Posaconazole in paediatric malignancy and haematopoietic stem cell transplant: dosing to achieve therapeutic concentration.

OBJECTIVES: Posaconazole is increasingly used for the treatment and prophylaxis of invasive fungal infections in immunocompromised children. We aimed to review evidence for paediatric posaconazole dosing regimens focusing on attainment of target concentrations and frequency of adverse effects. METHODS: In May 2023, the Cochrane, Embase, MEDLINE and PubMed databases were searched for articles reporting posaconazole dosing in children with malignancy or post-haematopoietic stem cell transplantation. Studies reporting the attainment of target serum concentrations were included. RESULTS: Overall, 24 studies were included. Eighteen studies of the oral suspension consistently reported poor attainment of target concentrations for prophylaxis (≥0.7 µg/mL, 12%-78%) despite high daily doses of 14-23 mg/kg/day (max. 1200 mg/day). Target attainment was significantly affected by gastric pH and food intake. Six studies of the delayed-release tablet (DRT) reported 58%-94% achieved concentrations ≥0.7 µg/mL, with the majority using lower doses of 4-12 mg/kg/day (max. 300 mg/day). Similarly, one study of powder for oral suspension found 67%-100% achieved target concentrations with a dose of 6 mg/kg/day (max. 300 mg/day). As expected, the IV formulation had high attainment of prophylaxis targets (81%-90%) with 6-10 mg/kg/day (max. 400 mg/day). All formulations were well tolerated, and no relationship between adverse effects and posaconazole concentrations was identified. CONCLUSIONS: The required posaconazole dose in immunocompromised children varies depending on the formulation. The IV infusion had the highest attainment of therapeutic concentration followed by the DRT and powder for suspension. By contrast, the oral suspension had low attainment of target concentrations despite higher daily doses.

Metastatic oropharyngeal squamous cell carcinoma to the thyroid: A case report and review of literature.

Oral squamous cell carcinoma (OSCC) with metastasis to the thyroid gland is exceedingly rare, with limited documentation within the literature. Between 1984 and 2023, only 40 cases of head and neck squamous cell carcinoma (SCC) with thyroid gland metastasis were described in published literature. Herein, we present a distinctive case of second primary oropharyngeal SCC with metastasis to the thyroid, detected during surveillance positron emission tomography (PET) scanning subsequent to negative margin resection and radiation therapy for SCC originating from the hard palate. The underlying mechanisms overseeing metastasis remain elusive, with hypotheses ranging from lymphatic drainage routes connecting the thyroid gland and retropharyngeal lymph nodes to hematologic dissemination. The management of metastases to the thyroid gland is multifaceted, encompassing approaches ranging from lobectomy and total thyroidectomy to palliative interventions. We present this atypical case alongside supportive pathological and radiological findings and a comprehensive review of this rare clinical entity to offer insight into its diagnosis and management.

Attrition from pediatric trauma-focused cognitive behavioral therapy: A meta-analysis.

Trauma-focused cognitive behavioral therapy (TF-CBT) is one of the leading interventions for trauma-exposed children and adolescents and is associated with significant improvements in a variety of trauma-related symptoms. Nonetheless, attrition from TF-CBT is quite common, and children who do not receive the full intervention may continue to suffer from trauma-related symptoms. Rates of premature termination have varied across studies, and to date, no meta-analyses have been conducted regarding dropout from TF-CBT. The objective of the present study was to conduct a meta-analysis of the rates of attrition from TF-CBT, as well as review factors related to premature termination from this intervention. A total of 22 studies were available for inclusion in this meta-analysis. The prevalence of attrition was 33.9% (95% CI [26.2%, 42.5%]) from 2,059 children receiving TF-CBT. Clinician-rated attrition was 38.5%, and 17.5% did not receive an adequate dose of TF-CBT (e.g., 12+ sessions). Further, the study type was related to differing rates of dropout, with randomized controlled trials having a much lower attrition rate. Regarding risk factors for premature termination, the emerging literature suggests that a child's age, racial-ethnic minority status, and symptom levels may evince some ties to attrition. Caregiver, family, therapist, and treatment factors remain underexplored in relation to premature termination; however, preliminary work suggests that lack of caregiver attendance and difficulty in the child-therapist relationship may be related to attrition. A substantial number of children prematurely terminate from TF-CBT, underscoring the need to better prevent dropout.

Novel approaches to the prediction and diagnosis of pulmonary complications in the paediatric haematopoietic stem cell transplant patient.

PURPOSE OF REVIEW: Haematopoietic stem cell transplant (HSCT) remains the only curative treatment option for many children with relapsed leukaemia, primary immunodeficiencies and haemoglobinopathies. Unfortunately, infectious and noninfectious pulmonary complications following HSCT continue to cause significant morbidity and mortality. This review will focus on recent advances in the field that enhance clinically available diagnostic tools and the role of novel diagnostic techniques. RECENT FINDINGS: Research continues to highlight the role of standard diagnostic modalities, including imaging using computed topography chest and Fluorodeoxyglucose-positron emission tomography (FDG-PET) in the diagnosis of posttransplant pulmonary infections. Similarly, bronchoalveolar lavage using bronchoscopy to obtain samples for microbiological analysis remains an important tool in the clinical and diagnostic algorithm for these children. The application of more novel diagnostic techniques such as metagenomic next-generation sequencing and the use of specific biomarkers remain potential future tools in children in whom the aetiology of posttransplant lung disease is unknown. The impact of the pulmonary microbiome on infectious and noninfectious pulmonary disease post HSCT is a future research direction. SUMMARY: Pulmonary infectious complications post HSCT remain a devastating complication for children and their families. Despite improvements in standard and novel diagnostic modalities, the aetiology of pulmonary disease remains unknown for many patients. There is an urgent need for ongoing collaborative research to bridge this critical knowledge gap and lead to better patient outcomes.

Non-neutropenic fever in children with cancer: Management, outcomes and clinical decision rule validation.

INTRODUCTION: Fever and infection are an important complication of childhood cancer therapy. Most research and guideline development has focussed on febrile neutropenia, with a paucity directed at non-neutropenic fever (NNF). We describe the clinical presentation, management and outcomes of NNF in children with cancer, and externally validate the Esbenshade Vanderbilt (EsVan) clinical decision rules (CDR) to predict bacteraemia. METHOD: Using a prospective database, retrospective data were collected on consecutive NNF episodes (fever ≥38.0°C and absolute neutrophil count >1.0 cells/mm3 ). Sensitivity, specificity and area under the receiver operator characteristic curve (AUC-ROC) of the CDR were compared to derivation study. RESULTS: There were 203 NNF episodes occurring in 125 patients. Severe sepsis was uncommon (n = 2, 1%) and bacteraemia occurred in 10 (4.9%, 95% confidence interval [CI]: 2.7%-8.8%) episodes. A confirmed or presumed bacterial infection requiring antibiotics occurred in 31 (15%) patients. Total 202 (99%) episodes received at least one dose of intravenous broad-spectrum antibiotic and 141 (70%) episodes were admitted to hospital. Six (3%) episodes required intensive care unit (ICU)-level care and there were no infection-related deaths. The EsVan 1 rule had an AUC-ROC of 0.67, 80% were identified as low risk, and sensitivity and specificity were 50% and 81.5%, respectively, for a risk threshold of 10%. CONCLUSIONS: Serious infection and adverse outcome are uncommon in children with NNF. Many children did not have a bacterial cause of infection identified, but were still treated with broad-spectrum antibiotics and admitted to hospital. National clinical practice guidelines should be developed for this important cohort to enable risk stratification and optimise antibiotic management. Further research is required to determine appropriateness of EsVan CDR in our cohort.

Relational Factors Associated With Posttraumatic Stress Among Emerging Adults of Color Exposed to Community Violence.

The relationship between trauma exposure and posttraumatic stress symptoms (PTSS) is well-documented, but less is known about factors that contribute to the expression of PTSS following community violence exposure, particularly among emerging adults of color. Utilizing the Person-Environment Interaction model (Slaug et al., 2018), this study examined the role of relational factors, specifically ethnic identity, community cohesion, and social support, associated with PTSS following exposure to community violence. Participants included 243 emerging adult university students of color (Mage = 20.27, SD = 1.95, 83.5% female). Linear regression analyses indicated that less frequent trauma exposure and greater perceived social support were related to lower PTSS. A significant interaction was also found between social support and exposure to community violence, such that at low levels of social support, individuals with more community violence exposure had the highest levels of PTSS. Regression and moderation analyses indicated that ethnic identity and community cohesion were not significantly associated with PTSS in this sample. Findings highlight the importance of incorporating social support strategies in treatments for PTSS following community violence exposure.

Growth hormone and targeted oncological agents: Are we stopping children with brain tumours from reaching their true height potential?

Children with low-grade gliomas have excellent long-term survival outcomes. The development of therapies targeted to the driver mutations along the Mitogen Activated Protein (MAP) kinase signalling pathway are providing long-term stability for many patients with these tumours. Given the frequency of these tumours residing within or near the suprasellar region, our patients commonly suffer from hormone deficiencies. In Australia, the Pharmaceutical Benefits Scheme currently restricts growth hormone therapy to patients who are not being actively treated for cancer, including those receiving targeted therapies. This viewpoint hopes to facilitate an important discussion amongst our colleagues as to whether this should be changed to allow growth hormone to become available to children on chronic tumour suppressive therapy.

Child Sexual Abuse and Adult Sexual Assault among Emerging Adults: Exploring the Roles of Posttraumatic Stress Symptoms, Emotion Regulation, and Anger.

Child sexual abuse (CSA) has been previously linked with a risk for adult sexual assault (ASA) and posttraumatic stress symptoms (PTSS). Yet, the relations between CSA, ASA, and other psychological outcomes that may contribute to increased risk for ASA are less clear. This study aims to: 1) examine the links between CSA and ASA and potential risk factors (i.e., PTSS, emotion dysregulation, anger), 2) determine whether there are indirect effects between CSA and ASA through each factor, and 3) investigate whether there are indirect effects between CSA and ASA through the DSM-5 posttraumatic stress disorder (PTSD) symptom clusters. The sample included 567 undergraduates (Mage = 20.84, SD = 4.10; 81.1% women; 56.6% white) from two universities. Both CSA and ASA were related to PTSS, emotion dysregulation, and anger. There were indirect effects of CSA on ASA through PTSS and anger (B = .04, B = .01, respectively). CSA was associated with each of the PTSD symptom clusters, but only marked alterations in arousal and reactivity were linked with ASA (B = .01). The clusters had no indirect effects on the relation between CSA and ASA. These findings revealed several factors that may be linked with increased risk for sexual victimization.

Sexual Assault, Posttraumatic Stress Symptoms, and Indices of Aggression Among Women.

Sexual assault is associated with many adverse outcomes, including a higher risk for developing posttraumatic stress symptoms (PTSS). Although nonsexual trauma exposure has been linked to aggression, the associations between sexual assault and aggression are understudied. Further, the DSM-5 conceptualization of posttraumatic stress disorder (PTSD) includes a symptom related to aggression, and associations between symptom clusters and aggression with regard to the new criteria are underexplored. The present study aimed to (a) examine the relations between sexual assault and indices of aggression (i.e., physical/verbal aggression, anger, and hostility) after accounting for PTSS and (b) investigate PTSD symptom clusters in relation to aggression among 263 women (Mage = 29.03 years, SD = 11.71; 67.6% white). Path analysis revealed that sexual assault was unrelated to indices of aggression, ßs = .003-.08; however, PTSS was consistently linked with increased aggression, ßs = .22-.49. Results indicated specificity in the associations between the symptom clusters and aspects of aggression. Negative alterations in cognitions and mood corresponded with increased physical aggression, ß = .28, and hostility, ß = .38, and avoidance was related to verbal aggression, ß = .19. Hyperarousal was also tied to higher levels of anger, hostility, and verbal aggression, ßs = .21-.33. Nonetheless, lower levels of intrusion symptoms were associated with increased anger and hostility, ß = -.26. With regard to understanding women's risk for aggression, PTSS may be more relevant than sexual assault. Further, there may be specificity related to the type of PTSD symptoms and aspects of aggression.

Analysis of volatile profiles of green Hawai'ian coffee beans damaged by the coffee berry borer (Hypothenemus hampei).

BACKGROUND: The coffee berry borer (CBB), Hypothenemus hampei, is the most destructive insect pest of coffee globally, causing significant losses in yield and leading to 'off' flavors in damaged beans. Automated headspace sampling (AHS) and gas chromatography-mass spectrometry (GC-MS) were used to investigate changes in the volatile profiles of CBB-damaged green coffee beans. Green coffee from three coffee farms on the island of Hawai'i were sorted into three levels of CBB damage: non-damaged, slightly damaged (1-2 pinholes/bean), and heavily damaged (> 2 pinholes/bean). RESULTS: Distinct differences were found between green coffee bean samples based on the amounts of eight prominent volatiles. The amount of CBB damage was particularly correlated with the amount of both hexanal and 2-pentylfuran. Principal component analysis showed clustering of non-damaged green beans, which did not overlap with the slightly or heavily damaged clusters. Good separation was also found between a mixture of 50% slightly damaged and non-damaged coffee. However, 20% slightly damaged and non-damaged coffee clusters showed strong overlap. CONCLUSION: Understanding the effects of CBB damage on coffee flavor profiles is critical to quality control for this valuable agricultural product. The results of this study show that the volatile profiles of green coffee beans vary with CBB damage. With specific volatile profiles for CBB-damaged coffee identified, coffee samples can be tested in the lab, or potentially on the farm or in coffee mills, to identify high levels of CBB damage that may lead to off flavors and a reduction in product quality and value. © 2018 Society of Chemical Industry.

New Zealand palliative care nurses experiences of providing spiritual care to patients with life-limiting illness.

BACKGROUND: Internationally it is recognised that providing spiritual care is essential to reduce spiritual distress, particularly in patients who are facing a life-limiting illness. AIM: This study sought to explore palliative care nurses experiences providing spiritual care to their patients who are facing a life-limiting illness. METHOD: This study used a qualitative approach: interviews took place with nine nurses working across three hospices in New Zealand in 2013. FINDINGS: Nine palliative care nurses participated in the study. Their average age was 53 years and palliative care experience ranged from 3-22 years, with an average of 9 years. The narrative descriptions of nine palliative care nurses were demonstrated under the categories of the assessment of spiritual needs: recognition of spiritual distress, provision of spiritual care and documentation of spiritual care. Additionally, eight sub-categories: individuality and respect; connection; love and compassion; meaning, touching and presence; communication; divine-related spiritual care provision and referral; death preparation and post-modern spiritual care were identified under the category of provision of spiritual care. CONCLUSION: There are challenges in identifying and defining spiritual distress and there is complexity in the provision of spiritual care. However, for the nurses in this study, focusing on the individual patient and developing a relationship that enabled the patient's unique spiritual needs to be met was highly valued. Creating a culture where nurses, and other health professionals involved in the patient's care, share their experiences of spiritual care provision and discussion about how this can be documented is needed.

"We're checking them out": Indigenous and non-Indigenous research participants' accounts of deciding to be involved in research.

BACKGROUND: It is important for researchers to understand the motivations and decision-making processes of participants who take part in their research. This enables robust informed consent and promotes research that meets the needs and expectations of the community. It is particularly vital when working with Indigenous communities, where there is a history of exploitative research practices. In this paper, we examine the accounts of Australian Indigenous and non-Indigenous research participants in terms of how and why they agree to take part in research. METHODS: A qualitative research approach was employed to undertake individual interviews with 36 research participants in Victoria, Australia. Eight participants identified as Indigenous and 28 were non-Indigenous. Thematic analysis was used to interpret the data. RESULTS: There were stark differences between Indigenous and non-Indigenous research participants in terms of why and how they decided to participate in research. For Indigenous participants, taking part in research was primarily to benefit their communities rather than for personal interests. Indigenous participants often started from a position of caution, and showed a considered and deliberate process of decision making. In weighing up their decision to participate, some Indigenous participants clearly articulated what was valued in conducting research with Indigenous communities, for example, honesty, reciprocity, and respect; these values were explicitly used to assist their decision whether or not to participate. This was in contrast to non-Indigenous participants who took researchers' claims on face value, and for whom deciding to participate in research was relatively straightforward. The motivations to participate of non-Indigenous participants were due to personal interests, a desire to help others, or trust in the medical practitioner who recruited them for the research project. CONCLUSION: Understanding research participants' motivations about taking part in research is important. This is particularly relevant for Indigenous communities where there is a reported history of research abuse leading to mistrust. This understanding can lead to research practice that is more respectful and responsive to the needs of Indigenous communities and abides by the values of Indigenous communities. Moreover it can lead to more ethical and respectful research practice for all.

Initiation of Breast Cancer Screening at a Later Age May Disproportionately Impact Minority Groups: Review of Ohio Data (1996-2022).

Among women with breast cancer, delays in diagnosis and earlier presentation have been documented among minority women. Consequently, initiation of breast cancer screening at a later age may disproportionately harm minority groups. This study seeks to determine whether minority women face a higher proportional risk of younger age breast cancer than their White peers. Using publicly available data from the Ohio Department of Public Health Data Warehouse, we constructed a database allowing for retrospective evaluation of all breast cancer patients in the state of Ohio from 1996 to 2020. White women represented the bulk of total breast cancer cases in each age group and overall; however, the proportion of cancers attributable to White women increased in each successively older cohort group: 80.7% of cases under age 40 up to 91.3% of the 80 or older group. By a significant margin, the opposite is true in minority groups with African American women accounting for 15% of cases under the age of 40, trending down to 7.8% of the 80 and older group. Comparison of the proportions of these groups demonstrates statistically significant proportional decreases among minority groups and statistically significant increases among White women. Our findings suggest that women of color in the Ohio population face a disproportionately high risk of being diagnosed with younger age breast cancer and support the findings of other authors who recommend tailoring breast cancer screening by racial cohort. Efforts should be made to promote younger-age screening for minority women to prevent disproportionate harm.

An investigation of the associations between trauma exposure, racial stereotypes, and racist beliefs.

OBJECTIVE: Given the concerning rise in hate crimes in recent years, it is critical to better understand factors associated with racist beliefs. As suggested by terror management theory (TMT), trauma exposure and posttraumatic stress symptoms (PTSS) may activate existential distress and anxiety, which may strengthen worldviews, including prejudiced beliefs (Greenberg & Kosloff, 2008; Weise et al., 2012). Although PTSS include negative alterations in beliefs about other people and the world, the connection between trauma and racist beliefs has not been investigated. There may also be key differences in terms of types of trauma exposure, such as interpersonal and noninterpersonal trauma, and racial beliefs. METHOD: The present study aimed to determine: (a) whether cumulative trauma exposure and PTSS are associated with endorsement of racist perceptions and stereotypes regarding Black people, and (b) if interpersonal trauma is more strongly tied to prejudiced and stereotyped beliefs than noninterpersonal trauma among 277 White undergraduates (Mage = 23.33, SD = 6.11; 76.4% female). RESULTS: Neither cumulative trauma nor PTSS were found to be related to elevated racist beliefs or positive or negative stereotypes. However, noninterpersonal trauma exposure was associated with stronger endorsement of racist beliefs and negative stereotypes (ηp² = .03, .01). Surprisingly, interpersonal trauma exposure corresponded with lower racist beliefs (ηp² = .02). CONCLUSIONS: Noninterpersonal trauma exposure may thus activate TMT and strengthen prejudiced ideology, whereas interpersonal traumatic experiences and PTSS may not. More research is needed to better understand how types of traumatic events may relate to the development of prejudiced beliefs. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Pulmonary immune profiling reveals common inflammatory endotypes of childhood wheeze and suppurative lung disease.

Suppurative lung disease and wheezing are common respiratory diseases of childhood, however, due to poor understanding of underlying pathobiology, there are limited treatment options and disease recurrence is common. We aimed to profile the pulmonary and systemic immune response in children with wheeze and chronic suppurative lung disease for identification of endotypes that can inform improved clinical management. We used clinical microbiology data, highly multiplexed flow cytometry and immunoassays to compare pulmonary [bronchoalveolar lavage (BAL)] and systemic immunity in children with lung disease and controls. Unsupervised analytical approaches were applied to BAL immune data to explore biological endotypes. We identified two endotypes that were analogous in both frequency and immune signature across both respiratory diseases. The hyper-inflammatory endotype had a 12-fold increase in neutrophil infiltration and upregulation of 14 soluble signatures associated with type 2 inflammation and cell recruitment to tissue. The non-inflammatory endotype was not significantly different from controls. We showed these endotypes are measurable in a clinical setting and can be defined by measuring only three immune factors in BAL. We identified hyper-inflammatory and non-inflammatory endotypes common across pediatric wheeze and chronic suppurative lung disease that, if validated in future studies, have the potential to inform clinical management.

Evaluating real-world emissions from in-use buses and taxis using on-road remote sensing.

Assessing real-world emissions from buses and taxis is vital to comprehend their impact on urban air quality. Such vehicles differ significantly from the majority of the fleet owing to their higher mileage rates. However, few studies have focused on specifically assessing the emissions from this segment of the vehicle fleet. In this context, this study evaluated the real-world emissions of nitrogen oxides (NOx) from in-use buses and taxis in Dublin, Ireland, using crossroad remote sensing technology. The remote sensing system was deployed at strategic locations throughout the city to capture on-road emissions from passing vehicles. The collected data included vehicle related information such as emission standard, make, and mileage, and pollutants including NOx. Based on this data, analysis was aimed to understand the impact of Euro emission standard, ambient temperature, mileage, and make of the vehicle on NOx emissions. The results reveal that the average emissions from taxis reduce by 37% from Euro 5 to Euro 6b, and average emissions from Euro 6 buses are 87% lower compared to Euro 5. The trends in emission factors (EFs) of buses and taxis were similar during summer and winter sampling. Moreover, on comparing the emissions from the top five taxi manufacturers, different trends in the emission factors were observed. Finally, the study found that the effect of vehicle mileage on emissions was unclear for both buses and taxis. In any case, these findings provide valuable insights into the real-world emission performance of the existing fleet of buses and taxis in Dublin and highlight the need for targeted measures to reduce emissions from these vehicles. The results can assist policymakers and urban planners in formulating evidence-based strategies to improve air quality in Dublin and other cities facing similar challenges.

Transient peripheral blood transcriptomic response to ketamine treatment in children with ADNP syndrome.

Activity-dependent neuroprotective protein (ADNP) syndrome is a rare neurodevelopmental disorder resulting in intellectual disability, developmental delay and autism spectrum disorder (ASD) and is due to mutations in the ADNP gene. Ketamine treatment has emerged as a promising therapeutic option for ADNP syndrome, showing safety and apparent behavioral improvements in a first open label study. However, the molecular perturbations induced by ketamine remain poorly understood. Here, we investigated the longitudinal effect of ketamine on the blood transcriptome of 10 individuals with ADNP syndrome. Transcriptomic profiling was performed before and at multiple time points after a single low-dose intravenous ketamine infusion (0.5mg/kg). We show that ketamine triggers immediate and profound gene expression alterations, with specific enrichment of monocyte-related expression patterns. These acute alterations encompass diverse signaling pathways and co-expression networks, implicating up-regulation of immune and inflammatory-related processes and down-regulation of RNA processing mechanisms and metabolism. Notably, these changes exhibit a transient nature, returning to baseline levels 24 hours to 1 week after treatment. These findings enhance our understanding of ketamine's molecular effects and lay the groundwork for further research elucidating its specific cellular and molecular targets. Moreover, they contribute to the development of therapeutic strategies for ADNP syndrome and potentially, ASD more broadly.

Transient peripheral blood transcriptomic response to ketamine treatment in children with ADNP syndrome.

Activity-dependent neuroprotective protein (ADNP) syndrome is a rare neurodevelopmental disorder resulting in intellectual disability, developmental delay and autism spectrum disorder (ASD) and is due to mutations in the ADNP gene. Ketamine treatment has emerged as a promising therapeutic option for ADNP syndrome, showing safety and apparent behavioral improvements in a first open label study. However, the molecular perturbations induced by ketamine remain poorly understood. Here, we investigated the longitudinal effect of ketamine on the blood transcriptome of 10 individuals with ADNP syndrome. Transcriptomic profiling was performed before and at multiple time points after a single low-dose intravenous ketamine infusion (0.5 mg/kg). We show that ketamine triggers immediate and profound gene expression alterations, with specific enrichment of monocyte-related expression patterns. These acute alterations encompass diverse signaling pathways and co-expression networks, implicating upregulation of immune and inflammatory-related processes and down-regulation of RNA processing mechanisms and metabolism. Notably, these changes exhibit a transient nature, returning to baseline levels 24 hours to 1 week after treatment. These findings enhance our understanding of ketamine's molecular effects and lay the groundwork for further research elucidating its specific cellular and molecular targets. Moreover, they contribute to the development of therapeutic strategies for ADNP syndrome and potentially, ASD more broadly.

Revictimization Risk Factors Following Childhood Maltreatment: A Literature Review.

Revictimization research, to date, has primarily focused on sexual revictimization (i.e., child sexual abuse and adult sexual assault), which has resulted in a lack of understanding of trauma revictimization more generally. Specifically, it is unclear what factors are placing individuals with a history of child maltreatment (i.e., sexual abuse, physical abuse, and witnessing intimate partner violence [IPV]) at greater risk for subsequent adult victimization (i.e., sexual assault and IPV). Existing theoretical and empirical work on revictimization suggest that multiple risk factors are likely present within this framework (e.g., posttraumatic stress symptoms [PTSS], emotion dysregulation, and risk-taking behaviors). Prior research has suggested that PTSS are often linked with these other risk factors, and it is possible that the development of PTSS following child maltreatment may be related to the development or maintenance of additional factors that increase the likelihood of revictimization. The purpose of this review was to synthesize findings regarding risk factors that place maltreated individuals at greater risk for adult revictimization. Approximately 228 studies were identified following a thorough search of the peer-reviewed literature using multiple databases (PsycINFO, PILOTS, and Google Scholar). Each study was critically analyzed for relevance. The included studies were used in our review of prevalence, specific risk factors that have been identified, and unanswered questions in this literature. PTSS were noted to be particularly important in the revictimization framework, and thus, a novel model of revictimization was also proposed where PTSS are illustrated as being associated with the development and maintenance of other factors within the revictimization framework.