Browsing by Subject "Abuse"
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Item Child abuse and neglect among orphaned children and youth living in extended families in sub-Saharan Africa: What have we learned from qualitative inquiry?(Taylor & Francis, 2013) Morantz, Gillian; Cole, Donald; Vreeman, Rachel; Ayaya, Samuel; Ayuku, David; Braitstein, Paula; Pediatrics, School of MedicineResearchers and aid organizations have reported that orphans in sub-Saharan Africa (SSA) are particularly vulnerable to abuse and neglect. This article is a review of qualitative studies that address experiences of maltreatment among orphaned children and youth living in extended families in SSA. It aims to inform policy and programming by providing a better understanding of the types of maltreatment encountered and the perceived risk factors. A literature search was carried out using Google, PubMed, Scholars Portal Search and Scopus. Searches of relevant bibliographies and publications of authors were also undertaken. Studies from peer-reviewed journals and the grey literature were reviewed for relevance and quality. Eligible studies had to include orphans living with extended family in SSA as participants, explore their maltreatment experiences and employ a sound qualitative methodology. Findings were coded, extracted, compared and synthesized. Twenty articles, representing 15 studies, were selected. These studies, from diverse SSAn countries, reported similar forms of maltreatment among orphaned children and youth: experiences of intra-household discrimination; material and educational neglect; excessive child labour; exploitation by family members and psychological, sexual and physical abuse. The perceived risk factors were poverty, living with a non-biological caregiver, stigma and alcohol abuse. The findings of the included studies suggest that awareness, prevention and intervention initiatives aimed to curb child abuse and neglect within communities in SSA are needed and should be coupled with efforts to promote education and reduce poverty and stigma.Item Child maltreatment and protection in the Arab Gulf Cooperation Council countries: A scoping review(Elsevier, 2022) Neville, Sarah Elizabeth; Zidan, Tarek; Williams, Adam; Smith Rotabi-Casares, Karen; School of Social WorkBackground: Research on child maltreatment and protection in the Arab Gulf Cooperation Council countries-Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates (UAE)-is limited but growing, as is child protection as a sector. Objectives: We aimed to identify themes and gaps in existing research on child maltreatment and protection, identify opportunities for building capacity in research and practice. Participants and setting: N/A. Methods: We conducted a scoping review of empirical studies published in peer-reviewed journals in English and Arabic and reported methods and findings according to the PRISMA-ScR reporting protocol. Articles were coded by country, topic of research, and type of abuse studied, if any. Results: Our database search returned 6109 articles and 160 articles were included in our review. Themes included (1) prevalence, incidence, and characteristics of maltreatment, (2) outcomes associated with maltreatment, (3) attitudes, awareness, and reporting, (4) accidental injury and death potentially associated with neglect, (5) policy and practice. Eighty-seven articles studied Saudi Arabia, while 28 studied the UAE, 21 Kuwait, 13 Qatar, 12 Oman, and 11 Bahrain. Physical abuse was studied in 77 articles, followed by sexual abuse in 54 articles and emotional abuse in 54. Conclusion: Although the medical community produces an encouraging volume of child maltreatment research, gaps remain. Intervention research is lacking, and further inquiry into family dynamics, culture, and spirituality could inform the development of effective interventions. Cross-sectoral collaboration among education, social work, law enforcement, and healthcare is also needed to safeguard children's rights in the GCC.Item Early Adverse Life Events and Post-Traumatic Stress Disorder in Patients with Constipation and Suspected Disordered Defecation(Wiley, 2022) Hendrix, Justin; Ranginani, Dheeksha; Montero, Anne Mary; Lockett, Carolyn; Xu, Huiping; James-Stevenson, Toyia; Shin, Andrea; Medicine, School of MedicineBackground: Early adverse life events (EALs) and post-traumatic stress disorder (PTSD) are associated with irritable bowel syndrome (IBS). Disordered defecation (DD) presents with symptoms of IBS or functional constipation (FC) and is associated with psychological distress. However, the role of trauma and stress in chronic constipation is poorly defined. We aimed to examine EALS, PTSD, and psychological symptoms in patients with constipation and suspected DD. Methods: We conducted a survey study among adults with constipation who completed anorectal manometry (ARM) and balloon expulsion testing (BET). Data were collected on socio-demographics, EALs, PTSD, bowel symptoms, quality of life, and anxiety and depression. We performed comparisons between individuals with normal versus abnormal ARM or BET, subgroup analysis by detailed ARM and BET findings, and latent class analysis using individual EAL domains. Key results: Among 712 eligible patients, 69 completed the study. EALs and provisional PTSD were present in 75.4% and 27.5%, respectively; rates did not differ between those with normal versus abnormal ARM or BET. Normal testing was associated with higher rates of specific EAL domains (emotional abuse and mental illness), higher depression scores, and poorer mental component scores in both primary and subgroup comparisons (all p < 0.05). Normal testing was associated with a lower likelihood of high-EAL latent class (p = 0.01) membership. Presence of IBS or FC did not influence associations. Conclusions & inferences: Early adverse life events and PTSD are prevalent in patients with constipation and suspected DD. Those with normal ARM and BET have higher rates of prior emotional abuse and poorer mental health.Item Injury Patterns and Demographics in Older Adult Abuse and Falls: A Comparative Study in Emergency Department Settings(Wiley, 2024) Khurana, Bharti; Bayne, Haley N.; Prakash, Jaya; Loder, Randall T.; Orthopaedic Surgery, School of MedicineBackground: Falls and interpersonal violence pose significant threats to older adults, leading to injuries, hospitalizations, and emergency department (ED) visits. This study investigates the demographics and injury patterns in older adults (aged 60 and above) who sought ED care due to assaults, comparing them with those who experienced falls to gain a deeper understanding of older adult abuse patterns. Method: This study utilizes data from the National Electronic Injury Surveillance System (NEISS) All Injury Program (2005-2019) to examine injuries among older adults aged 60 years and above. Participants were categorized into two groups: older adult abuse and injuries due to falls. The differences between the groups by demographics, injury locations, patterns, and temporal trends were analyzed using statistical methods accounting for the weighted stratified nature of the data. Cosinor analysis and Joinpoint regression were used for temporal analysis. Results: Over 15 years, there were an estimated 307,237 ED visits for older adult abuse and 39,477,217 for falls. Older adults experiencing abuse were younger and had lower hospital admission rates compared to fall patients. Injuries associated with abuse included contusions/abrasions, penetrating injuries, and fractures to the head/neck, fingers, toes, ribs, and lower extremities. In contrast, fall patients had higher admission rates, with more fractures, including cervical spine and hip fractures. Temporal patterns showed a higher rate of assaults during the summer, whereas abuse demonstrated bimodal peaks in the summer and fall. Conclusions: Injuries associated with abuse such as facial, upper trunk, and upper extremity fractures should raise suspicion even in the absence of severe symptoms. These findings emphasize the importance of early identification to connect older adults with support resources, as patients experiencing abuse often get discharged from the ED.Item Leveraging genome-wide data to investigate differences between opioid use vs. opioid dependence in 41,176 individuals from the Psychiatric Genomics Consortium(Springer Nature, 2020-08) Polimanti, Renato; Walters, Raymond K.; Johnson, Emma C.; McClintick, Jeanette N.; Adkins, Amy E.; Adkins, Daniel E.; Bacanu, Silviu-Alin; Bierut, Laura J.; Bigdeli, Tim B.; Brown, Sandra; Bucholz, Kathleen K.; Copeland, William E.; Costello, E. Jane; Degenhardt, Louisa; Farrer, Lindsay A.; Foroud, Tatiana M.; Fox, Louis; Goate, Alison M.; Grucza, Richard; Hack, Laura M.; Hancock, Dana B.; Hartz, Sarah M.; Heath, Andrew C.; Hewitt, John K.; Hopfer, Christian J.; Johnson, Eric O.; Kendler, Kenneth S.; Kranzler, Henry R.; Krauter, Kenneth; Lai, Dongbing; Madden, Pamela A.F.; Martin, Nicholas G.; Maes, Hermine H.; Nelson, Elliot C.; Peterson, Roseann E.; Porjesz, Bernice; Riley, Brien P.; Saccone, Nancy; Stallings, Michael; Wall, Tamara L.; Webb, Bradley T.; Wetherill, Leah; Biochemistry and Molecular Biology, School of MedicineTo provide insights into the biology of opioid dependence (OD) and opioid use (i.e., exposure, OE), we completed a genome-wide analysis comparing 4503 OD cases, 4173 opioid-exposed controls, and 32,500 opioid-unexposed controls, including participants of European and African descent (EUR and AFR, respectively). Among the variants identified, rs9291211 was associated with OE (exposed vs. unexposed controls; EUR z = -5.39, p = 7.2 × 10-8). This variant regulates the transcriptomic profiles of SLC30A9 and BEND4 in multiple brain tissues and was previously associated with depression, alcohol consumption, and neuroticism. A phenome-wide scan of rs9291211 in the UK Biobank (N > 360,000) found association of this variant with propensity to use dietary supplements (p = 1.68 × 10-8). With respect to the same OE phenotype in the gene-based analysis, we identified SDCCAG8 (EUR + AFR z = 4.69, p = 10-6), which was previously associated with educational attainment, risk-taking behaviors, and schizophrenia. In addition, rs201123820 showed a genome-wide significant difference between OD cases and unexposed controls (AFR z = 5.55, p = 2.9 × 10-8) and a significant association with musculoskeletal disorders in the UK Biobank (p = 4.88 × 10-7). A polygenic risk score (PRS) based on a GWAS of risk-tolerance (n = 466,571) was positively associated with OD (OD vs. unexposed controls, p = 8.1 × 10-5; OD cases vs. exposed controls, p = 0.054) and OE (exposed vs. unexposed controls, p = 3.6 × 10-5). A PRS based on a GWAS of neuroticism (n = 390,278) was positively associated with OD (OD vs. unexposed controls, p = 3.2 × 10-5; OD vs. exposed controls, p = 0.002) but not with OE (p = 0.67). Our analyses highlight the difference between dependence and exposure and the importance of considering the definition of controls in studies of addiction.Item Maltreatment experiences and associated factors prior to admission to residential care: A sample of institutionalized children and youth in western Kenya(Elsevier, 2013) Morantz, Gillian; Cole, Donald C.; Ayaya, Samuel; Ayuku, David; Braitstein, Paula; Medicine, School of MedicineObjectives: This study aims to determine the prevalence of maltreatment experienced by institutionalized children prior to their admission to Charitable Children's Institutions (orphanages) in western Kenya, and to describe their socio-demographic characteristics, reasons for admission, and the factors associated with prior experiences of maltreatment. Methods: A systematic file review was undertaken in five CCIs. Demographic, prior caregiving settings and maltreatment data were extracted. Forms of maltreatment were recorded according to WHO and ISPCAN guidelines. Logistic regression was used in bivariate and multivariable analyses of factors associated with reasons for placement and forms of maltreatment. Results: A total of 462 files were reviewed. The median (interquartile range) age of children was 6.8 (5.08) years at admission, 56% were male, and 71% had lost one or both parents. The reasons for admission were destitution (36%), abandonment (22%), neglect (21%), physical/sexual abuse (8%), and lack of caregiver (8%). The majority of child and youth residents had experienced at least one form of maltreatment (66%): physical abuse (8%), sexual abuse (2%), psychological abuse (28%), neglect (26%), medical neglect (18%), school deprivation (38%), abandonment (30%), and child labor (23%). The most common reason for non-orphans to be admitted was maltreatment (90%), whereas the most common reason for orphans to be admitted was destitution (49%). Girls (adjusted odds ratio, AOR: .61, 95% CI: .39-.95) and orphans (AOR: .04, 95% CI: .01-.17) were both independently less likely to have a history of maltreatment irrespective of whether it was the reason for admission. Children whose primary caregiver had not been a parent (AOR: .36, 95% CI: .15-.86) and orphans (AOR: .17, 95% CI: .06-.44) were less likely to have been admitted for maltreatment, while children who were separated from siblings were more likely to have been admitted for maltreatment (AOR: 1.62, 95% CI: 1.01-2.60). Conclusions: The high prevalence of maltreatment prior to admission, particularly among nonorphans, suggests the need for better child abuse and neglect prevention programs in communities, and psychosocial support services in institutions. The significant proportion of children admitted for poverty, predominantly among orphans, indicates that community-based poverty-reduction programs might reduce the need for institutionalization.Item Opioid Overdoses in Indiana: A Closer Look at Opioid Type(The Center for Health Policy, 2018-06-01) Kooreman, HaroldThe misuse of prescription and illicit opioids remains at epidemic proportions, costing the United States billions of dollars annually. Overdose deaths in both the U.S. and Indiana have seen a dramatic increase over the past ten years. Until recently, prescription opioids were responsible for the greatest number of overdose deaths, but now have been surpassed by fatalities involving heroin and illicitly manufactured narcotics, primarily fentanyl.Item Prevalence, incidence and chronicity of child abuse among orphaned, separated, and street-connected children and adolescents in western Kenya: What is the impact of care environment?(Elsevier, 2023) Ayaya, Samuel; DeLong, Allison; Embleton, Lonnie; Ayuku, David; Sang, Edwin; Hogan, Joseph; Kamanda, Allan; Atwoli, Lukoye; Makori, Dominic; Ott, Mary A.; Ombok, Caroline; Braitstein, Paula; Pediatrics, School of MedicineBackground: The effect of different types of care environment on orphaned and separated children and adolescents' (OSCA) experiences of abuse in sub-Saharan Africa is uncertain. Objective: Our two primary objectives were 1) to compare recent child abuse (physical, emotional, and sexual) between OSCA living in institutional environments and those in family-based care; and 2) to understand how recent child abuse among street-connected children and youth compared to these other vulnerable youth populations. Participants and setting: This project followed a cohort of OSCA in Uasin Gishu County, Kenya (2009-2019). This analysis includes 2393 participants aged 18 years and below, 1017 from institutional environments, 1227 from family-based care, and 95 street-connected participants. Methods: The primary outcome of interest was recent abuse. Multiple logistic regression was used to estimate the odds of recent abuse at baseline, follow-up, and chronically for each abuse domain and adjusted odds ratios (AOR) between care environments, controlling for multiple factors. Results: In total, 47 % of OSCA reported ever experiencing any kind of recent abuse at baseline and 54 % in follow-up. Compared to those in family-based care, street-connected participants had a much higher reported prevalence of all types of recent abuse at baseline (AOR: 5.01, 95 % CI: 2.89, 9.35), in follow-up (AOR: 5.22, 95 % CI: 2.41, 13.98), and over time (AOR: 3.44, 95 % CI: 1.93, 6.45). OSCA in institutional care were no more likely than those in family-based care of reporting any recent abuse at baseline (AOR: 0.85 95 % CI: 0.59-1.17) or incident abuse at follow-up (AOR: 0.91, 95 % CI: 0.61-1.47). Conclusion: OSCA, irrespective of care environment, reported high levels of recent physical, emotional, and sexual abuse. Street-connected participants had the highest prevalence of all kinds of abuse. OSCA living in institutional care did not experience more child abuse than those living in family-based care.Item Substance Abuse in Indiana: An Urban-Rural Perspective(The Center for Health Policy, 2017-06-01) Kooreman, Harold E.; Greene, Marion S.The use of alcohol and drugs is a significant public health problem in the United States. Indiana, like many other states in the nation, is lacking in substance abuse treatment services and rural areas are particularly underserved. Rural residents may encounter additional barriers to receiving substance abuse treatment, including stigma, fear that they may know their treatment providers, a lack of access to specialized services, inferior quality of care, and having to pay more for treatment.Item Substance Abuse Trends in Indiana: A 10-Year Perspective(The Center for Health Policy, 2017-04-01) Balio, Casey; Greene, Marion S.Substance use is a significant public health problem in the United States. Excessive use of alcohol and drugs has been linked to increased morbidity and mortality from cardiovascular conditions; injuries and motor vehicle crashes; sexually transmitted and blood-borne illnesses, including HIV/AIDS and hepatitis B and C, resulting from risky sexual behaviors and/or injection drug use; pregnancy complications and neonatal abstinence syndrome (NAS); and drug overdoses [5, 6].