Long term effects of childhood trauma and abuse: Narrative on functional neurological disorder.

Functional neurological disorder is a condition in which a person experiences physical symptoms that cannot be fully explained by a medical condition. In Pakistan, domestic violence as well as emotional, physical and sexual abuse in children are prevalent. Despite legal and social support for victims, stigmatisation regarding seeking psychological help complicates the challenge. Some of the research culminated that patients with neurological disorder reported high level of sexual abuse and trauma. The symptomatology of functional neurological disorder is being ignored in Asian countries due to indigenous factors like poverty, lack of information on reporting abuse, poor law-enforcement and victim blaming. Functional neurological disorder can be manifested in various ways in the human body, such as blindness, paralysis, dystonia, swallowing difficulties, difficulty walking, motor symptoms affecting limbs, voice production, problems in sensory functions, problems in cognitive function, psychogenic non-epileptic seizures and even dementia, whereas differential diagnosis is established after screening for organicity. The common risk factors of functional neurological disorder may include psychosocial stressors, family history of functional neurological disorder, and significant life changes. It is critical to understand the disorder in reference to predisposing risk factors, cultural context, comorbidities and gender specification to diagnose and treat functional neurological disorder in time so that better intervention protocols could be devised to treat it efficiently.

Development and Evaluation of a Community Advisory Board for Family Violence.

Although intimate partner violence (IPV) is an important risk factor for child physical abuse, most IPV-exposed children are not evaluated for abusive injuries. A Community Advisory Board (CAB) was formed to (a) optimize a program to evaluate IPV-exposed children for abusive injuries and (b) inform research methods to engage IPV victims and their children. The objectives of this study were to implement and to evaluate the family violence CAB. Following best practices on CAB formation, we recruited local stakeholders with key roles as service providers, community leaders, and knowledge experts in IPV, child abuse, and emergency care. Fourteen members met bimonthly to develop a family-centered intervention and to inform research and advocacy activities. A shared memorandum of understanding outlined goals and objectives. One year after the CAB's implementation, a research assistant interviewed CAB members to understand their experiences, perceived benefits of participation, and desired improvements. Eleven CAB members, including an IPV survivor, participated. Emerging categories included (a) motivations to join the CAB (victim advocacy), (b) benefits of participation (development of relationships among members and increased acceptability of research methods), (c) facilitators of sustainability (program adaptability and development of trust), and (d) desired improvements (case-based follow-up). The CAB was successfully implemented and facilitated the development of collaborative relationships among stakeholders with key roles in IPV and child abuse. The CAB led to community member-proposed changes in research activities and clinical care for victims of IPV.

Caseload factors predictive of family abuse and neglect treatment outcomes.

BACKGROUND: In child welfare, caseloads are frequently far higher than optimal. Not all cases are created equal; however, little is known about which combination and interaction of factors make caseloads more challenging and impact child and family outcomes. OBJECTIVE: This study aims to identify which case, provider, and organizational factors most strongly differentiate between families with favorable and less-than-positive treatment outcomes. PARTICIPANTS AND SETTING: Participants were 25 family advocacy program providers and 17 supervisors at 11 Department of the Air Force installations. METHODS: Following informed consent, participants completed demographic and caseload questionnaires, and we collected information about organizational factors. Providers were sent a weekly case update and burnout questionnaire for seven months. We used linear mixed-effects model tree (LMM tree) algorithms to determine the provider, client, and organizational characteristics that best distinguish between favorable vs. unfavorable outcomes. RESULTS: The LMM tree predicting provider-rated treatment success yielded three significant partitioning variables: (a) commander involvement, (b) case complexity, and (c) % of clients in a high-risk field. The LMM predicting client-rated treatment progress yielded seven significant partitioning variables: (a) command involvement; (b) ease of reaching tenant unit command; (c) # of high-risk cases; (d) % of clients receiving Alcohol and Drug Abuse Prevention and Treatment services; (e) ease of reaching command; (f) % of clients with legal involvement; (g) provider age. CONCLUSIONS: This study is a first step toward developing a dynamic caseload management tool. An intelligent, algorithm-informed approach to case assignment could help child welfare agencies operate in their typically resource-scarce contexts in a manner that improves outcomes.

Receipt of parenting, disability, unemployment, and other income support payments in persons aged 16 to 33 years - the associations with child maltreatment.

BACKGROUND: Child maltreatment (CM) is a major public health concern with life-long effects. Its impact on income support has rarely been studied. OBJECTIVE: To examine the association between CM and receipt of income support payments and the budgetary impact for persons 16 to 33 years. PARTICIPANTS AND SETTING: A South Australian birth cohort, born 1986 to 2004 (n = 339,411). METHODS: We linked child protection (CP) administrative records with national welfare payment records, ending March 2020. Receipt of income support payments and mean payment amounts were described by CP contact (adjusted for child and family attributes). Budget impact was modelled at the national level. RESULTS: Adjusted odds ratio (AOR) for receipt of any income support payment was 3.01 (2.95-3.07) for individuals with any CP contact versus no CP contact. Among those receiving any payment, adjusted annualised mean benefit payment was $3754 (US$1446) among individuals with no CP contact, $6262 (US$4,307) in persons with any CP contact, and $9,747 in persons who'd been in OOHC. Cumulative payments modelled from age 16 to 33 years totalled $38,570 (US$26,652) for individuals with no CP contact, and $181,743 (US$125,003) for individuals who'd been in OOHC. Modelled for the Australian population to age 33, the extra cost associated with CP contact added 39 % to the government income support budget. CONCLUSION: CM is strongly associated with receipt of income support payments. Investment in effective preventive and protective strategies for CP involved children could address this core social determinant of health, while providing budget savings.

The ripple effect of trauma: Evaluating vulnerability, post-traumatic stress symptoms, and aggression within a child and adolescent population.

BACKGROUND: The deleterious effects of experiencing adverse childhood experiences (ACEs), especially those associated with child abuse and neglect (CM-ACEs), is well documented. Two common behavioral and emotional concerns observed in children following CM-ACEs is post-traumatic stress and aggression. While support for cognitive models explaining both of these outcomes exists, little is known about any shared cognitive vulnerabilities that may explain the presence of both. OBJECTIVE: The purpose of the current study was to evaluate a cognitive model of vulnerability/safety as a shared underlying mechanism for the development of post-traumatic stress symptoms (PTSS) and aggression following the occurrence of CM-ACEs in children. METHODS: Male youth between the ages of 6 and 14 attending school within a residential setting participated in a school-based performance improvement program. As a part of the program, data were collected on the child's history of abuse, PTSS, aggression, and feelings of safety and vulnerability. RESULTS: The results of the SEM suggested that there was a significant serial indirect effect of vulnerability and PTSS on the relation between CM-ACEs and reactive aggression. This was not true for proactive aggression. DISCUSSION: The current results suggest that that there may be a shared schema-based model in which feelings of vulnerability and cognitive models promoting the world as an unsafe place may contribute to the maintenance and development of both PTSS and reactive aggression among children who have experienced abuse/neglect.

Childhood Trauma and its Relationship with Anxiety, Depression, and Suicidal Ideation among a Community Sample in Ilisan-Remo, Southwestern Nigeria: A Cross-Sectional Study.

BACKGROUND: Childhood exposure to maltreatment is an endemic health issue with tragic personal and socioeconomic repercussions. There is a dearth of information on the psychological outcomes of childhood trauma, specifically anxiety and depression, in adulthood in Nigeria. This study was conducted to determine the prevalence of childhood trauma and its relationship with anxiety, depression, and suicidal ideation among adults in a Nigerian community. METHODS: The study is a product of a secondary analysis of the relevant aspects of the data collected for the Ilisan-Remo Functional Bowel Disorder Project. It was a cross-sectional community-based study of adult aged 18-70 years in Nigeria. The relevant aspects of the research instrument included the demographic information; the Beck Anxiety and Depression Inventories for assessing anxiety and depression respectively, and the Early Trauma Inventory-Self Report Short-Form for accessing childhood trauma. Data were summarized and analyzed with appropriate instruments. Variables with p-values < 0.05 were considered significant. RESULTS: Adequate data for statistical analysis was available for 501 respondents. The mean age of the respondents was 32.69 ±12.8 years. Four hundred and forty (87.8%) respondents had at least one childhood trauma exposure. Physical punishment had the highest prevalence (77.2%), followed by general trauma (68.9%), emotional abuse (51.1%) and sexual abuse (34.9%). All the childhood traumas were either moderately or weakly correlated with the psychopathologies except physical trauma which was not correlated with suicidal ideation. Childhood trauma had a significant association with anxiety [AOR = 1.23 (95% CI, 1.13 - 1.35), p<0.001], depression [AOR = 1.19 (95% CI, 1.13 - 1.25), p <0.001] and suicidal ideation [AOR = 1.09 (95% CI, 1.02 - 1.16), p = 0.007]. CONCLUSION: The prevalence of childhood trauma was high in our study population and was associated with sychopathologies in adulthood. Stakeholders such as parents, government, teachers, and civil society organizations should make a concerted effort to deter it.

CONTEXTE: L'exposition des enfants aux mauvais traitements est un problème de santé endémique avec des répercussions personnelles et socio-économiques tragiques. Il existe une pénurie d'informations sur les conséquences psychologiques des traumatismes infantiles, notamment l'anxiété et la dépression à l'âge adulte au Nigeria. Cette étude a été menée pour déterminer la prévalence des traumatismes infantiles et leur relation avec l'anxiété, la dépression et les idées suicidaires chez les adultes d'une communauté nigériane. MÉTHODES: L'étude est issue d'une analyse secondaire des aspects pertinents des données collectées pour le projet Ilisan-Remo sur les troubles fonctionnels de l'intestin. Il s'agissait d'une étude transversale communautaire auprès d'adultes âgés de 18 à 70 ans au Nigeria. Les aspects pertinents de l'instrument de recherche comprenaient des informations démographiques ; les inventaires d'anxiété et de dépression de Beck pour évaluer respectivement l'anxiété et la dépression, et l'inventaire des traumatismes précoces - auto-rapport version courte pour évaluer les traumatismes infantiles. Les données ont été résumées et analysées avec des instruments appropriés. Les variables avec des valeurs de p < 0,05 ont été considérées comme significatives. RÉSULTATS: Des données adéquates pour l'analyse statistique étaient disponibles pour 501 répondants. L'âge moyen des répondants était de 32,69 ±12,8 ans. Quatre cent quarante (87,8 %) répondants avaient été exposés à au moins un traumatisme infantile. La punition physique avait la plus haute prévalence (77,2 %), suivie des traumatismes généraux (68,9 %), des abus émotionnels (51,1 %) et des abus sexuels (34,9 %). Tous les traumatismes infantiles étaient modérément ou faiblement corrélés avec les psychopathologies, sauf le traumatisme physique qui n'était pas corrélé avec les idées suicidaires. Les traumatismes infantiles avaient une association significative avec l'anxiété [OR ajusté = 1,23 (IC à 95 %, 1,13 ­ 1,35), p < 0,001], la dépression [OR ajusté = 1,19 (IC à 95 %, 1,13 ­ 1,25), p < 0,001] et les idées suicidaires [OR ajusté = 1,09 (IC à 95 %, 1,02 ­ 1,16), p = 0,007]. CONCLUSION: La prévalence des traumatismes infantiles était élevée dans notre population d'étude et était associée à des psychopathologies à l'âge adulte. Les parties prenantes telles que les parents, le gouvernement, les enseignants et les organisations de la société civile devraient faire des efforts concertés pour les prévenir. MOTS CLÉS: Traumatismes infantiles, Maltraitance des enfants, Anxiété, dépression, Nigeria.

Reviewing hereditary connective tissue disorders: Proposals of harmonic medicolegal assessments.

Hereditary connective tissue disorders (HCTDs) are a heterogeneous group of inherited diseases. These disorders show genetic mutations with loss of function of primary components of connective tissue, such as collagen and elastic fibers. There are more than 200 conditions that involve hereditary connective tissue disorders, while the most known are Marfan syndrome, Osteogenesis Imperfecta, and Ehlers-Danlos syndromes. These disorders need continuous updates, multidisciplinary skills, and specific methodologic evaluations sharing many medicolegal issues. Marfan syndrome and Ehlers-Danlos syndromes show a high risk of early sudden death. As a consequence of this, postmortem genetic testing can identify novel genotype-phenotype correlations which help the clinicians to assess personalized cardiovascular screening programs among the ill subjects. Genetic testing is also essential to identify children suffering from Osteogenesis Imperfecta, especially when a physical abuse is clinically suspected. However, this is a well-known clinical problem even though there are still challenges to interpret genetic data and variants of unknown significance due to the current extensive use of new genetic/genomic techniques. Additionally, the more significant applications and complexities of genomic testing raise novel responsibilities on the clinicians, geneticists, and forensic practitioners as well, increasing potential liability and medical malpractice claims. This systematic review provides a detailed overview on how multidisciplinary skills belonging to clinicians, medicolegal consultants, radiologists, and geneticists can cooperate to manage HCTDs from autopsy or clinical findings to genetic testing. Thus, technical aspects need to be addressed to the medicolegal community since there is no consensus works or guidelines which specifically discuss these issues.

Alexithymia as a mediator between adverse childhood events and the development of psychopathology: a meta-analysis.

Introduction: Victims of child abuse have an elevated risk of developing mental health issues later in life. Several variables have been suggested as mediators of this correlation, but little is known about the possible influence of alexithymia. Alexithymia is a sub-clinical personality trait that manifests as difficulties recognizing and verbalizing emotions. Methods: In this study, two separate meta-analyses were conducted using questionnaire data, and Pearson correlations for overall effects were estimated. Results: The correlation between child abuse and alexithymia showed to be significant (r = .26), as did the correlation between alexithymia and general psychopathology (r = .44). Further analyses revealed no indication for possible publication bias. When investigating differences between various subtypes of child maltreatment, each subtype significantly correlated with alexithymia. Emotional abuse, emotional neglect, and physical neglect had stronger correlations than physical and sexual abuse. Discussion: These results suggest that alexithymia plays a mediating role, at least in part, in the relationship between experiences of child abuse and general psychopathology in adulthood. Therefore, alexithymia may be relevant to further research and deserves attention in the prevention of and therapy for mental health issues in victims of child abuse.

"I got to say two or three lines"-A systematic review of children's participation in child protective services.

BACKGROUND: Although children's right to participate in decisions that influence their lives is widely recognized, it is rarely present in the assessment and decision-making processes in child protective services (CPS). OBJECTIVE: The aim of this systematic review was to examine children's views and experiences of participating in CPS cases of child abuse and neglect and to identify the gap in scientific knowledge. METHODS: The systematic review follows the PRISMA statement and includes 13 peer-reviewed articles published in several academic journals from 2016 to 2023 reporting primary research with abused and neglected children registered in CPS. RESULTS: Thematic analysis identified five main themes: participation: assessment and decision-making, information and understanding, interaction and relationships, children vs parents, and experience of younger children. The findings show that although a few children reported instances of meaningful participation, overall, children's participation was often reduced to a tokenistic engagement, with limited influence on the decision-making processes. Children, especially younger children, receive insufficient information and struggle to understand the proceedings. Examples of prioritizing parents' views, needs, and rights rather than centering the children's perspectives are reported. CONCLUSIONS: The findings highlight a need for significant changes in how child participation is conceptualized and operationalized within CPS. Implications for practice, policy, and research are discussed to foster children's participation in CPS to contribute to the effective care and protection of children experiencing child abuse and neglect.

A hybrid digital parenting programme to prevent abuse of adolescents in Tanzania: statistical analysis plan for a pragmatic cluster randomised controlled trial.

BACKGROUND: Globally, violence against children poses substantial health and economic challenges, with estimated costs nearing USD 7 trillion. This prompts the urgent call for effective evidence-based interventions in preventing and mitigating violence against children. ParentApp is a mobile, open-source application designed to offer a remote version of the Parenting for Lifelong Health (PLH) programme. ParentApp is the first digital parenting intervention for caregivers of adolescents aged 10-17 years to be tested in low- and middle-income settings. METHODS: This study is a pragmatic, two-arm, cluster-randomised trial in Mwanza, Tanzania's urban and peri-urban areas. Assessments are set for baseline, 1 month post-intervention, and 12 months post-intervention. We randomised 80 clusters, each with about 30 caregiver-adolescent dyads, with a 1:1 ratio stratified by urban or peri-urban location. Both arms receive an entry-level smartphone preloaded with Kiswahili apps-ParentApp for intervention and WashApp control. The primary method of analysis will be generalised linear mixed-effects models with adjustment for person-level characteristics and multiple imputation. In three-level models, measurement waves are nested within a person, nested within a sub-ward. Regressions will constrain groups to be equal at baseline and include covariates for stratification, percentage of male caregivers, and individual-level characteristics. DISCUSSIONS: Preparations for the trial began in December 2022, including community mobilisation and sensitisation. Rolling recruitment, baseline data collection, and implementation onboarding took place between April and September 2023. One-month post-test data collection began in August 2023 and thus far achieved 97% and 94% retention rates for caregivers and adolescents respectively. Final post-test data collection will begin in September 2024, anticipated to run until April 2025. This SAP was submitted to the journal before the interim analysis to preserve scientific integrity under a superiority hypothesis testing framework. TRIAL REGISTRATION: The trial was registered on the Open Science Framework on 14 March 2023: https://doi.org/10.17605/OSF.IO/T9FXZ . The trial protocol was published in Trials 25, 119 (2024): Baerecke, L., Ornellas, A., Wamoyi, J. et al. A hybrid digital parenting programme to prevent abuse of adolescents in Tanzania: study protocol for a pragmatic cluster-randomised controlled trial. Trials 25, 119 (2024). https://doi.org/10.1186/s13063-023-07893-x .

Deliberate Practice as an Effective Method for Reducing Diagnostic Error in Identifying Burn and Bruise Injuries Suspicious for an Abusive Injury.

OBJECTIVES: To examine the effectiveness of an education intervention for reducing physician diagnostic error in identifying pediatric burn and bruise injuries suspicious for abuse, and to determine case-specific variables associated with an increased risk of diagnostic error. STUDY DESIGN: This was a multicenter, prospective, cross-sectional study. A convenience sample of pediatricians and other front-line physicians who treat acutely injured children in the United States and Canada were eligible for participation. Using a web-based education and assessment platform, physicians deliberately practiced with a spectrum of 300 pediatric burn and bruise injury image-based cases. Participants were asked if there was a suspicion for abuse present or absent, were given corrective feedback after every case, and received summative diagnostic performance overall (accuracy), suspicion for abuse present (sensitivity), and absent (specificity). RESULT: Of the 93/137 (67.9%) physicians who completed all 300 cases, there was a significant reduction in diagnostic error (initial 16.7%, final 1.6%; delta -15.1%; 95% CI 13.5, 16.7), sensitivity error (initial 11.9%, final 0.7%; delta -11.2%; 95% CI 9.8, 12.5), and specificity error (initial 23.3%, final 6.6%; delta -16.7%; 95% CI 14.8, 18.6). Based on 35,627 case interpretations, variables associated with diagnostic error included patient age, sex, skin color, mechanism of injury, and size and pattern of injury. CONCLUSION: The education intervention substantially reduced diagnostic error in differentiating the presence versus absence of a suspicion for abuse in children with burn and bruise injuries. Several case-based variables were associated with diagnostic error, and these data can be used to close specific skill gaps in this clinical domain.

Identifying inflicted injuries in infants and young children.

Child physical abuse is a common cause of pediatric morbidity and mortality. Up to half of all children presenting with abusive injuries have a history of a prior suspicious injury, suggesting a pattern of repeated physical abuse. Medical providers are responsible for identifying children with suspicious injuries, completing mandated reporting to child protective services for investigation, and screening for occult injuries and underlying medical conditions that can predispose to injuries. Early identification of inflicted injuries appropriate evaluations may serve as an opportunity for life-saving intervention and prevent further escalation of abuse. However, identification of abuse can be challenging. This article will review both physical exam findings and injuries that suggest abuse as well as the evaluation and management of physical abuse.

Trauma-informed care.

In recent years, trauma informed care has become a heavily researched topic; however, it has yet to achieve a universal standard in the field of pediatric medicine. One of the primary tenants of trauma informed care is a clear understanding of the pervasiveness and complexities of childhood trauma, and its intersection with a child and caregiver's physical wellness. A major component of trauma informed care is addressing the way medical providers may be exposed to vicarious trauma, secondary traumatic stress, and compassion fatigue. By taking proactive steps to educate medical providers on the effects of trauma, they are better equipped to assess a family's needs and provide enhanced quality of care for their patients and themselves.

Barriers to medical consultation and strategies for enhancing the prevention and reporting of child abuse: A cross-sectional survey of caregivers of paediatric patients at a tertiary care center in Karachi, Pakistan.

Objective: To assess the knowledge of caregivers in a tertiary care setting about child abuse, their perception of potential barriers in the way of seeking medical advice for the victims, and to identify proposed solutions to ensure prevention and reporting of child abuse. METHODS: The cross-sectional study was conducted from June to December 2022 at the paediatric ward of the Aga Khan University Hospital, Karachi, and comprised caregivers who were attendants of inpatients. Data was collected using a predesigned anonymous questionnaire consisting of demographic information and 27 items that were scored on a 6-point Likert scale. Data was analysed using SPSS 20. RESULTS: Of the 144 caregivers, 96(66.6%) were females and 48(33.3%) were males. Overall, 86(59.7%) were aged <35 years, 132(91.7%) were married, and 120(83.3%) were the admitted child's parent. The majority of caregivers 110(76.4%) perceived themselves to possess a high level of knowledge about child abuse. Barriers identified included a lack of trust in police and medicolegal departments 136(94.4%), fear of repercussion from the suspect 120(83.3%) and lack of confidentiality of the victims' identity 116(80.6%). The proposed solutions included spreading awareness among teachers 136(94.4%) and caregivers 131(91.0%) about timely reporting and consultation, and developing proper mechanisms to follow-up on victims 133(92.4%). There were significant associations between some demographic characteristics of the respondents and their self-perceived knowledge and perceptions (p<0.05). Conclusion: There was found a need to enhance public trust, ensure confidentiality, and fostering awareness through targeted strategies for a safer and more facilitative environment for children.

Violencia y maltrato infantil. El aporte del médico radiólogo al abordaje integral multidisciplinario / Child maltreatment and violence. Contributions from radiologists to a comprehensive multidisciplinary approach

El maltrato infantil es definido por la Organización Mundial de la Salud (OMS) como "el abuso y la desatención que sufren los niños menores de 18 años. Incluye todo tipo de maltrato físico y/o emocional […] que resulte en un daño real o potencial para la salud, la supervivencia, el desarrollo o la dignidad del niño". Al examinar los rastros corporales del maltrato físico, siguiendo los mecanismos de lesión más frecuentemente implicados, es posible detectar patrones radiológicos típicos. La evaluación imagenológica del hueso en reparación permite inferir cronologías para correlacionar con los datos obtenidos en la anamnesis. Los profesionales de la salud deben detectar oportunamente lesiones radiológicas sospechosas y activar de forma temprana el resguardo del menor. Nuestro propósito es realizar una revisión sobre las publicaciones recientes referidas al estudio imagenológico en niños de quienes se sospeche que puedan ser víctimas de violencia física.

The World Health Organization (WHO) defines child maltreatment as "the abuse and neglect that occurs to children under 18 years of age. It includes all types of physical and/or emotional ill-treatment [...], which results in actual or potential harm to the child's health, survival, development or dignity." By examining the bodily traces of physical abuse, following the most frequently involved mechanisms of injury, it is possible to identify typical radiological patterns. The imaging studies of the bone under repair allows inferring a timeline that may be correlated to the data obtained during history taking. Health care providers should detect suspicious radiological lesions in a timely manner and promptly activate the safeguarding of the child. Our objective was to review recent publications on the imaging studies of children suspected of being victims of physical violence.

Fractura craneal deprimida congénita ("fractura ping-pong") en neonatos como diagnóstico diferencial de maltrato físico / Congenital depressed skull fracture ("ping-pong" fracture) in newborn infants as a differential diagnosis of physical abuse

Las fracturas con hundimiento de cráneo sin una explicación clara sobre su origen orientan al traumatismo con un objeto romo y a la sospecha de maltrato infantil. En el caso de los bebés recién nacidos, su corta edad es un factor de vulnerabilidad y obliga a una exhaustiva evaluación. Ante la sospecha de maltrato infantil, resulta importante evaluar los diagnósticos diferenciales para realizar la intervención más adecuada posible. Es necesario evitar tanto intervenciones excesivas como omitir la intervención que sea necesaria. Las fracturas craneales deprimidas congénitas, descritas como "fracturas pingpong", son raras (0,3 a 2/10 000 partos). Pueden aparecer sin antecedentes traumáticos o en partos instrumentalizados. Se describe en este artículo el caso de un recién nacido con una fractura ping-pong como ejemplo de una fractura no intencional.

Depressed skull fractures without a clear explanation as to their origin point to trauma with a blunt object and suspected child abuse. In the case of newborn infants, their young age is a vulnerability factor and requires an exhaustive assessment. When child abuse is suspected, an assessment of the differential diagnoses is required to make the most appropriate intervention possible. Both an excessive intervention and an omission of a necessary intervention should be avoided. Congenital depressed skull fractures, described as "ping-pong fractures", are rare (0.3 to 2/10 000 births). They may appear without any trauma history or in instrumentalized childbirth. Here we describe the case of a newborn infant with a ping-pong fracture as an example of an accidental fracture.

Conhecimentos e condutas dos cirurgiões-dentistas do estado do Rio Grande do Norte sobre denúncias e notificações de maus-tratos infantis / Knowledge and conduct of dentists of State of Rio Grande do Norte regarding complaints and notifications of child abuse

Os maus-tratos infantis são considerados um problema de saúde a nível mundial. Diante dessa realidade, destaca-se a relevante atuação dos profissionais de saúde na identificação, diagnóstico, notificação e, consequentemente, na redução no número de casos. O Cirurgião-Dentista apresenta-se em uma posição privilegiada no que diz respeito à identificação de casos de violência, visto que a maioria das lesões de ordem física a crianças e adolescentes se apresenta em região de cabeça e pescoço. Dessa forma, objetiva-se identificar as experiências e conduta dos cirurgiões-dentistas do Rio Grande do Norte sobre maus-tratos infantis. Foi realizado um estudo exploratório de caráter quantitativo mediante aplicação de um formulário eletrônico, com questões semiestruturadas, enviado aos dentistas com inscrições ativas no Conselho Regional de Odontologia do Rio Grande do Norte. Foi obtido um total de 100 questionários respondidos. Para análise dos dados, utilizou-se a estatística descritiva e testes de associação. Os resultados revelaram que 14% dos profissionais relataram ter visto caso suspeito de abuso físico, porém nenhum destes realizou notificação no último semestre. Apesar das médias das respostas terem sido superiores a 6 quanto à disposição para detecção, capacidade de diagnóstico e de identificação dos maus-tratos, esses resultados não corroboram com o número de profissionais que considera necessário maior qualificação em diagnóstico ou que desconhecem qualquer meio de notificação. A capacitação técnico-científica para a identificação e diagnóstico diferencial é importante e a responsabilidade pela notificação de casos suspeitos às autoridades é imprescindível para o exercício da profissão em consonância com os valores de cidadania e justiça

Child abuse is considered a global health problem. Given this reality, the relevant role of health professionals in identifying, diagnosing, reporting and, consequently, reducing the number of cases stands out. The dentist is in a privileged position with regard to identifying cases of violence, given that the majority of physical injuries to children and adolescents occur in the head and neck region. Thus, the objective is to identify the experiences and conduct of dentists in Rio Grande do Norte regarding child abuse. An exploratory quantitative study was carried out using an electronic form, with semi-structured questions, sent to dentists with active registrations at the Rio Grande do Norte Regional Dentistry Council. A total of 100 completed questionnaires were obtained. For data analysis, descriptive statistics and association tests were used. The results revealed that 14% of professionals reported having seen a suspected case of physical abuse, but none of them reported it in the last semester. Although the response averages were higher than 6 in terms of willingness to detect, diagnose and identify abuse, these results do not corroborate the number of professionals who consider it necessary to have greater qualifications in diagnosis or who are unaware of any means of reporting. Technical-scientific training for identification and differential diagnosis is important and the responsibility for reporting suspected cases to the authorities is essential for exercising the profession in line with the values of citizenship and justice

Prevalence of childhood trauma in patients with psychiatric disorders and its association with perceived social support and suicide attempts: A cross-sectional observational study in a tertiary hospital in South India.

Background: Adverse childhood experiences include exposure of children to physical abuse, physical neglect, emotional neglect, emotional abuse, and sexual abuse. Children exposed to severe maltreatment and trauma during their early childhood are at a higher risk of early onset of psychiatric disorders. Aim: To find the prevalence of childhood adverse experiences in psychiatric patients and its association with perceived social support and suicidal attempts. Materials and Methods: A cross-sectional observational study was conducted in the psychiatry outpatient department at a tertiary care hospital in Kerala. Patients with a diagnosis of substance use disorders, psychotic disorders, mood disorders, and neurotic disorders according to ICD-10 (F10-F45) and in remission were included in the study. Institutional Ethical Committee approval and informed consent from the participants were obtained. Socio-demographic and clinical details were obtained. Childhood Trauma Questionnaire-Short Form and Multidimensional scale of Perceived Social Support were administered. Descriptive statistics and Chi-square test were employed for data analysis. Results: Eighty-five per cent of the subjects had a history of at least one type of childhood trauma. Emotional abuse was the most commonly reported type of trauma. Among patients with childhood trauma, 47.2% reported high levels of perceived social support, whereas 18.5% individuals reported a history of at least one suicide attempt. Conclusions: A significant proportion of patients with psychiatric disorders in an Indian setting have experienced childhood trauma. Childhood trauma in psychiatric disorders is associated with a higher risk of attempting suicide.

Screening for Child Abuse in the Emergency Department of Academic Hospital Paramaribo in Suriname.

Background. Child abuse in Suriname has a prevalence between 58.2% and 68.8%. This prospective observational study evaluates the implementation of screening for child abuse at the Emergency Department (ED) of the Academic Hospital Paramaribo (AZP). Methods. Children (0-16 years) presenting with injury from 01-02-2018 until 31-08-2018 were eligible. Case-record-forms were completed. Multidisciplinary meetings were used to evaluate positive screened and admitted patients. Diagnostic accuracy was calculated and results were compared to retrospective data from 2016. Results. 3253 Children attended the ED. In 1190 (36.6%) children, the screening was completed. The screening was positive in 148 (12%); in 71 (6%) cases child abuse was confirmed. The sensitivity and specificity were 0.88 and 0.92 respectively, PPV 0.43, NPV 0.99. There was a significant increase of detected child abuse cases; 4.4% in 2016 versus 6% in 2018 (P = .04). Conclusion. Implementation of screening at the ED in the AZP increased detection of child abuse. To improve screening's accuracy, more education for healthcare professionals is pivotal.