Child Sexual Abuse in the United States: A Commentary on Current Policy Approaches to Prevention and Aspirations for the Future

Child sexual abuse (CSA) is a significant threat to the health and well-being of children in the United States (US). Public policies are a key public health strategy for the primary prevention of violence, including CSA. In 2021, the Enough Abuse Campaign and Prevent Child Abuse America published a comprehensive report entitled A Call to Action for Policymakers and Advocates: Child Sexual Abuse Prevention Legislation in the States to encourage state leaders to create a comprehensive strategy to prevent CSA in the US. Findings from the report show that the nation has made some effort to address CSA, but more focus needs to be given to primary prevention strategies that stop it from occurring in the first place. The report also illustrates the variability of CSA prevention policies across the US and highlights critical gaps in current approaches that must be addressed. In the spirit of the special issue, the authors reflect on key policy issues in the field, including the lack of a federal policy framework for CSA prevention, dedicated funding for the prevention of CSA, and research on the effectiveness of policies intended to prevent CSA. Suggestions for future directions in relation to policy development provided in this commentary will be useful to a variety of stakeholders interested in the topic of CSA prevention policy.

Disparities Associated with Shared Decision-making in Prostate Cancer Screening

BACKGROUND

Prostate cancer screening guidelines recommend shared decision-making (SDM) regarding prostate-specific antigen (PSA) testing. However, it is unclear who undergoes SDM and whether any disparities exist.

OBJECTIVE

To examine sociodemographic differences in participation of SDM and its association with PSA testing in prostate cancer screening.

DESIGN, SETTING, AND PARTICIPANTS

A retrospective cross-sectional study was conducted among men aged 45-75 yr undergoing PSA screening, using the 2018 National Health Interview Survey database. The evaluated sociodemographic features included age, race, marital status, sexual orientation, smoking status, working status, financial difficulty, US geographic regions, and cancer history. Questions regarding self-reported PSA testing and whether respondents discussed its advantages and disadvantages with their healthcare provider were analyzed.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS

Our primary outcome was to evaluate the possible associations between various sociodemographic factors and undergoing PSA screening and SDM. We used multivariable logistic regression analyses to detect potential associations.

RESULTS AND LIMITATIONS

A total of 59596 men were identified, of whom 5605 answered the question regarding PSA testing, with 2288 (40.6%) undergoing PSA testing. Of these men, 39.5% (n = 2226) discussed the advantages and 25.6% (n = 1434) discussed the disadvantages of PSA testing. On a multivariable analysis, older (odds ratio [OR] 1.092; 95% confidence interval [CI] 1.081-1.103, p < 0.001) and married (OR 1.488; 95% CI 1.287-1.720, p < 0.001) men were more likely to undergo PSA testing. Although Black men were more likely to discuss PSA advantages (OR 1.421; 95% CI 1.150-1.756, p = 0.001) and disadvantages (OR 1.554; 95% CI 1.240-1.947, p < 0.001) than White men, this did not correlate with higher rates of PSA screening (OR 1.086; 95% CI 0.865-1.364, p = 0.477). The lack of important clinical data remains a limitation.

CONCLUSIONS

Overall, SDM rates were low. Older and married men had an increased likelihood of SDM and PSA testing. Despite higher rates of SDM, Black men had similar rates of PSA testing to White men.

PATIENT SUMMARY

We evaluated sociodemographic differences in shared decision-making (SDM) in prostate cancer screening using a large national database. We found that SDM had varying results in different sociodemographic groups.

The effect of intensified illuminance and artificial light at night on fitness and susceptibility to abiotic and biotic stressors

Changing light conditions due to human activities represents an important emerging environmental concern. Although changes to natural light conditions can be independently detrimental, in nature, organisms commonly face multiple stressors. To understand the consequences of altered light conditions, we exposed a model amphibian (wood frog; Lithobates sylvaticus) to a control and two anthropogenic light conditions: intensified daytime illuminance and artificial light at night - ALAN (intensified daytime illuminance + extended photoperiod). We measured (1) metrics of fitness (hatching success as well as survival to, size at, and time to metamorphosis) (2) susceptibility (time to death) to a commonly co-occurring anthropogenic stressor, road salt (NaCl) and (3) susceptibility (infection load) to a common parasite (trematode). We also explored behavioral (swimming activity) and physiological (baseline corticosterone (CORT) release rates) changes induced by these light conditions, which may mediate changes in the other measured parameters. We found that both intensified daytime illuminance and ALAN reduced hatching success. In contrast, for amphibians that successfully hatched, neither treatment affected amphibian survival or time to metamorphosis but individuals exposed to ALAN were larger at metamorphosis. The light treatments also had marginal effects; individuals in ALAN treatments were more susceptible to NaCl and trematodes. Finally, tadpoles exposed to ALAN moved significantly less than tadpoles in the control and intensified daytime illuminance treatments, while light had no effect on CORT release rate. Overall, changes in light conditions, in particular ALAN, significantly impacted an amphibian model in laboratory conditions. This work underscores the importance of considering not only the direct effects of light on fitness metrics but also the indirect effects of light with other abiotic and biotic stressors. Anthropogenic-induced changes to light conditions are expected to continue increasing over time so understanding the diverse consequences of shifting light conditions will be paramount to protecting wildlife populations.

Submarine thermal sprirngs on the galapagos rift

The submarine hydrothermal activity on and near the Galápagos Rift has been explored with the aid of the deep submersible Alvin. Analyses of water samples from hydrothermal vents reveal that hydrothermal activity provides significant or dominant sources and sinks for several components of seawater; studies of conductive and convective heat transfer suggest that two-thirds of the heat lost from new oceanic lithosphere at the Galápagos Rift in the first million years may be vented from thermal springs, predominantly along the axial ridge within the rift valley. The vent areas are populated by animal communities. They appear to utilize chemosynthesis by sulfur-oxidizing bacteria to derive their entire energy supply from reactions between the seawater and the rocks at high temperatures, rather than photosynthesis.

[Microbial processes of the carbon and sulfur cycles in the Chukchi Sea]

The research performed in August 2004 within the framework of the Russian-American Long-term Census of the Arctic (RUSALCA) resulted in the first data concerning the rates of the key microbial processes in the water column and bottom sediments of the Bering strait and the Chukchi Sea. The total bacterial counts in the water column varied from 30 x 10(3) cells ml(-1) in the northern and eastern parts to 245 x 10(3) cells ml(-1) in the southern part. The methane content in the water column of the Chukchi sea varied from 8 nmol CH4 l(-1) in the eastern part of the sea to 31 nmol CH4 l(-1) in the northern part of the Herald Canyon. Active microbial processes occurred in the upper 0-3 cm of the bottom sediments; the methane formation rate varied from 0.25 to 16 nmol CH4 dm(-3) day(-1). The rates of methane oxidation varied from 1.61 to 14.7 nmol CH4 dm(-3) day(-1). The rates of sulfate reduction varied from 1.35 to 16.2 micromol SO4(2-) dm(-3) day(-1). The rate of methane formation in the sediments increased with depth, while sulfate reduction rates decreased (less than 1 micromol SO4(2-) dm(-3) day(-1)). These high concentrations of biogenic elements and high rates of microbial processes in the upper sediment layers suggest a specific type of trophic chain in the Chukchi Sea. The approximate calculated balance of methane emission from the water column into the atmosphere is from 5.4 to 57.3 micromol CH4 m(-2) day(-1).

Detection of Chlamydia trachomatis in an Australian high school student population

OBJECTIVE

To assess the prevalence of Chlamydia trachomatis infections among an Australian high school adolescent population.

METHODS

Over a 4 year period, 14 high schools were selected in which an infertility prevention programme targeting C. trachomatis was delivered to senior student populations. Coded first catch urine specimens were analysed by Amplicor PCR and infected students treated. Data retrospectively obtained from chlamydia screening programmes conducted among disadvantaged young people detached from formal education were also collated for comparison.

RESULTS

Of a total student test population of 1174, 15 (1.3%; 95% CI 0.7% to 2.1%) were diagnosed with C. trachomatis. Of 516 females and 658 males, 12 (2.3%; 95% CI 1.1% to 4.1%) and 3 (0.5%; 95% CI 0.1% to 1.4%) were tested positive respectively. Data collated for three populations of disadvantaged youth returned at total of 89 C. trachomatis infections out of 560 people (15.9% 95%CI 13.0-19.2%).

CONCLUSION

The overall prevalence of C. trachomatis infection among this population of senior high school adolescents is low, and significantly differs from the higher chlamydia rates detected in disadvantaged adolescents detached from formal schooling (p<0.0001).

An admission avoidance team: its role in the Accident & Emergency department

The recent problems and pressures felt by Accident and Emergency departments around the country led a team at Newham Hospital, London, to develop a scheme to prevent frail elderly and vulnerable younger patients being unnecessarily admitted, thus blocking acute hospital beds. This paper outlines the creation of the scheme, its aims and practice, and early results.

Mutant cell lines resistant to azetidine-2-carboxylic acid: alterations in the synthesis of proline from glutamic acid

Two mutant Chinese hamster lung fibroblast lines have been isolated that are resistant to the toxic proline analog L-azetidine-2-carboxylic acid. The line designated AZCA-1 has 30-fold elevated activity of pyrroline-5-carboxylate synthase and a large increase in the rate of proline production and release compared to controls. Pyrroline-5-carboxylate synthase activity is not elevated in the resistant line designated AZCA-4, but the enzyme is less sensitive to inhibition by ornithine and proline than control enzyme. Intracellular proline is elevated in AZCA-4 cells, with no change in the rate of release of proline synthesized from glutamate. Resistance to azetidine carboxylic acid in both mutant lines is attributed to the expanded intracellular proline pool that results from alterations in pyrroline-5-carboxylate synthase. These results indicate that intracellular proline levels are determined at least in part by the regulated activity of pyrroline-5-carboxylate synthase.