Child Behavior Problems and Maltreatment Exposure

OBJECTIVES

Establish the longitudinal cross-lagged associations between maltreatment exposure and child behavior problems to promote screening and the type and timing of interventions needed.

METHODS

The Longitudinal Studies of Child Abuse and Neglect, a multiwave prospective cohort study of maltreatment exposure, enrolled children and caregivers (N = 1354) at approximately age 4 and followed them throughout childhood and adolescence. Families completed 7 waves of data collection with each wave occurring 2 years apart. Maltreatment was confirmed using official case records obtained from Child Protective Services. Six-month frequencies of behavior problems were assessed via caregiver-report. Two random-intercept, cross-lagged panel models tested the directional relations between maltreatment exposure and externalizing and internalizing behaviors.

RESULTS

Maltreatment exposure predicted increases in externalizing behaviors at ages 8 (b = 1.06; 95% confidence interval [CI] 0.14-1.98), 12 (b = 1.09; 95% CI 0.08-2.09), and 16 (b = 1.67; 95% CI 0.30-3.05) as well as internalizing behaviors at ages 6 (b = 0.66; 95% CI 0.03-1.29), 12 (b = 1.25; 95% CI 0.33-2.17), and 14 (b = 1.92; 95% CI 0.76-2.91). Increases in externalizing behaviors predicted maltreatment exposure at age 12 (odds ratio 1.02; 95% CI 1.00-1.05).

CONCLUSIONS

Maltreatment exposure is robustly associated with subsequent child behavior problems, strengthening inferences about the directionality of these relations. Early screening of externalizing behaviors in pediatric settings can identify children likely to benefit from intervention to reduce such behaviors as well as prevent maltreatment exposure at entry to adolescence.

Retinodural haemorrhage of infancy: Support for continuing current terminology and approaches

This commentary is on the invited review by Squier on pages 290–297 of this issue.

Ethical Testimony in Cases of Suspected Child Maltreatment: The Ray E. Helfer Society Guidelines

New guidelines for ethical testimony were developed by the Ray E. Helfer Society, the largest medical professional society for physicians working in the field of child maltreatment. Building on the foundation of ethical guidelines set forth by the American Academy of Pediatrics, these new guidelines set detailed standards for testifying in cases of suspected child maltreatment and recommend that hospitals, medical practices, academic institutions, and professional societies hold their members accountable for court testimony related to child maltreatment as with other forms of medical practice and expert testimony.

The use of TeleCAM as a remote Web-based application for child maltreatment assessment, peer review, and case documentation

Approximately 1 million children are physically or sexually abused each year in the United States. Accurate diagnosis of these children and subsequent extensive legal intervention requires a thorough clinical assessment as well as legal documentation. A Web-based application developed for the remote sharing of child maltreatment assessment among multiple child protection providers is presented. Usability data was collected from medical personnel at three remote Utah Children's Advocacy Centers (CACs) and one urban tertiary children's hospital. Qualitative findings are summarized and satisfaction differences are reported between remote sites and their referral tertiary center.

Annual risk of death resulting from short falls among young children: less than 1 in 1 million

OBJECTIVE

The objective of the work was to develop an estimate of the risk of death resulting from short falls of <1.5 m in vertical height, affecting infants and young children between birth and the fifth birthday.

METHODS

A review of published materials, including 5 book chapters, 2 medical society statements, 7 major literature reviews, 3 public injury databases, and 177 peer-reviewed, published articles indexed in the National Library of Medicine, was performed.

RESULTS

The California Epidemiology and Prevention for Injury Control Branch injury database yielded 6 possible fall-related fatalities of young children in a population of 2.5 million young children over a 5-year period. The other databases and the literature review produced no data that would indicate a higher short-fall mortality rate. Most publications that discuss the risk of death resulting from short falls say that such deaths are rare. No deaths resulting from falls have been reliably reported from day care centers.

CONCLUSIONS

The best current estimate of the mortality rate for short falls affecting infants and young children is <0.48 deaths per 1 million young children per year. Additional research is suggested.

Effects of CS-905, a novel dihydropyridine calcium channel blocker, on arterial pressure, renal excretory function, and inner medullary blood flow in the rat

CS-905 is a dihydropyridine calcium channel antagonist which stands out for its prolonged hypotensive effect, and which is currently under investigation for the treatment of hypertension. The aim of the current series of studies was to investigate the effects of CS-905 on renal function in relation to its effects on arterial pressure. In anesthetized spontaneously hypertensive rats (SHR), intravenous bolus injection of CS-905 reduced mean arterial pressure (MAP) in a dose-dependent fashion. In parallel, there was a dose-related increase in urine flow (V), sodium excretion (UNaV), renal plasma flow (RPF), and glomerular filtration rate (GFR). In chronically cannulated unanesthetized SHR, single-dose CS-905 by gavage produced a sustained reduction in MAP, a significant increase in V and UNaV, no effect on RPF, and an increase in GFR. Continuous intrarenal infusion of CS-905 in anesthetized normotensive Munich Wistar rats at doses that did not affect MAP caused a marked diuresis and natriuresis, without affecting RPF or GFR. To determine whether the diuretic and natriuretic effects of CS-905 were mediated by changes in inner medullary blood flow, the effect of CS-905 on vasa recta blood flow (Qvr) was studied by fluorescent videomicroscopy in anesthetized normotensive Munich Wistar rats during continuous intrarenal infusion. At low infusion rates, CS-905 was diuretic and natriuretic while increasing Qvr. With a high infusion rate, although the diuretic and natriuretic effects of CS-905 were maximal, Qvr decreased. These findings suggest that the diuretic and natriuretic effects of CS-905 are dissociated from and cannot be accounted for by changes in RPF, GRF, or Qvr, and are most likely secondary to a direct action of CS-905 on renal tubule handling of sodium and water.

Effect of indomethacin, aspirin, nordihydroguairetic acid, and piperonyl butoxide on cyclophosphamide-induced bladder damage

Cyclophosphamide (CP), a widely used antineoplastic and immunosuppressant drug, is a prototypical bladder toxin in humans and experimental animals. CP itself is biologically inert. However, following bioactivation, acrolein, a potent tissue alkylator is generated. It is currently accepted that CP activation occurs via oxidative metabolism by the mixed-function oxidase system (MFO). Previous evidence from this laboratory demonstrated that CP can be metabolized by pathways other than MFO. In the current study, it was demonstrated that two inhibitors of the prostaglandin hydroperoxide synthase enzyme system, indomethacin and nordihydroguairetic acid (NDGA), diminish CP-induced bladder toxicity. However, the ability of these inhibitors to provide protection did not appear to be due to interference with CP metabolism. Many of the biologic effects of acrolein have been attributed to interaction with cellular thiols. Indomethacin and NDGA protected against CP-induced losses of soluble thiols in liver and protein thiols in bladder. Additionally, animals pretreated with indomethacin prior to CP appeared to have more glutathione available for conjugation, providing a potential mechanism for its protective effects against CP-induced bladder damage.