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Kenny KS, Wall-Wieler E, Frank K, Courchene L, Burton M, Dreaver C, Champagne M, Bennett M, Rocke C, Brownell M, Anderson M, Urquia ML. Infant rates of child protective services contact and termination of parental rights by first nations status from 1998 to 2019: An example of intergenerational transmission of colonial harm. CHILD ABUSE & NEGLECT 2024:106760. [PMID: 38866661 DOI: 10.1016/j.chiabu.2024.106760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 02/25/2024] [Accepted: 03/18/2024] [Indexed: 06/14/2024]
Abstract
BACKGROUND Rates of child removal by child protective services (CPS) in Manitoba are the highest in Canada with a profoundly disproportionate impact on First Nations families. Despite infants constituting the highest proportion of children affected, no research has examined population-level rates of infant contact with CPS. OBJECTIVE We examined the incidence of infant contact with different levels of CPS, including termination of parental rights (TPR), according to First Nations status. PARTICIPANTS We identified 217,261 infants (47,416 First Nations; 169,845 non-First Nations) born between 1998 and 2014 in Manitoba, Canada and residing in the province until at least age 5. METHODS We used linked administrative data to calculate population-level rates of contact with different levels of CPS by First Nations status, including an open file before age 1, out-of-home placement before age 1, and TPR before age 5. RESULTS Overall 35.8 % of First Nations infants had an open file, 8.5 % experienced out-of-home placement, and 5.4 % experienced TPR. Among other infants, 8.5 % had an open file, 1.3 % experienced out-of-home placement and 0.7 % experienced TPR. The rate of early-stage contact increased the fastest among First Nations infants, with a rise of 22.4 % in our study period, compared to a rise of 1.7 % among all other infants. CONCLUSIONS CPS contact was exceptionally high among First Nations infants compared to other infants, with early-stage contact accelerating most dramatically over time. Findings support calls to greatly reduce the disruption of system contact in the lives of First Nations families.
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Affiliation(s)
- Kathleen S Kenny
- Manitoba Centre for Health Policy, University of Manitoba, Room 408-727 McDermot Avenue, Winnipeg R3E 3P5, Canada; Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Room S113 - 750 Bannatyne Avenue, Winnipeg R3E 0W3, Canada.
| | - Elizabeth Wall-Wieler
- Manitoba Centre for Health Policy, University of Manitoba, Room 408-727 McDermot Avenue, Winnipeg R3E 3P5, Canada; Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Room S113 - 750 Bannatyne Avenue, Winnipeg R3E 0W3, Canada
| | - Kayla Frank
- First Nations Family Advocate Office, 200-286 Smith Street, Winnipeg R3C 1K4, Canada
| | - Lindey Courchene
- First Nations Family Advocate Office, 200-286 Smith Street, Winnipeg R3C 1K4, Canada
| | - Mary Burton
- Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Room S113 - 750 Bannatyne Avenue, Winnipeg R3E 0W3, Canada; Fearless R2W, PO Box 44095 Redwood Postal Outlet, Winnipeg, Manitoba R2W 5M3, Canada
| | - Cheryle Dreaver
- Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Room S113 - 750 Bannatyne Avenue, Winnipeg R3E 0W3, Canada
| | - Michael Champagne
- Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Room S113 - 750 Bannatyne Avenue, Winnipeg R3E 0W3, Canada; Fearless R2W, PO Box 44095 Redwood Postal Outlet, Winnipeg, Manitoba R2W 5M3, Canada
| | - Marlyn Bennett
- Faculty of Social Work, University of Calgary, 2500 University Dr NW MacKimmie Tower 301, Calgary, Alberta T2N 1N4, Canada
| | - Cathy Rocke
- Faculty of Social Work, University of Regina, Education Building 456, Regina, Saskatchewan S4S 0A2, Canada
| | - Marni Brownell
- Manitoba Centre for Health Policy, University of Manitoba, Room 408-727 McDermot Avenue, Winnipeg R3E 3P5, Canada; Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Room S113 - 750 Bannatyne Avenue, Winnipeg R3E 0W3, Canada
| | - Marcia Anderson
- Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Room S113 - 750 Bannatyne Avenue, Winnipeg R3E 0W3, Canada; Ongomiizwin Indigenous Institute of Health and Healing, Rady Faculty of Health Sciences, University of Manitoba, P122 Pathology Building, 770 Bannatyne Ave, Winnipeg, Manitoba R3W 0W3, Canada
| | - Marcelo L Urquia
- Manitoba Centre for Health Policy, University of Manitoba, Room 408-727 McDermot Avenue, Winnipeg R3E 3P5, Canada; Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Room S113 - 750 Bannatyne Avenue, Winnipeg R3E 0W3, Canada
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Dougall N, Savinc J, Maxwell M, Karatzias T, O'Connor RC, Williams B, John A, Cheyne H, Fyvie C, Bisson JI, Hibberd C, Abbott-Smith S, Nolan L, Murray J. Childhood adversity and mental health admission patterns prior to young person suicide (CHASE): a case-control 36 year linked hospital data study, Scotland UK 1981-2017. BJPsych Open 2024; 10:e124. [PMID: 38826035 DOI: 10.1192/bjo.2024.69] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/04/2024] Open
Abstract
BACKGROUND Childhood adversity is associated with increased later mental health problems and suicidal behaviour. Opportunities for earlier healthcare identification and intervention are needed. AIM To determine associations between hospital admissions for childhood adversity and mental health in children who later die by suicide. METHOD Population-based longitudinal case-control study. Scottish in-patient general and psychiatric records were summarised for individuals born 1981 or later who died by suicide between 1991 and 2017 (cases), and matched controls (1:10), for childhood adversity and mental health (broadly defined as psychiatric diagnoses and general hospital admissions for self-harm and substance use). RESULTS Records were extracted for 2477 'cases' and 24 777 'controls'; 2106 cases (85%) and 13 589 controls (55%) had lifespan hospitalisations. Mean age at death was 23.7; 75.9% were male. Maltreatment or violence-related childhood adversity codes were recorded for 7.6% cases aged 10-17 (160/2106) versus 2.7% controls (371/13 589), odds ratio = 2.9 (95% CI, 2.4-3.6); mental health-related admissions were recorded for 21.7% cases (458/2106), versus 4.1% controls (560/13 589), odds ratio = 6.5 (95% CI, 5.7-7.4); 80% of mental health admissions were in general hospitals. Using conditional logistic models, we found a dose-response effect of mental health admissions <18y, with highest adjusted odds ratio (aOR) for three or more mental health admissions: aORmale = 8.17 (95% CI, 5.02-13.29), aORfemale = 15.08 (95% CI, 8.07-28.17). We estimated that each type of childhood adversity multiplied odds of suicide by aORmale = 1.90 (95% CI, 1.64-2.21), aORfemale = 2.65 (95% CI, 1.94-3.62), and each mental health admission by aORmale = 2.06 (95% CI, 1.81-2.34), aORfemale = 1.78 (95% CI, 1.50-2.10). CONCLUSIONS Our lifespan study found that experiencing childhood adversity (primarily maltreatment or violence-related admissions) or mental health admissions increased odds of young person suicide, with highest odds for those experiencing both. Healthcare practitioners should identify and flag potential 'at-risk' adolescents to prevent future suicidal acts, especially those in general hospitals.
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Affiliation(s)
- Nadine Dougall
- School of Health & Social Care, Edinburgh Napier University, UK
| | - Jan Savinc
- School of Health & Social Care, Edinburgh Napier University, UK
| | - Margaret Maxwell
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, UK
| | | | | | - Brian Williams
- School of Health, Social Care & Life Sciences, University of the Highlands & Islands, UK
| | - Ann John
- Department of Population Psychiatry, Suicide and Informatics, Swansea University Medical School, UK; and Public Health Wales, Cardiff, UK
| | - Helen Cheyne
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, UK
| | | | | | - Carina Hibberd
- Faculty of Health Sciences & Sport, University of Stirling, UK
| | - Susan Abbott-Smith
- Child and Adolescent Mental Health Service (CAMHS), NHS Lothian, Edinburgh, UK
| | - Liz Nolan
- Aberlour, Scotland's children's charity (SC007991), Stirling, UK
| | - Jennifer Murray
- School of Health & Social Care, Edinburgh Napier University, UK
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Han Q, Jocson R, Kunovski I, Raleva M, Juhari R, Okop K, Oppler A, Wilson K, Cirovic T, Sacolo Gwebu H, Alampay L, Eagling-Peche S, Calderon F, Vallance I, Muharam F, Chen Y, Lachman J. The bidirectional temporal relationship between parenting stress and child maltreatment: A cross-lagged study based on intervention and cohort data. J Affect Disord 2024; 354:302-308. [PMID: 38479502 DOI: 10.1016/j.jad.2024.03.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 02/27/2024] [Accepted: 03/09/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND Parenting stress has long been proposed as a major risk factor for child maltreatment. However, there is a lack of evidence from existing studies on the temporal sequence to establish a causal relationship. This study aims to examine bidirectional temporal relationships between parenting stress and child maltreatment. METHODS Longitudinal data from two different sources were analysed: a pre-post study of an online parenting programme conducted across six countries - the ePLH Evaluation Study, and a prospective cohort study in the United States - LONGSCAN. Cross-lagged panel model on parenting stress and child maltreatment was used in each dataset. RESULTS Based on repeatedly measured data of 484 caregivers in the ePLH study across five time points (every two weeks), we found that parenting stress at an earlier time point predicted later child maltreatment (IRR = 1.14, 95 % CI: 1.10,1.18). In addition, the occurrence of child maltreatment was associated with higher subsequent short-term parenting stress (IRR = 1.04, 95 % CI: 1.01,1.08) and thus could form a vicious circle. In the LONGSCAN analysis with 772 caregivers who were followed up from child age of 6 to child age of 16, we also found parenting stress at an earlier time point predicted later child maltreatment (β = 0.11, 95 % CI: 0.01,0.20), but did not observe an association between child maltreatment and subsequent long-term parenting stress. LIMITATIONS Potential information bias on the measurements. CONCLUSIONS This study provides evidence for a bidirectional temporal relationship between parenting stress and child maltreatment, which should be considered in parenting intervention programmes.
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Affiliation(s)
| | | | | | - Marija Raleva
- St. Cyril and Methodius University Skopje, North Macedonia
| | | | | | | | | | | | | | | | | | | | | | | | | | - Jamie Lachman
- University of Oxford, UK; University of Cape Town, South Africa.
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Cavallaro F, Clery A, Gilbert R, van der Meulen J, Kendall S, Kennedy E, Phillips C, Harron K. Evaluating the real-world implementation of the Family Nurse Partnership in England: a data linkage study. HEALTH AND SOCIAL CARE DELIVERY RESEARCH 2024; 12:1-223. [PMID: 38784984 DOI: 10.3310/bvdw6447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
Background/objectives The Family Nurse Partnership is an intensive home visiting programme for adolescent mothers. We aimed to evaluate the effectiveness of the Family Nurse Partnership on outcomes up to age 7 using national administrative data. Design We created a linked cohort of all mothers aged 13-19 using data from health, educational and children's social care and defined mothers enrolled in the Family Nurse Partnership or not using Family Nurse Partnership system data. Propensity scores were used to create matched groups for analysis. Setting One hundred and thirty-six local authorities in England with active Family Nurse Partnership sites between 2010 and 2017. Participants Mothers aged 13-19 at last menstrual period with live births between April 2010 and March 2019, living in a Family Nurse Partnership catchment area and their firstborn child(ren). Interventions The Family Nurse Partnership includes up to 64 home visits by a family nurse from early pregnancy until the child's second birthday and is combined with usual health and social care. Controls received usual health and social care. Main outcome measures Indicators of child maltreatment (hospital admissions for injury/maltreatment, referral to social care services); child health and development (hospital utilisation and education) outcomes and maternal hospital utilisation and educational outcomes up to 7 years following birth. Data sources Family Nurse Partnership Information System, Hospital Episode Statistics, National Pupil Database. Results Of 110,520 eligible mothers, 25,680 (23.2%) were enrolled in the Family Nurse Partnership. Enrolment rates varied across 122 sites (range: 11-68%). Areas with more eligible mothers had lower enrolment rates. Enrolment was higher among mothers aged 13-15 (52%), than 18-19 year-olds (21%). Indicators of child maltreatment: we found no evidence of an association between the Family Nurse Partnership and indicators of child maltreatment, except for an increased rate of unplanned admissions for maltreatment/injury-related diagnoses up to age 2 for children born to Family Nurse Partnership mothers (6.6% vs. 5.7%, relative risk 1.15; 95% confidence interval 1.07 to 1.24). Child health and developmental outcomes: there was weak evidence that children born to Family Nurse Partnership mothers were more likely to achieve a Good Level of Development at age 5 (57.5% vs. 55.4%, relative risk 1.05; 95% confidence interval 1.00 to 1.09). Maternal outcomes: There was some evidence that Family Nurse Partnership mothers were less likely to have a subsequent delivery within 18 months of the index birth (8.4% vs. 9.3%, relative risk 0.92; 95% confidence interval 0.88 to 0.97). Younger and more vulnerable mothers received higher numbers of visits and were more likely to achieve fidelity targets. Meeting the fidelity targets was associated with some outcomes. Limitations Bias by indication and variation in the intervention and usual care over time and between areas may have limited our ability to detect effects. Multiple testing may have led to spurious, significant results. Conclusions This study supports findings from evaluations of the Family Nurse Partnership showing no evidence of benefit for maltreatment outcomes measured in administrative data. Amongst all the outcomes measured, we found weak evidence that the Family Nurse Partnership was associated with improvements in child development at school entry, a reduction in rapid repeat pregnancies and evidence of increased healthcare-seeking in the mother and child. Future work Future evaluations should capture better measures of Family Nurse Partnership interventions and usual care, more information on maternal risk factors and additional outcomes relating to maternal well-being. Study registration The study is registered as NIHR CRN Portfolio (42900). Funding This award was funded by the National Institute of Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: 17/99/19) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 11. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
| | - Amanda Clery
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - Ruth Gilbert
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - Jan van der Meulen
- UCL Great Ormond Street Institute of Child Health, London, UK
- London School of Hygiene and Tropical Medicine, London, UK
| | - Sally Kendall
- UCL Great Ormond Street Institute of Child Health, London, UK
- Centre for Health Services Studies, University of Kent, Canterbury, UK
| | - Eilis Kennedy
- UCL Great Ormond Street Institute of Child Health, London, UK
- Eilis Kennedy, Tavistock and Portman NHS Foundation Trust, London, UK
| | - Catherine Phillips
- UCL Great Ormond Street Institute of Child Health, London, UK
- Centre for Health Services Studies, University of Kent, Canterbury, UK
| | - Katie Harron
- UCL Great Ormond Street Institute of Child Health, London, UK
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Otterman G, Haney S. How Is Parental Mental Health a Risk for Child Maltreatment? Pediatrics 2024; 153:e2023063611. [PMID: 38311983 DOI: 10.1542/peds.2023-063611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/16/2023] [Indexed: 02/06/2024] Open
Affiliation(s)
| | - Suzanne Haney
- University of Nebraska Medical Center, Omaha, Nebraska
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Kenny KS, Wall-Wieler E, Frank K, Courchene L, Burton M, Dreaver C, Champagne M, Nickel NC, Brownell M, Rocke C, Bennett M, Urquia ML, Anderson M. Identifying newborn discharge to child protective services: Comparing discharge codes from birth hospitalization records and child protection case files. Ann Epidemiol 2024; 91:44-50. [PMID: 38184029 DOI: 10.1016/j.annepidem.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 12/11/2023] [Accepted: 01/03/2024] [Indexed: 01/08/2024]
Abstract
PURPOSE Newborn removal by North America's child protective services (CPS) disproportionately impacts Indigenous and Black families, yet its implications for population health inequities are not well understood. To guide this as a domain for future research, we measured validity of birth hospitalization discharge codes categorizing newborns discharged to CPS. METHODS Using data from 309,260 births in Manitoba, Canada, we compared data on newborns discharged to CPS from hospital discharge codes with the presumed gold standard of custody status from CPS case reports in overall population and separately by First Nations status (categorization used in Canada for Indigenous peoples who are members of a First Nation). RESULTS Of 309,260 newborns, 4562 (1.48%) were in CPS custody at hospital discharge according to CPS case reports and 2678 (0.87%) were coded by hospitals as discharged to CPS. Sensitivity of discharge codes was low (47.8%), however codes were highly specific (99.8%) with a positive predictive value (PPV) of 81.4%, and a negative predictive value (NPV) of 99.2%. Sensitivity, PPV and specificity were equal for all newborns but NPV was lower for First Nations newborns. CONCLUSIONS Canadian hospital discharge records underestimate newborn discharge to CPS, with no difference in misclassication based on First Nations status.
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Affiliation(s)
- Kathleen S Kenny
- Manitoba Centre for Health Policy, University of Manitoba, Room 408-727 McDermot Avenue, Winnipeg R3E 3P5, Manitoba, Canada; Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Room S113 - 750 Bannatyne Avenue, Winnipeg R3E 0W3, Manitoba, Canada.
| | - Elizabeth Wall-Wieler
- Manitoba Centre for Health Policy, University of Manitoba, Room 408-727 McDermot Avenue, Winnipeg R3E 3P5, Manitoba, Canada; Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Room S113 - 750 Bannatyne Avenue, Winnipeg R3E 0W3, Manitoba, Canada
| | - Kayla Frank
- First Nations Family Advocate Office, 200-286 Smith Street, Winnipeg, R3C 1K4, Manitoba, Canada
| | - Lindey Courchene
- First Nations Family Advocate Office, 200-286 Smith Street, Winnipeg, R3C 1K4, Manitoba, Canada
| | - Mary Burton
- Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Room S113 - 750 Bannatyne Avenue, Winnipeg R3E 0W3, Manitoba, Canada; Fearless R2W, PO Box 44095 Redwood Postal Outlet, Winnipeg, R2W 5M3, Manitoba, Canada
| | - Cheryle Dreaver
- Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Room S113 - 750 Bannatyne Avenue, Winnipeg R3E 0W3, Manitoba, Canada
| | - Micheal Champagne
- Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Room S113 - 750 Bannatyne Avenue, Winnipeg R3E 0W3, Manitoba, Canada; Fearless R2W, PO Box 44095 Redwood Postal Outlet, Winnipeg, R2W 5M3, Manitoba, Canada
| | - Nathan C Nickel
- Manitoba Centre for Health Policy, University of Manitoba, Room 408-727 McDermot Avenue, Winnipeg R3E 3P5, Manitoba, Canada; Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Room S113 - 750 Bannatyne Avenue, Winnipeg R3E 0W3, Manitoba, Canada
| | - Marni Brownell
- Manitoba Centre for Health Policy, University of Manitoba, Room 408-727 McDermot Avenue, Winnipeg R3E 3P5, Manitoba, Canada; Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Room S113 - 750 Bannatyne Avenue, Winnipeg R3E 0W3, Manitoba, Canada
| | - Cathy Rocke
- Faculty of Social Work, University of Regina, Education Building 456, Regina S4S 0A2, Saskatchewan, Canada
| | - Marlyn Bennett
- Faculty of Social Work, University of Calgary, 2500 University Dr NW MacKimmie Tower 301, Calgary T2N 1N4, Alberta, Canada
| | - Marcelo L Urquia
- Manitoba Centre for Health Policy, University of Manitoba, Room 408-727 McDermot Avenue, Winnipeg R3E 3P5, Manitoba, Canada; Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Room S113 - 750 Bannatyne Avenue, Winnipeg R3E 0W3, Manitoba, Canada; Dalla Lana School of Public Health, Faculty of Medicine, University of Toronto, 155 College Street, Room 500, Toronto M5T 3M7, Ontario, Canada
| | - Marcia Anderson
- Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Room S113 - 750 Bannatyne Avenue, Winnipeg R3E 0W3, Manitoba, Canada; Ongomiizwin Indigenous Institute of Health and Healing, Rady Faculty of Health Sciences, University of Manitoba, P122 Pathology Building, 770 Bannatyne Ave, Winnipeg R3W 0W3, Manitoba, Canada
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Baghdadi S, Momtaz D, Torres-Izquierdo B, Pereira DE, Gonuguntla R, Mittal M, Hosseinzadeh P. The shifting trends in the epidemiology and risk factors of non-accidental fractures in children. CHILD ABUSE & NEGLECT 2024; 149:106692. [PMID: 38395018 DOI: 10.1016/j.chiabu.2024.106692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 01/11/2024] [Accepted: 02/07/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND Fractures are a common presentation of non-accidental trauma (NAT) in the pediatric population. However, the presentation could be subtle, and a high degree of suspicion is needed not to miss NAT. OBJECTIVE To analyze a comprehensive database, providing insights into the epidemiology of fractures associated with NAT. PARTICIPANTS AND SETTING The TriNetX Research Network was utilized for this study, containing medical records from 55 healthcare organizations. TriNetX was queried for all visits in children under the age of 6 years from 2015 to 2022, resulting in a cohort of over 32 million. METHODS All accidental and non-accidental fractures were extracted and analyzed to determine the incidence, fracture location, and demographics of NAT. Statistical analysis was done on a combination of Python and Epipy. RESULTS Overall, 0.36 % of all pediatric patients had a diagnosis of NAT, and 4.93 % of fractures (34,038 out of 689,740 total fractures) were determined to be non-accidental. Skull and face fractures constituted 17.9 % of all NAT fractures, but rib/sternum fractures had an RR = 6.7 for NAT. Children with intellectual and developmental disability (IDD) or autism spectrum disorder (ASD) had a 9 times higher risk for non-accidental fractures. The number of non-accidental fractures significantly increased after 2019. CONCLUSIONS The study findings suggest that nearly 1 out of all 20 fractures in children under age 6 are caused by NAT, and that rib/sternum fractures are most predictive of an inflicted nature. The study also showed a significant increase in the incidence of NAT, during and after the pandemic.
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Affiliation(s)
- Soroush Baghdadi
- Division of Orthopaedic Surgery and Sports Medicine, Ann & Robert H. Lurie Children's Hospital, Chicago, IL, USA
| | - David Momtaz
- UT Health San Antonio, Department of Orthopaedics, San Antonio, TX, USA
| | | | - Daniel E Pereira
- Washington University School of Medicine, Department of Orthopaedics, St. Louis, MO, USA
| | - Rishi Gonuguntla
- UT Health San Antonio, Department of Orthopaedics, San Antonio, TX, USA
| | | | - Pooya Hosseinzadeh
- Washington University School of Medicine, Department of Orthopaedics, St. Louis, MO, USA.
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Smith JN, Guttmann A, Kopp A, Vandermorris A, Shouldice M, Harron KL. Association of maternal risk factors with infant maltreatment: an administrative data cohort study. Arch Dis Child 2023; 109:23-29. [PMID: 37758290 DOI: 10.1136/archdischild-2022-325239] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 09/06/2023] [Indexed: 10/03/2023]
Abstract
OBJECTIVE We aimed to evaluate the risk of infant maltreatment associated with commonly used criteria for home visiting programmes: young maternal age, maternal adversity (homelessness, substance abuse, intimate partner violence), newcomer status and mental health concerns in Ontario, Canada. DESIGN This retrospective cohort study included infants born in hospital in Ontario from 1 April 2005 to 31 March 2017 captured in linked health administrative and demographic databases. Infants were followed from newborn hospitalisation until 1 year of age for child maltreatment captured in healthcare or death records. The association between type and number of maternal risk factors, and maltreatment, was analysed using multivariable logistic regression modelling, controlling for infant characteristics and material deprivation. Further modelling explored the association of each year of maternal age with maltreatment. RESULTS Of 989 586 infants, 434 (0.04%) had recorded maltreatment. Maternal age <22 years conferred higher risk of infant maltreatment (adjusted OR (aOR) 5.5, 95% CI 4.5 to 6.8) compared with age ≥22 years. Maternal mental health diagnoses (aOR 2.0, 95% CI 1.6 to 2.5) were also associated with maltreatment, while refugee status appeared protective (aOR 0.6, 95% CI 0.4 to 1.0). The odds of maltreatment increased with higher numbers of maternal risk factors. Maternal age was associated with maltreatment until age 28 years. CONCLUSION Infants born to young mothers are at greater risk of infant maltreatment, and this association remained until age 28 years. These findings are important for ensuring public health interventions are supporting populations experiencing structural vulnerabilities with the aim of preventing maltreatment.
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Affiliation(s)
- Jennifer N Smith
- Division of Pediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
- The London School of Hygiene and Tropical Medicine (affiliated at the time of acquiring REB approval), London, UK
| | - Astrid Guttmann
- Division of Pediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Edwin S. H. Leong Centre for Healthy Children, University of Toronto, Toronto, Ontario, Canada
| | | | - Ashley Vandermorris
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
- Division of Adolescent Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Michelle Shouldice
- Division of Pediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Katie L Harron
- The London School of Hygiene and Tropical Medicine (affiliated at the time of acquiring REB approval), London, UK
- ICES, Toronto, Ontario, Canada
- UCL Great Ormond Street Institute of Child Health, London, UK
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Nation A, Pacella R, Monks C, Mathews B, Meinck F. Prevalence of violence against children in the United Kingdom: A systematic review and meta-analysis. CHILD ABUSE & NEGLECT 2023; 146:106518. [PMID: 37944361 DOI: 10.1016/j.chiabu.2023.106518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 10/10/2023] [Accepted: 10/16/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Violence against children can have extensive, long-term, and far-reaching adverse impacts on survivors and society. There is currently little consensus in the United Kingdom around the prevalence of violence against children: maltreatment, intimate partner violence, sexual violence, bullying, and community violence, and most existing studies focus on only a single or a few forms of violence. This study aims to produce data to highlight the current magnitude of the problem in the UK, to inform policy, drive action and allow for monitoring of progress over time. OBJECTIVE To produce weighted prevalence estimates by violence type, as well as gender and age sub-categories, to give as full a picture as possible of the current prevalence of violence against children in the UK. PARTICIPANTS AND SETTING The prevalence of violence against children from 23 self-report studies conducted in the United Kingdom was gathered through a systematic review. METHODS Databases were searched from inception to 24th June 2022. Studies were reviewed systematically for appropriate data and meta-analyses were conducted to give pooled prevalence data based on a quality effects model. RESULTS The most prevalent self-reported experience of childhood violence was community violence at 27.33 % (95 % CI [9.84, 48.97]). Prevalence of bullying was also high at 22.75 % (95 % CI [13.25, 33.86]). The most prevalent forms of child maltreatment were domestic violence exposure at 11.9 % (95 % CI [6.34, 18.84]) and emotional maltreatment at 11.84 % (95 % CI [5.58, 19.89]). CONCLUSION National child maltreatment surveys are needed in the UK, using a comprehensive and conceptually robust approach, and valid and reliable instruments, to provide data for researchers and policymakers on the prevalence of all types of violence against children including exposure to multiple types. This allows monitoring of trends over time, can inform strategies for prevention, and can enable monitoring of future progress in reducing violence against children and its associated health and economic burden.
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Affiliation(s)
- Alexandra Nation
- Institute for Lifecourse Development, University of Greenwich, Park Row, Greenwich, London SE10 9LS, United Kingdom.
| | - Rosana Pacella
- Institute for Lifecourse Development, University of Greenwich, Park Row, Greenwich, London SE10 9LS, United Kingdom
| | - Claire Monks
- Institute for Lifecourse Development, University of Greenwich, Park Row, Greenwich, London SE10 9LS, United Kingdom
| | - Ben Mathews
- Australian Centre for Health Law Research, Queensland University of Technology, 130 Victoria Park Road, Brisbane, Queensland 4059, Australia; Johns Hopkins University, Bloomberg School of Public Health, 3400 N Charles Street, Baltimore, MD 21218, United States of America
| | - Franziska Meinck
- School of Social and Political Science, University of Edinburgh, EH8 9LD, United Kingdom; School of Public Health, University of the Witwatersrand, Johannesburg, South Africa; Optentia, North-West University, Vanderbijlpark, South Africa
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10
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Zhang H, Wang W, Liu S, Feng Y, Wei Q. A Meta-Analytic Review of the Impact of Child Maltreatment on Self-Esteem: 1981 to 2021. TRAUMA, VIOLENCE & ABUSE 2023; 24:3398-3411. [PMID: 36341581 DOI: 10.1177/15248380221129587] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
An increasing number of studies have examined the relationship between child maltreatment and self-esteem. In this study, we assess the magnitude of this association through a meta-analytic approach. Four English databases (PubMed, PsycINFO, PsycARTICLES, and Web of Science), three Chinese databases (China National Knowledge Infrastructure, Wanfang, and Weipu), and grey literature were systematically searched. A total of 254 independent studies, including 550 effect sizes, met the inclusion criteria for this meta-analysis. Child maltreatment was significantly and negatively associated with self-esteem (P C C ¯ = -0.24, p < .001); emotional abuse and neglect were associated with decreased self-esteem (P C C ¯ = -0.23, p < .01; P C C ¯ = -0.22, p < .01, respectively) at a moderate level; and physical abuse, sexual abuse, and physical neglect were negatively associated with self-esteem (P C C ¯ = -0.14, p < .01; P C C ¯ = -0.14, p < .01; P C C ¯ = -0.17, p < .001, respectively) at a small level. Furthermore, the meta-regression results suggested that the aggregated associations between child maltreatment and self-esteem were not inflated by publication bias, but they were moderated by age and culture. General and subtypes of child maltreatment are associated with decreased self-esteem. Evidence-based and culturally sensitive child maltreatment prevention and intervention programs should be developed and implemented as early as possible.
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Affiliation(s)
| | | | - Shiqin Liu
- Renmin University of China, Beijing, China
| | - Yali Feng
- University Library, University of Illinois at Urbana-Champaign, Urbana-Champaign, USA
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11
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van Gemert MJC, Vlaming M, Gabaeff SC, Nikkels PGJ, Neumann HAM. Asymptomatic Infant Rib Fractures Are Primarily Non-abuse-Related and Should Not Be Used to Assess Physical Child Abuse. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1827. [PMID: 38002918 PMCID: PMC10670409 DOI: 10.3390/children10111827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 10/27/2023] [Accepted: 11/17/2023] [Indexed: 11/26/2023]
Abstract
Finding infant rib fractures was for many years an almost undisputed proof that physical child abuse took place. Yet, these rib fractures are virtually always occult and asymptomatic and are only identified when looked for, usually with X-rays, from physical child abuse accusations related to, e.g., suspicion of the shaken baby syndrome. In a recent systematic literature review (searched in Cochran, Embase, PubMed and Sociological Abstracts), Güvensel questioned the diagnostic accuracy of rib fractures to be caused by abuse, due to lack of sufficient scientific evidence. Further, there is currently a world-wide disagreement between physicians considering themselves child abuse specialized, and physicians that explore non-abuse-related symptoms that may mimic physical abuse, which, it is hoped, will significantly reduce current unjustified child abuse diagnoses. In an attempt to help resolving this disagreement, we hypothesize that the probability of physical child abuse-related infant rib fractures is significantly lower than the probability of all other possible non-abuse-related causes of occult asymptomatic infant rib fractures, e.g., from birth trauma, prematurity, osteogenesis imperfecta, hypermobile Ehlers-Danlos Syndrome, severe chronic placental pathology (e.g., massive perivillous fibrin depositions and severe chronic histiocytic intervillositis), and vitamin-D deficiency. As method, we attempted to assess the incidence of these various causes of infant rib fractures, in the Netherlands and the USA. The results are that the estimated Dutch and USA physical abuse-related infant rib fracture incidences are at least about 250 and 45 times lower than the sum of all the non-abuse-related estimates. Because these latter rib fractures are occult and asymptomatic, it is likely that (many) more could be out there. In conclusion, occult asymptomatic rib fractures develop perinatally, virtually always as birth trauma, in infants with sufficiently weak bones due to vitamin D deficiency, transmitted by their vitamin D deficient pregnant mothers. This group also includes cortical rib cracks due to deformation forces, with an estimated 186/100,000 incidence. And, despite obvious uncertainties in all estimated incidences, we provided strong evidence that our hypothesis has relevance, implying that the abundant occult asymptomatic rib fractures, when found in infants, should not be used to assess potential physical child abuse.
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Affiliation(s)
- Martin J. C. van Gemert
- Department of Biomedical Engineering & Physics, Amsterdam University Medical Centers, Location AMC, 1105 AZ Amsterdam, The Netherlands
| | - Marianne Vlaming
- Private Practice, Criminal Psychology and Law, 6986 CL Angerlo, The Netherlands;
| | | | - Peter G. J. Nikkels
- Department of Pathology, Wilhelmina Children’s Hospital, University Medical Center, 3584 CX Utrecht, The Netherlands;
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12
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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] [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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13
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Backhaus S, Leijten P, Jochim J, Melendez-Torres G, Gardner F. Effects over time of parenting interventions to reduce physical and emotional violence against children: a systematic review and meta-analysis. EClinicalMedicine 2023; 60:102003. [PMID: 37251634 PMCID: PMC10209692 DOI: 10.1016/j.eclinm.2023.102003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 04/19/2023] [Accepted: 04/25/2023] [Indexed: 05/31/2023] Open
Abstract
Background Violence against children affects over one billion children globally. International organisations promote parenting interventions as a main strategy to reduce violence against children. Parenting interventions have therefore been implemented rapidly across the globe. Yet, evidence for their longer-term effects remains unclear. We integrated global evidence to estimate effects over time of parenting interventions to reduce physical and emotional violence against children. Methods In this systematic review and meta-analysis, we searched 26 databases and trial registries (14 non-English: Spanish, Chinese, Farsi, Russian, Thai) and conducted an extensive grey literature search up to August 01, 2022. We included randomised controlled trials (RCTs) of parenting interventions based on social learning theory for parents of children aged 2-10 years, without time or context restrictions. We critically appraised studies using Cochrane's Risk of Bias Tool. Data were synthesised using robust variance estimation meta-analyses. This study is registered with PROSPERO, CRD42019141844. Findings We screened 44,411 records and included 346 RCTs. Sixty RCTs reported outcomes on physical or emotional violence. Trials were distributed across 22 countries (22% LMICs). Risk of bias was high for various domains. Outcome data ranged from 0 weeks to 2 years after the intervention, and was largely based on parent self-report. Parenting interventions reduced physical and emotional violent parenting behaviours immediately after the intervention (n = 42, k = 59; d = -0.46; 95% CI: -0.59, -0.33), at 1-6 months follow-up (n = 18, k = 31; d = -0.24; 95% CI: -0.37, -0.11) and at 7-24 months follow-up (n = 12, k = 19; d = -0.18; 95% CI: -0.34, -0.02), but effects were smaller over time. Interpretation Our findings suggest that parenting interventions can reduce physical and emotional violence against children. Effects are maintained up to 24 months follow-up, but with diminished effect sizes. With global policy interest and imminent importance, research beyond 2 years and how effects can be better sustained over time is urgently needed. Funding Student scholarship from the Economic Social Research Council, Clarendon, and Wolfson Isaiah Berlin Fund.
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Affiliation(s)
- Sophia Backhaus
- Centre for Evidence-based Intervention, Department of Social Policy and Intervention, University of Oxford, 32 Wellington Square, OX1 2ER, Oxford, UK
| | - Patty Leijten
- Research Institute Child Development and Education, University of Amsterdam, Nieuwe Achtergracht 127, Postbus 15776, 1001 NG, Amsterdam, the Netherlands
| | - Janina Jochim
- Centre for Evidence-based Intervention, Department of Social Policy and Intervention, University of Oxford, 32 Wellington Square, OX1 2ER, Oxford, UK
| | | | - Frances Gardner
- Centre for Evidence-based Intervention, Department of Social Policy and Intervention, University of Oxford, 32 Wellington Square, OX1 2ER, Oxford, UK
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14
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van Gemert MJC, Zwinderman AH, Koppen PJV, Neumann HAM, Vlaming M. Child Abuse, Misdiagnosed by an Expertise Center-Part II-Misuse of Bayes' Theorem. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10050843. [PMID: 37238391 DOI: 10.3390/children10050843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 04/26/2023] [Accepted: 05/04/2023] [Indexed: 05/28/2023]
Abstract
A newborn girl had, from two weeks on, small bruises on varying body locations, but not on her chest. Her Armenian grandmother easily bruised, too. Her mother was diagnosed with hypermobility-type Ehlers-Danlos-Syndrome (hEDS), an autosomal dominant connective tissue disorder, with a 50% inheritance probability. Referral to a University Medical Center located "Dutch Expertise Center for Child Abuse" resulted (prior to consultation) in physical abuse suspicion. Protocol-based skeletal X-rays showed three healed, asymptomatic rib fractures. A protocol-based Bayesian likelihood ratio guesstimation gave 10-100, erroneously used to suggest a 10-100 times likelier non-accidental-than-accidental cause. Foster care placement followed, even in a secret home, where she also bruised, suggesting hEDS inheritance. Correct non-accidental/accidental Bayes' probability of symptoms is (likelihood ratio) × (physical abuse incidence). From the literature, we derived an infant abuse incidence between about ≈0.0009 and ≈0.0026 and a likelihood ratio of <5 for bruises. For rib fractures, we used a zero likelihood ratio, arguing their cause was birth trauma from the extra delivery pressure on the chest, combined with fragile bones as the daughter of an hEDS-mother. We thus derived a negligible abuse/accidental probability between <5 × 0.0009 <0.005 and <5 × 0.0026 <0.013. The small abuse incidence implies that correctly using Bayes' theorem will also miss true infant physical abuse cases. Curiously, because likelihood ratios assess how more often symptoms develop if abuse did occur versus non-abuse, Bayes' theorem then implies a 100% infant abuse incidence (unwittingly) used by LECK. In conclusion, probabilities should never replace differential diagnostic procedures, the accepted medical method of care. Well-known from literature, supported by the present case, is that (child abuse pediatrics) physicians, child protection workers, and judges were unlikely to understand Bayesian statistics. Its use without statistics consultation should therefore not have occurred. Thus, Bayesian statistics, and certainly (misused) likelihood ratios, should never be applied in cases of physical child abuse suspicion. Finally, parental innocence follows from clarifying what could have caused the girl's bruises (inherited hEDS), and rib fractures (birth trauma from fragile bones).
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Affiliation(s)
- Martin J C van Gemert
- Department of Biomedical Engineering & Physics, Amsterdam University Medical Centers, Location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Aeilko H Zwinderman
- Department of Clinical Epidemiology & Bio-Statistics, Amsterdam University Medical Centers, Location AMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Peter J van Koppen
- Department of Criminal Law and Criminology, Faculty of Law, VU University, 1081 HV Amsterdam, The Netherlands
| | | | - Marianne Vlaming
- Private Practice, Criminal Psychology and Law, 6986 CL Angerlo, The Netherlands
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15
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Abdul Rahim R, Pilkington R, Procter AM, Montgomerie A, Mittinty MN, D'Onise K, Lynch J. Child protection contact among children of culturally and linguistically diverse backgrounds: A South Australian linked data study. J Paediatr Child Health 2023; 59:644-652. [PMID: 36744551 PMCID: PMC10946611 DOI: 10.1111/jpc.16364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 01/10/2023] [Accepted: 01/23/2023] [Indexed: 02/07/2023]
Abstract
AIM To describe the cumulative incidence of child protection (CP) system contact, maltreatment type, source of reports to age 7 years, and socio-demographic characteristics for culturally and linguistically diverse (CALD) Australian children. METHODS We used CP, education, health, and birth registrations data for children followed from birth up to age 7 from the South Australian Better Evidence, Better Outcomes, Linked Data (SA BEBOLD) platform. PARTICIPANTS SA born children enrolled in their first year of school from 2009 to 2015 (n = 76 563). CALD defined as non-Aboriginal or Torres Strait Islander, spoken language other than English, Indigenous or Sign, or had at least one parent born in a non-English speaking country. OUTCOMES MEASURES For CALD and non-CALD children, we estimated the cumulative incidence (risk) of CP contacts up to age 7, relative risk and risk differences for all levels of CP contact from notification to out-of-home care (OOHC), primary maltreatment type, reporter type, and socio-economic characteristics. Sensitivity analyses explored different population selection criteria and CALD definitions. RESULTS By age 7, 11.2% of CALD children had 'screened-in' notifications compared to 18.8% of non-CALD (risk difference [RD] 7.6 percentage points (95% confidence interval: 6.9-8.3)), and 0.6% of CALD children experienced OOHC compared to 2.2% of non-CALD (RD 1.6 percentage points (95% confidence interval: 1.3-1.8)). Emotional abuse was the most common substantiated maltreatment type for CALD and neglect for non-CALD. Among both groups, the most common reporter sources were police and education sector. Socio-economic characteristics were broadly similar. Sensitivity analyses results were consistent with primary analyses. CONCLUSION By age 7, CALD children had lower risk of contact with all levels of CP. Estimates based on primary and sensitivity analyses suggested CALD children were 5-9 percentage points less likely to have a report screened-in, and from 1.0 to 1.7 percentage points less likely to have experienced OOHC.
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Affiliation(s)
- Razlyn Abdul Rahim
- School of Public HealthThe University of AdelaideAdelaideSouth AustraliaAustralia
| | - Rhiannon Pilkington
- School of Public HealthThe University of AdelaideAdelaideSouth AustraliaAustralia
- Robinson Research InstituteThe University of AdelaideAdelaideSouth AustraliaAustralia
| | - Alexandra M Procter
- School of Public HealthThe University of AdelaideAdelaideSouth AustraliaAustralia
- Robinson Research InstituteThe University of AdelaideAdelaideSouth AustraliaAustralia
| | - Alicia Montgomerie
- School of Public HealthThe University of AdelaideAdelaideSouth AustraliaAustralia
- Robinson Research InstituteThe University of AdelaideAdelaideSouth AustraliaAustralia
| | - Murthy N Mittinty
- School of Public HealthThe University of AdelaideAdelaideSouth AustraliaAustralia
| | - Katina D'Onise
- School of Public HealthThe University of AdelaideAdelaideSouth AustraliaAustralia
- Prevention and Population HealthWellbeing SAAdelaideSouth AustraliaAustralia
| | - John Lynch
- School of Public HealthThe University of AdelaideAdelaideSouth AustraliaAustralia
- Robinson Research InstituteThe University of AdelaideAdelaideSouth AustraliaAustralia
- Bristol Medical School, Population Health SciencesUniversity of BristolBristolUK
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Wells K. Commentary on Kempe, the Next 50 Years. INTERNATIONAL JOURNAL ON CHILD MALTREATMENT : RESEARCH, POLICY AND PRACTICE 2023; 6:1-5. [PMID: 37360286 PMCID: PMC10037355 DOI: 10.1007/s42448-023-00162-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/15/2023] [Indexed: 03/26/2023]
Abstract
This paper provides a reflection on the evolution of child maltreatment systems and research across the globe during the time since the establishment of the Kempe Center for the Prevention and Treatment of Child Abuse and Neglect (Kempe Center) over 50 years ago. While research has demonstrated that children who are victims of maltreatment have poorer outcomes than their peers, it is also clear that the child welfare workforce faces workforce challenges, and the system established 50 years ago is not the same as it is today. Efforts to move this field of study forward in a changing world rely upon the understanding of child abuse and neglect in the broader culture of our world, including disentangling poverty and social structures from neglect, supporting underrepresented people and communities, and identifying how best to balance the role of child welfare with community services. The Kempe Center's continued commitment to a multidisciplinary approach to understanding, preventing, and treating child maltreatment, while challenging professional and social reticence to address complex contributing issues and the impact of historical actions, is at the core of its work looking forward to the next 50 years. The continued focus of centering research as a critical component in moving the field forward in just and equitable ways is demonstrated in this sampling of current efforts to support better outcomes for children and families.
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Affiliation(s)
- Kathryn Wells
- University of Colorado School of Medicine, Aurora, USA
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17
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Soneson E, Das S, Burn AM, van Melle M, Anderson JK, Fazel M, Fonagy P, Ford T, Gilbert R, Harron K, Howarth E, Humphrey A, Jones PB, Moore A. Leveraging Administrative Data to Better Understand and Address Child Maltreatment: A Scoping Review of Data Linkage Studies. CHILD MALTREATMENT 2023; 28:176-195. [PMID: 35240863 PMCID: PMC9806482 DOI: 10.1177/10775595221079308] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
BACKGROUND This scoping review aimed to overview studies that used administrative data linkage in the context of child maltreatment to improve our understanding of the value that data linkage may confer for policy, practice, and research. METHODS We searched MEDLINE, Embase, PsycINFO, CINAHL, and ERIC electronic databases in June 2019 and May 2020 for studies that linked two or more datasets (at least one of which was administrative in nature) to study child maltreatment. We report findings with numerical and narrative summary. RESULTS We included 121 studies, mainly from the United States or Australia and published in the past decade. Data came primarily from social services and health sectors, and linkage processes and data quality were often not described in sufficient detail to align with current reporting guidelines. Most studies were descriptive in nature and research questions addressed fell under eight themes: descriptive epidemiology, risk factors, outcomes, intergenerational transmission, predictive modelling, intervention/service evaluation, multi-sector involvement, and methodological considerations/advancements. CONCLUSIONS Included studies demonstrated the wide variety of ways in which data linkage can contribute to the public health response to child maltreatment. However, how research using linked data can be translated into effective service development and monitoring, or targeting of interventions, is underexplored in terms of privacy protection, ethics and governance, data quality, and evidence of effectiveness.
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Affiliation(s)
- Emma Soneson
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Shruti Das
- University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Anne-Marie Burn
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Marije van Melle
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | | | - Mina Fazel
- Department of Psychiatry, Warneford Hospital, University of Oxford, Headington, Oxford, UK
| | - Peter Fonagy
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Tamsin Ford
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Ruth Gilbert
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Katie Harron
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Emma Howarth
- School of Psychology, University of East London, London, UK
| | - Ayla Humphrey
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Peter B. Jones
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Anna Moore
- Department of Psychiatry, University of Cambridge, Cambridge, UK
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Structural evaluation of child physical abuse in trauma: Social determinants of health at the population level. J Pediatr Surg 2023; 58:106-110. [PMID: 36335011 DOI: 10.1016/j.jpedsurg.2022.09.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 09/16/2022] [Indexed: 01/07/2023]
Abstract
PURPOSE Child physical abuse (CPA) is closely linked to social factors like insurance status with limited evaluation at a structural population-level. This study evaluates the role of social determinants of health within the built environment on CPA. METHODS A single-institution retrospective review of pediatric trauma patients was conducted between January 2016 and December 2020. Patient address was geocoded to the census-tract level. Socioeconomic metrics, including poverty rate, supermarket access and Social Vulnerability Index (SVI) were estimated from the Food Access Research Atlas. Univariate and multivariable regression analyses were conducted to compare demographics and outcomes. RESULTS Of 3,540 patients, 317 (9.0%) had concern for physical abuse reported in the registry. CPA patients were younger (7.5 vs 9.6 years, p<0.0001) and more often Black (37.0%, N = 117 vs 23.5%, N = 753; p<0.0001). CPA had higher injury severity scores (ISS) (7.9 vs 5.8, p<0.0001) and longer length of stay (5.3 vs 2.9 days, p<0.0001). CPA had higher Medicaid (73.0%, N = 232 vs 53.8%, N = 1748, p<0.0001) and SVI (0.65 vs 0.59, p<0.0001) with lower median income ($52,100 vs $56,100, p<0.0001) and more low-food access tracts (59.6% vs 53.6%, p = 0.06). Combined low-income and low-food access populations showed widened disparities (40.0% vs 28.9%, p = 0.0002). On multivariate analysis, CPA was associated with poverty (OR 2.3, 95% CI [0.979, 3.60], p = 0.0006), low-access Black share (OR 3.3, 95% CI [1.18, 5.47], p = 0.002) and urban designation (OR 1.5, 95% CI [1.13, 1.87], p = 0.004). CONCLUSION The built-environment and population-level social determinants of health are related to child physical abuse and should influence advocacy and prevention. LEVEL OF EVIDENCE Level III. TYPE OF STUDY Retrospective.
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Fleischer T, Ulke C, Ladwig KH, Linkohr B, Johar H, Atasoy S, Speerforck S, Kruse J, Zöller D, Binder H, Otten D, Brähler E, Beutel ME, Tibubos AN, Grabe HJ, Schomerus G. [Sex- and Regionalspecific Differences in Child Abuse and Violence Before the German Reunification. Results from GESA, a Multi-Cohort Study]. Psychother Psychosom Med Psychol 2022; 72:550-557. [PMID: 36195099 DOI: 10.1055/a-1926-7428] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Results from a population-based study suggest sex-specific patterns of self-reported child maltreatment, more frequently reported in former West than East Germany. Aim of the current study was to examine these patterns in two regional samples of the former East- (SHIP, 2008 - 2012) and West German (KORA, 2013 - 2014) population. Child maltreatment was assessed using the Childhood Trauma Screener (CTS). Overall, child maltreatment was less often reported in the East German sample, compared to the West German sample. The most prominent differences were identified in self-rated emotional violence (east 6.1%, west 8.7%), physical violence (east 5.7%, west 10.3%) and physical neglect (east 10.0%, west 19.2%). However, we could not find differences in sex-specific patterns between the East and West German samples. Results were discussed within a historical context, since the events took place before the German reunification in two oppose political systems.
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Affiliation(s)
- Toni Fleischer
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Christine Ulke
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Karl-Heinz Ladwig
- Institut für Epidemiologie, Helmholtz Zentrum München Deutsches Forschungszentrum für Gesundheit und Umwelt, Neuherberg, Germany.,Psychosomatische Medizin und Psychotherapie, Klinikum rechts der Isar der Technischen Universitat Munchen, Munchen, Germany
| | - Birgit Linkohr
- Institut für Epidemiologie, Helmholtz Zentrum München Deutsches Forschungszentrum für Gesundheit und Umwelt, Neuherberg, Germany
| | - Hamimatunnisa Johar
- Institut für Epidemiologie, Helmholtz Zentrum München Deutsches Forschungszentrum für Gesundheit und Umwelt, Neuherberg, Germany.,Psychosomatische Medizin und Psychotherapie, Klinikum rechts der Isar der Technischen Universitat Munchen, Munchen, Germany.,Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Malaysia
| | - Seryan Atasoy
- Institut für Epidemiologie, Helmholtz Zentrum München Deutsches Forschungszentrum für Gesundheit und Umwelt, Neuherberg, Germany.,Psychosomatische Medizin und Psychotherapie, Klinikum rechts der Isar der Technischen Universitat Munchen, Munchen, Germany.,Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Gießen Marburg, Gießen, Germany
| | - Sven Speerforck
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Johannes Kruse
- Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Gießen Marburg, Gießen, Germany
| | - Daniela Zöller
- Institut für Medizinische Biometrie und Statistik, Albert-Ludwigs-Universitat Freiburg Medizinische Fakultat, Freiburg, Germany.,Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz, Germany
| | - Harald Binder
- Institut für Medizinische Biometrie und Statistik, Albert-Ludwigs-Universitat Freiburg Medizinische Fakultat, Freiburg, Germany.,Freiburger Zentrum für Datenanalyse und Modellbildung, Albert-Ludwigs-Universitat Freiburg, Freiburg im Breisgau, Germany
| | - Danielle Otten
- Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz, Germany
| | - Elmar Brähler
- Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz, Germany
| | - Manfred E Beutel
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Ana N Tibubos
- Pflegewissenschaft, Diagnostik in der Gesundheitsversorgung und E-Health, Universität Trier, Trier, Germany.,Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz, Germany
| | - Hans Jörgen Grabe
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Georg Schomerus
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Leipzig, Leipzig, Germany
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20
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McCahill C, Laycock HC, Guris RJD, Chigaru L. State-of-the-art management of the acutely unwell child. Anaesthesia 2022; 77:1288-1298. [PMID: 36089884 PMCID: PMC9826095 DOI: 10.1111/anae.15816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2022] [Indexed: 01/11/2023]
Abstract
Children make up around one-fifth of all emergency department visits in the USA and UK, with an increasing trend of emergency admissions requiring intensive care. Anaesthetists play a vital role in the management of paediatric emergencies contributing to stabilisation, emergency anaesthesia, transfers and non-technical skills that optimise team performance. From neonates to adolescents, paediatric patients have diverse physiology and present with a range of congenital and acquired pathologies that often differ from the adult population. With increasing centralisation of paediatric services, staff outside these centres have less exposure to caring for children, yet are often the first responders in managing these high stakes situations. Staying abreast of the latest evidence for managing complex low frequency emergencies is a challenge. This review focuses on recent evidence and pertinent clinical updates within the field. The challenges of maintaining skills and training are explored as well as novel advancements in care.
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Affiliation(s)
- C. McCahill
- Department of AnaesthesiaGreat Ormond Street HospitalLondonUK
| | - H. C. Laycock
- Department of AnaesthesiaGreat Ormond Street HospitalLondonUK,Department of Surgery and CancerImperial CollegeLondonUK
| | - R. J. Daly Guris
- Department of Anesthesiology and Critical Care MedicineChildren's Hospital of PhiladelphiaPhiladelphiaPAUSA,Department of Anesthesiology and Critical CareUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPAUSA
| | - L. Chigaru
- Department of AnaesthesiaGreat Ormond Street HospitalLondonUK,Children's Acute Transport ServiceLondonUK
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21
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Shenk CE, O'Donnell KJ, Pokhvisneva I, Kobor MS, Meaney MJ, Bensman HE, Allen EK, Olson AE. Epigenetic Age Acceleration and Risk for Posttraumatic Stress Disorder following Exposure to Substantiated Child Maltreatment. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2022; 51:651-661. [PMID: 33471576 PMCID: PMC8289945 DOI: 10.1080/15374416.2020.1864738] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Child maltreatment is among the strongest predictors of posttraumatic stress disorder (PTSD). However, less than 40% of children who have been maltreated are ever diagnosed with PTSD, suggesting that exposure to child maltreatment alone is insufficient to explain this risk. This study examined whether epigenetic age acceleration, a stress-sensitive biomarker derived from DNA methylation, explains variation in PTSD diagnostic status subsequent to child maltreatment. METHOD Children and adolescents (N = 70; 65.7% female), 8-15 years of age (M = 12.00, SD = 2.37) and exposed to substantiated child maltreatment within the 12 months prior to study entry, were enrolled. Participants provided epithelial cheek cells via buccal swab for genotyping and quantification of epigenetic age acceleration within a case-control design. PTSD diagnostic status was determined using the Child PTSD Symptoms Scale according to the DSM-IV-TR algorithm. RESULTS Epigenetic age acceleration predicted current PTSD status, revealing an effect size magnitude in the moderate range, OR = 2.35, 95% CI: 1.22- 4.51, after adjusting for sample demographics, polygenic risk for PTSD, and lifetime exposure to other childhood adversities. Supplemental analyses demonstrated that epigenetic age acceleration was related to a greater severity of PTSD arousal symptoms (r =.29, p =.015). There were no differential effects for child maltreatment subtype on epigenetic age acceleration or PTSD status. CONCLUSIONS The biological embedding of child maltreatment may explain variation in PTSD diagnostic status and serve as a novel approach for informing selective prevention or precision-based therapeutics for those at risk for PTSD.
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Affiliation(s)
- Chad E Shenk
- Department of Human Development and Family Studies, The Pennsylvania State University
- Department of Pediatrics, The Pennsylvania State University College of Medicine
| | - Kieran J O'Donnell
- The Douglas Hospital Research Centre, Department of Psychiatry, McGill University
- Child and Brain Developmental Program, Canadian Institute for Advanced Research
| | - Irina Pokhvisneva
- The Douglas Hospital Research Centre, Department of Psychiatry, McGill University
| | - Michael S Kobor
- Child and Brain Developmental Program, Canadian Institute for Advanced Research
- Centre for Molecular Medicine and Therapeutics, Department of Medical Genetics, University of British Columbia
| | - Michael J Meaney
- The Douglas Hospital Research Centre, Department of Psychiatry, McGill University
- Child and Brain Developmental Program, Canadian Institute for Advanced Research
- Agency for Science, Technology and Research, Singapore Institute of Clinical Sciences
| | - Heather E Bensman
- Department of Pediatrics, The University of Cincinnati College of Medicine
| | - Elizabeth K Allen
- Department of Human Development and Family Studies, The Pennsylvania State University
| | - Anneke E Olson
- Department of Human Development and Family Studies, The Pennsylvania State University
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22
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Walsh K, Eggins E, Hine L, Mathews B, Kenny MC, Howard S, Ayling N, Dallaston E, Pink E, Vagenas D. Child protection training for professionals to improve reporting of child abuse and neglect. Cochrane Database Syst Rev 2022; 7:CD011775. [PMID: 35788913 PMCID: PMC9301923 DOI: 10.1002/14651858.cd011775.pub2] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Many nations require child-serving professionals to report known or suspected cases of significant child abuse and neglect to statutory child protection or safeguarding authorities. Considered globally, there are millions of professionals who fulfil these roles, and many more who will do so in future. Ensuring they are trained in reporting child abuse and neglect is a key priority for nations and organisations if efforts to address violence against children are to succeed. OBJECTIVES To assess the effectiveness of training aimed at improving reporting of child abuse and neglect by professionals and to investigate possible components of effective training interventions. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, 18 other databases, and one trials register up to 4 June 2021. We also handsearched reference lists, selected journals, and websites, and circulated a request for studies to researchers via an email discussion list. SELECTION CRITERIA All randomised controlled trials (RCTs), quasi-RCTs, and controlled before-and-after studies examining the effects of training interventions for qualified professionals (e.g. teachers, childcare professionals, doctors, nurses, and mental health professionals) to improve reporting of child abuse and neglect, compared with no training, waitlist control, or alternative training (not related to child abuse and neglect). DATA COLLECTION AND ANALYSIS We used methodological procedures described in the Cochrane Handbook for Systematic Reviews of Interventions. We synthesised training effects in meta-analysis where possible and summarised findings for primary outcomes (number of reported cases of child abuse and neglect, quality of reported cases, adverse events) and secondary outcomes (knowledge, skills, and attitudes towards the reporting duty). We used the GRADE approach to rate the certainty of the evidence. MAIN RESULTS We included 11 trials (1484 participants), using data from 9 of the 11 trials in quantitative synthesis. Trials took place in high-income countries, including the USA, Canada, and the Netherlands, with qualified professionals. In 8 of the 11 trials, interventions were delivered in face-to-face workshops or seminars, and in 3 trials interventions were delivered as self-paced e-learning modules. Interventions were developed by experts and delivered by specialist facilitators, content area experts, or interdisciplinary teams. Only 3 of the 11 included studies were conducted in the past 10 years. Primary outcomes Three studies measured the number of cases of child abuse and neglect via participants' self-report of actual cases reported, three months after training. The results of one study (42 participants) favoured the intervention over waitlist, but the evidence is very uncertain (standardised mean difference (SMD) 0.81, 95% confidence interval (CI) 0.18 to 1.43; very low-certainty evidence). Three studies measured the number of cases of child abuse and neglect via participants' responses to hypothetical case vignettes immediately after training. A meta-analysis of two studies (87 participants) favoured training over no training or waitlist for training, but the evidence is very uncertain (SMD 1.81, 95% CI 1.30 to 2.32; very low-certainty evidence). We identified no studies that measured the number of cases of child abuse and neglect via official records of reports made to child protection authorities, or adverse effects of training. Secondary outcomes Four studies measured professionals' knowledge of reporting duty, processes, and procedures postintervention. The results of one study (744 participants) may favour the intervention over waitlist for training (SMD 1.06, 95% CI 0.90 to 1.21; low-certainty evidence). Four studies measured professionals' knowledge of core concepts in all forms of child abuse and neglect postintervention. A meta-analysis of two studies (154 participants) favoured training over no training, but the evidence is very uncertain (SMD 0.68, 95% CI 0.35 to 1.01; very low-certainty evidence). Three studies measured professionals' knowledge of core concepts in child sexual abuse postintervention. A meta-analysis of these three studies (238 participants) favoured training over no training or waitlist for training, but the evidence is very uncertain (SMD 1.44, 95% CI 0.43 to 2.45; very low-certainty evidence). One study (25 participants) measured professionals' skill in distinguishing reportable and non-reportable cases postintervention. The results favoured the intervention over no training, but the evidence is very uncertain (SMD 0.94, 95% CI 0.11 to 1.77; very low-certainty evidence). Two studies measured professionals' attitudes towards the duty to report child abuse and neglect postintervention. The results of one study (741 participants) favoured the intervention over waitlist, but the evidence is very uncertain (SMD 0.61, 95% CI 0.47 to 0.76; very low-certainty evidence). AUTHORS' CONCLUSIONS The studies included in this review suggest there may be evidence of improvements in training outcomes for professionals exposed to training compared with those who are not exposed. However, the evidence is very uncertain. We rated the certainty of evidence as low to very low, downgrading due to study design and reporting limitations. Our findings rest on a small number of largely older studies, confined to single professional groups. Whether similar effects would be seen for a wider range of professionals remains unknown. Considering the many professional groups with reporting duties, we strongly recommend further research to assess the effectiveness of training interventions, with a wider range of child-serving professionals. There is a need for larger trials that use appropriate methods for group allocation, and statistical methods to account for the delivery of training to professionals in workplace groups.
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Affiliation(s)
- Kerryann Walsh
- School of Early Childhood and Inclusive Education, Queensland University of Technology, Brisbane, Australia
| | - Elizabeth Eggins
- School of Social Science, University of Queensland, Brisbane, Australia
- School of Applied Psychology, Griffith University, Brisbane, Australia
| | - Lorelei Hine
- School of Social Science, University of Queensland, Brisbane, Australia
| | - Ben Mathews
- School of Law, Queensland University of Technology, Brisbane, Australia
| | - Maureen C Kenny
- Department of Psychology, Florida International University, Miami, FL, USA
| | - Sarah Howard
- Library Services Directorate, Queensland University of Technology, Brisbane, Australia
| | - Natasha Ayling
- School of Early Childhood and Inclusive Education, Queensland University of Technology, Brisbane, Australia
| | | | - Elizabeth Pink
- School of Early Childhood and Inclusive Education, Queensland University of Technology, Brisbane, Australia
| | - Dimitrios Vagenas
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
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23
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Syed S, Gonzalez-Izquierdo A, Allister J, Feder G, Li L, Gilbert R. Identifying adverse childhood experiences with electronic health records of linked mothers and children in England: a multistage development and validation study. Lancet Digit Health 2022; 4:e482-e496. [PMID: 35595677 DOI: 10.1016/s2589-7500(22)00061-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 02/14/2022] [Accepted: 03/15/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND Electronic health records (EHRs) of mothers and children provide an opportunity to identify adverse childhood experiences (ACEs) during crucial periods of childhood development, yet well developed indicators of ACEs remain scarce. We aimed to develop clinically relevant indicators of ACEs for linked EHRs of mothers and children using a multistage prediction model of child maltreatment and maternal intimate partner violence (IPV). METHODS In this multistage development and validation study, we developed a representative population-based birth cohort of mothers and children in England, followed from up to 2 years before birth to up to 5 years after birth across the Clinical Practice Research Datalink (CPRD) GOLD (primary care), Hospital Episode Statistics (secondary care), and the Office for National Statistics mortality register. We included livebirths in England between July 1, 2004, and June 30, 2016, to mothers aged 16-55 years, who had registered with a general practitioner (GP) that met CPRD quality standards before 21 weeks of gestation. The primary outcome (reference standard) was any child maltreatment or maternal IPV in either the mother's or child's record from 2 years before birth (maternal IPV only) to 5 years after birth. We used seven prediction models, combined with expert ratings, to systematically develop indicators. We validated the final indicators by integrating results from machine learning models, survival analyses, and clustering analyses in the validation cohort. FINDINGS We included data collected between July 1, 2002, and June 27, 2018. Of 376 006 eligible births, we included 211 393 mother-child pairs (422 786 patients) from 400 practices, of whom 126 837 mother-child pairs (60·0%; 240 practices) were randomly assigned to a derivation cohort and 84 556 pairs (40·0%; 160 practices) to a validation cohort. We included 63 indicators in six ACE domains: maternal mental health problems, maternal substance misuse, adverse family environments, child maltreatment, maternal IPV, and high-risk presentations of child maltreatment. Excluding the seven indicators in the reference standard, 56 indicators showed high discriminative validity for the reference standard of any child maltreatment or maternal IPV between 2 years before and 5 years after birth (validation cohort, area under the receiver operating characteristic curve 0·85 [95% CI 0·84-0·86]). During the 2 years before birth and 5 years after birth, the overall period prevalence of maternal IPV and child maltreatment (reference standard) was 2·3% (2876 of 126 837 pairs) in the derivation cohort and 2·3% (1916 of 84 556 pairs) in the validation cohort. During the 2 years before and after birth, the period prevalence was 39·1% (95% CI 38·7-39·5; 34 773 pairs) for any of the 63 ACE indicators, 22·2% (21·8-22·5%; 20 122 pairs) for maternal mental health problems, 15·7% (15·4-16·0%; 14 549 pairs) for adverse family environments, 8·1% (7·8-8·3%; 6808 pairs) for high-risk presentations of child maltreatment, 6·9% (6·7-7·2%; 7856 pairs) for maternal substance misuse, and 3·0% (2·9-3·2%; 2540 pairs) for any child maltreatment (2·4% [2·3-5·6%; 2051 pairs]) and maternal IPV (1·0% [0·8-1·0%; 875 pairs]). 62·6% (21 785 of 34 773 pairs) of ACEs were recorded in primary care only, and 72·3% (25 140 cases) were recorded in the maternal record only. INTERPRETATION We developed clinically relevant indicators for identifying ACEs using the EHRs of mothers and children presenting to general practices and hospital admissions. Over 70% of ACEs were identified via maternal records and were recorded in primary care by GPs within 2 years of birth, reinforcing the importance of reviewing parental and carer records to inform clinical responses to children. ACE indicators can contribute to longitudinal surveillance informing public health policy and resource allocation. Further evaluation is required to determine how ACE indicators can be used in clinical practice. FUNDING None.
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Affiliation(s)
- Shabeer Syed
- Population, Policy and Practice Research and Teaching Department, University College London Great Ormond Street Institute of Child Health, London, UK; Oxford Institute of Clinical Psychology Training and Research, Medical Sciences Division, University of Oxford, Oxford, UK.
| | | | | | - Gene Feder
- Centre for Academic Primary, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Leah Li
- Population, Policy and Practice Research and Teaching Department, University College London Great Ormond Street Institute of Child Health, London, UK
| | - Ruth Gilbert
- Population, Policy and Practice Research and Teaching Department, University College London Great Ormond Street Institute of Child Health, London, UK
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24
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Wong RS, Tung KTS, Ho FKW, Lee TMC, Chan KL, Bacon-Shone J, Coghill D, Man KKC, Sham PC, Wong WHS, Tso WWY, Chua GT, Wong ICK, Ip P. Associations between childhood maltreatment and psychiatric disorders: analysis from electronic health records in Hong Kong. Transl Psychiatry 2022; 12:231. [PMID: 35668084 PMCID: PMC9170694 DOI: 10.1038/s41398-022-01986-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 05/20/2022] [Accepted: 05/25/2022] [Indexed: 11/09/2022] Open
Abstract
There has been a lack of high-quality evidence concerning the association between childhood maltreatment and psychiatric diagnoses particularly for Axis II disorders. This study aimed to examine the association between childhood maltreatment exposure and Axis I and Axis II psychiatry disorders using electronic health records. In this study, the exposed group (n = 7473) comprised patients aged 0 to 19 years with a first-time record of maltreatment episode between January 1, 2001 and December 31, 2010, whereas the unexposed group (n = 26,834) comprised individuals of the same gender and age who were admitted into the same hospital in the same calendar year and month but had no records of maltreatment in the Hong Kong Clinical Data Analysis and Reporting System (CDARS). Data on their psychiatric diagnoses recorded from the date of admission to January 31, 2019 were extracted. A Cox proportional hazard regression model was fitted to estimate the hazard ratio (HR, plus 95% CIs) between childhood maltreatment exposure and psychiatric diagnoses, adjusting for age at index visit, sex, and government welfare recipient status. Results showed that childhood maltreatment exposure was significantly associated with subsequent diagnosis of conduct disorder/ oppositional defiant disorder (adjusted HR, 10.99 [95% CI 6.36, 19.01]), attention deficit hyperactivity disorder (ADHD) (7.28 [5.49, 9.65]), and personality disorders (5.36 [3.78, 7.59]). The risk of psychiatric disorders following childhood maltreatment did not vary by history of childhood sexual abuse, age at maltreatment exposure, and gender. Individuals with a history of childhood maltreatment are vulnerable to psychiatric disorders. Findings support the provision of integrated care within the primary health care setting to address the long-term medical and psychosocial needs of individuals with a history of childhood maltreatment.
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Affiliation(s)
- Rosa S. Wong
- grid.194645.b0000000121742757Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong, China ,grid.194645.b0000000121742757Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong, China ,grid.194645.b0000000121742757Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China
| | - Keith T. S. Tung
- grid.194645.b0000000121742757Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong, China
| | - Frederick K. W. Ho
- grid.8756.c0000 0001 2193 314XInstitute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Tatia M. C. Lee
- grid.194645.b0000000121742757State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong, China ,grid.194645.b0000000121742757Laboratory of Neuropsychology, The University of Hong Kong, Hong Kong, China
| | - Ko Ling Chan
- grid.16890.360000 0004 1764 6123Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hong Kong, China
| | - John Bacon-Shone
- grid.194645.b0000000121742757Social Sciences Research Centre, The University of Hong Kong, Hong Kong, China
| | - David Coghill
- grid.1008.90000 0001 2179 088XDepartment of Paediatrics and Psychiatry, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC Australia ,grid.1058.c0000 0000 9442 535XMurdoch Children’s Research Institute, Melbourne, VIC Australia
| | - Kenneth K. C. Man
- grid.194645.b0000000121742757Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong, China ,grid.83440.3b0000000121901201Research Department of Practice and Policy, UCL School of Pharmacy, London, UK
| | - Pak C. Sham
- grid.194645.b0000000121742757Department of Psychiatry, The University of Hong Kong, Hong Kong, China ,grid.194645.b0000000121742757Centre for PanorOmic Sciences, The University of Hong Kong, Hong Kong, China
| | - Wilfred H. S. Wong
- grid.194645.b0000000121742757Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong, China
| | - Winnie W. Y. Tso
- grid.194645.b0000000121742757Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong, China ,grid.194645.b0000000121742757State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong, China
| | - Gilbert T. Chua
- grid.194645.b0000000121742757Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong, China
| | - Ian C. K. Wong
- grid.194645.b0000000121742757Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong, China ,grid.83440.3b0000000121901201Research Department of Practice and Policy, UCL School of Pharmacy, London, UK
| | - Patrick Ip
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong, China.
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25
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Eid K, Torkildsen Ø, Aarseth J, Aalstad M, Bhan A, Celius EG, Cortese M, Daltveit AK, Holmøy T, Myhr KM, Riise T, Schüler S, Torkildsen CF, Wergeland S, Gilhus NE, Bjørk MH. Association of adverse childhood experiences with the development of multiple sclerosis. J Neurol Neurosurg Psychiatry 2022; 93:645-650. [PMID: 35379699 PMCID: PMC9148981 DOI: 10.1136/jnnp-2021-328700] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 02/22/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To study whether exposure to childhood emotional, sexual or physical abuse is associated with subsequent multiple sclerosis (MS) development. METHODS A nationwide, prospective cohort study based on participants in the Norwegian Mother, Father and Child cohort study. Enrolment took place 1999-2008, with follow-up until 31 December 2018. Childhood abuse before age 18 years was obtained from self-completed questionnaires. We identified MS diagnoses through data-linkage with national health registries and hospital records. The Cox model was used to estimate HRs for MS with 95% CIs, adjusting for confounders and mediators. RESULTS In this prospective cohort study, 14 477 women were exposed to childhood abuse and 63 520 were unexposed. 300 women developed MS during the follow-up period. 71 of these (24%) reported a history of childhood abuse, compared with 14 406 of 77 697 (19%) women that did not develop MS. Sexual abuse (HR 1.65, 95% CI 1.13 to 2.39) and emotional abuse (HR 1.40, 95% CI 1.03 to 1.90) in childhood were both associated with an increased risk of developing MS. The HR of MS after exposure to physical abuse was 1.31 (95% CI 0.83 to 2.06). The risk of MS was further increased if exposed to two (HR 1.66, 95% CI 1.04 to 2.67) or all three abuse categories (HR 1.93, 95% CI 1.02 to 3.67). INTERPRETATION Childhood sexual and emotional abuse were associated with an increased risk of developing MS. The risk was higher when exposed to several abuse categories, indicating a dose-response relationship. Further studies are needed to identify underlying mechanisms.
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Affiliation(s)
- Karine Eid
- Department of Neurology, Haukeland University Hospital, Bergen, Norway
- Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Øivind Torkildsen
- Neuro-SysMed, Department of Neurology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Jan Aarseth
- Neuro-SysMed, Department of Neurology, Haukeland University Hospital, Bergen, Norway
- The Norwegian Multiple Sclerosis and Biobank, Haukeland University Hospital, Bergen, Norway
| | - Mari Aalstad
- Department of Neurology, Innlandet Hospital Trust, Lillehammer, Norway
| | - Alok Bhan
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Department of Neurology, Stavanger University Hospital, Stavanger, Norway
| | - Elisabeth G Celius
- Department of Neurology, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Marianna Cortese
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Anne Kjersti Daltveit
- Department of Health Registry Research and Development, Norwegian Institute of Public Health, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Trygve Holmøy
- Department of Neurology, Akershus University Hospital, Lorenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Kjell-Morten Myhr
- Neuro-SysMed, Department of Neurology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Trond Riise
- Neuro-SysMed, Department of Neurology, Haukeland University Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Stephan Schüler
- Department of Neurology, Nord-Trøndelag Hospital Trust, Namsos, Norway
| | - Cecilie F Torkildsen
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Department of Obstetrics and Gynecology, Stavanger University Hospital, Stavanger, Norway
| | - Stig Wergeland
- Neuro-SysMed, Department of Neurology, Haukeland University Hospital, Bergen, Norway
- The Norwegian Multiple Sclerosis and Biobank, Haukeland University Hospital, Bergen, Norway
| | - Nils Erik Gilhus
- Department of Neurology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Marte-Helene Bjørk
- Department of Neurology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
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Miller AL, Stein SF, Sokol R, Varisco R, Trout P, Julian MM, Ribaudo J, Kay J, Pilkauskas NV, Gardner-Neblett N, Herrenkohl TI, Zivin K, Muzik M, Rosenblum KL. From zero to thrive: A model of cross-system and cross-sector relational health to promote early childhood development across the child-serving ecosystem. Infant Ment Health J 2022; 43:624-637. [PMID: 35638583 DOI: 10.1002/imhj.21996] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 11/30/2021] [Indexed: 11/05/2022]
Abstract
Early relational health between caregivers and children is foundational for child health and well-being. Children and caregivers are also embedded within multiple systems and sectors, or a "child-serving ecosystem", that shapes child development. Although the COVID-19 pandemic has made this embeddedness abundantly clear, systems remain siloed and lack coordination. Fostering relational health amongst layers of this ecosystem may be a way to systematically support young children and families who are facing adversity. We integrate theory, examples, and empirical findings to develop a conceptual model informed by infant mental health and public health frameworks that illustrates how relational health across the child-serving ecosystem may promote child health and well-being at a population level. Our model articulates what relational health looks like across levels of this ecosystem from primary caregiver-child relationships, to secondary relationships between caregivers and child-serving systems, to tertiary relationships among systems that shape child outcomes directly and indirectly. We posit that positive relational health across levels is critical for promoting child health and well-being broadly. We provide examples of evidence-based approaches that address primary, secondary, and tertiary relational health, and suggest ways to promote relational health through cross-sector training and psychoeducation in the science of early development. This model conceptualizes relational health across the child-serving ecosystem and can serve as a template for promoting child health and well-being in the context of adversity.
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Affiliation(s)
- Alison L Miller
- School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Sara F Stein
- School of Public Health, University of Michigan, Ann Arbor, Michigan, USA.,School of Social Work, University of Michigan, Ann Arbor, Michigan, USA
| | - Rebeccah Sokol
- School of Social Work, Wayne State University, Detroit, Michigan, USA
| | - Rachel Varisco
- School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Phoebe Trout
- School of Public Health, University of Michigan, Ann Arbor, Michigan, USA.,Ford School of Public Policy, University of Michigan, Ann Arbor, Michigan, USA
| | - Megan M Julian
- Department of Psychiatry, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Julie Ribaudo
- School of Social Work, University of Michigan, Ann Arbor, Michigan, USA
| | - Joshua Kay
- University of Michigan Law School, Ann Arbor, Michigan, USA
| | | | | | - Todd I Herrenkohl
- School of Social Work, University of Michigan, Ann Arbor, Michigan, USA
| | - Kara Zivin
- School of Public Health, University of Michigan, Ann Arbor, Michigan, USA.,Department of Psychiatry, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA.,Department of Obstetrics and Gynecology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Maria Muzik
- Department of Psychiatry, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA.,Department of Obstetrics and Gynecology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Katherine L Rosenblum
- Department of Psychiatry, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA.,Department of Obstetrics and Gynecology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
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Charlton C, Mani RR, Chinnappan S, Balaraman AK, Muthusamy T, Paranjothy C, Suresh D, Krishnan S, Lokhotiya K, Kodiveri Muthukaliannan G, Baxi S, Jayaraj R. Bibliometric and Density Visualisation Mapping Analysis of Domestic Violence in Australia Research Output 1984-2019. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19084837. [PMID: 35457702 PMCID: PMC9029041 DOI: 10.3390/ijerph19084837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 03/25/2022] [Accepted: 04/09/2022] [Indexed: 02/06/2023]
Abstract
Domestic violence is highly prevalent in Australia and has serious and complex impacts. This study aimed to analyse research outputs on domestic violence in Australia from the period of 1984 to 2019. Articles relevant to domestic violence in Australia that met specified inclusion criteria were retrieved using the Scopus database. Bibliometric analysis of the output was conducted to examine trends in publications. A trend of an increase in publications relating to domestic violence in Australia over time was identified, with the majority published in institutions located in densely populated capital cities. Significant diversity was found in the subject matter of highly cited articles, reflecting the far-reaching impacts of domestic violence. The increase in social attention to domestic violence over time was reflected in an increase in publications. Future research would benefit from examining trends in the reporting of domestic violence, and analysing the effectiveness of interventions for perpetrators and victims.
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Affiliation(s)
- Chloe Charlton
- Department of Veterans Affairs, Charles Darwin University, Darwin, NT 0810, Australia;
| | - Ravishankar Ram Mani
- Department of Pharmaceutical Biology, Faculty of Pharmaceutical Sciences, UCSI University Kuala Lumpur (South Wing), Kuala Lumpur 56000, Malaysia; (R.R.M.); (S.C.); (A.K.B.)
| | - Sasikala Chinnappan
- Department of Pharmaceutical Biology, Faculty of Pharmaceutical Sciences, UCSI University Kuala Lumpur (South Wing), Kuala Lumpur 56000, Malaysia; (R.R.M.); (S.C.); (A.K.B.)
| | - Ashok Kumar Balaraman
- Department of Pharmaceutical Biology, Faculty of Pharmaceutical Sciences, UCSI University Kuala Lumpur (South Wing), Kuala Lumpur 56000, Malaysia; (R.R.M.); (S.C.); (A.K.B.)
| | - Thangavel Muthusamy
- Research and Development Wing, Sri Balaji Medical College and Hospital, Bharath Institute of Higher Education and Research, Chromepet, Chennai 600044, Tamil Nadu, India;
| | | | - Deepa Suresh
- Division of Endocrinology, Department of Internal Medicine, Mayo Clinic Florida, Jacksonville, FL 32224, USA;
| | - Sunil Krishnan
- Department of Radiation Oncology, Mayo Clinic Florida, 4500 San Pablo Road S, Jacksonville, FL 32224, USA;
| | - Kartik Lokhotiya
- Vellore Institute of Technology (VIT), School of Biosciences and Technology, Vellore 632014, Tamil Nadu, India; (K.L.); (G.K.M.)
| | | | - Siddhartha Baxi
- Genesis Care Gold Coast Radiation Oncologist, John Flynn Hospital, Tugun, QLD 4224, Australia;
| | - Rama Jayaraj
- Clinical Sciences, Northern Territory Institute of Research and Training, Darwin, NT 0909, Australia
- Correspondence:
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Högberg U. Transfer of knowledge to diagnose infant abuse and its incidence - a time-series analysis from Sweden. Implement Sci 2022; 17:15. [PMID: 35120543 PMCID: PMC8815122 DOI: 10.1186/s13012-022-01188-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 01/05/2022] [Indexed: 12/04/2022] Open
Abstract
Aim To analyse the transfer of knowledge on how to detect physical abuse, especially shaken baby syndrome/abusive head trauma (SBS/AHT), and its association to trends in infant abuse diagnoses (maltreatment and assault). Methods Design: retrospective population-based and quasi-experimental. Setting: Sweden 1987–2019. Patients: Children below age 1 year, selected from the National Patient Register (n = 1150). Exposures: Literature search for transfer of knowledge by diffusion, dissemination and implementation, and whether supportive or disruptive of the SBS/AHT paradigm. Main outcome measure: Abuse diagnoses (maltreatment or assault). Analyses: Incidence rate, incidence rate ratio (IRR). Results The overall incidence rate of abuse was 32.23 per 100,000 during the years 1987–2019. It was rather stable 1987–2000. The SBS diagnosis was introduced in the late 1990s. A comprehensive increase of transfer of knowledge on physical abuse, specifically on SBS/AHT and dangers of shaking, took place from 2002 and onward through diffusion, dissemination and implementation. Maltreatment diagnoses, but not assault diagnosis, increased steeply during 2002–2007, peaking in 2008–2013 [IRR 1.63 (95% confidence interval 1.34–1.98)]. Transfer of disruptive knowledge on SBS/AHT during the period 2014–2019 was associated with a decline in maltreatment diagnoses [IRR 0.84 (95% confidence interval 0.71–0.99)]. Conclusion An increase in maltreatment diagnoses was associated with transfer of supportive knowledge of the SBS/AHT paradigm, while a decline occurred toward the end of the study period, which might indicate a burgeoning de-implementation process. Supplementary Information The online version contains supplementary material available at 10.1186/s13012-022-01188-6.
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Affiliation(s)
- Ulf Högberg
- Department of Women's and Children's Health, Uppsala University, SE-751 85, Uppsala, Sweden. .,Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden.
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Kantor V, Verginer L, Glück TM, Knefel M, Lueger-Schuster B. Barriers and facilitators to accessing mental health services after child maltreatment in foster care: An Austrian survivors’ perspective. EUROPEAN JOURNAL OF TRAUMA & DISSOCIATION 2022. [DOI: 10.1016/j.ejtd.2021.100228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Yamaoka Y, Obikane E, Isumi A, Miyasaka M, Fujiwara T. Incidence of hospitalization for abusive head trauma in Chiba City, Japan. Pediatr Int 2022; 64:e14903. [PMID: 34191364 DOI: 10.1111/ped.14903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 05/16/2021] [Accepted: 06/08/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUNDS This study aimed to examine the incidence of abusive head trauma (AHT) admissions by calculating admission rates of AHT cases among infants <12 months old in a population-based sample in Chiba city, Chiba prefecture, Japan. METHODS We retrospectively examined medical records of infants admitted to all pediatric secondary and tertiary hospitals in Chiba city between 2011 and 2015. We collected 13 AHT cases, as assessed by hospital-based multidisciplinary child protection teams. One experienced pediatric radiologist and two pediatricians evaluated the case histories and computed tomography images of cases to evaluate them clinically as "strongly" or "moderately" suspected AHT. RESULTS The overall incidence per 100 000 person-years was 34.5 cases (95% confidence interval (CI): 18.4-59.1), of which 13.3 (95% CI: 4.3-31.0), were strongly suspected to be AHT and 21.3 (95% CI: 9.2-41.9) were moderately suspected. There were no statistical differences in computed tomography findings between severe and moderately suspected AHT. CONCLUSIONS The incidence of hospitalization of infants with AHT was similar to that reported in population-based studies in other countries.
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Affiliation(s)
- Yui Yamaoka
- Department of Global Health Promotion, Tokyo Medical and Dental University, Bunkyo-ku, Japan
| | - Erika Obikane
- Department of Mental Health, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Japan
| | - Aya Isumi
- Japan Society for the Promotion of Science, Tokyo, Japan
| | - Mikiko Miyasaka
- Radiology, National Center for Child Health and Development, Setagaya-ku, Japan
| | - Takeo Fujiwara
- Department of Global Health Promotion, Tokyo Medical and Dental University, Bunkyo-ku, Japan
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Conti G, Pizzo E, Morris S, Melnychuk M. The economic costs of child maltreatment in UK. HEALTH ECONOMICS 2021; 30:3087-3105. [PMID: 34523182 DOI: 10.1002/hec.4409] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 04/20/2021] [Accepted: 07/15/2021] [Indexed: 06/13/2023]
Abstract
Child maltreatment is a major public health problem with significant consequences for individual victims and for society. In this paper, we quantify for the first time the economic costs of fatal and nonfatal child maltreatment in the UK in relation to several short-, medium-, and long-term outcomes ranging from physical and mental health problems to labor market outcomes and welfare use. We combine novel regression analysis of rich data from the National Child Development Study and the English Longitudinal Study of Aging with secondary evidence to produce an incidence-based estimate of the lifetime costs of child maltreatment from a societal perspective. The discounted average lifetime incidence cost of nonfatal child maltreatment by a primary caregiver is estimated at £89,390 (95% uncertainty interval £44,896 to £145,508); the largest contributors to this are costs from social care, short-term health, and long-term labor market outcomes. The discounted lifetime cost per death from child maltreatment is estimated at £940,758, comprising health care and lost productivity costs. Our estimates provide the first comprehensive benchmark to quantify the costs of child maltreatment in the UK and the benefits of interventions aimed at reducing or preventing it.
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Affiliation(s)
- Gabriella Conti
- Department of Economics and Social Research Institute, University College London, London, UK
| | - Elena Pizzo
- Department of Applied Health Research, University College London, London, UK
| | - Stephen Morris
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Mariya Melnychuk
- Department of Applied Health Research, University College London, London, UK
- Faculty of Law and Social Sciences, Universidad Rey Juan Carlos, Madrid, Spain
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Socio-political context as determinant of childhood maltreatment: a population-based study among women and men in East and West Germany. Epidemiol Psychiatr Sci 2021. [PMCID: PMC8611929 DOI: 10.1017/s2045796021000585] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Aim Being subjected to childhood maltreatment has devastating long-term adverse effects and is a major risk factor for mental health problems in adult life. There is empirical support that socio-political factors can be risk factors for childhood maltreatment. Here we examine whether socio-political context predicts self-rated childhood maltreatment in a sample of the German population. Methods Data were drawn from surveys of representative samples of the East and West German population, including participants born 1980 or earlier (5836 participants; 3146 women). Childhood maltreatment was assessed using the Childhood Trauma Screener, the German short screening version of the childhood trauma questionnaire. To examine whether socio-political context is a predictor of childhood maltreatment in women and men, we conducted logistic regression analyses. Results We found that in women, socio-political context (West Germany) significantly predicted childhood maltreatment (odds ratio [95% confidence interval] 1.7 [1.2–2.5], 1.6 [1.1–2.3], 2.5 [1.6–4.1] and 1.8 [1.3–2.5] for emotional neglect, and emotional, physical and sexual violence, respectively). In men, the socio-political context (West Germany) was a predictor of physical and sexual violence (odds ratio [95% confidence interval] 1.8 [1.2–2.7] and 2.5 [1.4–4.5]), respectively. Concerning emotional neglect and violence, socio-political context was not a significant predictor in men. The examination of differential item functioning revealed that our results could not be attributed to differential response behaviour between East and West Germans caused by item bias. Conclusions The results suggest that socio-political context is an important determinant to consider when examining childhood maltreatment. Future research should continue to focus on risk and protective factors at the societal level, such as legal frameworks addressing gender equality and child protection laws, to create further evidence for population-wide prevention strategies ensuring safe, nurturing and thriving environments for children and families.
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Fluke JD, Tonmyr L, Gray J, Bettencourt Rodrigues L, Bolter F, Cash S, Jud A, Meinck F, Casas Muñoz A, O'Donnell M, Pilkington R, Weaver L. Child maltreatment data: A summary of progress, prospects and challenges. CHILD ABUSE & NEGLECT 2021; 119:104650. [PMID: 32861435 DOI: 10.1016/j.chiabu.2020.104650] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 06/19/2020] [Accepted: 07/25/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND In 1996, the ISPCAN Working Group on Child Maltreatment Data (ISPCAN-WGCMD) was established to provide an international forum in which individuals, who deal with child maltreatment data in their respective professional roles, can share concerns and solutions. OBJECTIVE This commentary describes some of the key features and the status of child maltreatment related data collection addressed by the ISPCAN-WGCMD. METHODS Different types of data collection methods including self-report, sentinel, and administrative data designs are described as well as how they address different needs for information to help understand child maltreatment and systems of prevention and intervention. RESULTS While still lacking in many parts of the world, access to child maltreatment data has become much more widespread, and in many places a very sophisticated undertaking. CONCLUSION The ISPCAN-WGCMD has been an important forum for supporting the continued development and improvement in the global effort to understand and combat child maltreatment thus contributing to the long term goals of the UN Convention on the Rights of the Child. Nevertheless, based on what has been learned, even greater efforts are required to improve data in order to effectively combat child maltreatment.
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Affiliation(s)
- John D Fluke
- Kempe Center, Department of Paediatrics, University of Colorado School of Medicine, USA.
| | - Lil Tonmyr
- Family Violence Surveillance, Public Health Agency of Canada, Ontario, Canada
| | | | | | - Flora Bolter
- Chargée d'études chez L'Observatoire national de la protection de l'enfance, France
| | - Scottye Cash
- School of Social Work, The Ohio State University, USA
| | - Andreas Jud
- Department of Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Germany; School of Social Work, Lucerne University of Applied Sciences and Arts, Lucerne, Switzerland
| | - Franziska Meinck
- School of Social and Political Sciences, University of Edinburgh, UK; Optentia, Faculty of Health Sciences, North-West University, Vanderbejlpark, South Africa
| | | | | | - Rhiannon Pilkington
- School of Public Health, The University of Adelaide, South Australia, Australia
| | - Leemoy Weaver
- The University of the West Indies, Mona Campus, Jamaica
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Apfeld JC, Crichton KG, Minneci PC, Puls HT, Cooper JN. Identification of physical abuse-related hospitalizations in young children: Impact of the transition to ICD-10-CM coding. CHILD ABUSE & NEGLECT 2021; 118:105159. [PMID: 34147940 PMCID: PMC8292224 DOI: 10.1016/j.chiabu.2021.105159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 05/28/2021] [Accepted: 06/03/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Administrative healthcare databases are frequently used for child physical abuse (CPA)-related research and surveillance. In October 2015, the United States transitioned to the International Classification of Diseases, Clinical Modification-10th Revision (ICD-10-CM) coding regimen. ICD-10-CM expands coding related to CPA, including codes to differentiate suspected from confirmed CPA. OBJECTIVE This study examined the impact of the transition to ICD-10-CM coding on population-level trends in rates of hospitalizations coded for CPA. PARTICIPANTS AND SETTINGS Hospitalizations coded as related to CPA in children <5 years-of-age from 2010 to 2017 were identified across 19 Statewide Inpatient Databases. METHODS Interrupted time series analyses were used to assess the impact of the coding transition on hospitalizations coded for CPA, overall and by child race/ethnicity. RESULTS Of 9715 hospitalizations coded for CPA, 2797 (29%) occurred after the coding transition, including 51% coded for suspected CPA and 49% coded for confirmed CPA. There was a marginally-significant increase in the trend in CPA-related hospitalization after the coding transition among all children (0.09 per 100,000 children-per-quarter, p = 0.06), a significant increase in the trend among white children (0.15 per 100,000 children-per-quarter, p = 0.01), and no change among Black or Hispanic children. After the coding transition, hospitalizations coded for suspected CPA increased significantly overall (0.10 per 100,000 children-per-quarter, p < 0.001), and in particular among white children (0.12 per 100,000 children-per-quarter, p = 0.01) but not among Black or Hispanic children. CONCLUSIONS The transition to ICD-10-CM differentially impacted trends in hospitalizations coded for CPA by child race/ethnicity. Further research is necessary to discern the reasons for these discrepancies.
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Affiliation(s)
- Jordan C Apfeld
- Center for Surgical Outcomes Research and Center for Innovation in Pediatric Practice, Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Dr., Columbus 43205, OH, USA.
| | - Kristin G Crichton
- Division of Child and Family Advocacy, Nationwide Children's Hospital, 655 E Livingston Ave, Columbus 43205, OH, USA.
| | - Peter C Minneci
- Center for Surgical Outcomes Research and Center for Innovation in Pediatric Practice, Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Dr., Columbus 43205, OH, USA; Department of Surgery, Nationwide Children's Hospital, 700 Children's Dr., Columbus 43205, OH, USA.
| | - Henry T Puls
- Division of Hospital Medicine, Department of Pediatrics, Children's Mercy Kansas City, University of Missouri-Kansas City School of Medicine, 2401 Gillham Road, Kansas City 64108, MO, USA.
| | - Jennifer N Cooper
- Center for Surgical Outcomes Research and Center for Innovation in Pediatric Practice, Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Dr., Columbus 43205, OH, USA.
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Lucas S, Janson S. Childhood exposure to physical and emotional violence over a 57-year period in Sweden. Scand J Public Health 2021; 50:1172-1178. [PMID: 34162281 DOI: 10.1177/14034948211023634] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIMS The aim of the present study was to examine the prevalence of childhood experiences of physical violence (CPV) and emotional violence (CEV) at the hands of parents over a 57-year period among adults born between 1937 and 1993. METHODS In 2012, a survey among women and men aged 18-74 years in Sweden was undertaken to examine the lifetime prevalence of physical, psychological and sexual violence and associations with current health in adulthood. Questionnaires were based on the Adverse Childhood Experiences study and a previous national survey of violence exposure. Descriptive statistics were used to analyse the frequency of exposure to CPV and CEV, and changes over time were analysed using analysis of variance and logistic regression. RESULTS A total of 10,337 individuals participated (response rates: 56% for women and 48% for men). CPV decreased significantly over the time period studied, particularly for those born after 1983. This decrease was more evident for male respondents. Throughout the time period studied, the proportion of women reporting CEV was higher than for men. Among both genders there was a steady rise in CEV rates from those born in the late 1930s to those born in the mid-1980s, after which there was a decline that was more marked for men. CONCLUSIONS A significant group of children in Sweden experience violence at the hands of parents. However, our data corroborate previous national studies that children's exposure to violence has decreased. Clear gender differences indicate that these changes have affected girls and boys differently.
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Affiliation(s)
- Steven Lucas
- Department of Women's and Children's Health, Uppsala University, Sweden
| | - Staffan Janson
- Department of Women's and Children's Health, Uppsala University, Sweden
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Chikwava F, Cordier R, Ferrante A, O’Donnell M, Speyer R, Parsons L. Research using population-based administration data integrated with longitudinal data in child protection settings: A systematic review. PLoS One 2021; 16:e0249088. [PMID: 33760881 PMCID: PMC7990188 DOI: 10.1371/journal.pone.0249088] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 03/11/2021] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION Over the past decade there has been a marked growth in the use of linked population administrative data for child protection research. This is the first systematic review of studies to report on research design and statistical methods used where population-based administrative data is integrated with longitudinal data in child protection settings. METHODS The systematic review was conducted according to Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) statement. The electronic databases Medline (Ovid), PsycINFO, Embase, ERIC, and CINAHL were systematically searched in November 2019 to identify all the relevant studies. The protocol for this review was registered and published with Open Science Framework (Registration DOI: 10.17605/OSF.IO/96PX8). RESULTS The review identified 30 studies reporting on child maltreatment, mental health, drug and alcohol abuse and education. The quality of almost all studies was strong, however the studies rated poorly on the reporting of data linkage methods. The statistical analysis methods described failed to take into account mediating factors which may have an indirect effect on the outcomes of interest and there was lack of utilisation of multi-level analysis. CONCLUSION We recommend reporting of data linkage processes through following recommended and standardised data linkage processes, which can be achieved through greater co-ordination among data providers and researchers.
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Affiliation(s)
- Fadzai Chikwava
- School of Allied Health, Curtin University, Perth, Western Australia, Australia
| | - Reinie Cordier
- School of Allied Health, Curtin University, Perth, Western Australia, Australia
- Department of Social Work, Education and Community Wellbeing, Northumbria University, Newcastle, United Kingdom
| | - Anna Ferrante
- School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Melissa O’Donnell
- Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia
- Australian Centre for Child Protection, University of South Australia, Adelaide, South Australia, Australia
| | - Renée Speyer
- School of Allied Health, Curtin University, Perth, Western Australia, Australia
- Department of Special Needs Education, University of Oslo, Oslo, Norway
- Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Centre, Leiden, The Netherlands
| | - Lauren Parsons
- School of Allied Health, Curtin University, Perth, Western Australia, Australia
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Hori H, Itoh M, Lin M, Yoshida F, Niwa M, Hakamata Y, Matsui M, Kunugi H, Kim Y. Childhood maltreatment history and attention bias variability in healthy adult women: role of inflammation and the BDNF Val66Met genotype. Transl Psychiatry 2021; 11:122. [PMID: 33574220 PMCID: PMC7878504 DOI: 10.1038/s41398-021-01247-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 01/09/2021] [Accepted: 01/25/2021] [Indexed: 01/31/2023] Open
Abstract
Childhood maltreatment has been associated with greater attention bias to emotional information, but the findings are controversial. Recently, a novel index of attention bias, i.e., attention bias variability (ABV), has been developed to better capture trauma-related attentional dysfunction. However, ABV in relation to childhood trauma has not been studied. Here, we examined the association of childhood maltreatment history with attention bias/ABV in 128 healthy adult women. Different types of childhood maltreatment were assessed with the Childhood Trauma Questionnaire. Attention bias/ABV was measured by the dot-probe task. Possible mechanisms whereby childhood maltreatment affects attention bias/ABV were also explored, focusing on blood proinflammatory markers and the BDNF Val66Met polymorphism. We observed a significant positive correlation between childhood emotional abuse and ABV (P = 0.002). Serum high-sensitivity tumor necrosis factor-α levels were significantly positively correlated with ABV (P < 0.001), but not with childhood maltreatment. Jonckheere-Terpstra trend test showed a significant tendency toward greater ABV with increasing numbers of the BDNF Met alleles (P = 0.021). A two-way analysis of variance further revealed that the genotype-by-emotional abuse interaction for ABV was significant (P = 0.022); individuals with the Val/Met and Met/Met genotypes exhibited even greater ABV when childhood emotional abuse was present. These results indicate that childhood emotional abuse can have a long-term negative impact on emotional attention control. Increased inflammation may be involved in the mechanism of ABV, possibly independently of childhood maltreatment. The BDNF Met allele may dose-dependently increase ABV by interacting with childhood emotional abuse.
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Affiliation(s)
- Hiroaki Hori
- Department of Behavioral Medicine, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan.
| | - Mariko Itoh
- grid.419280.60000 0004 1763 8916Department of Behavioral Medicine, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan ,grid.39158.360000 0001 2173 7691Center for Environmental and Health Sciences, Hokkaido University, Sapporo, Japan
| | - Mingming Lin
- grid.419280.60000 0004 1763 8916Department of Behavioral Medicine, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Fuyuko Yoshida
- grid.419280.60000 0004 1763 8916Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Madoka Niwa
- grid.419280.60000 0004 1763 8916Department of Behavioral Medicine, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Yuko Hakamata
- grid.419280.60000 0004 1763 8916Department of Behavioral Medicine, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan ,grid.411731.10000 0004 0531 3030Department of Clinical Psychology, International University of Health and Welfare, Tokyo, Japan
| | - Mie Matsui
- grid.9707.90000 0001 2308 3329Department of Clinical Cognitive Neuroscience, Institute of Liberal Arts and Science, Kanazawa University, Kanazawa, Japan
| | - Hiroshi Kunugi
- grid.419280.60000 0004 1763 8916Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Tokyo, Japan ,grid.264706.10000 0000 9239 9995Department of Psychiatry, Teikyo University School of Medicine, Tokyo, Japan
| | - Yoshiharu Kim
- grid.419280.60000 0004 1763 8916Department of Behavioral Medicine, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
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Engström M, Hiltunen J, Wallby T, Lucas S. Child Health Nurses' experiences of addressing psychosocial risk factors with the families they meet. Acta Paediatr 2021; 110:574-583. [PMID: 32716528 PMCID: PMC7891612 DOI: 10.1111/apa.15492] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/12/2020] [Accepted: 07/21/2020] [Indexed: 12/02/2022]
Abstract
Aim To examine how child health nurses perceive the routine assessment of psychosocial risk factors in the family environment as well as their self‐reported competence and the present organisational conditions in this context. Method A mixed‐methods design was used, including three focus group interviews and a web‐based survey. Qualitative data were analysed using systematic text condensation. Quantitative data were analysed at the descriptive level. Results Nurses expressed that identifying psychosocial risk factors was both important and relevant to their work. They had little formal training and education on most psychosocial risk factors, and they lacked structured methods to address them. In areas where nurses reported more formal education and a structured methodology (depression, parental stress), they rated to a higher degree that they possessed sufficient skills and sense of security. The nurses perceived that they seldom came into contact with families with financial problems, hazardous alcohol use or intimate partner violence. Conclusions There is a gap between the nurses’ attitudes regarding the importance of helping families in need and their ability to do so with the current level of training and methodological support. The results suggest that, in many cases, psychosocial problems remain undetected.
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Affiliation(s)
- Maria Engström
- Department of Women’s and Children’s Health Uppsala University Uppsala Sweden
| | | | - Thomas Wallby
- Department of Women’s and Children’s Health Uppsala University Uppsala Sweden
| | - Steven Lucas
- Department of Women’s and Children’s Health Uppsala University Uppsala Sweden
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BUHAŞ CL, JUDEA-PUSTA C, BUHAŞ BA, BUNGAU S, JUDEA AS, SAVA C, POPA VC, CIOCA G, TIT DM. Physical, Psychological and Sexual Abuse of the Minor in the Families from the Northwestern Region of Romania- Social and Medical Forensics. IRANIAN JOURNAL OF PUBLIC HEALTH 2021; 50:121-129. [PMID: 34178770 PMCID: PMC8213634 DOI: 10.18502/ijph.v50i1.5078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Accepted: 08/21/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND In Romania, the abuse within the family of the minor child is a widespread phenomenon, its extent is insufficiently known because of ignorance/not reporting all the existing cases. METHODS The participants of the research are represented by two independent groups from the NW Romania 2007-2011, one for sociological study (1544 parents and 1283 children) and another for forensic statistical study (2761 cases of abused children). The sociological study was carried out by analyzing questionnaires applied in schools located in Bihor County, both to children and parents. The statistical analysis was carried out by studying the cases of the physically, sexually, and psychologically abused minors, recorded at Bihor County Forensic Service. RESULTS Physical neglect and physical abuse are the most common forms of child abuse. The forensic analysis highlight that most of the victims are male from urban areas. Physical abuse is more common in the 16-18 age group, psychological abuse in children aged between 6-10 yr, and sexual abuse in children under the age of 14 years. Girls were subject to sexual abuse, neglect, and emotional abuse, more frequently in rural areas; boys were most often victims of exploitation, physical, and emotional abuse in both urban and rural areas. CONCLUSION The results of the study led to the formulation of general guidelines on this phenomenon and highlight the need for proposals to improve the current situation of child abuse within the family.
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Affiliation(s)
- Camelia Liana BUHAŞ
- Department of Morphological Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, Oradea, Romania
| | - Claudia JUDEA-PUSTA
- Department of Morphological Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, Oradea, Romania
| | | | - Simona BUNGAU
- Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, Oradea, Romania
| | - Adrian Sorin JUDEA
- Department of Morphological Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, Oradea, Romania
| | - Cristian SAVA
- Department of Psycho-Neuroscience and Recovery, Faculty of Medicine and Pharmacy, University of Oradea, Oradea, Romania
| | - Viorel Cristian POPA
- Faculty of Orthodox Theology “Episcop Dr. Vasile Coman”, University of Oradea, Oradea, Romania
| | - Gabriela CIOCA
- Faculty of Medicine, Lucian Blaga University of Sibiu, Sibiu, Romania
| | - Delia Mirela TIT
- Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, Oradea, Romania
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Stewart DE, MacMillan H, Kimber M. Recognizing and Responding to Intimate Partner Violence: An Update. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2021; 66:71-106. [PMID: 32777936 PMCID: PMC7890590 DOI: 10.1177/0706743720939676] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Donna E Stewart
- University Professor, Department of Psychiatry, 7938University of Toronto, Toronto, Ontario, Canada; Head of Research and Academic Development, Centre for Mental Health, Senior Scientist, University Health Network, Toronto, Ontario, Canada; Ethics and Review Committee, World Psychiatric Association, Geneva, Switzerland
| | - Harriet MacMillan
- Distinguished University Professor, Departments of Psychiatry and Behavioural Neurosciences, and Pediatrics, and Chedoke Health Chair in Child Psychiatry, Offord Centre for Child Studies, 3710McMaster University, Hamilton, Ontario, Canada
| | - Melissa Kimber
- Assistant Professor, Department of Psychiatry and Behavioural Neurosciences and Core Member of the Offord Centre for Child Studies, 3710McMaster University, Hamilton, Ontario, Canada
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Rebbe R, Martinson ML, Mienko JA. The Incidence of Child Maltreatment Resulting in Hospitalizations for Children Under Age 3 Years. J Pediatr 2021; 228:228-234. [PMID: 32822739 PMCID: PMC7752851 DOI: 10.1016/j.jpeds.2020.08.040] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 08/10/2020] [Accepted: 08/14/2020] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To assess the incidence of child maltreatment-related hospitalizations for children under 3 years for the population of Washington State. STUDY DESIGN A population-based study using retrospective linked administrative data for all children born in Washington State from 2000 through 2013 (n = 1 191 802). The dataset was composed of linked birth and hospitalization records for the entire state. Child maltreatment-related hospitalizations were identified using diagnostic codes, both specifically attributed to and suggestive of maltreatment. Incidence were calculated for the population, by birth year, by sex, and by maltreatment subtype. RESULTS A total of 3885 hospitalizations related to child maltreatment were identified for an incidence of 10.87 per 10 000 person-years. Hospitalizations related to child maltreatment accounted for 2.1% of all hospitalizations for children under the age of 3 years. This percentage doubled over time, reaching a high in 2012 (3.6%). More than one-half of all hospitalizations were related to neglect. Maltreatment-related hospitalizations occurred most frequently in the first year of life for all subtypes except for neglect, which occurred the most between 1 and 2 years of age. Male children had higher incidence than female children in general (11.97 vs 9.70 per 10 000 person-years) and across all subtypes. CONCLUSIONS Hospitalizations can be a useful source of population-based child maltreatment surveillance. The identification of neglect-related hospitalizations, likely the result of supervisory neglect, because the most common subtype is an important finding for the development of prevention programming.
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Affiliation(s)
- Rebecca Rebbe
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA.
| | | | - Joseph A Mienko
- Center for Social Sector Analytics & Technology, School of Social Work, University of Washington
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Lonne B, Higgins D, Herrenkohl TI, Scott D. Reconstructing the workforce within public health protective systems: Improving resilience, retention, service responsiveness and outcomes. CHILD ABUSE & NEGLECT 2020; 110:104191. [PMID: 31543276 DOI: 10.1016/j.chiabu.2019.104191] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 08/24/2019] [Accepted: 09/13/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Unacceptably high staff turnover has plagued traditional approaches to child protection, seemingly forever. Around the globe, numerous studies, reports and inquiries have highlighted how statutory agencies, focusing on risk-oriented investigations of suspected maltreatment, experience significant issues with worker stress and its occupational and organisational consequences. Yet, promoting staff resilience within child protection agencies' workforces has proved to be quite elusive at a systems level. While concern about child protection services often centers on the children and families agencies they intend to assist, the experiences of workers within the system provide further evidence that the system is itself failing. As a result, governments around the world are increasingly embracing system reforms that promote public health approaches focusing on early intervention and prevention to build child, family and neighbourhood support capacity and resilience and thereby reduce child maltreatment. OBJECTIVE We review the workforce issues affecting traditional child protection approaches and its impacts. In light of this, we examine the knowledge to be applied in the development of public health approaches that embrace integrated and coordinated systems of community care. Such reforms, with altered organisational remits that are far broader than narrow tertiary responses of investigation and removal, utilize evidence-based interventions targeted at differentiated risk and service user needs to provide effective supports and reduce maltreatment. This article unpacks the strategies needed to build and properly prepare a re-tooled workforce capable of implementing a public health model of preventive interventions. PARTICIPANTS AND SETTING Not applicable. METHODS Current public health reforms are examined through the lens of their potential impacts upon contemporary workforce issues. Focusing upon building a stable, resilient and appropriately skilled workforce for a public health model, we examine the implications for key stakeholders including workers, program and organisational leaders, educators, researchers, academics and community members, especially children and vulnerable families. RESULTS AND CONCLUSIONS Public health approaches to protecting children seek to provide effective supports and services in timely ways in order to prevent unnecessary statutory interventions, which affect those from cultural and poor communities disproportionately. But remodelling systems to embrace these approaches entails complex practice, program, policy and legislative changes, using evidence to intervene in ways that are primarily voluntary rather than coercive. In doing so they provide potential to recast the basis of the helping relationship to attend better to the relational aspects of changed behaviour. Embedding workforce resilience strategies in reformed systems is necessary to address retention and ensure service effectiveness and responsiveness to the diversity of needs of struggling families and impoverished communities. Thereby, public health approaches are well placed to achieve their true potential.
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Affiliation(s)
- Bob Lonne
- Social Work Discipline Lead, School of Health, University of New England, Armidale, NSW, 2350, Australia.
| | - Daryl Higgins
- Institute of Child Protection Studies, Australian Catholic University, Melbourne, Victoria, Australia.
| | | | - Debbie Scott
- Monash University, Richmond, Victoria, Australia.
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Zhang S, Lin X, Yang T, Zhang S, Pan Y, Lu J, Liu J. Prevalence of childhood trauma among adults with affective disorder using the Childhood Trauma Questionnaire: A meta-analysis. J Affect Disord 2020; 276:546-554. [PMID: 32871685 DOI: 10.1016/j.jad.2020.07.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 06/05/2020] [Accepted: 07/02/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND Childhood trauma is associated with major depressive disorder (MDD) and bipolar disorder (BD) in adults. However, no meta-analysis was performed on the prevalence of different types of childhood trauma in adults with affective disorders, using the Childhood Trauma Questionnaire (CTQ). METHODS Four databases were used to search articles regarding the prevalence of childhood emotional abuse (CEA), childhood physical abuse (CPA), childhood sexual abuse (CSA), childhood physical neglect (CPN), and childhood emotional neglect (CEN) in patients with MDD and BD using the CTQ. RESULTS A total of 17 and 11 articles were found analyzing patients with MDD and BD, respectively. A pooled prevalence rate of 33.0% and 30.0% for CEA, 17.0% and 18.0% for CPA, 19.0% and 22.0% for CSA, 37.0% and 31.0% for CEN, and 31% and 30.0% for CPN was found in patients with MDD and BD respectively. A difference in 95% confidence interval in the CSA rate between men and women was found in patients with MDD in the gender subgroup and in the rate of some types of childhood trauma in the continent subgroup in both patient types. LIMITATIONS A limited number of articles were included in some continents, thus, the heterogeneity in the meta-analysis was generally high. CONCLUSION The prevalence of CEA, CEN, and CPN in patients with affective disorders was relatively high, whereas that of CPA and CSA was relatively low. These childhood traumas might be affected by continent and gender.
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Affiliation(s)
- Simei Zhang
- Shenzhen Kangning Hospital, Shenzhen Mental Health Center; Shenzhen University, Mental Health School, Shenzhen 518020, China
| | - Xiujin Lin
- Department of Maternal and Child Health, School of Public Health, Sun Yat-Sen University, Guangzhou 510080
| | - Tingyu Yang
- Mental Health Institute of the Second Xiangya Hospital, Central South University, Changsha 410011, China
| | - Shengjie Zhang
- Department of Psychology, School of Public Health, Guangxi Medical University, Nanning 530000, China
| | - Yuli Pan
- Department of Psychology, School of Public Health, Guangxi Medical University, Nanning 530000, China
| | - Jianping Lu
- Shenzhen Kangning Hospital, Shenzhen Mental Health Center; Shenzhen University, Mental Health School, Shenzhen 518020, China.
| | - Jianbo Liu
- Shenzhen Kangning Hospital, Shenzhen Mental Health Center; Shenzhen University, Mental Health School, Shenzhen 518020, China.
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Pearson RJ, Jay MA, O'Donnell M, Wijlaars L, Gilbert R. Characterizing newborn and older infant entries into care in England between 2006 and 2014. CHILD ABUSE & NEGLECT 2020; 109:104760. [PMID: 33053479 PMCID: PMC7718112 DOI: 10.1016/j.chiabu.2020.104760] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 09/18/2020] [Accepted: 09/22/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND The risk of entry to state care during infancy is increasing, both here in England and abroad, with most entering within a week of birth ('newborns'). However, little is known about these infants or of their pathways through care over early childhood. OBJECTIVE To characterize infant entries to care in England. PARTICIPANTS AND SETTING All children in England who first entered care during infancy, between April 2006 and March 2014 (n = 42,000). METHODS We compared sociodemographic and care characteristics for infants entering care over the study period by age at first entry (newborn: <1wks, older infant 1-51wks). Among those who entered before April 2010, we further characterized care over follow-up (i.e. 4 years from first entry) and employed latent class analysis to uncover any common pathways through care. RESULTS Almost 40 % of infants first entered care as a newborn. Most infants first entered care under s 20 arrangements (i.e. out-of-court, 60 % of newborns vs 47 % of older infants). Among infants entering before April 2010, most were adopted over follow-up (60 % vs 37 %), though many were restored to parental care (20 % vs 32 %) or exited care to live with extended family (13 % vs 19 %). One in six infants (17.7 %) had particularly unstable care trajectories over early childhood, typified by three or more placements or failed reunification. CONCLUSIONS Evidence-based strengthening of pre-birth social work support is needed to improve preventive interventions before birth, to more effectively target infant placement into care. Linkages between child protection records and information on parents are needed to inform preventive strategies.
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Affiliation(s)
- Rachel J Pearson
- Population, Policy and Practice Research and Teaching Department, University College London Great Ormond Street Institute of Child Health, London, United Kingdom.
| | - Matthew A Jay
- Population, Policy and Practice Research and Teaching Department, University College London Great Ormond Street Institute of Child Health, London, United Kingdom.
| | - Melissa O'Donnell
- Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia; Australian Centre for Child Protection, University of South Australia, Adelaide, South Australia, Australia.
| | - Linda Wijlaars
- Population, Policy and Practice Research and Teaching Department, University College London Great Ormond Street Institute of Child Health, London, United Kingdom.
| | - Ruth Gilbert
- Population, Policy and Practice Research and Teaching Department, University College London Great Ormond Street Institute of Child Health, London, United Kingdom.
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Najman JM, Kisely S, Scott JG, Strathearn L, Clavarino A, Williams GM, Middeldorp C, Bernstein D. Agency notification and retrospective self-reports of childhood maltreatment in a 30-Year cohort: Estimating population prevalence from different data sources. CHILD ABUSE & NEGLECT 2020; 109:104744. [PMID: 33011350 DOI: 10.1016/j.chiabu.2020.104744] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 09/10/2020] [Accepted: 09/13/2020] [Indexed: 05/26/2023]
Abstract
BACKGROUND There is little known about how two sources of child maltreatment reports correspond, specifically for emotional, physical, sexual abuse and emotional or physical neglect. OBJECTIVE To compare agency and self-reports of child maltreatment and determine whether they are predicted by similar early life course adverse experiences. Participants Data are taken from a long running birth cohort study (Mater-University of Queensland Study of Pregnancy - MUSP). Mothers (N=7223) were recruited in 1981-83 and their children were followed-up 30 years later (2010-14). In 2000 data from the relevant child protection agency were accessed and linked to the survey data. Setting Consecutive women giving birth to a live singleton baby at a major obstetrical service in Brisbane, Australia were recruited and both mother and child were repeatedly follow-up over a 30 year period. Methods Birth cohort study with data linkage of child protection agency records and self-report survey data (using the Childhood Trauma Questionnaire - CTQ) of childhood maltreatment experiences. We compare reports of emotional, physical and sexual abuse and neglect using agency and self-reports (Cramer's V and kappa). RESULTS Most children who are notified cases of maltreatment subsequently self-report they experienced little or no maltreatment in childhood. Most children who report experiencing severe maltreatment have not previously been notified to the protection agency. Teenage mothers have children who are notified 2.89 (1.52, 5.52) times, self-report 2.01 (1.31, 3.09) times and both notified and self-report 3.61 (2.26, 6.10) times more than their older comparison mothers. CONCLUSIONS Different methods of assessing maltreatment identify different subsets of those children who have experienced maltreatment.
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Affiliation(s)
- Jackob M Najman
- School of Public Health, The University of Queensland, 288 Herston Road, Herston, QLD, 4006, Australia.
| | - Steve Kisely
- Faculty of Medicine, The University of Queensland, Princess Alexandra Hospital, Woolloongabba, QLD, 4102, Australia
| | - James G Scott
- Child and Youth Research Group, QIMR Berghofer Medical Research Institute, 300 Herston Road, Herston, QLD, 4006, Australia
| | - Lane Strathearn
- Stead Family Department of Pediatrics, University of Iowa, 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | - Alexandra Clavarino
- School of Public Health, The University of Queensland, 288 Herston Road, Herston, QLD, 4006, Australia
| | - Gail M Williams
- School of Public Health, The University of Queensland, 288 Herston Road, Herston, QLD, 4006, Australia
| | - Christel Middeldorp
- Child Health Research Centre, Centre for Children's Health Research, The University of Queensland, 62 Graham Street, South Brisbane, QLD, 4101, Australia
| | - David Bernstein
- Clinical Psychological Science Department, Faculty of Psychology and Neuroscience, Maastricht University, Univesiteitssingel 40, 6229 ER, Maastrichts, Netherlands
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Thumath M, Humphreys D, Barlow J, Duff P, Braschel M, Bingham B, Pierre S, Shannon K. Overdose among mothers: The association between child removal and unintentional drug overdose in a longitudinal cohort of marginalised women in Canada. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 91:102977. [PMID: 33129662 DOI: 10.1016/j.drugpo.2020.102977] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Revised: 09/17/2020] [Accepted: 09/21/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Accidental overdose is a major public health concern in North America with research primarily focused on cisgender men. Little is known about the burden of overdose among marginalised women, particularly in the context of child custody loss. This study aims to examine the prevalence of overdose and the association with child removal in a cohort of marginalised women. METHODS This study draws on a merged dataset (2010-2018) of two community-based longitudinal cohorts of over 1000 marginalised women in Canada recruited using time-location sampling. After restricting to women who had ever had a live birth, bivariate and multivariable logistic regression using generalised estimating equations (GEE) were used to examine the association between child removal and overdose. Joint effects of child removal and Indigeneity were also investigated. RESULTS Of the 696 women who reported ever having a live birth, 39.7% (n = 276) reported child removal at baseline. Unintended, non-fatal overdose rates were high, with 35.1% (n = 244) of women reporting ever having an overdose. Using bivariate GEE analyses, having a child apprehended and being Indigenous were positively correlated with overdose. Using multivariable GEE, child removal increased the odds of overdose by 55% (AOR: 1.55; 95% CI 1.01-2.39) after adjusting for education and Indigenous ancestry. Using multivariable joint-effects analysis, Indigenous women who had experienced child removal had over twice the odds of an unintended overdose than non-Indigenous women who had not lost custody after adjusting for education, food insecurity, and sex work (AOR: 2.09; 95% CI 1.15-3.79). CONCLUSION This analysis suggests that, after controlling for known confounders, women who have a child removed experience higher odds of overdose, and these odds are highest among Indigenous women. The high prevalence of overdose in this cohort suggests the need for further strategies to prevent overdose among pregnant and parenting women.
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Affiliation(s)
- Meaghan Thumath
- Centre for Gender & Sexual Health Equity, 1081 Burrard Street, Vancouver BC, Canada; Department of Social Policy and Intervention, University of Oxford, Barnett House, 32 -37 Wellington Square, Oxford OX1 2ER; University of British Columbia, School of Nursing, T201-2211 Wesbrook Mall, Vancouver, BC Canada V6T 2B5.
| | - David Humphreys
- Department of Social Policy and Intervention, University of Oxford, Barnett House, 32 -37 Wellington Square, Oxford OX1 2ER
| | - Jane Barlow
- Department of Social Policy and Intervention, University of Oxford, Barnett House, 32 -37 Wellington Square, Oxford OX1 2ER
| | - Putu Duff
- Centre for Gender & Sexual Health Equity, 1081 Burrard Street, Vancouver BC, Canada
| | - Melissa Braschel
- Centre for Gender & Sexual Health Equity, 1081 Burrard Street, Vancouver BC, Canada
| | - Brittany Bingham
- Centre for Gender & Sexual Health Equity, 1081 Burrard Street, Vancouver BC, Canada; Vancouver Coastal Health, Aboriginal Health, 2750 E. Hastings Street, Vancouver, BC
| | - Sophie Pierre
- ʔAq̓am, St. Mary's Indian Band, Ktunaxa Nation, 7470 Mission road, Cranbrook, B.C., V1C 7E5
| | - Kate Shannon
- Centre for Gender & Sexual Health Equity, 1081 Burrard Street, Vancouver BC, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6
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Mussmann B, Hardy M, Rajalingam R, Peters D, McFadden S, Abdi AJ. Local diagnostic reference levels for skeletal surveys in suspected physical child abuse. Radiography (Lond) 2020; 27:425-429. [PMID: 33876733 DOI: 10.1016/j.radi.2020.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 10/05/2020] [Accepted: 10/06/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION The purpose was to determine if an age based, local diagnostic reference level for paediatric skeletal surveys could be established using retrospective data. METHODS All children below two years of age referred for a primary skeletal survey as a result of suspected physical abuse during 2017 or 2018 (n = 45) were retrospectively included from a large Danish university hospital. The skeletal survey protocol included a total of 33 images. Dose Area Product (DAP) and acquisition parameters for all images were recorded from the Picture Archival and Communication System (PACS) and effective dose was estimated. The 75th percentile for DAP was considered as the diagnostic reference level (DRL). RESULTS The 75th percentile for DAP was 314 mGy∗cm2, 520 mGy∗cm2 and 779 mGy∗cm2 for children <1 month, 1-11 months and 12 < 24 months of age respectively. However, only the age group 1-11 months had a sufficient number of children (n = 27) to establish a local DRL. Thus, for the other groups the DAP result must be interpreted with caution. Effective dose was 0.19, 0.26 and 0.18 mSv for children <1, 1-11 months and 12 < 24 months of age respectively. CONCLUSION For children between 1 and 11 months of age, a local diagnostic reference level of 520 mGy∗cm2 was determined. This may be used as an initial benchmark for primary skeletal surveys as a result of suspected physical abuse for comparison and future discussion. IMPLICATIONS FOR PRACTICE While the data presented reflects the results of a single department, the suggested diagnostic reference level may be used as a benchmark for other departments when auditing skeletal survey radiation dose.
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Affiliation(s)
- B Mussmann
- Department of Radiology, Odense University Hospital, Denmark; Research and Innovation Unit, University of Southern, Denmark; Faculty of Health Sciences, Oslo Metropolitan University, Norway.
| | - M Hardy
- Faculty of Health Studies, University of Bradford, UK
| | - R Rajalingam
- Department of Radiography, University College Lillebaelt, Denmark
| | - D Peters
- Lillebaelt Hospital, Department of Radiology, Denmark
| | - S McFadden
- School of Health Sciences, University of Ulster, UK
| | - A J Abdi
- Department of Radiology, Odense University Hospital, Denmark; Research and Innovation Unit, University of Southern, Denmark
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48
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Kenny KS, Pulver A, O'Campo P, Guttmann A, Urquia ML. Do socioeconomic and birth order gradients in child maltreatment differ by immigrant status? J Epidemiol Community Health 2020; 75:22-28. [PMID: 32938615 PMCID: PMC7788479 DOI: 10.1136/jech-2019-212759] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 06/29/2020] [Indexed: 11/25/2022]
Abstract
Background While literature has documented strong gradients in child maltreatment (CM) by socioeconomic status and family composition in the general population, how these patterns extend to immigrants remain inconclusive. Using population-based administrative data, we examined, for the first time, whether gradients in CM by neighbourhood income and childbirth order vary by immigrant status. Methods We used linked hospitalisation, emergency department visits, small-area income, birth and death records with an official Canadian immigration database to create a retrospective cohort of all 1 240 874 children born from 2002 to 2012 in Ontario, Canada, followed from 0 to 5 years. We estimated rate ratios of CM among immigrants and non-immigrants using modified Poisson regression. Results CM rates were 1.6 per 100 children among non-immigrants and 1.0 among immigrants. CM was positively associated with neighbourhood deprivation. The adjusted rate ratio (ARR) of CM in the lowest neighbourhood income quintile versus the highest quintile was 1.57 (95% CI 1.49 to 1.66) for non-immigrants and 1.33 (95% CI 1.15 to 1.54) for immigrants. The socioeconomic gradient disappeared when restricted to children of immigrant mothers arrived at 25+ years and in analyses excluding emergency department visits. Compared to a first child, the ARR of CM for a fourth or higher-order child was 1.75 (95% CI 1.63 to 1.89) among non-immigrants and 0.57 (95% CI 0.44 to 0.74) among immigrants. Conclusions Immigrants exhibited lower CM rates than non-immigrants across neighbourhood income quintiles and differences were greatest in more deprived neighbourhoods. The contrasting birth order gradients between immigrants and non-immigrants require further investigation.
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Affiliation(s)
- Kathleen S Kenny
- Department of Community Health Sciences, Max Rady College of Medicinea, University of Manitoba, Winnipeg, Canada
| | - Ariel Pulver
- Department of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Patricia O'Campo
- Department of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,Li Ka Shing Knowledge Institute, St.Michael's Hospital, Toronto, Canada
| | - Astrid Guttmann
- Division of Paediatric Medicine, Hospital for Sick Children, Toronto, Canada.,Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Marcelo L Urquia
- Department of Community Health Sciences, Max Rady College of Medicinea, University of Manitoba, Winnipeg, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Canada
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49
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Omar A, Rees P, Cooper A, Evans H, Williams H, Hibbert P, Makeham M, Parry G, Donaldson L, Edwards A, Carson-Stevens A. Health and social care-associated harm amongst vulnerable children in primary care: mixed methods analysis of national safety reports. Arch Dis Child 2020; 105:731-737. [PMID: 32144091 DOI: 10.1136/archdischild-2019-318406] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 01/24/2020] [Accepted: 02/07/2020] [Indexed: 11/03/2022]
Abstract
PURPOSE Patient safety failures are recognised as a global threat to public health, yet remain a leading cause of death internationally. Vulnerable children are inversely more in need of high-quality primary health and social-care but little is known about the quality of care received. Using national patient safety data, this study aimed to characterise primary care-related safety incidents among vulnerable children. METHODS This was a cross-sectional mixed methods study of a national database of patient safety incident reports occurring in primary care settings. Free-text incident reports were coded to describe incident types, contributory factors, harm severity and incident outcomes. Subsequent thematic analyses of a purposive sample of reports was undertaken to understand factors underpinning problem areas. RESULTS Of 1183 reports identified, 572 (48%) described harm to vulnerable children. Sociodemographic analysis showed that included children had child protection-related (517, 44%); social (353, 30%); psychological (189, 16%) or physical (124, 11%) vulnerabilities. Priority safety issues included: poor recognition of needs and subsequent provision of adequate care; insufficient provider access to accurate information about vulnerable children, and delayed referrals between providers. CONCLUSION This is the first national study using incident report data to explore unsafe care amongst vulnerable children. Several system failures affecting vulnerable children are highlighted, many of which pose internationally recognised challenges to providers aiming to deliver safe care to this at-risk cohort. We encourage healthcare organisations globally to build on our findings and explore the safety and reliability of their healthcare systems, in order to sustainably mitigate harm to vulnerable children.
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Affiliation(s)
- Adhnan Omar
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Philippa Rees
- Division of Population Medicine, Cardiff University, Cardiff, UK.,Population Policy and Practice, University College London Institute of Child Health, London, UK
| | - Alison Cooper
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Huw Evans
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Huw Williams
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Peter Hibbert
- Australian Institute of Health Innovation, Macquarie University Faculty of Medicine and Health Sciences, Sydney, New South Wales, Australia.,Division of Health Sciences, School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Meredith Makeham
- Department on Clinical Medicine, Macquarie University Faculty of Medicine and Health Sciences, Sydney, New South Wales, Australia
| | - Gareth Parry
- Institute for Healthcare Improvement, Cambridge, Massachusetts, USA.,Harvard Medical School, Harvard University, Cambridge, Massachusetts, USA
| | - Liam Donaldson
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Adrian Edwards
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Andrew Carson-Stevens
- Division of Population Medicine, Cardiff University, Cardiff, UK .,Australian Institute of Health Innovation, Macquarie University Faculty of Medicine and Health Sciences, Sydney, New South Wales, Australia
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50
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Nickel NC, Turnbull L, Wall-Wieler E, Au W, Ekuma O, MacWilliam L, Enns JE, Lee JB, McCulloch S, Burchill C, Brownell M. Overlap between child protection services and the youth justice system: protocol for a retrospective population-based cohort study using linked administrative data in Manitoba, Canada. BMJ Open 2020; 10:e034895. [PMID: 32713845 PMCID: PMC7383946 DOI: 10.1136/bmjopen-2019-034895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Children who have a history of involvement in child protection services (CPS) are over-represented in the youth and adult criminal justice systems. There are significant health and socioeconomic implications for individuals involved in either or both CPS and the justice system. Understanding the 'overlap' between these two systems would provide insight into the health and social needs of this population. This protocol describes a research programme on the relationship between the child welfare and the youth justice systems, looking specifically at the population involved in both CPS and the youth justice system. We will examine the characteristics associated with involvement in these systems, justice system trajectories of individuals with a history of CPS involvement and early adult outcomes of children involved in both systems. METHODS AND ANALYSIS Administrative data sets will be linked at the individual level for three cohorts born 1991, 1994 and 1998 in Manitoba, Canada. Involvement in CPS will be categorised as 'placed in out-of-home care', 'received in-home services, but was not placed in care' or 'no involvement'. Involvement in the youth justice system will be examined through contacts with police between ages 12 and 17 that either led to charges or did not proceed. Individual, maternal and neighbourhood characteristics will be examined to identify individuals at greatest risk of involvement in one or both systems. ETHICS AND DISSEMINATION The study was approved by the University of Manitoba Health Research Ethics Board and permission to access data sets has been granted by all data providers. We also received approval for the study from the First Nations Health and Social Secretariat of Manitoba's Health Information Research Governance Committee and the Manitoba Metis Federation. Strategies to disseminate study results will include engagement of stakeholders and policymakers through meetings and workshops, scientific publications and presentations, and social media.
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Affiliation(s)
- Nathan C Nickel
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Lorna Turnbull
- Faculty of Law, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Wendy Au
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Okechukwu Ekuma
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Leonard MacWilliam
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jennifer Emily Enns
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Janelle Boram Lee
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Scott McCulloch
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Charles Burchill
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Marni Brownell
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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