Intentional Abuse Research Articles

Epidemiology of Inhalant Abuse Reported to Two Regional Poison Centers

The regional poison information center is a potential sentinel for substance abuse patterns. Its central data collection system allows it to access information from large population groups. We report results from a one year prospective cases series of inhalation abuse from two regional poison information centers. Prospective case series. All inhalation exposures reported to two regional poison information centers with a reason of intentional abuse were included. One hundred sixty-five cases were collected. One hundred twenty-four exposures (75%) were male. Age ranged from 4 to 45 y, with a mean, median and mode of 16.6 (SD 7.3), 15 and 13, respectively. Nine children were < 6 years old. There were 22 substances involved, but two substances (spray paint and gasoline) accounted for more than 61% of all cases. In children < 9 y (n = 18, 11%) gasoline alone accounted for 83% of exposures. Abuse occurred statewide, in both urban and rural settings, but tended to occur more often in rural environments (75%). Abuse was reported throughout the day with a peak incidence at 8 pm. One hundred twenty-three patients received direct medical evaluation or care. There was one fatality in this series and 15 patients were described as having life threatening symptoms. Inhalation abuse may begin very early in childhood and abuse appears to peak in adolescence. The regional poison information center can act as a sentinel for abuse patterns. This information can assist health care providers in poison and abuse prevention efforts.

Role of Intentional Abuse in Children 1 to 5 Years Old with Isolated Femoral Shaft Fractures

Role of Intentional Abuse in Children 1 to 5 Years Old with Isolated Femoral Shaft Fractures

Intentional abuse of dextromethorphan products: 1985 to 1988 statewide data

Intentional abuse of dextromethorphan products: 1985 to 1988 statewide data

International and uninternational abuse of infants and children

Intentional abuse of an infant is usually apparent. External injuries such as burns, bites, and bruises, as well as the skeletal changes of fractures, frequently multiple and in various stages of healing, are obviously intentionally inflicted, and are impossible accidental injuries for the nonambulatory young infant. Similar injuries in young children may be more difficult to evaluate because of their fear of and intimidation by the person who inflicted the injury. Fortunately, the high degree of suspicion regarding the nature of the injury permits the physician to make his accusations with legal protection in our judicial system. Every radiologist should be concerned with the responsibility of reporting to the referring physician the possibility of intentional trauma to infants and children. In Harris County, where Houston is located, there are 1,500 reports per month of child abuse; in other words, this approximates 18,000 cases a year in our community, and the radiologist is frequently the first physician to see evidence of the abused child. Not only is it a moral responsibility for the radiologist to report his suspicions, but in the state of Texas, as in other states, "any person having cause to believe that a child's physical and mental health, or welfare has been or may be adversely affected by abuse or neglect shall report" to the appropriate agency. A more recent amendment to this law is a penalty for failure to report. A person commits an offense if the person has cause to believe that a child's physical and mental health or welfare has been or may be adversely affected further by abuse or neglect and knowingly fails to report it. It is hoped that any radiologist recognizing either pathognomonic or suspicious signs of child abuse will have the conscience and courage to take a strong stand for the protection of the abused infant or child. Accidental injuries in older children may offer problems in diagnosis if there is no history available or if there is a denial of an injury. Some of these injuries may produce radiographic findings suggesting some form of metaphyseal or diaphyseal dysplasia. Iatrogenic injuries are frequently the result of physiologic or anatomical response to proper and lifesaving treatment. The most serious of these are found in the premature infant, who may suffer chronic lung disease or, more seriously, brain damage.(ABSTRACT TRUNCATED AT 400 WORDS)

Methylene chloride inhalation: An unusual form of drug abuse

Methylene chloride is a chlorinated hydrocarbon used widely in home and industry. Its intentional abuse has not been reported previously. We describe the case of a 14-year-old boy who presented with lethargy, nausea, and chills six hours after the intentional inhalation of a household product containing methylene chloride. The patient's elevated carboxyhemoglobin level responded well to 100% oxygen therapy. The pathophysiology and treatment of methylene chloride are discussed.

Compensating Injured Research Subjects: II. The Law

O ne reason for public concern about human experimentation is the awareness that research subjects in the past have suffered physical injury, pain, or even death. Although Institutional Review Boards and informed consent may minimize intentional abuse of subjects, they cannot eliminate subject injury altogether. Injuries will occur because of human error, ignorance about drug or treatment effects, or fraud or abuse. While the frequency of research-related injuries is unknown, and may be much rarer in nontherapeutic than therapeutic research, a recent survey (New England Journal of Medicine, September 16, 1976) suggests that they are pervasive and serious enough to warrant public attention.

Sexual Trauma in Young Blind Children

Severely disturbed blind children referred to the authors for training and therapy had suffered a wide range of sexually traumatic experiences. Citing specific cases, attention is focused on incidents ranging from unintentional direct sexual stimulation to severe intentional sexual abuse inflicted by others on the blind child. The alleviation of isolation and the alertness of parents and professionals in preventing deviant incidents is stressed. A plea is made for innovative sex education for blind children.

A Portable Geiger-Müller Counter

While all of the material presented here is not new, the original circuit was published in a physics journal (1) to which few radiologists have access, and some important changes have since been made. While the principle involved in a counter for field use is the same as that in the more complicated laboratory instrument, the practical design must differ greatly, as simplicity, ruggedness, and freedom from connection to power lines must be maintained without sacrifice of sensitivity. The above requirements appear to be well met in the little instrument described here, as it has been successful in the recovery of much radium, not only by the author but by Dr. George Henny of Philadelphia, Dr. Kenneth Corrigan of Detroit, and others. As shown in Figure 1, the instrument is completely contained in a steel box measuring approximately 5 1/2 × 6 × 3 inches, which is carried in a canvas case having a pocket for the headphones. Thus the hands of the operator are left free for carrying a stop-watch and tally counter with which to record the number of impulses per minute. The sensitivity is the same as that of other counters described by the author. "Sensitivity" is arbitrarily defined as the ability to double the normal count when 50 mg. of radium are located at a distance of about 212 feet, this count being directly proportional to the amount of radium and inversely proportional to the square of the distance. With a brief description, the diagram (Fig. 3) should be self-explanatory. The old type Ford spark coil normally has one end of the secondary winding grounded to the primary. This end must be removed from the primary and brought out by a well insulated lead to the plate and screen of the rectifier tube. This end of the secondary is easily located by fluoroscopy. Proper polarity of the primary to the battery must be determined by trial, since the secondary current is partly unidirectional and, to use the weaker alternation of the cycle, will result in sparking across the tube socket. In the compact arrangement shown here, the coil is removed from its wooden box and insulating compound, but some trouble can be saved if a slightly larger metal box is used to house the instrument. The size of the instrument has been considerably reduced by the use of a 1T4 for rectifier and another for amplifier instead of the larger tubes. Despite their miniature size they stand up under operation and even intentional abuse. The choke coil in series with the filament of the amplifier tube almost entirely prevents the sound of the vibrator in the phones. This choke consists of the core from any miniature transformer, wound with about six ohms (DC resistance) of No. 28 wire.