Psychiatric disorders in adolescents exposed to domestic violence and physical abuse.

The relationship between abuse and psychiatric diagnoses was investigated in two groups of physically abused adolescents, 57 living in homes with interparental violence and 32 in homes without such violence, and in 96 nonabused adolescents living in nonviolent homes. Adolescents in the first group were found to be at greater risk for depression, separation anxiety disorder, post-traumatic stress disorder, and oppositional defiant disorder than were those in the second group. Adolescents in the first group also appeared more vulnerable to anxiety and depression.

Family violence.

Domestic and intimate partner abuse, child and adolescent physical and sexual abuse, and elder abuse constitute family violence. Such violence is responsible for a significant proportion of intentional injury and, accordingly, is a major public health problem. This chapter provides information on aspects of each type of family violence.

Child and adolescent abuse and neglect research: a review of the past 10 years. Part I: Physical and emotional abuse and neglect.

OBJECTIVE: To review the clinically relevant literature on the physical and emotional abuse and neglect of children and adolescents published during the past 10 years. METHOD: Literature published between 1988 and 1998 was reviewed following a systematic search of Medline, Psychinfo, and the National Clearinghouse on Child Abuse and Neglect. RESULTS: During the last decade there has been substantial progress in understanding the symptomatology associated with maltreatment. However, prevention and intervention research studies are relatively rare and frequently have important methodological limitations. CONCLUSIONS: Child maltreatment research in the next decade needs to focus on understanding factors leading to resilient outcomes and on assessing the effectiveness of psychotherapeutic and psychopharmacological treatment strategies. Increased resources are needed to support child maltreatment research studies and investigators.

Physically abused adolescents: behavior problems, functional impairment, and comparison of informants' reports.

OBJECTIVE: This study, like earlier studies that focused on younger abused children, ascertained whether physically abused adolescents exhibited increased internalizing and externalizing behaviors. Relevance to pediatric practice is discussed. DESIGN: A cross-sectional design was used to compare the behavior of physically abused adolescents and comparison adolescents using self-reports, parent reports, and teacher reports. The level of agreement among raters was also examined. PARTICIPANTS: The subjects were 99 physically abused adolescents between the ages of 12 and 18 years, who were recruited from Child Protective Services. Comparison subjects were 99 community-recruited nonabused adolescents who were matched for age, gender, and income with the abused adolescents. MEASURES: The behavior of the adolescents was assessed using the Child Behavior Checklist, and the comparable Youth Self-Report and Teacher Report Form, which are widely used measures of behavioral and emotional problems. The Child Global Assessment Scale was also used as a measure of functional impairment and of the need for mental health services. RESULTS: Parents and teachers rated the problems of abused adolescents as significantly greater than the problems of nonabused adolescents on all checklist subscales. Abused adolescents reported significantly greater problems only on externalizing behavior subscales. In addition, based on interviewer ratings, physically abused adolescents exhibited significantly greater functional impairment. CONCLUSIONS: Similar to previous research on abused children, physically abused adolescents exhibit externalizing and internalizing behavior problems and experience greater functional impairment. Parent, teacher, and adolescent reports of externalizing behaviors were similar, but physically abused adolescents reported fewer internalizing behaviors than did the other informants.

Palmar fracture dislocation of the proximal interphalangeal joint.

Palmar fracture dislocation of the proximal interphalangeal joint is uncommon. Thirteen patients treated for this injury were retrospectively reviewed. There were 9 acute injuries. Seven were treated by closed reduction and percutaneous pin fixation and 2 were treated by open reduction and internal fixation. The 4 chronic injuries (more than 1 month after injury) were treated with open reduction and soft tissue reconstruction. The length of follow-up averaged 55 months. Eight patients were free from pain. Postoperative proximal interphalangeal motion averaged 91 for the acute injuries and 70 degrees for the chronic injuries. Follow-up radiographic findings were notable for an increased height of the middle phalangeal base in 6 patients, articular irregularity in 4, and residual subluxation in 2; however, these changes did not correlate with the clinical results. Complications included loss of reduction in 1 patient, progressive swan neck deformity in 1, and development of an average 25 degrees extension lag of the distal interphalangeal joint in 5.

The Stener lesion revisited: a case report.

Proximal displacement of a ruptured ulnar collateral ligament of the metacarpophalangeal joint of a thumb (Stener lesion) can result in chronic instability if left untreated. Rupture without displacement generally leads to complete recovery. An associated fracture can give information about the position of the ruptured ligament. However, 2 cases are presented demonstrating that displacement of the ligament can occur in the absence of displacement of the bony fragment. This suggests that physical examination is required to determine stability with injuries to the ulnar structures of the thumb metacarpophalangeal joint.

Adolescent physical abuse: risk for adolescent psychiatric disorders.

OBJECTIVE: The present study examined whether physical abuse functions as an additional risk factor for adolescent psychopathology after other important known risk factors are controlled for. METHOD: The authors recruited 99 adolescents aged 12 to 18 years directly from the New York State Department of Social Services after official documentation of physical abuse. The abused adolescents were compared to 99 nonabused adolescents matched for age, gender, race, and community income. Diagnostic interviews and measures of selected risk factors for psychopathology were administered to the adolescents and their parents and then entered into a multiple logistic regression model testing the added risk contributed by physical abuse to adolescent psychopathology. RESULTS: Physical abuse added significantly to other risk factors in accounting for lifetime diagnoses of major depression, dysthymia, conduct disorder, drug abuse, and cigarette smoking. Physical abuse also contributed significantly to prediction of current adolescent unipolar depressive disorders, disruptive disorders, and cigarette smoking. CONCLUSIONS: Since physically abused adolescents are at greater risk for the development of psychiatric disorders, recognition of adolescent abuse and the provision of psychiatric and substance abuse services may reduce morbidity.

PIP: The association between physical abuse of adolescents and adolescent psychopathology was investigated in a case-control study conducted in Long Island, New York (US). 99 White adolescents 12-18 years of age identified from the New York State Department of Social Services Central Register for Child Abuse in 1989-91 and 99 nonabused adolescents matched for age, gender, race, and community income were enrolled. Diagnostic interviews and measures of selected risk factors for psychopathology were administered to the adolescents and their parents and then entered into a multiple logistic regression model testing the added risk contributed by physical abuse. Physical abuse added significantly to other risk factors in accounting for lifetime diagnoses of major depression, dysthymia, conduct disorder, drug abuse or dependence, and cigarette smoking. Physical abuse also contributed significantly to the prediction of current adolescent unipolar depressive disorders, disruptive disorders, and cigarette smoking. These findings underscore the importance of increased identification of physically abused adolescents so that mental health and substance abuse services can be provided.

Adolescent physical abuse and suicide attempts.

OBJECTIVE: The rate of suicide attempts and the exposure to risk factors for suicide in an unselected sample of confirmed cases of physically abused adolescents recruited directly from the New York State Central Register for Nassau and Suffolk Counties was compared with those of a community sample of nonabused adolescents. METHOD: Semistructured and structured diagnostic interviews were used in the assessment of psychopathology of adolescents and their parents RESULTS: The proportion of adolescents attempting suicide did not differ for the two groups. However, the abused adolescents showed significantly greater exposure to risk factors for adolescent suicide, including family disintegration, and diagnoses of depression, disruptive behavior disorders, and substance abuse and dependence. Comparisons of the 8 physically abused adolescents who attempted suicide with the 91 who did not attempt suicide showed that the following factors were associated with significantly greater risk for suicide attempts: adolescents' perceptions of their families as lacking cohesiveness and maternal support, higher adolescent "hostility" ideation scores, adolescent diagnoses of disruptive disorders and conduct disorders, adolescent substance abuse/dependence, and exposure to a suicide attempt by a family member or a friend. CONCLUSION: A transactional model of abuse, family and personal stressors, and the development of adolescent vulnerability leading to psychopathology is offered to explain the results.

Implementation of discharge plans for chronically ill elders discharged home.

Although discharge plans are viewed as the primary means to ensure that patients' needs will be met in the posthospital environment, little is known about the implementation of arranged care. This study addressed the extent to which discharge plans for elderly patients with congestive heart failure were implemented as planned, tested the consequences of implementation problems, and identified factors associated with implementation problems. For 40 percent of patients, one or more components of the discharge plan were not implemented as planned, with discrepancies more likely among low-income patients. Implementation discrepancies had negative consequences in terms of unmet needs, deficient quantity of help, and less than adequate care. Implications for hospital discharge planners and home health care are discussed.

Predictive factors in the non-surgical treatment of carpal tunnel syndrome.

To identify which patients are likely to respond the medical management of carpal tunnel syndrome, 331 hands in 229 patients were evaluated. They were then treated with a wrist splint and anti-inflammatory medication. Follow-up averaged 15.4 months (minimum six months). Treatment was successful in 18.4%. Statistical evaluation identified five factors which were important in predicting response to treatment: age over 50 years, duration over ten months, constant paraesthesiae, stenosing flexor tenosynovitis, and a Phalen's test positive in less than 30 seconds. When none of these factors was present, two-thirds of patients were cured by medical therapy. 59.6% of patients with one factor, 83.3% with two factors, and 93.2% with three factors failed. No patient with four or five factors present was cured by medical management.

Defining suicide: Importance and implications for Judaism.

One of the more problematic situations in the Jewish tradition is seeing to the psychological needs of the family of a suicide. This is due to the legal statements found within the tradition, placing some restrictions on the funeral rite. As a result of this, the criteria for the suicide are to be well examined and understood to ensure proper pastoral care.

Trochanteric advancement for recurrent dislocation after total hip arthroplasty.

Twenty-one patients had trochanteric advancement after experiencing an average of 3.9 dislocations in a mean period of 46 weeks following total hip arthroplasty. Before trochanteric advancement was performed, component malposition and mechanical impingement were excluded as causes of dislocation. Radiographic measurements revealed that the trochanter was advanced an average of 16 +/- 7.7 mm (1 SD). Four patients, all with rheumatoid arthritis, had trochanteric migration greater than 1 cm. Seventeen of the 21 hips had no further dislocations following trochanteric advancement, with mean follow-up period of 2.7 years. Two patients dislocated because of extremes in hip position and had no further dislocations. Two patients dislocated who had trochanteric migration greater than 1 cm. Only one patients with a technically satisfactory trochanteric advancement continued to dislocate repeatedly. In patients without component malposition or obvious sources of impingement, trochanteric advancement is an effective and safe procedure for prevention of recurrent dislocations after total hip arthroplasty.

Tensile strength of bovine trabecular bone.

Data on the tensile and compressive properties of trabecular bone are needed to define input parameters and failure criteria for modeling total joint replacements. To help resolve differences in reports comparing tensile and compressive properties of trabecular bone, we have developed new methods, based on porous foam technology, for tensile testing of fresh/frozen trabecular bone specimens. Using bovine trabecular bone from an isotropic region from the proximal humerus as a model material, we measured ultimate strengths in tension and compression for two groups of 24 specimens each. The average ultimate strength in tension was 7.6 +/- 2.2 (95% C.I.) MPa and in compression was 12.4 +/- 3.2 MPa. This difference was statistically significant (p = 0.013) and was not related to density differences between the test groups (p = 0.28). Strength was related by a power-law function of the local apparent density, but, even accounting for density influences, isotropic bovine trabecular bone exhibits significantly lower strengths in tension than in compression.

Monitoring the healing of a tibial osteotomy in the rabbit treated with external fixation.

Fracture site axial rigidity was monitored non-destructively at weekly intervals during healing of tibial osteotomies in adult rabbits. Two groups of 20 rabbits each were treated with external fixators of two different rigidities. Four animals from each group were killed at 3, 5, 6, 7, and 8 weeks to determine the bending moments at failure of the healing fractures. Normal fracture healing was accompanied by characteristic phases in the development of fracture site axial rigidity. From 0 to 3 weeks there was a period of low and approximately constant rigidity, followed by a linear increase during 3 to 5 weeks to an approximately three to four times greater rigidity. The maximum average normalized axial rigidities were reached at 6 weeks and were 57% (high rigidity group) and 77% (low rigidity group) of the untreated contralateral controls. The maximum average normalized failure moments occurred at 8 weeks and were 48% (high rigidity) and 44% (low rigidity) of controls. The differences due to fixator rigidity were not statistically significant except for a large increase in failure moments at 3 weeks for the low rigidity group. Axial rigidities were correlated (r2 = 0.74 and 0.53, respectively) with failure moments, but only during the first 6 weeks. The monitoring technique provides a nondestructive means for following the biomechanical progress of fracture healing in an animal model. The occurrence of the characteristic increase in fracture site axial rigidity at 3 to 5 weeks can also be used to distinguish between normal and abnormal healing.