Trauma exposure among young children in rural Pakistan: Associations with gender, mental health, and cognitive skills.

BACKGROUND: The burden of childhood trauma (violence, injury/illness, loss) in low-resource settings is high, although the effect of trauma on children's mental and cognitive health is under-researched. Child gender may moderate the association between trauma and outcomes; boys are more likely to experience trauma, but girls are more likely to show distress following trauma. METHODS: We draw on data from the Bachpan cohort (n = 888), a sample of mother-child dyads in rural Pakistan, to investigate these associations among 6-year-old children in a South Asian, low-resource setting. Mothers reported on children's lifetime exposure to 15 possible traumas and their current mental health. In addition, children were assessed for their verbal skills, working memory, and inhibitory control. We estimated trauma prevalence and used generalized estimating equations to test the association between number of traumatic events and child mental health and cognitive skills in the overall sample and by gender. RESULTS: 90.5% of children experienced at least one trauma. The most common traumas were death of a loved one (47%) and hearing about war/terrorism on the TV/radio (48%). On average, boys experienced more traumas (M = 3.00) than girls (M = 2.67). Specifically, boys were more likely than girls to experience an injury or hospitalization (30% vs. 21%, p < .05) and to hear about war/terrorism on the TV/radio (52% vs. 43%, p < .05). Trauma was associated with increased mental health difficulties and increased anxiety scores. There was little evidence that trauma exposure was associated with child cognitive skills. The strength of association between trauma and outcomes was similar for boys and girls. CONCLUSIONS: Findings show that childhood trauma exposure is common in this setting and associated with worse mental health problems among young boys and girls. Results suggest that trauma-informed interventions are important for supporting child mental health in South Asia.

Disability severity and risk of new or recurrent intimate partner violence - Evidence from a cohort study in rural Pakistan.

BACKGROUND: People with disabilities are more likely to experience intimate partner violence (IPV) than those without. Most research examining the relationship between disability and IPV, however, is cross-sectional and approaches disability as a binary variable. This relationship is also important to consider in a South Asian context, where it may be affected by cultural norms surrounding IPV, and resources for people with disabilities. OBJECTIVE: To estimate the degree to which disability severity increases the risk of subsequent IPV among a cohort of mothers living in rural Pakistan. METHODS: Mothers from the Bachpan study (N = 869) with data for at least two consecutive waves between 1-, 2-, 3-, and 6-years postpartum were included in this study. Modified Poisson regression models were used to estimate the relationship between disability level in the preceding wave and psychological, physical, and sexual IPV in the following wave. RESULTS: For psychological IPV, the risk ratio (RR) for medium severity was 1.27 (95 % CI: 1.10, 1.46) and the RR for high severity was 1.23 (95 % CI: 1.02, 1.48), relative to low severity. Physical IPV had a medium severity RR of 1.44 (95 % CI: 1.00, 2.06) and high severity RR of 1.60 (95 % CI: 1.02, 2.53). For sexual IPV, the medium severity RR was 1.35 (95 % CI: 1.05, 1.75) and the high severity RR was 1.53 (95 % CI: 1.11, 2.10). CONCLUSIONS: This study supports that, in a low-income, rural South Asian context, mothers with disabilities are particularly susceptible to future psychological, physical, and sexual IPV.

An integrated risk assessment tool for team-based periodontal disease management.

Mounting evidence suggests a potential association of periodontal disease with systemic diseases such as diabetes, cardiovascular disease, cancer and stroke. The objective of this study is to develop an integrated risk assessment tool that displays a patients' risk for periodontal disease in the context of their systemic disease, social habits and oral health. Such a tool will be used by not just dental professionals but also by care providers who participate in the team-based care for chronic disease management. Displaying relationships between risk factors and its influence on the patient's general health could be a powerful educational and disease management tool for patients and clinicians. It may also improve the coordination of care provided by the provider-members of a chronic care team.