Signs Of Physical Abuse Research Articles

Bruising in Infants: An Approach to the Recognition of Child Physical Abuse.

Infants (children <12 months of age) are maltreated at more than twice the rate of any other child age group, and infants die because of maltreatment at 3 times the rate of any other age group in childhood. The incidence of hospitalization for serious physical abuse in children also is highest for infants. Successful recognition of medically mild signs of physical abuse in infants, such as certain bruising patterns, can, therefore, lead to lifesaving interventions. The importance of the recognition of medically mild injuries due to physical abuse is underscored by the finding that a high percentage of infants (27.5%) hospitalized with serious physical abuse were found to have previously sustained milder injuries, such as bruising. Clinicians must be aware of patterns of bruising suggestive of abuse to distinguish between infants who have been abused and those who have been accidentally injured. To maximize the likelihood that abused infants will be identified and protected, as well to minimize the likelihood that an accidentally injured infant will be mischaracterized as abused, the application of an evidence-based approach to the evaluation of bruised infants should be applied. A consistent, evidence-based practice in this setting also may reduce the influence of racial and socioeconomic bias and decrease disparities in care.

Elder Abuse: A Comprehensive Overview and Physician-Associated Challenges.

Elder abuse can present in many forms, including physical abuse, psychological/emotional abuse, sexual abuse, financial abuse, and neglect. Many studies estimate that about 10% of all people over the age of 65 experience some form of abuse. These rates are often higher in long-term care facilities such as nursing homes, despite government regulations aimed toward addressing this issue. Because patients who experience abuse tend to have higher rates of hospitalization and mortality, it is important for physicians to be able to accurately identify cases of abuse. However, many studies have found that healthcare professionals are often undertrained and ill-equipped in diagnosing elder abuse. In this article, we outline tools that may be able to aid healthcare professionals in their diagnoses, such as survey-based methodology and common physical signs of abuse. In addition, we propose evidence-based solutions, including the use of multidisciplinary teams and increased training on the subject, so that healthcare professionals can more easily identify victims of abuse. Essentially, it is our hope that this article further spotlights elder abuse and its challenges, while serving as a guide to healthcare professionals.

Medical approach to children who may have been sexually abused-a narrative review.

The medical approach to children who may have been sexually abused involves several issues and aspects that need to be considered. The medical examination of children with suspected sexual abuse is important, but a detailed medical history from the child and the parents or caretakers is always part of every thorough examination. It can take a long time until victims disclose their abuse and physical signs of abuse may no longer be visible at the time of examination. If the physical examination is performed non-acutely, only 2.2% of sexually abused girls show diagnostic signs of injury. An experienced examiner should ideally perform the examination in suspected sexual abuse of children. Knowledge of the current literature is of importance, as the interpretation of findings has changed over the past decades and it can be difficult to differentiate between normal variants, symptoms of other medical problems, and signs of sexual assault. Furthermore, sexual abuse of children presents in various form, not necessarily leading to physical injuries. Since 1992, Adams et al. publish a regularly updated system for the classification of anogenital findings in children with suspected sexual abuse, including a detailed list of physical findings and infections related to sexual abuse. The purpose of this article is to summarize important aspects of the medical approach to children with suspected sexual abuse according to the current literature.

A modern danger for adolescents: from online flirtation to sexual abuse

A modern danger for adolescents: from online flirtation to sexual abuse Objective: The Internet is an important communication tool facilitating access to information. Use of social media has been rapidly increasing among young people in Turkey. Thus, adolescents could be regarded to be at risk of online sexual abuse. This study evaluates Internet use as a means of child sexual abuse, looking at the reasons and personal and familial characteristics. Method: The study was performed with 3429 cases that presented to the Child Follow-up Center with the claim of child sexual abuse between January 2011 and December 2015. The case files were reviewed retrospectively and it was determined that 135 children had met with the abuser via Internet. Results: The vast majority (94.8%) of these 135 cases were female and the victims’ mean age was 15.61 years. It was found that 71.1% of the victims were exposed to penetration, and it was detected that 40.0% of the victims had physical signs of abuse. In addition, 11.1% of the victims were found to be pregnant. Also, low levels of socioeconomic status (97.8%) and of parents’ education (59.3%) were identified as familial risk factors. Conclusion: Education about safe use of the Internet, dissemination of interventions against cyberbullying, and conscious Internet use in populations at risk can be useful in preventing potential negative outcomes.

The mouth and maltreatment: safeguarding issues in child dental health

From the first cry of a newborn baby, the first smile, first tooth, first word, the mouth plays a key role in children’s health and development. It benefits from a...

Nonaccidental injury presenting as unilateral retinal detachment in two infants

The association between abusive head trauma and retinal hemorrhages is well documented. As such, ophthalmic review in suspected nonaccidental injury has become routine. However, there is a paucity of reports focusing on ocular trauma and retinal detachment presenting as unilateral findings in nonaccidental injury and in the absence of other signs of physical abuse. This report identifies 2 suspected cases of nonaccidental injury in infants presenting to a tertiary care center with retinal detachment presumed secondary to severe unilateral direct ocular trauma. The fellow eye was normal in both cases. Findings were inconsistent with the reported histories from parents.

Signs of physical abuse and neglect in the mature patient

Neglect and physical abuse of elderly are worrisome health problems, which are expected to grow even further, considering the aging of the population. By 2060, the number of people aged above 65 years is expected to double, whereas birth rates are low. This trend will cause a significant imbalance between different age groups and put more senior adults at risk for abuse. Risk factors, associated with abuse and neglect, are well established and can be categorized in sociodemographic-, victim-, or perpetrator-related risk factors. The effects of these risk factors depend mainly on the setting, which can be community-dwelling or institutionalized older adults. In community-based settings, 90% of perpetrators are family members. In each setting, suspicious physical injuries should be recognized and addressed promptly. This can be very challenging in elderly, among others, due to the age-related skin changes, which can mimic abuse; however, there are some cutaneous clues that should always raise suspicion of abuse, such as patterned shape or distribution, different healing stages of wounds, parallel injuries, signs of blunt trauma, and irregular patches of alopecia. General awareness is needed, and the advice of dermatologists, who are best trained to differentiate between those lesions, should be systematically sought, to reduce false-positive and false-negative interpretations.

Identifying and Assisting Sexually Exploited and Trafficked Patients Seeking Women's Health Care Services.

It is estimated that 21 million people are trafficked worldwide, including 11.4 million women and girls. Approximately 4.5 million are forced to do sexual labor. The exact prevalence of human trafficking is difficult to ascertain, however, given the limitations of data collection in an illegal industry. Obstetrician-gynecologists should not only be aware of the widespread nature of human trafficking, but also have the tools to assess patients for trafficking and respond to victim identifications. Patients may present with signs of physical abuse, depression, anxiety, posttraumatic stress disorder, substance use, sexually transmitted infections, pregnancy, and nonspecific somatic complaints. As with intimate partner violence, clinicians should be suspicious if the patient is accompanied by an individual who refuses to leave her side. Other potential red flags include patients with wounds in various stages of healing, patients appearing fearful or unable to answer specific questions, and patients who do not have any personal identification. Health care providers should speak with the patient privately, using professional interpreters when indicated. Although there are no validated screening questions for the health care setting, in this article, we provide sample questions such as, "Is anyone forcing you to do anything physically or sexually that you do not want to do?" The physical examination should be thorough with appropriate workup, sexually transmitted infection prophylaxis, and emergency contraception. Physicians and patients should be aware of their state's mandatory reporting requirements and careful documentation is essential. Finally, to ensure a comprehensive, interdisciplinary response to trafficked patients, practitioners should engage hospital-based and community-based services when appropriate.

Assessment of knowledge and attitudes of dental students in regard to child abuse in Turkey.

Child abuse is a serious public problem. Signs of abuse are often present in the oro-facial region and dentists are in a strategic position to recognise and report suspected cases. The aim of this study was to investigate dental students' knowledge about and attitudes towards child abuse. This study was performed at the Faculty of Dentistry of the Ondokuz Mayis University. The data were collected through a self-report questionnaire administered to dental students (137 female/111 male) in three different dental classes (third, fourth and fifth study years) and grouped by considering those students who have been training in the school year of 2013. The definition of physical and social indicators of abuse, awareness regarding legal and ethical responsibilities, students' experience and requests made by students were evaluated by the students' response to questions put in the questionnaire. Descriptive statistics and chi-square tests were performed to analyse the questionnaire data. The questionnaire completion rate was 100%. About 67.74% of the third year, 40.71% of the fourth year and 16.67% of the fifth year believed that they could detect child abuse cases. However, results indicated a major lack of knowledge of social indicators, signs of physical abuse and reporting procedure amongst all respondents. The assessment of the total correct answers exhibited significant differences amongst third-, fourth- and fifth-year students' answers. Fifth-year students had the highest rate of correct responses (P < 0.05). Most students wanted to receive more knowledge about this topic. Dental students in Turkey are not sufficiently prepared for their role in diagnosing suspected cases of child abuse.

Öğretmen Adaylarının Çocuklardaki Fiziksel İstismar Belirtilerine İlişkin Farkındalıkları

Ogretmen adaylarinin cocuklardaki fiziksel istismar belirtilerine iliskin farkindalik duzeylerinin incelenmesi amaciyla yapilan arastirmanin calisma grubuna, Afyon Kocatepe Universitesi Egitim Fakultesi’nde ogrenim goren 764 ogretmen adayi dahil edilmistir. Arastirmada veri toplama araci olarak, ogretmen adaylarinin demografik ozelliklerinin yer aldigi genel bilgi formu ve Erol (2007) tarafindan gelistirilen “Fiziksel Istismar Belirtileri Degerlendirme Formu” kullanilmistir. Arastirmanin sonucunda, ogretmen adaylarinin cinsiyetleri, branslari ve sinif duzeylerine gore Fiziksel Istismar Belirtilerini Degerlendirme Formu’nun durum, davranissal ozellikler ve anne baba davranislari bolum puanlari arasinda istatistiksel olarak anlamli derecede farkliligin olmadigi, ogretmen adaylarinin cocuk ihmal ve istismarina yonelik egitim alma durumlarina gore ise Fiziksel Istismar Belirtilerini Degerlendirme Formu’nun durum ve davranissal ozellikler puan degerleri acisindan istatistiksel olarak anlamli derecede farklilik oldugu belirlenmistir.

Factors related to child maltreatment in children presenting with burn injuries.

The underpinnings of maltreatment in children presenting with burn injuries are necessary to discern as detection and prevention rest on a clear delineation of factors associated with maltreatment. Inaccurate identification of child victims can result in perpetuation of the maltreatment and its attendant neuropsychological sequela. The authors sought to determine factors associated with maltreatment in children presenting with burn injuries, which would guide the burn team in assessing the likelihood of maltreatment. All consenting children admitted with burn injuries were surveyed regarding their injury mechanism and current sociodemographic status. Suspicious injuries were referred by the burn team to the multidisciplinary review team (MRT). The MRT reported injuries with signs of physical abuse, supervision neglect, neglect of other basic needs, or sexual abuse. These children constituted the cases in our study. Variables related to maltreatment were entered into stepwise logistic regression to identify independent predicting variables. P< .05 was considered significant. MRT identified 16 children (24%) admitted with burn injuries with suspicions of maltreatment. Risk factors related to suspicions of maltreatment included: young age, large burns, tap water injury, immersion lines, delay in care, absence of a two-parent family (unconventional family structure), young parents, inconsistent history, and injury pattern. In this single-center prospective study, the authors identified several factors that, when present in injuries with initial suspicion of maltreatment, should trigger a child maltreatment workup. Burn clinicians have an important role as advocates for children and their families. It is important to continue to further the knowledge of maltreatment detection and prevention among children presenting with burn injuries.

Tissue Scurvy – Not Shaken Baby

Parents and carers are often falsely accused of injuring a child asserting that unexplained bruises, fractures, retinal and subdural hemorrhages with ischemic encephalopathy, the so called “Triad”, are signs of physical abuse. However these features can be the result of Tissue Scurvy, a disorder of Vitamin C metabolism in which Vitamin C, although abundant in the plasma, is unable to enter the cell because of a lack of Insulin which is necessary to conduct the transfer of the Vitamin C into the cell. The cause is an autoimmune reaction to a viral, bacterial or parasitic infection or a vaccine which destroys the Insulin-producing Beta cells of the Pancreas, as evidenced by Hyperglycaemia and Glycosuria, in some genetically susceptible children. Here it is shown that the evidence of the Prosecution Experts alleging death from the Shaken Baby Syndrome was demonstrably flawed. The diagnosis Shaken Baby Syndrome is false and an innocent man was incarcerated. This irrational diagnosis should beabandoned.

Child physical abuse: assessment of dental students’ attitudes and knowledge in United Arab Emirates

To investigate dental students' educational experience, attitudes and knowledge with regard to child physical abuse in all dental schools in United Arab Emirates. The data were collected by self-administered structured questionnaire completed by 578 under graduate dental students in four (all) dental schools in United Arab Emirates. Data were analysed using descriptive analyses for responses to each question. The results indicated that there was lack of knowledge of reporting procedure, signs of physical abuse and social indicators among all respondents. Over 80% of the students agreed that dentists should be legally mandated to report abuse cases and a high percentage (94.3%) of the participants believed they had an ethical duty to report child abuse. Most students indicated that their dental school was the main source of information on this topic. The majority of the respondents expressed a need for further training. Dental students were not sufficiently prepared to know what to look for when they suspect child abuse and what to actually do when they encounter this problem in a professional setting. To provide better care for these young domestic violence victims, dental schools' curriculum modifications should focus on providing students with concrete educational experiences regarding child abuse cases.

Child sexual abuse

To evaluate the prevalence of sexual abuse in the pediatric population of the Federal District and discuss the difficulties in interpreting the examination of the genitalia in this age group, both by general practitioners as medical expert forensic officers. This is a retrospective, transversal, and epidemiological study on children younger than 12 years, who attended the Institute of Forensic Medicine of DF (IML-DF), Brasilia, Brazil, with suspicion of sexual abuse between 2008 and 2009. During this period, 3607 persons with suspected sexual abuse and 1762 (48.8%) children younger than 12 years were treated in IML-DF. Of this total, 238 (13.5%) were boys, and 1524 (86.5%) were girls. Among the boys, the average age was 6.5 years, and 9.6% were found to have injuries consistent with sexual abuse. In 43.4% of these cases, the perpetrator was known. The main lesions found were anal fissures and lacerations, bruises, and anal dilatation. In 20 cases (8.4%), the time interval between fact and examination precluded any conclusion. The girls (1524 cases) referred to the IML-DF were subjected to two types of tests: libidinous acts (773 to 50.7%) and rape (751 to 49.3%). In tests of libidinous acts, 5.3% had signs of sexual abuse perpetrated by acquaintances (68.2%), and 3.0% were inconclusive because of the long time lag between the examination and fact. In survey of rape cases, only 2.1% of subjects examined had lesions consistent with abuse. In 57 of 1524 cases, specimens were sampled for sperm test, and five cases (8.7%) showed positive results. The average age of girls being sexually abused (10.7 years) was higher than that for boys (6.5 years). Our findings confirm the discrepancy between the expectations of parents and the general practitioner, and the reality of the findings in specialized centers. Approximately 90% of child victims of abuse do not show evidence of physical damage. These were found in less than 10% of abused children. Physical signs of abuse often are difficult to recognize and should not be the only indicators.

Knowledge, educational experiences and attitudes towards child abuse amongst Jordanian dentists

Signs of physical abuse often present in the oro-facial region and dentists are in a strategic position to recognise and report suspected cases. The aim of this study was to assess the knowledge, educational experiences and attitudes of Jordanian dentists towards child abuse and to assess their educational needs. A cross-sectional survey of a random sample of Jordanian dentists (n=400) was conducted using an anonymous, self-administered structured questionnaire. The response rate was 64%. Thirty-four per cent (n=88) of the respondents reported having formal training in recognising and reporting child abuse, and 42% (n=106) had post-qualification/continuing education training on the topic. Half of the dentists (127/256) suspected a case of child abuse in the past 5 years, but only 12% (31/256) reported their suspicions. The main reasons for not reporting suspicions of abuse were fear from anger of parents (43%), uncertainty about diagnosis (41%) and uncertainty about referral procedures (41%). Those dentists who had formal training in dental school (P=0.0001) and post-qualification courses in child abuse (P=0.006) were significantly more likely to report suspicions. A significant gap existed between recognising signs of physical child abuse and responding effectively. Improvements in child abuse education and continuing education courses are advised to provide dentists in Jordan with adequate knowledge of indicators of physical child abuse and to inform them on the protocol to follow when suspicions arise.

Jordanian Dental Students’ Knowledge and Attitudes in Regard to Child Physical Abuse

The aim of this study was to investigate Jordanian dental students' educational experience, attitudes, and knowledge regarding child physical abuse. Data were collected from a self-administered questionnaire completed by 441 undergraduate and postgraduate dental students in both dental schools in Jordan. Descriptive statistics were used to report responses to each question. The chi-square test was used to analyze the relationship between students' responses and level of education; the difference was considered significant if the probability of the difference was less than 5 percent. Results indicated major lack of knowledge of social indicators, signs of physical abuse, and reporting procedure among all respondents with no significant difference between postgraduate and undergraduate students. Most students indicated that their dental school was the main source of information on this topic; however, more postgraduates reported benefit from extracurricular sources. We conclude that dental students in Jordan are not sufficiently prepared to undergo their role in protection of children from abuse. Dental curricula in both dental schools include information on the topic of child abuse; however, the content should be expanded to better prepare the students.

Role of the odontologist in the investigation of domestic violence, neglect of the vulnerable, and institutional violence and torture

Dentists have a significant role to identify and intervene in domestic abuse, violence, and neglect of the vulnerable. Over 75% of abuse victims have injuries to the head, face, mouth, and neck and so dentists are often first responders. However, under recognition and under reporting of domestic abuse and violence is a particular problem among health care providers, including dentists. Forensic odontologists are well suited to lead the training of their clinical colleagues in the various cultural determinants to abuse, including etiology, symptoms, physical signs of abuse, as well as appropriate reporting. In addition to leading their colleagues, forensic odontologists play an essential role as part of multidisciplinary teams that investigate conflict situations, serious crimes, exploitation of disadvantaged populations, and other serious violence and abuse. Whether in conflict zones or within private families, early detection and intervention is important to prevent establishment of abusive social and family patterns that perpetuate a “cycle of violence”. This is especially true in young children, the most vulnerable population of all. To support this theory of early and effective intervention, this paper comprehensively reviews the most recent evidence concerning the etiology, detection, and prevention of violence and abuse.

La formazione dei medici alla diagnosi di abuso come importante contributo al miglioramento della rilevazione

- The limited contribution of doctors to the notification of suspected abuse cases stems, for the most part, out of the limited knowledge of physical signs of abuse. In this paper the authors illustrate a specific project of education of doctors about physical signs of abuse, based on the use of an information tool available both on paper and on the web. An example is discussed in the paper, about fractures: details are given about a diagnostic algorithm, which requests the presence (or the consultation with) specifically trained doctors, intended to increase diagnostic accuracy (reducing both false positive and false negative cases).Key words: child abuse, fractures, Rx imaging, diagnosis.Parole chiave: abuso, fratture, immagini radiologiche, diagnosi.

Issues in the Application of Bayes' Theorem to Child Abuse Decision Making

Proposals for the application of Bayes' Theorem as an aid to child abuse decision making are discussed critically. Subsequently, two examples of the application of research findings concerning signs of child abuse to decision making are demonstrated, using data from research studies of signs of physical abuse and sexual abuse. The calculation of the probability of the presence of abuse using Bayes' Theorem is described, given prevalence information and specific indicators of abuse. In addition, a method for describing the degree of imprecision in estimates of the probability of abuse is discussed. Specific issues that affect the valid application of research findings within Bayes' Theorem are discussed, including estimates of the prevalence or base rate of child abuse, sensitivity and specificity of diagnostic signs, and the independence of information that is combined in Bayes' Theorem. Recommendations for addressing these issues when Bayes' Theorem is applied to child abuse decision making are discussed, including assessment of the independence of indicators that are combined in Bayes' Theorem, suitable bases for estimating the prevalence of abuse, and the calculation of imprecision in probability estimates of abuse.

Be Alert to Signs of Physical Abuse in Children

Be Alert to Signs of Physical Abuse in Children