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.

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.

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.

An Observational Study of Sexual Assaults in French Guiana During 2019-2020.

Introduction: Sexual violence is a major public health issue, including in French Guiana. The feeling of insecurity is significant in this part of France. Sexual violence is an important reason for consultation in forensic and emergency medicine. The challenge is to provide care within the first 72 hours, particularly in medicolegal terms and for infectious disease management. The objectives of our study were, firstly, to establish the epidemiology of sexual assaults at Cayenne General Hospital (CGH), and secondly, to evaluate the management of these victims. Materials and Methods: From January 1st, 2019 to December 31st, 2020, we conducted a single-center retrospective descriptive study including patients who were consulted for sexual assaults in the Forensic medicine and the Emergency departments of CGH. Results: Over this period, 400 sexual assault victims were consulted. Most of them, were women (87%) with a median age of 13 years-old [8; 17.5]. The aggressor was mostly male (99%) frequently known by the victim (87%) and from her family (39%). Suspected assaults represented 19% of consultations. The most frequent assault on women was penile-vaginal penetration (82%) and penile-anal penetration (77%) on men. The delay of consultation was superior to 72 hours in 60% of the cases. A psychological follow-up was recommended for 62% of these victims. Conclusion: This work allowed to identify a young and female population at risk, most often assaulted by a male known to her. Most of the patients consulted more than 72 hours after the assault. Our study highlights the need for prevention actions in French Guiana focusing on this population at risk.

Prevalence and associated factors of adolescent psychological abuse, neglect in Western China a multi-center cross-sectional study.

Background: The western region of China has a dense population, relatively underdeveloped economy, and a significant number of left-behind children. Currently, the prevalence of adolescent psychological abuse, neglect, and the factors associated with these issues in the region remain unclear. This study aims to evaluate the current status of adolescent psychological abuse and neglect and its associated factors in this region.Methods: Data were collected from 50 schools in western China through cluster sampling to target adolescents aged 12 to 18. A comprehensive survey form was used to collect socio-demographic characteristics of adolescents. The Child Psychological Abuse and Neglect Scale was employed to assess the current psychological abuse and neglect of adolescents. Independent samples t-tests were used for inter-group comparisons. A Directed Acyclic Graph was constructed for controlling confounding variables. Subsequently, binary logistic regression analysis was performed, and a nomogram risk factors model was developed using R Studio.Results: This study included 12,743 teenagers, with an average age of 15.53(±1.39) years. Among them, 4,965 individuals, accounting for 39.0%, reported experiences of psychological abuse, while 4,167 individuals, accounting for 32.7%, reported experiences of neglect. The rates of psychological abuse and neglect in adolescents are influenced by gender, grade, left-behind experience, parental marital status, and living on campus (P < .05).Conclusion: Adolescents in western China exhibit higher rates of psychological abuse and neglect compared to those in the eastern and northern regions of China. Gender, grade, left-behind experience, and family factors significantly influence the psychological abuse and neglect of adolescents.

This study is the first large-scale, multi-centre, cross-sectional analysis of psychological abuse and neglect among youth in Western China, a region with relatively underdeveloped economic and social conditions.This article fills in the gap in the region's research on psychological abuse and neglect by addressing the issues of small sample size, limited coverage, and a lack of variables included.This provides a crucial theoretical foundation for enhancing the mental well-being of youth in this region and preventing psychological and mental illnesses among youth.

Practice Analysis: Developing a Content Outline for the Child Abuse Pediatrics Certification Exam.

The examination by which physicians achieve board certification in CAP should reflect the knowledge and skills required of the modern practitioner. The American Board of Pediatrics (ABP) assembled a 12-member volunteer panel of practicing child abuse pediatricians to conduct a practice analysis. In the first phase of the project, the panel identified and documented the practice domains, tasks, knowledge, and skills required for clinical practice. During the second phase, the panel organized testable knowledge areas into content domains and subdomains and updated the ABP CAP content outline. Feedback on the revised outline was requested from all ABP board-certified child abuse pediatricians via an online survey and results from the survey informed final revisions to the outline.

A comparison of virtual versus in-person delivery of SafeCare on parent and implementation outcomes.

BACKGROUND: Evidence-based prevention services for child abuse and neglect (CAN), typically delivered via home visiting (HV), pivoted to virtual delivery in 2020 to continue family services while adhering to the COVID-19 public health guidelines. OBJECTIVE: The study aims are to compare parent and implementation outcomes for the HV program, SafeCare©, delivered virtually versus in-person, across a 2-year period. METHODS: Three data sources were used to examine parent program engagement and skill mastery, as well as provider fidelity. Sources included: 1) quantitative service data collected as part of routine SafeCare implementation (in-person families, n = 923; virtual families, n = 1978), 2) qualitative survey data collected from SafeCare providers (n = 212) and 3) focus group data with SafeCare Providers (n = 9). RESULTS: Service data were examined using mixed models due to the nesting of the data, with all analyses controlling for time. Qualitative data from the survey and focus groups were analyzed using thematic coding. Data were triangulated from the three sources to answer the primary research question. Findings suggest that virtual delivery of SafeCare holds promise, with parents who participated virtually completing more modules at a faster pace than in-person clients. SafeCare parents demonstrated positive programmatic outcomes regardless of whether they participated in the program virtually or in-person. Provider fidelity remained high in the transition to virtual delivery. However, technology-related logistical issues and provider self-efficacy related to virtual delivery presented challenges to program success. CONCLUSIONS: The study has multiple implications for the HV field about the viability of virtual service delivery. Further research is warranted with data collected directly from parents, and a more critical analysis of what works best for whom and when to further advance the field.

Intersection of adverse childhood experiences, suicide and overdose prevention.

Adverse childhood experiences (ACEs), suicide and overdose are linked across the life course and across generations and share common individual-, interpersonal-, community- and societal-level risk factors. The purpose of this review is to summarise the shared aetiology of these public health issues, synthesise evidence regarding potential community- and societal-level prevention strategies and discuss future research and practice directions.Growing evidence shows the potential for community- and societal-level programmes and policies, including higher minimum wage; expanded Medicaid eligibility; increased earned income tax credits, child tax credits and temporary assistance for needy families benefits; Paid Family Leave; greater availability of affordable housing and rental assistance; and increased participation in the Supplemental Nutrition Assistance Program (SNAP), to contribute to ACEs, suicide and overdose prevention. Considerations for future prevention efforts include (1) expanding the evidence base through rigorous research and evaluation; (2) assessing the implications of prevention strategies for equity; (3) incorporating a relational health perspective; (4) enhancing community capacity to implement, scale and sustain evidenced-informed prevention strategies; and (5) acknowledging that community- and societal-level prevention strategies are longer-term strategies.

Structural Racism in Newborn Drug Testing: Perspectives of Health Care and Child Protective Services Professionals.

PURPOSE: Black birthing parents and their newborns disproportionately experience newborn drug testing for prenatal substance exposure by health care professionals (HCPs), which contributes to Child Protective Services (CPS) reporting, family separation, and termination of parental rights. This qualitative study aims to interrogate dominant power structures by exploring knowledge, attitudes, and experiences of HCPs and CPS professionals regarding the influence of structural racism on inequities in newborn drug testing practices. METHODS: We conducted semistructured interviews with 30 physicians, midwives, nurses, social workers, and CPS professionals guided by an explanatory framework, and conducted inductive, reflexive thematic analysis. RESULTS: We identified 3 primary themes: (1) levels of racism beyond the hospital structure contributed to higher rates of drug testing for Black newborns; (2) inconsistent hospital policies led to racialized application of state law and downstream CPS reporting; and (3) health care professionals knowledge of the benefits and disproportionate harms of CPS reporting on Black families influenced their decision making. CONCLUSION: Health care professionals recognized structural racism as a driver of disproportionate newborn drug testing. Lack of knowledge and skill limitations of HCPs were barriers to dismantling power structures, thus impeding systems-level change. Institutional changes should shift focus from biologic testing and reporting to supporting the mutual needs of birthing parent and child through family-centered substance use treatment. State and federal policy changes are needed to ensure health equity for Black families and eliminate reporting to CPS for prenatal substance exposure when no concern for child abuse and neglect exists.

Investigating the Effect of Substance Desire and Child Abuse in Adolescent Suicide Attempt.

Background: This study aimed to investigate the impact of child abuse and substance desire on adolescent suicide. Methods: This cross-sectional analytical study was conducted on all adolescents aged 12 to 19 who attempted suicide in 2018 at Khorshid Hospital, Isfahan, Iran. A checklist of the patients' demographic information, toxicological data, and 2 standard questionnaires, including substance desire (family, personal, social) and child abuse questionnaire (emotional abuse, physical abuse, and neglect abuse), were collected. The data were analyzed using SPSS version 15. Comparisons between the 2 groups were performed using t tests, chi-square tests, regression analysis, and crude model analysis. Odds ratio (OR) and 95% confidence interval were calculated based on logistic regression. Findings: A total of 196 teenagers were included in the study, with a mean age of 16.48±1.6 years. Out of these, 155 individuals (79.1%) were female, resulting in a female-to-male ratio of 3.78. There was a significant relationship between gender and alcohol consumption in the personal aspect, as well as between the history of psychiatric diseases and alcohol consumption in the physical aspect (P<0.005). The previous history of suicide was the only variable that showed significance in all aspects of both the substance desire and child abuse questionnaires. History of neglect abuse (OR: 1.2, 95% CI [1.07-1.41]; P=0.009) was a predictive factor for suicide attempt. However, being male (OR: 0.12, 95% CI [0.039-0.37], P=0.000), having no psychiatric history (OR: 0.23, 95% CI [0.10-0.52], P<0.001) and not consuming alcohol (OR 0.33, 95% CI 0.15-0.71, P=0.005) were identified as protective factors for attempted suicide. Conclusion: A public health strategy for suicide prevention includes implementing prevention strategies aimed at reducing risk factors, such as alcohol consumption and the risk of neglect abuse.

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.

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 .

"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.

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.

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.