A Study of the Effects of Child Sexual Abuse, Treatment, and Interventions

The last two decades have seen the topic of child sexual abuse emerge from an issue that was considered rare, or at least uncommon, to one currently viewed as a leading concern of mental health professionals. Public reaction to incest and sexual abuse has changed from one of disbelief to one of active concern. Public awareness and education about the issue of child sexual abuse has developed into a critical area of concern. Sexual abuse of children is now recognized as a serious mental health problem, both because it is so widespread, and because of increasing evidence of its traumatic effects. In the very recent past, mental health clinicians were rarely, if ever, exposed to the topic of sexual abuse in class content, supervision, professional conferences, or literature, although therapists now report that rather than seeing a solitary sexual abuse survivor, their client load consists of two-thirds of clients reporting experiences of childhood sexual abuse. The methodology employed in this research project was qualitative. A survey was used to gather information from mental health professionals in a mid-west metropolitan area. One hundred thirty-four surveys were returned from a total of 270 distributed to therapists who were associated with hospitals and agencies that specialized in treating children who had been abused sexually. The intent of the study was to discover whether mental health professionals in the St. Louis metropolitan area agreed about the definition of sexual abuse, the various effects of sexual abuse on children who had experienced this trauma and what kind of treatment modalities were indicated. Questions in the survey focused on the effects of the experience of sexual abuse on children, as well as on the corresponding implications for treatment. The purpose of the study was to gain practical information about a sensitive, but critical area of treatment for therapists and others concerned with the welfare of children

Decreasing Inappropriate Classroom Behaviours Through a Videotape Self-Modelling and Self-Monitoring Treatment Package

Children with autism frequently display an inability to function independently. This has led researchers to develop treatments that are aimed at overcoming the dependency of these children on parents and teachers and which teach them to manage their own behaviour. A self-management treatment package consisting of videotaped self-modelling, self-monitoring, and self-reinforcement was investigated in the present study. The focus was the effect of the treatment package on the inappropriate classroom behaviours of three children with autism. The behaviours that were chosen were those that were most likely to interfere with the participants\u27 ability to work independently in the classroom. The dependent variables were off-task behaviour, stereotypic behaviour, latency time to commence a task, inappropriate vocalizations, the accuracy of self-monitoring, and the ability to follow a four-step self-monitoring procedure without assistance from the researcher. Each of the studies in the present research project was consistent with a single-subject, withdrawal design. The first two studies followed an A-B-A design and the third study followed an A-B-A-C-A design. Follow-up data were collected in Studies I and 2. A represented the baseline conditions, B the intervention condition, and C the second intervention condition. Three male students with autism participated in the study. These children were aged between nine years and one month and eleven years and seven months. Two of the children were described as severely autistic and the third was described as moderately autistic. The children demonstrated deficits in the social, language and communication domains as well abnormalities in the range of interests and activities. The results indicated considerable decreases in each of the inappropriate target behaviours during the period of intervention. Moderate maintenance gains were in evidence for two of the children. Follow-up data revealed some regression in the target behaviours two weeks later. The accuracy of self-monitoring was very high for all of the children. The children were typically inaccurate in self-recording when inappropriate behaviour had occurred. Two of the children displayed very high levels of independence in performing the four-steps of the self-monitoring procedure. The third child demonstrated an inability to follow the procedure without assistance from the researcher. The intervention follow-up data indicated that one of the children had retained the steps of the self-monitoring procedure two weeks after the withdrawal of the intervention. Some implications for teaching and recommendations for future research are presented

Current trends and practices in the use of imprisonment

This article charts the rapid rise in the use of imprisonment in recent decades before considering some of the most pressing issues of concern in the use of imprisonment today. First among these is prison overcrowding, which continues to blight the record of many countries in their treatment of prisoners. To illustrate the potentially dire consequences of overcrowding – a problem common to many other countries and regions – an account is given of a recent visit to a prison in El Salvador. The article then provides an overview of the relevant regional and international standards on the treatment of prisoners, referring also to the role of judicial bodies in ensuring implementation

Late-Term Elective Abortion and Susceptibility to Posttraumatic Stress Symptoms

The primary aim of this study was to compare the experience of an early abortion (1st trimester) to a late abortion (2nd and 3rd trimester) relative to Posttraumatic Stress Disorder (PTSD) symptoms after controlling for socio-demographic and personal history variables. Online surveys were completed by 374 women who experienced either a 1st trimester abortion (up to 12 weeks gestation) or a 2nd or 3rd trimester abortion (13 weeks gestation or beyond). Most respondents (81%) were U.S. citizens. Later abortions were associated with higher Intrusion subscale scores and with a greater likelihood of reporting disturbing dreams, reliving of the abortion, and trouble falling asleep. Reporting the pregnancy was desired by one's partner, experiencing pressure to abort, having left the partner prior to the abortion, not disclosing the abortion to the partner, and physical health concerns were more common among women who received later abortions. Social reasons for the abortion were linked with significantly higher PTSD total and subscale scores for the full sample. Women who postpone their abortions may need more active professional intervention before securing an abortion based on the increased risks identified herein. More research with diverse samples employing additional measures of mental illness is needed

Do men regret prostate biopsy: Results from the PiCTure study

Abstract Background Understanding men\u2019s experience of prostate biopsy is important as the procedure is common, invasive and carries potential risks. The psychological aspects of prostate biopsy have been somewhat neglected. The aim of this study was to explore the level of regret experienced by men after prostate biopsy and identify any associated factors. Methods Men attending four clinics in Republic of Ireland and two in Northern Ireland were given a questionnaire to explore their experience of prostate biopsy. Regret was measured on a Likert scale asking men how much they agreed with the statement \u201cIt [the biopsy] is something I regret.\u201d Results Three hundred thirty-five men responded to the survey. The mean age was 63\ua0years (SD \ub17\ua0years). Three quarters of respondents (76%) were married or co-habiting, and (75%) finished education at primary or secondary school level. For just over two thirds of men (70%) their recent biopsy represented their first ever prostate biopsy. Approximately one third of men reported a diagnosis of cancer, one third a negative biopsy result, and the remaining third did not know their result. Two thirds of men reported intermediate or high health anxiety. 5.1% of men agreed or strongly agreed that they regretted the biopsy. Conclusions Level of regret was low overall. Health anxiety was the only significant predictor of regret, with men with higher anxiety reporting higher levels of regret than men with low anxiety (OR\u2009=\u20093.04, 95% CI 1.58, 5.84). Men with high health anxiety may especially benefit from careful counselling before and after prostate biopsy

A single centre experience with sequential and concomitant chemoradiotherapy in locally advanced stage IV tonsillar cancer

<p>Abstract</p> <p>Background</p> <p>Chemo-radiotherapy offers an alternative to primary surgery and adjuvant therapy for the management of locally advanced stage IV squamous cell carcinomas of the tonsil.</p> <p>Methods</p> <p>A retrospective analysis was performed of the outcomes of 41 patients with locoregionally advanced squamous cell carcinoma of the tonsil treated non-surgically at the Yorkshire Cancer Centre between January 2004 and December 2005. Due to long radiotherapy waiting times, patients received induction chemotherapy with cisplatin and 5-fluorouracil followed by either cisplatin concurrent chemoradiotherapy or radiotherapy alone.</p> <p>Results</p> <p>Median age was 55 years (range 34-76 years) and 28 (68%) patients were male. 35/41 patients (85%) received 2 or more cycles of induction chemotherapy. Following induction chemotherapy, 32/41 patients (78%) had a clinical response. Concomitant chemotherapy was given to 30/41 (73%). All patients received the planned radiotherapy dose with no delays. There were no treatment related deaths. Six (15%) patients had gastrostomy tubes placed before treatment, and 22 (54%) required nasogastric tube placement during or after treatment for nutritional support. 17 patients required unplanned admissions during treatment for supportive care. At 4 months post treatment assessment 35 out of 41 (85%) patients achieved complete clinical and radiographic response. Median follow-up is 38 months (8-61 months). Local and regional control rate in complete responders at 3 years was 91%. Distant metastases have been found in 4 (9.8%) patients. Three year progression-free survival rate in all patients is 75%. The 3-year cause specific survival and overall survival are 75% and 66% respectively.</p> <p>Conclusion</p> <p>Cisplatin-based induction and concurrent chemoradiotherapy provides excellent tumour control with acceptable toxicity for patients with locally advanced tonsillar cancer.</p

Feasibility of a multiparametric MRI protocol for imaging biomarkers associated with neoadjuvant radiotherapy for soft tissue sarcoma

OBJECTIVE: Soft tissue sarcoma (STS) is a rare malignancy with a 5 year overall survival rate of 55%. Neoadjuvant radiotherapy is commonly used in preparation for surgery, but methods to assess early response are lacking despite pathological response at surgery being predictive of overall survival, local recurrence and distant metastasis. Multiparametric MR imaging (mpMRI) is used to assess response in a variety of tumours but lacks a robust, standardised method. The overall aim of this study was to develop a feasible imaging protocol to identify imaging biomarkers for further investigation. METHODS: 15 patients with biopsy-confirmed STS suitable for pre-operative radiotherapy and radical surgery were imaged throughout treatment. The mpMRI protocol included anatomical, diffusion-weighted and dynamic contrast-enhanced imaging, giving estimates of apparent diffusion coefficient (ADC) and the area under the enhancement curve at 60 s (iAUC(60)). Histological analysis of resected tumours included detection of CD31, Ki67, hypoxia inducible factor and calculation of a hypoxia score. RESULTS: There was a significant reduction in T1 at visit 2 and in ADC at visit 3. Significant associations were found between hypoxia and pre-treatment iAUC(60), pre-treatment ADC and mid-treatment iAUC(60). There was also statistically significant association between mid-treatment ADC and Ki67. CONCLUSION: This work showed that mpMRI throughout treatment is feasible in patients with STS having neoadjuvant radiotherapy. The relationships between imaging parameters, tissue biomarkers and clinical outcomes warrant further investigation. ADVANCES IN KNOWLEDGE: mpMRI-based biomarkers have good correlation with STS tumour biology and are potentially of use for evaluation of radiotherapy response

Recurrence patterns of locally advanced head and neck squamous cell carcinoma after 3D conformal (chemo)-radiotherapy

<p>Abstract</p> <p>Background</p> <p>To establish recurrence patterns among locally advanced head and neck non-nasopharyngeal squamous cell carcinoma (HNSCC) patients treated with radical (chemo-) radiotherapy and to correlate the sites of loco-regional recurrence with radiotherapy doses and target volumes</p> <p>Method</p> <p>151 locally advanced HNSCC patients were treated between 2004-2005 using radical three-dimensional conformal radiotherapy. Patients with prior surgery to the primary tumour site were excluded. The sites of locoregional relapses were correlated with radiotherapy plans by the radiologist and a planning dosimetrist.</p> <p>Results</p> <p>Median age was 59 years (range:34-89). 35 patients had stage III disease, 116 patients had stage IV A/B. 36 patients were treated with radiotherapy alone, 42 with induction chemotherapy, 63 with induction and concomitant chemoradiotherapy and 10 concomitant chemoradiotherapy. Median follow-up was 38 months (range 3-62). 3-year cause specific survival was 66.8%. 125 of 151 (82.8%) achieved a complete response to treatment. Amongst these 125 there were 20 local-regional recurrence, comprising 8 local, 5 regional and 7 simultaneous local and regional; synchronous distant metastases occurred in 7 of the 20. 9 patients developed distant metastases in the absence of locoregional failure. For the 14 local recurrences with planning data available, 12 were in-field, 1 was marginal, and 1 was out-of-field. Of the 11 regional failures with planning data available, 7 were in-field, 1 was marginal and 3 were out-of-field recurrences.</p> <p>Conclusion</p> <p>The majority of failures following non-surgical treatment for locally advanced HNSCC were loco-regional, within the radiotherapy target volume. Improving locoregional control remains a high priority.</p

The Impact of 18F-FDG PET CT Prior to Chemoradiotherapy for Stage III/IV Head and Neck Squamous Cell Carcinoma

Introduction. To determine the value of a FDG-PET-CT scan in patients with locally advanced head and neck squamous cell carcinoma (HNSCC) prior to chemoradiotherapy. Materials and Methods. Consecutive patients with stage III or IV HNSCC who had undergone a staging FDG-PET-CT scan prior to chemoradiotherapy between August 2008 and April 2011 were included. Clinical details and conventional imaging (CT and/or MRI) were, retrospectively, reviewed, a TNM stage was assigned, and levels of cervical lymph node involvement were documented. This process was repeated with the addition of FDG-PET-CT. Radiotherapy plans were reviewed for patients with an alteration identified on TNM staging and/or nodal level identification with FDG-PET-CT and potential alterations in radiotherapy planning were documented. Results. 55 patients were included in the analysis. FDG-PET-CT altered the TNM stage in 17/55 (31%) of patients, upstaging disease in 11 (20%) and downstaging in 6 (11%); distant metastases were identified by FDG-PET-CT in 1 (2%) patient. FDG-PET-CT altered the lymph node levels identified in 22 patients (40%), upclassifying disease in 16 (29%) and downclassifying in 6 (11%). Radiotherapy plans were judged retrospectively to have been altered by FDG-PET-CT in 10 patients (18%). Conclusions. The use of FDG-PET-CT potentially impacts upon both treatment decisions and radiotherapy planning