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2.
Anasthesiol Intensivmed Notfallmed Schmerzther ; 54(11-12): 685-703, 2019 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-31805587

RESUMO

In Germany, the increasing focus on child abuse led to remarkable changes in recent years. The latest child protection laws (Kinderschutzgesetz, 2012) and the new medical guideline (AWMF S3+ Kinderschutzleitlinie, 2019) provide effective means for child protection services. Sound knowledge of the clinical manifestations, the parties involved, and the legal situation are required in order to provide effective child protection interventions. This article presents an update of the epidemiology, the legal situation, and the clinical manifestations concerning child abuse. With this information it foremost adresses medical professionals seeing children regularly without having a child protection team at disposal.


Assuntos
Maus-Tratos Infantis , Criança , Maus-Tratos Infantis/diagnóstico , Maus-Tratos Infantis/prevenção & controle , Alemanha , Humanos , Relações Interprofissionais
4.
Pediatrics ; 144(4)2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31537633

RESUMO

Congenital syphilis (CS) is a preventable infection, yet the incidence has surged to the highest rates in 20 years. Because 50% of live-born infants with CS are asymptomatic at birth, there is an increasing likelihood that pediatric providers will encounter older infants whose diagnoses were missed at birth, emphasizing the importance of timely prenatal screening and treatment. We present one such case of an infant admitted twice at 3 and 4 months of age with long bone fractures and suspected nonaccidental trauma. On her second presentation, several additional symptoms prompted evaluation for and eventual diagnosis of CS. In this case, it is demonstrated that an isolated long bone fracture can be a first presentation of CS, with other classic findings possibly appearing later. Pediatric providers should be familiar with the varied presentations of CS in older children, including the radiographic findings that we describe. The rising rates of CS reveal deficiencies in our current strategy to prevent CS and, thus, we recommend reconsideration of universal syphilis screening in the third trimester and at delivery, with timely treatment to prevent CS during pregnancy.


Assuntos
Sífilis Congênita/diagnóstico , Antibacterianos/uso terapêutico , Maus-Tratos Infantis/diagnóstico , Diagnóstico Diferencial , Erros de Diagnóstico , Feminino , Fraturas Espontâneas/etiologia , Humanos , Fraturas do Úmero/etiologia , Lactente , Penicilina G/uso terapêutico , Periostite/microbiologia , Úlcera Cutânea/microbiologia , Sífilis Congênita/tratamento farmacológico , Transaminases/sangue
6.
Am Surg ; 85(7): 700-707, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31405411

RESUMO

The purpose of this study was to identify the risk factors for hospital readmission for child maltreatment after trauma, including admissions across different hospitals nationwide. The Nationwide Readmissions Database for 2010-2014 was queried for all patients younger than 18 years admitted for trauma. The primary outcome was readmission for child maltreatment. The secondary outcome was readmission for maltreatment presenting to a hospital different than the index admission hospital. A subgroup analysis was performed on patients without a diagnosis of maltreatment during the index admission. Multivariable logistic regression was performed for each outcome. There were 608,744 admissions identified and 44,569 (7.32%) involved maltreatment at the index admission. Readmission for maltreatment was found in 1,948 (0.32%) patients and 368 (18.89%) presented to a different hospital. The highest risk for readmission for maltreatment was found in patients with maltreatment identified at the index admission (odds ratios (OR) 9.48 [8.35-10.76]). The strongest risk factor for presentation to a different hospital was found with the lowest median household income quartile (OR 3.50 [2.63-4.67]). The subgroup analysis identified 647 (0.11%) children with readmission for maltreatment that was missed during the index admission. The strongest risk factor for this outcome was Injury Severity Score > 15 (OR 3.29 [2.68-4.03]). This study demonstrates that a significant portion of admissions for trauma in children and teenagers could be misrepresented as not involving maltreatment. These index admissions could be the only chance for intervention for child maltreatment. Identifying these at-risk individuals is critical to prevention efforts.


Assuntos
Maus-Tratos Infantis/estatística & dados numéricos , Readmissão do Paciente/estatística & dados numéricos , Ferimentos e Lesões/epidemiologia , Adolescente , Criança , Maus-Tratos Infantis/diagnóstico , Pré-Escolar , Feminino , Hospitais/estatística & dados numéricos , Humanos , Lactente , Escala de Gravidade do Ferimento , Modelos Logísticos , Masculino , Razão de Chances , Estudos Retrospectivos , Fatores de Risco , Estados Unidos/epidemiologia
8.
Pediatrics ; 144(3)2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31451610

RESUMO

When a healthy infant dies suddenly and unexpectedly, it is critical to correctly determine if the death was caused by child abuse or neglect. Sudden unexpected infant deaths should be comprehensively investigated, ancillary tests and forensic procedures should be used to more-accurately identify the cause of death, and parents deserve to be approached in a nonaccusatory manner during the investigation. Missing a child abuse death can place other children at risk, and inappropriately approaching a sleep-related death as maltreatment can result in inappropriate criminal and protective services investigations. Communities can learn from these deaths by using multidisciplinary child death reviews. Pediatricians can support families during investigation, advocate for and support state policies that require autopsies and scene investigation, and advocate for establishing comprehensive and fully funded child death investigation and reviews at the local and state levels. Additional funding is also needed for research to advance our ability to prevent these deaths.


Assuntos
Maus-Tratos Infantis/mortalidade , Maus-Tratos Infantis/prevenção & controle , Morte Súbita do Lactente/etiologia , Autopsia/economia , Causas de Morte , Maus-Tratos Infantis/diagnóstico , Financiamento Governamental , Patologia Legal/economia , Pesar , Política de Saúde , Humanos , Lactente , Pais/psicologia , Pediatras , Papel do Médico , Radiografia , Morte Súbita do Lactente/diagnóstico , Morte Súbita do Lactente/prevenção & controle , Tomografia Computadorizada por Raios X
9.
J Forensic Nurs ; 15(3): 193-194, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31436684

RESUMO

The International Association of Forensic Nurses has developed a Position Statement regarding child maltreatment. The Position Statement identifies the problem statement, association position, and rationale for interventions.


Assuntos
Maus-Tratos Infantis/diagnóstico , Papel do Profissional de Enfermagem , Criança , Maus-Tratos Infantis/prevenção & controle , Enfermagem Forense , Humanos , Avaliação em Enfermagem , Fatores de Risco , Sociedades de Enfermagem
10.
BMC Health Serv Res ; 19(1): 507, 2019 Jul 22.
Artigo em Inglês | MEDLINE | ID: mdl-31331329

RESUMO

BACKGROUND: This study provides an empirical test of the reasoned action approach (RAA) socio-cognitive theory with the aim of 1) predicting the intention of public dental health personnel (PDHP) to report suspected child-maltreatment to child welfare services (CWS); 2) estimating the effects of the theoretical constructs of RAA, including experiential and instrumental attitudes, injunctive and descriptive norms, and perceived capacity and autonomy regarding PDHP's behavioural intentions; and 3) exploring whether the RAA operates equivalently (i.e., is invariant) in male and female providers. METHODS: This national cross-sectional study was conducted in Norway. An electronic survey was distributed to 1542 dentists and dental hygienists working in the public dental health service. The survey included RAA items constructed in accordance with the recommendations for the RAA model. Structural equation modelling (SEM) was used to identify factors derived from the theory of RAA to predict PDHP reporting intentions. RESULTS: A total of 77.8% (1200) of those surveyed responded to the survey. The present study provided support for the utility of the RAA across both male and female providers in predicting their intention to report suspected child-maltreatment to the CWS. The final modified SEM model revealed that instrumental attitudes and perceived behavioural control (based on merged capacity and autonomy parameters) were the strongest predictors of intention to report, followed by the reporting of descriptive norms, injunctive norms and experiential attitudes. These factors explained 63.6% of the observed variance in the reporting intention. CONCLUSIONS: The large amount of explained variance suggests that RAA is a well-functioning theory that predicts PDHP's reporting intentions to CWS across gender, and gives an understanding of the socio-cognitive factors involved. To strengthen reporting intention among dental personnel, this study suggests educators should focus on the value and positive consequences of reporting, the resources available and how to overcome obstacles; attention to normative expectations and individuals' feelings about reporting may also be helpful.


Assuntos
Atitude do Pessoal de Saúde , Maus-Tratos Infantis/diagnóstico , Intenção , Notificação de Abuso , Saúde Bucal , Adolescente , Adulto , Criança , Estudos Transversais , Odontólogos , Feminino , Humanos , Masculino , Noruega , Inquéritos e Questionários , Adulto Jovem
11.
J Forensic Sci ; 64(6): 1622-1632, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31265140

RESUMO

In 2012, the Harris County Institute of Forensic Sciences began prospectively collecting injury data from pediatric autopsies. These data and associated case information from 635 pediatric cases are archived in the Infant Injury Database (IID). This paper introduces the IID to the forensic community and demonstrates its potential utility for child abuse and infant fatality investigations. The database is intended to be a source of evidence-based research for coroners/medical examiners and clinicians in the recognition and diagnosis of child abuse. RR estimates were employed to quantify the relationship between individual autopsy findings to trauma-related and nontrauma-related causes of death. For example, unsurprisingly, the RR of trauma cases with multiple injury types is significantly greater than other causes of death, but the RR results provide a quantitative representation of the relationship. ROC curve modeling of the presence/absence of various injury types performed well at discriminating trauma from other causes of death (AUC = 0.96).


Assuntos
Maus-Tratos Infantis/diagnóstico , Bases de Dados Factuais , Ferimentos e Lesões/patologia , Distribuição por Idade , Autopsia , Causas de Morte , Pré-Escolar , Grupos de Populações Continentais/estatística & dados numéricos , Feminino , Antropologia Forense , Patologia Legal , Humanos , Lactente , Recém-Nascido , Masculino , Distribuição por Sexo , Texas
12.
Eur J Paediatr Neurol ; 23(4): 604-608, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31147107

RESUMO

Pediatric abusive head trauma (AHT) or non accidental head trauma (NAHT) is a major cause of death from trauma in children under 2 years of age. Main etiological factor for non accidental head trauma is shaking a baby, causing brain injury by rotational head acceleration and deceleration. The consequent brain damage as shown by magnetic resonance imaging (MRI) is subdural haemorrhage and to a lesser extent parenchymal injuries of variable severity. Involvement of the cerebellum has very rarely been described. We report the clinical history and the development of cerebral magnetic resonance imaging findings in two children with serious brain injury following probable shaking who presented the typical "triad" with subdural haematoma, retinal haemorrhage and encephalopathy. We want to draw attention to cerebellar involvement characterized by cortico-subcortical signal alterations most prominent on T2w images following diffusion changes during the acute period. We discuss cerebellar involvement as a sign of higher severity of AHT which is probably underrecognized.


Assuntos
Lesões Encefálicas/patologia , Cerebelo/lesões , Cerebelo/patologia , Maus-Tratos Infantis , Traumatismos Craniocerebrais/patologia , Lesões Encefálicas/diagnóstico por imagem , Cerebelo/diagnóstico por imagem , Maus-Tratos Infantis/diagnóstico , Traumatismos Craniocerebrais/diagnóstico por imagem , Feminino , Humanos , Lactente , Imagem por Ressonância Magnética/métodos , Masculino
13.
Pediatr Ann ; 48(5): e192-e196, 2019 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-31067334

RESUMO

Pediatric head injuries are common and may present with varying degrees of altered mental status in children. The approach to evaluation, diagnosis, treatment, and prevention of further injury is important in achieving good health outcomes after a head injury. In this article, we review the pathophysiology, classifications, signs and symptoms, and management of traumatic brain injury. We also discuss the importance of preventing a secondary injury during recovery by educating families about head injury sequelae and return-to-play guidelines. [Pediatr Ann. 2019;48(5):e192-e196.].


Assuntos
Lesões Encefálicas Traumáticas , Transtornos da Consciência/etiologia , Adolescente , Lesões Encefálicas Traumáticas/classificação , Lesões Encefálicas Traumáticas/diagnóstico , Lesões Encefálicas Traumáticas/fisiopatologia , Lesões Encefálicas Traumáticas/terapia , Criança , Maus-Tratos Infantis/diagnóstico , Pré-Escolar , Transtornos da Consciência/diagnóstico , Transtornos da Consciência/fisiopatologia , Transtornos da Consciência/terapia , Feminino , Humanos , Lactente , Recém-Nascido , Prognóstico , Prevenção Secundária/métodos
14.
WMJ ; 118(1): 47-48, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31083836

RESUMO

INTRODUCTION: Abusive head trauma is a serious, often fatal condition; early identification is important to prevent repeat episodes and/or injuries to siblings. This case emphasizes the importance of a thorough workup in cases of suspected abusive head trauma. CASE PRESENTATION: A 4-month-old infant was found to have a severe subdural hematoma requiring surgical evacuation. Initially, abusive head trauma was considered as a diagnosis. Testing revealed vitamin K deficiency bleeding (VKDB) despite prophylactic vitamin K administration at birth. The infant eventually was diagnosed with progressive familial Iintrahepatic cholestasis type 2 (PFIC2). DISCUSSION: Although VKDB is a known cause of infantile intracranial hemorrhage, PFIC has not been previously reported to cause severe VKDB resulting in an intracranial hemorrhage. CONCLUSION: Our case illustrates the importance of a comprehensive systematic approach to investigate causes other than abusive head injury when intracranial bleeding is a significant finding.


Assuntos
Colestase Intra-Hepática/diagnóstico , Hematoma Subdural/diagnóstico , Maus-Tratos Infantis/diagnóstico , Colestase Intra-Hepática/tratamento farmacológico , Traumatismos Craniocerebrais/diagnóstico , Diagnóstico Diferencial , Feminino , Humanos , Lactente , Vitamina K/uso terapêutico
15.
Pediatr Surg Int ; 35(7): 773-778, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31115655

RESUMO

PURPOSE: A review of our child abuse evaluation system demonstrated a lack of standardization leading to low reporting levels. The purpose of this quality improvement initiative was to develop a standard child abuse screening tool; an education program increasing awareness to child abuse; and to measure the impact of the screening tool in reporting. METHODS: A screening tool was developed and implemented for all trauma patients < 15 years of age; staff was educated; and a child protection team (CPT) was established. Within 9 months, screening was extended to all patients admitted to the children's hospital. Screening compliance, number of child abuse reporting forms (CY-47) filed, and consultations to the CPT were monitored. RESULTS: Initially, there was an average screening compliance of 56%. After making the program hospital-wide, the compliance rate increased to an average of 96%; and the average number of CPT consults increased from 2 to 10 per month. Over this study period, the average number of CY-47s filed increased from 6.1 to 7.3 per month. CONCLUSIONS: Hospital-wide use of an objective screening tool, frequent re-education, and the support of an experienced child protection team led to improved child abuse screening compliance and more consistent suspected-abuse reporting rates.


Assuntos
Maus-Tratos Infantis/diagnóstico , Hospitais Pediátricos/estatística & dados numéricos , Programas de Rastreamento/métodos , Melhoria de Qualidade , Sistema de Registros , Ferimentos e Lesões/diagnóstico , Adolescente , Criança , Maus-Tratos Infantis/estatística & dados numéricos , Pré-Escolar , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Estados Unidos/epidemiologia , Ferimentos e Lesões/epidemiologia , Ferimentos e Lesões/etiologia
16.
J Pediatr Surg ; 54(7): 1277-1285, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30948199

RESUMO

BACKGROUND: The pediatric surgeon is in a unique position to assess, stabilize, and manage a victim of child physical abuse (formerly nonaccidental trauma [NAT]) in the setting of a formal trauma system. METHODS: The American Pediatric Surgical Association (APSA) endorses the concept of child physical abuse as a traumatic disease that justifies the resource utilization of a trauma system to appropriately evaluate and manage this patient population including evaluation by pediatric surgeons. RESULTS: APSA recommends the implementation of a standardized tool to screen for child physical abuse at all state designated trauma or ACS verified trauma and children's surgery hospitals. APSA encourages the admission of a suspected child abuse patient to a surgical trauma service because of the potential for polytrauma and increased severity of injury and to provide reliable coordination of services. Nevertheless, APSA recognizes the need for pediatric surgeons to participate in a multidisciplinary team including child abuse pediatricians, social work, and Child Protective Services (CPS) to coordinate the screening, evaluation, and management of patients with suspected child physical abuse. Finally, APSA recognizes that if a pediatric surgeon suspects abuse, a report to CPS for further investigation is mandated by law. CONCLUSION: APSA supports data accrual on abuse screening and diagnosis into a trauma registry, the NTDB and the Pediatric ACS TQIP® for benchmarking purposes and quality improvement.


Assuntos
Maus-Tratos Infantis/diagnóstico , Serviços de Proteção Infantil/organização & administração , Notificação de Abuso , Encaminhamento e Consulta/organização & administração , Cirurgiões , Criança , Maus-Tratos Infantis/estatística & dados numéricos , Hospitais Pediátricos , Humanos , Comunicação Interdisciplinar , Sociedades Médicas , Estados Unidos/epidemiologia
17.
Arch Pediatr ; 26(4): 199-204, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30954367

RESUMO

OBJECTIVE: To assess the knowledge of professionals on abusive head trauma (AHT) and shaking so as to adapt their training and thus promote the improvement of AHT screening and prevention. METHOD: A questionnaire was developed on the knowledge of the intensity of movement, the frequency of repetition, the existence and progression of sequelae over time, the legal nature of AHT as a criminal offence leading to the possibility of compensation, and the existence of HAS (French National Authority for Health) recommendations on shaken baby diagnosis and legal consequences. RESULTS: Over a 4-year period 311 physicians, 123 magistrates, and 644 early childhood professionals responded to the questionnaire as an introduction to a course on AHT. Whatever the professional field, incorrect answers (wrong or "I don't know") were frequent as to the possibility that play could induce AHT lesions (51-58%), the violence of the act (43-52%), the repetition of shaking (58-82.5%), the presence of side effects (52-58%), and the existence of recommendations to professionals (48-58.5%). Twenty to 47% of physicians and early childhood professionals were unaware that shaking a baby was a criminal offence and 20-27% were unaware that AHT required a report to the judicial authorities. DISCUSSION/CONCLUSION: This lack of knowledge about AHT is detrimental to the child. The improvement of initial and continuing education is necessary to help reduce the dysfunctions existing in the care of child victims of AHT.


Assuntos
Maus-Tratos Infantis/diagnóstico , Maus-Tratos Infantis/legislação & jurisprudência , Competência Clínica , Traumatismos Craniocerebrais/diagnóstico , Competência Profissional , Síndrome do Bebê Sacudido/diagnóstico , França , Humanos , Lactente , Notificação de Abuso , Inquéritos e Questionários
19.
JMIR Mhealth Uhealth ; 7(3): e11306, 2019 03 25.
Artigo em Inglês | MEDLINE | ID: mdl-30907745

RESUMO

BACKGROUND: Disclosure is a difficult but important process for victims of child maltreatment. There is limited research on child maltreatment disclosure. Young people have been reluctant to disclose victimization to adults, but short message service (SMS) crisis services may represent one novel method of engaging young people around sensitive topics. OBJECTIVE: The purpose of this study was to determine characteristics of child maltreatment disclosure to an SMS-based crisis service. METHODS: We conducted a content analysis of all conversations (N=244) that resulted in a mandatory report by an SMS-based crisis service between October 2015 and July 2017. We coded characteristics of the disclosure process, including the reason for initial contact, phrase used to disclose abuse, perpetrator, type of abuse, and length of victimization. After identifying terms used by young people to disclose child abuse, we randomly selected and analyzed 50 conversations using those terms to determine if use of the terms differed between conversations that did and did not result in mandatory report. RESULTS: Parents were the most common perpetrator. Physical abuse was the most common form of abuse discussed in the initial abuse disclosure (106/244, 43.4%), followed by psychological abuse (83/244, 34.0%), sexual abuse (38/244, 15.6%), and neglect (15/244, 6.1%). More than half of the texters discussed abuse or other significant family issues in the first message. An explicit description of the experience or definite language, such as abuse, rape, and molested, was common in disclosures. CONCLUSIONS: Early disclosure, combined with explicit language, may suggest at least a portion of young victims are actively seeking safe ways to talk about their experiences with abuse, rather than incidentally sharing experiences while seeking support for other issues. SMS text messaging may be a valuable way to engage with young people around sensitive topics, but these approaches will require careful consideration in their development, implementation, and evaluation to ensure a positive experience for young people.


Assuntos
Maus-Tratos Infantis/diagnóstico , Maus-Tratos Infantis/psicologia , Intervenção na Crise/métodos , Mensagem de Texto/instrumentação , Revelação da Verdade , Adolescente , Criança , Vítimas de Crime/psicologia , Intervenção na Crise/instrumentação , Intervenção na Crise/normas , Feminino , Humanos , Masculino , Notificação de Abuso , Mensagem de Texto/normas , Mensagem de Texto/estatística & dados numéricos
20.
Nord J Psychiatry ; 73(2): 125-131, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30856038

RESUMO

BACKGROUND: In addition to psychiatric disorders, childhood adversities may increase the risk of suicidal behavior. In previous studies, the effects of clinical co-morbidity and overlap of childhood adversities has rarely been taken into account. AIM: The study aims to search associations of psychiatric diagnoses and childhood adversities and trauma (CAT) with suicide risk. METHODS: Altogether 415 adult patients attending primary and psychiatric outpatient care filled in the Trauma and Distress Scale, including assessment of five core CAT domains (emotional, physical and sexual abuse, and emotional and physical neglect). The study patients' current psychiatric disorders and suicide risk were assessed by the Mini International Neuropsychiatric Interview. RESULTS: Age, poor perceived health, poor social support, current psychiatric treatment, all psychiatric disorders, except hypomania, emotional and physical abuse, and emotional neglect did associate significantly with suicide risk. Number of psychiatric disorders and CAT domains had dose-dependent effects on suicide risk. In multivariate analysis, current psychiatric treatment, current and life-time major depression, social phobia, alcohol, and drug dependency, as well as emotional abuse had direct associations with suicide risk. In females, manic disorders and drug dependence, and in males, dysthymia, social phobia, and emotional abuse associated with suicide risk. CONCLUSIONS: Psychiatric disorders and most CAT domains associate with suicide risk. However, when the effect of co-morbidity and overlap of CAT domains is controlled, major depression, social phobia, alcohol, and drug dependency and emotional abuse seem to increase the risk of suicide. The risk profile varies between the genders.


Assuntos
Sobreviventes Adultos de Maus-Tratos Infantis/psicologia , Maus-Tratos Infantis/psicologia , Transtornos Mentais/psicologia , Ideação Suicida , Suicídio/psicologia , Adulto , Criança , Maus-Tratos Infantis/diagnóstico , Maus-Tratos Infantis/tendências , Comorbidade , Transtorno Depressivo Maior/diagnóstico , Transtorno Depressivo Maior/epidemiologia , Transtorno Depressivo Maior/psicologia , Feminino , Humanos , Masculino , Transtornos Mentais/diagnóstico , Transtornos Mentais/epidemiologia , Pessoa de Meia-Idade , Escalas de Graduação Psiquiátrica , Fatores de Risco , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/psicologia , Suicídio/tendências
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