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Families were identified, in north-east Wiltshire (UK), (population 200,000), in which there was a pattern of two or more generations of child maltreatment and where there were also two or more children maltreated in the current generation (born between 1960 and 1980). These children had high rates of mental handicap, backwardness, and antisocial behaviour, and there were also characteristic patterns of emotional disturbance. The post-neonatal death rate for the 294 index children was very high, but higher still for their brothers and sisters. Some of the deaths, and at least 11 cases of violence-induced mental handicap (VIMH), were caused by characteristic types of child abuse - particularly violent shaking and throwing of infants, and secret suffocatory practices. There were very strong indications that larger numbers of children than the 11 proven VIMH cases had also suffered blunting of the intellect, physical complications such as epilepsy, and educational problems, as well as emotional and social maladjustment as the consequence of ill-treatment and neglect. Within the families, for children remaining at home, forms of ill-treatment and poor quality care persisted and ultimately affected most, or all, of the children in each family unit. Many families were chaotic, and within each family unit there were children frequently in care who suffered multiple placements, and who needed sustained specialist support throughout their childhood, encompassing a huge range of professional and other social support services. Such detail was generally underplayed or not accessible, and its full significance for children in each family could only be assessed by combining direct personal clinical involvement with record linkage methods, depending in turn on good co-operation from all agencies concerned wholly or partly with child protection.
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PMID:Successive generations of child maltreatment. The children. 325 Jun 97

In abused children, subdural hematoma is one of the most common causes of damage to the central nervous system. We report six Japanese cases of child abuse with subdural hematoma and discuss differences from those in the United States. The majority of abused children with subdural hematomas in Japan have suffered direct violence to the face and head, resulting in external signs of trauma. Failure to detect these external traces of trauma, however, might result in an incorrect diagnosis of infantile acute subdural hematoma attributed to accidental trivial head injury. Child abuse with subdural hematoma in the United States is frequently caused by whiplash shaking injury in which external signs of trauma may not be evident. In the United States, retinal hemorrhage and subdural hematoma together suggest child abuse; some cases of infantile acute subdural hematoma might be mistakenly diagnosed as child abuse. Thus, the constellation of retinal bleeding and subdural hematoma combined with the absence of visible signs of trauma is differently interpreted in the United States and Japan.
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PMID:Subdural hematomas in abused children: report of six cases from Japan. 370 22

Shaken baby syndrome is a serious form of physical child abuse, which is frequently overlooked. It should be suspected in all children younger than one year of age, who present with drowsiness, coma, seizures or apnoea. A combination of subdural haematomas and retinal haemorrhages with minimal or no trauma and no coagulopathy is almost pathognomonic of the syndrome. The findings are caused by shaking with or without impact. Physical signs of violence are often absent and the syndrome may easily be mistaken for serious infection or seizure disorder. Many cases are fatal or lead to severe disability including blindness, cerebral palsy, mental retardation or epilepsy in about 60% of the children. There are many unresolved problems regarding diagnosis, pathophysiology, treatment, prognosis, prophylaxis and legal actions. We discuss these problems and in addition present eleven children with shaken baby syndrome.
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PMID:[Shaken baby syndrome]. 982 79

This study explores the prevalence and correlates of past-year physical violence against women in slum and nonslum areas of urban Bangladesh. The authors use multivariate logistic regression to analyze data from the 2006 Urban Health Survey, a population-based survey of 9,122 currently married women aged between 15 and 49 who were selected using a multistage cluster sampling design. The prevalence of reported past-year physical spousal violence is 31%. Prevalence of past-year physical spousal violence is higher in slums (35%) than in nonslums (20%). Slapping/arm-twisting and pushing/shaking/ throwing something at the women are the most commonly reported acts of physical abuse. Multivariate analysis shows that the risk of physical spousal abuse is lower among older women, women with post-primary education, and those belonging to rich households and women whose husbands considered their opinion in decision making. Women are at higher risk of abuse if they had many children, believe that married woman should work if the husband is not making enough money, and approve wife-beating norms. This study serves to confirm the commonness of physical spousal abuse in urban Bangladesh, demonstrating the seriousness of this multifaceted phenomenon as a social and public health issue. The present findings suggest the need for comprehensive prevention and intervention strategies that capitalize on the interplay of individual and sociocultural factors that cause physical spousal violence. Our study adds to a growing literature documenting domestic violence against women in urban areas of developing south Asian nations.
J Interpers Violence 2011 Sep
PMID:Prevalence and correlates of physical spousal violence against women in slum and nonslum areas of urban Bangladesh. 2183 70

Shaken baby syndrome/abusive head trauma is a leading cause of morbidity and mortality in infants. The presence of a diffuse subdural hematoma without evidence of accident is a key diagnostic clue. The hematoma is typically attributed to rupture of the cerebral bridging veins due to violent shaking, with or without impact. Dating the incident, however, remains controversial. The aim of this article is to review the most reliable features used for dating the incident, based on both legal statements by perpetrators and medical documentation. The key points are: 1) The high (yet likely underestimated) frequency of repeated shaking is around 50%, 2) Children do not behave normally immediately after shaking, and the time of onset of even mild symptoms appears to be the best clue for dating the incident and 3) Brain imaging provides strong indicators of "age-different" injuries but the ranges for dating the causal event are wide. The density pattern in a single subdural hematoma location provides no reliable clues for assessing repeated violence. Only the finding of different density in two distant subdural hematomas argues in favor of "age-different" injuries, i.e. repeated violence. MRI is difficult to interpret in terms of dating subdural hemorrhages and must be analyzed in conjunction with CT. Most importantly, all of the child's previous clinical and radiological data must be carefully studied and correlated to provide accurate information on the date and repetition of the trauma.
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PMID:Dating the abusive head trauma episode and perpetrator statements: key points for imaging. 2825 88

The purpose of this study was to investigate whether maternal intimate partner violence (IPV) victimization during pregnancy is associated with abusive behavior by the mother towards infants at 4 months of age. A population-based sample of 6590 mothers with 4-month-old infants participated in this study in Japan. Abusive behavior was assessed via questionnaire and defined as frequency of shaking and smothering during the preceding month. Both verbal and physical IPV during pregnancy were assessed retrospectively. Multiple logistic regression analysis was used, adjusting for types of IPV and potential covariates, specifically postpartum depression. Maternal exposure to verbal and physical IPV during pregnancy was reported by 10.9% and 1.2% of women, respectively. In the adjusted model, women exposed to verbal IPV alone were significantly more likely to abuse offspring (odds ratio: 1.59, 95% confidence interval: 1.17-2.16) while exposure to physical IPV did not have an additive effect for abusive behavior. Maternal victimization by verbal, but not physical IPV was associated with maternal abusive behavior towards their 4-month-old infant. Screening for verbal abuse during pregnancy might be an efficient approach to identify high-risk mothers of infant abuse.
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PMID:Association between maternal intimate partner violence victimization during pregnancy and maternal abusive behavior towards infants at 4 months of age in Japan. 2708 52

Shaking and smothering in response to infant crying are life-threatening child abuse. Parental childhood abuse history is known to be one of the most robust risk factors for abusing their offspring. In addition to childhood abuse history, other adverse childhood exposures (ACEs) need to be considered due to co-occurrence. However, few studies have investigated the impact of ACEs on caregivers shaking and smothering their infant. This study aims to investigate the association of ACEs with shaking and smothering among caregivers of infants in Japan. A questionnaire was administered to caregivers participating in a four-month health checkup between September 2013 and August 2014 in Chiba City, Japan, to assess their ACEs (parental death, parental divorce, mentally ill parents, witness of intimate partner violence, physical abuse, neglect, psychological abuse and economic hardship), and shaking and smothering toward their infants (N=4297). Logistic regression analysis was used to examine the cumulative and individual impacts of ACEs on shaking and smothering. Analyses were conducted in 2015. A total of 28.3% reported having experienced at least one ACE during their childhood. We found that only witness of IPV had a significant association with shaking of infant (OR=1.93, 95% CI: 1.03-3.61). The total number of ACEs was not associated with either shaking or smothering. Our findings suggest that shaking and smothering in response to crying can occur regardless of ACEs. Population-based strategies that target all caregivers to prevent shaking and smothering of infants are needed.
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PMID:Association of adverse childhood experiences with shaking and smothering behaviors among Japanese caregivers. 2726 6

Abusive head trauma (AHT) is a serious form of child maltreatment that needs to be prevented. The aim of this study was to summarize the main AHT prevention strategies described in literature, aiming to identify evidence of their efficiency, as well as strengths and limitations. International databases were reviewed from 2005 to 2015 using the key words Shaken Baby Syndrome or abusive head trauma or nonaccidental head trauma or abusive head injury or nonaccidental head injury and prevention. A total of 1,215 articles were found and 34 complete articles were selected for this study. Five initiatives with the main objective of reducing infant crying in the first months of life were found, three aimed at caregiver's emotional regulation and 12 aimed at raising parents and caregivers awareness on AHT. Among them, parental education about infant crying and risks of shaking a baby stands out for its empirical evidence.
Trauma Violence Abuse 2018 12
PMID:Pediatric Abusive Head Trauma Prevention Initiatives: A Literature Review. 2782 97

Herod the Great was appointed "king of Jews," to govern Judea, by the Roman Emperor and Senate. He lived from 73/74 BCE to 4 CE. He died with an illness and symptoms that have been the source of considerable speculation. Richard Strauss depicted Herod in his classic opera, "Salome." That opera was derived from a play of the same name by Oscar Wilde, which was based on an 1876 painting, "Salome Dancing Before Herod," by Gustave Moreau. The operatic Herod was afflicted with an illness characterized by dementia, hallucinations, paranoia, alcoholism (from drinking the Emperor's wine), violence, twitches, and sterility; different interpretations showed him also with falls, chills, shaking, thirst, forgetfulness, and sleepiness, for which we suggest the novel diagnosis of chronic lead intoxication (which can manifest to rheumatologists as saturnine gout). He had compatible symptoms (encephalopathy and neuromuscular abnormalities) and consumed excessive quantities of imperial wine, known to be highly contaminated with lead and likely associated with similar symptoms among Roman aristocracy. Herod's demented cruelties-an oppressive reign which including the beheading of John the Baptist-exacerbated the political climate and may have contributed to the subsequent violent 7-year revolt culminating in the destruction of the second temple. How different might history have been if Herod the Great had been abstemious?
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PMID:Did King Herod suffer from a rheumatic disease? 2873 92

Scholars are beginning to use the concept medicalization of poverty to theorize how the United States spends large amounts of money on illnesses related to poverty but invests much less in preventing these illnesses and the conditions that create them (e.g., economic insecurity, housing instability, continuous exposure to violence, and racism). This study examines the connection between poverty, disease burden and health-related costs through the in-depth interviews of 86 Black mothers living in neighborhoods with high levels of violence on the South Side of Chicago. The rippling costs of poverty and violence include 56 percent of the mothers reporting post-traumatic stress disorder symptoms and 48 percent reporting mild to severe depressive symptoms. Mothers also report poor housing quality such as "toxic mold." The physical costs include reports of back pains, stomach aches, hair falling out, panic attacks, hands shaking, insomnia (sometimes for two days), fainting from exhaustion and lack of sexual desire, and children with asthma and osteomyelitis reportedly from the exposure to mold. Transformative solutions are explored that build upon the cultural resources of Black mothers (e.g., women-centered networks, spirituality and collective-cooperatives) and engage policy levers (e.g., Earned Income Tax Credit and Tax Increment Financing).
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PMID:The Medicalization of Poverty in the Lives of Low-Income Black Mothers and Children. 3033 76


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