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Pulver A, Guttmann A, Ray JG, O'Campo P, Urquia ML. Differences in Early Childhood Maltreatment by Maternal Birthplace and Child Sex. J Pediatr 2020; 218:184-191.e2. [PMID: 31955877 DOI: 10.1016/j.jpeds.2019.11.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 11/04/2019] [Accepted: 11/22/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To identify patterns of health system-identified early childhood maltreatment by maternal birthplace and child sex, within a multicultural society with universal access to healthcare. STUDY DESIGN This retrospective population-based cohort study included 1240946 children born in Ontario, Canada, between 2002 and 2012, and followed from birth to age 5 years using administrative data. Modified Poisson regression was used to estimate adjusted rate ratios for maltreatment-physical abuse or neglect-among the children of immigrant vs nonimmigrant mothers. Conditional logistic regression was used to estimate further the odds of maltreatment comparing a daughter vs son of the same mother. RESULTS Maltreatment rates were 36% lower (adjusted rate ratio, 0.64; 95% CI, 0.61-0.66) among children of immigrant mothers (10 per 1000) than those of nonimmigrant mothers (16 per 1000). Maltreatment rates were 27%-48% lower among children of maternal immigrant groups relative to that among Canadian-born mothers, except children of Caribbean-born mothers (16 per 1000). No significant differences were seen between daughters and sons in the odds of early childhood health system-identified maltreatment by maternal birthplace. CONCLUSIONS Health system-identified maltreatment in early childhood is highest among children of Canadian- and Caribbean-born mothers. Maltreatment did not differ between daughters and sons of the same mother. These data may inform strategies aimed at decreasing maltreatment among vulnerable groups.
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Affiliation(s)
- Ariel Pulver
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
| | - Astrid Guttmann
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada; Division of Pediatric Medicine, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Joel G Ray
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada; Department of Obstetrics and Gynecology, St Michael's Hospital, Toronto, Ontario, Canada; Department of Medicine, St Michael's Hospital, Toronto, Ontario, Canada
| | - Patricia O'Campo
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
| | - Marcelo L Urquia
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada; Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada.
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Buek KW, Lakey DL, Mandell DJ. Paternity establishment at birth and early maltreatment: Risk and protective effects by maternal race and ethnicity. CHILD ABUSE & NEGLECT 2019; 95:104069. [PMID: 31301546 DOI: 10.1016/j.chiabu.2019.104069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 06/18/2019] [Accepted: 06/27/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Minority race/ethnicity, low socioeconomic status, and lack of established paternity have been identified in previous research as risk factors for child maltreatment. However, given vastly different patterns of income distribution, single parenting and co-parenting across racial and ethnic populations, it is difficult to know which of these factors contribute most to maltreatment risk. OBJECTIVE The current study explores whether the odds of maltreatment differ across race/ethnicity when paternity is not established at birth after controlling for maternal socioeconomic status. METHODS Using merged birth certificate and child protective services records for children born between 2009 and 2011 in Texas (N = 1,175,804), we conducted multiple logistic regression analyses testing the main effects of maternal race and lack of established paternity, as well as the interaction of the two, on substantiated maltreatment. RESULTS Results show that children of black mothers were less likely to have established paternity and more likely to experience maltreatment compared with other groups. However, the odds of maltreatment were lower for children of black mothers without established paternity compared to children of white mothers without established paternity (OR = .71, 95% CI [0.67,0.75]). Alternatively, the odds of maltreatment were higher when paternity was not established at birth for Hispanic mothers (OR = 1.13, 95% CI [1.08,1.18]) and mothers of other race/ethnicities (OR = 1.35, 95% CI [1.11,1.65]) compared to white mothers. CONCLUSION Research and prevention programming must consider that the processes and pathways linking paternity establishment and maltreatment may differ within and between racial/ethnic groups.
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Affiliation(s)
- Katharine W Buek
- University of Texas Health, Science Center at Tyler & Population Health, Office of Health Affairs, University of Texas System, 210 W. 7th St., Austin, TX, USA.
| | - David L Lakey
- University of Texas Health, Science Center at Tyler & Population Health, Office of Health Affairs, University of Texas System, 210 W. 7th St., Austin, TX, USA.
| | - Dorothy J Mandell
- University of Texas Health, Science Center at Tyler & Population Health, Office of Health Affairs, University of Texas System, 210 W. 7th St., Austin, TX, USA.
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Aquila I, Ricci P, Mocciaro R, Gratteri S. A case of suspected illegal abortion: how clinicians may assist the forensic pathologist. BMJ Case Rep 2018; 2018:bcr-2017-220577. [PMID: 29970605 DOI: 10.1136/bcr-2017-220577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Abortion may be performed in a safe or unsafe manner, the latter being a frequent and dangerous event. It can also be performed in countries where abortion is legally recognised but, for various reasons, may be undertaken in an illegal environment. We present a case of a possible illegal abortion. A woman presented to the hospital with a dead fetus, saying that she was the victim of a car accident. Forensic and gynaecological examination of the woman were carried out, along with an autopsy of the fetus. It was discovered that the woman had performed a clandestine abortion. The differential diagnosis between illegal abortion and miscarriage represents a complicated issue and requires both clinical and forensic support. The gynaecologist may be of assistance to the forensic pathologist in confirming whether an illegal abortion has been performed.
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Affiliation(s)
- Isabella Aquila
- Institute of Legale Medicine, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Pietrantonio Ricci
- Institute of Legale Medicine, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Rita Mocciaro
- Institute of Legale Medicine, University Magna Graecia of Catanzaro, Catanzaro, Italy
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Yamaoka Y, Morisaki N, Noguchi H, Takahashi H, Tamiya N. Comprehensive Assessment of Risk Factors of Cause-Specific Infant Deaths in Japan. J Epidemiol 2018; 28:307-314. [PMID: 29434084 PMCID: PMC5976875 DOI: 10.2188/jea.je20160188] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background Public attention is given to infants with socially high risks of child abuse and neglect, while clinical attention is provided to infants with a biologically high risk of diseases. However, few studies have systematically evaluated how biological or social factors cross over and affect cause-specific infant mortality. Methods We linked birth data with death data from the Japanese national vital statistics database for all infants born from 2003–2010. Using multivariate logistic regression, we examined the association between biological and social factors and infant mortality due to medical causes (internal causes), abuse (intentional external causes), and accidents (unintentional external causes). Results Of 8,941,501 births, 23,400 (0.26%) infants died by 1 year of age, with 21,884 (93.5%) due to internal causes, 175 (0.75%) due to intentional external causes, and 1,194 (5.1%) due to unintentional external causes. Infants with high social risk (teenage mothers, non-Japanese mothers, single mothers, unemployed household, four or more children in the household, or birth outside of health care facility) had higher risk of death by intentional, unintentional, and internal causes. Infant born with small for gestational age and preterm had higher risks of deaths by internal and unintentional causes, but not by intentional causes. Conclusions Both biological as well as social factors were associated with infant deaths due to internal and external causes. Interdisciplinary support from both public health and clinical-care professionals is needed for infants with high social or biological risk to prevent disease and injury.
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Affiliation(s)
- Yui Yamaoka
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba
| | - Naho Morisaki
- Department of Social Medicine, National Center for Child Health and Development
| | - Haruko Noguchi
- Faculty of Political Science and Economics, Waseda University
| | - Hideto Takahashi
- Office of Information Management and Statistics, Radiation Medical Science Center for the Fukushima Health Management Survey, Faculty of Medicine, Fukushima Medical University
| | - Nanako Tamiya
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba
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Ahrens KA, Rossen LM, Thoma ME, Warner M, Simon AE. Birth Order and Injury-Related Infant Mortality in the U.S. Am J Prev Med 2017; 53:412-420. [PMID: 28666774 PMCID: PMC5697982 DOI: 10.1016/j.amepre.2017.04.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 04/11/2017] [Accepted: 04/24/2017] [Indexed: 10/19/2022]
Abstract
INTRODUCTION The purpose of this study was to evaluate the risk of death during the first year of life due to injury, such as unintentional injury and homicide, by birth order in the U.S. METHODS Using national birth cohort-linked birth-infant death data (births, 2000-2010; deaths, 2000-2011), risks of infant mortality due to injury in second-, third-, fourth-, and fifth or later-born singleton infants were compared with first-born singleton infants. Risk ratios were estimated using log-binomial models adjusted for maternal age, marital status, race/ethnicity, and education. The statistical analyses were conducted in 2016. RESULTS Approximately 40%, 32%, 16%, 7%, and 4% of singleton live births were first, second, third, fourth, and fifth or later born, respectively. From 2000 to 2011, a total of 15,866 infants died as a result of injury (approximately 1,442 deaths per year). Compared with first-born infants (2.9 deaths per 10,000 live births), second or later-born infants were at increased risk of infant mortality due to injury (second, 3.6 deaths; third, 4.2 deaths; fourth, 4.8 deaths; fifth or later, 6.4 deaths). The corresponding adjusted risk ratios were as follows: second, 1.84 (95% CI=1.76, 1.91); third, 2.42 (95% CI=2.30, 2.54); fourth, 2.96 (95% CI=2.77, 3.16); and fifth or later, 4.26 (95% CI=3.96, 4.57). CONCLUSIONS Singleton infants born second or later were at increased risk of mortality due to injury during their first year of life in the U.S. This study's findings highlight the importance of investigating underlying mechanisms behind this increased risk.
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Affiliation(s)
- Katherine A Ahrens
- Office of Population Affairs, Office of the Assistant Secretary for Health, U.S. DHHS, Rockville, Maryland.
| | - Lauren M Rossen
- National Center for Health Statistics, Centers for Disease Control and Prevention, Division of Vital Statistics, Reproductive Health Statistics Branch, Hyattsville, Maryland
| | - Marie E Thoma
- National Center for Health Statistics, Centers for Disease Control and Prevention, Division of Vital Statistics, Reproductive Health Statistics Branch, Hyattsville, Maryland; Department of Family Science, School of Public Health, University of Maryland, College Park, Maryland
| | - Margaret Warner
- National Center for Health Statistics, Centers for Disease Control and Prevention, Division of Vital Statistics, Mortality Statistics Branch, Hyattsville, Maryland
| | - Alan E Simon
- Office on Women's Health, Office of the Assistant Secretary for Health, U.S. DHHS, Washington, District of Columbia
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Ahrens KA, Thoma ME, Rossen LM, Warner M, Simon AE. Plurality of Birth and Infant Mortality Due to External Causes in the United States, 2000-2010. Am J Epidemiol 2017; 185:335-344. [PMID: 28180240 PMCID: PMC6700729 DOI: 10.1093/aje/kww119] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 06/14/2016] [Indexed: 11/13/2022] Open
Abstract
Risk of death during the first year of life due to external causes, such as unintentional injury and homicide, may be higher among twins and higher-order multiples than among singletons in the United States. We used national birth cohort linked birth-infant death data (2000-2010) to evaluate the risk of infant mortality due to external causes in multiples versus singletons in the United States. Risk of death from external causes during the study period was 3.6 per 10,000 live births in singletons and 5.1 per 10,000 live births in multiples. Using log-binomial regression, the corresponding unadjusted risk ratio was 1.40 (95% confidence interval (CI): 1.30, 1.50). After adjustment for maternal age, marital status, race/ethnicity, and education, the risk ratio was 1.68 (95% CI: 1.56, 1.81). Infant deaths due to external causes were most likely to occur between 2 and 7 months of age. Applying inverse probability weighting and assuming a hypothetical intervention where no infants were low birth weight, the adjusted controlled direct effect of plurality on infant mortality due to external causes was 1.64 (95% CI: 1.39, 1.97). Twins and higher-order multiples were at greater risk of infant mortality due to external causes, particularly between 2 and 7 months of age, and this risk appeared to be mediated largely by factors other than low-birth-weight status.
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Child Maltreatment Among Singletons and Multiple Births in Japan: A Population-Based Study. Twin Res Hum Genet 2015; 18:806-11. [PMID: 26364622 DOI: 10.1017/thg.2015.67] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND The occurrence of multiple births has been recognized as a risk factor for child maltreatment. However, few population-based studies have examined the relationship between multiple births and child maltreatment. This study aimed to evaluate the degree of risk of child maltreatment among singletons and multiple births in Japan and to identify factors associated with increased risk. METHODS Using population-based data, we analyzed the database of records on child maltreatment and medical checkups for infants aged 1.5 years filed at Nishinomiya City Public Health Center between April 2007 and March 2011. To protect personal information, the data were transferred to anonymized electronic files for analysis. RESULTS After adjusting by logistic regression for each associated factor and gestation number, multiples themselves were not associated with the risk of child maltreatment. However, compared with singletons, multiples had a significantly higher rate of risk factors for child maltreatment, including low birth weight and neural abnormality. Moreover, compared with mothers of singleton, mothers of twins had a significantly higher rate of poor health, which is a risk factor of child maltreatment. CONCLUSION Multiples were not associated with the risk of child maltreatment. However, compared with singletons, multiples and their mothers had a significantly higher rate of risk factors of child maltreatment.
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Ooki S. Fatal child maltreatment associated with multiple births in Japan: nationwide data between July 2003 and March 2011. Environ Health Prev Med 2013; 18:416-21. [PMID: 23558473 DOI: 10.1007/s12199-013-0335-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Accepted: 03/07/2013] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES The purpose of the present study is to clarify the impact of multiple births in fatal child maltreatment (child death due to maltreatment). METHODS The national annual reports on fatal child maltreatment, which contain all cases from July 2003 to March 2011, published by the Ministry of Health, Labor and Welfare of Japan, were used as the initial sources of information. Parent-child murder-suicide cases were excluded from the analyses. Multiple births, teenage pregnancy and low-birthweight were regarded as the exposed groups. The relative risks (RRs) and their 95 % confidence intervals (CIs) were estimated using the data from the above reports and vital statistics. These analyses were performed both including and excluding missing values. RESULTS Among 437 fatal child maltreatment cases, 14 multiple births from 13 families were identified. The RRs of multiple births per individual were 1.8 (95 % CI 1.0-3.0) when including missing values and 2.7 (95 % CI 1.5-4.8) when excluding missing values. The RRs of multiple births per family were 3.6 (95 % CI 2.1-6.2) when including missing values and 4.9 (95 % CI 2.7-9.0) when excluding missing values. The RR tended to be much lower than the RR of teenage pregnancy (RR 12.9 or 22.2), but slightly higher than the RR of low-birthweight (RR 1.4 or 2.9). CONCLUSIONS Families with multiple births had elevated risk for fatal child maltreatment both per individual and per family unit. Health providers should be aware that multiple pregnancies/births may place significant stress on families and should provide appropriate support and intervention.
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Affiliation(s)
- Syuichi Ooki
- Department of Health Science, Ishikawa Prefectural Nursing University, 1-1 Gakuendai, Kahoku, Ishikawa, 929-1210, Japan,
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Infant mortality among singletons and twins in Japan during 1999-2008 on the basis of risk factors. Twin Res Hum Genet 2013; 16:639-44. [PMID: 23360862 DOI: 10.1017/thg.2012.156] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The infant mortality rate (IMR) among single and twin births from 1999 to 2008 was analyzed using Japanese Vital Statistics. The IMR was 5.3-fold higher in twins than in singletons in 1999 and decreased to 3.9-fold in 2008. The reduced risk of infant mortality in twins relative to singletons may be related, partially, to survival rates, which improved after fetoscopic laser photocoagulation for twin - twin transfusion syndrome. The proportion of neonatal deaths among total infant deaths was 54% for singletons and 74% for twins. Thus, intensive care of single and twin births may be very important during the first month of life to reduce the IMR. The IMR decreased as gestational age (GA) rose in singletons, whereas the IMR in twins decreased as GA rose until 37 weeks and increased thereafter. The IMR was significantly higher in twins than in singletons from the shortest GA (<24 weeks) to 28 weeks as well as ≥38 weeks, whereas the IMR was significantly higher in singletons than in twins from 30 to 36 weeks. As for maternal age, the early neonatal and neonatal mortality rates as well as the IMR in singletons were significantly higher in the youngest maternal age group than in the oldest one, whereas the opposite result was obtained in twins. The lowest IMR in singletons was 1.1 per 1,000 live births for ≥38 weeks of gestation and heaviest birth weight (≥2,000 g), while the lowest IMR in twins was 1.8 at 37 weeks and ≥2,000 g.
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Bretherick KL, Fairbrother N, Avila L, Harbord SHA, Robinson WP. Fertility and aging: do reproductive-aged Canadian women know what they need to know? Fertil Steril 2009; 93:2162-8. [PMID: 19296943 DOI: 10.1016/j.fertnstert.2009.01.064] [Citation(s) in RCA: 119] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2008] [Revised: 12/19/2008] [Accepted: 01/07/2009] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Female fertility declines with age; however, women are increasingly delaying childbearing until later in their reproductive years. One of the factors that may contribute to this trend is a general lack of knowledge about the decline in fertility with age. DESIGN Self-report survey. Questions pertained to participant demographics and childbearing intentions, and knowledge of the decline in fertility and increased risk of pregnancy loss with age. SETTING The University of British Columbia in Vancouver, British Columbia, Canada. PATIENTS Female undergraduate students (N = 360). INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Knowledge of fertility over the life span, predictors of age of intended childbearing. RESULT(S) Although most women were aware that fertility declines with age, they significantly overestimated the chance of pregnancy at all ages and were not conscious of the steep rate of fertility decline. Surprisingly, women overestimated the chance of pregnancy loss at all ages, but did not generally identify a woman's age as the strongest risk factor for miscarriage. CONCLUSION(S) Education regarding the rate at which reproductive capacity declines with age is necessary to avoid unintended childlessness among female academics and professionals.
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Affiliation(s)
- Karla L Bretherick
- Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia V5Z 1L3, Canada.
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