Marked differences in local bone remodelling in response to different marrow stimulation techniques in a large animal.

Marrow stimulation, including subchondral drilling and microfracture, is the most commonly performed cartilage repair strategy, whereby the subchondral bone plate is perforated to release marrow-derived cells into a cartilage defect to initiate repair. Novel scaffolds and therapeutics are being designed to enhance and extend the positive short-term outcomes of this marrow stimulation. However, the translation of these newer treatments is hindered by bony abnormalities, including bone resorption, intralesional osteophytes, and bone cysts, that can arise after marrow stimulation. In this study, three different marrow stimulation approaches - microfracture, subchondral drilling and needle-puncture - were evaluated in a translationally relevant large-animal model, the Yucatan minipig. The objective of the study was to determine which method of marrow access (malleted awl, drilled Kirschner wire or spring-loaded needle) best preserved the underlying subchondral bone. Fluorochrome labels were injected at the time of surgery and 2 weeks post-surgery to capture bone remodelling over the first 4 weeks. Comprehensive outcome measures included cartilage indentation testing, histological grading, microcomputed tomography and fluorochrome imaging. Findings indicated that needle-puncture devices best preserved the underlying subchondral bone relative to other marrow access approaches. This may relate to the degree of bony compaction occurring with marrow access, as the Kirschner wire approach, which consolidated bone the most, induced the most significant bone damage with marrow stimulation. This study provided basic scientific evidence in support of updated marrow stimulation techniques for preclinical and clinical practice.

The differences between sex offenders who victimise older women and sex offenders who offend against children.

OBJECTIVES: Within the literature on sex offending, much attention is paid to the distinction between those sex offenders who offend against adults and those who offend against children. In contrast, there is a paucity of research into sex offenders who offend specifically against elderly or older victims. METHOD: A detailed interview and psychometric tests were conducted with a sample of 28 sex offenders who had been convicted of a sexually motivated offence against an older female. These data were compared to a sample of 23 child sex offenders. RESULTS: Results indicate that amongst other significant differences between these sub-groups, men who offend against older women are generally younger, are more violent, and are more likely to use a weapon and cause injury and death compared to child sex offenders. The men who offended against children were more likely to think about and plan their offending, spend more time with the victim pre and post offence, admit sexual arousal during the offence, and admit to a sexual motivation for the offence. CONCLUSIONS: This study suggests that men who sexually offend against older women and men who sexually offend against children are distinct groups. Treatment and risk management strategies should take this into account. Further exploration of this sub-group of offenders is recommended to help inform treatment and risk management strategies for sex offenders who offend against older people.

Risk factor characteristics in carers who physically abuse or neglect their elderly dependants.

This study investigates the prevalence of, and differences in, risk factor characteristics in a sample of two select populations of carers, one of which physically abused their elderly dependants and one of which neglected them. Nineteen carers (nine who had physically abused and 10 who had neglected their elderly relatives), who were referred to clinical psychology by either their general practitioner or their psychiatrist, were invited to take part in this study. A detailed history of risk factors was obtained, including history of alcohol dependency, type and history of mental ill health, history of maltreatment earlier in life, who they were caring for, how long they had been a carer and whether they felt isolated as a carer. Subjects were then given five assessments to determine whether there were any differences between the two groups. These were the Conflict Tactic Scale, Strain Scale, Beck Depression Inventory, Beck Anxiety Inventory and Cost of Care Index. An examination of the risk factors suggests that heavy alcohol consumption and past childhood abuse by fathers were likely to lead to physical abuse. Significantly higher conflict and depression scores were also present in the physical abuse group, while the neglect group had significantly higher anxiety scores. It is suggested that these findings should be incorporated into an assessment of future risk of abuse or neglect by the carer.

An evaluation of favorite kind of day drawings from physically maltreated and non-maltreated children.

OBJECTIVE: This study aimed to replicate Manning's (1987) research that looked at "Favorite Kind of Day" drawings produced by children who had been maltreated in comparison to non-maltreated children. The hypothesis of the study was that the maltreated children's drawings would consistently differ from drawings produced by non-maltreated children over time. METHOD: Eighteen children aged between 4 and 8 years old were individually asked to draw their "Favorite Kind of Day" (FKD). The drawings from six physically maltreated participants were compared to 12 non-maltreated children matched for age, sex, socio-economic and educational background. The drawings were compared on three criteria: inclement weather, size, and movement of weather. RESULTS: The results showed that over a period of 18 months, maltreated and non-maltreated children consistently drew similar drawings, and no significant differences were found between the groups. CONCLUSIONS: The implications of these findings cannot be underestimated, as clinical use of the FKD technique suggested by Manning's findings, for English children at least, would lead to incorrect identification of children as having suffered maltreatment when they may in fact not have.

Investigation into nursing staff knowledge and attitude to dementia.

The knowledge and attitudes to the concept of dementia of nurses working within the general (N = 70) and psychiatric (N = 236) hospital settings were investigated by questionnaire. The study shows that knowledge was good regardless of type of level of training for basic facts. Nurses also report positive attitudes towards the elderly but there were significant differences when the questions became more controversial. A significant number of nursing in psychiatric units (x2 p < 0.01) favoured euthanasia for demented patients compared with their colleagues in acute general units.

Child abuse and neglect--a public health concern.

OBJECTIVE: To review the phenomenon of child abuse and neglect from a public health perspective. DATA SOURCES: Literature review before the publication of the landmark article by the pediatrician C. Henry Kempe and coworkers in 1962, "The battered-child syndrome", and selected publications until the end of 1999. STUDY SELECTION: Studies published in the period before the discovery of the battered-child syndrome, studies after that publication dealing with the definition of child abuse and neglect, epidemiology of child abuse, fatal child abuse, child sexual abuse, emotional abuse, and domestic violence. DATA EXTRACTION: Studies or data linked to child physical abuse, neglect, psychological abuse, sexual abuse, structural abuse, other forms of abuse and domestic violence. DATA SYNTHESIS: In the 19th century more understanding for children's rights was acknowledged and in the 20th century child abuse was discovered in 1962 after many years of "looking with the blind eye". The number of reported cases of child abuse world wide has ever since exploded into a public health epidemic with a ten times higher incidence than cancer (child abuse rate: 40 per 1,000 population; cancer 3.9 per 1,000 population. CONCLUSIONS: Child abuse and neglect is complex, involving many professionals and agencies, which can be one of the reasons why the field has not been able to attract enough resources for prevention, treatment, education, and research. Child abuse must be looked upon as a major public health problem, and professionals must enter the new century with an effort to really make it a "century for the child."

Theory and observation of attachment and its relation to child maltreatment: a review.

OBJECTIVE: The aim of this paper was to review the literature on attachment and child maltreatment in relation to the intergenerational transmission of maltreatment. METHOD: A review of the literature to date was undertaken, and a descriptive analysis of 13 studies on the quality of attachment in maltreated samples was conducted. RESULTS: Quality of infant attachment seems to be in the most part dependent upon the sensitiveness of the mother. Not surprisingly the majority of studies demonstrates that on average maltreated children are less securely attached to their mothers than nonmaltreated children. This early mother-infant relationship is said to be internalized by the child and consequently form a prototype to which all future relationships are assimilated. Thus maltreated children may have problems forming relationships with peers, partners and their own children. CONCLUSIONS: It is suggested that this is the primary process by which maltreatment continues from one generation to the next. The implications of this process for the prediction and prevention of childhood maltreatment are discussed.

The prediction of child maltreatment in Greek families.

OBJECTIVE: The study had two aims: First, to identify characteristics of physically maltreating families in the Attica region of Greece; and second, to produce a checklist of high risk predictors which may be used for screening, as an assessment, to enable secondary prevention of physical abuse and neglect. METHOD: A case control design was used with individual matching. The sample comprised 197 physically abused and neglected children and their families referred to a multidisciplinary team. These were compared with 163 control children and their families attending a community health center. RESULTS: The findings suggest that abusing families differ from controls on a number of variables related to child, parental, and family characteristics. The statistical analysis produced a checklist of 15 Predictors. Their classification into High, Medium, and Low Predictors pointed out that the most prominent characteristics were those associated with parents' own adverse life experiences, mental health problems, bad quality of relationship between spouses, and parental neglect of the child's hygiene. The predictive ability of the checklist produced a sensitivity of 92% and a specificity of 96% (logistic regression) and a sensitivity of 86.8% and a specificity of 96.3% (discriminant function). The use of this checklist for screening is discussed with emphasis on methodological and ethical issues. Special emphasis is given on the cultural relevance of such an application within the Greek cultural milieu. CONCLUSION: The findings indicate that secondary prevention of child maltreatment in Greece is feasible by using a checklist of risk factors as predictors. Such screening should be accompanied by clinical assessment based on qualitative aspects of mother-infant interaction. Special emphasis should be given to the cultural relevance of this approach while ethical issues should be considered.

The institutionalized elderly: dry to the bone!

The fluid intake of 57 elderly male and female patients, drawn from psychogeriatric, long-term care and geriatric admission units, was monitored. The fluid intake was determined by direct observation and recording of fluids consumed by each subject over three 24-hour periods. In all cases, regardless of the unit, level of dependency, cognitive or continence status, elderly patients received considerably less fluid than the recommended daily intake of 2000-2500 ml. In the case of patients who were cognitively impaired, dependent and incontinent, fluid intake was less than patients who did not have these impediments. Forty-seven nurses, working on the three units, completed a self-administered questionnaire on the fluid needs of elderly patients. Generally, nurses' knowledge was inadequate in a number of areas such as the signs and complications of dehydration and the fluid requirements of the elderly. A study of this size does not permit general conclusions to be drawn. Nonetheless, if the results are indicative of current practice, nurses do not have a good knowledge of the fluid needs of the elderly, and the low level of fluid intake constitutes a form of neglect.

Partnership in care.

The Alberta Child Health Passport was developed to provide parents and health professionals with a shared record of the child's health, growth, development, immunization and contacts with health services. A structured evaluation of the passport, and survey of the views of mothers and community nurses using it was carried out. The need for such a record was confirmed by those questioned. Responses also helped to identify sections of the booklet that are particularly useful and those which might be modified or removed. The passport is seen as having considerable advantages in improving the relationship between health professionals and clients.

The influence of elderly patients' mental impairment on nurse-patient interaction.

The study investigates nurse-patient interaction on a geriatric ward. The Clifton Assessment Procedure for the Elderly was used to measure cognitive and behavioural functioning and the 23 subjects studied were divided into three groups: lucid; slightly confused; and confused or demented. Information relating to the subjects' activities and interactions with nursing staff was gained from time sampling by direct observation. One hundred and eighteen nurses also completed a questionnaire to elicit their priorities in care. The results reveal very low levels of staff-patient communication. Nurses interact significantly less with confused than lucid patients. Patients spent only 9.7% of observed time in self-care activities, and 5.9% eating and drinking; the remaining time they were inactive. Nursing staff, however, regarded their care priority as physical care rather than psychosocial interaction or restorative activities.