Unmet health care needs over the first 2 years after pediatric traumatic brain injury.

AIM: Few studies have addressed how children and adolescents with traumatic brain injuries (TBIs) access health care and educational services. This study aimed to investigate the course of symptoms during the first two years after TBI, whether symptoms implied a need for health care and/or educational services, and the extent of unmet needs. The association between unmet needs and health-related quality of life was also explored. METHODS: This prospective cohort study was conducted at Oslo University Hospital, Norway, from 2015 to 2018. Forty-nine patients aged 1-15 years hospitalized due to TBI were included and followed for 24 months. Registration of symptoms and identification of unmet needs was based on clinical assessment, self-reports and interviews with patients and parents during the acute phase and at 6 and 24 months postinjury. RESULTS: Twenty-five percent of the sample presented with unmet needs at 24 months. Compared to the group with no needs and met needs, these patients reported lasting cognitive and emotional symptoms affecting school and social interaction and scored lower on health-related quality of life. CONCLUSION: Pediatric patients with TBI may have long-term symptom burden affecting school and social functioning, leading to unmet needs if targeted services are not provided.

Violence and sexual abuse rates before and during the Covid-19 pandemic: A prospective population-based study on Norwegian youth.

BACKGROUND: Considerable concern is raised as to whether the pandemic has led to an increase in violence and sexual abuse against children. OBJECTIVE: The present study objective is to provide rates of violence and sexual abuse against adolescents the year before the pandemic compared to one year into the pandemic. PARTICIPANTS AND SETTING: Two samples of Norwegian 12-16-year-olds were approached. A representative pre-pandemic sample of 9240 adolescents (M age (SD) = 14.11(0.88), and a sample recruited one year into the pandemic resulting in 3540 responses (M age (SD) = 14.5 (0.96)). METHODS: An online survey was administered during school hours including established measures of violence and sexual abuse exposure. Sociodemographic characteristics were assessed. RESULTS: There was 1.4 percentage point increase in sexual abuse by an adult, and a 3.9 percentage point decrease in psychological violence by a parent during the pandemic compared to the year before the pandemic. Otherwise, violence and sexual abuse rates remained stable across these two time periods. Risk factors for violence and sexual abuse were amplified during the pandemic. CONCLUSION: Norway, a high-income welfare state, imposed measures to counteract the burden of the pandemic mitigation actions for adolescents. This might partly explain the absence of the feared increase in violence towards adolescents. The disproportionate risk for violence and sexual abuse for some groups of adolescents is however concerning, and should be followed up over time.

Almost half of children and adolescents had unmet need 6 months after their traumatic brain injury.

AIM: Very few studies have focused on how children with traumatic brain injuries (TBI) access and use publicly funded healthcare and educational services. We aimed to compare the symptoms, recovery and service use of children with TBIs and a control group with other traumatic injuries. METHODS: This case-control study was conducted at Oslo University Hospital, Norway, from 2015 to 2020. It focused on 49 patients aged 1-15 years who were hospitalised with TBIs and compared them with 51 matched patients with other traumatic injuries. Unmet needs were based on reports from parents, patients and clinicians 6 months after the injury. RESULTS: Many children hospitalised after TBIs experienced persistent cognitive and emotional symptoms that effected their return to school and subsequent social interactions. These were associated with reduced quality of life. Nearly half (47%) of the children in the TBI group had unmet needs after 6 months, compared to 12% of the controls. Patients with TBIs also had more symptoms and showed less favourable recoveries than the controls. CONCLUSION: Paediatric patients with TBIs had long-term cognitive and emotional symptoms that affected their return to school and social functioning. Almost half of them had unmet needs 6 months after their acute injury.

The regulatory role of affective inhibitory control in somatic symptoms among adolescents exposed to child maltreatment: a population-based study.

Adolescents exposed to child maltreatment are at increased risk for various somatic symptoms, but which psychological factors that contribute to this relationship need to be further investigated. Emotion dysregulation is suggested to serve as a proximal link between child maltreatment and somatic complaints. The purpose of the present study was to investigate whether individual differences in affective inhibitory control, a central component in implicit emotion regulation, contribute to the risk of somatic symptoms in adolescents exposed to child maltreatment. Data were drawn from the UEVO study, a national population-based survey of adolescents between 12 and 16 years of age (N = 9240). For this study, we included participants who completed the emotional go/no-go task measuring affective inhibitory control (N = 7241; Mage/SD = 14 years/.87; 52% girls, 47% boys), of which N = 3349 reported at least one incident of maltreatment exposure (57% girls, 41% boys). Exposure to psychological abuse and sexual abuse were associated with somatic symptoms. Affective inhibitory control was related to somatic symptoms, both in the total sample and in adolescents exposed to child maltreatment. The strength of relationships between exposure to psychological abuse and somatic symptoms, as well as sexual abuse and somatic symptoms, were moderated by individual differences in affective inhibitory control problems. Our study suggests that psychological abuse and sexual abuse increase the risk for somatic symptoms in adolescence. Affective inhibitory control, a central component in implicit emotion regulation, was related to somatic symptoms and moderated the relationships between psychological abuse and somatic symptoms, and sexual abuse and somatic symptoms. Revealing these associations in a population-based sample indicates that treatment targeting affective inhibitory control may be beneficial and should be explored further in clinical settings.

Epidemiology of traumatic brain injury in children 15 years and younger in South-Eastern Norway in 2015-16. Implications for prevention and follow-up needs.

OBJECTIVE: This retrospective study aimed to describe the volume, severity, and injury mechanism of all hospital-admitted pediatric traumatic brain injury (pTBI) at Oslo University Hospital (OUH), emphasizing consequences for prevention and factors indicating a need for follow-up programs. METHOD: Data were extracted from the OUH Trauma registry on 176 children, 0-15 years old, admitted to OUH in 2015 and 2016 with a pTBI diagnosis. The dataset contains demographic data, injury mechanism, type, and severity (Glasgow coma scale, GCS; abbreviated injury scale, AIS; injury severity score, ISS), ICD-10 diagnosis codes, level of treatment, and destination of discharge. RESULTS: 79.5% had mild, 9% moderate, and 11.4% severe TBI. The incidence of hospital-treated pTBI in Oslo was 29 per 100,000 per year. The boy: girl ratio was 1.9:1, but in the young teenage group (14-15 years), the ratio was 1:1. Intracranial injury (ICI) identified on CT/MRI was associated with extended hospital stays, with a median of 6 days compared to 1 day for patients without ICI. 27% of the patients assessed as mild TBI at admission had ICI. Children below eight years of age had a higher incidence of moderate and severe ICI from trauma (53% v.s. 28% in children ≥ eight years). CONCLUSION: The injury characteristics of hospital-treated pTBI are in line with other European countries, but we find the boy-girl ratio different as young teenage girls seem to be catching up with the boys. ICI and length of stay should be considered when deciding which patients need follow-up and rehabilitation.

Evaluating a Web-Based Health-Promoting Dialogue Tool in School Health Services: Feasibility and User Experiences.

Adolescence is a sensitive period in life and a time to redefine and learn new skills. In Norway, school health services provide individual health-promoting consultations with all eighth-grade students. As an aid to support these consultations, a dialogue tool called SchoolHealth was developed using a co-creation approach. SchoolHealth consists of a web-based health information form designed to be completed by the students and generates individual feedback reports to help the school nurses to prepare for the consultation and tailor it to the individual student's need. Our aims were to evaluate the feasibility and user experiences of SchoolHealth among students and school nurses using a mixed methods approach. A total of 79 eighth-grade students (69% of those invited) and four school nurses from three schools participated. Analyses indicated that SchoolHealth was feasible, promoted reflection among students, and helped prepare students and school nurses for the consultation.

Cohort profile: Norwegian youth study on child maltreatment (the UEVO study).

PURPOSE: Exposure to childhood maltreatment is not uncommon, and is linked to both short-term and long-term health problems. Population-based surveys for adolescent samples provide excellent opportunities for addressing the substantial burden of early-life adversities, because collecting information close in time to exposure may increase accuracy of assessment. Still few large studies have been conducted, following individuals through adolescence. Therefore, the UEVO cohort was created with the aim of investigating prevalence of child maltreatment throughout childhood and adolescence, and its effects on health and functioning in a long-term perspective in a representative sample of Norwegian adolescents. PARTICIPANTS: The baseline for the cohort includes a representative sample of 9240 Norwegian adolescents (response rate 86.6%) aged 12-16 years, surveyed in January and February 2019. The cohort to be followed over time comprises the 5502 adolescents who agreed to be recontacted for subsequent data collection waves. FINDINGS TO DATE: The overall prevalence figures from the first wave of measurement have been published in a comprehensive national report on child maltreatment in Norway. FUTURE PLANS: A second study wave will commence in 2021, including about half of the original cohort (longitudinal), as well as a new sample starting at age 12. For participants above age 16, original survey data will be connected to national registries (pending indvidual consent), enabling the study of real-life functioning within the areas of healthcare utilisation, school drop-out, work-force participation and prescription of medication.

Adolescent abuse victims displayed physical health complaints and trauma symptoms during post disclosure interviews.

AIM: We investigated whether adolescents who had recently disclosed sexual abuse or family violence displayed more psychological trauma symptoms and physical health complaints than unaffected controls. We also investigated to what degree physical health complaints were associated with trauma symptoms in these abuse victims. METHODS: Abuse, trauma symptoms and physical health complaints were assessed during face-to-face interviews with 40 sexual abuse victims and 35 family violence victims aged 10-18 years. They had all attended forensic interviews at the Barnehus in Oslo, a specialised Norwegian police unit where evidence is gathered in adolescent-friendly surroundings, from October 2016 to November 2018. Their symptoms were compared with 41 controls from the general population. Linear regression analyses investigated associations between trauma symptoms and physical health complaints. RESULTS: Sexually abused adolescents displayed higher levels of post-traumatic stress reactions, depression, dissociation and physical health complaints than unaffected controls. Family violence victims displayed higher levels of post-traumatic stress reactions. Trauma symptoms were associated with physical health complaints, and these were most prominent in the adolescents with the highest burden of symptoms. CONCLUSION: Based on the high burden of symptoms revealed, clinical examinations of abused adolescents should include a systematic assessment of trauma symptoms and physical health complaints.

Am I an island? A network analysis exploring aspects of social landscapes after childhood violence.

OBJECTIVE: Exposure to violence during childhood can have severe long-term consequences for social relationships. In the current study, we sought to disentangle some of the phenomena involved by utilizing a network approach to study the perceptions of aspects of social landscapes in young adulthood of victims of childhood violence. METHOD: We used network analysis to describe the connections between perceived positive social support, barriers to social support, violence-related shame, childhood family cohesion, and perceived negative responses from others for 443 individuals exposed to childhood violence. RESULTS: Respondents' enjoyment of spending time with family in childhood was strongly connected to many other aspects of their social landscapes. The highest values for expected influence were found for worrying about what others thought and experiencing support from others. Finding that other people withdrew from them after the violence had occurred had both high strength centrality and a high value of expected influence and was associated with shame and barriers to social support. CONCLUSIONS: The results suggest that these elements can play important roles in the social landscapes of victims of childhood violence. Further research specifying the directionality between these elements is necessary. It may be helpful for clinicians working with victims of childhood violence to explore their perceptions of their social landscapes. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Bullying in School: Importance of and Challenges Involved in Talking to the School Nurse.

Bullying has negative consequences for health and quality of life of students. This study is part of a pilot project, "School Health," which included a web-based questionnaire completed by students before a consultation with the school nurse. The aim of this study was to explore how students experience answering questions about bullying before an individual consultation and how they talk about bullying with the school nurse. This study had qualitative design with individual and focus group interviews and involved 38 students aged 13-14 years, both boys and girls, from three schools. Data were analyzed according to Kvale's three levels of interpretation within a phenomenological and hermeneutic perspective. The students found it difficult to report being bullied. They expressed confidence in the school nurse and liked talking with her. Some complained about the school environment and reported that having a friend was important.

The Social Context of Violence: A Study of Repeated Victimization in Adolescents and Young Adults.

Multiple factors may influence the risk of exposure to childhood violence and repeated victimization, although most research has focused on individual rather than contextual factors. Moreover, it is unclear whether family background factors associated with exposure to childhood violence also are associated with revictimization in young adulthood. This article investigates individual and contextual factors associated with childhood abuse and revictimization. Data from a community telephone survey, collected at two different time points (N = 1,011, 16-33 years of age), were used. Logistic regression analysis was applied to analyze family background factors in childhood violence-exposed cases and non-exposed controls. Similar analyses were conducted for the relationship of individual and contextual variables in the revictimized and the non-revictimized groups. The adjusted analyses showed that social problems (≥2 or more social problems: odds ratio [OR] = 2.89, 95% confidence interval [CI] = [1.41, 5.94]) and frequent binge drinking (OR = 1.21, 95% CI = [1.05, 1.40]) were significantly associated with repeated victimization whereas social support decreased the odds (OR = 0.74, 95% CI = [0.55, 0.99]). Family problems and low family cohesion growing up (although measured at Wave 2) were significantly associated with childhood exposure to violence, but not with revictimization. Our findings emphasizes that it is useful to separate factors associated with childhood abuse from factors related to revictimization to identify current ecological aspects that can be addressed to prevent further abuse.

The mediating role of posttraumatic stress reactions in the relationship between child abuse and physical health complaints in adolescence and young adulthood.

Background: Child abuse is associated with physical health problems in adolescence and adulthood, but the mechanisms involved are unclear. A possible mediating effect of posttraumatic stress reactions (PTSR) linking child abuse with later physical health complaints has not been fully investigated. Objective: The current study investigated whether PTSR could be a potential mediator in the relationship between child abuse and physical health complaints in adolescents and young adults. If so, we also investigated whether this was the case for different child abuse types alone or in combination. Method: The study sample comprised 506 adolescents and young adult victims of child abuse and 504 unexposed matched controls aged 16-33 from a community sample. We measured child abuse retrospectively and current PTSR at wave 1 (2013), and current physical health complaints at wave 2 (2014/15). We tested a model of PTSR as a possible mediator between child abuse and physical health complaints and conducted causal mediation analysis to estimate direct and indirect pathways. Each child abuse type was studied in isolation and in combination with other abuse types. Results: PTSR had a notable, significant mediating effect on the relationship between child abuse and physical health complaints in our overall model (average causal mediation effect; ACME = 0.14, p < 0.001), accounting for 85% of the total effect. The mediated pathway was also significant in analyses of the different child abuse types. The mediating effect of PTSR was most prominent in individuals reporting exposure to more than one child abuse type. Conclusions: The current study indicates that PTSR may be an important mediator in the relationship between child abuse and physical health complaints. Health professionals should be aware of the important role that PTSR may have in maintaining or exacerbating physical health problems in child abuse victims. However, a reverse model could not be tested in this study and the results need confirmation in future prospective studies.

Antecedentes: El maltrato infantil se encuentra asociado con problemas de salud física en la adolescencia y en la adultez, pero los mecanismos involucrados no son claros. Un posible efecto mediador de las reacciones de estrés traumático (PTSR en su sigla en inglés) relacionando el maltrato infantil con quejas de salud física posteriores no ha sido investigado suficientemente.Objetivo: El presente estudio investigó si la PTSR podría ser un mediador potencial en la relación entre el maltrato infantil y las quejas de salud física en adolescentes y adultos jóvenes. También investigamos si esto era el caso para diferentes tipos de maltrato infantil de forma individual o en combinación.Método: La muestra del estudio consistió en 506 adolescentes y adultos jóvenes víctimas de maltrato infantil y 504 controles sin exposición al maltrato con edades de 16 a 33 años provenientes de una muestra comunitaria. Medimos el maltrato infantil retrospectivamente, el actual PTSR en la ola 1 (2013), y las quejas actuales de salud física en la ola 2 (2014/2015). Pusimos a prueba un modelo de la PTSR como un posible mediador entre el maltrato infantil y las quejas de salud física y llevamos a cabo un análisis de mediación causal para estimar los efectos directos e indirectos. Cada tipo de maltrato fue estudiado de forma separada y en combinación con otros tipos de abuso.Resultados: La PTSR tuvo un efecto mediador significativo en la relación entre el maltrato infantil y las quejas de salud física en nuestro modelo general (efecto mediador causal promedio; ACME en sus siglas en inglés = 0.14, p <0.001), correspondiendo al 85% del efecto total. La mediación fue también significativa en los análisis de los diferentes tipos de maltrato infantil. El efecto mediador de la PRSR fue más prominente en aquellos individuos que reportaron la exposición a más de un tipo de maltrato infantil.Conclusiones: PTSR podría ser un mediador importante en la relación entre el maltrato infantil y las quejas de salud física. Los profesionales de la salud deberían estar conscientes del rol que la PTSR puede tener en la mantención y la exacerbación de los problemas de salud física en las víctimas de maltrato infantil. Sin embargo, un modelo reverso no pudo ser probado y los resultados necesitan confirmación en futuros estudios prospectivos.

Shame predicts revictimization in victims of childhood violence: A prospective study of a general Norwegian population sample.

OBJECTIVE: Victims of childhood violence often experience new victimization in adult life. However, risk factors for such revictimization are poorly understood. In this longitudinal study, we investigated whether violence-related shame and guilt were associated with revictimization. METHOD: Young adults (age = 17-35) exposed to childhood violence (n = 505) were selected from a (Country) population study of 6,589 persons (Wave 1), and reinterviewed by telephone 12-18 months later (Wave 2). Wave 1 measures included shame, guilt, social support, posttraumatic stress, and binge drinking frequency, as well as childhood violence. Logistic regression was used to estimate associations between Wave 1 risk factors and Wave 2 revictimization (physical or sexual violence, or controlling partner behavior). RESULTS: In total, 31.5% (n = 159) had been revictimized during the period between Wave 1 and 2. Of these, 12.9% (n = 65) had experienced sexual assault, 22% (n = 111) had experienced physical assault and 7.1% (n = 36) had experienced controlling behavior from partner. Both shame and guilt were associated with revictimization, and withstood adjustment for other potentially important risk factors. In mutually adjusted models, guilt was no longer significant, leaving shame and binge drinking frequency as the only factors uniquely associated with revictimization. CONCLUSIONS: Violence-prevention aimed at victims of childhood violence should be a goal for practitioners and policymakers. This could be achieved by targeting shame, both on both on the individual level (clinical settings) and the societal level (changing the stigma of violence). (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Violence against children, later victimisation, and mental health: a cross-sectional study of the general Norwegian population.

BACKGROUND: Violence in childhood is associated with mental health problems and risk of revictimisation. Less is known about the relative importance of the various types of childhood and adult victimisation for adult mental health. OBJECTIVE: To estimate the associations between various types of childhood and adult violence exposure, and their combined associations to adult mental health. METHOD: This study was a cross-sectional telephone survey of the Norwegian adult population; 2,435 women and 2,092 men aged 18-75 participated (19.3% of those we tried to call and 42.9% of those who answered the phone). The interview comprised a broad array of violence exposure in both childhood and adulthood. Anxiety/depression was measured by the Hopkins Symptom Check List (HSCL-10). RESULTS: Victimisation was commonly reported, for example, child sexual abuse (women: 10.2%, men: 3.5%), childhood-parental physical violence (women: 4.9%, men: 5.1%), and lifetime forcible rape (women: 9.4%, men: 1.1%). All categories of childhood violence were significantly associated with adult victimisation, with a 2.2-5.0 times higher occurrence in exposed children (p<0.05 for all associations). Anxiety/depression (HSCL-10) associated with adult abuse increased with the number of childhood violence categories experienced (p<0.001). All combinations of childhood violence were significantly associated with anxiety/depression (p<0.001 for all associations). Individuals reporting psychological violence/neglect had the highest levels of anxiety/depression. CONCLUSIONS: RESULTS should be interpreted in light of the low response rate. Childhood violence in all its forms was a risk factor for victimisation in adulthood. Adult anxiety/depression was associated with both the number of violence categories and the type of childhood violence experienced. A broad assessment of childhood and adult violence exposure is necessary both for research and prevention purposes. Psychological violence and neglect should receive more research attention, especially in combination with other types of violence.

Maternal childhood abuse predicts externalizing behaviour in toddlers: a prospective cohort study.

AIMS: To investigate the impact of maternal childhood abuse on toddlers' behaviour and assess the potential mediation of maternal mental distress for this pathway. METHODS: This study was based on the Norwegian Mother and Child Cohort Study, conducted by the Norwegian Institute of Public Health. The study sample consisted of 25,452 children and their mothers. Maternal childhood abuse was investigated as a potential predictor for child externalizing behaviour at 36 months of age. Maternal mental distress at child age 18 months was assessed as a potential mediator. Hierarchical linear regressions were used for analyses. RESULTS: Childhood emotional abuse alone was reported by 8.3% of the mothers and physical and/or sexual abuse by 8.9%. Mothers with childhood abuse experiences were younger, less educated, more at risk for adult abuse and mental distress, and fewer were married or lived with a partner compared with women not reporting childhood abuse. Children of mothers with childhood abuse experiences showed significantly more externalizing behaviour even after adjusting for maternal age, education, single motherhood, gender and adult abuse experiences. When maternal mental health was entered into the model, the associations remained statistically significant, but were substantially attenuated. CONCLUSIONS: Maternal childhood abuse consistently predicted increased externalizing behaviour in the offspring, and this study suggests that childhood abuse impacts subsequent generations. Multiple pathways are possible, but this study identified increased maternal mental distress as a possible pathway between maternal childhood abuse and increased externalizing behaviour in the offspring.

Familial factors and child characteristics as predictors of injuries in toddlers: a prospective cohort study.

OBJECTIVE: To identify family and child characteristics that put toddlers at risk of injuries. DESIGN: A prospective cohort study. SETTING: This study was based on the Norwegian Mother and Child Cohort Study, conducted by the Norwegian Institute of Public Health. PARTICIPANTS: The study sample consisted of 26 087 children and their mothers. OUTCOME MEASURES: Family and child characteristics measured before or at 18 months of age were investigated as potential predictors of hospital-attended injuries that occurred between 18 and 36 months of age. RESULTS: In the multivariable analysis, younger maternal age (OR 0.93, 95% CI 0.86 to 1.00), financial problems (OR 1.18, 95% CI 1.01 to 1.39), maternal mental distress (OR 1.09, 95% CI 1.03 to 1.16), having older siblings (OR 1.22, 95% CI 1.08 to 1.39), increased gestational age at birth (OR 1.04, 95% CI 1.00 to 1.07) and male gender (OR 1.26, 95% CI 1.11 to 1.42) were risk factors for hospital-attended injuries. Children with impaired gross motor development had a decreased risk of injury (OR 0.65, 95% CI 0.42 to 0.99), whereas those with impaired fine motor development had an increased risk (OR 1.55, 95% CI 1.22 to 1.97). Shyness was a protective factor (OR 0.92, 95% CI 0.86 to 0.98). Children with three reported attention problems had a slightly increased risk of hospital-attended injuries (OR 1.33, 95% CI 1.02 to 1.72; p=0.035); otherwise, behaviour was not a significant risk factor. CONCLUSIONS: This study demonstrated that a wide variety of factors were in play as predictors of injuries in young children. Both child-related factors (gender, gestational age at birth, child motor development, shyness and attention) and familial factors (having older siblings, maternal age, financial difficulties and maternal mental health problems) were associated with injuries in toddlers.

[A newborn infant with hyperventilation]. / Et nyfødt barn med hyperventilasjon.

Respiratory alkalosis is an early sign of urea cycle disorder. A high level of plasma ammonia will strengthen this suspicion. It is of great importance to transfer the infant as soon as possible to a unit capable of giving specific treatment with Na-benzoate, Na-phenylbutyrate, argininchloride and carglumic acid. The early treatment may also include haemodialysis, which is preferred over peritoneal dialysis or exchange transfusion. We here describe an infant with respiratory alkalosis within the first two days of life and a high plasma level of ammonia (> 700 micromol/L). He did not respond to conventional therapy and died 48 hours after birth in spite of specific treatment. DNA-analysis showed a gene defect in the OTC gene, c.67C >T (p.R23X), a known mutation leading to urea cycle disorder (OTC). It is important to detect carriers among older siblings and to inform the parents of the possibility of prenatal diagnostics.