Child sexual abuse evaluations: the scientist-practitioner model

This review presents published data on various aspects of gap junction functioning during development. The process of formation of these junctions and their structure, along with relationships between molecular characteristics of connexins and properties of gap junctions channels are considered in detail. Some newly discovered functions of gap junctions in early embryonic development, their participation in the formation of various cellular compartments and in coordinated behavior are discussed; their relationship with other types of cell interactions is also reviewed. Promising problems for further research are outlined.     

Resident documentation of diagnostic impression in sexual abuse evaluations

In sexual abuse evaluations, the documentation of the examiner's diagnostic impression is essential. If the diagnostic impression is not documented, the examiner will have to rely on memory rather than the medical record when called to testify. The purpose of this study was to determine whether pediatric residents adequately document their diagnostic impression in child sexual abuse evaluations. We performed a three-year retrospective chart review from patients 0-17 years of age who were evaluated at our emergency room for suspected sexual abuse. We reviewed 1,487 charts for historical information, physical findings, and diagnostic impression. Physical findings were categorized as normal, nonspecific, suggestive, or indicative of penetration. In 77% of cases (N = 256) with hymenal findings indicative of penetration and 84% of cases (N = 31) with vaginal findings indicative of penetration, residents recorded no impression or a nonspecific impression. Results were similar for vulvar and rectal findings indicative of penetration. Residents fail to document an adequate interpretation of their physical examinations in sexual abuse evaluations.     

Childhood sexual abuse, stigmatization, internalizing symptoms, and the development of sexual difficulties and dating aggression.

Potential pathways from childhood sexual abuse (CSA) to subsequent romantic intimacy problems were examined in a prospective longitudinal study of 160 ethnically diverse youth with confirmed CSA histories. Participants were interviewed at the time of abuse discovery, when they were 8-15 years of age, and again 1-6 years later. Stigmatization (abuse-specific shame and self-blame) and internalizing symptoms (posttraumatic stress and depressive symptoms), more than abuse severity, explained which youth with CSA histories experienced more sexual difficulties and dating aggression. Stigmatization was found to operate as a predictive mechanism for subsequent sexual difficulties. Internalizing symptoms were not predictive of romantic intimacy problems, although they did show correlational relations with sexual difficulties and dating aggression. Early interventions such as trauma-focused cognitive-behavioral therapy that target stigmatization may be important for preventing the development of sexual difficulties in CSA youth. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Posttraumatic stress symptoms mediate the relation between childhood sexual abuse and nonsuicidal self-injury.

Prior research consistently has shown a strong relation between childhood abuse and nonsuicidal self-injury (NSSI), yet it is unclear why this relation exists. The authors examined 2 specific posttraumatic stress disorder (PTSD) symptom clusters as potential mechanisms through which childhood abuse may be related to NSSI. Participants were 86 adolescents (78% female, 22% male; 73% Caucasian, 27% other races/ethnicities; mean age = 17.03 years, range = 12-19 years) who completed measures of childhood abuse, Diagnostic and Statistical Manual of Mental Disorders (4th ed.) PTSD symptoms, and NSSI. Analyses revealed a significant relation between childhood sexual abuse in particular and the presence and frequency of NSSI. Moreover, data supported a theoretical model in which PTSD reexperiencing and avoidance/numbing symptoms independently mediate this relation. Future research must test the temporal relation between childhood sexual abuse, PTSD symptoms, and NSSI and identify additional pathways to engagement in NSSI. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Childhood sexual abuse, adolescent sexual behaviors and sexual revictimization

OBJECTIVE: The aims of this study were to examine the extent to which exposure to childhood sexual abuse (CSA) was associated with increased rates of sexual risk taking behaviors and sexual revictimization during adolescence. METHOD: A birth cohort of 520 New Zealand born young women was studied at regular intervals from birth to the age of 18. At age 18 retrospective reports of CSA were obtained from sample members. Over the course of the 18 year study information was gathered on: (a) childhood, family, and related circumstances; and (b) the young women's history of sexual experiences from 14 to 18 years. RESULTS: Young women reporting CSA, and particularly severe CSA involving intercourse, had significantly higher rates of early onset consensual sexual activity, teenage pregnancy, multiple sexual partners, unprotected intercourse, sexually transmitted disease, and sexual assault after the age of 16. Logistic regression analyses suggested that the associations between CSA and sexual outcomes in adolescence arose by two routes. First, exposure to CSA was associated with a series of childhood and family factors including social disadvantage, family instability, impaired parent child relationships, and parental adjustment difficulties that were also associated with increased sexual vulnerability in adolescence. Second, there appeared to be a causal chain relationship between CSA and sexual experiences in which CSA was associated with early onset sexual activity which, in turn, led to heightened risks of other adverse outcomes in adolescence. CONCLUSIONS: The findings of this study suggest that those exposed to CSA have greater sexual vulnerability during adolescence. This appears to arise because: (a) the childhood and family factors that are associated with CSA are also associated with increased sexual risks during adolescence; and (b) exposure to CSA may encourage early onset sexual activity which places those exposed to CSA at greater sexual risk over the period of adolescence.     

Care for survivors of childhood sexual abuse

Childhood sexual abuse affects at least 18% of British women but the true figure may be far higher. Repressed memories may resurface at childbirth. Midwives need to be aware of certain behavioural tendencies which may indicate childhood sexual abuse. There are four recognised labour styles which may be adopted by abuse survivors. Extra sensitivity should be used by midwives when caring for a possible abuse survivor. Disclosure of abuse must always come from the client.     

Group treatment for child sexual abuse.

Describes a 12-wk group therapy program used with more than 50 preadolescent children (aged 7–12 yrs) who have experienced intrafamilial sexual abuse. A cotherapy model is used. 90-min group sessions consist of 4 parts: circle time, focused activities, diary time, and snack. Activities are designed to highlight (1) development of trust, cohesiveness, and safety; (2) identification and labeling of feelings; (3) discussion of family relationships and family changes; and (4) exploration of issues associated with the offender. Sessions also examine legal issues and concerns and focus on self-esteem enhancement, social skills development, sex education, prevention of future abuse, and termination issues. (French abstract) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Evaluation of a sexual abuse prevention program for adults with mental retardation

We have measured the Fourier transform spectrum of natural OCS from 3700 to 4800 cm-1 with a near Doppler resolution and a line-position accuracy between 4 and 8 x 10(-5) cm-1. For the normal isotopic species, 37 vibrational transitions have been analyzed for both frequencies and intensities. We also report 15 bands of OC34S, eight bands of O13CS, nine bands of OC33S, and two bands of 18OCS. Important effective Herman-Wallis terms are explained on the basis of eigenvectors. A comparison of different line-pointing programs is also presented. Copyright 1998 Academic Press.     

A relationship between childhood sexual abuse and professional sexual misconduct.

This article identifies specific factors that place therapists at risk for engaging in sexual activity with clients and provides guidelines to minimize the likelihood of such behavior. In a national, randomly drawn sample of 323 mental health practitioners, 3 of 5 men who reported severe childhood sexual abuse and whose psychological symptoms met the criteria for a high degree of psychological distress reported sexual boundary violations with clients. High-risk clinicians should avoid the isolation of private practice, closely monitor their boundaries with clients, obtain ongoing professional supervision, and seek personal psychotherapy to address any remaining abuse-related issues. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Prodromal signs and symptoms of schizophrenic relapse.

Six-week periods prior to 17 psychotic relapses and to 10 relapses characterized by depression and/or hostility were examined for 23 recent-onset schizophrenic outpatients. These prodromal periods were compared with periods that did not precede relapse for the same patients and for 27 schizophrenic patients who did not relapse. The Brief Psychiatric Rating Scale (BPRS) was used to assess symptomatology. Psychotic relapse was defined as an elevation to severe or extremely severe from nonpathological levels on one or more of BPRS items: Hallucinations, Unusual Thought Content, and Conceptual Disorganization. Nonpsychotic relapses were similarly defined using the Depression and Hostility items of the BPRS. Even small elevations in odd thought content, unusual perceptual experiences, depression, somatic concern, and guilt above the levels usually present for a given patient may presage psychotic relapse during the 6 to 8 weeks prior to its occurrence. When compared with nonprodromal periods of other patients, periods before relapse were found to show significantly higher levels of hostility and grandiosity in addition to higher levels of unusual thought content and perceptual abnormalities. For relapses characterized by depression and hostility, an elevation of activation was found in the prodromal period. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Childhood sexual and physical abuse. Incidence in patients with vulvodynia

From December 1994 to November 1995 an unusual accumulation of Listeria infections occurred at the University Hospital Hamburg-Eppendorf, Germany. Eleven immunosuppressed patients from different departments developed septicemia due to Listeria monocytogenes during hospitalization. In a retrospective study, serotyping and pulsed-field gel electrophoresis revealed that six isolates were identical or genetically related. Four of them had been isolated from renal transplant recipients. Listeria monocytogenes was neither detected in food samples of the renal transplantation ward, nor in stool specimens obtained from the ward staff. There had been no close contacts among the infected patients. Before transplantation, the renal transplant recipients had been dialysed in different dialysis centers. Nosocomial foodborne transmission could not be proven but seems likely.     

Children''s refusal of gynecologic examinations for suspected sexual abuse

BACKGROUND: Olfactory dysfunction is a common finding in patients suffering from allergic rhinitis. However, little is known about the pathophysiology underlying this phenomenon and about the time course of hyposmia in seasonal allergy. METHODS: A prospective controlled study was performed on 17 patients with allergic rhinitis to grass pollen in order to evaluate olfactory function in correlation to the duration of allergen exposition, symptoms, eosinophil cationic protein (ECP) in nasal secretions, and nasal volume flow (NVF). Olfactory function was evaluated preseasonally and on days 3, 7, 14, and 21 of the season using a modified Connecticut Chemosensory Clinical Research Center testing procedure for threshold, identification, and discrimination. Twelve volunteers without allergy served as controls. RESULTS: Preseasonally, patients and controls performed equally in discrimination and identification testing, but not in threshold testing. No changes were found in the controls, but a significant decrease in threshold and identification from the 7th day of the season in patients with allergy was noted that was better correlated to ECP than to NVF. NVF was already maximally decreased from the 3rd intraseasonal day with no further changes. ECP increase became significant at day 14. CONCLUSION: Patients with grass pollen allergy develop olfactory dysfunction during natural allergen exposure that might be related to allergic inflammatory mechanisms.     

Nonepileptic seizures and childhood sexual and physical abuse

Nonepileptic seizures (NES) must be distinguished from epilepsy to avoid the adverse effects of unnecessary antiepileptic drugs and to initiate appropriate psychiatric treatment. A higher frequency of prior sexual abuse has been suspected in NES, although no prospective controlled study has compared patients with NES and epilepsy. A series of patients with conversion disorder presenting as epilepsy and 140 patients with complex partial epilepsy (CPE) without evidence of conversion were selected from a series of consecutive admissions to a comprehensive epilepsy center. The groups did not differ with respect to age, years of education, race, or marital status, but the percentage of women was greater in the conversion NES group (73.2%) than in the CPE control group (50.7%; p < 0.002). The frequency of a history of sexual or physical abuse was greater in the NES group (32.4%) than in the CPE controls (8.6%; p < 0.000). Severity of sexual but not physical abuse was significantly greater in the NES group relative to controls (p < 0.05). There was a trend for a closer relationship of the perpetrator of sexual abuse to the victim among the NES patients compared with CPE controls (p < 0.1). These results support the impression that childhood abuse is more common among patients with conversion NES than with epilepsy, and suggests that in some cases childhood abuse may be a contributory pathogenetic factor.     

Differential effects of women's child sexual abuse and subsequent sexual revictimization.

Examines the differential effects of sexual revictimization in a community sample of 248 African-American and White American women (aged 18–36 yrs). Two classifications of sexual revictimization over the life course were used to assess the effects of later sexual and psychological functioning. The findings suggest that unintended pregnancies and abortions were significantly associated with sexual revictimization. Women who reported more than one incident in both childhood and adulthood were also likely to have multiple partnerships and brief sexual relationships. The findings are discussed within the context of the dynamics of sexual revictimization and its effects. Suggestions are offered for therapeutic strategies with survivors in order to minimize the effects of sexual revictimization. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Incidence of Helicobacter pylori infection in Ghanaian patients with dyspeptic symptoms referred for upper gastrointestinal endoscopy

There is a lack of information in the United Kingdom on the prevalence of third molars in older patients. The aim of this study was therefore to define the pattern of lower third molar retention in UK dental practice attenders aged 35 years and over. A random sample of 599 eligible patients from a rural dental practice were included in the study. Information was obtained from clinical notes and panoramic radiographs. Data collected included age, gender, presence or absence of lower third molars, number of teeth present in the lower arch and eruption status. Two hundred and sixty-four (44.1 per cent) had at least one lower third molar present (mean age = 57.1 years) while 335 (55.9 per cent) had no lower third molars (mean age = 50.2 years). The data suggest that a greater proportion of men than women retain at least one lower third molar although this finding was not statistically significant. Seventy per cent of retained lower third molars reported in the study were fully erupted. Sixty per cent were vertically placed. There was an association between age and number of teeth present (chi 2 = 38.85, 4DF, P < 0.05), older patients having fewer lower teeth. These data suggest that a large number of patients can expect to keep their lower third molars beyond the age of 35 years and that in many cases a conservative "wait and see' policy for lower third molars in the early twenties is appropriate.