Munchausen syndrome by proxy: A family affair

Munchausen syndrome by proxy is an unusual form of child abuse: a child presents with an illness that has been factitiously produced by a parent, typically the mother. A case of chronic illicit insulin administration to a one-year-old girl is described. Despite temporary separation of the child from the mother and long-term psychiatric intervention, factitious illnesses continued, including urine specimen contamination, laxative-induced diarrhea, suspected bladder catheterization, and suspected poisoning. Retrospective review of the medical records of the mother and two siblings demonstrated previously unrecognized evidence of factitious illnesses. The medical records contained evidence of 30 separate episodes of suspected or documented factitious illness in these four members of the same family. This unique family illustrates the significant morbidity of Munchausen syndrome by proxy and a poor response to psychiatric treatment.     

The perpetrators of medical child abuse (Munchausen Syndrome by Proxy) – A systematic review of 796 cases

IntroductionLittle is known about the perpetrators of medical child abuse (MCA) which is often described as “Munchausen’s syndrome by proxy” or “factitious disorder imposed on another”. The demographic and clinical characteristics of these abusers have yet to be described in a sufficiently large sample. We aimed to address this issue through a systematic review of case reports and series in the professional literature.MethodA systematic search for case reports and series published since 1965 was undertaken using MEDLINE, Web of Science and EMBASE. 4100 database records were screened. A supplementary search was then conducted using GoogleScholar and reference lists of eligible studies. Our search yielded a total sample of 796 perpetrators: 309 from case reports and 487 from case series. Information extracted included demographic and clinical characteristics, in addition to methods of abuse and case outcomes.ResultsNearly all abusers were female (97.6%) and the victim’s mother (95.6%). Most were married (75.8%). Mean caretaker age at the child’s presentation was 27.6 years. Perpetrators were frequently reported to be in healthcare-related professions (45.6%), to have had obstetric complications (23.5%), or to have histories of childhood maltreatment (30%). The most common psychiatric diagnoses recorded were factitious disorder imposed on self (30.9%), personality disorder (18.6%), and depression (14.2%).ConclusionsFrom the largest analysis of MCA perpetrators to date, we provide several clinical recommendations. In particular, we urge clinicians to consider mothers with a personal history of childhood maltreatment, obstetric complications, and/or factitious disorder at heightened risk for MCA. Longitudinal studies are required to establish the true prognostic value of these factors as our method may have been vulnerable to publication bias.     

大学生网络成瘾及其焦虑水平的调查研究

为了对IAD者的有效心理治疗提供一定的理论基础及方法指导,采用纸笔测验对在校100名较喜好上网的大学生进行网络成瘾诊断测验及焦虑症自测并用SPSS11.0软件进行处理与分析。结果发现:(1)网络成瘾者与非成瘾者在焦虑水平上并未表现出显著性差异,但它在性别和焦虑水平上的交互作用却表现出很大的差异。(2)大学生网络使用者的行为特点和认知方式在焦虑水平上存在显著性差异。由此可见,大学生网络成瘾在性别和焦虑水平上表现出一定的差异,且影响其成瘾的因素也主要集中于行为和认知两维度上。     

A Review of the Research on Internet Addiction

Research indicates that maladaptive patterns of Internet use constitute behavioral addiction. This article explores the research on the social effects of Internet addiction. There are four major sections. The Introduction section overviews the field and introduces definitions, terminology, and assessments. The second section reviews research findings and focuses on several key factors related to Internet addiction, including Internet use and time, identifiable problems, gender differences, psychosocial variables, and computer attitudes. The third section considers the addictive potential of the Internet in terms of the Internet, its users, and the interaction of the two. The fourth section addresses current and projected treatments of Internet addiction, suggests future research agendas, and provides implications for educational psychologists.     

Care taker blogs in caregiver fabricated illness in a child: A window on the caretaker's thinking?

Three recently diagnosed cases of caregiver-fabricated illness in a child at Seattle Children's Hospital shed light on a new manifestation of their caretakers’ attention seeking. The patients’ mothers were actively blogging about their children's reputed illnesses. Although it is not uncommon for parents of chronically ill children to blog about their child's medical course, specific themes in these blogs of parents suspected of medically abusing their children were noted. In particular, gross distortions of the information parents had received from medical providers were presented online, describing an escalation of the severity of their children's illnesses. The mothers reported contacting palliative care teams and Wish organizations, independently from their medical providers’ recommendations. They sought on-line donations for their children's health needs. We believe these blogs provide additional direct evidence of the suspected caregivers’ fabrications. Although we have not performed formal content analysis, blogs might also provide insight into the caretakers’ motivations. Protective Services and/or police investigators could consider querying the internet for blogs related to children at risk for caregiver-fabricated illness in a child. These blogs, if viewed in parallel with the children's medical records, could assist medical diagnosis and legal documentation of medical fabrication and assist in protective planning for the affected children.     

Persistence of pediatric post traumatic stress disorder after 2 years

One-hundred and fifty-six children were randomly evaluated at an inner-city juvenile/family court. These children were removed from their parent's custody subsequent to a finding of severe child maltreatment. From our original sample of 156 children, 62 met strict criteria for Post Traumatic Stress Disorder (PTSD). Fifty-two of these 62 were successfully recruited and participated in the 2 year re-examination. Each PTSD diagnosis was conferred by the Diagnostic Interview for Children and Adolescents (DICA). From our sample of 52 PTSD children re-examined after 2 years, 17 (32.7%) retained the full PTSD diagnosis, while 67.3% did not meet criteria.     

社会支持对高中生网络成瘾的影响

为探讨社会支持对高中生网络成瘾的影响,本研究采用随机整群抽样法,从温州地区6所不同性质的高级中学各抽取高一和高二年级1个班级,共12个班级480名学生,用网络成瘾诊断量表、社会支持评定量表及自编网络使用调查问卷对其进行调查。结果显示:高中生网络成瘾发生率为8.3%;高中男生网络成瘾发生率显著高于高中女生网络成瘾发生率;职高生网络成瘾发生率居于首位,但其与普通和重点高中生网络成瘾发生率之间不存在显著性差异;网络成瘾者的社会支持各因子分及总分均显著低于非网络成瘾者;社会支持与高中生网络成瘾之间存在显著的负相关。研究结论:高中生中存在一定程度的网络成瘾现象,提高社会支持可以预防高中生网络成瘾。     

网络成瘾的成因及心理治疗

网络成瘾是上个伴随着网络的发展而出现的新的疾病，对青少年的身心发展产生巨大的负面影响。网络成瘾的形成与网络本身的特性、成瘾者本人的人格特征、近期遭受重大的环境压力及其未满足的需要有关。对网络成瘾的治疗，目前多以行为矫正和认知行为治疗的方法为主。     

用ISA Server确保Internet的安全性实验

迅速发展的Internet给人们的生活、工作带来了巨大的方便,人们可以坐在家里或办公室通过Internet收发电子邮件、打电话、网上聊天、进行网上购物、银行转帐等等.正因为网络的开放性,给黑客攻击企业内部数据等机密文件提供了方便.为了保护内部数据,在工作期间禁止用户上互联网的硬件和软件很多,其中ISA Server就是其中最安全也最简单的路由级网络防火墙之一.     

论高校网络成瘾大学生心理干预

大学生上网成瘾现象已产生严重消极影响,主要表现在耽误学习、危害身心健康、损害人际交往、引发道德问题等方面。究其心理成因主要有猎奇心理、孤僻心理、娱乐心理、自我减压心理等。对此,高校教育工作者应通过调整教育内容,改进教学方式,构建网络心理健康教育阵地,开辟课堂内外互动交流平台等途径,采取认知疗法、替代疗法、心理脱敏疗法、强化疗法等心理干预策略,帮助网络成瘾大学生戒除＂网瘾＂。     

Toward instituting a chaperone policy in outpatient pediatric clinics

ObjectivesWe sought to evaluate child, parent and medical provider preferences for chaperones for outpatient encounters and to evaluate the acceptability and frequency of utilization following institution of a chaperone policy. Secondarily, we sought to understand what medical history and examinations teens consider “sensitive.”DesignWe conducted an observational study 1 month before and 1 month after institution of outpatient clinic chaperone policy. Post clinic questionnaires were used for patients ≥12 years old, parents, and clinicians. A research assistant observed chaperone use.SettingAdolescent Medicine, Urology, and Rehabilitation Clinics at a regional, tertiary-care pediatric hospital, in a major metropolitan area were studied.ParticipantsConvenience sample: 117 clinic patients during control period and 119 after policy implementation.Main outcome measuresPreferences for and satisfaction with chaperone use were documented.ResultsAlthough non-parent chaperones were usually declined (99.6%), offers were appreciated. Non-parent chaperone use increased modestly (5.3–18.1%).Most patients preferred not to have non-parent chaperones. This preference was greater among older patients (88%), than early teens (52%). After experiencing sensitive examinations, more young adolescent patients (89%) wished their parent had been present than older patients (38%). Patients’ opinions about what constitutes “sensitive” questions and examinations and chaperone preferences varied widely. Providers often did not recognize issues patients and parents considered sensitive questioning (21% agreement), but recognized sensitive physical examinations better (74% agreement). Providers felt chaperones had been a detriment to examination and exams would have gone better without one only 1% of the time.ConclusionsAlthough usually declined, offers of chaperones were appreciated and use of non-parent chaperones increased modestly. Offering chaperones for sensitive examinations may remind providers about appropriate, respectful patient encounters. Implications for children's hospitals’ patient safety and satisfaction, and institutional staff protection and costs are significant.Practice implicationsQuestions and examinations which patients consider sensitive vary widely. Asking patients for their preferences for examination chaperones may reassure them about the appropriateness of examinations, remind staff to conduct respectful examinations and protect providers from accusations of impropriety. Since most chaperone offers are declined, the cost of asking is likely to be minimal.     

Criminological differences between child pornography offenders arrested in Spain

BackgroundLack of studies on CP offenders from non-English speaking countries motivated the analysis of the profile of adult men arrested in Spain for such crimes (N = 347).ObjectiveThe current study examined differences between groups of CP users according to their criminal history (i.e., CP-only offenders, CP offenders with other nonviolent or non-sexually violent crimes, and dual offenders).MethodsAnalyses of case investigation files were performed across seven key areas: (1) sociodemographic characteristics, (2) criminological data, (3) characteristics of index CP offending, (4) characteristics of CP collections, (5) access to children, (6) indication of pedophilic or hebephilic interests, and (7) recidivism outcomes.ResultsCP-only offenders presented with fewer prior criminal records and lower general (6.7%) and violent (1.1%) recidivism rates. They were also less likely to be arrested for CP production, although they had greater access to children living in their residence. CP offenders with other nonviolent or non-sexually violent crimes exhibited characteristics on a continuum between the other two groups. Dual offenders were more likely to have prior criminal records for sexual offenses and higher sexual recidivism rates (16.7%). 55.6% had produced their own CP material, and they were more likely to have content depicting boys. They were also more likely to admit or be diagnosed with pedophilic/hebephilic interests, and they also had the largest proportion of legal child-related content (72.2%).ConclusionsAuthors conclude there are significant differences between dual and CP-only offenders which suggests a need for specialized treatment and risk assessment tools.     

Association between mothers’ problematic Internet use and maternal recognition of child abuse

BackgroundThere are few studies about mothers’ problematic Internet use (PIU). Mothers’ PIU may lead to inadequate parenting and child abuse.ObjectiveThis cross-sectional study aimed to clarify the association between mothers’ PIU and their recognition of child abuse.Participants and settingWe analyzed data collected of health examinations of children aged 4 months, 1.5 years, and 3 years which were carried out in Matsue City, Shimane Prefecture, Japan between April 2016 and March 2017. The number of the subjects were 1685, 1729, 1674, respectively.MethodsWe used logistic regression analysis to clarify the association between mothers’ PIU (Young’s Diagnostic Questionnaire for Internet Addiction score: ≥5) and their recognition of child abuse (selecting < True of me > for < I sometimes think that I am abusing my child > on a questionnaire survey), which was adjusted for covariates such as maternal age, number of children, daytime caretaker, social support, postpartum depression, and current smoking status of the parents.ResultsBased on the multivariate logistic regression analysis, the mothers’ PIU was significantly correlated with their recognition of child abuse for children aged 4 months, 1.5 years, or 3 years [odds ratio (OR): 13.30, 95% confidence interval (CI): 1.26–139.98, OR: 7.02, 95% CI: 1.28–38.55, and OR: 28.06, 2.48–317.93, respectively].ConclusionThis study revealed the possibility that mothers with PIU recognize child abuse more than mothers without PIU. However, further studies should be conducted to increase reliability and validity.     

大学生手机上网成瘾原因及干预策略分析

手机网络是一把“双刃剑”,一方面,手机上网可以获取所需资源;另一方面,手机上网容易成瘾,在一定程度上严重影响了大学生的学习和生活,不利于提高高等教育质量。文章分析了大学生手机上网成瘾原因,并提出了一些有效干预大学生手机上网成瘾的策略。     

Explanations for child sexual abuse given by convicted offenders in Malawi: no evidence for "HIV cleansing"

Objective

A commonly cited, but unproven reason given for the rise in reported cases of child sexual abuse in Sub-Saharan Africa is the “HIV cleansing myth”—the belief that an HIV infected individual can be cured by having sex with a child virgin. The purpose of this study was to explore in Malawi the reasons given by convicted sex offenders for child sexual abuse and to determine if a desire to cure HIV infection motivated their offence.

Methods

Offenders convicted of sexual crimes against victims under the age of 18 were interviewed in confidence in Malawi's two largest prisons. During the interview the circumstances of the crime were explored and the offenders were asked what had influenced them to commit it. Each participant was asked the closed question “Did you think that having sex with your victim would cure or cleanse you from HIV?”

Results

58 offenders agreed to participate. The median (range) age of offenders and victims was 30 (16-66) years and 14 (2-17) years, respectively. Twenty one respondents (36.2%) denied that an offence had occurred. Twenty seven (46.6%) admitted that they were motivated by a desire to satisfy their sexual desires. Six (10.3%) stated they committed the crime only because they were under the influence of drugs or alcohol. None of the participants said that a desire to cure or avoid HIV infection motivated the abuse.

Conclusion

This study suggests that offenders convicted of a sexual crime against children in Malawi were not motivated by a desire to be cured or “cleansed” from HIV infection. A need to fulfil their sexual urges or the disinhibiting effect of drugs or alcohol was offered by the majority of participants as excuses for their behaviour.     

大学生感觉寻求与网络成瘾的关系研究

采用中国版大学生感觉寻求问卷和网络成瘾问卷,对294名大学生进行感觉寻求和网络成瘾情况及其相互关系调查。结果:感觉寻求存在显著性别差异,男生的感觉寻求水平高于女生;网络成瘾存在显著的性别差异,男生比女生更容易对网络上瘾;感觉寻求总分和去抑制与网络成瘾的相关显著。结论:感觉寻求和网络成瘾之间确实存在一定的关系。     

Child maltreatment by nursing staff and caregivers in German institutions: A population-representative analysis

BackgroundChild maltreatment by caregivers seem to make a significant contribution to general maltreatment rates. Interestingly, research assessing prevalence rates of maltreatment mainly focuses on individual components either in relation to different types of maltreatment or in relation to different types of institutions.ObjectiveThe current study assesses prevalence rates for child maltreatment by caregivers in hospitals, rehabilitation centers, facilities for the disabled, schools, Kindergartens, and after-school care or residential care.Participants and setting: In a cross-sectional survey, a representative sample of the German population above the age of 14 (N = 2,516) was selected in a random route approach. Participants were questioned retrospectively for the experience of physical, emotional and sexual abuse and neglect by caregivers in institutions.ResultsThe results demonstrate a relatively high rate of child maltreatment in German institutions. In detail, during inpatient stays in medical institutions, 19.0% of the participants reported to have experienced at least one type of maltreatment by nursing staff. Furthermore, 30.3% reported to have experienced at least one type of maltreatment by teachers during school life and 11.6% reported maltreatment by caregivers in care facilities. A significant number of participants reported multiple forms of maltreatment in all assessed institutions. Younger age of the respondents was associated with lower prevalence rates, which could be attributed to higher awareness for maltreatment in institutions nowadays.ConclusionsOur results demonstrate that child maltreatment by caregivers in institutions is a prevalent problem. A higher awareness for caregivers as potential perpetrators of maltreatment in institutions, including schools, medical institutions and care facilities, is needed in order to improve this alarming situation.     

The potential use of social media and other internet-related data and communications for child maltreatment surveillance and epidemiological research: Scoping review and recommendations

Collecting child maltreatment data is a complicated undertaking for many reasons. As a result, there is an interest by child maltreatment researchers to develop methodologies that allow for the triangulation of data sources. To better understand how social media and internet-based technologies could contribute to these approaches, we conducted a scoping review to provide an overview of social media and internet-based methodologies for health research, to report results of evaluation and validation research on these methods, and to highlight studies with potential relevance to child maltreatment research and surveillance. Many approaches were identified in the broad health literature; however, there has been limited application of these approaches to child maltreatment. The most common use was recruiting participants or engaging existing participants using online methods. From the broad health literature, social media and internet-based approaches to surveillance and epidemiologic research appear promising. Many of the approaches are relatively low cost and easy to implement without extensive infrastructure, but there are also a range of limitations for each method. Several methods have a mixed record of validation and sources of error in estimation are not yet understood or predictable. In addition to the problems relevant to other health outcomes, child maltreatment researchers face additional challenges, including the complex ethical issues associated with both internet-based and child maltreatment research. If these issues are adequately addressed, social media and internet-based technologies may be a promising approach to reducing some of the limitations in existing child maltreatment data.     

Cues of paternal uncertainty and father to child physical abuse as reported by mothers in Rio de Janeiro, Brazil

Objective

Paternity is uncertain, so if paternal feelings evolved to promote fitness, we might expect them to vary in response to variables indicative of paternity probability. We therefore hypothesized that the risk of lapses of paternal affection, including abusive assaults on children, will be exacerbated by cues of non-paternity.

Methods

Cross-sectional study of 331 Brazilian mothers, interviewed about 1 focal child (age 1–12) residing with her and the putative father. Child physical abuse was assessed using the Conflict Tactic Scales: Parent Child (CTSPC). Two potential cues of (non) paternity were (1) whether the parents co-resided when the child was conceived, and (2) whether third parties allegedly commented on father–child resemblance. Data were analyzed through multiple logistic regressions.

Results

Mothers reported child physical abuse by 15.9% (95% CI 4.6–27.1) of fathers who had not cohabited with them at conception, compared to 5.9% (95% CI 3.1–8.7) of those who had. The odds ratio for abuse by fathers who had not cohabited at conception in relation to those who had—adjusted for income, education, age, sex of child, whether child was first born, household size, time father spent with child, and alcohol abuse and drug use by father—was 4.3 (95% CI 1.4–13.8). Mothers reported abuse of 7.0% (95% CI 4.0–10.0) of children who purportedly resembled their fathers, versus 8.7% (95% CI 0.2–17.1) of those who did not.

Conclusion

According to maternal reports, not having co-resided at conception quadrupled the chance of child physical abuse by currently co-residing Brazilian fathers. The reported prevalence of abuse was unrelated to reported allegations of father–child resemblance.