A systematic review of the probability of asphyxia in children aged <2 years with unexplained epistaxis

ObjectiveTo determine the proportion of children aged <2 years who have been asphyxiated presenting with epistaxis in the absence of trauma or medical explanation and to identify the characteristics of the clinical presentation indicative of asphyxiation.Study designAn all-language systematic review was conducted by searching 10 databases from 1900 to 2015 and gray literature to identify high-quality studies that included children with epistaxis aged <2 years (alive or dead) with explicit confirmation of intentional or unintentional asphyxiation (upper airway obstruction). Studies of traumatic or pathological epistaxis were excluded. For each comparative study, the proportion of children presenting with epistaxis that were asphyxiated is reported with 95% CI.ResultsOf 2706 studies identified, 100 underwent full review, resulting in 6 included studies representing 30 children with asphyxiation-related epistaxis and 74 children with non–asphyxiation-related epistaxis. The proportion of children presenting with epistaxis that had been asphyxiated, reported by 3 studies, was between 7% and 24%. Features associated with asphyxiation in live children included malaise, altered skin color, respiratory difficulty, and chest radiograph abnormalities. There were no explicit associated features described among those children who were dead on arrival.ConclusionThere is an association between epistaxis and asphyxiation in young children; however, epistaxis does not constitute a diagnosis of asphyxia in itself. In any infant presenting with unexplained epistaxis, a thorough investigation of etiology is always warranted, which must include active exploration of asphyxia as a possible explanation

Mediators and Effect Modifiers of the Causal Pathway Between Child Exposure to Domestic Violence and Internalizing Behaviors Among Children and Adolescents : A Systematic Literature Review

Peer reviewedPublisher PD

Organic-Conventional Dairy Systems Trial in New Zealand: Four Years’ Results

The Organic-Conventional Comparative Dairy Systems trial at Massey University began in August 2001, and the organic farmlet achieved certification in August 2003. The trial is unique because it is the only comparative grassland-based open grazing dairy study in the world. The organic and conventional systems are managed individually according to best practice, and both are intensively monitored for production, animal health, and environmental impacts. The systems remained similar for the first two years, but began to diverge in the third and fourth years. Production has been 10-20% lower on the organic farm, but environmental impacts appear to be less than on the conventional unit, and net incomes would be similar given a 20% price premium for the organic product. Animal health issues have been manageable on the organic farmlet, and not too dissimilar from the conventional farmlet. Full results after four years of the trial will be available and presented at the conference

Influence of agents and mechanisms of injury on anatomical burn locations in children &lt;5 years old with a scald

Objective To demonstrate how the mechanism and agent of injury can influence the anatomical location of a scald. Design Prospective multicentre cross-sectional study. Setting 20 hospital sites across England and Wales including emergency departments, minor injury units and regional burns units. Patients Children aged 5 years and younger who attended hospital with a scald. Main outcome measures Primary outcome: a descriptive analysis of the mechanism, agent and anatomical location of accidental scalds. Secondary outcome: a comparison of these factors between children with and without child protection (CP) referral. Results Of 1041 cases of accidental scalds, the most common narrative leading to this injury was a cup or mug of hot beverage being pulled down and scalding the head or trunk (132/1041; 32.9% of cases). Accidental scalds in baths/showers were rare (1.4% of cases). Accidental immersion injuries were mainly distributed on hands and feet (76.7%). There were differences in the presentation between children with accidental scalds and the 103 who were referred for CP assessment; children with scalds caused by hot water in baths/showers were more likely to get referred for CP assessment (p<0.0001), as were those with symmetrically distributed (p<0.0001) and unwitnessed (p=0.007) scalds. Conclusions An understanding of the distributions of scalds and its relationship to different mechanisms of injury and causative agents will help clinicians assess scalds in young children, particularly those new to the emergency department who may be unfamiliar with expected scald patterns or with the importance of using appropriate terminology when describing scalds

The causal web of foetal alcohol spectrum disorders : a review and causal diagram

Peer reviewedPublisher PD

Establishing the international prevalence of self-reported child maltreatment: a systematic review by maltreatment type and gender

Background Estimating the prevalence of child maltreatment is challenging due to the absence of a clear ‘gold standard’ as to what constitutes maltreatment. This systematic review aims to review studies using self-report maltreatment to capture prevalence rates worldwide. Methods PubMed, Ovid SP and grey literature from the NSPCC, UNICEF, The UK Government, and WHO from 2000 to 2017 were searched. The literature review focused on the variation found in self-reported lifetime prevalence for each type of maltreatment between studies by continent and gender, and how methodological differences may explain differences found. Results Sexual abuse is the most commonly studied form of maltreatment across the world with median (25th to 75th centile) prevalence of 20.4% (13.2% to 33.6%) and 28.8% (17.0% to 40.2%) in North American and Australian girls respectively, with lower rates generally for boys. Rates of physical abuse were more similar across genders apart from in Europe, which were 12.0% (6.9% to 23.0%) and 27.0% (7.0% to 43.0%) for girls and boys respectively, and often very high in some continents, for example, 50.8% (36.0% to 73.8%) and 60.2% (43.0% to 84.9%) for girls and boys respectively in Africa. Median rates of emotional abuse were nearly double for girls than boys in North America (28.4% vs 13.8% respectively) and Europe (12.9% vs 6.2% respectively) but more similar across genders groups elsewhere. Median rates of neglect were highest in Africa (girls: 41.8%, boys: 39.1%) and South America (girls: 54.8%, boys: 56.7%) but were based on few studies in total, whereas in the two continents with the highest number of studies, median rates differed between girls (40.5%) and boys (16.6%) in North America but were similar in Asia (girls: 26.3%, boys: 23.8%). Conclusions Median prevalence rates differ substantially by maltreatment category, gender and by continent. The number of studies and available data also varies and relatively little is known about prevalence for some forms of maltreatment, particularly outside of the North American context. Prevalence rates require caution in interpretation as some variation will reflect methodological differences, including the data collection methods, and how the maltreatment is defined

The effectiveness and cost-effectiveness of first aid interventions for burns given to caregivers of children: A systematic review

Objectives: the effectiveness and cost-effectiveness of burns first-aid educational interventions given to caregivers of children. Methods: Systematic review of eligible studies from seven databases, international journals, trials repositories and contacted international experts. Results: Of 985 potential studies, four met the inclusion criteria. All had high risk of bias and weak global rating. Two studies identified a statistically significant increase in knowledge after of a media campaign. King et al. (41.7% vs 63.2%, p<0.0001), Skinner et al. (59% vs 40%, p=0.004). Skinner et al. also identified fewer admissions (64.4% vs 35.8%, p<0.001) and surgical procedures (25.6% vs 11.4%, p<0.001). Kua et al. identified a significant improvement in caregiver’s knowledge (22.9% vs 78.3%, 95% CI 49.2, 61.4) after face-to-face education intervention. Ozyazicioglu et al. evaluated the effect of a first-aid training program and showed a reduction in use of harmful traditional methods for burns in children (29% vs 16.1%, p<0.001). No data on cost-effectiveness was identified. Conclusion: There is a paucity of high quality research in this field and considerable heterogeneity across the included studies. Delivery and content of interventions varied. However, studies showed a positive effect on knowledge. No study evaluated the direct effect of the intervention on first aid administration. High quality clinical trials are needed

Agents, mechanisms and clinical features of non-scald burns in children: a prospective UK study

ABSTRACT Aims: To inform childhood burn prevention by identifying demographics, clinical features and circumstances of unintentional non-scald burns. Methods: A prospective cross-sectional study was conducted across Cardiff, Bristol and Manchester, including six emergency departments, three minor injury units and one burns unit between 13/01/2013-01/10/2015. Data collected for children aged <16 years with any burn (scald, contact, flame, radiation, chemical, electrical, friction) included: demographics, circumstances of injury and clinical features. Scalds and burns due to maltreatment were excluded from current analysis. Results: Of 564 non-scald cases, 60.8% were male, 51.1% were 0.6meters and 76.5% affected the hands. Hairstyling devices were the most common agent of contact burns (20.5%), 34.1% of hairstyling devices were on the floor. 63.7% of children aged 10-15 years sustained contact burns of which 23.2% were preparing food, and in burns from hairstyling devices, 73.3% were using them at the time of injury. Conclusions: Parents of toddlers must learn safe storage of hazardous items. Older children should be taught skills in safe cooking and hairstyling device use