1,354 research outputs found
Contact Burns:The Influence of Agents and Mechanisms of Injury on Anatomical Burn Locations in Children <5 Years Old and Associations with Child Protection Referrals
An evaluation of the efficacy and impact of a clinical prediction tool to identify maltreatment associated with childrenâs burns
Background An estimated 10%â24% of children attending emergency departments with a burn are maltreated.
Objective To test whether a clinical prediction tool (Burns Risk assessment for Neglect or abuse Tool; BuRN-Tool) improved the recognition of maltreatment and increased the referral of high-risk children to safeguarding services for assessment.
Methods A prospective study of children presenting with burns to four UK hospitals (2015â2018), each centre providing a minimum of 200 cases before and after the introduction of the BuRN-Tool. The proportions of children referred to safeguarding services were compared preintervention and postintervention, and the relationship between referral and the recommended cut-off for concern (BuRN-Tool score (BT-score) â„3) was explored.
Results The sample was 2443 children (median age 2 years). Nurses and junior doctors mainly completed the BuRN-Tool, and a BT-score was available for 90.8% of cases. After intervention, 28.4% (334/1174) had a BT-score â„3âand were nearly five times more likely to be discussed with a senior clinician than those with a BT-score <3 (65.3% vs 13.4%, p<0.001). There was no overall difference in the proportion of safeguarding referrals preintervention and postintervention. After intervention, the proportion of referrals for safeguarding concerns was greater when the BT-score was â„3 (p=0.05) but not for scores <3 (p=0.60). A BT-score of 3 as a cut-off for referral had a sensitivity of 72.1, a specificity of 82.7 and a positive likelihood ratio of 4.2.
Conclusions A BT-score â„3 encouraged discussion of cases of concern with senior colleagues and increased the referral of <5 year-olds with safeguarding concerns to childrenâs social care
Identifying cerebral palsy from routinely-collected data in England and Wales
Purpose: An observational study using routinely-collected health care data to describe the extent to which children and young people (CYP) with cerebral palsy (CP) can be identified and the prevalence of CP can be estimated.
Patients and methods: Routinely-collected anonymized data, for CYP (aged 0â25 years old between 1 January 2004 and 31 December 2014) were analyzed in two linked datasets, from England and Wales respectively. Datasets included National Health Service; General Practitioner (GP), inpatients, outpatients, and national mortality records. CP was identified using ICD-10 codes G80.0âG83.3 and equivalent Read v2 codes. Ascertainment rates of CP were identified for each data source and compared between countries. Frequency and consistency of coding were investigated, and prevalence of CP estimated.
Results: A total of 7,113 and 5,218 CYP with CP were identified in the English and Welsh datasets respectively. Whilst the majority of CYP with CP would be expected to attend their GP, 65.3% (4,646/7,113) of English and 65.1% (3,396/5,218) of Welsh cases were ascertained from GP datasets. Further cases were identified solely in inpatient datasets (2,410 in England, 1,813 in Wales). Few cases were coded for CP within outpatient datasets. Four character codes that specified CP type were rarely used; one in five health care records were coded both with G80 codes (explicitly CP) and with G81â83 codes (other paralytic syndromes) or equivalent Read codes. Estimated period prevalence of CYP with CP was 2.5â3.4 per 1,000 in England and 2.4â3.2 per 1,000 in Wales.
Conclusion: In England and Wales, coding of CP in routine data is infrequent, inconsistent, non-specific, and difficult to isolate from conditions with similar physical signs. Yet the prevalence estimates of CP were similar to those reported elsewhere. To optimize case recognition we recommend improved coding quality and the use of both primary and secondary care datasets as a minimum
Feasibility of Safe-Tea: A parent targeted intervention to prevent hot drink scalds in pre-school children
Objective Despite the high prevalence of preventable hot drink scalds in preschool children, there is a paucity of research on effective prevention interventions and a serious need to improve parentsâ knowledge of first aid. This study investigates the feasibility of âSafe-Teaâ, an innovative multifaceted community-based intervention delivered by early-years practitioners.
Methods âSafe-Teaâ was implemented at Childcare, Stay&Play and Home Visit settings in areas of deprivation in Cardiff, UK. A mixed-methods approach was used, including preintervention and postintervention parent questionnaires and focus groups with parents and practitioners to test the acceptability, practicality and ability of staff to deliver the intervention, and parentsâ knowledge and understanding.
Results Intervention materials, activities and messages were well received and understood by both parents and community practitioners. Interactive and visual methods of communication requiring little to no reading were most acceptable. Parentsâ understanding of the risk of hot drink scalds in preschool children and knowledge of appropriate first aid improved postintervention. Parents knew at baseline that they âshouldâ keep hot drinks out of reach. Focus group discussions after intervention revealed improved understanding of likelihood and severity of scald injury to children, which increased vigilance. Parents gained confidence to correct the behaviours of others at home and pass on first aid messages.
Conclusion This feasibility study is a vital step towards the development of a robust, evidence-based behaviour change intervention model. Work is underway to refine intervention materials based on improvements suggested by parents, and test these more widely in communities across the UK
Cultural transmission of vocal dialect in the naked mole-rat
Naked mole-rats (Heterocephalus glaber) form some of the most cooperative groups in the animal kingdom, living in multigenerational colonies under the control of a single breeding queen. Yet how they maintain this highly organized social structure is unknown. Here we show that the most common naked mole-rat vocalization, the soft chirp, is used to transmit information about group membership, creating distinctive colony dialects. Audio playback experiments demonstrate that individuals make preferential vocal responses to home colony dialects. Pups fostered in foreign colonies in early postnatal life learn the vocal dialect of their adoptive colonies, which suggests vertical transmission and flexibility of vocal signatures. Dialect integrity is partly controlled by the queen: Dialect cohesiveness decreases with queen loss and remerges only with the ascendance of a new queen.The European Research Council and a South African Research Chair for Mammalian Behavioral Research.http://www.sciencemag.orghj2022Mammal Research InstituteZoology and Entomolog
Factors influencing clinicians', health visitors' and social workers' professional judgements, decisionâmaking and multidisciplinary collaboration when safeguarding children with burn injuries: a qualitative study
Burns are a common injury to young children, sometimes related to neglect or physical abuse. Emergency department (ED) clinicians, health visitors and social workers must work collaboratively when safeguarding children with burns; however, little is known about the factors influencing their professional judgements, decisionâmaking and multidisciplinary collaboration. Objective was to explore factors affecting ED clinicians', health visitors' and social workers' professional judgements and decisionâmaking when children present to the ED with burns, and experiences of multidisciplinary collaboration, to identify areas for improvement. This was a qualitative semiâstructured interview study using purposive and snowball sampling to recruit participants. Data were analysed using âcodebookâ thematic analysis. Four themes were identified: âperceived roles and responsibilities when safeguarding children with burn injuriesâ, âfactors influencing judgment of risk and decisionâmakingâ, âinformation sharingâ and âbarriers and facilitators to successful multidisciplinary collaborationâ. There is limited understanding between the groups about each other's roles. Each agency is dependent on one another to understand the full picture; however, information sharing is lacking in detail and context and hindered by organisational and resource constraints. Formal opportunities for multiagency team working such as strategy meetings can be facilitators of more successful collaborations. Professionals may benefit from multiagency training to improve understanding of one another's roles. Greater detail and context are needed when notifying health visitors of burn injuries in children or making a referral to children's services
Neoliberalisation and 'lad cultures' in higher education
This paper links HE neoliberalisation and âlad culturesâ, drawing on interviews and focus groups with women students. We argue that retro-sexist âladdishâ forms of masculine competitiveness and misogyny have been reshaped by neoliberal rationalities to become modes of consumerist sexualised audit. We also suggest that neoliberal frameworks scaffold an individualistic and adversarial culture among young people that interacts with perceived threats to menâs privilege and intensifies attempts to put women in their place through misogyny and sexual harassment. Furthermore, âlad culturesâ, sexism and sexual harassment in higher education may be invisibilised by institutions to preserve marketability in a neoliberal context. In response, we ask if we might foster dialogue and partnership between feminist and anti-marketisation politics
First aid for children's burns in the US and UK: An urgent call to establish and promote international standards
Introduction
Appropriate first aid can reduce the morbidity of burns, however, there are considerable variations between international first aid recommendations. We aim to identify, and compare first aid practices in children who present to Emergency Departments (ED) with a burn.
Methods
A prospective cross-sectional study of 500 children (0â16 completed years) presenting with a burn to a paediatric ED in the UK (Cardiff) and the USA (Denver, Colorado), during 2015â2017. The proportion of children who had received some form of first aid and the quality of first aid were compared between cities.
Results
Children attending hospital with a burn in Cardiff were 1.47 times more likely (RR 1.47; CI 1.36, 1.58), to have had some form of first aid than those in Denver. Denver patients were 4.7 time more likely to use a dressing and twice as likely to apply ointment/gel/aloe vera than the Cardiff cohort. First aid consistent with local recommendations was only administered to 26% (128/500) of children in Cardiff and 6% (31/500) in Denver. Potentially harmful first aid e.g. application of food, oil, toothpaste, shampoo or ice was applied to 5% of children in Cardiff and 10% in Denver.
Conclusion
A low number of children received optimal burns first aid, with potentially harmful methods applied in a considerable proportion of cases. There is an urgent need for internationally agreed, evidence-based burn first aid recommendations
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The PSEN1, p.E318G Variant Increases the Risk of Alzheimer's Disease in APOE-Δ4 Carriers
The primary constituents of plaques (AÎČ42/AÎČ40) and neurofibrillary tangles (tau and phosphorylated forms of tau [ptau]) are the current leading diagnostic and prognostic cerebrospinal fluid (CSF) biomarkers for AD. In this study, we performed deep sequencing of APP, PSEN1, PSEN2, GRN, APOE and MAPT genes in individuals with extreme CSF AÎČ42, tau, or ptau levels. One known pathogenic mutation (PSEN1 p.A426P), four high-risk variants for AD (APOE p.L46P, MAPT p.A152T, PSEN2 p.R62H and p.R71W) and nine novel variants were identified. Surprisingly, a coding variant in PSEN1, p.E318G (rs17125721-G) exhibited a significant association with high CSF tau (p = 9.2Ă10â4) and ptau (p = 1.8Ă10â3) levels. The association of the p.E318G variant with AÎČ deposition was observed in APOE-Δ4 allele carriers. Furthermore, we found that in a large case-control series (n = 5,161) individuals who are APOE-Δ4 carriers and carry the p.E318G variant are at a risk of developing AD (OR = 10.7, 95% CI = 4.7â24.6) that is similar to APOE-Δ4 homozygous (OR = 9.9, 95% CI = 7.2.9â13.6), and double the risk for APOE-Δ4 carriers that do not carry p.E318G (OR = 3.9, 95% CI = 3.4â4.4). The p.E318G variant is present in 5.3% (n = 30) of the families from a large clinical series of LOAD families (n = 565) and exhibited a higher frequency in familial LOAD (MAF = 2.5%) than in sporadic LOAD (MAF = 1.6%) (p = 0.02). Additionally, we found that in the presence of at least one APOE-Δ4 allele, p.E318G is associated with more AÎČ plaques and faster cognitive decline. We demonstrate that the effect of PSEN1, p.E318G on AD susceptibility is largely dependent on an interaction with APOE-Δ4 and mediated by an increased burden of AÎČ deposition
Genetic associations of adult height with risk of cardioembolic and other subtypes of ischemic stroke: A mendelian randomization study in multiple ancestries
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