Validation, certification and registration of veterinary diagnostic test kits by the World Organisation for Animal Health Secretariat for Registration of Diagnostic Kits.

In the field of diagnostic test validation, World Organisation for Animal Health (OIE) Reference Laboratories (RLs) have a pivotal role and provide the international community with impartial advice and support in the selection, development and validation of diagnostic tests, which can be applied to the specialist diseases for which they are designated. National RLs provide an invaluable function in supporting the introduction, ongoing validation and application of validated diagnostic tests in line with international standards. Experienced staff with extensive knowledge of such systems and access to specialist facilities for conducting work are available to monitor changes or advancements in technology. They consider their relevance and value to evolving diagnostic test requirements. Reference Laboratories often have a broad mandate of activity linking research or development programmes and surveillance activities to benefit the continual assessment and, if necessary, improvement of diagnostic tools. Reference Laboratories maintain or have access to unique biological archives (known positive and negative sample populations) and produce international reference standards, both of which are vital in establishing the necessary and detailed validation of any diagnostic test. Reference Laboratories act either singularly or in collaborative partnerships with other RLs or science institutes, but also, when required, and with impartiality, with the commercial sector, to ensure new tests are validated according to OIE standards. They promote and apply formal programmes of quality assurance (including proficiency testing programmes) for newly validated tests, ensuring ongoing monitoring and compliance with standards, or as required set out any limitations or uncertainties. Reference Laboratories publish information on test validation in the scientific literature and on relevant websites, as well as disseminating information at workshops and international conferences. Furthermore, they can offer training in the processes and systems underpinning test validation.

Dans le domaine de la validation des tests de diagnostic, les Laboratoires de référence de l'Organisation mondiale de la santé animale (OIE) jouent un rôle central et fournissent à la communauté internationale des conseils impartiaux ainsi qu'un soutien pour la sélection, la mise au point et la validation des tests de diagnostic utilisés pour la détection des maladies correspondant à leur domaine de spécialisation. Les Laboratoires de référence nationaux remplissent une fonction inestimable en facilitant l'introduction, la validation continue et l'application de tests de diagnostic validés conformément aux normes internationales. Ces laboratoires sont dotés de personnels expérimentés possédant une connaissance approfondie de ces systèmes et qui ont accès à des installations spécialisées pour mener à bien leurs opérations et suivre de près les changements ou les avancées technologiques. Ils peuvent ainsi examiner leur pertinence et intérêt au regard de l'évolution des exigences relatives aux tests de diagnostic. Le mandat des Laboratoires de référence recouvre souvent un large éventail d'activités reliant les programmes de recherche ou développement et les activités de surveillance, ce qui permet de réaliser une évaluation continue des outils diagnostiques et, si besoin, de procéder à leur amélioration. Les Laboratoires de référence entretiennent ou ont accès à des banques de matériels biologiques uniques (panels d'échantillons positifs et négatifs connus) et produisent des réactifs de référence internationale, deux catégories de matériels essentielles pour procéder à la validation point par point d'un test diagnostique suivant les critères requis. Les Laboratoires de référence interviennent individuellement ou en partenariat avec d'autres Laboratoires de référence ou instituts scientifiques, mais aussi, lorsque c'est nécessaire et dans le respect des règles d'impartialité, avec le secteur privé, afin de s'assurer que les nouveaux tests sont validés conformément aux normes de l'OIE. Ils soutiennent et appliquent des programmes officiels d'assurance de la qualité (y compris en participant à des programmes d'essais d'aptitude inter-laboratoires) pour les tests nouvellement validés et garantissent leur suivi continu ainsi que leur conformité avec les normes, ou, suivant les cas, définissent les limites ou le niveau d'incertitude à prendre en considération. Les Laboratoires de référence publient les données relatives à la validation des tests dans des journaux scientifique et sur les sites Web pertinents et diffusent également des informations sur le sujet lors d'ateliers et de conférences internationales. En outre, ils peuvent proposer des formations sur les procédures et les systèmes qui sous-tendent la validation des tests.

En el terreno de la validación de pruebas de diagnóstico, los Laboratorios de Referencia de la Organización Mundial de Sanidad Animal (OIE) cumplen una función central y proporcionan a la comunidad internacional servicios de apoyo y asesoramiento imparcial para la selección, el desarrollo y la validación de pruebas de diagnóstico, que pueden aplicarse a la enfermedad para la que cada laboratorio esté designado. Los laboratorios de referencia nacionales cumplen una inestimable función de apoyo a la implantación, la continua validación y la utilización de pruebas de diagnóstico validadas con arreglo a las normas internacionales. Disponen de personal experimentado y muy buen conocedor de estos sistemas y de acceso a instalaciones especializadas de trabajo, lo que les permite seguir de cerca los cambios o adelantos tecnológicos y estudiar su utilidad o interés en relación con la evolución de los requisitos de las pruebas de diagnóstico. Los Laboratorios de Referencia suelen tener un mandato amplio, que a los programas de investigación y desarrollo aúna actividades de vigilancia, en aras de la continua evaluación y, en caso necesario, mejora de las herramientas de diagnóstico. Estos laboratorios poseen (o tienen acceso a) archivos biológicos únicos (conjuntos de muestras probadamente positivas y negativas) y elaboran patrones de referencia internacional, elementos ambos indispensables para llevar a buen fin la necesaria validación detallada de toda prueba de diagnóstico. Los Laboratorios de Referencia pueden trabajar en solitario o en colaboración con otros Laboratorios de Referencia, con institutos científicos e incluso, cuando hace falta, y procediendo con imparcialidad, con entidades del sector privado, a fin de garantizar que toda nueva prueba sea validada con arreglo a las normas de la OIE. También promueven y llevan adelante programas oficiales de garantía de la calidad de pruebas recién validadas (incluidos programas de pruebas de competencia), lo que asegura un seguimiento continuo y el cumplimiento de la normativa en todo momento, o fijan, cuando es necesario, limitaciones o niveles de incertidumbre. Asimismo, estos laboratorios publican datos sobre la validación de pruebas en revistas científicas y sitios web conexos y difunden información al respecto en talleres y conferencias internacionales. Además, pueden impartir formación sobre los procesos y sistemas que fundamentan la validación de pruebas de diagnóstico.

A qualitative analysis of health information-sharing networks in the Indonesian poultry sector.

Animal production systems are developing into increasingly complex value chains involving a large diversity of actors with multiple and dynamic linkages, concurrently creating many opportunities for disease spread. Access to timely and good-quality animal health information is vital for designing effective disease management strategies. However, several factors may hamper information flows along those chains. Understanding the structure and dynamics of information networks is essential to develop effective and acceptable health information systems. We applied a qualitative network approach to understand how information about poultry health is generated, disseminated and used for decision-making along the poultry value chain in Indonesia. Maps of the value chain and information networks were generated based on data from key informant interviews to illustrate the linkages and information-sharing patterns between stakeholders. Four types of farm business models were identified: company-owned, contract, partnership and independent. Although companies and most independent farmers collected health and production data routinely, their systems were strongly siloed and still relied on a mix of digital and paper-based methods, which impaired their analytical capacity. Technical service providers from the upstream sector and industry associations were identified as key intermediaries in the information-sharing network with the ability to create informal bridges between separate business networks and public actors. These actors can play a strategic role in the development of integrated information systems to improve stakeholders' capacity to monitor, anticipate and manage disease threats at all levels of the value chain. This study contributes to fill an important knowledge gap regarding the layer sector and may help decision-makers to design effective policies and interventions tailored to the type of business model.

The Crystal Backlighter Imager: A spherically bent crystal imager for radiography on the National Ignition Facility.

The Crystal Backlighter Imager (CBI) is a quasi-monochromatic, near-normal incidence, spherically bent crystal imager developed for the National Ignition Facility (NIF), which will allow inertial confinement fusion capsule implosions to be radiographed close to stagnation. This is not possible using the standard pinhole-based area-backlighter configuration, as the self-emission from the capsule hotspot overwhelms the backlighter signal in the final stages of the implosion. The CBI mitigates the broadband self-emission from the capsule hot spot by using the extremely narrow bandwidth inherent to near-normal-incidence Bragg diffraction. Implementing a backlighter system based on near-normal reflection in the NIF chamber presents unique challenges, requiring the CBI to adopt novel engineering and operational strategies. The CBI currently operates with an 11.6 keV backlighter, making it the highest energy radiography diagnostic based on spherically bent crystals to date. For a given velocity, Doppler shift is proportional to the emitted photon energy. At 11.6 keV, the ablation velocity of the backlighter plasma results in a Doppler shift that is significant compared to the bandwidth of the instrument and the width of the atomic line, requiring that the shift be measured to high accuracy and the optics aligned accordingly to compensate. Experiments will be presented that used the CBI itself to measure the backlighter Doppler shift to an accuracy of better than 1 eV. These experiments also measured the spatial resolution of CBI radiographs at 7.0 µm, close to theoretical predictions. Finally, results will be presented from an experiment in which the CBI radiographed a capsule implosion driven by a 1 MJ NIF laser pulse, demonstrating a significant (>100) improvement in the backlighter to self-emission ratio compared to the pinhole-based area-backlighter configuration.

Aperture design for the third neutron and first gamma-ray imaging systems for the National Ignition Facility.

The current construction of a new nuclear-imaging view at the National Ignition Facility will provide a third line of sight for hotspot and cold fuel imaging and the first dedicated line of sight for 4.4-MeV γ-ray imaging of the remaining carbon ablator. To minimize the effort required to hold and align apertures inside the vacuum chamber, the apertures for the two lines of sight will be contained in the same array. In this work, we discuss the system requirements for neutron and γ-ray imaging and the resulting aperture array design.

Diagnostic Performance of Ultrafast Brain MRI for Evaluation of Abusive Head Trauma.

BACKGROUND AND PURPOSE: MR imaging with sedation is commonly used to detect intracranial traumatic pathology in the pediatric population. Our purpose was to compare nonsedated ultrafast MR imaging, noncontrast head CT, and standard MR imaging for the detection of intracranial trauma in patients with potential abusive head trauma. MATERIALS AND METHODS: A prospective study was performed in 24 pediatric patients who were evaluated for potential abusive head trauma. All patients received noncontrast head CT, ultrafast brain MR imaging without sedation, and standard MR imaging with general anesthesia or an immobilizer, sequentially. Two pediatric neuroradiologists independently reviewed each technique blinded to other modalities for intracranial trauma. We performed interreader agreement and consensus interpretation for standard MR imaging as the criterion standard. Diagnostic accuracy was calculated for ultrafast MR imaging, noncontrast head CT, and combined ultrafast MR imaging and noncontrast head CT. RESULTS: Interreader agreement was moderate for ultrafast MR imaging (κ = 0.42), substantial for noncontrast head CT (κ = 0.63), and nearly perfect for standard MR imaging (κ = 0.86). Forty-two percent of patients had discrepancies between ultrafast MR imaging and standard MR imaging, which included detection of subarachnoid hemorrhage and subdural hemorrhage. Sensitivity, specificity, and positive and negative predictive values were obtained for any traumatic pathology for each examination: ultrafast MR imaging (50%, 100%, 100%, 31%), noncontrast head CT (25%, 100%, 100%, 21%), and a combination of ultrafast MR imaging and noncontrast head CT (60%, 100%, 100%, 33%). Ultrafast MR imaging was more sensitive than noncontrast head CT for the detection of intraparenchymal hemorrhage (P = .03), and the combination of ultrafast MR imaging and noncontrast head CT was more sensitive than noncontrast head CT alone for intracranial trauma (P = .02). CONCLUSIONS: In abusive head trauma, ultrafast MR imaging, even combined with noncontrast head CT, demonstrated low sensitivity compared with standard MR imaging for intracranial traumatic pathology, which may limit its utility in this patient population.

Design of the polar neutron-imaging aperture for use at the National Ignition Facility.

The installation of a neutron imaging diagnostic with a polar view at the National Ignition Facility (NIF) required design of a new aperture, an extended pinhole array (PHA). This PHA is different from the pinhole array for the existing equatorial system due to significant changes in the alignment and recording systems. The complex set of component requirements, as well as significant space constraints in its intended location, makes the design of this aperture challenging. In addition, lessons learned from development of prior apertures mandate careful aperture metrology prior to first use. This paper discusses the PHA requirements, constraints, and the final design. The PHA design is complex due to size constraints, machining precision, assembly tolerances, and design requirements. When fully assembled, the aperture is a 15 mm × 15 mm × 200 mm tungsten and gold assembly. The PHA body is made from 2 layers of tungsten and 11 layers of gold. The gold layers include 4 layers containing penumbral openings, 4 layers containing pinholes and 3 spacer layers. In total, there are 64 individual, triangular pinholes with a field of view (FOV) of 200 µm and 6 penumbral apertures. Each pinhole is pointed to a slightly different location in the target plane, making the effective FOV of this PHA a 700 µm square in the target plane. The large FOV of the PHA reduces the alignment requirements both for the PHA and the target, allowing for alignment with a laser tracking system at NIF.

Combined neutron and x-ray imaging at the National Ignition Facility (invited).

X-ray and neutrons are commonly used to image inertial confinement fusion implosions, providing key diagnostic information on the fuel assembly of burning deuterium-tritium (DT) fuel. The x-ray and neutron data provided are complementary as the production of neutrons and x-rays occurs from different physical processes, but typically these two images are collected from different views with no opportunity for co-registration of the two images. Neutrons are produced where the DT fusion fuel is burning; X-rays are produced in regions corresponding to high temperatures. Processes such as mix of ablator material into the hotspot can result in increased x-ray production and decreased neutron production but can only be confidently observed if the two images are collected along the same line of sight and co-registered. To allow direct comparison of x-ray and neutron data, a combined neutron x-ray imaging system has been tested at Omega and installed at the National Ignition Facility to collect an x-ray image along the currently installed neutron imaging line of sight. This system is described, and initial results are presented along with prospects for definitive coregistration of the images.

Two-color spatial and temporal temperature measurements using a streaked soft x-ray imager.

A dual-channel streaked soft x-ray imager has been designed and used on high energy-density physics experiments at the National Ignition Facility. This streaked imager creates two images of the same x-ray source using two slit apertures and a single shallow angle reflection from a nickel mirror. Thin filters are used to create narrow band pass images at 510 eV and 360 eV. When measuring a Planckian spectrum, the brightness ratio of the two images can be translated into a color-temperature, provided that the spectral sensitivity of the two images is well known. To reduce uncertainty and remove spectral features in the streak camera photocathode from this photon energy range, a thin 100 nm CsI on 50 nm Al streak camera photocathode was implemented. Provided that the spectral shape is well-known, then uncertainties on the spectral sensitivity limits the accuracy of the temperature measurement to approximately 4.5% at 100 eV.

A new streaked soft x-ray imager for the National Ignition Facility.

A new streaked soft x-ray imager has been designed for use on high energy-density (HED) physics experiments at the National Ignition Facility based at the Lawrence Livermore National Laboratory. This streaked imager uses a slit aperture, single shallow angle reflection from a nickel mirror, and soft x-ray filtering to, when coupled to one of the NIF's x-ray streak cameras, record a 4× magnification, one-dimensional image of an x-ray source with a spatial resolution of less than 90 µm. The energy band pass produced depends upon the filter material used; for the first qualification shots, vanadium and silver-on-titanium filters were used to gate on photon energy ranges of approximately 300-510 eV and 200-400 eV, respectively. A two-channel version of the snout is available for x-ray sources up to 1 mm and a single-channel is available for larger sources up to 3 mm. Both the one and two-channel variants have been qualified on quartz wire and HED physics target shots.

Genitalia in children's drawings: an association with sexual abuse.

Many sexual abuse victims have been observed to draw genitalia on human figures. To test the hypothesis that sexually abused children draw genitalia on human figures more often than do nonabused children, drawings from 57 children, 3 through 7 years of age, who were referred to child protective services as alleged sexual abuse victims, were compared with drawings from an age-, sex-, race-, and socioeconomically matched group of 55 nonabused children receiving well-child care in medical settings. A standardized procedure to obtain drawings was followed by a structured interview to collect demographic, past medical, and developmental information. Five evaluators unaware of the children's backgrounds independently examined drawings for the presence or absence of five body parts; there was 94% agreement for all body parts and 93% agreement for genitalia. Eight children were excluded from the analysis because they only scribbled (n = 5) or because evaluators could not agree on whether genitalia were present in their drawings (n = 3). Ten percent (5/52) of the alleged sexual abuse victims and 2% (1/52) of the comparison children drew genitalia (P = .10, one-tailed Fisher exact test). The estimated relative risk was 5.4; that is, alleged sexual abuse victims were 5.4 times more likely to draw genitalia than were comparison children. Children known to have been sexually abused were 6.8 times more likely to draw genitalia than were comparison children (P = .07, one-tailed Fisher exact test).(ABSTRACT TRUNCATED AT 250 WORDS)

Behavioral risk, emotional risk, and child abuse among adolescents in a nonclinical setting.

In this replication study of adolescents in a nonclinical setting, the prevalence of reported problem behaviors, emotions, and abuse is evaluated, and the impact of abuse on multivariate emotional and behavioral risk is assessed. A total of 3998 students (69%) in a rural midwestern community in grades 7 to 12 participated in the study. Almost 20% of the students reported some form of physical and/or sexual abuse, with more girls than boys reporting sexual abuse (chi 2 = 48.5, P less than .001). Some problem behaviors (alcohol use) and emotions (trouble sleeping, difficulty with anger) were common among all adolescents and some were strongly associated with a history of abuse (especially, considering or attempting suicide, running away, laxative use, and vomiting to lose weight). Higher emotional and behavioral risk scores among abused students were confirmed. The effects of physical and sexual abuse on risk scores were independent and additive; no interaction was observed. An interaction of gender and sexual abuse on problem behavior was observed, with problem behavior being significantly greater among sexually abused boys. The results confirm increased risk of problem behaviors and negative feelings among abused adolescents when compared with nonabused peers, and better define influences of gender and abuse type on emotional and behavioral risks.

Pediatric endocrinologic recommendations, pediatric practice, and current pediatric training regarding care of children with diabetes.

Many pediatric diabetes patients are cared for by community-based pediatricians. Training for pediatricians in optimal diabetes care should be based on both the recommendations of pediatric endocrinologists regarding optimal care and the practices of general pediatricians. Pediatric endocrinologists, general pediatricians, and pediatric residency coordinators were surveyed to assess the consonance of current recommendations, practices, and training in pediatric diabetes care. Not surprisingly, pediatric endocrinologists recommended more subspecialty care than pediatricians reported practicing. A major difference between endocrinologists and pediatricians emerged in the area of psychosocial support. A total of 85% of endocrinologists answered that there should be a mental health diabetes team member, but only 37% of pediatricians reported often or sometimes working with one to develop care plans. Pediatricians who provide complete diabetes care for most of their patients measure frequent glycosylated hemoglobin levels, obtain yearly lipid measurements marginally less often, and use urinary glucose measurements more often than recommended by pediatric endocrinologists. According to the descriptions of most pediatric residency training programs, multidisciplinary teams include a pediatrician, an endocrinologist, and a dietician. However, 25% do not include a social worker or nurse and 70% do not include a psychologist. Although most training programs operate on the assumption that their trainees will ultimately share responsibility with a subspecialist for diabetes care, in 26% of programs residents saw no diabetics in their continuity clinics. Most residents do not participate in providing diabetes education.(ABSTRACT TRUNCATED AT 250 WORDS)

Pediatrics residents' attitudes about insulin-dependent diabetes mellitus and children with diabetes.

Nationwide, pediatricians provide a substantial portion of the health care of children with diabetes. Their beliefs and attitudes about diabetes and children with the illness have an important influence on their treatment decisions. The attitudes and beliefs of a 1988 sample of pediatrics residents were compared with data from a 1987 national survey of practicing pediatricians' beliefs and attitudes about children with insulin-dependent diabetes mellitus and about the disease itself. Pediatrics residents in their second and third years of training were considerably more negative about diabetes and diabetic children than were either the members of the national sample of practicing pediatricians or the residents' first-year colleagues.

Child abuse and mental health among adolescents in dependent care.

Do adolescents in dependent care who have been abused or neglected demonstrate more mental health problems than their nonabused peers? This study examined relationships of child abuse, depression, and self-esteem among 82 adolescents (mean age 14.5 years, 52% male, 82.9% white) living in a dependent care facility. Of these, 32 adolescents were victims of child abuse or neglect. Upon admission, 54 adolescents were identified as depressed on the Beck Depression Inventory. Initial scores on the depression and self-esteem instruments did not differ by age, race, or history of maltreatment, though trends among subtypes of abuse were identified. Females had significantly lower self-esteem and tended toward more depression. Repeat evaluation 6 months after admission revealed significant improvement in both depression and self-esteem scores for the entire sample. As a group, however, the maltreated adolescents did not demonstrate significant improvement in depression, and a history of neglect was associated with less improvement. Depression in this dependent care sample was common, however, we did not identify the maltreated adolescents as having significantly more problems with self-esteem or depression. For some adolescents, dependent care may be an appropriate and helpful alternative.

Patterns of child sexual abuse knowledge among professionals.

To better understand knowledge and perceptions of child sexual abuse, a survey was conducted of 902 professionals attending child sexual abuse educational programs during 1986-1987. About half (50.8%) of the group reported seeing at least two child sexual abuse cases a month, while 20.5% reported seeing five or more. Almost half (48.9%) of the respondents reported previous formal training regarding child sexual abuse. Professionals were generally knowledgeable about child sexual abuse; however, at least 20% of the professionals were not knowledgeable about some items that are important in the identification of child sexual abuse and that might hamper the legal and medical investigation of a case. Those with formal training, more years of professional practice, and who see five or more victims per month answered more questions correctly, but the differences were not always statistically significant. Further training for both medical and non-medical professionals is needed to ensure appropriate care of child sexual abuse victims and to improve communication and coordination of efforts between professions.

Medical evaluation referral patterns for sexual abuse victims.

It has been recommended that all children suspected of being sexually abused should have medical evaluations. To better understand practices and perceptions of child sexual abuse medical evaluations, a survey was conducted of 579 professionals attending educational programs on child sexual abuse; 85.8% (N = 497) responded. Half (50%) of the respondents reported no previous training in child sexual abuse. Of the 336 nonphysician professionals, 194 (57.7%) were in positions where they make referrals of the victims, and 69% of these did not refer all of the children they saw for medical evaluations. The first referral choice for medical evaluation was most often to the victim's primary physician (57%). For those professionals who did not refer all alleged victims for medical evaluation, neither the victims' age, gender, nor accessibility to care were generally considered relevant in determining the decision to refer. However, the type of abuse and presence of physical and psychological symptoms were considered relevant in making the decision. The majority indicated that the findings of the medical exam were very useful in substantiating or refuting the allegation of abuse. Further training for both medical and nonmedical professionals is needed to increase awareness of the need for and implications of the medical evaluation if children are to receive comprehensive assessments. Physicians may play an active role in this process through education of professionals and provision of care.

Behavioral problems in alleged sexual abuse victims.

This study was conducted to compare the parental assessments of problem behaviors, using the Achenbach Child Behavior Checklist, among alleged sexual abuse victims (n = 81) and an age, race, and gender matched group of nonabused comparison subjects (n = 90). Alleged sexual abuse victims demonstrated significantly higher mean total behavior problem, internalizing and externalizing scores than the comparison sample. Subscale profiles were all in the direction consistent with withdrawal, impairment in social interaction, and sexual problems. Item comparison indicated that sexual abuse victims were more likely to be assessed as having some problem behaviors that have been reported as being indicative of sexual abuse. A significant difference was not obtained on several behaviors that have been previously reported as indicative of sexual abuse. These findings support concerns that sexual abuse victims do exhibit more problem behaviors, but caution must be exercised when interpreting individual behaviors because of their frequency in a nonabused sample.

Components of child and parent interviews in cases of alleged sexual abuse.

Considerable discussion in child sexual abuse evaluation centers around minimizing the number of victim interviews, however, the completeness of one professional's interview is not always addressed. In this study, professionals (medical, social, law enforcement/legal, mental health) indicated what components they included in their interviews of sexual abuse victims and their parents. Components included: details of abuse, family relationships, school situation/performance, child's development (toilet training, bed wetting, language development, etc.), child's knowledge of body part names, child's knowledge of body part functions, child-rearing practices (bathing, sleeping), medical history (illnesses, surgery), behavior problems, psychological symptoms (nightmares, sadness), physical complaints (pain, discharge), parental teaching about sex, and child's access to sexually explicit television or magazines. Interview components varied by profession, consistent with expected professional bias. This study demonstrates some professional bias in interviewing children and parents and suggests that having a single interview or interviewer may not always be optimal for a thorough evaluation. Increased communication and teamwork among professionals, and cross-training among disciplines could facilitate both the recognition of appropriateness of some "multiple interviews" as well as provide efforts to consolidate interviews when possible.

Educational program on evaluation of alleged sexual abuse victims.

Increased awareness of the problem of child sexual abuse has resulted in increasing numbers of children presenting to professionals for the evaluation of possible sexual victimization. A multidisciplinary project to develop professionals' knowledge and skills in the identification and evaluation of possible victims is described. The program focused on the child as a victim and emphasized developmental perspectives with regard to identification, interviewing children, the medical examination, and children in the legal system. Fifty-one medical and social work professionals from ten Indiana counties attended the program and responded to questionnaires about their experience and knowledge. Of 40 (78%) respondents, 63% had had no previous training in the medical evaluation for child sexual abuse. Child protective workers referred alleged victims primarily to the child's regular physician (37%) or emergency room (31%) for medical examination. Knowledge about child sexual abuse improved significantly at two weeks postsymposium (p = .001) and remained improved at six months postsymposium (p less than .02). These original participants have subsequently organized similar multidisciplinary programs in their local communities for medical, social, law enforcement, and legal professionals; thus, they have been "seeds" for further educational and cooperative efforts throughout the state.

Attorney attitudes regarding behaviors associated with child sexual abuse.

There appears to be a good deal of disagreement between professionals as to what constitutes child abuse. Attorneys as a group have been found to judge behaviors associated with child abuse more leniently than other abuse professionals. However, no one has discriminated between defense and prosecuting attorneys in these areas. It was hypothesized that because of divergent roles in child sexual abuse cases attitudes toward adult-child behaviors associated with sexual abuse would differ among attorney groups. Two prosecuting and two defense attorneys from every county in the state of Indiana were sent questionnaires. Participants were asked to indicate if a behavior was acceptable, inappropriate, or sexual abuse if it occurred on one or on multiple occasions. Prosecutors had more severe judgements than the defense attorneys on 32 of the 42 behaviors. They were more likely to indicate that a behavior was inappropriate or abuse. Cognitive dissonance theory is proposed as a possible explanation for these findings.