No abstract

WHO Department of Violence and Injury Prevention and Disability.

BackgroundIncreasing pressures on emergency departments (ED) are straining services and creating inefficiencies in service delivery worldwide. A potentially avoidable pressure is inappropriate attendances (IA); typically low urgency, self-referred patients better managed by other services. This study examines demographics and temporal trends associated with IA to help inform measures to address them.MethodsUsing a national ED dataset, a cross-sectional examination of ED attendances in England from April 2011 to March 2012 (n = 15,056,095) was conducted. IA were defined as patients who were self-referred; were not attending a follow-up; received no investigation and either no treatment or ‘guidance/advice only’; and were discharged with either no follow-up or follow-up with primary care. Small, nationally representative areas were used to assign each attendance to a residential measure of deprivation. Multivariate analysis was used to predict relationships between IA, demographics (age, gender, deprivation) and temporal factors (day, month, hour, bank holiday, Christmas period).ResultsOverall, 11.7% of attendances were categorized as inappropriate. IA peaked in early childhood (adjusted odds ratio (AOR) = 1.53 for both one and two year olds), and was elevated throughout late-teens and young adulthood, with odds reducing steadily from age 27 (reference category, age 40). Both IA and appropriate attendances (AA) were most frequent in the most deprived populations. However, relative to AA, those living in the least deprived areas had the highest odds of IA (AOR = 0.89 in most deprived quintile). Odds of IA were also higher for males (AOR = 0.95 in females). Both AA and IA were highest on Mondays, whilst weekends, bank holidays and the period between 8 am and 4 pm saw more IA relative to AA.ConclusionsPrevention of IA would be best targeted at parents of young children and at older youths/young adults, and during weekends and bank holidays. Service provision focusing on access to primary care and EDs serving the most deprived communities would have the most benefit. Improvements in coverage and data quality of the national ED dataset, and the addition of an appropriateness field, would make this dataset an effective monitoring tool to evaluate interventions addressing this issue.

BackgroundAdverse childhood experiences (ACEs) including maltreatment and exposure to household stressors can impact the health of children. Community factors that provide support, friendship and opportunities for development may build children’s resilience and protect them against some harmful impacts of ACEs. We examine if a history of ACEs is associated with poor childhood health and school attendance and the extent to which such outcomes are counteracted by community resilience assets.MethodsA national (Wales) cross-sectional retrospective survey (n = 2452) using a stratified random probability sampling methodology and including a boost sample (n = 471) of Welsh speakers. Data collection used face-to-face interviews at participants’ places of residence. Outcome measures were self-reported poor childhood health, specific conditions (asthma, allergies, headaches, digestive disorders) and school absenteeism.ResultsPrevalence of each common childhood condition, poor childhood health and school absenteeism increased with number of ACEs reported. Childhood community resilience assets (being treated fairly, supportive childhood friends, being given opportunities to use your abilities, access to a trusted adult and having someone to look up to) were independently linked to better outcomes. In those with ≥4 ACEs the presence of all significant resilience assets (vs none) reduced adjusted prevalence of poor childhood health from 59.8 to 21.3%.ConclusionsBetter prevention of ACEs through the combined actions of public services may reduce levels of common childhood conditions, improve school attendance and help alleviate pressures on public services. Whilst the eradication of ACEs remains unlikely, actions to strengthen community resilience assets may partially offset their immediate harms.Electronic supplementary materialThe online version of this article (10.1186/s12889-018-5699-8) contains supplementary material, which is available to authorized users.

Ileocolic intussusception is an important cause of acute abdomen in infants. When there is no surgical indication, reduction under fluorosco-pic vision has been the main radiologic treatment performed in our country. Ultrasound examination is broadly used as a diagnostic method but reports on local experiences with ultrasound for guidance in intussusception reduction have not been recorded. A series of five cases of successful hydrostatic reduction performed under ultrasonographic control is presented and images of different stages of the reduction process are shown. Our aim is to promote a change in monitoring procedures so as to avoid the use of ionizing radiation. Resumen: La invaginación ileocólica es una causa importante de abdomen agudo en lactantes y su tratamiento de elección en nuestro medio es la re-ducción bajo visión fluoroscópica, cuando no existe indicación quirúrgica. El ultrasonido es utilizado como método de diag-nóstico y su uso como guía para la reducción de la invaginación no ha sido comunicado en nuestro medio. Se presenta una pequeña serie de 5 casos de reducciones hidrostáticas exitosas efectuadas bajo control ultrasonográfico y se muestran imágenes de ultrasonido características de las diferentes etapas de la desinvaginación, con el objeto de estimular el cambio de método de monitorización en este proce-dimiento, evitando el uso de radiación ionizante. Palabras clave: Invaginación ileocólica, Reducción hidrostática, Ultrasonido. Introducción La invaginación intestinal íleocólica es una causa importante de abdomen agudo en lactantes, con una incidencia de 33,1 casos en 100.000 menores de 24 meses en nuestro país (1) y su tratamiento de elec-ción en nuestro medio, cuando no existe indicación quirúrgica, es la reducción bajo visión fluoroscópica utilizando aire, bario o ambos como elementos de reducción (2). La cirugía está indicada cuando hay sospecha de necrosis intestinal, peritonitis o shock y también cuando ha habido una reducción incompleta, terce-ra recidiva de reducción o antecedentes de varias recidivas (3). Actualmente, el ultrasonido (US) se utiliza sólo como método de diagnóstico y en nuestro medio no se ha comunicado su uso como guía en el procedimiento de reducción de la invaginación ileocólica. Objetivos • Revisar los signos ultrasonográficos diagnósticos de la invaginación ileocólica y su diferenciación con respecto de la íleoileal, que no requiere pro-cedimientos de reducción. • Mostrar las imágenes ultrasonográficas caracte-rísticas de las diferentes etapas de la desinvagi-nación. • Recomendar el cambio de método de monitoriza-ción en la reducción hidrostática de la invaginación ileocólica. Material y método Utilizando ecógrafo ATL 5000 y transductor lineal 7-12 MHz se efectuó el diagnóstico de invaginación íleocólica y el monitoreo de la reducción. Se realizó diagnóstico diferencial con la invaginación ileoileal ya que esta última presenta un aspecto ecográfico semejante; su diámetro es menor que la ileocólica, alcanzando como máximo 25 mm (4) y además se ubica fuera del m...

Background Adverse childhood experiences (ACEs) can increase risks of health-harming behaviours and poor health throughout life. While increases in risk may be affected by resilience resources such as supportive childhood relationships, to date few studies have explored these effects. Methods We combined data from cross-sectional ACE studies among young adults (n = 14 661) in educational institutions in 10 European countries. Nine ACE types, childhood relationships and six health outcomes (early alcohol initiation, problem alcohol use, smoking, drug use, therapy, suicide attempt) were explored. Multivariate modelling estimated relationships between ACE counts, supportive childhood relationships and health outcomes. Results Almost half (46.2%) of participants reported ≥1 ACE and 5.6% reported ≥4 ACEs. Risks of all outcomes increased with ACE count. In individuals with ≥4 ACEs (vs. 0 ACEs), adjusted odds ratios ranged from 2.01 (95% CIs: 1.70–2.38) for smoking to 17.68 (95% CIs: 12.93–24.17) for suicide attempt. Supportive childhood relationships were independently associated with moderating risks of smoking, problem alcohol use, therapy and suicide attempt. In those with ≥4 ACEs, adjusted proportions reporting suicide attempt reduced from 23% with low supportive childhood relationships to 13% with higher support. Equivalent reductions were 25% to 20% for therapy, 23% to 17% for problem drinking and 34% to 32% for smoking. Conclusions ACEs are strongly associated with substance use and mental illness. Harmful relationships are moderated by resilience factors such as supportive childhood relationships. Whilst ACEs continue to affect many children, better prevention measures and interventions that enhance resilience to the life-long impacts of toxic childhood stress are required.

Textbooks shape teaching and learning in introductory biology and highlight scientists as potential role models who are responsible for significant discoveries. We explore a potential demographic mismatch between the scientists featured in textbooks and the students who use textbooks to learn core concepts in biology. We conducted a demographic analysis by extracting hundreds of human names from common biology textbooks and assessing the binary gender and race of featured scientists. We found that the most common scientists featured in textbooks are white men. However, women and scientists of colour are increasingly represented in contemporary scientific discoveries. In fact, the proportion of women highlighted in textbooks has increased in lockstep with the proportion of women in the field, indicating that textbooks are matching a changing demographic landscape. Despite these gains, the scientists portrayed in textbooks are not representative of their target audience—the student population. Overall, very few scientists of colour were highlighted, and projections suggest it could take multiple centuries at current rates before we reach inclusive representation. We call upon textbook publishers to expand upon the scientists they highlight to reflect the diverse population of learners in biology.

Analyses identify four lifetime periods for violence: up to 10 years (prepubescent), 11-20 years (adolescence), 21-45 years (younger adults), and over 45 years (older adults). While violence is most common in adolescence, its concentration in poorer areas during prepubescence and in younger adulthood (parenting age) suggests that poorer children are exposed to much more aggressive communities. This is likely to contribute to the disproportionate escalation in violence they experience during adolescence. Effective interventions to prevent such escalations are available and need to be implemented particularly in poor communities.