Active and intelligent packaging for food: is it the future?

This paper gives an overview of the legal consequences of a new EU framework regulation on food contact materials which includes controls on active and intelligent packaging. Recent developments in active and intelligent packaging systems are described, two examples of which aim at achieving improvements in quality and safety of food products. The first one is an on-command preservative-releasing packaging system. The second system is an intelligent concept, based on the development of a non-invasive microbial growth sensor to monitor the sterility of food products.

Forensic evidence findings in prepubertal victims of sexual assault.

OBJECTIVE: The American Academy of Pediatrics recommends forensic evidence collection when sexual abuse has occurred within 72 hours, or when there is bleeding or acute injury. It is not known whether these recommendations are appropriate for prepubertal children, because few data exist regarding the utility of forensic evidence collection in cases of child sexual assault. This study describes the epidemiology of forensic evidence findings in prepubertal victims of sexual assault. METHODS: The medical records of 273 children <10 years old who were evaluated in hospital emergency departments in Philadelphia, Pennsylvania, and had forensic evidence processed by the Philadelphia Police Criminalistics Laboratory were retrospectively reviewed for history, physical examination findings, forensic evidence collection, and forensic results. RESULTS: Some form of forensic evidence was identified in 24.9% of children, all of whom were examined within 44 hours of their assault. Over 90% of children with positive forensic evidence findings were seen within 24 hours of their assault. The majority of forensic evidence (64%) was found on clothing and linens, yet only 35% of children had clothing collected for analysis. After 24 hours, all evidence, with the exception of 1 pubic hair, was recovered from clothing or linens. No swabs taken from the child's body were positive for blood after 13 hours or sperm/semen after 9 hours. A minority of children (23%) had genital injuries. Genital injury and a history of ejaculation provided by the child were associated with an increased likelihood of identifying forensic evidence, but several children had forensic evidence found that was unanticipated by the child's history. CONCLUSIONS: The general guidelines for forensic evidence collection in cases of acute sexual assault are not well-suited for prepubertal victims. The decision to collect evidence is best made by the timing of the examination. Swabbing the child's body for evidence is unnecessary after 24 hours. Clothing and linens yield the majority of evidence and should be pursued vigorously for analysis.

Do we neglect child neglect?

Child neglect is a condition in which a major need of the child is not met, regardless of the cause or who is responsible for the condition. Multiple interacting factors at the individual (child and parent), familial, community, and societal levels contribute to child neglect. In typical neglect cases, a caretaker, either deliberately or through extraordinary inattentiveness, permits the child to experience avoidable suffering and/or fails to provide one or more of the components generally deemed essential for developing the child's physical, intellectual, and emotional capacities. Neglect varies in type, severity and chronicity. Both actual and potential harm should be weighed by a physician in considering reporting to child protective services. Outcome data on intervention are lacking, therefore proper intervention should be individualized and the results carefully monitored.

Yield from stool testing of pediatric inpatients.

OBJECTIVES: To quantify the yield from stool testing in pediatric inpatients and to identify criteria to test stool more deliberately without sacrificing diagnostic sensitivity. DESIGN: A retrospective review was performed of all stool cultures, ova and parasite examinations, and Clostridium [correction of Clostridia] difficile toxin assays performed on pediatric inpatients, aged 3 days to 18 years, at Thomas Jefferson University Hospital, Philadelphia, Pa, for 1 year. Medical records were reviewed for positive cases, each with 2 controls matched for age and test type. For this study, the term admission refers to the interval between the times each patient was admitted to and discharged from the hospital. Some patients had multiple stool tests sent to the laboratory during a single admission; some patients had more than 1 admission during the study period. Statistical analysis was performed using X2 analysis and the Student 2-tailed t test with a commercially available statistical software package (Statworks, Cricket Software, Philadelphia). RESULTS: Of 250 patient admissions to the hospital for which stool was cultured, 7 cultures (2.8%) were positive. Of 63 patient admissions having ova and parasite testing, 1 (2%) had a positive result. Clostridium [correction of Clostridia] difficile toxin assays were performed on 40 patient admissions to the hospital, and 7 (18%) had a positive result. Only 18 (3.0%) of 598 of all test results reviewed were positive. Costs of negative test results totaled $26,084. More patients (71%) with positive stool cultures than control patients (21%) had a temperature higher than or equal to 38 degrees C (X2, P < .05); however, relying on this sign missed 29% of the children with bacterial infection. A white blood cell band count of at least 0.10 was 100% sensitive and 79% specific in identifying patients with positive stool culture. There was no statistically significant relationship between stool culture results and age, total white blood cell count or white blood cell segmented neutrophil count, and no relationship between C. difficile toxin assay results and any of the above characteristics. Clostridium [correction of Clostridia] difficile was the most common pathogen identified (6 of 9) in patients developing gastrointestinal symptoms after admission; however, Salmonella enteritidis and Shigella sonnei were also significant causes (3 of 9). CONCLUSIONS: There is low yield from stool testing of pediatric inpatients: C. difficile toxin assay has the highest yield. Clostridium [correction of Clostridia] difficile testing is most valuable for children with nosocomial gastrointestinal symptoms although other bacterial pathogens do cause nosocomial symptoms in children. More selective stool testing could help us be more efficient with our patient care resources.

Home phototherapy: use and attitudes among community pediatricians.

Rather than using home phototherapy (HP), many pediatricians admit neonates to the hospital for the treatment of unconjugated hyperbilirubinemia. This study investigates the concerns and experiences of pediatricians related to HP use. A questionnaire was sent to 150 pediatricians in the Philadelphia, PA, area and 94 returned questionnaires. Of the responders, 30 of 94 had used HP. Twenty-nine users and 62 of 64 nonusers answered detailed questions regarding HP. Few practitioners follow American Academy of Pediatrics guidelines in selection of HP candidates. Among 29 pediatricians, prematurity (7), Rh incompatibility (13), positive direct Coombs (21), and ABO incompatibility (22) were not considered contraindications, although the American Academy of Pediatrics recommends all as contraindications. Almost all (29/30) HP users identified at least one problem with home treatment. The most commonly reported problems were parental anxiety, blood testing difficulties, and reimbursement issues. Nonusers (62) were asked their reasons for not using HP. The most common replies related to concerns about noncompliance (25), medical-legal issues (23), and administrative difficulties (22), none of which were cited as problems by HP users.

Finger injuries involving stationary exercise bicycles.

Injuries to children related to exercise bicycles can result in significant morbidity, but are almost entirely preventable. To forestall these injuries, manufacturers should continue to focus their attention on improved design and developing safer equipment. In addition, pediatricians and other primary care providers need to play a role in educating parents and the community about the possible hazards that exercise bicycles present to young children.

Legal proof of child sexual abuse in the absence of physical evidence.

Child sexual abuse criminal court cases from a 12-month period were reviewed to determine the frequency and significance of physical evidence in legally "proven" felony cases with penetration. One hundred fifteen consecutive cases were reviewed, and 87 (76%) had resulted in conviction of the perpetrator on felony charges. Charges of vaginal rape were made in 88 cases, and oral and/or anal sodomy in 67 cases. Physical evidence was present in only 23% of all cases that resulted in felony convictions. Felony convictions were obtained in 67 (79%) of 85 cases without physical evidence and in only 20 (67%) of 30 cases with physical evidence. Eight of the 10 cases without physical evidence that did not result in conviction involved victims younger than 7 years of age. Cases involving the youngest victims had a significantly lower conviction rate (12 of 23), despite a very high frequency (13 of 23) of physical evidence (P less than .0005). Physical evidence was neither predictive nor essential for conviction. Successful prosecution, particularly in cases involving the youngest victims, depended on the quality of the verbal evidence and the effectiveness of the child victim's testimony.

Urinary tract symptoms and urinary tract infection following sexual abuse.

During a routine follow-up visit, 428 victims of sexual abuse and their caretakers were asked about genitourinary complaints. Symptoms elicited included vaginal pain, increased urinary frequency, dysuria, and enuresis. A urinalysis was performed for all victims with symptoms, and those with positive or equivocal urinalysis results had a urine culture done. Urinalysis and urine culture were performed on a control group of 53 consecutive asymptomatic victims. Twenty percent (85/428) of the victims complained of one or more genitourinary symptoms. The most common symptom was vaginal pain (51%). Of the symptomatic victims, only 2 had a urinary tract infection. None of the 53 asymptomatic control victims had a urinary tract infection. There was no significant relationship between the presence of genitourinary symptoms and repetitive abuse, genital trauma, vaginal contact, or gender of the victim. However, patients younger than 6 years of age were more likely to have genitourinary symptoms than older patients. These findings indicate that urinary tract symptoms following sexual abuse are common but that urinary tract infection is quite uncommon. Our study does not support routine screening of children for urinary tract infection solely because they have been sexually abused.

Frequency and significance of physical evidence in legally proven cases of child sexual abuse.

Clinicians have long recognized and attorneys have disputed that physical evidence of injury, sexually transmitted diseases, and seminal fluid are often absent in cases of child sexual abuse. To determine the frequency and significance of physical evidence in legally "proven" felony cases with penetration, a retrospective review of sexual abuse court records was done. A total of 45 randomly selected cases were reviewed; 39 (87%) had resulted in conviction of the perpetrator for felony. Charges of vaginal rape were made in 32 cases, and charges of oral and/or anal sodomy in 23 cases. No significant difference in rate of felony conviction was found in cases with or without physical evidence. Of 32 cases without physical evidence, 30 (94%) resulted in felony convictions, whereas only 9 of 13 cases (69%) with physical evidence resulted in a felony conviction. Multiple variables describing the abuse situation were not shown to effect the legal outcome of the cases. Of cases that resulted in felony convictions, physical evidence was present in only 23% (9 of 39). These results should be helpful for the clinician in counseling the family of the sexual abuse victim and the attorney who prosecutes child sexual abuse cases.

Sexual interactions among siblings and cousins: experimentation or exploitation?

Incest by cousins has not been well documented compared with sibling incest. The purpose of this study was to describe the features of incest by cousins and siblings presenting to a sexual assault center and to differentiate cases of abusive behavior from normal sexual exploration. Four criteria were considered indicative of abusive behavior: (1) age difference of greater than or equal to 5 years between victim and perpetrator; (2) use of force, threat, or authority by abuser; (3) attempted penile penetration; and (4) documented injury in victim. Of 831 sexually abused children less than 14 years of age evaluated for sexual assault complaints, 49 cases of cousin incest (5.9%) and 35 cases of sibling incest (4.2%) were identified. A total of 54 male cousins abused 8 boys and 41 girls; brothers abused 3 boys and 32 girls. The victims' median age was 5 years for cousins and 7 years for siblings. The perpetrators' mean age was 16.2 years for cousins and 15.5 years for siblings, with only 16 (19%) of all perpetrators being greater than 16 years old. Of the perpetrators, 66 (79%) were greater than or equal to 5 years older than their victims. All 18 victims with age differences of less than 5 years met one or more of the other abusive criteria. A similar pattern of adolescent perpetrators having abusive sexual contact with young children was demonstrated by analysis of cousin incest and sibling incest in this study. Appropriate case management requires understanding of normal sexual experimentation and recognition of the abusive nature of these cases.

Maternal responses to the sexual abuse of their children.

To define categories of maternal response and determine their relationship to variable features of the abuse situation, a questionnaire was administered to mothers of 103 children returning for a routine 2- to 3-week follow-up of a sexual abuse episode. Three categories of response were identified: nonsupportive, supportive without emotional changes, and supportive with emotional changes. Nonsupportive mothers (n = 32) believed that the abuse complaint was a lie, a misunderstanding, or the child's fault. They rarely considered pressing charges or requested counseling. Supportive mothers (n = 71) believed that the child was telling the truth and that the assailant was primarily responsible. Anger, fear, anxiety, and guilt were commonly expressed. Thirty-nine of the supportive mothers reported behavior or mood changes including sleep, appetite, or somatic complaints and recurrent crying. Most were pressing charges (79%) and sought counseling for themselves (74%) and their children (82%). The 32 supportive mothers without behavior or mood changes also frequently pressed charges (88%) but sought counseling for themselves (6%) and the children (53%) less often (P less than .001). Individual personality and coping mechanisms may determine the maternal response. Maternal emotional responses do not appear to be related to variable features of the abuse situation but are significantly related to the approach to subsequent psychologic and legal issues.

Sexually transmitted diseases in sexually abused children.

To determine the prevalence and pattern of sexually transmitted diseases among sexually abused children, we evaluated 532 victims under 14 years of age for the presence of Neisseria gonorrhoeae and Treponema pallidum. Twenty-five girls with vaginal discharge and six children with perineal skin lesions underwent more detailed microbiologic examination. Thirty-four infections were identified in 33 children. Gonorrhea was present in 25 (4.7%) of the 532 children, and other sexually transmitted diseases were identified in nine children. Rates of gonococcal infection were higher for children with multiple episodes of abuse (8.1%), delayed reporting (7.4%), and for children evaluated for "suspicion of abuse" without a specific history (28%). Eight gonococcal infections (32%) were discovered at sites not involved in the abuse, according to the child's history. Eleven (44%) infected children were asymptomatic. Routine cultures of oropharyngeal and anogenital sites detected clinically unsuspected cases of oral, vaginal, and rectal gonorrhea. These data suggest that routine cultures are indicated for sexually abused children.

The medical evaluation of sexual abuse in children.

A number of questions must be addressed in order to effectively manage cases of sexual abuse in children. The author discusses when sexual abuse should be suspected, why physicians are often reluctant to manage such cases, who should perform the medical examination, the possibility of children contracting various sexually transmitted diseases, how to distinquish sexual fantasy from actual abuse, and reasons that a child might delay or retract a report of abuse.

Vaginitis due to Gardnerella vaginalis and to Candida albicans in sexual abuse.

Sexually transmitted diseases may be transferred to children and adolescents during voluntary or involuntary sexual contact. Two children are reported with the unusual association of sexual abuse and Candida albicans or Gardnerella vaginalis infections. Awareness of the techniques for diagnosis of these infections is essential for appropriate management of the abused child. These organisms should not be considered normal flora when found in symptomatic children and adolescents and should raise the possibility of sexual abuse.