Child abuse and neglect: Are future medical doctors prepared?

Child Sexual Abuse: Comparison of Male and Female Victims

ABSTRACT

In the scientific literature, few authors deal with child sexual abuse (CSA) in boys. In addition, these authors debate this phenomenon in most available articles without statistically evaluating the occurrence of different or similar distributions of variables under sex. In light of the above, the authors compared multiple variables between female and male samples. The aim was to explore the characteristics of boys' CSA, identifying the main differences existing compared with the same phenomenon occurring in girls. The authors selected 2 samples for sex: group A, females; group B, males. The authors statistically compared the main variables between the 2 groups. The study yielded the following main results: the population was characterized by 607 children (476 were females-group A; 131 were males-group B); the variables' source of the referral and the type of anogenital findings were statistically significant. These data gave new insights into the CSA phenomenon. Because this study pointed out that sexual abuse does not have the same characteristics in boys and girls, researchers and safeguarding agencies should consider the abovementioned differences when planning preventive strategies against CSA.

Impact of a Parent Education Program Delivered by Nurses and Health Care Providers in Reducing Infant Physical Abuse Hospitalization Rates in British Columbia, Canada

BACKGROUND

The Period of PURPLE Crying Program® (PURPLE) is a universal parent education program that is delivered by nurses and health care providers to all parents/caregivers of newborns in British Columbia (B.C.). The aim of the program is to reduce the incidence of Traumatic Head Injury -Child Maltreatment (THI-CM), a form of child physical abuse.

OBJECTIVE

To determine if the PURPLE program had an impact on the rate of physical abuse hospitalizations for children less than or equal to 24 months of age in B.C. since implementation in 2009.

METHODS

The analysis measured physical abuse hospitalization rates for the period January 1, 1999 to December 31, 2019 and excluded any cases of confirmed Traumatic Head Injury-Child Maltreatment. Data were divided into pre-implementation period January, 1999 to December, 2008, and post-implementation period January, 2009 to December, 2019. Data were obtained from the Discharge Abstract Database and B.C. THI-CM Surveillance System to capture information on infant child abuse. Poisson regression and ANCOVA was applied to model the change in rates pre and post program implementation.

RESULTS

Physical abuse hospitalization rates decreased by 30% post-implementation period (95% CI: -14%, 57%, p  =  0.1561). The decreasing linear trend in the post-implementation period was significantly different than the increasing linear trend in the pre-implementation period (F1,17  =  4.832, p  =  0.042).

CONCLUSIONS

Nurses' role in engaging parents in conversations about PURPLE messages over multiple timepoints within a structured universal program model resulted in a decrease in physical abuse hospitalization rates since the implementation of PURPLE.

Knowledge of child abuse and neglect in nursing students: Assessment and perspectives

Misdiagnosis of child abuse and neglect can delay early treatment. Some authors have pointed out that nurses can miss child abuse and neglect diagnoses due to a lack of knowledge. It is unclear whether the lack of knowledge is due to students' insufficient preparation in nursing school and/or a deficiency in continuing education. An 18-item questionnaire was administered to final-year nursing students to assess their degree of knowledge on child abuse and neglect and to evaluate if the lack of knowledge was due to insufficient teaching/training during nursing school. The students were also asked to evaluate themselves by assigning a score to their knowledge. A statistical comparison was performed to define whether sufficient/insufficient results were associated with the following variables: sex, pediatric or general nursing student, attending pediatric lectures, training in pediatric wards/ambulatories, and attending specific lectures on child abuse and neglect. The study population comprised 175 students (154 females, 20 males, 1 unknown). Exactly 66.3% of the participants had ≤9/18 correct answers. Of all students, 77.7% self-evaluated their level of knowledge as ≤5/10. The comparisons yielded statistically significant differences between the groups with sufficient objective knowledge and those unrelated to training in pediatric wards/ambulatories or pediatric nursing students. Overall, there was little objective knowledge on the subject, which may be related to insufficient teaching/training in nursing schools. Useful corrective strategies include further teaching on child abuse and neglect, preferably using a practical approach. Further, common teaching/training programs should be conducted by both pediatric and general nursing schools.

Artificial Intelligence and Child Abuse and Neglect: A Systematic Review

All societies should carefully address the child abuse and neglect phenomenon due to its acute and chronic sequelae. Even if artificial intelligence (AI) implementation in this field could be helpful, the state of the art of this implementation is not known. No studies have comprehensively reviewed the types of AI models that have been developed/validated. Furthermore, no indications about the risk of bias in these studies are available. For these reasons, the authors conducted a systematic review of the PubMed database to answer the following questions: "what is the state of the art about the development and/or validation of AI predictive models useful to contrast child abuse and neglect phenomenon?"; "which is the risk of bias of the included articles?". The inclusion criteria were: articles written in English and dated from January 1985 to 31 March 2023; publications that used a medical and/or protective service dataset to develop and/or validate AI prediction models. The reviewers screened 413 articles. Among them, seven papers were included. Their analysis showed that: the types of input data were heterogeneous; artificial neural networks, convolutional neural networks, and natural language processing were used; the datasets had a median size of 2600 cases; the risk of bias was high for all studies. The results of the review pointed out that the implementation of AI in the child abuse and neglect field lagged compared to other medical fields. Furthermore, the evaluation of the risk of bias suggested that future studies should provide an appropriate choice of sample size, validation, and management of overfitting, optimism, and missing data.

Child Abuse: Adherence of Clinical Management to Guidelines for Diagnosis of Physical Maltreatment and Neglect in Emergency Settings

Child maltreatment is a phenomenon of great importance due to the significant socio-health implications related to it. Purpose of the study is assessing compliance child abuse clinical management with guidelines and suggest corrective actions to avoid false negative or false positive judgments. The data come from 34 medical records of child victims of suspected abuse hospitalized in a pediatric clinic. We examined diagnostic and medico-legal management through the analysis of pediatric, dermatological, ophthalmological (including fundus examination), and gynecological (only in some cases) consultations, brain and skeletal imaging, laboratory tests (with reference to the study of hemostasis), and medico-legal advice. Of 34 patients, the average age was 23 months, ranging from 1 month to 8 years. The judgment was positive for abuse for 20 patients and negative for 12 patients; in two cases it was not possible to express a conclusive judgment. Two children died because of the injuries sustained. We underline the need of clinical-diagnostic standardized protocols, coroner in emergency settings, short-distance follow-up, social worker support. We also suggest objectifying in a descriptive way (using a common and repeatable language) and with photographic documentation the results of all the investigations carried out, to evaluate signs of physical maltreatment and neglect.

An evaluation of Italian medical students attitudes and knowledge regarding forensic medicine

INTRODUCTION

This study aims to assess students' knowledge of forensic medicine concepts and their opinions regarding the course taught during the degree course in Medicine and Surgery in an Italian university. Consequently, the study aims to assess the impact of the course on the students' knowledge and attitude in choosing a medical residency.

MATERIALS AND METHODS

A cross-sectional study was conducted through an anonymous web-based survey of medical students at the Università Cattolica del Sacro Cuore. Descriptive and univariate analysis were conducted.

RESULTS

1166 students completed the survey. The forensic medicine course appears to be extremely important in providing training in the fundamental concepts of forensic medicine, especially professional liability, defensive medicine, and forensic pathology. Attending autopsies is important during the course, and their number should be more than ten. Additionally, univariate analysis demonstrates that students' awareness of forensic medicine topics, such as the function of the forensic physicians, professional liability, and defensive medicine, improves in the fifth or sixth year of the course. After the course, more students would choose to pursue a nonclinical and nonsurgical specialty, and forensic medicine specifically, for their residency.

CONCLUSIONS

The forensic medicine course has the task of defining the duties and responsibilities of forensic physicians, providing indispensable tools for future medical practitioners, regardless of their future specialisation, and limiting the increasing use of defensive medicine. In conclusion, we recommend further multicenter studies to evaluate the role and direct effect of undergraduate forensic medicine courses on students and on the quality of practice.

Knowledge and Attitudes of Medical and Nursing Students in Greece Regarding Child Abuse and Neglect

Data on the knowledge and attitudes of healthcare practitioners in training regarding child abuse and neglect (CAN) are scarce. The aim of this study was to investigate the knowledge and attitudes regarding CAN of medical and nursing students in Greek universities. We performed a questionnaire-based e-survey on a convenience sample of students and recruited 609 students (366 medical and 243 nursing). An unsatisfactory level of knowledge in the field was reported overall. Most of the students (92.2%) were aware of their future responsibility to protect vulnerable children and report suspected cases of CAN; at the same time, they were willing to obtain further education. Based on the above, appropriate training in the undergraduate curriculum should be developed in order to strengthen future healthcare practitioners and boost their confidence in dealing with suspected cases of CAN and protect children's welfare.