Frits Boer

The prevalence of child maltreatment in Suriname has never been subjected to a reliable assessment. The only data available include rough estimates of a range of internationally comparable indicators extrapolated from child protection and police corps statistics for offenses against children. This study aimed to provide a reliable estimate of the prevalence of all forms of child maltreatment in Suriname. One thousand three hundred and ninety-one (1,391) adolescents and young adults of different ethnicities completed a questionnaire about child maltreatment. The study sample, obtained by random probability sampling, consisted of students (ages 12 through 22) from five districts in Suriname. A significant proportion of Surinamese children experienced maltreatment. In total, 86.8% of adolescents and 95.8% of young adults reported having been exposed to at least one form of child maltreatment during their lives. Among the adolescents, 57.1% were exposed to child maltreatment in the past year. When the definition of the National Incidence Study was applied, 58.2% of adolescents and 68.8% of young adults had been exposed to at least one form of maltreatment. Among adolescents, 36.8% reported having experienced at least one form of maltreatment in the past year. The results indicate the (extremely) high lifetime and year prevalence of child maltreatment in Suriname. The serious and often lifelong consequences of such maltreatment indicate that a national approach to child abuse and neglect, including the development of a national strategic plan, a national surveillance system and changes to the state's programmatic and policy response, is urgently needed.

Samenvatting  Onderzoek naar de rol van sociale relaties voor de ontwikkeling van kinderen is belangrijk, maar ook complex. De onderzoeken in dit themanummer hebben dan ook een beperkte focus. Ze richten zich ofwel op de rol van ouders in de thuissituatie, ofwel op de rol van leeftijdgenoten in de schoolcontext. Dit lokt beschouwingen uit over de mogelijke rol van leeftijdgenoten in de thuiscontext en van volwassenen in de schoolcontext. Ook de meerwaarde van longitudinaal onderzoek naar sociale relaties en ontwikkeling wordt besproken. Er wordt geconcludeerd dat de longitudinale onderzoeken in dit themanummer een antwoord bieden op de vraag of sociale relaties een risicofactor vormen voor de latere ontwikkeling (en omgekeerd), maar dat verder onderzoek naar storende variabelen en mediërende processen nodig zijn om tot causaliteit te besluiten.

This article seeks to examine the nature of negative life events of anxiety-disordered children: to what extent are they unique, to what extent are they shared with siblings, and when they are shared, is the impact similar or different? Twenty-five anxiety-disordered children aged 8 to 13 years, referred to a child psychiatric clinic, were compared with matched non-clinical controls, and with their nearest in age nonreferred sibling aged 6 to 13 years on the number of parent-reported stressful life events. Anxiety-disordered children differ significantly from well controls in the number of negative life events reported by their parents over their lifetime, and the year preceding referral. Anxiety disordered children also differ significantly from their non-referred nearest in age sibling in the number of negative life events, both non-shared and shared. The difference in shared events is due to differences in appraisal by the parents of the impact of a shared event on the respective...

In this experiment 20 one year old bulls received a single intramuscular injection of the anabolic preparation diethylstilbestrol dipropionate (DES-DP) (an oil preparation or an emulsion). Four animals received a corresponding placebo. The application of DES-DP to bulls caused characteristic histological alterations in the peripheral glandular epithelium of the prostate, which could be observed until four weeks after treatment. The value of histological investigation as a screening method was, however, limited by the occurrence of only few metaplastic lesions and a rapid recovery. By contrast, immunohistochemistry using a polyclonal cytokeratin antiserum K40 appeared to be a specific and very sensitive method to detect oestrogen-induced lesions in the prostate. In only two animals, six weeks after injection with the DES-emulsion, false-negative results were obtained, demonstrating the potential value of this screening method. The excretion of DES in the urine and faeces was monitored using radioimmunoassay following chromatographic purification of the urine and faeces extracts. The excretion of DES in urine was faster for animals of the oil group. The DES content in urine decreased to the 1 microgram/l level after 42 days (emulsion group) or 70 days (oil group). The excretion in faeces was comparable to that in urine. After day 21 the excretion patterns of the two excreta were indistinguishable.

In an earlier study the Auditory Startle Response (ASR) of anxiety disordered (AD) children proved to be enlarged. This study examines in a controlled design to what extent this increase is responsive to symptom reduction during Cognitive Behavioral Therapy (CBT) METHODS: The activity of 6 muscles following 104 dB tones in 20 patients (M = 12,7 years; SD = 2.5) and 25 matched controls was measured with an electromyogram (EMG). In addition, the sympathetic skin response was investigated. Response to treatment was investigated with the Anxiety Disorder Interview Schedule for Children (ADIS-C) and the Spence Children's Anxiety Scale (SCAS). Treatment responders (n = 12) showed a significant ASR decrease over time, whereas non-responders (n = 8) showed a significant ASR increase or no significant ASR difference. In controls, the ASR was not significantly different at follow up compared to baseline. The sympathetic skin response was stable in controls and treatment responders but significantly increased over time in treatment non-responders. Linear regression suggested that one of the ASR pre-treatment parameters (multiple muscle EMG magnitude) predicts treatment response. The ASR decreases in AD children when anxiety symptoms diminish. In addition, the ASR may be useful in predicting response to CBT in AD children.

The psychometric properties of the Buss and Plomin (1984) EAS Temperament Survey for Children (Parental Ratings) were examined in a sample of Dutch children between 4 and 13 years of age. Ratings were obtained from 230 mothers and 172 fathers. The findings presented here provide the lacking cross-validation of the original analyses by Rowe and Plomin (1977): Emotionality, activity, and shyness were independent temperaments, regardless of age and gender. The factorial position of the yet experimental Sociability scale is more ambiguous: Sociability was significantly related to both shyness and activity but was more strongly associated with shyness in the youngest age cohort and most strongly with activity in the oldest cohort. This age trend, combined with a positive association with activity, supports the premise that sociability cannot be equated to nonshyness and justifies the inclusion of a separate Sociability scale in the EAS. All four EAS scales are reliable in terms of internal consistency and interrater agreement, but one modification of the Sociability scale is needed.

Previous research established that children with ADHD and comorbid anxiety have a later age of ADHD onset, show less off-task and hyperactive behavior, and have more school problems than children with ADHD alone. Comorbid anxiety appears to ameliorate behavioral inhibition deficits, worsen working memory problems, and lengthen reaction times in ADHD. This study investigated the effect of comorbid anxiety on a broad range of neurocognitive functions and includes child-, parent- and teacher reports of anxiety. The sample consisted of 509 children in the age range 5-19 years, including 238 children with a diagnosis of ADHD combined subtype and 271 normal control children. Children were tested on a broad battery of neurocognitive tasks that proved highly sensitive to ADHD in previous work. Linear Structural Equation Modeling (SEM) was used to estimate the effect of comorbid anxiety on the neurocognitive functions. Child reported anxiety was associated with slower motor speed and response speed and better behavioral inhibition. Teacher reported anxiety was related to worse time production. Parent reported anxiety was not significantly associated with any of the neurocognitive functions. Compared to parent and teacher reports of anxiety, child reported comorbid anxiety shows foremost the largest associations with the neurocognitive dysfunctions observed in children with ADHD. This stresses the importance of including child self-reported anxiety assessments in clinical and research practice.

Both temperament and parental child-rearing style are found to be associated with childhood anxiety disorders in population studies. This study investigates the contribution of not only temperament but also parental child-rearing to clinical childhood anxiety disorders. It also investigates whether the contribution of temperament is moderated by child-rearing style, as is suggested by some studies in the general population. Fifty children were included (25 with anxiety disorders and 25 non-clinical controls). Child-rearing and the child's temperament were assessed by means of parental questionnaire (Child Rearing Practices Report (CRPR) (Block in The Child-Rearing Practices Report. Institute of Human Development. University of California, Berkely, 1965; The Child-Rearing Practices Report (CRPR): a set of Q items for the description of parental socialisation attitudes and values. Unpublished manuscript. Institute of Human Development. University of California, Berkely, 1981), EAS Temperament Survey for Children (Boer and Westenberg in J Pers Assess 62:537-551, 1994; Buss and Plomin in Temperament: early developing personality traits. Lawrence Erlbaum Associates, Inc, Hillsdale, 1984s). Analysis of variance showed that anxiety-disordered children scored significantly higher on the temperamental characteristics emotionality and shyness than non-clinical control children. Hierarchical logistic regression analyses showed that temperament (emotionality and shyness) and child-rearing style (more parental negative affect, and less encouraging independence of the child) both accounted for a unique proportion of the variance of anxiety disorders. Preliminary results suggest that child-rearing style did not moderate the association between children's temperament and childhood anxiety disorders. The limited sample size might have been underpowered to assess this interaction.

A secondary analysis of 140 consecutive out-of-home placements of children up to eleven years of age in the Netherlands taking into account their sibling status showed that children placed singly, with other siblings at home, differ from children placed together with siblings in their background characteristics. Children placed individually more often have severe personal problems, while children placed together with

We have studied, in 14 patients undergoing elective aorto-coronary bypass surgery, the effect of the type of ventilation on pulmonary retention of alfentanil and sufentanil using a double indicator technique. Patients were allocated to one of two groups to receive either bolus doses of sufentanil 33.2 micrograms (n = 6) or alfentanil 654 micrograms (n = 8), mixed with indocyanine green. In each patient, pulmonary first-pass retention was studied during apnoea (during the 1-min study period), normoventilation and positive end-expiratory pressure (10 mm Hg) ventilation, the order of which was randomized. After sufentanil, mean (95% confidence interval) first-pass pulmonary retention was 50.9 (41.7-60.1)% during apnoea, 50.8 (42.9-58.8)% during normoventilation and 54.4 (43.7-65.0)% during positive end-expiratory pressure ventilation. After alfentanil, first-pass pulmonary retention was 18.7 (5.4-32.0)% during apnoea, 19.9 (8.3-31.5)% during normoventilation and 16.6 (5.6-27.6)% during positive end-expiratory pressure ventilation. First-pass pulmonary retention of alfentanil and sufentanil was not significantly affected by the type of ventilation.

The person-centred analysis and prevention approach has long dominated proposals to improve patient safety in healthcare. In this approach, the focus is on the individual responsible for making an error. An alternative is the systems-centred approach, in which attention is paid to the organizational factors that create precursors for individual errors. This approach assumes that since humans are fallible, systems must be designed to prevent humans from making errors or to be tolerant to those errors. The questions raised by this approach might, for example, include asking why an individual had specific gaps in their knowledge, experience, or ability. The systems approach focuses on working conditions rather than on errors of individuals, as the likelihood of specific errors increases with unfavourable conditions. Since the factors that promote errors are not directly visible in the working environment, they are described as latent risk factors (LRFs). Safety failures in anaesthesia, in particular, and medicine, in general, result from multiple unfavourable LRFs, so we propose that effective interventions require that attention is paid to interactions between multiple factors and actors. Understanding how LRFs affect safety can enable us to design more effective control measures that will impact significantly on both individual performance and patient outcomes.

Twenty-eight patients undergoing elective coronary artery bypass surgery were allocated randomly to receive either propofol 2 mg kg-1 or an equivalent volume of its vehicle during cardiopulmonary bypass with constant pump flow. Peripheral vascular resistance (PVR) was calculated from perfusion pressure and pump flow. After propofol, PVR decreased from 1767 (SD 415) dyn s cm-5 to a minimum of 1263 (283) dyn s cm-5 at 2 min, and remained significantly less than the control value until 12.5 min after administration of propofol. In the group given the vehicle, PVR did not change significantly. In a second study in 10 patients, venous blood samples were withdrawn before and 2, 4, 6, 8, 10, 20 and 30 min after injection of propofol 2 mg kg-1 during cardiopulmonary bypass, for measurement of blood concentrations of propofol. Concentrations were greater than predicted by a computer simulation based on published pharmacokinetic data. The decrease in PVR may be an important factor in the hypotension caused by propofol during induction of anaesthesia.

We have studied the effect of thiopentone, etomidate and propofol on systemic vascular resistance (SVR) during cardiopulmonary bypass with constant pump flow in 30 patients undergoing elective coronary artery bypass surgery. SVR decreased to 78% of control values after thiopentone 4 mg kg-1, to 72% of control after etomidate 0.3 mg kg-1, and to 68% of control after propofol 2 mg kg-1; it returned to control values 10 min after administration of thiopentone and propofol and 7 min after administration of etomidate. Analysis of variance showed that there were no significant differences in the changes in SVR between the groups.

We have studied the pulmonary extraction and retention of sufentanil, alfentanil and morphine using a double indicator technique in 30 patients undergoing elective aortocoronary bypass surgery. Patients were allocated to three groups (10 each) to receive sufentanil 43 micrograms, alfentanil 672 micrograms or morphine 1887 micrograms, mixed with indocyanine green as indicator. After sufentanil, mean peak extraction was 93.7% (95% confidence interval 87.1-100.4%) and release occurred after 16.1 (13.8-18.4) s; first-pass retention was 61.1 (51.3-70.9)%. After alfentanil, peak extraction was 67.4 (42.7-92.0)% and release occurred after 9.9 (8.5-11.3) s; first-pass retention was 10.1 (3.5-16.7)%. After morphine, peak extraction was 58.3 (44.4-72.2)% and release occurred after 7.2 (4.4-10.1) s; first-pass retention was 7.1 (-4.7-19.9)%. Both peak extraction and first-pass retention were significantly greater after sufentanil. There was no significant difference in the peak extraction and first-pass retention between alfentanil and morphine.