Alexithymia as a mediator of the associations between child maltreatment and internalizing and externalizing behaviors in adolescence.

Child maltreatment is a global concern that profoundly affects individuals throughout their lives. This study investigated the relationships between various forms of child maltreatment and behavior problems involving internalization and externalization during adolescence. Data obtained from a diverse sample of 1802 Canadians aged 14-18 years was used to examine the mediating role of alexithymia-a difficulty in recognizing and expressing emotions-in these associations. Results indicated that adolescents who experienced sexual abuse, emotional abuse, and exposure to intimate partner violence (IPV) in their childhood exhibited higher levels of alexithymia, which was correlated with elevated levels of both internalizing and externalizing problems. Physical abuse and parental neglect were only associated with externalizing problems. Gender differences also emerged, with gender-diverse adolescents reporting a higher prevalence of maltreatment, alexithymia, and behavior problems compared with their peers. However, alexithymia's mediating role was consistent across genders. Overall, this study highlights the intricate relationships between child maltreatment, alexithymia, and adolescent behavior problems. The findings of this study how different forms of child maltreatment significantly shape behavioral outcomes and indicate the importance of interventions in enhancing emotional awareness and expression in adolescents with a childhood history of maltreatment.

Prevalence of physical violence against people in insecure migration status: A systematic review and meta-analysis.

OBJECTIVES: This study summarised evidence on the prevalence of interpersonal, community and state physical violence against people in insecure migration status. METHODS: We conducted a systematic review and meta-analysis of primary studies that estimated prevalence of physical violence against a population in insecure migration status. We searched Embase, Social Policy and Practice, Political Science Complete, SocINDEX and Web of Science Social Sciences Citation Index for reports published from January 2000 until 31 May 2023. Study quality was assessed using an adapted version of the Joanna Briggs assessment tool for cross-sectional studies. Two reviewers carried out screening, data extraction, quality assessment and analysis. Meta-analysis was conducted in Stata 17, using a random effects model and several exploratory subgroup analyses. RESULTS: We retrieved 999 reports and included 31 retrospective cross-sectional studies with 25,997 migrants in insecure status. The prevalence estimate of physical violence was 31.16% (95% CI 25.62-36.70, p < .00). There was no statistically significant difference in the estimates for prevalence of violence for men (35.30%, 95% CI 18.45-52.15, p < .00) and for women (27.78%, 95% CI 21.42-34.15, p < .00). The highest point estimate of prevalence of violence was where insecure status was related to employment (44.40%, 95% CI 18.24-70.57, p < .00), although there were no statistically significant difference in the subgroup analysis. The prevalence of violence for people in undocumented status was not significantly different (29.13%, 95% CI 19.86-38.41, p < .00) than that for refugees and asylum seekers (33.29%, 95% CI 20.99-45.59, p < .00). The prevalence of violence in Asia was 56.01% (95% CI 22.47-89.55, p < .00). Europe had the lowest point prevalence estimate (17.98%, 95% CI 7.36-28.61, p < .00), although the difference was not statistically significant. The prevalence estimate during the migration journey was 32.93% (95% CI 24.98-40.88, p < .00). Intimate partner violence attached to insecure status was estimated at 29.10%, (95% CI 8.37-49.84, p = .01), and state violence at 9.19% (95% CI 6.71-11.68, p < .00). CONCLUSIONS: The prevalence of physical violence is a concern among people in a range of insecure migration statuses. Prevalence of violence is not meaningfully higher for people in undocumented status than for people in other types of insecure status. REVIEW REGISTRATION: PROSPERO (CRD42021268772).

Does it add up? Educational achievement mediates child maltreatment subtypes to allostatic load.

BACKGROUND: Childhood maltreatment (CM) has been linked to higher levels of allostatic load (AL) and educational achievement is a possible pathway and may differ across gender. It is also critical to determine if CM severity or specific subtypes of CM are more or less influential. OBJECTIVE: This study examined educational achievement as a mediator linking cumulative and individual types of CM to AL and examined gender as a moderator. PARTICIPANTS AND SETTING: Using two waves of data, 897 adults from the study Midlife in the United States were analyzed. METHODS: Multiple group structural equation models stratified across gender to test were used cumulative maltreatment and maltreatment subtypes to AL and test gender as a moderator. RESULTS: Overall CM was associated with educational achievement (ß = -0.12, p < .01) and AL (ß = 0.11, p < .05) and education was inversely associated with AL (ß = -0.17, p < .001) in men but not women. The subtypes model revealed that physical abuse predicted lower level of education achievement (ß = -0.20, p < .001) and among men. Educational achievement, in turn, was associated with lower levels of AL (ß = -0.02, p = .002). Educational achievement was a possible pathway linking physical abuse to AL (ß = 0.02, 95 % CI [0.001, 0.040]) among men but was non-significant in women. Gender did not moderate any of the pathways. CONCLUSIONS: Educational achievement is a potentially modifiable social determinant of health that can be a focus of prevention and intervention efforts among men who were maltreated, particularly for those who experienced physical abuse.

Pilot study using machine learning to improve estimation of physical abuse prevalence.

BACKGROUND: International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes have been shown to underestimate physical abuse prevalence. Machine learning models are capable of efficiently processing a wide variety of data and may provide better estimates of abuse. OBJECTIVE: To achieve proof of concept applying machine learning to identify codes associated with abuse. PARTICIPANTS AND SETTING: Children <5 years, presenting to the emergency department with an injury or abuse-specific ICD-10-CM code and evaluated by the child protection team (CPT) from 2016 to 2020 at a large Midwestern children's hospital. METHODS: The Pediatric Health Information System (PHIS) and the CPT administrative databases were used to identify the study sample and injury and abuse-specific ICD-10-CM codes. Subjects were divided into abused and non-abused groups based on the CPT's evaluation. A LASSO logistic regression model was constructed using ICD-10-CM codes and patient age to identify children likely to be diagnosed by the CPT as abused. Performance was evaluated using repeated cross-validation (CV) and Reciever Operator Characteristic curve. RESULTS: We identified 2028 patients evaluated by the CPT with 512 diagnosed as abused. Using diagnosis codes and patient age, our model was able to accurately identify patients with confirmed PA (mean CV AUC = 0.87). Performance was still weaker for patients without existing ICD codes for abuse (mean CV AUC = 0.81). CONCLUSIONS: We built a model that employs injury ICD-10-CM codes and age to improve accuracy of distinguishing abusive from non-abusive injuries. This pilot modelling endeavor is a steppingstone towards improving population-level estimates of abuse.

Workplace violence against Chinese licensed doctors: a cross-sectional study.

Introduction: China has issued and implemented a series of policies aimed at preventing and controlling workplace violence (WPV) against licensed doctors. However, the prevalence of WPV has not been fundamentally curbed. The aim of this study was to present the prevalence of WPV, identify its influencing factors and propose responsive measures. Method: The online Chinese Physician Practice Survey was conducted with purposive sampling method among licensed doctors in China from January 2022 to June 2022. Data covered licensed doctors' sociodemographic characteristics, occupational characteristics, prevalence of WPV, and perception of effective countermeasures. Results: A total of 74,305 licensed doctors participated in this study. A total of 44.88% of respondents had experienced WPV, among them, either physical violence only (1.06%) or non-physical violence only (89.91%) or encountered both of them (9.03%). Age, gender, marital status, education level, professional title and registration type were all associated with WPV, being younger, non-married, more educated, and higher professional title are all risk factors for WPV. Male (OR = 1.396, 95CI%: 1.355 to 1.439), clinicians (OR = 1.342,95%CI: 1.177 to 1.529), who were single (OR = 1.174, 95%CI: 1.111 to 1.241), with master's degree (OR = 2.021, 95%CI: 1.739 to 2.349) and professional title were subsenior (OR = 1.194, 95%CI: 1.125 to 1.267) were most likely to occur WPV. WPV occurred mostly in provincial capitals, public hospitals, primary and community hospitals, and departments of internal medicine, surgery, pediatrics, emergency medicine and mental health. Overall, 44.24% of doctors perceived that strengthening crackdowns on criminal behaviors was the most effective measure to prevent WPV against healthcare staff. Conclusion: The frequency of WPV decreased after the implementation of relevant laws and policies. Future efforts should be made to strengthen crackdowns on illegal and criminal activities and to issue specific legal provisions on the prevention and control of WPV against doctors.

The reciprocal relationship between child maltreatment and children's bullying victimization in China.

Children who experience physical and psychological maltreatment within their family are more likely to become victims of abuse outside the family. In Chinese culture, children's victimization may also be a precursor to parenting behaviors. Nevertheless, the reciprocal relationship between child maltreatment and children's bullying victimization remains unclear, particularly in Chinese culture. This study aimed to evaluate the reciprocal association between child maltreatment and children's bullying victimization in China, as well as its gender differences. A total of 891 children aged 8-11 years in China participated in the study at four time points. The potential reciprocal link was examined using a cross-lagged model. The results indicated that physical abuse predicted children's bullying victimization across four time points, while physical neglect predicted children's bullying victimization during the first three time points. The effects of emotional abuse and neglect were negligible. Conversely, children's bullying victimization consistently predicted various types of parental maltreatment over time. Some gender differences in the relationship were found. The findings emphasized a reciprocal relationship between child maltreatment within the family and children's bullying victimization at school. Understanding the cyclical patterns between child maltreatment and bullying victimization may help improve family education approaches and reduce children's bullying victimization.

Racial and ethnic disparities in diagnostic imaging for child physical abuse.

IMPORTANCE: Racial bias may affect occult injury testing decisions for children with concern for abuse. OBJECTIVES: To determine the association of race on occult injury testing decisions at children's hospitals. DESIGN: In this retrospective study, we measured disparities in: (1) the proportion of visits for which indicated diagnostic imaging studies for child abuse were obtained; (2) the proportion of positive tests. SETTING: The Pediatric Health Information System (PHIS) administrative database encompassing 49 tertiary children's hospitals during 2017-2019. PARTICIPANTS: We built three cohorts based on guidelines for diagnostic testing for child abuse: infants with traumatic brain injury (TBI; n = 1952), children <2 years old with extremity fracture (n = 20,842), and children <2 years old who received a skeletal survey (SS; n = 13,081). MAIN OUTCOMES AND MEASURES: For each group we measured: (1) the odds of receiving a specific guideline-recommended diagnostic imaging study; (2) among those with the indicated imaging study, the odds of an abuse-related injury diagnosis. We calculated both unadjusted and adjusted odds ratios (AOR) by race and ethnicity, adjusting for sex, age in months, payor, and hospital. RESULTS: In infants with TBI, the odds of receiving a SS did not differ by racial group. Among those with a SS, the odds of rib fracture were higher for non-Hispanic Black than Hispanic (AOR 2.05 (CI 1.31, 3.2)) and non-Hispanic White (AOR 1.57 (CI 1.11, 2.32)) patients. In children with extremity fractures, the odds of receiving a SS were higher for non-Hispanic Black than Hispanic and non-Hispanic White patients (AOR 1.97 (CI 1.74, 2.23)); (AOR 1.17 (CI 1.05, 1.31)), respectively, and lower for Hispanic than non-Hispanic White patients (AOR 0.59 (CI 0.53, 0.67)). Among those receiving a SS, the rate of rib fractures did not differ by race. In children with skeletal surveys, the odds of receiving neuroimaging did not differ by race. Among those with neuroimaging, the odds of a non-fracture, non-concussion TBI were lower in non-Hispanic Black than Hispanic patients (AOR 0.7 (CI 0.57, 0.86)) and were higher among Hispanic than non-Hispanic White patients (AOR 1.23 (CI 1.02, 1.47)). CONCLUSIONS AND RELEVANCE: We did not identify a consistent pattern of race-based disparities in occult injury testing when considering the concurrent yield for abuse-related injuries.

Congenital depressed skull fracture ("ping-pong" fracture) in newborn infants as a differential diagnosis of physical abuse. / Fractura craneal deprimida congénita ("fractura ping-pong") en neonatos como diagnóstico diferencial de maltrato físico.

Depressed skull fractures without a clear explanation as to their origin point to trauma with a blunt object and suspected child abuse. In the case of newborn infants, their young age is a vulnerability factor and requires an exhaustive assessment. When child abuse is suspected, an assessment of the differential diagnoses is required to make the most appropriate intervention possible. Both an excessive intervention and an omission of a necessary intervention should be avoided. Congenital depressed skull fractures, described as "ping-pong fractures", are rare (0.3 to 2/10 000 births). They may appear without any trauma history or in instrumentalized childbirth. Here we describe the case of a newborn infant with a ping-pong fracture as an example of an accidental fracture.

Las fracturas con hundimiento de cráneo sin una explicación clara sobre su origen orientan al traumatismo con un objeto romo y a la sospecha de maltrato infantil. En el caso de los bebés recién nacidos, su corta edad es un factor de vulnerabilidad y obliga a una exhaustiva evaluación. Ante la sospecha de maltrato infantil, resulta importante evaluar los diagnósticos diferenciales para realizar la intervención más adecuada posible. Es necesario evitar tanto intervenciones excesivas como omitir la intervención que sea necesaria. Las fracturas craneales deprimidas congénitas, descritas como "fracturas pingpong", son raras (0,3 a 2/10 000 partos). Pueden aparecer sin antecedentes traumáticos o en partos instrumentalizados. Se describe en este artículo el caso de un recién nacido con una fractura ping-pong como ejemplo de una fractura no intencional.

Mother-child reporting discrepancies of child physical abuse: Associations with internalizing and externalizing symptoms.

BACKGROUND: Mother-child discrepancies frequently occur in reports of child physical abuse. Such report discrepancies raise important challenges for interpreting and integrating data from multiple informants in forensic and clinical settings. OBJECTIVES: The main goal of this study was to identify patterns of mother-child discrepancies in reporting CPA using latent profile analysis. We then tested differences between profiles on mothers' mental health problems and children's internalizing and externalizing symptoms. PARTICIPANTS AND SETTING: Participants were 159 mother-child dyads with police-documented exposure to intimate partner violence. METHOD: Participants were recruited from Child Protective Services and shelter residences from all regions of Portugal. After obtaining informed consent, assessment protocols were administered separately to mothers and children. RESULTS: We identified two convergent profiles (mother-child agreement on reports of both high and low exposure to CPA) and one divergent profile (the child reported significantly higher exposure to CPA than the mother). Mothers from the divergent profile reported more depressive and post-traumatic stress symptoms than mothers from the convergent profiles. Children of the divergent profile and one of the convergent profiles (mother-child agreement on high exposure to CPA) showed the highest internalizing and externalizing symptoms. CONCLUSIONS: These results illustrate how examining informant discrepancies in the assessment of abusive parenting practices increases our understanding of children's psychological adjustment in high-risk contexts.

SCAN for Abuse: Electronic Health Record-Based Universal Child Abuse Screening.

BACKGROUND: Identification of physical abuse at the point of care without a systematic approach remains inherently subjective and prone to judgement error. This study examines the implementation of an electronic health record (EHR)-based universal child injury screen (CIS) to improve detection rates of child abuse. METHODS: CIS was implemented in the EHR admission documentation for all patients age 5 or younger at a single medical center, with the following questions. 1) "Is this patient an injured/trauma patient?" 2) "If this is a trauma/injured patient, where did the injury occur?" A "Yes" response to Question 1 would alert a team of child abuse pediatricians and social workers to determine if a patient required formal child abuse clinical evaluation. Patients who received positive CIS responses, formal child abuse work-up, and/or reports to Child Protective Services (CPS) were reviewed for analysis. CPS rates from historical controls (2017-2018) were compared to post-implementation rates (2019-2021). RESULTS: Between 2019 and 2021, 14,150 patients were screened with CIS. 286 (2.0 %) patients screened received positive CIS responses. 166 (58.0 %) of these patients with positive CIS responses would not have otherwise been identified for child abuse evaluation by their treating teams. 18 (10.8 %) of the patients identified by the CIS and not by the treating team were later reported to CPS. Facility CPS reporting rates for physical abuse were 1.2 per 1000 admitted children age 5 or younger (pre-intervention) versus 4.2 per 1000 (post-intervention). CONCLUSIONS: Introduction of CIS led to increased detection suspected child abuse among children age 5 or younger. LEVEL OF EVIDENCE: Level II. TYPE OF STUDY: Study of Diagnostic Test.

Association between longitudinal patterns of child maltreatment experiences and adolescent substance use.

BACKGROUND: Although there is a well-established link between child maltreatment and adolescent substance use, it remains unclear if and how longitudinal patterns of maltreatment experiences are associated with substance use in adolescence. OBJECTIVE: The purpose of the study was to examine how distinct patterns of longitudinal maltreatment experiences are associated with adolescent substance use. PARTICIPANTS AND SETTING: The participants were 899 adolescents from the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN). METHODS: We conducted repeated measures latent class analysis (RMLCA) to identify patterns of physical abuse, sexual abuse, and neglect from birth to age 17 and their relations to tobacco, alcohol, and marijuana use at age 18. RESULTS: RMLCA identified three physical abuse classes (Stable low physical abuse; School age peak physical abuse; Physical abuse primarily in infancy/toddlerhood), two sexual abuse classes (Stable no/low sexual abuse; School age peak sexual abuse), and three neglect classes (High neglect in childhood; Neglect primarily in infancy/toddlerhood; Neglect primarily at school age). Adolescents in the school age peak physical abuse class showed greater alcohol, cigarette, and marijuana use, compared to other physical abuse classes. Similarly, adolescents in the school age peak sexual abuse class showed greater substance use than those in the stable no/low sexual abuse class. Lastly, adolescents in the neglect primarily in infancy/toddlerhood class showed significantly less substance use than those in the other two neglect classes. CONCLUSIONS: Findings highlight the importance of early intervention and ongoing maltreatment prevention.

A reciprocal relationship between parental maltreatment and child bullying perpetration in China.

This study aimed to examine the longitudinal reciprocal relationship between parental maltreatment and child bullying perpetration from middle childhood to early adolescence in China and the associated gender differences. Eight hundred ninety-one children completed a battery of questionnaires at four time points. A random-intercept cross-lagged model was established. The results indicated that at the between-person level, child bullying perpetration was positively associated with physical and psychological maltreatment. At the within-person level, there was a significant association between an increase in bullying perpetration and an increase in parental psychological and physical maltreatment across the four time points. Conversely, an increase in physical maltreatment led to an increase in child bullying perpetration from T1 to T2, while an increase in psychological maltreatment resulted in an increase in child bullying perpetration from T1 to T2 and T2 to T3. Furthermore, an increase in physical maltreatment increased boys' bullying perpetration but decreased that in girls from T2 to T3. These findings provide inspiration for future family education and anti-bullying interventions in schools.

Consequences of the lack of clinical forensic medicine in emergency departments.

Most victims of physical violence sooner or later will access a hospital or medical cabinet because of that violence, and in particular emergency departments (EDs). This paper aims to analyze the performance of emergency ward clinicians in the forensic management of such victims by examining the activities carried out and the data reported. A total of 991 medical records were extrapolated from the database of the ED of the Policlinico of Milan in an average pre-pandemic 1-year activity. For each medical record, 16 parameters were analyzed in-depth including epidemiological data, information on the type of violent actions, injuries, and time between the infliction of the lesion and access to the ED. In the vast majority of cases, all the actions with medicolegal implications had been neglected by health professionals causing loss of data not only for the justice system but especially for correctly interpreting what happened and taking appropriate measures to protect the patient/victim. Hence, given that clinicians in EDs are busy with non-forensic clinical tasks (and rightly so), it should be ensured that there be specific forensic clinical personnel. However, it is crucial that when unfortunately there can be no forensic staff, at least the clinicians who work in the ED are properly trained to correctly apply essential medicolegal measures. Overall, timely and informed medical and forensic intervention is possible and necessary for the improvement and maintenance of the mental and physical health of victims of violence.

Prevalence and Correlates of Economic Abuse Among Married Women in a Nigerian Population.

Economic abuse (EA) is a form of intimate partner violence (IPV) whereby abusers employ various tactics to control their partners' ability to acquire, access, and maintain economic resources thus threatening their economic security and potential for self-sufficiency. It poses a global public health challenge as economic concern is a significant reason for the observed persistent high prevalence of IPV given that even when women want to leave abusive relationships, they are less likely to if they lack the means to cater for themselves and their children upon doing so. However, very few studies in Nigeria have focused on EA. The current study assessed the prevalence and correlates of EA among a Nigerian population of married women. Survey responses of 480 randomly selected married women were used for analysis. The prevalence of EA among respondents was found to be 64.2% while that for emotional abuse, sexual abuse, and physical abuse were 40.2%, 17.3%, and 16.7%, respectively. EA was also found to be significantly associated with other forms of IPV such as physical abuse, emotional abuse, and sexual abuse. The study findings add to the literature by highlighting the high prevalence of EA among Nigerian women. It also underscores the importance of empowering women to minimize victimization. Study limitations are discussed and directions for future research are presented.

Associations Between Verbal and Physical Abuse in the Home and Mental Health Indicators Among Heterosexual and Lesbian, Gay, Bisexual, and Questioning High School Students in the US-Adolescent Behaviors and Experiences Survey, 2021.

PURPOSE: A number of factors may contribute to disparities in mental health and suicidality for lesbian, gay, bisexual, and questioning (LGBQ) students, including parental abuse. METHODS: The Centers for Disease Control and Prevention's (CDC) Adolescent Behaviors and Experiences Survey included a nationally representative sample of US high school students during the COVID-19 pandemic. The current analyses examined experiences of verbal and physical abuse in the home with mental health and suicidality among LGBQ students compared to heterosexual students. RESULTS: The relationship between abuse and mental health and suicidality was significant for all students; however, LGBQ students experienced substantially more abuse and had significantly poorer mental health and greater suicidality than heterosexual students. DISCUSSION: Experiencing verbal or physical abuse in the home is strongly associated with poor mental health and suicidality among youth, regardless of sexual identity; however, among LGBQ students who experienced abuse, the prevalence of poor mental health and suicidality reached crisis levels.

Type of Victimization Exposure, Perpetrator Type, and Timing of Victimization: The Impact on Behavioral Health Outcomes.

The effect of abuse victimization in correctional samples has been researched previously, particularly with an eye toward these experiences on justice-involved youth and prison samples' offending and recidivism behavior. The role of this type of victimization, including physical abuse, sexual abuse, and polyvictimization, is less studied in jail populations. The effect of abuse victimization is also less researched among other outcomes, including behavioral health disorders (BHDs) and substance use disorder (SUD). While the effect of abuse, generally, has been examined, less is known about how abuse perpetrator type and timing of abuse impact justice-involved individuals' outcomes. Using logistic regressions, we examined the influence of abuse perpetrator type (non-stranger or stranger) and timing (before childhood, after childhood, or before and after childhood) in a population of jailed adults from one state (n = 4,713). Outcomes studied included internalizing BHDs, externalizing BHDs, and severe SUD. Results indicated that abuse perpetrated by a non-stranger yielded a greater impact on mental illness compared to abuse perpetrated by a stranger. In contrast to abuse experienced as an adult, childhood abuse was more consistently associated with internalizing and externalizing disorders but was not related to severe SUD, with an exception of physical abuse. Further, BHDs and SUD were strongly associated with each other. Overall, polyvictimization had the strongest effect on the outcomes compared to either physical abuse or sexual abuse alone. Our findings suggest that screening for abuse experiences as a potential destabilizing factor in justice-involved populations could improve case management and interventions for people incarcerated in jails. Results also highlight the importance of distinguishing between the perpetrator type of abuse and timing of abuse.

Risk of Injury-Related Readmission Varies by Initial Presenting-Hospital Type Among Children at High Risk for Physical Abuse.

OBJECTIVES: Children experiencing physical abuse may initially present to hospitals with underappreciated minor injuries, only to experience more severe injuries in the future. The objectives of this study were to 1) describe young children presenting with high-risk diagnoses for physical abuse, 2) characterize the hospitals to which they initially presented, and 3) evaluate associations of initial presenting-hospital type with subsequent admission for injury. METHODS: Patients aged younger than 6 years from the 2009-2014 Florida Agency for Healthcare Administration database with high-risk diagnoses (codes previously associated with >70% risk of child physical abuse) were included. Patients were categorized by the hospital type to which they initially presented: community hospital, adult/combined trauma center, or pediatric trauma center. Primary outcome was subsequent injury-related hospital admission within 1 year. Association of initial presenting-hospital type with outcome was evaluated with multivariable logistic regression, adjusting for demographics, socioeconomic status, preexisting comorbidities, and injury severity. RESULTS: A total of 8626 high-risk children met inclusion criteria. Sixty-eight percent of high-risk children initially presented to community hospitals. At 1 year, 3% of high-risk children had experienced subsequent injury-related admission. On multivariable analysis, initial presentation to a community hospital was associated with higher risk of subsequent injury-related admission (odds ratio, 4.03 vs level 1/pediatric trauma center; 95% confidence interval, 1.83-8.86). Initial presentation to a level 2 adult or combined adult/pediatric trauma center was also associated with higher risk for subsequent injury-related admission (odds ratio, 3.19; 95% confidence interval, 1.40-7.27). CONCLUSIONS: Most children at high risk for physical abuse initially present to community hospitals, not dedicated trauma centers. Children initially evaluated in high-level pediatric trauma centers had lower risk of subsequent injury-related admission. This unexplained variability suggests stronger collaboration is needed between community hospitals and regional pediatric trauma centers at the time of initial presentation to recognize and protect vulnerable children.

Global Prevalence of Childhood Exposure to Physical Violence within Domestic and Family Relationships in the General Population: A Systematic Review and Proportional Meta-Analysis.

Efforts to identify and prevent childhood exposure to physical violence within domestic and family relationships must be underpinned by reliable prevalence estimates to ensure the appropriate allocation of resources and benchmarks for assessing intervention efficacy. We conducted a systematic review and meta-analysis of the global prevalence of childhood exposure to physical domestic and family violence separately as a victim or witness. Searches were conducted in Criminal Justice Abstracts, Embase, Scopus, PubMed, PsychInfo, and Google Scholar. Studies were included if they were peer-reviewed, published in English, had a representative sample, unweighted estimates, and were published between January 2010 and December 2022. One-hundred-and-sixteen studies comprising 56 independent samples were retained. Proportional meta-analysis was conducted to calculate the pooled prevalence for each exposure. Pooled prevalence estimates were also stratified by region and sex. The global pooled prevalence of childhood exposure to physical domestic and family violence as a victim or witness was 17.3% and 16.5%, respectively. Prevalence estimates were highest in West Asia and Africa (victim = 42.8%; witness = 38.3%) and lowest for the Developed Asia Pacific region (victim = 3.7%; witness = 5.4%). Males were 25% more likely than females to be the victim of physical domestic and family violence during childhood, while both were equally likely to have witnessed it. These findings suggest that childhood exposure to domestic and family violence is relatively common, affecting around one-in-six people by 18 years of age globally. Regional variations in prevalence estimates may reflect underlying economic conditions, cultural norms, and service availability.

Prevalence and risk factors of physical violence against husbands: evidence from India.

As the proportion of women being victims of spousal violence in India is higher than men, laws are usually framed to safeguard women. However, men who have experienced physical spousal violence are not unheard of. The study aims to provide the nationwide prevalence of physical violence against husbands and the risk factors for such violence, using large-scale nationally representative 'National Family Health Survey' (NFHS 4) data. The study used descriptive, bivariate, logistic, and multilevel regression models with a random intercept clustering within states and households to explain the physical violence against husband. Sample size for the analysis was 62,716 currently married women aged 15-49 years. Findings revealed that in most of the states of India, physical spousal violence has increased over time. Behavioural characteristics like marital control, alcoholism, and childhood experience of parental violence have a consistent and strong role in explaining the experience of physical violence across states. With age, experience of violence against husbands increases. Differences in socio-economic characteristics do not have unidirectional effect on violence experienced by husbands across regions of India. Working women who are earning cash and having access to mobile phones perpetrate more physical violence in selected regions. Education shows a gradient on such violence perpetration, indicating that only after achieving a certain level of education, chances of violence reduce. Regionally contrasting social and economic risk factors in explaining violence strengthen the argument that violence is space and culture-specific, and development alone may not resolve violence unless the system is addressing the behavioural aspects. There is a need for supporting men experiencing domestic violence within the existing system facilities. Revisiting the present domestic violence laws and programmes for inclusivity is the need of the hour.