Carmelle Tsai

Purpose of Review: Obesity is an overwhelmingly common medical entity seen in the adult population. A growing body of research demonstrates that there is a significant relationship between child maltreatment and adult obesity. Recent Findings: Emerging research demonstrates a potential dose–response relationship between various types of child abuse and adulthood BMI. Recent work also explores the potential role of the hypothalamic–pituitary–adrenal (HPA) axis, and other hormonal mediators such as sex-hormone binding globulin and leptin. There are also studies that suggest factors such as depression and socioeconomic and environmental influences mediate this relationship. Comorbidities that have been reported include cardiovascular and metabolic disease, diabetes, and insulin resistance. Preliminary work also demonstrates potential gender and racial disparities in the effect of abuse on adulthood obesity. Summary: In this narrative review, we summarize the existing work describing the different child maltreatment types (physical, sexual, emotional, verbal, and child neglect) and their relation to adult obesity, what is known about a potential dose-response relationship, potential mediators and pathophysiology, comorbidities, and preliminary work on gender and racial/ethnic disparities. We review the limited data on interventions that have been studied, and close with a discussion of implications and suggestions for clinicians who treat adult obesity, as well as potential future research directions.

This review focuses on the literature on child trafficking in the Greater Mekong Region (GMR) in the last decade, as an update to Rafferty's (2007) review. The research is primarily organised into several main themes: public health implications, the trafficking of boys, cross‐border trafficking, the changing context and venues in which trafficking occurs, and trafficking in lesser‐studied regions of the GMR. The research reveals that children who are trafficked experience physical symptoms of abuse, sexually transmitted infections, mental health sequelae and substance abuse. Emerging research on the trafficking of boys elucidates relevant cultural issues, describing exploitation in street‐based and establishment‐based venues. Recent work describing children who are exploited in the Thai‐Cambodian border region reveals economic depression as a driver for migration into the area and high rates of violence. The literature also describes a shift in trafficking venues in Cambodia from brothels to entertainment venues. Much of the research to date has been conducted in Cambodia, Vietnam and Thailand, and there is preliminary research from the Lao People's Democratic Republic, but much remains unknown about trafficking in other GMR countries. Further research is required to identify the interactions of trafficked children in the GMR with healthcare settings, and, more specifically, to understand the medical implications of trafficking.‘This review focuses on the literature on child trafficking in the Greater Mekong Region in the last decade, as an update to Rafferty's (2007) review’Key Practitioner Messages: Children trafficked in the GMR experience health consequences as a result of exploitation. Venues for trafficking in the GMR are shifting from brothels to off‐site and entertainment venues as a consequence of governments and local authorities increasing legal enforcement. Boys in the GMR are vulnerable to trafficking. Children who migrate for work in the GMR are vulnerable to trafficking. A trauma‐informed approach and a heightened level of awareness for a history of trafficking are important for practitioners caring for patients from the GMR.

Liberia is a low‐income country in West Africa that has faced significant challenges, including a civil war and the recent Ebola epidemic. Little data exists on the more current post‐war and pre‐Ebola trends of child health in Liberia in the rural setting. This study is a retrospective chart review of pediatric mortality in 2013 at a rural tertiary care center in Liberia, 10 years post‐war. From January 2013 to December 2013, there were 50 pediatric deaths, or 5.4% of the 920 total pediatric admissions. The most common cause of neonatal death was sepsis, and the most common cause of death under five years of age was malaria. The majority (82.0%) of the deaths were in children under five. Pediatric mortality at this hospital was similar to other reported mortality six years post‐war, and lower than that reported immediately post‐war. Neonatal sepsis and malaria are two significant causes of pediatric mortality in this community and, therefore, further efforts to decrease childhood mortality should focus on these causes.