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...