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.     

Prediction and prevention of child abuse and neglect

Utilizing an interview, a questionnaire, and observations during labor, delivery, and the postpartum period, a sample of one hundred mothers was identified as at high risk for abnormal parenting practices. These mothers were randomly divided into a “High-Risk Intervene” group (N=50) and a “High-Risk Nonintervene” group (N=50). The “Intervene” group received comprehensive pediatric follow-up by a single physician, a lay health visitor, and/or a public health nurse in the home. The “Non-intervene” group received routine care, although the results of these screening procedures were shared with the physicians and nurses responsible for their ongoing care. Another group of 50 mothers, who delivered during the same time period and who were assessed as low risk in terms of abnormal parenting practices, served as controls. When the children were approximately two years old (mean age 26.8 months), 25 families in each of the three groups were chosen at random for detailed evaluation.     

浅析在新形势下如何提高骨科年轻护士临床护理能力

目的分析目前骨科年轻护士队伍中存在的主要问题,以便科室层面针对现状采取培训方法。方法制订骨科年轻护士的培训计划,从提高年轻护士综合能力入手,通过床边实境培训,培养年轻护士的护理思维能力、病情观察能力、专业知识运用能力和实际解决问题能力,变被动工作为主动工作,在深度、广度上挖掘,体现专科护理的内涵和价值。结果实施后年轻护士的个人素质提高,患者和医生满意度提升。结论这种临床实境培训方法,内容紧密联系实际,现场讲课、床边实践、即时纠正,提高了年轻护士的能力,使护士的整体技能水平有了明显的提升。     

Sex,Male Teachers and Young Children

The recent case of a male student nursery nurse found guilty of sexually abusing children brought into focus the absence of policies on men working with young children in schools regarding such issues as how to handle physical contact, intimacy and masculinity, their female colleagues and the children in their care. This means individual male teachers have to construct their own frameworks in which to work ‘safely’ with children. If male teachers and children are to work together within a protective and supportive environment, issues involving sex and masculinity need to be given a forum for discussion.     

Interpretations of colposcopic photographs: evidence for competence in assessing sexual abuse?

Accurate assessment of physical findings for child sexual abuse is medically and legally important. This study evaluated (1) interobserver reliability of clinicians rating colposcopic photographs, and (2) correlates of reliable interpretations. Seventy physicians and two nurse practitioners, divided by professional levels, assessed colposcopic photographs and completed a questionnaire. Ratings by a professional with extensive experience in this field were used as an accuracy standard. Leaders in the field of child sexual abuse assessment made significantly more "accurate" assessments than pediatricians, pediatric and family practice residents, and intern physicians. Leaders made fewer "inaccurate" interpretations than interns. Predictors of agreement with standard assessments, although weak, were knowledge of female perineal anatomy and professional level. Total number of sexual abuse examinations conducted and knowledge of sexually transmitted diseases as acquired by children were not significant predictors of accurate assessment. The findings are interpreted as to their potential relevance to actual sexual abuse evaluations of children.     

斐奇诺论医生

中世纪的人们注重精神而轻视身体,医生沦为一种低贱的职业,文艺复兴时期人们开始发现自己,斐奇诺即是从古代文化和基督教的起源中重新认识身体健康的价值和医生的作用,他认为医术是一种高贵且神圣的技艺,医生是学者们追求智慧的指引者,而医生的职责则与牧师的职责密切相关。     

Predicting psychopathology in six-year-olds from early social relations

113 children were seen at 1 and 6 years of age in order to examine the relationship between the quality of the early attachment relationship and later psychopathology. On the basis of scores from the Achenbach and Edelbrock Child Behavior Profile, an outcome measure of psychopathology at 6 years, the results indicated different outcomes for male and female children. For males, attachment classification at 1 year was significantly related to later psychopathology; insecurely attached males showed more psychopathology than securely attached males. No relationship between attachment and later psychopathology was observed for females. Even for males, the attachment classification only partly predicted later behavioral problems. Several other factors, including life-stress events and family demographic variables, appeared to influence the development of psychopathology. The findings suggest that although the child's attachment relationship plays an important role in the development of psychopathology, the child is neither made invulnerable by an early secure attachment nor doomed to psychopathology by an insecure attachment.     

Storybook models and achievement behavior of preschool children

The effects of orally presented storybook models on children's cognitive achievement behavior were assessed in two experiments. Experiment I involved 100 preschool-age children who were given one exposure to either a story depicting achievement behaviors by a male/female model, or a control story describing no achievement behavior. Subjects then were asked to perform a related achievement task. No significant modeling effects were found, but a significant relationship existed between the children's recall of the story content and their performance on the subsequent task. Experiment 11 employed 60 preschool-age children who were given repeated exposures (3 to 4) to, and group discussion of, the same achievement stories or non-achievement control story. A significant relationship was observed between type of story and type of solutions to the subsequent achievement task. These findings are discussed in the context of modeling theory, with practical implications.     

‘We are the ones that talk about difficult subjects’: nurses in schools working to support young people’s mental health

As health professionals in an educational setting, nurses in schools occupy a unique place in the spectrum of children’s services. Yet the service is often overlooked and has been described as invisible. This paper draws on findings from a study, funded by the Scottish Government’s National Programme for Improving Mental Health and Well‐being, which explored the role of school nurses in promoting and supporting the mental health of children and young people. The school nursing service throughout the United Kingdom is at a pivotal point as its role is being redefined to align with moves across the National Health Service towards a public health model. This paper therefore offers a timely overview of the mental health work of school nurses, and raises key issues for future work. Interviews were conducted with 25 school nurse managers across Scotland. Interviewees claimed that the contribution of nurses in schools was distinctive, owing to the quality and consistency of relationship that they could offer, and the autonomy that the service allowed young people. However, significant challenges were reported in making this contribution, and tensions were evident in the conceptualisation of their role. The framework of resilience is used to discuss the findings on the significance of building relationships in promoting mental health.     

Does war contribute to family violence against children? Findings from a two-generational multi-informant study in Northern Uganda

After 20 years of civil war in Northern Uganda, the continuity of violence within the family constitutes a major challenge to children's healthy development in the post-conflict era. Previous exposure to trauma and ongoing psychopathology in guardians potentially contribute to parental perpetration against children and dysfunctional interactions in the child's family ecology that increase children's risk of maltreatment. In order to investigate distal and proximal risk factors of child victimization, we first aimed to identify factors leading to more self-reported perpetration in guardians. Second, we examined factors in the child's family environment that promote child-reported experiences of maltreatment. Using a two-generational design we interviewed 368 children, 365 female guardians, and 304 male guardians from seven war-affected rural communities in Northern Uganda on the basis of standardized questionnaires. We found that the strongest predictors of self-reported aggressive parenting behaviors toward the child were guardians’ own experiences of childhood maltreatment, followed by female guardians’ victimization experiences in their intimate relationship and male guardians’ posttrautmatic stress disorder (PTSD) symptoms and alcohol-related problems. Regarding children's self-report of victimization in the family, proximal factors including violence between adults in the household and male guardians’ PTSD symptom severity level predicted higher levels of maltreatment. Distal variables such as female guardians’ history of childhood victimization and female guardians’ exposure to traumatic war events also increased children's report of maltreatment. The current findings suggest that in the context of organized violence, an intergenerational cycle of violence persists that is exacerbated by female guardians’ re-victimization experiences and male guardians’ psychopathological symptoms.     

护士针刺伤的原因及对策分析

目的:调查护士针刺伤的原因,提出防止针刺伤的对策。方法:选取我市某医院临床一线护士380名,调查2018年3月至2019年3月一年中发生针刺伤的情况。结果:护士针刺伤发生率为88.16%,发生原因有各种因素。结论:针刺伤在临床护士工作中发生率较高,护士应多重视,提高自我防护意识,在工作中规范操作流程,同时要使用安全医疗器具和防护工具。通过多种途径降低护士针刺伤,保护自身安全,降低职业暴露的风险。     

The relative roles of IQ and cognitive processes in reading disability

The purpose of the present study was to explore the relative roles of IQ and cognitive processes in reading performance. A sample of 443 Spanish children (264 male, 179 female) ranging in age from 7 to 13 years were classified into four groups according to IQ scores (<80, 80–90, 90–110, >110) and reading disabled (RD) and normally achieving readers (NR) were compared. The findings indicate that IQ scores were not related to the differences between children with RD and NR. We found that reading‐related cognitive deficits do differentiate between RD and NR children. Therefore, IQ scores do not make a significant contribution to our understanding of reading disability.     

Gender-based wage differentials in a predominantly female profession: observations from nursing

Despite numerous studies examining nursing wages, very little attention has focused on nursing wage differentials. We build on previous research by modeling nursing wages and examining male–female wage differences within the context of the current nursing shortage. Our results show that male nurses do earn a wage premium, largely explained by employment as a nurse anesthetist, job satisfaction, and experience. Whether or not this differential indicates discrimination toward females in the US nursing labor market is unclear. Since males represent a small proportion of the nursing workforce, the time required for males to become prevalent in the nursing labor market and help ease the nursing shortage is unknown. Consequently, one must ask whether the male wage premium is sufficient to attract substantial numbers of men into nursing, and whether wages, in general, are sufficient to attract the requisite numbers of males and females into nursing to address the shortage ‘crisis’.     

Becoming a physician: The influence of the undergraduate experience

This study employed a national sample of college students who initially aspired to be, or later became, physicians to determine the influence of precollege characteristics, college origins, and the academic and social experience of college on the likelihood of becoming a physician. Estimates of a 14-variable causal model indicated that the major direct effects on attainment were attributable to college characteristics and the academic experience of college. Net of other causes, the selectivity/prestige of the undergraduate institution attended, collegiate academic achievement, and majoring in the physical or life sciences each had significant direct effects on becoming a physician. The direct positive influence of college quality, however, was partially counterbalanced by its negative indirect effect. Moreover, the greatest advantage in attending an elite institution accrued to those students with relatively high levels of academic performance. As academic performance declined, so did the positive effect of college quality. The effects of precollege characteristics on becoming a physician were largely indirect, mediated by the student's college experience. Net of other factors, women were no less likely than men to become physicians, but being female had a significant negative indirect effect. Conversely, secondary school achievement did not directly influence attainment but did have a large positive indirect influence.An earlier version of this paper was presented at the annual meeting of the Association for the Study of Higher Education, San Diego, February, 1987.     

Physician‐patient communication: Mutual role expectations

This study examined physician‐patient communication as it relates to expectations that patients and physicians hold for themselves and each other. Dimensions of mutual role expectation were determined to be physician as humanistic practitioner, physician authority, patient in the sick role, and patient as consumer. The study tested five hypotheses. Results showed patients had significantly higher expectations for patients in the sick role than had physicians. Other role expectations varied significantly by age within physician and patient groups. The implications of these differences for physician‐patient communication are discussed.     

Physicians' Involvement with the New York State Health Care Proxy

This study examined physicians' attitude, involvement, and perceived barriers with the health care proxy. A cross sectional, correlational design was used to survey practicing physicians (N = 70). Physicians had positive attitudes toward the health care proxy and indicated that the most significant barriers to health care proxy completion were patient discomfort in discussing the topic, patient knowledge about the health care proxy, and timing of discussions. Physician involvement with the health care proxy included supporting patients' wishes on the health care proxy, initiating discussions with patients about the New York State (NYS) health care proxy, and advocating for patients' rights about the health care proxy. A multiple regression analysis was conducted to understand the factors that predicted overall physician involvement. End-of-life training was a significant predictor. Implications for training and education of physicians and multidisciplinary work with health care professionals, including social workers and nurses, are discussed.     

Early childhood teachers' affectionate behavior: Differential expression to female children,male children,and groups of children

This study examined differences in (1) the amount of affectionate behavior that early childhood teachers expressed to individuals versus groups of children and (2) the amount of affection that teachers expressed to female and male children. Data were collected by conducting naturalistic observations of 47 female teachers in six day care centers. Teachers' affectionate behavior and the types of recipients were recorded. The behaviors observed were smiling, affectionate words, active affectionate physical contact, and passive affectionate physical contact. The data were converted to percentages and subjected to parametric multivariate analyses of variance. The teachers were found to express more affection to female children than to male children and more affection to individual children than to groups of children. Implications for teacher training and early childhood programs are discussed.     

Effects of narrator gender on conceptual learning

Audiovisual materials for nursing students typically show a female nurse demon-strating activities as they are described (and sometimes directed) by a male narrator. Of obvious concern is the effect of such sex stereotyping on female students. Further, do students (male and female) learn as well from instructional video-tapes narrated by an equally competent female narrator? The investigator sought to control all variables but gender of narrator in this study of conceptual learning from videotapes.