Human immunodeficiency virus transmission by child sexual abuse

Article Abstract:

A study was carried out of the 14 children (11 girls, 3 boys) in a group of 96 pediatric AIDS patients who had been victims of sexual abuse. Child sexual abuse (CSA) was diagnosed after consideration of each child's medical and behavioral histories, an interview and physical examination, and evaluation for the presence of other sexually transmitted diseases. The five routes of human immunodeficiency virus (HIV) transmission that were considered were: vertical transmission (from pregnant mother to child); via transfusion; via clotting factor concentrates; via intravenous drug use; and via sexual abuse, including child prostitution. Results showed that the children's ages ranged from 3 1/2 to 13 years; 11 were black, 2 white, and 1 Native American. All the girls had abnormal findings on examination of the hymen or vaginal opening, and two of the boys had abnormal results on anal examinations. Eight children were able to reveal that CSA had occurred, and two more were able to partially disclose it. The forms of abuse that occurred are described. All perpetrators were male; several children had been abused by more than one perpetrator. The organisms associated with gonorrhea or chlamydia were not cultured from these children, but three had a sexually associated disease besides HIV. Three of the suspected perpetrators were HIV-positive and knew this when they abused the children; eight knew the children were HIV-positive when they abused them. In neither case was ''safe sex'' practiced. A list of the social risk factors for CSA is presented: they include living apart from both biological parents, living in poverty, being handicapped, the presence of alcoholic or drug-abusing family members, and prostitution in the home. The majority of these 14 children had three or more such risk factors. The proportion of this group who became infected through CSA (4/96, or 4.2 percent) is a low value for pediatric HIV infection acquired in this way, since these children were not found through screening for abuse. CSA is thus an important route for transmitting HIV to children and adults and risk factors for the two conditions overlap. (Consumer Summary produced by Reliance Medical Information, Inc.)

Testing, HIV infection, HIV infections, Diseases, Disease transmission, Sexually abused children

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Child pedestrian injuries in the United States

Article Abstract:

In 1985, a total of 1,852 fatal pedestrian injuries were sustained by infants, children and adolescents between the ages of 0 and 19 years. The total number of pedestrian injuries (fatal and nonfatal) in this group was 51,062 events. Male injuries exceeded those for females, comprising 60.9 percent of the total. The increased risk in boys is due to differences in behavioral and socialization patterns. Pedestrian-motor vehicle accidents occur most frequently in the 5- to 9-year-old age group. The risk of pedestrian injury is greater in children of lower socioeconomic status; environmental circumstances and the likelihood of lesser traffic control and intervention in poorer neighborhoods are contributing factors. Most children are injured during daylight hours and involve vehicles backing-up, children crossing at unprotected intersections and against traffic signal directions. The classic epidemiologic triad of the interaction of host, agent and environment come into play when developing and implementing measures to prevent pedestrian injuries and deaths in children. The host, the child, requires continuous education and reinforcement of safe procedures and actions. The agent, or motor vehicle, must be maintained and operated in the safest manner. Drivers should be well trained and alert to the particular concern of driving in areas with high concentrations of pedestrian traffic. Automotive design should be directed to minimize contact injuries. The environment, the roads, sidewalks, and other pedestrian walk-ways, should be marked clearly for the benefit of both drivers and pedestrians. Separating pedestrians from traffic with overpasses or underpasses would reduce the number of injuries. The key to a successful risk reduction effort is adequate and appropriate involvement of parents in developing and implementing these programs. (Consumer Summary produced by Reliance Medical Information, Inc.)

Patient outcomes, Mortality, Statistics, Children, Accidents, Study and teaching, Traffic accidents, Traffic safety, Children's accidents, Pedestrians, Traffic safety and children

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Triage decisions in child care for sick children

Article Abstract:

High employee absenteeism is a serious problem. Unmet child-care needs were reported to account for 61 percent of employee absenteeism in one study. Almost all child-care arrangements must be changed when the child becomes sick. There is a need to provide day-care for children who develop mild, acute illness. This can be done in different ways. The regular day-care center may have a separate section able to care for sick children; mildly ill children may be cared for at some hospitals; free-standing child-care centers for sick children also exist. Currently standards are being developed for out-of-home child-care programs for sick children. Michigan is developing rules and regulations for such centers. A method of triage (decision making based on severity of illness) needs to be established. Criteria must be developed for a standardized screening process. Questions such as who when will a child be admitted to the sick-child center, who will decide whether the admission is appropriate, and what criteria will be used to make that decision, must be answered. Two tables are presented with guidelines. The first is for use in screening children without a specific diagnosis and is organized by signs, symptoms, and complaints. The second table is for use in screening children with an already established diagnosis. Guidelines were established based on the following assumptions: the safety of the child and others was primary; there may not have been prior physician contact; all children have up-to-date immunizations; cross-infection from child to child will be minimized. Children with chronic illnesses and handicaps require special consideration, as do children with immune system deficiencies. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Management, Laws, regulations and rules, Child care, Sick children, Michigan, Day care centers, Day care centers for sick children

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