Discussion

Adverse childhood experiences (ACEs) are strongly related to the development of various health problems. Several previous studies have revealed the link between ACEs, parental mental health, and child psychopathology. However, the direct association between ACEs and parenting behaviors is still understudied.

To examine the relationship between parental ACEs and parenting, the effect of mental health which possibly mediated parenting behaviors, and the prevalence of ACEs.

Data was obtained from 403 parents of 6–18-year-old students in Chiang Mai, Thailand, from January to February 2023.

Relationships among ACEs, depression, anxiety, stress, and parenting behaviors were examined using correlation analysis and path analysis. The direct and indirect effects of potential associated factors on parenting behaviors were also examined.

Overall, 62.5 % of parents reported at least one ACE. Path analysis revealed significant direct effects of ACEs on poorer mental health in all subscales: depression, anxiety, and stress (β = 0.19, 0.21, 0.18 respectively). ACEs were directly associated with the use of corporal punishment (β = 0.15). Stress also had a positive direct effect on inconsistent discipline (β = 0.18).

ACEs are common in parents and associated with mental health problems. ACEs also affect parenting behaviors via direct and indirect pathways. It is important to detect and provide interventions to parents having a history of ACEs and poor mental health to improve the quality of parenting practices.

It has been demonstrated that childhood maltreatment (CM) is associated with an increased risk of depression and psychotic symptoms. However, there is still a lack of studies on the prevalence of co-occurring severe depression and psychotic symptoms (CSDPS) and the association between CM and CSDPS among college students.

We aim to investigate the prevalence and demographic distribution of CSDPS among Chinese college students and to examine its relationship with CM.

A total of 7351 college students aged 18 and above completed the survey. Finally, 6854 valid questionnaires were included for further analysis.

The Childhood Trauma Questionnaire and the item for witnessing domestic violence were used to assess the CM. The Prodromal Questionnaire-16 and the depression subscale of the Depression Anxiety and Stress-21 scale were used to assess psychotic symptoms and depressive symptoms.

The prevalence of CSDPS was 1.47 % among the college students. The multivariate logistic regression analysis showed that emotional abuse and emotional neglect were associated with an increased risk of CSDPS (all p < 0.05). The risk of CSDPS was dramatically increased for individuals who had experienced ≥3 types of CM (OR = 22.929, p < 0.001), as compared to those who had experienced 1‐2 types of CM (OR = 4.452, p < 0.001) and those without the experience of CM.

CM was found to be associated with an increased risk of CSDPS among the college students. Notably, experiencing more types of CM was also associated with a higher risk of CSDPS.

Trauma-informed care includes a range of practices that build a culture of safety, empowerment, and healing. Limited information is available regarding the lived experience of trauma-informed care by healthcare professionals treating burns in a multidisciplinary setting.

The primary aim of this study was to understand what ‘trauma-informed care’ means to staff and students working in burns at a tertiary pediatric hospital.

Semi-structured interviews and focus group were conducted with healthcare professionals (medical, nursing, allied health, pre-graduate students) working in paediatric burn care (or their line manager). Analysis of the dataset was undertaken using qualitative methods (interpretive phenomenological approach and qualitative content analysis).

Eleven interviews and one focus group were completed and transcribed verbatim. Three superordinate themes were applicable across the five cohorts: ‘what does trauma-informed care mean?’, ‘being able to deliver trauma-informed care’ (agency) and ‘impact of the setting’. Eleven components of trauma-informed care practice (for example, everyday interactions with patients and colleagues, screening and assessment) and service-level approaches (for example, service provider training) were described by participants.

Healthcare professionals’ experiences of delivering trauma-informed care in a burns centre highlighted the need to clarify the concept of ‘trauma-informed care’ as a first step. Enabling the workforce to understand trauma-informed care and apply it in everyday interactions with patients and colleagues, and a strategic commitment to practice change needs to be actioned more systematically to support implementation of a trauma-informed care approach in pediatric health services.

Creating inclusive LGBTQ+ environments is important in the provision of inclusive care. This cross sectional study assessed whether patient intake forms in pediatric surgery departments were LGBTQ+ inclusive (L-I).

North American pediatric surgery departments affiliated with pediatric surgery fellowships or general surgery residencies were contacted to retrieve patient intake forms. Forms were assessed for LGBTQ+ inclusivity using a novel L-I scoring system consisting of 6 criteria: preferred name, pronouns, preferred language, gender identity, sex assigned at birth, and l-I guardianship. Institutions without intake forms were invited to comment on their use of l-I intake questions.

59/125 programs responded to our query, 10 of which provided intake forms. Median l-I score was 2/6 points (range 1–4). l-I guardianship was the most common question asked. No intake form asked for pronouns. Of the 49 institutions without forms, 30.5% reported asking l-I questions during initial visits. Narratives from these institutions varied widely. Some institutions supported routine l-I questions while others stated l-I questions were unnecessary, irrelevant, and/or offensive.

Few North American pediatric surgery departments consistently ask l-I questions during the intake process. Comments questioning the appropriateness and necessity of l-I questions highlight the need for LGBTQ+ education.

Level III.

Cross sectional study.

Trauma, specifically adverse childhood experiences (ACEs), predicts significant health and mental health disparities, yet there is a paucity of research with LGBTQ + youth.

This study explored ACE prevalence in a large sample of LGBTQ+ youth; examined ACE patterns within and across subgroups; and compared results with the general population.

Participant (n = 3,508) ages ranged between 14–18 (x̄ = 16.02) and represented a range of sexual orientations: pansexual (33.9 %), bisexual (26.6 %), and queer (16.2 %), and gender identities: female (39.9 %), non-conforming (38 %), male (14.9 %), and transgender (16.6 %).

An online cross-sectional survey was conducted with LGBTQ+ youth ages 14–18 that self-identified as LGBTQ+ and resided in the US or Canada. Descriptive statistics generated the prevalence of ACEs, and ANOVAs and post-hoc tests were run for comparisons.

Participants reported multiple ACEs (M = 3.14, SD = 2.44) with emotional neglect (58 %), emotional abuse (56 %), and living with a family member with mental illness (51 %) as the most prevalent. Notably, 43 % of participants experienced 4+ ACEs, considered to be a high level of trauma exposure. Compared to national samples, LGBTQ + youth demonstrated unique patterns of ACEs and were higher in 9 of 10 categories. Significantly high (all p < .001) ACEs were found in pansexual (t = 7.67), transgender and gender non-conforming (t = 5.19), American-Indian (t = 6.42), Latinx (t = 2.83) and rural youth (F = 12.12) while those with highly educated parents (F = 83.30, p < .001), lived with a parent (t = 6.02), and in Canada (t = 6.14) reported fewer ACEs.

LGBTQ+ youth experience significant childhood trauma with potential impact on their mental health. This study identifies implications for trauma-informed practice and research.

Trauma is the leading cause of mortality in children. Factors influencing recidivism after major trauma have not been well documented in children. The objective of this study is to determine the burden of pediatric trauma recidivism and to identify predisposing factors in the United States.

The 2010–2015 National Readmissions Database was queried for pediatric patients (≤ 18 years) with a diagnosis of major traumatic injuries. Patients readmitted for major trauma were subsequently identified. Patients that did not survive their index-hospitalization were excluded. Information on mechanism, intent, nature and injury severity including Abbreviated Injury Scale (AIS) and Injury Severity Scores (ISS) was obtained. Multivariable-regression analyses were performed adjusting for demographic, hospital-level and injury characteristics.

Of 286,508 pediatric trauma records analyzed, trauma recidivists represented 2.9% of the total population. Recidivists had a higher proportion of severe (AIS ≥ 3) head injury (11.3%). Recidivists were more likely to have public-insurance (OR [95% CI]:1.30[1.25–1.37]), and belong to lower income families (OR [95% CI]:1.22[1.15–1.31]). Recidivism was more common amongst patients with penetrating injuries (OR [95% CI]:2.12[1.96–2.28]). The risk adjusted cost of readmission for trauma was $8401[95% CI: 6748-10,053] higher compared to the index hospitalization with a total increased cost of 11.5 million USD annually.

Although not common, recidivism after major trauma remains a significant public-health concern. This study gauges the previously unquantified burden of recidivism amongst children and identifies factors predisposing to recurrent trauma.

III

Case control study