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Healthcare Professionals' Views for the Content of the Teddy Bear Hospital for a Child Sexual Abuse Prevention Module

Rashid AA, Cheong AT, Shamsuddin NH, Roslan D, Hisham Shunmugam R

J Child Sex Abus, 2021 02 23;30(4):442-460.
PMID: 33620024 DOI: 10.1080/10538712.2021.1890294

Worldwide studies have reported a drastic increase in child sexual abuse (CSA) involving very young children. In Malaysia, several attempts have been made to combat this problem via educational programs. Teachers have reported a lack of confidence in teaching this topic; hence a less threatening approach is needed. The Teddy Bear Hospital (TBH) is an innovation whereby the children bring their teddies while visiting the volunteers assuming healthcare practitioners' role. This execution is effective in reducing the children's anxieties about hospitalization and increasing their health knowledge. Therefore, our objective is to explore healthcare practitioners' (HCP) views for the content of TBH and its approach as a personal safety module toward preventing CSA. Eighteen in-depth-interviews were conducted. Interviews were thematically analyzed. Participants suggest the TBH method as a good approach to teaching prevention of CSA among preschoolers. Four main themes emerged from this study: (1) educating children about personal safety, (2) moral values and faith as a medium to prevent child sexual abuse, (3) addressing social media use in children, and (4) general approach to content delivery. The involvement of parents is crucial. Addressing moral values and faith and usage of social media platforms are also essential factors to look into.

Matched MeSH terms: Child Abuse*; Child Abuse, Sexual*
The evolving evidence base for child protection in Chinese societies

Dunne MP, Chen JQ, Choo WY

Asia Pac J Public Health, 2008;20(4):267-76.
PMID: 19124321 DOI: 10.1177/1010539508325047

Child maltreatment is a substantial public health problem worldwide. Although extensively studied in Western countries, until recently little systematic research had been published about the situation in the world's most populous nation and ethnic diaspora. In this review, we examine trends from community-based research with Chinese young people and parents in mainland China, Hong Kong SAR, Taiwan, Singapore, and Malaysia. It is clear that many Chinese adolescents experience a substantial burden from various forms of maltreatment and the psychological and behavioral correlates are similar to those found in other cultures. However, the research reveals a large gap between this reality and Chinese adults' perceptions about emotional, physical, and sexual abuse. Comprehensive awareness programs are needed to close this information gap and thereby mobilize support for prevention and care initiatives.

Matched MeSH terms: Child Abuse/ethnology*; Child Abuse/prevention & control*; Child Abuse/psychology; Child Abuse/statistics & numerical data; Child Abuse, Sexual/ethnology; Child Abuse, Sexual/prevention & control; Child Abuse, Sexual/psychology; Child Abuse, Sexual/statistics & numerical data; Adult Survivors of Child Abuse/psychology
Fulltext A Review of Research on Child Abuse in Malaysia

Cheah IG, Choo WY

Med J Malaysia, 2016 06;71(Suppl 1):87-99.
PMID: 27801391 MyJurnal

The aim of this review was to summarise published literature on child abuse and neglect and its consequences in Malaysia, to discuss the implications of the research findings and to identify gaps in the local literature on child abuse and neglect. Medical and social literature in the English language published between the year 2000 to 2015 were searched for, resulting in forty four papers to be reviewed inclusive of a few key papers in the earlier years to provide some background information. The literature shows that child abuse and neglect is an important impact factor on mental health outcomes, involvement in substance abuse and delinquency due to the slant of the research interest from social studies. At least 70% of perpetrators are known to the affected children according to school-based prevalence studies. Safety programs and rehabilitation outcome studies involve small cohort groups. Studies on childhood mortality from child abuse or neglect are very limited. Overall, there are a few comprehensive studies involving school children but overall available studies are too patchy in to advocate for resource allocation, change in statutory procedures or training requirements. More extensive studies looking at the complex interaction of social environment, parenting skills, societal attitudes and responses, resilience factors and child safety nets and statutory response and their impact on different types of abuse or neglect are required.

Matched MeSH terms: Child Abuse*
Fulltext The bidirectional temporal relationship between parenting stress and child maltreatment: A cross-lagged study based on intervention and cohort data

Han Q, Jocson R, Kunovski I, Raleva M, Juhari R, Okop K, et al.

J Affect Disord, 2024 Jun 01;354:302-308.
PMID: 38479502 DOI: 10.1016/j.jad.2024.03.063

BACKGROUND: Parenting stress has long been proposed as a major risk factor for child maltreatment. However, there is a lack of evidence from existing studies on the temporal sequence to establish a causal relationship. This study aims to examine bidirectional temporal relationships between parenting stress and child maltreatment.
METHODS: Longitudinal data from two different sources were analysed: a pre-post study of an online parenting programme conducted across six countries - the ePLH Evaluation Study, and a prospective cohort study in the United States - LONGSCAN. Cross-lagged panel model on parenting stress and child maltreatment was used in each dataset.
RESULTS: Based on repeatedly measured data of 484 caregivers in the ePLH study across five time points (every two weeks), we found that parenting stress at an earlier time point predicted later child maltreatment (IRR = 1.14, 95 % CI: 1.10,1.18). In addition, the occurrence of child maltreatment was associated with higher subsequent short-term parenting stress (IRR = 1.04, 95 % CI: 1.01,1.08) and thus could form a vicious circle. In the LONGSCAN analysis with 772 caregivers who were followed up from child age of 6 to child age of 16, we also found parenting stress at an earlier time point predicted later child maltreatment (β = 0.11, 95 % CI: 0.01,0.20), but did not observe an association between child maltreatment and subsequent long-term parenting stress.
LIMITATIONS: Potential information bias on the measurements.
CONCLUSIONS: This study provides evidence for a bidirectional temporal relationship between parenting stress and child maltreatment, which should be considered in parenting intervention programmes.

Matched MeSH terms: Child Abuse*
Fulltext Social problems encountered in the rehabilitation of physically-abused women: two case reports

Loke KH, Alves K

Med J Malaysia, 1983 Sep;38(3):232-6.
PMID: 6672567

Physical abuse of women has been documented since the dawn of history. However, it is not frequent that such patients come for help as such. Rather, they present as part ofrelated complicated problems such as marital discord, attempted suicide, depression and even psychotic illness. Women have been traditionally considered to be the inferior sex and as such, in many countries, social rehabilitation is difficult within the legal rights granted by the provisions of the appropriate laws. Two cases of physical abuse were admitted to the University Hospital in 1981-82 and their difficult rehabilitation is described to highlight the inadequacies of the existing laws under which protection and rehabilitation of the patients were sought. An account of what was and could be done for them is given.

Matched MeSH terms: Child Abuse*
Battered child syndrome in a malaysian hospital

Hwang WT, Leng LK, Chin C

Med J Malaysia, 1974 Jun;28(4):239-43.
PMID: 4278650
Matched MeSH terms: Child Abuse*
Fulltext Unilateral ischaemic retinopathy and bilateral subdural haemorrhage in an infant with non-accidental injury: An ophthalmological approach

Ee CL, Mohd Abdullah AA, Samsudin A, Khaliddin N

Ulus Travma Acil Cerrahi Derg, 2019 09;25(5):527-530.
PMID: 31475330 DOI: 10.5505/tjtes.2018.57059

Non-accidental injury (NAI) is not an uncommon problem worldwide, which leads to significant morbidity and mortality in infants. The presence of retinal or subdural haemorrhages, or encephalopathy with injuries inconsistent with the clinical history is highly suggestive of NAI. In this study, we report on a case of a a 3-month-old infant who presented to the casualty department with a very sudden onset of recurrent generalised tonic-clonic seizures. There was no history of trauma or visible external signs. She was found to have bilateral subdural haemorrhages and atypical unilateral ischaemic retinopathy. Retinal photocoagulation was performed with subsequent resolution of vitreous and retinal haemorrhages. However, visual recovery in that eye remained poor. The findings showed that a high index of suspicion of NAI is required in infants with intracranial haemorrhage and unilateral retinal haemorrhages.

Matched MeSH terms: Child Abuse*
Systematic review and critical appraisal of child abuse measurement instruments

Saini SM, Hoffmann CR, Pantelis C, Everall IP, Bousman CA

Psychiatry Res, 2019 02;272:106-113.
PMID: 30580133 DOI: 10.1016/j.psychres.2018.12.068

Child abuse is a major public health concern and a strong predictor of adult psychopathology. However, a consensus on how best to measure child abuse is not evident. This review aimed to critically appraise the methodological quality and measurement properties of published child abuse measures, examined the strength of evidence of these instruments for research use using the COnsensus-based Standards for the selection of health Measurement InstrumeNts (COSMIN) checklist and determined which measures were capable of providing information on the developmental timing of abuse. Systematic search of electronic databases identified 52 eligible instruments from 2095 studies. Only 15% (n = 8) of the instruments had strong to moderate levels of evidence for three or more of the nine COSMIN criteria. No instrument had adequate levels of evidence for all criteria, and no criteria were met by all instruments. Our results indicate there is no single instrument that is superior to all others across settings and populations. The availability of measures capable of capturing the effects of child abuse on brain development and associated behavioral phenotypes are limited. Refined instruments with a focus on capturing abuse events during development are warranted in addition to further evaluation of the psychometric properties of these instruments.

Matched MeSH terms: Child Abuse*
Fulltext Typologies and Psychological Profiles of Child Sexual Abusers: An Extensive Review

Lim YY, Wahab S, Kumar J, Ibrahim F, Kamaluddin MR

Children (Basel), 2021 Apr 25;8(5).
PMID: 33922985 DOI: 10.3390/children8050333

Child sexual abuse is a public health issue that has been associated with a variety of negative health outcomes. Child sexual abusers constitute a heterogeneous population of individuals. This review lays out an overview of the current understanding of typologies and psychological profiles of child sexual abusers. Typologies of child sexual abusers in general and online child sexual abusers are reviewed to summarise the existing knowledge. Psychological traits including personality traits, cognitive distortion, empathy, and impulsivity are examined to provide a wider perspective of the psycho-criminogenic factors of child sexual abuse. Although past research on child sexual abusers has provided insights into the organisation and classification of different types of child sexual abusers, the classification of these typologies has drawn widespread criticisms. In this review, we discuss the challenges and limitations pertaining to the existing typologies and studies related to the psychological profile of child sexual abusers.

Matched MeSH terms: Child Abuse; Child Abuse, Sexual
A battered child

Hock YO, Hwang WT

Med J Malaysia, 1975 Sep;30(1):43-47.
PMID: 1207531
Matched MeSH terms: Child Abuse*
An Overview of the Psychodynamics of Addiction

Alfonso CA

Psychodyn Psychiatry, 2021;49(3):363-369.
PMID: 34478324 DOI: 10.1521/pdps.2021.49.3.363

The author provides an overview of the psychodynamics of addiction, diverging from outdated conceptualizations such as orality and regression, and emphasizing the clinical relevance of the self-medication hypothesis. Rado and Bion paved the way for Khantzian's self-medication hypothesis by describing the drug user's need to escape unpleasure and seek self- containment. The author reviews research corroborating the relevance of the self-medication hypothesis and other relevant constructs such as self-deceptive attempts at adaptation, inability to prioritize self-care or delay gratification, excessive hedonism and novelty seeking, and impulsivity. Adverse childhood experiences, abuse and neglect are known to cause epigenetic changes altering gene expression, which may endure throughout life and be transmitted intergenerationally. Effective psychotherapeutic interventions have the potential to reverse DNA methylation and other epigenetic changes triggered by trauma and co-morbid psychopathology. Lastly, this editorial also introduces the psychodynamically informed clinical recommendations of Baurer and Gottdiener, further described in separate articles in this issue of Psychodynamic Psychiatry.

Matched MeSH terms: Child Abuse*
Fulltext Coining: an ancient treatment widely practiced among asians

Tan AK, Mallika PS

Malays Fam Physician, 2011;6(2-3):97-8.
PMID: 25606235 MyJurnal

Coining is a technique used in treating many illnesses since ancient times. It is a form of dermabrasion therapy still widely practiced in China and South East Asia. This ancient treatment method is employed to rid the body of "heatiness" or "negative energies". Coining is associated with serious complications, and has been confused with child abuse by physicians unfamiliar to Asian cultures. Despite the availability of more simple and effective treatment for fever, coining is still widely practiced among Asians.

Matched MeSH terms: Child Abuse
Child abuse in Malaysia: recent development and challenges

Woon TH

Family Physician, 1996;9:12-16.

This article highlighted the recent development in the prevention and management of child abuse in Malaysia. There is now a willingness to recognise the conlplex social, moral, medical, educational, legal and economic problems related to child abuse. Multidisciplinary research, comprehensive and longitudinal targeted services to prevent child abuse and neglect are needed.

Matched MeSH terms: Child Abuse
Social situational stresses which lead to child abuse in Kuala Lumpur

Loke KH

Family Practitioner, 1987;10:31-33.

Child abuse is as age-old problem which involves physical, emotional and sexual abuse and also the unauthorised administration of drugs to children. The problem does not arise from just a single cause or factor but is multifactorial. One big area is the presence of social situational stresses prior to or during the episodes of abuse. The author has carried out a retrospective study of twenty cases of child abuse investigated by the Department of Social Welfare, Kuala Lumpur from December 1979 to January 1980. This paper describes part of the findings, namely the social situational stresses. The findings are found to be similar to those of other studies, both local and abroad.

Matched MeSH terms: Child Abuse
Fulltext Osteogenesis Imperfecta and non-accidental injury: problems in diagnosis and management

Kasim MS, Cheah I, Sameon H

Med J Malaysia, 1995 Jun;50(2):170-5.
PMID: 7565189

It has been noted in the literature that Osteogenesis Imperfecta is frequently mistaken for non-accidental injury. This article serves to illustrate the difficulty in differentiating between the two conditions and that they can occur concomitantly in one patient.

Matched MeSH terms: Child Abuse/diagnosis*
Fulltext Drowning in a child: accidental or neglect?

Faridah MN, Khairani O

Med J Malaysia, 2003 Dec;58(5):774-6.
PMID: 15190669

We report the case of an infant who was found dead in the toilet of a nursery. Examination of the scene revealed an element of neglect in the care of the child. Postmortem showed evidence of drowning. Her blood sample showed a toxicologic evidence of alcohol exposure.

Matched MeSH terms: Child Abuse*
Suspected child abuse and neglect cases in a single tertiary hospital in Malaysia - a 5-year retrospective study

Vinitha P, Rohaizah B, Faiza MR

Med J Malaysia, 2020 09;75(5):548-554.
PMID: 32918425

BACKGROUND: Published reports by the Social Welfare Department of Malaysia suggests that child abuse and neglect cases has been steadily increasing. There is a lack of basic data and qualitative study on child maltreatment in Malaysia.
OBJECTIVE: The aim is to describe the pattern and demographic features of all suspected child abuse and neglect (SCAN) cases seen in a single tertiary hospital in Malaysia over a period of five years.
METHODS: A retrospective descriptive review of children suspected of maltreatment, aged 0 to 18 years old who presented to the Hospital Serdang (HS), Selangor, Malaysia from January 2014 to December 2018 was done. A list of registered SCAN cases obtained from One Stop Crisis Centre (OSCC) HS census. Clinical information of patients was retrieved from the computerised database.
RESULTS: In all, there were a total of 391 SCAN cases over five years with almost a 3-fold increase in the number of cases from 2014 to 2018. Physical abuse was the most common (55%) seen followed by sexual abuse (34%) and neglect (10%). There were four deaths, all involving infants <1 year old who were physically abused by babysitters. The main perpetrator in sexual abuse were people known to the victim. Ninety-three percent of patients were neglected by their biological parents and more than 2/3rd of neglect cases occurred due to inadequate supervision.
DISCUSSION: Child maltreatment is an inevitable burden to our health system and infants are the most vulnerable group to sustain significant injuries leading to death and disabilities.

Matched MeSH terms: Child Abuse*
Fulltext Predisposing Factors and Impact of Child Victimization: A Qualitative Study

Wahid Satar SNA, Norhayati MN, Sulaiman Z, Othman A, Yaacob LH, Nik Hazlina NH

Int J Environ Res Public Health, 2021 09 05;18(17).
PMID: 34501964 DOI: 10.3390/ijerph18179373

Sexual abuse of children is increasing at an alarming rate. This study aims to describe the risk factors and the effects of sexual abuse on children. This unobtrusive qualitative study was conducted on children aged 10 to 18 years old who experienced sexual abuse and followed-up at a psychiatric clinic between the years 2019 and 2021. The information from case records was transcribed. Thematic analysis was performed. Thirty case records were reviewed. The mean age of the victims was 14.6 years; 94% of the victims had experienced vaginal penetration, and 23% of the cases involved incest. The results indicated that socio-psychological predisposing factors involving family structure and dynamic dysfunction, low intrapersonal strength, social influence, and low family socioeconomic status could lead to sexual victimization. This sexual victimization can then lead to emotional turmoil, negative effects on cognitive, academic and social function, negative parental reactions toward the incident, the creation of baby-mother relationships and love-hate relationships, and a lack of goals and hope for the future. Children who experienced sexual abuse may show rape or pregnancy symptoms but may also show entirely non-specific ones. A thorough examination of their history, including biopsychosocial aspects, is necessary to appropriately care for them.

Matched MeSH terms: Child Abuse, Sexual*
Fulltext Pattern of Sexual Offences Attended at Accident and Emergency Department of HUSM from Year 2000 to 2003: A Retrospective Study

Islam MN, See KL, Ting LC, Khan J

Malays J Med Sci, 2006 Jan;13(1):30-6.
PMID: 22589588

This paper investigates the pattern of sexual offence cases attended at the One Stop Crisis Center (OSCC) of the Accident and Emergency Department, Hospital Universiti Sains Malaysia (HUSM), Kelantan. A total of 439 reported sexual offence cases were examined over a period of 4 years from 2000 to 2003. Sexual offence constituted by male partner or boyfriend in 18.9%, by relatives in 27.3% and by "others" in 53.8% of cases. Only 0.7% of victims did not attempt to lodge a police report. There is a significant relationship between occupation and the risk of experiencing sexual violence. Students were mostly targeted by the perpetrator throughout the study period. Among the offences, rape cases were the highest in number, among those who attended at the OSCC, HUSM with a total of 72.7%; followed by 27.3% of incest; 26.4% of child sexual abuse; 4.8% of sodomy and lastly 1.6% of gerontophilia cases. Only 70% of the specimens obtained from sexual offences victims were sent for laboratory analysis. The result remained negative in 82.4% specimens and thus the laboratory analysis result is merely functioning as a supportive evidence for sexual offence cases attended at OSCC. The studies showed that most of the sexual assault perpetrators were known to the victims. The place of crime was also known to the perpetrators. Health sectors of various levels should be working in conjunction to promote a societal changes to improve more of the women's right and thus to reduce the violence crime.

Matched MeSH terms: Child Abuse; Child Abuse, Sexual
Prevalence of childhood sexual abuse among Malaysian paramedical students

Singh HS, Yiing WW, Nurani HN

Child Abuse Negl, 1996 Jun;20(6):487-92.
PMID: 8800523

There has been increasing awareness that sexual abuse of children is a problem in Malaysia. Existing data is based on notification of cases. Population based studies are required to plan services for sexually abused children. This study utilized trainee paramedical staff as a community population to determine the prevalence of childhood sexual abuse. An anonymous, self-administered questionnaire was given to student nurses and trainee medical assistants at the Ipoh School of Nursing and Hospital Bahagia Medical Assistant Training School. Questionnaires were distributed directly to all students in a classroom setting and retrieved after a 30-minute interval. Information collected included questions on personal experiences of sexual abuse. Sexual abuse was defined as rape, sodomy, molestation, or exhibitionism occurring to a child less than 18 years of age. Six hundred and sixteen students participated in the study; 6.8% of the students admitted to having been sexually abused in their childhood, 2.1% of males and 8.3% of females. Of those abused, 69% reported sexual abuse involving physical contact, 9.5% of whom experienced sexual intercourse. The age at first abuse was < 10 years in 38.1% of the cases; 59.5% were repeatedly abused and 33.3% had more than one abuser. Of the abusers, 71.4% were known to the respondent, 14.2% of whom were brothers, 24.5% relatives, and 24.5% a family friend. Further, 28.9% of all students knew of an individual who had been sexually abused as a child. While this population may not be entirely reflective of the community, this study does provide an indication of the prevalence of sexual abuse in Malaysian children. The prevalence figures in this study are lower than those reported in industrialized countries and this may reflect local sociocultural limitations in reporting abuse.

Matched MeSH terms: Child Abuse, Sexual/ethnology; Child Abuse, Sexual/prevention & control; Child Abuse, Sexual/statistics & numerical data*

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