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Preterm Birth and Infantile Appendicitis
Pediatrics
Abstract
OBJECTIVE
To investigate the potential association between preterm birth and infantile appendicitis.
METHODS
We conducted a retrospective, multicenter, matched case-control study. This study included consecutive patients <1 year of age with surgery- or autopsy-confirmed appendicitis, admitted between December 2007 and May 2023. For each case, 10 healthy infants were randomly selected and matched by age. Infants were categorized as neonates (0 to 28 days) or older infants (>28 days and <1 year).
RESULTS
The study included 106 infants diagnosed with appendicitis (median age 2.4 months) and 1060 age-matched healthy controls. In the univariate analysis, preterm birth was significantly associated with the development of appendicitis within the first year of life (odds ratio [OR], 4.23; 95% confidence interval [CI], 2.67–6.70). Other factors associated with a higher risk of infantile appendicitis included being male (OR, 1.91; 95%CI, 1.25–2.94), weight-for-age z-score (OR, 0.72; 95%CI, 0.64–0.81), and exclusively fed on formula (OR, 2.95; 95%CI, 1.77–4.91). In multivariable analyses, preterm remained significantly associated with appendicitis (adjusted OR, 3.32; 95%CI, 1.76–6.24). Subgroup analysis revealed that a preterm birth history increased the risk of appendicitis in both neonates (adjusted OR, 4.56; 95%CI, 2.14–9.71) and older infants (adjusted OR, 3.63; 95%CI, 1.72–7.65). However, preterm did not significantly influence the incidence of appendiceal perforation.
CONCLUSIONS
Preterm infants have an increased risk of appendicitis during the first year of life. A preterm birth history may help improve the timely diagnosis of infantile appendicitis.
... Neonatal appendicitis has a propensity to rapidly progress to a life-threatening condition, necessitating early and accurate diagnosis and treatment to reduce mortality rates. The characteristics of neonatal appendicitis has been reported in previous studies [8,14]. The symptoms are very nonspecific, and the clinical signs are vague within this demographic, complicating the timely diagnosis and emphasizing the need for supportive diagnostic tools, especially abdominal ultrasonography [15,16]. ...
Background
Neonatal appendicitis is a rare but critical condition that presents diagnostic challenges due to its nonspecific symptoms and clinical manifestations. Early and accurate diagnosis is crucial for reducing the high mortality rates associated with this condition. Abdominal ultrasonography plays a pivotal role in identifying characteristic signs of appendicitis in neonates. This study aimed to investigate whether neonatal appendicitis can be diagnosed with abdominal ultrasonography by identifying its specific signs.
Methods
This study reviewed 20 consecutive cases of neonatal appendicitis confirmed through surgery at a National Medical Center. Preoperative abdominal ultrasonography was analyzed for direct and indirect signs of appendicitis.
Results
Our study included neonates with a mean age of 13.0 ± 7.1 days. The appendix was identifiable in 13 out of 20 cases (65%). The mean outer diameter of the appendix was 4.6 ± 1.8 mm. Eight cases had appendix diameter ≥ 4 mm. Fluid accumulation within the appendiceal cavity was noted in 6 (30%) patients, and peri-appendiceal fluid accumulation was detected in 5 (25%) patients. Ultrasonography revealed appendiceal perforation in 12 out of 16 cases (75%). The indirect signs of neonatal appendicitis included right lower quadrant (RLQ) abscess, pneumoperitoneum, and thickening of the intestinal wall and mesentery in the RLQ.
Conclusion
Most cases of neonatal appendicitis may be diagnosed through abdominal ultrasonography by identifying both direct and indirect signs. Future studies with larger patient cohorts are needed to improve ultrasonographic diagnosis of neonatal appendicitis.
Filicide, the murder of a child by a parent, is a multifaceted phenomenon with various causes and characteristics. This review of the existing literature delineates the present state of knowledge regarding filicide and illustrates similarities and differences between offenses perpetrated by mothers and by fathers. The importance of numerous reports of an association between filicide and parental pre-existing psychiatric disorders is compounded by indications that a significant number of homicidal parents come to the attention of psychiatrists or other health professionals before the offense occurs. As prevention implies the recognition of causes involved in particular situations, a better understanding of potentially fatal parental/familial dynamics leading to filicide could facilitate the identification of risk and enable effective intervention strategies.
Experiences of teen dating violence (TDV), sexual violence, and bullying during adolescence are all forms of interpersonal violence victimization (IVV) and are associated with health and behavioral issues during adulthood. Data from the nationally representative 2011-2021 Youth Risk Behavior Surveys were used to estimate the 2021 prevalence of IVV reported by U.S. high school students. IVV included past-year sexual TDV, physical TDV, sexual violence by anyone, electronic bullying, being bullied on school property, and lifetime forced sex and was analyzed by demographic characteristics and sex of sexual contacts. This report also explored trends in IVV over this 10-year period among U.S. high school students. In 2021, a total of 8.5% of students reported physical TDV, 9.7% reported sexual TDV, 11.0% reported sexual violence by anyone (with 59.5% of those also reporting sexual TDV), 15.0% reported bullying on school property, and 15.9% reported electronic bullying victimization during the past 12 months; 8.5% also reported experiencing forced sex in their lifetime. Disparities were observed for each form of IVV assessed for females and for most forms of IVV among racial and ethnic minority students; students who identified as lesbian, gay, bisexual, questioning, or other (LGBQ+); and students who reported their sexual contacts as same sex only or both sexes. Trend analyses indicated that physical TDV, sexual TDV, any physical or sexual TDV, and both physical and sexual TDV victimization decreased from 2013 to 2021 (although sexual TDV increased from 2019 to 2021). Any bullying victimization decreased from 2011 to 2021. Lifetime forced sexual intercourse decreased from 2011 to 2015, then increased from 2015 to 2021. Being bullied on school property was unchanged from 2011 to 2017, then decreased from 2017 to 2021. Sexual violence by anyone increased from 2017 to 2021. This report highlights disparities in IVV and provides the first national estimates among Native Hawaiian or other Pacific Islander youths. Findings, including trend analyses indicating recent increases in certain forms of IVV, point to the continued urgency of violence prevention efforts for all U.S. youths and especially those who are disproportionately affected by IVV.
Necrotizing enterocolitis (NEC) is the leading basis for gastrointestinal morbidity and poses a significant risk for neurodevelopmental impairment (NDI) in preterm infants. Aberrant bacterial colonization preceding NEC contributes to the pathogenesis of NEC, and we have demonstrated that immature microbiota in preterm infants negatively impacts neurodevelopment and neurological outcomes. In this study, we tested the hypothesis that microbial communities before the onset of NEC drive NDI. Using our humanized gnotobiotic model in which human infant microbial samples were gavaged to pregnant germ-free C57BL/6J dams, we compared the effects of the microbiota from preterm infants who went on to develop NEC (MNEC) to the microbiota from healthy term infants (MTERM) on brain development and neurological outcomes in offspring mice. Immunohistochemical studies demonstrated that MNEC mice had significantly decreased occludin and ZO-1 expression compared to MTERM mice and increased ileal inflammation marked by the increased nuclear phospho-p65 of NFκB expression, revealing that microbial communities from patients who developed NEC had a negative effect on ileal barrier development and homeostasis. In open field and elevated plus maze tests, MNEC mice had worse mobility and were more anxious than MTERM mice. In cued fear conditioning tests, MNEC mice had worse contextual memory than MTERM mice. MRI revealed that MNEC mice had decreased myelination in major white and grey matter structures and lower fractional anisotropy values in white matter areas, demonstrating delayed brain maturation and organization. MNEC also altered the metabolic profiles, especially carnitine, phosphocholine, and bile acid analogs in the brain. Our data demonstrated numerous significant differences in gut maturity, brain metabolic profiles, brain maturation and organization, and behaviors between MTERM and MNEC mice. Our study suggests that the microbiome before the onset of NEC has negative impacts on brain development and neurological outcomes and can be a prospective target to improve long-term developmental outcomes.
Understanding the burden of gun violence among youth is a public health imperative. While most estimates are based on direct and witnessed victimization, living nearby gun violence incidents may be consequential too. Yet detailed information about these broader experiences of violence is lacking. We use data on a population-based cohort of youth merged with incident-level data on deadly gun violence to assess the prevalence and intensity of community exposure to gun homicides across cross-classified categories of exposure distance and recency, overall and by race/ethnicity, household poverty, and neighborhood disadvantage. In total, 2–18% of youth resided within 600 m of a gun homicide occurring in the past 14–365 days. These percentages were 3–25% for incidents within 800 m and 5–37% for those within a 1300-m radius. Black and Latinx youth were 3–7 times more likely, depending on the exposure radius, to experience a past-year gun homicide than white youth and on average experienced incidents more recently and closer to home. Household poverty contributed to exposure inequities, but disproportionate residence in disadvantaged neighborhoods was especially consequential: for all racial/ethnic groups, the difference in the probability of exposure between youth in low vs high poverty households was approximately 5–10 percentage points, while the difference between youth residing in low vs high disadvantage neighborhoods was approximately 50 percentage points. Given well-documented consequences of gun violence exposure on health, these more comprehensive estimates underscore the importance of supportive strategies not only for individual victims but entire communities in the aftermath of gun violence.
Importance:
Preterm birth complications are the leading cause of death in children younger than 5 years worldwide. Despite advancing knowledge of risk factors and mechanisms related to preterm labor, the preterm birth rate has risen in most industrialized countries. Moreover, the burden of neonatal preterm birth remains unclear across the world.
Objective:
To determine the trends in incidence and mortality of neonatal preterm birth at the global, regional, and national levels to quantify its burden from 1990 to 2019 using data from the 2019 Global Burden of Disease study.
Design, setting, and participants:
Annual incident cases, deaths, age-standardized incidence rates (ASIRs), and age-standardized mortality rates (ASMRs) of neonatal preterm birth between 1990 and 2019 were collected from the 2019 Global Burden of Disease study. The percentage of relative changes in incident cases and deaths as well as the estimated annual percentage changes (EAPCs) of ASIRs and ASMRs were calculated to quantify their temporal trends. Correlations of EAPC of ASIRs and ASMRs with sociodemographic index (SDI) and universal health coverage index were evaluated by Pearson correlation analyses.
Exposures:
Infants born alive before 37 completed weeks of gestation between 1990 and 2019.
Main outcomes and measures:
Incident cases, deaths, ASIRs, and ASMRs of neonatal preterm birth.
Results:
Globally, the incident cases of neonatal preterm birth decreased by 5.26% from 16.06 million in 1990 to 15.22 million in 2019, and the deaths decreased by 47.71% from 1.27 million in 1990 to 0.66 million in 2019. The overall ASIR (EAPC = -0.19 [95% CI, -0.27 to -0.11]) and ASMR (EAPC = -2.09 [95% CI, -1.99 to -2.20]) decreased in this period. The ASIR of neonatal preterm birth increased by a mean of 0.25% (95% CI, 0.13%-0.38%) in high-SDI regions from 1990 to 2019. The ASMR of neonatal preterm birth increased by a mean of 2.09% (95% CI, 1.99%-2.20%) in Southern Sub-Saharan Africa in this period. A positive correlation was observed between EAPC of ASIR and SDI or universal health coverage index in 2019, while a negative correlation was observed between EAPC in ASMR and SDI or universal health coverage index in 2019 at national levels.
Conclusions and relevance:
Preterm birth remains a crucial issue in children worldwide, with an increasing trend in ASIR in high-SDI regions and in ASMR in Southern Sub-Saharan Africa between 1990 to 2019. Efforts to reduce both the incidence and mortality of preterm births are essential.
Problem/condition:
In 2019, approximately 67,000 persons died of violence-related injuries in the United States. This report summarizes data from CDC's National Violent Death Reporting System (NVDRS) on violent deaths that occurred in 42 states, the District of Columbia, and Puerto Rico in 2019. Results are reported by sex, age group, race and ethnicity, method of injury, type of location where the injury occurred, circumstances of injury, and other selected characteristics.
Period covered:
2019.
Description of system:
NVDRS collects data regarding violent deaths obtained from death certificates, coroner and medical examiner records, and law enforcement reports. This report includes data collected for violent deaths that occurred in 2019. Data were collected from 39 states with statewide data (Alabama, Alaska, Arizona, Colorado, Connecticut, Delaware, Georgia, Hawaii, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Rhode Island, South Carolina, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, and Wyoming), three states with data from counties representing a subset of their population (30 California counties, representing 57% of its population, and 47 Illinois counties and 40 Pennsylvania counties, representing at least 80% of their populations), the District of Columbia, and Puerto Rico. NVDRS collates information for each violent death and links deaths that are related (e.g., multiple homicides, homicide followed by suicide, or multiple suicides) into a single incident.
Results:
For 2019, NVDRS collected information on 50,374 fatal incidents involving 51,627 deaths that occurred in 42 states (39 states collecting statewide data, 30 California counties, 47 Illinois counties, and 40 Pennsylvania counties), and the District of Columbia. In addition, information was collected for 831 fatal incidents involving 897 deaths in Puerto Rico. Data for Puerto Rico were analyzed separately. Of the 51,627 deaths, the majority (64.1%) were suicides, followed by homicides (25.1%), deaths of undetermined intent (8.7%), legal intervention deaths (1.4%) (i.e., deaths caused by law enforcement and other persons with legal authority to use deadly force acting in the line of duty, excluding legal executions), and unintentional firearm deaths (<1.0%). The term "legal intervention" is a classification incorporated into the International Classification of Diseases, Tenth Revision, and does not denote the lawfulness or legality of the circumstances surrounding a death caused by law enforcement. Demographic patterns and circumstances varied by manner of death. The suicide rate was higher for males than for females. Across all age groups, the suicide rate was highest among adults aged 45-54 years. In addition, non-Hispanic American Indian or Alaska Native (AI/AN) and non-Hispanic White (White) persons had the highest suicide rates among all racial and ethnic groups. Among males, the most common method of injury for suicide was a firearm, whereas poisoning was the most common method of injury among females. Among all suicide victims, suicide was most often preceded by a mental health, intimate partner, or physical health problem or by a recent or impending crisis during the previous or upcoming 2 weeks. The homicide rate was higher for males than for females. Among all homicide victims, the homicide rate was highest among persons aged 20-24 years compared with other age groups. Non-Hispanic Black (Black) males experienced the highest homicide rate of any racial or ethnic group. Among all homicide victims, the most common method of injury was a firearm. When the relationship between a homicide victim and a suspect was known, the suspect was most frequently an acquaintance or friend for male victims and a current or former intimate partner for female victims. Homicide most often was precipitated by an argument or conflict, occurred in conjunction with another crime, or, for female victims, was related to intimate partner violence. Nearly all victims of legal intervention deaths were male, and the legal intervention death rate was highest among men aged 25-29 years. The legal intervention death rate was highest among AI/AN males, followed by Black males. A firearm was used in the majority of legal intervention deaths. When a specific type of crime was known to have precipitated a legal intervention death, the type of crime was most frequently assault or homicide. The three most frequent circumstances reported for legal intervention deaths were as follows: the victim's death was precipitated by another crime, the victim used a weapon in the incident, and the victim had a mental health or substance use problem (other than alcohol use). Unintentional firearm deaths were most frequently experienced by males, White persons, and persons aged 15-24 years. These deaths most frequently occurred while the shooter was playing with a firearm and were precipitated by a person unintentionally pulling the trigger or mistakenly thinking the firearm was unloaded. The rate of deaths of undetermined intent was highest among males, particularly among Black and AI/AN males, and among adults aged 30-44 years. Poisoning was the most common method of injury in deaths of undetermined intent, and opioids were detected in nearly 80% of decedents tested for those substances.
Interpretation:
This report provides a detailed summary of data from NVDRS on violent deaths that occurred in 2019. The suicide rate was highest among AI/AN and White males, whereas the homicide rate was highest among Black males. Mental health problems, intimate partner problems, interpersonal conflicts, and acute life stressors were primary circumstances for multiple types of violent death.
Public health action:
Violence is preventable, and data can guide public health action. NVDRS data are used to monitor the occurrence of violence-related fatal injuries and assist public health authorities in developing, implementing, and evaluating programs, policies, and practices to reduce and prevent violent deaths. For example, the New Hampshire Violent Death Reporting System (VDRS), Indiana VDRS, and Colorado VDRS have used their VDRS data to guide suicide prevention efforts and generate reports highlighting where additional focus is needed. In New Hampshire, VDRS data have been used to monitor the increase in suicide rates during 2014-2018 and guide statewide collaborative prevention efforts. Indiana VDRS used local data to demonstrate differences in suicide and other related mental health problems among Black persons and highlight a need for improved suicide awareness and culturally competent mental health care. The Colorado VDRS conducted geospatial and demographic analysis, considering local VDRS data with existing suicide prevention efforts and resources, to identify regions with high suicide rates regions and populations at high risk for suicide. Similarly, states participating in NVDRS have used their VDRS data to examine related to homicide in their state. In North Carolina for example, where homicide rates among AI/AN and Black persons were approximately 2.5 times higher than the statewide homicide rate, the North Carolina VDRS program aims to partner with historically Black colleges and universities in the state to train researchers to use VDRS data to address health equity issues in and around their immediate community.
Viral diarrhea is one of the leading causes of morbidity and mortality in children. This study was conducted to disclose the etiological cause and epidemiological features of viral diarrhea among children in China. From 2009 to 2021, active surveillance was performed on pediatric patients with acute diarrhea and tested for five enteric viruses. Positive detection was determined in 65.35% (3,325/5,072) patients and an age‐specific infection pattern was observed. Significantly higher positive rate was observed in 12‐23‐months old children for rotavirus (47.46%,) and adenovirus (7.06%), while significantly higher positive rate was observed for norovirus (37.62%) in 6‐11‐months old patients, and for astrovirus (11.60%) and sapovirus (10.79%) in 24‐47‐months old patients. Higher positive rate of rotavirus in girls and norovirus in boys was observed only among 6‐11 months patients. We also observed more norovirus among patients from rural areas in 0‐5‐months and 36‐47‐months groups and more rotavirus in those from rural areas in 12‐23‐months group. Diarrhea severity was greater for rotavirus in 6‐23‐months group and norovirus in 6‐11‐months group. Coinfections were observed in 29.26% of patients, which was most frequently observed between rotavirus and others (89.31%). Our findings could help the prediction, prevention, and potential therapeutic approaches of viral diarrhea in children. This article is protected by copyright. All rights reserved.
Background
Causes of mortality are a crucial input for health systems for identifying appropriate interventions for child survival. We present an updated series of cause-specific mortality for neonates and children younger than 5 years from 2000 to 2019.
Methods
We updated cause-specific mortality estimates for neonates and children aged 1–59 months, stratified by level (low, moderate, or high) of mortality. We made a substantial change in the statistical methods used for previous estimates, transitioning to a Bayesian framework that includes a structure to account for unreported causes in verbal autopsy studies. We also used systematic covariate selection in the multinomial framework, gave more weight to nationally representative verbal autopsy studies using a random effects model, and included mortality due to tuberculosis.
Findings
In 2019, there were 5·30 million deaths (95% uncertainty range 4·92–5·68) among children younger than 5 years, primarily due to preterm birth complications (17·7%, 16·1–19·5), lower respiratory infections (13·9%, 12·0–15·1), intrapartum-related events (11·6%, 10·6–12·5), and diarrhoea (9·1%, 7·9–9·9), with 49·2% (47·3–51·9) due to infectious causes. Vaccine-preventable deaths, such as for lower respiratory infections, meningitis, and measles, constituted 21·7% (20·4–25·6) of under-5 deaths, and many other causes, such as diarrhoea, were preventable with low-cost interventions. Under-5 mortality has declined substantially since 2000, primarily because of a decrease in mortality due to lower respiratory infections, diarrhoea, preterm birth complications, intrapartum-related events, malaria, and measles. There is considerable variation in the extent and trends in cause-specific mortality across regions and for different strata of all-cause under-5 mortality.
Interpretation
Progress is needed to improve child health and end preventable deaths among children younger than 5 years. Countries should strategize how to reduce mortality among this age group using interventions that are relevant to their specific causes of death.
Funding
Bill & Melinda Gates Foundation; WHO.
Antimicrobial peptides (AMPs) are short cationic amphipathic peptides with a wide range of antimicrobial properties and play an important role in the maintenance of immune homeostasis by modulating immune responses in the reproductive tract. As intra-amniotic infection and microbial dysbiosis emerge as common causes of preterm births (PTBs), a better understanding of the AMPs involved in the development of PTB is essential. The altered expression of AMPs has been reported in PTB-related clinical presentations, such as preterm labor, intra-amniotic infection/inflammation, premature rupture of membranes, and cervical insufficiency. Moreover, it was previously reported that dysregulation of AMPs may affect the pregnancy prognosis. This review aims to describe the expression of AMPs associated with PTBs and to provide new perspectives on the role of AMPs in PTB.
Background
Multi-victim homicides are a persistent public health problem confronting the United States. Previous research shows that homicide rates in the U.S. are approximately seven times higher than those of other high-income countries, driven by firearm homicide rates that are 25 times higher; 31% of public mass shootings in the world also occur in the U.S.. The purpose of this analysis is to examine the characteristics of mass, multiple, and single homicides to help identify prevention points that may lead to a reduction in different types of homicides.
Methods
We used all available years (2003–2017) and U.S. states/jurisdictions (35 states, the District of Columbia, and Puerto Rico) included in CDC’s National Violent Death Reporting System (NVDRS), a public health surveillance system which combines death certificate, coroner/medical examiner, and law enforcement reports into victim- and incident-level data on violent deaths. NVDRS includes up to 600 standard variables per incident; further information on types of mental illness among suspected perpetrators and incident resolution was qualitatively coded from case narratives. Data regarding number of persons nonfatally shot within incidents were cross-validated when possible with several other resources, including government reports and the Gun Violence Archive. Mass homicides (4+ victims), multiple homicides (2-3 victims) and single homicides were analyzed to assess group differences using Chi-square tests with Bonferroni-corrected post-hoc comparisons.
Results
Mass homicides more often had female, child, and non-Hispanic white victims than other homicide types. Compared with victims of other homicide types, victims of mass homicides were more often killed by strangers or someone else they did not know well, or by family members. More than a third were related to intimate partner violence. Approximately one-third of mass homicide perpetrators had suicidal thoughts/behaviors noted in the time leading up to the incident. Multi-victim homicides were more often perpetrated with semi-automatic firearms than single homicides. When accounting for nonfatally shot victims, over 4 times as many incidents could have resulted in mass homicide.
Conclusions
These findings underscore the important interconnections among multiple forms of violence. Primary prevention strategies addressing shared risk and protective factors are key to reducing these incidents.
Objectives
To update the WHO estimate of preterm birth rate in China in 1990–2016 and to further explore variations by geographic regions and years of occurrence.
Design
Systematic review and meta-analysis.
Data sources
Pubmed, Embase, Cochrane Library and Sinomed databases were searched from 1990 to 2018.
Eligibility criteria
Studies were included if they provided preterm birth data with at least 500 total births. Reviews, case–control studies, intervention studies and studies with insufficient information or published before 1990 were excluded. We estimated pooled incidence of preterm birth by a random effects model, and preterm birth rate in different year, region and by livebirths or all births in subgroup analyses.
Results
Our search identified 3945 records. After the removal of duplicates and screening of titles and abstracts, we reviewed 254 studies in full text and excluded 182, leaving 72 new studies. They were combined with the 82 studies included in the WHO report (154 studies, 187 data sets in total for the meta-analysis), including 24 039 084 births from 1990 to 2016. The pooled incidence of preterm birth in China was 6.09% (95% CI 5.86% to 6.31%) but has been steadily increasing from 5.36% (95% CI 4.89% to 5.84%) in 1990–1994 to 7.04% (95% CI 6.09% to 7.99%) in 2015–2016. The annual rate of increase was about 1.05% (95% CI 0.85% to 1.21%). Northwest China appeared to have the highest preterm birth rate (7.3%, 95% CI 4.92% to 9.68% from 1990 to 2016).
Conclusions
The incidence of preterm birth in China has been rising gradually in the past three decades. It was 7% in 2016. Preterm birth rate varied by region with the West having the highest occurrence.
Purpose
Intimate partner violence (IPV) among adolescents, or teen dating violence (TDV), is a significant public health issue that may affect up to two-thirds of youth aged 12–18. Gun violence among adolescents is similarly high, accounting for 18.7% of all firearm injuries from 2010 to 2016. Despite these statistics and evidence showing that TDV continues into adulthood as IPV, gun-related TDV has not received the same level of attention as adult IPV. In this scoping review, we are guided by the following questions: (1) what are the known risk and protective factors for gun-related TDV across micro (individual, interpersonal), mezzo (school, neighborhood), and macro (policy, social norms) domains? (2) What are the future directions for this area of research?
Methods
We conducted a scoping review of eight academic databases to identify peer-reviewed studies examining risk and protective factors for gun-related TDV published in 1999–2019.
Results
Our search returned few unique results (N = 16). Most of the published studies described the shared individual risk factors of gun carrying/access and TDV. Mezzo studies discussed TDV within the context of peer aggression or youth delinquency and gun carrying. There were zero macro studies meeting our search parameters.
Conclusion
Our review suggests that adolescence may confer a unique blend of risk factors for both firearm and relationship violence, yet the intersection of these issues has received relatively little attention compared to gun violence in adult relationships. Areas for future inquiry involve increased surveillance of this issue and interventions addressing the shared risks for gun carrying/access and TDV.
Intimate partner violence (IPV) is defined as physical violence, sexual violence, stalking, and/or psychological aggression carried out by an individual’s current or former intimate partner. IPV is prevalent in society and has lasting adverse consequences for survivors and their children, including poor physical health, psychological distress, and social consequences like isolation from social networks. Given the well established, potentially devastating consequences of IPV for the entire family, there is a critical need for researchers, practitioners, and decision makers to better understand the services that exist to help prevent IPV and address it effectively when it occurs.
IPV services reach a relatively small proportion of men, women, and families affected by IPV. Men in particular can be difficult to reach. Services like battering intervention programs (BIPs) can be prohibitively expensive, even though a majority of referrals to BIPs are made through court-ordered mandates or via child protective services requirements. Therefore, not all users of violence can access BIPs even when mandated or required. Further, the stigma and shame attached to being a male survivor of IPV or to receiving either survivor services or services for users of violence can limit disclosures of violence. Federal Responsible Fatherhood (RF) programs serve men who may be at an increased risk for using or being survivors of IPV. Fathers served through these programs may be motivated to seek out IPV services mostly by their desire to become better fathers. Thus, RF programs are in a unique position to address IPV among fathers, and especially to help prevent it from occurring in the first place.
This report summarizes findings from the Preventing and Addressing Intimate Violence when Engaging Dads (PAIVED) research study funded by the Office of Family Assistance (OFA) and overseen by the Office of Planning, Research, and Evaluation (OPRE). Child Trends and their partners, Boston Medical Center and Futures Without Violence, conducted the study, which examines how RF programs aim to prevent and address IPV through their fatherhood programming. Specifically, this report presents information about the approaches that RF programs take to provide IPV-related services. It also discusses challenges and successes to providing these services, promising practices, and areas for growth.
The interviewees for this study preferred (and overwhelmingly used) the term “domestic violence” (DV), rather than “intimate partner violence.” As a result, this report uses IPV and DV interchangeably. To ensure consistent use of terminology, we use IPV throughout the overview, background, and methodology sections. When we transition to the study findings, we use DV to accurately reflect the language choices of interviewees.
Domestic homicides account for more than one in four homicides in the United States and frequently involve multiple victims. This study examined the prevalence of firearm use in domestic homicides in the United States and the associated risk of a multiple homicide event. We used weighted negative binomial regression to model the effects of firearm use on the number of additional victims in domestic and nondomestic homicides using data from the Federal Bureau of Investigation's Supplementary Homicide Reports. Results showed that firearms were used in 54.1 percent of domestic homicides. Firearm use was associated with a 70.9 percent and 38.7 percent increased incidence of additional victimization in domestic and nondomestic homicides, respectively. Whereas male and female perpetrators differed minimally in the likelihood of additional victims in domestic homicides committed with a non-firearm (3.6% versus 2.5%), males were nearly three times more likely to have multiple victims in domestic homicides involving a firearm (6.9% versus 2.4%). Interaction tests showed that the risk of additional victims associated with firearm use was stronger in domestic situations than in nondomestic situations and among male perpetrators. These findings highlight the risk of multiple homicides in domestic homicide situations and the role of firearms in expanding the risk of victimization beyond a single victim.
Human milk contains non-nutritional factors that promote intestinal maturation and protect against infectious and inflammatory conditions. In the Neonatal Intensive Care Unit (NICU) setting, donor milk (DM) is recommended when availability of own mother’s milk (OMM) is not enough. Our aim was to compare the incidence of necrotizing enterocolitis (NEC) and late-onset sepsis (LOS) in very preterm infants (VPI) after the introduction of DM. Growth and breastfeeding rates were examined as secondary outcomes. Single center, observational and retrospective cohort study comparing 227 VPI admitted to our neonatal unit before (Group 1, n = 99) and after (Group 2, n = 128) DM introduction. Enteral nutrition was started earlier after DM availability (2.6 ± 1.1 vs. 2.1 ± 1 days, p = 0.001). Incidence of NEC decreased in group 2 (9.1% vs. 3.4%, p = 0.055), especially in those born between 28 and 32 weeks (5.4 vs. 0.0%, p = 0.044). Surgical NEC was also less frequent. Suffering NEC was 4 times more likely in group 1 (multivariate analysis). Availability of DM did not impact breastfeeding rates or preterm growth. Our findings support the protective role of DM against NEC, particularly in non-extreme VPI, a group less frequently included in clinical guidelines and research studies on the use of DM.
Intestinal barrier immaturity, or “leaky gut,” is the proximate cause of susceptibility to necrotizing enterocolitis in preterm neonates. However, the impact of intestinal microbiota development on intestinal mucosal barrier maturation has not been evaluated in this population. In this study, we investigated a longitudinally sampled cohort of 38 preterm infants < 33 weeks gestation monitored for intestinal permeability (IP) and fecal microbiota during the first 2 weeks of life. Rapid decrease in IP indicating intestinal barrier function maturation correlated with significant increase in community diversity. In particular, members of the Clostridiales and Bifidobacterium were highly transcriptionally active, and progressively increasing abundance in Clostridiales was significantly associated with decreased intestinal permeability. Further, neonatal factors previously identified to promote intestinal barrier maturation, including early exclusive breastmilk feeding and shorter duration antibiotic exposure, associate with the early colonization of the intestinal microbiota by members of the Clostridiales, which altogether are associated with improved intestinal barrier function in preterm infants.
Background
Preterm birth is the leading cause of death in children younger than 5 years worldwide. Although preterm survival rates have increased in high-income countries, preterm newborns still die because of a lack of adequate newborn care in many low-income and middle-income countries. We estimated global, regional, and national rates of preterm birth in 2014, with trends over time for some selected countries.
Methods
We systematically searched for data on preterm birth for 194 WHO Member States from 1990 to 2014 in databases of national civil registration and vital statistics (CRVS). We also searched for population-representative surveys and research studies for countries with no or limited CRVS data. For 38 countries with high-quality data for preterm births in 2014, data are reported directly. For countries with at least three data points between 1990 and 2014, we used a linear mixed regression model to estimate preterm birth rates. We also calculated regional and global estimates of preterm birth for 2014.
Findings
We identified 1241 data points across 107 countries. The estimated global preterm birth rate for 2014 was 10·6% (uncertainty interval 9·0–12·0), equating to an estimated 14·84 million (12·65 million–16·73 million) live preterm births in 2014. 12· 0 million (81·1%) of these preterm births occurred in Asia and sub-Saharan Africa. Regional preterm birth rates for 2014 ranged from 13·4% (6·3–30·9) in North Africa to 8·7% (6·3–13·3) in Europe. India, China, Nigeria, Bangladesh, and Indonesia accounted for 57·9 million (41×4%) of 139·9 million livebirths and 6·6 million (44×6%) of preterm births globally in 2014. Of the 38 countries with high-quality data, preterm birth rates have increased since 2000 in 26 countries and decreased in 12 countries. Globally, we estimated that the preterm birth rate was 9×8% (8×3–10×9) in 2000, and 10×6% (9×0–12×0) in 2014.
Interpretation
Preterm birth remains a crucial issue in child mortality and improving quality of maternal and newborn care. To better understand the epidemiology of preterm birth, the quality and volume of data needs to be improved, including standardisation of definitions, measurement, and reporting.
Funding
WHO and the March of Dimes.
Intimate partner homicide (IPH) is a critical public health and safety issue in the USA. In this study, we determine the prevalence and correlates of perpetrator suicide and additional homicides following intimate partner homicide (IPH) in a large, diverse state with high quality data. We extract IPHs from the North Carolina Violent Death Reporting System for 2004-2013 and identify suicides and other homicides that were part of the same incidents. We analyze the likelihood (in odds ration form) of perpetrator suicide and additional homicides using logistic regression analysis. Almost all IPH-suicide cases were by men with guns (86.6%). Almost one-half of IPHs committed by men with guns ended with suicide. Male-perpetrated IPH incidents averaged 1.58 deaths if a gun was used, and 1.14 deaths otherwise. It is well-known that gun access increases the chance that a violent domestic relationship will end in death. The current findings demonstrate that gun IPH is often coupled with additional killings. As suicidal batterers will not be deterred from IPH by threat of punishment, the results underline the importance of preemption by limiting batterers' access to guns.
Neonatal appendicitis is a rare clinical entity associated with remarkable morbidity and mortality. Appen¬dicular perforation is common and the diagnosis is usually made intra-operatively. The causative etiology of neonatal perforated appendicitis (NPA) is a subject of debate and has not been elucidated. Although many etiologic theories exist, increasing evidence suggests a subset of NPA cases may represent a form of necrotizing enterocolitis (NEC) localized to the appendix. We herein present a review of the current litera¬ture to include cases of NPA attributed to localized NEC. A high index of clinical suspicion and early laparotomy are recommended.
Homicide is one of the leading causes of death for women aged ≤44 years.* In 2015, homicide caused the death of 3,519 girls and women in the United States. Rates of female homicide vary by race/ethnicity (1), and nearly half of victims are killed by a current or former male intimate partner (2). To inform homicide and intimate partner violence (IPV) prevention efforts, CDC analyzed homicide data from the National Violent Death Reporting System (NVDRS) among 10,018 women aged ≥18 years in 18 states during 2003-2014. The frequency of homicide by race/ethnicity and precipitating circumstances of homicides associated with and without IPV were examined. Non-Hispanic black and American Indian/Alaska Native women experienced the highest rates of homicide (4.4 and 4.3 per 100,000 population, respectively). Over half of all homicides (55.3%) were IPV-related; 11.2% of victims of IPV-related homicide experienced some form of violence in the month preceding their deaths, and argument and jealousy were common precipitating circumstances. Targeted IPV prevention programs for populations at disproportionate risk and enhanced access to intervention services for persons experiencing IPV are needed to reduce homicides among women.
Objectives
To estimate the cost savings and health benefits in the UK NHS that could be achieved if human milk usage in the NICU was increased. MethodsA systematic review established the disease areas with the strong sources of evidence of the short, medium and long-term benefits of human milk for preterm infants as opposed to the use of formula milk. The analysis assessed the economic impact of reducing rates of necrotising enterocolitis, sepsis, sudden infant death syndrome, leukaemia, otitis media, obesity and neurodevelopmental impairment. ResultsBased on the number of preterm babies born in 2013, if 100% of premature infants being fed mother’s milk could be achieved in the NICU, the total lifetime cost savings to the NHS due to improved health outcomes is estimated to be £46.7 million (£30.1 million in the first year) with a total lifetime QALY gain of 10,594, There would be 238 fewer deaths due to neonatal infections and SIDS, resulting in a reduction of approximately £153.4 million in lifetime productivity. Sensitivity analyses indicated that results were robust to a wide range of inputs. Conclusions
This analysis established that increasing the use of human milk in NICUs in the UK would lead to cost savings to the NHS. More research is needed on the medium and long term health and economic outcomes associated with breastfeeding preterm infants, and the differences between mother’s own and donor breast milk.
Background:
Despite remarkable progress in the improvement of child survival between 1990 and 2015, the Millennium Development Goal (MDG) 4 target of a two-thirds reduction of under-5 mortality rate (U5MR) was not achieved globally. In this paper, we updated our annual estimates of child mortality by cause to 2000-15 to reflect on progress toward the MDG 4 and consider implications for the Sustainable Development Goals (SDG) target for child survival.
Methods:
We increased the estimation input data for causes of deaths by 43% among neonates and 23% among 1-59-month-olds, respectively. We used adequate vital registration (VR) data where available, and modelled cause-specific mortality fractions applying multinomial logistic regressions using adequate VR for low U5MR countries and verbal autopsy data for high U5MR countries. We updated the estimation to use Plasmodium falciparum parasite rate in place of malaria index in the modelling of malaria deaths; to use adjusted empirical estimates instead of modelled estimates for China; and to consider the effects of pneumococcal conjugate vaccine and rotavirus vaccine in the estimation.
Findings:
In 2015, among the 5·9 million under-5 deaths, 2·7 million occurred in the neonatal period. The leading under-5 causes were preterm birth complications (1·055 million [95% uncertainty range (UR) 0·935-1·179]), pneumonia (0·921 million [0·812 -1·117]), and intrapartum-related events (0·691 million [0·598 -0·778]). In the two MDG regions with the most under-5 deaths, the leading cause was pneumonia in sub-Saharan Africa and preterm birth complications in southern Asia. Reductions in mortality rates for pneumonia, diarrhoea, neonatal intrapartum-related events, malaria, and measles were responsible for 61% of the total reduction of 35 per 1000 livebirths in U5MR in 2000-15. Stratified by U5MR, pneumonia was the leading cause in countries with very high U5MR. Preterm birth complications and pneumonia were both important in high, medium high, and medium child mortality countries; whereas congenital abnormalities was the most important cause in countries with low and very low U5MR.
Interpretation:
In the SDG era, countries are advised to prioritise child survival policy and programmes based on their child cause-of-death composition. Continued and enhanced efforts to scale up proven life-saving interventions are needed to achieve the SDG child survival target.
Funding:
Bill & Melinda Gates Foundation, WHO.
There is a paucity of data on the effect of preterm birth on the immunological composition of breast milk throughout the different stages of lactation. We aimed to characterise the effects of preterm birth on the levels of immune factors in milk during the 1st month postpartum, to determine whether preterm milk is deficient in antimicrobial factors. Colostrum (days 2–5 postpartum), transitional milk (days 8–12) and mature milk (days 26–30) were collected from mothers of extremely preterm (<28 weeks of gestation, n=15), very preterm (28–<32 weeks of gestation, n=15), moderately preterm (32–<37 weeks of gestation, n=15) and term infants (37–41 weeks of gestation, n=15). Total protein, lactoferrin, secretory IgA, soluble CD14 receptor (sCD14), transforming growth factor- β2 (TGF-β2), α-defensin 5 (HD5), β-defensins 1 (HBD1) and 2, IL-6, IL-10, IL-13, interferon-γ, TNF-α and lysozyme (LZ) were quantified in milk. We examined the effects of lactation stage, gestational age, volume of milk expressed, mode of delivery, parity and maternal infection on milk immune factor concentrations using repeated-measures regression analysis. The concentrations of all factors except LZ and HD5 decreased over the 1st month postpartum. Extremely preterm mothers had significantly higher concentrations of HBD1 and TGF-β2 in colostrum than term mothers did. After controlling for other variables in regression analyses, preterm birth was associated with higher concentrations of HBD1, LZ and sCD14 in milk samples. In conclusion, preterm breast milk contains significantly higher concentrations of some immune proteins than term breast milk.
Homicide-suicide incidents involving child victims can have a detrimental impact on survivors of the violence, family members and friends of the decedents, and other community members, but the rare occurrence of these acts makes using quantitative data to examine their associated antecedents challenging. Therefore, using qualitative data from the 2003-2011 National Violent Death Reporting System, we examined 175 cases of homicide-suicide involving child victims in an effort to better understand the complex situational factors of these events. Our findings indicate that 98% of homicide-suicides with child victims are perpetrated by adults (mostly parents) and propelled by the perpetrators’ intimate partner problems, mental health problems, and criminal/legal problems. These events are often premeditated, and plans for the violence are sometimes disclosed prior to its occurrence. Findings provide support for several theoretical perspectives, and implications for prevention are discussed.
We investigated the levels and antimicrobial activity of antimicrobial proteins and peptides (AMPs) in breast milk consumed by preterm infants, and whether deficiencies of these factors were associated with late-onset neonatal sepsis (LOS), a bacterial infection that frequently occurs in preterm infants in the neonatal period.
Breast milk from mothers of preterm infants (≤32 weeks gestation) was collected on days 7 (n = 88) and 21 (n = 77) postpartum. Concentrations of lactoferrin, LL-37, beta-defensins 1 and 2, and alpha-defensin 5 were measured by enzyme-linked immunosorbent assay. The antimicrobial activity of breast milk samples against Staphylococcus epidermidis, Staphylococcus aureus, Escherichia coli, and Streptococcus agalactiae was compared to the activity of infant formula, alone or supplemented with physiological levels of AMPs. Samples of breast milk fed to infants with and without subsequent LOS were compared for levels of AMPs and inhibition of bacterial growth.
Levels of most AMPs and antibacterial activity in preterm breast milk were higher at day 7 than at day 21. Lactoferrin was the only AMP that limited pathogen growth >50% when added to formula at a concentration equivalent to that present in breast milk. Levels of AMPs were similar in the breast milk fed to infants with and without LOS, however, infants who developed LOS consumed significantly less breast milk and lower doses of milk AMPs than those who were free from LOS.
The concentrations of lactoferrin and defensins in preterm breast milk have antimicrobial activity against common neonatal pathogens.
Objectives:
We estimated the frequency and examined the characteristics of intimate partner homicide and related deaths in 16 US states participating in the National Violent Death Reporting System (NVDRS), a state-based surveillance system.
Methods:
We used a combination of quantitative and qualitative methods to analyze NVDRS data from 2003 to 2009. We selected deaths linked to intimate partner violence for analysis.
Results:
Our sample comprised 4470 persons who died in the course of 3350 intimate partner violence-related homicide incidents. Intimate partners and corollary victims represented 80% and 20% of homicide victims, respectively. Corollary homicide victims included family members, new intimate partners, friends, acquaintances, police officers, and strangers.
Conclusions:
Our findings, from the first multiple-state study of intimate partner homicide and corollary homicides, demonstrate that the burden of intimate partner violence extends beyond the couple involved. Systems (e.g., criminal justice, medical care, and shelters) whose representatives routinely interact with victims of intimate partner violence can help assess the potential for lethal danger, which may prevent intimate partner and corollary victims from harm.
To describe homicide-followed-by-suicide incidents involving child victims Methods: Using 2003-2009 National Violent Death Reporting System data, we characterized 129 incidents based on victim and perpetrator demographic information, their relationships, the weapons/mechanisms involved, and the perpetrators' health and stress-related circumstances.
These incidents accounted for 188 child deaths; 69% were under 11 years old, and 58% were killed with a firearm. Approximately 76% of perpetrators were males, and 75% were parents/caregivers. Eighty-one percent of incidents with paternal perpetrators and 59% with maternal perpetrators were preceded by parental discord. Fifty-two percent of incidents with maternal perpetrators were associated with maternal psychiatric problems.
Strategies that resolve parental conflicts rationally and facilitate detection and treatment of parental mental conditions might help prevention efforts.
The mounting social and professional awareness of the negative effects on children of exposure to the behavior of batterers has drawn attention to the need for effective tools for assessing risk to children from batterers as parents or guardians (e.g. Williams, Boggess, & Carter, 2001). Such tools are particularly needed by child protective personnel, custody evaluators, and courts with jurisdiction over child custody and child welfare cases, but are also important to the work of many therapists, battered women's service providers, batterer intervention programs, and programs for children exposed to batterers. The model we are proposing here is particularly suited to assessment of post-separation risk to children from batterers. We commonly encounter the mistaken assumption among professionals, including judges and custody evaluators, that children are in less danger from a batterer once a couple is no longer living together, when the reality is often the opposite (Bancroft & Silverman, 2002; Langford, Isaac, & Kabat, 1999). Assessment of risk to children post-separation should be carried out with as much caution as would be called for in intervening with an intact family. While couples are still living together, a batterer's danger to children can be mediated to some extent by their mother's ability to protect them. Assessment of her ability to protect requires the examination of such elements as the level of physical dangerousness of the batterer, the mother's strengths as a parent, the ability of her community to provide the necessary legal and supportive resources, and the mother's capacity to seek and use help for herself and her children (Whitney & Davis, 1999), while also avoiding the mistake of characterizing a battered woman as "failing to protect" her children (Magen, 1999). Therefore, the use of our model in assessing risk in intact families needs to be combined with careful and compassionate assessment of the mother's protective capabilities and her willingness to work collaboratively with child protective personnel. Before describing the elements of a proper assessment, we will review the most serious physical, sexual, and psychological risks that batterers can pose to children, and describe the elements necessary for children's emotional recovery from exposure to battering behavior. Many of the errors currently made by professionals in assessing children's safety with a batterer are a product of the lack of clear delineation of what the central risks are, including the important possibility that a batterer's conduct with children may interfere with their emotional healing from traumatic experiences they have already undergone.
Societal responses to child maltreatment and to woman battering have developed in separate and sometimes conflicting ways. It is only in recent years that greater attention has been devoted to the possible overlap between child maltreatment and woman battering in the same families. Thirty-five studies conducted over the past 2½ decades that mentioned an overlap between child maltreatment and adult domestic violence in the same families were identified. These studies are reviewed and their strengths and weaknesses identified. The article concludes with a discussion of the implications these findings have for practice, policy, and research.
Studies of intimate partner violence (IPV) and child maltreatment (CM) have examined the association between IPV and physical abuse. Children in homes with IPV may also experience other forms of CM. The objective is to determine the prevalence of CM in homes with and without IPV using cross-sectional analysis of survey data of mothers with partners (n = 1,232). The Conflict Tactics Scale and Parent Child Conflict Tactics Scale were used to determine IPV, physical, psychological, sexual abuse, and neglect. Mothers reporting IPV (either man to woman or woman to man) report 2.57 times the odds of physical abuse compared to those not reporting IPV (95% CI 1.11-5.97). Moms reporting IPV report 2.04 times the odds of neglect. Those reporting IPV report 9.58 times the odds of psychological abuse (95% CI 4.27-21.49). Mothers reporting IPV report 4.90 times the odds of sexual abuse (95% CI 0.43-55.67). IPV is associated with all forms of CM in this sample. Providers of IPV services for women with children should also assess for all forms of child maltreatment. © The Author 2007. Published by Oxford University Press. All rights reserved.
Necrotizing enterocolitis (NEC) is an inflammatory disease affecting premature infants. Intestinal microbial composition may play a key role in determining which infants are predisposed to NEC and when infants are at highest risk of developing NEC. It is unclear how to optimize antibiotic therapy in preterm infants to prevent NEC and how to optimize antibiotic regimens to treat neonates with NEC. This article discusses risk factors for NEC, how dysbiosis in preterm infants plays a role in the pathogenesis of NEC, and how probiotic and antibiotic therapy may be used to prevent and/or treat NEC and its sequelae.
The strong association between firearms, domestic violence (particularly intimate partner homicide), and additional victimization suggests that prioritization of measures to decrease access to firearms to perpetrators of domestic violence may also reduce the incidence of mass shootings. The majority of mass shootings are associated with domestic violence. The current study by Kivisto and Porter examines whether the use of a firearm in domestic homicide affects the risk that others will also be killed during the same incident. Earlier studies have demonstrated that domestic homicide often extends to additional victims linked to the primary perpetrator or victim, either through a preexisting relationship or through physical proximity to the violence. Based on a national surveillance database, Kivisto and Porter confirm findings from earlier, more limited studies. Firearm use is associated with an increased incidence of multiple homicide victimization, especially in domestic situations. This suggests that additional laws to prevent those who perpetrate domestic violence from purchasing or possessing firearms, and vigorous enforcement of new and existing laws, may decrease the incidence of mass shootings, whether additional victims are inside or outside the home.
Neonatal appendicitis is a rare disease with a high mortality rate. Appendicitis is difficult to diagnose in neonatal and infant populations because it mimics other more common conditions in these age groups. Furthermore, signs and symptoms of appendicitis are often nonspecific in nonverbal patients and a high index of suspicion is necessary to initiate the appropriate diagnostic work-up. The keys to successful management of appendicitis in infants include keeping the diagnosis on the differential in the setting of unexplained intra-abdominal sepsis, following a diagnostic algorithm in the work-up of infant abdominal pathology, and performing appendectomy once the diagnosis is confirmed.
A tragic but true story involves teen romances that end up with one partner killed by the other, usually the boy killing the girl, usually during the course of a breakup or when jealousy is involved, and almost always with a gun, a recent study has found. Seven percent of homicides of adolescents are committed by intimate partners.
Importance
Intimate partner violence during adolescence is widespread, and consequences can be severe. Intimate partner homicide (IPH) is the most extreme form of intimate partner violence, but literature on IPH has almost exclusively focused on adults.
Objectives
To determine the proportion of adolescent homicides that is perpetrated by intimate partners and to describe the victim, perpetrator, and incident characteristics of these IPHs.
Design, Setting, and Participants
Analysis of quantitative and qualitative surveillance data from the National Violent Death Reporting System from 2003 to 2016. Data represent 32 states that contributed to the system for 1 year or longer. There were 8048 homicides of victims aged 11 to 24 years with a known relationship between the victim and perpetrator. For persons aged 11 to 18 years, there were 2188 homicides. Analysis began September 2018.
Main Outcomes and Measures
An incident was identified as an IPH if the relationship between the perpetrator and victim was coded as spouse, ex-spouse, girlfriend or boyfriend, ex-girlfriend or ex-boyfriend, or girlfriend or boyfriend (unspecified current or former). Variables of interest included demographic characteristics (age, sex, race/ethnicity) for the victim and perpetrator, relationship status at time of death, homicide-suicide, homicide method, firearm type, and location of homicide. Contextual categories were created from the qualitative narratives.
Results
Of adolescent homicides, 150 (6.9%) were classified as IPH. A total of 135 victims (90%) were female (mean [SD] age, 16.8 [1.3] years). Overall, 102 perpetrators (77.9%) were 18 years and older (mean [SD] age, 20.6 [5.0] years), and 94 (62.7%) were current intimate partners of the victim. Firearms, specifically handguns, were the most common mechanism of injury. Compared with IPHs of young adults aged 19 to 24 years, perpetrators of adolescent victims were younger and less likely to be a current intimate partner. The most common categories of adolescent IPH homicides were broken/desired relationship or jealousy and an altercation followed by reckless firearm behavior and pregnancy related.
Conclusions and Relevance
Adolescents, particularly girls, in dating relationships may face risk of homicide, especially in circumstances of a breakup or jealousy and when perpetrators have access to firearms. Understanding homicide in early dating relationships can inform prevention and intervention efforts tailored to adolescents.
Introduction
The present study focuses on gaining an understanding of the motives of men who commit a filicide. Motivation is a concept at the crossroads of psychology and criminology that allows for a better understanding of filicide.
Objective
On one hand, our study evaluates the motives of men who have committed a filicide, and on the other, it compares groups of men with regard to socio-demographic, psychological and criminological characteristics according to the underlying motivation.
Method
The 50 male filicides committed in the province of Quebec between 1997 and 2012 were analyzed using a Grille d’analyse multidimensionnelle de l’homicide intrafamilial and subgroups based on motivation.
Results
Male filicides are mainly motivated by marital separation or fatal physical abuse (ill treatments causing death). Some characteristics help distinguish these men according to motivation including: the victim's age, hospitalizations that occurred during the year preceding the crime, the presence of depressive and/or psychotic symptoms, and the sentence rendered.
Conclusion
Our results highlight the presence of distinct profiles based on motivation and the relevance of considering motivation in order to develop specific and effective prevention strategies.
Introduction:
Child victims physically harmed in intimate partner violence incidents are understudied. The U.S. National Violent Death Reporting System abstractors can identify intimate partner violence-related child homicides in part through descriptive narratives from coroner/medical examiner and law enforcement reports. This study characterizes these homicides and assesses how well the coded and narrative data within the National Violent Death Reporting System align in identifying intimate partner violence-related child homicides.
Methods:
This study examines homicides of children ages 2-14 years from 16 states for 2005-2014. An existing variable purportedly indicates intimate partner violence-related child homicides where the perpetrator also kills or attempts to kill the intimate partner (Type 1) or intimate partner conflict (e.g., divorce, separation, custody) precedes the homicide (Type 2). The authors read all narratives in 2018 to assess whether the death was intimate partner violence-related and compared this classification to that coded by the National Violent Death Reporting System abstractor.
Results:
Of 1,386 child homicide victims, 144 (10.4%) were coded in the National Violent Death Reporting System as intimate partner violence-related. However, from the narratives, an additional 138 were classified as intimate partner violence-related, identifying a total of 280 (20.2%) victims. Of the 280 victims, 54.3% were killed in Type 1 incidents. Compared with other perpetrators of child homicides, intimate partner violence-related perpetrators were more likely to be white, use a firearm, and die by suicide. Type 2 incidents were more likely than Type 1 to be homicide-suicides.
Conclusions:
The National Violent Death Reporting System currently understates intimate partner violence-related child homicide cases. Many cases involve immediate intimate partner conflict, suggesting the need for services to help people cope before conflicts lead to deadly incidents. Primary prevention of intimate partner violence may have survival benefits for children.
One in 10 newborns will be born before completion of 36 weeks’ gestation (premature birth). Infection and sepsis in preterm infants remain a significant clinical problem that represents a substantial financial burden on the healthcare system. Many factors predispose premature infants for having the greatest risk of developing and succumbing to infection as compared with all other age groups across the age spectrum. It is clear that the immune system of preterm infants exhibits distinct, rather than simply deficient, function as compared with more mature and older humans and that the immune function in preterm infants contributes to infection risk. While no single review can cover all aspects of immune function in this population, we will discuss key aspects of preterm neonatal innate and adaptive immune function that place them at high risk for developing infections and sepsis, as well as sepsis-associated morbidity and mortality.
In the research literature on homicide, gender has generally received less attention than other demographic characteristics, specifically the age and race of victims and offenders. To some extent, this is understandable because the overwhelming majority, almost three-quarters, of homicides in the United States involve a male killing another male. Therefore, the usual patterns of homicide mirror for the most part the patterns of male homicide. However, there are substantial differences in the trends and patterns of female offending and victimization that should not be ignored in the aggregate. In this article, we employ a national homicide database (the FBI's Supplementary Homicide Reports, SHR) from 1976 through 2015 with multiple imputation of missing information to examine gender differences among victims and offenders in terms of characteristics such as age, race, weapon, circumstances, and victim-offender relationship.
Importance:
Practice variation is believed to be a driver of excess health care spending, although few objective data exist to guide the prioritization of comparative effectiveness research (CER) in pediatric surgery.
Objective:
To identify high-priority general pediatric surgical procedures for CER on the basis of the following 2 complementary measures: the magnitude of interhospital cost variation as a surrogate for the need for and potential effect of CER at the patient level and the cumulative fiscal burden of this cost variation when considering the case volume from all hospitals as a surrogate for public health relevance.
Design, setting, and participants:
This was a cohort study of patients undergoing 1 of the 30 most costly pediatric surgical operations at 45 children's hospitals between January 1, 2014, and September 30, 2015. Cost data were extracted from the Pediatric Health Information System database and adjusted for differences in unit-based costing at the hospital level and for differences in case mix and disease severity at the patient level.
Main outcomes and measures:
First, the width of the interquartile range (WIQR) of the adjusted procedure-specific median cost across hospitals. Second, the procedure-specific cost variation burden, which was calculated as the aggregate sum of absolute cost differences between the overall adjusted median cost derived from all patients treated at all hospitals and the adjusted cost of each individual patient treated at all hospitals.
Results:
A total of 92 535 encounters were analyzed. The median number of encounters per hospital was 2011 (interquartile range [IQR], 1224-2619), and the median number of encounters per procedure was 610 (IQR, 442-2610). In the final cohort, 66.9% (n = 61 933) of the patients were male, and the median age was 7 years (IQR, 1.9-12.3 years). Cost variation at the hospital level was greatest for gastroschisis (WIQR, 111 566 [IQR, 139 936]), congenital diaphragmatic hernia (WIQR, 154 730 [IQR, 173 712]), tracheoesophageal fistula/esophageal atresia (WIQR, 105 259 [IQR, 126 541]), and total colectomy for ulcerative colitis (WIQR, 34 910 [IQR, 53 312]). The following 5 diagnoses accounted for 52.5% of the cumulative cost variation burden from all 30 conditions: uncomplicated appendicitis (18.0% [51 702 402]), gastroschisis (9.5% [21 227 436]), and small-intestinal atresia (5.1% [$18 840 546]). Neonatal cases contributed 3.6% of the case volume and accounted for 26.8% of the cumulative cost variation burden from all 30 conditions.
Conclusions and relevance:
A small number of procedures account for most of the cost variation burden in pediatric surgery, with some demonstrating wide cost variation among hospitals. Gastroschisis and small-intestinal atresia may be particularly high-yield targets for multidisciplinary CER efforts, while the management of appendicitis and gastrostomy should be considered high-priority conditions among pediatric surgeons.
There is no question that birth at extremely low gestational ages presents a significant threat to an infant's survival, health and development. Growing evidence suggests that gestational age may be conceptualised as a continuum in which births before 28 weeks of gestation (extremely preterm: EP) represent the severe end of a spectrum of health and developmental adversity. Although comprising just 1%–2% of all births, EP deliveries pose the greatest challenge to neonatal medicine and to health, education and social services for the provision of ongoing support for survivors with additional needs. Studying the outcomes of these infants remains critical for evaluating and enhancing clinical care, planning long-term support and for advancing our understanding of the life-course consequences of immaturity at birth. Here we review literature relating to early and long-term neurodevelopmental, cognitive, behavioural and educational outcomes following EP birth focusing on key themes and considering implications for intervention.
Development of the infant small intestine is influenced by bacterial colonization. To promote establishment of optimal microbial communities in preterm infants, knowledge of the beneficial functions of the early gut microbiota on intestinal development is needed. The purpose of this study was to investigate the impact of early preterm infant microbiota on host gut development using a gnotobiotic mouse model. Histological assessment of intestinal development was performed. The differentiation of four epithelial cell lineages (enterocytes, goblet cells, Paneth cells, enteroendocrine cells) and tight junction (TJ) formation was examined. Using weight gain as a surrogate marker for health, we found that early microbiota from a preterm infant with normal weight gain (MPI-H) induced increased villus height and crypt depth, increased cell proliferation, increased numbers of goblet cells and Paneth cells, and enhanced TJs compared to the changes induced by early microbiota from a poor weight gain preterm infant (MPI-L). Laser capture microdissection (LCM) plus qRT-PCR further revealed, in MPI-H mice, a higher expression of stem cell marker Lgr5 and Paneth cell markers Lyz1 and Cryptdin5 in crypt populations; along with higher expression of the goblet cell and mature enterocyte marker Muc3 in villus populations. In contrast, MPI-L microbiota failed to induce the aforementioned changes and presented intestinal characteristics comparable to a germ free host. Our data demonstrate that microbial communities have differential effects on intestinal development. Future studies to identify pioneer settlers in neonatal microbial communities necessary to induce maturation may provide new insights for preterm infant microbial ecosystem therapeutics.
“Spousal revenge” killers murder their child apparently out of a desire to cause harm to their ex-partner, the child’s other parent. Standard explanations of these killings fail to provide an adequate solution to what I call the problem of spousal revenge filicide. This is the problem of how a killer comes to take their rage at their former partner out on their own child and how that child can be dehumanized to the point of murder. Although the dehumanization of the victim is acknowledged to occur, why it occurs is not well understood. Here, I offer an hypothesis that the killer fails to represent their child as a moral subject with a mind of their own. This is due to a deficit in the killer’s capacity for person perception which is, by hypothesis, pathological. As such, the killer experiences the child as an object, rather than a person, which is of significant emotional value to the other parent. The specificity of this disorder explains why the ex-partner themselves is not targeted, and it explains how the killer is able to understand that killing the child will harm the other parent.
This paper provides a comprehensive historical and contemporary picture of filicide in Canada for more than half a century. Focusing on 1,612 children under age 18 that were killed by their parents between 1961 and 2011, regional and temporal trends in the gender of accused are examined as well as differences in maternal and paternal filicides by the gender and age of the victim, the age and marital status of the accused, type of parental relationship, cause of death, motive, history of family violence, and clearance status. Results show that there are significant differences in filicides by mothers and fathers. Five possible emerging trends were identified: an increasing gender gap in accused, increasing presence of relationship breakdown, growing number of cases involving stepfathers and a prior history of family violence, and declines in accused who committed suicide. Implications of these trends for interventions and prevention are discussed and future research priorities highlighted.
Copyright © 2015 Elsevier Ltd. All rights reserved.
This paper examines the epidemiology of fatal and nonfatal firearm violence in the United States. Trends over two decades in homicide, assault, self-directed and unintentional firearm injuries are described along with current demographic characteristics of victimization and health impact.
Fatal firearm injury data were obtained from the National Vital Statistics System (NVSS). Nonfatal firearm injury data were obtained from the National Electronic Injury Surveillance System (NEISS). Trends were tested using Joinpoint regression analyses. CDC Cost of Injury modules were used to estimate costs associated with firearm deaths and injuries.
More than 32,000 persons die and over 67,000 persons are injured by firearms each year. Case fatality rates are highest for self-harm related firearm injuries, followed by assault-related injuries. Males, racial/ethnic minority populations, and young Americans (with the exception of firearm suicide) are disproportionately affected. The severity of such injuries is distributed relatively evenly across outcomes from outpatient treatment to hospitalization to death. Firearm injuries result in over $48 billion in medical and work loss costs annually, particularly fatal firearm injuries. From 1993 to 1999, rates of firearm violence declined significantly. Declines were seen in both fatal and nonfatal firearm violence and across all types of intent. While unintentional firearm deaths continued to decline from 2000-2012, firearm suicides increased and nonfatal firearm assaults increased to their highest level since 1995.
Firearm injuries are an important public health problem in the United States, contributing substantially each year to premature death, illness, and disability. Understanding the nature and impact of the problem is only a first step toward preventing firearm violence. A science-driven approach to understand risk and protective factors and identify effective solutions is key to achieving measurable reductions in firearm violence.
Copyright © 2015. Published by Elsevier Inc.
The gastrointestinal (GI) tract is a large potential portal for multiple infectious agents to enter the human body. The GI system performs multiple functions as part of the neonate's innate immune system, providing critical defense during a vulnerable period. Multiple mechanisms and actions are enhanced by the presence of human breast milk. Bioactive factors found in human milk work together to create and maintain an optimal and healthy environment, allowing the intestines to deliver ideal nutrition to the host and afford protection by a variety of mechanisms.