Head injury secondary to suspected child maltreatment: results of a prospective Canadian national surveillance program

Objective

We sought to determine the incidence, clinical features, and demographic profile of head injury secondary to suspected child maltreatment (abuse or neglect) in Canada to help inform the development and evaluation of prevention programs for abusive head injuries.

Methods

From March 1, 2005 to February 28, 2008, an average of 2,545 paediatricians and paediatric subspecialists were surveyed monthly through the established network of the Canadian Paediatric Surveillance Program. We calculated incidence rates using the number of confirmed cases over the product of the duration of the study (3 years) and population estimates by age group.

Results

There were 220 confirmed cases of head injury from suspected child maltreatment. The annual incidence rate was 14.1 per 100,000 for children less than 1 year of age and 1.4 per 100,000 for those less than 15 years. Seventy three percent (141) of cases involved infants less than 12 months of age and 52% (100) of cases involved infants less than 6 months of age. Seventy-five percent (165) of cases presented to the emergency room. With regard to outcome, 12% (27) of cases resulted in death and 45% (75) of survivors had neurological sequelae at discharge. Thirty percent (67) of all cases, as well as 30% (8) of deaths were previously known to child welfare authorities.

Conclusion

This study provides an estimate of the rate of head injury secondary to suspected child maltreatment in Canada. The young age and poor medical outcomes of those involved highlights the need for prevention efforts that are implemented early in life. Given that a significant percentage of injured infants and children were already known to child welfare authorities, the study also highlights the need to establish and evaluate additional preventive efforts for parents and caregivers already in the child welfare system.     

Rapid Prototyping a Collections-based Mobile Wayfinding Application

This research presents the results of a project that investigated how students use a library developed mobile app to locate books in the library. The study employed a methodology of formative evaluation so that the development of the mobile app would be informed by user preferences for next generation wayfinding systems. A key finding is the importance of gathering ongoing user feedback for designing useful and used mobile academic library applications. Elements and data points to include in future mobile interfaces are discussed.     

Validity and reliability of a low-cost dynamometer to assess maximal isometric strength of upper limb

Muscle imbalance and deficit are key parameters for guiding rehabilitation and sports sessions and avoiding injuries. However, the high cost and non-portable nature of most instruments employed for muscle strength assessment frequently hamper an affordable evaluation in field conditions. This study evaluated the validity and reliability of a low-cost digital dynamometer to assess the maximal isometric strength of upper limb muscles. Fourteen physically active volunteers performed the main movements of the upper limb at maximal isometric strength: flexion-extension, internal-external rotation and abduction-adduction of the shoulder; and flexion-extension of both elbow and wrist. Validity was examined by comparing the strength values from the low-cost digital dynamometer and those measured by an isokinetic dynamometer, assumed as the gold standard. The correlation between both devices was perfect (r > 0.913), while Bland-Altman plots showed absolute agreement between both devices, the maximum range of the values of bias was ?0.99–1.00 N in wrist extension. Inter-tester and intra-tester reliability were excellent for all movements (ICC ≥ 0.855). The low-cost digital dynamometer showed strong validity and excellent reliability in assessing maximal isometric strength during the main movements of the upper limb. Professionals may use it for an affordable isometric muscle strength assessment in field situations.     

‘To educate children from birth’: a genealogical analysis of some practices of subjectivation in Spanish and French scientific childcare (1898–1939)

The aim of this paper is to analyse certain techniques of subjectivation in modern child-rearing and the way in which medical discourse leads to the construction of children through those techniques. As a case study, several manuals on childcare used during the first third of the twentieth century in Spain and France have been selected. A historical-genealogical perspective is adopted, according to which childhood is not a natural or ahistorical category, but depends on cultural practices. In Western countries, these practices have been strongly influenced by expert discourses. The techniques proposed in the manuals are identified and the theoretical justification for them analysed according to the socio-cultural and historical context. It is shown in what sense the practices recommended by doctors for mothers constituted a kind of early informal education contributing to the creation of future well-educated citizens.