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Traumatic head injury due to child maltreatment (THI-CM), also known as abusive head trauma (AHT), is a significant public health problem due to the wide array of consequences affecting multiple domains of a child's health and development. Several studies have evaluated its cost on healthcare systems, families, and societies. Many jurisdictions have implemented caregiver education programs to prevent THI-CM.This paper aims to provide a brief overview of the epidemiology and cost analysis of THI-CM and discuss its prevention and the intergenerational transmission of child maltreatment.Although not systematic, a literature search of original articles published from 2000 to 2022 in English and French was undertaken using the following databases: PubMed, EMBASE (Ovid), and PsycINFO (OVID). The search combined terms related to traumatic head injury and child maltreatment, with terms related to its cost and prevention. Studies of children aged 0-5 years old were included. The authors completed a screen of the titles and abstracts to determine relevance with respect to this article.Globally, although THI-CM accounts for a small proportion of cases of child maltreatment, there is a high incidence of death and neurological sequelae compared to other causes of head trauma.The incidence of THI-CM is likely underestimated due to the lack of standardized definitions, differences in reporting, and challenges in identifying less severe cases. Cost analysis studies reveal the significant short- and long-term costs associated with THI-CM. Caregiver education programs have been studied and implemented in many centers and have shown varying but promising results.A multi-pronged approach to prevention efforts should be considered to support families and help to prevent THI-CM and maltreatment throughout childhood.

Child sexual abuse (CSA) is associated with many repercussions on adolescents' mental health, including suicidal ideation. Yet, the mechanisms linking CSA to adverse outcomes have rarely been investigated within a longitudinal design. The current study aimed to examine the role of affect dysregulation in the association between depressive symptoms and suicidal ideation 1year after the first assessment in a sample of 119 sexually abused adolescent girls. An integrative mediational model was conceptualized to examine the explicatory role of affect dysregulation (Time 2) in the association between depressive symptoms (Time 1) and suicidal ideation (Time 3). Approximately 31% of the girls reported suicidal ideation at Time 3. Path analysis with logistic regressions revealed that the association between depressive symptoms and suicidal ideation presence was partly explained by affect dysregulation, which increased the risk of suicidal ideation presence by 18.4%, OR = 1.18, 95% CI [1.07, 1.33]. The integrative model explained 21.5% of the variance in suicidal ideation. These findings identify potential predictors of suicidal ideation among sexually abused adolescent girls. This present study highlights the role of affect dysregulation in the presence of suicidal ideation and provides potential targets for intervention practices when working with adolescent girl victims of CSA. As such, interventions for this vulnerable population should aim to decrease depressive symptoms and affect dysregulation to reduce suicidal risk.

Summary Aim Serum creatinine level is the most used test to evaluate renal function in patients with anorexia nervosa (AN). We investigated which formula of glomerular filtration rate (GFR) based on simple blood sample had the best correlation with the gold standard in malnourished adolescent patients with AN. Methods A prospective study was conducted on 34 adolescents hospitalized for the restrictive type of AN between 2014 and 2017. The GFR was measured by isotopic technique and calculated using the Cockroft–Gault, Schwartz equations and 3 other formula. Results For the 34 AN patients, mean BMI -2.7 zscore, the mean measured GFR was 107+/-26 mL/min/1.73 m2. Among them, 35% (12/34) had a GFR under 90 mL/min/1.73 m2. The calculated GFR with Cockroft–Gault formula had the best correlation with the measured GFR (R2 = 0.852), whatever the creatinine level. No correlation was found between creatinine level and measured GFR. Conclusion Kidney dysfunction is common in malnourished AN adolescents, so clinicians should always evaluate AN patients for renal impairments. Creatinine level is a poor indicator of renal function in this population. The most accurate formula to test GFR with a simple blood test is the Cockroft-Gault formula.

This study explored the pathways underlying the relationships between child maltreatment (CM) subtypes (i.e., physical, sexual, and emotional abuse and neglect) and factors associated with a heightened risk of pregnancy complications by examining post-traumatic stress disorder (PTSD) symptoms as a potential mediator.A sample of 98 pregnant parents between the ages of 18 and 29 years was recruited through social media and community organizations throughout Canada. Participants completed a series of surveys on their exposure to CM, PTSD symptoms, and pregnancy experiences on a secure online platform. Following data cleaning procedures, 85 participants were included in this study.Four separate mediation analyses were conducted with child neglect, physical abuse, sexual abuse, and emotional abuse as factors associated with a heightened risk of pregnancy complications (i.e., a congregate score of limited prenatal care, weight gain concerns, smoking, second-hand smoke, alcohol consumption, substance use, and insufficient food intake during pregnancy). Each CM subtype was associated with increased PTSD symptoms, which were in turn associated with the presence of more factors known for increasing the risk of pregnancy complications. Neglect, physical abuse, sexual abuse, and emotional abuse were all indirectly associated with the presence of more factors associated with a heightened risk of pregnancy complications through their association with PTSD symptoms.Findings from this study could encourage prenatal care providers to screen for CM history and PTSD symptoms. Furthermore, mental health treatment early in the prenatal period may improve pregnant parents' health and lower their risk of pregnancy complications.

Purpose This matched cohort study aims to determine whether teenagers with a history of childhood sexual abuse (CSA) are at greater risk of consulting for a pregnancy and related complications than teenagers from the general population. It also aims to compare provoked abortion, live births, and fetal losses of participants who were sexually abused in childhood and those of the general population. Methods A total of 661 girls (aged 13–18 years) with a corroborated by Child Protection Services CSA report between 2001 and 2010 were matched to 661 girls from the general population upon age, biological sex, urban Child Protection Services area, and public drug insurance admissibility at reporting date. Pregnancy consultations and complications during pregnancy and delivery were documented using diagnoses from public health insurance administrative databases from January 1996 to March 2013. Socioeconomic status was controlled. Results Results indicate that compared with participants from the general population, those with a history of CSA were 4.6 times more likely to consult for at least one pregnancy, 5.3 times more likely to consult for at least one complication during pregnancy or delivery, and on average 5.2 and 3.3 times more likely to consult for at least one live birth and provoked abortion, respectively. There were too few observations to compare fetal losses between groups. Conclusions Medical interventions for teenage pregnancies and related complications should take into consideration a possible history of CSA to reinforce gynecological follow-up and treatment for girls who were sexually abused and to prevent unfavorable outcomes.

A better understanding of the individual difficulties reported by adolescents presenting with anorexia nervosa seems like an interesting avenue to refine our understanding of their psychological functioning. This study aimed to: (1) describe the behavioral and affective profile of difficulties of inpatient adolescent girls presenting a restricting type of anorexia (ANR); and (2) investigate the presence of a relationship between behavioral and affective problems and severity of the disorder. The sample consisted of 52 inpatient adolescent girls presenting an ANR. The youth self report assessed the behavioral and emotional profile of difficulties of participants while the Eating Disorder Risk Composite of the Eating Disorder Inventory measured the symptomatology of the disorder. A ratio between body mass index at admission and at the end of the treatment served as an indicator of weight gain. The sample presented an internalized profile of problems. Individual differences were found and three profiles of difficulties were present in the sample: normative, pure internalizing and mixed (clinical on the internalizing and externalizing clusters). This study provides information on the heterogeneity of this specific population otherwise quite similar and demonstrates how severity of the disorder can be associated with a wide range of other behavioral and affective difficulties. Level V, cross-sectional descriptive study.

Background Anorexia Nervosa (AN) is a highly prevalent disease in adolescents and young adults (AYAs). The quality of initial inpatient medical management in a patient with severe malnutrition due to AN is crucial to prevent further medical instability. This review aims to inventory evidence regarding initial refeeding and management of AYAs with AN in an inpatient setting, in order to avoid medical complications. Methods A systematic review will be conducted using PubMed, MEDLINE, All EBM Reviews, Embase, PsycINFO, Cochrane Database and CINAHL. The search strategy consists of terms related to anorexia, hospitalization and Pediatrics. Randomized controlled trials, case-control studies, cross-sectional and cohort studies will be included. Participants will include adolescents and adults 18–24 years old diagnosed with AN and meeting criteria for severe disease. The primary outcome will be any of the following complications: hypophosphatemia, refeeding syndrome, hypoglycemia, cardiac arrythmia, hepatic cytolysis or death. Data will be extracted and the risk of bias will be assessed by one author and reviewed by a second author. Results will be presented in a systematic narrative synthesis format. The quality of evidence for all outcomes will be evaluated using the GRADE methodology. Discussion This systematic review will examine current evidence on initial inpatient refeeding and help to document effectiveness of initial inpatient management in AYAs with severe AN in avoiding further medical complications. Trial registration This study is registered on PROSPERO under the reference number CRD42019123608.

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The aim of this study was to better understand the relationship between parents' experience of caregiving and expressed emotion during the early stage of their child's eating disorder. Fifty mothers and 38 fathers of adolescents suffering from anorexia nervosa and hospitalized for the first time participated in this study. They completed the Experience of Caregiving Inventory, a measure of the negative and positive aspects of the caregiving experience, and the Family Questionnaire, which measured the different dimensions of expressed emotion, namely emotional over-involvement and critical comments. Results showed that caregiving experience is significantly and positively correlated to expressed emotion. Among the negative aspects of caregiving, sense of loss contributed most to emotional over-involvement, while difficult behaviours contributed most to critical comments. The results suggest that parents' perceptions of their child and child's future are strongly related to their tendency to be over-involved. The perception of disruptive behaviours in their child could be one of the principal triggers or exacerbating factors of parents' critical attitudes.

Child sexual abuse (CSA) has been strongly associated with a range of psychological and physical problems in childhood and adulthood, such as anxiety, post-traumatic stress disorder (PTSD), and infectious diseases. Despite the strength of these associations, no studies to date have investigated psychobiological processes that might underlie the relationship between CSA and physical health problems occurring during childhood, such as infectious diseases. The goal of the current study is to evaluate PTSD as a potential mediator between CSA and the occurrence of infectious diseases among children and adolescents. Furthermore, we postulate that PTSD plays a specific role as an indicator of chronic stress during childhood, in comparison to other mental disorders, such as anxious and non-anxious disorders (e.g., depression). Via a prospective matched-cohort design, administrative data were used to document PTSD, anxious and non-anxious disorders, and infectious diseases. The sample size was 882 persons with a substantiated report of sexual abuse and 882 matched controls. Negative binomial regressions revealed that CSA is associated with a greater number of anxious diseases diagnoses that, in turn, predict more infectious diseases diagnoses. These findings highlight the importance of preventing and intervening among sexually abused youth with anxious disorder symptoms to limit negative outcomes on physical health.

Few studies have examined how the perceived quality of multiple interpersonal relationships is related to eating disorder (ED) symptom severity in adolescents and how psychological variables might influence these associations. The aim of this study is to determine whether the perceived level of trust, communication, and alienation in the relationship with one's mother, father, and peers are predictive of ED severity in adolescent females and to test the mediating effects of low self-esteem and negative mood on these associations. Adolescent females aged 12 to 18 (N = 186) with a diagnosis of Anorexia Nervosa (Restrictive; AN-R or Binge/Purge; AN-B/P) completed self-report measures evaluating the perceived quality of interpersonal relationships, ED symptom severity, low self-esteem, and negative mood. Multiple regressions revealed that the level of perceived alienation in the relationship with one's mother and peers was positively associated with ED symptom severity. Low self-esteem and negative mood acted as mediators of these associations. Considering that a high level of perceived alienation in the relationship with one's mother and peers appears to be associated with more severe ED symptoms through its impact on self-esteem and mood, improvements in the quality of these interactions are likely to be an effective target of intervention among adolescents.

The impact of child sexual abuse (CSA) disclosure on parents’ psychological health has been documented among samples of nonoffending parents. Much less is known about the parents’ physical health. ...

Objective To compare genitourinary health problems of children and adolescents with a substantiated report of sexual abuse with those of the general pediatric population. Study design Via a prospective matched-cohort design, administrative databases between January 1996 and March 2013 were used to document genitourinary problems of 882 sexually abused children and those of 882 matched controls. Generalized linear mixed models determined the association between a substantiated sexual abuse and diagnoses for sexually transmitted infections and urinary and genital health problems. Results Adjusted results revealed that up to 12 years after a sexual abuse was substantiated, abused girls had, respectively, 2.1 and 1.4 times more diagnoses for urinary and genital health problems compared with girls from the general population, whereas no difference was found for sexually transmitted infections. Sexually abused boys had an equivalent number of diagnoses as those from the general population for all 3 outcomes. Depending on the genitourinary health problem, abused girls and those from the general population had between 2.5 and 11 times more diagnoses than abused boys or those from the general population. Conclusions This study showed that substantiated childhood sexual abuse is associated with more urinary and genital health problems among girls but not boys. Early prevention and intervention efforts may mitigate the problems such that they do not persist or worsen over time and into adulthood.

L’anorexie mentale prepubere peut entrainer de multiples consequences physiques. Lorsque le trouble debute avant la puberte, il serait lie a un plus mauvais pronostic ainsi qu’a une plus grande res...

Background Sleep disorders are prevalent in children and are associated with significant comorbidity. Objective To assess the training, knowledge, attitudes and practices of Canadian health care providers (HCPs) regarding sleep disorders in children. Method A 42-item survey, designed to collect information on frequency of paediatric sleep disorders-related screening and diagnosis, implementation of evidence-based interventions and related knowledge base, was completed by HCPs. Results Ninety-seven HCPs completed the survey. One per cent obtained training in paediatric sleep during undergraduate training and 3% obtained such training during their residencies, yet 34.9% estimated that 25 to 50% of their patients suffered from sleep disorders. Most HCPs thought that sleep disorders significantly impacted children's health and daytime function. Most HCPs screened for developmental sleep issues, but not consistently for sleep disorders. Most recommended evidence-based behavioural interventions for behavioural sleep disorders, but some also reported behavioural interventions that were not first-line or recommended. Inadequate knowledge regarding melatonin use was evident. Most participants reported rarely/never ordering a sleep study for a child with suspected obstructive sleep apnea (OSA). Most were familiar with surgical and weight loss management options for OSA; many were unfamiliar with benefits of continuous positive airway pressure. Participants' knowledge scores were highest on developmental and behavioural aspects of sleep, and lowest on sleep disorders. Conclusions HCPs exhibit significant gaps in their knowledge, screening, evaluation and treatment practices for paediatric sleep disorders. Training at the undergraduate, graduate and postgraduate levels, as well as Continuing Medical Education are needed to optimize recognition, treatment and follow-up of paediatric sleep disorders.

Introduction : L’agression sexuelle durant l’enfance est associée à de nombreux problèmes de santé physique et mentale. Toutefois, au Québec, nous ne connaissons pas bien les problèmes de santé physique et mentale que présentent les enfants et les adolescents ayant vécu une agression sexuelle corroborée en comparaison de ceux de la population générale. Objectif : L’objectif de la présente étude est donc de déterminer si les jeunes agressés sexuellement consultent ou sont davantage hospitalisés pour des problèmes de santé physique et mentale que ceux de la population générale sur une période de 10 ans après un premier signalement. Méthode : Des données administratives ont servi à documenter les diagnostics médicaux de 882 jeunes (75 % filles) ayant au moins un signalement fondé d’agression sexuelle entre le 1er janvier 2001 et le 31 décembre 2010 au Centre jeunesse de Québec-Institut universitaire. Ces diagnostics sont comparés à ceux de 882 jeunes de la population générale appariés en genre et en âge au groupe de jeunes agressés sexuellement. Résultats : Les résultats indiquent que l’agression sexuelle à l’enfance entraîne un risque jusqu’à cinq fois plus élevé de consultations externes et d’hospitalisations pour des problèmes de santé mentale et physique, et ce, jusqu’à 10 ans après le signalement d’agression sexuelle., Childhood sexual abuse is associated with many physical and mental health problems. However, it is not clear how the physical and mental health problems of children and adolescents in Quebec who experienced sexual abuse compare to those of the general population. The objective of the current study is to determine if, in Quebec, sexually abused youth consult about or are hospitalized for physical and mental health problems more often than those in the general population over the 10-year period following a first report. Administrative databases were used to document the medical diagnoses of 882 children and adolescents (75 % girls) who had at least one substantiated report of sexual abuse between January 1, 2001, and December 31, 2010, at the Centre jeunesse de Québec – Institut universitaire. Their diagnoses are compared to those of 882 youth from the general population paired according to gender and age. The results reveal that childhood sexual abuse entails a five-fold increased risk of outpatient medical consultation and hospitalization, for both mental and physical health problems, up to 10 years after the substantiated report of sexual abuse., La agresión sexual durante la infancia está asociada a numerosos problemas de salud física y mental. Sin embargo, en Quebec, no conocemos bien los problemas de salud física y mental que presentan los niños y adolescentes que padecieron una agresión sexual corroborada, en comparación con aquéllos de la población general. El objetivo del presente estudio consiste pues en determinar si los jóvenes agredidos sexualmente consultan, o son hospitalizados en mayor medida, por problemas de salud física y mental que aquéllos de la población general, durante un período de 10 años después de una primera denuncia. Los datos administrativos han servido para documentar los diagnósticos médicos de 882 jóvenes (75 % de niñas) que poseen, al menos, una denuncia fundada de agresión sexual entre el 1 de enero de 2001 y el 30 de diciembre de 2010 señalada al Centre jeunesse de Québec-Institut universitaire. Dichos diagnósticos son comparados con los de 882 jóvenes de la población general, emparejados en términos de género y edad con el grupo de jóvenes agredidos sexualmente. Los resultados indican que la agresión sexual durante la infancia conlleva un riesgo de hasta cinco veces mayor de consultaciones externas y de hospitalizaciones por problemas de salud mental y física, y esto hasta 10 años después de la denuncia de agresión sexual.

Resume But de l’etude Cette etude poursuit trois objectifs. Le premier vise a decrire la repartition, a travers les differents stades de motivation au changement, d’un groupe d’adolescentes hospitalisees pour une anorexie mentale (AM) de type restrictif. Le second propose d’examiner le lien entre l’intensite du trouble et le niveau de motivation au changement chez celles-ci. Et le troisieme vise a comparer deux instruments de mesure de motivation utilises dans l’etude. Methode L’echantillon est constitue de 32 adolescentes âgees entre 12 et 17 ans, hospitalisees pour la premiere fois pour une AM. Les participantes ont complete des autoquestionnaires a leur arrivee a l’hopital. La motivation au changement est evaluee a l’aide de deux instruments : les versions francophones de l’Anorexia Nervosa Stages of Change Questionnaire (ANSOCQ) et du Motivational Stages of Change for Adolescents Recovering from an Eating Disorder (MSCARED). L’intensite du trouble alimentaire est mesuree a l’aide de trois echelles du Eating Disorder Inventory-3 (EDI-3) et de l’indice de masse corporelle (IMC). Resultats Les resultats montrent que l’echantillon se repartit a travers les cinq stades de motivation au changement et que l’intensite du trouble mesuree avec l’EDI-3 est liee negativement au niveau de motivation evalue. Les resultats obtenus avec les deux instruments de motivation au changement suggerent qu’ils sont similaires. Conclusions Cette etude avance que le niveau de motivation au changement est une variable importante a considerer dans l’intervention aupres des personnes atteintes d’AM. Les resultats de l’etude sont discutes en regard des ecrits anterieurs sur le sujet et des implications cliniques associees.

Study Objective Estrogens are suspected to have a negative effect on pulmonary function in women with cystic fibrosis (CF). The aim of our study was to investigate, in a CF adolescent population, the effect of hormonal contraception (HC) on lung function by assessing the forced expiratory volume in 1 second (FEV1), the number of exacerbations of pulmonary condition, and antibiotic use. Design, Setting, Participants, Interventions, and Main Outcome Measures We conducted a cohort retrospective chart review of girls from age 13 to 18 years old who were followed in the CF clinic of a university hospital center. Wilcoxon rank sum test with continuity correction, 2-sample t test, conditional test of Poisson rates, and χ2 test were conducted to identify differences in results between adolescents with or without use of HC for the following outcomes: FEV1, use of antibiotics by nebulizer, and hospital admission for exacerbations of pulmonary condition. Results Among 127 adolescents, 64/127 (50.4%) took HC; 12/127 (9%) continuously had been taking HC over 3 years. For girls taking HC for more than 3 years, FEV1 at 18 years old was significantly higher than for girls who had never taken HC (85.17% vs 71.05%; P = .043). However, there was no difference in the number of hospital admissions for exacerbation of pulmonary condition between these 2 groups (P = .057). There was no difference between HC vs non-HC users in the percent of patients taking antibiotics by nebulizer over the 6 years of follow-up. Conclusion Our study suggests that in adolescents with CF, HC has no deleterious effects on the FEV1. Further prospective studies could be done to confirm these results.

Depressive symptoms, posttraumatic stress disorder, and suicidal ideation are among the most prevalent problems associated with sexual abuse. Based on the Traumagenic dynamic of stigmatization model, the aim of this study was to investigate whether self-blame, shame, and maladaptive coping strategies predicted posttraumatic stress disorder, depressive symptoms, and suicidal ideation among sexually abused adolescent girls using a longitudinal design. A total of 100 adolescent girls completed a series of questionnaires at the initial visit at the intervention center (T1) and 6 months later (T2). Path analysis reveals shame at T1 predicted posttraumatic stress disorder symptoms at T2 whereas self-blame at T1 predicted depressive symptoms at T2. Furthermore, avoidance coping at T1 and depressive symptoms at T2 predicted suicidal ideation at T2 and accounted for 54% of the variance. These findings suggest that interventions designed for sexually abused adolescent girls should target shame, self-blame, and avoidance coping to foster recovery in this vulnerable population.

RésuméContexte de l’étudeLes médecins sont parmi les professionnels les plus sollicités par les parents pour obtenir des conseils sur l’exercice du rôle parental. Pourtant, ils sont rarement formés pour informer les parents, et particulièrement en ce qui concerne la légitimité des pratiques disciplinaires comme la punition corporelle (PC).ObjectifsCette étude vise à documenter les attitudes de médecins québécois en faveur de la PC ainsi que leur pratique de soutien auprès des parents.MéthodesAu total 113 médecins œuvrant au moins 20% du temps avec des enfants mineurs ou leurs parents ont complété un sondage en ligne sur leurs caractéristiques personnelles et professionnelles, leurs connaissances et attitudes face à la PC et leurs pratiques de soutien.RésultatsLes résultats montrent que les répondants connaissent bien les balises légales de l’article 43 du Code criminel canadien qui encadrent le recours aux PC et qu’ils sont en désaccord avec cette méthode disciplinaire. Lorsqu’ils soupçonnent une situation de PC envers un enfant, les médecins répondants offrent diverses modalités de soutien aux parent (ex.: aborder le sujet, proposer d’autres pratiques disciplinaires), ce qui est moins souvent le cas lorsque la situation implique un adolescent. Enfin, les résultats montrent que certains facteurs sont associés aux pratiques de soutien des répondants, dont les attitudes face aux PC et le sentiment d’être suffisamment formé pour aborder les pratiques disciplinaires avec les parents.ConclusionsCes résultats soulignent l’importance d’outiller et de soutenir les médecins dans leurs interventions auprès des parents en difficulté.

The goal of the current study was to explore the rates of medical consultation and hospitalizations of sexually abused boys. Specifically, to examine if sexually abused boys had higher rates of medical consultations and hospitalizations for physical and mental health problems than boys from the general population. Administrative databases were used to compare medical diagnoses of 222 boys with a substantiated sexual abuse report with those of 222 matched-controls. Results revealed that sexually abused boys were up to five times more likely than those from the general population to consult a physician for mental health problems. With regards to physical health problems, sexually abused boys were as likely as those from the general population to consult a physician, but up to 10 times more likely to be hospitalized.

Anorexia nervosa (AN) is a complex medical condition affecting mainly adolescents and young adults. To monitor and prevent refeeding syndrome, current guidelines recommend daily laboratory testing in the first week of hospitalization and 2–3 times/week for the following 3 weeks. The aims of this study were to determine the proportion of abnormal results of the blood tests done during the first week of nutritional rehabilitation in adolescents with AN, the proportion of test having led to supplementation and the cost of all these tests. A retrospective chart review of admissions for eating disorders between May 2014 and May 2015 in a tertiary Pediatric University Hospital center was performed. Patients were included if they were younger than 18 years, admitted for protocol-based refeeding and met criteria for AN (DSM 5). Among the 99 hospitalizations included in the study, the mean age was 14.6 years (± 1.7), with a female predominance (97%). The mean admission BMI was 15.3 ± 2 kg/m2 (Z-score − 2.6 ± 1.4). The mean length of hospitalization was 40.3 days ± 21.8. Of the 1289 laboratory tests performed, only 1.5% revealed abnormal values and 0.85% led to supplementation. No critical value was identified. The total cost for the tests performed was 148,926.80 CAD$, 1504$/admitted patient, instead of 3890$/admitted patient had we followed the recommendations. More precise criteria should be developed regarding the frequency of laboratory tests needed to monitor and prevent refeeding syndrome. At present, the recommendations could lead to unnecessary testing and expenses. Level IV: Dramatic results in uncontrolled trials.

The objective this study was to investigate the relative contributions of gender, common mental health symptoms, and experiences of interpersonal violence to the presence of sleep disturbances in Youth in Care under Child Welfare Society admitted to residential facilities.A sample of 315 teenagers (14-18 years old) completed a self-reported questionnaire upon admission, followed by a medical consultation with a nurse and a physician. Information regarding experiences of interpersonal violence, mental health symptoms, and sleep disturbances was collected using a standardized questionnaire.Anxiety, ADHD symptoms, and sexual abuse were associated with sleep disturbances, F(10, 264) = 5.95, p 0.001. Results from hierarchical regression analyses revealed that experiences of interpersonal violence, more specifically sexual abuse, were associated with sleep disturbances over and beyond gender and the presence of mental health symptoms.These results highlight practical implications for health professionals in terms of assessment and intervention for vulnerable youth exposed to interpersonal violence. Implications for research and practice are discussed.

Background Though many studies have linked child sexual abuse (CSA) to psychological health problems, little is known regarding the relationship between CSA and children and adolescents’ physical health. Objective The objective of this study was to assess the relationship between CSA and infectious disease diagnoses. Participants Of the 955 eligible children and adolescents who had a substantiated report of sexual abuse between 2001 and 2010, medical data was retrieved for 882 individuals, who formed the sexually abused group. These 882 participants were matched to 882 participants on age, gender, and administrative healthcare region to form the general population group. Setting and methods This matched-cohort study, conducted in a large Canadian city, compared the number of infectious disease diagnoses between the date of the substantiated sexual abuse report and August 1, 2013, between the two groups. Results Results indicate that sexually abused participants had 1.27 times more (95% CI – 1.13 to 1.42) infectious diseases diagnoses than those from the general population. They received 1.83 times more genitourinary infection diagnoses (95% CI – 1.43 to 2.33), 1.31 times more diagnoses for other types of infections (95% CI – 1.11 to 1.55) and 1.21 times more respiratory and ear infection diagnoses (95% CI – 1.05 to 1.40). There was no statistically significant difference regarding skin infection diagnoses. These results indicate an association between CSA and more frequent infectious diseases diagnoses.

The purpose of our study is to establish if the proportion of patients diagnosed with anorexia nervosa that have a history of excess weight has increased over a 10-year period and to study how different premorbid weight groups vary in terms of clinical characteristics. We performed a single-center, retrospective cohort study of all new patients presenting with anorexia nervosa, restrictive and binge/purge subtypes, in 2004 and 2014 at the Adolescent Medicine Clinic of Sainte-Justine University Health Centre (n = 172). The prevalence of excess premorbid weight was similar in both cohorts (32% in 2004 versus 29.5% in 2014). The historically overweight subgroup had a lower heart rate at intake (64.77 versus 69.75, p = 0.03). Patients with excess premorbid weight lost an average of 1 kg more per month than their historically thinner counterparts (2.6 kg versus 1.6 kg/month, p = 0.0011). The total decrease in BMI was much greater in patients with a history of excess weight (7 BMI points versus 3.8, p = 0.0001).Conclusion: Since overweight and obese patients present with significant weight suppression values, our study stresses the importance of screening for AN in all patients rather than in only the noticeably underweight. What is Known: • More than one third of patients presenting with AN have a history of overweight or obesity, which is comparable to the general population. • A delay between AN onset and diagnosis has been described in overweight adolescents. What is New: • Historically overweight patients presenting with AN demonstrate increased speed of weight loss, greater drop in BMI, and lower heart rate at presentation. • For patients with a history of excess weight considered as having recovered from AN, the average BMI at discharge was within normal limits.

BACKGROUND La douleur chronique, d’origine organique ou somatique, représente un fardeau financier important au niveau du système de santé. L’intervention multidisciplinaire a été démontrée efficace pour améliorer cliniquement l’impact fonctionnel de cette condition. OBJECTIVES Étude de l’impact d’une prise en charge multidisciplinaire pédiatrique et psychologique sur les symptômes douloureux fonctionnels et leur retentissement dans une population adolescente référée pour échec de prise en charge nitiale. DESIGN/METHODS Analyse rétrospective de dossiers d’adolescents, de 14 à 18 ans, suivis en clinique des adolescents pour des symptômes douloureux fonctionnels entre janvier 2016 et juin 2017. L’équipe multidisciplinaire est composée de pédiatre, psychologue en suivi individuel ou lors du groupe d’intervention en gestion de la douleur, physiothérapeute et infirmière. RESULTS 24/36 adolescents ayant des symptômes réfractaires avaient des dossiers exploitables. L’âge médian était de 15,9 ans [14,9; 16,3] avec 87,5% de filles dans l’échantillon. Les principales plaintes rapportées étaient des céphalées (50%), nausées/vomissements (50%), douleurs abdominales (37,5%), douleurs musculo-squelettiques (37,5%), fatigue (37,5%) et symptômes neurologiques (20,8%). Le nombre médian de plaintes étaient de 2 par patient. À la consultation initiale, pour le symptôme principal, la durée médiane écoulée depuis l’apparition était de 13 mois [3,75; 34,5], l’intensité médiane de 6/10 et la fréquence médiane de 7 jours/semaine. Le nombre médian de consultations médicales avant la prise en charge spécialisée était de 3 [2; 5], dont 76,6% d’entre elles en surspécialité pédiatrique. Les patients avaient un nombre médian d’intervenants psychosociaux impliqués au dossier initial de 1, dont un psychologue dans 42,4%. Initialement, 83,3% des patients présentaient un absentéisme scolaire significatif. Suite à la prise en charge, nous avions une amélioration des symptômes pour 70,8% et de l’absentéisme scolaire pour 63,6%. Les symptômes de nausées/vomissements étaient les plus persistants. Sur notre petit groupe d’adolescents, il n’a pas été possible de mettre en évidence de différence significative entre ceux qui avaient bénéficié du groupe d’intervention et les autres. CONCLUSION Dans une population d’adolescents avec symptômes douloureux fonctionnels dont la prise en charge en première ligne n’a pas été efficace, une prise en charge multidisciplinaire spécialisée permet une amélioration des symptômes et de la fréquentation scolaire dans 2/3 des cas.

L’anorexie mentale prépubère peut entrainer de multiples conséquences physiques. Lorsque le trouble débute avant la puberté, il serait lié à un plus mauvais pronostic ainsi qu’à une plus grande résistance au traitement. À ce jour, les études portant sur l’anorexie mentale prépubère ont traité majoritairement de la symptomatologie, mais rarement des facteurs associés.

Sexual abuse is associated with a host of negative repercussions in adolescence. Yet the possible mechanisms linking sexual abuse and negative outcomes are understudied. The purpose of this study was to investigate the relationships among self-blame, shame, coping strategies, posttraumatic stress disorder, depressive symptoms, and suicidal ideation. The sample included 147 sexually abused adolescent girls between 14 and 18 years of age. A total of 66% of girls reached clinical score for posttraumatic stress disorder, and 53% reached clinical score for depressive symptoms. Close to half (46%) reported suicidal thoughts in the past 3 months. Shame was found to partially mediate the relationship between self-blame and posttraumatic stress disorder. Shame and depressive symptoms were also found to partially mediate the relationship between self-blame and suicidal ideation. Results suggest that shame is a crucial target in interventions designed for sexually abused adolescent girls.

Resume But Cette etude a pour but de decrire les caracteristiques psychologiques, sociodemographiques et somatiques de tous les enfants (âges de 8 a 12 ans) qui ont consulte pour un probleme alimentaire sur une unite de soins pediatriques d’un centre hospitalier universitaire pendant une periode de 15 ans. Methode Nous avons revu les dossiers medicaux de 215 enfants a l’aide d’une grille detaillee elaboree pour cette etude. Des statistiques descriptives (tests-t, Chi2) ont ete effectuees. Resultats L’echantillon total est compose majoritairement de filles (92 %, n = 197), 4 % d’entre elles sont des jumelles. Des 215 enfants, 52 % ont ete hospitalises au moins une fois et 48 % ont ete soignes en service ambulatoire. Dans l’echantillon, 82 % expriment des preoccupations a l’egard de la nourriture et du poids, 69,4 % ont peur de prendre du poids, 57,5 % desirent encore en perdre et 46,6 % ont des preoccupations par rapport a leur image corporelle. La majorite des enfants, soit 95 %, ont des comportements restrictifs et 13,3 % ont des comportements boulimiques. Des difficultes alimentaires durant l’enfance sont presentes chez 15,9 % des enfants. Un peu plus de la moitie des enfants (55,8 %) a au moins un autre trouble comorbide et la presence d’antecedents familiaux de maladies psychiatriques est notee chez 36,3 % des enfants de l’echantillon. Les filles et les garcons obtiennent des resultats similaires sur la majorite des variables de l’etude. On note une seule difference significative entre eux : les garcons sont plus isoles socialement. Des differences significatives sont observees entre les enfants plus jeunes (âges de 8 a 10 ans) et les plus âges (10–12 ans) constituant l’echantillon. Conclusion Les resultats soulevent des questionnements sur l’etiologie du trouble et sur son eventuelle evolution. Des etudes sur le devenir de ces enfants sont essentielles afin de mieux les comprendre et nous aider a mieux adapter nos strategies d’interventions aupres d’eux.

Parental support provided to child sexual abuse (CSA) victims is a key element in their recovery process. Yet, little is known about the extent and nature of support provided by fathers when they are not identified as the perpetrators. This study compares abuse-specific and nonspecific support provided by 92 mothers and 32 fathers after disclosure and six months later. The assessment of both types of support revealed that only the provision of nonspecific support was predicted by gender. With the exception of social support, all other dimensions increased in the months following disclosure. Implications for child protective agencies include early detection of a small group of parents who may have difficulty offering support to their child, in order to foster the development of optimal support strategies.

Disclosure of child sexual abuse can be traumatic for nonoffending parents. Research has shown its impact on mothers' mental health, which includes heightened psychological distress, depression, and post-traumatic stress disorder. Very little is known, however, about its impact on their physical health or on fathers' health. The self-perceived mental and physical health of nonoffending parents after child sexual abuse disclosure was compared to determine gender-related differences in this regard. Interviews were conducted with 109 mothers and 43 fathers of 6- to 13-year-old sexually abused children. Bivariate analyses revealed that a fair proportion of parents reported psychological and physical problems after disclosure. However, proportionally more mothers than fathers reported psychological distress, depression, and use of professional services. Fathers were more likely to resort to health services instead of social services and to use medication for depression. Study findings provide leads for health and social service providers for the development of intervention protocols and referral procedures sensitive to gender issues, and they shed new light on specific needs of nonoffending parents.

Participants in the ESPACE sexual abuse prevention workshop were in grades 1 through 4 and attended three Montreal, Canada, public schools in low socioeconomic areas. The sample was culturally diverse, with half born outside of Canada. An evaluation was conducted to explore the effects associated with participating in the workshop and the effects of booster sessions conducted two years later. Outcomes included knowledge gained, the ability to offer behavioral responses to abusive situations, peer victimization, sense of safety, empathy, self-efficacy, and support. Results revealed that participants in this sample obtained low scores on measures of sexual abuse knowledge and that short booster sessions that elicit children's recall of the learned material might produce greater improvements.

Objective To evaluate parents' and nurses' opinions regarding the adequacy of an educational program on shaken baby syndrome: the Perinatal Shaken Baby Syndrome Prevention Program (PSBSPP). Design Qualitative and quantitative assessments in the form of interviews and questionnaires administered in French. Setting Two birthing institutions in Montreal, QC, Canada: a university hospital and a regional center. Participants Two hundred and sixty-three parents (73.8% mothers, 26.2% fathers) received the intervention after the birth of their child, and 69 nurses administered it. Methods Parents' and nurses' assessments of the adequacy and relevance of the program and nurses' assessments of the training they received to administer the program were evaluated. Results Both parents and nurses supported this initiative. Most parents appreciated the usefulness of the information. Nurses believed the program was adequate, and their training to deliver the program was satisfactory. All participants reported that the program was highly relevant, especially for new parents. Conclusion The Perinatal Shaken Baby Syndrome Prevention Program achieves the goals of (a) increasing parents' knowledge about infant crying, anger, and shaken baby syndrome and (b) helping parents identify coping strategies. The relevance of introducing the PSBSPP in all birthing institutions is supported. Future studies should focus on vulnerable and culturally diverse populations, and longitudinal follow-up could help determine if the PSBSPP reduces the incidence of shaken baby syndrome.

INTRODUCTION: Apparent changes in adolescent sexual behaviours have led to debate in recent years. A survey on adolescent sexuality was designed to determine mainstream Canadian adolescents' current knowledge and sources of sexual health information, to identify their needs, and to understand the perceptions and the role of parents in sexual health education. METHODOLOGY: In October 2005, on-line interviews were conducted by Ipsos Reid (Ipsos Canada) with 1171 Canadian teenagers (14 to 17 years of age) and 1139 mothers of teenagers. RESULTS: Twenty-seven per cent of teens were sexually active at a mean age of 15 years, with an average of 2.5 lifetime partners, and had been in their current relationship for longer than eight months. The last time that they had had sex, 76% had used a condom. Teens and mothers overestimated the percentages of teens sexually active at any age. Most valuable sources of information were school, parents, friends and doctors. Sixty-nine per cent of teens could not find the information that they were looking for, and 62% reported obstacles in getting information. Teens lacked knowledge about sexually transmitted infections and their consequences. Seventy-five per cent of mothers believed that their teenagers' friends were significant role models when it came to sexuality, and 50% mentioned entertainment celebrities at par with them. However, 45% of teenagers regarded their parents as their role models, far ahead of friends (32%) and entertainment celebrities (15%). Despite saying that they had positive relationships with their mothers, 38% of teens had not discussed sexuality with them. Most teens trusted the information given by health professionals (94%) and believed that it was their role to provide sexual health information. CONCLUSIONS: Most adolescents are responsible when it comes to sexuality, but there are still areas of concern. Adolescents identify barriers to getting information and lack knowledge about sexually transmitted infections. Parents should feel more comfortable when it comes to discussing sexuality, especially the more value-based issues. Health care professionals and teachers have a role to play, and should ensure that teens are getting correct information. It is important to have diverse sources of information. All teens are not ready at the same time to receive the information; thus, it should be repeated. Governments, health, education and public health authorities have an essential role to play to make sexual health information accurate, accessible, inclusive and salient to the reality of Canadian adolescents.

We aim to estimate HIV prevalence and associated risk factors among street youth in Montreal, Canada. We conducted a one-year cross-sectional anonymous study in 1995. We recruited youth aged 13-25 years meeting specific criteria for itinerancy through the 20 major Montreal street youth agencies. Participation included a structured interview and provision of an oral specimen for HIV testing. Among the 909 subjects studied, 99.3% had been sexually active, 25.9% had exchanged sex for money, gifts, drugs, a place to sleep, or other things; 31.8% reported anal sex; and 36.4% reported having ever injected drugs. Overall, HIV prevalence was 1.9% (1.1% in girls and 2.2% in boys). Multivariate logistic regression showed that being over 20 years of age (adjusted odds ratio (AOR) 7.09), having injected drugs (AOR 4.48), having engaged in prostitution (AOR 3.32), and being born outside Canada (AOR 4.41) were all independently associated with HIV infection.

Over the past 30 years in Canada, adolescent medicine has achieved a distinct role within the field of paediatrics. An increasing number of Canadian paediatricians have chosen to subspecialize in adolescent medicine, despite the fact that it had not previously been a certified sub-specialty in the country. Until quite recently, paediatricians who were interested in pursuing subspecialty training in this field either trained in the United States where adolescent medicine had been accredited since 1994, or completed subspecialty training in one of a small number of nonaccredited programs in Canada (The Hospital for Sick Children [Toronto, Ontario], Montreal Children’s Hospital and Sainte-Justine UHC [Montreal, Quebec]). A combination of changes in clinical practice, scientific advances, paediatric training needs and expectations, a growing adolescent population and societal changes have contributed to defining the need for this new field within paediatrics (1). Over the past three years, a group of Canadian paediatricians with subspecialty training in adolescent medicine have pursued paediatric subspecialty certification for adolescent medicine through the Royal College of Physicians and Surgeons of Canada (RCPSC). This endeavour has met with success, and adolescent medicine has recently been recognized by the RCPSC as a subspecialty of paediatrics.

OBJECTIVES: To document risk behaviours and prevalence of chlamydia and gonorrhoea infections among adolescents aged 14 to17 years entering care in Quebec Youth Protection Centres (YPC). METHODS: From July 2008 to May 2009, adolescents residing in six YPCs completed a questionnaire during a face-to-face interview. Questions covered sexual and substance use behaviours prior to admission, as well as other health issues affecting respondents’ mental and physical health. Urine samples were tested for Chlamydia trachomatis genital infection (CTGI) and Neisseria gonorrhoea genital infection (NGGI). RESULTS: Among 578 participants aged 14 to 17 years, 89% had had consensual sexual relations. Sexual risk behaviours included early sexual initiation (66% at