A cumulative risk model of child physical maltreatment potential: findings from a community-based study

"Published online before print November 20, 2015"Previous studies have identified the predictive risk factors of child physical maltreatment (CPM). However, a significant number of these studies assessed risk factors in isolation. The cumulative risk hypothesis postulates that health problems are caused by the accumulation of risk factors, independently of the presence or absence of specific risk indicators. Few studies examined the effect of cumulative risk on CPM potential. This study aimed to test two concurrent models of cumulative risk of CPM potential by investigating whether CPM potential was better predicted by a threshold cumulative risk model or a linear cumulative risk model. Data from the National Representative Study of Psychosocial Context of Child Abuse and Neglect in Portugal were used. Parents of school-age children (N = 796) answered to self-report measures regarding sociodemographic variables, history of child maltreatment, psychological distress, and CPM potential. A cumulative risk index was computed, comprising 10 dichotomized risk factors. Evidence for a threshold cumulative effect was found. Additional bivariate logistic regressions revealed that the odds for high-potential CPM were dramatically higher for those parents with six or more risk factors when compared with parents with any one risk factor. By testing and confirming a threshold cumulative effect on CPM potential, it was possible to find a "trigger point" from which a dramatic increase in child physical maltreatment potential occurs.This study was supported by the Portuguese Foundation of Science and Technology through a research grant to the second author (POCTI/PSI/14276/1998

Determining weight-bearing tissue condition using peak reactive hyperemia response trend and ultrasonographic features: implications for pressure ulcer prevention

Frequent repositioning is important to prevent pressure ulcer (PU) development, by relieving pressure and recovering damages on skin areas induced by repetitive loading. Although repositioning is the gold standard to prevent PU, there is currently no strategy for determining tissue condition under preventive approaches. In this study, the peak reactive hyperemia (RH) trends and ultrasonographic (US) features are compared with the tissue condition under histopathological examination to determine the potential use of these features in determining the tissue condition noninvasively. Twenty-one male Sprague–Dawley rats (seven per group), with body weight of 385–485 g, were categorized into three groups and subjected to different recovery times, each with three repetitive loading cycles at skin tissues above of right trochanter area. The first, second, and third groups were subjected to short (3 minutes), moderate (10 minutes), and prolonged (40 minutes) recovery, respectively, while applying fixed loading time and pressure (10 minutes and 50 mmHg, respectively), to provide different degree of recovery and tissue conditions (tissue damage and tissue recovery). Peak RH was measured in the three cycles to determine RH trend (increasing, decreasing, and inconsistent). All rat tissues were evaluated using ultrasound at pre- and post-experiment and rated by two raters to categorize the severity of tissue changes (no, mild, moderate, and severe). The tissue condition was also evaluated using histopathological examination to distinguish between normal and abnormal tissues. Most of the samples with increasing RH trend is related to abnormal tissue (71%); while inconsistent RH trends is more related to normal tissue (82%). There is no relationship between the tissue conditions evaluated under ultrasonographic and histopathological examination. Peak RH trend over repetitive loading may serve as a new feature for determining the tissue condition that leading to pressure ulcer

Preschool children's health and its association with parental education and individual living conditions in East and West Germany

BACKGROUND: Social inequalities in health exist globally and are a major public health concern. This study focus on a systematic investigation into the associations between health indicators, living conditions and parental educational level as indicator of the social status of 6-year-old children living in West and East Germany in the decade after re-unification. Explanations of observed associations between parental education and health indicators were examined. METHODS: All boys and girls entering elementary school and living in predefined areas of East and West Germany were invited to participate in a series of cross-sectional surveys conducted between 1991 and 2000. Data of 28,888 German children with information on parental education were included in the analysis. Information about educational level of the parents, individual living conditions, symptoms and diagnoses of infectious diseases and allergies were taken from questionnaire. At the day of investigation, atopic eczema was diagnosed by dermatologists, blood was taken for the determination of allergen-specific immuno-globulin E, height and weight was measured and lung function tests were done in subgroups. Regression analysis was applied to investigate the associations between the health indicators and parental educational level as well as the child's living conditions. Gender, urban/rural residency and year of survey were used to control for confounding. RESULTS: Average response was 83% in East Germany and 71% in West Germany. Strong associations between health indicators and parental education were observed. Higher educated parents reported more diagnoses and symptoms than less educated. Children of higher educated parents were also more often sensitized against grass pollen or house dust mites, but had higher birth weights, lower airway resistance and were less overweight at the age of six. Furthermore, most of the health indicators were significantly associated with one or more living conditions such as living as a single child, unfavourable indoor air, damp housing condition, maternal smoking during pregnancy or living near a busy road. The total lung capacity and the prevalence of an atopic eczema at the day of investigation were the only health indicators those did not show associations with any of the predictor variables. CONCLUSION: Despite large differences in living conditions and evidence that some poor health outcomes were directly associated with poor living conditions, only few indicators demonstrated poorer health in social disadvantaged children. These were in both parts of Germany increased levels of overweight, higher airway resistance and, in East Germany only, reduced height in children with lower educated parents compared to those of higher education. In both East and West Germany, higher prevalence of airway symptoms was associated with a damp housing condition, and lower birth weight, reduced height and increased airway resistance at the age of six were associated with maternal smoking during pregnancy. The latter explained to a large extent the difference in birth weight and airway resistance between the educational groups

High Levels of Education Are Associated With an Increased Risk of Latent Autoimmune Diabetes in Adults: Results from the Nord-Trøndelag Health Study

Although autoimmune diabetes in adults is a common form of diabetes, knowledge on risk factors and long term consequences of the disease is limited. The aims of this thesis were to investigate the influence of socioeconomic factors (education and occupation), sleep disturbances and psychological well-being on the risk of developing autoimmune diabetes in adults, to investigate whether genetic variation in the melatonin receptor 1B (MTNR1B) contributes to the association between poor sleep and type 2 diabetes which has been previously suggested, and finally to investigate the risk of mortality from all causes, cardiovascular disease and ischemic heart disease in adult-onset autoimmune diabetes, with consideration of the possible influence of metabolic risk factors, glycaemic control, lifestyle factors and socioeconomic position. These studies are based on data from the Norwegian HUNT Study, to date the largest population-based study where incident cases of autoimmune diabetes in adults can be separated from cases of type 2 diabetes. The HUNT Study consists of three separate surveys performed on three occasions in 1984-2008 and contains information from questionnaires, clinical examinations and blood samples. Information on mortality was obtained by linkage to the national Cause of Death Registry. Individuals who were positive for antibodies against glutamic acid decarboxylase and with onset of diabetes at ≥35 years were classified as having autoimmune diabetes in adults. The main finding of Study I was that high educational levels (university versus primary school) were associated with an increased risk of autoimmune diabetes in adults (HR 1.98, 95% CI 1.21-3.26) after adjustment for BMI, physical activity, smoking, alcohol consumption, and family history of diabetes, whereas type 2 diabetes was more common in those with low education. An increased risk of autoimmune diabetes in adults was also seen in individuals who reported having sleep disturbances and low psychological well-being (HR 1.84, 95% CI 1.10-3.09), a risk similar to that seen in type 2 diabetes (HR 1.31, 95% CI 1.13-1.50) (Study II). The results from Study III indicated that there was no influence of the MTNR1B genetic variant on the association between poor sleep and type 2 diabetes. The association remained after adjustment for genotype and was seen in non-carriers as well as in carriers of the risk allele. Mortality from all causes (HR 1.55, 95% CI 1.25-1.92), cardiovascular disease (HR 1.87, 95% CI 1.40-2.48) and ischemic heart disease (HR 2.39, 95% CI 1.57-3.64) was increased in autoimmune diabetes in adults compared to individuals without diabetes. Importantly, mortality risk was as high as in type 2 diabetes, despite a more favourable metabolic risk profile in patients with autoimmune diabetes. In these patients, excess mortality appeared to be primarily associated with poor glycaemic control. These findings suggest, for the first time, that socioeconomic and psychosocial factors contribute to the development of autoimmune diabetes in adults. The results are in line with previous data indicating that the aetiology of autoimmune diabetes is partly similar to that of type 2 diabetes but suggest, also, that there are other, currently unidentified, environmental risk factors for autoimmune diabetes that remain to be explored. Finally, the results indicate that survival in individuals with autoimmune diabetes with adult onset would be improved by a more effective treatment

What did HERA teach us about the structure of the proton?

Starting in 2008 the H1 and ZEUS experiments have been combining their data in order to provide the most complete and accurate set of deep-inelastic data as the legacy of HERA. The present review presents these combinations, both published and preliminary, and explores how they have been used to give information on the structure of the proton. The HERAPDF parton distribution functions (PDFs) are presented and compared with other current PDFs and with data from the Tevatron and LHC colliders.Comment: 49 pages, 49 figures, to be published in J.Phys.

Diode-pumped, planar lossless splitter at 1.5 microns for optical networks

We demonstrate the first planar lossless splitter at 1.5µm. The ion-exchanged waveguide circuit in Er/Yb codoped silicate glass achieved 1x2 lossless splitting at 1537nm with a 980 nm laser diode pump

Women out, children out : the effect of female labor on portuguese preschool enrollment rates

This article tests whether Portuguese female activity rates have increased preschool enrollment rates. Particularly during the last 20 years, Portuguese women have assumed new roles in the marketplace and have become active workers outside of the home environment. This change has encouraged more sensible decisions with respect to preschool enrollment. Using cointegration techniques, we concluded that female activity rates and real income per capita caused a long-term increase in preschool enrollment rates. Although the percentage of agricultural gross value added to the gross domestic product and the number of preschool institutes were also found to be significant in the estimated vector error correction model, their causal relationship with preschool enrollment was only short term.COMPETE; QREN; FEDER; Fundação para a Ciência e a Tecnologia (FCT

The first wave of pandemic influenza (H1N1) 2009 in Germany: From initiation to acceleration

<p>Abstract</p> <p>Background</p> <p>The first imported case of pandemic influenza (H1N1) 2009 in Germany was confirmed in April 2009. However, the first wave with measurable burden of disease started only in October 2009. The basic epidemiological and clinical characteristics of the pandemic were analysed in order to understand the course of the pandemic in Germany.</p> <p>Methods</p> <p>The analysis was based on data from the case-based, mandatory German surveillance system for infectious diseases. Cases notified between 27 April and 11 November 2009 and fulfilling the case definition were included in the study.</p> <p>Results</p> <p>Two time periods with distinct epidemiologic characteristics could be determined: 23,789 cases (44.1%) occurred during the initiation period (IP, week 18 to 41), and 30,179 (55.9%) during the acceleration period (AP, week 42 to 45). During IP, coinciding with school summer holidays, 61.1% of cases were travel-related and one death occurred. Strict containment efforts were performed until week 32. During AP the majority of cases (94.3%) was autochthonous, 12 deaths were reported. The main affected age group shifted from 15 to 19 years in IP to 10 to 14 years in AP (median age 19 versus 15 years; p < 0.001). The proportion of cases with underlying medical conditions increased from 4.7% to 6.9% (p < 0.001). Irrespective of the period, these cases were more likely to be hospitalised (OR = 3.6 [95% CI: 3.1; 4.3]) and to develop pneumonia (OR = 8.1 [95% CI: 6.1; 10.7]). Furthermore, young children (0 to 2 years) (OR = 2.8 [95% CI: 1.5; 5.2]) and persons with influenza-like illness (ILI, OR = 1.4 [95% CI: 1.0; 2.1]) had a higher risk to develop pneumonia compared to other age groups and individuals without ILI.</p> <p>Conclusion</p> <p>The epidemiological differences we could show between summer and autumn 2009 might have been influenced by the school summer holidays and containment efforts. The spread of disease did not result in change of risk groups or severity. Our results show that analyses of case-based information can advise future public health measures.</p

Ion-exchanged planar lossless splitter for analog CATV distribution systems at 1.5µm

We demonstrate for the first time an ion-exchanged, planar lossless splitter pumped at 980 nm in an analog CATV distribution system at 1.5 µm

Contribution of smoking and air pollution exposure in urban areas to social differences in respiratory health

<p>Abstract</p> <p>Background</p> <p>Socio-economic status, smoking, and exposure to increased levels of environmental air pollution are associated with adverse effects on respiratory health. We assessed the contribution of occupational exposures, smoking and outdoor air pollution as competing factors for the association between socio-economic status and respiratory health indicators in a cohort of women from the Ruhr area aged 55 at the time of investigation between 1985 and 1990.</p> <p>Methods</p> <p>Data of 1251 women with spirometry and complete questionnaire information about respiratory diseases, smoking and potential confounders were used in the analyses. Exposure to large-scale air pollution was assessed with data from monitoring stations. Exposure to small-scale air pollution was assessed as traffic-related exposure by distance to the nearest major road. Socio-economic status was defined by educational level. Multiple regression models were used to estimate the contribution of occupational exposures, smoking and outdoor air pollution to social differences in respiratory health.</p> <p>Results</p> <p>Women with less than 10 years of school education in comparison to more than 10 years of school education were more often occupationally exposed (16.4% vs. 10.1%), smoked more often (20.3% vs. 13.9%), and lived more often close to major roads (26.0% vs. 22.9%). Long-term exposure to increased levels of PM₁₀was significantly associated with lower school education. Women with low school education were more likely to suffer from respiratory symptoms and had reduced lung function. In the multivariate analysis the associations between education and respiratory health attenuated after adjusting for occupational exposure, smoking and outdoor air pollution. The crude odds ratio for the association between the lung function indicator FEV₁less than 80% of predicted value and educational level (<10 years vs. >10 years of school education) was 1.83 (95% CI: 1.22–2.74). This changed to 1.56 (95% CI: 1.03–2.37) after adjusting for occupational exposure, smoking and outdoor air pollution.</p> <p>Conclusion</p> <p>We found an association between socio-economic status and respiratory health. This can partly be explained by living conditions indicated by occupational exposure, smoking behaviour and ambient air pollution. A relevant part of the social differences in respiratory health, however, remained unexplained.</p