[Child sex abuse: pretext to a return of sexual repression]. / Les abus sexuels de l'enfant: prétexte à un retour de la répression sexuelle.

This article is based on observations and thoughts during intensive psychotherapeutic work with 997 sexually abused children and their parents after they had been reported to the Confidential Doctor Center Kind in Nood of the VUB (between 1986 and 1994). Without denying the existence of sexual abuse of children, it is important not to exaggerate this phenomena, which can be described as the Child Sexual Abuse Panic Syndrome. Doing this only gives way to denial and indignation or scandalization and revenge, and certainly does not lead to a clear analysis of the problem. Accurate observation enables some existing myths to become unravelled: abusive fathers are seldom power robots, mothers are not always warm-hearted, innocent creatures and children are not black boxes without feeling and sexual desires. The underlying message is about the bitter fight against modernization of sexuality, which seems again experienced as dangerous. However it is fear for a free, adult sexuality that is at the core of sexual exploitation of children, which should encourage caution in professional answers to this delicate issue.

Enzyme linked immunosorbent assay used to monitor serum antibodies to bovine respiratory disease viruses.

An enzyme linked immunosorbent assay (ELISA) was applied to the detection of serum antibodies against infectious bovine rhinotracheitis (IBR), parainfluenza-3 (PI3), adenovirus type 3 (adeno 3) and bovine respiratory syncytial (BRS) viruses. Paired serum samples from calves vaccinated with live attenuated virus vaccines were tested. The ELISA compared favorably with the virus neutralization test for detecting serologic responses to IBR, BRS, and adeno 3 viruses or with the hemagglutination inhibition test for PI3 virus. The simplicity, sensitivity and rapidity of the ELISA test makes it a useful tool for immunological studies with respiratory viruses.

[Evaluation in primary prevention: an obligation, I. The obstetrical point of view]. / Evaluation en prevention primaire: une obligation, I. Le point de vue obstetrical.

Evaluation of research in primary prevention is often complicated. Various objections and difficulties are discussed: imprecision or lack of practical definition of the child abuse syndrome, definition of primary prevention, lack of epidemiological data, and the existence of ethical problems. Obstetrical models of evaluation are proposed: evaluation of screening methods, postpartum follow-up and contraception, action against prematurity, and unfollowed pregnancies. Results of a four-year antenatal program are presented as indicators and may be served to determine the efficiency of preventive action. Therefore, evaluation of antenatal prevention is possible for at-risk parents.

[Evaluation in primary prevention: a must, II, The child psychiatry point of view]. / Evaluation en prevention primaire: un must, II, Le point de vue pedopsychiatrique.

The evaluation of any antenatal prevention program of child abuse and neglect is limited for statistical and ethical reasons, as shown in the first part of the present study (cf., The obstetrical viewpoint by G. Soumenkoff). The authors propose a child psychiatry model of evaluation. Use of the model is illustrated by a 4-year survey of 374 selected high-risk pregnant women followed in the antenatal out-patient department of St. Pieters Hospital in Brussels. A child psychiatrist worked together with several gynecologists, supporting the high-risk couples as well as their children. Several indirect evaluation methods of the quality of screening and the efficiency of the work are analyzed. Long-term evaluation of the children is an absolute necessity. In order to evaluate this type of approach, a simple questionnaire concerning the quality of life of the children under study was derived from a model used in pediatric oncology by the EORTC and adapted to the problems of abused children. One part was answered by the parents which allowed the researchers to evaluate their perception of the child. The second part was filled out by the sociomedical professionals who followed the child. The combination of these two views is rich in information concerning the patient as well as the parents' attitude toward their child.

[Can the action of the social worker lead to child abuse?]. / L'aide sociale peut-elle induire les mauvais traitements a l'enfant?

The authors report a case where the interference of a health worker led to child abuse in a family for which he had charge. They examine the interactions existing between the concerned team and the high-risk family. They notice that violent situations are often maintained by the higher number of psychosocial interventions and by the intrusive and rigid attitudes of the health workers. A real change in the parental situation can only be obtained by a systematic approach to the families involved, centered not only on the interactions between the child and its parents but also on the interactions between the health system and the family.

Institutional abuse: tubal sterilization in a population at risk of ill-treating their children.

Among the 145 patients at risk of child abuse and neglect who were seen in 1980 in our institution in the prevention of child abuse and neglect prenatal clinic, 19 were sterilized after giving birth. The criteria applied to these 19 patients were compared to the common criteria applied to our general maternity population. We were able to prove that these common criteria were systematically disregarded in the case of a mother at risk of ill-treating her child. We further studied our approach from the angle of the conflict which could exist for health care professionals between the choice of leaving these women with the right to reproduce or putting an end to a history of ill-treatment of children.

PIP: Among the 145 patients at risk of child abuse and neglect who were seen in 1980 in the authors' institution in the prevention of child abuse and neglect prenatal clinic, 19 were sterilized after giving birth. The criteria applied to these 19 patients were compared to the common criteria applied to the general maternity population. It was possible to prove that these common criteria were systematically disregarded in the case of a mother at risk of ill-treating her child. The authors further studied the approach from the angle of the conflict which could exist for health care professionals between the choice of leaving these women with the right to reproduce and or putting an end to a history of ill-treatment of children.

A coordinated attempt for prevention of child abuse at the antenatal care level.

The authors report the preliminary result of an integrated approach to the primary prevention of the child abuse syndrome. The problem has been approached through a new concept of prenatal and postnatal care, the obstetrical team working in close cooperation with the child psychiatrist of the department of pediatrics. The obstetrical team followed 91 patients during their pregnancy; they were all discussed at supervisory sessions. This permitted a gynaecologist and a social nurse to develop a therapeutic plan for 72 patients. For the 19 more problematic cases, the child psychiatrist intervened immediately in the surroundings of the antenatal clinic. Short, specific psychotherapeutic interventions based on the alleviation of a family crisis have remedied important stress situations. The favourable influence of this new methodology has led to: (1) reduction of a potentially high expected prematurity rate; (2) improved integration of out-patient and in-patient care; (3) improved adaptation of the health staff to this type of situation. A case example to illustrate the functioning of both teams is given.