Leslie L. Davidson

The impact of the Safe Kids/Healthy Neighborhoods Injury Prevention Program in Harlem, 1988 through 1991.

OBJECTIVES This study evaluated the effectiveness of a community coalition to prevent severe injuries to children in Central Harlem, New York, NY. It was hypothesized that injury incidence rates would decline during the intervention (1989 through 1991) relative to preintervention years (1983 through 1988); that the decline would be greatest for the targeted age group (5 through 16 years) and targeted injury causes (traffic accidents, assaults, firearms, outdoor falls); and that the decline would occur in the intervention community rather than a control community. METHODS Surveillance of injuries that result in hospitalization and/or death among children in the two communities has been under way since 1983. Data from this surveillance were used to test whether the incidence of severe injury declined during the intervention; other temporal variations were controlled by Poisson regression. RESULTS The incidence of injury among school-aged children in central Harlem declined during the intervention. The decline was specific to the targeted age group and targeted causes. A nonspecific decline also occurred in the control community. CONCLUSIONS The declining incidence rate in Central Harlem is consistent with a favorable program effect, but additional investigation of possible secular trend or spillover effects is needed.

Validity of the Ten Questions screen for childhood disability: Results from population-based studies in Bangladesh, Jamaica, and Pakistan

An international study to validate the Ten Questions screen for serious childhood disability was undertaken in communities in Bangladesh, Jamaica, and Pakistan, where community workers screened more than 22,000 children ages 2–9 years. All children who screened positive, as well as random samples of those who screened negative, were referred for clinical evaluations. Applying comparable diagnostic criteria, the sensitivity of the screen for serious cognitive, motor, and seizure disabilities is acceptable (80–100%) in all three populations, whereas the positive predictive values range from 3 to 15%. These results confirm the usefulness of the Ten Questions as a low-cost and rapid screen for these disabilities, although not for vision and hearing disabilities, in populations where few affected children have previously been identified and treated. They also show that the value of the Ten Questions for identifying disability in underserved populations is limited to that of a screen; more thorough evaluations of children screened positive are necessary to distinguish true- from false-positive results and to identify the nature of the disability if present.

Screening women for intimate partner violence in healthcare settings: abridged Cochrane systematic review and meta-analysis.

Objective To examine the effectiveness of screening for intimate partner violence conducted within healthcare settings to determine whether or not screening increases identification and referral to support agencies, improves women’s wellbeing, decreases further violence, or causes harm. Design Systematic review and meta-analysis of trials assessing effectiveness of screening. Study assessment, data abstraction, and quality assessment were conducted independently by two of the authors. Standardised estimations of the risk ratios and 95% confidence intervals were calculated. Data sources Nine databases searched up to July 2012 (CENTRAL, Medline, Medline(R), Embase, DARE, CINAHL, PsycINFO, Sociological Abstracts, and ASSIA), and five trials registers searched up to 2010. Eligibility criteria for selecting studies Randomised or quasi-randomised trials of screening programmes for intimate partner violence involving all women aged ≥16 attending a healthcare setting. We included only studies in which clinicians in the intervention arm personally conducted the screening, or were informed of the screening result at the time of the consultation, compared with usual care (or no screening). Studies of screening programmes that were followed by structured interventions such as advocacy or therapeutic intervention were excluded. Results 11 eligible trials (n=13 027) were identified. In six pooled studies (n=3564), screening increased the identification of intimate partner violence (risk ratio 2.33, 95% confidence interval 1.39 to 3.89), particularly in antenatal settings (4.26, 1.76 to 10.31). Based on three studies (n=1400), we detected no evidence that screening increases referrals to domestic violence support services (2.67, 0.99 to 7.20). Only two studies measured women’s experience of violence after screening (three to 18 months after screening) and found no reduction in intimate partner violence. One study reported that screening does not cause harm. Conclusions Though screening is likely to increase identification of intimate partner violence in healthcare settings, rates of identification from screening interventions were low relative to best estimates of prevalence of such violence. It is uncertain whether screening increases effective referral to supportive agencies. Screening does not seem to cause harm in the short term, but harm was measured in only one study. As the primary studies did not detect improved outcomes for women screened for intimate partner violence, there is insufficient evidence for screening in healthcare settings. Studies comparing screening versus case finding, or screening in combination with therapeutic intervention for women’s long term wellbeing, are needed to inform the implementation of identification policies in healthcare settings.

Hyperactivity, antisocial behavior, and childhood injury: a critical analysis of the literature.

Studies investigating the relationship between hyperactivity, antisocial behavior, and injury in children are reviewed. Most of the studies have reported that these behaviors are important risk factors for injury. However, design problems with these studies are noted. Early studies employed inappropriate control groups, or omitted them altogether, whereas more recent studies have used retrospective measures that depend on the recall of mothers and teachers, and which are therefore vulnerable to bias. When, on the other hand, prospective designs were used, a relationship between hyperactivity and injury was not found. In all these recent studies, a relationship between injury and management problem or aggressive behavior was reported. It is concluded that the relationship between hyperactivity and injury is still under question, and that a further prospective study will be required to resolve the issue. J Dev Behav Pediatr 8:335–340, 1987. Index terms: injury, hyperactivity, child behavior, antisocial behavior, aggression.

Improving communication between health professionals and women in maternity care: a structured review

Objective To review trials of the effectiveness of interventions aimed at improving communication between health professionals and women in maternity care.

Agreement between hospital records and maternal recall of mode of delivery: Evidence from 12 391 deliveries in the UK Millennium Cohort Study

Objective  The objective of this study was to measure the agreement between hospital records and maternal reporting of mode of delivery in a representative UK sample.

Training Programs for Healthcare Professionals in Domestic Violence

Although women who experience domestic violence seek healthcare services frequently, screening and counseling rates remain low, and healthcare professionals report feeling inadequately trained to care for abused women. The English language literature from 1989 to 1999 was searched to identify and evaluate published assessments of the education of healthcare providers in domestic violence toward women. Major deficiencies in program evaluation were found. They included the use of a historical comparison group, lack of an experimental design, selection of nonstandardized outcomes without clinical performance measures, short-term follow-up, limited documentation of course content and theory, and lack of focus on the impact of programs on abused women. Educational programs generally consisted of a single session of limited duration (1-3 hours). Based on published reports, it appears that few rigorously designed evaluations have been conducted of training programs for healthcare providers in the detection and treatment of women affected by domestic violence.

Method of delivery and neonatal outcome in very low-birthweight vertex-presenting fetuses

OBJECTIVE This study was undertaken to compare neonatal outcome by method of delivery in very low-birthweight less than 1500 g vertex-presenting fetuses. STUDY DESIGN A retrospective cohort was conducted of 2466 very low-birthweight singleton liveborn vertex-presenting fetuses in Washington State (1994-2003). The exposure considered was cesarean delivery vs vaginal delivery. The risk of neonatal demise was estimated by logistic regression. Secondary outcomes included intraventricular hemorrhage, respiratory distress, and neonatal sepsis. Analyses were stratified by birthweight, gestational age, and growth restriction to assess subgroup differences. RESULTS Cesarean delivery offered no survival advantage to very low-birthweight infants when compared with vaginal delivery (adjusted odds ratio [95% confidence interval]: 1.08 [0.78-1.49]). Survival benefit was noted for growth-restricted infants (adjusted odds ratio [95% confidence interval]: 0.09 [0.02-0.47]) although only 12% of such infants delivered vaginally. CONCLUSION For very low-birthweight vertex-presenting fetuses at risk of preterm delivery, cesarean delivery does not improve neonatal survival. Further studies are warranted to assess the potential benefit of cesarean delivery to growth-restricted very low-birthweight infants.

Identification of childhood disability in Jamaica: the ten question screen.

This is the first in a series of papers that report the testing of two instruments for the identification and assessment of childhood disability by community workers (CWs) in Third World countries. It is part of the International Epidemiologic Study on Childhood Disability. The Ten Question Screen (TQ) was used as the main instrument to identify disability in a two stage population-based survey of 5478 children aged 2-9 years in Clarendon, Jamaica. In the second stage, TQ positive and 8% of the screen negative controls were professionally assessed by a doctor and a psychologist using standard criteria based on the main classification system of the ICIDH. Sensitivity of the TQ as a whole varied in different strata of the group and amongst different disabilities, from perfect in girls under 6 years, fits and motor disabilities and for serious disability in all group except boys over 5 years with cognitive disability. Specificity was good but the false positive rate was unacceptably high at 74%. It was concluded, firstly, that the validation of a simple questionnaire of perceptions of behaviour against objective measurements of impairments was perhaps not fair to the TQ. In spite of this, the TQ would be a very useful instrument in collecting disability data or for identifying people in need of rehabilitation help, if a way of reducing false positives could be found.

Economic implications of multiple births : inpatient hospital costs in the first 5 years of life

Objectives: To estimate long term health service costs for hospital stays associated with singleton, twin, and higher order multiple births up to 5 years of age. Design: Costs from specialty based data from the English Department of Health’s NHS Trust Financial Returns were applied to admissions recorded in the Oxford record linkage study during 1970–1993. Setting: Oxfordshire and West Berkshire, United Kingdom. Subjects: A total of 276 897 children, of whom 270 428 were singletons, 6284 were twins, and 185 were higher order multiple births. Main outcome measures: Duration of hospital admissions during the first 5 years of life. Costs, expressed in £ sterling and valued at 1998–1999 prices, of hospital inpatient services. Results: The total duration of hospital admissions for twins and triplets were respectively twice and eight times that for singletons, once duration of life had been taken into account. Inpatient costs were significantly higher for multiple births than for singletons, with the cost differences concentrated in the first year of life. Over the first 5 years of life, the adjusted mean cost was estimated at £1532 (95% confidence interval (CI) £1516 to £1548) for singletons, £3826 (95%CI £3724 to £3929) for twins, and £8156 (95%CI £7559 to £8754) for higher order multiple births (p < 0.0001). Conclusions: Multiple births contribute disproportionately to hospital inpatient costs, especially during the children’s first year of life.