Child Maltreatment最新文献

This study aimed to investigate the connection between childhood abuse history and cardiovascular health indicators among a nationally representative sample of young adults aged 24-32. Using data from waves three and four of the National Longitudinal Study of Adolescent to Adult Health (n = 4, 164) multivariate logistic regression was employed to investigate childhood trauma (i.e., childhood physical abuse, sexual abuse, and neglect) as predictors for cardiovascular disease, hypertension, high cholesterol, diabetes, and obesity. Results showed that adults who reported history of sexual abuse were 4.3 times more likely to report diagnosis of cardiovascular disease and those who reported childhood physical abuse at wave three had 1.4 times the odds of reporting high cholesterol diagnosis. Although trauma history is often calculated as a composite, some forms of childhood abuse may have greater impacts on cardiovascular risk than others.

The examination by which physicians achieve board certification in CAP should reflect the knowledge and skills required of the modern practitioner. The American Board of Pediatrics (ABP) assembled a 12-member volunteer panel of practicing child abuse pediatricians to conduct a practice analysis. In the first phase of the project, the panel identified and documented the practice domains, tasks, knowledge, and skills required for clinical practice. During the second phase, the panel organized testable knowledge areas into content domains and subdomains and updated the ABP CAP content outline. Feedback on the revised outline was requested from all ABP board-certified child abuse pediatricians via an online survey and results from the survey informed final revisions to the outline.

The development of medical knowledge follows specific principles. These also apply to abusive head trauma. The seminal literature from the early 20^th century is based on earlier research from Europe, which is fundamental to understand the evolution of understanding and nomenclature of abusive head trauma. A review of original medical literature on intracranial injuries in children, published in German, English, and French, was conducted using PubMed and Google Scholar for articles before 1950. The primary search focused on subdural hemorrhages and pachymeningitis in children, followed by a snowball search of references. Full texts of available manuscripts were reviewed. Primary literature as early as 1839 was reviewed by native language speakers, referring to intracranial collections of blood that underwent an evolution in nomenclature and understanding of causation. Initially termed pachymeningitis hemorrhagica, implying an inflammatory cause, the nomenclature evolved to subdural hematoma, as traumatic causes aligned with clinical experience. Advances in diagnostic imaging further enhanced understanding and nomenclature. The clinical findings associated with abusive head trauma have been described for centuries, with consistent signs and symptoms until the present day. As the understanding of the disease evolved due to modern diagnostic techniques, changes in nomenclature became necessary.

Emergency department (ED) utilization for preventable reasons by patients with foster care history is unexplored. Medical records of ED encounters from primary care patients were pulled from a southwestern children's hospital system. Necessity of ED encounter was categorized using the New York University- ED Algorithm into emergent, intermediate, or non-emergent. Associations were explored at the encounter- and patient-level. Partial proportional logistic models generated odds of preventable (i.e., intermediate or nonemergent) ED utilization among encounters, and Poisson models determined incidence of preventable ED use at the patient level. Findings suggested that when a patient with history in foster care used the ED, the odds that it was preventable were lower than if the child did not have such experience. Further, patients with foster care history were less likely to use the ED for concerns that did not need immediate attention but were more likely to use the ED for intermediate reasons.

Childhood adversity (CA) is associated with increased risk of negative health outcomes. Research implicates brain structure following CA as a key mechanism of this risk, and recent models suggest different forms of adversity differentially impact neural structure as a function of development (accelerated or attenuated development). Employing the Dimensional Model of Adversity and Psychopathology, we examined whether deprivation and threat differentially impact age-related change in cortical thickness, cortical surface area, and subcortical structure volume, using whole-brain and region of interest analyses (N = 135). In youth without CA, age predicted less surface area across adolescence, consistent with normative data. However, for adolescents with more deprivation exposure, as age increased there was attenuated surface area decreases in the orbitofrontal and superior-parietal cortex, regions recruited for higher-order cognition. Further, for those with more threat exposure, as age increased surface area increased in the inferior-temporal and parietal cortex, regions recruited in socio-emotional tasks. These novel findings extend work examining the impact of dimensions of adversity at a single-age and broaden current conceptualizations of how adversity might impact developmental timing.

Conjunctivitis due to Neisseria gonorrhoeae is uncommon in prepubescent children. When identified in this age group, it is highly concerning for sexual contact and warrants further evaluation. This report examines 6 cases of gonococcal conjunctivitis in prepubertal children and provides updated guidance on extragenital testing for sexually transmitted infections in this population. We retrospectively reviewed cases of gonococcal conjunctivitis in prepubertal children at our institution from 2007-2022. Neonates and adolescents with this condition were excluded as were cases in which confirmatory testing was not completed. Six prepubertal children had confirmed gonococcal conjunctivitis due to N. gonorrhoeae from 2007-2022. Ages ranged from 8 months to 8 years. Fifty percent of cases had sexually transmitted infections at additional anatomical sites. Although rare, gonococcal conjunctivitis due to N. gonorrhoeae in prepubertal children should prompt further comprehensive sexually transmitted infection testing and medical evaluation. Protective agency reporting is also advised.

Limited research describes approaches for applying a public health lens to fatal child maltreatment classification. Specialized terminology and tools could help improve consistency in classifying deaths resulting from caregiver behavior. A six-criterion classification tool was developed via expert panel review of over 100 child deaths by the Alaska Division of Public Health's Child Death Review (CDR) program. Next, accuracy and acceptability were assessed by inviting staff from other CDRs using a national listserv to classify 21 brief case scenarios with the tool. Among the 47 respondents, sensitivity was 0.87, specificity 0.77, and accuracy 0.84. Variability by tool criterion ranged from 97% to 74% accurate. Most respondents (66%) reported the tool as being helpful for classifying deaths and moderate reliability was found. Study participants found it difficult to consistently apply specific criteria which resulted in a modification of the tool to improve the potential for universal adoption.

Forensic nurses (FNs) can work in various settings such as children's advocacy centers, hospitals, clinics, and emergency departments. Pediatric FNs focus on caring for vulnerable children in crisis and must respond empathetically to victims using trauma-informed care principles. They also support the families of child victims, who often experience shock and disbelief. Pediatric FNs and multidisciplinary teams (MDTs) handle complex family dynamics in child maltreatment cases, requiring robust skills to care for both patients and themselves to combat secondary trauma. Forensic professionals assess child abuse allegations, formulate safety plans, and make key recommendations. Understanding how they develop resilience is crucial, as better resilience is linked to retention in the field, which needs skilled professionals. In our qualitative study, we explored how FNs develop resilience during their careers. We interviewed a sample of eight experienced FNs from two different programs involved in the care of victims, including maltreated children and adolescents in the southeast United States to understand how they mitigate burnout, compassion fatigue, and secondary trauma. Our aim was to identify factors contributing to resilience in child abuse nursing, which can inform best practices to reduce these challenges among child abuse professionals.

Child maltreatment (CM) is associated with negative health outcomes in adulthood, including deliberate self-harm (DSH), suicidal behaviours, and victimisation. It is unknown if associations extend to emergency department (ED) presentations for non-DSH related injuries. Birth cohort study data was linked to administrative health data, including ED presentations for non DSH related injuries and agency-reported and substantiated notifications for CM. Adjusted analyses (n = 6087) showed that any type of agency-reported notification for CM was significantly associated with increased odds of ED presentation for injuries (aOR = 1.57; 95% CI 1.32-1.87). In moderation analyses, women yielded significantly higher odds of notified and substantiated physical abuse, substantiated emotional abuse, and being subject to more than one type of substantiated abuse than males. ED presentations for injuries could be a proxy for risky behaviours, disguised DSH/suicidal behaviours, or physical abuse. The consistent findings in women may point to victimisation via interpersonal violence.

The Multidisciplinary Pediatric Education and Evaluation Consortium (MPEEC) is a medically directed program that mandates real-time interagency collaboration among child abuse pediatricians (CAPs), child protective services (CPS) investigators, and law enforcement. MPEEC provides consultation resulting in a definitive medical opinion regarding manner of injury when allegations of serious harm involving children less than three years old living in Chicago are reported to Illinois Department of Children and Family Services (DCFS). This study is the first to link data from a medically directed, inter-agency program with CPS investigations data to specifically examine the duration of CPS investigations and the level of concordance between the manner of injury as determined by CAPs and the investigation's outcome when CPS investigators and medical professionals are required to formally collaborate. On average, MPEEC produced a written opinion 16 days from the time of referral and DCFS made a finding 45 days after receiving the MPEEC report for the 690 cases referred to MPEEC over a 3-year period. The concordance level ranged from 75-90%. Our results highlight the need for more analysis of linked data to promote efficiency and proficiency in CPS investigations.