Risk factors for child maltreatment by the utilization of medical service and socioeconomic environment in Taiwan.

Child maltreatment is complicated by cultural, welfare, and socioeconomic factors. However, the relationship between child maltreatment and socioeconomic factors has not been completely understood. We investigated risk factors for child abuse and neglect in Taiwan.The data in our study was obtained from Taiwan National Statistics at county level from 2004 to 2015. We included 4 areas (eastern, western, southern, northern) involving 20 cities and counties. The trends of child maltreatment rate based on different years and different areas were surveyed. In addition, panel data analysis was used to analyze the links between child maltreatment rate and socioeconomic factors.An increasing trend of child maltreatment rate in Taiwan was observed. During the past decade, child maltreatment rate increased from 14.5 in 2004 to 23.4 cases per 10000 children in 2014. The peak, which was 43 cases per 10000 children, occurred in 2012. Significant geographical differences were observed, and the highest child maltreatment rate was seen in eastern Taiwan. Panel data analysis revealed a lag effect of the unemployment rate on child maltreatment rate at the county level: the child maltreatment rate increased by 7 percent, while the prior unemployment rate increased by one percent. In addition, the medical personnel density was related to the child maltreatment rate within the county.Previous unemployment rate had a lag impact on child maltreatment occurrence. Unemployment rate has not only a direct impact on the economy but also sequential effects on child maltreatment.

Diffusion-Weighted Imaging of Periventricular Leukomalacia in Very Young Children: Assessment of Peritrigonal Stripe of Restricted Diffusion.

Purpose In periventricular leukomalacia (PVL), apparent diffusion coefficient (ADC) reduction, normally shown as dark stripe in the peritrigonal (PT) white matter, may be incomplete. We assessed the PT dark stripe to differentiate between PVL patients and control subjects. Patients and Methods We reviewed the magnetic resonance studies of 27 neonates and young children with PVL and 67 control subjects to assess the PT dark stripe on ADC maps. In PVL patients, the assessment was referred to the location of PVL lesion on fluid-attenuated inversion recovery (FLAIR) imaging. In the controls, the PT region or the location corresponding to FLAIR hyperintensity was evaluated for the dark stripe. We compared the prevalence of the dark stripe on ADC map and the PT FLAIR hyperintensity between the PVL and the control subjects. Results On ADC map, complete PT dark stripe was present in 67 (100%) of 67 controls but only in 4 (14.8%) of 27 PVL patients (p-value < 0.01), with sensitivity of 0.85, specificity of 1.0, and accuracy of 0.96. PT FLAIR hyperintensity was present in 44 (65.7%) of 67 controls and in 18 (66.7%) of 27 PVL patients (p = 0.920). Conclusion PVL patients can be differentiated from the control subjects with PT dark stripe on ADC map.

Antineuronal antibodies and infectious pathogens in severe acute pediatric encephalitis.

The pathogenesis of acute encephalitis is divided into either direct infection or by immune-mediated inflammation, but the cause is still unknown. This retrospective study aimed to screen antineuronal antibodies in children with severe acute encephalitis. Thirty-four children (22 boys and 12 girls) underwent assessments such as antineuronal antibodies survey for autoimmune encephalitis and polymerase chain reaction/viral culture and antibody assays for all commonly recognized causes of infectious encephalitis. Sixteen (47.1%) were positive for autoantibodies, including antiglutamic acid decarboxylase antibodies in 16 and voltage-gated potassium channel complex antibodies in 1. Sixteen patients (47.1%) had presumed infectious etiologies, including 6 with influenza, 6 with Mycoplasma pneumoniae, 3 with enterovirus, and 1 with herpes simplex virus. In this study, influenza and Mycoplasma pneumoniae infection are the main presumed causes of severe acute encephalitis in children, although an immune-mediated mechanism may also play a role.

Transcranial ultrasound diagnosis of intracranial lesions in children with headaches.

The diagnostic value of transcranial ultrasound for intracranial lesions in children with headaches was evaluated. From January 1995 to December 1998, 444 children with headaches for more than 2 weeks visited our Pediatric Neurologic and Neurosurgical Outpatient Clinics. A 2-MHz-sector sonographic transducer was used to perform transcranial ultrasound. Nineteen patients were lost to follow-up. Two patients, both 15 years of age, failed to have a successful examination. Thirteen of the enrolled 423 patients presented with headaches and other symptoms and positive neurologic signs and had positive magnetic resonance imaging findings of intracranial lesions correlating with their transcranial ultrasound findings. Twelve of the remaining 410 children complaining of isolated headache had abnormal transcranial ultrasound findings. Nine of the 12 patients were confirmed to have intracranial lesions by magnetic resonance imaging studies. Among the nine patients, five had brain tumors, two patients had hydrocephalus, one patient had intracerebral hematoma, and one patient had temporal arachnoid cyst. The other three patients were misinterpreted to have a suprasellar lesion by transcranial ultrasound. These three patients and the remaining 398 children were regularly followed for at least 12 months. All revealed no evidence of an intracranial lesion. The sensitivity and specificity of transcranial ultrasound to detect intracranial lesions for children with isolated headaches were 75% and 99.7%, respectively. The average saving from utilizing this technique was $222 U.S. dollars per person. We suggest that transcranial ultrasound study is a reliable, convenient, time-saving, and economic diagnostic tool in detecting intracranial lesions in children with headaches.