The relationship between the transverse hymenal orifice diameter by the separation technique and other possible markers of sexual abuse

OBJECTIVE: To evaluate the relationship between the transverse hymenal orifice diameter as measured by separation technique (THODST), using a method that maximized the diameter of the hymenal orifice, and other possible markers of sexual abuse in girls from 3 through 12 years old. METHODS: Over a 10-year period, clinical information was recorded on girls referred to the WakeMed Child Sexual Abuse Team in Raleigh, NC at the time of examination. The study population comprised 1975 girls of the 2058 evaluated for sexual abuse. The girls were interviewed, examined, and tested for sexually transmitted diseases. Information from referral sources, accompanying guardians, and previous recent physical examinations was recorded. The girls were assigned to three groups based upon their risk of being sexually abused. Linear regression was performed to evaluate how well the THODST distinguished between the risk groups, as well as how it was correlated with individual established markers of sexual abuse. RESULTS: The size of the THODST did not distinguish between the three risk groups, nor did it correlate with any potential or established markers of sexual abuse other than three potential markers of hymenal trauma: narrowing of the posterior hymenal rim, hymenal tears and lacerations, and hymenal clefts between 5 and 7 o'clock in the supine position. CONCLUSION: Thus, we found the THODST as we measured it to have no value for answering the question, "Was this child sexually abused?"     

Perianal findings in prepubertal children selected for nonabuse: a descriptive study

The results of the perianal portion of a project designed to collect normative data of the anogenital anatomy from a representative sample of prepubertal children is presented. A total of 318 children were examined by three physicians from a child sexual abuse evaluation program. After screening for the onset of puberty and the possibility of undetected abuse, 267 subjects remained. The sample included 161 girls and 106 boys ranging in age from 2 months to 11 years. The perianal findings that were encountered with the greatest frequency included erythema (41%), increased pigmentation (30%), and venous engorgement (52%) after two minutes in the knee-chest position. Wedge-shaped smooth areas in the midline, with or without depressions, were found both anterior and posterior to the anus in 26% of the children. Anal skin tags/folds were discovered anterior to the anus in 11%. In 49% of the children there was some dilatation of the anus which opened and closed intermittently in 62%. Flattening of the anal verge and rugae occurred during dilatation by the midpoint of the examination in 44% and 34%, respectively. Perianal findings that were found infrequently in all subgroups included skin tags/folds (0%) and scars (1%) outside the midline, anal dilatation greater than 20 mm without the presence of stool in the rectal ampulla (1.2%), irregularity of the anal orifice after complete dilatation (3%), and prominence of the anal verge (3%). No abrasions, hematomas, fissures, or hemorrhoids were encountered. Less commonly detected findings within specific subgroups included perianal erythema in girls (32%) as compared to boys (57%), pigmentation in the lighter skinned white children (22%) when compared to black (53%) and Hispanic (58%) children, and venous congestion at the beginning of the examination (7%) when compared to the same findings after four minutes in the knee-chest position (73%). There were no perianal skin tags/folds found in the boys. The relatively high incidence of perianal soft tissue changes that were found in this study, when compared to the frequency of similar observations in children suspected of having been sexually abused, reemphasizes the caution medical examiners must exercise in rendering an opinion as to the significance of medical findings.     

Isolation of Gardnerella vaginalis in the diagnosis of sexual abuse in children

INTRODUCTION: The study of sexual transmitted diseases is more and more frequent in patient with suspicion of sexual abuse, and this help to the final medical diagnosis. Organisms like Neisseria gonorrhoeae and Treponema indicate a sure sexual contact. However the role of the rest of organisms in the sexual abuse is more difficult of specifying. OBJECTIVE: To know the role of the Gardnerella vaginalis in the diagnosis of sexual abuse in patient with this possible diagnosis. METHODS: Retrospective study of 135 girls with suspicion of abuse, visited from May of 1997 to February of 1998. Vaginal swabs were taken from 45 of 135 girls evaluated. RESULTS: In five patients the vaginal culture were positive to Gardnerella. The characteristics of these five patients are described (age, aggressor, type and duration of the abuse, physical exploration and final diagnosis). All our patients were the pubertal or prepubertal girls. In these patients the final diagnosis settled with the clinical history and the physical exploration, without keeping in mind the result of the culture. CONCLUSION: It is necessary to discard sexual abuse in all prepubertal girl with a positive culture with Gardnerella vaginalis, being difficult to specify the value of the Gardnerella in the adolescent patients.     

A profile of the oro-facial injuries in child physical abuse at a children's hospital

OBJECTIVE: The aim of the present study was to determine the head, face and neck injuries associated with child abuse cases in the Cape Peninsula, Cape Town. South Africa. METHOD: A retrospective, record-based analysis (n = 300) of non-accidental injuries at a Children's Hospital over a 5-year period (1992-1996) was carried out. RESULTS: The mean age of the sample was 4.75 years--54.3% were boys and 45.7% were girls. Most of the crimes were committed in the child's own home (88.7%). Crimes were reported by mothers (48.7%), grandmothers (11.7%) and day hospitals (13%). Ninety percent of the perpetrators were known to the victim. The majority of the perpetrators were male (79%)--20% the perpetrators were the mother's boyfriend; 36% the father or step father, and in 12% the mother was responsible. Thirty-five percent of perpetrators were under the influence of alcohol or drugs when they committed the offence: 64.7% of cases suffered serious injuries, 48.7% had to be hospitalized, four children were critically injured and died. The head, face, neck, and mouth were the sites of physical injury in 67% of the 300 cases reviewed. The face was the most frequently injured (41%) part of the body, with the cheek being the most common site for the injury. The range and diversity of the oro-facial injuries included skull fractures, subdural hematomas, retinal hemorrhages, bruises, burns, and lacerations. Injuries to the mouth included fractured teeth, avulsed teeth, lacerations to the lips, frenum, tongue, and jaw fractures. CONCLUSIONS: The main conclusions of this study were (i) under 2-year-old children were most at risk from abuse (36%); (ii) the number of the reported injuries to the oral cavity was extremely low (11%); and (iii) no dentists participated in the examination of any of the patients. Intra-oral injuries may be overlooked because of the medical examiner's unfamiliarity with the oral cavity. Oral health professionals should be consulted for diagnosis, advice and treatment.     

Genital examinations for alleged sexual abuse of prepubertal girls: findings by pediatric emergency medicine physicians compared with child abuse trained physicians

OBJECTIVE: This study compares abnormal genital examination findings made by pediatric emergency medicine (PEM) physicians to examinations by physicians with training in child sexual abuse in the evaluation of prepubertal girls for suspected sexual abuse. METHOD: A prospective study was performed following the genital examination by a PEM physician of prepubertal girls suspected of being sexually abused. A physician with training in child sexual abuse re-examined those girls whose examinations were interpreted as abnormal by the PEM physicians. The findings and interpretations of the PEM physician were then compared to those by the physicians with training in child abuse. RESULTS: Between October 1994 and October 1998, 46 patients diagnosed by PEM physicians with nonacute genital findings indicative of sexual abuse were re-examined by a physician with training in child abuse. The follow-up examinations were done 2 days-16 weeks (mean 2.1 weeks) after the emergency department visit. The physicians with training in child abuse concluded that only eight of these children (17%) showed clear evidence of abuse. Normal findings were noted in 32 children (70%), nonspecific changes were noted in 4 children (9%), and 2 children (4%) had findings that are more commonly seen in abused children than nonabused children but are not diagnostic for abuse (concerning for abuse). CONCLUSIONS: There was poor agreement between the pediatric emergency medicine physicians and the physicians with training in child sexual abuse. This study suggests that emergency medicine physicians should consider additional training in this area. In addition, all children with abnormal ED examinations should have follow-up examinations by a child abuse trained physician.     

The improvement of student teachers’ instructional quality during a 15-week field experience: a latent multimethod change analysis

Most studies evaluating the effectiveness of school internships have relied on self-assessments that are prone to self-presentational distortions. Therefore, the present study analyzed the improvement in the instructional quality of 102 student teachers (46 women) from a German university during a 15-week internship at a local secondary school across three rating sources: the student teachers themselves, their students, and their mentors (experienced teachers). A latent multimethod change analysis identified a significant increase in instructional quality during the practice semester. However, ratings from the three informant groups only marginally converged.     

Family rearing antecedents of pubertal timing

Two general evolutionary hypotheses were tested on 756 White children (397 girls) studied longitudinally: (1) rearing experiences would predict pubertal timing; and (2) children would prove differentially susceptible to rearing. Analysis of pubertal measurements, including some based on repeated physical assessments, showed that mothering and fathering, earlier and later in childhood, predicted pubertal development, but only for girls, with negative parenting appearing most influential; maternal harsh control predicted earlier menarche. Rearing effects varied by infant negative emotionality, proving stronger (and opposite) for girls who in infancy were lower rather than higher in negativity. Maternal menarche, controlled in all analyses, was a stronger predictor than rearing. Findings are discussed in terms of theory development, genetic and nutritional influences, and sample restrictions.     

Psychosocial antecedents of variation in girls' pubertal timing: maternal depression, stepfather presence, and marital and family stress

Drawing on Belsky, Steinberg, and Draper's evolutionary theory of the development of reproductive strategies, we tested a model of individual differences in girls' pubertal timing. This model posits that a history of psychopathology in mothers results in earlier pubertal maturation in daughters, and that this effect is mediated by discordant family relationships and father absence/ stepfather presence. The model was supported in a short-term longitudinal study of 87 adolescent girls. In the primary test of the model, it was found that a history of mood disorders in mothers predicted earlier pubertal timing in daughters, and this relation was fully mediated by dyadic stress and biological father absence. In families in which the mother's romantic partner was not the biological father, dyadic stress accounted for almost half of the variation in daughters' pubertal timing. Stepfather presence, rather than biological father absence, best accounted for earlier pubertal maturation in girls living apart from their biological fathers. We propose that stepfather presence and stressful family relationships constitute separate paths to early pubertal maturation in girls.     

Father Absence in Pregnancy or During Childhood and Pubertal Development in Girls and Boys: A Population-Based Cohort Study

This cohort study, including 15,810 children born 2000–2003 in Denmark, aimed to investigate the association between father absence in pregnancy or during childhood and pubertal development in girls and boys. The children were followed from 11 years of age and throughout pubertal development. Mean age differences according to exposure groups were estimated for each pubertal marker separately and for a combined pubertal marker. The results suggested that father absence in pregnancy and during childhood was associated with earlier pubertal development in girls, and father absence from late childhood was associated with earlier pubertal development in boys. The paternal investment theory, the psychosocial acceleration theory and the energetics theory were explored, and did not seem to explain the observed associations.     

Perceptions of Pubertal Timing and Discrimination Among African American and Caribbean Black Girls

This study used a nationally representative sample of African American and Caribbean Black adolescent females to examine the relation between perceived pubertal timing relative to peers and discriminatory experiences. Participants included the 607 girls who participated in the National Survey of American Life-Adolescent (NSAL-A), and ranged in age from 13 to 17. Most African American girls perceived their development as on-time relative to their same-aged peers; whereas the majority of Caribbean Black girls perceived their development as earlier than their same-aged peers. The results indicated that girls who perceived that their pubertal development was earlier than their same-aged peers reported more general and racial discrimination experiences.     

Reaction to videocolposcopy in the assessment of child sexual abuse.

OBJECTIVE: The purpose of this study was to clinically assess children's reactions to videocolposcopy with real-time observation of magnified anogenital images (VCO), and to evaluate whether these reactions are affected by patient or other characteristics such as response to preparation, disclosure of child sexual abuse (CSA), or examination findings. METHOD: Consecutive cases of children ages less than 18 years referred to a children's hospital clinic for nonemergent evaluation of suspected CSA during 1997 through 1999 were studied. We noted the child's response with clinical observation before and after videocolposcopy, and used the Genital Examination Distress Scale (GEDS) after evaluation. We compared these responses to patient gender, age, ethnicity, pubertal status, disclosure of child sexual abuse (CSA), and physical examination findings using univariate and regression analyses. RESULTS: Two hundred twenty-seven children (mean age 7.2 years, range 0-17) underwent videocolposcopy, of whom 55.1% disclosed sexual abuse and 17.2% had a positive examination. More than 80% were female, prepubertal, and non-Hispanic White. Most (85%) watched their examination on the monitor and were either cooperative or enthusiastic before and after videocolposcopy. Fewer very young children (ages 0-3 years) or female adolescents (13-17 years) watched the monitor. Summed GEDS scores were strongly correlated with observed responses after the procedure (p = .01), and children with CSA disclosure were three times more likely to watch the monitor and five times more likely than those without disclosure to have improved comfort. Other patient characteristics were not significantly associated with patient reaction to VCO. CONCLUSIONS: Most children are interested in watching their anogenital examination using magnified real-time images obtained during videocolposcopy and tolerate the procedure well. The GEDS is highly correlated with subjective clinical observation. While some children may particularly benefit from participating in their examination by using VCO, long-term effects of the evaluation and any relationship of a child's reaction to videocolposcopy with their history of sexual victimization remain to be established.     

Biological and social contributions to negative affect in young adolescent girls

This study is a preliminary attempt to investigate whether internal or external pubertal changes and whether social or biological factors are more likely to be associated with negative affect. About 100 white girls aged 10-14 years were given a physical examination, had blood drawn, and filled out the Youth Behavior Profile and a life-events checklist. Negative affect increased during the most rapid rises in hormone levels; however, hormones accounted for only 4% of the variance in negative affect. Pubertal status and timing were not associated with negative affect. In contrast, social factors accounted for more variance than hormonal pubertal factors alone (8%-18%), as did the interaction of negative life events and pubertal factors (9%-15%). Results are discussed in terms of what hormonal activation effects are most likely to be found, the meaning of such effects for subsequent behavior, and the interaction of biological and social events.     

大学生精神信仰的发展特点——以泉州师范学院为例

采用大学生精神信仰问卷对泉州师范学院210名大学生进行调查。研究显示：大学生的一级信仰之间存在显著的差异,由高到低依次为社会信仰、实用信仰及超自然信仰。说明当代大学生对社会信仰更认同。而超自然信仰并没有想象中的那么严重。大学生对民族主义、生命崇拜、政治信仰以及国家主义等次级信仰的认同程度较高．而对宗教信仰、神灵信仰以及金钱崇拜等次级信仰的认同程度较低。相对而言,男生更容易产生金钱崇拜,女生更容易产生生命崇拜;学生干部比非学生干部更容易产生家族崇拜;大四比其他年级的学生更容易产生实用信仰：来自城镇的大学生更容易产生神灵崇拜,而来自农村的大学生更容易产生家庭主义。     

The impact of timing of puberty on psychosomatic symptoms among fourteen- to sixteen-year-old Finnish girls

All eighth-grade pupils of secondary schools in a Finnish town completed questionnaires 3 times during a 17-month follow-up. A total of 935 girls were included in the study. The mean age of the girls at the start of the study was 14.5 years. The results showed that there were differences in psychosomatic symptoms, dating, and alcohol use by age of menarche. However, the results suggested that the differences by age of menarche were largely associated with pubertal development as such. After controlling for time since menarche, the impact of timing on psychosomatic symptoms was demonstrated only at the beginning of the study, not later. Differences in behavior also seemed to be related to pubertal development rather than timing. Differences in symptoms by age of menarche remained after controlling for dating and alcohol use.     

Interparental discord and child adjustment: prospective investigations of emotional security as an explanatory mechanism

Advancing the process-oriented study of links between interparental discord and child adjustment, 2 multimethod prospective tests of emotional security as an explanatory mechanism are reported. On the basis of community samples, with waves spaced 2 years apart, Study 1 (113 boys and 113 girls, ages 9-18) identified emotional security as a mediator in a 2-wave test, whereas Study 2 (105 boys and 127 girls, ages 5-7) indicated emotional security as an intervening mechanism in a 3-wave test. Relations between discord and emotional security increased as children moved into adolescence in Study 1. Emotional security was identified as an explanatory mechanism for both internalizing and externalizing problems in children.     

Reassessing the Effect of Survey Characteristics on Common Method Bias in Emotional and Social Intelligence Competencies Assessment

Since the idea of method variance was inspired by D. T. Campbell and Fiske in 1959, many papers have demonstrated an ongoing debate about both its nature and impact. Often, method variance entails an upward bias in correlations among observed variables—common method bias. This article reports a split-ballot multitrait–multimethod experimental design for estimating 2 opposite biases: the upward biasing method variance from the reaction to the length of the response scale and the position of the survey items in the questionnaire and the downward biasing effect of poor data quality. The data are derived from self-reported behavior related to emotional and social competencies. This article illustrates a methodology to estimate common method bias and its components: common method scale variance, common method occasion variance, and the attenuation effect due to measurement errors. The results show that common method variance has a much smaller impact than random and systematic measurement errors. The results also corroborate previous findings: the greater reliability of longer scales and the lower reliability of items placed toward the end of the survey.     

“2＊4”矫治技术矫治替牙期前牙反的临床疗效观察

目的探讨＂2＊4＂矫治技术矫治替牙期前牙反的效果和特点。方法应用＂2＊4＂矫治技术配合上颌垫和Ⅲ类牵引矫正替牙期前牙反。结果＂2＊4＂矫治技术可以矫治前牙反,缩短疗程,同时还可以减少患者复诊的次数。结论＂2＊4＂矫治技术是一种矫正替牙期前牙反的有效方法。     

Hormones, emotional dispositions, and aggressive attributes in young adolescents

Relations among hormone levels, emotional dispositions, and aggressive attributes were examined in 56 boys and 52 girls, age 9 to 14 years. The adolescents represented all 5 stages of pubertal development. Serum levels of gonadotropins, gonadal steroids, adrenal androgens, and testosterone-estradiol binding globulin were assessed. Levels of these hormones were related to stage of pubertal development and were assumed to represent relatively stable biological characteristics. The emotional dispositions assessed were adolescent self-reported anger, nervousness, sadness, and impulse control. The aggressive attributes assessed were mother-reported acting out and aggressive behavior problems and rebellious and nasty characteristics. Hormone levels were related to emotional dispositions and aggressive attributes for boys but not for girls. For example, higher levels of androstenedione in boys were related to higher levels of acting-out behavior problems. Level of testosterone-estradiol binding globulin was negatively related to sad affect and acting out behavior.     

First-time mothers' selection of infant supine sleep positioning

The incidence of Sudden Infant Death Syndrome (SIDS) has decreased dramatically since the inception of the "Back to Sleep" campaign initiated by the American Academy of Pediatrics in 1992. However, that decrease has leveled off and many new parents cease to follow the recommendation to place their infants in the supine position for sleep between 1 and 3 months of age, the peak age for the incidence of SIDS. Shortened hospital stays for new mothers and the overwhelming amount of required patient teaching dictate the need to find the best method of instruction. The purpose of this study was to determine if a one-on-one teaching intervention improved the effectiveness of patient education and led to an increase in the desired behavior of placing the infant to sleep in the supine position. A quantitative experimental approach was used to examine the difference in compliance of supine infant positioning. Participants were drawn from a convenience sample of 61 primiparous women between the ages of 18 and 35 years with random assignment to either the experimental or control group. Compared to mothers in the control group, mothers in the experimental group demonstrated greater compliance in selecting supine sleep position in the first week home from the hospital and on the day of follow-up 6 weeks later. However, no difference in "usual position" was reported at 6 weeks and for the night previous to follow-up.     

Vaginal lacerations from consensual intercourse in adolescents

Objective

(1) To describe lacerations of the vaginal fornices, an injury known to be associated with consensual sexual intercourse, including known complications and treatment course, (2) to contrast these injuries with injuries sustained during sexual assault, and (3) to discuss the assessment of adolescent patients for sexual injuries.

Methods

We present a case series of 4 female adolescent patients seen at a children's hospital over a period of 6 months. Each patient developed significant vaginal bleeding after sexual intercourse, and 3 of the patients presented to the emergency department with vital signs consistent with compensated shock.

Results

Each patient was evaluated by pediatric surgery, and found to have a laceration of the vagina. Three of the patients described consensual intercourse prior to the onset of bleeding, and had lacerations of the vaginal fornices; these patients were determined to have injuries resulting from consensual sexual intercourse. The fourth patient reported sexual assault as the cause of her injuries, and was treated for longitudinal lacerations of the vaginal wall.

Conclusions

Lacerations of the upper vagina are not frequently reported in forced vaginal intercourse, but are occasionally reported as injuries sustained during consensual coitus. In the absence of reported sexual assault, a severe vaginal fornix laceration is consistent with the diagnosis of coital injury from consensual intercourse. Diagnosis and treatment of this injury can be delayed due to the sensitive nature of these injuries. Bleeding can be profuse, leading to hemorrhagic shock, and these injuries may require transfusion of blood products and surgical repair in some cases. Complications may include hemoperitoneum, pneumoperitoneum, or retroperitoneal hematoma, even in the absence of complete vaginal perforation.

Practice implications

Knowledge of the consensual sexual injuries that may occur in adolescent patients can guide diagnosis, treatment, and counseling for the patient and her family, preventing long-term medical complications and legal consequences.