Self-harming behavior in relation to exposure to inter-personal violence among youth and young adults in Colombia.

The effects of violence exposure on the risk of self-harming behaviors of youth in low- and middle-income countries is not well-understood. Using household survey data from one nationally representative sample and one sample from conflict-affected areas, we examined violence exposure and self-harm among Colombian youth aged 13-24. Survey-weighted prevalence ratios comparing self-harming behaviors by exposure to violence were estimated with Poisson log-linear models, controlling for age, sex, education and food insecurity. Compared to unexposed youth, those exposed to violence in both home and community settings were 7.97 (95% confidence interval [CI]:2.72-23.36) times more likely in the conflict-affected sample, and 21.05 (95% CI: 8.80-50.34) times more likely in the national sample to report having attempted suicide. Among Colombian youth, exposure to violence as either witness or victim was associated with greater prevalence of self-harming behaviors. Youth suicide prevention programs can address exposures to violence as a risk factor for self-harm.

Factors associated with physical violence against children in Haiti: a national population-based cross-sectional survey.

Considering the recent sociopolitical and environmental stress in Haiti, from the COVID pandemic to repeated natural disasters, we aimed to identify risk and protective factors associated with childhood physical violence (CPV) after the 2010 earthquake. A population-based national survey was administered to 13-24-year-old Haitians in 2012. A three-stage clustered sample design was utilized. Adjusted prevalence ratios (aPR) and risk ratios (aRR). 64% of survey respondents experienced CPV were estimated. Respondents who reported emotional and/or sexual abuse prior to age 12 were twice as likely to be victims of physical violence later during childhood (emotional aRR 1.9, 95% CI 1.3-2.7; sexual aRR 2.1, 95% CI 1.4-3.1). Feeling close or very close to one's mother was protective (aPR 0.66, 95% CI 0.47-0.92). This study is the first to describe risk and protective factors and also delineate temporality of exposures associated with CPV.Supplemental data for this article is available online at https://doi.org/10.1080/17457300.2021.1996398.

Concussion Incidence, Duration, and Return to School and Sport in 5- to 14-Year-Old American Football Athletes.

OBJECTIVE: To collect prospective data on concussion incidence, risk factors, duration of symptoms, and return to school and sport in 5- to 14-year-old American football participants. STUDY DESIGN: We conducted a prospective cohort study over 2 years collecting data during two 10-week fall seasons. Youth with concussion were followed to determine time to return to school, sport, and baseline level of symptoms. Logistic regression was used to estimate the risk of sustaining a concussion associated with baseline demographic factors. Time to return to school, sport, and baseline symptoms were analyzed using Kaplan-Meier survival curves. RESULTS: Of 863 youth followed (996 player-seasons), 51 sustained a football-related concussion, for an athlete-level incidence of 5.1% per season. Youth with history of concussion had a 2-fold increased risk for sustaining an incident concussion (OR, 2.2; 95% CI, 1.1-4.8). Youth with depression had a 5-fold increased risk of concussion (OR, 5.6; 95% CI, 1.7-18.8). After a concussion, 50% of athletes returned to school by 3 days, 50% returned to sport by 13 days, and 50% returned to a baseline level of symptoms by 3 weeks. CONCLUSIONS: Concussion rates in this study were slightly higher than previously reported, with 5 of every 100 youth sustaining a football-related concussion each season. One-half of youth were still symptomatic 3 weeks after injury. Further research is needed to address the risk of concussion in youth football.

Prevalence of physical violence against children in Haiti: A national population-based cross-sectional survey.

Although physical violence against children is common worldwide, there are no national estimates in Haiti. To establish baseline national estimates, a three-stage clustered sampling design was utilized to administer a population-based household survey about victimization due to physical violence to 13-24 year old Haitians (n=2,916), including those residing in camps or settlements. Descriptive statistics and weighted analysis techniques were used to estimate national lifetime prevalence and characteristics of physical violence against children. About two-thirds of respondents reported having experienced physical violence during childhood (67.0%; 95% CI 63.4-70.4), the percentage being similar in males and females. More than one-third of 13-17 year old respondents were victimized in the 12 months prior to survey administration (37.8%; 95% CI 33.6-42.1). The majority of violence was committed by parents and teachers; and the perceived intent was often punishment or discipline. While virtually all (98.8%; 95% CI 98.0-99.3) victims of childhood physical violence were punched, kicked, whipped or beaten; 11.0% (95% CI 9.2-13.2) were subject to abuse by a knife or other weapon. Injuries sustained from violence varied by victim gender and perpetrator, with twice as many females (9.6%; 95% CI 7.1-12.7) than males (4.0%; 95% CI 2.6-6.1) sustaining permanent injury or disfigurement by a family member or caregiver (p-value<.001). Our findings suggest that physical violence against children in Haiti is common, and may lead to severe injury. Characterization of the frequency and nature of this violence provides baseline estimates to inform interventions.

Variability in the characteristics and quality of care for injured youth treated at trauma centers.

OBJECTIVE: To survey US level I trauma centers to assess the characteristics of child and adolescent psychosocial service delivery. STUDY DESIGN: Trauma program staff at US level I trauma centers were asked to complete a survey on the characteristics and quality of service delivery for youth. The presence of pediatric services and screening of injured youth for alcohol use problems and posttraumatic stress disorder symptoms were assessed. RESULTS: A total of 150 of 202 trauma centers (74%) responded to the survey. Substantial variability was observed in trauma center age cutoff points for pediatric and adolescent patients. Although most sites endorsed having specialized pediatric, intensive care unit, and surgical services, marked differences were found in the reported percentage of youth receiving psychosocial services. Although most sites screened injured youth for alcohol use problems, variability was observed in the actual percentage of children and adolescents screened. Only 20% of sites endorsed specialized posttraumatic stress disorder services. CONCLUSIONS: Our investigation observed marked variability across trauma centers in the delivery of child and adolescent services. Future research could develop high-quality pediatric psychosocial services to inform trauma center standards nationwide.

Bullying and school safety.

OBJECTIVE: To identify an association between involvement in bullying and problems in school. STUDY DESIGN: This was a cross-sectional study of 5391 students in grades 7, 9, and 11 in an urban public school district. The main outcome measure was involvement in bullying. Secondary outcomes included attendance, grade point average, psychosocial distress, and perceived acceptability of carrying guns to school. RESULTS: Of the 5391 children surveyed, 26% were involved in bullying either as victim, bully, or both (bully-victim). All 3 groups were significantly more likely than bystanders to feel unsafe at school and sad most days. Victims and bully-victims were more likely to say they are "no good." Victims were more likely to feel that they "do not belong" in their school. The odds of being a victim (vs a bystander) were 10% lower for every 1 point increase in grade point average. Bully-victims were more likely to say that it is "not wrong" to take a gun to school. CONCLUSIONS: Associations between involvement in bullying and academic achievement, psychological distress, and the belief that it is not wrong to take a gun to school reinforce the notion that school environment is interrelated with mental health and school success.

A comparison of reviewers selected by editors and reviewers suggested by authors.

OBJECTIVE: To compare reviews done by editor-selected reviewers with reviews by author-suggested reviewers, examining the quality, timeliness, and recommendations of the 2 sets of reviewers. STUDY DESIGN: Comparison of reviews for 140 manuscripts submitted to a pediatric journal in 2005. For each manuscript, a review by an editor-selected reviewer was compared with a review by an author-suggested reviewer. Reviews were rated using a 7-item quality scale with summary scores ranging from 0 (worst) to 100% (best). RESULTS: The mean quality score for all 7 items was 48.2% for reviewers selected by editors and 43.9% for reviewers suggested by authors, a small difference that was not statistically significant. Mean days to review completion was 25.4 for editor-selected reviewers and 27.8 for author-suggested reviewers; this difference also was not statistically significant. Editor-selected reviewers recommended acceptance less often than rejection or revision compared with author-suggested reviewers (risk ratio = 0.67; 95% confidence interval = 0.53 to 0.85). CONCLUSIONS: Editor-selected reviewers did not give significantly higher-quality reviews, nor where they significantly faster compared with author-suggested reviewers. Editor-selected reviewers were less likely to recommend acceptance.

Publication ethics: editors' perspectives.

The medical literature serves a critical role in the translation of evidence into practice. Although the ethics of research conduct receive considerable attention, much less attention has been focused on the ethics of the publication process. Given how important the process is to the advancement of medicine, this oversight seems unfortunate. This article reviews several salient ethical challenges from the perspective of two editors of a pediatric journal.

Television, video, and computer game usage in children under 11 years of age.

OBJECTIVE: To conduct a population-based survey of television and other media usage in young children to determine (1) total media usage; (2) the proportion of children who have televisions in their bedrooms and who eat breakfast or dinner in front of the television; and (3) predictors of parental concern about the amount of television their child watches. STUDY DESIGN: Telephone survey administered to 1454 parents of children <11 years old derived from a diverse clinic population. RESULTS: The mean age of the index child was 5.05 years. Mean daily reported child media use was as follows: television (1.45 hours; SD, 1.5); videos (1.1 hours; SD, 1.30); and computer games (0.54 hours; SD, 0.96). Thirty percent of parents reported that their child ate breakfast or dinner in front of the television in the past week, and 22% were concerned about the amount of television that their child watched. In multivariate linear regression, eating breakfast or dinner in front of the television in the past week was associated with increased hours of television viewing (0.38 hours [0.21, 0.54]) and video (0.19 hours [0.04, 0.34]). Having a television in a child's bedroom was associated with increased hours of television (0.25 hours [0.07, 0.43]), video viewing (0.31 hours [0.16, 0.47]), and computer games (0.21 hours [0.10, 0.32]). In general, higher parental education was associated with decreased hours of television and video but not computer games. Older children were 2 to 3 times more likely than younger children to have a television in their bedroom and to have eaten a meal in front of it in the past week. More educated parents were less likely to report that their child had a television in their bedroom and more likely to be concerned about the amount of television their child viewed. CONCLUSIONS: Combined video and computer game usage exceeded television usage. Both children of low- and high-income parents are at risk for certain behaviors associated with television usage. Parents whose children watched more television were more likely to be concerned about the amount of television their child viewed.