Monitoring child abuse and neglect at a population level: patterns of hospital admissions for maltreatment and assault.

OBJECTIVES: To investigate the prevalence, trends, and characteristics of maltreatment and assault related hospital admissions and deaths among children; and identify common injuries and conditions associated with these admissions using routinely collected morbidity and mortality data. METHODS: A retrospective cohort study of all children aged 0-17 years in Western Australia from 1980 to 2005 was identified from linked de-identified population level data. Annual trends in prevalence of assault and maltreatment related admissions were calculated and child characteristics were investigated using logistic regression models. RESULTS: Assault admissions more than doubled from 2.8 per 10,000 children in 1981 to 6.1 per 10,000 in 2005 (p<0.0001) and maltreatment admissions rose from 0.7 per 10,000 children in 1981 to 1.3 per 10,000 in 2005 (p<0.0001). Males aged greater than 12 years were at greater risk of an assault, while children aged less than 6 years were more likely to be at risk of maltreatment as well as those from greater disadvantaged backgrounds. Aboriginal children were more likely to be identified with assault and maltreatment compared to non-Aboriginal children. Common indicators of assault admissions included injuries of the skull and facial bones, intracranial, wrist, hand, and abdominal injuries. Children with maltreatment-related admissions were more likely to have superficial head or abdominal injuries and a high proportion had infectious and parasitic diseases, particularly intestinal infections. Many of these cases were associated with factors influencing health status, particularly socioeconomic and psychosocial circumstances. CONCLUSIONS: There has been a steady increase in the prevalence of assault and maltreatment related admissions. Specific child characteristics and injuries associated with child assault and maltreatment-related admissions have been identified using routinely collected morbidity data and may be utilized as potential indicators for identifying and monitoring child abuse and neglect. PRACTICE IMPLICATIONS: Broadening child maltreatment surveillance to children's admissions for assault and maltreatment is an important public health initiative which can be improved by the increased use of external cause codes. Health data is collected using international coding standards enhancing comparability across states and countries and has clinical implications in highlighting injuries associated with child abuse and neglect.

The use of cross-jurisdictional population data to investigate health indicators of child maltreatment.

OBJECTIVES: To determine the extent to which children with a hospital admission related to assault or maltreatment or to a notified sexually transmitted infection (STI) have contact with the Western Australian Department for Child Protection (DCP), and to investigate injuries and conditions often associated with child maltreatment and subsequent contact with the DCP. DESIGN, PARTICIPANTS AND SETTING: Retrospective cohort study using de-identified, record-linked child protection and hospital morbidity data to identify all children aged 0-17 years in Western Australia between 1 January 1990 and 31 December 2005, and a subcohort of children born in WA between these dates, admissions of these children to public and private hospitals in WA, and their contact with the Western Australian DCP. MAIN OUTCOME MEASURES: Annual trends in notifications and substantiations of child maltreatment; proportion of children with assault-related and maltreatment-related hospital admissions resulting in notifications, substantiations, or out-of-home care. RESULTS: Most children admitted for maltreatment-related reasons (90%) had contact with the DCP, with 81% of these children being notified, 68% having maltreatment substantiated, and 50% entering out-of-home care. Specific injuries and conditions were associated with children who had greater contact with the DCP, including retinal haemorrhage, rib fractures, multiple injuries, STIs at under 14 years of age, and malnourishment. CONCLUSIONS: The health system effectively identifies and notifies real cases of maltreatment, and a high proportion of these are substantiated. Health data play an important role in improving maltreatment surveillance, providing opportunities to make valid comparisons over time and between jurisdictions, as well as to monitor conditions and injuries associated with child maltreatment.

Characteristics of non-Aboriginal and Aboriginal children and families with substantiated child maltreatment: a population-based study.

OBJECTIVES: To investigate specific child and parental factors associated with increased vulnerability to substantiated child maltreatment. METHODS: A retrospective cohort study of all children born in Western Australia during 1990-2005 using de-identified record linked child protection, disability services and health data. Cox regression was used for univariate and multivariate analysis to determine the risk of substantiated child maltreatment for a number of child and parental factors, including child disability, parental age, socio-economic status, parental mental health, substance use and assault-related hospital admissions. Separate analyses were conducted for Aboriginal and non-Aboriginal children. RESULTS: This study found a number of child and parental factors that increase the risk of substantiated child maltreatment. The strongest factors were child intellectual disability, parental socio-economic status, parental age and parental hospital admissions related to mental health, substance use and assault. CONCLUSIONS: Awareness of the factors that make children and families vulnerable may aid the targeting of child maltreatment prevention programmes. To prevent child abuse and neglect it is essential that we have a platform of universal services, which assist parents in their role, as well as targeted services for at-risk families.

Increasing prevalence of neonatal withdrawal syndrome: population study of maternal factors and child protection involvement.

OBJECTIVES: Illicit drug use during pregnancy is an important public health issue, with adverse effects on the newborn and implications for subsequent parenting. The aim of this study was to measure the birth prevalence of neonatal withdrawal syndrome over time, associated maternal characteristics and child protection involvement. METHODS: This is a retrospective cohort study that used linked health and child protection databases for all live births in Western Australia from 1980 to 2005. Maternal characteristics and mental health-and assault-related medical history were assessed by using logistic regression models. RESULTS: The birth prevalence of neonatal withdrawal syndrome increased from 0.97 to a high of 42.2 per 10 000 live births, plateauing after 2002. Mothers with a previous mental health admission, low skill level, Aboriginal status or who smoked during pregnancy were significantly more likely to have an infant with neonatal withdrawal syndrome. These infants were at greater risk for having a substantiated child maltreatment allegation and entering foster care. Increased risk for maltreatment was associated with mothers who were aged <30 years, were from socially disadvantaged backgrounds, Aboriginal status, and had a mental health-or assault-related admission. CONCLUSIONS: There has been a marked increase in neonatal withdrawal syndrome in the past 25 years. Specific maternal characteristics identified should facilitate planning for early identification and intervention for these women. Findings demonstrate an important pathway into child maltreatment and highlight the need for well-supported programs for women who use illicit drugs during pregnancy as well as the need for sustained long-term support after birth.

Project to policy: TUFH principles in action in Australia.

CONTEXT: In 1999, Towards Unity For Health developed principles for patient-based health systems which included partnerships, raising the level of partnerships, integration of individual, population and public health, information management and measurement of outcomes. OBJECTIVE: To address the health workforce crisis in an area of remote north western New South Wales (NSW) in Australia. METHOD: The NSW Rural Doctors Network applied the TUFH principles in overcoming much of the crisis and developing an ongoing local health system which has answered many of the local needs. CONCLUSION: The project provided experience for policy change and development at both State and National levels.

A B cell-based sensor for rapid identification of pathogens.

We report the use of genetically engineered cells in a pathogen identification sensor. This sensor uses B lymphocytes that have been engineered to emit light within seconds of exposure to specific bacteria and viruses. We demonstrated rapid screening of relevant samples and identification of a variety of pathogens at very low levels. Because of its speed, sensitivity, and specificity, this pathogen identification technology could prove useful for medical diagnostics, biowarfare defense, food- and water-quality monitoring, and other applications.