Children's exposure to psychological abuse and neglect: A population-based study in rural Bangladesh.

AIM: We aimed to estimate the prevalence and risk factors of child psychological abuse and neglect in a rural area of Bangladesh. METHODS: Data were obtained from interviewing 1416 children aged 11-17 years administering the International Society for the Prevention of Child Abuse and Neglect Child Abuse Screening Tool for Children between March and April 2017. Linear regression analysis was used to estimate the risks of child psychological abuse and neglect. RESULTS: The prevalence rates of at least one form of psychological abuse both in the past year and lifetime were more than 97 per cent. Moreover, the rates of at least one form of neglect were about 58 per cent during the past year and 78 per cent over lifetime. Living separately from parents posed children to significant risks of neglect and psychological abuse. Working children and greater number of siblings in a family were risk factors for neglect, whereas witnessing family violence and being bullied were risk factors for psychological abuse. Children with more years of schooling experienced less neglect and psychological abuse. CONCLUSION: The high prevalence of child psychological abuse and neglect in this study shows child maltreatment as an ignored issue in Bangladesh.

Children's exposure to physical abuse from a child perspective: A population-based study in rural Bangladesh.

BACKGROUND: Although child physical abuse (CPA) is considered as a major global public health problem, it has not yet been recognized as such in Bangladesh. Very few studies have assessed the prevalence and victims' characteristics of multiple forms of CPA. OBJECTIVE: This population-based study assessed the prevalence of CPA committed by adults in a rural area of Bangladesh and examined its association with demographic and socio-contextual factors. METHODS: Data were obtained using ISPCAN Child Abuse Screening Tool for Children (ICAST-C) in a random sample of 1416 children (49% girls, 51% boys) aged 11 to 17 years by face-to-face interviews during March-April 2017. The response rate was 91.5%. To estimate predictors of CPA, physical abuse was categorized into frequent and less frequent groups. RESULTS: The prevalence of at least one form (≥ 1), two forms (≥2) and three or more forms (≥ 3) of CPA were estimated approximately to 99%, 95% and 83% in their lifetime and 93%, 79%, and 57% in the past year respectively. Hitting (except on buttocks), standing/kneeling and slapping were the most common physical abuse whereas given drugs or alcohol, pinched, burned or scalded, beaten-up and locked up were less reported. Female children were faced severe forms of CPA more than that of males. Male children, younger age groups, witnessing adults using weapons at home, bullied by siblings and low level of maternal education were found to be significant risk factors for both ≥ 1 form and ≥ 2 forms of frequent CPA whereas adding also adult shouting in a frightening way was found as a significant risk factor for ≥ 2 forms of frequent CPA. CONCLUSION: Self-reported prevalence of CPA is extremely common in the Bangladeshi rural society. The prevalence was associated with demographic and socio-contextual characteristics of the children such as being younger, witnessing domestic violence and maternal low education. The findings provide evidence to support parents and policy-makers to take effective measures to implement policy and programme on alternative up-bringing methods and creating awareness of negative effects of CM which in turn help Bangladesh to line up with UN Convention on the Rights of the Child, which the country signed in 1990.

Swedish population-based study of pupils showed that foster children faced increased risks for ill health, negative lifestyles and school failure.

AIM: This population-based study explored whether foster children faced a higher risk of health problems than children of the same age who were not in foster care. METHODS: Data for 13 739 pupils aged 10, 13 and 16 years were obtained from the Pupil Health Database in the county of Värmland, Sweden, for the school years 2012/2013 and 2013/2014. These included data on school performance, health, lifestyle and social relationships, based on children's interviews with school nurses. RESULTS: Of all the pupils, 171 (1.2%) were in foster care. Children in foster care were generally unhealthier than other children. Both girls and boys were at higher risk of chronic health problems, daily smoking, use of drugs and school failure. When the girls in foster care were compared to other girls, we found that they faced a higher risk of psychological and psychosomatic symptoms. This difference was not found for boys. Foster children were also more likely to express a more negative view on life. CONCLUSION: We confirmed earlier studies that children in foster care tended to have inferior health and well-being than other children. These findings emphasise that health, risky behaviour and school performance should be considered together when assessing foster children.

School Nurses Avoid Addressing Child Sexual Abuse.

Child sexual abuse (CSA) is a global public health problem with major consequences for the individual child and society. An earlier Swedish study showed that the school nurses did not initially talk about nor mention CSA as one form of child abuse. For the child to receive adequate support, the disclosure is a precondition and is dependent on an available person prepared to listen. The aim of the study was to explore the ability of the school nurses to detect and support sexually abused children. It is a secondary analysis of focus group interviews with school nurses. Thematic analysis was performed. Results showed that the school nurses avoided addressing CSA due to arousal of strong emotions, ambivalence, and a complicated disclosure process. In order to detect CSA and support abused children, attentiveness of sexual abuse as a possible cause of physical and mental ill-health is crucial.

The School Nurse's Ability to Detect and Support Abused Children: A Trust-Creating Process.

Child abuse has negative health consequences. Early detection and preventive measures lead to avoidance of prolonged and more complex problems. School nurses have a child protection role and should pay attention to vulnerable children. Through health dialogues and other interactions with pupils, school nurses have the opportunity to detect child abuse. The aim of the study was to explore how school nurses detect child abuse and initiate support measures. Focus group interviews were conducted with 23 school nurses. The data were analyzed using a grounded theory approach. Results showed that the main concern of the school nurses was support and assistance to children who are abused which was preceded by a trust-creating and trust-strengthening process. Trust contains self-confidence and confidence in the system and trust can be strengthened or undermined. Building trustful relations is time consuming and is facilitated by networking, refined assessment instruments, and collaboration.

Case analyses of all children's drowning deaths occurring in Sweden 1998-2007.

AIMS: The goal of this research project was to explore circumstances surrounding each drowning death occurring to children and adolescents ages 0-17 in Sweden during the years 1998-2007. METHODS: Records from the National Board of Forensic Medicine (NBFM) and other sources were analysed. We collected information on children's personal characteristics (sex, age, ethnic background, weight, height, physical condition, and pre-existing health conditions) and the circumstances of deaths (time and place of occurrence, type of drowning, resuscitation efforts and medical care given, for example). We also collected information on prevention factors: the physical environment, adult supervision, whether or not the child could swim, and if the child was using a personal flotation device at the time of death. RESULTS: Our analysis showed that 109 children had drowned in Sweden during the study period - of this group, 96 had died from unintentional causes. Children from immigrant backgrounds, particularly with families coming from the Middle East and Iran, were inordinately represented in the group of victims who had died from unintentional drowning deaths. Other risk factors included: coming from a single parent-headed family, alcohol use by older victims and a lack of ability to swim. CONCLUSIONS: Prevention efforts to prevent drowning in the future should focus on preventing alcohol use by young bathers; better fencing around swimming sites; improved coverage of swimming lessons to all children in Sweden, especially children from immigrant families; more education on drowning risks for single parents; and better awareness by adults on the need for constant supervision of children and adolescents in and near water.

Insecure social relations at work and long-term sickness absence due to burnout and other mental diagnoses.

OBJECTIVE: The association between diagnosis and psychosocial work factors in a sickness absent population was examined in order to test the existence of a previously suggested hypothesis of "the burnout staircase", a seven step process prior to the long-term sickness absence due to burnout starting with reorganisations followed by insecure social bonds affecting the work situation as well as trust in oneself and others. PARTICIPANTS: The study population comprised of 2055 employed sick-listed persons (1414 women, 641 men), a sub sample derived from the 2002 national Swedish survey on health, working conditions, life situation and sick-listing. METHODS: Through multinomial logistic regression it was analysed if experiences of the different steps in the burnout staircase increased the probability of burnout compared to other medical diagnoses. RESULTS: The hypothesis was supported. The study revealed strong and significant associations between having experienced reorganisations, insecure social relations fraught with conflicts, incompatible demands, lack of trust and diminished self-esteem and burnout. This was true for both women and men. Strong and significant associations were found also between each step studied and other mental diagnoses for men. CONCLUSION: More studies are needed to further test the hypothesis.

Falling between two stools; how a weak co-operation between the social security and the unemployment agencies obstructs rehabilitation of unemployed sick-listed persons.

PURPOSE: To explore significant factors behind the weak co-operation between local social insurance and unemployment agencies impairing the rehabilitation of unemployed sick-listed persons. METHOD: Individual, semi-structured face-to-face interviews with main actors directly involved in the sick-listing and rehabilitation process were conducted in the year 2000. In all 39 persons were interviewed: 25 professionals (physicians, public employment and social insurance officers) and 14 clients. Data were analysed according to Grounded theory method. RESULTS: The majority of unemployed sick-listed persons were declared too sick to work and were erased from the unemployment registers. This measure weakened the incentives for co-operation between the two main rehabilitation actors. The implication was that the unemployed sick-listed persons lost the opportunity of the co-ordinated rehabilitation they were entitled to. Three significant factors behind this process were identified by the main actors: indistinct regulation of co-operation, shifting political goals over time and conflicting goals between agencies; the last factor mainly a consequence of the other two. CONCLUSIONS: The findings suggest that labour market changes and manifest political goals influence the rehabilitation efforts giving low priority to difficult-to-place individuals such as unemployed sick-listed persons. In fact, a labour market problem turns into a medical problem. The hypothesis needs further testing in quantitative studies.

Long-term sickness absence due to burnout: absentees' experiences.

In the late 1990s, there was a marked increase in Sweden in long-term sickness absence with mental diagnoses. In the extensive research on burnout, little attention has been paid to the link with sickness absence. Our aim in this study was to discover what caused burnout, or such severe stress that it led to long-term sickness absence (> 28 days). We interviewed 32 individuals on long-term sickness absence with a diagnosis of burnout and used grounded theory to analyze the data. We believe that events prior to the sickness absence can be understood as a process of emotional deprivation, and we described the process in terms of a flight of stairs with eight steps: "The Burnout Stairs." We argue that the emotion conveying the process of emotional deprivation is unacknowledged shame, which has its basis in poor social relations at work. We discuss the study's limitations and the need for further research in this field.