Juan M. Parra

Characteristics of childhood sexual abuse in a predominantly Mexican-American population

Little has been written about the characteristics of childhood sexual abuse among Mexican Americans. In addition, certain aspects of the epidemiology of reported sexual abuse in the United States have changed significantly over the past 12 years. To better understand how characteristics of sexual abuse vary with ethnicity, race, gender, and age, we reviewed the records of 2,130 children under age 18 who were evaluated at our university-based facilities for possible sexual abuse from 1987 to 1989. The demographic, historical, and physical findings of the cases from our predominantly Mexican-American population were analyzed. T-test, analysis of variance, and chi-square analyses were used to test for differences related to ethnicity, race, gender, and age. Significant differences in these factors were found with respect to the relationship of the perpetrator to the child, the number of perpetrators, the interval from the abuse to the evaluation, the types of abuse, and the findings of the physical examination. This study demonstrates the important influences of ethnicity, race, gender, and age on characteristics of childhood sexual abuse. Awareness of these influences can be helpful in understanding factors that contribute to childhood sexual abuse, preparing for legal proceedings, and designing appropriate prevention programs.

Child Fatality Review Teams

The history of child fatality review (CFR) begins with the work of Ambrose Tardieu in 1860. More than a century later, in 1978, the first team was established in Los Angeles, California. This article reviews the history of CFR, the composition of teams, and its purpose based in preventive public health. The successes of three decades and challenges for the future of CFR are discussed.

Differences in Childhood Sexual Abuse Experience between Adult Hispanic and Anglo Women in a Primary Care Setting.

ABSTRACT The literature on racial and ethnic factors in childhood sexual abuse is limited. The purpose of this exploratory study was to document Hispanic-Anglo differences in childhood sexual abuse experiences and assess whether these differences may be explained by socio-demographic and family environmental differences. Adult Hispanic (n = 69) and Anglo (n = 19) women from a family medicine clinic waiting room reporting a history of childhood sexual abuse completed an in-depth survey concerning the sexual abuse experience and their childhood environment. In this study, Hispanics were more likely to report a family member as the perpetrator and to experience more self-blame as a result of the abuse. Hispanics were also more likely to take action in response to the abuse, especially those who were more acculturated to U.S. culture. However, most of the observed differences in this study could be explained by socio-demographic or family environment variables, not by ethnic background. Qualitative research on the family environments of Hispanic victims of child sexual abuse may further explicate the dynamics and risk factors for abuse by family members.

Resident Documentation of Diagnostic Impression in Sexual Abuse Evaluations

In sexual abuse evaluations, the documentation of the examiners diagnostic impression is essential. If the diagnostic impression is not documented, the examiner will have to rely on memory rather than the medical record when called to testify. The purpose of this study was to determine whether pediatric residents adequately document their diagnostic impression in child sexual abuse evaluations. We performed a three-year retrospective chart review from patients 0-17 years of age who were evaluated at our emergency room for suspected sexual abuse. We reviewed 1,487 charts for historical information, physical findings, and diagnostic impression. Physical findings were categorized as normal, nonspecific, suggestive, or indicative of penetration. In 77% of cases (N=256) with hymenal findings indicative of penetration and 84% of cases (N=31) with vaginal findings indicative of penetration, residents recorded no impression or a nonspecific impression. Results were similar for vulvar and rectal findings indicative of penetration. Residents fail to document an adequate interpretation of their physical examinations in sexual abuse evaluations.

A rectovaginal fistula in a sexually assaulted child

In most cases of child sexual abuse, there will be no visible evidence of genital or anal injury.1 There are several reasons for this observation. First, the type of sexual contact may not result in observable tissue damage. Second, children typically make delayed disclosures2 and present for examinations after injuries have resolved. Injuries may resolve completely and quickly within days. Sexual assault injuries are rarely severe enough to require surgical management. Most cases of severe trauma present for medical attention within hours of the injury. We present a case of a young girl with a severe anogenital injury who was first evaluated several weeks after she was sexually assaulted.

Enhanced tumor metastases upon drug delivery in cross-linked albumin beads

Growth of the murine hepatoma H6 was significantly suppressed by amiloride, a sodium influx inhibitor. Primary tumor growth inhibition was augmented by loading the drug into cross-linked albumin carriers, but lung metastases were enhanced. These results emphasize the importance of using metastatic tumor models when testing new drugs and/or alternative modes of drug delivery.