Child Abuse and Neglect in Military and Non-Military Families: An Analysis of the National Child Abuse and Neglect Data System, 2000-2003

Context: The impact and stress of war extend beyond the military soldier to include emotional upheaval for his or her family, yet little is known about how war affects the occurrence of child maltreatment in families. This study is the first to use data from a national surveillance system to compare child maltreatment in military and non-military families. Further, it is the only known study to characterize military perpetrators of child maltreatment and to examine the effects of the September 11th, 2001 attacks on the occurrence of child maltreatment. Objective: The first objective of this study was to determine if being a child in a military family is protective of, or a risk factor for, substantiated child maltreatment. The second objective was to assess the impact the attacks of September 11th, 2001 and the subsequent US military response had on the occurrence of substantiated child maltreatment in military families. Methods: This study is a secondary analysis of the National Child Abuse and Neglect Data System that incorporates state-level information from the US Census Bureau and the Department of Defense to calculate and compare the rates of occurrence of substantiated maltreatment in children of military and non-military families. All reports of child maltreatment in the state of Texas that received a disposition of substantiation from January 1, 2000 through June 30, 2003 were the focus of these analyses. Texas was iv selected because of the completeness and quality of its NCANDS data and its large military population. Results: The rate of occurrence of substantiated child maltreatment in military families is generally lower than that of non-military families. However, the rate doubled when comparing the period after October 1, 2002 to the period before. The periods with the highest rates of child maltreatment corresponded to intense military operations in Iraq, the highest percentage of departures to operational deployments, and the lowest percentage of returns from operational deployments. Conclusion: Compared to children of non-military families, children of military families generally experienced lower rates of child maltreatment. However, this protective effect seemed to disappear when military combat increased and military families experienced operation-related deployment

Increased Responsiveness to Novelty is Associated with Successful Cognitive Aging

The animal literature suggests that exposure to more complex, novel environments promotes neurogenesis and cognitive performance in older animals. Studies in humans indicate that participation in intellectually stimulating activities may serve as a buffer against mental decline and help to sustain cognitive abilities. Here, we show that across old adults, increased responsiveness to novel events (as measured by viewing duration and the size of the P3 event-related potential) is strongly linked to better performance on neuropsychological tests, especially those involving attention/executive functions. Cognitively high performing old adults generate a larger P3 response to visual stimuli than cognitively average performing adults. These results suggest that cognitively high performing adults successfully manage the task by appropriating more resources and that the increased size of their P3 component represents a beneficial compensatory mechanism rather than less efficient processing

Evaluation of the Pyrrolizidine Alkaloid Induced Liver Disease (PAILD) Active Surveillance System in Tigray, Ethiopia

Pyrrolizidine Alkaloid Induced Liver Disease has been an emerging public health problem in the Tigray region in Ethiopia since 2002, with 1033 cases, including 314 deaths, detected as of September 2011. Disease surveillance started in 2009 to determine the magnitude and distribution of the disease, to detect and manage cases, and to inform officials for resource allocation. Despite limited resources and logistical challenges, the system operated at a high standard and met its original objectives. Maintenance of this high level of operation will be an ongoing challenge but will be critical to ensure continual disease monitoring through this system

Evaluation of the Pyrrolizidine Alkaloid Induced Liver Disease (PAILD) Active Surveillance System in Tigray, Ethiopia

OBJECTIVE: To describe the results of the evaluation of the PAILD active surveillance system and lessons learned for similar surveillance efforts in a resource-limited setting. INTRODUCTION: A liver disease of unknown etiology, called unknown liver disease (ULD) by the community, was first identified in 2002 in Tigray; a rugged, semi-arid, mountainous region that is considered one of the most drought-prone and food insecure regions of Ethiopia. ULD is a chronic condition characterized by epigastric pain, abdominal distention, ascites, emaciation, and hepato/splenomegaly. In 2005, the Ethiopian Health and Nutritional Research Institute was assigned by the Ethiopia Ministry of Health to assist the Tigray Regional Health Bureau and oversee the disease investigation. In 2008, Centers for Disease Control and Prevention (CDC) assisted the Ethiopian team and jointly developed the surveillance tools. The surveillance system was implemented in 2009 with the objectives to determine the magnitude and distribution of the disease; identify disease trends; detect cases to provide them with clinical care; and inform health officials and funding bodies for resource allocation. After several investigations, a local plant containing a particular type of pyrrolizidine alkaloid (PA) toxin that contaminated local foodstuffs was identified as the etiologic agent, and ULD was renamed PAILD in 2011. METHODS: From 20 September to 1 October 2011, we conducted site visits, held semi-structured interviews with 20 staff members, reviewed reporting materials, and summarized the information flow including data collection, reporting, analysis, and dissemination. RESULTS: This surveillance system was implemented in 13 rural, resource-limited districts in the NW, Central and Western Zones. The system identified a total of 1033 cases, including 314 deaths, as of September 2011; guided medication distribution to the health facilities; served as a registry for patient follow up; and provided decision-makers with information needed to allocate resources. A large-scale training was conducted in 2010; however, high staff turnover and a lack of backup surveillance staff at each site suggested that additional training may be needed. Due to the absence of a diagnostic test, the case definition was very simple to enable frontline staff in the communities and at the health posts/centers to identify disease cases. These individuals travelled long distances by foot to deliver paper surveillance forms to the district health offices. A surveillance team placed in the NW Zonal office collected missing reports from the health facilities given limited transportation; however they have left since this evaluation. Information from the surveillance system was shared with partner agencies at the national level every 3 to 6 months; however, this information was not shared with frontline staff. CONCLUSIONS: The PAILD Active Surveillance System met its objectives as originally defined. Evaluation of this unique surveillance system for a chronic disease with unknown cause in a resource-limited setting provides several lessons that can inform similar surveillance efforts. Ongoing logistical challenges (e.g., shortage of paper forms, lack of transportation, and long distances between locations) complicated data collection and reporting. While electronic reporting may have helped overcome some of these difficulties, it was not feasible in this setting. Frontline staff identified cases in the community so that they could receive treatment; these key staff can be further incentivized by receiving regular training and surveillance reports. Ongoing support will be critical to overcome these unique challenges to ensure continual disease monitoring as interventions to disrupt PA exposure are implemented in the community

Outbreak of acute renal failure in Panama in 2006: a case-control study

OBJECTIVE: In September 2006, a Panamanian physician reported an unusual number of patients with unexplained acute renal failure frequently accompanied by severe neurological dysfunction. Twelve (57%) of 21 patients had died of the illness. This paper describes the investigation into the cause of the illness and the source of the outbreak. METHODS: Case-control and laboratory investigations were implemented. Case patients (with acute renal failure of unknown etiology and serum creatinine > 2 mg/dl) were individually matched to hospitalized controls for age (± 5 years), sex and admission date (< 2 days before the case patient). Questionnaire and biological data were collected. The main outcome measure was the odds of ingesting prescription cough syrup in cases and controls. FINDINGS: Forty-two case patients and 140 control patients participated. The median age of cases was 68 years (range: 25-91 years); 64% were male. After controlling for pre-existing hypertension and renal disease and the use of angiotensin-converting enzyme inhibitors, a significant association was found between ingestion of prescription cough syrup and illness onset (adjusted odds ratio: 31.0, 95% confidence interval: 6.93-138). Laboratory analyses confirmed the presence of diethylene glycol (DEG) in biological samples from case patients, 8% DEG contamination in cough syrup samples and 22% contamination in the glycerin used to prepare the cough syrup. CONCLUSION: The source of the outbreak was DEG-contaminated cough syrup. This investigation led to the recall of approximately 60 000 bottles of contaminated cough syrup, widespread screening of potentially exposed consumers and treatment of over 100 affected patients