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Laughney CI, Lee YG, Mergenova G, Vinogradov V, Zhakupova G, Paine EA, Primbetova S, Terlikbayeva A, Wu E. Earlier Sexual Debut and Exchange Sex among Men Who Have Sex with Men (MSM) in Kazakhstan. J Sex Res 2023; 60:919-924. [PMID: 36657067 PMCID: PMC10354213 DOI: 10.1080/00224499.2023.2167064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Limited research has examined prevalence rates and associations related to exchange sex behaviors among gay, bisexual, and other men who have sex with men (MSM) in Kazakhstan. This study aimed to examine associations between earlier sexual debuts and lifetime exchange sex behaviors among Kazakhstani MSM. Using data from a National Institute on Drug Abuse-funded Human Immunodeficiency Virus (HIV) prevention trial, we conducted a secondary analysis of self-reported data from 766 adult cisgender MSM in Kazakhstan, who completed structured screening interviews. Earlier sexual debuts were measured as age of sexual onset prior to 16 years old with ages 16 and older as the reference group. Logistic regression models were used to estimate associations between earlier sexual debuts and lifetime reports of buying or selling sex for resources, with covariance adjustment for sociodemographic characteristics. The study findings indicated that, among our sample of MSM in Kazakhstan, 23% had sold sex, and 26% had bought sex in their lifetime. Kazakhstani MSM who reported an earlier sexual debut had significantly higher odds of ever selling or buying sex in their lifetime. Future research should examine how consensual and non-consensual sexual activities during childhood and adolescence relate to exchange sex behaviors and risk among MSM.
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Affiliation(s)
| | - Yong Gun Lee
- Social Intervention Group, Columbia School of Social Work, New York, NY, 10027, USA
| | | | | | | | - Emily Allen Paine
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality, and Health, Columbia University and New York State Psychiatric Institute, New York, NY 10032, USA
| | | | | | - Elwin Wu
- Social Intervention Group, Columbia School of Social Work, New York, NY, 10027, USA
- Global Health Research Center of Central Asia, Almaty, Kazakhstan
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Hornor G. Genital Examination of the Prepubertal Female: Essentials for Pediatric Nurse Practitioners. J Pediatr Health Care 2022; 36:489-499. [PMID: 35987556 DOI: 10.1016/j.pedhc.2022.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 05/04/2022] [Accepted: 05/06/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Gail Hornor
- Gail Hornor, Forensic Nurse Specialist, International Association of Forensic Nurses, Hilliard, OH.
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da Costa EL, Faúndes A, Nunes R. The association between victim-offender relationship and the age of children and adolescents who suffer sexual violence: a cross-sectional study. J Pediatr (Rio J) 2022; 98:310-315. [PMID: 34469770 PMCID: PMC9432057 DOI: 10.1016/j.jped.2021.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 07/06/2021] [Accepted: 07/12/2021] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES Sexual violence is a problem that affects children and adolescents regardless of social class, age, origin, religion, education level, marital status, race, or sexual orientation. This study aimed to analyze the associations between victim-offender relationships and the victim's age in cases of sexual violence involving female victims. METHODS This cross-sectional, retrospective observational study used data from the Brazilian Ministry of Health's Department of Public Health Surveillance in Brasília regarding the reportable crime of rape as informed by female victims in the Federal District between January 1, 2012, and December 31, 2018. The age of the victim was classified as <15 years or 15-19 years. The offenders were classified into eight different categories according to their relationship with the victim: father, stepfather, brother, husband, boyfriend, friend, stranger, and others. The association between the victim-offender relationship and the victim's age was assessed. RESULTS Overall, there were 4,617 reported cases of sexual violence, with 78.3% of these (n = 3614) corresponding to children under 15 and 21.7% to adolescents 15-19 years old (n = 1003). Close relatives, including brothers, and friends were the main perpetrators in cases of girls < 15 years old. Strangers and friends were the principal perpetrators in the group of girls 15-19 years old. CONCLUSIONS Children under 15 are the group most affected by sexual violence. Strategies must be developed to prevent the sexual abuse of children and adolescents and to facilitate the rehabilitation of victimized children.
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Affiliation(s)
- Evaldo Lima da Costa
- Universidade do Porto/Conselho Federal de Medicina, Faculdade de Medicina, Porto, Portugal
| | - Anibal Faúndes
- Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brazil; Centro de Pesquisas em Saúde Reprodutiva de Campinas (CEMICAMP), Campinas, SP, Brazil.
| | - Rui Nunes
- Universidade do Porto, Faculdade de Medicina, Porto, Portugal
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İsbir C, Kıllı İ, Taşkınlar H, Naycı A. pH and specific gravity of corrosive agents as indicators in caustic injuries. Pediatr Int 2022; 64:e14931. [PMID: 34297425 DOI: 10.1111/ped.14931] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 06/08/2021] [Accepted: 07/08/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Video endoscopy, which remains the diagnostic gold standard after ingestion of a corrosive substance, is performed under general anesthesia in children, requires advanced technology, and is costly. Simple and accessible methods are therefore needed to determine the need for endoscopy. The aim of this study was to evaluate the role of the pH and specific gravity of ingested substance in determining endoscopy indications after corrosive ingestion. METHODS This prospective study included pediatric patients who presented after ingesting a corrosive substance from June 2018 to June 2019. Relationships between the extent of damage detected by endoscopy and the patient's age, physical examination findings, and the pH and specific gravity of the causative substance were evaluated. RESULTS The degree of damage detected on endoscopy was significantly milder for corrosive substances with a pH between 2 and 12 (P = 0.003). In addition, pH values between 2 and 12 were significantly more common among patients without physical examination findings (P = 0.029). Specific gravity less than 1,005 was associated with mild injury detected by video-endoscopy (P = 0.011). Patients in whom severe injury was detected by endoscopy had marked findings on physical examination (P < 0.001). There was no significant relationship between physical examination findings and the specific gravity of the substance involved (P = 0.087). CONCLUSIONS The results of this study suggest that conservative treatment options can be used without performing endoscopy in patients who have no physical examination finding after corrosive ingestion and where the pH of the substances is between 2 and 12 and the specific gravity of the substances is less than 1,005.
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Affiliation(s)
- Caner İsbir
- Department of Pediatric Surgery, Mersin University Faculty of Medicine, Mersin, Turkey
| | - İsa Kıllı
- Department of Pediatric Surgery, Mersin University Faculty of Medicine, Mersin, Turkey
| | - Hakan Taşkınlar
- Department of Pediatric Surgery, Mersin University Faculty of Medicine, Mersin, Turkey
| | - Ali Naycı
- Department of Pediatric Surgery, Mersin University Faculty of Medicine, Mersin, Turkey
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Yoon S, Speyer R, Cordier R, Aunio P, Hakkarainen A. A Systematic Review Evaluating Psychometric Properties of Parent or Caregiver Report Instruments on Child Maltreatment: Part 2: Internal Consistency, Reliability, Measurement Error, Structural Validity, Hypothesis Testing, Cross-Cultural Validity, and Criterion Validity. Trauma Violence Abuse 2021; 22:1296-1315. [PMID: 32270753 PMCID: PMC8739544 DOI: 10.1177/1524838020915591] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
AIMS Child maltreatment (CM) is global public health issue with devastating lifelong consequences. Global organizations have endeavored to eliminate CM; however, there is lack of consensus on what instruments are most suitable for the investigation and prevention of CM. This systematic review aimed to appraise the psychometric properties (other than content validity) of all current parent- or caregiver-reported CM instruments and recommend the most suitable for use. METHOD A systematic search of the CINAHL, Embase, ERIC, PsycINFO, PubMed, and Sociological Abstracts databases was performed. The evaluation of psychometric properties was conducted according to the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidelines for systematic reviews of patient-report outcome measures. Responsiveness was beyond the scope of this systematic review, and content validity has been reported on in a companion paper (Part 1). Only instruments developed and published in English were included. RESULTS Twenty-five studies reported on selected psychometric properties of 15 identified instruments. The methodological quality of the studies was overall adequate. The psychometric properties of the instruments were generally indeterminate or not reported due to incomplete or missing psychometric data; high-quality evidence on the psychometric properties was limited. CONCLUSIONS No instruments could be recommended as most suitable for use in clinic and research. Nine instruments were identified as promising based on current psychometric data but would need further psychometric evidence for them to be recommended.
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Affiliation(s)
- Sangwon Yoon
- Department of Special Needs Education, Faculty of Educational Sciences, University of Oslo, Norway
| | - Renée Speyer
- Department of Special Needs Education, Faculty of Educational Sciences, University of Oslo, Norway
- School of Occupational Therapy, Social Work and Speech Pathology, Faculty of Health Sciences, Curtin University, Perth, Australia
- Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Centre, the Netherlands
| | - Reinie Cordier
- Department of Special Needs Education, Faculty of Educational Sciences, University of Oslo, Norway
- School of Occupational Therapy, Social Work and Speech Pathology, Faculty of Health Sciences, Curtin University, Perth, Australia
- Department of Social Work, Education and Community Wellbeing, Faculty of Health and Life Sciences, Northumbria University, Newcastle, United Kingdom
| | - Pirjo Aunio
- Department of Special Needs Education, Faculty of Educational Sciences, University of Oslo, Norway
- Department of Education, University of Helsinki, Finland
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Nihan K, Makda A, Salat H, Khursheed M, Fayyaz J, Khan UR. Assessment of knowledge, attitude, and practice of child abuse amongst health care professionals working in tertiary care hospitals of Karachi, Pakistan. J Family Med Prim Care 2021; 10:1364-1368. [PMID: 34041180 PMCID: PMC8140284 DOI: 10.4103/jfmpc.jfmpc_1691_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 10/27/2020] [Accepted: 01/05/2021] [Indexed: 11/24/2022] Open
Abstract
Introduction: UNICEF report (2004) states that a significant percentage of total child population under the age of 5 years suffered malnutrition. Child sexual abuse remains undiscussed across Pakistan. Health care professionals (HCPs) are usually the first notifiers of child abuse and are ethically obliged to manage and report it. Objective: This study was conducted to assess HCPs' response in dealing with patients of child abuse. With a better understanding, we can have a better outcome for the victims. Methods: A total of 101 participants filled out a structured questionnaire by HCPs working in three tertiary hospitals of Karachi i.e., Aga Khan University, National Institute of Child Health (NICH), and Civil Hospital. Data were entered into SPSS 19.0. Results: HCPs believed that young male relatives were thought to be most likely the offender, and that every child regardless of class is prone to get abused triggered by financial stressors and the absence of parents. Proper physical exams helped identify cases. A proper system of reporting was required in hospitals, but HCPs were reluctant to report the cases to authorities. There was a significant difference noted between public and private hospitals. Conclusion: Our findings indicate that HCPs have limited knowledge in defining various types of abuse and most were unaware of any reporting facility in hospitals. Senior HCPs as consultants have a better understanding of child abuse than nurses or interns. Mandatory reporting should be implicated so that prompt action could be taken. There could be a more successful outcome of managing a child abuse victim with proper training.
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Affiliation(s)
- Khuld Nihan
- Jinnah Sindh Medical University, Karachi, Pakistan
| | - Aamir Makda
- Jinnah Sindh Medical University, Karachi, Pakistan
| | | | | | - Jabeen Fayyaz
- Sick Children Hospital, University of Toronto, Canada
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Widom CS, Li X. The role of psychiatric symptoms and environmental vulnerability factors in explaining the relationship between child maltreatment and suicidality: A prospective investigation. J Affect Disord 2020; 276:720-731. [PMID: 32871705 PMCID: PMC9375955 DOI: 10.1016/j.jad.2020.06.039] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 05/06/2020] [Accepted: 06/14/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Childhood maltreatment has been associated with suicide thoughts and attempts; however, few longitudinal studies have assessed risk of suicidality into adulthood. Fewer have examined potential mediators (psychiatric symptoms and environmental vulnerability factors). METHODS Prospective cohort design. Children with documented cases of maltreatment (N = 495, ages 0-11) were matched with non-maltreated children (N = 395) and followed up into adulthood. Psychiatric symptoms (depression, anxiety, dysthymia, post-traumatic stress,antisocial personality,and substance use) and environmental vulnerability (social isolation, physical disability/illness, and homelessness) were assessed at mean age 29 and suicide thoughts and attempts at 39. Structural equation models tested for mediation, controlling for age, sex, race, and IQ. RESULTS Childhood maltreatment predicted suicide attempts (Beta = 0.44, p<0.001), but not suicide thoughts only.Individuals with only suicide thoughts differed significantly from those with suicide attempts in psychiatric symptoms, physical disability/ illness, and homelessness. There were significant paths from child maltreatment to suicide attempts through psychiatric symptoms (0.18, p<0.001), ASPD (0.13, p<0.001), substance use (0.07, p<0.01), and homelessness (0.10, p<0.05). LIMITATIONS Court cases of child maltreatment may not generalize to middle- or upper- class and non-reported cases.Effect sizes were small but significant. CONCLUSIONS Psychiatric risk factors for suicide are well recognized. These new results provide strong evidence that environmental vulnerability factors, particularly homelessness, are associated with increased risk for suicide attempts and warrant attention.Although many people report suicide thoughts, maltreated children with more psychiatric symptoms and experience homelessness are more likely to attempt suicide and warrant targeted interventions.
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Affiliation(s)
- Cathy Spatz Widom
- Psychology Department, John Jay College and City University of New York, New York City, NY, United States.
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Xiao D, Wang T, Huang Y, Wang W, Zhao M, Zhang WH, Guo L, Lu C. Gender differences in the associations between types of childhood maltreatment and sleep disturbance among Chinese adolescents. J Affect Disord 2020; 265:595-602. [PMID: 32090782 DOI: 10.1016/j.jad.2019.11.099] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 10/15/2019] [Accepted: 11/21/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND To explore the association between different types of childhood maltreatment and sleep disturbance among Chinese adolescents, with a particular focus on gender differences. METHODS A cross-sectional study was conducted in 7 randomly selected provinces of China via the 2015 School-Based Chinese Adolescents Health Survey. Questionnaires from 153,547 students were completed and were eligible for this study. The Chinese Version of the Pittsburgh Sleep Quality Index (CPSQI) and Childhood Trauma Questionnaire-Short Form (CTQ-SF) were used to assess sleep disturbance and childhood maltreatment, respectively. RESULTS The prevalence of sleep disturbance among adolescents in China was 21.6%. A significantly increased risk of sleep disturbance was associated with physical abuse (aOR=1.22, 95% CI=1.21-1.24), emotional abuse (aOR=1.15, 95% CI=1.14-1.15), sexual abuse (aOR=1.16, 95% CI=1.15-1.18), physical neglect (aOR=1.04, 95% CI=1.03-1.05), and emotional neglect (aOR=1.03, 95% CI=1.02-1.03). A significant dose-response relationship was found between cumulative childhood maltreatment experiences and sleep disturbance. The interaction terms (between physical abuse/emotional abuse/sexual abuse/physical neglect/emotional neglect/number of childhood traumas and gender) were significantly associated with sleep disturbance. Further stratification analyses by gender showed that girls who reported experiencing one or more of these five types of childhood maltreatment had a higher risk of sleep disturbance than boys. LIMITATIONS The study only included school students, and the cross-sectional design limited our ability to make causal inferences. CONCLUSIONS The study findings suggest that childhood maltreatment increases the risk of sleep disturbance in adolescents. Furthermore, exposure to single and multiple types of childhood maltreatment predicts lower sleep quality in girls.
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Fix RL, Falligant JM, Alexander AA, Burkhart BR. Race and Victim Age Matter: Sexual Behaviors and Experiences Among Confined African American and European American Youth With Sexual and Nonsexual Offenses. Sex Abuse 2019; 31:50-72. [PMID: 28760088 DOI: 10.1177/1079063217720926] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Previous research has found differences in sexual behavior and types of sexual offending by offense category and racial/ethnic group. The present study examined effects of offense category, victim age, and race/ethnicity on sexual behavior. Data from 561 confined adolescents adjudicated for illegal sexual behavior (AISBs) and adolescents adjudicated for illegal nonsexual behavior (AINBs) were included in the present study. A hierarchical multinomial logistic regression was run to test whether sexual experiences and behaviors differentially predicted AINBs, AISBs with child victims, and AISBs with peer/adult victims. Results supported the utility of distinguishing AISBs by victim age. Comparisons between AISBs and AINBs indicated AISBs had more sexual abuse and were more sexually restricted, whereas AINBs reported more sexual behavior, reflecting a finding potentially mirroring sexual development, sexual experiences, and caregiver approaches to discussing sexuality. Over 60% of AINBs and 30% of AISBs reported behaviors that could be classified as distribution of child pornography. Within the group of AISBs, select racial/ethnic group differences emerged such that European American participants were more likely to have had intrafamilial sexual experiences and were far less likely to have had vaginal intercourse than African American AISBs. Future directions and implications regarding policies related to sexual education and sexting are discussed.
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Bahk YC, Jang SK, Choi KH, Lee SH. The Relationship between Childhood Trauma and Suicidal Ideation: Role of Maltreatment and Potential Mediators. Psychiatry Investig 2017; 14:37-43. [PMID: 28096873 PMCID: PMC5240465 DOI: 10.4306/pi.2017.14.1.37] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 03/29/2016] [Accepted: 04/28/2016] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Childhood trauma is recognized as an important risk factor in suicidal ideation, however it is not fully understood how the different types of childhood maltreatment influence suicidal ideation nor what variables mediate the relationship between childhood trauma and suicidal ideation. This study examined the path from childhood trauma to suicidal ideation, including potential mediators. METHODS A sample of 211 healthy adults completed the Childhood Trauma Questionnaire (CTQ), Beck scale for Suicidal Ideation (BSI), Functional Social Support Questionnaire (FSSQ) and Hospital Anxiety and Depression Scale (HADS). Path analysis was used to investigate the relationship among study variables. RESULTS Of the several types of childhood maltreatment we considered, only childhood sexual abuse directly predicted suicidal ideation (β=0.215, p=0.001). Childhood physical abuse (β=0.049, 95% confidence interval: 0.011-0.109) and childhood emotional abuse (β=0.042, 95% confidence interval: 0.001-0.107) indirectly predicted suicidal ideation through their association with anxiety. Childhood neglect indirectly predicted suicidal ideation through association with perceived social support (β=0.085, 95% confidence interval: 0.041-0.154). CONCLUSION Our results confirmed that childhood sexual abuse is a strong predictor of suicidal ideation. Perceived social support mediated the relationship between suicidal ideation and neglect. Anxiety fully mediated the relationship between suicidal ideation and both physical abuse and emotional abuse. Interventions to reduce suicidal ideation among survivors of childhood trauma should focus on anxiety symptoms and attempt to increase their social support.
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Affiliation(s)
- Yong-Chun Bahk
- Clinical Emotion and Cognition Research Laboratory, Inje University, Goyang, Republic of Korea
- Department of Psychology, Korea University, Seoul, Republic of Korea
| | - Seon-Kyeong Jang
- Clinical Emotion and Cognition Research Laboratory, Inje University, Goyang, Republic of Korea
- Department of Psychology, Korea University, Seoul, Republic of Korea
| | - Kee-Hong Choi
- Department of Psychology, Korea University, Seoul, Republic of Korea
| | - Seung-Hwan Lee
- Department of Psychology, Korea University, Seoul, Republic of Korea
- Department of Psychiatry, Inje University, Ilsan-Paik Hospital, Goyang, Republic of Korea
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Chang YC, Huang JL, Hsia SH, Lin KL, Lee EP, Chou IJ, Hsin YC, Lo FS, Wu CT, Chiu CH, Wu HP. Child protection medical service demonstration centers in approaching child abuse and neglect in Taiwan. Medicine (Baltimore) 2016; 95:e5218. [PMID: 27858867 PMCID: PMC5591115 DOI: 10.1097/md.0000000000005218] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Child abuse includes all forms of physical and emotional ill treatment, sexual abuse, neglect, and exploitation that results in actual or potential harm to the child's health, development, or dignity. In Taiwan, the Child Protection Medical Service Demonstration Center (CPMSDC) was established to protect children from abuse and neglect. We further analyzed and compared the trends and clinical characteristics of cases reported by CPMSDC to evaluate the function of CPMSDC in approaching child abuse and neglect in Taiwan. We prospectively recorded children with reported child abuse and neglect in a CPMSDC in a tertiary medical center from 2014 to 2015. Furthermore, we analyzed and compared age, gender, scene, identifying settings, time of visits, injury type, injury severity, hospital admission, hospitalization duration, and outcomes based on the different types of abuse and the different settings in which the abuse or neglect were identified. Of 361 child abuse cases (mean age 4.8 ± 5.36 years), the incidence was highest in 1- to 6-year-old children (n = 198, 54.85%). Physical abuse and neglect were predominant in males, while sexual abuse was predominant in females (P < 0.001). Neglect was most common (n = 279, 75.85%), followed by physical (n = 56, 15.51%) and sexual abuse (n = 26, 7.2%). The most common identifying setting was the emergency department (n = 320, 88.64%), with neglect being most commonly reported. Head, neck, and facial injuries were more common in physically abused children than in neglected and sexual abused children (P < 0.005), leading to longer hospitalization (P = 0.042) and a higher Injury Severity Score (P = 0.043). There were more skin injuries in neglect (P < 0.001). The mortality rate was 2.49% (n = 9). The CPMSDC could enhance the ability, alertness, and inclination of professionals to identify suspected cases of child abuse, and to increase the rate of registry. Cases of physical abuse had a higher Injury Severity Score, longer duration of hospitalization, and more injuries of head, face, and neck compared with other types of abuse. The reported rate of neglect was highly elevated after the CPMSDC established during the study period. Recognition of neglect is not easy, but the consequent injury, especially asphyxia, may lead to mortality.
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Affiliation(s)
- Yu-Ching Chang
- Division of Pediatric General Medicine, Department of Pediatrics, Chang Gung Memorial Hospital at Linko, Kweishan
- College of Medicine, Chang Gung University
| | - Jing-Long Huang
- College of Medicine, Chang Gung University
- Division of Pediatric Allery, Asthma, and Rheumatology, Department of Pediatrics
| | - Shao-Hsuan Hsia
- College of Medicine, Chang Gung University
- Division of Pediatric Critical Care Medicine, Department of Pediatrics
| | - Kuang-Lin Lin
- College of Medicine, Chang Gung University
- Division of Pediatric Neurology, Department of Pediatrics
| | - En-Pei Lee
- Division of Pediatric Critical Care Medicine, Department of Pediatrics
| | - I-Jun Chou
- College of Medicine, Chang Gung University
- Division of Pediatric Neurology, Department of Pediatrics
| | - Yi-Chen Hsin
- Division of Pediatric General Medicine, Department of Pediatrics, Chang Gung Memorial Hospital at Linko, Kweishan
- College of Medicine, Chang Gung University
| | - Fu-Song Lo
- College of Medicine, Chang Gung University
- Divsion of Pediatric Endocrinology, Department of Pediatrics
| | - Chang-Teng Wu
- Division of Pediatric General Medicine, Department of Pediatrics, Chang Gung Memorial Hospital at Linko, Kweishan
- College of Medicine, Chang Gung University
| | - Cheng-Hsun Chiu
- College of Medicine, Chang Gung University
- Division of Pediatric infectious diseases, Department of Pediatrics
| | - Han-Ping Wu
- Division of Pediatric General Medicine, Department of Pediatrics, Chang Gung Memorial Hospital at Linko, Kweishan
- College of Medicine, Chang Gung University
- Correspondence: Han-Ping Wu, Division of Pediatric General Medicine, Department of Pediatrics, Chang Gung Memorial Hospital at Linko, Kweishan, Taoyuan, Taiwan, No. 5, Fu-Hsin Street, Kweishan, Taoyuan, Taiwan (e-mail: )
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Sofuoğlu Z, Sariyer G, Aydin F, Cankardas S, Kandemirci B. Child Abuse and Neglect Among Children Who Drop Out of School: A Study in Izmir, Turkey. Soc Work Public Health 2016; 31:589-598. [PMID: 27331866 DOI: 10.1080/19371918.2016.1160343] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Child abuse and neglect (CAN), and dropping out of school have long been recognized as pervasive social problems globally, and Turkey is no exception. This study aims to explore the prevalence and incidence of CAN in children who drop out of school of Turkey, using the ISPCAN Child abuse Screening Tool, Children's Version, which is an appropriate tool for multinational comparisons. Data from a convenience sample of children who drop out of school age 11, 13, and 16 from Izmir were collected either by interviews or by self-completion. The results show that, compared to children who do not drop out of school, children who drop out of school have higher rates of psychological and physical abuse and neglect within the family. This study not only highlights the need for preventive laws for CAN and dropping out of school, but also points to direction for future research.
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Affiliation(s)
- Zeynep Sofuoğlu
- a Association of Emergency Ambulance Physicians , Izmir , Turkey
| | - Görkem Sariyer
- b Faculty of Economics and Administrative Sciences, Yasar University , Izmir , Turkey
| | - Fulya Aydin
- a Association of Emergency Ambulance Physicians , Izmir , Turkey
| | - Sinem Cankardas
- a Association of Emergency Ambulance Physicians , Izmir , Turkey
| | - Birsu Kandemirci
- a Association of Emergency Ambulance Physicians , Izmir , Turkey
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Abstract
OBJECTIVE To investigate whether individual differences in coping self-efficacy mediated the association of child abuse and symptoms of ADHD in young adults. METHOD Self-reported measures of coping self-efficacy, child abuse, and ADHD were obtained from 66 adults. RESULTS Adults who reported childhood physical or sexual abuse (prior to the age of 17) had significantly higher levels of ADHD than those who did not. Individual differences in coping self-efficacy fully mediated the association between child abuse and ADHD symptoms in adulthood, such that individuals who endorsed child abuse had lower coping self-efficacy, and coping self-efficacy negatively predicted ADHD symptoms. DISCUSSION The findings suggest a potential causal mechanism by which childhood physical and sexual abuse may result in ADHD symptoms later in life. Interventions that improve coping skills may be useful in preventing later ADHD symptoms among adults with a childhood history of physical and sexual abuse.
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Affiliation(s)
| | | | - Steve S Lee
- University of California, Los Angeles, CA, USA
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Regnaut O, Jeu-Steenhouwer M, Manaouil C, Gignon M. Risk factors for child abuse: levels of knowledge and difficulties in family medicine. A mixed method study. BMC Res Notes 2015; 8:620. [PMID: 26514128 PMCID: PMC4627620 DOI: 10.1186/s13104-015-1607-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 10/19/2015] [Indexed: 11/15/2022] Open
Abstract
Background Family physicians (FPs) have a central role in the detection and management of child abuse. According to the literature, only 2–5 % of initial reports of child abuse come from the medical profession. Methods The objective of this study was to assess levels of knowledge of risk factors for child abuse by Family Physicians (FPs) and the attention that the physicians pay to these risk factors. We conducted a mixed-method survey based on semi-structured interviews. 50 FPs practicing in the Somme County (northern France) were interviewed with closed and open questions. The FPs’ level of knowledge of risk factors for child abuse and obstacles in the detection of child abuse were assessed. Results The FPs’ level of knowledge of risk factors for child abuse was similar to that reported in the literature. However, FPs knew little about the significant role of prematurity. Likewise, the FP’s training did not seem to influence their knowledge of risk factors. Fear of an incorrect diagnosis was the main obstacle to reporting a suspected case. The FPs considered that they were often alone in dealing with a difficult situation and considered that the judicial system and the social services were not sufficiently active. Conclusions Few FPs had actually received specific training in the detection and management of child abuse but many stated their need for this type of training. FPs encounter many obstacles in the detection of child abuse, which sometimes make the FP reluctant to report a suspected or potential case. Medical education need to be improved in this field. Electronic supplementary material The online version of this article (doi:10.1186/s13104-015-1607-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Océane Regnaut
- Medical School, University of PicardyJules Verne, 3 Rue des Louvels, 80000, Amiens, France. .,Forensic and Social Medicine Unit, Amiens University Medical Center, 80054, Amiens Cedex 1, France.
| | - Marie Jeu-Steenhouwer
- Medical School, University of PicardyJules Verne, 3 Rue des Louvels, 80000, Amiens, France. .,Primary Care Department, Jules Verne University of Picardy, 3 Rue des Louvels, 80000, Amiens, France.
| | - Cécile Manaouil
- Medical School, University of PicardyJules Verne, 3 Rue des Louvels, 80000, Amiens, France. .,Forensic and Social Medicine Unit, Amiens University Medical Center, 80054, Amiens Cedex 1, France.
| | - Maxime Gignon
- Medical School, University of PicardyJules Verne, 3 Rue des Louvels, 80000, Amiens, France. .,Laboratory Educations and Health Practices, EA 3412, University Paris 13, 74, Rue Marcel Cachin, 93017, Bobigny, France. .,Health Training Center (SimUSanté©), Amiens University Medical Center, 80054, Amiens Cedex 1, France.
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Moreira GAR, Vasconcelos AA, Marques LDA, Vieira LJES. Instrumentação e conhecimento dos profissionais da equipe saúde da família sobre a notificação de maus-tratos em crianças e adolescentes. Rev paul pediatr 2013; 31:223-30. [DOI: 10.1590/s0103-05822013000200014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Accepted: 02/04/2013] [Indexed: 11/22/2022]
Abstract
OBJETIVO: Analisar a instrumentação e o conhecimento dos profissionais da Equipe de Saúde da Família sobre a notificação de maus-tratos em crianças e adolescentes. MÉTODOS: Estudo de corte transversal realizado em três municípios do Estado do Ceará, de janeiro a abril de 2012. Participaram da pesquisa 51 profissionais: médicos (9), enfermeiros (26) e cirurgiões-dentistas (16) que trabalhavam na Estratégia Saúde da Família. Utilizou-se um questionário para a coleta, e os dados foram submetidos à análise estatística descritiva e analítica por meio da aplicação do teste do qui-quadrado de Pearson, sendo significante p≤0,05. RESULTADOS: Na amostra selecionada predominaram profissionais que não haviam participado de treinamento na área de violência contra crianças e adolescentes (86,3%), conheciam o Estatuto da Criança e do Adolescente (90,2%) e conheciam a ficha de notificação de maus-tratos (62,7%). A maioria afirmou que a unidade de saúde possuía a ficha (70,5%) e que sabia para qual lugar encaminhar as vítimas (82,3%). Prevaleceram os profissionais que não se depararam com situações de maus-tratos (62,8%); dos 37,2% que já tinham identificado algum caso, 60,0% relataram as ocorrências. Houve associação significante (p=0,035) entre o ato de notificar e a participação do profissional em treinamento sobre o tema. CONCLUSÕES: Este estudo mostrou que os participantes têm dificuldades na notificação de maus-tratos em crianças e adolescentes. Existem lacunas no conhecimento e fragilidades na instrumentação para essa prática.
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Villaveces A, Stucky BD, Runyan CW, Moore KS, Berlin SP. The Development of an Instrument for Evaluating Core Competencies in Violence and Injury Prevention. Journal of Public Health Management and Practice 2010; 16:337-44. [DOI: 10.1097/phh.0b013e3181bede2a] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Massoni ACDLT, Ferreira ÂMB, Aragão AKR, Menezes VAD, Colares V. Aspectos orofaciais dos maus-tratos infantis e da negligência odontológica. Ciênc saúde coletiva 2010; 15:403-10. [DOI: 10.1590/s1413-81232010000200016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2008] [Accepted: 11/18/2008] [Indexed: 11/22/2022] Open
Abstract
O objetivo deste artigo foi identificar os principais aspectos orofaciais dos maus-tratos infantis e da negligência odontológica, contribuindo com a identificação destas vítimas no ambiente odontológico. Foi realizada uma pesquisa bibliográfica nas bases de dados Adolec, MEDLINE, LILACS e BBO. Utilizaram-se como descritores: maus-tratos infantis, manifestações bucais, odontólogos, papel (figurativo) e responsabilidade legal. Verificou-se que os maus-tratos infantis acontecem em geral em domicílio e os ferimentos orofaciais decorrentes incluem trauma, queimaduras e lacerações dos tecidos duros e moles, marcas de mordida e hematomas em vários estágios de cura. Pode haver ferimentos que envolvem outras partes do corpo próximas à cavidade bucal, como hematoma periorbital e contusão nasal. Quanto ao abuso sexual, muitas vítimas não apresentam nenhum sinal físico associado; assim, indicadores comportamentais devem ser observados. A imediata identificação e o relato de maus-tratos infantis e da negligência odontológica pelo cirurgião-dentista são essenciais para a proteção das crianças, sendo fundamental uma maior atuação destes profissionais, através do registro e denúncia dos casos suspeitos às agências de proteção à criança.
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Abstract
Despite being underreported and underrecognized, child maltreatment is one of the most common causes of childhood morbidity and mortality. The epilepsy monitoring unit is especially amenable for identification of those at risk because it involves direct observation of behavior for days at a time. Although nonepileptic events may suggest psychosocial etiologies, we describe a case where the diagnosis of child maltreatment was made when no habitual events were recorded in the epilepsy monitoring unit.
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Affiliation(s)
- Lily Tran
- Division of Pediatric Neurology, Rainbow Babies and Children's Hospital, Cleveland, OH, USA
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Eballe AO, Epée E, Koki G, Bella L, Mvogo CE. Unilateral childhood blindness: a hospital-based study in Yaoundé, Cameroon. Clin Ophthalmol 2009; 3:461-4. [PMID: 19714264 PMCID: PMC2732056 DOI: 10.2147/opth.s5289] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2009] [Indexed: 11/23/2022] Open
Abstract
Introduction: We performed an analytic and prospective study over a period of 12 months from January 2nd to December 31st, 2008, at the Gynaeco-Obstetric and Paediatric Hospital of Yaoundé, Cameroon. Our aim was to determine the prevalence and causes of unilateral blindness in school children aged 6 to 15 years. Results: Among the 1,266 children aged 6 to 15 years who were recruited, 60 presented with unilateral blindness (4.7%): 42 boys (6.96%) and 18 girls (2.71%). The mean age was 10.15 ± 3.4 years. In patients with unilateral blindness, 65% was due to ocular trauma. Discussion: The hospital-based prevalence of unilateral blindness in children is relatively high and ocular trauma is the leading etiology. Conclusion: Unilateral blindness in school children is avoidable and its incidence could be markedly reduced by emphasizing an information strategy and education based on prevention of ocular trauma. Early management of nontraumatic diseases such as infantile glaucoma and some tumors could improve outcome and avoid blindness.
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Affiliation(s)
- André Omgbwa Eballe
- Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon.
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Sabaté Rotés A, Sancosmed Ron M, Cebrián Rubio R, Canet Ponsa M, Martín González M. [Suspected child abuse in paediatric emergency service]. An Pediatr (Barc) 2009; 71:60-3. [PMID: 19423410 DOI: 10.1016/j.anpedi.2008.12.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2008] [Revised: 12/29/2008] [Accepted: 01/05/2009] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To describe the epidemiology of child abuse in an emergency department of a tertiary paediatric hospital. METHODS Descriptive and retrospective study from January 2008 to January 2006 including patients less than sixteen years of age who were suspected of being abused during the examination in the emergency department. RESULTS Child maltreatment was 0.07% of all paediatric emergencies (45% physical abuse, 35% sexual abuse and 20% neglect). Mean age of 6 years old, with no gender differences. 86% were suspected of maltreatment. An adult living with the child was suspected in 67% of cases. Social and judicial procedures were activated. A total of 24 children were admitted, 14 under medical criteria and the rest in order to protect the child; 2 had serious neurological consequences and one died. Eight patients were discharged to social service care centres. CONCLUSIONS We believe it is necessary to improve the pediatrician's knowledge of child abuse and to create specialized units.
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Affiliation(s)
- A Sabaté Rotés
- Servicio de Urgencias de Pediatría y Unidad de Atención al Cliente y Trabajo Social, Hospital Universitario Vall d'Hebron, Barcelona, España
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Guenther E, Olsen C, Keenan H, Newberry C, Dean JM, Olson LM. Randomized prospective study to evaluate child abuse documentation in the emergency department. Acad Emerg Med 2009; 16:249-57. [PMID: 19154562 DOI: 10.1111/j.1553-2712.2008.00346.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The objective was to determine whether an educational intervention for health care providers would result in improved documentation of cases of possible physical child abuse in children <36 months old treated in the emergency department (ED) setting. METHODS This study had a statewide group-randomized prospective trial design. Participating EDs were randomized to one of three intervention groups: no intervention, partial intervention, or full intervention. Medical records for children <36 months of age were abstracted before, during, and after the intervention periods for specific documentation elements. The main outcome measure was the change in documentation from baseline. Generalized estimating equations (GEEs) were used to test for intervention effect. RESULTS A total of 1,575 charts from 14 hospitals EDs were abstracted. Hospital and demographic characteristics were similar across intervention groups. There were 922 (59%) injury visits and 653 (41%) noninjury visits. For each specific documentation element, a GEE model gave p-values of >0.2 in independent tests, indicating no evidence of significant change in documentation after the intervention. Even among the 26 charts in which the possibility of physical abuse was noted, documentation remained variable. CONCLUSIONS The educational interventions studied did not improve ED documentation of cases of possible physical child abuse. The need for improved health care provider education in child abuse identification and documentation remains. Future innovative educational studies to improve recognition of abuse are warranted.
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Affiliation(s)
- Elisabeth Guenther
- Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA.
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22
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Abstract
This article provides primary care providers, including pediatric nurse practitioners, with a framework for completing a genitourinary assessment. Many primary care providers are reluctant to examine the genitalia of their patients. Routine genital examinations increase diagnostic skills, provide a baseline for future examinations, may improve parent and child compliance with the examination, and may reveal previously undiscovered anomalies or trauma. An assessment of the reproductive and urologic systems should begin with obtaining a focused history from the parent from birth to present. Techniques for performing a focused genitourinary examination will be discussed.
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Affiliation(s)
- Gail Hornor
- Children's Hospital, Center for Child and Family Advocacy, Columbus, OH 43205, USA.
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23
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Abstract
Pedophilia has become a topic of increased interest, awareness, and concern for both the medical community and the public at large. Increased media exposure, new sexual offender disclosure laws, Web sites that list the names and addresses of convicted sexual offenders, politicians taking a 'get tough' stance on sexual offenders, and increased investigations of sexual acts with children have increased public awareness about pedophilia. Because of this increased awareness, it is important for physicians to understand pedophilia, its rate of occurrence, and the characteristics of pedophiles and sexually abused children. In this article, we address research that defines the various types and categories of pedophilia, review available federal data on child molestation and pornography, and briefly discuss the theories on what makes an individual develop a sexual orientation toward children. This article also examines how researchers determine if someone is a pedophile, potential treatments for pedophiles and sexually abused children, the risk of additional sexual offenses, the effect of mandatory reporting laws on both physicians and pedophiles, and limitations of the current pedophilic literature.
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Affiliation(s)
- Ryan C W Hall
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins Hospital, Baltimore, MD, USA
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24
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Abstract
Incident estimates of sexual abuse in children and adults in the United States range from 6% to 74%, depending on case findings and documentation methods. A past history of abuse can put the patient at risk of developing physical and psychological sequelae including fear of medical procedures. Invasive procedures such as endoscopy and colonoscopy may further exacerbate fears and provoke stress reactions in patients with a past history of abuse. Although patients may not disclose a past history of abuse, their reactions during the procedure may provide cues for the healthcare team. This article reviews the need for a careful assessment and intervention during endoscopy procedures for patients with a past history of abuse. Guidelines for compassionate care and follow-up are discussed.
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Abstract
BACKGROUND Injuries account for an estimated 9% of global mortality. Health professionals worldwide receive little formal injury prevention training, especially in developing countries. OBJECTIVE To identify injury prevention training topics taught in a sample of medical schools throughout the world. DESIGN AND SETTING Cross sectional survey of 82 medical schools from 31 countries. Based on a convenience sample, respondents recalled the injury prevention concepts they were taught, estimated the time dedicated to these topics, specified the courses and rotations where these concepts were taught, and noted whether they were compulsory or elective sessions. PARTICIPANTS Medical students in their last year of medical training. MAIN EXPOSURE MEASURES Student recall of classes and rotations where topics of injury prevention and control were discussed. RESULTS Basic injury prevention concepts including risk factors for injuries and injury classification systems were not covered in 60% of medical schools. Concepts related to child abuse and neglect and emergency care were more commonly taught than others such as traffic injury prevention and youth violence prevention. In general, injury prevention and control concepts were less frequently taught in Middle Eastern and African universities compared with other regions and some topics such as violence prevention were more frequently taught in medical schools in the Americas. Injury prevention concepts were taught most frequently in preventive medicine, forensic medicine, emergency medicine, surgery and pediatrics courses, and rotations. CONCLUSIONS Injury prevention and control education is infrequent and fragmented in medical schools around the world. Inclusion or further development of curricula on this subject could benefit prevention and control efforts.
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Affiliation(s)
- A Villaveces
- Instituto CISALVA, Universidad del Valle, Cali, Colombia.
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26
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Abstract
Many American children and families are affected by child sexual abuse. The diagnosis of sexual abuse is typically made on the basis of the child's history. Objective evidence of sexual abuse, including abnormal physical findings noted on physical examination or the presence of a sexually transmitted disease, are rare. Ano-genital herpes is one of the most common sexually transmitted diseases found in adults. However, is the presence of ano-genital herpes in children evidence of sexual abuse? The link between ano-genital herpes and sexual abuse requires an understanding of viral transmission and typing to properly interpret its significance. Ano-genital herpes in children creates serious medical, social, and legal implications. It is important that primary care providers have an understanding of the appearance, mode of transmission, and diagnostic technique of ano-genital herpes. Implications for practice will provide guidelines for diagnosing, evaluating, and properly managing ano-genital herpes in children.
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Affiliation(s)
- Gail Hornor
- Center for Child and Family Advocacy, 655 E. Livingston Ave., Columbus, OH 43205, USA.
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Abstract
Almost all care managers are mandated reporters and as such they are responsible for reporting suspected cases of child abuse or neglect to state child protective services. Experienced case managers understand that making a call to an abuse hotline does not guarantee that the family or child will get the help that they believe will reduce the child’s risk of abuse. This article addresses legal and policy aspects of reporting child maltreatment and will include an examination of the policies on mandated reporting and professional and legal definitions of abuse. It will define the fundamental elements of parents’ rights and will demonstrate how those rights interface with governments’ responsibilities to protect children. It will also identify ways in which care managers can enhance child risk assessments and the results of reporting suspected child abuse through planning, facilitation, outcome, and professional development.
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Affiliation(s)
- Laura Dreuth Zeman
- School of Social Work, Southern Illinois University, Carbondale 62901, USA.
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28
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Abstract
PURPOSE OF REVIEW Childhood sexual abuse (CSA) is a problem of epidemic proportion affecting children and communities worldwide. This review will examine the most recent published CSA literature emphasizing not only new findings in diagnosis, management, and prevention, but also practice implications for the medical and community-based provider. Sexual assault and rape, though forms of sexual abuse, are broader than the scope of this article and not discussed in detail at this time. RECENT FINDINGS Prevalence rates for CSA are difficult to obtain. To identify populations at greatest risk and tailor treatment and prevention initiatives, consistent methods for defining and reporting cases of CSA are needed. Appreciating the quality and quantity of adverse health outcomes associated with CSA has helped clinicians and community providers expand and develop treatment programs. The physical and psychological late effects of abuse can be permanent and life threatening and the primary care provider should assess for mental health problems as well as physical maladies in all routine examinations. Children do not often disclose experiences of abuse for months to years and caregivers must be cognizant of the medical and behavioral indicators that signal early abuse. Child advocacy centers are community-based programs that incorporate medical, psychological, and legal support services for children and their families. This therapeutic model is based on a multidisciplinary team assessment aimed at decreasing stress, providing adequate protection and services for the child, and optimizing chances for a successful legal outcome. SUMMARY While prevention remains the ultimate goal, improved awareness and education for communities and professionals alike is required to ensure appropriate and quality care for all children who are sexually abused.
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Affiliation(s)
- Mark V Sapp
- Department of Pediatrics, Harvard Medical School, and the Child Protection Program, Children's Hospital Boston, Boston, Massachusetts 02115, USA.
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Li L, Fowler D, Liu L, Ripple MG, Lambros Z, Smialek JE. Investigation of sudden infant deaths in the State of Maryland (1990–2000). Forensic Sci Int 2005; 148:85-92. [PMID: 15639601 DOI: 10.1016/j.forsciint.2004.01.021] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2003] [Accepted: 01/27/2004] [Indexed: 11/30/2022]
Abstract
The Office of the Chief Medical Examiner (OCME) has recorded a significant decline in the deaths of sudden infant death syndrome (SIDS) in the state of Maryland since 1994. However, infants who died of accidental or non-accidental injuries remained consistent during the same time period. This report focuses on the epidemiological characteristics and scene investigation findings of infant victims who died suddenly and unexpectedly in Maryland between 1990 and 2000. A retrospective study of OCME cases between 1990 and 2000 yielded a total of 1619 infant fatalities. 802 infant deaths were determined to be SIDS, which represented 50% of the total infant deaths in our study population. Five hundred and twenty-three (31.8%) deaths were due to natural diseases, 128 (7.9%) deaths were accidents, and 74 (4.6%) were homicides. The manner of death could not be determined after a thorough scene investigation, review of history and a complete postmortem examination in 92 (5.7%) infants. SIDS deaths most often involved infants who were male and black. The peak incidence of SIDS was between 2 and 4 months of age. The majority of SIDS infants (60%) were found unresponsive on their stomach. Among SIDS infants, 269 (33.4%) were found in bed with another person or persons (bed sharing). Of the bed-sharing SIDS cases, 182 (68%) were African-American. In the past 11 years, 52 infants died of asphyxia due to unsafe sleeping environment, such as defective cribs, ill-fitting mattresses, inappropriate bedding materials. Of the 74 homicide victims, 53 (70%) involved infants less than 6 months of age. Twenty (27%) exhibited the classical abuse syndrome characterized by repeated acts of trauma to the infants.
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Affiliation(s)
- Ling Li
- Office of the Chief Medical Examiner, State of Maryland, 111 Penn Street, Baltimore, MD 21201, USA.
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Abstract
CONTEXT Child maltreatment remains a significant public health and social problem in the United States. Incidence data rely on substantiated reports of maltreatment known to official social service agencies. OBJECTIVE The objective of this study was to describe the epidemiologic features of child physical and sexual abuse, on the basis of maternal self-reports. DESIGN, SETTING, AND PARTICIPANTS Computer-assisted, anonymous, cross-sectional, telephone surveys (N = 1435) were conducted with mothers of children 0 to 17 years of age in North and South Carolina. Mothers were asked about potentially abusive behaviors used by either themselves or their husbands or partners in the context of other disciplinary practices. They were also asked about their knowledge of any sexual victimization their children might have experienced. MAIN OUTCOME MEASURES The incidence of physical and sexual maltreatment determined through maternal reports. RESULTS Use of harsh physical discipline, equivalent to physical abuse, occurred with an incidence of 4.3%. Shaking of very young children as a means of discipline occurred among 2.6% of children <2 years of age. Mothers reported more frequent physical discipline of their children, including shaking, for themselves than for fathers or father figures. Nearly 11 of 1000 children were reported by their mothers as having been sexually victimized within the past year. The incidence of physical abuse determined with maternal self-reports was 40 times greater than that of official child physical abuse reports, and the sexual abuse incidence was 15 times greater. For every 1 child who sustains a serious injury as a result of shaking, an estimated 150 children may be shaken and go undetected. There was no statistically significant difference in the overall rates of physical or sexual maltreatment between the 2 states. CONCLUSIONS Official statistics underestimate the burden of child maltreatment. Supplemental data obtained with alternative strategies can assist policymakers and planners in addressing needs and services within communities and states. These data support the need for continued interventions to prevent maltreatment.
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Affiliation(s)
- Adrea D Theodore
- Department of Pediatrics, University of North Carolina, CB 7220, 5th Floor, Bioinformatics Building, Chapel Hill, NC 27599, USA.
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Abstract
This article provides an abbreviated literature review on the role of health care providers in recognizing and reporting child sexual abuse (CSA). Barriers to reporting CSA, data on health care providers' reporting habits, and screening criteria for CSA are also included. Recommendations to enhance recognition of CSA and increase reporting of suspected cases are presented.
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Affiliation(s)
- Shelia Savell
- University of Arkansas for Medical Sciences, Little Rock, USA
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32
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Abstract
Child sexual abuse is a worldwide concern. It is an insidious, persistent, and serious problem that, depending on the population studied and definition used, affects 2-62% of women and 3-16% of men as victims. Pain and tissue injury from child sexual abuse can completely heal in time, but psychological and medical consequences can persist through adulthood. Associated sexually transmitted diseases (such as HIV) and suicide attempts can be fatal. All physicians who treat children should be aware of the manifestations and consequences of child sexual abuse, and should be familiar with normal and abnormal genital and anal anatomy of children. This aim is best accomplished through training and routine examination of the anus and genitalia of children. Because as many as 96% of children assessed for suspected sexual abuse will have normal genital and anal examinations, a forensic interview by a trained professional must be relied on to document suspicion of abuse.
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Affiliation(s)
- Charles Felzen Johnson
- Ohio State University College of Medicine, Child Abuse Program at Children's Hospital, 700 Children's Drive, Columbus, Ohio 43205, USA.
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Affiliation(s)
- Marcellina Mian
- Hospital for Sick Children, University of Toronto, and International Society for Prevention of Child Abuse and Neglect, Toronto, Ontario, Canada.
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34
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Abstract
Sexual abuse is a problem of epidemic proportions in the United States. Given the scope of the problem of sexual abuse and the amount of media attention it receives, it is not unusual for parents or caretakers who witness a child exhibiting sexual behavior to become alarmed. Primary care providers, including pediatric nurse practitioners, may be the first professional parents contact with concerns regarding a child's sexual behavior. It is imperative that primary care providers understand childhood sexuality and respond appropriately when confronted with child sexual behaviors in their practice. Although the literature includes little research on the subject of normal child sexual development, certain guidelines have been identified to describe normal child sexual behaviors and those of concern. Case studies illustrate the response of two primary care providers when they are confronted with sexual behaviors in their patients. Implications for practice are discussed, with examples and guidelines provided for primary care providers to use when evaluating sexual behavior in their pediatric patients.
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Affiliation(s)
- Gail Hornor
- Center for Child and Family Advocacy, Columbus Children's Hospital, Columbus, Ohio 43205, USA.
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