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《Child abuse & neglect》2014,38(11):1766-1777
Nonadherence to antiretroviral treatment has serious health implications for HIV-infected children, at times warranting referral to child protective services (CPS). The current study of 134 children with perinatally acquired HIV infection aimed to investigate rates of treatment adherence and CPS involvement, multilevel variables associated with nonadherence, and the manner in which these risks operated together in the prediction of adherence outcomes. Risk factors for nonadherence were grouped on the basis of confirmatory factor models, and factor score regression was carried out to determine which factors were uniquely predictive of adherence. A series of indirect effects models were then tested in order to examine how these factors operated together in the prediction of adherence. Results showed that almost half of the sample demonstrated suboptimal adherence to treatment, and in one-fifth, CPS was involved for medical neglect. Caregiver Health, Caregiver Involvement, Caregiver Acceptance, and Child Adaptation were predictive of nonadherence, and together explained 54% of the variance in treatment adherence. There were significant indirect effects of Caregiver Health on adherence that operated through Caregiver Involvement and Child Adaptation and an indirect effect of Caregiver Involvement on adherence through Child Adaptation. Findings extend current literature that has independently linked various factors predictive of medical adherence in pediatric HIV by showing separate but simultaneous associations with nonadherence and unique pathways to adherence involving multilevel risks. Healthcare and child welfare implications are discussed. 相似文献
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BackgroundOral injuries in young children may indicate physical abuse. The prevalence of oral injuries in young children presenting to the emergency department is unknown. These data would assist providers in making decisions about the need for further abuse evaluation.ObjectiveTo determine the prevalence of oral injuries, associated chief complaints and characteristics, and frequency of abuse evaluations in children younger than 24 months presenting to a pediatric emergency department (PED). Participants and Setting: Twelve pediatric emergency medicine physicians consecutively enrolled children younger than 24 months in a tertiary care PED.MethodsWe performed a prospective observational study. Enrolled patients underwent a complete oral examination. Providers recorded patient demographics, type of chief complaint, oral injury details, developmental ability, and the presence of an abuse evaluation.ResultsOral injuries occurred in 36/1303 (2.8%, 95% CI 1.9–3.8%) and were more common in patients with traumatic (26/200, 13%) versus medical chief complaints (10/1,103, 0.9%) (p < .001). Of patients with oral injuries (36), 78% were mobile and 72% had traumatic chief complaints. Nine (25%) children with oral injuries were evaluated for abuse. Oral injuries in children 0–11 months old were more likely to be evaluated for abuse than children 12–24 months old (70.0% vs. 7.7%, p < .001).ConclusionsThe prevalence of oral injuries in children <24 months old presenting to a PED was low. Most occurred in mobile children and in children with traumatic chief complaints. Younger, non-mobile children with oral injuries had a higher likelihood of having an abuse evaluation. 相似文献
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Child abuse and neglect (CAN) are likely to have negative consequences on health; however, for oral health, studies on associated outcomes are sparse. The purpose of this study was to assess oral health and oral health behaviors in relation to suspected CAN among children being investigated by the Swedish Social Services. The material comprised data from the Social Services and dental records; the sample, 86 children and 172 matched controls. The children in the study group had a higher prevalence of dental caries than the control group; in addition, levels of non-attendance and dental avoidance were high, as was parental failure to promote good oral health. We found four factors that, taken together, indicated a high probability of being investigated because of suspected CAN: prevalence of dental caries in primary teeth, fillings in permanent teeth, dental health service avoidance, and referral to specialist pediatric dentistry clinics. If all four factors were present, the cumulative probability of being investigated was 0.918. In conclusion, there is a high prevalence of dental caries, irregular attendance, and a need for referral a pediatric dental clinic among Swedish children under investigation due to suspected CAN. Social context is an important factor in assessing the risk of developing dental caries, the inclination to follow treatment plans, and the prerequisites for cooperation during treatment. Routinely requesting dental records during an investigation would provide important information for social workers on parental skills and abilities to fulfill the basic needs of children. 相似文献
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Surupa Basu Ruchi Gupta Monjori Mitra Apurba Ghosh 《Indian journal of clinical biochemistry : IJCB》2015,30(2):167-173
Vitamin D deficiency is highly prevalent in Indian children of northern, western and southern states. Serum 25 hydroxy cholecalferol (ng/ml) was analyzed in 310 children and adolescents of pediatric hospital of Kolkata, India. Serum calcium (mg/dl), phosphorous (mg/dl) and alkaline phosphatase (IU/L) data was obtained. Median 25(OH)D was 19 ng/ml. 19.2 % of population had serum 25(OH)D < 10 ng/ml (severe deficiency), 52.9 % had <20 ng/ml (deficiency), 24.5 % had 20–29 ng/ml (insufficiency) and 22.6 % had >30 ng/ml (optimum). Deficiency was highest in adolescents (86.1 %), followed by school children (61.0 %), lowest in pre-school children (41.6 %). 25(OH)D concentrations was lowest in winters (P = 0.002) and spring (P = 0.03) compared to summer. There was no correlation with calcium (P = 0.99), phosphorous (P = 0.23) and ALP (P = 0.63). There is high prevalence of vitamin D deficiency in children and adolescents of eastern India. Prevalence was lower in younger subjects. 25(OH)D did not correlate with bone mineral markers. 相似文献
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目的:探讨SOAP(Subjective–Objective–Assessment-Plan)临床思维模式在儿科临床见习病史汇报教学中的应用。方法:以临床医学本科四年级学生69人为研究对象。由同一培训教师对所有学生进行SOAP临床思维模式培训,并将其应用于病史汇报。培训前后由测试组对病史汇报情况评分,比较评分差异。结果:培训前病史汇报平均成绩(73.42±1.2)分,优良率27.5%。培训后病史汇报平均成绩(85.68±0.9)分,优良率73.9%。培训后病史汇报成绩较以前明显提高,差异有统计学意义(P<0.01)。结论SOAP临床思维模式训练有助于提高临床医学本科生的儿科见习病史汇报水平,可应用于儿科临床见习教学。 相似文献
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BackgroundAlthough research on the negative effects of childhood poly-victimization is substantial, few studies have examined the relationship between poly-victimization and younger children’s physical health and diseases.ObjectiveThis study examines the associations between poly-victimization and children’s health problems requiring medical attention.MethodsA national stratified cluster random sampling was used to select and approach 25% of the total primary schools in Taiwan, and 49% of the approached schools agreed to participate in this study. We collected data with a self-report questionnaire from 6233 (4th-grade) students aged 10–11, covering every city and county in Taiwan.ResultsLogistic regression analyses demonstrate a significant dose-response relationship between children’s poly-victimization exposure and their health problems including hospitalization, serious injury, surgery, daily-medication requirements, heart murmurs, asthma, dizziness or fainting, allergies, kidney disease, therapies for special needs, smoking, and alcohol use. The results indicate that children’s risk of having a health problem grew significantly with each increase in the number of victimization types that children experienced.ConclusionsThese research findings underscore the effect of poly-victimization on children’s health problems requiring medical attention, and stress the need for both proper screening methods for children’s exposure to poly-victimization and stronger awareness of poly-victimization’s effects on health conditions in healthcare clinics. 相似文献
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