Association of perpetrator relationship to abusive head trauma clinical outcomes

The diagnosis of abusive head trauma (AHT) remains a significant public health problem with limited prevention success. Providing protection from further harm is often challenged by the difficulty in identifying the alleged perpetrator (AP) responsible for this pediatric trauma. The objective of this study was to evaluate demographic and clinical characteristics of children with AHT and the relationship between APs and their victims in a large, multi-site sample. Understanding the AHT risks from various caregivers may help to inform current prevention strategies. A retrospective review of all cases of AHT diagnosed by child protection teams (CPT) from 1/1/04 to 6/30/09 at four children's hospitals was conducted. Clinical characteristics of children with AHT injured by non-parental perpetrators (NPP) were compared to parental perpetrators (PP). There were 459 children with AHT; 313 (68%) had an identified AP. The majority of the 313 children were <1 year of age (76%), Caucasian (63%), male (58%), receiving public assistance (80%), and presented without a history of trauma (62%); mortality was 19%. Overall, APs were: father (53%), parent partner (22%), mother (8%), babysitter (8%), other adult caregiver (5%); NPP accounted for 39% of APs. NPPs were more likely to cause AHT in children ≥1 year (77% vs. 23%, p < 0.001) compared to PP. Independent associations to NPP included: older child, absence of a history of trauma, retinal hemorrhages, and male perpetrator gender. While fathers were the most common AP in AHT victims, there is a significant association for increased risk of AHT by NPPs in the older child, who presents with retinal hemorrhages, in the hands of a male AP. Further enhancement of current prevention strategies to address AHT risks of non-parental adults who provide care to children, especially in the post-infancy age seems warranted.     

Parents’ behavior in response to infant crying: Abusive head trauma education

Abusive head trauma (AHT) is still too common, and probably underestimated. It is the leading cause of death from child abuse. Crying is thought to contribute to the act of shaking. Objectives of this study were to (a) assess parents’ knowledge about infant crying, their ability to manage crying, and their knowledge about AHT; and (b) assess the feasibility and the impact of a simple educational intervention about crying and AHT with parents shortly after their child's birth. A short questionnaire was completed orally by the parents of 190 consecutive newborns in a maternity hospital at day 2 of life. Then, during the routine examination of the child, the pediatrician gave parents a short talk about infant crying and AHT, and a pamphlet. Finally, parents were contacted by phone at 6 weeks for the post-intervention questionnaire assessing their knowledge about crying and AHT. Among 202 consecutive births, parents of 190 children were included (266 parents; 70% mothers) over a 1-month period and answered the pre-intervention questionnaire. The intervention was feasible and easy to provide. Twenty-seven percent of mothers and 36% of fathers had never heard of AHT. At 6 weeks, 183 parents (68% of the sample; 80% mothers) answered the post-intervention questionnaire. Parents’ knowledge improved significantly post-intervention. Parents found the intervention acceptable and useful. Health care professionals such as pediatricians or nurses could easily provide this brief talk to all parents during systematic newborn examination.     

Prior opportunities to identify abuse in children with abusive head trauma

Infants with minor abusive injuries are at risk for more serious abusive injury, including abusive head trauma (AHT). Our study objective was to determine if children with AHT had prior opportunities to detect abuse and to describe the opportunities. All AHT cases from 7/1/2009 to 12/31/2011 at four tertiary care children's hospitals were included. A prior opportunity was defined as prior evaluation by either a medical or child protective services (CPS) professional when the symptoms and/or referral could be consistent with abuse but the diagnosis was not made and/or an alternate explanation was given and accepted. Two-hundred-thirty-two children with AHT were identified; median age (IQR) was 5.40 (3.30, 14.60) months. Ten percent (22/232) died. Of the 232 patients diagnosed with AHT, 31% (n = 73) had a total of 120 prior opportunities. Fifty-nine children (25%) had at least one prior opportunity to identify abuse in a medical setting, representing 98 prior opportunities. An additional 14 (6%) children had 22 prior opportunities through previous CPS involvement. There were no differences between those with and without a prior opportunity based on age, gender, race, insurance, mortality, or institution. Children with prior opportunities in a medical setting were more likely to have chronic subdural hemorrhage (48 vs. 17%, p < 0.01) and healing fractures (31 vs. 19%, p = 0.05). The most common prior opportunities included vomiting 31.6% (38/120), prior CPS contact 20% (24/120), and bruising 11.7% (14/120). Improvements in earlier recognition of AHT and subsequent intervention might prevent additional injuries and reduce mortality.     

Epidemiology of abusive head trauma in West Virginia children <24 months: 2000–2010

BackgroundFew states have published statewide epidemiology of abusive head trauma (AHT).ObjectiveTo examine the statewide epidemiology of AHT in West Virginia (WV), with the primary objective of establishing AHT incidence for comparison to national data, and to use as a baseline for comparison to incidence post-implementation of a statewide AHT prevention program.Participants and settingAHT cases in children less than 2 years old were identified from the 3 tertiary pediatric centers in WV.MethodsCases were identified by using ICD-9 codes for initially identifying those with injuries which might be consistent with AHT, followed by medical record review to determine which of these met the criteria for inclusion as a case. Medical examiner data was used to find additional cases of AHT. Using the number of cases identified along with relevant census data, incidence of AHT was calculated.ResultsThere were 120 cases of AHT treated in WV hospitals from 2000 to 2010, 100 of which were WV residents. The incidence was 36.1/100,000 children <1 year of age and was 21.9 cases per 100,000 children <2 years of age. Incidence in infants increased during the latter years (2006–2010) of the study to 51.8/100,000 compared to the incidence during 2000–2005, which was 24.0/100,000 (p < .01).ConclusionsCompared to US national, state and regional figures, the WV incidence of AHT was among the highest. In addition, the incidence of AHT increased significantly over the study period. Possible factors contributing to the rise in incidence are discussed.     

双侧标准大骨瓣减压治疗特重型颅脑损伤

总结2002年5月至2005年5月间采取双侧标准大骨瓣减压救治的38例特重型颅脑损伤的临床效果。探讨双侧去大骨瓣减压术治疗特重型颅脑损伤的手术方法与临床意义等问题。指出早期标准外伤大骨瓣开颅减压能明显改善特重型颅脑损伤病人的预后。     

Increased expression of aquaporin-4 in human traumatic brain injury and brain tumors

Objective:To characterize the expression of aquaporin-4(AQP4),one of the aquaporins(AQPs),in human brainspecimens from patients with traumatic brain injury or brain tumors.Methods:Nineteen hnman brain specimens were obtahledfrom the patients with traumatic brain injury,brain tumors,benign meningioma or early stage hemorrhagic stroke.MRI or CTimaging was used to assess brain edema.Hematoxylin and eosm staining were used to evaluate cell damage,Immunohistochem-istry was used to detect the AQP4 expression.Results:AQP4 expression was increased from 15 h to at least 8 d after injury.AQP4immunoreactivity was strong around astrocytomas,ganglioglioma and metastatic adenocarcinoma.However,AQP4 immunore-activity was only found in the centers of astrocytomas and ganglioglioma,but not in metastatic adenocarcinoma derived from lung.Conclusion:AQP4 expression increases in human brains alter traumatic brain injury,within brain-derived tumors,and aroundbrain tumors.     

青少年心理创伤特点及干预研究述评

青少年在经历巨大创伤性事件后,内心遭受重创,心理反应表现出独有特点．主要反映在：（1）情感上,抑郁程度重,焦虑情绪高．（2）认知上,对自身及世界的消极认知固着,记忆出现不同程度的障碍,特别是言语记忆受损严重．（3）意志上,表现为更封闭、退缩,生活动力相对缺失,内倾性增大．（4）行为上,易形成各种不良的习惯,同伴间的攻击行为增多．对此可以采用认知行为疗法、精神催眠辅助治疗、症状监控、多维家庭治疗技术等进行干预．     

Maslow and Team Organization

Many middle schools use the Web to disseminate and gather information. Online barriers often limit the accessibility of the Web for students with disabilities. The purpose of this study was to evaluate the accessibility of home pages of a sample of middle schools. The authors located 165 Web sites using a popular online directory and evaluated the sites for accessibility. A software program quantified the number of accessibility errors at each site. Most middle school home pages had accessibility problems, and the majority of them represented severe concerns that should be given a high priority for improvement. The good news is that the majority of the errors can easily be corrected. The work reflects a need for middle schools to continuously examine the accessibility of their home pages. Direction for improving accessibility is provided.     

老年脑卒中患者生活质量的现状与康复护理干预

采用随机抽样法获取老年脑卒中患者80例作为研究对象,将其随机分为干预组与对照组。探讨老年脑卒中患者生活质量的现状与康复护理干预。结果表明,康复护理干预方法优于传统护理方法,有助于提高老年脑卒中患者本人和家属对健康的认识及健康价值水平,促进老年脑卒中患者掌握有效的康复训练方法,改善老年脑卒中患者的运动、语言、认知和其它受损的功能,使其在精神、心理和社会上再适应,提高生活质量。