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Chen HH, Wang IA, Hsieh TW, Tsay JH, Chen CY. Early predictors for maltreatment-related injuries in infancy and long-term mortality: a population-based study. BMC Public Health 2023; 23:2232. [PMID: 37957616 PMCID: PMC10641954 DOI: 10.1186/s12889-023-17180-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 11/07/2023] [Indexed: 11/15/2023] Open
Abstract
INTRODUCTION Incidence, health consequences, and social burden associated with child maltreatment appeared to be borne disproportionately by very young children. We conducted a population-based data linkage study to explore child- and family-level factors that affect receiving different diagnoses of maltreatment injuries and investigate excessive mortality throughout toddlerhood. METHODS We conducted a retrospective cohort study comprising 2.2 million infants born in 2004-2014 in Taiwan. Incident cases of child maltreatment were defined by hospitalization or emergency department visits for three heterogeneous diagnostic groups of maltreatment-related injuries (i.e., maltreatment syndrome, assaults, and undetermined causes) within 12 months after birth. The generalized linear model and landmark survival analyses were used to evaluate risk factors. RESULTS An estimated 2.9‰ of infants experienced at least one maltreatment-related injury, with a three-year mortality rate of 1.3%. Low birthweight was associated with increased risk of receiving the diagnosis of three maltreatment injuries, particularly maltreatment syndrome (adjusted Incidence Rate Ratio [aIRR] = 4.08, 95% confidence interval [CI]: 2.93-5.68). Socially advantaged family condition was inversely linked with receiving the diagnosis of maltreatment syndrome and assaults (e.g., high income: aIRR = 0.55 and 0.47), yet positively linked with undetermined cause (aIRR = 2.05, 95% CI: 1.89-2.23). For infants exposed to maltreatment, low birth weight and non-attendance of postnatal care were highly predictive of fatality; low birthweight served as a vital predictor for premature death during toddlerhood (aIRR = 6.17, 95% CI: 2.36-15.4). CONCLUSIONS Raising awareness of maltreatment-related injuries in infancy and predictors should be a priority for appropriate follow-up assessment and timely intervention.
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Affiliation(s)
- Hsin-Hung Chen
- Institute of Public Health, National Yang Ming Chiao Tung University, Medical Building II, No. 155, Sec. 2, Linong Street, Taipei, 112, Taiwan
- Division of Pediatric Neurosurgery, The Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - I-An Wang
- Center of Neuropsychiatric Research, National Health Research Institutes, Zhunan, Taiwan
| | - Tan-Wen Hsieh
- Center of Neuropsychiatric Research, National Health Research Institutes, Zhunan, Taiwan
| | - Jen-Huoy Tsay
- Department of Social Work, National Taiwan University, Taipei, Taiwan
| | - Chuan-Yu Chen
- Institute of Public Health, National Yang Ming Chiao Tung University, Medical Building II, No. 155, Sec. 2, Linong Street, Taipei, 112, Taiwan.
- Center of Neuropsychiatric Research, National Health Research Institutes, Zhunan, Taiwan.
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Su YB, Li TH, Huang CC, Tsai HC, Huang SF, Hsieh YC, Yang YY, Huang YH, Hou MC, Lin HC. Chronic calcitriol supplementation improves the inflammatory profiles of circulating monocytes and the associated intestinal/adipose tissue alteration in a diet-induced steatohepatitis rat model. PLoS One 2018; 13:e0194867. [PMID: 29684027 PMCID: PMC5912737 DOI: 10.1371/journal.pone.0194867] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Accepted: 03/12/2018] [Indexed: 01/10/2023] Open
Abstract
Vitamin D deficiency and up-regulated TNFα-related signals are reported to be involved in abnormalities including intestinal hyper-permeability, bacterial translocation, systemic/portal endotoxemia, intestinal/adipose tissue/hepatic inflammation, and hepatic steatosis in nonalcoholic steatohepatitis (NASH). This study aims to explore the molecular mechanisms and effects of chronic calcitriol [1,25-(OH)2D3, hormonal form of vitamin D] on gut-adipose tissue-liver axis abnormalities using a high-fat diet (HFD)-fed rat model of NASH. In HFD-fed obese rats on a 10-week calcitriol (0.3 μg/kg/TIW) or vehicle treatment (NASH-vit. D and NASH-V rats) reigme, various in vivo and in vitro experiments were undertaken. Through anti-TNFα-TNFR1-NFκB signaling effects, chronic calcitriol treatment significantly restored plasma calcitriol levels and significantly improved vitamin D receptor (VDR) expression in monocytes and the small intestine of NASH-vit. D rats. Significantly, plasma and portal endotoxin/TNFα levels, bacterial translocation to mesenteric lymph nodes, plasma DX-4000-FITC, fecal albumin-assessed intestinal hyper-permeability, over-expression of TNFα-related immune profiles in monocytes, inflammation of intestinal/mesenteric adipose tissue (MAT)/liver and hepatic steatosis were improved by chronic calcitriol treatment of NASH rats. Additionally, in vitro experiments with acute calcitriol co-incubation reversed NASH-V rat monocyte supernatant/TNFα-induced monolayer barrier dysfunction in caco-2 cells, cytokine release from MAT-derived adipocytes, and triglyceride synthesis by lean-V rat hepatocytes. Using in vivo and in vitro experiments, our study reported calcitriol signaling in the gut as well as in adipose tissue. Meanwhile, our study suggests that restoration of systemic and intestinal vitamin D deficiency using by chronic vitamin D treatment effectively reduces TNFα-mediated immunological abnormalities associated with the gut-adipose tissue-liver axis and hepatic steatosis in NASH rats.
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Affiliation(s)
- Yen-Bo Su
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Tzu-Hao Li
- Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
- Division of Allergy and Immunology, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Clinical Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
- Chia-Yi Branch of Taichung Veterans General Hospital, Chiayi, Taiwan
| | - Chia-Chang Huang
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
- Institute of Clinical Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Hung-Cheng Tsai
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Shiang-Fen Huang
- Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
- Division of Infection, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yun-Cheng Hsieh
- Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
- Division of Gastroenterology and Hepatology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ying-Ying Yang
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
- Institute of Clinical Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
- Division of Gastroenterology and Hepatology, Taipei Veterans General Hospital, Taipei, Taiwan
- Division of General Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- * E-mail: (YYY); (HCL)
| | - Yi-Hsiang Huang
- Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
- Division of Gastroenterology and Hepatology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ming-Chih Hou
- Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
- Division of Gastroenterology and Hepatology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Han-Chieh Lin
- Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
- Division of Gastroenterology and Hepatology, Taipei Veterans General Hospital, Taipei, Taiwan
- * E-mail: (YYY); (HCL)
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Yang LY, Huang CC, Hsu HC, Yang YY, Chang CC, Chuang CL, Lee WS, Liang JF, Cheng HM, Huang CC, Lee FY, Ho ST, Kirby R. Voluntary attendance of small-group brainstorming tutoring courses intensify new clerk's "excellence in clinical care": a pilot study. BMC Med Educ 2017; 17:2. [PMID: 28056969 PMCID: PMC5217545 DOI: 10.1186/s12909-016-0843-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 12/14/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Clerkship provides a unique way of transferring the knowledge and skills gathered during medical school's curriculum into real-ward clinical care environment. The annual program evaluation has indicated that the training of clerks in diagnostic and clinical reasoning skills needed to be enhanced. Recently, "clinical excellence" program have been promoted in our institution to augment the excellence in clinical care of new clerks. Current study aims to evaluate whether this pilot program improve the "clinical excellence" of new clerks. METHODS In a pilot study, groups of new clerks in years 2013 and 2014 voluntarily attended either a small-group brainstorming course or a didactic classroom tutoring courses as part of their 3-month internal medicine clinical rotation block. A third group of new clerks did not join either of the above courses and this group served as the control group. Pre-block/post-block self-assessment and post-block 5-station mini-Objective Subjective Clinical Examinations (OSCEs) were used to evaluate the effectiveness of these two additional courses that trained diagnostic and clinical reasoning skills. RESULTS Overtime, the percentages of new clerks that attended voluntarily either the small-group brainstorming or classroom tutoring courses were increased. Higher post-block self-assessed diagnostic and clinical reasoning skill scores were found among individuals who attended the small-group brainstorming courses compared to either the didactic group or the control group. In a corresponding manner, the small-group brainstorming group obtained higher summary OSCEdiag and OSCEreason scores than either the didactic group or control group. For all basic images/laboratory OSCE stations, the individual diagnostic skill (OSCEdiag) scores of the small-group brainstorming group were higher than those of the didactic group. By way of contrast, only the clinical reasoning skill (OSCEreason) scores of the basic electrocardiogram and complete blood count + biochemistry OSCE station of thesmall-group brainstorming group were higher than those of the didactic group. Among the small-group brainstorming group, clerks with higher cumulative learning hours (>30-h) had significant higher OSCEdiag and OSCEreason scores (>400) than those with less cumulative learning hours. CONCLUSION Our pilot study provides a successful example of the use of a small-group tutoring courses for augmenting the diagnostic and clinical reasoning skills of new clerks. The positive results obtained during the initial 2-year long pilot "clinical excellence" program have encouraged the formal implementation of this course as part of the clerkship curriculum.
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Affiliation(s)
- Ling-Yu Yang
- Department of Medical Education, Yilan, Taiwan
- Department of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chia-Chang Huang
- Division of Clinical Skills Training, Yilan, Taiwan
- Department of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Hui-Chi Hsu
- Department of Medicine, Division of General Medicine, Yilan, Taiwan
- Camillians Saint Mary's Hospital Luodong, Yilan, Taiwan
- Department of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ying-Ying Yang
- Division of Clinical Skills Training, Yilan, Taiwan.
- Department of Medicine, Division of General Medicine, Yilan, Taiwan.
- Department of Medicine, National Yang-Ming University, Taipei, Taiwan.
| | - Ching-Chi Chang
- Department of Medicine, Division of General Medicine, Yilan, Taiwan
- Department of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chiao-Lin Chuang
- Department of Medicine, Division of General Medicine, Yilan, Taiwan
- Department of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Wei-Shin Lee
- Department of Medicine, Division of General Medicine, Yilan, Taiwan
- Department of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Jen-Feng Liang
- Department of Medical Education, Yilan, Taiwan
- Department of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Hao Min Cheng
- Department of Medical Education, Yilan, Taiwan
- Department of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chin-Chou Huang
- Division of Clinical Skills Training, Yilan, Taiwan
- Department of Medicine, Division of General Medicine, Yilan, Taiwan
- Department of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Fa-Yauh Lee
- Taipei Veterans General Hospital, Yilan, Taiwan
- Department of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Shung-Tai Ho
- Taipei Veterans General Hospital, Yilan, Taiwan
- Department of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ralph Kirby
- Department of Medicine, National Yang-Ming University, Taipei, Taiwan
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