Characterizing child maltreatment fatalities among child victims with disabilities in the United States, 2010-2019.

BACKGROUND: There has been little research on child maltreatment-related fatalities among children with disabilities. Despite being a minority of children in the United States, children with disabilities experience higher rates of victimization. OBJECTIVE: To characterize fatalities due to child maltreatment among children with disabilities in the United States. METHODS: Data from the National Violent Death Reporting System from 2010 to 2019 were analyzed to describe child maltreatment-related deaths among children with disabilities aged birth to 17 years. RESULTS: There were 106 fatalities meeting the study criteria. The average age of the victims was 5.9 years old and 74.6 % were male. The most frequent suspected perpetrators of maltreatment-related fatalities were biological mothers (35.2 %), and most perpetrators were White (55.7 %). Analyses showed a statistically significant relationship between fatalities caused by neglect and diagnoses of attention deficit hyperactivity disorder, autism spectrum disorder, cerebral palsy, and/or traumatic brain injury. Overall, physical abuse and/or neglect resulting in a fatality among children with disabilities were significantly correlated with the relationship of the perpetrator to the victim. CONCLUSIONS: Children with disabilities who died as a result of abuse were more likely to have autism spectrum disorder, a developmental disability, or other physical impairment, with physical abuse being the most prevalent type of abuse that resulted in death. To decrease the likelihood of abuse of disabled children, healthcare practitioners and caseworkers should work together to create strategies to help caregivers cope with the financial, mental, and physical stress that comes with raising children with disabilities.

Association of Individual and Familial History of Correctional Control With Health Outcomes of Patients in a Primary Care Center.

Importance: Research has shown that experiences of incarceration, probation, and parole are associated with worse health outcomes for incarcerated individuals and their families. Objectives: To quantify the proportion of patients in an urban primary care clinic with an individual or family history of incarceration, probation, and/or parole and to evaluate how correctional control is associated with subjective and objective health outcomes. Design, Setting, and Participants: This cross-sectional, mixed-methods study used patient surveys and retrospective medical record review to assess the experience of correctional control among 200 English-speaking adult patients presenting for care at the Rhode Island Hospital Center for Primary Care between July 9, 2019, and January 10, 2020. Main Outcomes and Measures: Patient surveys included closed and open-ended questions pertaining to personal or familial experiences of incarceration, probation, and parole, as well as health outcomes associated with these experiences. Medical record review abstracted key health indicators and health care use data. Results: In this cross-sectional study of 200 adult patients (1 participant was removed from the full analytic sample owing to missing ethnicity data; 113 of 199 men [56.8%]; mean [SD] age, 51.2 [14.0] years) presenting for primary care, 78 of 199 (39.2%) had a history of incarceration, 32 of 199 (16.1%) were on probation or parole at the time of the study, and 92 of 199 (46.2%) reported having a family member with a history of incarceration. Of the 199 patients, 62 (31.2%) identified as non-Hispanic Black, 93 (46.7%) identified as non-Hispanic White, and 44 (22.1%) identified as belonging to another race (American Indian and Alaska Native, Asian, Native Hawaiian and Other Pacific Islander, or other nonspecified). Compared with participants without a history of correctional control, those with a personal history of incarceration were at greater odds of having an emergency department visit that did not result in hospitalization in models adjusted for age, sex, and race and ethnicity (odds ratio, 2.87; 95% CI, 1.47-5.75). Conclusions and Relevance: This cross-sectional study suggests that primary care clinicians should screen for correctional control as a prevalent social determinant of health.

Intermolt development reduces oxygen delivery capacity and jumping performance in the American locust (Schistocerca americana).

Among animals, insects have the highest mass-specific metabolic rates; yet, during intermolt development the tracheal respiratory system cannot meet the increased oxygen demand of older stage insects. Using locomotory performance indices, whole body respirometry, and X-ray imaging to visualize the respiratory system, we tested the hypothesis that due to the rigid exoskeleton, an increase in body mass during the intermolt period compresses the air-filled tracheal system, thereby, reducing oxygen delivery capacity in late stage insects. Specifically, we measured air sac ventilation frequency, size, and compressibility in both the abdomen and femur of early, middle, and late stage sixth instar Schistocerca americana grasshoppers. Our results show that late stage grasshoppers have a reduced air sac ventilation frequency in the femur and decreased convective capacities in the abdomen and femur. We also used X-ray images of the abdomen and femur to calculate the total proportion of tissue dedicated to respiratory structure during the intermolt period. We found that late stage grasshoppers had a lower proportion of their body dedicated to respiratory structures, especially air sacs, which convectively ventilate the tracheal system. These intermolt changes make oxygen delivery more challenging to the tissues, especially critical ones such as the jumping muscle. Indeed, late stage grasshoppers showed reduced jump frequencies compared to early stage grasshoppers, as well as decreased mass-specific CO(2) emission rates at 3 kPa PO(2). Our findings provide a mechanism to explain how body mass changes during the intermolt period reduce oxygen delivery capacity and alter an insect's life history.