979 research outputs found
Investigating sudden unexpected deaths in infancy and childhood and caring for bereaved families : an integrated multiagency approach
The sudden unexpected death of an infant or child is
one of the worst events to happen to any family.
Bereaved parents expect and should receive appropriate,
thorough, and sensitive investigations to identify the
medical causes of such deaths. As a result, several parallel
needs must be fulfilled. Firstly, the needs of the family
must be recognisedāincluding the need for information
and support. Further, there is the need to identify any
underlying medical causes of death that may have
genetic or public health implications; the need for a
thorough forensic investigation to exclude unnatural
causes of death; and the need to protect siblings and
subsequent children. Alongside this, families need to
be protected from false or inappropriate accusations.
Limitations in the present coronial system have led to
delays or failures to detect deaths caused by relatives,
carers, or health professionals. Several recent,
highly publicised trials have highlighted the possibilities
of parents facing such accusations. As a result of this the
whole process of death certification has come under
intense scrutiny.
We review the medical, forensic, and sociological
literature on the optimal investigation and care of
families after the sudden death of a child. We describe
the implementation in the former county of Avon of a
structured multiagency approach and the potential
benefits for families and professionals
Major epidemiological changes in sudden infant death syndrome : a 20-year population-based study in the UK
Background
Results of case-control studies in the past 5 years suggest that the epidemiology of sudden infant death syndrome (SIDS) has changed since the 1991 UK Back to Sleep campaign. The campaign's advice that parents put babies on their back to sleep led to a fall in death rates. We used a longitudinal dataset to assess these potential changes.
Methods
Population-based data from home visits have been collected for 369 consecutive unexpected infant deaths (300 SIDS and 69 explained deaths) in Avon over 20 years (1984ā2003). Data obtained between 1993 and 1996 from 1300 controls with a chosen āreferenceā sleep before interview have been used for comparison.
Findings
Over the past 20 years, the proportion of children who died from SIDS while co-sleeping with their parents, has risen from 12% to 50% (p<0Ā·0001), but the actual number of SIDS deaths in the parental bed has halved (p=0Ā·01). The proportion seems to have increased partly because the Back to Sleep campaign led to fewer deaths in infants sleeping aloneārather than because of a rise in deaths of infants who bed-shared, and partly because of an increase in the number of deaths in infants sleeping with their parents on a sofa. The proportion of deaths in families from deprived socioeconomic backgrounds has risen from 47% to 74% (p=0Ā·003), the prevalence of maternal smoking during pregnancy from 57% to 86% (p=0Ā·0004), and the proportion of pre-term infants from 12% to 34% (p=0Ā·0001). Although many SIDS infants come from large families, first-born infants are now the largest group. The age of infants who bed-share is significantly smaller than that before the campaign, and fewer are breastfed.
Interpretation
Factors that contribute to SIDS have changed in their importance over the past 20 years. Although the reasons for the rise in deaths when a parent sleeps with their infant on a sofa are still unclear, we strongly recommend that parents avoid this sleeping environment. Most SIDS deaths now occur in deprived families. To better understand contributory factors and plan preventive measures we need control data from similarly deprived families, and particularly, infant sleep environments
Responding to unexpected infant deaths : experience in one English region
New national procedures for responding to the unexpected death of a child in England
require a joint agency approach to investigate each death and support the bereaved
family. As part of a wider population-based study of sudden unexpected deaths in
infancy (SUDI) we evaluated the implementation of this approach.
Methods: A process evaluation using a population-based study of all unexpected
deaths from birth to 2 years in the South West of England between January 2003 and
December 2006. Local police and health professionals followed a standardised
approach to the investigation of each death, supported by the research team set up to
facilitate this joint approach as well as collect data for a wider research project.
Results: We were notified of 155/157 SUDI, with a median time to notification of 2
hours. Initial multi-agency discussions took place in 93.5% of cases. A joint home
visit by police officers with health professionals was carried out in 117 cases, 75%
within 24 hours of the death. Time to notification and interview reduced during the 4
years of the study. Autopsies were conducted on all cases, the median time to autopsy
being 3 days. At the conclusion of the investigation, a local multi-agency case
discussion was held in 88% of cases. The median time for the whole process
(including family support) was 5 months.
Conclusions: This study has demonstrated that with appropriate protocols and
support, the joint agency approach to the investigation of unexpected infant deaths
can be successfully implemented
Hazardous cosleeping environments and risk factors amenable to change: case-control study of SIDS in south west England
Objectives: To investigate the factors associated with sudden infant death syndrome (SIDS) from birth to age 2 years, whether recent advice has been followed, whether any new risk factors have emerged, and the specific circumstances in which SIDS occurs while cosleeping (infant sharing the same bed or sofa with an adult or child).
Design: Four year population based case-control study. Parents were interviewed shortly after the death or after the reference sleep (within 24 hours) of the two control groups.
Setting: South west region of England (population 4.9 million, 184 800 births).
Participants: 80 SIDS infants and two control groups weighted for age and time of reference sleep: 87 randomly selected controls and 82 controls at high risk of SIDS (young, socially deprived, multiparous mothers who smoked).
Results: The median age at death (66 days) was more than three weeks less than in a study in the same region a decade earlier. Of the SIDS infants, 54% died while cosleeping compared with 20% among both control groups. Much of this excess may be explained by a significant multivariable interaction between cosleeping and recent parental use of alcohol or drugs (31% v 3% random controls) and the increased proportion of SIDS infants who had coslept on a sofa (17% v 1%). One fifth of SIDS infants used a pillow for the last sleep (21% v 3%) and one quarter were swaddled (24% v 6%). More mothers of SIDS infants than random control infants smoked during pregnancy (60% v 14%), whereas one quarter of the SIDS infants were preterm (26% v 5%) or were in fair or poor health for the last sleep (28% v 6%). All of these differences were significant in the multivariable analysis regardless of which control group was used for comparison. The significance of covering the infantās head, postnatal exposure to tobacco smoke, dummy use, and sleeping in the side position has diminished although a significant proportion of SIDS infants were still found prone (29% v 10%).
Conclusions: Many of the SIDS infants had coslept in a hazardous environment. The major influences on risk, regardless of markers for socioeconomic deprivation, are amenable to change and specific advice needs to be given, particularly on use of alcohol or drugs before cosleeping and cosleeping on a sofa
The Confidential Inquiry into premature deaths of people with intellectual disabilities in the UK: a population-based study
SummaryBackgroundThe Confidential Inquiry into premature deaths of people with intellectual disabilities in England was commissioned to provide evidence about contributory factors to avoidable and premature deaths in this population.MethodsThe population-based Confidential Inquiry reviewed the deaths of people with intellectual disabilities aged 4 years and older who had been registered with a general practitioner in one of five Primary Care Trust areas of southwest England, who died between June 1, 2010, and May 31, 2012. A network of health, social-care, and voluntary-sector services; community contacts; and statutory agencies notified the Confidential Inquiry of all deaths of people with intellectual disabilities and provided core data. The Office for National Statistics provided data about the coding of individual cause of death certificates. Deaths were described as avoidable (preventable or amenable), according to Office for National Statistics definitions. Contributory factors to deaths were identified and quantified by the case investigator, verified by a local review panel meeting, and agreed by the Confidential Inquiry overview panel. Contributory factors were grouped into four domains: intrinsic to the individual, within the family and environment, care provision, and service provision. The deaths of a comparator group of people without intellectual disabilities but much the same in age, sex, and cause of death and registered at the same general practices as those with intellectual disabilities were also investigated.FindingsThe Confidential Inquiry reviewed the deaths of 247 people with intellectual disabilities. Nearly a quarter (22%, 54) of people with intellectual disabilities were younger than 50 years when they died, and the median age at death was 64 years (IQR 52ā75). The median age at death of male individuals with intellectual disabilities was 65 years (IQR 54ā76), 13 years younger than the median age at death of male individuals in the general population of England and Wales (78 years). The median age at death of female individuals with intellectual disabilities was 63 years (IQR 54ā75), 20 years younger than the median age at death for female individuals in the general population (83 years). Avoidable deaths from causes amenable to change by good quality health care were more common in people with intellectual disabilities (37%, 90 of 244) than in the general population of England and Wales (13%). Contributory factors to premature deaths in a subset of people with intellectual disabilities compared with a comparator group of people without intellectual disabilities included problems in advanced care planning (p=0Ā·0003), adherence to the Mental Capacity Act (p=0Ā·0008), living in inappropriate accommodation (p<0Ā·0001), adjusting care as needs changed (p=0Ā·009), and carers not feeling listened to (p=0Ā·006).InterpretationThe Confidential Inquiry provides evidence of the substantial contribution of factors relating to the provision of care and health services to the health disparities between people with and without intellectual disabilities. It is imperative to examine care and service provision for this population as potentially contributory factors to their deathsāfactors that can largely be ameliorated.FundingDepartment of Health for England
Impacts and Management of Invasive Burrowing Herbivores in Grasslands
Maintenance of the productivity of the worldās grasslands is critical for livestock production, bio-diversity conservation and ecosystem services. Using case studies from Australasia, North America and China, we identify general principles of managing invasive native and introduced herbivores. Management aims to achieve optimised livestock production while conserving biodiversity and ecosystem services, which are often intangible. We identify similarities and differences in the ecologies and impacts of European wild rabbits, Californian ground squirrel and plateau zokors, discuss management tools and strategies, and the ecological, social and cultural factors affecting management. The ecosystem engineering characteristics of these species that make them important for ecosystem function in grasslands are perversely the selfsame ones that bring them into conflict with livestock producers. All three species create habitat patches through their bur-rowing and foraging behaviours, but changes in vegetation floristics and structure, increased soil exposure and decreased litter negatively affect grassland and livestock production when the animals are superabundant. Management is therefore complex and we recommend an adaptive approach that is founded on the scientific knowledge of the local agri-ecosystem, economic principles and social inclusion to increase knowledge and iteratively improve management
Systematic Literature Review Report for the National Child Safeguarding Practice Review into the Sudden Unexpected Death of Infants (SUDI) in families where the children are considered to be at risk of significant harm
Interventions to Improve Safer Sleep Practices in Families With Children Considered to Be at Increased Risk for Sudden Unexpected Death in Infancy:A Systematic Review
Background: Advice to families to follow infant care practices known to reduce the risks of Sudden Unexpected Death in Infancy (SUDI) has led to a reduction in deaths across the world. This reduction has slowed in the last decade with most deaths now occurring in families experiencing social and economic deprivation. A systematic review of the literature was commissioned by the National Child Safeguarding Practice Review Panel in England. The review covered three areas: interventions to improve engagement with support services, parental decision-making for the infant sleep environment, and interventions to improve safer sleep practices in families with infants considered to be at risk of SUDI. Aim: To describe the safer sleep interventions tested with families with infants at risk of SUDI and investigate what this literature can tell us about what works to reduce risk and embed safer sleep practices in this group. Methods: Eight online databases were systematically searched in December 2019. Intervention studies that targeted families with infants (0ā1 year) at increased risk of SUDI were included. Studies were limited to those from Western Europe, North America or Australasia, published in the last 15 years. The Quality Assessment Tool for Studies with Diverse Designs was applied to assess quality. Data from included studies were extracted for narrative synthesis, including mode of delivery using Michie et al.'s Mode of Delivery Taxonomy. Results: The wider review returned 3,367 papers, with 23 intervention papers. Five types of intervention were identified: (1) infant sleep space and safer sleep education programs, (2) intensive or targeted home visiting services, (3) peer educators/ambassadors, (4) health education/raising awareness interventions, (5) targeted health education messages using digital media. Conclusion: Influencing behavior in families with infants at risk of SUDI has traditionally focused on āgetting messages across,ā with interventions predominantly using education and awareness raising mechanisms. This review found evidence of interventions moving from āinformation givingā to āinformation exchangeā models using personalized, longer term relationship-building models. This shift may represent an improvement in how safer sleep advice is implemented in families with infants at risk, but more robust evidence of effectiveness is required. Systematic Review Registration: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/901091/DfE_Death_in_infancy_review.pdf, identifier: CRD42020165302
Interlaced particle systems and tilings of the Aztec diamond
Motivated by the problem of domino tilings of the Aztec diamond, a weighted
particle system is defined on lines, with line containing
particles. The particles are restricted to lattice points from 0 to , and
particles on successive lines are subject to an interlacing constraint. It is
shown that marginal distributions for this particle system can be computed
exactly. This in turn is used to give unified derivations of a number of
fundamental properties of the tiling problem, for example the evaluation of the
number of distinct configurations and the relation to the GUE minor process. An
interlaced particle system associated with the domino tiling of a certain half
Aztec diamond is similarly defined and analyzed.Comment: 17 pages, 4 figure
Physiological responses to cuddling babies with hypoxicāischaemic encephalopathy during therapeutic hypothermia:an observational study
OBJECTIVES: To determine whether parents cuddling infants during therapeutic hypothermia (TH) would affect cooling therapy, cardiorespiratory or neurophysiological measures. The secondary aim was to explore parentāinfant bonding, maternal postnatal depression and breastfeeding. DESIGN: Prospective observational study. SETTING: Two tertiary neonatal intensive care units (NICU). PARTICIPANTS: Parents and their term-born infants (n=27) receiving TH and intensive care for neonatal hypoxicāischaemic encephalopathy. INTERVENTIONS: Cuddling up to 2 hours during TH using a standard operating procedure developed in the study (CoolCuddle). MAIN OUTCOME MEASURES: Mean difference in temperature, cardiorespiratory and neurophysiological variables before, during and after the cuddle. Secondary outcomes were parental bonding, maternal postnatal depression and breastfeeding. RESULTS: During 70 CoolCuddles (115 cumulative hours), there were measurable increases in rectal temperature (0.07Ā°C (0.03 to 0.10)) and upper margin of amplitude-integrated electroencephalogram (1.80 ĀµV (0.83 to 2.72)) and decreases in oxygen saturations (ā0.57% (ā1.08 to ā0.05)) compared with the precuddle period. After the cuddle, there was an increase in end-tidal CO(2) (0.25 kPa (95% CI 0.14 to 0.35)) and mean blood pressure (4.09 mm Hg (95% CI 0.96 to 7.21)) compared with the precuddle period. From discharge to 8 weeks postpartum, maternal postnatal depression declined (13 (56.5%) vs 5 (23.8%), p=0.007); breastfeeding rate differed (71% vs 50%, p=0.043), but was higher than national average at discharge (70% vs 54.6%) and motherāinfant bonding (median (IQR): 3 (0ā6) vs 3 (1ā4)) remained stable. CONCLUSION: In this small study, CoolCuddle was associated with clinically non-significant, but measurable, changes in temperature, cardiorespiration and neurophysiology. No infant met the criteria to stop the cuddles or had any predefined adverse events. CoolCuddle may improve breastfeeding and requires investigation in different NICU settings
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