INTRODUCTION: Adverse childhood experiences (ACEs) are associated with significant long-term impacts, yet few interventions specifically target ACE exposure, especially in Asian populations. Anchor, Singapore's first home visitation programme, addresses maltreat-ment among preschool children. This study evaluated Anchor's impact on children's developmental and behavioural outcomes. METHOD: We conducted a prospective evaluation of children under 4 years assessed for maltreatment from November 2019 to July 2023. Developmental and behavioural progress was measured every 6 months using the Ages and Stages Questionnaires (ASQ-3) and ASQ:Social-Emotional (ASQ:SE-2), and annually using the Child Behaviour Checklist (CBCL). RESULTS: The results of 125 children (mean age 20.0 months, 48% female) were analysed. The mean length of stay in programme was 21.2 (7.3) months. At baseline, 92 (73.6%) children were at risk of develop-mental delay and 25 (31.7%) children aged ≥18 months had behavioural concerns. The programme was associated with significant improvements in gross motor (P=0.002) and fine motor (P=0.001) domains of the ASQ-3 and internalising problem scale (P=0.001) of the CBCL. CONCLUSION Anchor effectively enhances develop-mental and behavioural outcomes for children exposed to maltreatment. Targeted early intervention through such programmes can mitigate adverse impacts, optimising developmental trajectories and potentially reducing the long-term clinical and economic burdens associated with ACEs.
Humans ; Female ; Male ; Child Abuse/therapy* ; Child, Preschool ; Singapore ; House Calls ; Infant ; Prospective Studies ; Child Development ; Developmental Disabilities/epidemiology* ; Program Evaluation ; Child Behavior Disorders ; Child Behavior

INTRODUCTION: Paediatric sexual assault (SA) victims should be assessed for post-exposure prophylaxis (PEP) to mitigate the risk of sexually transmitted infections (STIs). We describe the clinical characteristics of children and young persons (CYPs) presenting with SA at KK Women's and Children's Hospital in Singapore, viral PEP (human immunodeficiency virus [HIV] and hepatitis B virus [HBV]) prescribing practices, and STI evaluation at follow-up. METHOD: Medical records of CYPs ≤16 years who presented with SA between January 2022 and August 2023 were reviewed, including assault and assailant characteristics, baseline and follow-up STI screening, PEP prescription, adherence and follow-up attendance. CYPs with SA in the preceding 72 hours by HIV-positive or HIV-status unknown assailants with high-risk characteris-tics were eligible for HIV PEP. RESULTS: We analysed 278 CYPs who made 292 SA visits. There were 40 (13.7%) CYPs eligible for HIV PEP, of whom 29 (82.9%) received it. Among those tested at baseline, 9% and 34.9% of CYPs tested positive for Chlamydia trachomatis and Gardnerella vaginalis, respectively. None tested positive for Neisseria gonorrhoeae, Trichomonas vaginalis, HIV, HBV or hepatitis C. Majority of CYPs tested were HBV non-immune (n=167, 67.6%); only 77 (46.1%) received the vaccine. Out of 27 CYPs eligible for HBV PEP with immunoglobulin, only 21 (77.7%) received immunoglobulin. A total of 37 CYPs received HIV PEP, including 8 who were retrospectively deemed ineligible. Only 10 (27%) completed the course. Overall, 153 (57.7%) CYPs attended follow-up, and none seroconverted for HIV or HBV. CONCLUSION We report suboptimal rates of HBV post-exposure vaccination, and low compliance to HIV PEP and follow-up among paediatric SA victims. Factors contri-buting to poor compliance should be examined to optimise care for this vulnerable population.
Humans ; Post-Exposure Prophylaxis/methods* ; Female ; Child ; Adolescent ; Singapore/epidemiology* ; HIV Infections/prevention & control* ; Male ; Sexually Transmitted Diseases/epidemiology* ; Retrospective Studies ; Hepatitis B/prevention & control* ; Follow-Up Studies ; Child, Preschool ; Sex Offenses/statistics & numerical data* ; Child Abuse, Sexual

BACKGROUND

Intimate partner violence (IPV) is a global public health issue with profound physical, psychological, and social consequences. Despite legislative measures in the Philippines, there is limited research on the profile of IPV survivors consulting specialized healthcare units.

This study aimed to describe the profile of female survivors of IPV consulting at the Philippine General Hospital Women’s Desk (PGH-WD), focusing on sociodemographic, psychological, relationship, community, and partner factors as contributors to their risk of experiencing IPV.

A cross-sectional study was conducted to analyze data from IPV survivors who consulted the PGH-WD between January 2022 and December 2023. Data collection involved a chart review of eligible cases, guided by predefined inclusion and exclusion criteria. Inclusion criteria required that participants be female survivors of IPV aged 19 years and above, with consultations specifically related to IPV. Exclusion criteria included male survivors, non-Filipino nationals, individuals not residing in the Philippines, and charts missing key components. Descriptive statistics were used to analyze sociodemographic, psychological, relationship, community, and partner-related factors. Survivors were categorized into low-, moderate-, or high-risk groups based on the number of identified risk factors.

A total of 518 charts were reviewed, of which 106 met the inclusion criteria and were analyzed. Survivors’ ages ranged from 19 to 74 years, with 46 (43.4%) aged 19–34. Most survivors belonged to lower socioeconomic strata, with 61 (57.5%) categorized as poor. Psychological distress was common, with 24 (22.6%) reporting depression and 22 (20.8%) having attempted suicide. Relationship factors included dissatisfaction in 91 cases (85.9%) and prior abuse by partners in 88 (83.0%). Community factors showed that 104 survivors (98.1%) were aware of the Anti-Violence Against Women and Children (Anti-VAWC) law, and 101 (95.5%) reported having social support networks. Partner-related factors were less frequently reported, with 3 survivors (2.8%) indicating perpetrator substance use and 2 (1.9%) reporting histories of childhood abuse. Risk profiling categorized survivors into low-risk (39/106, 36.8%), moderate-risk (39/106, 36.8%), and high-risk (28/106, 26.4%) groups based on the number of identified risk factors.

This study provided a detailed profile of female IPV survivors consulting at the PGH-WD. Survivors were predominantly younger women from lower socioeconomic backgrounds, with high rates of psychological distress, relationship dissatisfaction, and histories of prior partner abuse. Community factors, including strong social support networks and awareness of the Anti-VAWC law, were identified as potential protective mechanisms post-IPV.

OBJECTIVES

This study aims to describe patterns of IPV-associated ophthalmic injuries among women: Specifically, it seeks to identify factors associated with ophthalmic injuries in women secondary to IPV, determine practices and/or protocols in identifying IPV-associated ophthalmic injuries, and to examine practices in referral to ancillary services for IPV survivors with such injuries.

A systematic literature search was conducted for observational studies published from 2009 to 2022 using PubMed, Google Scholar, HERDIN, and the Cochrane Library. Studies were screened and appraised using the Newcastle-Ottawa Quality Assessment Scale (NOS) for risk of bias. Relevant data on injury types, screening protocols, and referral practices were extracted and synthesized. Analysis of risk of bias (ROB) for each study utilizing the NOS scale indicated that four studies exhibited a good ROB.

A total of 567 female patients with IPV-related facial injuries were included in the selected studies. Of these, 98 cases (17.28%) involved ophthalmic injuries, including orbital fractures, subconjunctival hemorrhages, and contusions. Factors associated with these injuries included delayed healthcare-seeking behavior, bilateral and recurrent trauma, and psychological distress. Current practices in IPV identification were found to be inconsistent, with a lack of standardized screening protocols, especially in ophthalmology settings. Referral to ancillary services was often suboptimal due to poor interdepartmental coordination and absence of formal pathways.

There is a significant gap in the recognition and management of IPV-associated ophthalmic injuries among women. Establishing standardized screening protocols and improving referral systems can enhance care outcomes and provide holistic support for survivors, particularly in low-resource settings.

BACKGROUND

Cutaneous findings are the most common manifestations of abuse. Hence, a thorough dermatologic evaluation is crucial to rule out the possibility of injuries - accidental or intentional. Underreporting and incomplete documentation were also identified research gaps. The objectives of this study are to establish a baseline database, describe trends in the WCPU and ER medicolegal cases, and identify relationships among demographics, cutaneous findings, and injuries.

This is a case-control study conducted in a Tertiary Hospital in the Philippines. Medico-legal records from the emergency room and WCPU during 2019-2023 were retrieved and analyzed.

There were 2,611 WCPU Cases and 9511 ER Cases. Only 2,663 ER Cases (28%) have complete findings. The majority of the physically abused patients in the ER and WCPU perpetrators were adult males. Most WCPU patients were minor females. Only 25% of the WCPU cases were reported within three days. The majority of sexual perpetrators are not strangers to their victims. A significant fraction of sexual abuse is also incestuous. Several significant cutaneous findings suggestive of physical abuse were observed in this study. Intuitively, Gunshot wounds and stab wounds were associated with intentional injuries. Contusion and hematoma were more likely seen in cases of assaults involving accessible areas during altercations – the cheek, eye, eyelid, and nose. Injuries over protected body sites such as the chest and neck also warrant suspicion of intentional injuries. The abdomen, back, and chest were sites of predilection for both GSW and stab wounds.

It should be second nature for all physicians to identify dermatologic and demographic cues to rule out possible cases of abuse.

On July 4, 2021, a Philippine C-130 military plane carrying 104 personnel crashed in Patikul, Sulu after attempting to land at Jolo Airport, killing 53 individuals and injuring 50 others, both on board and on the ground. Some of the injured sustained multiple injuries, including fractures and burns. This incident triggered a swift response from various agencies. Mass casualty incidents, including those with multiple burn-injured patients, pose significant challenges to health care systems and can lead to high morbidity and mortality rates.1 2 3 Burn injuries, which account for at least 200,000 deaths annually, are a major global public health issue, particularly in low-resource settings, and can easily overwhelm the limited burn resources available.4 5 6 Efficient management of mass casualty incidents, proper triage decisions, and sound health care planning are crucial for optimizing patient outcomes and matching potential needs with available resources.7 Burn mass casualty incidents (BMCI) are incidents that involve at least three burn victims. These incidents, whether due to natural or human-caused accidents, can occur anywhere and anytime. The injuries are unpredictable and involve a large number of victims, requiring a significant consumption of logistics and medical attention. Medical response tasks in massive burn injuries are much more challenging than those required in separate burn incidents due to the unexpected nature of the events and the simultaneous involvement of a large number of patients. Such situations require the immediate mobilization of a significant number of personnel, resources, and facilities to address upcoming issues. In this article, we describe the management of BMCIs based on our experiences in responding to the Patikul incident. We elucidate the strategies that are put into action and offer insights aimed at improving protocols for handling BMCIs in the future. Our goal is to contribute to the body of knowledge in this field and aid in the development of more effective responses to such critical situations.
Mass Casualty Incidents ; Burns

A burn mass casualty incident (BMCI), an incident that involves at least three burn victims with severe injuries,1 presents several unique challenges. In a mass casualty event, between 25 and 30 percent of those injured can sustain moderate-to-severe burn injuries.2 Management of burn patients necessitates a significant amount of health resources and logistical support, along with prompt and high-quality care to optimize the functional and cosmetic outcomes of severely injured patients. While some developed countries have sound disaster management plans, many countries where most BMCIs occur lack such well-established plans.3 The effective management of BMCIs is crucial for positive patient outcomes. Given resource scarcity, especially in geographically isolated and disadvantaged areas, comprehensive mitigation and preparedness strategies are essential. These strategies must address worst-case scenarios that may challenge the existing internal protocols, especially at the local level.4 The surge in health care facility capacity during BMCIs can quickly overwhelm local and regional resources, from prehospital care to specialized burn centers. In the Philippines, disaster response levels and adequacy may vary widely among different regions and local government units (LGU). While the Department of Health has issued guidelines for health emergency and disaster response management,5 there are currently no policies or guides on specifically addressing preincident planning for BMCIs. The aim of this article is to recommend policies that will potentially improve the current health care approach to BMCIs.
Mass Casualty Incidents ; Burns

OBJECTIVES: To study the influence of family structure on depression and anxiety symptoms in adolescents and its mechanism. METHODS: The cluster sampling method was used to select the students from seven middle schools in Shanghai, China. An online questionnaire survey was conducted using a self-made general status questionnaire, Childhood Trauma Questionnaire, Children's Depression Inventory, and Screen for Child Anxiety Related Emotional Disorders. The methods including one-way analysis of variance, chi-square test, binary logistic regression analysis, and mediating effect analysis were used to evaluate depression and anxiety symptoms in adolescents and the difference in childhood trauma and its mediating effect. RESULTS: Compared with the adolescents from nuclear families, the adolescents from three-generation lineal families had a lower risk of depression symptoms (OR=0.794, 95%CI: 0.649-0.972, P<0.05), while those from host families had a higher risk of depression symptoms (OR=4.548, 95%CI: 1.113-18.580, P<0.05). The adolescents from inter-generational families and host families had a significantly higher score on the Childhood Trauma Questionnaire subscale of emotional neglect (P<0.05). Emotional neglect played a mediating role in the influence of inter-generational families and host families on depression symptoms in adolescents. CONCLUSIONS Parents and grandparents have a certain positive effect in family structures. Separation from parents may make adolescents perceive more emotional neglect, which may increase the occurrence of depression symptoms.
Child ; Humans ; Adolescent ; Depression/epidemiology* ; Family Structure ; Child Abuse/psychology* ; China ; Anxiety/epidemiology* ; Surveys and Questionnaires

Child ; Humans ; East Asian People ; Quality of Life ; Students ; Child Abuse, Sexual ; Young Adult ; Resilience, Psychological

Objective: To analyze the association between exposure patterns of adverse childhood experiences (ACEs) and anxiety symptom trajectories in medical college students. Methods: A survey was conducted on first-year students from Anhui Medical College and Anqing Medical College, using the Childhood Abuse Questionnaire, Family Disability Questionnaire, Childhood Adverse Social Experience Item, and Anxiety Self Rating Scale. The baseline survey was conducted from November to December 2019, and two follow-up visits were conducted once every six months until November to December 2020. The latent class analysis (LCA) was used to analyze the exposure patterns of ACEs. The latent class growth analysis (LCGA) was used to analyze the development trajectory of anxiety symptoms. The multiple logistic regression model was used to analyze the correlation between different exposure patterns of ACEs and the trajectory of anxiety symptom trajectories. Results: A total of 3 662 college students aged (19.2±1.0) were surveyed. The LCA showed that the exposure patterns of ACEs could be divided into the "high ACEs" group (13.4%), "high neglect/emotional abuse" group (25.7%), "high family dysfunction" group (6.9%), "high neglect" group (27.1%), and "low ACEs" group (26.3%). The LCGA divided anxiety trajectories into four groups: "high anxiety decline" (7.1%),"anxiety increase "(4.1%), "moderate anxiety"(52.9%), and "low anxiety"(35.9%). Using the low ACEs group as a reference group, compared with the low anxiety trajectory, the high ACEs group, high neglect/emotional abuse group, high family dysfunction group, high neglect group, and medium to high-level anxiety trajectory were all associated with an increased risk (P<0.05). Conclusion: There is heterogeneity in ACEs exposure patterns among medical college students, and ACEs exposure patterns are important influencing factors for anxiety symptom trajectories.
Humans ; Adverse Childhood Experiences ; Anxiety/epidemiology* ; Child Abuse/psychology* ; Students/psychology* ; Surveys and Questionnaires ; Adolescent ; Young Adult