Allan Kate, Joh-Carnella Nicolette, Fallon Barbara, Vandermorris Ashley, Houston Emmaline
Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada.
Division of Adolescent Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada.
Paediatr Child Health. 2021 May 27;26(7):e283-e289. doi: 10.1093/pch/pxab012. eCollection 2021 Nov.
This study explores child welfare investigations for medical neglect in Ontario, Canada, focusing on household, family and child characteristics of such investigations and factors associated with substantiated victimization.
This analysis used data from the Ontario Incidence Study of Reported Child Abuse and Neglect 2018. Bivariate analyses compared medical neglect with other neglect investigations to create a profile of medical neglect investigations in Ontario, and a binary logistic regression determined which case characteristics were associated with substantiation of medical neglect.
Compared with other neglect investigations, medical neglect investigations were more likely to involve children less than 1 year old and caregivers under 21 years old, households that had run out of money in the past 6 months for basic necessities, primary caregivers with few social supports, mental health issues or drug/solvent abuse concerns, and children with at least one functioning concern. Medical neglect investigations in which the primary caregiver had few social supports were almost four times more likely to be substantiated (OR=3.698, P<0.05).
While the public's perception of medical neglect tends to focus on parental refusal of treatment due to philosophical/religious beliefs, this Ontario sample indicates that medical neglect is often driven by financial constraints and a lack of social support. Implications for health care providers within a universal health care system are discussed.
本研究探讨加拿大安大略省针对医疗忽视的儿童福利调查，重点关注此类调查中的家庭、家庭及儿童特征以及与已证实的受害情况相关的因素。
本分析使用了2018年安大略省报告的儿童虐待和忽视发生率研究的数据。双变量分析将医疗忽视与其他忽视调查进行比较，以勾勒出安大略省医疗忽视调查的概况，二元逻辑回归确定哪些案件特征与医疗忽视的证实相关。
与其他忽视调查相比，医疗忽视调查更有可能涉及1岁以下儿童和21岁以下的照顾者、过去6个月内没钱购买基本必需品的家庭、社会支持很少的主要照顾者、有心理健康问题或药物/溶剂滥用问题的照顾者，以及至少有一项功能问题的儿童。主要照顾者社会支持很少的医疗忽视调查被证实的可能性几乎高出四倍（比值比=3.698，P<0.05）。
虽然公众对医疗忽视的认知往往集中在父母因哲学/宗教信仰而拒绝治疗，但安大略省的这个样本表明，医疗忽视往往是由经济限制和缺乏社会支持驱动的。讨论了全民医疗保健系统中对医疗保健提供者的影响。
