Child abuse inventory at emergency rooms: CHAIN-ER rationale and design

<p>Abstract</p> <p>Background</p> <p>Child abuse and neglect is an important international health problem with unacceptable levels of morbidity and mortality. Although maltreatment as a cause of injury is estimated to be only 1% or less of the injured children attending the emergency room, the consequences of both missed child abuse cases and wrong suspicions are substantial. Therefore, the accuracy of ongoing detection at emergency rooms by health care professionals is highly important. Internationally, several diagnostic instruments or strategies for child abuse detection are used at emergency rooms, but their diagnostic value is still unknown. The aim of the study 'Child Abuse Inventory at Emergency Rooms' (CHAIN-ER) is to assess if active structured inquiry by emergency room staff can accurately detect physical maltreatment in children presenting at emergency rooms with physical injury.</p> <p>Methods/design</p> <p>CHAIN-ER is a multi-centre, cross-sectional study with 6 months diagnostic follow-up. Five thousand children aged 0-7 presenting with injury at an emergency room will be included. The index test - the SPUTOVAMO-R questionnaire- is to be tested for its diagnostic value against the decision of an expert panel. All SPUTOVAMO-R positives and a 15% random sample of the SPUTOVAMO-R negatives will undergo the same systematic diagnostic work up, which consists of an adequate history being taken by a pediatrician, inquiry with other health care providers by structured questionnaires in order to obtain child abuse predictors, and by additional follow-up information. Eventually, an expert panel (reference test) determines the <it>true </it>presence or absence of child abuse.</p> <p>Discussion</p> <p>CHAIN-ER will determine both positive and negative predictive value of a child abuse detection instrument used in the emergency room. We mention a benefit of the use of an expert panel and of the use of complete data. Conducting a diagnostic accuracy study on a child abuse detection instrument is also accompanied by scientific hurdles, such as the lack of an accepted reference standard and potential (non-) response. Notwithstanding these scientific challenges, CHAIN-ER will provide accurate data on the predictive value of SPUTOVAMO-R.</p

Child abuse: current problems and key public health challenges

Child abuse has recently been recognized by the World Health Organization as a major worldwide health problem impairing the health and welfare of children and adolescents. This paper attempts to look at child abuse from a public health perspective taking into account the vast cultural diversity in which children and adolescents live focusing on the issue of abuse and violence in a broad public health perspective, and trying to highlight the need for greater attention to be given to possible country-specific interventions

Intentional childhood injuries in Greece 1996-97 - Data from a population-based Emergency Department Injury Surveillance System (EDISS)

Aim: It has been gradually recognized that intentional injuries among children represent a largely hidden problem in modern societies. With the exception of mortality. population-based data from Greece have not been previously reported. To assess the magnitude and the characteristics of intentional injuries among children aged 0-14 years old, data from the population-based Emergency Department Injury Surveillance System (EDISS) database during the period 1996-97 were used. Methods: EDISS relies oil personal interiews with children and their escorts who contact the emergency departments of three hospitals. Two or these hospitals are district hospitals of the county of Magnesia and the island of Corfu. whereas the other is a university children’s hospital that covers the Greater Athens area on alternative days. Results: Among 46.807 children recorded in EDISS 108 injuries (0.23%) were attributed to acts or violence. Among the 108 intentional injuries, only 11 were caused by firearms or other weapons and only 4 concerned infants. In comparison to unintentional home and leisure injuries, intentional childhood injuries increase significantly with age and they are more common among migrant children. They Occur more frequently during late night and early morning hours, they are more serious, and they are more often multiple and concentrated on the head. Conclusions: In Greece, a problem of violence directed against children does exist. The actual magnitude of this problem is difficult to estimate, but its size appears to be smaller in comparison with that reported in other populations

Political theory and public health theory

This chapter examines political theory, social justice, human rights and the responsibility of the state, incorporating a discussion of Locke, Mill, Rawls and the rights of children. It then focuses on Martha Nussbaum, her Capabilities Approach, and its incorporation of a special priority for children, and notes its implications for public policy about child sexual abuse. The chapter then explores public health theory, drawing on the origins of public health, and considering public health and its connected concepts of social justice and human rights, with reference to leading theorists. Then, it discusses public health law and its multidimensional capacity and role in this context, applying public health theory to child sexual abuse. Importantly, this chapter then discusses the concept of human dignity as articulated and defended by Charles Foster, concluding that dignity is an important useful concept in this context, in addition to the traditional ethical concepts and political theory as proposed by the Capabilities Approach. The key message of this chapter is that this broad range of theoretical concepts provide insights and justifications for a range of legitimate public policy and legal strategies to prevent, identify, and respond to child sexual abuse

Psychometric properties of the Portuguese version of the Conflict Tactics Scales: Parent-child Version (CTSPC) used to identify child abuse Propriedades psicométricas da versão em português do instrumento Conflict Tactics Scales: Parent-child Version (CTSPC) utilizado para identificar violência contra a criança

This article follows another, which presented the first phase of the cross-cultural adaptation process examining the psychometric properties of the Conflict Tactics Scales, Parent-child Version (CTSPC), Portuguese version. Fieldwork took place in three public maternity wards in Rio de Janeiro, Brazil, from March to September 2000. Interviews relate to siblings of randomly selected live births. Respondents were mothers. Information on partners was obtained by proxy. Almost all intra-observer reliability kappa estimates were above 0.75. Depending on the scale and type of perpetrator, internal consistency (a) estimates ranged from 0.49 to 0.68. Using the same sample, the iterated principal factor analysis identified four dimensions. Although most items performed well, some failed to adequately load in their expected factors. Construct validity involved exploring the relationship between several other theoretical dimensions and a variable encompassing the cumulative pattern of violence severity. All the hypotheses tested were corroborated. The current evaluation indicates that the CTSPC can be recommended for use in Portuguese-speaking contexts. Still, it also identified some important points needing further investigation and discussion.<br>Este artigo segue outro que apresentava a primeira fase do processo de adaptação transcultural, examinando as propriedades psicométricas da versão em português do instrumento Conflict Tactics Scales: Parent-child Version (CTSPC). O trabalho de campo ocorreu de março a setembro de 2000 em três maternidades públicas de grande porte do Rio de Janeiro, Brasil. Irmãos de recém-nascidos foram amostrados aleatoriamente. Entrevistas foram realizadas com mães. Informações sobre parceiros foram obtidas por proxi. A maioria das estimativas de confiabilidade intra-observador (kappa) se mostrou acima de 0,75. Consistência interna (a) variou de 0,49-0,68, dependendo da escala e tipo de perpetrador. Usando a mesma amostra, a análise de fatores principais iterativa identificou quatro dimensões. Ainda que a maioria dos itens se saísse bem, alguns não carregaram adequadamente nos fatores esperados. Validade de construto envolveu uma exploração entre diversas dimensões teóricas e uma variável abarcando um padrão cumulativo de gravidade de violência. Todas as hipóteses foram corroboradas. A presente avaliação indica que CTSPC pode ser recomendada para uso em contextos lusófonos. Ainda assim, foram identificados alguns pontos importantes que necessitam mais investigações e discussão