况,设定呼吸机初始参数,并根据临床血气分析进行必要的调整,15例低龄小儿先心病患儿均治愈、护理出院 [结论]根据低龄小儿先心病术后采取针对性的护理,是确保低龄小儿先心病术后成功率的关键     

Epidemiology of child homicide in Jefferson County, Alabama

OBJECTIVE: The purpose of this study was to present the epidemiology of homicide among children younger than 6 years of age in Jefferson County, Alabama. This study focused on obtaining great detail on homicides and suspicious deaths occurring within a fixed population. METHODS: For purposes of this study, cases included Jefferson County deaths attributed to "homicide" or that were "undetermined" as noted in the coroner files among children younger than 6 years of age who were born and died between January 1, 1988 and December, 31, 1998. Victim and offender characteristics were obtained from the Jefferson County Coroner/Medical Examiner Office records. Environmental factors and circumstances surrounding the death were noted as well. RESULTS: The 53 study subjects were mainly female (55%), Black (69%), younger than 2 years of age (85%), had single mothers (38%), and a history of abuse (53%). Offenders were more likely to be male (64%), Black (73%), and a parent of the victim (53%). Homicides primarily resulted from an angry impulse (61%), with hands the most common weapon (61%). CONCLUSIONS: The majority of deaths in this study occurred among children younger than age 2, with a high proportion of fatalities among Black children of unmarried mothers. The offender most often knew the victim, with half of all homicides and two-thirds of all infant homicides involving a parent. More than half of the homicides resulted from an angry impulse, while the most common scenario for deaths with undetermined intent involved the caretaker finding the child unresponsive.     

Attachment for Infants in Foster Care: The Role of Caregiver State of Mind

The concordance between foster mothers' attachment state of mind and foster infants' attachment quality was examined for 50 foster mother-infant dyads. Babies had been placed into the care of their foster mothers between birth and 20 months of age. Attachment quality was assessed between 12 and 24 months of age, at least 3 months after the infants' placement into foster care. The two-way correspondence between maternal state of mind and infant attachment quality was 72%, kappa = .43, similar to the level seen among biologically intact mother-infant dyads. Contrary to expectations, age at placement was not related to attachment quality. Rather, concordance between maternal state of mind and infant attachment was seen for relatively late-placed babies, as well as early placed babies. These findings have two major implications. First, following a disruption in care during the first year and a half of life, babies appear capable of organizing their behavior around the availability of new caregivers. Second, these data argue for a nongenetic mechanism for the intergenerational transmission of attachment.     

Complex coronary lesions and rotational atherectomy: one hospital’s experience

Objective

To evaluate the safety and effectiveness of rotational atherectomy followed by drug eluting stent (DES) implantation in patients with complex coronary lesions.

Methods

From August 2006 to August 2012, 253 consecutive patients with 289 lesions and who underwent rotational atherectomy in our center were enrolled in this study.

Results

The overall procedure success rate was 98% with the cost of two (0.8%) coronary perforations, three (1.2%) dissections, five (2.0%) slow flows or no flows, three (1.2%) peri-procedure myocardial infarctions, and two (0.8%) in hospital deaths. During follow-up (mean three years), one (0.4%) patient died, two (0.8%) patients had acute myocardial infarction, 14 (5.5%) had restenosis, and target lesion revascularization occurred in eight patients (3.2%).

Conclusions

Rotational atherectomy followed by DES implantation is a safe and effective technique for patients with complex coronary lesions, especially calcified and non-dilatable lesions.     

Non-organic failure to thrive: Decision for and videotaped evaluations

Infants hospitalized for non-organic failure to thrive in the first six months of life are in a life-threatening situation and are already at risk for poor bonding with mother. In light of this, the meaning and use of foster care and how this separation affects the developing mother-child relationship are the issues addressed through examination of 16 cases in which 8 of the infants were placed in foster care and 8 discharged home after the failure to thrive hospitalization. This paper examines (1) maternal histories of pregnancy, labor and delivery and the neonatal status of placed and non-placed infants; (2) the developmental and weight status of placed children; (3) the nature of the decision criteria for after-hospital care; and (4) the mother-infant relationship at initial intake in terms of mother's report of events and observations of feeding and play interactions during a videotaped assessment process. The study found that the interactions between mother and infant in those situations which required foster care were clearly more dysfunctional when compared to those in which the baby was discharged home to mother. Babies in the two groups were comparable in weight status at the time of hospitalization although babies in foster placement had slightly lower scores on the Bayley Scales. Maternal histories of pregnancy, labor, and delivery were similar for the two groups as were the birth and neonatal histories of the infants.     

Social class and violent child death: An analysis of fatal nonaccidental injury,murder, and fatal child neglect

A total population study to analyse socio-economic status (SES) concomitants of violent and nonaccidental deaths involving children in Queensland, Australia is reported. Cases were traced from coronial files of the Institute of Forensic Pathology, Queensland. All children dying of nonaccidental injuries, neglect, and murder were included. Children were excluded where death was part of the neonaticide syndrome of pregnancy-parturition-concealment. Socioeconomic status scores were assigned to each case using the Congalton four point scale of occupational status. Of the 43 children in the study, 58% were girls. The age of greatest risk of death was in the 1st year of life. A second modal age at 3 years was evident for children who were murdered. Differences in age distribution and socioeconomic status were evident between children who died as a result of nonaccidental injury (N.A.I.), and those who were frankly murdered. All of the children who died as a result of N.A.I. were from lower socioeconomic groups. However, the socioeconomic status distribution for all violent deaths (N.A.I., murder and neglect) is not unlike the socioeconomic status distribution for the general population.     

Effects of a prenatal care intervention for adolescent mothers on birth weight, repeat pregnancy, and educational outcomes at one year postpartum

About one-third of adolescent mothers receive inadequate prenatal care, and babies born to young mothers are more likely to be of low birth weight. The objective of this study is to evaluate a peer-centered prenatal care program for adolescent mothers. Pregnant adolescents were randomly assigned to an experimental or control group in a mastery modeling peer-support intervention designed to improve long- and short-term perinatal outcomes. A sample of 282 urban pregnant adolescents (94% African American, 4% Caucasian, 2% other) participated in the study. Participants were recruited from five clinics located mainly in Detroit, Michigan. Participants in the experimental group received care in a small group setting and learned to perform critical measurements with a peer partner during prenatal visits. Participants in the control group received individual prenatal care in the same clinics. Outcome measures included birth weight, years of schooling completed at one year postpartum, planned and unplanned pregnancy at one year postpartum, and employment and school attendance at one year postpartum. Mothers in the experimental group had a lower rate of low birth weight (6.6% vs. 12.5%, p=0.08). The rate of unplanned pregnancy was also lower for adolescents in the experimental group (13.4% vs. 15.9%), although this difference was not statistically significant. Adolescents who participated in the intervention were more likely to have continued their education during the pregnancy and the postpartum year. The mastery modeling, peer-centered, prenatal care program produced some positive pregnancy outcomes for adolescent mothers.     

Physical abuse of abandoned children in India

Child abuse and neglect, though existing in India, has not come to light because of underlying social constraints like poverty, malnutrition and infection. With an intention to study the problem of physical abuse in neglected children, patients admitted to the pediatric wards of our institution, predominantly with some form of physical abuse were specifically looked for from January 1976 onwards. Over a period of 4$\text{1}\text{2}$ years, 18 such cases were encountered. Most of the babies were less than four weeks of age, were predominantly females, were quite often premature or malnourished, and rarely had a physical deformity. These babies were deserted and later were found by police or social workers in gutters, dustbins, garbage tins, railway platforms, etc. The spectrum of abuse and injuries included newborn babies with intact placenta, at times lacerated, strangling marks on the throat, multiple bruises, bleeding from the umbilicus, avulsion of the scalp with severe bleeding, shock as a result of environmental stress (i.e., hypothermia), evidence of infection, rat bite marks, and fractures. The morbidity was very high, ultimately resulting in 88.9% mortality over varying periods of time, maximum survival being 22 days. The motive behind this abuse always was an unwanted baby.     

Extended households and the life course of young mothers: understanding the associations using a sample of mothers with premature, low birth weight babies

This paper examined whether the greater average schooling and employment, and lower parenting competence, of young mothers who reside with adult relatives reflect preexisting differences versus potential causal mechanisms. The sample included 554 young mothers (ages 13 to 25; nearly two thirds African American) from the Infant Health and Development Program (IHDP) a random-assignment intervention study of premature, low birth weight babies followed 8 times from birth to age 3. Ordinary least squares, fixed-effects, and random-effects models indicated that young mothers of low birth weight babies sorted into extended households based on preexisting characteristics that were correlated with their lower parenting skills and knowledge. In contrast, coresidence predicted greater schooling or employment across models, with some variations for different subgroups.     

南宋襄阳宰相范宗尹考论

南宋高宗朝宰相范宗尹生于北宋元符二年(1099年),卒于南宋绍兴六年(1136年),今人忽略文献记载的矛盾,误信《宋史·范宗尹传》的记载,将他的生年"提前"或"推后"。范宗尹三十二岁任相,是宋代最年轻的宰相。范宗尹如此年轻便位极人臣与南宋初期混乱的政局密不可分。范氏任相时间虽然不长——十四个月,但主政期间数项重大的政治决策帮助南宋王朝渡过内外交困的阶段。然而,范宗尹自身的缺陷,使他很快失去了宋高宗的信任被罢免。罢相后的范宗尹,再未能回到南宋政权的中枢。绍兴六年(1136年),三十八岁的范宗尹病逝于天台。     

试论《红楼梦》中三烈女—鸳鸯、司棋、尤三姐之死

《红楼梦》是一部女性的悲剧 ,很多女性在封建统治、封建文化的双重压迫下死去 ,鸳鸯、司棋、尤三姐的死尤其悲壮。她们看透了封建统治、封建文化的天罗地网 ,与其任人宰割 ,不如主动消灭自己的形骸———以一死保障了自己的意志的自由 ,让统治者目瞪口呆 ,捍卫了自己的人格尊严     

History of abuse and neglect in patients with schizophrenia who have a history of violence

Objective

To determine the prevalence of five forms of abuse/neglect during childhood and adolescence in a group of schizophrenic patients with a history of violence.

Methods

Twenty-eight patients hospitalized in a highly secured psychiatric unit were included. Abuse and neglect during patients’ growth were evaluated with the childhood trauma questionnaire (CTQ). History of substance abuse (consumption of cannabis, and/or alcohol, and/or heroin, and/or cocaine during the year that preceded the hospitalization), incarceration, and death of a close parent were also collected.

Results

We found that 46.4% of patients experienced at least 1 form of abuse and/or neglect during childhood and 21.4% of them had experienced more than 2 forms of abuse and/or neglect. The 2 most frequent forms of neglect and abuse were physical abuse (39.3%) and emotional neglect (17.9%). History of substance abuse was found for cannabis (57.1%), alcohol (57.1%), and cocaine and/or heroin (35.7%). We found that 42.8% of patients had 1 close relative who had died during their growth and that 41.6% of these deaths were violent.

Conclusion

It appears important to systematically search for and assess a history of abuse and neglect during growth in schizophrenic patients with a history of violence, in order to offer specific treatments for this group of patients.     

Forty Years Later: C.P. Snow's Two Cultures Revisited

About 40 years ago, in May 1959, the British novelist Charles Percy Snow was invited to give that year's Rede Lecture at Cambridge. The event became the cause of a major dispute that has not died down since. His concept of ‘The two cultures’ as the lecture was entitled echoes to our day, especially in the technical curriculum discussion. In fact, Snow's Rede Lecture is the only work of his still in print.     

Child maltreatment deaths in the U.S. National Child Death Review Case Reporting System

Comprehensive reviews of child death are increasingly conducted throughout the world, although limited information is available about how this information is systematically used to prevent future deaths. To address this need, we used cases from 2005 to 2009 in the U.S. National Child Death Review Case Reporting System to compare child and offender characteristics and to link that information with actions taken or recommended by review teams. Child, caretaker, and offender characteristics, and outcomes were compared to team responses, and findings were compared to published case series. Among 49,947 child deaths from 23 states entered into the Case Reporting System during the study period, there were 2,285 cases in which child maltreatment caused or contributed to fatality. Over one-half had neglect identified as the maltreatment, and 30% had abusive head trauma. Several child and offender characteristics were associated with specific maltreatment subtypes, and child death review teams recommended and/or planned several activities in their communities. Case characteristics were similar to those published in other reports of child maltreatment deaths. Teams implemented 109 actions or strategies after their review, and we found that aggregating information from child death reviews offers important insights into understanding and preventing future deaths. The National Child Death Review Case Reporting System contains information about a large population which confirms and expands our knowledge about child maltreatment deaths and which can be used by communities for future action.