10 research outputs found
Proposal of an exploitation method of a national database, the PMSI, to estimate the frequency of the abused children in France, from 0 to 5 years old, their lethality and the characteristics of their hospital stays
Les situations de maltraitances Ă enfants sont nombreuses et les consĂ©quences peuvent ĂȘtre dramatiques. Le nombre dâenfants maltraitĂ©s en France est trĂšs probablement sous-estimĂ© par le sous-repĂ©rage de ces enfants et le manque de donnĂ©es Ă©pidĂ©miologiques. Nous proposons une mĂ©thode innovante de repĂ©rage rĂ©trospectif des situations de maltraitances physiques Ă enfants et de leurs consĂ©quences, en termes de mortalitĂ©, retentissement somatique ou psychiatrique et consommation de soins, Ă partir de grandes bases de donnĂ©es nationales existantes : le Programme de MĂ©dicalisation des SystĂšmes dâInformation (PMSI) et le SystĂšme Nationale dâInformation Inter-RĂ©gimes de lâAssurance Maladie (SNIIRAM). Les donnĂ©es de la base nationale du PMSI permettront de fournir un ordre de grandeur de la frĂ©quence des maltraitances physiques faites aux enfants au niveau national et rĂ©gional. Pour approcher cette valeur, nous souhaitons lâencadrer par une borne supĂ©rieure et une borne infĂ©rieure. Nous avons pensĂ© que la borne infĂ©rieure pourrait correspondre aux cas de maltraitances physiques codĂ©es comme telles dans le PMSI, dont nous savons quâils sont sous-dĂ©clarĂ©s. La borne supĂ©rieure correspondrait Ă la somme de ces cas et de tous ceux susceptibles de lâĂȘtre. Les cas susceptibles de reprĂ©senter des situations de maltraitance Ă enfant (ou cas potentiels) ont Ă©tĂ© identifiĂ©s par le repĂ©rage de caractĂ©ristiques particuliĂšres des lĂ©sions traumatiques et de lâĂąge de lâenfant sur son ou ses sĂ©jours hospitaliers. Le SystĂšme National d'Information Inter-RĂ©gimes de l'Assurance maladie (SNIIRAM) rassemble des donnĂ©es individuelles des bĂ©nĂ©ficiaires, depuis 2004. Ces donnĂ©es sont lâĂąge, le sexe, la commune de rĂ©sidence, lâexistence dâune affection de longue durĂ©e (ALD), le bĂ©nĂ©fice de la couverture universelle complĂ©mentaire (CMU-C), le statut vital et la consommation de soin en ville. Lâanalyse du SNIIRAM permettra ainsi de retracer le parcours des patients selon la pathologie prĂ©sentĂ©e. Dans le cas des enfants repĂ©rĂ©s comme Ă©tant maltraitĂ©s, il semble intĂ©ressant de pouvoir dĂ©crire les pathologies somatique et psychiatrique associĂ©es et de les comparer aux pathologies prĂ©sentĂ©es par les enfants non repĂ©rĂ©s comme Ă©tant maltraitĂ©s. Ce retentissement pourra ĂȘtre dĂ©crit via les codes ALD (concernant les affections de longues durĂ©es), mais Ă©galement via les donnĂ©es de consommation de mĂ©dicaments et dâautres prestations.Importance: Childhood abuse is a global public health issue yet there is a serious lack of reliable epidemiological data and the figures reported are very often underestimated. A large part of these children are not diagnosed. Moreover, diagnosed children are not recorded in a single database.Objective: The aim of this study is to provide two estimations of the frequency of child physical abuse requiring hospitalization (hospital prevalence) and the corresponding in-hospital fatality. Design, setting and participants: This was a national retrospective study using a national hospital database (PMSI).We included all children aged less than 2 years old hospitalized at least once in France from 2007 to 2014. Infants less than 1 month old were excluded in order to exclude all pathologies and neonatal complications.Three groups were defined: group1 - physically abused children (identified by the ICD 10 codes used in the PMSI concerning physical abuse); group2 - possible physically abused children (suspicious physical injuries associated with child maltreatment); and group3 - all other hospitalized children (the control group).Main outcomes and measurements: First, based on the number of children aged 0 to 2 years in France in 2010, we provide two estimations of the frequency of child physical abuse requiring hospitalization (hospital prevalence): a lower bound represented by the children of group 1 and an upper bound represented by the children of group 1+2.Secondly, we studied the follow-up of these children from their inclusion to 2014, thanks to the linkage of the differents hospital stays; with regard to the number of hospitalizations, their length of stay, their reasons and in-hospital fatality.Results: In our study, 2,628,386 children were included: 4,172 in group1, 12,024 in group2 and 2,612,190 in group3. The national annual hospital prevalence of child physical abuse (and hospital fatality) in children aged 0 to 2 years ranged from 1.6â° (2.52%) to 5.7â° (2.01%). Most hospital deaths occurred during the first hospital stay (between 99% and 99.6%) and are 10 times higher than in the control group. The length of stay of abused children is up to 5 times longer than for other children. Conclusions and relevance: To our knowledge, this is the first study to provide an estimation of the frequency of child physical abuse requiring hospitalization and the corresponding in-hospital fatality. Three out of four children may not be identified as being maltreated and are at risk of recurrent abuses. More effective prevention should be implemented by health professionals in order to identify those children
Proposition d'une méthode d'exploitation d'une base de donnée nationale, le PMSI, pour estimer la fréquence des enfants maltraités en France, ùgés de 0 à 5 ans, leur taux de létalité hospitaliÚre et les caractéristiques de leurs séjours hospitaliers
Importance: Childhood abuse is a global public health issue yet there is a serious lack of reliable epidemiological data and the figures reported are very often underestimated. A large part of these children are not diagnosed. Moreover, diagnosed children are not recorded in a single database.Objective: The aim of this study is to provide two estimations of the frequency of child physical abuse requiring hospitalization (hospital prevalence) and the corresponding in-hospital fatality. Design, setting and participants: This was a national retrospective study using a national hospital database (PMSI).We included all children aged less than 2 years old hospitalized at least once in France from 2007 to 2014. Infants less than 1 month old were excluded in order to exclude all pathologies and neonatal complications.Three groups were defined: group1 - physically abused children (identified by the ICD 10 codes used in the PMSI concerning physical abuse); group2 - possible physically abused children (suspicious physical injuries associated with child maltreatment); and group3 - all other hospitalized children (the control group).Main outcomes and measurements: First, based on the number of children aged 0 to 2 years in France in 2010, we provide two estimations of the frequency of child physical abuse requiring hospitalization (hospital prevalence): a lower bound represented by the children of group 1 and an upper bound represented by the children of group 1+2.Secondly, we studied the follow-up of these children from their inclusion to 2014, thanks to the linkage of the differents hospital stays; with regard to the number of hospitalizations, their length of stay, their reasons and in-hospital fatality.Results: In our study, 2,628,386 children were included: 4,172 in group1, 12,024 in group2 and 2,612,190 in group3. The national annual hospital prevalence of child physical abuse (and hospital fatality) in children aged 0 to 2 years ranged from 1.6â° (2.52%) to 5.7â° (2.01%). Most hospital deaths occurred during the first hospital stay (between 99% and 99.6%) and are 10 times higher than in the control group. The length of stay of abused children is up to 5 times longer than for other children. Conclusions and relevance: To our knowledge, this is the first study to provide an estimation of the frequency of child physical abuse requiring hospitalization and the corresponding in-hospital fatality. Three out of four children may not be identified as being maltreated and are at risk of recurrent abuses. More effective prevention should be implemented by health professionals in order to identify those children.Les situations de maltraitances Ă enfants sont nombreuses et les consĂ©quences peuvent ĂȘtre dramatiques. Le nombre dâenfants maltraitĂ©s en France est trĂšs probablement sous-estimĂ© par le sous-repĂ©rage de ces enfants et le manque de donnĂ©es Ă©pidĂ©miologiques. Nous proposons une mĂ©thode innovante de repĂ©rage rĂ©trospectif des situations de maltraitances physiques Ă enfants et de leurs consĂ©quences, en termes de mortalitĂ©, retentissement somatique ou psychiatrique et consommation de soins, Ă partir de grandes bases de donnĂ©es nationales existantes : le Programme de MĂ©dicalisation des SystĂšmes dâInformation (PMSI) et le SystĂšme Nationale dâInformation Inter-RĂ©gimes de lâAssurance Maladie (SNIIRAM). Les donnĂ©es de la base nationale du PMSI permettront de fournir un ordre de grandeur de la frĂ©quence des maltraitances physiques faites aux enfants au niveau national et rĂ©gional. Pour approcher cette valeur, nous souhaitons lâencadrer par une borne supĂ©rieure et une borne infĂ©rieure. Nous avons pensĂ© que la borne infĂ©rieure pourrait correspondre aux cas de maltraitances physiques codĂ©es comme telles dans le PMSI, dont nous savons quâils sont sous-dĂ©clarĂ©s. La borne supĂ©rieure correspondrait Ă la somme de ces cas et de tous ceux susceptibles de lâĂȘtre. Les cas susceptibles de reprĂ©senter des situations de maltraitance Ă enfant (ou cas potentiels) ont Ă©tĂ© identifiĂ©s par le repĂ©rage de caractĂ©ristiques particuliĂšres des lĂ©sions traumatiques et de lâĂąge de lâenfant sur son ou ses sĂ©jours hospitaliers. Le SystĂšme National d'Information Inter-RĂ©gimes de l'Assurance maladie (SNIIRAM) rassemble des donnĂ©es individuelles des bĂ©nĂ©ficiaires, depuis 2004. Ces donnĂ©es sont lâĂąge, le sexe, la commune de rĂ©sidence, lâexistence dâune affection de longue durĂ©e (ALD), le bĂ©nĂ©fice de la couverture universelle complĂ©mentaire (CMU-C), le statut vital et la consommation de soin en ville. Lâanalyse du SNIIRAM permettra ainsi de retracer le parcours des patients selon la pathologie prĂ©sentĂ©e. Dans le cas des enfants repĂ©rĂ©s comme Ă©tant maltraitĂ©s, il semble intĂ©ressant de pouvoir dĂ©crire les pathologies somatique et psychiatrique associĂ©es et de les comparer aux pathologies prĂ©sentĂ©es par les enfants non repĂ©rĂ©s comme Ă©tant maltraitĂ©s. Ce retentissement pourra ĂȘtre dĂ©crit via les codes ALD (concernant les affections de longues durĂ©es), mais Ă©galement via les donnĂ©es de consommation de mĂ©dicaments et dâautres prestations
Maltraitance envers les enfants et Covid-19
En France, au dĂ©but de lâannĂ©e 2020, environ 690â000 vies ont pu ĂȘtre Ă©pargnĂ©es grĂące au confinement gĂ©nĂ©ral de la population et aux mesures restrictives de lutte contre la Covid-19. ConsĂ©quence inattendue, ces mesures ont eu un impact sur une autre frange vulnĂ©rable de la population : celle des jeunes enfants, pour lesquels il a Ă©tĂ© dĂ©montrĂ© une augmentation des maltraitances subies Ă cette pĂ©riode. Ă partir de donnĂ©es de la littĂ©rature et de lâapport de nos travaux de recherche dans le domaine, nous proposons une documentation de cette crise des violences intra-familiales, intriquĂ©e dans la crise sanitaire de la Covid-19
Hospitalization for physical child abuse: Associated medical factors and medical history since birth
International audienceBackground: Physical abuse often begins at a very young age and sometimes results in serious or fatal injuries. It is crucial to diagnose physical abuse as early as possible to protect this vulnerable population. Objective: To study the factors associated with the first hospitalization for physical abuse from birth to the infant's first birthday in France. Participants and setting: We included all singleton children born in a hospital setting in France between 2009 and 2013, who were identified from the French national information system database (SNDS). Methods: To study factors associated with the first hospitalization for physical abuse during the first year after birth, we used the Fine and Gray regression model. Factors included in the multivariate model were the infant's sex, prematurity, neonatal conditions, the number of hospitalizations (at least two), medical consultations and complementary universal health insurance (proxy for family precariousness and socio-economic vulnerability). Results: Over the 2009â2013 period, among 3,432,921 newborn singletons, 903 (0.026 %) were hospitalized for physical abuse in the year following birth. Among the factors associated with physical abuse, such as prematurity (aHR = 2.2[1.8â2.7]), male sex (aHR = 1.3[1.2â1.5]), or having had at least two hospitalizations (aHR = 1.7[1.4â2.1]), we found that complementary universal health insurance coverage was the factor most associated (aHR = 4.1[3.5â4.7]) with being hospitalized for physical abuse. Conclusion: These findings could help introduce preventative measures for infant protection in certain groups, such as parents of infants born prematurely, especially if they are in a precarious situation. This study also suggests that particular attention should be paid to infants who have been hospitalized at least two times in the first year of life, whatever the reason
Physical abuse of young children during the COVID-19 pandemic: Alarming increase in the relative frequency of hospitalizations during the lockdown period
International audienceBackground: In France, the COVID-19 pandemic led to a general lockdown from mid-March to mid-May 2020, forcing families to remain confined. We hypothesized that children may have been victims of more physical abuse during the lockdown, involving an increase in the relative frequency of hospitalization. Methods: Using the national administrative database on all admissions to public and private hospitals (PMSI), we selected all children aged 0â5 years hospitalized and identified physically abused children based on ICD-10 codes. We included 844,227 children hospitalized in MarchâApril 2017â2020, of whom 476 (0.056%) were admitted for physical abuse. Relative frequency of hospitalization for physical abuse observed in March to April 2020 were compared with those from the same months in the three previous years (2017â2019). Findings: Even if absolute number of children exposed to physical abuse did not fluctuate significantly, we found a significant increase in the relative frequency of young children hospitalized for physical abuse from 2017 (0.053%) to 2020 (0.073%). Compared with the 2017â2019 period, and considering the observed decrease in the number of overall hospital admissions during the first lockdown, the number of children exposed to physical violence was 40% superior to what would be expected. Interpretation: The sharp increase in the relative frequency of hospitalizations for physical abuse in children aged 0â5 years in France is alarming. As only the most severe cases were brought to the hospital for treatment during the lockdown, our figures probably only represent the tip of the iceberg of a general increase of violence against young children
Examen médical des personnes gardées à vue en France : état actuel des pratiques dans les instituts médicolégaux au niveau national
The continuum of breast cancer care and outcomes in the U.S. Military Health System: an analysis by benefit type and care source
Estimation in the progressive illness-death model: a nonexhaustive review
Multistate models can be successfully used for describing complex event history data, for example, describing stages in the disease progression of a patient. The soâcalled âillnessâdeathâ model plays a central role in the theory and practice of these models. Many timeâtoâevent datasets from medical studies with multiple end points can be reduced to this generic structure. In these models one important goal is the modeling of transition rates but biomedical researchers are also interested in reporting interpretable results in a simple and summarized manner. These include estimates of predictive probabilities, such as the transition probabilities, occupation probabilities, cumulative incidence functions, and the sojourn time distributions. We will give a review of some of the available methods for estimating such quantities in the progressive illnessâdeath model conditionally (or not) on covariate measures. For some of these quantities estimators based on subsampling are employed. Subsampling, also referred to as landmarking, leads to small sample sizes and usually to heavily censored data leading to estimators with higher variability. To overcome this issue estimators based on a preliminary estimation (presmoothing) of the probability of censoring may be used. Among these, the presmoothed estimators for the cumulative incidences are new. We also introduce feasible estimation methods for the cumulative incidence function conditionally on covariate measures. The proposed methods are illustrated using real data. A comparative simulation study of several estimation approaches is performed and existing software in the form of R packages is discussed.This research was financed by Portuguese Funds through FCT - âFundação para a CiĂȘncia e a Tecnologia,â within the research
grant SFRH/BPD/93928/2013. LuĂs Meira-Machado acknowledges financial support from the Spanish Ministry of Economy
and Competitiveness MINECO through project MTM2017-82379-R funded by (AEI/FEDER, UE) and acronym âAFTERAM.â
Thanks to the Associate Editor and two anonymous referees for comments and suggestions that have improved the presentation
of the paper