Correlates of recidivism among adolescents who have sexually offended

The present study investigates the recidivism rates of a sample of 351 male adolescents who sexually offended, and were assessed at an outpatient psychiatric clinic in Montreal, Canada, between 1992 and 2002. The mean age of the participants was 15.8 years (SD=1.8). Data on adolescent and adult recidivism were collected in Summer 2005 from official criminality sources in Canada. Over an 8-year follow-up period, 45% (n=158) of the participants were charged with a new criminal offense, 30% (n=104) were charged with a violent offense, and 10% (n=36) were charged with a sexual offense. Cox regression results suggest that overall, violent, and sexual recidivism can be predicted by a variety of developmental, social, and criminological factors. Paternal abandonment, childhood sexual victimization, association with significantly younger children, and having victimized a stranger were associated with a higher risk of sexual recidivism. Previous delinquency, attention deficit disorder, and childhood sexual victimization were found to increase the risk for both violent and overall recidivism. Also, the use of violence during a sex crime and victimizing a stranger were associated with violent recidivism, and school delay and association with delinquent peers were predictive of overall recidivism. The results confirm that a significant proportion of adolescents who have sexually offended pursue a criminal activity beyond adolescence, although few specialize in sexual offending.     

Psychological stress reactions of women in Sweden who have been assaulted: acute response and four-month follow-up

Violence is a global health problem. Women in particular are likely to be targets of violent behavior. This study investigated the reactions of female victims to an individual act of interpersonal violence. A sample of 68 assaulted women registered as injured parties in 2 police districts were assessed for symptoms of acute stress disorder (ASD) and post-traumatic stress disorder (PTSD) at 3 weeks and after 4 months. Risk factors for developing psychological distress in the long-term were explored. High rates of ASD symptoms and distress measured with Post Traumatic Symptom Scale (PTSS-10), Impact of Event Scale (IES), and General Health Questionnaire (GHQ-20) were reported by the women in the acute phase. Four months post-assault, the high rates of stress reactions measured with PTSS-10, IES, and GHQ-20 were significantly reduced, but not for all the women. Dissatisfaction with one's previous life, previous mental health problems, post-assault life events and earlier abuse were risk factors for 4 months post-assault stress reactions.     

Issues and dynamics of sexually assaulted adolescents and their families

Interpersonal violence such as sexual assault creates a variety of traumatic responses. Adolescents encounter a significantly high rate of exposure to sexual assault. In the aftermath of sexual assault, issues and dynamics related to traumatic responses include ongoing fear and threats to personal safety, stability, and structure of the family and environment. Each issue is of concern for community and health care practitioners. Sexual assault has a detrimental effect on adolescent intrapsychic development and interpersonal relationships. Symptoms are disturbing and disruptive to daily routines, negatively affect adolescent normal growth and development, and can result in post-traumatic stress disorder. Issues and dynamics regarding sexual assault are explored, with suggestions on how to help adolescents avoid developing a negative world view and long-term negative health consequences.     

Characteristics of perpetrators of child sexual abuse who have been sexually victimized as children

This paper reports on a study of all convicted child sexual abusers in S.E. London. Almost half the offenders reported experiences of sexual victimization in childhood, and the authors aimed to explore the differences between the abused and nonabused child sexual abusers. A range of background and offending variables were examined. It was found that sexually victimized child abusers were significantly more likely to have experienced a range of childhood abuse and associated difficulties; they were more likely to have a range of psychosexual difficulties, to report greater levels of deviant offence-related attitudes on psychometric measure, to be recidivists, and to offend against boys. Both emotional abuse/physical neglect in childhood and having homosexual contacts in adulthood significantly contributed to a predictive model, reliably distinguishing between sexually victimized and nonsexually victimized child sexual abusers. The implication of these findings for treatment approaches for sex offenders is discussed.     

Differences in legal outcomes for male and female children who have been sexually abused

The goal of the present study was to determine whether or not there were sex differences in legal outcomes for children who were sexually abused. Using the methodology of Joa and Edelson (2004), the results indicated that males who were sexually abused had poorer legal outcomes than females. Specifically, it was found that cases involving male victims were less likely to be filed with the District Attorney (DA) than cases involving female victims and had fewer criminal counts charged. For those children seen at a Child Abuse Assessment Center, cases involving female victims were significantly more likely to be filed by the DA's office than were cases involving male victims. Finally, there were differences in whether guilty defendants pled guilty or were found guilty at trial depending on whether the defendant sexually abused a male or female. The implications of the findings are discussed.     

Assessment of criminal recidivism risk with adolescents who have offended sexually: a review

The assessment of criminal recidivism risk among adolescents who have offended sexually is a complex task with significant implications for the adolescent and the community. We reviewed the empirical and professional literature on factors associated with criminal recidivism in adolescents who have offended sexually. Supported, promising, possible, and unlikely risk factors are presented and findings are contrasted against the extensive data available for adults who offend sexually and adolescent criminality in general. Limitations with the existing literature are noted, such as shortage of validated risk factors for qualitative aspects of reoffending and research specifically with females and ethnic minorities. Recent attempts to combine evidence-based risk factors with case-specific clinical considerations into structured professional or empirically guided judgment formats are presented. We conclude with suggesting practical strategies for the assessment and communication of recidivism risk.     

Reflections on the education and training of mental health staff who work with women who have been sexually abused in childhood

Strategies to reduce sexual assault on women patients in mental health inpatient acute wards have included effective policies, a consistent approach to recording and monitoring data relating to incidences of sexual assault, increased staff levels and improvements in the ward layout. A series of workshops were devised to enable mental health staff to work with greater awareness and sensitivity to keep women patients safer on inpatient wards. What emerged in particular during the training was the ways in which staff felt at loss as to how to build therapeutic relationships with women patients, particularly those with histories of sexual abuse. These patients may repeat early ways of relating which may at times be a challenge for the staff caring for them. This paper suggests that psychoanalytic insights offer an understanding of these ways of relating. This can be combined with frequent and supportive supervision to enable staff to safely articulate their often troubling responses to caring for women patients, this creating a caring and supportive environment for staff.     

超声引导自动活检术诊断恶性骨肿瘤的护理69例

超声引导自动活检术已在临床大量应用,在肝脏、肾脏、前列腺、甲状腺等部位已成功开展[1,2],但是骨科超声应用较少,骨肿瘤的超声引导自动活检术开展更少[3]。本文就我院近3年开展的超声引导自动活检术诊断恶性骨肿瘤的应用及护理进行总结,现报道如下。临床资料1·一般资料。近3     

Health care utilization by persons with chronic disabilities who have been vocationally rehabilitated.

This investigation focuses on the effect of vocational rehabilitation on persons with chronic disabilities who have epilepsy, heart disease, spinal cord injury, arthritis, or emphysema. A thesis is proposed that such rehabilitants might be more vulnerable to unemployment than others, and it is also hypothesized that this frequently would be related to health care utilization. The study comprised 338 former clients of the State Rehabilitation Agency who had their cases successfully closed in the two-year period immediately prior to this study. All persons were sent a 12-page questionnaire dealing with matters of health, employment, social support, demography, medical economics, expressed needs, and relationship with the rehabilitation agency. Two-thirds (N = 213) of the clients responded. In addition, supplemental information was volunteered substantially by narrative and telephone. The primary thesis of the project was sustained; 43.7% were either unemployed or working less than full time six months after rehabilitation. However, few of the respondents reported having difficulties with health care utilization or availability. We propose a different rehabilitation services model to meet the needs of such clients. It should accentuate better diagnosis, careful selection of objectives, adequate vocational preparation, health care advisement, and more extensive job follow-up.     

The lived experience of parents of adolescents who have sexually offended: I am a survivor

This study aimed to describe the lived experience of parents of adolescents who had sexually offended. The participants (n= 4) were parents and parental figures of adolescents legally adjudicated for sexual offenses and currently involved in sex offender-specific treatment. Using an ethnographic research design guided by the premises of the Trauma Outcome Process, a focus group and individual interviews were conducted with these participants. Content analysis and constant comparison yielded four main themes: the initial reaction, the relationship with the child, "dealing with it," and being a survivor. These results support the development of an individualized intervention to meet the self-identified needs of this population.     

Evaluation and management of the sexually assaulted woman

The evaluation and management of the sexually assaulted woman is a challenging task that emergency physicians frequently face. The physician must assume dual roles as advocate for the patient and as an agent of the government. While caring for the immediate physical and emotional well being of the victim, the physician also must be diligent in the forensic evaluation and evidence collection. To receive quality care, the victim should receive a thorough history and physical examination with appropriate diagnosis and treatment of injuries, a thorough evidentiary examination, counseling and treatment for prevention of pregnancy and STDs, provisions for initial and ongoing mental health evaluation, and appropriate follow-up. To provide this high quality care, the physician must be familiar with the process of the evidentiary examination, have knowledge of the current recommendations for pregnancy and STD prophylaxis. and have thorough knowledge of the community resources that are available.     

Prescribing prophylaxis to patients who have been exposed to HIV

Emergency nurse practitioners should be prepared to prescribe post-exposure prophylaxis for sexual exposure (PEPSE) to people who may have been exposed to HIV, even where the number of such presentations is small. As this article makes clear, nurse prescribers require a sound knowledge of the drugs recommended in PEPSE protocols, and of their side effects, to relieve patients' anxiety and inform them about safe sexual practice. The article offers a case study and reflection to show that patients, particularly those who may have been exposed to HIV, who have been given the information they want are more likely to complete their courses of treatment.     

The evaluation and treatment of the sexually assaulted patient

There are several significant problems encountered in treating the assault victim in the Emergency Department setting. In a busy Emergency Department, the patient who has been assaulted may be prioritized behind other patients with more significant life-threatening illnesses or injuries. The delay in treatment that ensues may aggravate the emotional trauma already experienced. Additionally, the legal and technical aspects involved in the evaluation and subsequent testimony may erect a psychological barrier on the part of the physician or nurse. This article provides guidelines and handling all of the above problems with regard to the sexually assaulted patient.