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Child Abuse & Neglect Jul 2024More than 60 % of people exposed to sex trafficking access hospital emergency departments (ED), making the ED a critical setting for child sex trafficking...
BACKGROUND AND OBJECTIVE
More than 60 % of people exposed to sex trafficking access hospital emergency departments (ED), making the ED a critical setting for child sex trafficking identification. Children exposed to sex trafficking (CEST) do not always recognize that they are being exploited. With many ED leaders confirming that there are no formal processes or assessment tools to screen for human trafficking in EDs, it is especially challenging for healthcare providers to identify CEST. Accordingly, the following study sought to examine healthcare providers' child sex trafficking identification practices in Ontario pediatric EDs.
METHODS
We conducted interviews with healthcare providers (N = 12) who work in an Ontario pediatric ED and have provided services to CEST. Thematic analysis and intersectionality theory guided our analytic approach.
RESULTS
Participants underscored the key role of Registered Nurses for identifying presentations of child sex trafficking in Ontario pediatric EDs. Although white, feminine presenting youth are the predominantly identified demographic of CEST in Ontario pediatric EDs, healthcare providers also described key intersections between race, poverty, child welfare agency system involvement, and adverse childhood life experiences as factors that heightened vulnerability to child sex trafficking. Common presentations to the ED were for non-specific concerns, injuries, following a sexual assault, or for mental health concerns. Suggested methods for identification varied but were centred around the principles of trauma- and violence-informed care.
CONCLUSION
Identifying child sex trafficking in Ontario pediatric EDs is a complex practice, requiring human trafficking training and education for healthcare providers. The interrelated indicators of child sex trafficking, including the sociodemographic and clinical profile of the patient, must be considered jointly, using a trauma- and violence-informed approach.
Topics: Humans; Human Trafficking; Ontario; Emergency Service, Hospital; Female; Child; Qualitative Research; Male; Health Personnel; Adult; Adolescent; Child Abuse, Sexual
PubMed: 38776630
DOI: 10.1016/j.chiabu.2024.106852 -
Child Abuse & Neglect Jul 2024Although clergy-perpetrated child sexual abuse (CSA) implies severe traumatic repercussions for the victims, they may also experience posttraumatic growth (PTG) deriving...
INTRODUCTION
Although clergy-perpetrated child sexual abuse (CSA) implies severe traumatic repercussions for the victims, they may also experience posttraumatic growth (PTG) deriving from the need to deal with the trauma suffered. This PTG is associated with the processes of recovery, healing, and empowerment.
OBJECTIVE
Applying a mixed methods approach to analyse PTG outcomes and to explore experiences of PTG in survivors of Spanish clergy-perpetrated CSA and its relation with psychosocial, mental and spiritual suffering.
PARTICIPANTS
Thirty-one survivors (M = 51.6 years; SD = 12.4) in the quantitative stage of the research, and seven (M = 49.3; SD = 8.9) in the qualitative stage.
METHODS
A sequential explanatory mixed methods study design was applied using standardized questionnaires and semi-structured interviews. Descriptive, correlation and thematic analyses were conducted. The quantitative and qualitative data were integrated.
RESULTS
Positive associations were found between PTG and psychosocial and mental health problems (r = 0.53; p < .01), damage to faith in God (r = 0.43; p < .05) and damage to faith in the Church (r = 0.48; p < .01). Three themes emerged from the qualitative data that explained, expanded, and complemented the quantitative results, highlighting the relationship between damage and growth and the specific meanings of PTG from the perspectives of the survivors.
CONCLUSIONS
This study shows that survivors may develop PTG in the course of the processes of psychological suffering, spiritual transformation, and meaning-making of traumatic experiences.
Topics: Humans; Female; Male; Clergy; Middle Aged; Adult; Posttraumatic Growth, Psychological; Adult Survivors of Child Abuse; Child Abuse, Sexual; Spirituality; Child; Spain; Qualitative Research; Surveys and Questionnaires; Survivors; Stress Disorders, Post-Traumatic
PubMed: 38776629
DOI: 10.1016/j.chiabu.2024.106862 -
Injury Epidemiology May 2024A 2022 survey in the USA found concerningly high prevalences of support for and personal willingness to engage in political violence, of beliefs associated with such...
BACKGROUND
A 2022 survey in the USA found concerningly high prevalences of support for and personal willingness to engage in political violence, of beliefs associated with such violence, and of belief that civil war was likely in the near future. It is important to determine the durability of those findings.
METHODS
Wave 2 of a nationally representative cohort survey was conducted May 18-June 8, 2023; the sample comprised all respondents to 2022's Wave 1. Outcomes are expressed as weighted proportions; changes from 2022 to 2023 are for respondents who participated in both surveys, based on aggregated individual change scores.
RESULTS
The completion rate was 84.2%; there were 9385 respondents. After weighting, 50.7% (95% confidence interval (CI) 49.4%, 52.1%) were female; weighted mean (SD) age was 48.5 (25.9) years. About 1 in 20 respondents (5.7%, 95% CI 5.1%, 6.4%) agreed strongly/very strongly that "in the next few years, there will be civil war in the United States," a 7.7% decrease. In 2023, fewer respondents considered violence to be usually/always justified to advance at least 1 of 17 specific political objectives [25.3% (95% CI 24.7%, 26.5%), a 6.8% decrease]. However, more respondents thought it very/extremely likely that within the next few years, in a situation where they consider political violence justified, "I will be armed with a gun" [9.0% (95% CI 8.3%, 9.8%), a 2.2% increase] and "I will shoot someone with a gun" [1.8% (95% CI 1.4%, 2.2%), a 0.6% increase]. Among respondents who considered violence usually/always justified to advance at least 1 political objective, about 1 in 20 also thought it very/extremely likely that they would threaten someone with a gun (5.4%, 95% CI 4.0%, 7.0%) or shoot someone (5.7%, 95% CI 4.3%, 7.1%) to advance such an objective.
CONCLUSIONS
In this cohort, support for political violence declined from 2022 to 2023, but predictions of firearm use in political violence increased. These findings can help guide prevention efforts, which are urgently needed.
PubMed: 38773542
DOI: 10.1186/s40621-024-00503-7 -
The Journal of Headache and Pain May 2024Atogepant is an oral calcitonin gene-related peptide receptor antagonist approved for the preventive treatment of migraine in adults. These analyses evaluated the... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Atogepant is an oral calcitonin gene-related peptide receptor antagonist approved for the preventive treatment of migraine in adults. These analyses evaluated the proportions of clinical trial participants who experienced sustained responses to atogepant over 12 or 52 weeks of treatment.
METHODS
These were post hoc analyses of ADVANCE, a 12-week, double-blind, randomized trial of atogepant 10, 30, and 60 mg once daily vs. placebo for the preventive treatment of episodic migraine, and a separate open-label long-term safety (LTS) trial of atogepant 60 mg once daily over 52 weeks. The 60 mg dose of atogepant was used to detect safety issues. An initial response was defined as ≥50%, ≥75%, or 100% reduction from baseline in MMDs in month 1 for ADVANCE or quarter 1 for the LTS trial. The proportions of participants who continued to experience a response above each response-defining threshold through each subsequent month (for ADVANCE) or each quarter (for LTS) were calculated.
RESULTS
In ADVANCE, sustained response rates during months 2 and 3 varied with dose and were as follows: 70.8-81.1% following an initial ≥50% response, 47.3-61.9% following an initial ≥75% response, and 34.8-41.7% following an initial 100% response. Of those who experienced an initial ≥75% or 100% response during month 1, more than 79% continued to experience at least a 50% response during both months 2 and 3. During the LTS trial, sustained response rates through quarters 2, 3, and 4 were 84.7% following an initial ≥50% response, 72.6% following an initial ≥75% response, and 37.8% following an initial 100% response. Of those who experienced an initial ≥75% or 100% response during quarter 1, more than 90% continued to experience at least a 50% response through quarters 2, 3, and 4.
CONCLUSION
Over 70% of participants who experienced an initial response with atogepant treatment had a sustained response with continued treatment.
TRIAL REGISTRATION
ClinicalTrials.gov: NCT03777059 (submitted: December 13, 2018); NCT03700320 (submitted: September 25, 2018).
Topics: Humans; Migraine Disorders; Double-Blind Method; Female; Male; Adult; Calcitonin Gene-Related Peptide Receptor Antagonists; Middle Aged; Dose-Response Relationship, Drug; Azepines; Treatment Outcome; Piperidines; Pyridines; Pyrroles; Spiro Compounds
PubMed: 38773375
DOI: 10.1186/s10194-024-01783-6 -
Scientific Reports May 2024Fibromyalgia syndrome (FMS) is a chronic pain syndrome characterized by disruptions in pain processing within the central nervous system. It exhibits a high prevalence... (Randomized Controlled Trial)
Randomized Controlled Trial
Fibromyalgia syndrome (FMS) is a chronic pain syndrome characterized by disruptions in pain processing within the central nervous system. It exhibits a high prevalence among patients with a history of traumatic experiences, notably childhood sexual abuse (CSA). This study compared the efficacy of hyperbaric oxygen therapy (HBOT) to the current pharmacological standard of care for individuals suffering from CSA-related FMS. Forty-eight participants diagnosed with FMS and a history of CSA were randomly assigned to either the HBOT group (60 sessions of 100% oxygen at 2 ATA for 90 min, with air breaks every 5 min) or the medication (MED) group (FDA-approved medications, Pregabalin and Duloxetine). The primary endpoint was the Fibromyalgia impact questionnaire (FIQ) score, while secondary endpoints encompassed emotional status and daily functioning questionnaires, as well as pain thresholds and conditioned pain modulation tests. Brain activity was evaluated through single photon emission computed tomography (SPECT). Results revealed a significant group-by-time interaction for the FIQ score favoring HBOT over MED (p < 0.001), with a large effect size (Cohen's d = - 1.27). Similar findings were observed in emotional symptoms and functional measures. SPECT imaging demonstrated an increase in activity in pre-frontal and temporal brain areas, which correlated with symptoms improvement. In conclusion, HBOT exhibited superior benefits over medications in terms of physical, functional, and emotional improvements among FMS patients with a history of CSA. This associated with increased activity in pre-frontal and temporal brain areas, highlighting the neuroplasticity effect of HBOT.
Topics: Humans; Fibromyalgia; Hyperbaric Oxygenation; Female; Male; Adult; Middle Aged; Child Abuse, Sexual; Prospective Studies; Duloxetine Hydrochloride; Pregabalin; Treatment Outcome; Surveys and Questionnaires; Tomography, Emission-Computed, Single-Photon; Analgesics
PubMed: 38773296
DOI: 10.1038/s41598-024-62161-5 -
Cureus Apr 2024Background Postpartum depression (PPD) is a significant public health concern globally characterized by a spectrum of mood disturbances ranging from mild mood swings to...
Background Postpartum depression (PPD) is a significant public health concern globally characterized by a spectrum of mood disturbances ranging from mild mood swings to severe depressive episodes initiating within four weeks post childbirth and potentially persisting up to 12 months. Besides affecting the mother, it also affects the mental health and development of the babies born to affected mothers. Despite its considerable burden and potential adverse effects on both maternal and child well-being, PPD often goes undetected and untreated. Materials and methods A cross-sectional study was conducted from January 2024 to March 2024 at a tertiary care center in Gorakhpur to assess PPD in 280 postpartum women. The Edinburgh Postnatal Depression Scale (EPDS) score ≥ 10 was used to confirm depression. Data collection involved a pretested, structured questionnaire. Data were analyzed using SPSS version 22 (IBM Corp., Armonk, NY). A p-value < 0.05 was considered statistically significant. Results The prevalence of PPD was 12.14%. Age and education were significant sociodemographic risk factors (p < 0.05). In psychosocial factors, adverse life events (p < 0.001), wishing for a male child but giving birth to a female (p = 0.01), domestic violence (p = 0.005), relationship issues, an alcoholic spouse (p = 0.01), and poor in-law relations (p < 0.001) were found to be linked to PPD. Obstetric factors such as complicated antenatal history, physical illness, cesarean section, complicated intranatal history, and postpartum complications were also found to be important factors. Conclusion PPD affects many women, emphasizing the need for effective measures. Initiatives like the appointment of healthcare counselors and PPD screening programs in healthcare settings are essential to detect and support affected mothers.
PubMed: 38770470
DOI: 10.7759/cureus.58653 -
Scientific Reports May 2024Childhood maltreatment is reportedly associated with atypical gray matter structures in the primary visual cortex (V1). This study explores the hypothesis that retinal...
Childhood maltreatment is reportedly associated with atypical gray matter structures in the primary visual cortex (V1). This study explores the hypothesis that retinal structures, the sensory organs of vision, are associated with brain atypicality and child maltreatment and examines their interrelation. General ophthalmologic examinations, visual cognitive tasks, retinal imaging, and structural magnetic resonance imaging (MRI) were conducted in children and adolescents aged 9-18 years with maltreatment experiences (CM) and typically developing (TD) children. The retinal nerve fiber layer (RNFL), the most superficial of the ten distinct retinal layers, was found to be significantly thinner in both eyes in CM. While whole-brain analysis using Voxel-based morphometry revealed a significantly larger gray matter volume (GMV) in the thalamus in CM, no significant correlation with RNFL thickness was observed. However, based on region-of-interest analysis, a thinner RNFL was associated with a larger GMV in the right V1. Although it cannot be ruled out that this outcome resulted from maltreatment alone, CM demonstrated subclinical structural atypicality in the retina, which may also correlate with the immaturity of V1 development. Examination of retinal thickness offers a novel clinical approach to capturing characteristics associated with childhood maltreatment.
Topics: Humans; Child; Gray Matter; Male; Adolescent; Female; Retina; Child Abuse; Magnetic Resonance Imaging; Visual Cortex
PubMed: 38769421
DOI: 10.1038/s41598-024-62392-6 -
Journal of Urban Health : Bulletin of... Jun 2024Self-appraisal after a life-altering event is a critical process for individuals, often comprised by assigned labels that may not align with an individuals' perceptions...
Self-appraisal after a life-altering event is a critical process for individuals, often comprised by assigned labels that may not align with an individuals' perceptions of themselves or of their situation. Existing research within this victim-survivor dichotomy largely rests in the interpersonal violence space, with a victim assuming legal recourse and wrongdoing, and a survivor associating with positive personal characteristics like grit and resilience. Much existing literature on self-appraisal after interpersonal injury is heavily concentrated within the sexual violence literature, and this study applies these concepts to a sample of Black men injured by firearms. Ten Black men enrolled in a hospital-based violence intervention program (HVIP) were interviewed to understand how they label their experience of firearm injury, and if their perceptions aligned with common labels seen among other populations and/or in other areas of study (e.g., cancer, domestic violence). Each participant assigned themselves their own label, with three labels emerging: survivor, victim and survivor, and neither victim nor survivor. The results illustrate the nuance of experiences beyond the victim-survivor dichotomy, and how labels and personal identities may shift following injury into new terms and considerations of resilience and trauma processing. More research is warranted to understand the factors that shape self-labeling within this population, including influences of masculine norms, racialized stereotypes, community context, and availability of services. Findings support public awareness campaigns to reframe surviving violence as a strength, and for community partners and practitioners to increase access to culturally competent and trauma-informed mental healthcare.
Topics: Humans; Male; Adult; Survivors; Black or African American; Wounds, Gunshot; Middle Aged; Violence; Young Adult; Self Concept; Interviews as Topic
PubMed: 38767764
DOI: 10.1007/s11524-024-00874-8 -
Scientific Reports May 2024Childhood maltreatment (CM) is known to influence brain development. To obtain a better understanding of related brain alterations, recent research has focused on the...
Childhood maltreatment (CM) is known to influence brain development. To obtain a better understanding of related brain alterations, recent research has focused on the influence of the type and timing of CM. We aimed to investigate the association between type and timing of CM and local brain volume. Anatomical magnetic resonance images were collected from 93 participants (79 female/14 male) with a history of CM. CM history was assessed with the German Interview Version of the "Maltreatment and Abuse Chronology of Exposure" scale, "KERF-40 + ". Random forest regressions were performed to assess the impact of CM characteristics on the volume of amygdala, hippocampus and anterior cingulate cortex (ACC). The volume of the left ACC was predicted by neglect at age 3 and 4 and abuse at age 16 in a model including both type and timing of CM. For the right ACC, overall CM severity and duration had the greatest impact on volumetric alterations. Our data point to an influence of CM timing on left ACC volume, which was most pronounced in early childhood and in adolescence. We were not able to replicate previously reported effects of maltreatment type and timing on amygdala and hippocampal volume.
Topics: Humans; Female; Male; Child Abuse; Magnetic Resonance Imaging; Child; Adolescent; Brain; Child, Preschool; Hippocampus; Adult; Amygdala; Organ Size; Gyrus Cinguli; Young Adult
PubMed: 38762570
DOI: 10.1038/s41598-024-62051-w -
BMC Public Health May 2024This study investigated the correlation between the prevalence of dental caries and the presence and type of abuse.
BACKGROUND
This study investigated the correlation between the prevalence of dental caries and the presence and type of abuse.
METHODS
Participants were 534 children admitted for care at two child guidance centers (CGCs) in Niigata, Japan. Data pertaining to abuse, including the reason for temporary protective care and the type of abuse, and the oral examination results of the children, were collected. These results were then compared with those of a national survey and analyzed in relation to the presence and type of abuse.
RESULTS
The odds ratio for decayed teeth was 4.1, indicating a higher risk in children admitted to the CGCs. However, no significant association was found between the presence of decayed, filled, or caries-experienced teeth and the presence of abuse. A significant positive association was observed between dental caries and one type of abuse, indicating a greater prevalence of dental caries in cases of neglect. The findings of this study suggest that the type of abuse, rather than its presence, is associated with dental caries.
CONCLUSIONS
Our findings suggest that proactive support should be provided to children in problematic nurturing environments, regardless of whether they have been subjected to abuse.
Topics: Humans; Dental Caries; Japan; Female; Prevalence; Male; Child Abuse; Child, Preschool; Child; Child Protective Services; Infant
PubMed: 38762490
DOI: 10.1186/s12889-024-18833-y