Perceptions of caregivers and adolescents of the use of telemedicine for the child sexual abuse examination

BackgroundChildhood sexual abuse is a common cause of morbidity and mortality. All victims should receive a timely comprehensive medical exam. Currently there is a critical shortage of child abuse pediatricians who can complete the comprehensive child sexual abuse examination. Telemedicine has emerged as an innovative way to provide subspecialty care to this population. Despite the growing popularity of telemedicine, no literature exists describing patient and caregiver perceptions of telemedicine for this sensitive exam.ObjectiveTo explore caregiver and adolescent perspectives of the use of telemedicine for the child sexual abuse examination and discover factors that drive satisfaction with the technology.Participants and SettingCaregivers and adolescents who presented for a child sexual abuse medical evaluation at our county’s child advocacy center.MethodsWe completed semi structured interviews of 17 caregivers and 10 adolescents. Guided by the Technology Acceptance Model interviews assessed perceptions about: general feelings with the exam, prior use of technology, feelings about telemedicine, and role of the medical team. Interviews were audio-recorded, transcribed, coded and analyzed using content analysis with constant comparative coding. Recruitment ended when thematic saturation was reached.ResultsThere was an overwhelming positive response to telemedicine. Participants reported having a good experience with telemedicine regardless of severity of sexual abuse or prior experience with technology. Behaviors that helped patients and caregivers feel comfortable included a clear explanation from the medical team and professionalism demonstrated by those using the telemedicine system.ConclusionTelemedicine was widely accepted by adolescents and caregivers when used for the child sexual abuse examination.     

The use of telemedicine in child sexual abuse evaluations

OBJECTIVE: To describe the advantages, disadvantages and current status of child abuse consultations conducted through telemedicine networks. METHOD: The results of a telephone survey of seven statewide telemedicine networks are reported and discussed with respect to goals, funding, technical support and expertise, infrastructure, and extent of use. Quality assurance and liability issues concerning telemedicine child abuse consultations are also reviewed. RESULTS: The goals of telemedicine networks in child abuse are to provide (1) expertise to less experienced clinicians primarily in rural areas; (2) a method for peer review and quality assurance to build consensus of opinions particularly in sexual abuse cases; and (3) support for professionals involved in an emotionally burdensome area of pediatrics. Problems encountered by existing networks include: (1) funding for equipment and reimbursement for consultation; (2) consistent technical support: (3) clinician lack of technical expertise, knowledge, or motivation; and (4) lack of network infrastructure. Legal considerations include licensure exemptions for consulting across state lines, potential for malpractice, patient confidentiality and security of images forwarded over modem lines, and liability of the equipment, consulting site, and the consultant in criminal proceedings. CONCLUSIONS: Telemedicine consultations offer a unique opportunity to raise the standard of care in child abuse evaluations, but success depends on clinician motivation, appropriate infrastructure, and ongoing funding and technical support.     

Preparing Healthcare Professionals for Telemedicine: Results from Educational Needs Research

As part of an overall research program to create a set of web-based interactive distance learning modules, an educational needs assessment was conducted. The educational needs assessment is undertaken to collect information via observation and interview as to which knowledge areas are most desirable for incorporation into the interactive distance learning modules. This research is best undertaken with a neutral stance and without any preconceptions or hypotheses as to which knowledge areas are likely to be most useful. The interactive modules were designed to enhance the utilization of telemedicine by health care providers. This paper is a report on the methodology used and the findings of the needs assessment. The educational needs assessment acts as a compass to guide the creation of curricula. In the design of interactive learning, the needs assessment may be an important tool that informs not only the selection of the content, but also the selection of technology and courseware processes. The methodology described herein may be useful as a template for other authors of interactive learning courseware. The results of this study identified four clusters of content to be offered and confirmed the selection of interactive, web-based distance learning as the most appropriate delivery approach.     

贵州远程医疗现状及对策研究

远程医疗在增加基层和相对欠发达地区的优质医疗资源可及性、降低医疗费用方面具有重要作用。本文总结了贵州远程医疗的建设现状,梳理了服务体系建设、提升基层服务能力和减轻患者经济负担等方面取得的成效,分析了目前贵州远程医疗发展面临的问题,主要包括利益分配机制落实不到位、信息互联互通建设滞后及公众对远程医疗的认识不够充分,并提出了针对性的对策建议。     

Depression and Its Treatments

Abstract

The aim of the present study was to gather information within a specific college population about the general prevalence of anti-depressant use and psychotherapy for depression, which treatments people tend to prefer, people's perceptions of the helpfulness of treatments, and if this information was consistent with the research and the current status of the managed health care system. The results demonstrate a high prevalence rate, that people tend to prefer psychotherapy, and that the managed health care system is not providing the best or equal coverage of treatments for depression.     

Impact of telemedicine on the quality of forensic sexual abuse examinations in rural communities

To assess the quality and diagnostic accuracy of pediatric sexual abuse forensic examinations conducted at rural hospitals with access to telemedicine compared with examinations conducted at similar hospitals without telemedicine support. Medical records of children less than 18 years of age referred for sexual abuse forensic examinations were reviewed at five rural hospitals with access to telemedicine consultations and three comparison hospitals with existing sexual abuse programs without telemedicine. Forensic examination quality and accuracy were independently evaluated by expert review of state mandated forensic reporting forms, photo/video documentation, and medical records using two structured implicit review instruments. Among the 183 patients included in the study, 101 (55.2%) children were evaluated at telemedicine hospitals and 82 (44.8%) were evaluated at comparison hospitals. Evaluation of state mandatory sexual abuse examination reporting forms demonstrated that hospitals with telemedicine had significantly higher quality scores in several domains including the general exam, the genital exam, documentation of examination findings, the overall assessment, and the summed total quality score (p < 0.05 for each). Evaluation of the photos/videos and medical records documenting the completeness and accuracy of the examinations demonstrated that hospitals with telemedicine also had significantly higher scores in several domains including photo/video quality, completeness of the examination, and the summed total completeness and accuracy score (p < 0.05 for each). Rural hospitals using telemedicine for pediatric sexual abuse forensic examination consultations provided significantly higher quality evaluations, more complete examinations, and more accurate diagnoses than similar hospitals conducting examinations without telemedicine support.     

Development of a Curriculum for Long-Term Care Nurses to Improve Recognition of Depression in Dementia

There is increasing recognition of the severe consequences of depression in long-term care residents with dementia. Most health care providers are unprepared to recognize and to manage the complexity of depression in dementia. Targeted educational initiatives in nursing homes are needed to address this growing problem. This paper describes the development of competencies, learning objectives, and learning outcomes for a curriculum on depression in dementia for nurses working in nursing home settings. This work provides the foundation for a curriculum to improve learning for nurses and, ultimately, to advance health care outcomes for residents with cooccurring depression and dementia.     

远程医学的应用及管理

远程医学是以图像和视频传输为基础的新型学科,远程医学教育是远程医学的重要方面,远程医学的通讯方式有卫星、ISDN、互联网和普通电话线(PSTN)等。技术上把实现电话线上医学资料的共享功能作为软件开发的重点,以满足远程医疗会诊和讲座式远程教育的要求。     

Childhood adversity and adult depression among the incarcerated: Differential exposure and vulnerability by race/ethnicity and gender

The relationship between childhood adversity and adult depression is well-established but less is known about the association between childhood adversity and adult depression among the incarcerated. In this paper, we examine differential exposure and vulnerability to childhood adversity by race/ethnicity and gender on adult depression among the incarcerated in the United States. We address three research questions: does exposure to childhood adverse experiences vary by race/ethnicity and gender? Is there an association between these childhood adverse events and depression and does the strength of the association vary by the specific adverse experiences? And does vulnerability to childhood adversity vary by gender and race/ethnicity? Using the 2004 Survey of Inmates in State and Federal Correctional Facilities (SI-SFCF), we measure four key childhood adverse events – parental/caretaker substance abuse, physical assault, having been placed in foster care, and sexual assault. We use ordinary least squares regression and a series of interaction effect analyses to examine differential exposure and vulnerability to the four childhood adverse experiences by race/ethnicity and gender. Incarcerated women are more likely to report parental substance abuse, but all inmates/prisoners are similarly vulnerable to this experience. For the other three adverse experiences measured, we find that there are important racial/ethnic and gender differences in both exposure and vulnerability. African American men and women are more vulnerable to the effects of physical and sexual victimization than White and Hispanic men and women. Women are much more likely to be exposed to sexual victimization, but men who report this experience are significantly more depressed. Hispanic women and White men and women are more likely to report foster care, but all inmates/prisoners who report foster care experiences are significantly more depressed than other inmates/prisoners, with the exception of white men. The findings indicate that there are significant differences in exposure and vulnerability to childhood adversity by race/ethnicity and gender. We conclude that in order to effectively design and implement programs to decrease the probability that childhood adversity is a risk factor for adult depression interventions must be targeted toward specific, vulnerable groups according to race/ethnicity and gender.     

College Students’ Reasons for Depression Nondisclosure in Primary Care

Unwillingness to share depression experiences with primary care physicians contributes to the undertreatment of depression. This project examined college students’ reasons for depression nondisclosure to primary care providers (PCPs). Undergraduate participants read a vignette describing someone with depression and completed measures of disclosure barriers. Analyses indicated 26% of respondents would NOT disclose depression symptoms to PCPs. Reasons for nondisclosure included difficulty initiating the depression conversation, medication aversion, and fear of referral to a psychologist. Also, anger toward the vignette character varied with disclosure willingness, suggesting that nondisclosers feel more stigma than disclosers and are less likely to engage in psychotherapy. Because engagement in pharmacological and/or psychotherapeutic treatment requires identification of depression in healthcare settings, increased understanding of disclosure barriers could increase students’ access to depression treatment.     

高职远程心电监护实验教学的探索

远程心电监护是一项新兴的远程医疗技术.讨论了通过“任务驱动、项目导向”模式将远程心电监护实验引入高职院校远程医疗课程中的实验教学方法,介绍了取得良好效果的经验.     

The Developing Brain: A largely overlooked health endpoint in risk assessments for synthetic chemical substances

A large body of experimental animal research on the neurotoxic effects of certain environmental chemicals provides evidence of a cascade of neurobehavioural effects including learning deficits, hyperactivity, anxiety, depression, lack of motivation, increased aggressiveness, altered maternal care and bonding, and an over‐reaction to small stressors. For a number of years, scientific meetings and reports have recommended that assessing risk in chemical safety evaluations should include tests for developmental neurotoxicity (DNT) to uncover the potential of chemical substances to affect the developing brain. However, DNT testing has been required only in rare circumstances, and for some classes of neurotoxic pesticides. The role of developmental neurotoxicants as causative or contributory factors in children’s learning and behavioural disorders warrants more attention in both research and policy.     

The joint impact of parental psychological neglect and peer isolation on adolescents’ depression

Adolescents receive psychological or emotional care from both parents and peers, which is crucial for mental health at this stage. Little research has been undertaken to evaluate the experience and consequences of caregiver psychological neglect during adolescence. Less is known about the unique and combined impacts of neglectful experiences with parents and peers. The purpose of this study was to evaluate the relationship between exposure to caregiver psychological neglect and isolation from peers with depression for a population of at-risk adolescents. A sample of 2776 adolescents who represent a cohort population of adolescents in contact with Child Protective Services in the U.S. was studied. Data come from the National Survey of Child and Adolescent Well-being (NSCAW) and are pooled across four waves representing seven years duration. Structural equation modeling with latent variables was used to estimate within-time associations. A two-stage-least squares path model was used to determine within-time reciprocal effects between depression and neglectful experiences. Adolescents who are emotionally neglected by their primary caregivers and are isolated from peers have substantially increased depression, a combined standardized effect of 0.78–0.91. Isolation from peers is more impactful for depression compared to psychological neglect by caregivers. The effects of deficits in these two primary sources of emotional support explain 40 percent of the variation in depression. The relationships between depression and peer isolation and depression and psychological neglect are reciprocal, but the primary direction of effect is from neglectful experiences to depression.     

教师如何辅助干预学生的抑郁心理——基于视觉艺术教育的视角

本文探索从视觉艺术教育的角度来调节学生非良性的抑郁心理,运用提升视觉安全和视觉心理的快乐适应方式来开展教师对学生的心理护理。探讨视觉艺术教育的精神之一是融入社会主流意识、校园文化、教师教育和家庭氛围的共同媒介和促进体,进而成为调节学生抑郁心理的辅助干预方式。     

Examining the Experiences of a Short Break Scheme amongst Adolescents with Disabilities (Service Users) and their Parents

Globally, families who care for a child or adolescent with disabilities have been found to experience high levels of maternal ill health, stress, depression and family breakdown. In extreme cases, children and adolescents may have to move away from their family to a permanent residential placement. A potentially more appropriate and cost-effective approach is the provision of family support services; predominantly these have taken the form of short break schemes, whereby temporary (respite) care is issued to provide short-term relief for the family (e.g. regular afternoon care). This research reported the impact of a short break scheme from the perspective of the service users and their parents by conducting interviews with adolescents with disabilities and quantitative questionnaires with the parents, following a summer short break scheme.     

Childhood adversity and adult depression: The protective role of psychological resilience

Adverse childhood experiences (ACEs), such as childhood abuse, neglect, and household dysfunction, have been identified as salient risk factors for adult depression. However, not all individuals who experience ACEs go on to develop depression. The extent to which resilience- or the ability to demonstrate stable levels of functioning despite adversity- may act as a buffer against depression among individuals with a history of ACEs has not been adequately examined. To address the associations between ACEs, depression, and resilience, 4006 adult participants were recruited from primary care clinics. Participants completed self-report questionnaires including: the Adverse Childhood Experiences Questionnaire, a retrospective measure of childhood adversity; the Patient Health Questionnaire-9, a measure of the presence and severity of the major symptoms of depression; and the Connor Davidson Resilience Scale, a measure of psychological resilience. Results from regression analyses indicated that, while controlling for a range of demographic variables, both ACEs and resilience independently predicted symptoms of depression, F(9, 3040) = 184.81, R² = 0.354. Further, resilience moderated the association between ACEs and depression, F(10, 3039) = 174.36, p < 0.001, R² = 0.365. Specifically, the association between ACEs and depression was stronger among individuals with low resilience relative to those with high resilience. This research provides important information regarding the relationships among ACEs, resilience, and depression. Results have the potential to inform the development of treatments aimed to reduce symptoms of depression among primary care patients with a history of childhood adversity.     

Four research findings that will change what we think about perinatal depression

Research by health psychologists is changing what we know about perinatal depression. In this guest editorial, the author examines depression in pregnant and breastfeeding women in light of this recent research and describes four major findings that are influencing how we think about depression in new mothers: inflammation has an etiologic role in depression, a relationship exists between sleep disturbances and depression, breastfeeding protects maternal mental health, and all effective treatments for depression are anti-inflammatory interventions.     

University staff mental health literacy,stigma and their experience of students with mental health problems

Despite high rates of mental disorders in university students, very few seek professional help. University teaching staff are well placed to connect students with mental health care. However, little is known about university staff attitudes to and knowledge about mental health problems, or whether these factors influence their experience with and assistance of students with these problems. A total of 224 teaching staff members at the Australian National University, Canberra completed an anonymous online survey via an email link (16.4% response rate from N ~ 1370). Measures included demographic and professional information, experiences with student mental health, knowledge of depression (literacy) and attitudes to depression (stigma). Strength of stigmatising attitude did not predict whether a teaching staff member would approach a student to assist with mental health problems. Teaching staff with higher levels of depression literacy (OR = 1.14, p = 0.007) were more likely to feel sufficiently informed to help students with mental health problems. Ensuring staff complete mental health literacy training and have adequate skills to respond appropriately to students with mental health problems may help in connecting young people to appropriate care in a university context.     

Emotion dysregulation as a mediator between childhood emotional abuse and current depression in a low-income African-American sample

Abuse and neglect in childhood are well-established risk factors for later psychopathology. Past research has suggested that childhood emotional abuse may be particularly harmful to psychological development. The current cross-sectional study employed multiple regression techniques to assess the effects of childhood trauma on adulthood depression and emotion dysregulation in a large sample of mostly low-income African Americans recruited in an urban hospital. Bootstrap analyses were used to test emotion dysregulation as a potential mediator between emotional abuse in childhood and current depression. Childhood emotional abuse significantly predicted depressive symptoms even when accounting for all other childhood trauma types, and we found support for a complementary mediation of this relationship by emotion dysregulation. Our findings highlight the importance of emotion dysregulation and childhood emotional abuse in relation to adult depression. Moving forward, clinicians should consider the particular importance of emotional abuse in the development of depression, and future research should seek to identify mechanisms through which emotional abuse increases risk for depression and emotion dysregulation.     

Filipino Arts Among Elders in Institutionalized Care Settings

The use of traditional art in recreational therapies is unexplored. This paper, thus, attempts to surface the unique power of traditional Filipino arts (TFA) as synergizing lens in capturing the individual and the collective experiences of a select group of Filipino elderly in an institutionalized care setting relative to their feelings of depression and self-esteem. Three Filipino elderly housed in an institutionalized care setting were chosen for this phenomenological study, a robotfoto and a series of semistructured interviews constitute the main data gathering tool. Field texts were subjected to phenomenological reduction via the repertory grid analysis. Emerged themes were subjected to a series of member checking procedures to ensure the trustworthiness of the reported data. Depression and self-esteem were interpreted via two emerged themes. The themes were Me, Myself, and Melancholy and Will Not Let My Worth Wither. Through recreational therapies in the form of traditional Filipino arts, participants found novel psychological crutches that overcame the challenges of depression and give them hope toward more positive views of themselves and life.