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Trafficked children face challenges to obtaining appropriate health care that may be addressed by clinician training. We evaluated emergency department (ED) staff's training experiences regarding child trafficking and attitudes toward educational efforts to provide informed recommendations for improvement in the recognition and evaluation of trafficked children in the ED setting.In this cross-sectional study of general and pediatric ED staff across 6 cities in the United States, participants completed a 25-question, online anonymous survey. Differences in proportions between categorical data were examined using χ2/Fisher exact tests. Differences in means were evaluated using Student t test and 1-way analysis of variance.The 484 participants included physicians (33.0%), nurses (27.4%), resident physicians (12.2%), and social workers (10.1%). Only 12.4% reported being very confident in recognizing child trafficking. Barriers to recognition included lack of awareness and training on child sex trafficking (37.4%, 58.3%) and labor trafficking (38.4%, 50.6%), sensitivity of the topic (44.4%), lack of institutional guidelines (29.8%) and social work coverage (26.0%), and the assumption that children will not disclose victimization (16.5%). Although 62.2% of the respondents had prior training in child sex trafficking, only 13.3% reported that it was adequate. Barriers to training included lack of easy access (82.5%), belief that prior training was adequate (13.3%), poor-quality curricula (5.1%), and low priority of topic (4.1%). Recommendations for training included a 1-hour module/webinar/lecture (43.1%), rounds (40.5%), written guidelines (9.8%), and individualized, case-based learning (6.6%).We found that although most ED providers stated that they had prior training in the recognition of child trafficking, few expressed confidence in their ability to recognize and evaluate trafficked children. Barriers to education included a lack of awareness of and access to available curricula. Providers supported a variety of formats for further education. Strategies for improving educational access are discussed.

INTRODUCTION: Child abuse pediatricians continuously encounter trauma experienced by abused children, putting them at risk of secondary traumatic stress (STS), a syndrome with symptoms similar to those of posttraumatic stress disorder. OBJECTIVE: To examine the relationship between secondary trauma, hope, meaningful work, and burnout in child abuse pediatric clinicians. METHODS: Participants were solicited from the Helfer and Special Interest Group on Child Abuse for Medical Professionals listservs. They were sent a link to a Web-based survey consisting of the Oldenburg Burnout Inventory, the STS Scale, the Dispositional Hope Scale, and the Work as Meaning Inventory. RESULTS: A total of 151 participants completed the survey. Correlational analyses showed strong positive associations between the STS score and burnout (R(2) = 0.47; F(3,140) = 40.64; p < 0.001). Hope and meaning in work demonstrated negatively moderate associations with STS and burnout (ΔR(2) = 0.07, p < 0.001). CONCLUSION: A national sample of child abuse pediatric clinicians shows that STS is associated with burnout. Meaning in work and hope can mitigate these effects.

Background The COVID-19 pandemic has contributed to risk factors for child abuse and neglect and disrupted conventional abuse surveillance. Objective The goal of this study was to assess how counts of criminal charges have been affected by COVID-19 social distancing measures and related policy changes. Participants and Setting This study used publicly available court filings pertaining to child abuse and neglect from Jan 1, 2010 to June 30, 2020. Methods Autoregressive integrated moving average (ARIMA) algorithms were constructed with case data from January 2010 to January 2020 to forecast trends in criminal charges for February to June 2020. These forecasted values were then compared to actual charges filed for this time period. Results Criminal cases filed between February and June 2020, had an overall 25.7 percent lower average than forecasted. All individual months had progressively lower cases than forecasted with the exception of March. June had the largest deviation from forecasted with 60.1 percent fewer cases than predicted. Conclusions Although risk factors for child abuse have increased due to COVID-19, these findings demonstrate a declining trend in child abuse charges. Rather than a decreasing incidence of child abuse and neglect, it is more likely that less cases are being reported. The results warrant immediate action and further investigation in order to address the dangers this pandemic poses for children in abusive situations.

Background: Children who are victims of sex or labor trafficking may seek medical care in Emergency Departments (EDs). We sought to determine barriers and facilitators to recognition by ED providers of such children when they present for emergency care. Methods This was a cross-sectional study. A voluntary, online, anonymous survey was sent to Emergency Department providers at academic institutions in Portland OR (CARES Northwest), St. Louis, MO (Washington University School of Medicine), Rochester MN (Mayo Clinic), Atlanta GA (Emory School of Medicine) and New Haven CT (Yale School …

BACKGROUND AND OBJECTIVE: Reducing radiation exposure to minimize risk has been emphasized in recent years. In child abuse, the risk of missing occult injuries is often believed to outweigh radiation risk associated with skeletal surveys. Our hypothesis was that there would be no clinically significant difference in results from a limited view, follow-up skeletal survey (SS2) protocol, which omits spine and pelvis views unless these views have findings on the initial skeletal survey (SS1), compared with a traditional SS2 protocol for radiographic evaluation of suspected physical abuse. METHODS: This study was a retrospective record review involving 5 child protection teams. Consultations for suspected physical abuse were reviewed to identify subjects RESULTS: We identified 534 study subjects. Five subjects had newly identified spine fractures, and no subjects had newly identified pelvis fractures on traditional SS2 studies. Only 1 subject with a newly identified spine fracture would have been missed with the limited view SS2 protocol used in this study (0.2% [95% confidence interval: CONCLUSIONS: We found no clinically significant difference in the results of a limited view SS2 protocol versus a traditional SS2 protocol for radiographic evaluation of suspected abuse.

Oxidative stress may be an important determinant of the severity of acute pancreatitis. One-electron reduction of oxidants generates reactive oxygen species (ROS) via redox cycling, whereas two-electron detoxification, e.g. by NAD(P)H:quinone oxidoreductase, does not. The actions of menadione on ROS production and cell fate were compared with those of a non-cycling analogue (2,4-dimethoxy-2-methylnaphthalene (DMN)) using real-time confocal microscopy of isolated perfused murine pancreatic acinar cells. Menadione generated ROS with a concomitant decrease of NAD(P)H, consistent with redox cycling. The elevation of ROS was prevented by the antioxidant N-acetyl-l-cysteine but not by the NADPH oxidase inhibitor diphenyliodonium. DMN produced no change in reactive oxygen species per se but significantly potentiated menadione-induced effects, probably via enhancement of one-electron reduction, since DMN was found to inhibit NAD(P)H:quinone oxidoreductase detoxification. Menadione caused apoptosis of pancreatic acinar cells that was significantly potentiated by DMN, whereas DMN alone had no effect. Furthermore, bile acid (taurolithocholic acid 3-sulfate)-induced caspase activation was also greatly increased by DMN, whereas DMN had no effect per se. These results suggest that acute generation of ROS by menadione occurs via redox cycling, the net effect of which is induction of apoptotic pancreatic acinar cell death. Two-electron detoxifying enzymes such as NAD(P)H:quinone oxidoreductase, which are elevated in pancreatitis, may provide protection against excessive ROS and exert an important role in determining acinar cell fate.