Relationship Between Peer Victimization and Posttraumatic Stress Among Primary School Children

Peer victimization is a common stressor experienced by children. Although peer victimization has been studied extensively, few studies have examined the potential link between peer victimization and posttraumatic stress disorder (PTSD), and no studies of which we are aware have examined this link among children in primary school. The paucity of studies examining the link between PTSD and peer victimization in primary school is surprising because peer victimization occurs more frequently and is more likely to be physical among 7‐ and 8‐year‐old children. This study assessed the relationship between peer victimization and PTSD in a sample of 358 elementary school children (ages 6–11 years). Results indicated that peer victimization accounted for 14.1% of PTSD symptom severity among boys and 10.1% among girls. Additionally, we found gender differences in the types of peer victimization that were most associated with PTSD symptom severity (d = 0.38). The long‐term developmental consequences that may be associated with peer victimization‐linked PTSD symptomatology are discussed.     

Posttraumatic Stress Disorder in Maltreated Children Grown Up: The Influence of Neighborhood

In this study, we examined the effects of childhood neighborhood characteristics on the development of posttraumatic stress disorder (PTSD) in a sample of abused and neglected individuals and matched controls followed into adulthood (N = 1,132). Using generalized linear models (GLM), the results indicated that growing up in more advantaged neighborhoods (middle‐ and upper‐class) was associated with the development of fewer PTSD symptoms, R² = .09, p < .001. In contrast, growing up in more economically disadvantaged areas was associated with more PTSD symptoms, but only for nonmaltreated controls, R² = .09, p < .001. We did not find that neighborhood characteristics were associated with PTSD in terms of the number of traumatic events reported, R² = .60, p < .001, or being the victim of more than one type of maltreatment, pseudo R² = .11, p < .001. The results generally supported the premise that characteristics of one's residential environment in childhood, especially factors reflecting social and economic advantage and disadvantage, have an influence on mental health functioning later in life. Future research should examine the mechanisms that might explain the impact of childhood neighborhood on PTSD outcomes and the aggravating effects of pretrauma vulnerabilities associated with neighborhood disadvantage.     

Group Meetings Benefit Families of Burned Children

Recognition must be given to the continuing burden carried by parents of children who have been discharged from a burns hospital. Weekly parents' meetings under the direction of social workers are offered during clinic hours in an effort to maintain support and offer guidance. Unlike other therapeutic groups, these parents are not screened by interests, background or age. Their only common denominator is that of having a severely burned child. Also, unlike other groups, the participants change each week, depending on the clinic schedule. However, despite the lack of continuity in participaton, the parents have come to know that by returning to the group at any time, they can find help and understanding and often receive renewed strength for coping. It is interesting to note that the same problems recur in the meetings' content: 1) Adjustment of the home schedule immediately following discharge in order to deal with the demands of the children and the time required for skin care, 2) parents' tendency to project their guilt by over-protecting the children, 3) adolescent problems stemming from burn scars affecting body image and self-esteem, 4) changes in marital relationships. Often, parents of children who are still in the acute stage attend these meetings and take their first cautious steps toward facing the future supported by “those who have been there”. All learn that this is an hour when they may freely question, share feelings, and leave knowing they are supported and not alone.     

癫痫患儿家庭慢性悲伤的护理干预

目的 缓解癫痫患儿家庭的慢性悲伤情绪.方法 将90名癫痫患儿家长随机分为时照组50名和观察组40名,对照组予常规护理,观察组予针对性集体干预和个别干预,分别于干预前及干预3个月后采用ABQ问卷和父母用应对方式量表(cHIP)评估两组惠儿家长心理状况和应对方式.结果 干预后观察组ABQ问卷各情绪评分以及总分改善程度显著优于对照组(均P<0.05);应对方式总分及分量表1、2评分显著优于对照组(均P<0.05).结论 癫痫患儿家庭存在慢性悲伤,早期评估并实施针对性干预,有利于缓解癫痫患儿父母心理负担,减轻其家庭慢性悲伤.     

Sex Disparities in Risk of Mortality Among Children With ESRD

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Criminal Victimization, Posttraumatic Stress Disorder, and Comorbid Psychopathology Among a Community Sample of Women

This paper provides information on the relation between victimization status, crime factors, posttraumatic stress disorder (PTSD), and several other psychological disorders among a community sample of women. Results indicated that victims of crime were more likely than nonvictims to suffer from PTSD, major depressive episode, agoraphobia, obsessive-compulsive disorder, social phobia, and simple phobia. Furthermore, life threat was associated with increased risk of major depression, agoraphobia, obsessive-compulsive disorder, and social phobia. Completed rape was strongly related to almost every disorder assessed, while robbery and burglary were not related to any disorder. When demographics, victimization status, and crime factors were entered hierarchically into multivariate logistic regressions with PTSD in the final step, associations between victimization status, other crime characteristics (e.g., life threat, injury), and non-PTSD Axis I disorders were greatly reduced. This suggests that PTSD may be an important mediating factor in the victimization-psychopathology relation for many disorders.     

Linear Growth Patterns in Prepubertal Children Following Liver Transplantation

Factors impacting linear growth following pediatric liver transplantation (LT) are not well understood. This longitudinal analysis examines predictors of linear growth impairment in prepubertal children included in Studies of Pediatric Liver Transplantation. In 1143 children with serial measurements, mean height scores increased from −1.55 at LT to −0.87 and −0.68 at 24 and 36 months post LT with minimal subsequent catch up growth observed until 60 months. Subgroup analysis of height measurements at 24 months (n = 696), 33.8% were below 10th percentile at 24 months post LT. Multivariate analysis revealed linear growth impairment more likely in patients with metabolic disease (OR 4.4, CI: 1.83–10.59) and >18 months of steroids exposure (OR 3.02, CI: 1.39–6.55). Higher percentiles for weight (OR 0.80, CI: 0.65–0.99) and height (OR 0.62, CI: 0.51–0.77) at LT decreased risk. Less linear catch up was observed in patients with metabolic disease, non-Biliary atresia cholestatic diseases and lower weight and higher height percentiles prior to LT. Prolonged steroid exposure and elevated calculated glomerular filtration rate and γ-Glutamyltransferase following LT were associated with less catch up growth. Linear growth impairment and incomplete linear catch up growth are common following LT and may improve by avoiding advanced growth failure before LT and steroid exposure minimization.     

Predictors of Attrition Among Young Children Receiving Trauma-Focused Therapy

Findings from studies of predominately school-aged children indicate that few children complete trauma-focused treatment; however, researchers have not specifically examined risk factors for dropout among young trauma-exposed children. The purpose of the present study was to investigate risk factors for attrition among young children receiving trauma-focused therapy. Study participants were 189 treatment-seeking children aged 3–5 years (M = 4.86 years, SD = 0.71; 54.1% female, 47.7% White) and their nonoffending legal guardian(s). Child and family characteristics, number of traumatic events, and pretreatment posttraumatic stress symptoms (PTSS) were examined in relation to two attrition definitions: (a) clinician-rated dropout and (b) whether the child received an adequate treatment dose (i.e., 12 or more sessions). Although 70.3% of children prematurely terminated therapy per their clinician, a nearly equivalent portion (67.4%) received an adequate treatment dose. Family characteristics were largely not associated with attrition, although residing farther from the clinic was related to clinician-rated treatment dropout, OR = 0.96. As expected, higher levels of externalizing symptoms were associated with clinician-rated dropout and inadequate dose status, ORs = .95 and .96, respectively, whereas lower levels of trauma-related anger were related to clinician-rated treatment completion, OR = 1.03, and lower levels of PTSS and sexual concerns corresponded with an increased likelihood the child received an inadequate treatment dose, ORs = 1.03 and 1.02, respectively. Thus, child and family factors appear to play a small role in predicting attrition; however, higher levels of externalizing problems and lower levels of PTSS may increase the risk for dropout.     

Predictive Genetic Screening and Clinical Findings in Multiple Endocrine Neoplasia Type I Families

Germline mutations of the MEN1 gene have been identified as the causative genetic defect of multiple endocrine neoplasia type I (MEN-I), an autosomal dominantly inherited condition. To establish the basis for predictive family screening we evaluated the spectrum of MEN1 gene mutations in MEN-I patients treated at our institution. Relatives at risk were subjected to predictive genetic screening after genetic counseling. Gene carriers were subjected to extensive clinical screening for MEN-I, including biochemical tests for basal hormone concentrations in blood and urine, a standardized meal stimulation test and imaging procedures (ultrasonography, computed tomography, magnetic resonance imaging). Among index patients of 15 independent MEN-I kindreds, 14 heterozygous MEN1 germline mutations were identified by single-strand conformational variant analysis (SSCV) and direct DNA sequence analysis. Of 51 individuals at risk, 26 predictively tested relatives with the wild-type MEN1 gene could be excluded from further screening procedures because they had not inherited the disease. In all previously presumed unaffected relatives with the mutant gene, our extensive clinical screening program revealed at least one manifestation of MEN-I. Furthermore, 22 additional diagnoses could be established in identified MEN-I patients. We show that mutation analysis enables predictive genetic screening for MEN-I families, providing a valuable tool for genetic counseling and clinical management. An extensive clinical screening program focusing on genetically proven individuals at risk allows detection of MEN-I manifestations at an early, asymptomatic stage of the disease. Controlled, prospective studies are now required to prove whether timely appropriate treatment on the basis of predictive screening might help improve disease-related quality of life and prolong life expectancy in MEN-I kindreds.     

Reliability of Reports of Violent Victimization and Posttraumatic Stress Disorder Among Men and Women With Serious Mental Illness

Although violent victimization is highly prevalent among men and women with serious mental illness (SMI; e.g., schizophrenia, bipolar disorder), future research in this area may be impeded by controversy concerning the ability of individuals with SMI to report traumatic events reliably. This article presents the results of a study exploring the temporal consistency of reports of childhood sexual abuse, adult sexual abuse, and adult physical abuse, as well as current symptoms of posttraumatic stress disorder (PTSD) among 50 people with SMI. Results show that trauma history and PTSD assessments can, for the most part, yield reliable information essential to further research in this area. The study also demonstrates the importance of using a variety of statistical methods to assess the reliability of self-reports of trauma history.     

Multiple Urethral Calculi in Children: Report of Two Cases

(Received for publication on June 16, 1997; accepted on Jan. 6, 1998)     

Dietary Patterns in Relation to Bone Mineral Density Among Menopausal Iranian Women

Our aim was to determine if zoledronic acid (ZA) changes ⁴⁵Ca pharmacokinetics and bone microstructure in irradiated, ovary-intact (I) and irradiated, ovariectomized mice (OVX), two groups with different patterns of skeletal damage. The hind limbs of I and OVX BALB/c mice received a single 16-Gy radiation dose, simulating pre- and postmenopausal female cancer patients undergoing radiation treatment. All I and OVX mice were radiolabeled with 15 μCi ⁴⁵Ca. Mice were treated with or without a 0.5 mg/kg injection of ZA. The time course of bone mineral remodeling was evaluated using a fecal ⁴⁵Ca assay, measured by liquid scintillation. A group of nonirradiated, intact mice were used for the longitudinal evaluation of ⁴⁵Ca biodistribution. Distal femur bone histomorphometric parameters were measured using microCT at 50 days post–ZA intervention. Most ⁴⁵Ca was incorporated into the skeleton and eliminated from the soft tissues within 3–5 days postirradiation, attaining a steady state of excretion at 25–30 days. ZA intervention in both groups resulted in a rapid decrease in fecal ⁴⁵Ca excretion. There was a significant difference in ⁴⁵Ca excretion in the OVX ± ZA (P = 0.005) group but not in the I ± ZA (P = 0.655) group. The rate of excretion of fecal ⁴⁵Ca was slower in the OVX + ZA compared to the I + ZA group (P = 0.064). ⁴⁵Ca assay is useful to monitor the time course of bone mineral remodeling after an antiresorptive intervention in irradiated mice, providing a basis to investigate bone effects of cancer therapy protocols. For equivalent doses of ZA, recovery may depend on the nature and degree of skeletal damage.     

Evaluating Knowledge of Autonomic Dysreflexia Among Individuals With Spinal Cord Injury and Their Families

Background/Objective:     

Burden of Surgically Correctable Disabilities Among Children in the Dadaab Refugee Camp

Background

Surgery is increasingly recognized as a means to reduce the morbidity and mortality of disabling impairments in resource-limited environments. We sought to estimate the burden of surgically correctable disabling impairments and the cost-effectiveness of their treatment among children in a large refugee camp.

Methods

This is a chart review of all patients aged 0–18 years from Dadaab Refugee Camp (Kenya) treated at a facility primarily responsible for providing pediatric surgical care in the region. Total disability-adjusted life years (DALYs) averted were calculated using life expectancy tables and established or estimated disability weights. A sensitivity analysis was performed using various life expectancy tables. Delayed averted DALYs caused by delay in care were also estimated. Inpatient costs were collected to perform a cost-effectiveness analysis.

Results

Between 2005 and 2011 a total of 640 procedures were performed on 341 patients. The median age at surgery was 4.6 years, and 33 % of the children treated were female. Only 13.5 % of surgeries estimated as required for common congenital surgical conditions were actually performed. The total number of DALYs averted ranged from 4,136 to 9,529 (6.4–14.8 per patient), depending on the calculation method used. Cost-effectiveness analysis resulted in values of $40–$88 per DALY.

Conclusions

The burden of pediatric surgical disabling impairments in refugee camps is substantial. Surgical intervention to address this burden is both feasible and cost-effective. Such intervention can significantly decrease the burden of disability among children affected by armed conflicts.     

Heterogenous Patterns of Sensory Dysfunction in Postherpetic Neuralgia Suggest Multiple Pathophysiologic Mechanisms

Background: Postherpetic neuralgia (PHN) is considered by some investigators to be predominantly a deafferentation-type central pain syndrome; others suggest that activity of remaining peripheral nociceptors plays a critical role. The authors investigated the sensory dysfunction in subjects with PHN of varying duration and at different sites to gain further insight into the mechanisms responsible for the clinical features of neuropathic pain. In addition, the relationships between ongoing pain and pain evoked by mechanical and thermal stimuli were compared in patients with trigeminal and truncal PHN, to determine if the pathophysiologic mechanisms differed among subjects.

Methods: In 63 subjects with PHN, quantitative sensory testing was performed in the region of maximum allodynia or ongoing pain and the corresponding contralateral site. The intensity of ongoing pain was recorded. Sensory thresholds for warmth, coolness, heat pain, and cold pain were determined. Pain induced by various mechanical stimuli (dynamic, static, punctate) was rated using a numerical rating scale of 0-10.

Results: The mean rating of ongoing PHN pain was 7.3 +/- 2.0 (mean +/- SD). Allodynia induced by one or more mechanical stimuli was observed in 78% of subjects. A smaller subset (40%) had hyperalgesia to heat or cold stimuli. In subjects with duration of PHN of <= 1 yr duration, but not in those with duration of > 1 yr, the intensity of ongoing pain correlated with intensity of allodynia induced by dynamic stimuli. Deficits in thresholds for heat and cold pain were observed in the affected region of subjects with PHN in the thoracic dermatomes (P < 0.005), but not in the trigeminal distribution. No relationship was observed between the thermal deficits and ongoing pain or mechanical allodynia in the groups of subjects with either trigeminal or thoracic PHN.