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Tate AR, Fisher-Owens SA, Spiller L, Muhlbauer J, Lukefahr JL. Oral and Dental Aspects of Child Abuse and Neglect: Clinical Report. Pediatrics 2024; 154:e2024068024. [PMID: 39155729 DOI: 10.1542/peds.2024-068024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2024] [Revised: 06/21/2024] [Accepted: 06/24/2024] [Indexed: 08/20/2024] Open
Abstract
In all 50 states, the District of Columbia, and the Commonwealth of Puerto Rico, pediatricians, dental professionals, and other physicians are mandated to report suspected cases of abuse and neglect to social service or law enforcement agencies. The purpose of this clinical report is to review the oral aspects of abuse and dental neglect in children and the role of pediatricians, dental professionals, and other physicians in evaluating such conditions. This clinical report addresses recommendations on the evaluation of bite marks, as well as perioral and intraoral injuries, infections, and diseases that may raise suspicion for child abuse or neglect. Some physicians may have received less education pertaining to oral health, dental injury, and oral disease. These physicians may not detect the mouth and gum findings possibly related to abuse or neglect as readily as abuse injuries involving other areas of the body. Therefore, pediatricians, dental professionals, and other physicians are encouraged to collaborate to increase the prevention, detection, and treatment of these conditions in children.
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Affiliation(s)
- Anupama Rao Tate
- Division of Oral Health, Children's National Hospital, and Department of Pediatrics, George Washington Medical School, Washington, District of Columbia
| | - Susan A Fisher-Owens
- Departments of Pediatrics and Preventive and Restorative Dental Sciences, University of California, San Francisco, San Francisco, California
| | - Lora Spiller
- Division of Child Abuse Pediatrics, Department of Pediatrics, University of Texas Health San Antonio, San Antonio, Texas
| | | | - James L Lukefahr
- Division of Child Abuse Pediatrics, Department of Pediatrics, University of Texas Health San Antonio, San Antonio, Texas
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Johnston AW, Hensel DJ, Roth JD, Wiener JS, Misseri R, Szymanski KM. Prevalence of sexual abuse and intimate partner violence in adults with spina bifida. Disabil Health J 2024; 17:101617. [PMID: 38531731 DOI: 10.1016/j.dhjo.2024.101617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 03/12/2024] [Accepted: 03/19/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND People with disabilities and chronic medical conditions are known to be at higher risk of sexual abuse (SA) and intimate partner violence (IPV). People with spina bifida (SB) are vulnerable, but little is known about the prevalence of abuse in this population. OBJECTIVE To evaluate the prevalence and risk factors of SA and IPV in adults with SB. METHODS An anonymous international cross-sectional online survey of adults with SB asked about history of SA ("sexual contact that you did not want") and IPV ("hit, slapped, kicked, punched or hurt physically by a partner"). RESULTS Median age of the 405 participants (61% female) was 35 years. Most self-identified as heterosexual (85%) and were in a romantic relationship (66%). A total of 19% reported a history of SA (78% no SA, 3% preferred not to answer). SA was more frequently reported by women compared to men (27% vs. 5%, p < 0.001) and non-heterosexual adults compared to heterosexuals (41% vs. 15%, p < 0.001). Twelve percent reported a history of IPV (86% no IPV, 2% preferred not to answer). IPV was more frequently reported by women compared to men (14% vs. 9%, p = 0.02), non-heterosexuals compared to heterosexuals (26% vs. 10%, p = 0.002), and adults with a history of sexual activity versus those without (14% vs. 2%, p = 0.01). CONCLUSION People with SB are subjected to SA and IPV. Women and non-heterosexuals are at higher risk of both.
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Affiliation(s)
- Ashley W Johnston
- Division of Pediatric Urology, Riley Hospital for Children, 705 Riley Hospital Drive, Indianapolis, IN, 46202, USA
| | - Devon J Hensel
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Joshua D Roth
- Division of Pediatric Urology, Riley Hospital for Children, 705 Riley Hospital Drive, Indianapolis, IN, 46202, USA
| | - John S Wiener
- Division of Pediatric Urology, Duke University Medical Center, Durham, NC, USA
| | - Rosalia Misseri
- Division of Pediatric Urology, Riley Hospital for Children, 705 Riley Hospital Drive, Indianapolis, IN, 46202, USA
| | - Konrad M Szymanski
- Division of Pediatric Urology, Riley Hospital for Children, 705 Riley Hospital Drive, Indianapolis, IN, 46202, USA.
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Bailey C, Shaw J, Harris A. Adolescents and sexual assault: A critical integrative review. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2024; 73:337-359. [PMID: 38303610 DOI: 10.1002/ajcp.12740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 12/19/2023] [Accepted: 01/03/2024] [Indexed: 02/03/2024]
Abstract
Adolescents are sexually assaulted at remarkably high rates. Adolescents are also unique given the specific dynamics of adolescent sexual assault, their current stage in human development, their limited legal standing and rights, and their experiences navigating postassault services and resources. While literature exists within each of these domains, it is somewhat disconnected and overlooks how adolescents are often relegated to the margins in research and practice. The purpose of this integrative review is to (1) provide a more complete understanding of adolescent sexual assault and survivors' nuanced needs; (2) frame adolescent survivors as a too-often-overlooked oppressed group that researchers and responders must consider and center in their work, lest contribute to their further marginalization; and (3) inspire and orient social justice-minded scholar activists to various action steps to take to center and prioritize adolescents in research and practice. Through our intersectional feminist approach, we offer specific action steps for social justice-minded scholar activists to recenter adolescents in their research and practice.
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Affiliation(s)
- Caroline Bailey
- Department of Psychology, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Jessica Shaw
- Department of Psychology, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Abril Harris
- School of Social Work, University of Washington, Seattle, Washington, USA
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Mora-Theuer EA, Klomfar S, Ramazanova D, Grylli C, Kletecka-Pulker M, Völkl-Kernstock S, Otterman G, Simon J, Greber-Platzer S. Cohort analysis of child abuse and neglect cases treated during the initial 2 years of a programme to support hospital-based child protection work in Austria. BMJ Open 2023; 13:e071536. [PMID: 37451739 PMCID: PMC10351272 DOI: 10.1136/bmjopen-2022-071536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 06/09/2023] [Indexed: 07/18/2023] Open
Abstract
OBJECTIVE To describe characteristics of suspected child abuse and neglect (CAN) cases associated with the decision of paediatric departments (PDs) in Vienna, Austria, to involve services of a regional tertiary child protection service programme (Forensische Kinder- und JugendUntersuchungsStelle, FOKUS). DESIGN Retrospective cohort analysis of a regional data collection of CAN cases over the first 2 years of FOKUS's operational period (1 July 2015-30 June 2017). SETTING All CAN cases reported to the PDs of six public hospitals in Vienna. Five of these public hospitals were secondary heath care centres and one was a tertiary healthcare centre. RESULTS Overall, 231 cases (59.1%) were treated without and 160 (40.9%) with additional involvement of the FOKUS service programme. The odds of a case to be treated without FOKUS involvement were higher if neglect was suspected (OR 3.233, 95% CI 2.024 to 5.279). In contrast, when sexual abuse was suspected, the odds for involvement with FOKUS were significantly higher (OR 7.577, 95% CI 4.580 to 12.879). The odds of being managed with FOKUS services nearly doubled when multiple forms of abuse were suspected (OR 1.926, 95% CI 1.136 to 3.285). The odds for additional FOKUS involvement were significantly lower for patients treated as inpatients (OR 0.239, 95% CI 0.151 to 0.373). CAN patients managed with FOKUS involvement were significantly more often reported to law enforcement (LE) (OR 3.234, 95% CI 2.078 to 5.002). Concurrently, suspected sexual abuse cases and cases reported to LE were more frequently treated in the PD of the tertiary centre than in other PDs (χ2 p<0.001). CONCLUSION CAN case characteristics significantly influenced if PDs involved a tertiary child protection programme. Suspected sexual abuse, if more than one form of CAN was suspected and cases reported to LE required additional specialist expertise. For suspected neglect involvement of tertiary services seemed less important.
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Affiliation(s)
- Eva Anna Mora-Theuer
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Sophie Klomfar
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Dariga Ramazanova
- Center for Medical Data Science, Medical University of Vienna, Vienna, Austria
| | - Chryssa Grylli
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Maria Kletecka-Pulker
- Ludwig Boltzmann Institute for Digital Health and Patient Safety, Medical University of Vienna, Vienna, Austria
| | - Sabine Völkl-Kernstock
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Gabriel Otterman
- Department of Biomedical and Clinical Sciences, Linköping University, Linkoping, Sweden
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Judit Simon
- Department of Health Economics, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - Susanne Greber-Platzer
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
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Bailey C, Shaw J, Harris A. Mandatory Reporting and Adolescent Sexual Assault. TRAUMA, VIOLENCE & ABUSE 2023; 24:454-467. [PMID: 34238071 DOI: 10.1177/15248380211030239] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Adolescents experience alarmingly high rates of sexual violence, higher than any other age-group. This is concerning as sexual violence can have detrimental effects on teens' personal and relational well-being, causing long-term consequences for the survivor. Still, adolescents are hesitant to report the assault or seek out services and resources. When an adolescent survivor does seek out services, they may interact with a provider who is a mandatory reporter. This scoping review sought to synthesize the current U.S.-based research on the role, challenges, and impact of mandatory reporting (MR) in the context of adolescent sexual assault. Database searches using key words related to MR, sexual assault, and adolescence identified 29 peer-reviewed articles. However, none of these articles reported on empirical investigations of the phenomenon of interest and instead consisted of case studies, commentaries, and position papers. The scoping review was expanded to provide a lay of the land of what we know about the intersection of adolescent sexual assault and MR. Results of the review indicate that though implemented broadly, MR policies vary between individuals, organizations, and states and have historically been challenging to implement due to this variation, conflicts with other laws, tension between these policies and providers' values, and other factors. Based on the available literature, the impact of MR in the context of adolescent sexual assault is unknown. There is a critical need for research and evaluation on the implementation and impact of MR policies, especially in the context of adolescents and sexual violence.
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Affiliation(s)
- Caroline Bailey
- Department of Psychology, University of Illinois at Chicago, IL, USA
| | - Jessica Shaw
- Department of Psychology, University of Illinois at Chicago, IL, USA
| | - Abril Harris
- School of Social Work, Boston College, Chestnut Hill, MA, USA
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Sexual violence experiences among adolescent and young adult males: a review to empower healthcare providers. Curr Opin Pediatr 2022; 34:297-305. [PMID: 35836391 DOI: 10.1097/mop.0000000000001124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Despite 3-17% of adolescent and young adult males (AYAMs) experiencing sexual violence, there is a paucity of information regarding their sexual violence experiences leaving them vulnerable to dangerous and detrimental sequelae. RECENT FINDINGS There is underreporting and under-discussion of AYAMs' experiences of sexual violence, with disclosure influenced by societal perceptions of male sexuality, shame, and fear of discrimination. AYAMs experience sexual violence from individuals known to them, with many experiencing physical violence, threats, coercion, and electronic harassment. Intersectionality, previous traumas, inappropriate childhood exposures to sexually explicit situations, select online media consumption, and adverse childhood experiences (ACEs) increase the risk of sexual violence. AYAMs who experience sexual violence are at increased risk of re-victimization, perpetrating sexual violence, experiencing bodily harm, contracting sexually transmitted infections (STIs), and experiencing internalizing and externalizing symptoms, which can lead to significant morbidity and mortality. Research on male-specific protective and resilience factors is scarce and represents an ongoing need. SUMMARY After reviewing AYAMs' experiences of sexual violence, including risk and protective factors, media influences, detrimental sequelae, and resilience factors, we provide a screening framework to empower the healthcare provider (HCP) to champion tailored prevention, screening, intervention, and advocacy efforts to support AYAMs.
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Balint N, David M, Fegert JM, Fryszer LA, Helling-Bakki A, Herrmann B, Hirchenhain C, Schmidt U, Winter SM. Statement of the DGGG - Recommendations on the Care and Support of Female Minors Suspected of Having Been Subjected to Acute Sexual Violence or Rape. Geburtshilfe Frauenheilkd 2022; 82:694-705. [PMID: 35815100 PMCID: PMC9262634 DOI: 10.1055/a-1860-0562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 05/22/2022] [Indexed: 11/07/2022] Open
Abstract
Ziele Die vorgelegten Empfehlungen sollen zur weiteren Verbesserung und Standardisierung der ärztlichen Versorgung von Betroffenen sexualisierter Gewalt, insbes. von einer Vergewaltigung betroffenen weiblichen Minderjährigen in Deutschland beitragen. Sie wendet sich vor allem an Frauenärztinnen und Frauenärzte in der Klinik und in der Niederlassung und ergänzt die umfangreiche Kinderschutzleitlinie der Bundesrepublik Deutschland. Methoden Unter Einbeziehung der Ergebnisse einer umfassenden selektiven Literaturrecherche wurden von einer interdisziplinär besetzten Gruppe von Expertinnen und Experten in einem 3-stufigen Verfahren im Auftrag des Vorstands der DGGG diese Empfehlungen erarbeitet und im Konsens verabschiedet. Zusammenfassung Diese DGGG-Stellungnahme ist entsprechend dem Alter der Betroffenen (ca. 14 bis 17 Jahre/pubertär; 0 bis ca. 13 Jahre/präpubertär) zweigeteilt. Dies hat medizinische, strukturelle und forensische Gründe. Es werden zahlreiche Empfehlungen zum Umgang mit den mutmaßlich von akuter sexualisierter Gewalt bzw. einer Vergewaltigung betroffenen Minderjährigen, zur Erstversorgung, zu Versorgungsformen (z. B. Vertrauliche Spurensicherung), zur Anamneseerhebung, zur medizinisch-forensischen Untersuchung, zur medizinischen, psychischen und psychosozialen Versorgung sowie zur Nachbetreuung gegeben.
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Affiliation(s)
- Nicole Balint
- Klinik für Gynäkologie, Campus Virchow-Klinikum, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Matthias David
- Klinik für Gynäkologie, Campus Virchow-Klinikum, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Jörg M. Fegert
- Klinik für Kinder- und Jugendpsychiatrie/Psychotherapie, Universitätsklinikum Ulm, Ulm, Germany
| | - Lina Ana Fryszer
- Klinik für Gynäkologie mit Brustzentrum, Campus Charité Mitte, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Astrid Helling-Bakki
- World Childhood Foundation (Deutschland), Stiftung für hilfsbedürftige Kinder, Geschäftsführung, Stuttgart, Germany
| | - Bernd Herrmann
- Ärztliche Kinderschutzambulanz, Klinik für Neonatologie und allgemeine Pädiatrie, Klinikum Kassel, Kassel, Germany
| | - Christine Hirchenhain
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden,
Germany
| | - Ulrike Schmidt
- Institut für Rechtsmedizin, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg, Germany
| | - Sibylle Maria Winter
- Klinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes- und Jugendalters, Campus Virchow-Klinikum, Charité – Universitätsmedizin Berlin, Childhood-Haus Berlin,
Berlin, Germany
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Viana VAO, Madeiro AP, Mascarenhas MDM, Rodrigues MTP. Temporal trend of sexual violence against adolescent women in Brazil, 2011-2018. CIENCIA & SAUDE COLETIVA 2022; 27:2363-2371. [PMID: 35649023 DOI: 10.1590/1413-81232022276.14992021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 11/03/2021] [Indexed: 11/21/2022] Open
Abstract
This study aimed to analyze the temporal trend of sexual violence (SV) reports against adolescent women in Brazil from 2011 to 2018. An ecological time series study was performed on reports of SV against women aged 10 to 19, which were available in the National Notifiable Diseases Reporting System (SINAN). Data were collected in 2020 but are related to reports filed from 2011 to 2018. The Prais-Winsten linear regression model was applied to analyze the time trend, including a calculation of the annual percentage variation (APC) and 95% confidence intervals (95%CI). We found a significant trend increase in all Brazilian regions. Although the rates in the Northern region are higher at the beginning and at the end of the analyzed time period, the reporting rates of the Southeast (APC 14.56%; 95%CI 7.98;21.54) and the South (APC 14.19%; 95%CI 6.56;22.36) showed a greater increase. The increase of SV reports in recent years shows how vulnerable adolescent women are to this type of violence, but also indicates greater improvement of violence surveillance systems. We conclude that both reporting systems and public policies aimed at tackling SV against women need to be further developed.
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Affiliation(s)
- Vera Alice Oliveira Viana
- Programa de Pós-Graduação em Saúde e Comunidade, Universidade Federal do Piauí. Av. Frei Serafim 2280, Centro. 64000-020 Teresina PI Brasil.
| | - Alberto Pereira Madeiro
- Programa de Pós-Graduação em Saúde e Comunidade, Universidade Federal do Piauí. Av. Frei Serafim 2280, Centro. 64000-020 Teresina PI Brasil.
| | - Márcio Dênis Medeiros Mascarenhas
- Programa de Pós-Graduação em Saúde e Comunidade, Centro de Inteligência e Agravos Tropicais, Emergentes e Negligenciados. Teresina PI Brasil
| | - Malvina Thaís Pacheco Rodrigues
- Programa de Pós-Graduação em Saúde e Comunidade, Centro de Inteligência e Agravos Tropicais, Emergentes e Negligenciados. Teresina PI Brasil
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093 Sexual abuse in childhood and adolescence. Eur J Obstet Gynecol Reprod Biol 2022. [DOI: 10.1016/j.ejogrb.2022.02.122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Rahnavardi M, Shahali S, Montazeri A, Ahmadi F. Health care providers' responses to sexually abused children and adolescents: a systematic review. BMC Health Serv Res 2022; 22:441. [PMID: 35379242 PMCID: PMC8981665 DOI: 10.1186/s12913-022-07814-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 03/21/2022] [Indexed: 11/25/2022] Open
Abstract
Background Sexual abuse of children and adolescents is a significant health concern worldwide. Appropriate and timely health services for victims can prevent severe and long-term consequences. This study identified and categorized diagnostic and treatment services needed for sexually abused children and adolescents. Methods Several databases, including MEDLINE, Web of Science, Scopus, Science Direct, ProQuest, and Google Scholar, were searched to retrieve studies on the topic and clinical guidelines in English covering the literature from 2010 to 2020 using search terms. Primary studies and guidelines were reviewed to identify treatment strategies and medical interventions related to sexually abused children and adolescents. Results Twenty-one studies and guidelines were selected and analyzed narratively. The quality of evidence was relatively good. We identified that effective health care systems for sexually abused children include the following: interview and obtain medical history, physical and anogenital examination, collecting forensic and DNA evidence, documenting all the findings, prevention and termination of pregnancy, diagnostic tests, prophylaxis for HIV and other STIs, vaccinations, and psychological intervention. Conclusions This review provides up-to-date evidence about adequate health care services for children and adolescent victims of sexual abuse. We conclude that recent studies have focused more on prophylaxis against HIV and other STIs, studies on vaccinating against HPV for victims are still limited, and future research in this area is needed. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07814-9.
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Affiliation(s)
- Mona Rahnavardi
- Department of Reproductive Health and Midwifery, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Shadab Shahali
- Department of Reproductive Health and Midwifery, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran.
| | - Ali Montazeri
- Health Metrics Research Center, Institute for Health Sciences Research, ACECR, Tehran, Iran.,Faculty of Humanity Sciences, University of Science &Culture, Tehran, Iran
| | - Fazlollah Ahmadi
- Department of Nursing, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
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Barbara G, Albertini V, Tagi VM, Maggioni L, Gorio MC, Cattaneo C, Parazzini F, Ricci E, Buggio L, Kustermann A. Characteristics of Sexual Violence Against Adolescent Girls: A 10 Years' Retrospective Study of 731 Sexually Abused Adolescents. Int J Womens Health 2022; 14:311-321. [PMID: 35273451 PMCID: PMC8901429 DOI: 10.2147/ijwh.s343935] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 02/04/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction Sexual violence against young girls is a pervasive multifaceted phenomenon which embraces several different forced sexual acts, including attempted and/or completed rape, sexual coercion and harassment, and sexual contact with force or threat of force. The aim of this study is to evaluate the characteristics of sexual violence in adolescent girls, by a retrospective analysis of 731 consecutive cases of sexually abused girls. Materials and Methods We analyzed demographic characteristics, risk factors for rape, and the eventual subsequent presence and type of ano-genital lesions. Results We found that sexual violence with penetration was perpetrated in 591 (80%) cases. Vulnerability factors related with a major risk of rape were age >17 years old and consumption of alcohol and/or other drugs. About 196 (55%) victims had at a least one genital lesion. Conclusion A prompt identification of red flags of sexual violence may help physicians in suspecting and managing cases of sexual assault in adolescent girls, even in the absence of typical lesions.
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Affiliation(s)
- Giussy Barbara
- Gynecological Unit and SVSeD, Service for Sexual and Domestic Violence, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Valentina Albertini
- Department of Emergencies, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | | | - Lidia Maggioni
- Department of Biomedical Science, Legal Medicine Section, University of Milan, Milan, Italy
| | - Maria Carlotta Gorio
- Department of Clinical and Biomedical Sciences Luigi Sacco, University of Milan, Milan, Italy
| | - Cristina Cattaneo
- Department of Biomedical Science, Legal Medicine Section, University of Milan, Milan, Italy
| | - Fabio Parazzini
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Elena Ricci
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Laura Buggio
- Gynecological Unit and SVSeD, Service for Sexual and Domestic Violence, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alessandra Kustermann
- Gynecological Unit and SVSeD, Service for Sexual and Domestic Violence, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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Torres ASB, Teixeira AL, Côrtes MTF, Alves ÂC, Alabarse O, Azevedo RCSD, Fernandes A. Sexual Violence Suffered by Women in Early and Late Adolescence: Care Provided and Follow-Up. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRICIA : REVISTA DA FEDERACAO BRASILEIRA DAS SOCIEDADES DE GINECOLOGIA E OBSTETRICIA 2022; 44:667-677. [PMID: 35276748 PMCID: PMC10032055 DOI: 10.1055/s-0042-1743094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To compare the sexual violence suffered by women in early and late adolescence, the reactions triggered after the aggression, and the care provided. METHODS A retrospective study in which we reviewed the medical records of 521 female adolescents treated by a multidisciplinary team at a reference hospital in the city of Campinas, state of São Paulo, Brazil. We analyzed sociodemographic variables, and those pertainin to the characteristics of the episodes of violence, the emergency care, and the physical and psychological reactions observed during the follow-up. For the analysis, the sample was divided into groups of early (10 to 14 years) and late (15 to 18 years) adolescence. We used the Chi-squared/Fisher Exact, Mann-Whitney, and Kruskal-Wallis tests to compare the groups; the level of significance adopted was 5%. RESULTS The early group (n = 242) contained more adolescents who were enrolled in school (p < 0.001), suffered more daytime aggressions (p = 0.031), in their residences (p < 0.001), by an aggressor with whom they were acquainted (p < 0.001), had greater need of legal protection (p = 0.001), and took longer to seek care (p = 0.048). Feelings of guilt, shame, and the perception of violence were similar between the groups. In the late group (n = 279), there was greater consumption of alcohol during the aggression (p = 0,005); they received significantly more prophylaxis treatments; reported more physical symptoms (p = 0.033), sleep disorders (p = 0.003), symptoms of anxiety (p = 0.045), and feelings of anguish (p = 0.011); and had more prescriptions of psychotropics (p = 0.005). Only 52% completed the 6-month follow-up, with no differences between the groups. CONCLUSION The age groups showed differences in the characteristics of the episodes of violence; early adolescents took longer to seek help, and the late group presented more intense symptoms and psychological worsening during the follow-up. Measures of prevention and specific care aimed at this population are needed.
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Affiliation(s)
- Alejandra Suyapa Becerra Torres
- Department of Gynecology and Obstetrics, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brazil
| | - Ana Luiza Teixeira
- Department of Gynecology and Obstetrics, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brazil
| | - Maria Teresa Ferreira Côrtes
- Department of Gynecology and Obstetrics, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brazil
| | - Ândria Cléia Alves
- Department of Gynecology and Obstetrics, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brazil
| | - Otávio Alabarse
- Department of Gynecology and Obstetrics, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brazil
| | - Renata Cruz Soares de Azevedo
- Department of Gynecology and Obstetrics, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brazil
| | - Arlete Fernandes
- Department of Gynecology and Obstetrics, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brazil
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A Standardized Peer Review Program Improves Assessment and Documentation of Child Sexual Abuse. Pediatr Qual Saf 2022; 7:e522. [PMID: 35071959 PMCID: PMC8782112 DOI: 10.1097/pq9.0000000000000522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 09/29/2021] [Indexed: 11/26/2022] Open
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Souza VPD, Perrelli JGA, Brandão Neto W, Pereira MBFLDO, Guedes TG, Monteiro EMLM. CONSTRUÇÃO E VALIDAÇÃO DE VÍDEO EDUCACIONAL PARA PREVENÇÃO DA VIOLÊNCIA SEXUAL DE ADOLESCENTES. TEXTO & CONTEXTO ENFERMAGEM 2022. [DOI: 10.1590/1980-265x-tce-2021-0171pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
RESUMO Objetivo: avaliar o processo de construção e validação de um vídeo educacional para prevenção da violência sexual em adolescentes em idade escolar. Métodos: trata-se de um estudo metodológico, desenvolvido durante o período de setembro de 2018 a fevereiro de 2021 em Recife-PE. Foi realizada a produção de vídeo educacional de acordo com a trajetória metodológica proposta por Kindem e Musberg. O vídeo foi submetido a validação de conteúdo e avaliação de aparência, por juízes especialistas e adolescentes em idade escolar, respectivamente. Na análise dos dados, utilizou-se frequência absoluta, índice de validade de conteúdo e teste binomial. Resultados: na validação de conteúdo, a concordância foi satisfatória e a média do índice de validade para todos os itens do vídeo foi de 0,92. Na avaliação de aparência, os adolescentes consideraram o vídeo compreensível, com nível de concordância mínima de 92,3%. Conclusão: o vídeo educacional construído foi considerado válido por juízes, para contribuir no conhecimento e atitude de adolescentes em idade escolar sobre a prevenção da violência sexual.
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Souza VPD, Perrelli JGA, Brandão Neto W, Pereira MBFLDO, Guedes TG, Monteiro EMLM. ELABORATION AND VALIDATION OF AN EDUCATIONAL VIDEO FOR THE PREVENTION OF SEXUAL VIOLENCE IN ADOLESCENTS. TEXTO & CONTEXTO ENFERMAGEM 2022. [DOI: 10.1590/1980-265x-tce-2021-0171en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Objective: to evaluate the elaboration and validation process of an educational video for the prevention of sexual violence in school-age adolescents. Method: this is a methodological study, developed from September 2018 to February 2021 in Recife-PE. Production of the educational video was carried out according to the methodological path proposed by Kindem and Musberg. The video was submitted to content validation and face evaluation by expert judges and school-age adolescents, respectively. In the data analysis, absolute frequency, Content Validity Index and binomial test were used. Results: in content validation, agreement was satisfactory and the mean validity index for all video items was 0.92. In the face evaluation, the adolescents considered the video understandable, with a minimum agreement level of 92.3%. Conclusion: the educational video elaborated was considered by the judges as valid to contribute to the knowledge and attitude of school-age adolescents regarding the prevention of sexual violence.
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Hsu KK, Rakhmanina NY. Adolescents and Young Adults: The Pediatrician's Role in HIV Testing and Pre- and Postexposure HIV Prophylaxis. Pediatrics 2022; 149:183848. [PMID: 34972226 PMCID: PMC9645702 DOI: 10.1542/peds.2021-055207] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Most sexually active youth in the United States do not believe that they are at risk for contracting HIV and have never been tested. Creating safe environments that promote confidentiality and respect, obtaining an accurate sexual and reproductive health assessment, and providing nonstigmatizing risk counseling are key components of any youth encounters. Pediatricians can play a key role in preventing and controlling HIV infection by promoting risk-reduction counseling and offering routine HIV testing and prophylaxis to adolescent and young adult (youth) patients. In light of persistently high numbers of people living with HIV in the United States and documented missed opportunities for HIV testing, the Centers for Disease Control and Prevention and the US Preventive Services Task Force recommend universal and routine HIV screening among US populations, including youth. Recent advances in HIV diagnostics, treatment, and prevention help support this recommendation. This clinical report reviews epidemiological data and recommends that routine HIV screening be offered to all youth 15 years or older, at least once, in health care settings. After initial screening, youth at increased risk, including those who are sexually active, should be rescreened at least annually, and potentially as frequently as every 3 to 6 months if at high risk (male youth reporting male sexual contact, active injection drug users, transgender youth; youth having sexual partners who are HIV-infected, of both genders, or injection drug users; youth exchanging sex for drugs or money; or youth who have had a diagnosis of or have requested testing for other sexually transmitted infections). Youth at substantial risk for HIV acquisition should be routinely offered HIV preexposure prophylaxis, and HIV postexposure prophylaxis is also indicated after high-risk exposures. This clinical report also addresses consent, confidentiality, and coverage issues that pediatricians face in promoting routine HIV testing and HIV prophylaxis for their patients.
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Affiliation(s)
- Katherine K Hsu
- Division of STD Prevention and HIV/AIDS Surveillance, Massachusetts Department of Public Health, Jamaica Plain, Massachusetts,Section of Pediatric Infectious Diseases, Boston University Medical Center, Boston, Massachusetts,Address correspondence to Katherine K. Hsu, MD, MPH, FAAP. E-mail:
| | - Natella Yurievna Rakhmanina
- Children’s National Hospital, School of Medicine and Health Sciences, The George Washington University, Washington, DC,Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC
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Wiener SJ, Fitzgerald S, Einhorn H. A trauma-informed guide to caring for adolescents following sexual assault. Curr Opin Pediatr 2021; 33:354-360. [PMID: 34039900 DOI: 10.1097/mop.0000000000001030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Sexual assault is common among adolescents worldwide. Survivors of sexual assault may experience various immediate and long-term effects on their physical and mental health. It is important that pediatric healthcare providers (HCPs) are aware of the high prevalence of sexual assault and recognize the impact on their adolescent patients. The aim of this update is to discuss how pediatric HCPs can embody a trauma-informed approach when caring for survivors of sexual assault across various settings. RECENT FINDINGS All adolescent patients should be screened for sexual assault during routine clinical visits; in responding to a disclosure, providers should exhibit compassion, express validation, and help connect the patient to resources to aid in healing. Caring for survivors of sexual assault should ideally be multidisciplinary, involving treatment of the medical complications (including the possibility of pregnancy or infection) and mental health sequelae (including increased likelihood of depression, posttraumatic symptoms, and suicidality). SUMMARY A trauma-informed approach can be applied to all aspects of caring for survivors of sexual assault, from screening for sexual assault and responding to disclosure, to providing acute and longitudinal care following sexual assault.
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Affiliation(s)
- Susan J Wiener
- Division of Adolescent/Young Adult Medicine, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
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18
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Houtrow A, Elias ER, Davis BE. Promoting Healthy Sexuality for Children and Adolescents With Disabilities. Pediatrics 2021; 148:peds.2021-052043. [PMID: 34183359 DOI: 10.1542/peds.2021-052043] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
This clinical report updates a 2006 report from the American Academy of Pediatrics titled "Sexuality of Children and Adolescents With Developmental Disabilities." The development of a healthy sexuality best occurs through appropriate education, absence of coercion and violence, and developmental acquisition of skills to navigate feelings, desires, relationships, and social pressures. Pediatric health care providers are important resources for anticipatory guidance and education for all children and youth as they understand their changing bodies, feelings, and behaviors. Yet, youth with disabilities and their families report inadequate education and guidance from pediatricians regarding sexual health development. In the decade since the original clinical report was published, there have been many advancements in the understanding and care of children and youth with disabilities, in part because of an increased prevalence and breadth of autism spectrum disorder as well as an increased longevity of individuals with medically complex and severely disabling conditions. During this same time frame, sexual education in US public schools has diminished, and there is emerging evidence that the attitudes and beliefs of all youth (with and without disability) about sex and sexuality are being formed through media rather than formal education or parent and/or health care provider sources. This report aims to provide the pediatric health care provider with resources and tools for clinical practice to address the sexual development of children and youth with disabilities. The report emphasizes strategies to promote competence in achieving a healthy sexuality regardless of physical, cognitive, or socioemotional limitations.
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Affiliation(s)
- Amy Houtrow
- Division of Pediatric Rehabilitation Medicine, Department of Physical Medicine and Rehabilitation, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania;
| | - Ellen Roy Elias
- School of Medicine, University of Colorado and Special Care Clinic, Children's Hospital Colorado, Aurora, Colorado
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19
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Child Maltreatment and Neglect. Emerg Med Clin North Am 2021; 39:589-603. [PMID: 34215404 DOI: 10.1016/j.emc.2021.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Emergency medicine clinicians are mandated reporters, legally, which obligates clinicians to report any behavior suspicious for child maltreatment to local authorities. Pediatric patients often present to the emergency department with concern for physical injury and other pervasive complaints. In some cases, these injuries are nonaccidental. To appropriately advocate and protect children from further physical and emotional trauma, it is important for clinicians to recognize the signs and symptoms of child maltreatment and sexual abuse.
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Tomlinson TA, Mears DP, Turanovic JJ, Stewart EA. Forcible Rape and Adolescent Friendship Networks. JOURNAL OF INTERPERSONAL VIOLENCE 2021; 36:4111-4136. [PMID: 30027792 DOI: 10.1177/0886260518787807] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Studies have found that sexual victimization can adversely affect an adolescent's psychological well-being, physical health, and behavior. Little is known, however, about how friendships are influenced by such victimization. Drawing on research on sexual violence and the salience of peers among adolescents, the current study extends prior work by examining the effects of forcible rape on adolescent social networks. Using a subsample of females from the National Longitudinal Study of Adolescent to Adult Health (N = 4,386), the study employs multivariate regression analyses to estimate the effects of youth forcible rape on the popularity, centrality, and density of adolescent friendship networks and to determine whether depression and attachment to others (e.g., to friends and to school) mediate these effects. The analyses indicated that forcible rape was associated with a decrease in the popularity and centrality of females within their friendship networks; however, no effect on the density of these networks was identified. In addition, forcible rape effects on popularity and centrality were partially mediated by depression and social attachments. The results suggest that forcible rape may adversely affect adolescent females' levels of popularity and centrality within their friendship networks. Combined with prior research, the results indicate that the harmful effects of rape have the potential to extend across diverse domains, including social relationships. This possibility suggests that services and assistance to female adolescents may be useful in navigating these relationships after victimization. It suggests, too, that potential benefits that may arise from interventions that educate adolescents-victims and nonvictims alike-about the challenges that victims of sexual violence experience.
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21
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Becerra Torres AS, Duarte CA, Wittmann BZ, Côrtes MTF, Alves ÂC, Teixeira AL, de Azevedo RCS, Fernandes AMDS. Care to female adolescents victims of sexual violence at a referral service in Brazil from 2011 to 2018. Int J Gynaecol Obstet 2021; 156:276-283. [PMID: 33899927 DOI: 10.1002/ijgo.13724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 04/15/2021] [Accepted: 04/22/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To evaluate the characteristics of aggression, care, and follow-up of sexual violence in adolescent women at a university service in Campinas, São Paulo, Brazil. METHODS In a retrospective cohort study from 2011 to 2018, we assessed sociodemographic characteristics, type and form of sexual violence perpetration, background and perception of the victim about violence, and characteristics of care and social/legal support during follow-up. RESULTS Of 521 adolescents 242 (46.5%) were aged 10-14 years, 354 (68%) had not started sexual life, 465 (89%) perceived the violence and they had low prevalence of alcohol (71, 16%) and other psychoactive substance consumption (25, 6%), and 24 (4.6%) had an intellectual disability. Intimidation through physical force, acute abuse, vaginal penetration, acquaintance aggressor, being approached in a public place, and family/acquaintance residence were the most prevalent characteristics of aggression. In the 2017-2018 biennium, we observed a decrease in the prevalence of adolescents who were students (P < 0.001), an increase in the number of acquaintance aggressors (P = 0.008), and medical care after 72 hours (P < 0.033). CONCLUSION Adolescents were victims of severe sexual violence. There was a decrease in prophylactic treatments and half of the adolescents did not complete outpatient follow-up. The economic worsening over the last decade may have contributed to these results.
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Affiliation(s)
- Alejandra Suyapa Becerra Torres
- Gynecological Division, Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil
| | - Caroline Alves Duarte
- Gynecological Division, Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil
| | - Barbara Zantut Wittmann
- Gynecological Division, Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil
| | - Maria Teresa Ferreira Côrtes
- Department of Medical Psychology and Psychiatry, School of Medical Sciences, University of Campinas (UNICAMP, Campinas, Brazil
| | - Ândria Cléia Alves
- Gynecological Division, Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil
| | - Ana Luiza Teixeira
- Gynecological Division, Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil
| | - Renata Cruz Soares de Azevedo
- Department of Medical Psychology and Psychiatry, School of Medical Sciences, University of Campinas (UNICAMP, Campinas, Brazil
| | - Arlete Maria Dos Santos Fernandes
- Gynecological Division, Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil
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Kedia SK, Dillon PJ, Jiang Y, James W, Collins AC, Bhuyan SS. The Association Between Substance Use and Violence: Results from a Nationally Representative Sample of High School Students in the United States. Community Ment Health J 2021; 57:294-306. [PMID: 32500451 DOI: 10.1007/s10597-020-00648-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 05/25/2020] [Indexed: 11/26/2022]
Abstract
With over 52% of high school students reporting that they have tried alcohol or illicit drugs, 16% carrying a weapon, and 23% engaging in a physical fight, substance use and youth violence remain critical public health challenges in the United States. Using data from the 2017 Youth Risk Behavior Survey, study results revealed that youth who reported heavy use of either alcohol, marijuana, or illicit drugs were three to ten times more likely to report carrying a weapon or engaging in a physical fight. Similarly, youth with heavy substance use were one and half times to 14 times more likely to be a victim of violence or sexual or dating violence. The SEM analysis indicated that substance use had a significant effect on all aspects of violence. School-based behavioral health specialists and community-based pediatricians may need to develop targeted messages to address the potential for violence among youth who use alcohol and/or illicit drugs.
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Affiliation(s)
- Satish K Kedia
- Division of Social and Behavioral Sciences, School of Public Health, The University of Memphis, 205 Robison Hall, Memphis, TN, 38152, USA.
| | - Patrick J Dillon
- School of Communication Studies, Kent State University at Stark, North Canton, USA
| | - Yu Jiang
- Division of Epidemiology, Biostatistics, and Environmental Health Sciences, School of Public Health, University of Memphis, Memphis, USA
| | - Wesley James
- Department of Sociology, University of Memphis, Memphis, USA
| | - Andy C Collins
- Division of Social and Behavioral Sciences, School of Public Health, The University of Memphis, 205 Robison Hall, Memphis, TN, 38152, USA
| | - Soumitra S Bhuyan
- Edward J. Bloustein School of Planning and Public Policy, Rutgers University, New Brunswick, USA
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23
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Hornberger LL, Lane MA. Identification and Management of Eating Disorders in Children and Adolescents. Pediatrics 2021; 147:peds.2020-040279. [PMID: 33386343 DOI: 10.1542/peds.2020-040279] [Citation(s) in RCA: 79] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Eating disorders are serious, potentially life-threatening illnesses afflicting individuals through the life span, with a particular impact on both the physical and psychological development of children and adolescents. Because care for children and adolescents with eating disorders can be complex and resources for the treatment of eating disorders are often limited, pediatricians may be called on to not only provide medical supervision for their patients with diagnosed eating disorders but also coordinate care and advocate for appropriate services. This clinical report includes a review of common eating disorders diagnosed in children and adolescents, outlines the medical evaluation of patients suspected of having an eating disorder, presents an overview of treatment strategies, and highlights opportunities for advocacy.
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Affiliation(s)
- Laurie L Hornberger
- Division of Adolescent Medicine, Children's Mercy Kansas City and School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri; and
| | - Margo A Lane
- Department of Pediatrics and Child Health, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba
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Van Tu P, Ngoc TU, Nguyen PL, Thuong NH, Van Tuan N, Van Hung N, Nga VT, Van Quan T, Lam LT, Chu DT. The impact of sexual harassment on obesity in female adolescents: An update and perspective to control. Diabetes Metab Syndr 2020; 14:1931-1939. [PMID: 33038851 DOI: 10.1016/j.dsx.2020.09.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 09/28/2020] [Accepted: 09/30/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND AIMS Sexual victimization, happened during childhood and beyond, is known to be a substantial contributing factor for obesity development later in life. This work aims to bring about updated information on the relationship between sexual harassment and obesity. METHODS Based on an intensive scientific literature review in Google Scholar, Pubmed databases, the total of 106 studies (N = 141,199) were assessed including 52 studies on the connection between negative lifetime impacts and obesity, 11 studies on post-traumatic stress disorder (PTSD) symptoms with proposed biological mechanisms related to obesity, 15 studies on the relationship between major depressive disorder (MDD) symptoms and obesity, 11 studies on the body dismorphic disorder (BDD) and 17 studies on the binge eating disorder (BED) were also examined to evaluate the association of obesity and traumatic life experiences. RESULTS Although 40-70% of all cases related to obesity have been considered to be hereditary, many experts argue that deviations in the environment contribute to excessive food intake and depressed physical activity in numerous Western countries. Several studies have identified that childhood sexual abuse (CSA) may be nearly as common as obesity. However, just a few researchers have taken notice of the possible connection between these two. CONCLUSIONS By mentioning some possible obesity-related psychological disorders in response to CSA, we present updated information on the relationship between sexual harassment and obesity.
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Affiliation(s)
- Pham Van Tu
- Faculty of Social Work, Hanoi National University of Education, Hanoi, Viet Nam
| | - Tran Uyen Ngoc
- Department of Animal Sciences, Wageningen University & Research, Wageningen, Netherlands
| | | | - Nguyen Hiep Thuong
- Faculty of Social Work, Hanoi National University of Education, Hanoi, Viet Nam
| | | | - Nguyen Van Hung
- National Center for Special Education, the Vietnam National Institute of Educational Sciences, Hanoi, Viet Nam
| | - Vu Thi Nga
- Institute for Research and Development, Duy Tan University, Danang, Viet Nam
| | | | - Le Thi Lam
- University of Science and Education - the University of Da Nang, Viet Nam
| | - Dinh-Toi Chu
- Faculty of Biology, Hanoi National University of Education, Hanoi, Viet Nam.
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Bechtel K, Bhatnagar A, Joseph M, Auerbach M. Sexual Assault in an Adolescent Female: A Pediatric Simulation Case for Emergency Medicine Providers. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2020; 16:10942. [PMID: 32875091 PMCID: PMC7449576 DOI: 10.15766/mep_2374-8265.10942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 01/25/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Many emergency medicine (EM) physicians have limited training in the care of sexual assault patients. Simulation is an effective means to increase the confidence and knowledge of physicians in such high-stakes, low-frequency clinical scenarios as sexual assault. We sought to develop and implement a sexual assault simulation with a structured debriefing for EM residents and to determine its impact on resident learners' attitudes and knowledge skills in the care of patients with sexual assault. METHODS The simulation blended psychomotor skills (e.g., collecting forensic evidence), cognitive skills (e.g., ordering laboratory studies and medications), and communication skills (e.g., obtaining relevant patient history, responding to psychosocial concerns raised by team members and simulator). Our emergency department checklist was available as a cognitive aid for each step of the evidence collection process. A content expert answered questions in real time during the simulation and provided structured debriefing following the simulation. Trainees completed an anonymous survey within a week after the intervention and a follow-up survey within 8 months. RESULTS Nineteen EM trainees participated. Presimulation, 39% reported never having received training in the medical care of a patient with sexual assault. The proportion of trainees agreeing or strongly agreeing with the statement "I am comfortable and confident managing a case of sexual assault" increased from 21% to 74% following the simulation (p < .05). DISCUSSION This intervention was associated with EM trainees' increased confidence with and knowledge of medical and forensic evaluations for an adolescent with sexual assault.
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Affiliation(s)
- Kirsten Bechtel
- Associate Professor, Departments of Pediatrics and Emergency Medicine, Yale chool of Medicine
| | - Ambika Bhatnagar
- Research Associate, Departments of Pediatrics and Emergency Medicine, Yale School of Medicine
| | - Melissa Joseph
- Assistant Professor, Department of Emergency Medicine, Yale School of Medicine
| | - Marc Auerbach
- Associate Professor, Departments of Pediatrics and Emergency Medicine, Yale chool of Medicine
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26
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What to do when a child reports sexual harassment and sexual assault to a medical professional. Int J Impot Res 2020; 34:8-17. [PMID: 32826967 DOI: 10.1038/s41443-020-00345-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 08/01/2020] [Accepted: 08/10/2020] [Indexed: 11/09/2022]
Abstract
Global exposure of children to sexual abuse is widespread. Disclosure may be extremely upsetting for both families and medical professionals. This review provides medical practitioners with practical tips for a stepwise approach of the child who discloses sexual abuse. Having secured a private examination room, the physician should approach the child and caregivers separately to determine the level of concern for abuse and the urgency of the situation. The medical evaluation is based on the information gathered, including a complete physical examination, inspection of the genitalia, collection of forensic evidence, and testing for sexually transmitted diseases. On a case-by-case basis, the need for surgical intervention, prophylactic treatment, and immunization is discussed. Finally, important questions for the medical team to address are outlined with the goal of supporting the child and his/her family and ultimately stopping the abuse.
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27
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Jones ME, Tully JM. Hepatitis B prophylaxis in adolescents who present for examination after alleged sexual assault. J Paediatr Child Health 2020; 56:1178-1184. [PMID: 32162752 DOI: 10.1111/jpc.14860] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 01/29/2020] [Accepted: 02/26/2020] [Indexed: 11/29/2022]
Abstract
AIM In Australia, the risk of hepatitis B virus (HBV) transmission from single sexual contact is low. This, combined with assumed widespread immunity from vaccination, has resulted in a lack of clarity surrounding the necessity for hepatitis B post-exposure prophylaxis following recent sexual assault. METHODS This retrospective audit was conducted through the Victorian Forensic Paediatric Medical Service (VFPMS) at the Royal Children's Hospital, Melbourne, Australia. Subjects were patients aged 13-17 years who presented to VFPMS between 1 January 2007 and 31 December 2016 for forensic medical examination following an alleged penetrative sexual assault. Data collected included subject demographics, immunisation status, route of potential HBV exposure, time between alleged sexual assault and presentation, whether HBsAb levels were tested and the results and whether HBV prophylaxis was administered to the subject and its timing. RESULTS A total of 2121 records were reviewed, and 420 subjects were found to be eligible for inclusion; 26.2% (n = 110) had HBsAb levels measured at initial presentation. Of these 110 subjects, 45.5% (n = 50) had titre levels less than 10 (deemed to be non-protective) and were therefore vulnerable to HBV infection. Of the 420 subjects, 4.5% (n = 19) received HBV prophylaxis as a result of their assessment. CONCLUSIONS Results suggest that a high proportion of Australian adolescents presenting following recent sexual assault may be at risk of hepatitis B infection. Very few received timely prophylaxis. Follow-up attendance rates were poor. Administration of the hepatitis B booster vaccine at the point of contact may reduce the risk of HBV infection in this group of adolescents.
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Affiliation(s)
- Michael E Jones
- Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia.,VFPMS, Royal Children's Hospital, Melbourne, Victoria, Australia.,VFPMS, Monash Children's Hospital, Melbourne, Victoria, Australia
| | - Joanna M Tully
- Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia.,VFPMS, Royal Children's Hospital, Melbourne, Victoria, Australia.,VFPMS, Monash Children's Hospital, Melbourne, Victoria, Australia
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Abstract
Child sexual abuse is a severely underreported crime in the United States. The consequences of child sexual abuse extend beyond physical injury, including an increased likelihood to develop chronic physical and mental diseases/disorders, including substance abuse and suicide. Care involves trauma-informed screening, assessment, and documentation, education of, and access to sexually transmitted infection prophylaxis and emergency contraception, safety interventions, and access to community resources. Medical providers should know the response process their facility, community, and state practices for victims of sexual abuse. Acknowledging and responding to victims of sexual abuse as a multidisciplinary team will ensure comprehensive care for the patient.
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Affiliation(s)
- Christine Banvard-Fox
- Department of Pediatrics, West Virginia University, 6040 University Town Center Drive, Morgantown, WV 26501, USA; Department of Adolescent Medicine, West Virginia University, 6040 University Town Center Drive, Morgantown, WV 26501, USA.
| | - Meredith Linger
- Department of Emergency Medicine, WVU Medicine, 1 Medical Center Drive, PO Box 8220, Morgantown, WV 26506, USA
| | - Debra J Paulson
- Department of Emergency Medicine, West Virginia University, 1 Medical Center Drive, PO Box 9149, Morgantown, WV 26506, USA
| | - Lesley Cottrell
- Department of Pediatrics, West Virginia University, 1 Medical Center Drive, PO Box 9214, Morgantown, WV 26506, USA
| | - Danielle M Davidov
- Department of Social and Behavioral Sciences, West Virginia University, 1 Medical Center Drive, PO Box 9190, Morgantown, WV 26506, USA
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Grubb LK, Powers M. Emerging Issues in Male Adolescent Sexual and Reproductive Health Care. Pediatrics 2020; 145:peds.2020-0627. [PMID: 32341182 DOI: 10.1542/peds.2020-0627] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Pediatricians are encouraged to address male adolescent sexual and reproductive health on a regular basis, including taking a sexual history, discussing healthy sexuality, performing an appropriate physical examination, providing patient-centered and age-appropriate anticipatory guidance, and administering appropriate vaccinations. These services can be provided to male adolescent patients in a confidential and culturally appropriate manner, can promote healthy sexual relationships and responsibility, can and involve parents in age-appropriate discussions about sexual health.
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Affiliation(s)
- Laura K Grubb
- Departments of Adolescent Medicine, Pediatrics, and Public Health and Community Medicine, Floating Hospital for Children at Tufts Medical Center, Boston, Massachusetts; and
| | - Makia Powers
- Departments of Pediatrics and Public Health and Community Medicine, Morehouse School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia
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30
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Abstract
A 13-year-old girl presents to the emergency department for the second time with an unresponsive episode. She has a GCS (Glasgow Coma Scale) score of 11 on arrival and all other observations are normal. The story is unclear, but there are ongoing safeguarding concerns and the family are known to social services. All investigations are normal. After a period of observation on the ward, her GCS returns to normal and she appears well. Both on the first presentation and this presentation ingestion of a toxin was suspected. However, this was denied by the patient and urine toxicology screen was negative. Does this rule out toxin ingestion? Will this change your management?
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Affiliation(s)
- Emma M Dyer
- Evelina London Children's Healthcare, London, UK
| | - Sormeh Salehian
- Paediatric Department, Addenbrooke's Hospital, Cambridge, UK
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31
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Nolan MS, Cruz AT, Erickson T. Retrospective Chart Analysis of Child and Adolescent Trichomonas vaginalis Infection in Houston, Texas. J Pediatric Infect Dis Soc 2020; 9:75-81. [PMID: 30624683 DOI: 10.1093/jpids/piy134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 12/21/2018] [Indexed: 11/13/2022]
Abstract
BACKGROUND Trichomonas vaginalis infection causes significant morbidity in the United States. Despite its high national disease burden, the epidemiologic characteristics of child and adolescent cases are not well understood. In this study, we aimed to describe the socioeconomic, transmission risk factors, clinical manifestations, and geospatial variables associated with cases of T vaginalis infection in the Houston, Texas, metropolitan area. METHODS We performed a retrospective chart abstraction of all T vaginalis cases at 2 large pediatric hospitals in Houston between 2008 and 2016. RESULTS We identified 87 patients (mean age, 16 years; range, 4-18 years); 30% of them were asymptomatic, and 39% were coinfected with another sexually transmitted infection(s). Almost all T vaginalis infections in sexually assaulted patients were diagnosed incidentally. Geospatial analysis identified clustering of cases in areas of high poverty and in minority populations. CONCLUSIONS Our findings indicate that children and adolescents are at risk for T vaginalis infection; however, their risk factors might differ from those in adults. In addition, our geospatial analysis revealed the need for dedicated resources in neighborhoods associated with health disparities to prevent future incident cases.
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Affiliation(s)
- Melissa S Nolan
- Section of Tropical Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, Texas.,Department of Epidemiology, Arnold School of Public Health, University of South Carolina, Columbia
| | - Andrea T Cruz
- Section of Emergency Medicine & Infectious Diseases, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Tim Erickson
- Section of Tropical Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
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32
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Scull TM, Malik CV, Morrison A, Keefe EM. Study protocol for a randomized controlled trial to evaluate a web-based comprehensive sexual health and media literacy education program for high school students. Trials 2020; 21:50. [PMID: 31915060 PMCID: PMC6950901 DOI: 10.1186/s13063-019-3992-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 12/11/2019] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND School-based comprehensive sexual health education can improve adolescent health outcomes, and web-based programs are a promising approach to overcoming challenges associated with teacher-led formats by ensuring that students receive content that is consistent, unbiased, and medically accurate. However, many adolescents do not receive high-quality sexual health education and turn to the media for information about sex and relationships. Consumption of sexual media messages is related to early and risky sexual behaviors. Media literacy education (MLE) is a proven approach to adolescent sexual health promotion, yet there are no rigorously evaluated web-based MLE programs to promote sexual and relationship health among high school students. METHODS This study will test the efficacy, in a randomized controlled trial, of Media Aware, a web-based comprehensive sexual health promotion program for high school students that uses an MLE approach. Participants will be students in 9th and 10th grade health classes in participating schools. Randomization will take place at the school level, and data collection will take place at three time points (i.e., pretest, posttest, and 3 months follow-up). Students in the intervention classrooms will receive Media Aware between pretest and posttest, and students in the delayed-intervention classrooms will receive Media Aware after study completion (i.e., after 3 months follow-up data collection). Students in the delayed-intervention classes will receive their standard health education programming, and teachers in the delayed-intervention classes will be asked to refrain from teaching sexual health or MLE during the study timeframe. The primary outcome variables are intentions, willingness, and behaviors related to sexual health and sexual activity. DISCUSSION There are currently no evidence-based comprehensive sexual health programs for high school students that are web-based and use an MLE approach. Media Aware has the potential to be an engaging, less expensive, and effective sexual and relationship health program for high school students. Media Aware is unique in two important ways: (1) the web-based format reduces many of the challenges to fidelity of implementation associated with teacher-led sexual health education; and (2) the MLE approach addresses a commonly ignored influence on adolescent sexual and relationship health, namely, media. TRIAL REGISTRATION ClinicalTrials.gov, NCT04035694. Registered on 29 July 2019. Contact for Scientific Queries: Tracy Scull, PhD (Principal Investigator); innovation Research & Training at 5316 Highgate Drive, Suite 121, Durham, North Carolina, USA 27713; tscull@irtinc.us.
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Affiliation(s)
- Tracy M Scull
- Innovation Research & Training, 5316 Highgate Drive, Suite 121, Durham, NC, 27713, USA.
| | - Christina V Malik
- Innovation Research & Training, 5316 Highgate Drive, Suite 121, Durham, NC, 27713, USA
| | - Abigail Morrison
- Innovation Research & Training, 5316 Highgate Drive, Suite 121, Durham, NC, 27713, USA
| | - Elyse M Keefe
- Innovation Research & Training, 5316 Highgate Drive, Suite 121, Durham, NC, 27713, USA
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33
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Houtrow A, Roland M. Sexual health and education guidelines for the care of people with spina bifida. J Pediatr Rehabil Med 2020; 13:611-619. [PMID: 33361622 PMCID: PMC7838962 DOI: 10.3233/prm-200743] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Sexual development is not only comprised of the changes to a person's body during puberty; it is a part of social development and should be considered in the context of basic and routine human desires for connectedness and intimacy, beliefs, values and aspirations. As is true for everyone, it is important that individuals with spina bifida have opportunities to acquire developmentally appropriate, relevant and accurate sexual health knowledge. Those with spina bifida need to be able to negotiate sexual desire, intimacy and sexual expression. They also need education about their sexual health and how to limit the negative outcomes of sexual activity related to sexually transmitted infections, unplanned pregnancy or sexual coercion, violence, abuse or exploitation. This article discusses the Spina Bifida Sexual Health and Education Healthcare Guidelines from the 2018 Spina Bifida Association's Fourth Edition of the Guidelines for the Care of People with Spina Bifida using the World Health Organization's framing of sexual health and reviews the literature on sexual health and education for individuals with spina bifida.
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Affiliation(s)
- Amy Houtrow
- Pediatrics and Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA
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34
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Helton JJ, Carbone JT, Vaughn MG, Cross TP. Emergency Department Admissions for Child Sexual Abuse in the United States From 2010 to 2016. JAMA Pediatr 2020; 174:89-91. [PMID: 31682675 PMCID: PMC6830431 DOI: 10.1001/jamapediatrics.2019.3988] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
This study uses data from the US Nationwide Emergency Department Sample and the US Census Bureau to examine patterns and characteristics among children admitted to the emergency department for sexual abuse from 2010 to 2016.
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Affiliation(s)
- Jesse J. Helton
- School of Social Work, College of Public Health and Social Justice, St Louis University, St Louis, Missouri
| | - Jason T. Carbone
- School of Social Work, Wayne State University, Detroit, Michigan
| | - Michael G. Vaughn
- School of Social Work, College of Public Health and Social Justice, St Louis University, St Louis, Missouri
| | - Theodore P. Cross
- School of Social Work and Children and Family Research Center, University of Illinois, Urbana
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35
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Abstract
This clinical report is a revision of "Preparing for Pediatric Emergencies: Drugs to Consider." It updates the list, indications, and dosages of medications used to treat pediatric emergencies in the prehospital, pediatric clinic, and emergency department settings. Although it is not an all-inclusive list of medications that may be used in all emergencies, this resource will be helpful when treating a vast majority of pediatric medical emergencies. Dosage recommendations are consistent with current emergency references such as the Advanced Pediatric Life Support and Pediatric Advanced Life Support textbooks and American Heart Association resuscitation guidelines.
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Affiliation(s)
- Rohit P Shenoi
- Texas Children's Hospital and Department of Pediatrics, Baylor College of Medicine, Houston, Texas; and
| | - Nathan Timm
- Cincinnati Children's Hospital Medical Center and Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio
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36
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Anastassiou A, Shiboleth T, Caswell RJ. Teens, sexual assault and ethical research: how do we include their voice? Sex Transm Infect 2019; 95:555-556. [PMID: 31748342 DOI: 10.1136/sextrans-2019-054326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Andrea Anastassiou
- Centre for Social Care, Health and Related Research, Birmingham City University, Birmingham, West Midlands, UK
| | - Tamara Shiboleth
- Centre for Social Care, Health and Related Research, Birmingham City University, Birmingham, West Midlands, UK
| | - Rachel J Caswell
- Sexual Health and HIV Medicine, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK .,Sexual Violence Special Interest Group, British Association for Sexual Health and HIV (BASHH), London, UK
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37
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A Multispecialty Perspective on Physician Responsibility to Sexual Assault Survivors. Obstet Gynecol 2019; 134:58-62. [DOI: 10.1097/aog.0000000000003314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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38
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Flaherty E, Legano L, Idzerda S, Sirotnak AP, Budzak AE, Gavril AR, Haney SB, Laskey A“T, Messner SA, Moles RL, Palsuci VJ. Ongoing Pediatric Health Care for the Child Who Has Been Maltreated. Pediatrics 2019; 143:peds.2019-0284. [PMID: 30886109 DOI: 10.1542/peds.2019-0284] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Pediatricians provide continuous medical care and anticipatory guidance for children who have been reported to state child protection agencies, including tribal child protection agencies, because of suspected child maltreatment. Because families may continue their relationships with their pediatricians after these reports, these primary care providers are in a unique position to recognize and manage the physical, developmental, academic, and emotional consequences of maltreatment and exposure to childhood adversity. Substantial information is available to optimize follow-up medical care of maltreated children. This new clinical report will provide guidance to pediatricians about how they can best oversee and foster the optimal physical health, growth, and development of children who have been maltreated and remain in the care of their biological family or are returned to their care by Child Protective Services agencies. The report describes the pediatrician's role in helping to strengthen families' and caregivers' capabilities and competencies and in promoting and maximizing high-quality services for their families in their community. Pediatricians should refer to other reports and policies from the American Academy of Pediatrics for more information about the emotional and behavioral consequences of child maltreatment and the treatment of these consequences.
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Affiliation(s)
- Emalee Flaherty
- Department of Pediatrics, Northwestern University, Chicago, Illinois
| | - Lori Legano
- Department of Pediatrics, School of Medicine, New York University, New York, New York; and
| | - Sheila Idzerda
- Billings Clinic Bozeman Acorn Pediatrics, Bozeman, Montana
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39
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Abstract
Sexual violence and intimate partner violence are common among adolescents, especially for those who are developmentally disabled. Pediatricians have a critical role in treating and preventing sexual violence in adolescents. As medical providers, they possess trusted access to identify sexual violence in adolescents and to intervene to help prevent further violence and mitigate associated health effects. Therefore, it is imperative that pediatricians are aware of the scope of sexual violence in adolescents. Specific sexual violence screening recommendations for sexual assault, intimate partner violence, reproductive coercion, and sex trafficking are reviewed in this article. In addition, recommendations for the comprehensive treatment of adolescents exposed to sexual violence are examined. National and local resources for victims and promising strategies to prevent sexual violence, including sex trafficking, are identified. Through collaboration with community partners in multidisciplinary efforts, pediatricians can most effectively promote the health of adolescents and prevent further victimization. [Pediatr Ann. 2019;48(2):e58-e63.].
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40
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Hoehn EF, Overmann KM, Fananapazir N, Simonton K, Makoroff KL, Bennett BL, Duma EM, Murtagh Kurowski E. Improving Emergency Department Care for Pediatric Victims of Sexual Abuse. Pediatrics 2018; 142:peds.2018-1811. [PMID: 30413558 DOI: 10.1542/peds.2018-1811] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/02/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Evidence-based medical care of sexual abuse victims who present to the pediatric emergency department (PED) is necessary to facilitate forensic evidence collection and prevent pregnancy and sexually transmitted infections. Adherence to testing and treatment guidelines remains low in PEDs, despite recommendations from the American Academy of Pediatrics and Centers for Disease Control and Prevention. We aimed to increase the proportion of patient encounters at a PED for reported sexual abuse that receive algorithm-adherent care from 57% to 90% within 12 months. METHODS Our team of PED and child abuse pediatricians outlined our theory for improvement, and multiple plan-do-study-act cycles were conducted to test interventions that were aimed at key drivers. Interventions included the construction of a best practice algorithm derived from published guidelines, targeted clinician education, and integration of an electronic order set. Our primary outcome was the proportion of patient encounters in which care adhered to algorithm recommendations. Data were abstracted from the records of all patient encounters evaluated in the PED for reported sexual abuse. RESULTS We analyzed 657 visits between July 2015 and January 2018. The proportion of patient encounters with algorithm-adherent care improved from 57% to 87% during the study period. This improvement has been sustained for 13 months. Failure to test for hepatitis and syphilis constituted the majority of nonadherent care. CONCLUSIONS Using improvement methodology, we successfully increased algorithm-adherent evaluation and management of patients presenting for sexual abuse. Targeted education and an electronic order set were associated with improved adherence to a novel care algorithm.
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Affiliation(s)
- Erin F Hoehn
- Division of Emergency Medicine and .,Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Kevin M Overmann
- Division of Emergency Medicine and.,Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Nafeh Fananapazir
- Division of Emergency Medicine and.,Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Kirsten Simonton
- Mayerson Center for Safe and Healthy Children, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Kathi L Makoroff
- Mayerson Center for Safe and Healthy Children, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Berkeley L Bennett
- Division of Emergency Medicine, Nationwide Children's Hospital, Columbus, Ohio; and.,Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, Ohio
| | - Elena M Duma
- Division of Emergency Medicine and.,Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Eileen Murtagh Kurowski
- Division of Emergency Medicine and.,Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio
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41
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Abstract
PURPOSE OF REVIEW Despite an increasing understanding of the impact of emotional trauma and physical abuse on children, clinicians and hospitals still sometimes miss the diagnosis of abuse. The literature in 2017 focused on creating standardized approaches to recognition and diagnosis of physical abuse and occult injury, including using the electronic medical record to provide triggers for consultation of the hospital Child Protection Program. The American College of Radiology updated their standardized approach to the evaluation of physical abuse in the child, and other authors gave us screening tools for commercial exploitation, as well as guidance about how to recognize risks for emotional abuse in families. The opioid epidemic and legalization of marijuana are both impacting children, and providers are searching for ways to provide support for parents with substance use disorders whilst considering the safety of children.This article reviews relevant publications during the past year about issues of child maltreatment. It is intended to guide those providers in primary care or other medical disciplines who care for children and families. RECENT FINDINGS Child maltreatment cases are still not always diagnosed, either because of provider bias (leading to under evaluation), or because clinicians lack experience or understanding of proper evaluation approaches. There are many new tools to assist in recognition of abuse, including screening instruments and flags that can be used in the electronic medical record to trigger a consult with the Child Protection Program. The evaluation and diagnosis of sexual abuse continues to evolve, with the literature providing advice about what is or is not normal on physical exam, as well as advice for providers who work with adolescent sexual assault victims. The debate about the validity of abusive head trauma (AHT) diagnoses continues, with sweden being the most recent center of controversy. With the opioid epidemic having such a significant effect on families and children, clinicians are struggling to support parents with substance use disorder while protecting children from the impact of their parents' disease. SUMMARY The past year in child abuse literature has yielded increased clarity in screening and diagnostic recommendations across the fields of physical abuse, AHT, sexual abuse, and commercial sexual exploitation of children (CSEC). The body of literature surrounding emotional abuse and neglect continues to grow, especially in light of the burgeoning opioid epidemic. Critically, the year's research reflects an evolving understanding of effective prevention and intervention initiatives to address child maltreatment.
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42
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Deutsch SA, Benyo S, Xie S, Carlin E, Andalaro B, Clagg B, De Jong A. Addressing Human Papillomavirus Prevention During Pediatric Acute Sexual Assault Care. JOURNAL OF FORENSIC NURSING 2018; 14:154-161. [PMID: 30130316 PMCID: PMC6114142 DOI: 10.1097/jfn.0000000000000209] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND/OBJECTIVES Human papillomavirus (HPV) is the most common sexually transmitted infection in the United States. Pediatric sexual assault (SA) victims are a special population eligible for HPV vaccination at the age of 9 years. National clinical practice guidelines advise clinicians to address HPV during emergency department (ED)-based SA care and at follow-up. At our institution, addressing HPV among suspected SA victims was highly variable, and HPV counseling was subsequently recommended on an ED-based acute SA clinical pathway as standard care. The aim of this study was to determine the proportion of age-eligible SA victims who received HPV counseling, determine victim characteristics associated with addressing HPV during SA care, and identify barriers to addressing HPV in the ED. METHODS This study used a retrospective chart review of 448 pediatric SA victims presenting to the ED for acute postassault care. RESULTS HPV was discussed in 10 of 56 (18%) and 37 of 49 (76%) cases in the control versus intervention groups, respectively. To verify vaccination status, caregiver recall was relied upon for 32 of 56 patients in the control group (57%) and 24 of 49 patients in the intervention group (48.9%). Factors associated with failure to discuss HPV during postassault care were younger age at encounter (OR = 0.78, 95% CI [0.67, 0.90], p < 0.001), verbal report of vaccination status verification (OR = 2.98, 95% CI [1.51, 6.01]), and male gender of the victim (OR = 3.35, 95% CI [1.20, 11.94]). CONCLUSIONS Significant barriers to addressing HPV in the ED setting exist, most significantly reliance on caregiver recall to guide vaccination administration, raising concern for overvaccination and undervaccination.
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Affiliation(s)
| | - Sarah Benyo
- Sidney Kimmel Medical College at Thomas Jefferson University
| | | | - Eileen Carlin
- Delaware-CTR ACCEL Program, Nemours/Alfred I. DuPont Hospital for Children
| | - Bridgett Andalaro
- Delaware-CTR ACCEL Program, Nemours/Alfred I. DuPont Hospital for Children
| | - Bernadette Clagg
- Delaware-CTR ACCEL Program, Nemours/Alfred I. DuPont Hospital for Children
| | - Allan De Jong
- Department of General Pediatrics, Alfred I. DuPont Hospital for Children
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43
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Lopez HN, Focseneanu MA, Merritt DF. Genital injuries acute evaluation and management. Best Pract Res Clin Obstet Gynaecol 2017; 48:28-39. [PMID: 29117923 DOI: 10.1016/j.bpobgyn.2017.09.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 09/04/2017] [Accepted: 09/19/2017] [Indexed: 10/18/2022]
Abstract
Genital trauma may result in external injuries to the labia, vulva or vagina, urethra and anus and internal injuries to the bony pelvis, bladder, bowels and reproductive organs. Worldwide, the most common cause of genital trauma in reproductive age women is injury sustained during childbirth, but in this chapter we will focus on accidental genital injuries as well as those arising from sexual violence, and female genital mutilation. While genital injuries alone rarely result in death; if not properly managed, chronic discomfort, dyspareunia, infertility, or fistula formation may result. Clinicians need to be able to recognize these injuries and provide initial management, and assure that the patient's mental, emotional and physical needs are addressed.
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Affiliation(s)
- Heather N Lopez
- Department of Obstetrics and Gynecology, Washington University School of Medicine in Saint Louis, 660 South Euclid, Saint Louis, MO, 63110, Barnes Jewish Hospital, USA.
| | - Mariel A Focseneanu
- Children's Hospital of the King's Daughters, 601 Children's Lane, Norfolk, VA, 23507, USA.
| | - Diane F Merritt
- Washington University School of Medicine in Saint Louis, 660 South Euclid, Barnes Jewish Hospital, St. Louis Children's Hospital, Missouri Baptist Medical Center, Saint Louis, MO, 63110, USA.
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44
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Marcell AV, Burstein GR, Braverman P, Adelman W, Alderman E, Breuner C, Hornberger L, Levine D. Sexual and Reproductive Health Care Services in the Pediatric Setting. Pediatrics 2017; 140:peds.2017-2858. [PMID: 29061870 DOI: 10.1542/peds.2017-2858] [Citation(s) in RCA: 98] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Pediatricians are an important source of health care for adolescents and young adults and can play a significant role in addressing their patients' sexual and reproductive health needs, including preventing unintended pregnancies and sexually transmitted infections (STIs), including HIV, and promoting healthy relationships. STIs, HIV, and unintended pregnancy are all preventable health outcomes with potentially serious permanent sequelae; the highest rates of STIs, HIV, and unintended pregnancy are reported among adolescents and young adults. Office visits present opportunities to provide comprehensive education and health care services to adolescents and young adults to prevent STIs, HIV, and unintended pregnancies. The American Academy of Pediatrics, other professional medical organizations, and the government have guidelines and recommendations regarding the provision of sexual and reproductive health information and services. However, despite these recommendations, recent studies have revealed that there is substantial room for improvement in actually delivering the recommended services. The purpose of this clinical report is to assist pediatricians to operationalize the provision of various aspects of sexual and reproductive health care into their practices and to provide guidance on overcoming barriers to providing this care routinely while maximizing opportunities for confidential health services delivery in their offices.
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Affiliation(s)
- Arik V. Marcell
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, School of Medicine and
- Department of Population, Family and Reproductive Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland; and
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45
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Goldberg AP. Genital piercings in the context of acute sexual assault. J Forensic Leg Med 2017; 52:181-183. [PMID: 28946082 DOI: 10.1016/j.jflm.2017.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 09/06/2017] [Accepted: 09/12/2017] [Indexed: 10/18/2022]
Abstract
After an acute sexual assault, children and adolescents often present for medical evaluation and treatment. Physicians have an important role in both the medical and legal components of these cases. Careful physical examination and questioning are important in determining the origin of the trauma. In the presented case report, genital trauma after an acute sexual assault was noted and attributed to the alleged offender's penis piercing. The genital trauma caused by the piercing provided physical evidence linking offender to victim and may have implications for the victim's risk of HIV infection and other blood borne pathogens.
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Affiliation(s)
- Amy P Goldberg
- The Warren Alpert Medical School of Brown University, Department of Pediatrics, Providence, RI, United States; Hasbro Children's Hospital, Providence, RI, United States.
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