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In this article translated from the German original, author Kathrin Asper explores Frida Kahlo's life and art—the scars and cuts of life, both physical and emotional, that were balanced by the light side of existence. Suffering the consequences of polio contracted as a child and a streetcar accident that left her with lifelong pain, Kahlo found herself through painting, using her experience as a palette. The themes of her art include suffering, transience, and nearness to death as well as the cuts of her husband's, Diego Rivera's, love affairs. Rarely were these experiences portrayed without the juxtaposition of the bright, beautiful, and colorfulness of life, however. [ABSTRACT FROM AUTHOR]

Objective: Traffic crashes have high mortality and morbidity for young children. Though many specialized child restraint systems improve injury outcomes, no large-scale studies have investigated the cross-chest clip's role during a crash, despite concerns in some jurisdictions about the potential for neck contact injuries from the clips. This study aimed to investigate the relationship between cross-chest clip use and injury outcomes in children between 0 and 4 years of age.Methods: Child passengers between 0 and 4 years of age were selected from the NASS-CDS data sets (2003-2014). Multiple regression analysis was used to model injury outcomes while controlling for age, crash severity, crash direction, and restraint type. The primary outcomes were overall Abbreviated Injury Score (AIS) 2+ injury, and the presence of any neck injury.Results: Across all children aged 0-4 years, correct chest clip use was associated with decreased Abbreviated Injury Scale (AIS) 2+ injury (odds ratio [OR] = 0.44, 95% confidence interval [CI], 0.21-0.91) and was not associated with neck injury. However, outcomes varied by age. In children <12 months old, chest clip use was associated with decreased AIS 2+ injury (OR = 0.09, 95% CI, 0.02-0.44). Neck injury (n = 7, all AIS 1) for this age group only occurred with correct cross-chest clip use. For 1- to 4-year-old children, cross-chest clip use had no association with AIS 2+ injury, and correct use significantly decreased the odds of neck injury (OR = 0.49; 95% CI, 0.27-0.87) compared to an incorrectly used or absent cross-chest clip. No serious injuries were directly caused by the chest clips.Conclusions: Correct cross-chest clip use appeared to reduce injury in crashes, and there was no evidence of serious clip-induced injury in children in 5-point harness restraints. [ABSTRACT FROM AUTHOR]

Despite the strong evidence of child safety seats (CSSs) effectiveness in reducing injuries, it is still rarely used in some societies. The purpose of this study was to determine prevalence and predictors of CSS use in Mashad, Iran. Five hundred ninety kindergarten children whose parents owned a car were enrolled in the study. Parents were asked about using CSS for their children, reasons for CSS use/non-use, demographics, history of road traffic injuries and receiving any advice on CSS. Of families, 25.5% expressed that they used CSS for their child at present or any time in the past, but only 6.3% of children travelled restrained in CSS at the time of study. Age-appropriate CSS use was reported in 14.5% of infants and 2.3% of 1–5-year-old children. A significant relationship was observed between lower child age, higher maternal education and high family income with CSS use. The main reasons for CSS none-use were reported as not feeling the need (42%), followed by its high price (22%). Use of CSS was uncommon. The financial concerns and information gap about the essential need for CSS should be considered as priorities for action especially among lower socio-economic groups of society. [ABSTRACT FROM PUBLISHER]

A 16 year old patient had ingested two sewing needles about 4.5 cm long accidentally that eventually resided in extra intestinal tract position, and being asymptomatic, she ignored the problem for a long period about 2 years. She only consulted the hospital after having symptoms. The needles were located by X-ray imaging and retrieved with the aid of C-arm fluoroscope at a laparotomy. Her postoperative period was uneventful. [ABSTRACT FROM AUTHOR]

This study reports good consistency in international comparisons of the number and severity of backover crashes. More than half occurred to pedestrians aged 60 years and older. Children less than 9 years comprised 5% of these crashes with a similar percent aged 10 to 19 years. A significant 41% reduction in real-world backover crashes was found for Australian vehicles with reversing cameras. A range of driver and pedestrian maneuvers was found and 11 crash scenarios were identified in backover collisions. Mandating the fitting of reversing cameras to all vehicles and enhancements would likely enhance the safety of pedestrians in reversing maneuvers. [ABSTRACT FROM AUTHOR]

Trauma is the leading cause of mortality and morbidity among children in the USA. To examine the variation in the epidemiology and patterns of visits to emergency departments (EDs), and test the hypothesis that children evaluated at trauma centre EDs will have higher injury severity and a higher likelihood of hospitalisation versus those evaluated at non-trauma centre EDs, we analysed a national database of all injured children aged 0–20 years evaluated at US EDs in 2009. Childhood injuries are a frequent cause of visits to US EDs, with a national point prevalence of 620 cases per 10,000 children aged 0–20 years. Epidemiology of childhood injuries in the USA is significant for male gender preponderance, significant seasonal and geographical variation, and disproportionately more frequent injury to the extremities than other sites of the body. National hospital resource use was significant, with greater burden borne by trauma centres which disproportionately provided care to the most severely injured children. [ABSTRACT FROM PUBLISHER]

Objective:There is limited knowledge of the long-term medical consequences for children injured in car crashes. Thus, in the event of injury, the aim of the study was to specify patterns and risks of injuries resulting in permanent medical impairment of children (0–12 years) for different body regions and injury severity levels, according to Abbreviated Injury Scale (AIS). The aim was also to compare the impairment outcome with adults. Methods:Data were obtained from the Folksam insurance company, including reported car crashes from 1998 to 2010 with at least one injured child 0–12 years of age. In all, 2619 injured children with 3704 reported medical diagnoses were identified. All injuries were classified according to the AIS 2005 revision. If the child had not recovered within 1 year postinjury an assessment of permanent medical impairment (PMI) was made by one or several medical specialists. Results:In all, 55 children sustained 59 injuries resulting in PMI of which 75 percent were at AIS 1 or AIS 2. The head and cervical spine were the body regions sustaining the most injuries resulting in PMI. Sixty-eight percent of all injuries resulting in PMI were AIS 1 injuries to the cervical spine, with the majority occurring in frontal or rear impacts. Given an injury to the cervical spine, the risk of injuries resulting in PMI was 3 percent, and older children (≥6 years) had a significantly higher risk (3% versus 1%) than younger children. The head was the second most commonly injured body region with injuries resulting in PMI (12/59), which were predominantly AIS 2+. In addition, mild traumatic brain injuries at AIS 1 were found to lead to PMI. Whereas for children the injuries leading to PMI were primarily limited to the head and cervical spine, adults sustained injuries that led to PMI from a more diverse distribution of body regions. Conclusion:The pattern of injuries resulting in permanent medical impairment is different for children and adults; therefore, safety priorities for children need to be based on child data. The majority of those injuries leading to PMI were at lower AIS levels. Furthermore, AIS 1 cervical spine and AIS 1+ head injuries should be given priority concerning mitigation of long-term consequences for children. [ABSTRACT FROM AUTHOR]

Approximately two thirds of the children killed or seriously injured on Great Britain's roads are child pedestrians. Recognizing this issue, the Department for Transport introduced and evaluated a pilot child pedestrian training scheme, Kerbcraft, from 2002 to 2007. Kerbcraft aimed to teach roadside pedestrian skills to children between age 5 and 7 and was successfully trialled across 75 local authorities in England and Scotland. The UK government has since recommended Kerbcraft as the best practice example for roadside child pedestrian training. This article revisits a sample of local authorities that participated in the pilot and presents the findings from a new survey: identifying the status of child pedestrian training and assessing how the delivery, evaluation, and learning mechanisms have changed since the pilot. The results suggest that following on from the Kerbcraft scheme, the majority of local authorities continue to provide pedestrian training but in an adapted form—often delivering less training than that suggested by the Kerbcraft model. The implications are discussed. [ABSTRACT FROM PUBLISHER]

To date, few studies have examined the use of embedded performance validity indicators in pediatric populations. The present study examined the utility of variables within the California Verbal Learning Test, Children’s Version (CVLT-C) in detecting noncredible effort among a pediatric mild traumatic brain injury sample. The sample consisted of 411 clinically referred patients aged 8–16 years. A total of 13% of the participants failed both the Medical Symptom Validity Test and at least one other performance validity measure. No demographic or injury-related variables differentiated the noncredible and adequate effort groups. The noncredible group performed significantly worse than the adequate effort group across a majority of CVLT-C variables. Logistic regression analysis revealed that the Recognition Discriminability (RD) score was the most robust in predicting noncredible effort. Among this relatively high-functioning sample, an RD cutoffz-score of –0.5 resulted in sensitivity of 55% and specificity of 91%. A more conservative RD cutoffz-score of –1.0 resulted in sensitivity of 41% and specificity of 97%. These findings are comparable to the classification statistics found for many embedded indicators in the adult literature. Although only moderately sensitive, the RD score on the CVLT-C appears to have good utility in identifying noncredible effort in a relatively high-functioning pediatric mTBI population. [ABSTRACT FROM PUBLISHER]

In Australia trampolines contribute one quarter of all childhood play equipment injuries. The objective of this study was to gather and evaluate injury data from a non-traditional, ‘soft-edged’, consumer trampoline, where the design aimed to minimise injuries from the equipment and from falling off. The manufacturer of the non-traditional trampoline provided the University of Technology Sydney with their Australian customer database. The study involved surveys in Queensland and New South Wales, between May 2007 and March 2010. Initially injury data was gathered by a phone interview pilot study, then in the full study, through an email survey. The 3817 respondents were the carers of child users of the ‘soft-edge’ trampolines. Responses were compared with Australian and US emergency department data. In both countries the proportion of injuries caused by the equipment and falling off was compared with the proportion caused by the jumpers to themselves or each other. The comparisons showed a significantly lower proportion resulted from falling-off or hitting the equipment for this design when compared to traditional trampolines, both in Australia and the US. This research concludes that equipment-induced and falling-off injuries, the more severe injuries on traditional trampolines, can be significantly reduced with appropriate trampoline design. [ABSTRACT FROM AUTHOR]

Objective:Traffic-related injuries are the main cause of death during childhood and youth in the United Arab Emirates (UAE), use of safety restraints by citizens is uncommon, rollovers are frequent, and current legislation does not protect rear-seat occupants. Because little was known about the circumstances of hospitalizations for traffic injuries to guide prevention, a trauma registry was used to assess causes and determinants for traffic-related injuries during childhood and youth (<19 years) and its value for prevention. Methods:One hundred ninety-three children and youth with traffic injuries were admitted for more than 24 h at surgical wards of the main trauma hospital in the Al-Ain region during a 36-month period (2003–2006). Injuries were analyzed by age, nationality, road user and vehicle types, severity, anatomical region, and the presence of head injury using Injury Severity Scores (ISS) and the Abbreviated Injury Scale (AIS). Results:Traffic injuries represented 40 percent (n= 193) of injuries to 0- to 19-year-olds, followed by falls (39 percent). Among 15- to 19-year-olds, who accounted for 46 percent of child and youth victims, the incidence was 150/100,000 person years, compared to an incidence of 15 to 51 for younger age groups. Overall, 53 percent were vehicle occupants, 23 percent were pedestrians, 14 percent were bicyclists, 6 percent were motorcyclists, with 4 percent other. The ratio of male-to-female victims was 6.7:1; for drivers it was 33:0; and for pedestrians, bicyclists, and motorcyclists it was between 10:1 and 12:1; injured females were mainly rear-seat passengers and the male: female ratio was 1.4:1. Seventy-one percent of pedestrians were ≤9 years old. Although the ratio of UAE children to foreign children was estimated at 0.7:1 in the community, 58 percent of the injured were UAE citizens. The ratio of injured UAE: non-UAE citizens was 1.4:1 overall but 5.6:1 for drivers and 4.5:1 for motorcyclists. Forty-one percent of citizens were injured in 4-wheel drive sport utility vehicles compared to 13 percent of non-citizens. Head injuries occurred in 68 percent of vehicle occupants and 51 percent of nonoccupants, with AIS ≥ 3 injuries in 23 percent of occupants and 26 percent of nonoccupants. Sixty-seven percent of rear occupants had head injuries. Conclusions:Male drivers and vulnerable road users were at an unusually high risk relative to females. A relatively high frequency of traffic-related head injuries among UAE children and youth, including rear-seat passengers and other vehicle occupants, suggests that considerable preventable morbidity is associated with nonuse of safety restraints and/or other factors such as excess speed and rollovers of 4-wheel drive vehicles. Trauma registries can be useful for prevention; inclusion of data on safety restraints and helmet use by road user type is essential. [ABSTRACT FROM AUTHOR]

Childhood injuries remain understudied in Uganda. The objective of this study was to determine the extent, nature and determinants of school-related childhood injury risk in north-western Uganda. A cohort of 1000 grade fives from 13 elementary schools was followed-up for one term. Survival and multi-level modelling techniques compared the risk rates across gender, schools and locations. Childhood injuries are common in north-western Uganda. Most of them occur during travel, breaks, practical classes and gardening, while walking, playing, learning and digging. Most injuries result from collisions with objects, sports and falls. Two-thirds of children receive first aid and hospital care. Times to injury were 72.1 and 192.9 person days (p = 0.0000). Gender differences in time to event were significant (p = 0.0091). Girls had better survival rates: cumulative prevalence of childhood injury was 36.1%; with significant gender differences (p = 0.007). Injury rate was 12.3/1000 person days, with a hazard ratio of 1.4. Compared to girls, boys had a 37% higher injury rate (p = 0.004). Rates varied among schools. Associated factors include sex and school. Rural–urban location and school differences do influence childhood injury risk. Childhood injuries are common: the risk is high, gender- and school-specific. Determinants include gender and school. Location and school contexts influence injury risk. [ABSTRACT FROM AUTHOR]

Objectives: This paper quantifies pediatric thoracoabdominal response to belt loading to guide the scaling of existing adult response data and to assess the validity of a juvenile porcine abdominal model for application to the development of physical and computational models of the human child.  Methods: Table-top belt-loading experiments were performed on 6, 7, and 15 year-old pediatric post-mortem human subjects (PMHS). Response targets are reported for diagonal belt and distributed loading of the anterior thorax and for horizontal belt loading of the abdomen. Results: The pediatric PMHS exhibited abdominal response similar to the swine, including the degree of rate sensitivity.  The thoraces of the PMHS were as stiff as, or slightly more stiff than, published adult corridors.  Conclusions: An assessment of age-related changes in thoracic stiffness suggests that the effective stiffness of the chest increases through the fourth decade of life and then decreases, resulting in stiffness values similar for children and elderly adults. [ABSTRACT FROM PUBLISHER]

Objective: The goal of this article is to propose a new methodology to estimate the sagittal plane displacement of the head, spine, and pelvis of a 6-year-old (6YO) occupant during a high-speed frontal impact. Research has shown major discrepancies between the spinal kinematics of current pediatric anthropomorphic test devices and humans during frontal impacts. This article provides an estimation of the kinematics of a pediatric subject that may assist in the development of physical and computational models of a 6YO occupant in high-speed frontal impacts. Methods: This article presents data on 4 different experimental data sets corresponding to noninjurious low-speed (nominally 9 km/h) frontal impacts involving pediatric and adult volunteers and to low-speed (9 km/h) and high-speed (40 km/h) frontal impacts with postmortem human subjects (PMHS). Kinematic data from each subject were first normalized to the size of a 50th percentile within its age group. Two already published and commonly used scaling methods (mass scaling and the Society of Automotive Engineers [SAE] scaling methods) were assessed using volunteer data. A new scaling method based on energy considerations was developed. Results: Both the mass scaling and the SAE scaling methods failed to predict the actual pediatric displacement at 9 km/h. The newly proposed method substantially improved the prediction of the pediatric kinematics at low speed and it was applied to the high-speed PMHS data to provide an approximation of the displacements of the head, thoracic spine, and pelvis of a 6YO occupant in a 40 km/h frontal impact. Conclusions: A new scaling method based on energy conservation improved the prediction of the displacement of the pediatric head, thoracic spine, and pelvis at 9 km/h. This method was then applied to the response of the PMHS in a high-speed impact to provide an approximation of the 6YO kinematics in a 40 km/h frontal impact. The article also discusses the limitations of the method, which failed to completely describe the kinematics of pediatric occupants. [ABSTRACT FROM AUTHOR]

The objective of this study was to identify the incidence of burn injuries among children in a sub-Saharan urban area and describe contributing factors in the home environment. A cross-sectional household survey was conducted in Dar es Salaam, Tanzania between 8 and 22 July 2009. Demographic characteristics of participants were reported using descriptive statistics. Bivariate analyses using Pearson's chi-square tests for categorical variables were used to explore possible associations. Burns represented 16.3% of reported injuries. The one-month incidence was calculated to be 1.73%. The most common contributor to burn injury was open flame 36.9%, followed by hot liquids 33.8%. Most burns occurred in urban areas with 88% occurring in the home. A significant association with burn injury was found in the 0–4 age category. There exists a continued need for research examining the mechanisms of safety provision in the home in low resource settings, especially concerning burn injury. [ABSTRACT FROM AUTHOR]

The study reported in this paper adopted a holistic design approach to investigate issues associated with height related playground injuries from a users' perspective. The main objective was to gain an understanding of the relationship between height and fun so as to establish practical guidelines for addressing the causes of height related injuries whilst maintaining the attributes of playground equipment that children find fun and challenging. Results show that, on the one hand, the risk of injury increases when height is coupled with the use of upper body strength and, on the other hand, that coordination is a greater source of fun and challenge than height for children. Accordingly, it is suggested that the level of risk of injury attached to children's playground equipment can be reduced when the use of lower body strength and coordination are combined with lower free fall heights. [ABSTRACT FROM AUTHOR]

Parents with intellectual disabilities (PID) are overrepresented in the child protective services (CPS) system. This study examined a more nuanced view of the role of cognition in parenting risk. Its goal was to validate a social information processing (SIP) model of child neglect that draws on social cognition research and advances in neuroscience. Mothers who had CPS child neglect cases were compared to mothers with no CPS involvement on a set of SIP factors. Mothers with low IQs were oversampled. As predicted, the Neglect group had significantly greater SIP problems than the Comparison mothers. SIP problems were associated with direct measures of neglect (e.g., cognitive stimulation provided children, home hygiene, beliefs regarding causes of child injuries). Further, for the direct measures that were most closely linked to CPS Neglect status, IQ did not add significant predictive capacity beyond SIP factors in preliminary model testing. Implications for intervention with PID are discussed. [ABSTRACT FROM AUTHOR]

Local inflammation after a surgical incision is an essential prerequisite for wound healing and later scar formation both in children and adults. However, the underlying regulatory mechanisms are still poorly known and need further investigations. In this study, one hundred sternotomy patients, operated on routinely for cardiac disease, were studied with the Cellstick device to harvest wound inflammatory cells for differential count and subsequent computerized analysis using an artificial neural network. As a result a nonparametric line of ranked nodes was obtained reflecting wound inflammatory cell response in individual patients at hour 24 post surgery. A number of preoperative and operative parameters were recorded to see their possible correlation with the node values of wound inflammatory cell response. It was found that the age of the patient had a remarkable role in this respect while a majority of laboratory values, if within reference values of healthy persons, had a minor correlation or no correlation at all. Therefore, individual and genetic factors seemed to play a dominant role providing that the patient had a good or moderate general condition and surgical site infection was avoided. [ABSTRACT FROM AUTHOR]

The objective was to determine patterns and circumstances of childhood falls in a low-income setting in Dar es Salaam, Tanzania. This cross sectional study is based on a household survey conducted in July 2009. A total of 3927 children up to age 18 from 1928 households in 15 sampled wards were surveyed through a structured questionnaire. The current study includes information regarding fall occurrence, socio-demographic and economic factors. Data were analysed using chi-square, t-test and logistic regression. Male children had 42% higher odds of falls compared to females, and rural residents had more than two times higher odds compared to urban residents. Falls occurred three times more among age group 1–4 and two times more among age group 5–9 compared to those between 15 and 18 years. Most falls occurred outdoors (62%) while playing (51%) with boys being over-represented. Females and children aged 1–4 years fell more from stairs whereas most infants fell from furniture. Male gender, younger age groups and rural residence were significant factors for fall injuries. The circumstances in which these falls occur also differ significantly. Intervention efforts should emphasise these patterns. [ABSTRACT FROM PUBLISHER]

Abstract: Objectives: To evaluate the predictability of intracranial pressure (ICP), cerebral perfusion pressure (CPP) and hemodynamic monitoring for outcome of children with severe traumatic brain injury (TBI). Patients and methods: The study included 53 children with severe TBI. All the patients were immediately admitted to Neurosurgical Intensive Care Unit (NICU) for determination of baseline data and to receive first aid management and assessment of head injury severity according to post-resuscitation Glasgow coma scale (GCS) and patients were enrolled if they had GCS of ⩽8. All the patients had insertion of the intraventicular ICP sensor either at the end of surgery if indicated or through Kocher’s pathway and were maintained for a maximum of 5days. All the patients had non-invasive monitoring for heart rate (HR), blood pressure measures and CPP. Glasgow outcome scale (GOS) was determined at discharge time and 6months thereafter. Results: Thirty-seven patients continued their ICU stay and were discharged alive for a survival rate of 75.8% and 28 of survivors (75.7%) had favorable outcome. Hemodynamic parameters estimated at the time of catheter removal showed significant changes in survivors compared to their levels estimated at the time of catheter insertion and to non-survivors. Patients having favorable outcome showed more stable hemodynamic changes, while those who had unfavorable outcome showed autonomic instability manifested as significantly lower SBP, DBP and MAP with non-significantly lower ICP and CPP. Statistical analysis defined CPP as the highly significant predictor of outcome with CPP as the significant predictor for survival and favorable outcome. Analysis of the variability of estimated hemodynamic parameters, as predictors for survival defined disturbed ICP as the significant sensitive predictor and disturbed SBP as a significant predictor. Conclusion: Hemodynamic stability for children had TBI mandatory for improvement of their outcome with high and low CPP with concomitant large range of SBP variability which could be considered as predictors for bad outcome. [Copyright &y& Elsevier]

Background. Colchicine poisoning is potentially life-threatening. Deaths generally result from hypovolemic shock and cardiovascular collapse or secondary to rapidly progressive multiorgan failure. Objective. The purpose of this study is to discuss the clinical effects, treatments and outcomes of pediatric colchicine poisoning and highlight the possible benefits of urgent plasma and whole blood exchange therapy for those patients who were believed to ingest potentially lethal doses of the drug. Methods. Current study was designed as an observational case series study. The medical records of children aged 0-16 years who were hospitalized for colchicine poisoning at the Pediatric Intensive Care Unit of, between November 1985 and March 2011 were retrospectively evaluated. Results. We present twenty-three children with colchicine poisoning. Nausea and vomiting were the most common presenting complaint, in 70% of patients. Sixteen of the 23 cases presented after ingesting sub-toxic doses of colchicine (< 0.5 mg/kg), whereas 3 patients had consumed toxic doses of the drug (0.5-0.8 mg/kg). The remaining 4 patients were hospitalized after taking colchicine at a lethal dose (> 0.8 mg/kg). Three patients (13%) died. Conclusions. Any patient suspected of ingesting high doses of colchicine should prompt immediate fluid and electrolyte resuscitation and invasive hemodynamic monitorization in a pediatric intensive care unit. Although there is lack of strong evidence, early initiation of either whole blood or plasma exchange may be considered in patients presenting with lethal-dose colchicine intoxication. These reported experience of us put forth further research for consideration. [ABSTRACT FROM AUTHOR]

The majority of child crash analyses have been evaluated using child dummies. Due to structural simplifications in modelling human anatomy in crash testing dummies, the predictive capabilities of dummies for injuries are limited. In previous studies, a three-year-old human child model was modified by implementing the child neck biomechanical behaviour. The altered biofidelity of the cervical spine was validated with paediatric cadaver head/neck tests reported in the literature. This study focuses on the crash evaluation of the modified three-year-old human child model, by comparing kinematic and biomechanical responses to those of the unmodified human child model and the Q3s dummy model in simulated side impacts. Four different restraint conditions, namely near-side, far-side, near-side misuse (without top tether) and far-side misuse, were selected for comparison in terms of the Head Injury Criteria, head acceleration, head excursion, head contact force, neck force and chest acceleration, under a forward-facing configuration. [ABSTRACT FROM AUTHOR]

The objective of this study was to define the crash characteristics of near-side impact crashes in which children seated in the rear rows are injured. The crash characteristics included the direction of force, heading angle, horizontal impact location, vertical impact location, extent of deformation and intrusion at the child occupant's seating position. Cases from in-depth crash investigation databases of the NASS-CDS (National Automotive Sampling System-Crashworthiness Data System), CIREN (Crash Injury Research and Engineering Network) and Chalmers University of Technology were reviewed. The principal direction of force was most frequently between 60° and 75°. The heading angle of the bullet vehicle was most commonly between 61° and 90°. The bullet vehicle hit the passenger compartment of the target vehicle, particularly the rear door. Often, one or both of the adjacent pillars to the rear door were involved, most commonly the B pillar. In 11 of 16 crashes, the car sill was not engaged. Most commonly, the deformation extent was into Zone 3 or more - about 40 cm - and the intrusion at the child's seating position was in the range 20-30 cm. This review of the crashes revealed differences between the current side impact test procedures and the actual side impact crashes in which children were injured. [ABSTRACT FROM AUTHOR]

Objective: To compare rates, circumstances, and outcomes of cyclist crashes between children (aged 0-9 years), adolescents (aged 10-19 years), and adults (aged 20 years and over) in Victoria, Australia. Methods: A retrospective analysis of cyclist crashes in police records and the Victorian Admitted Episodes Dataset during the period 2004-2008. Results: Adolescent cyclists had the highest rates, per 100 000 people, of police-reported (32.6, 95% confidence interval [CI]: 30.7-34.5) and hospitalized cyclist crashes (71.6, 95% CI: 68.7-74.4). Police-reported helmet use at the time of the crash was lowest among children (57.1%, 95% CI: 49.5-64.8) compared to 60.2 percent (95% CI: 57.3-63.1) in adolescents and 77.7 percent (95% CI: 76.5-78.8) in adults. This was reflected in the hospital data, which indicated that more than one third of cyclist hospitalizations among children (37.4%) resulted in head injuries compared to around 1 in 4 hospitalized cyclist crashes in adolescents (26.8%) and adults (23.7%). Cyclists emerging off a footpath into the path of a vehicle as well as cyclists struck by vehicles emerging form a driveway were the most frequent types of police-reported crashes involving children (73.9%) and adolescents (48.1%). In contrast, most adult cyclist crashes occurred on the roadway, mainly at intersections. Conclusions: Programs to improve the safety knowledge and behavior of children and adolescent cyclists, particularly focusing on helmet use, should be part of a comprehensive approach that encompasses legislative and environmental changes, including appropriate cyclist facilities and reduced speed limit in residential areas. [ABSTRACT FROM AUTHOR]

We studied social cognition in 49 children 3 months after moderate to severe traumatic brain injury (TBI) and in 39 children with orthopedic injury (OI). Children underwent diffusion tensor imaging (DTI) and a mental attribution task showing two triangles. Mental state attributions increased when one triangle reacted to intentions of the other, but less so in the TBI than the OI group. DTI identified injury to white matter microstructure in the TBI group, but the relation of DTI to mental attributions did not differ between groups. Moderate to severe TBI produces white matter disconnections that may affect social cognitive networks. [ABSTRACT FROM AUTHOR]

Objectives: Head injuries are the most common serious injuries sustained by children in motor vehicle crashes and are of critical importance with regard to long-term disability. There is a lack of understanding of how seat belt-restrained children sustain head injuries in frontal impacts. The aim of the study was to identify the AIS2+ head injury causation scenarios for rear-seated, belt-restrained children in frontal impacts, including the set of parameters contributing to the injury. Method: In-depth crash investigations from two National Highway Traffic Safety Administration (NHTSA) databases, the National Automotive Sampling System-Crashworthiness Data System (NASS-CDS; 1997-2008) and the Crash Injury Research and Engineering Network (CIREN; 1996-2009), were collected and analyzed in detail. Selection criteria were all frontal impacts with principal direction of force (PDOF) of 11, 12, and 1 o'clock involving rear-seated, three-point belt-restrained, with or without booster cushion, children from 3 to 13 years with an AIS2+ head injury. Cases were analyzed using the BioTab method of injury causation assessment in order to systematically analyze the injury causation scenario for each case. Results: There were 27 cases meeting the inclusion criteria, 19 cases with MAIS2 head injuries and 8 cases with MAIS3+ head injuries, including 2 fatalities. Three major injury causation scenarios were identified, including head contact with seatback (10 cases), head contact with side interior (7 cases,) and no evidence of head contact (9 cases). Conclusions: Head injuries with seatback or side interior contact typically included a PDOF greater than 10 degree (similar to the Insurance Institute for Highway Safety [IIHS] and EuroNCAP offset frontal testing) and vehicle maneuvers. For seatback contact, the vehicle's movements contributed to occupant kinematics inboard the vehicle, causing a less than optimal restraint of the torso and/or torso roll out of the shoulder belt. For side interior contact, the PDOF and/or maneuvers forced the occupant toward the side interior. The cases without evidence of head/face contact were characterized by high crash severity and accompanied by severe injuries to the thorax and spine. These data lead to increased understanding of the injury patterns and causation in this crash restraint scenario so that interventions to mitigate the burden of injury can be advanced. [ABSTRACT FROM AUTHOR]

Introduction: Children with acquired brain injury (ABI) often experience cognitive, motor, and psychosocial deficits that affect participation in everyday activities. Cognitive Orientation to Daily Occupational Performance (CO-OP) is an individualized treatment that teaches cognitive strategies necessary to support successful performance. Objective: This study explores the use of CO-OP with children with ABI. Method: Children with ABI, experiencing school and self-care difficulties, were identified from a previous study. Six children, aged 6–15 years, completed 10 weekly intervention sessions with occupational therapists. Children and parents rated the child's performance of challenging everyday tasks and their satisfaction with this performance. Task performance was also evaluated objectively through videotape analysis. Results: Participants showed significant improvement in their ability to perform child-chosen tasks and maintained this performance 4 months later. However, they had difficulty applying the executive problem-solving strategy and discovering cognitive strategies on their own. Issues related to the use of CO-OP with this population are discussed. [ABSTRACT FROM AUTHOR]

Objective: To confirm the clinical impression that younger pre-school children (<4 years at time of injury) who are referred to a tertiary care centre for management with moderate-to-severe traumatic brain injury (TBI) have poorer social, cognitive, physical and emotional outcomes compared to older pre-schoolers (4–6 years at time of injury) and to describe the prevalence and severity of their social impairment at 8 years of age. Methods: This is a retrospective review of pre-schoolers with moderate-to-severe TBI from 1995–2009. Their social, cognitive, physical and emotional outcomes were assessed at 8 years of age using the Mayo-Portland Adaptability Inventory–Paediatric. Results: Of 130 pre-schoolers enrolled in the database who sustained a TBI < 6 years, 93 were seen at 8 years of age (57 males, 36 females). Younger pre-schoolers ( n = 61, mean 2.6 years) had inferior social outcomes ( p = 0.04) and cognitive abilities ( p = 0.006), trended toward poorer physical outcomes ( p = 0.1), with no difference for emotional outcomes ( p = 0.2), compared to older pre-schoolers ( n = 32, mean 5.0 years). Overall, 19/93 had normal social function, 38/93 had mild impairment, 21/93 had moderate impairment and 15/93 had severe impairment to social function. Conclusions: Children <4 years at the time of moderate-to-severe TBI have poorer social, cognitive and physical outcomes compared to older pre-schoolers. [ABSTRACT FROM AUTHOR]

Objective: Fatalities from motor vehicle collisions are one of the leading causes of death among children in developed countries. Previous publications have shown that the rate is approximately 4 times higher in Latin American countries. We aimed to determine the prevalence and characteristics of child victims of motor vehicle collisions in Panama and to compare them with data from a more developed country. In this study, Spain was the country chosen for such comparison.Methods: A descriptive and retrospective study on the prevalence and characteristics of child victims from motor vehicle collisions that occurred from 2005 to 2012 in Panama was performed. To carry out this study, the records pertaining to victims of motor vehicle collisions in Panama were obtained from the National Institute of Statistics and Census and the Spanish data were obtained from the Road Accident Report. The variables analyzed were age, sex, number of victims, number of injuries, number of fatalities, and type of motor vehicle collision.Results: The child mortality rate in Panama by motor vehicle collisions during the evaluated time period ranged from 2.11 to 3.63, whereas mortality rates in Spain ranged from 0.6 to 1.9, making rates in Panama 3 to 4 times higher than the rates observed in Spain. Children under 5 years old were the group with the highest number of fatalities in Panama.Conclusions: In Panama, a lack of specific legislation on the use of child restraints (car seats) as well as a lack of information and awareness campaigns could be responsible for the high toll of child victims associated with motor vehicle collisions. [ABSTRACT FROM AUTHOR]

Extradural haematomas are a significant consequence of head injuries in children. The aim of this study was to evaluate the demographics, symptoms and signs, management and outcome of patients less than 18 years of age with extradural haematomas in our unit. We also specifically looked at repeat imaging performed, indications for this and its effect on further management. No previous reviews have included this. Fifty-six patients were identified from 01/01/1997 to 01/01/2007 for inclusion in this study. Their imaging was then reviewed as were the case notes. Of the patients studied, 70% were male. The average age was 10 years and 2 months with an average length of stay of one week. The commonest mechanisms of injury were a fall from height and an accident involving a bike. Presenting symptoms were documented in 40% of cases. 32% of patients had associated skull fractures. Six patients had other injuries, including long bone fractures and maxillofacial injuries . Glasgow Coma Scale was generally better on admission than pre-operatively and post-operatively was generally better than prior to surgery. Eight patients had neurological signs on admission, 11 had pre-operatively, and nine had post-operatively. 71% underwent a craniotomy with evacuation of the haematoma. Complications were reported in 16% with no mortality. 66% were seen in a neurosurgical clinic, with 46% seen in a Paediatric Head Injury Clinic after discharge. 66% had further imaging after their initial scan of which 52% had no clinical indication. Eight patients were operated on following re-imaging. Most extradural haematomas in children are caused by falls or vehicle accidents. The majority are treated surgically and do well. Indications for further scanning are often not present and in most, management is unchanged. The follow up of these patients also appears to be suboptimal. [ABSTRACT FROM AUTHOR]

Primary objective: To present an innovative approach to the management of children who are slow to recover after a sport-related concussion. Research design: The article describes the underlying principles and the development of specific interventions for a new rehabilitation programme as well as preliminary data on pre- and post-rehabilitation changes in outcome measures. Methods and procedures: Development of the intervention was done using multiple perspectives including that of the literature, of experts in the field of traumatic brain injury and of experienced clinicians involved with the paediatric and adolescent MTBI clientele. A logic model was developed providing sound theoretical background to the intervention. The intervention was implemented and evaluated with a sample of 16 children and adolescents. Main outcomes and results: The presented cases suggest that involvement in controlled and closely monitored rehabilitation in the post-acute period may promote recovery in children and adolescents who present with atypical recovery following a concussion. All 16 of the children and adolescents who participated in the programme experienced a relatively rapid recovery and returned to their normal lifestyles and sport participation. Conclusions: A gradual, closely-supervised active rehabilitation programme in the post-acute period (i.e. after 1 month post-injury) appears promising to improve the care provided to children who are slow to recover. [ABSTRACT FROM AUTHOR]

Given that reading, spelling and arithmetic skills are acquired through childhood, their development may be compromised following a childhood traumatic brain injury (TBI). The present study examined educational skills (reading accuracy, spelling and arithmetic) at a mean follow-up interval of 6.8 years post-injury in children who had sustained a mild, moderate, or severe TBI at two ages: 'Young' (age at injury: 3-7 years, n = 48) and 'Old': (age at injury: 8-12 years, n = 36). Comparisons between the young and old TBI groups resulted in inconsistent findings. While a dose-response relationship for severity was evident for the young group, this was not always the case for the old group. Significant predictors of outcome included both severity and acute intellectual function. [ABSTRACT FROM AUTHOR]

Objective: This study is a population-based, retrospective follow-up study of neuropsychological functions after severe and moderate TBI. Methods: One hundred and sixty-five survivors of TBI injured in 1987-1991 in the 0-17-year age group were identified. Of the traceable individuals (149), 53 patients who sustained injury at a mean of 9.96 years participated in a neuropsychological investigation 10 years post-injury. A control group of 40 healthy subjects, matched for age and sex was chosen. An extensive neuropsychological test battery was used. Results: The TBI group showed significantly poorer performance in tests of intellectual function, with substantially lower results in verbal tests and in tests of verbal learning and memory, visuo-constructive ability and executive functions. The severely injured group showed substantial recovery. Poor results in visuo-constructive tests and tests of executive functions remained. Conclusions: Severity of injury is an important factor when assessing outcome, even 10 years after childhood TBI. The TBI group obtained poorer results on most of the measurements compared with healthy controls. Verbal function was strongly affected which needs to be taken into consideration when preparing for rehabilitation programmes. Evaluations of final outcome should not be made before the subjects reach adulthood. [ABSTRACT FROM AUTHOR]

Conclusions. Facial palsy in children might be an alarming sign of serious underlying disease such as tumor, systemic disease or congenital anomalies and the recovery is poor in those cases. Therefore, careful investigation and differential diagnosis are essential in children. Prednisolone does not make a significant difference in the outcome in the treatment of children with Bell's palsy. The prognosis of Bell's palsy in the pediatric group is good; patients usually recover within 3 months. Objectives. To review and analyze the etiology, management, and outcome of facial palsy in children. Patients and methods. Using a retrospective chart review, patients under the age of 15 years with a diagnosis of facial palsy were collected from 1996 to 2002. Results. A total of 56 cases (29 male, 27 female) with a mean age of 6.9±4.5 years were included in this analysis. Causes of facial palsy were Bell's palsy (44 patients, 78.6%), neoplastic (4 patients, 7.1%), head injury (3 patients, 5.4%), congenital (3 patients, 5.4%), or infectious (2 patients, 3.6%). In Bell's palsy there was no significant difference in the recovery rate between the groups with or without prednisolone treatment and between the groups that received medication within 1 week of syndrome onset or after more than 1 week. [ABSTRACT FROM AUTHOR]

Objective: The aims were: (1) to quantify the functional limitation of children at the beginning of recovery of independent ambulation after Traumatic Brain Injury (TBI), using clinical-functional scales; (2) to evaluate the changes in gait pattern during rehabilitation (about 5 months later), using 3D Gait Analysis (GA) in post-acute phase; (3) to investigate the presence of correlation among parameters obtained by 3DGA, clinical assessment and measures connected with the trauma. Methods: Fourteen children with hemiplegia after severe TBI were evaluated at independent gait recovery (S0) and 5.5 months later (S1) by clinical assessment (GOS, DRS, WeeFIM and GMFM) and 3D GA (spatio-temporal parameters, kinematics and kinetics). Results: At S1 all clinical measures had improved. Regarding spatio-temporal parameters, velocity and step length improved. Significant progress was evident at the ankle joint, while an unchanged condition appeared at pelvis and hip in sagittal plane with a worsening of hip rotation which increased its internal rotation. Significant correlations were found between motor performance, clinical assessment and trauma-related measures. Conclusions: Repeated GA and clinical evaluations were useful in quantifying the motor recovery of children with TBI during rehabilitation underpinning the role of GA in quantifying these modifications in an objective and non-invasive way. [ABSTRACT FROM AUTHOR]

Primary objective: Many adults with mild traumatic brain injury (MTBI) fail effort tests, indicating poor effort and invalid test results. However, two studies have suggested a high rate of false positives on the Word Memory Test (WMT) in adults with MTBI. This study examines the question of false positives in adults with MTBI who failed the effort subtests of the WMT. Research design: A modified and shortened version of the WMT, the Medical Symptom Validity Test (MSVT) was given to adults with MTBI, some of whom failed the WMT. It was also given to samples of schoolchildren in grades two and above, to several hundred children with developmental disabilities and to healthy adults. Outcomes and results: Failures on the MSVT were far more frequent in adults with MTBI than in second grade children or in children with developmental disabilities. Adults with MTBI who failed the WMT scored much lower on the MSVT effort subtests than children with a mean FSIQ of 63 and much lower than children with impaired memory. Conclusions: Comparison with developmentally disabled children on the MSVT suggests that the adults with MTBI who failed the WMT were not making an effort to do well on either the WMT or the MSVT. Their results were invalid. False positives on the WMT in adults with mild TBI are very rare. [ABSTRACT FROM AUTHOR]

Objective: The objective of the current study was to describe the burden of back-over collisions within the context of other child pedestrian collisions as identified through a pediatric emergency room injury surveillance database. Methods: Injury data for child pedestrian motor vehicle collisions from 1994 to 2003 were obtained from the Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP). Back-over collisions involving children under the age of 14 were identified and classified by written narratives. Characteristics of children involved in back-over collisions were described, and for those admitted to hospital, the nature of injury was compared with other types of child pedestrian collisions. Results: There were 4295 child pedestrian motor vehicle collisions reported to CHIRPP during the study time period. Of the 4295 children, 148 (3.4%) were injured in a back-over collision, with 49 (33.1%) of these collisions involving a vehicle backing out of a driveway. Children involved in back-over collisions were significantly younger than those in forward-moving/other collisions; however, almost 50 percent of back-over collisions involved children older than age 4. Children involved in back-over collisions on driveways were significantly younger than those involved in collisions occurring at other locations. Of those admitted to hospital, children in back-over collisions were more likely to sustain injuries to internal organs. Children in back-over collisions were less likely to sustain severe/mild head injuries and hip/leg fractures. Conclusions: Although back-over collisions represent a small proportion of pedestrian motor vehicle collisions, they tend to involve more severe injuries, as indicated by their admission to hospital. It was found that older children are also at risk of back-over collisions and back-over collisions occur in areas other than driveways. In order to lessen the burden of back-over collisions, interventions must address children of different ages and a variety of locations. [ABSTRACT FROM AUTHOR]

Background: The risk of seizures is increased after a traumatic brain injury (TBI), but the impact and duration of this increased risk is not well characterized in children. Objective: To identify post-traumatic epilepsy (PTE) and post-concussion symptoms 10 years after a TBI during childhood. Research design: The study is a population-based retrospective follow-up study. Procedure: Ten years after brain injury all 165 survivors, who as children (<18 years) in 1987-1991 as residents in the south western Swedish health care region had had a TBI, were invited to participate in a follow-up. A questionnaire regarding medical conditions and medication was filled out by the patients themselves or their parents as was a 21-item questionnaire (PCSQ) regarding post-concussion symptoms. Of the surviving 165 individuals, 109 participated (67%). Results: Eight of 109 developed immediate seizures. During the follow-up period 12/109 had developed active epilepsy. Of these 12, five had had immediate seizures. The incidence of developing PTE within 10 years after a TBI was thus in this series 11%. The relative risk to develop late onset post-traumatic epilepsy (≥1 week after injury) for those who had had immediate seizures was 9.018 (p = 0.0003, 95% CI = 3.69-22.05). Conclusions: TBI is a relatively rare cause of epilepsy in childhood, although immediate seizures are associated with an increased risk of developing post-traumatic epilepsy. [ABSTRACT FROM AUTHOR]

Primary objective: To obtain parental ratings of children's quality of life, cognitive, emotional and behavioural functioning, as well as ratings of service provision, following traumatic brain injury (TBI). Research design: A retrospective, cross-sectional study. Methods and procedures: Parents of 47 children with mild or moderate-severe TBI completed standardized questionnaires evaluating quality of life (PedsQL 4.0) and cognitive, emotional and behavioural functioning (Strengths and Difficulties Questionnaire). Data collected was compared with published normative data for these scales. Views regarding parental experiences of care and their ratings of service provision were also obtained. Results: Quality of life was significantly lower in 13-times as many children with TBI than expected from the normative population. Parents reported that more than 43% of children with TBI had cognitive, emotional and behavioural difficulties that impacted on their daily life. Whilst high levels of social deprivation were found, this did not fully explain the significantly raised levels of difficulties. Another factor associated with this poor outcome was the absence of systematic, routine follow-up or intervention. Conclusions: Parents frequently reported poor quality of life and cognitive, emotional and behavioural problems in their children following TBI. These preliminary findings indicate that children, after TBI, are at risk of developing persistent clinical problems and require follow-up beyond the acute period of their recovery. [ABSTRACT FROM AUTHOR]

This study investigated the relationship of attributions to post-traumatic stress symptoms among women exposed to different types of traumatic events. Participants were 424 female undergraduates who previously experienced a serious accident, natural disaster, child abuse, or adult interpersonal violence. Path analysis indicated a significant indirect pathway from event type to post-traumatic stress through global attributions. Interpersonal-violence survivors exhibited the highest levels of global attributions and post-traumatic stress symptoms. Regression analyses revealed significant interactions between event type and attributions in predicting post-traumatic stress. Stable attributions were associated with increased symptoms in sexual-assault survivors and decreased symptoms in natural-disaster survivors. These findings have implications for improving cognitive interventions for survivors of different types of traumatic events. [ABSTRACT FROM AUTHOR]

This paper explores what makes children's risky play risky. Risky play can generally be defined as thrilling and exciting forms of play that involve a risk of physical injury. Few, if any, studies have been conducted to explore what identifies play activity as risky. The present study aims to determine what characteristics to judge risky play by. Risky play in two Norwegian preschools was observed and videotaped during 18 observation days over five months. The results reveal two categories of risk characteristics in children's play: (1) environmental characteristics (features of the play environment), and (2) individual characteristics (how the play was carried out by the child). These two categories include several different risk characteristics that identify the risk in risky play. The results indicate that both features of the play environment as well as children's risk-taking actions based on their subjective risk perception influence the objective risk present in the play situation. The study contributes to an increased focus on children's natural urge for risky play, and to what characterizes such play. [ABSTRACT FROM AUTHOR]

Objective: Design improvements to frontal air bags for vehicles of model year 1998 and newer have reduced the risk of injury to child occupants exposed to their deployment. These changes in conjunction with other improvements in the protection of front seat occupants give impetus for the reconsideration of rear seating recommendations for child occupants. Thus, the objective of this study was to evaluate the association between seating row (front vs. rear) and risk of injury to children in newer model year vehicles. Methods: Data was collected on child occupants from December 1, 1998, to November 30, 2007, via insurance claim records and a validated telephone survey. The study sample included child occupants aged 0 to 15 years seated in the front and rear rows of vehicles model year 1998 or newer, involved in a crash in sixteen states. Children were classified as injured if a parent or driver reported an injury corresponding with Abbreviated Injury Scale scores of ≥2. The age-specific relative risk of injury by seat row was calculated for the whole data set and then further stratified by model year. Results: Complete interview data were obtained on 10,670 crashes involving 16,920 children, representing an estimated 205,408 crashes with 314,968 child passengers in the study population. The adjusted relative risk of injury to children in the rear seat compared to those in the front was 0.36 (0.23-0.57) and 0.69 (0.49-0.98) for 0- to 8-year-olds and 9- to 12-year-olds, respectively. For 13- to 15-year-olds, the reduced injury risk associated with rear row seating narrowly missed statistical significance. When stratified by model year (1998 to 2002 and 2003+), all age group/model year combinations demonstrated a crude rear row injury risk that was lower than that of the front row. Conclusions: This analysis, conducted on a set of vehicles with advanced front seat safety systems including second-generation and newer air bags, strongly confirmed the recommendation that all children 0-12 years should be seated in the rear row(s) of their vehicles. Children in the rear row(s) were one half to two thirds as likely to sustain injury than those in the front after adjusting for potentially confounding crash, vehicle, and child factors. [ABSTRACT FROM AUTHOR]

By exploring the experiences of over a hundred child traders in Cusco, this research provides an insight into the more everyday circumstances of children's work in developing countries. The working conditions of child traders raise serious concerns, including: dangers of accidents, theft and abuse; shortage of time for play; and some disruption to education. Nevertheless, the positives of trading work are substantial. Although the children feel that they have to work, they gain enjoyment and economic empowerment. Moreover, they display a certain self esteem and confidence in the knowledge of their trading skills, and a spatial awareness of the best trading sites, demonstrating agency in their choice of trading locations. The findings suggest that international policy, which emphasises universal condemnation and prohibition of child work, requires revision. Such policy should be replaced by a more flexible approach, which recognises the benefits of children's work and embraces supportive protection for children engaged in the lighter forms of work such as trading. [ABSTRACT FROM AUTHOR]

Purpose: Traumatic brain injury (TBI) often leads to executive functions (EF) deficits, resulting in severe longstanding disabilities in daily life activities. The sensitivity and ecological validity of neuropsychological tests have been questioned. The aim of this study was to pilot a novel open-ended naturalistic task and to compare it to other standardized assessments of EF in children post-TBI. Methods: Ten children aged 8-14, with moderate-to-severe TBI, and 18 matched controls participated in the study. The clinical group was assessed using cognitive tests and parent-based questionnaires of EF. An interactive ecological cooking task was designed. Results: Analyses indicated mild-to-moderate executive deficits in the cognitive tests in approximately half of the TBI group. For the experimental cooking task, all quantitative and qualitative variables were significantly impaired for the TBI group compared to the control group and failure in the cooking task was associated with lower scores in cognitive tests of EF. The task was able to discriminate the TBI children from the control group. Conclusion: This pilot study highlights the role of naturalistic assessments, to complement standardized tests in assessing patients' dysexecutive impairments in complex activities of daily living post-childhood TBI. [ABSTRACT FROM AUTHOR]

Primary objective: This study aimed at investigating the long-term effects of the combination of severity of injury and time of injury in a 6-year-old bilingual Arabic-Italian child who sustained a severe left traumatic brain injury at the age of 7 months. Methods and procedures: Standard neurological, cognitive and neuropsychological assessments were administered at 40 days after surgery and again at 18, 31, 62 and 73 months. Main outcomes and results: The child presented with developmental arrest at 18 and 31 months. Later on, right hemiparetic and oculomotor signs gradually improved to a significant extent, as well as dysexecutive, visuospatial and praxic deficits. At present, persistent language disorders in a fluent speech characterize the child's profile to a similar extent and type in both languages, suggesting common underlying learning strategies which are ineffective for procedurally acquiring language. Conclusions: This case confirms that children who sustain severe left hemisphere traumatic brain injury in infancy present with increased vulnerability to linguistic deficits. Left frontotemporal, cortical-subcortical lesions which occur during very early language development may permanently disrupt the procedural language acquisition network required for first language acquisition. [ABSTRACT FROM AUTHOR]

Primary objective: The present study investigated working memory ability in children who sustained moderate-to-severe traumatic brain injuries in relation to pre-injury, injury-related and developmental factors. It was hypothesized that there would be a correlation between performance- and rater-based working memory measures; factors predictive of working memory impairment would include earlier age at injury, more severe injury, longer time since injury and poorer overall cognitive functioning; and working memory performance would be significantly impaired when compared to normative populations. Methods and procedures: Working memory was assessed in 62 children using a traditional performance measure (digit span backward) and parent report (Behaviour Rating Inventory of Executive Function (BRIEF)). Main outcomes and results: Contrary to prediction, there was no statistical association between performance- and rater-based measures of working memory. Regression analyses revealed injury severity, time-since-injury, overall cognitive ability and attention span were predictive of working memory performance. As a group, working memory was impaired relative to normative samples on both measures. Conclusions: Performance- and rater-based working memory measures, while not significantly correlated, are both sensitive to acquired cognitive dysfunction following paediatric traumatic brain injury. Demographic and clinical factors may be used to predict cognitive outcomes, educate caregivers and design clinical interventions. [ABSTRACT FROM AUTHOR]

Primary objective: To examine aggression in adolescent males with and without traumatic brain injury (TBI). Design: Quasi-experimental, matched-participants design. Methods: Thirty-nine adolescents were examined, including a TBI group (n = 11) and a matched, uninjured comparison group (n = 28). Participants with TBI were injured an average of 8.3 years (SD = 4.2 years) prior. Participants and parents completed the Youth Self Report (YSR) and the Child Behavior Checklist (CBCL), both measures of global psychopathology. In addition, the theoretically-driven Reactive and Proactive Aggression Questionnaire (RPQ) and the Form of Aggression Scale (FAS) were completed. Main outcomes and results: When compared using the YSR and CBCL, no group differences were detected. In contrast, using the self-report RPQ, participants with TBI reported more reactive and proactive aggression than non-injured peers. Using the FAS, participants with TBI reported engaging in aggression out of frustration and not to dominate or acquire objects. Conclusion: Aggressive behaviours are a long-term outcome after paediatric TBI. Measures of global psychopathology do not permit detailed examination of specific behaviour problems such as aggression, which may provide inaccurate data from which to derive incidence rates. In contrast, theoretically-driven measures can provide greater insight into post-TBI aggression with important treatment implications. [ABSTRACT FROM AUTHOR]

Unintentional injuries are the leading cause of death for young children. Although much research has identified risk factors for injury, integrating these findings into conceptual models that can guide prevention efforts has been limited. In this paper, we draw on empirical evidence to develop a conceptual model of injury risk and highlight the important role that causal attributions play in explaining parents’ decisions about whether or not to implement safety practices to prevent childhood injury. Implications of the model for injury-prevention programming are discussed. [ABSTRACT FROM PUBLISHER]

Two studies were conducted to determine the frequency of processing speed difficulties relative to estimates of other problem-solving abilities in children with and without traumatic brain injury (TBI). The two samples consisted of 213 normally functioning school-age children and 65 TBI children and 19 trauma controls. All children were administered the WISC-III/IV Vocabulary, Block Design, and Coding subtests. The frequency of children in each sample having a Coding subtest score of 3 or 4 scale points below the Vocabulary or Block Design score (whichever one was lower) was calculated. Using a 3-point scale difference, the presence of processing speed deficits relative to other cognitive abilities in the school sample was low (5.2%), and was equivalent to that demonstrated by trauma controls (5.3%). However, in the TBI sample, 18 out of 65 TBI patients (27.7%) showed this same pattern. Using a 4-point discrepancy scale, 3.3% of normal children and 16.9% of TBI children showed this pattern. The frequency of this pattern increased with severity of TBI, using two different but related classification systems. These preliminary findings require cross validation in a larger sample before definite conclusions can be reached. [ABSTRACT FROM AUTHOR]

Primary objective: To investigate the relationship between children's pre-injury behaviour and accident type (high vs. low risk), injury type (traumatic brain injury (TBI), fractures/dislocations and other injuries) and TBI severity. Research design: Cross-sectional comparison of 205 children with TBI aged 6-14 years, with 101 children aged 7-14 years with non-TBI injuries. Methods and procedures: Pre-injury behavioural data were collected via parental report with the Child Behaviour Checklist. Information on children's accident type and TBI severity was obtained from medical records. Main outcomes and results: The pre-injury behaviour of children involved in high or low risk accidents did not differ. Pre-injury behavioural differences were observed among children with TBI, fractures/dislocations, other injuries and normative samples. The involvement of children in high and low risk accidents differed depending on the severity of TBI. Pre-injury behaviour of children with mild or moderate/severe TBI was similar. Conclusions: Pre-injury behaviour does not appear to influence children's involvement in high vs. low risk accidents or the severity of their TBI. However pre-injury behaviour increases children's differential risk for types of accidental injuries. [ABSTRACT FROM AUTHOR]