Child Abuse Research Today is a free monthly online journal that collates and summarizes the latest research about Child Abuse, including details on family violence, examinations, long-term effects, psychiatrics disorders. | ||||||||
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Childhood abuse, nonadherence, and medical outcome in pediatric liver transplant recipients.Shemesh E, Annunziato RA, Yehuda R, Shneider BL, Newcorn JH, Hutson C, Cohen JA, Briere J, Gorman JM, Emre S Department of Psychiatry, Recanati-Miller Transplant Institute at Mount Sinai Medical Center, New York, NY, USA. shemesh@email.chop.edu OBJECTIVE: The study assessed the relationship between a history of child abuse, nonadherence to medications, and medical outcome in children who had a liver transplant. METHOD: Abuse history for children and adolescents ages 8 to 21 who underwent a liver transplantation at Mount Sinai Medical Center in New York was obtained in interviews in 2002. Adherence to tacrolimus was assessed from January 1 to December 31, 2003 by computing the SD of a series of medication blood levels for each patient. Biopsy-proven rejection episodes, degree of fluctuation of alanine aminotransferase (ALT), and maximal ALT levels were recorded as indicators of medical outcome. RESULTS: Of 72 eligible patients, 56 were evaluated. Five had documented abuse. Abused children were less adherent to their medication regimen (p = .02; 95% confidence interval [CI] -2.66 to -0.24), had poor disease control (higher maximal ALT, p <.01; 95% CI -613.72 to -249.55), had greater fluctuation in ALT levels (p <.01; 95% CI -151.19 to -65.91), and suffered more biopsy-proven rejection episodes (two episodes in the abused cohort versus none in the rest) in 2003. CONCLUSIONS: A history of child abuse is a significant risk factor for poor outcome posttransplantation and should be evaluated routinely. Adherence to medications can be a target for intervention in patients with a history of abuse. Published 21 September 2007 in J Am Acad Child Adolesc Psychiatry, 46(10): 1280-9.
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