A study was carried out to identify the characteristics of children who do not attend appointments at general outpatient clinics. Over six months, 359 children who had an appointment at a general clinic were studied using a questionnaire given to parents (740/o response rate) and by inspection of case notes. Based on their first appointment in the study period, children were divided into 'attenders' (n=262) and 'non-attenders' (n=97) for analysis. Nonattenders were significantly more likely to have one or more of the foilowing characteristics: lower social class, poorer housing, unmarried parent(s) (56% v 330/%), longer journey to clinic (35 v 27-6 minutes), more appointments per year (4.2 v 3.3), poorer past attendance record, and received their appointment by post (76% v 44%). Surprisingly parents of nonattenders rated their children to have a significantly more severe illness than those who attended. These results suggest that attendance is primarily determined by social and logistical factors as weil as appointment details, rather than illness severity. (Arch Dis Child 1996; 74: 121-125)

ObjectivesDomestic violence screening is advocated in some healthcare settings. Evidence that it increases referral to support agencies or improves health outcomes is limited. This study aimed to (1) investigate the proportion of hospital patients reporting domestic violence, (2) describe characteristics and previous hospital attendances of affected patients and (3) assess referrals to an in-house domestic violence advisor from Camden Safety Net.DesignA series of observational studies.SettingThree outpatient clinics at the Royal Free London NHS Foundation Trust.Participants10 158 patients screened for domestic violence in community gynaecology, genitourinary medicine (GUM) and HIV medicine clinics between 1 October 2013 and 30 June 2014. Also 2253 Camden Safety Net referrals over the same period.Main outcome measures(1) Percentage reporting domestic violence by age group gender, ethnicity and clinic. (2) Rates of hospital attendances in the past 3 years for those screening positive and negative. (3) Characteristics, uptake and risk assessment results for hospital in-house domestic violence referrals compared with Camden Safety Net referrals from other sources.ResultsOf the 10 158 patients screened, 57.4% were female with a median age of 30 years. Overall, 7.1% reported ever-experiencing domestic violence, ranging from 5.7% in GUM to 29.4% in HIV services. People screening positive for domestic violence had higher rates of previous emergency department attendances (rate ratio (RR) 1.63, 95% CI 1.09 to 2.48), emergency inpatient admissions (RR 2.27, 95% CI 1.37 to 3.84) and day-case admissions (RR 2.03, 95% CI 1.23 to 3.43) than those screening negative. The 77 hospital referrals to the hospital-based domestic violence advisor during the study period were more likely to be taken up and to be classified as high risk than referrals from elsewhere.ConclusionsSelective screening for domestic violence in high-risk hospital clinic populations has the potential to identify affected patients and promote good uptake of referrals for in-house domestic violence support.

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The beef cattle industry tends to focus on selecting production traits with the purpose of maximizing cow-calf performance. One such trait is milking ability, which is considered the primary influence on weaning weight of the calf. Therefore, the objective of this study was to determine the effect of actual milk yield on reproductive performance, circulating blood metabolites, and calf performance in beef cows in the Southeastern US. Over a 2 yr period, data were collected from 237, 3- to 9-yr-old Angus-sired beef cows on 3 research stations in Tennessee. On approximately d 58 and 129 postpartum, 24-hr milk production was measured with a modified weigh-suckle-weigh technique using a milking machine. Subsamples of milk were collected for analysis of milk components. Milk yield data were used to retrospectively classify cows on actual milk yield as High ( ≥ 10 kg/d), Mod (8 to 9 kg/d), or Low ( < 8 kg/d). Cow body weight (BW) and body condition score (BCS) were collected weekly at each location through breeding. Calf BW was recorded at birth, mid-weight at d 58, and weaning. At d 58 and 129 of postpartum, milk yields were different (P < 0.001) among the treatment groups. Cow BW during the entire study were not different (P ≥ 0.22) with increasing milk yield. Timed-AI pregnancy rate were the lowest (P = 0.02) in the High milk producing cows with no difference (P > 0.05) between Low and Mod milk cows. In addition, overall pregnancy rate continued to be the lowest (P = 0.04) in High milk producing cows with the greatest pregnancy rate in Mod milk cows. Calf mid-weight at ∼d 58 was increased (P < 0.001) in calves from Mod and High milking cows. However, calf BW at weaning was not different (P = 0.22) among calves from different milk treatment groups. Results from this study suggest that even in management systems that modify the grazing environments with harvested feedstuffs, high milk production decreases reproductive efficiency. In addition, increasing milk production up to d 129 postpartum did not result in increased calf BW at weaning, indicating that the genetic potential for calf BW at weaning could not be improved with increased genetic potential for milk production.

A burgeoning literature implicates sleep problems in risk for adolescent substance misuse as well as a negative prognostic indicator of substance abuse treatment response. Mechanisms underlying the relationship between sleep problems and propensity to abuse substances during this phase of development have yet to be elucidated. Many questions also remain about this relationship given the paucity of integrative models and data from prospective studies with a pre-drug exposure baseline. Our integrative, temporal model theorizes that sleep problems may increase propensity to substance misuse through interactions with emotion dysregulation and cognitive deficits. Stress exposure may exacerbate this confluence of factors, and ongoing hormonal and brain changes during puberty may also contribute to the relationship between stress and risk for substance misuse. Finally, substance use itself worsens sleep problems and further dysregulates emotion and cognition, promoting an escalating pattern of use. If sleep problems increase risk for substance misuse and treatment intractability, greater attention to causes of sleep problems in young people would have significant preventive and/or ameliorative implications given the malleability of these functions.