Children's exposure to psychological abuse and neglect: A population-based study in rural Bangladesh.

AIM: We aimed to estimate the prevalence and risk factors of child psychological abuse and neglect in a rural area of Bangladesh. METHODS: Data were obtained from interviewing 1416 children aged 11-17 years administering the International Society for the Prevention of Child Abuse and Neglect Child Abuse Screening Tool for Children between March and April 2017. Linear regression analysis was used to estimate the risks of child psychological abuse and neglect. RESULTS: The prevalence rates of at least one form of psychological abuse both in the past year and lifetime were more than 97 per cent. Moreover, the rates of at least one form of neglect were about 58 per cent during the past year and 78 per cent over lifetime. Living separately from parents posed children to significant risks of neglect and psychological abuse. Working children and greater number of siblings in a family were risk factors for neglect, whereas witnessing family violence and being bullied were risk factors for psychological abuse. Children with more years of schooling experienced less neglect and psychological abuse. CONCLUSION: The high prevalence of child psychological abuse and neglect in this study shows child maltreatment as an ignored issue in Bangladesh.

Children's exposure to physical abuse from a child perspective: A population-based study in rural Bangladesh.

BACKGROUND: Although child physical abuse (CPA) is considered as a major global public health problem, it has not yet been recognized as such in Bangladesh. Very few studies have assessed the prevalence and victims' characteristics of multiple forms of CPA. OBJECTIVE: This population-based study assessed the prevalence of CPA committed by adults in a rural area of Bangladesh and examined its association with demographic and socio-contextual factors. METHODS: Data were obtained using ISPCAN Child Abuse Screening Tool for Children (ICAST-C) in a random sample of 1416 children (49% girls, 51% boys) aged 11 to 17 years by face-to-face interviews during March-April 2017. The response rate was 91.5%. To estimate predictors of CPA, physical abuse was categorized into frequent and less frequent groups. RESULTS: The prevalence of at least one form (≥ 1), two forms (≥2) and three or more forms (≥ 3) of CPA were estimated approximately to 99%, 95% and 83% in their lifetime and 93%, 79%, and 57% in the past year respectively. Hitting (except on buttocks), standing/kneeling and slapping were the most common physical abuse whereas given drugs or alcohol, pinched, burned or scalded, beaten-up and locked up were less reported. Female children were faced severe forms of CPA more than that of males. Male children, younger age groups, witnessing adults using weapons at home, bullied by siblings and low level of maternal education were found to be significant risk factors for both ≥ 1 form and ≥ 2 forms of frequent CPA whereas adding also adult shouting in a frightening way was found as a significant risk factor for ≥ 2 forms of frequent CPA. CONCLUSION: Self-reported prevalence of CPA is extremely common in the Bangladeshi rural society. The prevalence was associated with demographic and socio-contextual characteristics of the children such as being younger, witnessing domestic violence and maternal low education. The findings provide evidence to support parents and policy-makers to take effective measures to implement policy and programme on alternative up-bringing methods and creating awareness of negative effects of CM which in turn help Bangladesh to line up with UN Convention on the Rights of the Child, which the country signed in 1990.

Swedish population-based study of pupils showed that foster children faced increased risks for ill health, negative lifestyles and school failure.

AIM: This population-based study explored whether foster children faced a higher risk of health problems than children of the same age who were not in foster care. METHODS: Data for 13 739 pupils aged 10, 13 and 16 years were obtained from the Pupil Health Database in the county of Värmland, Sweden, for the school years 2012/2013 and 2013/2014. These included data on school performance, health, lifestyle and social relationships, based on children's interviews with school nurses. RESULTS: Of all the pupils, 171 (1.2%) were in foster care. Children in foster care were generally unhealthier than other children. Both girls and boys were at higher risk of chronic health problems, daily smoking, use of drugs and school failure. When the girls in foster care were compared to other girls, we found that they faced a higher risk of psychological and psychosomatic symptoms. This difference was not found for boys. Foster children were also more likely to express a more negative view on life. CONCLUSION: We confirmed earlier studies that children in foster care tended to have inferior health and well-being than other children. These findings emphasise that health, risky behaviour and school performance should be considered together when assessing foster children.

School Nurses Avoid Addressing Child Sexual Abuse.

Child sexual abuse (CSA) is a global public health problem with major consequences for the individual child and society. An earlier Swedish study showed that the school nurses did not initially talk about nor mention CSA as one form of child abuse. For the child to receive adequate support, the disclosure is a precondition and is dependent on an available person prepared to listen. The aim of the study was to explore the ability of the school nurses to detect and support sexually abused children. It is a secondary analysis of focus group interviews with school nurses. Thematic analysis was performed. Results showed that the school nurses avoided addressing CSA due to arousal of strong emotions, ambivalence, and a complicated disclosure process. In order to detect CSA and support abused children, attentiveness of sexual abuse as a possible cause of physical and mental ill-health is crucial.

Temporal and spatial trends of PCBs, DDTs, HCHs, and HCB in Swedish marine biota 1969-2012.

In the 1960s, the Baltic Sea was severely polluted by organic contaminants such as PCBs, HCHs, HCB, and DDTs. Elevated concentrations caused severe adverse effects in Baltic biota. Since then, these substances have been monitored temporally and spatially in Baltic biota, primarily in herring (Clupea harengus) and in guillemot (Uria aalge) egg, but also in cod (Gadus morhua), perch (Perca fluviatilis), eelpout (Zoarces viviparous), and blue mussel (Mytilus edulis). These chemicals were banned in Sweden in the late 1970s/early 1980s. Since the start of monitoring, overall significant decreases of about 70-90 % have been observed. However, concentrations are still higher in the Baltic Sea than in, for example, the North Sea. CB-118 and DDE exceed the suggested target concentrations (24 µg kg(-1) lipid weight and 5 µg kg(-1) wet weight, respectively) at certain sites in some of the monitored species, showing that concentrations may still be too high to protect the most sensitive organisms.

The School Nurse's Ability to Detect and Support Abused Children: A Trust-Creating Process.

Child abuse has negative health consequences. Early detection and preventive measures lead to avoidance of prolonged and more complex problems. School nurses have a child protection role and should pay attention to vulnerable children. Through health dialogues and other interactions with pupils, school nurses have the opportunity to detect child abuse. The aim of the study was to explore how school nurses detect child abuse and initiate support measures. Focus group interviews were conducted with 23 school nurses. The data were analyzed using a grounded theory approach. Results showed that the main concern of the school nurses was support and assistance to children who are abused which was preceded by a trust-creating and trust-strengthening process. Trust contains self-confidence and confidence in the system and trust can be strengthened or undermined. Building trustful relations is time consuming and is facilitated by networking, refined assessment instruments, and collaboration.

Spatio-temporal trends of PCBs in the Swedish freshwater environment 1981-2012.

Polychlorinated biphenyls (PCBs) have been monitored in perch (Perca fluviatilis), pike (Esox lucius), and Arctic char (Salvelinus alpinus) in reference lakes since the late 1960s. Temporal trends and spatial patterns are currently monitored in nine and 32 lakes, respectively. Overall, PCB concentrations are decreasing. However, this is not consistent for all congeners across all lakes and species. Perch has comparatively low PCB concentrations relative to suggested target levels, but individual congener concentrations in some lakes are concerningly high. No temporal trend is seen for CB-118 and CB-153 in perch, but significant decreasing trends exist for Arctic char and pike, for which monitoring started earlier than for perch. The lower/higher chlorinated congener ratio decreased over time in most lakes, indicating fewer new emissions. CB-118 and CB-153 concentrations in perch show spatial gradients across Sweden, with higher concentrations found near urban/industrial areas.

Consequences of using pooled versus individual samples for designing environmental monitoring sampling strategies.

Choosing an appropriate sampling strategy for chemical analysis within environmental monitoring includes the important decision of whether to sample and store individual or pooled samples. This choice impacts on future analyses from Environmental Specimen Bank samples. A number of advantages exist to support using either individual or pooled samples for temporal trend studies. However, it is important to know the total and analytical variance to be able to design the best sampling strategy. Statistical power in temporal or spatial studies is determined by the random/unexplained sample variation. The relationship between chemical analytical error and other sources of variation, as well as the cost for collection, preparation of samples and chemical analysis, will determine the number of individuals in each pool, and the number of pools that should be analysed to achieve high cost efficiency and good statistical power. Various scenarios of different numbers of individual samples, different numbers of pooled samples containing various numbers of individual specimens, the relationships between chemical analytical error and other sources of sample variance, have been compared by simulating random sampling from computer generated populations using realistic measures of variation from ongoing monitoring activities. These results offer guidance in the design of a cost-efficient, statistically sound sampling strategy.

Case analyses of all children's drowning deaths occurring in Sweden 1998-2007.

AIMS: The goal of this research project was to explore circumstances surrounding each drowning death occurring to children and adolescents ages 0-17 in Sweden during the years 1998-2007. METHODS: Records from the National Board of Forensic Medicine (NBFM) and other sources were analysed. We collected information on children's personal characteristics (sex, age, ethnic background, weight, height, physical condition, and pre-existing health conditions) and the circumstances of deaths (time and place of occurrence, type of drowning, resuscitation efforts and medical care given, for example). We also collected information on prevention factors: the physical environment, adult supervision, whether or not the child could swim, and if the child was using a personal flotation device at the time of death. RESULTS: Our analysis showed that 109 children had drowned in Sweden during the study period - of this group, 96 had died from unintentional causes. Children from immigrant backgrounds, particularly with families coming from the Middle East and Iran, were inordinately represented in the group of victims who had died from unintentional drowning deaths. Other risk factors included: coming from a single parent-headed family, alcohol use by older victims and a lack of ability to swim. CONCLUSIONS: Prevention efforts to prevent drowning in the future should focus on preventing alcohol use by young bathers; better fencing around swimming sites; improved coverage of swimming lessons to all children in Sweden, especially children from immigrant families; more education on drowning risks for single parents; and better awareness by adults on the need for constant supervision of children and adolescents in and near water.

Improved reproductive success in otters (Lutra lutra), grey seals (Halichoerus grypus) and sea eagles (Haliaeetus albicilla) from Sweden in relation to concentrations of organochlorine contaminants.

We studied indices of reproductive outcome in three aquatic species in relation to organochlorine concentrations during four decades. In female otters, the frequency of signs of reproduction increased after 1990. In grey seals, pregnancy rate increased 1990-2010 and uterine obstructions ceased after 1993. The frequency of uterine tumours was highest 1980-2000. The number of sea eagle nestlings per checked nest increased 1985-2000, while the frequency of desiccated eggs decreased. Organochlorine concentrations decreased at annual rates between 3.5 and 10.2%. The estimated mean concentration (mg/kg lw) for total-PCB decreased from 70 to 8 (otters), from 110 to 15 (seals) and from 955 to 275 (eagles). The corresponding concentrations for ΣDDT decreased from 3.4 to 0.2 (otters), from 192 to 2.8 (seals) and from 865 to 65 (eagles). This study adds evidence to support the hypothesis that PCBs and DDTs have had strong negative effects on the reproduction and population levels of these species.

Comparison of organohalogen compounds in a white-tailed sea eagle egg laid in 1941 with five eggs from 1996 to 2001.

Eggs laid by white-tailed sea eagles (Haliaeetus albicilla), one in 1941 and five eggs between 1996 and 2001, all from the same geographical region of the Baltic Sea, were screened for organohalogen substances. The 1941 egg contained hexachlorobenzene (HCB), but did not contain either of the pesticides hexachlorocyclohexane (HCH) or p,p'-DDT, nor any metabolites of the latter. In contrast, the more recent eggs (REs) contained all of these compounds. Of the seven polychlorinated biphenyls (PCBs) analyzed (CB28, -52, -101, -118, -138/-163, -153 and 180), only the more highly chlorinated congeners were detected in the 1941 sample, with CB153 followed by CB180 showing the highest concentrations. All eggs demonstrated the same congener pattern with respect to the more highly chlorinated PCBs, but concentrations were approximately 70-230 times higher in the REs. All of the polychlorinated-p-dioxin and dibenzofuran (PCDD/Fs) congeners analyzed were detected in the eggs, with the dominant congener being 2,3,4,7,8-PeCDF (1250pg/gl.w. in 1941 and 1540pg/gl.w. (GM) for the REs, respectively). None of the other congeners exceeded 400pg/gl.w., and the concentrations of 2,3,7,8-TCDD, 2,3,7,8-TCDF and 1,2,3,7,8-PeCDF were all lower in the REs. None of five congeners of polybrominated diphenyl ethers (PBDEs) found in the REs was detected in the egg from 1941. The three methoxylated brominated diphenyl ethers (MeO-BDEs) analyzed were found at similar levels and with a similar congener pattern in REs as in the egg from 1941. In conclusion, this study has shown the absence of DDE and PBDE and the presence of HCB and PCBs in a white-tailed sea eagle egg laid in 1941, and a strong increase of PCBs, DDE and PBDE in white-tailed sea eagle eggs from the same area in 1996-2001. The MeO-BDEs were found in similar concentrations in the analyzed eggs. The 1941 sample shows substantial concentrations of PCDD/Fs, noteworthy in the same magnitude as in the recent samples, illustrating the historical and recent exposure of these compounds.

Insecure social relations at work and long-term sickness absence due to burnout and other mental diagnoses.

OBJECTIVE: The association between diagnosis and psychosocial work factors in a sickness absent population was examined in order to test the existence of a previously suggested hypothesis of "the burnout staircase", a seven step process prior to the long-term sickness absence due to burnout starting with reorganisations followed by insecure social bonds affecting the work situation as well as trust in oneself and others. PARTICIPANTS: The study population comprised of 2055 employed sick-listed persons (1414 women, 641 men), a sub sample derived from the 2002 national Swedish survey on health, working conditions, life situation and sick-listing. METHODS: Through multinomial logistic regression it was analysed if experiences of the different steps in the burnout staircase increased the probability of burnout compared to other medical diagnoses. RESULTS: The hypothesis was supported. The study revealed strong and significant associations between having experienced reorganisations, insecure social relations fraught with conflicts, incompatible demands, lack of trust and diminished self-esteem and burnout. This was true for both women and men. Strong and significant associations were found also between each step studied and other mental diagnoses for men. CONCLUSION: More studies are needed to further test the hypothesis.

Falling between two stools; how a weak co-operation between the social security and the unemployment agencies obstructs rehabilitation of unemployed sick-listed persons.

PURPOSE: To explore significant factors behind the weak co-operation between local social insurance and unemployment agencies impairing the rehabilitation of unemployed sick-listed persons. METHOD: Individual, semi-structured face-to-face interviews with main actors directly involved in the sick-listing and rehabilitation process were conducted in the year 2000. In all 39 persons were interviewed: 25 professionals (physicians, public employment and social insurance officers) and 14 clients. Data were analysed according to Grounded theory method. RESULTS: The majority of unemployed sick-listed persons were declared too sick to work and were erased from the unemployment registers. This measure weakened the incentives for co-operation between the two main rehabilitation actors. The implication was that the unemployed sick-listed persons lost the opportunity of the co-ordinated rehabilitation they were entitled to. Three significant factors behind this process were identified by the main actors: indistinct regulation of co-operation, shifting political goals over time and conflicting goals between agencies; the last factor mainly a consequence of the other two. CONCLUSIONS: The findings suggest that labour market changes and manifest political goals influence the rehabilitation efforts giving low priority to difficult-to-place individuals such as unemployed sick-listed persons. In fact, a labour market problem turns into a medical problem. The hypothesis needs further testing in quantitative studies.

Long-term sickness absence due to burnout: absentees' experiences.

In the late 1990s, there was a marked increase in Sweden in long-term sickness absence with mental diagnoses. In the extensive research on burnout, little attention has been paid to the link with sickness absence. Our aim in this study was to discover what caused burnout, or such severe stress that it led to long-term sickness absence (> 28 days). We interviewed 32 individuals on long-term sickness absence with a diagnosis of burnout and used grounded theory to analyze the data. We believe that events prior to the sickness absence can be understood as a process of emotional deprivation, and we described the process in terms of a flight of stairs with eight steps: "The Burnout Stairs." We argue that the emotion conveying the process of emotional deprivation is unacknowledged shame, which has its basis in poor social relations at work. We discuss the study's limitations and the need for further research in this field.

Microflora changes with norfloxacin and pivmecillinam in women with recurrent urinary tract infection.

Similar changes in the periurethral and vaginal microflora were observed in 19 women with recurrent urinary tract infection following treatment with norfloxacin (NOR) or pivmecillinam (PIV). Escherichia coli strains were suppressed by both treatments. Staphylococcus spp. and enterococci colony counts increased following PIV treatment in the periurethral flora but remained stable with NOR.

Caries and associated factors in a group of Swedish children 2- 3 years of age.

The reported skew distribution of caries prevalence in preschool children, with a small group of children with very high caries prevalence, stresses the importance of early identification for prevention. The present study aimed to describe the caries prevalence in a group of Swedish preschool children and to identify caries risk factors in this population. 221 children, 2 to 3 years old, agreed to participate in the study (82%). A standardized questionnaire was used to describe socio-economic factors, dietary and oral hygiene habits and exposure to fluoride. Initial and manifest dental caries was diagnosed and the presence of plaque was visually observed without disclosing solution. Saliva and plaque samples were collected for identification of mutans streptococci (MS). For statistical analysis,the Student's t-test,the Chi-square test and Fisher's exact test were used. The caries prevalence among the 2 to 3 year-olds was 7 and 18 percent respectively. An association between early childhood caries and a number of factors was found e.g. the presence of MS and visible plaque, nocturnal meals, frequent sugar consumption, mothers' state of employment and immigrant background. The Public Dental Health Service has been successful in decreasing the number of children with caries, but the challenge remains to be able to control caries in the high-risk group. The skew distribution, with many children without caries and a smaller group with very high caries prevalence, was confirmed. The study provided insight into various factors, useful for monitoring children at risk of developing early childhood caries.

A statistical resampling method to calculate biomagnification factors exemplified with organochlorine data from herring (Clupea harengus) muscle and guillemot (Uria aalge) egg from the Baltic sea.

A novel method for calculating biomagnification factors is presented and demonstrated using contaminant concentration data from the Swedish national monitoring program regarding organochlorine contaminants (OCs) in herring (Clupea harengus) muscle and guillemot (Uria aalge) egg, sampled from 1996 to 1999 from the Baltic Sea. With this randomly sampled ratios (RSR) method, biomagnification factors (BMF(RSR)) were generated and denoted with standard deviation (SD) as a measure of the variation. The BMFRsR were calculated by randomly selecting one guillemot egg out of a total of 29 and one herring out of a total of 74, and the ratio was determined between the concentration of a given OC in that egg and the concentration of the same OC in that herring. With the resampling technique, this was performed 50 000 times for any given OC, and from this new distribution of ratios, BMF(RSR) for each OC were calculated and given as geometric mean (GM) with GM standard deviation (GMSD) range, arithmetic mean (AM) with AMSD range, and minimum (BMF(MIN)) as well as maximum (BMF(MAX)) biomagnification factors. The 14 analyzed OCs were p,p'DDT and its metabolites p,p'DDE and p,p'DDD, polychlorinated biphenyls (PCB congeners: CB28, CB52, CB101, CB118, CB138, CB153, and CB180), hexachlorocyclohexane isomers (alpha-, beta-, and gammaHCH), and hexachlorobenzene (HCB). Multivariate data analysis (MVDA) methods, including principal components analysis (PCA), partial least squares regression (PLS), and PLS discriminant analyses (PLS-DA), were first used to extract information from the complex biological and chemical data generated from each individual animal. MVDA were used to model similarities/dissimilarities regarding species (PCA, PLS-DA), sample years (PLS), and sample location (PLS-DA) to give a deeper understanding of the data that the BMF modeling was based upon. Contaminants that biomagnify, that had BMF(RSR) significantly higher than one, were p,p'DDE, CB118, HCB, CB138, CB180, CB153, ,betaHCH, and CB28. The contaminants that did not biomagnifywere p,p'DDT, p,p'DDD, alphaHCH, CB101, and CB52. Eventual biomagnification for gammaHCH could not be determined. The BMF(RSR) for OCs present in herring muscle and guillemot egg showed a broad span with large variations for each contaminant. To be able to make reliable calculations of BMFs for different contaminants, we emphasize the importance of using data based upon large numbers of, as well as well-defined, individuals.

Total lipid extraction of homogenized and intact lean fish muscles using pressurized fluid extraction and batch extraction techniques.

The reliability and efficiency of pressurized fluid extraction (PFE) technique for the extraction of total lipid content from cod and the effect of sample treatment on the extraction efficiency have been evaluated. The results were compared with two liquid-liquid extraction methods, traditional and modified methods according to Jensen. Optimum conditions were found to be with 2-propanol/n-hexane (65:35, v/v) as a first and n-hexane/diethyl ether (90:10, v/v) as a second solvent, 115 degrees C, and 10 min of static time. PFE extracts were cleaned up using the same procedure as in the methods according to Jensen. When total lipid yields obtained from homogenized cod muscle using PFE were compared yields obtained with original and modified Jensen methods, PFE gave significantly higher yields, approximately 10% higher (t test, P < 0.05). Infrared and NMR spectroscopy suggested that the additional material that inflates the gravimetric results is rather homogeneous and is primarily consists of phospholipid with headgroups of inositidic and/or glycosidic nature. The comparative study demonstrated that PFE is an alternative suitable technique to extract total lipid content from homogenized cod (lean fish) and herring (fat fish) muscle showing a precision comparable to that obtained with the traditional and modified Jensen methods. Despite the necessary cleanup step, PFE showed important advantages in the solvent consumption was cut by approximately 50% and automated extraction was possible.

Characterization of the human immune response to the UK anthrax vaccine.

The anthrax bipartite lethal toxin (protective antigen (PA) and lethal factor (LF))-specific antibody responses of humans receiving the UK licensed anthrax vaccine were determined. The PA-specific IgG response peaked two weeks post immunization and fell back to pre-boost levels by week 12. The heterogeneity of the host population modulated the extent of the PA-specific antibody response. Significantly lower levels of LF-specific antibodies were also detected. Vaccinated individuals recognized the same PA epitope as the protective mouse lethal toxin neutralizing monoclonal 2D3 suggesting that this may also be a target for human protection.