The effects of COVID-19 on the development of reported incidents of child maltreatment over time: A systematic literature review.

BACKGROUND: During the COVID-19 pandemic, the life of families all over the world changed unprecedentedly, risks and vulnerabilities for child maltreatment might have altered. While several studies and reviews look at altered reports to child protective services and other organizations in the child protection system, particularly during the first lockdown in spring 2020, there is a gap in research on trends of reported child maltreatment incidents over time. OBJECTIVE: To bridge the gap on mid- to long-term developments and trends of changes over time, we aimed at summarizing findings on monthly breakdowns of CM reports over time during the pandemic. METHODS: In systematic searches of academic literature databases, we have identified 11 articles that adhere to the inclusion criteria of monthly breakdown data from child protective services during the COVID-19 pandemic with a pre-pandemic comparison period. Three additional grey literature reports haven been identified. Both studies and reports had to be published in either English, Arabic, French, German, Portuguese, or Spanish. RESULTS: Notably, overall, the level of reported incidents has decreased compared to the years before the COVID-19 pandemic. Overall, no clear and reliable picture emerges in developments by different types of reporters. If the number of reports decreases overall, consequently, the overall number or responses to reports does. Some studies, however, report an altered proportion of responses that increased. CONCLUSION: There is still a lot to be investigated and understood when it comes to the impact of the COVID-19 pandemic on CM. Policy-makers are called to not only invest into more research on the topic, but, first and foremost, to anticipate a potentially surging need in improved responses to a vulnerable group.

[Medical child protection during the coronavirus lockdown]. / Medizinischer Kinderschutz während des Corona-Lockdowns: Vergleichende Befunde der Kinderschutzfälle aus Kliniken und Ambulanzen in Deutschland.

BACKGROUND: There are indications that during the lockdown and the measures of social distancing due to the coronavirus disease 2019 (COVID-19) pandemic, physical and sexual child abuse and neglect may have increased. Additionally, decreased social control may have led to a lower detection rate of child protection cases. OBJECTIVE: This study aimed to better understand the impact of the lockdown in Germany on the frequency and severity of child abuse and neglect. To do so the quantity and quality of cases of suspected child abuse and neglect in German pediatric departments and outpatient departments for medical child protection were examined. METHODS: In May 2020 a total of 343 institutions of medical child protection were invited to fill in a questionnaire with items describing their institution and items depicting cases of child protection in March and April 2019 and 2020 regarding age, form and severity of abuse as well as items to describe particular remarks and ideas for child protection during the pandemic. RESULTS: Out of the 343 pediatric departments and outpatient departments of medical child protection invited, the participation rate was 46%. In this study 81 institutions reported the total cases of suspected child abuse or neglect for both March and April 2019 and 2020. The number of cases dropped from 454 to 387 (-15%) in outpatient child abuse clinics and from 307 to 246 (-20%) in pediatric inpatient departments. Regarding the age of affected children and the form of abuse no significant differences were found. CONCLUSION: The study found a decrease in reported cases of suspected child abuse and neglect during the lockdown in March and April 2020 compared to 2019. While the results do not show an increase of total child abuse and neglect, as suspected by many professionals, the decrease in reported cases may be explained by a steep increase in unreported cases due to reduced social control.

Validación del Inventario de Conductas Infantiles para niños de entre 1½-5 años (CBCL 1½-5) en la Ciudad de Santiago de Chile / Validation of Child Behavior Inventory for children ages 1½ to 5 years (CBCL 1½-5) at the Santiago de Chile City

Los estudios de prevalencia en salud mental en edades tempranas (primeros 5 años de vida) han sido insuficientes y escasos. Dado que la evidencia neurobiológica, económica, psicológica y social ha demostrado que intervenir durante los primeros años de vida es altamente efectivo para disminuir los problemas psicosociales, es que es urgente obtener datos nacionales sobre problemas afectivos y conductuales en la temprana infancia y edad preescolar. El presente trabajo tuvo como objetivo validar un instrumento de reporte parental denominado Inventario de Conductas Infantiles para niños de entre 1½-5 años (CBCL 1½-5). El test fue validado a través de un proceso de jueces expertos, para posteriormente obtener indicadores de confiabilidad y validez en una muestra de 418 niños pertenecientes a la Región Metropolitana. Los resultados obtenidos en la muestra chilena son coherentes con el modelo bifactorial propuesto por los autores del instrumento, la dimensión Internalización da cuenta de los problemas ansioso-depresivos, quejas somáticas y retraimiento en los niños/as y la Externalización, de los aspectos atencionales y la conducta agresiva. Se concluye que el CBCL 1½-5 es un instrumento válido y confiable para ser aplicado a la realidad nacional, permitiendo ser utilizado para obtener indicadores de diversos trastornos de salud mental en la temprana infancia y edad preescolar.

Prevalence studies in infant and preschool mental health have been scarce and insufficient. Considering the ample neurobiological, psychological, economical and social evidence that has demonstrated that intervening in early years may be a highly effective strategy for lowering the rates of mental health problems, is urgent to find prevalence data about early emotional and behavioral problems. To validate an instrument called Child Behavior Checklist for ages 1.5-5 (CBCL 1-5-5). The study was made through a process with expert judges, and subsequently, reliability and validation results were obtained in a sample of 418 children from Region Metropolitana. Data from a Chilean sample confirmed the bi-factorial model originally proposed by the authors who create the instrument. Internalizing dimension account for anxious-depression symptoms', somatic complaints, and withdrawal in children, and Externalizing dimension account for atentional and behavioral problems. The CBCL 1.5-5 is a valid and reliable instrument and can be apply to Chilean reality, obtaining good signs of emotional and behavioral problems in infancy and preschool ages.

Single capacitive discharge utilizing an auxiliary shock in the coronary venous system reduces the defibrillation threshold.

UNLABELLED: Auxiliary shocks (AS) from electrodes sutured to the left ventricle (LV) prior to primary biphasic shocks (PS) have been shown to reduce defibrillation thresholds (DFT). Two capacitors are required to generate these waveforms. We investigate delivery of AS from one capacitor using a novel waveform. The epicardial surface of the LV is accessed transvenously via the middle cardiac vein (MCV) avoiding a thoracotomy. METHODS: A defibrillation electrode was placed in the right ventricle (RV) and superior vena cava (SVC) in 12 pigs (37+/-2 kg). A 50x1.8 mm electrode was inserted in the MCV through a guide catheter. A can was placed in the left pectoral region. A monophasic AS (100 microF, 1.5 J) was delivered along one pathway before switching to deliver a biphasic waveform (40% tilt, 2 ms phase 2) along another. DFTs (PS+AS) were assessed using a binary search. Two configurations not incorporating AS acted as controls. DFTs were compared using repeated measures analysis of variance. RESULTS: DFTs of the four novel configurations (AS/PS) were: RV-->Can/MCV-->Can=14.9+/-3.7 J, MCV-->Can/RV-->Can=17.2+/-5.7 J, RV-->SVC+Can/MCV-->SVC+Can=13.4+/-4.6 J, MCV-->SVC+Can/RV-->SVC+Can=17.1+/-5.9 J. Delivering AS in the RV followed by PS in the MCV reduced the DFT (RV-->Can (19.9+/-7.3 J, P<0.01) and RV-->SVC+Can (19.2+/-6.0 J, P<0.05)). CONCLUSIONS: Delivering AS prior to PS in the MCV reduces the DFT by up to a third compared to conventional configurations of RV-->Can and RV-->SVC+Can. This is possible using only a single capacitor and an entirely transvenous approach to the LV.

Neural modulation of visuomotor functions underlying prey-catching behaviour in anurans: perception, attention, motor performance, learning.

The present review points out that visuomotor functions in anurans are modifiable and provides neurophysiological data which suggest modulatory forebrain functions. The retino-tecto/tegmento-bulbar/spinal serial processing streams are sufficient for stimulus-response mediation in prey-catching behaviour. Without its modulatory connections to forebrain structures, however, these processing streams cannot manage perceptual tasks, directed attention, learning performances, and motor skills. (1) Visual prey/non-prey discrimination is based on the interaction of this processing stream with the pretectal thalamus involving the neurotransmitter neuropeptide-Y. (2) Experiments applying the dopamine agonist apomorphine in combination with 2DG mapping and single neurone recording suggest that prey-catching strategies in terms of hunting prey and waiting for prey depend on dose dependent dopaminergic adjustments in the neural macronetwork in which retinal, pretecto-tectal, basal ganglionic, limbic, and mesolimbic structures participate. (3) Visual response properties of striatal efferent neurones support the concept that ventral striatum is involved in directed attention. (4) Various modulatory loops involving the ventral medial pallium modify prey-recognition in the course of visual or visual-olfactory learning (associative learning) or are responsible for stimulus-specific habituation (non-associative learning). (5) The circuits suggested to underlie modulatory forebrain functions are accentuated in standard schemes of the neural macronetwork. These provide concepts suitable for future decisive experiments.

Apomorphine alters prey-catching patterns in the common toad: behavioral experiments and (14)C-2-deoxyglucose brain mapping studies.

Previous studies on the dopaminergic modulation of visuomotor functions in amphibians showed that the dopamine agonist apomorphine (APO) alters prey-catching strategies. After systemic administration of APO in common toads Bufo bufo, prey-oriented turning and locomotion was attenuated whereas snapping toward prey was facilitated in a dose dependent manner. With systemic APO administration, toads which had previously been hunting, that is pursuing prey, behaved in a waiting position, that is sitting motionless and waiting for prey. This suggests that APO facilitates the ingestive component and inhibits the orientational and locomotory components of prey capture. To help unravel the cerebral sites of action of APO, the present study employs the (14)C-2-deoxyglucose method to compare the rate of local glucose utilization in 41 brain structures. The retinal projection fields - e.g. superficial optic tectum, pretectal nuclei, and anterior dorsal thalamic nucleus - showed an elevation in glucose utilization due to APO-induced increases in retinal output. The medial tectal layers and the ventral striatum, both involved in visuomotor functions related to prey-oriented turning and locomotion, displayed APO-induced decreases in glucose utilization. APO-induced increases in glucose utilization were observed in the medial reticular formation and the hypoglossal nucleus which participate in the motor pattern generation of snapping. APO-induced increases in glucose utilization were also detected in the nucleus accumbens and the ventral tegmentum (mesolimbic system) as well as in the ventromedial pallium ('primordium hippocampi') and the septum, both of which belonging to the limbic system. These structures contribute to motivational level control and may be responsible for the APO-induced elevation of the snapping rate. Various other structures revealed APO-induced increases in glucose utilization. These structures include the olfactory bulb, lateral pallium, suprachiasmatic nucleus, nucleus of the periventricular organ, and the nucleus of the solitary tract. The lateral amygdala displayed APO-induced decreases in glucose utilization. The APO-induced alterations in local cerebral glucose utilization are evaluated with reference to the distribution of dopaminergic structures, and this is compared with similar data obtained in the rat by other authors. A neural network explaining the APO-induced behavioral syndrome in the common toad is discussed.

Multidisciplinary team renal rehabilitation: interventions and outcomes.

Multidisciplinary team renal rehabilitation produces positive patient outcomes by broadening the knowledge base and evening out the work load. Rehabilitation is no longer viewed as an extra program to patient care done by a few people but seen as an integral part of the patients' care and dialysis treatment. Focusing on the 5E's of renal rehabilitation developed by the Life Options Rehabilitation Advisory Council, Renal Care Group of the Midwest, Inc has achieved positive clinical patient outcomes, such as meeting dialysis adequacy benchmark goals. Interventions and outcomes of two of the 5E's, education and exercise, are discussed.

Forebrain and midbrain structures involved in prey-catching behaviour of toads: stimulus-response mediating circuits and their modulating loops.

In anurans, visual prey information is filtered in the retina and processed in interacting pretectal and tectal retinal projection fields. Neuropeptide Y is involved in pretecto-tectal inhibition. Information related to prey and its location in space is transmitted to the bulbar/spinal motor pattern generating systems by ensembles of efferent tectal and tegmental neurons. This basic stimulus-response (S-R) mediating circuit is influenced by forebrain loops. It is suggested that ventral striatum and lateral thalamic nucleus participate in a loop responsible for gating S-R. The hippocampal pallium modifies S-R via the anterior thalamus with regard to previous experience. Dopaminergic modulation influences prey-catching strategies.

Responses of single neurons in the toad's caudal ventral striatum to moving visual stimuli and test of their efferent projection by extracellular antidromic stimulation/recording techniques.

Previous work in anuran amphibians has shown that activity in the caudal ventral striatum correlates with visuomotor activity: orienting responses toward prey fail to occur after striatal lesions. Thus it has been suggested that the striatum influences visually guided behavior. Therefore, the present study investigates visual response properties from neurons recorded in the striatum. Extracellular recordings of 104 single neurons of the cane toad's (Bufo marinus) caudal ventral striatum (STR) reveal five different response properties: resting discharge activity uninfluenced by the visual test stimuli (group STR1, 24.0%); resting discharge activity increased by any moving visual object (STR2, 31.7%); preference to moving compact objects (STR3, 15.4%); preference to certain configurational moving objects (STR4a and b, 13.5%), and resting activity reduced by visual stimuli (STR5, 15.4%). The receptive fields of these neurons encompassed the contralateral (46%) or the entire field of vision (54%). Of the neurons recorded in the striatum, 34% responded to electrical stimuli applied in the rostral diencephalon to the ipsilateral lateral forebrain bundle (LFB) which connects the striatum with the optic tectum (e.g. either directly or via pretectum or tegmentum). Various electrically driven STR neurons (40%) have axons that project caudally through the LFB, which was suggested by their antidromic activation in response to electrical stimuli applied to the LFB in the rostral diencephalon. In the present study, the main striatal output is mediated by 'motion detectors' (STR2) and 'compact object perceivers' (STR3). It is suggested that the caudal ventral striatum is involved in visual attentional processes that allow the translation of perception into action.

Neuropeptide Y (NPY) or fragment NPY 13-36, but not NPY 18-36, inhibit retinotectal transfer in cane toads Bufo marinus.

Previous work suggests that retinotectal information processing is influenced by pretectotectal ipsilateral projections. Neuropeptide Y (NPY) participates in the pretectotectal transmission. The present investigation demonstrates that administration of porcine NPY to the tectal surface causes a profound and prolonged attenuation of the initial excitatory N1 wave of the summated tectal surface field potential (FP) evoked by diffuse light off stimulation. The FP's on response was affected as well, but was less sensitive to NPY. Administration of the fragment NPY 13-36, a Y2 receptor agonist, had a smaller effect than did NPY. Fragment NPY 18-36, however, showed no comparable influences. The data suggest that NPY in the cane toad's pretectotectal pathway controls retinotectal transmission in an inhibitory manner via a Y2 receptor mechanism.

Neural correlates of key stimulus and releasing mechanism: a case study and two concepts.

Major themes in neuroethology concern the specificity of key stimuli, neurones tuned to such stimuli, and the release of corresponding behaviour. Neurobiological data from the analysis of visuomotor functions of prey-catching and avoiding in amphibians support the view that retinal outflow in different combinations is pooled for further computation in interacting processing streams, rather than segregated into distinct retinal channels. The keys by which the visual system gets access to perceptual-motor categories are shown to derive from specific computational strategies that evaluate significant configurational features of objects. Rapid behavioural responses are assured by visuomotor pathways which, monitoring different aspects of visual objects, collectively select appropriate motor patterns. Responses can be adapted to varying environmental and internal conditions via modulating and modifying loops. This requires parallel distributed processing and integration at various levels in a macro-network.

Dopaminergic modulation of visual responses in toads. I. Apomorphine-induced effects on visually directed appetitive and consummatory prey-catching behavior.

This study confirms for a phylogenetically basal terrestrial vertebrate that dopaminergic modulations interfere with the visually directed appetitive and consummatory feeding behaviors orienting and snapping, respectively. (1) In common toads Bufo bufo, intralymphatic administration of the dopamine D2/D1-receptor agonist apomorphine led to a dose-dependent facilitation of prey-snapping in response to moving objects. The snapping activity reached a maximum 15-35 min after apomorphine injection. (2) To changes in configurational stimulus features, the basic pattern of discrimination was maintained; however, the acuity of discrimination was reduced due to the high snapping response level. (3) The apomorphine-induced facilitation of snapping was accompanied by a suppression of prey-oriented lunging and turning. Toads snapped only if prey occurred frontally in the visual field at a relatively short distance. The snapping behavior was fixed in its form and stereotyped regarding its immediate release. (4) About 90 min after apomorphine administration, prey-oriented turning behavior was restored and displayed a facilitatory rebound. (5) In comparative experiments with the species B. marinus, both prey-oriented turning and snapping responses were suppressed by apomorphine in a dose-dependent manner. (6) After pre-treatment with the dopamine antagonist haloperidol, apomorphine showed no measurable effect on the visual release of prey orienting or snapping. (7) The results contribute to the sensorimotor and the motivation hypothesis of dopamine function proposed for higher vertebrates and stimulate a comparative discussion of anatomic homologies and functional analogies.

Dopaminergic modulation of visual responses in toads. II. Influences of apomorphine on retinal ganglion cells and tectal cells.

The behavioral studies of Part I have shown in common toads that after systemic administration of the dopamine agonist apomorphine the prey-directed orienting turning movements are suppressed while prey snapping is facilitated. Part II focuses on retinal and tectal single cell responses to moving objects. (1) After systemic administration of apomorphine, the discharge rates of retinal class R2 and R3 ganglion cell fibres--recorded from the retino-tectal projection--speeded up in response to visual objects traversing their excitatory receptive fields. This enhancing effect was independent of the recording site in the retino-tectal map. (2) The diameters of the excitatory receptive fields of R2 and R3 neurons doubled their sizes. Probably, apomorphine enhances the center-dominated excitatory responses at the expense of the strength of the inhibitory surround. (3) The apomorphine-induced effects were fully developed 20-35 min after drug administration. (4) At the same time the discharge rates of T5.1 and T5.2 tectal neurons were reduced under apomorphine. The effect was independent of the recording site in the retino-tectal map. The diameters of the excitatory receptive fields of these tectal neurons were not influenced. (5) To changes in configurational stimulus features, the basic pattern of discrimination was maintained. (6) It is suggested that tectal output to the turn-generating motor network--mediated by T5.1 and T5.2 neurons--is modulated by a pretecto-tectal pathway which involves dopaminergic pretectal cells. (7) The enhanced snapping can be interpreted in terms of a modulation of reticular/hypoglossal structures by dopaminergic preoptic/hypothalamic/solitary systems.

Apomorphine-induced suppression of prey oriented turning in toads is correlated with activity changes in pretectum and tectum: [14C]2DG studies and single cell recordings.

In common toads, after systemic administration of the dopamine agonist apomorphine (APO), prey-oriented turning was suppressed. Searching for neural correlates, the present study shows APO-induced increases in glucose utilization in the retinorecipient pretectum and dorsal optic tectum and a decrease in the medial tectal output layers. This pattern of metabolic activity is resembled by neuronal discharge activities recorded in response to a prey stimulus; the discharge rates are increased in retinal ganglion cells and pretectal neurons and decreased in tectal output neurons. We suggest that an APO-induced enhancement of pretecto-tectal inhibitory influences contributes to the reduction of tectal output, thus suppressing prey-oriented turning behavior.

A key by which the toad's visual system gets access to the domain of prey.

Searching for principles that allow toads to distinguish between prey and nonprey, we wondered how the toad's prey-catching activity measured as R differs in response to changes in significant configurational stimulus features. Elongated shapes moving worm-like in the direction of their longer axes are preferred prey dummies; but a toad is not a worm detector, and a worm is not the unique prey-catching releaser. Considering the frequency distributions of R values, we show that the release of prey catching is in a specific manner sensitive to the relation between the extensions of an object parallel (xl1) and perpendicular (xl2) to its direction of movement. It is the xl1 and xl2 features-relating algorithm that provides the key (instruction) by which the toad's visual system gets access to the domain of potential prey in terms of configurational cues. This, within behaviorally relevant limits, largely invariant algorithm also holds for segmented stimuli. Further investigations show that this principle of object discrimination is not due to experimental procedures but emerges as a species-common property, of which different toad species take advantage in a species-specific manner. Neurobiological correlates are discussed.

Disproportionate distribution of field potentials across the toad's tectal visual map in response to diffuse light ON and OFF stimulations.

In toads Bufo marinus and Bufo bufo spinosus, field potentials (FPs) were recorded from the surface of the optic tectum at different sites of the visual map in response to a sudden diffuse darkening (OFF) and lightening (ON) of the visual field of the contralateral eye. The OFF and ON responses were differently pronounced or even failed to occur. The latency of the former was significantly less than the one of the latter. FP amplitudes of the OFF and ON responses were strongest in the representation of a horizonto-superior anterio-lateral portion of the visual field and weakest toward the posterior field of vision. This phenomenon suggests various interpretations for subsequent experiments.

Influence of pretectal lesions on tectal responses to visual stimulation in anurans: field potential, single neuron and behavior analyses.

Investigating the fine structure of the anuran's optic tectum (OT), Székely and Lázár suggested that a focal tectal excitation would spread across the tectal network if there were no control by thalamic pretectal (TP) inhibitory influences. Disconnecting OT from TP by lancet lesions in toads, we show that visual prey-catching is hyperexcited and stimulus discrimination nearly abolished. Functional recovery exists. Micro-administration of the axon sparing excitotoxins kainic acid (KA) or ibotenic acid (IBO) confirm that the TP region is actually involved. Recordings from prey-selective tectal neurons in immobilized frogs reveal a KA-induced impairment of stimulus discrimination and an increase in spontaneous firing. Following TP-lesions, in freely moving toads a correlation is observed between any moving stimulus, enhanced neuron firing, and pray-catching. Tectal field potentials evoked by diffuse light on- and off-stimuli before and after administration of the conduction-blocking drug procaine (PRC) suggest that populations of tectal neurons are affected by pretectal inhibitory influences. Considering previous work on physiologically identified pretecto-tectal projection cells, three different kinds of pretecto-tectal influences are discussed. A working hypothesis suggests a loop by which striatal influences are controlling TP, thus gating and tuning the visual information processing in OT.

Effect of neuropeptide-Y on tectal field potentials in the toad.

Field potentials (FP) recorded from the surface of toad's optic tectum (OT) to electrical stimulation of the contralateral optic nerve (ON) show initial positive deflections P*, followed by negative wave N and positive wave P; the former result from axonal inputs, the latter two resemble excitatory and inhibitory postsynaptic processes, respectively. Electrostimulation of the pretectum ipsilaterally to the recorded OT--preceeding ON-stimulation--strongly attenuates the N wave, suggesting pretectotectal inhibitory influences. The N wave of the tectal FP evoked by ON-stimulation is reduced, too, after application of the neuropeptide-Y (NPY) to the tectal surface. Previous authors have shown that frog's pretectum contains NPY immunoreactive pretectotectal projecting cells.

Responses of retinal and tectal neurons in non-paralyzed toads Bufo bufo and B. marinus to the real size versus angular size of objects moved at variable distance.

Toads judge the real size of moving visual objects during prey-catching. But neither ganglion cells of the retinotectal projection nor tectal neurons showed a comparable phenomenon in muscle paralyzed toads. In non-paralyzed toads, however, tectal neurons, unlike neurons, displayed a sensitivity to the real size of an object moving at variable distance to the animal. Interestingly, this property was obtained both in monocular T5 smallfield neurons and in most of the investigated T4 widefield neurons.