Effect of thimerosal recommendations on hospitals' neonatal hepatitis B vaccination policies.

We describe neonatal hepatitis B virus (HBV) vaccine policies in Colorado before and after thimerosal recommendations, plans for use of thimerosal-free HBV vaccine, and nurses' awareness of high-risk criteria for HBV vaccination. The results suggest that fewer neonates are receiving HBV vaccine at birth hospitals.

Evidence for specific effects of childhood sexual abuse on mental well-being and physical self-esteem.

Women who are sexually abused are at increased risk for having mental health problems long after the abuse. Other nonexploitive experiences can also be psychologically detrimental, may coexist with sexual abuse, and may explain some portion of subsequent mental health problems. This study addresses the association between childhood sexual abuse and a woman's psychological functioning, independent of the quality of parental nurturance received during childhood and other variables which may influence mental health. Of 609 women completing mental health and self-concept measures, 98 reported sexual abuse; 110 of the remaining women were selected as comparisons. Women sexually abused as children scored lower on measures of mental health status. Both sexual abuse and fewer years of education were related to lower scores on a psychological well-being scale after variance accounted for by family and demographic variables was removed. Sexual abuse was not a predictor of general self-concept scores after the removal of family and demographic variables, but sexual abuse was independently associated with the subscale measuring the physical aspect of self-concept. These findings lend support to theorized causal links between child sexual abuse and some aspects of later psychological difficulties.

Common behavioral problems in infants and children.

Primary care physicians can serve as important sources of behavioral information to patients of infants, toddlers, school-aged children, and adolescents. Behavior results from a blend of biologic qualities, such as gender and temperament, and social experiences, such as attachment and family experiences. Common problems include disorders of sleep, crying, feeding and diet, discipline and sexuality, aggression and biting, toilet training, and school avoidance. Family physicians should be aware of the management of behavioral problems and provide anticipatory or responsive guidance or reference information.

The prospective assessment of self-concept in neglectful and physically abusive low income mothers.

Maternal self-esteem has long been associated with the quality of maternal-child interactions and many assume that low self-esteem contributes to the cause of maltreatment. Assessments of the self-concepts of maltreating parents, however, have been done only after maltreatment has occurred. Prospective measurement of self-concept would help to clarify its role in the etiology of maltreatment. In this study, 471 pregnant women completed the Tennessee Self-Concept Scale (TSCS). State protective services' records were reviewed 3 years after these children were born. When records of the 459 women with a known live-born child were reviewed, 29 were found to have maltreated their children (neglect n = 22; physical abuse n = 11; four women found to have both neglected and abused their children). Neglectful mothers had lower scores on scales measuring overall self-esteem, moral self-worth, personal and social adequacy, and perception of self-worth in family relationships than matched nonreported mothers. They described their identity and behavior more negatively and had greater general maladjustment and neurotic symptoms. Physically abusive mothers had lower scores on self-worth in family relationships. When measured prospectively, low self-esteem appears to be a risk factor for child neglect, but is not a strong predictor for physical abuse. Implications for prevention programs are discussed.

A prospective study of secondary prevention of child maltreatment.

This study sought (1) to retest an approach to the prediction of risk of child maltreatment and (2) to test the effect of a comprehensive prenatal and pediatric health services program on the rate of maltreatment. Of 2585 women screened at their first prenatal visit, 1154 qualified for the study. Risk assignment was determined by a structured interview. High-risk women (n = 314) were assigned to receive standard (high-risk control group; n = 154) or intervention (high-risk intervention group; n = 160) services throughout the prenatal period and during the first 2 years of their infants' life. A third group (low-risk control group; n = 295) was selected among low-risk women and received standard care without intervention services. State records were searched for substantive reports of child maltreatment up to 36 months after birth. Physical abuse was found for 5.1% of the study population; neglect was substantiated for 5.9%. Prediction efforts were effective in identifying risk of physical abuse but not of neglect. Comprehensive health services did not alter the reported abuse rate for high-risk parents and was associated with an increased number of neglect reports. Intervention reduced subject attrition and appeared to serve as a bias for detection of maltreatment. Thus this long-term, prospective approach was ineffective for child abuse prevention, perhaps because of detection biases and societal changes.

Behavioral antecedents of pediatric poisonings.

To determine how the behavior of 3- to 7-year-olds might contribute to pediatric poisoning, a taxonomy of pediatric ingestions was conceptualized and tested. Thirty-nine of 50 caretakers who called the Middle Tennessee Poison Center about poison ingestions by a child in this age group provided details of the poisoning history and family characteristics. Histories were coded by a psychologist according to the 14 antecedent conditions of the poisoning taxonomy. Improper storage, noncompliant behavior, curiosity, misinterpretation of the substance, improper child monitoring, and imitative behavior were judged the most common antecedent conditions of these ingestions. Lack of knowledge of poison prevention methods was infrequently coded. Noncompliant behavior as a condition of the poisoning was associated with parental reports of general child behavioral problems. Ingestions involving imitative behavior were associated with parental report of poor social supports. The findings highlight the need to address behavior in designing poison prevention programs.

Antecedents of child neglect in the first two years of life.

To determine the prenatal antecedents of child neglect by low-income women, data from a prospective study of child maltreatment were reviewed. Mothers determined to be at high risk prenatally for maltreatment were more likely to be identified as neglectful within 24 months of the interview. Neglectful mothers were less likely to have completed high school, had more children younger than 6 years of age, and had more aberrant responses on parenting skills and support systems scales. Neglected children were lower in birth weight, were rated more difficult temperamentally, and had poorer mental and motor developmental scores.

Interpretations of colposcopic photographs: evidence for competence in assessing sexual abuse?

Accurate assessment of physical findings for child sexual abuse is medically and legally important. This study evaluated (1) interobserver reliability of clinicians rating colposcopic photographs, and (2) correlates of reliable interpretations. Seventy physicians and two nurse practitioners, divided by professional levels, assessed colposcopic photographs and completed a questionnaire. Ratings by a professional with extensive experience in this field were used as an accuracy standard. Leaders in the field of child sexual abuse assessment made significantly more "accurate" assessments than pediatricians, pediatric and family practice residents, and intern physicians. Leaders made fewer "inaccurate" interpretations than interns. Predictors of agreement with standard assessments, although weak, were knowledge of female perineal anatomy and professional level. Total number of sexual abuse examinations conducted and knowledge of sexually transmitted diseases as acquired by children were not significant predictors of accurate assessment. The findings are interpreted as to their potential relevance to actual sexual abuse evaluations of children.

Chlamydial pneumonia of infancy in siblings.

We describe two brothers born 16 months apart who were hospitalized with culture-proved chlamydial pneumonia of infancy due to the same immunotype of Chlamydia trachomatis. Presumably the mother had either been chronically infected or had been reinfected. Chlamydial pneumonia of infancy is a preventable disease if genital infection in pregnant women is diagnosed and treated. However, if pregnant women at high risk are not screened for C. trachomatis, multiple offspring may acquire the infection and develop serious perinatal chlamydial disease.