Schnitzer Patricia G, Ewigman Bernard G
Sinclair School of Nursing, University of Missouri, Columbia, MO 65211, USA.
J Nurs Scholarsh. 2008;40(1):91-7. doi: 10.1111/j.1547-5069.2007.00211.x.
To determine if household composition is an independent risk factor for fatal unintentional injuries related to child maltreatment.
A population-based, case-control study using data from the Missouri Child Fatality Review Program for 1992-1999.
Children under age five who died during the 8-year study period were eligible for study. Cases were defined as children who died of an unintentional injury that occurred when a parent or other adult caregiver: (a) was not present, (b) was present but not capable of protecting the child, (c) placed the child in an unsafe sleep environment, or (d) failed to use legally mandated safety devices. Controls were randomly selected from children who died of natural causes. Household composition was classified based on relationship of the adults living in the household to the deceased child. The five household composition categories were households with: (a) two biologic parents and no other adults, (b) one biologic parent and no other adults, (c) one or two biologic parents and another adult relative, (d) stepparents or foster parents, and (e) one or two biologic parents and another unrelated adult. Logistic regression analyses were conducted and odds ratios estimating the risk of maltreatment-related unintentional death associated with each household category compared to the reference households: those with two biologic parents and no other adults.
Three hundred eighty children met the case definition. Children residing within households with adults unrelated to them had nearly six times the risk of dying of maltreatment-related unintentional injury (adjusted odds ratio [aOR] 5.9; 95% confidence interval [95% CI] 1.9-17.6). Children residing with step or foster parents and those living with other, related adults were also at increased risk of maltreatment death (aOR 2.6, 95% CI 1.0-6.5; and aOR 2.1, 95% CI 1.0-4.5, respectively). Risk was not elevated for children in households with a single biologic parent and no other adults in residence.
Young children residing in households with unrelated adults, step-parents, or foster parents are at increased risk of fatal unintentional injury related to maltreatment. Nurses can use the findings of this study to facilitate injury prevention by identifying families at risk for fatal unintentional injuries and providing these families with targeted education or referral.
确定家庭构成是否是与虐待儿童相关的致命意外伤害的独立危险因素。
一项基于人群的病例对照研究，使用1992 - 1999年密苏里州儿童死亡审查项目的数据。
8年研究期间死亡的5岁以下儿童符合研究条件。病例定义为死于意外伤害的儿童，这些意外伤害发生在父母或其他成年照顾者：(a)不在场；(b)在场但无能力保护儿童；(c)将儿童置于不安全的睡眠环境；或(d)未使用法律规定的安全装置时。对照从死于自然原因的儿童中随机选取。家庭构成根据居住在家庭中的成年人与已故儿童的关系进行分类。五个家庭构成类别为：(a)有两个亲生父母且无其他成年人；(b)有一个亲生父母且无其他成年人；(c)有一个或两个亲生父母及另一个成年亲属；(d)继父母或养父母；(e)有一个或两个亲生父母及另一个无亲属关系的成年人。进行逻辑回归分析，并计算比值比，以估计与每个家庭类别相比，参考家庭（有两个亲生父母且无其他成年人的家庭）发生与虐待相关的意外死亡的风险。
380名儿童符合病例定义。居住在与他们无亲属关系的成年人家庭中的儿童死于与虐待相关的意外伤害的风险几乎高出六倍（调整后的比值比[aOR] 5.9；95%置信区间[95% CI] 1.9 - 17.6）。与继父母或养父母一起生活以及与其他有亲属关系的成年人一起生活的儿童，遭受虐待死亡的风险也增加（分别为aOR 2.6，95% CI 1.0 - 6.5；以及aOR 2.1，95% CI 1.0 - 4.5）。对于居住在只有一个亲生父母且无其他成年人居住的家庭中的儿童，风险并未升高。
居住在与无亲属关系的成年人、继父母或养父母家庭中的幼儿，遭受与虐待相关的致命意外伤害的风险增加。护士可利用本研究结果，通过识别有致命意外伤害风险的家庭并为这些家庭提供针对性教育或转诊，来促进伤害预防。
