The hidden impact of alcohol on young victims: an analysis of alcohol-related police offences resulting in hospitalisation.

BACKGROUND: Alcohol-related harm (ARH) is a significant public health concern affecting young individuals, particularly those involved in alcohol-related police incidents resulting in hospitalisation. However, the impact of alcohol on young victims remains under researched. This study aimed to identify the characteristics of offenders and victims involved in these incidents, analyse the types of offences, and understand the under-ascertainment of ARH in hospital records. METHODS: A retrospective longitudinal study of 12-24-year-olds born between 1980 and 2005 was conducted using linked data from hospital admissions, emergency department presentations, and police incident records. Alcohol-related incidents were identified based on the attending officers' opinions in the Western Australia Police's Incident Management System (IMS). Logistic and log-binomial regression were utilised to analyse the factors associated with victimisation and under-ascertainment of ARH. RESULTS: Our study included 22,747 individuals (11,433 victims and 11,314 offenders) involved in alcohol-related police incidents, with a small majority of victims being female (53%, n = 6,074) and a large majority of offenders being male (84.3%, n = 9,532). Most victims did not receive a diagnosis of ARH (71%, n = 760). Women were 10 times more likely to have been a victim in ARH police incidents and 2 times more likely to have an undiagnosed alcohol-related hospital admission than men. Victims and offenders predominantly came from disadvantaged areas and major cities. Aboriginal individuals were overrepresented as both offenders and victims. A significant proportion of individuals experienced emergency department presentations or hospital admissions, with head injuries being the most common. Assault causing bodily harm was the most prevalent offence resulting in hospitalisation (66%, n = 2,018). CONCLUSIONS: There is a noteworthy disparity between the quantity of hospital admissions attributed to alcohol-related incidents and the number of cases that are formally classified as ARH in the hospital system. This disparity highlights a more profound issue of substantial under-ascertainment or inadequate identification of ARH than previously acknowledged. Our findings justify the prioritisation of prevention strategies, beyond improvement in the documentation of alcohol-related hospitalisation. Considering the scale of the problem, and the underestimation of the burden of alcohol-related hospitalisation, a proportional increase in investment is necessary to achieve population-level reductions in ARH.

Assessing the utility of night-time presentations as a proxy for alcohol-related harm among young emergency department trauma patients.

OBJECTIVE: To assess the usefulness of night-time presentations to measure alcohol-related harm (ARH) in young trauma patients, aged 12-24 years, attending Western Australian EDs. METHODS: A retrospective longitudinal study examined alcohol-related ED presentations in Western Australia (WA; 2002-2016) among 12- to 24-year-olds. Data from the Emergency Department Data Collection, WA State Trauma Registry Database and Hospital Morbidity Data Collection were used to identify ARH through specific codes and text searches. These were compared to ARH estimates based on presentation time. Statistical analysis involved sensitivity and specificity calculations and Cox proportional hazards modelling. RESULTS: We identified 2644 (17.8%) night-time presentations as a proxy measure of ARH among the 14 887 presentations of patients aged 12-24 years. This closely matched the 3064 (20.6%) identified as ARH through coding methods. The highest risk for an ARH presentation occurred during the night hours between 00.00 and 04.59 hours. During these hours, the risk was 4.4-5.1 times higher compared to presentations at midday (between 12.00 and 12.59 hours). However, when looking at individual patients, we observed that night-time presentations were not a strong predictor of ARH (sensitivity: 0.39; positive predictive value: 0.46). CONCLUSIONS: Implementing targeted interventions during night hours could be beneficial in addressing ARH presentations. However, relying solely on the time of presentation as a proxy for ARH is unlikely to effectively identify ARH in young individuals. Instead, the present study emphasises the importance of implementing mandatory data collection strategies in EDs to ensure accurate measurement of ARH cases.

Young people with prior health service contacts have increased risk of repeated alcohol-related harm hospitalisations.

INTRODUCTION: After a first alcohol-related hospitalisation in youth, subsequent hospitalisations may demonstrate an increased risk of further alcohol-related hospitalisations, but there is no existing data on this. METHODS: A retrospective longitudinal study between July 1992 and June 2017 using linked hospital administrative data identified 23 464 Western Australian young people [9009 (38.4%) females and 14 455 (61.6%) males], aged 12-24 years hospitalised for at least one alcohol-related harm (ARH) episode of care. Cox regression was used to estimate hazard ratios (HR) between risk factors and repeated alcohol-related hospitalisation after the first discharge for ARH. RESULTS: Of those admitted for an alcohol-related hospitalisation (n = 23 464), 21% (n = 4996) were readmitted for ARH. This high-risk sub-group comprised 46% (n = 16 017) of the total alcohol-related admissions (n = 34 485). After the first discharge for ARH, 16% (804) of people who experienced an alcohol-related readmission were readmitted within 1 month, and 51.8% (2589) were readmitted within 12 months. At increased risk of readmission were Aboriginal people and those with prior health service contacts occurring before their first alcohol-related hospitalisation, including illicit drug hospitalisations, mental health contacts and, in a sub-analysis, emergency department presentations. DISCUSSION AND CONCLUSIONS: The probability of a repeated ARH hospitalisation was highest in the first month after initial discharge. There is a high-risk sub-group of young people more likely to have a repeat ARH hospitalisation. This represents an opportunity to provide interventions to those most at risk of repeated ARH.

Trends in Hospital Admissions for Intimate Partner Violence in Australian Mothers With Children Born From 1990 to 2009.

This study aims to determine the prevalence, and trends over time, of Western Australian (WA) mothers who were victims of intimate partner violence (IPV) requiring hospital admission. The study investigated the prevalence of all mothers and the specific prevalence of Aboriginal and non-Aboriginal mothers. A population-based cohort study using de-identified linked health data of mothers of children born from 1990 to 2009 in WA was carried out. The prevalence of hospitalizations for IPV in mothers of children born in the period 1990-2009 (per 1,000 births) was calculated. Results indicate that the overall prevalence of hospital admissions for mothers assaulted 12 months prior to their child's birth month increased in the period 1990-2009, from 2.7 to 7.7 per 1,000 births. There was also an increase in the overall prevalence of hospital admissions of mothers who were assaulted 12 months prior to the birth month and 36 months after the birth month, from 8.9 per 1,000 births in 1990 to 19.4 per 1,000 births in 2009. In addition, being Aboriginal, having a mother <30 years of age, and being of low SES significantly increased the odds of having a mother with an IPV admission. This study highlights that while there has been an increase in the prevalence of IPV admissions for mothers of children born from 1990 to 2009 in WA, the level of prevalence has remained persistent for the last decade for the whole population. However, non-Aboriginal mothers have seen an increase in prevalence in the last decade. This increase is associated with the introduction of the Z63.0 code in International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification (ICD-10-AM). This study highlights the importance of prioritizing groups for targeted early intervention and prevention as well as the need for culturally appropriate strategies to reduce the burden of interpersonal violence.

Alcohol-related harm in emergency departments: linking to subsequent hospitalizations to quantify under-reporting of presentations.

TITLE: Alcohol-related harm in emergency departments: linking to subsequent hospitalizations to quantify under-reporting of presentations. AIMS: To quantify the proportion of emergency department (ED) presentations that could be identified as alcohol-related when linking to a patient's subsequent hospitalization, compared with using ED data alone, and to assess that comparison according to the change in alcohol harm rates over time and potential variations within subpopulations. DESIGN: A retrospective study using linked hospital administrative data to identify ED patients who had subsequent alcohol-related hospitalizations. SETTING: Western Australia. PARTICIPANTS: A total of 533 816 Western Australian young people (246 866 females and 286 950 males), aged 12-24 years. MEASUREMENTS: Whether or not presentations of young people to ED could be identified as alcohol-related, and for those that were not, how many had a subsequent alcohol-related hospitalization. Rates and proportions of alcohol-related harm for both methods of ascertainment were estimated by sex and Aboriginality across different age groups. FINDINGS: Alcohol-related hospitalizations that followed an initial presentation at ED allowed the identification of an additional 19 994 alcohol-related presentations (95% increase). Linking to additional hospitalization information also resulted in significant variation in alcohol-related harm trends. In particular, trends in alcohol-related ED presentations for 21-24-year-old males were stable to slightly increasing using only ED data, but decreased after linking with hospitalization data (P < 0.05). Similarly, trends among Aboriginal persons aged 21-24 shifted from increasing using only ED data to being stable in comparison to presentations using subsequent hospitalizations (P < 0.05). CONCLUSIONS: Among young people in Western Australia, twice as many emergency department presentations could be identified as being alcohol-related using diagnosis information from subsequent hospitalizations compared with emergency department data alone. When supplemented with hospitalization data, trends in alcohol-related harm presentations become significantly different within some subpopulations compared with using emergency department presentation data alone.

Harmful drinking is associated with mental health conditions and other risk behaviours in Australian young people.

OBJECTIVE: To investigate factors associated with alcohol use in adolescents, with the focus on analysing the comorbidities between single-occasion harmful-drinking episodes with mental health issues and risk behaviours. METHODS: This study used data from the Young Minds Matter survey, designed to inform on the prevalence of the seven most common mental health disorders of children and adolescents. Logistic regression modelling was used to assess the odds of harmful drinking behaviour in young people aged 13-17 years in Australia. RESULTS: We found a strong association between single-occasion harmful drinking and mental health issues, which hold after controlling for sociodemographic characteristics. Young people with severe mental health issues within the past year were four times more likely to have been drinking at harmful levels in the past 30 days. CONCLUSIONS: Alcohol use can have adverse health effects among children and adolescents. Research has found a bidirectional association between alcohol use and mental health conditions where the presence of one issue almost doubles the risk of having the other issue. Implications for public health: The comorbidity between these issues suggests the need for strategies to integrate policies addressing mental health and alcohol use disorders in young people.

Role of pre-existing adversity and child maltreatment on mental health outcomes for children involved in child protection: population-based data linkage study.

OBJECTIVES: To determine mental health outcomes for children with a history of child protection system involvement, accounting for pre-existing adversity, and to examine variation in risk across diagnostic groupings and child protection subgroups. DESIGN: A longitudinal, population-based record-linkage study. PARTICIPANTS: All children in Western Australia (WA) with birth records between 1990 and 2009. OUTCOME MEASURES: Mental health diagnoses, mental health contacts and any mental health event ascertained from International Classification of Diseases codes within WA's Hospital Morbidity Data Collection and Mental Health Information System from birth until 2013. RESULTS: Compared with children without child protection contact, children with substantiated maltreatment had higher prevalence of mental health events (37.4% vs 5.9%) and diagnoses (20% vs 3.6%). After adjusting for background risks, all maltreatment types were associated with an almost twofold to almost threefold increased hazard for mental health events. Multivariate analysis also showed mental health events were elevated across all child protection groups, ranging from HR: 3.54 (95% CI 3.28 to 3.82) for children who had entered care to HR: 2.31 (95% CI 2.18 to 2.46) for unsubstantiated allegations. Maternal mental health, aboriginality, young maternal age and living in socially disadvantaged neighbourhoods were all associated with an increased likelihood of mental health events. The increase varied across diagnostic categories, with particularly increased risk for personality disorder, and frequent comorbidity of mental health and substance abuse disorders. CONCLUSIONS: Young people who have been involved in the child protection system are at increased risk for mental health events and diagnoses. These findings emphasise the importance of services and supports to improve mental health outcomes in this vulnerable population. Adversities in childhood along with genetic or environmental vulnerabilities resulting from maternal mental health issues also contribute to young people's mental health outcomes, suggesting a role for broader social supports and early intervention services in addition to targeted mental health programmes.

Hospitalisations for maternal assault are associated with increased risk of child protection involvement.

BACKGROUND: Previous research shows a co-occurrence between children's exposure to violence and child maltreatment. OBJECTIVE: This study examined the risk of maltreatment allegations in children whose mothers had been hospitalised due to an assault. PARTICIPANTS AND SETTING: The study used a retrospective cohort of children born in Western Australia between 1990-2009 (N = 524,534) using de-identified linked-administrative data. METHODS: Multivariate Cox regression determined the adjusted and unadjusted hazard ratios for child maltreatment allegation in children with a mother hospitalised for assault. Models were adjusted for a range of sociodemographic characteristics. RESULTS: One in five children had a maltreatment allegation following their mother's hospitalisation for assault. This increased to two in five children when the mother was assaulted in the prenatal period. Aboriginal children accounted for 57.6% of all allegations despite representing only 7.8% of the population. Children whose mother had a hospitalisation for assault were nine-times (HR = 9.20, 95%CI: 8.98-9.43) more likely to have a subsequent maltreatment allegation than children whose mother did not have a hospitalisation for assault. Following adjustment for confounding factors, both Aboriginal and non-Aboriginal children had an almost two-fold increased risk of maltreatment allegation (HR = 1.56, 95%CI: 1.43-1.70; HR = 1.93 95%CI:1.80-2.07). CONCLUSIONS: Our study shows that child maltreatment allegation is common in children following a maternal hospitalisation for assault. Targeted early intervention is required for families with young children, and pregnant women experiencing violence. Importantly service staff need awareness of the impact of violence on families and the appropriate services to refer families to.

Overcrowded housing: One of a constellation of vulnerabilities for child sexual abuse.

BACKGROUND: Effective prevention of child abuse depends on an understanding of factors associated with the abuse. Increased risk of child sexual abuse has been associated with parental substance use and adverse socio-economic factors such as living in poverty and parental unemployment. This study investigated overcrowding as a potential socio-economic risk factor in child sexual abuse taking into account other socio-economic, child and parental factors. METHOD: This study used de-identified linked data from health and child protection data collections for the cohort of children born in Western Australia from 1990 to 2009 (n = 524,478). Cox regression was used to estimate adjusted and unadjusted hazard ratios and 95% confidence intervals for time to first sexual abuse allegation and first substantiated allegation, relative to the level of overcrowding and controlling for other risk factors. RESULTS: Higher levels of household overcrowding were associated with a 23%-46% increase in the risk of child sexual abuse allegations. Only the highest level of overcrowding was associated with a 40% increased risk of substantiated sexual abuse. CONCLUSION: The findings suggest that overcrowded living conditions are associated with an increased risk of sexual abuse for some children. This factor needs to be considered alongside other risk factors when assessing and improving child safety.

Trends in alcohol-related injury admissions in adolescents in Western Australia and England: population-based cohort study.

BACKGROUND: Alcohol-related harm in young people is now a global health priority. We examined trends in hospital admissions for alcohol-related injuries for adolescents in Western Australia (WA) and in England, identified groups most at risk and determined causes of injuries. METHODS: Annual incidence rates for alcohol-related injury rates were calculated using population-level hospital admissions data for WA and England. We compared trends in different types of alcohol-related injury by age and gender. RESULTS: Despite a decrease in the overall rate of injury admissions for people aged 13-17 years in WA, alcohol-related injuries have increased significantly from 1990 to 2009 (from 8 to 12 per 10 000). Conversely, alcohol-related injury rates have declined in England since 2007. In England, self-harm is the most frequently recorded cause of alcohol-related injury. In WA, unintentional injury is most common; however, violence-related harm is increasing for boys and girls. CONCLUSION: Alcohol-related harm of sufficient severity to require hospital admission is increasing among adolescents in WA. Declining trends in England suggest that this trend is not inevitable or irreversible. More needs to be done to address alcohol-related harm, and on-going monitoring is required to assess the effectiveness of strategies.

Maltreatment Risk Among Children With Disabilities.

BACKGROUND: Children with disabilities are at increased risk of child maltreatment; however, there is a gap in the evidence about whether all disabilities are at equal risk and whether risk factors vary according to the type of disability. METHODS: A population-based record-linkage study of all children born in Western Australia between 1990 and 2010. Children with disabilities were identified by using population-based registers and risk of maltreatment determined by allegations reported to the Department for Child Protection and Family Support. RESULTS: Although children with disabilities make up 10.4% of the population, they represent 25.9% of children with a maltreatment allegation and 29.0% of those with a substantiated allegation; however, increased risk of maltreatment was not consistent across all disability types. Children with intellectual disability, mental/behavioral problems, and conduct disorder continued to have increased risk of an allegation and substantiated allegation after adjusting for child, family, and neighborhood risk factors. In contrast, adjusting for these factors resulted in children with autism having a lower risk, and children with Down syndrome and birth defects/cerebral palsy having the same risk as children without disability. CONCLUSIONS: The prevalence of disabilities in the child protection system suggests a need for awareness of the scope of issues faced by these children and the need for interagency collaboration to ensure children's complex needs are met. Supports are needed for families with children with disabilities to assist in meeting the child's health and developmental needs, but also to support the parents in managing the often more complex parenting environment.

Entering out-of-home care during childhood: Cumulative incidence study in Canada and Australia.

Cumulative incidence provides a more accurate indicator than annual incidence rates of the number of children who experience out-of-home care during childhood. The study utilises a cohort of all children born in Western Australia (WA) 1994-2005 and Manitoba 1998-2008 using de-identified linked data. Life tables were used to calculate the age-specific cumulative incidence over time and for at-risk groups. Cox regression was used to compare risk factors for entry to care. Manitoba had a larger proportion of children entering care compared to WA (9.4% vs 1.5% by age 12). Over time children entered care at a younger age in both WA (HR=1.5, CI:1.4-1.5) and Manitoba (HR=1.5, CI:1.5-1.6). Similar factors were associated with earlier age care entries in both countries including: socioeconomic disadvantage, young maternal age, maternal hospital admissions for mental health issues, substance misuse and assault. Supplementary analysis for WA showed a time trend with young children (<3years of age) who entered care spending an increasing proportion of their early years in care. Whilst Manitoba had a larger proportion of children entering care, over time in Western Australia children have been entering care at a younger age and spending more time in care. These latter factors contribute to an increased burden on the out-of-home care system. Manitoba had over five times greater cumulative incidence than WA, however risk factors for entry to out-of-home care were consistent in both countries. Knowledge of the risk factors for entry to out-of-home care can inform targeted support and prevention programs.

Maternal mental health and risk of child protection involvement: mental health diagnoses associated with increased risk.

BACKGROUND: Previous research shows that maternal mental illness is an important risk factor for child maltreatment. This study aims to quantify the relationship between maternal mental health and risk of child maltreatment according to the different types of mental health diagnoses. METHODS: The study used a retrospective cohort of children born in Western Australia between 1990 and 2005, with deidentified linked data from routine health and child protection collections. RESULTS: Nearly 1 in 10 children (9.2%) of mothers with a prior mental health contact had a maltreatment allegation. Alternatively, almost half the children with a maltreatment allegation had a mother with a mental health contact. After adjusting for other risk factors, a history of mental health contacts was associated with a more than doubled risk of allegations (HR=2.64, 95% CI 2.50 to 2.80). Overall, all mental health diagnostic groups were associated with an increased risk of allegations. The greatest risk was found for maternal intellectual disability, followed by disorders of childhood and psychological development, personality disorders, substance-related disorders, and organic disorders. Maltreatment allegations were substantiated at a slightly higher rate than for the general population. CONCLUSIONS: Our study shows that maternal mental health is an important factor in child protection involvement. The level of risk varies across diagnostic groups. It is important that mothers with mental health issues are offered appropriate support and services. Adult mental health services should also be aware and discuss the impact of maternal mental health on the family and children's safety and well-being.

Multi-channel electrical bioimpedance: a new noninvasive method to simultaneously measure cardiac and peripheral blood flow.

OBJECTIVES: We sought to assess the ability of a new multi-channel electrical bioimpedance (MEB) methodology to accurately measure both cardiac blood flow and peripheral limb blood flow. BACKGROUND: Cardiac output is the primary determinant of peripheral blood flow; however, optimal regional tissue perfusion is ultimately dependent on the patency of the arterial conduits that transport that flow. A complete understanding of regional tissue perfusion requires knowledge of both cardiac and peripheral blood flow. Existing noninvasive devices do not simultaneously assess the cardiac and peripheral circulations. METHODS: Cardiac blood flow (cardiac output) was measured by MEB in 30 healthy volunteers and was compared to a 2D-Echo Doppler cardiac output. Peripheral blood flow (regional ankle and arm flow) was measured by MEB in 15 healthy volunteers. The MEB ankle/arm flow ratio (AAI index) was then compared to a conventional ankle/brachial pressure ratio (ABI index). RESULTS: There was good correlation between the mean cardiac index by MEB (3.08 l/min/m2) and by Echo Doppler (3.13 l/min/m2) and bias and precision was 0.051 (1.6%) and +/-0.52 l/min/m2 (+/-17%), respectively. The close correlation was maintained for each measurement over a wide range of cardiac indices. There was good correlation between AAI and ABI measurements (p < 0.05) with a sensitivity of 100% and specificity of 100%. CONCLUSIONS: MEB methodology can precisely measure cardiac output and peripheral limb flow in healthy volunteers.