Mental disorder as a risk factor for dog bites and post-bite cellulitis

Non-Fatal Attacks by Dogs: Characteristics of Victims and Attacking Dogs, From the Forensic Perspective: A Series of 106 Cases From Athens, Greece, and Brief Review of the Literature

Introduction: The close association of dogs with humans may explain the fact that dog bites are possibly the most common animal bites recorded. The relevant data concerning Greece is scarce. We aimed to study this phenomenon by describing its characteristics.

Methods: We performed a retrospective analysis of cases concerning dog attack victims, examined our Department, between 2011 and 2019. Recorded variables included sex, age, nationality, occupation, marital status, medical history, ownership status of the dog, injury anatomic location, incident time, the timing of clinical forensic examination, incapacitation time, and medical care provided.

Statistical analysis was performed using Stata/MP 13 (Stata Corp., College Station, TX) and IBM SPSS Statistics Version 20 (IBM, Armonk, NY). Statistical significance was defined as a two-sided p value of <0.05.

Results: Most incidents involved male victims (54.2%). The victim’s mean age was 44.9 years. The dog involved was unowned in 19.8% of cases. The most frequent anatomical site of injury was the legs (48.1%). Older victims suffered injuries in more sensitive areas of the body (head and neck), when compared to younger adults. Only 1.9% of victims required hospitalization. The mean incapacitation time was estimated at 5.39 days.

Conclusions: Per our results, males tend more often to be victims of dog attacks. Typically, victims are of increased age and are attacked by a dog already known to them. Most incidents take place during late winter and spring, more specifically during February and during May. The most frequently affected anatomical sites were the legs. Older people suffered injuries in more sensitive areas of the body.

Dog bite Emergency department presentations in Brisbane metro south: Epidemiology and exploratory medical geography for targeted interventions

Dog bites are a recognized public health issue due to their impact on human and animal health/welfare. This study aimed to investigate demographic and geographic disparities in the epidemiology of dog bites presentations reported to the emergency departments of the four main public hospitals in the Metro South region of Brisbane, Queensland, Australia. Dog bite patient hospitalization data geolocated to the street address were collected from clinical records management systems from the four main public hospitals in the Metro South Hospital Health Service region of Queensland for a 5-year period (ie. 01/07/2013 to 30/06/2017). We investigated the epidemiology of three clinical outcomes including probability of paediatric cases (paediatric vs. adult), probability of dog bites to the head (head injury vs. other injury), and probability of re-presentation to the ED following their initial dog bite (yes or no) by way of univariable then multivariable Bernoulli logistic regression models including patient postcode as a random effect. Residual semivariograms were created to identify spatial trends in the medical geography of dog bites and binomial geostatistical models were created to predict the probability of the outcomes of interest in Brisbane Metro south and surrounding suburbs. Our results demonstrate that compared to adult dog bite cases, paediatric dog bite cases were significantly associated with bites to the head or face or neck (OR 14.65, P < 0.001), bites to the lower body (OR 4.95, P = 0.035) and larger dogs (OR 0.25, P = 0.030 for small dogs). The probability of head injuries was greater in younger age groups (17-39 OR 0.25, P = 0.001; 40-64 OR 0.15, P = 0.001; 65-above OR 0.14, P = 0.029). Attacks by small dogs were more likely to inflict head wounds than large dogs (OR 6.12, P < 0.001). The probability of re-presentation was lower in patients bitten by medium sized dogs (OR 0.29, P = 0.027) than larger dogs. Our predictive maps showed significant clustering of paediatric case probability in the Logan city and Redlands councils associated with socioeconomic status of the places of residence. In conclusion, our findings demonstrate significant demographic and geographic heterogeneity in dog bite ED presentations. Public health interventions to reduce the burden of dog bites should be targeted to the populations most at-risk in the areas identified in this study.

Factors Associated With Bites to a Child From a Dog Living in the Same Home: A Bi-National Comparison

We conducted a veterinary clinic-based retrospective cohort study aimed at identifying child-, dog-, and home-environment factors associated with dog bites to children aged 5–15 years old living in the same home as a dog in Kingston, Jamaica (236) and San Francisco, USA (61). Secondarily, we wished to compare these factors to risk factors for dog bites to the general public. Participant information was collected via interviewer-administered questionnaire using proxy respondents. Data were analyzed using log-binomial regression to estimate relative risks and associated 95% confidence intervals (CIs) for each exposure–dog bite relationship. Exploiting the correspondence between X% confidence intervals and X% Bayesian probability intervals obtained using a uniform prior distribution, for each exposure, we calculated probabilities of the true (population) RRs ≥ 1.25 or ≤0.8, for positive or negative associations, respectively. Boys and younger children were at higher risk for bites, than girls and older children, respectively. Dogs living in a home with no yard space were at an elevated risk (RR = 2.97; 95% CI: 1.06–8.33) of biting a child living in the same home, compared to dogs that had yard space. Dogs routinely allowed inside for some portion of the day (RR = 3.00; 95% CI: 0.94–9.62) and dogs routinely allowed to sleep in a family member’s bedroom (RR = 2.82; 95% CI: 1.17–6.81) were also more likely to bite a child living in the home than those that were not. In San Francisco, but less so in Kingston, bites were inversely associated with the number of children in the home. While in Kingston, but not in San Francisco, smaller breeds and dogs obtained for companionship were at higher risk for biting than larger breeds and dogs obtained for protection, respectively. Overall, for most exposures, the observed associations were consistent with population RRs of practical importance (i.e., RRs ≥ 1.25 or ≤0.8). Finally, we found substantial consistency between risk factors for bites to children and previously reported risk factors for general bites.

How many people have been bitten by dogs? A cross-sectional survey of prevalence, incidence and factors associated with dog bites in a UK community

Background

Dog bite studies are typically based on hospital records and may be biased towards bites requiring significant medical treatment. This study investigated true dog bite prevalence and incidence at a community-level and victim-related risk factors, in order to inform policy and prevention.

Methods

A cross-sectional study of a community of 1280 households in Cheshire, UK, surveyed 694 respondents in 385 households. Data included dog ownership and bite history, demographics, health and personality (Ten Item Personality Inventory (TIPI) brief measure). Multivariable logistic regression modelled risk factors for having ever been bitten by a dog, accounting for clustering of individuals within households.

Results

A quarter of participants (24.78%, 95% CI 21.72 to 28.13) reported having ever been bitten by a dog during their lifetime, with only a third of bites described requiring further medical treatment and 0.6% hospital admission. Incidence of dog bites was 18.7 (11.0–31.8) per 1000 population per year. Males were 1.81 times more likely to have been bitten in their lifetime than females (95% CI 1.20 to 2.72, P=0.005). Current owners of multiple dogs were 3.3 times more likely (95% CI 1.13 to 9.69, P=0.03) to report having been bitten than people not currently owning a dog. Regarding all bites described, most commonly people were bitten by a dog that they had never met before the incident (54.7%). Individuals scoring higher in emotional stability had a lower risk of having ever been bitten (OR=0.77 for 1 point change in scale between 1 and 7, 95% CI 0.66 to 0.9, P=0.001).

Conclusion

This study suggests that the real burden of dog bites is considerably larger than those estimated from hospital records. Further, many bites do not require medical treatment and hospital-based bite data are not representative of bites within the wider population. Victim personality requires further investigation and potential consideration in the design of bite prevention schemes.

Are hospital emergency department visits due to dog bites associated with ambient temperature? A time-series study in Beijing, China

BACKGROUND

It is well documented that suboptimal ambient temperature is associated with cardiovascular and respiratory diseases. However, no study has examined the relation between temperature and dog bites.

OBJECTIVES

To study the association between ambient temperature and daily hospital emergency department visits due to dog bites (EDVDBs) in Beijing, China; and to explore whether the temperature-EDVDB association varies by sex and age.

METHODS

Daily EDVDBs were collected from a hospital appointed for dog bites in Beijing during 2012-2014. A quasi-Poisson regression with distributed lag non-linear model (DLNM) was employed to estimate the impact of temperature on daily EDVDBs. Stratified analysis was performed to examine the temperature-EDVDB association by sex and age-groups. Sensitivity analysis was performed to check the robustness of the results by adjusting other meteorological variables and air pollutants.

RESULTS

A total of 42,481 EDVDBs were collected, with daily cases ranged from 15 to 71. The association between temperature and EDVDBs was U-shaped, with extreme cold temperature showing a weaker, delayed and shorter effect on the risk of dog bites while the effect of extreme hot temperature being stronger, more immediate and lasting longer. Cold temperature had a greater impact on female whereas male was more sensitive to hot temperature. The temperature-EDVDB association was unapparent in the 15-21years group. The cold effect was only significant in the 0-14years group whereas all age-groups suffered from the similar heat effect except those aged 22-45years. Adjusting other meteorological variables and air pollutants did not change the results.

CONCLUSIONS

The impact of temperature on EDVDBs is U-shaped in Beijing, China which varies by sex and age. The temperature effect is independent from other meteorological variables and air pollutants.

A Comparative Study of Dog- and Cat-Induced Injury on Incidence and Risk Factors among Children

Background: Millions of people are bitten by animals each year, with approximately 90% of the injuries being caused by dogs and cats. However, few studies focus on risk factors of dog- and cat-induced injury in China. Therefore, the objective of this study was to investigate the rate of dog- and cat-induced injury and its potential risk factors. Methods: The data were from a population-based cross-sectional study conducted in 2015, with a sample of 9380 children 6-19 years of age from two cities, Shenzhen (large city) and Shantou (mid-sized city), in southern China. Multivariate logistic regression models were used to identify the risk factors of injury by dogs and cats. Results: The total rates of dog and cat-induced injury were 15.1% and 8.7% during the lifetime, and 3.4% and 1.7% during the past year, respectively. Dog bites mostly occurred in the dog's residence (49.4%). Cat scratches were more likely to be inflicted by one's own cat (47.5%). Children living in suburban and island county had 2.83 times and 2.53 times more dog-related injuries than central urban children, respectively. After stratification by cities, injuries in Shantou were correlated with non-single child families (OR (odds ratios), 1.46; 95% CI (95% confidence interval), 1.09-1.96) and raising cats (OR, 5.34; 95% CI, 3.88-7.35). Those who disliked animals (OR, 0.62; 95% CI, 0.45-0.88) or had good academic performance (OR, 0.46; 95% CI, 0.35-0.60) had lower risk for injury. Injuries in Shenzhen were related to the mother's educational level (OR, 1.51; 95% CI, 1.11-2.07) and mother being a migrant worker (OR, 2.10; 95% CI, 1.12-3.94). Conclusions: Family factors were important to predict dog- and cat-induced injury among children from Shenzhen, and personal factors were closely associated with injury among children form Shantou.

Risk of subsequent attention deficit-hyperactivity disorder in children with febrile seizures

OBJECTIVE

In this study, we obtained relevant data from a nationwide cohort database to investigate the risk of attention deficit-hyperactivity disorder (ADHD) in children with a history of febrile seizures (FS).

METHODS

We identified 1081 children with FS as the case cohort, and the date of diagnosis was used as an index date. Four controls were matched randomly with each case based on age, sex, urbanisation level, parents' occupation, and index date. We applied Cox's proportional hazards regression to estimate the HR and CI of FS-associated ADHD.

RESULTS

After 11 years of follow-up, the incidence of ADHD for the FS and control cohorts is 7.83 and 4.72 per 1000 person-years, respectively. The FS cohort was 1.66 times more at risk of ADHD occurrence (95% CI 1.27 to 2.18) than the control cohort. The risk of developing ADHD increased in conjunction with the frequency of FS-related visits.

CONCLUSIONS

FS may increase the risk of subsequent ADHD occurrence in children. Children who visited physicians for FS more than twice had a significantly higher cumulative incidence of ADHD.

Antecedents and consequences of pediatric dog-bite injuries and their developmental trends: 101 cases in rural China

OBJECTIVE

Study the contextual antecedents and consequences of pediatric dog bites in rural China.

METHODS

A total of 101 caregivers from rural Anhui Province, China, whose children had suffered dog-bite injuries in the past year, participated in a structured interview about the circumstances, antecedents and consequences of their child's injury.

RESULTS

Contextual circumstances identified frequently included outside-home environment and presence of peers but not adult supervisors. Frequent antecedents were dogs' initiation of the encounter, children walking to/from school, and dogs unleashed. Consequences to children identified frequently were rabies vaccines, restricted activity, and fear of dogs. Developmental trends emerged, with bite circumstances differing by children's ages.

CONCLUSIONS

These results offer data on common antecedents and consequences of pediatric dog bites in rural China, a necessary prerequisite for development of empirically supported prevention programs in a vulnerable population.

A multi-site study on knowledge, attitudes, beliefs and practice of child-dog interactions in rural China

This study examines demographic, cognitive and behavioral factors that predict pediatric dog-bite injury risk in rural China. A total of 1,537 children (grades 4–6) in rural regions of Anhui, Hebei and Zhejiang Provinces, China completed self-report questionnaires assessing beliefs about and behaviors with dogs. The results showed that almost 30% of children reported a history of dog bites. Children answered 56% of dog-safety knowledge items correctly. Regressions revealed both demographic and cognitive/behavioral factors predicted children’s risky interactions with dogs and dog-bite history. Boys behaved more riskily with dogs and were more frequently bitten. Older children reported greater risks with dogs and more bites. With demographics controlled, attitudes/beliefs of invulnerability, exposure frequency, and dog ownership predicted children’s self-reported risky practice with dogs. Attitudes/beliefs of invulnerability, dog exposure, and dog ownership predicted dog bites. In conclusion, both demographic and cognitive/behavioral factors influenced rural Chinese children’s dog-bite injury risk. Theory-based, empirically-supported intervention programs might reduce dog-bite injuries in rural China.