The true cost of child abuse at a level 1 pediatric trauma center.

BACKGROUND: Child physical abuse (CPA) is a significant cause of morbidity and mortality. Children who sustain CPA consume significant healthcare resources. We hypothesized that the costs to care for children who sustain for children with CPA-type injuries are greater than the costs to care for children who sustain accidental injuries. METHODS: All confirmed CPA patients between the ages of 0 and 19 years old, who were admitted to a level 1 pediatric trauma center between January 2010 and September 2018, were retrospectively reviewed. We compared outcomes, including mortality, length of stay (LOS), diagnostic work-up, and overall cost using propensity matching between CPA and accidentally injured trauma patients. Patients were matched based on injury severity score (ISS). RESULTS: The CPA cohort (n = 595) was younger (1.31 +/- 1.96 years, p < 0.0001) than the accidental trauma patients (8.6 +/-5.54 years). The majority of the CPA patients had Medicaid coverage (75.1%), when compared to accidental trauma patients (37.5%; p < 0.0001). CPA patients had longer ICU LOS (2.43 days; p < 0.0001), increased ventilation days (2.57 days; p < 0.0001), and longer hospital LOS (6.56 days; p = 0.0004). The overall mortality rate for CPA patients was higher than accidental trauma patients (9.9% vs. 1.2%; p < 0.0001). The median hospital cost was significantly higher for those with CPA ($18,000) than accidental trauma ($10,100; p < 0.0001). CONCLUSION: The costs to care for children who sustain CPA-type injuries are significantly greater than the costs to care for children who sustain accidental trauma. Better screening tools, more provider education and broader community outreach efforts are needed to reduce the societal and economic costs associated with child physical abuse. STUDY TYPE: Treatment. LEVEL OF EVIDENCE: Level III.

Mapping pediatric injuries to target prevention, education, and outreach.

BACKGROUND: Initiatives exist to prevent pediatric injuries, but targeting these interventions to specific populations is challenging. We hypothesized that mapping pediatric injuries by zip code could be used to identify regions requiring more interventions and resources. METHODS: We queried the trauma registries of two level I trauma centers for children 0-17years of age injured between 2009 and 2013 with home zip codes in our state. Maps were created to identify outlier zip codes. Multivariate linear regression analysis identified predictors within these zip codes. RESULTS: There were 5380 children who resided in the state and were admitted for traumatic injuries during the study period, with hospital costs totaling more than 200 million dollars. Choropleth mapping of patient addresses identified outlier zip codes in our metro area with higher incidences of specific mechanisms of injury and greater hospital charges. Multivariate analysis identified demographic features associated with higher rates of pediatric injuries and hospital charges, to further target interventions. CONCLUSIONS: We identified outlier zip codes in our metro area with higher frequencies of pediatric injuries and higher costs for treatment. These data have helped obtain funding for prevention and education efforts. Techniques such as those presented here are becoming more important as evidence based public health initiatives expand. LEVEL OF EVIDENCE: Type of Study: Cost Effectiveness, II.

The role of aedes aegypti survelliance and control in relation to the epidemiology. Prevention and control of dengue fever in Jamaica

The control of dengue fever depends on the level of Aedes aegypti infestation and thus relies heavily on the measures of controlling the vector. ... The vector apparently has adapted to or resisted most of the control methods. The failure of Aedes aegypti control programmes has been blamed on the vector's biological features fostering the development of species resistance to chemical control or environment factors favouring the increase of the Aedes aegypti population at a faster rate than the control methods can reduce them. Nevertheless, many Aedes aegypti control programmes are improperly planned and implemented or the control measures are often used as reactive methods of controlling dengue fever outbreaks, rather than as continuous proactive strategies for preventing the disease. Aedes aegypti breeding is basically a problem of domestic sanitation and therefore communities have an essential role to play in source reduction activities. The activities of some governmental departments, non govermental organizations and the private sector may encourage the increase of Aedes aegypti mosquitoes or play a positive role in vector control. Consequently, intra sectoral and intersectoral in vector control are very important. This study examined the control measures applied by the Jamaican Ministry of Health, Vector Control Department and the community for Aedes aegypti surveillance and control, and determined the effectiveness of and obstacles to the mosquito control activities presently being applied. The aim of the study was achieved through the execution of an entomology survey, an environmental survey, an insecticide susceptibility test, key informant interviews with vector control staff from the Ministry of Health and the administration of a Knowledge-Attitude-practice survey. The research results showed that the environmental conditions in the study area were conducive to Aedes aegypti breeding and proliferation, especially during the months July to October. Aedes aegypti mosquitoes were present throughout the study area, with a higher density ... Most of the community members in the study area had a poor attitude towards Aedes aegypti control and relied heavily on government to control... The attitude and practices of the community members relating to Aedes aegypti control were greatly influenced by whether the community was severly affected by mosquitoes or by the level of vector control attention given to the community by the government (AU)

The role of the aedes aegypti surveillance and control in relation to the epidemiology, prevention and control of Dengue Fever in Jamaica

The control of dengue fever depends on the level of Aedes aegypti infestation and thus relies heavily on the measures for controlling the vector. Quite recently, despite the implementation of mosquito control measures, the Aedes aegypti population has still escalated. The vector apparently has adapted to or resisted most of the control methods. The failure of Aedes aegypti control programmes has been blamed on the vector's biological features fostering the development of species resistance to chemical control or environmental factors favouring the increase of the Aedes aegypti' population at a faster rate than the control methods can reduce them. Nevertheless, many Aedes aegypti control programmes are improperly planned and implemented or the control measures are often used as reactive methods of controlling dengue fever outbreaks, rather than as continuous proactive strategies preventing disease. Aedes aegypti breeding is basically a problem of domestic sanitation and therefore communities have an essential role to play in source reduction activities. The activities of some governmental departments, non governmental organizations and the private sector may encourage the increase of Aedes aegypti mosquitoes or play a positive role in vector control. Consequently, intra sectoral and intersectoral in vector control are very important. This study examined the control measures applied by the Jamaican Ministry of Health, Vector Control Department and the community for Aedes aegypti surveillance and control, and determined the effectiveness of and obstacles to the mosquito control activities presently being applied. The aim of the study was achieved through the execution of an entomology survey, an environmental survey, an insecticide susceptibility test, key informant interviews with vector control staff from the Ministry of Health and the administration of a Knowledge-Attitude-pracitce survey. The research results showed that the environmental conditions in the study area were conducive to Aedes aegypti breeding and proliferation, especially during the months of July to October. Aedes aegypti mosquitoes were present throughout the study area, with a higher density of Aedes aegypti larvae in Tavern and Gordon Town. Aedes aegypti larvae collected from Mona and Hermitage were highly susceptible to a 1 percent abate larvicide.(Au)