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2.
Emerg Med Clin North Am ; 38(2): 383-400, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32336332

RESUMO

More than half of pediatric malpractice cases arise from emergency departments, primarily due to missed or delayed diagnoses. All providers who take care of children in emergency departments should be aware of this risk and the most common diagnoses associated with medicolegal liability. This article focuses on diagnosis and management of high-risk diagnoses in pediatric patients presenting to emergency departments, including meningitis, pneumonia, appendicitis, testicular torsion, and fracture. It highlights challenges and pitfalls that may increase risk of liability. It concludes with a discussion on recognition and management of abuse in children, including when to report and decisions on disposition.


Assuntos
Emergências , Imperícia , Gestão de Riscos , Adolescente , Fatores Etários , Apendicite/diagnóstico , Apendicite/terapia , Criança , Maus-Tratos Infantis/diagnóstico , Maus-Tratos Infantis/terapia , Pré-Escolar , Medicina de Emergência/legislação & jurisprudência , Medicina de Emergência/métodos , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Meningite/diagnóstico , Meningite/terapia , Pneumonia/diagnóstico , Pneumonia/terapia , Torção do Cordão Espermático/diagnóstico , Torção do Cordão Espermático/terapia , Ferimentos e Lesões/diagnóstico , Ferimentos e Lesões/terapia
3.
Am J Psychiatry ; 177(4): 357-358, 2020 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-32233685
4.
J Clin Pediatr Dent ; 44(2): 100-106, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32271661

RESUMO

Objectives: This study assessed the level of knowledge, attitudes, and awareness of child abuse and neglect (CAN) among dentists. Study design: The sample, consisted of 20,298 Turkish Dental Association (TDA) members, which comprise about two thirds of all dentists, specialists, academics and dental PhD students in Turkey. Among the 20,298 emails sent, 1,020 responses were obtained Descriptive analysis was performed and correlations were tested using the Chi-square and Fischer's Exact tests. A p value of <0.05 was considered statistically significant. Results: Of the participating dentists, 32.7% were able to identify cases of CAN cases, while 17.1% had suspected cases of child abuse and only 1% of them, reported these, to the authorities. The most frequently cited reasons for hesitation to report CAN cases were lack of adequate history (45%), lack of knowledge about the healthcare worker's role in reporting CAN (18.3%), and considerations of the possible consequences against the child (18.8%). Only 11.6% of the participants had received undergraduate level training on the topic of CAN; The majority (86.5%) expressed the need for further education on this issue, and, also, 84.3% believed that it should be a part of postgraduate education. Conclusions: Improvements in CAN education and continuing education courses are necessary to equip dentistry professionals with adequate knowledge about the physical and behavioral indicators of possible abuse, the current legislation regarding mandated reporting and the procedures for reporting suspected cases.


Assuntos
Atitude do Pessoal de Saúde , Maus-Tratos Infantis , Criança , Odontólogos , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Inquéritos e Questionários , Turquia
6.
Fa Yi Xue Za Zhi ; 36(1): 104-108, 2020 Feb.
Artigo em Inglês, Chinês | MEDLINE | ID: mdl-32250088

RESUMO

Abstract: In recent years, cases of child abuse that result in injuries and death have occurred from time to time in China, and there may be more undetected child abuse cases. However, many pediatricians and forensic doctors lack professional knowledge and formal training in detecting child abuse, which leads to the missed diagnosis, misdiagnosis and misidentification of many cases of child abuse. This paper reviews a large number of relevant domestic and foreign literatures, combined with practical work experience and China's national conditions, preliminarily summarizes the main points of clinical diagnosis and forensic identification of child abuse cases, in order to provide some help for early detection, accurate identification of child abuse cases and timely and effective treatment and protection for abused children.


Assuntos
Maus-Tratos Infantis , Fraturas Ósseas , Criança , China , Patologia Legal , Humanos , Pele
8.
PLoS One ; 15(3): e0225839, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32163421

RESUMO

In the current study a three-generational design was used to investigate intergenerational transmission of child maltreatment (ITCM) using multiple sources of information on child maltreatment: mothers, fathers and children. A total of 395 individuals from 63 families reported on maltreatment. Principal Component Analysis (PCA) was used to combine data from mother, father and child about maltreatment that the child had experienced. This established components reflecting the convergent as well as the unique reports of father, mother and child on the occurrence of maltreatment. Next, we tested ITCM using the multi-informant approach and compared the results to those of two more common approaches: ITCM based on one reporter and ITCM based on different reporters from each generation. Results of our multi-informant approach showed that a component reflecting convergence between mother, father, and child reports explained most of the variance in experienced maltreatment. For abuse, intergenerational transmission was consistently found across approaches. In contrast, intergenerational transmission of neglect was only found using the perspective of a single reporter, indicating that transmission of neglect might be driven by reporter effects. In conclusion, the present results suggest that including multiple informants may be necessary to obtain more valid estimates of ITCM.


Assuntos
Sobreviventes Adultos de Maus-Tratos Infantis/psicologia , Maus-Tratos Infantis/psicologia , Pai/psicologia , Relação entre Gerações , Relações Mãe-Filho/psicologia , Mães/psicologia , Adulto , Criança , Pré-Escolar , Humanos
11.
BMC Public Health ; 20(1): 136, 2020 Jan 30.
Artigo em Inglês | MEDLINE | ID: mdl-32000744

RESUMO

BACKGROUND: This study tests whether home visitation to prevent child maltreatment can be improved by adding manualized program components, targeting four key risk factors for child maltreatment: low parental self-efficacy, high levels of perceived stress, parental anger, and post-traumatic stress symptoms. Home visitation is widely implemented, but effects on child maltreatment risk tend to be modest at best. Home visitation tends to be rather flexible (i.e., professionals decide how to support each family). We will test whether adding manualized program components increases program effectiveness, by ensuring that key risk factors are addressed, while maintaining flexibility. In addition, we will test whether any component effects on reduced child maltreatment risk can be explained (i.e., is mediated) by ameliorated risk factors. Lastly, we will test whether the components are more effective for some mothers (e.g., those at highest child maltreatment risk) than for others. METHODS: We will conduct a randomized controlled trial among 398 mothers enrolled in a Dutch home visiting program targeting families at risk for child maltreatment. Mothers in the experimental group will receive the manualized components in two consecutive home visits, while mothers in the control group will receive regular home visits (care as usual). Mothers will fill out questionnaires at four time points: before and after each of the two home visits. Outcome variables include the four targeted risk factors parental self-efficacy, perceived stress, parental anger, and (recognition of) post-traumatic stress symptoms, as well as parenting practices (e.g., rejection and affection), and risk for child maltreatment. DISCUSSION: This study aims to determine whether adding manualized program components to a flexible home visiting program increases program effectiveness on risk for child maltreatment. In addition, our test of whether the effects of the components on risk for child maltreatment is explained (i.e., mediated) by amelioration of the targeted risk factors, may contribute to our understanding of the role of these risk factors in child maltreatment. Our tests of which mothers benefit most from adding the components may help move the field towards evidence-based personalized family support. TRIAL REGISTRATION: This trial has been retrospectively registered in the Netherlands Trial Register (NL8005).


Assuntos
Maus-Tratos Infantis/prevenção & controle , Educação Infantil/psicologia , Promoção da Saúde/métodos , Visita Domiciliar , Mães/psicologia , Gestão de Riscos/métodos , Estresse Psicológico/prevenção & controle , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Países Baixos , Avaliação de Programas e Projetos de Saúde , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Risco , Inquéritos e Questionários
12.
PLoS One ; 15(2): e0228911, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32078645

RESUMO

OBJECTIVES: To explore parents' experiences of seeking health care for their children and instead being accused by healthcare professionals of Shaken Baby Syndrome/Abusive Head Trauma (SBS/AHT), being reported to Social Services, undergoing judiciary processing, and the impact of these events on family (dis)integration. METHODS: Design: A qualitative study based on qualitative content analysis. Participants: Twelve parents in Sweden, mothers and fathers, seeking health care for their infants, encountering allegations of SBS/AHT, losing custody of their infants, and being subjected to a judiciary process, and finally regaining custody of their children. Data collection: In-depth interviews. RESULTS: An overarching theme 'Fighting for protection of their child after being trapped by doctors' and four sub-themes were developed to reflect the parents' experiences, reactions and interpretations. The first sub-theme, 'Being accused of injuring the child', illuminated the shock experienced when seeking care and instead being accused of being a perpetrator. The second, 'Chaos and powerlessness', refers to the emotions experienced when losing custody of the child and being caught in the enforcement of legislation by the authorities. The third, ´The unified fight against the doctors' verdict´, illustrates the parents' fight for innocence, their worry for the lost child, and their support and resistance. The fourth, 'The wounded posttraumatic growth', describes the emotions, grief, panic, anxiety, and challenges in reuniting the family, but also the parents' reflections on personal growth. Unanimously, they had experienced the authorities' inability to reconsider, and expressed a deep mistrust of paediatric care. CONCLUSIONS: Being wrongly accused of child abuse and alleged SBS/AHT evoked emotions of intense stress, but parents endured because of a successful fight to regain custody of their child. However, the trauma had a long-term impact on their lives with residual posttraumatic stress symptoms and mistrust towards healthcare services and the authorities. The results provide important inferences for restoring system failures within child protection services.


Assuntos
Custódia da Criança/ética , Pais/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Confiança/psicologia , Adulto , Criança , Maus-Tratos Infantis/prevenção & controle , Traumatismos Craniocerebrais/prevenção & controle , Decepção , Emoções , Pai/psicologia , Feminino , Humanos , Lactente , Masculino , Mães/psicologia , Pesquisa Qualitativa , Síndrome do Bebê Sacudido , Suécia
13.
PLoS One ; 15(2): e0228667, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32069303

RESUMO

This systematic review aims to summarise current evidence on the association between early life mental health and alcohol use behaviours in adulthood. Peer-reviewed publications were located by searching EMBASE, Medline, PsycINFO, and the ISI Web of Science up to 31 October 2018. Prospective longitudinal studies reporting associations between externalising problems (EXT), internalising problems (INT), depression, anxiety before age 18, and alcohol use behaviours (alcohol consumption, heavy/problematic drinking, alcohol use disorder) after age 18 were included. After screening 17259 articles, 36 articles met the inclusion criteria. Information extracted included strength of associations, age when mental health and alcohol use behaviours were measured, sex differences in the association, and other sample characteristics. 103 tests in 23 articles were identified on the externalising domain and 135 tests in 26 articles on the internalising domain. 37 out of 103 tests reported positive associations between EXT and alcohol use behaviours. The likelihood of observing positive associations was higher for more severe alcohol use outcomes, but this trend disappeared among high-quality studies. Findings on associations between internalising domain and alcohol use varied across their subtypes. INT tended to be negatively associated with alcohol consumption but positively associated with more severe outcomes (heavy/problematic drinking, alcohol use disorder). Depression tended to be positively associated with alcohol outcomes, while no clear association between anxiety and alcohol outcomes was evident. Variation of the association across developmental timing, sex, culture, historical period was explored where appropriate. Great heterogeneity in the current literature calls for greater attention to view the relationship developmentally.


Assuntos
Consumo de Bebidas Alcoólicas/epidemiologia , Alcoolismo/epidemiologia , Maus-Tratos Infantis/estatística & dados numéricos , Saúde Mental/estatística & dados numéricos , Adolescente , Adulto , Criança , Feminino , Humanos , Masculino
14.
PLoS One ; 15(2): e0229661, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32106231

RESUMO

PURPOSE: Adverse childhood experiences in sensitive periods of the developing brain render the individual at a life-long risk for a broad spectrum of aberrant health outcomes. However, there is a lack of scales for the comprehensive assessment of adverse childhood experiences providing information of various types and the age of occurrence. Based on the complete, experimental version of the Maltreatment and abuse chronology of exposure (MACE-X) scale, the present study aimed to develop and psychometrically test a Norwegian version of MACE. METHODS: The 75-item MACE-X was translated from German to Norwegian and administered as a self-report measure to 90 outpatients and 145 employees at a Division of specialized mental health care in South-Eastern Norway. The outpatients also completed the Childhood trauma questionnaire (CTQ) and the Symptom checklist 90 (SCL-90) to investigate convergent and predictive validity. To investigate test-retest reliability, outpatients completed MACE once more two weeks later. RESULTS: Rasch analysis and Anderson likelihood ratio tests on the combined outpatient and employee data resulted in a 55 item version of the Norwegian MACE. In the outpatient group, test-retest reliability of the MACE-55 was excellent for total scores (ICC ≥ 0.94) and good to excellent for 10 subscale scores (ICC ≥ 0.82). Convergent validity with the CTQ was moderate to high for both total scores (0.63 ≥ r ≥ 0.86) and subscale scores (0.56 ≥ r ≥ 0.82). As compared to CTQ total scores, a MACE total score that combined severity and duration of exposure was numerically more strongly associated with overall psychiatric symptoms and each of nine symptom domains on the SCL-90. CONCLUSIONS: The newly developed Norwegian MACE comprehensively assesses past exposure to adverse childhood experiences with high psychometric properties. This scale is a useful tool for research questions addressing sensitive periods for childhood adversities and associated health phenotypes.


Assuntos
Experiências Adversas da Infância/estatística & dados numéricos , Maus-Tratos Infantis/diagnóstico , Adolescente , Adulto , Fatores Etários , Idoso , Criança , Maus-Tratos Infantis/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Noruega , Pacientes Ambulatoriais , Psicometria/métodos , Reprodutibilidade dos Testes , Autorrelato , Inquéritos e Questionários , Adulto Jovem
16.
BMC Public Health ; 20(1): 124, 2020 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-31996179

RESUMO

BACKGROUND: Intimate partner violence against women (IPV) and violence against children (VAC) are both global epidemics with long-term health consequences. The vast majority of research to date focuses on either IPV or VAC, however the intersections between these types of violence are a growing area of global attention. A significant need exists for empirical research on the overlap of IPV and VAC, especially in contexts with particularly high rates of both types of violence. METHODS: This exploratory study includes secondary analysis of data from a cluster randomized controlled trial in Ugandan schools. Using baseline reports from a random sample of early adolescents attending school and their caregivers, this study uses a probability sample across all eligible schools of adolescent-caregiver dyads (n = 535). We categorized adolescent-caregiver dyads into four groups: those reporting VAC 'only', IPV 'only', both VAC and IPV, or 'no violence'. Two separate multinomial logistic regression models for male and female caregivers explored adolescent and caregiver characteristics associated with the VAC 'only', the IPV 'only', or the both VAC and IPV dyads, each compared to the 'no violence' dyad. RESULTS: One third of dyads reported both IPV and VAC and nearly 75% of dyads reported VAC or IPV. Dyads reporting IPV were more likely to also report VAC. Common contributing factors for female caregiver-adolescent dyads with both VAC and IPV include lower SES, less caregiver education, higher caregiver mental distress, more frequent caregiver alcohol use, and caregivers who report less emotional attachment to their intimate partner. Male caregiver-adolescent dyads with both VAC and IPV included caregivers with less emotional attachment to their intimate partner and more attitudes accepting VAC. CONCLUSIONS: Findings reveal a significant overlap of IPV and VAC and the importance for violence prevention and response programming to consider coordinated or integrated programming. Unique results for female and male caregivers highlight the importance of a gendered approach to addressing IPV and VAC intersections. TRIAL REGISTRATION: The trial was registered at clinicaltrials.gov, NCT01678846, on September 5, 2012.


Assuntos
Cuidadores/psicologia , Maus-Tratos Infantis/estatística & dados numéricos , Violência por Parceiro Íntimo/estatística & dados numéricos , Relações Pais-Filho , Adolescente , Adulto , África , Cuidadores/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco
17.
Pediatrics ; 145(2)2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31964756

RESUMO

The largest segment of missing children in the United States includes runaways, children who run away from home, and thrownaways, children who are told to leave or stay away from home by a household adult. Although estimates vary, as many as 1 in 20 youth run away from home annually. These unaccompanied youth have unique health needs, including high rates of trauma, mental illness, substance use, pregnancy, and sexually transmitted infections. While away, youth who run away are at high risk for additional trauma, victimization, and violence. Runaway and thrownaway youth have high unmet health care needs and limited access to care. Several populations are at particular high risk for runaway episodes, including victims of abuse and neglect; lesbian, gay, bisexual, transgender, and questioning youth; and youth in protective custody. Pediatricians and other health care professionals have a critical role to play in supporting runaway youth, addressing their unique health needs, fostering positive relationships within their families and with other supportive adults, and connecting them with available community resources. This report provides clinical guidance for pediatricians and other health care professionals regarding (1) the identification of adolescents who are at risk for running away or being thrown away and (2) the management of the unique medical, mental health, and social needs of these youth. In partnership with national, state, and local resources, pediatricians can significantly reduce risk and improve long-term outcomes for runaway youth.


Assuntos
Criança Abandonada , Jovens em Situação de Rua , Determinação de Necessidades de Cuidados de Saúde , Adolescente , Criança , Maus-Tratos Infantis , Criança Abandonada/psicologia , Criança Abandonada/estatística & dados numéricos , Previsões , Cuidados no Lar de Adoção/estatística & dados numéricos , Acesso aos Serviços de Saúde , Jovens em Situação de Rua/psicologia , Jovens em Situação de Rua/estatística & dados numéricos , Linhas Diretas/estatística & dados numéricos , Humanos , Pesquisa , Medição de Risco , Minorias Sexuais e de Gênero/psicologia , Minorias Sexuais e de Gênero/estatística & dados numéricos , Mídias Sociais , Estados Unidos
18.
Pediatrics ; 145(2)2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31964760

RESUMO

Pediatricians regularly care for children who have experienced child maltreatment. Child maltreatment is a risk factor for a broad range of mental health problems. Issues specific to child maltreatment make addressing emotional and behavioral challenges among maltreated children difficult. This clinical report focuses on 2 key issues necessary for the care of maltreated children and adolescents in pediatric settings: trauma-informed assessments and the role of pharmacotherapy in maltreated children and adolescents. Specific to assessment, current or past involvement of the child in the child welfare system can hinder obtaining necessary information or access to appropriate treatments. Furthermore, trauma-informed assessments can help identify the need for specific interventions. Finally, it is important to take both child welfare system and trauma-informed assessment approaches into account when considering the use of psychotropic agents because there are critical diagnostic and systemic issues that affect the prescribing and discontinuing of psychiatric medications among children with a history of child maltreatment.


Assuntos
Maus-Tratos Infantis/psicologia , Serviços de Proteção Infantil , Transtornos Mentais/tratamento farmacológico , Psicotrópicos/uso terapêutico , Adolescente , Ansiedade/etiologia , Ansiedade/terapia , Transtorno do Deficit de Atenção com Hiperatividade/diagnóstico , Transtorno do Deficit de Atenção com Hiperatividade/etiologia , Transtorno do Deficit de Atenção com Hiperatividade/terapia , Criança , Maus-Tratos Infantis/diagnóstico , Maus-Tratos Infantis/legislação & jurisprudência , Serviços de Proteção Infantil/legislação & jurisprudência , Bases de Dados Factuais , Depressão/etiologia , Depressão/terapia , Exposição à Violência/psicologia , Inquéritos Epidemiológicos , Humanos , Transtornos Mentais/diagnóstico , Transtornos Mentais/etiologia , Pediatras , Resiliência Psicológica , Transtornos do Sono-Vigília/etiologia , Determinantes Sociais da Saúde , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Transtornos de Estresse Pós-Traumáticos/etiologia , Transtornos de Estresse Pós-Traumáticos/terapia , Suspensão de Tratamento
19.
PLoS One ; 15(1): e0227884, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31990913

RESUMO

OBJECTIVES: Child maltreatment through physical abuse, sexual abuse, emotional abuse, neglect, and exposure to domestic violence, causes substantial adverse health, educational and behavioural consequences through the lifespan. The generation of reliable data on the prevalence and characteristics of child maltreatment in nationwide populations is essential to plan and evaluate public health interventions to reduce maltreatment. Measurement of child maltreatment must overcome numerous methodological challenges. Little is known to date about the extent, nature and methodological quality of these national studies. This study aimed to systematically review the most comprehensive national studies of the prevalence of child maltreatment, and critically appraise their methodologies to help inform the design of future studies. METHODS: Guided by PRISMA and following a published protocol, we searched 22 databases from inception to 31 May 2019 to identify nationwide studies of the prevalence of either all five or at least four forms of child maltreatment. We conducted a formal quality assessment and critical analysis of study design. RESULTS: This review identified 30 national prevalence studies of all five or at least four forms of child maltreatment, in 22 countries. While sound approaches are available for different settings, methodologies varied widely in nature and robustness. Some instruments are more reliable and obtain more detailed and useful information about the characteristics of the maltreatment, including its nature, frequency, and the relationship between the child and the person who inflicted the maltreatment. Almost all studies had limitations, especially in the level of detail captured about maltreatment, and the adequacy of constructs of maltreatment types. CONCLUSIONS: Countries must invest in rigorous national studies of the prevalence of child maltreatment. Studies should use a sound instrument containing appropriate maltreatment constructs, and obtain nuanced information about its nature.


Assuntos
Maus-Tratos Infantis/psicologia , Abuso Físico/psicologia , Adolescente , Criança , Maus-Tratos Infantis/prevenção & controle , Estudos Transversais , Feminino , Humanos , Masculino , Abuso Físico/prevenção & controle , Prevalência , Fatores de Risco , Inquéritos e Questionários
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