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OBJECTIVES: To determine the incidence of and risk factors associated with infant (< 1 year of age) physical abuse in Alaska. METHODS: A population-based retrospective cohort study for the 1994-2000 resident birth cohort was conducted by linking data from birth certificates, Child Protective Services, a statewide hospital-based trauma registry, hospital discharge data, and the Alaska Infant Mortality Review (including death certificates). The main outcome measures were the incidences of overall physical abuse and abuse resulting in hospitalization or death. A case of child abuse was defined as an instance of substantiated physical abuse to an infant identified in the Child Protective Services database or an infant death with homicide identified on the death certificate as the manner of death. RESULTS: During the 7-year study period, there were 70,842 births and 325 cases of physical abuse including 72 that led to hospitalization (n = 58), death (n = 4), or both (n = 10); respective incidences for all abuse and abuse leading to hospitalization or death were 4.6 and 1.0 per 1000 live births. Following multivariate analyses, the risk factors with the highest population attributable risks were maternal or paternal education < or = 12 years, unmarried mother, and maternal prenatal substance use. To determine if the study methodology was likely to have missed cases of severe abuse, we examined information for all 216 infants hospitalized for trauma during the study period who did not have identification of abuse in one of the study databases; of these, at least 39 had injuries inconsistent with the reported mechanism (a long bone or skull fracture that reportedly resulted from a fall of less than 3 feet or from a caretaker's arms or for which the caretaker denied a history of trauma). Conclusions: Alaska has one of the highest documented infant physical abuse incidences reported in the literature and abuse is associated with potentially modifiable-primarily social-risk factors. Despite this high incidence, substantial under-reporting of hospitalized cases likely occurs. 相似文献
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ABSTRACT Surface compliance has been shown to affect leg stiffness and energetics. It is unknown if compliance differences between common treadmills would elicit such changes. Therefore, the purpose of this study was to determine if compliance design differences of common treadmills would affect the mechanics and energetics of running. Eleven runners ran at moderate, self-selected, matched belt speeds for three minutes on two treadmills: compliant (CT) and rigid (RT) decks. During the last minute of each trial, oxygen consumption and six markers describing the torso, thigh, shank and foot, and one marker to determine treadmill deflection were recorded. Leg stiffness, continuous relative phase (CRP) and CRP variability were calculated. Compared to RT, running on CT resulted in a significantly more compliant leg (8.591 kN?m?1 > 9.063 kN?m?1), lower oxygen consumption (34.69 ml?kg?1?min?1 < 36.86 ml?kg?1?min?1), different coordination patterns and greater variability, particularly during the push-off phase. These results are inconsistent with the literature because the deck of CT rebounds back at the runner during the absorption phase and away from the runner during the push-off phase. Therefore, care should be taken when using treadmills for research and comparing mechanical and energetic measures between studies. 相似文献
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