Jun 06

Be Human Stop Child Abuse : Vol 18, 5th June, 2013

  Editorial

1. Approximately 90% of child victims of abuse do not show evidence of physical damage. These were found in less than 10% of abused children. Physical signs of abuse often are difficult to recognize and should not be the only indicators (Forensic Sci Int. 2012 Apr 10;217(1-3):1-4.)

2. The prevalence of clear evidence of sexual assault in the U.S. ranges from 3-23%, in Italy 9.5%, in Thailand 32% and in Denmark 40%. In Israel, as elsewhere in the world, few cases of sexual assault in children will have clear evidence of a sexual nature.

A lack of physical evidence does not rule out sexual assault, therefore, finding physical evidence during an examination is the exception rather than rule. Questioning the victim and investigating the circumstances of the case are crucial elements in all instances of presumed sexual assault on children. (Harefuah. 2011 Dec;150(12):895-8, 936.)

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 brought by the police suspected of being physically abused had bluish spots on lower back and legs.

Dr. Bad: It is a clinical bruise suggestive of physical abuse.

Dr. Good: It is a Mongolian spot.

Lesson: Mongolian spots are bluish-gray areas of skin discoloration. They normally disappear by one year but may persist into adulthood. They are seen most commonly on the buttocks and also lower back but may also be seen on the legs, shoulders, upper arms and scalp. At first glance they are often confused with fresh bruising but they do not change color as do bruises and fade over months to years rather than days.

Situation : A child with fractures of both wrists and forearms was brought by police to rule out physical abuse by parents.

Dr. Bad: Fracture at age 3 in children always means physical abuse.

Dr. Good: This appears to be a case of brittle bones.

Lesson:: Before labeling a patient as a case of physical abuse, always look for metabolic congenital anomalies as a cause of repeated fractures.

Situation : A patient with blisters was alleged by police to be a case of physical abuse by parents.

Dr. Bad: It is a case of physical abuse.

Dr. Good: This looks like phytophotodermatitis.

Lesson: Phytophotodermatitis is a condition with blister-like skin lesions that occur when sunlight interacts with photosynthesizing compound found in certain fruits, vegetables or fragrance products. The lesions may appear in unusual patterns of streaks and, sometimes, as fingerprints or handprints, which may be mistaken for child abuse.

Situation : A child with bullae was brought by police as a case of suspected physical abuse.

Dr. Bad: This is a case of physical abuse.

Dr. Good: This is due to reaction of garlic.

Lesson: Garlic application to the skin of infants as a naturopathy remedy can cause bullae and partial thickness burns.

Situation : A child with multiple skin lesions was brought to evaluate physical abuse.

Dr. Bad: This is a case of physical abuse.

Dr. Good: This is because of cupping.

Lesson: Cupping is a therapeutic technique practiced in complementary medicine. In cupping, the air in an open mouthed vessel is heated by various means and then the vessel is applied to the skin. The suction force created by cooling and contracting of a heated area is thought to draw out the ailments. The heated air and the rim of the cup can burn the skin. Cupping injury presents as a circular burn usually on the back. Central ecchymosis and or petechiae result from the suction affect of the heated air as it cools and contact.

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

May 30

Be Human Stop Child Abuse : Vol 17, 29th May, 2013

  Editorial

Understanding child abuse

i. Child maltreatment is defined as intentional harm or threat of harm to a child by a person who is acting in the role of a caretaker.

ii. Health care providers should care for children

iii. Four types of child maltreatment are described:

  1. Physical abuse
  2. Sexual abuse
  3. Emotional abuse
  4. Child neglect.

iv.  Child neglect is most prevalent form of child abuse accounting for more than 50% of cases and is defined as failure to provide for a child’s basic, physical, emotional, educational and medical needs. The types are:

  1. Physical neglect which is failure to provide adequate cloth, food, hygiene, protection, inadequate supervision with risk of harm to the child.
  2. Emotional neglect is failure to provide love, affection, security, emotional support and failure to provide a psychological care when needed, spouse abuse in presence of the child.
  3.  Educational neglect which is failure to enroll a child in the school of ensure school attendance, home school, failure to address specific educational needs.
  4. Medical neglect which is refusal to seek or delay in seeking medical care resulting in damage or risk of child health.

v. Emotional abuse is defined as a child abuse that results in impaired psychological growth and development. It is a repeated pattern of damaging interactions between care giver and the child that becomes typical of the relationship and conveys to the child he is unheard or unwanted. Categories are rejecting (refusing to counsel), terrorizing (verbal assault or threat), ignoring (depriving essential interactions), corrupting (stimulating antisocial behavior), verbal assault (abusing or hammering), over pressuring (criticizing age appropriate behaviors as inadequate).

vi. Physical abuse and sexual abuse – Physical abuse invariably involves injury or trauma. Sexual abuse is defined as attempted sexual touching of another person without their consent and includes sexual act (rape, sodomi – oral genital and anal genital contact) or fondling. The generally accepted definition is when one engages in sexual activity in which he cannot give consent, unprepared for apprehension or an activity that violates law or social taboos of society. This includes fondling and all forms of oral genital, genital or anal contact with the child whether the child is clothed or unclothed as well as in touching abuses such as exhibitionism or voyeurism or involving the child in pornography.

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)

News

Developmental trajectory of sexual risk behaviors from adolescence to young adulthood.

This study examined the trajectories of sexual risk behaviors among adolescents from ages 15 to 23, and factors associated with those trajectories. The sample was 5,419 adolescents from the 1997 National Longitudinal Survey of Youth. Using group-based trajectory modeling, five distinctive trajectory groups were identified. The High group had a high and increased risk trajectory over the observed ages. The Decreased group had a risk trajectory that accelerated before age 19, but decreased afterwards. The risk trajectories of the Increased-Early and Increased-Late groups were low at age 15, but increased significantly starting at ages 16 and 18 for the groups, respectively. Participants in the Low group remained at low risk over time. Sexual risk behaviors were also positively associated with alcohol use, marijuana use, and delinquency. Results highlight the need for intervention efforts to consider developmental timing of sexual risk behaviors and their associations with other problem behaviors.

Source: Huang DY, Murphy DA, Hser YI. Youth Soc. 2012 Dec;44(4):479-499

Preventing the Recurrence of Maltreatment

In the context of the federal child welfare performance measurement system, recurrence of maltreatment refers to circumstances in which children that have previously been substantiated as victims of abuse or neglect experience another incident of substantiated maltreatment. Multiple episodes of maltreatment can lead to: (1) more serious short and long term negative consequences, (2) entry into the juvenile justice system, and (3) juvenile delinquency.

Source: Carnochan S, Rizik-Baer D, Austin MJ. J Evid Based Soc Work. 2013 May;10(3):161-178.

Childhood abuse is associated with structural impairment in the ventrolateral prefrontal cortex and aggressiveness in patients with borderline personality disorder

Volume reduction and functional impairment in areas of the prefrontal cortex (PFC) have been found in borderline personality disorder (BPD), particularly in patients with a history of childhood abuse. These abnormalities may contribute to the expression of emotion dysregulation and aggressiveness. In this study we investigated whether the volume of the PFC is reduced in BPD patients and whether a history of childhood abuse would be associated with greater PFC structural changes. Structural MRI data were obtained from 18 BPD patients and 19 healthy individuals matched for age, sex, handedness, and education and were analyzed using voxel based morphometry. The Child Abuse Scale was used to elicit a past history of abuse; aggression was evaluated using the Buss-Durkee Hostility Inventory (BDHI). The volume of the right ventrolateral PFC (VLPFC) was significantly reduced in BPD subjects with a history of childhood abuse compared to those without this risk factor. Additionally, right VLPFC gray matter volume significantly correlated with the BDHI total score and with BDHI irritability and negativism subscale scores in patients with a history of childhood abuse. Our results suggest that a history of childhood abuse may lead to increased aggression mediated by an impairment of the right VLPFC.

Source: Morandotti N, Dima D, Jogia J, Frangou S, Sala M, Vidovich GZ, Lazzaretti M, Gambini F, Marraffini E, d’Allio G, Barale F, Zappoli F, Caverzasi E, Brambilla P. Psychiatry Res. 2013 May 18.

Readers Response
  1. Dear Sir, Pls keep it up. Regards:Dr Sharad

May 23

Be Human Stop Child Abuse : Vol 16, 23rd May, 2013

  Editorial

And now womb transplant

In January 2014, the world may see a child born to a woman who has undergone the first ever successful womb transplant.

The breakthrough procedure was carried out last year by Turkish surgeons on 21-year-old Derya Sert, who was born without a uterus.

Dr J Richard Smith, a British gynecologist from Queen Charlotte’s & Chelsea Hospital in London, is leading efforts in the UK to start a womb transplant programme.

One in every 5,000 women in the UK is born without a womb. Besides, around 1,000 UK women from the 15-24 age group have hysterectomies every year, a commonly performed procedure for treating cervical cancer.

The British charity says the only two options available for these women are adoption and surrogacy, both acceptable options but fraught with moral, ethical and financial difficulties.

The majority of the research, published in the 1960s to the 1980s, involved transplantation of the entire female genital tract (ovaries, womb, cervix and upper vagina) in a range of different mammals.

In 2000, the world’s first womb transplant was performed on a 26-year-old woman in Saudi Arabia.

Although this attempt was unsuccessful, much was learned and it was the stimulation for extensive research to continue around the world.

In December 2010, doctors in Sweden were able to report a pregnancy as a result of a womb transplant on a rat.

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)

News

Child Sexual Abuse Survivors with Dissociative Amnesia: What’s the Difference?

Although the issue of dissociative amnesia in adult survivors of child sexual abuse has been contentious, many research studies have shown that there is a subset of child sexual abuse survivors who have forgotten their abuse and later remembered it. Child sexual abuse survivors with dissociative amnesia histories have different formative and therapeutic issues than survivors of child sexual abuse who have had continuous memory of their abuse.

Source: Wolf MR, Nochajski TH. J Child Sex Abus. 2013 May-June;22(4):462-480.

Child sexual abuse in China: A meta-analysis of 27 studies.

A meta-analysis and meta-regression were conducted on 27 studies found in the English and Chinese language peer reviewed journals that involved general populations of students or residents, estimated CSA prior to age 18, and specified rates for males or females individually.
RESULTS: Estimates for Chinese females were lower than the international composites. For total CSA for females, the Chinese pooled estimate was 15.3% (95% CI=12.6-18.0) based on the meta-analysis of 24 studies, lower than the international estimate (Stoltenborgh, van IJzendoorn, Euser, & Bakermans-Kranenburg, 2011) but not significantly. For contact CSA for females, the pooled estimate was 9.5% (95% CI=7.5-11.5), based on 16 studies, significantly lower than the international prevalence. For penetrative CSA for females, the pooled estimate was 1% (95% CI=0.7-1.3), based on 15 studies, significantly lower than the international estimate of 15.1%. Chinese men reported significantly less penetrative CSA but significantly more total CSA than international estimates; while contact CSA reported by Chinese and international males appeared to be roughly equivalent. Chinese CSA prevalence estimates were lower in studies from urban areas and non-mainland areas (Hong Kong and Taiwan), and in surveys with larger and probability samples, multiple sites, face-to-face interview method and when using less widely used instruments. CONCLUSIONS:
The findings to date justify further research into possible cultural and sociological reasons for lower risk of contact and penetrative sexual abuse of girls and less penetrative abuse of boys in China. Future research should examine sociological explanations, including patterns of supervision, sexual socialization and attitudes related to male sexual prowess.

Source: Ji K, Finkelhor D, Dunne M. Child Abuse Negl. 2013 Apr 30

Childhood sexual abuse and adult developmental outcomes: Findings from a 30-year longitudinal study in New Zealand.

Childhood sexual abuse CSA is a traumatic childhood life event in which the negative consequences increase with increasing severity of abuse. CSA adversely influences a number of adult developmental outcomes that span: mental disorders, psychological wellbeing, sexual risk-taking, physical health and socioeconomic wellbeing. While the individual effect sizes for CSA typically range from small to moderate, it is clear that accumulative adverse effects on adult developmental outcomes are substantial.

Data from over 900 members of the New Zealand birth cohort the Christchurch Health and Development Study were examined. CSA prior to age 16 was assessed at ages 18 and 21 years, in addition to: mental health, psychological wellbeing, sexual risk-taking behaviors, physical health and socioeconomic outcomes to age 30.

After statistical adjustment for confounding by 10 covariates spanning socio-demographic, family functioning and child factors, extent of exposure to CSA was associated with increased rates of (B, SE, p): major depression (0.426, 0.094, <.001); anxiety disorder (0.364, 0.089, <.001); suicidal ideation (0.395, 0.089, <.001); suicide attempt (1.863, 0.403, <.001); alcohol dependence (0.374, 0.118, <.002); and illicit drug dependence (0.425, 0.113, <.001). In addition, at age 30 CSA was associated with higher rates of PTSD symptoms (0.120, 0.051, .017); decreased self-esteem (-0.371, 0.181, .041); and decreased life satisfaction (-0.510, 0.189, .007). Childhood sexual abuse was also associated with decreased age of onset of sexual activity (-0.381, 0.091, <.001), increased number of sexual partners (0.175, 0.035, <.001); increased medical contacts for physical health problems (0.105, 0.023, <.001); and welfare dependence (0.310, 0.099, .002). Effect sizes (Cohen’s d) for the significant outcomes from all domains ranged from .14 to .53, while the attributable risks for the mental health outcomes ranged from 5.7% to 16.6%.

Source: Fergusson DM, McLeod GF, Horwood LJ. Child Abuse Negl. 2013 Apr 24

Readers Response
  1. Dear Sir, Nice Updates. Regards:Dr Jagat

May 16

Be Human Stop Child Abuse : Vol 15, 15th May, 2013

  Editorial

Does Really Sex Addiction Exist?

Hypersexual Disorder has been proposed as a new psychiatric disorder for DSM-V, characterized by an increased frequency and intensity of sexually motivated fantasies, arousal, urges, and enacted behavior in association with an impulsivity component.

Excessive appetitive and consummatory behaviors, including hypersexuality, can become a non-chemical addiction.

Sexual addiction afflicts people having paraphilic or nonparaphilic behaviors associated with progressive risk-taking sexual behaviors, escalation or progression of sexual behaviors (tolerance), loss of control and significant adverse psychosocial consequences, such as unplanned pregnancy, pair-bond dysfunction, marital separation, financial problems and sexually transmitted diseases including HIV.

The most common behaviors involved in sexual addiction are fantasy sex, compulsive masturbation, pornography, cybersex, voyeuristic sex, anonymous sex and multiple sexual partners.

These behaviors are intended to reduce anxiety and other dysphoric affects (e.g., shame and depression).

Axis I psychiatric diagnosis, especially mood disorders, psychoactive substance abuse disorders and attention deficit hyperactivity disorders, are common comorbid disorders with sexual addiction.

There are significant gaps in the current scientific knowledge base regarding the clinical course, development risk factors and family history and data on women with sexual addiction are lacking.

Source: Echeburúa E. Adicciones. 2012;24(4):281-5.

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)

News

Sexual Dysfunction in Obsessive Compulsive Disorder And Panic Disorder

The study population consisted of 80 patients between 20 and 60 years of age with a diagnosis of OCD or PD who were followed and treated at the anxiety outpatient unit of Bakirkoy Research and Training Hospital for Psychiatric and Neurological Disorders between 2005 and 2006. The total study population comprised of 40 patients with OCD, 40 patients with PD, and 40 healthy volunteers as the control group. Of the two questionnaires used for study purposes, the first provided information on demographic data and certain parameters of sexual functioning, while the second was the validated Turkish translation of the Golombok-Rust Sexual Satisfaction Inventory with transliteral equivalence.
Male subjects with OCD had a lower age of first masturbation and first nocturnal ejaculation. Infrequency problem among female and male patients with OCD occurred in 63.6% and 57.1%, respectively. Corresponding figures for PD patients were 36% and 38%. Thus, infrequency problem was more frequent among OCD patients. Sexual avoidance was found in 60.6% of female OCD patients and in 64% of female PD patients. Anorgasmia was detected in 24.2% of the female subjects with OCD.

Source: Aksoy UM, Aksoy SG, Maner F, Gokalp P, Yanik M. Psychiatr Danub. 2012 Dec;24(4):381-5.

Female Sexual Compulsivity: A New Syndrome

This article discusses women who have sexual compulsivity, a disorder that is intensely shame-based and difficult to treat. The case studies presented show the family preconditioning of abandonment in childhood through inadequate care, abuse, neglect, and the presence of other addictions. As children, these women searched for something to soothe their distress when they could not rely on their caregivers. Maladaptive coping mechanisms, such as masturbation, food, romantic or violent fantasies, and any behavior to would gain attention, maintained their sanity in childhood. However, these behaviors also advanced to autonomy, eliminating the option of choices. In adulthood, the numbing of psychic pain by these found solutions became a preoccupation around which life was organized. Consequences developed and as the disease progressed, large amounts of time were regularly lost in fantasy and ritualistic behaviors, causing life to become unmanageable. The fear of being discovered, loneliness, and sexually transmitted diseases typically escalates to spiritual bankruptcy and eventual spiritual, psychological, and possibly physical death. The dilemma is too deep and powerful for women to heal themselves over time, partly because of her impaired thinking, unresolved trauma, and desperation-driven repeat of the behaviors. Proper intervention and treatment can make a difference. Restoration to full health takes years, requiring diligence, motivation, and a therapist who is knowledgeable, committed, patient, and willing to use all available modalities. Trust is a huge issue for these women, and even when taking a positive risk in therapy, trauma responses from early childhood may be evoked. These women are exquisitely sensitive to criticism, but if feeling safe most can learn to trust and will respond to help, because they long to be restored to their values, be self-sufficient, and have a voice that is respected. Uncovering sexual secrets from previous generations, still present in the families-of-origin, helps patients put their problems in context. Treatment can be successful if patients develop a capacity to bond, can tolerate the psychic pain of disclosure, are willing to be accountable, are resilient, and can forgive themselves and others. The rewards for this endeavor are great. The successful interruption and healing of patterns of abuse, shame, and distortions of intimacy and sexuality is a great contribution to society.

Source: Turner M. Psychiatr Clin North Am. 2008 Dec;31(4):713-27. doi: 10.1016/j.psc.2008.06.004.

Treatment of Compulsive Cybersex Behavior

Compulsive cybersex has become a significant problem for many men and women who have fallen prey to the accessibility, affordability, and anonymity of online sexual behaviors. Some patients develop problems with compulsive cybersex due to predisposition or accidental conditioning experiences. Other compulsive users of cybersex present with underlying trauma, depression, or addiction. Three case studies highlighted obsession, compulsion, and consequence in the pathogenesis of compulsive cybersex. While men and women differ somewhat in their use of cybersex, both genders exhibit maladaptive coping, conditioned behavior, dissociative reenactment of life trauma, courtship disorder, intimacy dysfunction, and addictive behavior. Comprehensive treatment of compulsive cybersex would include the following components: relapse prevention, intimacy enhancement, lovemap reconstruction, dissociative states therapy, arousal reconditioning, and coping skills training. Thanks to recent treatment advances in several fields, help is available for those caught in the dark side of the net.

Source: Southern S: Psychiatr Clin North Am. 2008 Dec;31(4):697-712. doi: 10.1016/j.psc.2008.06.003.

Readers Response
  1. Dear Sir, Thanks for the Update. Regards:Dr Shreya

May 08

Be Human Stop Child Abuse : Vol 14, 8th May, 2013

  Editorial

Childhood rape can change genes

Childhood rape or other traumatic events like car accidents or recurrent abuse can change the genetic functioning of the victim as per a study led by Divya Mehta of the Max Planck Institute of Psychiatry in Munich, Germany reports TOI.

Comparing the genetic structure of blood cells drawn from childhood abuse victims with that of persons who had not suffered such abuse, the researchers found that changes in the genes were 12 times more visible in the abused persons.

These are called epigenetic changes – the DNA has not changed but there are chemical differences that affect the way the genes do their work.

Epigenetic changes are caused by outside circumstances and usually last lifelong.

The study has been published in a recent issue of the scientific journal Proceedings of National Academy of Science (PNAS).

The research also has major implications for wider psychiatric treatment. One of the reasons why psychiatric treatment has a low success rate could be that patients with different ‘biologies’, that is, internal genetic structures are all being grouped under one disease.

The study shows that in the future, trauma victims will need to be first checked through blood markers whether they have childhood trauma changes – this will open the door to better more effective customized treatment.

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)

News

DNA testing

  • DNA parentage testing is primarily used to determine whether a man can be conclusively excluded as the biological father of a given child.
  • It has legal, financial, and social indications.
  • The testing uses tandemly repeated DNA length polymorphisms to compare DNA samples between individuals.
  • Samples from the child, mother, and alleged father are used.
  • Alleles not shared by mother and child represent obligate paternal alleles.
  • When the alleged father is not available, DNA grandparentage testing can produce highly conclusive results.
  • Alternatively, family reconstruction by DNA analyses can provide highly conclusive results if a sufficient number of family members with known relationship to the deceased is available for testing and if a sufficient number of highly diverse genetic sites is tested.
  • The combined paternity index (CPI) is the ratio of the chance that a tested man, given his entire analyzed genetic makeup, is the biological father of the child in question, compared to the likelihood of a random man producing the child.
  • A CPI of 1000 (equivalent to a probability of paternity of 99.9 percent) means that odds are 1000 times to 1 that the tested man is the biological father in comparison to a random man in the general population. A combined paternity index of 1000 should be utilized as a minimum requirement to establish paternity.
  • The Y-STR paternal lineage DNA test can be used to determine whether two or more males are related through their paternal lineage.
  • An opinion of non-paternity should not be rendered on the basis of a genetic mismatch at a single DNA site. A minimum of three genetic mismatches between the alleged father and the child should be present prior to rendering the diagnosis of non-paternity.
  • Prenatal paternity testing requires informed consent from all adults involved in testing, samples from the mother, one of the potential fathers, and the fetus (by either CVS or amniocentesis).
  • Parentage testing without consent or court order is unethical.
  • Regulation of DNA parentage laboratories is voluntary. (Source Uptodate)

What should I do if I am sexually assaulted?

  1. Find a safe place away from the person who attacked you.
  2. Call a close friend or family member. Choose someone who will give you support no matter what.
  3. Call your doctor or go to the emergency room.
  4. The doctor might also offer you medicines that can reduce your chances of getting pregnant (if you are a woman) or getting an infection.
  5. If you say it’s OK, the doctor can take samples of cells or fluid from your body and clothes. These samples can show who your attacker was and what he or she did.
  6. You do not have to let the doctor or nurse do anything you do not want.
  7. Do NOT try to clean up before you see a doctor or nurse. If you clean up, you might wash away proof of what happened
  8. Do not change clothes
  9. Do not take a shower or bath
  10. Do not brush your teeth
  11. Do not wash the inside of your vagina or rectum
  12. If you can wait, try not to go to the bathroom or to eat anything until after you have seen a doctor or nurse
  13. Find a counselor — someone you can talk to about what happened.
  14. Talk to your counselor about filing a police report.
  15. See your doctor or nurse again 1 to 2 weeks later. This gives them a chance to make sure everything is OK.
  16. Ask about “victim compensation services.
  17. Protect others if you might have an infection. If you have sex with someone after being raped, use a condom every time you have sex for at least 3 months.
Readers Response
  1. This message is too good. Keep it up.Regards:

    Dr Priya

Apr 24

Be Human Stop Child Abuse : Vol 13, 24th April, 2013

  Editorial

Problems faced by consultants in the city of Delhi

There was a time when smaller nursing homes were flooded with top consultants of the city but now most of them either are not opting for or have left the smaller medical establishments.

Most of them are opting for bigger private establishments to survive as the smaller nursing homes are unable to provide them with the latest infrastructure facilities.

Consultants prefer to do their procedures in bigger hospitals.

Most of the nursing homes, which are running are single consultant nursing home owned and run by the specialty of the owner.

In a bigger setup, there is a great disparity in salary structure.

Most of the corporate hospitals cater to only 1% of the population, which can afford treatment at these hospitals.

IMA CMAAO MEETING 22nd April 2013

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)

News

Shocking: 336% rise in child rape cases in India since 2001

Satya Prakash, Hindustan Times New Delhi, April 20, 2013

Child rape cases in India have witnessed 336% rise since 2001.

Citing National Crimes Record Bureau (NCRB) figures, the report by Asian Centre for Human Rights (ACHR) stated that 48,338 child rape cases were recorded during 2001-11, which was an increase of 336% in such cases since 2001 when only 2,113 child rape cases were recorded. The number rose to 7,112 cases in 2011.

With 9,465 cases, Madhya Pradesh was on the top of the child rape table, followed by Maharashtra (6,868) and Uttar Pradesh (5,949), while Daman and Diu (9), Dadra and Nagar Haveli (15) and Nagaland (38) reported the least number of child rape cases during 2001-11.

These are only the tip of the iceberg as the large majority of child rape cases are not reported to the police while children regularly become victims of other forms of sexual assault too.
The report – “India’s Hell Holes:

Child Sexual Assault in Juvenile Justice Homes” stated that sexual offences against children in India had reached epidemic proportions and a large number of such crimes were being committed in 733 juvenile justice homes run and aided by government. It cited 39 such cases – 11 from government-run juvenile justice homes and 27 from privately/NGO-run ones.

There were hundreds of unregistered child care homes across the country despite the requirement to register such homes within six months under Juvenile Justice (Care & Protection of Children) Act, 2006, it said, demanding registration of cases against those running unregistered juvenile justice homes.

According to the report, though there were 462 District Child Welfare Committees in 23 States mandated to verify fit institutions, majority of them existed
only on paper.

It said lack of segregation on the basis of gender, nature of offences and age facilitated senior inmates to commit offences against minor inmates, including girls.

ACHR recommended immediate establishment of Inspection Committees in all the districts and mandatory inspection of the juvenile justice homes by these committees in every three months; stopping funds to any home unless inspection reports are submitted; separate budgetary allocations for the functioning of the Inspection Committees and ban on posting of male staff in girls’ homes.

Readers Response
  1. This message is too good. Keep it up.Regards:

    Dr Priya

Apr 17

Be Human Stop Child Abuse : Vol 12, 17th April, 2013

  Editorial

The relationship between sexual abuse and risky sexual behavior among adolescent boys: a meta-analysis

Childhood and adolescent sexual abuse can substantially influence sexual behavior in adolescence among male survivors. To improve sexual health for all adolescents, even young men, we should strengthen sexual abuse prevention initiatives, raise awareness about male sexual abuse survivors’ existence and sexual health issues, improve sexual health promotion for abused young men, and screen all people, regardless of gender, for a history of sexual abuse.

Study

Childhood and adolescent sexual abuse has been shown to lead to increased odds of sexual behaviors that lead to sexually transmitted infections and early pregnancy involvement. Research, meta-analyses, and interventions, however, have focused primarily on girls and young women who have experienced abuse, yet some adolescent boys are also sexually abused. We performed a meta-analysis of the existing studies to assess the magnitudes of the link between a history of sexual abuse and each of the three risky sexual behaviors among adolescent boys in North America.

The three outcomes were (a) unprotected sexual intercourse, (b) multiple sexual partners, and (c) pregnancy involvement. Weighted mean effect sizes were computed from ten independent samples, from nine studies published between 1990 and 2011.

Sexually abused boys were significantly more likely than nonabused boys to report all three risky sexual behaviors. Weighted mean odds ratios were 1.91 for unprotected intercourse, 2.91 for multiple sexual partners, and 4.81 for pregnancy involvement.

Source: Homma Y, Wang N, Saewyc E, Kishor N. J Adolesc Health. 2012 Jul;51(1):18-24. doi: 10.1016/j.jadohealth.2011.12.032. Epub 2012 Mar 5.

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)

News

Yield of radiographic skeletal surveys for detection of hand, foot, and spine fractures in suspected child abuse.

Data, acquired during the film-screen era, suggest that fractures of the spine, hands, and feet may not be rare in infants and toddlers in cases of suspected child abuse. The benefits of eliminating views of these regions from the initial skeletal survey should be carefully weighed against the cost of missing these potentially important injuries in at-risk pediatric populations.

Previous studies have found that fractures involving the spine, hands, and feet are rare on skeletal surveys in cases of suspected child abuse, leading some authors to suggest eliminating these regions from the initial skeletal survey protocol. We assessed this recommendation by performing a historical review of these injuries in a pediatric population undergoing film screen-based radiographic skeletal surveys for suspected child abuse.

This cross-sectional retrospective study reviewed reports of initial skeletal surveys of all children younger than 2 years with suspected abuse imaged between April 1988 and December 2001. Radiographic skeletal survey imaging was performed according to American College of Radiology standards. Sixty-two percent (225/365) of all skeletal surveys had positive findings, and 44% (98/225) showed more than one fracture. Surveys with fractures involving the spine, hands, or feet were identified, and the data were tabulated and analyzed.

Twenty of 365 studies (5.5%) yielded fractures involving the spine, hands, or feet. Of all positive skeletal surveys, 8.9% (20/225) had fractures involving the spine, hands, or feet. Of all patients with more than one fracture on skeletal survey, 20.4% (20/98) had fractures involving these regions.

Source: Kleinman PK, Morris NB, Makris J, Moles RL, Kleinman PL: AJR Am J Roentgenol. 2013 Mar;200(3):641-4. doi: 10.2214/AJR.12.8878.

Screening for risk of child abuse and neglect. A practicable method?

Selective primary prevention programs for child abuse and neglect depend on risk screening instruments that have the goal of systematically identifying families who can profit most from early help. Based on a systematic review of longitudinal studies, a set of established risk factors for earlychild abuse and neglect is presented. Nearly half of the items included in screening instruments can be seen as validated. Available studies indicate a high sensitivity of risk screening instruments. Positive predictive values, however, are low. Overall, the use of risk screening instruments in the area of primary prevention for families at risk represents a feasible method, as long as stigmatizing effects can be avoided and participating families also benefit beyond preventing endangerment.

Kindler H<: Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2010 Oct;53(10):1073-9. doi: 10.1007/s00103-010-1132-x.

The effect of intimate partner violence against women on under-five children mortality: a systematic review and meta-analysis

Interventions aimed at improving child health and survival should focus to protect women from all forms of violence. Comprehensive and longitudinal studies are encouraged to address the issues of intimate partner violence against women and under five children mortality in more depth.

Intimate partner violence against women is one of the most common and widely occurring forms of violence against women that had consequences on the health of women and children. However, studies of the impact on children mortality reported controversial results.

To determine the overall magnitude, association directions of intimate partner violence against women and mortality among under five children, online databases were systematically searched for subject heading intimate partner violence against women and under five children mortality. On the final search 11 studies from developing countries were inputted into Metaesy add-in for MS Excel version 1.0.4 software for meta-analysis. Random effect model using DerSimonian and Laird’s (DL) estimator was used to calculate the pooled estimates of the studies.

Mother who reported past experiences of intimate partner violence were more likely to have under-five children mortality. Mean effect size, 95% CI; 0.23 (0.16 to 0.32) was observed which is significantly different from Zero. The value of pooled Odds Ratio corresponds to 95% CI is: 1.34 (1.12 to 1.46).

Source: Garoma S, Fantahun M, Worku A: Ethiop Med J. 2011 Oct;49(4):331-9.

IMA CMAAO MEETING

Readers Response
  1. This message is too good. Keep it up. Regards: Dr Priya

Apr 15

Be Human Stop Child Abuse : Vol 11, 10th April, 2013

  Editorial

Combating Child Abuse: The Role of a Dentist

Child abuse has serious physical and psychosocial consequences which adversely affect the health and overall well-being of a child. However, in a developing country like India there has been no knowledge of the extent, magnitude and trends of the problem.

This study reviews the overall scenario of child abuse in India as well as the role of the dentist in recognizing and thereby combating this problem. Results: Among health professionals, dentists are probably in the most favorable position to recognise child abuse, with opportunities to observe and assess not only the physical and the psychological condition of the children, but also the family environment.

The high frequency of facial injuries associated with physical abuse places the dentist at the forefront of professionals to detect and treat an abused child. Screening for maltreatment should be an integral part of any clinical examination performed on a child. Although many injuries are not caused by abuse, dentists should always be suspicious of traumatic injuries.

The dental professional’s role in child abuse and neglect is to know the current state law regarding reporting child abuse and to follow the law. Awareness, identification, documentation and notification should be carried out by the dentist.

Conclusion: Paediatric dentists can provide valuable information and assistance to physicians about oral and dental aspects of child abuse and neglect. Such efforts will strengthen the ability to prevent and detect child abuse and neglect and enhance care and protection for the children.

Source: Mathur S, Chopra R. Oral Health Prev Dent. 2013 Mar 15. doi: 10.3290/j.ohpd.a29357

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)

News

Child abuse: multiple foreign bodies in gastrointestinal tract

The incidents of foreign body ingestion in infants and children are usually viewed as accidents, but these events may be a form of child abuse. We are reporting a case of child abuse who presented with multiple foreign bodies in the gastrointestinal tract. Physicians are required to report abuse when they have reason to believe or to suspect that it occurred. The purpose of reporting is not punishment of the perpetrator – it is the protection of the child. It is certainly in the best interest of the child, because child abuse is a recurrent and usually escalating problem that exposes the child to substantial risk.

Source: Wadhera R, Kalra V, Gulati SP, Ghai A. Int J Pediatr Otorhinolaryngol. 2013

Subconjunctival hemorrhages in infants and children: a sign of nonaccidental trauma

Subconjunctival hemorrhages in infants and children can be a finding after nonaccidental trauma. We describe 14 children with subconjunctival hemorrhages on physical examination, who were subsequently diagnosed by a child protection team with physical abuse. Although infrequent, subconjunctival hemorrhage may be related to abuse. Nonaccidental trauma should be on the differential diagnosis of subconjunctival hemorrhage in children, and consultation with a child abuse pediatrics specialist should be considered.

Source: Deridder CA, Berkowitz CD, Hicks RA, Laskey AL Pediatr Emerg Care. 2013 Feb;29(2):222-6. doi: 10.1097/PEC.0b013e318280d663.

Psychopathological correlates of child sexual abuse: the case of female students in jimma zone, South west ethiopia.

Arguably, the sexual abuse of children raises a number of important questions for researchers at different times. Thus, the present study was aimed to examine psychopathological correlates of child sexual abuse.

This cross-sectional survey study compared the degree of vulnerability to psychopathological variables among respondents with a history of sexual abuse and their unabused counter parts in Jimma Zone. To this end, 400 female students were selected from five high schools as the sample population using multi-stage sampling procedure. Data were gathered using Reynold’s Adolescent Depression Scale (RADS), Adolescent Panic Anxiety Scale, and Posttraumatic stress disorder test. The collected data via self-administered questionnaire were analyzed through the two sample t-test statistical procedure.

The study revealed a result of t=3.83 for depression, t=2.46 for panic episode, and t=4.23 for PTSD score, whereas, the critical value of all the three psychopathological variables showed t (52) =1.676 at P=0.05. Results illustrate the presence of statistically significant differences in the mean scores of the above mentioned psychopathologies between females with history of sexual abuse and females who were not victims of this sexual attack at df =52 and P=0.05.

The findings of the present study indicate that history of childhood sexual abuse has adverse consequences on the future psychological wellbeing of females. Specifically, females with experience of sexual abuse were found to be more susceptible to develop depression, panic anxiety, and post-traumatic stress disorders than unabused females. Thus, parents, and teachers should give the necessary care and protection to female children. Primary bio-psychosocial care services need to be established in the school system, and both the Ministry of Health and the Ministry of Education should work together against sexual exploitation of female children.

Source: Haileye A. Ethiop J Health Sci. 2013 Mar;23(1):32-8.

Readers Response
  1. This message is too good. I wasn’t aware of these figures. Keep it up.RegardsDr Pranjali Shinde
Recent Newsletter
  1. Be Human Stop Child Abuse – Vol8, 13th March, 2013
  2. Be Human Stop Child Abuse – Vol7, 6th March, 2013
  3. Be Human Stop Child Abuse – Vol6, 27th February, 2013
  4. Be Human Stop Child Abuse – Vol5, 20th February, 2013
  5. Be Human Stop Child Abuse, Vol.4, 13th February, 2013
  6. Be Human Stop Child Abuse, Vol.3, 6th February, 2013
  7. Be Human Stop Child Abuse, Vol.2, 30th January,2013
  8. Be Human Stop Child Abuse, Vol.1, 23rd January,2013

Mar 28

Be Human Stop Child Abuse : Vol 10, 28th March, 2013

  Editorial

Childhood exposure to intimate partner violence

Intimate partner violence is a common form of violence against women. Between 25 to 35 percent of women in the United States have suffered violence from an intimate partner at some point in their lives.

Intimate partner violence against men also occurs. One in four men experiences rape, physical violence, and/or stalking by an intimate partner in their lifetime.

Women between the ages of 20 and 34 are at the greatest risk for intimate partner violence and because many of these women are mothers, millions of children are exposed to intimate partner violence.

Exposure to such violence is a major threat to children’s health and well-being.
Data from the Adverse Childhood Experiences (ACE) studies indicate that adverse childhood experiences, such as exposure to intimate partner violence, dramatically affect adult mental and physical health and mortality.

Chronic toxic stress in childhood causes physiologic changes that lead to stress-related chronic illness and unhealthy lifestyles in adulthood.

Intimate partner violence frequently remains undiagnosed because victims may conceal that they are in abusive relationships, and the clues pointing to abuse may be subtle or absent.

Pediatricians are well-placed to identify maternal intimate partner violence because victims of intimate partner violence seek health care for their children, even if they do not for themselves.

Intimate partner violence is a pattern of coercive behaviors that may include repeated sexual and physical violence, psychological abuse, progressive social isolation, deprivation, intimidation, stalking, and reproductive coercion.

Many children who are exposed to intimate partner violence exhibit an increase in externalizing behaviors such as aggression, conduct disorders, and impulsivity.

Take home messages

  1. Intimate partner violence is a pattern of coercive behaviors that may include repeated sexual and physical violence, psychological abuse, progressive social isolation, deprivation, intimidation, stalking, and reproductive coercion.
  2. Exposure to intimate partner violence has short- and long-term effects on a child’s emotional, social, and cognitive development.
  3. The presentation of children who are exposed to intimate partner violence is variable
  4. The “RADAR” acronym was developed to guide healthcare providers in screening for intimate partner violence
  5. Screening mothers and teenage patients for intimate partner violence should be performed when risk factors for intimate partner violence are present.
  6. Children who are exposed to intimate partner violence may benefit from mental health services.

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)

News

RADAR Acronym

Pediatric screening for intimate partner violence – RADAR acronym

Health effects

Effects of exposure to intimate partner violence
Infants and toddlers

Emotional distress and fear of being alone

Attachment problems
Pre-schoolers

Difficulty developing empathy
Poor self-esteem

Nightmares
Sleep difficulties
Separation/anxiety issues

School-age
Feeling guilty,blaming themselves
Adoption of anti-social rationales for abusive behavior
Poor social skills

Peer difficulties
Bullying/aggressive behavior
Parentification

Adolescents

Difficulty forming healthy relationships
Avoidant attachment style

Aggression
Abusive behaviors in their own intimate relationships

Mental and emotional disengagement
Parentification

Source: Can J Psychiatry 1990; 35:471.

Screening Algorithms

Intimate partner violence screening algorithm

IPV: intimate partner violence.

References:

  1. Futures without Violence. Available at: www.futureswithoutviolence.org (Accessed on September 19, 2012).
  2. Massachusetts Medical Society. Use your “RADAR” to recognize and treat intimate partner violence. Available at: www.massmed.org/AM/Template.cfm?Section=Home6&TEMPLATE=/CM/ContentDisplay.cfm&CONTENTID=7357 (Accessed on February 08, 2012).

Courtesy of Kathleen M Franchek-Roa, MD.
(Source Uptodate)

Readers Response
  1. This message is too good. I wasn’t aware of these figures. Keep it up.

    Regards

    Dr Pranjali Shinde

Recent Newsletter
  1. Be Human Stop Child Abuse – Vol8, 13th March, 2013
  2. Be Human Stop Child Abuse – Vol7, 6th March, 2013
  3. Be Human Stop Child Abuse – Vol6, 27th February, 2013
  4. Be Human Stop Child Abuse – Vol5, 20th February, 2013
  5. Be Human Stop Child Abuse, Vol.4, 13th February, 2013
  6. Be Human Stop Child Abuse, Vol.3, 6th February, 2013
  7. Be Human Stop Child Abuse, Vol.2, 30th January,2013
  8. Be Human Stop Child Abuse, Vol.1, 23rd January,2013

Mar 20

Be Human Stop Child Abuse : Vol 9, 20th March, 2013

  Editorial

Lok Sabha passes anti-rape bill, age of consent stays at 18

  1. The Lok Sabha has passed a bill which provides for natural life term or even death for repeat offenders of rape and other stringent punishment for various offences like stalking, voyeurism and acid attacks.
  2. The Criminal Law (Amendment) Bill-2013, brought against the backdrop of the country-wide outrage over Delhi gang-rape, also makes it clear that the age of consent for sex would be 18 years, which was a sticking point with political parties. 
  3. The Bill seeks to replace an Ordinance promulgated on February 3, which will expire on April 4. 
  4. It seeks to amend the Indian Penal Code, the Code of Criminal Procedure, the Indian Evidence Act and the Protection of Children from Sexual Offences Act. 
  5. The Bill was passed after all amendments moved by opposition and one by UPA constituent NCP for a life-term for perpetrators of acid attacks were defeated. 
  6. With an aim of providing a strong deterrent against rapes and gang-rapes, the Bill states that an offender can be sentenced to rigorous imprisonment for a term which shall not be less than 20 years, but which may extend to life, meaning imprisonment for the remainder of that person’s natural life and with a fine. 
  7. It has provisions for handing out death sentence to offenders who may have been convicted earlier for such crimes.
  8. The Bill, for the first time, defines stalking and voyeurism as non-bailable offences if repeated for a second time.
  9. Perpetrators of acid attack will attract a 10-year jail term.
  10. Bill has provisions for allowing rape victims and witnesses to use the services of interpreters or special educators for recording of statement.
  11. Post lady officers at every police station. 
  12. The Bill, for the first time, defines acid attack as a crime and also grants a victim the right to self-defence. It also has provisions for awarding a minimum 10-year jail term for perpetrators of the act. 
  13. New sections to prevent stalking and voyeurism were introduced following a strong demand from women’s organizations.  For the first time we are making these a punishable offence…So, we have made it bailable for the first instance. We will not spare him if he repeats the offence said the home minister.

Amendments seek to define and prescribe punishment for the offences of stalking, voyeurism and sexual harassment. The Bill also seeks to widen the definition of rape, broaden the ambit of aggravated rape and enhance the punishment for such crimes. The Bill also provides that all hospitals shall immediately provide first aid and/or medical treatment free of cost to the victims of acid attack or rape, and failure to do so will attract punishment.

It also has provisions for a minimum imprisonment of seven years which may extend to imprisonment for life and a fine for offender who is a police officer, a public servant, a member of the armed forces or management or the staff of a hospital. 

The Bill also seeks to amend the Indian Evidence Act to allow a rape victim, if she is temporarily or permanently mentally or physically disabled, to record her statement before a Judicial Magistrate with the assistance of an interpreter or a special educator. It also has provisions to videography the proceedings.  (PTI)

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)

News

New rape laws arrive with some teeth missing

Three months and three days after the horrific Delhi gang rape, the Lok Sabha yesterday passed the anti-rape bill which provides for death penalty for repeat offenders and stringent punishment for peeping Toms and stalker

Readers Response
  1. This message is too good. I wasn’t aware of these figures. Keep it up.

    Regards

    Dr Pranjali Shinde

Recent Newsletter
  1. Be Human Stop Child Abuse – Vol8, 13th March, 2013
  2. Be Human Stop Child Abuse – Vol7, 6th March, 2013
  3. Be Human Stop Child Abuse – Vol6, 27th February, 2013
  4. Be Human Stop Child Abuse – Vol5, 20th February, 2013
  5. Be Human Stop Child Abuse, Vol.4, 13th February, 2013
  6. Be Human Stop Child Abuse, Vol.3, 6th February, 2013
  7. Be Human Stop Child Abuse, Vol.2, 30th January,2013
  8. Be Human Stop Child Abuse, Vol.1, 23rd January,2013

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