***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Recent studies have raised significant concern about the high prevalence of childhood abuse in adults with chronic daily headache ( CDH ) . In a survey of 1348 adult migraine patients , 1 it was found that 21 % of patients reported a history of childhood physical abuse and 25 % reported a history of sexual abuse . Data from the ACE ( Adverse Childhood Experiences ) study and other studies have also found that childhood physical abuse and other forms of maltreatment were significantly associated with migraine headache.2–4 Although retrospective studies seem to provide strong evidence for an association between childhood abuse and CDH , one prospect i ve longitudinal study did not find a difference between those with and without a documented history of childhood abuse in terms of their risk for chronic pain in adulthood.2 These inconsistent results may be a result of varying method ologies , the effects of recall bias or because the connection between childhood abuse and pain in adulthood may be more complex . More prospect i ve research is needed to investigate the connection between childhood abuse and CDH . Children with CDH form a significant proportion of patients seen in pediatric neurology clinics , accounting for up to one third of newly referred patients .5 There is little research examining the prevalence of childhood physical and sexual abuse in pediatric headache patients , and the impact of an early abuse history in terms of clinical presentation of pediatric CDH patients ( headache frequency , severity , disability , and quality of life ) is not known . As part of the screening process for a large treatment study for pediatric CDH , our research team gathered comprehensive clinical data , including data on exposure to trauma among the patients . The objectives of this investigation were to 1 ) specifically examine the prevalence of physical and sexual abuse in these clinical ly referred children and adolescents with CDH and 2 ) to compare headache characteristics , headache-related disability , depressive symptoms , and quality of life between those who reported a history of abuse and those who did not . Based on the adult literature , we hypothesized that we would find a higher rate of childhood abuse in CDH than in the general population and a rate similar to what has been reported in the adult literature ( ie , approximately 20 % ) . Also , we hypothesized that CDH patients with a positive history of abuse would have higher levels of headache-related disability , more depressive symptoms , and lower quality of life than those without a history of abuse OBJECTIVE The present study evaluated the association between women 's health and physical and sexual abuse suffered before age 18 . METHODS A total of 3,568 r and omly sample d insured women ages 18 - 64 completed a telephone interview to assess history of physical only , sexual only , or both physical and sexual abuse before age 18 ( Behavioral Risk Factor Surveillance System ) ; and current health ( Short Form-36 , Center for Epidemiologic Studies -Depression , Presence of Symptoms surveys ) . Adjusted analyses compared the health of women with physical abuse only , sexual abuse only , or physical and sexual abuse to the health of women without these abuse histories . RESULTS Poorest health status was observed in women with a history of both physical and sexual child abuse compared to women without these abuse histories . In models that adjusted for age and income , women with both abuse types had increased prevalence of depression ( prevalence ratio , 2.16 ) , severe depression ( PR , 2.84 ) , physical symptoms ( PR range , 1.33 for joint pain to 2.78 for nausea/vomiting ) , fair/poor health ( PR , 1.84 ) , and lower SF-36 scores ( 3.15 - 5.40 points lower ) . Women with physical abuse only or sexual abuse only also had higher prevalence of symptoms and lower SF-36 scores but the associations were not as strong . CONCLUSIONS This study adds to the literature showing a grade d association between multiple adverse events in childhood and adult health Objectives The objectives were first , to assess the lifetime and 12-month prevalence of physical , psychological , and sexual abuse among a stratified r and om sample of Kuwaiti high school students and second , to explore the association of child abuse with parental characteristics , subjective quality of life ( QOL ) , self-esteem , anxiety , and depression . Method We assessed the students for experience of abuse by their mothers , fathers , and others , using st and ard scales on psychological , physical and sexual abuse . They also completed the short version of the World Health  Organization ’s  QOL Instrument ; the  Rosenberg self-esteem scale  , and a scale for anxiety and depression . Results We obtained responses from 4,467 students ( 49 % boys ) , mean age 16.9 years . About 18 , 15 , and 18 % , indicated that for at least six times in the past 12 months , they experienced psychological abuse by their mothers , fathers and others , respectively . The corresponding figures for lifetime experience were similar . The respective figures for experience of physical abuse during the past 12 months were 4.3 , 5.8 , and 6.4 % . For lifetime experience , the corresponding figures were 3.4 , 5.3 , and 5.8 % . The girls had significantly higher physical/psychological abuse scores . There were no significant gender differences in the prevalence of sexual attacks ( 8.6 % ) and someone threatening the subjects with sex ( 5.9 % ) . The prevalence of someone sexually exposing themselves to the students ( 15.3 % ) and unwanted touching of sexual parts ( 17.4 % ) was significantly higher among the boys . Over one-third of those abused had experienced multiple abuses . Child abuse was significantly associated with parental divorce , diminished QOL and self-esteem , high scores on anxiety/depression , and difficulty with studies , and social relationships . In the regression analysis involving only the abuse indices , psychological abuse by mothers was the most important predictor of depression , anxiety , and self-esteem ( 11.5–19.7 % of variance ) . Good quality of parental relationship seemed protective . Conclusion The findings support the impression that , despite the conservative culture , child abuse is being experienced by a significant number of children in the Arab world . Preventive education in this culture should include limits on child disciplinary measures , the vulnerable groups identified , the impact on psychosocial functioning , and the protective effect of parental harmony PURPOSE Several recent studies have found associations between childhood maltreatment and adverse adult health outcomes . However , method ologic problems with accurate case determination , appropriate sample selection , and predominant focus on sexual abuse have limited the generalizability of these findings . SUBJECTS AND METHODS We administered a survey to 1,225 women who were r and omly selected from the membership of a large , staff model health maintenance organization in Seattle , Washington . We compared women with and without histories of childhood maltreatment experiences with respect to differences in physical health status , functional disability , numbers and types of self-reported health risk behaviors , common physical symptoms , and physician-coded ICD-9 diagnoses . RESULTS A history of childhood maltreatment was significantly associated with several adverse physical health outcomes . Maltreatment status was associated with perceived poorer overall health ( ES = 0.31 ) , greater physical ( ES = 0.23 ) and emotional ( ES = 0.37 ) functional disability , increased numbers of distressing physical symptoms ( ES = 0.52 ) , and a greater number of health risk behaviors ( ES = 0.34 ) . Women with multiple types of maltreatment showed the greatest health decrements for both self-reported symptoms ( r = 0.31 ) and physician coded diagnoses ( r = 0.12 ) . CONCLUSIONS Women with childhood maltreatment have a wide range of adverse physical health outcomes AIM To assess the perpetrators of sexual abuse in childhood , forms of simultaneous abuse , and characteristics of the families of origin , and the possible effects of abuse on health in adult life . METHODS A cross sectional study conducted between 1998 and 2002 included a r and om group of 936 in patients ( 723 women ) aged ( mean+/-st and ard deviation ) 41.0+/-2.5 years at the psychosomatic clinic in Simbach , Germany . The following question naires , previously vali date d in German , were used to assess the patients : Question naire for Life Story and Partnership , Scale for Survey of Quality of Life , Existential Orientation Scale , Leipzig Incidence and Psychological Stress Question naire , Question naire for Assessment of One 's Own Body , Survey of Life Satisfaction , Frankfurt Physical Concept Scale , Giessen Complaint Survey , and the Survey for Collection of Health Behavior Data . We compared the in patients who had been sexually abused in their childhood ( n=250 ) with other psychiatric in patients in the control group ( n=486 ) . RESULTS Out of 250 sexually abused patients , 25.7 % were victimized by fathers/stepfathers , 4 % by mothers/stepmothers , 12.4 % by aunts or uncles , 10 % by brothers or sisters , 7.6 % by gr and mothers/gr and fathers , 30.1 % by family acquaintances , and 29.3 % by strangers . Unlike the parents of patients in the control group , the parents of sexually abused patients had more conflicts , especially over alcohol consumption ( p<0.001 ) and extramarital affairs ( p<0.001 ) , they divorced more frequently during the first seven years of the patient 's life ( p<0.001 ) , and had more underlying emotional ( p<0.001 ) and physical illnesses ( p=0.006 ) . Significantly more sexually abused patients reported having poor concentration ( odds ratio [OR]=5.03 ; 95 % confidence interval [CI]=1.98 - 9.70 ; p<0.001 ) and sexual h and icaps ( OR=5.16 ; 95 % CI=1.81 - 11.39 ; p<0.001 ) , tended to hide their body ( OR=3.65 ; 95 % CI=1.69 - 7.30 ; p<0.001 ) , abused illicit drugs ( OR=2.38 ; 95 % CI=1.08 - 6.01 ; p<0.001 ) , had borderline personality disorder ( OR=4.21 ; 95 % CI=2.44 - 8.40 ; p<0.001 ) , and suicidal ideation ( OR=2.87 ; 95 % CI=1.71 - 5.96 ; p<0.001 ) . CONCLUSION The patients who were sexually abused in childhood had significantly less satisfactory lives and more frequent psychiatric illnesses , suicidal ideation , disturbed social functioning and perception of the body , and psychosomatic diseases BACKGROUND Childhood abuse has been associated with abnormalities in brain development , particularly corpus callosum ( CC ) morphology . The impact of neglect has not been assessed , though it is the most prevalent form of childhood maltreatment . METHODS Regional CC area was measured from magnetic resonance imaging scans in 26 boys and 25 girls admitted for psychiatric evaluation ( 28 with abuse or neglect ) and compared with CC area in 115 healthy control subjects .  Data were analyzed by multivariate analysis of covariance , with age and midsagittal area as covariates . RESULTS Total CC area of the abused/neglected patients was 17 % smaller than in control subjects ( p = .0001 ) and 11 % smaller than in psychiatric patients who had not been abused or neglected ( contrast group ; p = .01 ) . Control subjects and the contrast group did not differ in total CC area . Neglect was the strongest experiential factor and was associated with a 15%-18 % reduction in CC regions 3 , 4 , 5 , and 7 ( all p < .02 ) . In contrast , sexual abuse seemed to be the strongest factor associated with reduced CC size in girls . CONCLUSIONS These data are consistent with animal research that demonstrated reduced CC size in nursery-reared compared with semi-naturally reared primates . Early experience might also affect the development of the human CC This paper describes constructing the Assessment of Quality of Life ( AQoL ) instrument ; design ed to measure health-related quality of life ( HRQoL )  , and to be the descriptive system for a multi-attribute utility instrument . Unlike previous utility instruments ' descriptive systems , the AQoL 's has been developed using state-of-the-art psychometric procedures . The result is a descriptive system which emphasizes five different facets of HRQoL and which can cl aim to have construct validity . Based on the WHO 's definition of health a model of HRQoL was developed . Items were written by focus groups of doctors and the research ers . These were administered to a construction sample , comprising hospital patients , and community members chosen at r and om . Final construction was through an iterative process of factor and reliability analyses . The AQoL measures 5 dimensions : illness , independent living , social relationships , physical senses and psychological wellbeing . Each has three items . Exploratory factor analysis showed the dimensions were orthogonal , and each was unidimensional . Internal consistency was α = 0.81 . Structural equation modeling explored its internal structure ; the comparative fit index was 0.90 . These preliminary results indicate the AQoL has the prerequisite qualities for a psychometric HRQoL instrument for evaluation ; replication with a larger sample is needed to verify these findings . Scaling it for economic evaluation using utilities is being undertaken . Respondents have indicated the AQoL is easy to underst and and is quickly completed . Its initial properties suggest it may be widely applicable BACKGROUND The application of health-related quality of life  ( HRQOL ) as a pediatric population health measure may facilitate risk assessment and re source allocation , the tracking of community health , the identification of health disparities , and the determination of health outcomes from inter 
    Output:
    
Number of types of maltreatment and HRQoL were found to be negatively related .