Correlates of sexual abuse and smoking among French adults

OBJECTIVE: The goal of this study was to examine the association between sexual abuse (SA) and initiation, cessation, and current cigarette smoking among a large representative adult population in France. METHOD: A random sample size of 12,256 adults (18-75 years of age) was interviewed by telephone concerning demographic variables, health practices and beliefs, and health status--for which SA and tobacco questions were included. Bivariate and multivariate analyses were conducted. RESULTS: Nearly 46% of SA survivors were current smokers compared to 34% of non-abused persons (p<.001). Survivors of SA consumed more cigarettes per day than non-abused individuals (14.5 vs. 12.4, p<.01). Survival analysis showed an increased risk of smoking initiation for respondents abused before 18 (adjusted relative hazard=1.55; p<.0001) with referent to the non-abused group. SA was not found to be a significant predictor of current smoking status among those who began smoking after the first incident of SA. Respondents who were not sexually abused were 1.8 times (95% CI, 1.12-2.99) more likely to quit smoking than people who began smoking after they were sexually abused. CONCLUSIONS: The early identification and treatment of sexually abused persons is critical to decrease smoking among adolescents and adults because of the association of SA with both smoking initiation and decreased cessation rates. It may be more difficult to detect an association between SA and current smoking due to the high rates of smoking and lower rates of quitting among the general French population.     

Nine years after child sexual abuse

OBJECTIVE: During 1988-1990, 103 children presented to Child Protection Units (CPU) at two children's hospitals in Sydney, Australia. Nine years later, the psychological adjustment of these young people (mean age=19.1 years, SD=3.4 years; range=14-25 years) was compared with that of non-abused young people of similar age and gender to assess group differences and examine potential risk factors. METHOD: At intake, data on the nature of the index sexual abuse, demographics and the family environment were collected by clinicians. A comparison group, of similar age and gender, was selected from schools in the catchment area of the CPUs. Six years after presentation for the abuse, records of the statutory child protection authority were checked to determine any further notifications for abuse and/or neglect. Nine years after intake, 49 of the abused young people and 68 of the non-abused young people and/or their parents were interviewed and assessed. RESULTS: The sexually abused young people performed more poorly than non-abused young people on psychometric tests of depression (p=.001), self-esteem (p<.001), anxiety (p<.001), behavior (Child Behavior Checklist: p=.01; Youth Self Report: p=.01; Young Adult Self Report: p<.001), and despair (p=.001). They were also more likely to have a history of bingeing (p=.002), self-inducing vomiting (p=.02), smoking cigarettes (p=.01), and using amphetamines (p=.002), ecstasy (p=.002) and cocaine (p=.004). Potential risk factors were in two groups, family and child. Family factors: family functioning, parental drug/alcohol problems, mother's sexual abuse history, mother's depression and socio-economic status. Child factors: despair and hopefulness, number of negative life events, ratings of their father's care, previous notifications for child sexual abuse and placements in out-of-home care by the statutory child protection authority. In the presence of other risk factors, child sexual abuse was a significant predictor of self-esteem, behavior and bingeing. CONCLUSIONS: Rather than focusing only on the individual's child sexual abuse, treatment may also need to address the family's functioning and the individual's feelings of despair.     

Cerebral infarct in head injury: relationship to child abuse

BACKGROUND: To determine whether CT-detected cerebral infarct in young children is associated more often with abuse or unintentional head injury. METHODS: Retrospective case-control study of injured children under age 6 who had abnormal initial head CT scans and who were admitted to the only Level I pediatric trauma center in Washington State for closed head injury (CHI) from January 1, 1992 to December 31, 1998. RESULTS: Fifteen children developed cerebral infarct after CHI during the 7 year period. These cases were compared to 53 controls (those who did not develop infarct). After adjusting for the presence of SDH and for severity of injury, patients with infarcts were six times more likely to have been abused than patients without infarcts (OR 6.1; 95% CI, 1.02-36.0). CONCLUSIONS: Cerebral infarct after CHI appears to result more frequently from abuse than unintentional injury in young children.     

Do abused young children feel less pain?

The objective of this study was to investigate whether acute pain in abused children was under recognized by doctors and nurses compared to children evaluated for accidental injuries. We hypothesize that an abused child’s reaction to physical pain could be an additional symptom of this challenging diagnosis. For the observational prospective case control study in an emergency department, children were eligible when: younger than six years old, the reported trauma occurred within the previous seven days, the trauma comprised a bone injury or burn, and the child was able to express his or her pain. The case group comprised children for whom the medical team reported their abuse suspicions and supporting information to a court, and whose cases of abuse were subsequently confirmed. The control group consisted of children with a plausible cause for their injury and no obvious signs of abuse. The children were matched according to their age and type of trauma. The pain was assessed by doctors and nurses before analgesic administration using a certified pain scale.Among the 78 included children, pain was significantly less recognized in the abused children vs. the controls (relative risk = 0.63; 95% CI: 0.402–0.986; p = 0.04). We observed a discrepancy between the nurses’ and doctors’ scores for the pain assessments (Kappa coefficient = 0.59, 95% CI: 0.40–0.77). Our results demonstrate that pain expression in abused children is under recognized by medical staff. They also suggest that abused children may have reduced pain expression after a traumatic event. Paying particular attention to the pain of abused children may also optimize the analgesic treatment.     

Estimating the probability of abusive head trauma after abuse evaluation

BackgroundEvidence-based, patient-specific estimates of abusive head trauma probability can inform physicians’ decisions to evaluate, confirm, exclude, and/or report suspected child abuse.ObjectiveTo derive a clinical prediction rule for pediatric abusive head trauma that incorporates the (positive or negative) predictive contributions of patients’ completed skeletal surveys and retinal exams.Participants and Setting500 acutely head-injured children under three years of age hospitalized for intensive care at one of 18 sites between 2010 and 2013.MethodsSecondary analysis of an existing, cross-sectional, prospective dataset, including (1) multivariable logistic regression to impute the results of abuse evaluations never ordered or completed, (2) regularized logistic regression to derive a novel clinical prediction rule that incorporates the results of completed abuse evaluations, and (3) application of the new prediction rule to calculate patient-specific estimates of abusive head trauma probability for observed combinations of its predictor variables.ResultsApplying a mean probability threshold of >0.5 to classify patients as abused, the 7-variable clinical prediction rule derived in this study demonstrated sensitivity 0.73 (95% CI: 0.66-0.79) and specificity 0.87 (95% CI: 0.82-0.90). The area under the receiver operating characteristics curve was 0.88 (95% CI: 0.85-0.92). Patient-specific estimates of abusive head trauma probability for 72 observed combinations of its seven predictor variables ranged from 0.04 (95% CI: 0.02-0.08) to 0.98 (95% CI: 0.96-0.99).ConclusionsSeven variables facilitate patient-specific estimation of abusive head trauma probability after abuse evaluation in intensive care settings.     

Comparison of computed tomography and chest radiography in the detection of rib fractures in abused infants

PURPOSE: Chest radiographs (CXR) are the standard method for evaluating rib fractures in abused infants. Computed tomography (CT) is a sensitive method to detect rib fractures. The purpose of this study was to compare CT and CXR in the evaluation of rib fractures in abused infants. METHODS: This retrospective study included all 12 abused infants identified from 1999 to 2004 who had rib fractures and both CXR and CT (8 abdomen CTs, 4 chest CTs). CT exams had been performed for clinical indications, and were obtained within one day of the CXR. Studies were reviewed by two pediatric radiologists to determine the number, locations, and approximate ages of the rib fractures. A total of 225 ribs were completely (192) or partially (33) seen by CT, and the matched ribs on CXR were used for the analysis. RESULTS: The mean patient age was 2.5 months (1.2-5.6), with seven females and five males. While 131 fractures were visualized by CT, only 79 were seen by CXR (p<.001). One patient had fractures only seen by CT. There were significantly (p<.05) more early subacute (24 vs. 4), subacute (47 vs. 26), and old fractures (4 vs. 0) seen by CT than by CXR. Anterior (42 vs. 11), anterolateral (21 vs. 12), posterolateral (9 vs. 3) and posterior (39 vs. 24) fractures were better seen by CT than by CXR (p<.01). Bilateral fractures were detected more often by CT (11) than by CXR (6). CONCLUSIONS: While this study group is small, these findings suggest that CT is better than CXR in visualizing rib fractures in abused infants.     

An epidemiological study of abused children and their families in the united kingdom between 1977 and 1982

Between 1977 and 1982 there were 6,532 children placed on the child abuse registers maintained by the National Society for the Prevention of Cruelty to Children (NSPCC) in England. This paper examines the data on these children. The rate of physical injury increased over the last four years of the study from .43 to .63 per thousand children under 15 in the NSPCC register areas, but the percentage of fatal and serious injuries decreased over the entire period. There was also a decline in the rate of re-injury. Infants, boys and low birthweights were overrepresented among the physically abused, neglected and nonorganic failure to thrive cases. Girls and 10-14 year olds were overrepresented among the sexually abused children. The parents or caretakers of the abused children were characterized by their early parenthood, marital instability, large families, criminality and mobility. An initial unemployment rate of 35% among the male caretakers increased to 58% over the last three years of the study.     

A comparison of sexually abused and non-sexually abused adolescents in a clinical treatment facility using the MMPI-A

OBJECTIVE: In the current study, the adolescent version of the Minnesota Multiphasic Personality Inventory, the MMPI-A, was used to address concerns voiced about the mixing of different developmental ages, use of inadequate comparison groups, and the lack of reliance on reliable and valid measures of psychological, behavioral, and psychosocial problems used in previous studies of sexually abused children and adolescents. METHOD: A total of 107 adolescents in residential treatment (73 boys and 34 girls) were included in the study. Seventy-two of these adolescents had reportedly been sexually abused (42 boys and 30 girls); 35 had not been abused (31 boys and 4 girls). Predictions based on previous research with adolescents were made and tested regarding which MMPI-A validity, clinical, and content scales would differ between the sexually abused and non sexually abused groups of adolescents. RESULTS: Overall, and consistent with many predictions, sexually abused adolescents had both statistically and clinically higher elevations on several MMPI-A scales than did their non-abused counterparts. No scales were more elevated for non-abused adolescents than for abused adolescents. CONCLUSIONS: Sexually abused adolescents in residential treatment, as a group, present with concerns that their non-abused counterparts did not have, or did not share to the same extent. Treatment recommendations based on the MMPI-A scale elevations are provided, limitations of the current study discussed, and directions for further research are suggested.     

SAFE Homes: is it worth the cost? An evaluation of a group home permanency planning program for children who first enter out-of-home care

OBJECTIVE: To evaluate the SAFE Homes (SH) program, a short-term group care program for children between 3 and 12 years of age who enter care for the first time. The program aims to improve case outcomes by consolidating resources to facilitate assessment and treatment planning. METHODS: The 1-year outcomes of 342 children who received SAFE Home services and 342 matched foster care (FC) control children were compared. The 684 subjects used in this report were selected from a larger pool of 909 subjects using propensity score matching to control for hidden bias in treatment group assignment. We hypothesized that SAFE Homes would result in greater continuity of care for children (e.g., fewer placements, more placements with siblings and in towns of origin), identification of more relatives for substitute care when needed, reduced use of high-cost restrictive care settings (e.g., residential, inpatient), and reduced rates of re-abuse through earlier detection and provision of services to meet child and family treatment needs. RESULTS: Prior to the initiation of the SAFE Homes program, 75% of the children who entered care in the State experienced three or more placements in the first year. The outcomes of both the SH and FC cases were significantly improved over pre-SAFE Home State statistics. The FC group, however, had comparable or better outcomes on most variables examined. In addition, the total cost for out-of-home care for the children in FC was significantly less, despite the fact that the two groups spent similar amounts of time in care (average time in care: 7 months). This finding held when the total placement cost was calculated using the State reimbursement rate of 206.00 US dollars per day for SAFE Home care (SH: 20,851 US dollars +/- 24,231 US dollars; FC: 8,441 US dollars +/- 21,126 US dollars, p < .001), and a conservative SAFE Home program fee of 85.00 US dollars per day that only considered the child care and custodial staffing costs uniquely associated with the program (SH: 13,314 US dollars +/- 21,718 US dollars; FC: 8,441 US dollars +/-21,126 US dollars, p < .001). CONCLUSION: Improvements in outcomes related to continuity of care can be attained through staff training. The SAFE Home model of care is not cost-effective for first-time placements.     

Maltreatment in multiple-birth children

ObjectiveThe rate of multiple births has increased over the last two decades. In 1982, an increased frequency of injuries among this patient population was noted, but few studies have evaluated the increased incidence of maltreatment in twins. The study aim was to evaluate the features of all multiple-birth children with substantiated physical abuse and/or neglect over a four-year period at a major children's hospital.Study design and methodsA Retrospective chart review was conducted of multiple-gestation children in which at least one child in the multiple set experienced child maltreatment from January 2006 to December 2009. Data regarding the child, injuries, family, and perpetrators were abstracted. We evaluated whether family and child characteristics were associated with maltreatment, and whether types of injuries were similar within multiple sets. For comparison, data from the same time period for single-birth maltreated children also were abstracted, including child age, gestational age at birth, and injury type.ResultsThere were 19 sets of multiple births in which at least one child had abusive injuries and/or neglect. In 10 of 19 sets (53%), all multiples were found to have a form of maltreatment, and all children in these multiple sets shared at least one injury type. Parents lived together in 63% of cases. Fathers and mothers were the alleged perpetrator in 42% of the cases. Multiple-gestation-birth maltreated children were significantly more likely than single-birth maltreated children to have abdominal trauma (13% vs. 1%, respectively; p < .01), fractures (83% vs. 39%; p < .01), and to be injured at a younger mean age (12.8 months vs. 34.8 months; p < .01).ConclusionsSiblings of maltreated, multiple-gestation children often, but not always, were abused. In sets with two maltreated children, children usually shared the same modes of maltreatment. Multiples are significantly more likely than singletons to be younger and experience fractures and abdominal trauma. The findings support the current standard practice of evaluating all children in a multiple set when one is found to be abused or neglected.     

The mediating role of secrecy in the development of psychopathology in sexually abused children

Although child sexual abuse (CSA) is associated with psychopathology, limited research examined mechanisms through which CSA leads to psychopathology in children. It is generally assumed that CSA is associated with secrecy among children, to our knowledge this assumption has not yet been empirically tested. This gap in our understanding of the aftermath of CSA is surprising in light of abundant evidence linking secrecy to psychopathology among children. The current study examined whether, as compared to children who have not experienced CSA, CSA victims have a greater tendency for secrecy as reported by mothers and children, and whether psychopathology in CSA victims may be explained by their tendency to keep secrets. Sixty-three non-offending mothers and their sexually abused children (68.3% female; M age = 10.89) and 48 mothers and their non-abused children (62.5% female; M age = 11.17) completed questionnaires on secrecy and psychopathology (i.e., internalizing and externalizing behavior problems). Mothers of abused children perceived higher levels of secrecy and psychopathology in their children as compared to mothers of non-abused children. There were no differences in child-reported secrecy between abused and non-abused children. Mediation analyses revealed that mother-reported secrecy mediated the association between CSA and psychopathology. These findings suggest that secrecy is a potential mechanism underlying psychopathology associated with CSA, which has important implications for treatment of abused children.     

Referrals to a hospital-based child abuse committee: a comparison of the 1960s and 1990s

OBJECTIVE: Although reports of child maltreatment have increased yearly since national data were first collected in 1976, little information is available about changes in the characteristics of children reported. Therefore, to examine changes over time in recognition and reporting in a medical setting, we compared referrals to a hospital-based child abuse committee in the late 1960s and early 1990s. DESIGN: Retrospective, cross-sectional review of medical records and logs of the hospital's child abuse committee. SETTINGS: Ambulatory, emergency, and inpatient services at Yale-New Haven Hospital. Patients: Medical records were reviewed for 101 of the 165 children referred to the child abuse committee in 1968-1969 (early group) and 107 of the 843 children referred in 1990-1991 (late group). Cases of sexual abuse were excluded. RESULTS: Referrals for nonsexual abuse cases increased from 80 children per year in the early group to 181.5 per year in the late group; the late group was characterized by a larger number of newborn referrals (1% vs. 52%, p < .001). When non-newborns were compared, the two groups were similar with respect to gender and race, but the late group had fewer patients with private insurance (31% vs. 12%, p < .05). The late group also had more female-headed households (32% vs. 67%, p < .05) and more parents with a history of substance abuse (4% vs. 49%, p < .001). Excluding newborns, who were all classified as "at-risk," the types of problems were classified as abuse (41% early vs. 29% late), neglect (41% vs. 35%), and "at-risk" (16% vs. 35%). Although the types of injuries were similar: superficial injuries (20% vs. 16%), burns (9% vs. 8%), and fractures (6% vs. 4%), fewer maltreated children suffered physical injuries in the late group (71% vs. 49%, p < .05). CONCLUSIONS: A substantial change has occurred in referrals to the hospital's child abuse committee for abuse or neglect. Most referrals have become socially high-risk newborns and children or children with minimal injuries. This shift is likely due to broader definitions of maltreatment and earlier recognition of troubled families.     

The incidence of severe physical child abuse in Wales

OBJECTIVES: The purposes of this study were: (1) to ascertain the incidence and nature of severe physical child abuse in Wales; (2) to ascertain the incidence of all physical abuse in babies under 1 year of age; and (3) to determine whether child protection registers (CPR) accurately reflect the numbers of children who are physically abused. METHODS: This is a population-based incidence study based in Wales, UK, for 2 years from April 1996 through March 1998. Children studied were under the age of 14 with severe physical abuse consistent with the criminal law level of Grievous Bodily Harm. This included seven categories of injury (death; head injury including subdural hemorrhage; internal abdominal injury; physical injury in Munchausen Syndrome by Proxy including suffocation; fracture; burn or scald; adult bite). Cases were ascertained by a pediatrician surveillance reporting system (WPSU). A criterion for inclusion was multidisciplinary agreement that physical abuse had occurred (at case conference, strategy meeting, or Part 8 Review). The incidence of all babies under 1 year of age with physical abuse was also studied. Ascertainment of babies under the age of 1 year was undertaken from CPR as well as the WPSU. RESULTS: Severe abuse is six times more common in babies [54/100,000/year (95% CI +/- 17.2)] than in children from 1 year to 4 years of age [9.2/100,000 (95% CI +/- 3.6)]. It is 120 times more common than in 5- to 13-year-olds [0.47/100,000 (95% CI +/- 0.47)]. This is mainly because two types of serious abuse (brain injury including subdural hemorrhage and fractures) are more common in babies under the age of 1 year than older children. Using data from two sources (the WPSU and CPRs), the incidence of physical abuse in babies is 114/100,000 (CI 114 +/- 11.8) per year. This equates to 1 baby in 880 being abused in the first year of life. The largely rural Health Authority area in Wales had incidence figures for abuse in babies that were 50% of the three other predominantly urban Health Authority areas. Boys throughout the series were more at risk of being severely abused than girls (p < .025). Only 29% of the babies under 1 year of age on the CPR had actually been injured. Thirty percent of abused babies under the age of 1 year and 73% of severely abused children over the age of 1 year had caused previous concern to health professionals regarding abuse or neglect. Conclusions: Physical abuse is a significant problem in babies under the age of 1 year. Very young babies (under 6 months old) have the highest risk of suffering damage or death as a result of physical abuse. Severe abuse, in particular subdural hematoma and fracture, is much more common in babies than in older children. There is evidence of failure of secondary prevention of child abuse by health professionals, with a greater need to act on concerns regarding abuse and neglect. Interagency child protection work in partnership with parents should focus more on protecting babies under age 1 year from further abuse than on maintenance of the infant within an abusive home. The CPR is not intended as an accurate measure of children suffering abuse. It is a record of children requiring a child protection plan and must not be used as a measure of numbers of abused children.     

Physical abuse during adolescence: Gender differences in the adolescents' perceptions of family functioning and parenting

OBJECTIVE: To examine the relationship between physical abuse of adolescents and parenting by mothers and fathers and whether the association differs by gender. METHODS: Subjects were adolescents, 51 girls and 45 boys, documented by Child Protective Services (CPS) as physically abused during adolescence. Comparison subjects were non-abused adolescents, 47 girls and 48 boys, from the same suburban communities. Subjects completed the following: Family Adaptability and Cohesion Evaluation Scale, Parental Bonding Instrument, modified Conflict Tactics Scale (assessing physical abuse/punishment by each parent). RESULTS: Although CPS generally cited fathers as the abuse perpetrators, abused boys and girls often reported experiencing physical maltreatment from both parents. Not surprisingly, comparison subjects rated parents more positively than abused subjects. For both groups, mothers were perceived as more caring and less controlling, were reported to have closer relationships with their adolescents, and were less likely to use abuse/harsh punishment than were fathers. Differences between the adolescents' perceptions of mothers and fathers were more pronounced for abused than for comparison subjects. Boys' and girls' perceptions of parenting were generally similar except that girls, especially the abused girls, reported feeling less close to fathers. Abused girls also viewed mothers as less caring than the other groups viewed mothers. Abused girls were also less likely than abused boys to perceive that either parent, but particularly fathers, had provided them with an optimum style of parenting. CONCLUSIONS: Adolescents who experienced relatively mild physical abuse reported dysfunctional family relationships, which may place them at risk of poor adult outcomes. Adolescents' reports suggest that CPS reports may underestimate physical maltreatment by mothers.     

Risk behaviors and resiliency within physically abused adolescents

OBJECTIVE: This study examines the relationship between physical abuse and several risk behaviors, and thriving behaviors, and the relationship between potential protective factors and engagement in risk and thriving behaviors among victims of physical abuse. Three categories of potential protective factors were examined: (1) individual characteristics, (2) family processes, and (3) extra-familial factors. We expected that high levels of protective factors would reduce engagement in risk behaviors (i.e., alcohol use, tobacco use, drug use, sexual activity, antisocial behavior, attempted suicide, and purging) among abused adolescents. RESULTS: Across all the risk behaviors, abused adolescents reported a higher frequency of engagement than non-abused adolescents. Several protective factors were identified for the seven risk behaviors. Peer group characteristics was a significant predictor in all seven of the logistic regressions, followed by positive school climate (six models), religiosity (five models), other adult support (five models), family support (four models), view of the future (two models), and involvement in extra-curricular activities (two models). The variance accounted for by the models ranged from 2% (risk behavior of purging) to 26% (risk behavior of alcohol use and antisocial behavior). CONCLUSIONS: The findings indicate that, with the exception of sexual activity, the majority of abused adolescents were not engaging in risk behaviors; however, significantly more abused adolescents were engaging in risk behaviors than their non-abused counterparts. In addition, that protective factors were found to exist at various levels of the adolescents' ecology has strong implications for practice.     

Prevalence and effects of child sexual abuse in a poor, rural community in El Salvador: a retrospective study of women after 12 years of civil war

OBJECTIVE: The purpose of this retrospective study was to examine the epidemiology of child sexual abuse (CSA) among women in a poor, rural community in El Salvador, which was recovering from a 12-year civil war. METHODS: A cross-sectional, door-to-door survey was administered to 83 women. The LA Times Sexual Abuse Survey was used to determine the prevalence of CSA. The Hopkins Symptom Checklist (HCL) was used to measure long-term psychological sequelae of abuse (somatization, anxiety, depression, interpersonal sensitivity, and obsessive-compulsive traits). Information also was obtained about participation and number of relatives killed in the country's 12-year civil war. RESULTS: Of the 83 women interviewed, 14 (17%) reported a total of 21 experiences of CSA. The median age of abuse was 14 years. The majority of perpetrators (90.4%) were strangers, friends, or neighbors. None was a parent. The only significant difference between abused and non-abused women was on the depression measure, where abused women showed more pathology. After controlling for the number of relatives killed in the war, however, that difference failed to reach statistical significance. CONCLUSIONS: Differences in the epidemiology of CSA from that of other countries may be secondary to a different social structure in the rural Salvadoran community and non-disclosure by the women surveyed. The lack of difference in psychological symptoms between abused and non-abused women may be related to the different characteristics of the abuse and perpetrators. It also may be secondary to adverse social conditions such as poverty and war, which could obscure the long-term effects of CSA.     

Peer group interaction of physically abused children

The aim of this research study was to test the assumption that physically abused children differ significantly from their non-abused peers along dimensions which characterize abusing adults and other social deviants. Nineteen 5-10 year-old physically abused children and 38 non-abused peers were assessed by video-taped behavioral observations during free-flowing social interaction in a playroom. The dimensions tapped were: aggression, warmth, fear, pleasure, concentration, imagination and social participation. The dimension social participation was split into three variables: total social participation, negative participation and positive participation. The data from these nine dimensions was subject to a Pearson's correlation. Given the high correlation amongst these variables the data was subject to a principal components analysis with varimax rotation. From this analysis two components emerged which explained 76.9% of the total variance. These components were designated "social interaction" (component 1) and "hostility" (component 2) and were then subject to analyses of variance. A significant difference was found between the two groups on the "social interaction" component. The implications of these findings were explored and treatment possibilities examined.     

Analysis of caretaker histories in abuse: comparing initial histories with subsequent confessions

OBJECTIVE: We hypothesize that perpetrators of abuse include elements of truth in their initial history and that an analysis of perpetrator confessions can teach professionals how to identify these initial truths. METHODS: The information from a consecutive sample of perpetrators' confessions concerning 41 children hospitalized because of injuries caused by child abuse was reviewed. The details about the injuries contained in the confessions were compared with the details provided when these children initially presented for medical care. Information about the perpetrator's gender and relationship to the child, the victim's age and gender, type of injury, family risk factors, the trigger of the abusive event, the circumstances surrounding the event, and the type of trauma were collected. RESULTS: A total of 45 perpetrators abused 41 children; 76% of perpetrators were male; 56% were the child's father; 34% were the child's mother. The perpetrators initially provided no explanation about how 68% of the children received an injury. In 91% of their initial histories, the perpetrators provided some element of truth about the circumstances or triggering event for the abuse. In 67% of confessions, crying was the circumstance that triggered the abuse. Mothers were more likely to describe the situation that triggered the abuse (85% of mothers versus 58% of fathers, p=ns), while fathers were more likely to describe accurately the circumstances surrounding the abuse (79% of fathers versus 62% of mothers, p=ns). CONCLUSIONS: Perpetrators of abuse provide initial truths in their presenting history. Child abuse professionals must take a careful history from all caretakers and "listen" for the "elements of truth." These truths are the child's behavior or circumstance that increased stress and triggered the abuse. Employing this method in a careful analysis of confessions can make a significant contribution to the capacity to identify child abuse. In addition, more information about the role of triggers may help to focus child abuse prevention strategies.     

XRCC1 Arg399Gln and clinical outcome of platinum-based treatment for advanced non-small cell lung cancer: a meta-analysis in 17 studies

Objective: XRCC1 polymorphism is a research hotpot in individual treatment for non-small cell lung cancer (NSCLC). To obtain the association between XRCC1 polymorphism and clinical outcome of platinum-based treatment for NSCLC, a meta-analysis was conducted. Methods: Databases including PubMed, Embase, Cochrane, and Chinese National Knowledge Infrastructure (CNKI) were searched for publications that met the inclusion criteria. A fixed effect model was used to estimate pooled odds ratio (OR) and hazard ratio (HR) with 95% confidence interval (CI) for the association between XRCC1 Arg399Gln and response or survival of platinum-based treatment for advanced NSCLC. A chi-squared-based Q-test was used to test the heterogeneity hypothesis. Egger’s test was used to check publication bias. Results: Seventeen published case-control studies that focus on the association between XRCC1 Arg399Gln and response or survival of platinum-based treatment for advanced NSCLC in 2 256 subjects were included in this meta-analysis, of whom 522 were AA genotypes (23.2% frequency), 916 AG genotypes (40.6% frequency), and 818 GG genotypes (36.2% frequency). The overall response rate (ORR) was 45.2% (110/243) for AA genotype patients, 29.9% for AG genotype (73/244), and 30.7% for GG genotype (124/403). The heterogeneity test did not show any heterogeneity and the Egger’s test did not reveal an obvious publication bias among the included studies. The meta-analysis indicated that AA genotype patients presented higher response rates toward platinum drug treatment compared with G model (GG+GA) patients (GG vs. AA model: OR=0.489, 95% CI 0.266–0.900, P=0.021; AG vs. AA model: OR=0.608, 95% CI 0.392–0.941, P=0.026; GA+AA vs. GG model: OR=1.259, 95% CI 0.931–1.701, P=0.135; GG+GA vs. AA model: OR=0.455, 95% CI 0.313–0.663, P=0.0001). However, no evidence validates XRCC1 associates with the survival following platinum drug therapy. Conclusions: Our meta-analysis suggested that XRCC1 Arg399Gln is related with the sensitivity of NSCLC patients to platinum-based treatment. AA genotype patients present more desirable curative effectiveness compared with other patients.