Sep 04

Be Human Stop Child Abuse : Vol 28, 4th September, 2013

  1. CMAAO India Conference will be held from September 12 to 14, 2013 at Hotel Shangri La.CMAAO represents Confederation of Medical Associations in Asian and Oceania. The theme for the conference on 12th and 13th will be “Be Human Stop Child Abuse” and on 14th will be “Lifestyle disorders”.
  2.  Mrs. Shiela Dikshit, Chief Minister of Delhi to inaugurate the CMAAO India conferenceThe CMAAO India conference will be inaugurated by Chief Minister of Delhi Smt. Shiela Dikshit on 12th September at Hotel Shangri La at1.30pm. Dr. Naresh Trehan, CMD Medanta Medcity will be the Guest of Honour. Dr. Vinay Aggarwal, Past President, IMA will take over as CMAAO President.
  3. Chief Minister of Delhi Smt. Shiela Dikshit to host a dinner for CMAAO India conference facultySmt. Shiela Dikshit, Chief Minister of Delhi will be hosting an invited limited faculty dinner at CM’s residence on 12th September at 8pm. The invitees will include the international and national faculty of CMAAO India conference.
  4. Smt. Krishna Tirath to inaugurate the Child Abuse seminar on “Be Human-Stop Child Abuse”. On 13th September, 2013, Smt. Krishna Tirath, Minister of Women and Child Development will be inaugurating the seminar at 1.30pm. The topic has been so chosen as child and sexual abuse has been the talk of the country in the recent past. The deliberations will be held where representatives of over 13 countries will come out with their presentations on the subject.

cammo

CMAAO

IMA
IMA

eMedinewS

Dr Vinay Aggarwal, President, Elect CMAAO

Dr K Vijayakumar (National President) IMA

Dr N Saini (Secretary General) IMA

Dr M Pillai (Chairman Organising Committee)

Dr D R Rai (Organising Secretary)

Dr S Arulrhaj (Chairman Scientific Committee)

Dr KK Aggarwal (Co-Chairman & Editor)

  1. Dear Sir, Nice updates. Regards:Dr SD Verma

Aug 22

Be Human Stop Child Abuse : Vol 27, 21st August, 2013

  1. Elder Mistreatment is the term used to new elder abuse, neglect and exploitation and is perpitrated by those with ongoing relationship that involves a expectation of responsibility towards the elder victim. 
  2. Elder mistreatment or elder abuse may be physical, emotional and/or sexual.
  3. The first obligation of the healthcare worker in conjuction with social worker of the society is to assure safety of at risk elder.
  4. Indicators of sexual abuse in elderly:

    a.Pain or sternness in the anal, genital area

    b.Evidence of venereal disease in the oral, anal, or genital regions

    c. Rectal bleeding

    d. Bruises or larval on the valva on the abdomen or breast.

  5. Bruises ulcers do not necessarily indicate elderly neglect but may occur more rapidly if the standard of care for prevention is not adhered to in a patient at risk is willful failure to follow the standard of care is an abuse.
  6. Dehydration may be a sign of elder neglect, denial of elder needs, assistance to be able to take sufficient fluids.
  7. Spiral fractures, fractures in wrist, hip or vertebrata in an elder person may be a symptom of elderly abuse.

cammo

CMAAO

IMA
IMA

eMedinewS

Dr Vinay Aggarwal, President, Elect CMAAO

Dr K Vijayakumar (National President) IMA

Dr N Saini (Secretary General) IMA

Dr M Pillai (Chairman Organising Committee)

Dr D R Rai (Organising Secretary)

Dr S Arulrhaj (Chairman Scientific Committee)

Dr KK Aggarwal (Co-Chairman & Editor)

  1. Dear Sir, Nice updates. Regards:Dr SD Verma

Aug 08

Be Human Stop Child Abuse : Vol 26, 7th August, 2013

  1. Children and adolescents in the United States spend an average of 6.5 hours per day watching television, playing video games, or using computers. Children’s television (particularly cartoons), movies, music videos, and video games are potential sources of violent content. 
  2. The effect of viewing violence depends upon the amount, the context in which it is seen, and the social message that accompanies the presentation. Televised violence differs from real violence in ways that affect its impact on children and adolescents. Media violence often is perceived as socially acceptable and without consequence. 
  3. Childhood television viewing is associated with increased risk of subsequent violence by demonstrating a temporal relationship; consistency, strength, and specificity of the association; and a coherent explanation for the association. 
  4. Some individuals are strongly affected by certain program elements, whereas other elements have no effect. The effect on individuals is influenced by temperamental and environmental variables. 
  5. Adverse effects of increased exposure to media violence may include

    a. Increased tendency to behave violently toward others (aggressor effect)b.Increased fearfulness of becoming a victim, with a resultant increase in self-protective behavior

    c.Increased callousness and desensitization toward actual violence (bystander effect)

    d. A cycle in which aggressive children who watch television violence identify with violent characters, act like those characters, and seek out more and more violent programming.

     

  6. Pediatric care providers can address the problem of media violence and associated violent behavior at three levels: the family, the community and school, and the legislative and regulatory approaches.

cammo

CMAAO

IMA
IMA

eMedinewS

Dr Vinay Aggarwal, President, Elect CMAAO

Dr K Vijayakumar (National President) IMA

Dr N Saini (Secretary General) IMA

Dr M Pillai (Chairman Organising Committee)

Dr D R Rai (Organising Secretary)

Dr S Arulrhaj (Chairman Scientific Committee)

Dr KK Aggarwal (Co-Chairman & Editor)

  1. Dear Sir, Nice updates. Regards:Dr SD Verma

Aug 01

Be Human Stop Child Abuse : Vol 25, 31st July, 2013

Paternal age and fertility

  1. Maternal age plays a major role in determining a woman’s fertility, regardless of the means used to achieve pregnancy (except donor egg)
  2. Women under 30 years old have higher pregnancy rates at three, six and 12 months than women over 30 years old.
  3. Women are generally aware of the reproductive issues related to advanced maternal age, typically defined as 35 years of age or older on the estimated date of confinement. These issues include higher risks of infertility, fetal aneuploidy, gestational diabetes, preeclampsia, and stillbirth
  4. Both women and men should be aware that childbearing after age 40 years is associated with higher rates of subfertility and adverse pregnancy related outcomes.
  5. Bulk of data point to a decrease in fertility with increasing age. This may be due to a number of factors, including decreased coital frequency, reduced sexual functioning, and poorer semen quality as men age.
  6. Advanced paternal age appears to be associated with a modest increase in the risk of miscarriage; this risk is lower than that observed with advanced maternal age.
  7. Older men can be reassured that any excess risk of disease in their offspring related to paternal age is very small, but not zero. Advanced paternal age is associated with an increase in new autosomal dominant mutations. The best estimate of risk of autosomal dominant disease in progeny is ≤0.5 percent.
  8. Infants born to older fathers have slightly increased risk of birth defects; however, the association is weak, thus paternal age likely plays no more than a small role in the etiology of birth defects.
  9. Paternal age appears to be a significant predictor of schizophrenia, but not of other psychiatric disorders, in offspring.
  10. There may be a small, but statistically significant, association between advancing paternal age and risk of autism spectrum disorders.
  11. Spontaneous germline mutations in X-linked genes may be more common with advancing paternal age. These mutations would be transmitted from carrier daughters to affected grandsons.
  12. There does not appear to be a significantly increased risk of fetal autosomal or sex chromosome aneuploidy related to advanced paternal age.
  13. Germ line cell mutations have been associated with aging and may be a cause of childhood cancer among children of older parents.

cammo

CMAAO

IMA
IMA

eMedinewS

Dr Vinay Aggarwal, President, Elect CMAAO

Dr K Vijayakumar (National President) IMA

Dr N Saini (Secretary General) IMA

Dr M Pillai (Chairman Organising Committee)

Dr D R Rai (Organising Secretary)

Dr S Arulrhaj (Chairman Scientific Committee)

Dr KK Aggarwal (Co-Chairman & Editor)

  1. Dear Sir, Nice updates. Regards:Dr Kanta

Jul 17

Be Human Stop Child Abuse : Vol 24, 17th July, 2013

Intimate partner violence

Short surveys for practicing clinicians — Several variations of short questions have been developed for use in the course of a patient visit. Following tools have high sensitivity and specificity:

  1. Food should be properly cooked for the right time and at the right temperature.
  2. HITS (Hurt, Insult, Threaten, Scream) (English and Spanish versions)
  3. STaT (Slapped, Threatened, and Throw)
  4. HARK (Humiliation, Afraid, Rape, Kick)
  5. CTQ-SF (Modified Childhood Trauma Questionnaire–Short Form)
  6. WAST (Woman Abuse Screen Tool)

It is essential to avoid frightening, intimidating, or shaming a patient.

Patients who have been involved with Intimate partner violence are likely to be extremely vulnerable and may misinterpret the provider’s best intentions. The Massachusetts Medical Society has proposed the following caveats.

Avoid using terms like “victim,” “abused,” or “battered” – instead, mirror the patient’s own word choices or use words like “hurt,” “frightened,” or “treated badly.”

Do not inquire about abuse in the presence of the partner, friends, or family members.

Do not disclose or discuss your concerns with the patient’s partner.

Do not ask the patient what he or she did to bring on the abuse.

Do not ask why the patient has not left the partner, or why they may have returned to the batterer.

A meta-analysis of qualitative studies identified the following expectations of women in regard to assessment for Intimate partner violence

Healthcare professionals who are nonjudgmental and compassionate

Assurance of confidentiality

Recognition of the complexities of violence and the difficulty of a quick resolution

Avoidance of “medicalizing” the issue

Discussion that is not rushed or hurried

Confirmation that the violence is undeserved

Supportive listening and feedback to bolster the patient’s confidence

Ability to progress at their own pace

No pressure to disclose, leave the relationship, or press charges

Shared decision-making and respect for the patient’s decisions

Psychological conditions associated with Intimate partner violence include:

Depression

Suicidality

Anxiety and panic disorder

Eating disorder

Substance use

Post traumatic stress disorder

Dissociative disorders

Victims of intimate partner violence are found among people of all ages, socioeconomic classes, ethnicities, gender identities, and sexual preferences.

Risk factors: Younger age, female, lower socioeconomic status, family history or personal history of violence.

Certain aspects of the history or observations made during the clinical encounter should heighten the clinician’s suspicion of IPV include:

An inconsistent explanation of injuries.

Delay in seeking treatment.

Frequent emergency department or urgent visits.

Missed appointments.

For pregnant women, late initiation of prenatal care.

Repeated abortions.

Medication nonadherence.

Inappropriate affect. Victims may appear jumpy, fearful, or cry readily. They may avoid eye contact and seem evasive or hostile.

Overly attentive or verbally abusive partner.

Apparent social isolation.

Reluctance to undress, have a genital or rectal examination, or difficulty with these examinations.

Indicators of Intimate Partner Violence in Emergency Departments

Intimate partner violence (IPV) is a serious, preventable public health problem affecting more than 32 million Americans.

IPV affects both sexes but women are more often victims than men. Lifetime estimates for IPV involving women in the United States range from 22 to 39 percent.

In countries around the world, 10 to 69 percent of women report physical assault by an intimate partner at some time in their life.

The term “intimate partner violence” describes actual or threatened psychological, physical, or sexual harm by a current or former partner or spouse. IPV can occur among heterosexual or same-sex couples and does not require sexual intimacy.

Among 5514 assault-related ED visits for women, 1530 visits were IPV related; 2040 were non-IPV related. Among 9476 assault-related visits for men, these frequencies were 395 and 2878, respectively. Among women, occurrence in the home (adjusted odds ratio (AOR) 12.8), head injury (AOR 1.6), and sexual violence (AOR 0.4) distinguished IPV- from non-IPV-related assaults. Among men, occurrence in the home (AOR 25.9) and alcohol use (AOR 2.0) distinguished IPV- from non-IPV-related assaults.

Source: Yau RK, Stayton CD, Davidson LL, J Emerg Med. 2013 Jul 8. pii: S0736-4679(13)00463-0.

Adolescent Sexuality

Young women reach puberty and sexual maturity at earlier age than ever.

In US 50% of high school youth report having had sexual contact and 33% being currently sexually active.

In US prevalence of sexually active adolescent increases with age rising from 33% in 9th Grade to 63% in 12th Grade.

In US 25% of sexually transmitted infection each year occur in your people aged 15 to 24 years.

In US human HPV infection, Chlamydia and trichomoniasis account of 90% of STIS in this age group.

In US 25% of young women aged between 14-19 years are infected with at least one of the four common STIS (HPV, Chlamydia infection, trichononiasis)

Approximately 5% of teens identify as lesbian, gay or bi-sexual.

Adolescent with both male and female sexual partners have higher rates of unprotected sex, teen dating violence and forced sex.

Gender identity is an individual innate sense of the male, female or somewhere in between.

Gender expression is how gender is presented to the outside world but does not necessarily co-relate with gender identity.  The gender role in society’s expectations and attitude, behavior and personality trade typically based on biologic sex.

Sexual orientation refers to an individual pattern of physical and emotional arousal and the gender of persons to whom an individual is physically or sexually attracted.

Middle adolescent means age between 15 to 18 years.

cammo

CMAAO

IMA
IMA

eMedinewS

Dr Vinay Aggarwal, President, Elect CMAAO

Dr K Vijayakumar (National President) IMA

Dr N Saini (Secretary General) IMA

Dr M Pillai (Chairman Organising Committee)

Dr D R Rai (Organising Secretary)

Dr S Arulrhaj (Chairman Scientific Committee)

Dr KK Aggarwal (Co-Chairman & Editor)

  1. Dear Sir, Nice updates. Regards:Dr SP Mishra

Jul 10

Be Human Stop Child Abuse : Vol 23, 10th July, 2013

Alcohol and rape facts

• Alcohol use contributes to the occurrence of date and acquaintance rape

• Alcohol consumption by the perpetrator, victim, or both, is estimated to be involved in approximately one-half of sexual assaults among adolescents and young adults.

• Sexual assaults involving alcohol are more likely to occur between partners who are acquaintances or casual dates than between partners who are steady dates.

• The use of alcohol may affect both the perpetrator and the victim.

• Alcohol use may lead the perpetrator to misinterpret friendly cues as sexual invitation, to inaccurately discriminate the date’s sexual intentions, to be unable to recognize the perpetrator’s own inappropriate sexual behavior, or to overestimate the date’s sexual arousal.

• Men perceive a woman who is drinking alcohol to be more sexually available and more likely to have sex with her partner than a woman who is not drinking.

• Some male perpetrators may encourage their dates to drink because they believe that alcohol increases the woman’s interest in sex, decreases her sexual inhibition and increases her sexual initiative whereas others may consume alcohol as a means of justifying their behavior.

• The effects of alcohol may reduce the victim’s perception of sexual assault risk, diminish the victim’s ability to cope with or ward off unwanted sexual advances, or to be aware of or remember the assault.

• Victims who have used alcohol may feel responsible for the sexual assault.

• Such perception of self-responsibility may have long-lasting psychologic implications for the victim.

Rape myths

• Most rapists are strangers.

• Acquaintance rape is not ‘real rape’ and does not harm the victim.

• All women want to be raped

• No means yes

• Only bad girls get raped

• Any healthy woman can resist a rapist if she really wants to

• Women who dress promiscuously are ‘asking for it.’

• Women lead men on therefore deserve to be raped

• Women ‘cry rape’ only when they’ve been jilted or have something to cover up

• A woman who goes to a man’s home on their first date implies that she is willing to have sex.

Dr Good Dr Bad

Situation: A depressed female with recent sexual assault was brought to the hospital

Dr. Bad: I need to do a medical examination

Dr. Good: I would also like to get serum cortisol levels done

Lesson: Prior history of assault was associated with diminished acute cortisol responsively at the emergency room visit. Prior assault history and cortisol both independently and interactively predicted PTSD and depression symptoms at first follow-up and over the course a 6-month follow-up. (Psychoneuroendocrinology. 2013 Jun 24)

Situation: A sexually assaulted girl was found to have a vaginal tear on examination.

Dr. Bad: This is unusual

Dr. Good: This is common

Lesson: A retrospective study of medical, medicolegal and social aspects was conducted in collaboration with the department of forensic medicine and toxicology during a period 2004-2009 among 42 victims of sexual assault who were admitted in the department of gynecology and obstetrics of RG Kar Medical College, Kolkata. Majority (71%) of the victims were girls between age group 6-15 years. Sixty per cent of the victims were from poor family, 43% were illiterate and 72% had vaginal tear which required surgical management. (J Indian Med Assoc. 2010 Oct;108(10):682, 690)

Situation: A student asked his senior whether rape was mentioned in the Holy Bible

Dr. Bad: It’s not mentioned in Bible

Dr. Good: It’s mentioned

Lesson: Main paraphilias, abnormal sexual behavior and sexual crimes to which explicit allusions were present in the Holy Bible were adultery, incest, sexual harassment, drug facilitated sexual assault, rape, gang rape, homosexuality, transvestism, voyeurism, bestiality, exhibitionism and necrophilia.(J Forensic Leg Med 2009 Apr;16(3):109-14)

cammo

CMAAO

IMA
IMA

eMedinewS

Dr Vinay Aggarwal, President, Elect CMAAO

Dr K Vijayakumar (National President) IMA

Dr N Saini (Secretary General) IMA

Dr M Pillai (Chairman Organising Committee)

Dr D R Rai (Organising Secretary)

Dr S Arulrhaj (Chairman Scientific Committee)

Dr KK Aggarwal (Co-Chairman & Editor)

  1. Dear Sir, Nice updates. Regards:Dr SP Mishra

Jul 03

Be Human Stop Child Abuse : Vol 22, 3rd July, 2013

  Intimate partner violence

Facts:

 1. The term intimate partner violence described actual or threatened

psychological or physical or sexual harm by a current or former partner    or spouse.

2.IPV can occur amongst hetero sexual or some sex couple and does    not require sexual intimacy.

3. Care of IPV patients require a team approach involving medical,    institutional and community resources.

4. IPV patients should be assessed for safety even if they deny their    danger.

5. Counseling is the main treatment.

6.  All over the world, IPV requires a mandate of reporting.

 

What should I do if I am sexually assaulted (a patient informed material)

1.  Find a safe place away from the person who attacked you.

2.  Call a person who can give you support, no matter what.

3.  Call your doctor.

4.  Go to an emergency room.

5.  Your doctor may give you a pill to reduce your chances of pregnancy     if you are a woman or preventing you from an infection.

6.  Once you go to the emergency room informing police is their      responsibility.

7.   Do not clean up before you see a doctor.

8.   Do not change cloth.

9.   Do not take a shower or bath.

10.  Do not brush your teeth.

11.   Do not douche.

12.  Do not eat anything till you see a doctor.

13.  Find a counselor.

14.  See your doctor again within one to two weeks.

15.  Ask about the victim compensation options.

16.  Protect others if you might have an infection.

cammo

CMAAO

IMA
IMA

eMedinewS

Dr Vinay Aggarwal, President, Elect CMAAO

Dr K Vijayakumar (National President) IMA

Dr N Saini (Secretary General) IMA

Dr M Pillai (Chairman Organising Committee)

Dr D R Rai (Organising Secretary)

Dr S Arulrhaj (Chairman Scientific Committee)

Dr KK Aggarwal (Co-Chairman & Editor)

  1. Dear Sir, Nice updates. Regards:Dr Shantanu

Jun 26

Be Human Stop Child Abuse : Vol 21, 26th June, 2013

  Facts about sexual abuse

Situation: A 9-year-old child came with injury in the genital area.

Dr. Bad: This is a classical case of child abuse.

Dr. Good: This can be an accident.
Lesson: Injuries in the genital region of boys are mostly caused by accidents. In a study, three cases of child abuse and one case suspicious for child abuse but explainable by a congenital undiscovered malformation was presented. Injuries or findings in the genital region are especially suspicious for child abuse, including sexual abuse. Because of the possible misinterpretation and the consequences of a false confirmation of a child abuse, an interdisciplinary cooperation between pediatrics, forensic experts, and pediatric urologist should be carried out in doubtful cases. (Int J Legal Med. 2013 Jun 7)
.

Situation: A 19-year-old male came with a history of substance abuse.

Dr. Bad: He is a drug addict.

Dr. Good: I need to take history of childhood and maltreatment.

Lesson: Childhood maltreatment has an impact in juvenile and adulthood periods in the form of offending, mental health concerns such as suicide and homicide, substance abuse, school failure, employment difficulties, teenage pregnancy, adult attachment difficulties, family violence, intergenerational violence. (Iran J Pediatr 2013 Apr;23(2):159-64)

Situation: A sexually abused child was brought for examination.

Dr. Bad: Lie down for physical examination.

Dr. Good: I need to check him physically and also examine stool guaiac test.
Lesson: Examination of the anus in both males and females may be accomplished with the patient lying in the lateral recumbent position and grasping his or her knees. The examiner separates the buttocks for
approximately 30 seconds, allowing sphincter relaxation and visualization of the anal canal. If penetration is suspected, a stool guaiac test should be performed. (J Pediatr Health Care 1999;13:112)

Situation: A child with suspected child abuse was found to have a lax anus.

Dr. Bad: This can be normal.

Dr. Good: This is suspicious of sexual abuse.
Lesson: Laxity of the anus may represent abuse. It also can be seen with chronic constipation, neurologic disorders, or sedation. Dilation greater than 20 mm is suggestive of abuse if there is no stool in the
ampulla.

(J Pediatr Adolesc Gynecol 2004;17:191)

Situation: A child with sexual abuse was found to have discoloration of the anus at 48 hours.

Dr. Bad: It cannot be sexual abuse.

Dr. Good: It can be sexual abuse.

Lesson: Evidence of acute anal trauma may be seen if the child is evaluated soon after the abuse; however, anorectal changes are rarely definitive indicators of abuse. Swelling of the anus with blue
discoloration is suggestive of trauma (Child Abuse Negl 1989;13:195) and may be present up to 48 hours
after the event. It is important not to confuse this finding with hemorrhoids.

Situation: A child with anal sexual abuse came after two years.

Dr. Bad: It was not a sexual abuse as there is no scaring.

Dr. Good: Sexual abuse cannot be ruled out.

Lesson: Penetrating injuries causing lacerations of the rectum may heal with scarring, but over time are difficult to detect. Midline anal tags are not indicative of abuse, whereas deformities outside of
the midline may indicate chronic trauma. (J Pediatr Health Care 1999; 13:112)

cammo

CMAAO

IMA
IMA

eMedinewS

Dr Vinay Aggarwal, President, Elect CMAAO

Dr K Vijayakumar (National President) IMA

Dr N Saini (Secretary General) IMA

Dr M Pillai (Chairman Organising Committee)

Dr D R Rai (Organising Secretary)

Dr S Arulrhaj (Chairman Scientific Committee)

Dr KK Aggarwal (Co-Chairman & Editor)

  1. Dear Sir, Nice updates. Regards:Dr Shantanu

Jun 19

Be Human Stop Child Abuse : Vol 20, 19th June, 2013

  Facts about sexual abuse

Situation: A 20-year-old male sexually assaulted a 13-year-old girl

Dr. Bad: This is a sexual play.

Dr. Good: This is sexual abuse.

Lesson: Sexual abuse occurs when there is asymmetry in age or development among the participants, with a coercive quality to the event.

Situation: A 14-year-old boy was accused of sexually assaulting a 13-year-old girl.

Dr. Bad: This is sexual abuse.

Dr. Good: This can be sexual play.
Lesson: “Sexual play” occurs in the absence of coercion and involves children of the same age (separated by no more than four years or developmental level who engage in viewing or touching each other’s genitalia because of mutual interest or curiosity).

Situation: A male child was brought with an allegation of having a sexual play with her classmate.

Dr. Bad: This is abnormal behavior.

Dr. Good: This may be a normal behavior.
Lesson: Sexual play is considered normal behavior and does not have the psychological, developmental, or physical consequences of sexual abuse.

Situation: A child was walking sexy in the class

Dr. Bad: This is an abnormal behavior.

Dr. Good: This may be normal behavior.
Lesson: In addition to sexual play, many preschool-aged children mimic behaviors of older family members, such as flirting, batting eyelids, and “walking sexy.” This behavior also is considered part of normal development.

Situation: A child was sexually abused

Dr. Bad: It is rare in the society.

Dr. Good: It is common in society.
Lesson: The US Department of Health and Human Services reports that >60,000 children are sexually abused annually.

Situation: The principal reported the first case of child abuse in a school.

Dr. Bad: Child abuse is rare.

Dr. Good: This is under reporting.
Lesson: Each year approximately 1 percent of children experience some form of sexual abuse.

Situation: A school reported that only 2% of their girls were ever sexually abused.

Dr. Bad: This is the usual percentage of cases reported.

Dr. Good: This is under reporting.
Lesson: Worldwide, an estimated 25% of girls and 9% of boys are exposed to any form of sexual abuse during childhood.

Situation: A preadolescent girl was sexually abused.

Dr. Bad: It is uncommon

Dr. Good: It is common.
Lesson: Sexual abuse of children occurs primarily in the preadolescent years.

Situation: A boy complaint of sexual abuse.

Dr. Bad: Boys are never sexually abused.

Dr. Good: They are but they report less.
Lesson: Girls are more likely than boys to be sexually abused; however, boys are less likely to report sexual abuse.

Situation: A child was sexually abused by an acquaintance of adolescent age.

Dr. Bad: It cannot happen.

Dr. Good: This is usual.
Lesson: Perpetrators of sexual abuse are usually male, and often trusted adult acquaintances.

Situation: A father was alleged to have sexually abused his prepubertal child.

Dr. Bad: A Father can never abuse his child.

Dr. Good: In 21% of the cases father is responsible.
Lesson: Statistics from reported cases in the United States indicate that “father” and “other relatives” were responsible for 21% and 19% of sexual abuse victims, respectively; mothers acting alone or with another person accounted for 4% and 8% of perpetrators, respectively.

Situation: A caretaker was alleged to have sexually abused a child.

Dr. Bad: Caretaker will never do it.

Dr. Good: Yes, this is normal.

Lesson: Perpetrators report that they gained access to children through caretaking (e.g., babysitting), that they targeted children using bribes, gifts, and games, and systematically desensitized children through touch, talk about sex, and persuasion.

cammo

CMAAO

IMA
IMA

eMedinewS

Dr Vinay Aggarwal, President, Elect CMAAO

Dr K Vijayakumar (National President) IMA

Dr N Saini (Secretary General) IMA

Dr M Pillai (Chairman Organising Committee)

Dr D R Rai (Organising Secretary)

Dr S Arulrhaj (Chairman Scientific Committee)

Dr KK Aggarwal (Co-Chairman & Editor)

  1. Dear Sir, Nice updates. Regards:Dr Shantanu

Jun 16

Be Human Stop Child Abuse : Vol 19, 12th June, 2013

  Editorial

Socio-demographic characteristics of sexually abused children

Of the victims, 56.4% (n = 57) were female and 43.6% (n = 44) were male. The mean age was 9.57 +/- 3.5, with a range of 4-17 years. Ninety-three (92.1%) of the victims had been admitted as part of the legal process. The majority (66.3%) of the victims had been abused by an acquaintance, while 33.7% had been abused by a stranger.

Anal or vaginal penetration was reported in 48.5% of the cases. Post-traumatic stress disorder was the most common (54.5%) psychiatric diagnosis established after sexual abuse. (J Forensic Sci. 2010 May;55(3):633-6.)

Little is known about risk/protective factors for sexually coercive behavior in general population youth. Swedish school-based population survey of sexual attitudes and experiences (response rate 77%) investigated literature-based variables across sexually coercive (SEX), non-sexual conduct problem (CP), and normal control (NC) participants to identify general and specific risk/protective factors for sexual coercion. Among 1,933 male youth, 101 (5.2%) reported sexual coercion (ever talked or forced somebody into genital, oral, or anal sex) (SEX), 132 (6.8%) were classified as CP, and the remaining 1,700 (87.9%) as NC. Of 29 tested variables, 25 were more common in both SEX and CP compared to NC youth, including minority ethnicity, separated parents, vocational study program, risk-taking, aggressiveness, depressive symptoms, substance abuse, sexual victimization, extensive sexual experiences, and sexual preoccupation. When compared to CP youth only, SEX youth more often followed academic study programs, used less drugs and were less risk-taking. Further, SEX more frequently than CP youth reported gender stereotypic and pro-rape attitudes, sexual preoccupation, prostitution, and friends using violent porn.

Finally, in a multivariate logistic regression, academic study program, pro-rape attitudes, sexual preoccupation, and less risk-taking independently remained more strongly associated with SEX compared to CP offending. In conclusion, several sociodemographic, family, and individual risk/protective factors were common to non-sexual and sexually coercive antisocial behavior in late adolescence. However, pro-rape cognitions, and sexual preoccupation, were sexuality-related, specific risk factors. (Arch Sex Behav. 2010 Oct;39(5):1161-9)

cammo

CMAAO

IMA

IMA

eMedinewS

Dr Vinay Aggarwal, President, Elect CMAAO

Dr K Vijayakumar (National President) IMA

Dr N Saini (Secretary General) IMA

Dr M Pillai (Chairman Organising Committee)

Dr D R Rai (Organising Secretary)

Dr S Arulrhaj (Chairman Scientific Committee)

Dr KK Aggarwal (Co-Chairman & Editor)

Dr Good Dr Bad

Situation: A child suspected to be sexually abused was brought to the doctor at 70 hours of the incident.

Dr. Bad: There is no use of any examination now.

Dr. Good: I will examine as per the protocol.

Lesson: Victims who present within 72 hours of the incident have obvious forensic evidence on their clothes and bodies, have continued risk of harm from the perpetrator, have genital or anal injuries, may have suicidal ideations and should receive an urgent evaluation. For prepubertal children who are evaluated more than 24 hours after the incident, the standard protocol should be followed recognizing that yield in evidence collection often decreases after 24 hours.

Situation: A prepubertal girl, who was sexually abused, was brought for examination.

Dr. Bad: I will follow standard examination.

Dr. Good: I will also test for sexually transmitted infections.

Lesson: Prepubertal girls who are likely to have been sexually abused based on history of physical examination should be tested for sexually transmitted infections. These patients should also receive antibiotic prophylaxis regardless of whether test is completed.

Situation: A sexually assaulted adolescent girl was brought for prevention of pregnancy.

Dr. Bad: It is not needed.

Dr. Good:It is needed.

Lesson:The overall risk of pregnancy resulting from sexual assault is 5%. The highest risk occurs during the three days preceding and including ovulation. Emergency contraception should be offered to all prepubertal female patients and should be strongly advised to females at highest risk of pregnancy.

Situation: An adult rape victim came for HIV prophylaxis.

Dr. Bad: It is not needed.

Dr. Good: It is needed.

Lesson: Antiretroviral prophylaxis is generally recommended for any adult rape victim, if it can be initiated within 72 hours of exposure and ideally within 4 hours. For children and adolescents, the decision is made on case to case basis depending on the likelihood of the assailant being HIV-positive, nature of sexual contact, time elapsed since the event and presence or absence of risk factor of HIV infection.

Situation: A sexual abused post pubertal child was brought for STI prophylaxis.

Dr. Bad: It is not needed.

Dr. Good: It is needed.

Lesson: For adolescents, sexually transmitted infections (STI) prophylaxis is recommended for those who present within 72 hours of the incident. STI prophylaxis is not routinely recommended for prepubertal victims because the incidence of infection is low and prepubertal girls have a lower risk of ascending infections and follow up is typically assured.

Readers Response
  1. Dear Sir, Nice updates. Regards:Dr Shantanu

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