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1.
Radiol Adv ; 1(2): umae018, 2024 Jul.
Article in English | MEDLINE | ID: mdl-39171131

ABSTRACT

Background: The classic metaphyseal lesion (CML) is a distinctive fracture highly specific to infant abuse. To increase the size and diversity of the training CML database for automated deep-learning detection of this fracture, we developed a mask conditional diffusion model (MaC-DM) to generate synthetic images with and without CMLs. Purpose: To objectively and subjectively assess the synthetic radiographic images with and without CMLs generated by MaC-DM. Materials and Methods: For retrospective testing, we randomly chose 100 real images (50 normals and 50 with CMLs; 39 infants, male = 22, female = 17; mean age = 4.1 months; SD = 3.1 months) from an existing distal tibia dataset (177 normal, 73 with CMLs), and generated 100 synthetic distal tibia images via MaC-DM (50 normals and 50 with CMLs). These test images were shown to 3 blinded radiologists. In the first session, radiologists determined if the images were normal or had CMLs. In the second session, they determined if the images were real or synthetic. We analyzed the radiologists' interpretations and employed t-distributed stochastic neighbor embedding technique to analyze the data distribution of the test images. Results: When presented with the 200 images (100 synthetic, 100 with CMLs), radiologists reliably and accurately diagnosed CMLs (kappa = 0.90, 95% CI = [0.88-0.92]; accuracy = 92%, 95% CI = [89-97]). However, they were inaccurate in differentiating between real and synthetic images (kappa = 0.05, 95% CI = [0.03-0.07]; accuracy = 53%, 95% CI = [49-59]). The t-distributed stochastic neighbor embedding analysis showed substantial differences in the data distribution between normal images and those with CMLs (area under the curve = 0.996, 95% CI = [0.992-1.000], P < .01), but minor differences between real and synthetic images (area under the curve = 0.566, 95% CI = [0.486-0.647], P = .11). Conclusion: Radiologists accurately diagnosed images with distal tibial CMLs but were unable to distinguish real from synthetically generated ones, indicating that our generative model could synthesize realistic images. Thus, MaC-DM holds promise as an effective strategy for data augmentation in training machine-learning models for diagnosis of distal tibial CMLs.

2.
J Surg Res ; 302: 490-494, 2024 Aug 21.
Article in English | MEDLINE | ID: mdl-39173525

ABSTRACT

INTRODUCTION: Homicide is a leading cause of death for American children. We hypothesized demographics and homicide circumstances would differ by victim age. METHODS: We performed a retrospective analysis of the 2003-2020 National Violent Death Reporting System. The National Violent Death Reporting System collects data from nearly all 50 states, the District of Columbia, and Puerto Rico. Demographics (age, sex, race, and ethnicity), homicide year, and weapon type were abstracted. Inclusion criteria were pediatric victims (age < 18). Two groups: 0-4 y old (young cohort [YC]) and 13-17 y old (teen cohort [TC]) were compared. Chi-squared tests, p-test, and t-tests with significance P < 0.05 were used to determine the association between victim demographics, cohort, and homicide mechanism. RESULTS: 10,569 pediatric (male: 70.2% [n = 7424], median age: 12 y old [interquartile range 1-16], black: 52.7% [n = 5573]) homicides met inclusion. Homicides demonstrated a bimodal age distribution (YC: 40.9% [n = 4320] versus TC: 48.9% [n = 5164]). Gender and race were both associated with homicide victimhood (P < 0.001). TC homicides were more likely to be male (YC: 57.8% [n = 2496] versus TC: 83.7% [n = 4320], P < 0.001) and black (YC: 40.1% [n = 1730] versus TC: 65.0% [n = 3357], P < 0.001). Pediatric homicides increased from 2018 (n = 1049) to 2020 (n = 1597), with only TC demonstrating a significant increase (2018: n = 522 versus 2020: n = 971, P < 0.001). Homicide mechanism was significantly associated with age (Blunt: YC: 57.5% [n = 2484] versus TC: 2.9% [n = 148], P < 0.001; Penetrating: YC: 7.9% [n = 340] versus TC: 92.8% [n = 4794], P < 0.001). CONCLUSIONS: Pediatric homicides demonstrate distinct demographic characteristics and homicide mechanisms between two at risk age cohorts. Age-based education and intervention strategies may increase injury prevention programs' efficacy.

3.
BMC Public Health ; 24(1): 2290, 2024 Aug 22.
Article in English | MEDLINE | ID: mdl-39174914

ABSTRACT

BACKGROUND: Domestic, family and sexual violence is a prevalent health and social issue. Nurses may be exposed to higher rates of this violence in their personal lives compared to the community, but little is known about their polyvictimisation experiences or health and well-being impacts. METHODS: An online descriptive, cross-sectional survey of women nurses, midwives and carer members of the Australian Nursing and Midwifery Federation (ANMF) (Victorian Branch) (response rate: 15.2% of nurses sent an invitation email/28.4% opened the email). Violence survey measures included: intimate partner violence (Composite Abuse Scale); child abuse and sexual violence (Australian Bureau of Statistics Personal Safety Survey items). Health measures included: Short Form-12; Fast Alcohol Screening Test; Patient Health Questionnaire-4; Short Screening for DSM-IV Posttraumatic Stress Disorder; well-being measures included: Connor-Davidson Resilience Scale, social support, and financial stress. Proportions were used to describe the prevalence of violence by sociodemographic characteristics and health and well-being issues; logistic regression predicted the odds of experiencing overlapping types of violence and of experiencing health and well-being outcomes. RESULTS: 5,982 participants (from a parent study of 10,674 nurses, midwives and carers) had experienced at least one type of lifetime violence; half (50.1%) had experienced two or three types (polyvictimisation). Survivors of child abuse were three times more likely to experience both intimate partner violence and non-partner adult sexual assault. Any violence was associated with poorer health and well-being, and the proportion of affected participants increased as the types of violence they had experienced increased. Violence in the last 12-months was associated with the poorest health and well-being. CONCLUSIONS: Findings suggest a cumulative, temporal and injurious life course effect of domestic, family and sexual violence. The polyvictimisation experiences and health and well-being associations reported by survivor nurses, midwives and carers underscores the need for more accessible and effective workplace interventions to prevent and mitigate psychosocial ill health, especially in the recent aftermath of violence.


Subject(s)
Caregivers , Domestic Violence , Sex Offenses , Humans , Cross-Sectional Studies , Female , Adult , Sex Offenses/psychology , Sex Offenses/statistics & numerical data , Middle Aged , Caregivers/psychology , Caregivers/statistics & numerical data , Australia , Domestic Violence/statistics & numerical data , Domestic Violence/psychology , Nurses/psychology , Nurses/statistics & numerical data , Male , Surveys and Questionnaires , Young Adult , Midwifery/statistics & numerical data
4.
Stud Health Technol Inform ; 316: 1652-1656, 2024 Aug 22.
Article in English | MEDLINE | ID: mdl-39176527

ABSTRACT

Emergency departments (EDs) are pivotal in detecting child abuse and neglect, but this task is often complex. Our study developed a machine learning model using structured and unstructured electronic health record (EHR) data to predict when children in EDs might need intervention from child protective services. We used a case-control study design, analyzing data from a pediatric ED. Clinical notes were processed with natural language processing (NLP) techniques to identify suspected cases and matched in a 1:9 ratio to ensure dataset balance. The features from these notes were combined with structured EHR data to construct a model using the XGBoost algorithm. The model achieved a precision of 0.95, recall of 0.88, and F1-score of 0.92, with improvements seen from integrating NLP-derived data. Key indicators for abuse included hospital admissions, extended ED stays, and specific clinical orders. The model's accuracy and the utility of NLP suggest the potential for EDs to better identify at-risk children. Future work should validate the model further and explore additional features while considering ethical implications to aid healthcare providers in safeguarding children.


Subject(s)
Child Abuse , Electronic Health Records , Emergency Service, Hospital , Machine Learning , Natural Language Processing , Humans , Child Abuse/diagnosis , Child , Child, Preschool , Case-Control Studies , Infant , Female , Male , Algorithms
5.
Psychiatr Psychol Law ; 31(4): 612-637, 2024.
Article in English | MEDLINE | ID: mdl-39118783

ABSTRACT

Introduction of evidence relating to the now-discredited behavioural-science syndrome known as 'child sexual abuse accommodation syndrome' in R v Ellis demonstrates the danger of syndrome reasoning in judicial fact finding. Comparable syndrome evidence is still used in the Family Court in the form of 'parental alienation syndrome'. Ellis should sound the death knell for all forensic applications of unreliable syndrome reasoning in the courts.

6.
Child Abuse Negl ; 155: 106982, 2024 Aug 15.
Article in English | MEDLINE | ID: mdl-39151248

ABSTRACT

BACKGROUND: The number of recent media reports of child maltreatment (CM) at international professional ballet schools surpasses the few studies on CM in dance. In general, studies on dance largely focus on psychological maltreatment. There is also little research on student experiences across the entire professional ballet school context, which typically include dance, academic, social life, and healthcare experiences, and for some students, living in residence or a homestay from a young age. OBJECTIVE: To explore how former professional ballet school students characterize and make sense of experiences of CM across the entire school context in dance training, academics, social life, living (e.g., in residence, homestay), and healthcare. PARTICIPANTS AND SETTING: Participants were 15 former professional ballet school students (12 women, three men) aged 18-27 years old across six countries. METHODS: Data from online semi-structured interviews and questionnaires were analyzed using reflexive thematic analysis. RESULTS: Experiences were interpreted in the wider context of participants' former ballet schools. Themes included: 1) psychological maltreatment in and beyond the studio; 2) neglect and devaluation: costs of over-prioritizing ballet; 3) physicalabuse: outdated but still rationalized as instrumental; and 4) sexual abuse in blurred private and public spaces. CONCLUSIONS: Participants used CM vocabulary to describe their own and peers' experiences and emphasized that CM should not be normalized. Sense making about experiences suggested a need for more ballet school community awareness about the multiple potential forms of harm of CM, as well as more research, intervention, and advocacy about CM at ballet schools.

7.
J Interpers Violence ; : 8862605241270077, 2024 Aug 17.
Article in English | MEDLINE | ID: mdl-39152737

ABSTRACT

This study examined rates of mental health disorders and health risk behaviors in people with diverse gender identities and associations with five types of child maltreatment. We used data from the Australian Child Maltreatment Study (ACMS), a nationally representative survey of Australian residents aged 16 years and more, which was designed to understand the experience of child maltreatment (physical abuse, sexual abuse, emotional abuse, neglect, exposure to domestic violence). Mental disorders-major depressive disorder, generalized anxiety disorder (GAD), alcohol use disorder, post-traumatic stress disorder (PTSD), and health risk behaviors-smoking, binge drinking, cannabis dependence, self-harm, and suicide attempt in the past 12 months were assessed. People with diverse gender identities who experienced child maltreatment were significantly more likely to have GAD (43.3%; 95% CI [30.3, 56.2]) than those who had experienced child maltreatment who were either cisgender men (13.8%; [12.0, 15.5]) or cisgender women (17.4%; [15.7, 19.2]). Similarly, higher prevalence was found for PTSD (21.3%; [11.1, 31.5]), self-harm (27.8%; [17.1, 38.5]) and suicide attempt (7.2%; [3.1, 11.3]) for people with diverse gender identities. Trauma-informed approaches, attuned to the high likelihood of any child maltreatment, and the co-occurrence of different kinds may benefit people with diverse gender identities experiencing GAD, PTSD, self-harm, suicidal behaviors, or other health risk behaviors.

8.
Trauma Violence Abuse ; : 15248380241270038, 2024 Aug 20.
Article in English | MEDLINE | ID: mdl-39162217

ABSTRACT

Pelvic examination, a routine practice for gynecological care, can cause anxiety and be considered traumatic. This study aimed to define the association between domestic or sexual violence and the experience of pelvic examination, as well as the uptake of gynecological care following domestic or sexual violence. Pubmed, Cochrane Library, ScienceDirect, and Google Scholar were searched, up to April 30, 2023. Cohort, cross-sectional, case-control studies and controlled trials assessing perception of pelvic examination or the use of gynecological care for women with a history of violence were selected and analyzed. Each study underwent a descriptive analysis and was assessed for bias using the Newcastle-Ottawa scale and the RoB2 tool. Twenty-three articles met the inclusion criteria. Eleven studies, including 7,329 women, investigated the experience of pelvic examination following lifetime or childhood sexual violence. Most reported an association between violence and adverse experiences of pelvic examination, such as discomfort, anxiety, distress, and pain perceptions. Ten studies, including 9,248 women, investigated the uptake of gynecological care following domestic or sexual violence and reported mixed results, such as a decreased or an increased uptake, particularly for acute symptoms. Two studies, including 1,304 women, examined both outcomes. The present study highlights the association between violence and adverse experiences of pelvic examination, as well as mixed results on the uptake of gynecological care. It argues for the necessity to screen for violence in consultations, particularly when considering a pelvic examination, to guarantee the utility of pelvic examinations, and to consider the traumatic impact of sexual violence in care.

9.
Trauma Violence Abuse ; : 15248380241270017, 2024 Aug 19.
Article in English | MEDLINE | ID: mdl-39158156

ABSTRACT

Child maltreatment (CM) poses significant risks to victims, resulting in enduring physical, psychological, and developmental consequences. Adult survivors of CM seem especially vulnerable to perinatal complications. However, existing research on perinatal outcomes presents mixed results and relies heavily on self-reported data, which may not align with official medical data. Hence, a systematic review using official health data may provide clarity on this association; it may orient future research and the provision of perinatal services. This scoping review aimed to synthesize and evaluate the quality of the literature that utilizes official health data to explore associations between CM and perinatal complications. Following Arksey and O'Malley's model, searches across four databases (PsycINFO, MEDLINE, Scopus, and ProQuest Dissertations/Thesis) produced 8,870 articles. After screening, 23 articles met the inclusion criteria (e.g., recorded perinatal complications using official health data, and peer-reviewed studies or dissertation). Evidence indicates CM survivors have less prenatal care visits, more fetal loss and preterm births, lower gestational age, and increases in emergency cesarean sections. Adults had more cervical insufficiency, lower episiotomies and sphincter ruptures, and overall pregnancy and postpartum complications while adolescents had lower Apgar scores. No associations were observed on other outcomes (e.g., vaginal bleeding, group B streptococcus, and fetal distress). Mixed findings emerged for other perinatal and maternal health concerns such as birth weight and blood pressure. CM survivors may face an increased risk of experiencing perinatal complications. Findings point to the relevance of leveraging health data for CM research and adopting trauma-informed practices in perinatal services.

10.
Radiologie (Heidelb) ; 2024 Aug 19.
Article in German | MEDLINE | ID: mdl-39158727

ABSTRACT

CLINICAL ISSUE: The diagnostics of physical child abuse are usually performed by a multidisciplinary team and frequently represent a clinical challenge. Radiological expertise is particularly important for the recognition of abusive injuries to the skeletal system and the central nervous system. The aim of the article is to give an overview of red flags of child abuse in radiological imaging. IMAGING METHODS: For the diagnostics of child abuse, conventional projection radiography of the skeletal system as well as computed tomography (CT) and magnetic resonance imaging (MRI) of the head are especially relevant. There is insufficient evidence with respect to sonography. CONCLUSION: Radiological imaging plays a key role for recognizing physical child abuse. Radiological red flags of child abuse can be crucial for making the diagnosis.

11.
Article in English | MEDLINE | ID: mdl-39150090

ABSTRACT

BACKGROUND: Childhood maltreatment contributes to a large mental health burden worldwide. Different measures of childhood maltreatment are not equivalent and may capture meaningful differences. In particular, prospective and retrospective measures of maltreatment identify different groups of individuals and are differentially associated with psychopathology. However, the reasons behind these discrepancies have not yet been comprehensively mapped. METHODS: In this review, we draw on multi-disciplinary research and present an integrated framework to explain maltreatment measurement disagreement. RESULTS: We identified three interrelated domains. First, methodological issues related to measurement and data collection methods. Second, the role of memory in influencing retrospective reports of maltreatment. Finally, the motivations individuals may have to disclose, withhold, or fabricate information about maltreatment. CONCLUSIONS: A greater understanding of maltreatment measurement disagreement may point to new ways to conceptualise and assess maltreatment. Furthermore, it may help uncover mechanisms underlying maltreatment-related psychopathology and targets for novel interventions.

12.
Front Public Health ; 12: 1174593, 2024.
Article in English | MEDLINE | ID: mdl-39104883

ABSTRACT

Introduction: With thousands of children abducted and abused each year, efforts are needed to keep children safe from predators. Revved Up Kids (RUK) is an intervention that gives elementary-aged children the necessary tools to recognize and avoid dangerous people and situations. The purposes of this study were to describe the RUK intervention components and document its effectiveness. Methods: This evaluation utilized a quasi-experimental design to determine the effectiveness of RUK. The single-session intervention was offered in two formats: one-hour (n = 119 youth) and three-hour (n = 28 youth) workshops. RUK workshop effectiveness was compared to a comparison group (n = 211 youth) that did not receive an intervention. Data were collected at baseline, immediate-post, and 1-month follow-up from second to fourth grade participants. A series of linear mixed models were fitted. Results: Compared to the comparison group, participants in both RUK workshops showed significant improvements across the three time points. More specifically, participants in the one-hour and three-hour RUK workshops significantly increased their safety knowledge measured by the Recognize Score (p < 0.01), Avoid Score (p < 0.01), and Escape Score (p < 0.01), respectively. Discussion: These effective single-session workshops can be easily introduced into schools and community-based settings to complement existing efforts to prevent child abduction and abuse.


Subject(s)
Program Evaluation , Humans , Child , Female , Male , Child Abuse/prevention & control , Predatory Behavior
13.
Article in English | MEDLINE | ID: mdl-39109633

ABSTRACT

AIM: To determine the attitudes and responses of Victorian paediatric intensive care doctors to the detection and reporting of child maltreatment. METHODS: A prospective study conducted in a 30-bed paediatric intensive care unit of a university teaching hospital using data collected from a questionnaire completed by paediatric intensive care consultants and registrars. The questionnaire covered the following domains - doctors' knowledge of Victorian mandatory reporting legislation, doctors' history of reporting and doctors' current role in the detection and reporting of child maltreatment. RESULTS: The questionnaire was completed by 37 doctors. All but one doctor considered their role in the detection and reporting of all six forms of maltreatment (physical abuse, sexual abuse, emotional abuse, neglect, exposure to domestic violence and grooming to facilitate later sexual activity with a child) very important or somewhat important. Thirty-two percent of doctors did not feel adequately trained to detect child maltreatment while 51% did not feel adequately trained to report maltreatment. If a doctor wanted to make a report to Child Protection about the physical or sexual abuse of a child, only one would likely make Child Protection their first point of contact. CONCLUSIONS: Paediatric intensive care doctors show a strong intent to detect and report child maltreatment across a broad range of maltreatment types. Doctors are likely to contact one or more members of a child's care team and/or one or more relevant hospital/community services before making a report to Child Protection about the physical or sexual abuse of a child. Opportunities exist for the further education of doctors in regards to the detection and reporting of child maltreatment.

14.
Child Maltreat ; : 10775595241271426, 2024 Aug 07.
Article in English | MEDLINE | ID: mdl-39110439

ABSTRACT

In cases of alleged child sexual abuse, information about the timing of events is often needed. However, published developmental laboratory research has demonstrated that children struggle to provide accurate and reliable testimony about time and there is currently a lack of field research examining how attorneys actually question child witnesses about time in court. The current study analyzed 130 trial transcripts from cases of alleged child sexual abuse containing a child witness between the ages of 5-17 years old to determine the frequency, style, and content of attorneys' questions and child responses about time. We found that attorneys primarily ask closed-ended temporal location questions (i.e., asking when an event took place using a temporal construct such as day, month, and year) to child witnesses. Additionally, children, of all ages, rarely said "I don't know" or expressed uncertainty in response to temporal questions. These findings are concerning as researchers find that children tend to struggle with temporally locating past events.

15.
Pediatr Radiol ; 2024 Aug 08.
Article in English | MEDLINE | ID: mdl-39115697

ABSTRACT

RATIONALE AND OBJECTIVES: Introduction of post-mortem imaging has helped improve sudden unexpected death in infancy (SUDI) management in Europe. French guidelines were issued in 2007 to homogenise SUDI investigations including imaging. The aim of this study was to evaluate current imaging management of SUDI in France. MATERIAL AND METHODS: Between January 2022 and July 2022, all 35 SUDI French referral centres were invited to answer an e-mailed online survey including 29 questions divided into four different sections covering imaging practices for SUDI including radiology department organisation, imaging modalities performed, methods of reading, and current training resources. Partial responses were secondarily completed by a personal call to the SUDI imaging consultant. The current implementation of the 2007 recommendations was compared with a previous evaluation from 2015 and with current North American practices. RESULTS: The participation rate of centres performing SUDI imaging was 100% (35/35). Imaging was systematically performed in 94.3% (33/35) of the centres: 74.3% (26/35) using radiography; 5.7% (2/35) using ultrasound; 94.3% (33/35) using computed tomography (CT), including 89% (31/35) whole-body CT and 5.7% (2/35) brain CT; and 20% (7/35) using magnetic resonance imaging (MRI). Two centres (5.7%, 2/35) did not systematically perform brain imaging. One (2.9%, 1/35) used ultrasound-guided biopsy. In comparison with 2015, rates of brain imaging increased by 25.4% (P=0.008). There was no significant difference in the number of forensic MRIs performed between France and North America (P=0.663). CONCLUSION: Despite improvements since 2015, full compliance with French guidelines for SUDI investigations remains incomplete. The use of imaging, particularly CT and brain imaging, has increased. Further efforts are needed to standardise imaging practices for optimal SUDI investigations.

16.
J Interpers Violence ; : 8862605241270047, 2024 Aug 14.
Article in English | MEDLINE | ID: mdl-39143752

ABSTRACT

A growing body of research has demonstrated that adverse childhood experiences (ACEs) are a risk factor for criminal justice system contact. However, much of this research is limited by (1) being conducted in the United States and (2) a lack of details on specific types of harmful experiences of criminal justice system contact, such as police contact characterized by intrusion or harassment. Using survey data from 940 individuals aged 16 to 30 in Canada from the Canadian Study of Adolescent Health Behaviors, this study investigates the relationship between ACEs and police contact, focusing on encounters involving intrusion or harassment. Results from logistic and multinomial logistic regression analyses reveal that individuals with high ACE exposure, particularly those with four or more ACEs, are more likely to have police contact, including experiences of intrusion and harassment. The results are significant in understanding the interplay between childhood trauma and later encounters with the criminal justice system, emphasizing the need for trauma-informed approaches in policing and healthcare. The study highlights the importance of early interventions to mitigate the effects of ACEs and prevent adverse outcomes in police interactions.

17.
Article in English | MEDLINE | ID: mdl-39138802

ABSTRACT

Contact burns in children are not uncommon and are often due to accidental contact. Medico-legal assessment is of paramount importance in these contexts to identify cases of abuse. In three cases of burns caused by contact with radiators or a portable heater -two accidental and one deliberate- thorough medico-legal assessment, combined with on-site event reconstruction, enabled accurate diagnoses. Accidental burns displayed a 'pattern' compatible with the incandescent instrument but were more irregular, with different depths and in different parts of the body. In contrast, intentional burns were uniform in depth, distribution and localisation, inconsistent with accidental events. In this context, the on-site inspection and direct evaluation of the objects involved were crucial in the medico-legal assessment. These are indispensable elements for a thorough analysis and abuse recognition.

18.
Front Public Health ; 12: 1397012, 2024.
Article in English | MEDLINE | ID: mdl-39100953

ABSTRACT

Introduction: This study investigates the cumulative effects of adverse childhood experiences (ACEs) on adult depression, anxiety, and stress in Abu Dhabi, controlling for demographic factors, lifestyle, and known health and mental health diagnoses. Methods: Utilizing a cross-sectional design and self-report measures, the research aims to fill a critical gap in understanding the specific impacts of ACEs in the UAE. Based on a multi-site, cross-sectional community sample of 697 residents of Abu Dhabi. Results: The findings reveal significant variances in current screening values for depression, anxiety, and stress attributable to ACEs after controlling for demographic factors, lifestyle risk factors, and adult diagnoses of health and mental health conditions. Discussion: The results underline the lifelong impact of ACEs and reinforce the importance of early identification and intervention. In particular, the implications for policy and practice in understanding and mitigating ACEs long-term effects on mental health are considered.


Subject(s)
Adverse Childhood Experiences , Anxiety , Depression , Mental Health , Humans , United Arab Emirates , Female , Male , Cross-Sectional Studies , Adult , Adverse Childhood Experiences/statistics & numerical data , Middle Aged , Depression/epidemiology , Depression/psychology , Mental Health/statistics & numerical data , Stress, Psychological/psychology , Risk Factors , Adolescent , Young Adult , Self Report
19.
J Pak Med Assoc ; 74(6): 1114-1118, 2024 06.
Article in English | MEDLINE | ID: mdl-38948982

ABSTRACT

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.


Subject(s)
Caregivers , Child Abuse , Health Knowledge, Attitudes, Practice , Tertiary Care Centers , Humans , Pakistan , Female , Male , Cross-Sectional Studies , Adult , Child Abuse/prevention & control , Child Abuse/statistics & numerical data , Child , Caregivers/psychology , Referral and Consultation , Surveys and Questionnaires , Trust , Mandatory Reporting
20.
Violence Vict ; 39(2): 189-203, 2024 Jun 01.
Article in English | MEDLINE | ID: mdl-38955471

ABSTRACT

Although intimate partner violence (IPV) is an important risk factor for child physical abuse, most IPV-exposed children are not evaluated for abusive injuries. A Community Advisory Board (CAB) was formed to (a) optimize a program to evaluate IPV-exposed children for abusive injuries and (b) inform research methods to engage IPV victims and their children. The objectives of this study were to implement and to evaluate the family violence CAB. Following best practices on CAB formation, we recruited local stakeholders with key roles as service providers, community leaders, and knowledge experts in IPV, child abuse, and emergency care. Fourteen members met bimonthly to develop a family-centered intervention and to inform research and advocacy activities. A shared memorandum of understanding outlined goals and objectives. One year after the CAB's implementation, a research assistant interviewed CAB members to understand their experiences, perceived benefits of participation, and desired improvements. Eleven CAB members, including an IPV survivor, participated. Emerging categories included (a) motivations to join the CAB (victim advocacy), (b) benefits of participation (development of relationships among members and increased acceptability of research methods), (c) facilitators of sustainability (program adaptability and development of trust), and (d) desired improvements (case-based follow-up). The CAB was successfully implemented and facilitated the development of collaborative relationships among stakeholders with key roles in IPV and child abuse. The CAB led to community member-proposed changes in research activities and clinical care for victims of IPV.


Subject(s)
Advisory Committees , Intimate Partner Violence , Humans , Female , Male , Child , Intimate Partner Violence/prevention & control , Child Abuse/prevention & control , Adult , Domestic Violence
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