Poverty and Health Inequities in Children Investigated by Child Protective Services.

The objective of our study was to examine the association between poverty and child health outcomes in school-age children referred to child protective services. We conducted a secondary analysis of children aged 5 to 9 years in the Second National Survey of Child and Adolescent Well-Being, a nationally representative longitudinal observational data set of children referred to protective services for maltreatment (2008-2012). We analyzed the association of poverty, defined as family income below the federal poverty level (FPL), with caregiver report of the child's overall health, primary care, and emergency department visits using Pearson's chi-squared test. Children below FPL compared with children above it had poorer overall health (29.8% vs 18.0%, P = .03). We also conducted a longitudinal multivariable logistic regression analysis and found poverty was associated with the child's poorer overall health at 36 months (odds ratios 2.78, 95% confidence interval 1.55-5.01). Future studies and interventions to improve health in this at-risk population should target poverty.

Imaging patterns of thoracic injuries in survivors of intimate partner violence (IPV).

PURPOSE: To recognize the imaging patterns of thoracic injuries in survivors of intimate partner violence (IPV). MATERIALS AND METHODS: A retrospective radiological review of 688 patients self-reporting IPV to our institution's violence intervention and prevention program between January 2013 and June 2018 identified 30 patients with 89 thoracic injuries. Imaging and demographic data were collected. RESULTS: Thirty survivors with 89 injuries to the thorax were identified with a median age of 43.5 years (21-65 years). IPV was reported or disclosed as the direct cause of injury in 50% (15/30) of survivors, including all nine patients who sustained penetrating injuries. The most common injury type was fracture (72%, 64/89) with 52 rib, 3 sternal, 2 clavicular, and 7 vertebral fractures. There were 3 acromioclavicular dislocations. Among rib fractures, right lower anterior rib fractures (9-12 ribs) were the most common(30%, 16/52). There were 10 superficial soft tissue injuries. There were 12 deep tissue injuries which included 2 lung contusions, 2 pneumomediastinum, 7 pneumothoraces, 1 hemothorax. One third of patients had concomitant injuries of other organ systems, most commonly to the head and face, followed by extremities and one third of patients had metachronous injuries. CONCLUSION: Acute rib fractures with concomitant injuries to the head, neck, face, and extremities with an unclear mechanism of injury should prompt the radiologist to discuss the possibility of IPV with the ordering physician. ADVANCES IN KNOWLEDGE: Recognizing common injuries to the thorax will prompt the radiologists to suspect IPV and discuss it with the clinicians.

Facial injury patterns in victims of intimate partner violence.

PURPOSE: To evaluate the imaging findings of facial injuries in patients reporting intimate partner violence (IPV). METHODS: A retrospective review of radiology studies performed for 668 patients reporting IPV to our institution's violence prevention support program identified 96 patients with 152 facial injuries. Demographics, imaging findings, and clinical data obtained from a review of the electronic medical records (EMR) were analyzed to categorize injury patterns. RESULTS: The study cohort consisted of 93 women and 3 men with a mean age of 35 years (range 19-76; median 32). At the time of presentation, 57 (59.3%) patients reported IPV as the mechanism of injury. The most frequent site of injury was the midface, seen in 65 (67.7%) patients. The most common fracture sites were the nasal bones (45/152, 29.6%), followed by the mandible (17/152, 11.1%), and orbits (16/152, 10.5%). Left-sided injuries were more common (90/152; 59.2%). A vast majority of fractures (94.5%) showed minimal or no displacement. Over one-third of injuries (60/152, 39.4%) demonstrated only soft tissue swelling or hematoma without fracture. Associated injuries were seen most frequently in the upper extremity, occurring synchronously in 11 (11.4%) patients, and preceding the index facial injury in 20 (21%) patients. CONCLUSION: /advances in knowledge. The midface was the most frequent location of injury in victims of intimate partner violence, and the nasal bone was the most commonly fractured facial bone. Recognizing these injury patterns can help radiologists suspect IPV and prompt them to discuss the possibility of IPV with the clinical providers.

Systematic Review of Human Trafficking Educational Interventions for Health Care Providers.

Human trafficking is a global population health threat. Trafficking minors threatens the safety and well-being of youth. Limited studies measure health care providers' awareness and attitudes toward trafficking. This systematic review synthesized retrospective and current knowledge and identified gaps in educational interventions aimed at increasing providers' awareness and attitudes toward trafficking. A systematic search of four databases identified peer-reviewed published papers between January 1, 2000 and September 1, 2018. The Cochrane Collaboration's Preferred Reporting Items for Systematic Reviews was followed. Study quality was assessed using the Downs and Black checklist. The Psychometric Grading Framework was used to assess the validity of instruments. Findings across studies (N = 7) reveal providers (mostly social workers and physicians) have low awareness of trafficking and can have negative attitudes toward victims. Multiphase educational approaches and use of content experts, including survivors, in developing interventions enhanced sustainability of outcomes. Targeting multidisciplinary health care teams, including nurses, enhanced interventions.

Promoting Health Equity Through Trauma-Informed Care: Critical Role for Physicians in Policy and Program Development.

Trauma-informed care has emerged as an important model to address the pervasiveness of traumatic experiences across the life cycle and their association with significant adverse medical and psychiatric consequences. To achieve health equity, in which all people have the opportunity for health, it is crucial for physicians to become comfortable with a neurobiopsychosocial understanding of trauma and how to provide optimal trauma-informed care. Given the pervasiveness of trauma exposure, and its impact on individual and community health, this paradigm shift in adult health care delivery systems requires physician engagement at every stage of development and implementation.

Radiologic Findings in Intimate Partner Violence.

Purpose To assess the radiologic findings associated with intimate partner violence (IPV). Materials and Methods Electronic medical records of 185 patients referred to the IPV support program from the emergency department (ED) between January 2015 and October 2016 were retrospectively reviewed and compared with an age- and sex-matched control group of 555 subjects (1:3 ratio of IPV victims to control subjects) who presented to the ED. Reports of all imaging studies performed within 5 years prior to the index ED visit were reviewed. Results The majority of patients who experienced IPV (mean age, 34.2 years ± 12.2 [standard deviation]) were female (178 of 185 [96.2%]) and were largely African American (69 of 185 [37.3%]). Demographic and clinical variables independently associated with IPV were race (odds ratio [OR] range, 3.2-5.9; 95% confidence interval [CI]: 1.8, 12.7), psychiatric comorbidities (OR, 5.4; 95% CI: 3.4, 8.8), and homelessness (OR, 13.0; 95% CI: 5.4, 31.2). IPV victims underwent more imaging studies in the preceding 5 years (median, four studies) than did control subjects (median, one study). Obstetric-gynecologic findings (OR, 4.4; 95% CI: 2.1, 9.6) and acute fractures (OR, 2.4, 95% CI: 1.1, 5.3) seen on images were independently associated with IPV. The addition of imaging findings to demographic and clinical variables increased the area under the receiver operating characteristic curve (AUC) of the multivariate model to detect IPV (0.87 vs 0.86, P < .01), and the cross-validated multivariate model had an AUC of 0.85. Acute fractures involved the face or skull (range, P < .01 to P = .05), and chronic fractures affected the extremities and nasal bone (P < .01 and P = .05, respectively) more frequently in the IPV group than in the control group. Conclusion Intimate partner violence victims undergo more imaging studies and have a higher frequency of potential violence-related imaging findings when compared with age- and sex-matched control subjects. © RSNA, 2019 See also the editorial by Flores and Narayan in this issue.