Validation of the traumatic sexualization survey for use with heterosexual men

Two studies were conducted to validate the Traumatic Sexualization Survey (TSS) for use with heterosexual men. In Study 1, an online sample of men completed the TSS and measures used to examine convergent and divergent validity. An exploratory factor analysis revealed that the TSS had a similar factor structure in men as previously found in women. The TSS demonstrated adequate reliability and validity with men. In Study 2, male sexually transmitted disease clinic patients completed the TSS and a measure of child maltreatment. Men with a child sexual abuse (CSA) history reported higher levels of traumatic sexualization than men with a history of only physical abuse or no abuse, providing some preliminary evidence of construct validity. The TSS appears to be an adequate measure of maladaptive attitudes that have been conceptually linked to CSA impact in men.     

The medical implications of Cleveland

SUMMARY. This article sets the ‘discovery’ of child sexual abuse in context and reviews the key issues for doctors now that the Inquiry Report has been published. In particular the author focuses on the controversy over diagnosis and ‘screening’ Not only is there a need for clarity on these issues, but also a need to restore basic trust between doctors, parents and children. She also urges development of multi-disciplinary training and working and explores the proposed ‘special assessment teams’, hut concludes that resources will he a major constraint     

The informal rationing of primary medical care

All social services are rationed, yet the effects of such rationing on the client are rarely fully explored. This article reviews the evidence on the existence of informal rationing devices in general practice. It examines the effects on patients of a wide range of informal rationing devices now used by individual general practitioners. Various suggestions for reforming the present rationing of primary medical care are evaluated and the likelihood of any reform being carried out is assessed. Although this article concentrates solely on rationing in the primary care sector of the National Health Service, the issues discussed are relevant to most welfare agencies as they are presently organized.     

The challenge of the medical setting for the clinical specialist in psychiatric nursing

The purpose of sharing these ideas about the role of the psychiatric clinical specialist in the medical setting has been threefold: first, to stimulate the interest of others by communicating the needs for and the value of such a role in improving health care; secondly, to convey the variety of potential opportunities available in the role; and third, to share some ideas about specific activities which can be pursued in such a role. The clinical specialist who chooses to work in the medical setting will discover opportunities to develop creativeness, to explore innovative ideas, and to utilize the variety of one's personal resources and past learning experiences. It affords one with opportunities to serve as a change agent, to influence the quality of patient care, and to stimulate the growth of other nurses. It allows for on-going contact and exchange with other professional groups comprising the health care team, and finally, it provides the nurses with a high level of autonomy and challenge in defining their own roles.     

The assessment of values in medical decision making

Individuals, families, and health care providers consider medical treatment decisions in light of their respective values about life iin varying states of health. The clarification of health care values is important not only in the context of everyday clinical decision making, but also for advance care planning and the resolution of ethical dilemmas. This article argues that objective assessment tools may facilitate the process of clarifying and communicating health care values in these contexts. The article reviews arguments for the importance of values assessment in health care planning, methods used to date for health care values assessment, conceptual and methodological challenges for the measurement of health care values, and lessons learned through the process of developing and piloting a Health Care Values Survey. Objective values assessment tools appear useful for eliciting health care values, although multiple challenges for reliable, valid, and clinically useful measurement of values are identified.     

Timing of the medical examination

The medical examination of the sexually abused child may have evidentiary, medical, and therapeutic purposes, and the timing of the examination requires consideration of each of these objectives. In cases of acute sexual assault, emergent examinations may be needed to identify injury, collect forensic evidence, and provide infection and pregnancy prophylaxis. Alternately, most sexually abused children are not identified immediately after assault, and the timing of the examination needs to balance physical and emotional issues with the availability of qualified examiners. In all cases, the best interests of the child should be paramount.     

Conducting the medical history

A key portion of the medical evaluation of child sexual abuse is the medical history. This differs from interviews or histories obtained by other professionals in that it is focuses more on the health and well-being of the child. Careful questions should be asked about all aspects of the child's medical history by a skilled, compassionate, nonjudgmental, and objective clinician. Often the diagnosis of sexual abuse is based only on the medical history. The history can be further understood by knowledge of how children are abused and their reactions to it. By addressing the child's and parent's concerns, reassurance can also be provided about what is normal and abnormal with the child's body.     

The role of the medical provider in the evaluation of sexually abused children and adolescents

It was only 30 years ago that the medical community began to develop an increased awareness of child sexual abuse, and the role of the medical provider in the evaluation of sexually abused children has evolved significantly. As clinicians worldwide develop a greater understanding of the impact of the sexual abuse evaluation on the child, the roles of the physician and nurse have changed. In the United States, current practice often uses a multidisciplinary assessment involving skilled forensic interviewing of the child and a medical examination done by a medical provider with specialized training in sexual abuse. In order to minimize child interviews, these assessments are frequently held in settings such as child advocacy centers, where forensic interviewers and medical clinicians, child protective service workers, and police and district attorneys can work jointly to address the legal and protective issues in a coordinated fashion.     

Doctors for the empire: The medical school of Goa and its narratives

This paper studies the establishment of medical teaching in Portuguese colonial settings as a means to understand the ways of empire building. The rules and regulations regarding surgeons and doctors in the African and Asian colonies evidence a structure of subalternities within the empire. Goa, in India, emerges as the second to the metropolis within that hierarchy, and the Medical School of Goa becomes the ultimate producer of doctors for the empire. We will bring to the analysis the narratives and representations of Goan doctors about their Medical School and its role in empire building. The analysis raises a number of issues that deserve further discussion: the ideologies of colonialism and the colonial condition, the formation of hierarchies within imperial structures, the tensions between social groups defined by the empire, the interaction between different bodies of knowledge and medical practices in the context of colonization, and the ambiguous position of creóle elites within a colonial system.     

The medical model of pathological gambling: Current shortcomings

Occasional, regular and pathological gambling are distributed in the population as a continuum. Failure to find categorical features of pathological gambling weakens the medical model for this condition, and the implications of this model concerning treatment, both in relation to the possibility of controlled gambling as an acceptable goal, and as to the effectiveness of social manipulations, such as restrictions of gambling outlets. Differences in gambling behavior patterns between pathological and nonpathological gamblers has not been consistently demonstrated and though some support exists for a relationship between addiction to gambling and alcohol, this could be accounted for by other factors than an addiction-prone personality. While findings support a relationship between personality variables and pathological gambling, the concept of a single personality type associated with the behavior seems unlikely. Nevertheless, evidence of physiological differences between pathological gamblers and controls has recently been reported and if established would provide strong support for a medical model, particularly one which allows for an interaction of physiological and sociological factors resulting in dimensional distribution of gambling behaviors.