Systematic screening for child abuse at emergency departments

Child abuse is a serious problem and has serious consequences for the victim, his or her environment and for society itself. It has been estimated that one in every 30 Dutch children is exposed to child abuse.1 While preventable morbidity and mortality of infectious diseases in childhood is enormously reduced over the past decades, unfortunately this has not been the case for the staggering statistics surrounding child abuse.2 Child abuse includes all forms of physical and emotional maltreatment, sexual abuse and neglect that result in actual or potential harm to the child’s health, development or dignity.3 Child abuse was already addressed as a public health problem in the 19th century by a French forensic expert, Ambroise Tardieu (Born in Paris on March 10, 1818). He was the fi rst physician to acknowledge the appearance of children being mistreated at the hands of their parents, and described the classical features of almost all forms of child abuse and neglect. A century later, in 1962, American physicians wrote a landmark article about child abuse being a pediatric and public health problem, called “The battered childsyndrome”. This was the starting point for further recognition and awareness of child abuse. The increasing awareness of child abuse by health care professionals since 1962 is refl ected in the enormous increase in articles published in the MEDLINE database. In 1963, 12 articles were categorized under the newly added keyword “child abuse” versus 914 in 2011.7 In 1970 the Dutch Association Against Child Abuse was founded

The detection of cervical intraepithelial neoplasia by electrical impedance spectroscopy: The effects of acetic acid and tissue homogeneity

Objective. To evaluate the efficacy of an electrical impedance probe (Epitheliometer) in the diagnosis of high grade cervical intraepithelial neoplasia (CIN) in women referred with cervical smear abnormalities and to assess the effect of acetic acid (AA) and tissue boundaries on the measurements. Methods. A prospective observational study was undertaken in the colposcopy clinic. One hundred and sixty-five women, either with a clinical indication or abnormal cervical cytology, were recruited into the study. A pencil type probe was used to record impedance spectra from 12 points on the cervix before and after the application of 5% AA. Spectra were also recorded from tissue boundaries. Colposcopic examinations, including probe positioning, were video recorded to allow for correlations between histopathological diagnosis of colposcopically directed biopsies, colposcopic impression and the diagnosis based on impedance measurements. Results. Receiver operating characteristic (ROC) curves were derived. The areas under the curves (AUCs) to discriminate original squamous from high grade CIN were 0.80 (pre AA) and 0.79 (post AA). Comparison of these curves showed no significant difference, indicating that application of AA does not produce a large change in spectra. The probe Could distinguish tissue boundaries from homogeneous tissue points. Conclusion. The Epitheliometer has the potential to be used as an adjunct to colposcopy in the diagnosis of high grade CIN. It has the advantage of real time results, decreasing the need for diagnostic cervical biopsies, and facilitates a wider use of the 'see and treat' policy without the risk of overtreatment. (C) 2009 Elsevier Inc. All rights reserved

Are dieting and dietary inadequacy a second hit in the association with polycystic ovary syndrome severity?

Background The composition of the diet is of increasing importance for the development and maturation of the ovarian follicles. In Polycystic Ovary Syndrome (PCOS) healthy dietary interventions improve the clinical spectrum. We hypothesized that dieting and diet inadequacy in the reproductive life course is associated with impaired programming of ovarian follicles and contributes to the severity of the PCOS phenotype. Methods and Findings To determine associations between the use of a self-initiated diet and diet inadequacy and the severity of the PCOS phenotype, we performed an explorative nested case control study embedded in a periconception cohort of 1,251 patients visiting the preconception outpatient clinic. 218 patients with PCOS and 799 subfertile controls were selected from the cohort and self-administered questionnaires, anthropometric measurements and blood samples were obtained. The Preconception Dietary Risk Score (PDR score), based on the Dutch dietary guidelines, was used to determine diet inadequacy in all women. The PDR score was negatively associated to cobalamin, serum and red blood cell folate and positively to tHcy. PCOS patients (19.9%), in particular the hyperandrogenic (HA) phenotype (22.5%) reported more often the use of a self-initiated diet than controls (13.1%; p = 0.023). The use of an inadequate diet was also significantly higher in PCOS than in controls (PDR score 3.7 vs 3.5; p = 0.017) and every point increase was associated with a more than 1.3 fold higher risk of the HA phenotype (adjusted OR 1.351, 95% CI 1.09-1.68). Diet inadequacy was independently associated with the anti-Müllerian Hormone (AMH) concentration (β 0.084; p = 0.044; 95% CI 0.002 to 0.165) and free androgen index (β 0.128; p = 0.013; 95% CI 0.028 to 0.229) in PCOS patients. Conclusions The use of a self-initiated diet and diet inadequacy is associated with PCOS, in particular with the severe HA phenotype. This novel finding substantiated by the association between diet inadequacy and AMH needs further investigation

Screening for child abuse at emergency departments: a systematic review

Introduction: Child abuse is a serious problem worldwide and can be difficult to detect. Although children who experience the consequences of abuse will probably be treated at an emergency department, detection rates of child abuse at emergency departments remain low. OBJECTIVE: To identify effective interventions applied at emergency departments that significantly increase the detection rate of confirmed cases of child abuse. DESIGN: This review was carried out according to the Cochrane Handbook. Two reviewers individually searched Pubmed, The Cochrane Library, EMBASE, Web of Science, and CINAHL for papers that met the inclusion criteria. RESULTS: Fifteen papers describing interventions were selected and reviewed; four of these were finally included and assessed for quality. In these studies the intervention consisted of a checklist of indicators of risk for child abuse. After implementation, the rate of detected cases of suspected child abuse increased by 180% (weighted mean in 3 studies). The number of confirmed cases of child abuse, reported in two out of four studies, showed no significant increase. CONCLUSIONS: Interventions at emergency departments to increase the detection rate of cases of confirmed child abuse are scarce in the literature. Past study numbers and methodology have been inadequate to show conclusive evidence on effectiveness

Effective use of the assisting hand in adolescents with cerebral palsy

Part one of this thesis evaluates the development, validation and reliability of the Assisting Hand Assessment for adolescents (Ad-AHA). The scale showed good construct validity within the whole age range (18 months to 18 years). The Ad-AHA is a valid performance-based instrument to monitor development from childhood to young adulthood, evaluate interventions and guide intervention planning. The Ad-AHA has good-to-excellent interrater and test-retest reliability in adolescents with unilateral CP. Reliable AHA-scores can be generated by using different age-appropriate tests activities. The Ad-AHA can be used to evaluate change over time with a score change of 5 AHA-units. Part two evaluates the effect of two interventions on the ability to perform daily activities in children and adolescents with CP. The performance of bimanual activities in children wearing a functional hand orthosis improved significantly. With evaluation on the level of individual AHA items, the therapist can decide in which activities the individual child will most likely be able to benefit most from the orthosis. The systematic review summarizes the clinical postoperative outcomes of upper extremity surgery (UES) on hand use in children and adolescents with CP. Considering the overall very low quality of the evidence, it is not possible to make clinical recommendations on the effect of upper extremity surgery. The outcomes of the clinical cohort study show that careful patient selection, based on multidisciplinary assessment and shared decision-making, results in clinically relevant improvements in patient-specific functional and/or cosmetic goals and manual ability after UES