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By R. Hjalte. William Jewell College.

In indicated child abuse cases generic detrol 2mg on line, the child abuse cannot be proven under the law but there is reason to suspect that the child was abused or at risk of abuse buy cheap detrol 1 mg line. Unsubstantiated ??? insufficient evidence was found to prove or suspect that child abuse had taken place. From there, CPS decides on appropriate action given the individual situation. Help for an abused child is needed when, unfortunately, steps taken to prevent abuse have failed. This is shockingly common as more than half-a-million children were confirmed victims of child abuse in 2010, according to Child Protective Services. In the United States , child abuse help is critical for these abused children so that their healing can begin and they can again return to a normal childhood. The first step in child abuse help is in properly dealing with the allegations of the abused child. If an abused child reports the abuse to you, you should: Reassure the child they did nothing wrong, it is not their fault and they will not be punishedReassure the child you believe them and that you are glad they toldOffer comfort ??? tell the child you will helpEnsure the safety of both you and the childUnderstand that the child may express him or herself with language appropriate for their age and may not know the proper terms for body parts or specific acts. Tell the child that you cannot keep this information secret (in many countries and states this is the law)Report the child abuse to the authorities immediatelyTo help an abused child you should not:Make suggestions as to what happenedAct shocked, disgusted or doubtful of the abuse. This may make the child uncomfortable and less likely to talk. These children continue to need love and support and if abuse is still suspected, the authorities should be informed. Child abuse help needs to take into account injuries that are physical, psychological and even spiritual in nature. This will likely mean that a team of people needs to be involved in helping the abused child. Persons on this team will likely include:A child psychologist or other mental health professionalA faith leader, if appropriateThe families of the abused child may also need their own treatment services to help get the family through a tough event that can affect everyone. Treatments that help abused children and their families include:Therapeutic day school programsHome and clinic setting treatmentGroup and family therapyWould you know how to spot child physical abuse? Despite the popular notion that physical child abuse is rare, almost 200,000 cases were reported in the United States and its territories in 2007. The actual number of cases is probably much higher because many people fail to report known or suspected abuse. Social workers and other health-related professionals used to refer to signs of child physical abuse as battered child syndrome. This terminology referred to the bone fractures and related injuries occurring when the child was too young to accidentally become injured in this way. Experts have now expanded the physical child abuse definition. Children in physically abusive situations often have unexplained broken bones, bruise marks in the shape of an object such as a belt or hand, or burn marks from cigarettes on exposed areas or on the genitalia. You may encounter someone that exhibits the signs of physical child abuse at a family or school event, church gathering, or any number of places. Sometimes health care professionals identify physical child abuse when an adult brings a child to the emergency room with an unlikely explanation about how the injury occurred. All states have laws in place requiring you to report known or suspected child physical abuse or neglect. Most states have a child abuse hotline that you can call to report child physical abuse. You can also call the Child Help National Child Abuse Hotline at 1-800-4-A-CHILD (1-800-422-4453). Of course, if you suspect a child is in immediate danger, call 911 immediately. For more information about state laws concerning physical child abuse, visit the Child Welfare Gateway Laws and Policies webpage. Child Protective Services (sometimes called Social Services, Human Services, Human Welfare, or Children and Family Services), the police or emergency services will never reveal your identity to the child or any adults involved in the abusive situation. Social workers and other appropriate authorities will investigate the situation and evaluate whether or not abuse or neglect has occurred. If they determine the child is being abused or neglected, they may temporarily or permanently remove the child from the situation and he or she will undergo further diagnostic tests and exams. The investigative team will then come up with the best possible recovery plan for the child. Parents or other adults involved in inflicting physical child abuse will need therapy and sometimes other (more punitive) interventions. Recovery prognosis for the child depends upon the extent of the abuse, the nature of the injuries, and the psychological effect these experiences have had on him or her.

Demographic and baseline characteristics for the 871 Symlin-treated patients are as follows: mean baseline HbA1c ranged from 9 buy detrol 2 mg low cost. Table 2 summarizes the composite results across both studies for patients assigned to the 120-mcg dose after 6 months of treatment cheap detrol 2 mg mastercard. Table 2: Mean (SE) Change in HbA1c, Weight, and Insulin at 6 Months in the Double-Blind, Placebo-Controlled Studies in Patients With Insulin-Using Type 2 DiabetesChange in HbA1c at 6 Months Relative to Baseline (%)Placebo-Subtracted HbA1c Change at 6 Months (%)Change in Weight at 6 Months Relative to Baseline (kg)Placebo-Subtracted Weight Change at 6 Months (kg)Percent Change in Insulin Doses at 6 Months: Rapid/Short-ActingPercent Change in Insulin Doses at 6 Months: Long-Acting* Statistically significant reduction compared with placebo (p-valueIn a cohort of 145 patients who completed two years of Symlin treatment the baseline-subtracted HbA1c and weight reductions were: ?v-0. Open-Label Study in the Clinical Practice SettingAn open-label study of Symlin was conducted at the recommended dose of 120 mcg in 166 patients with insulin-using type 2 diabetes who were unable to achieve glycemic targets using insulin alone. A flexible-dose insulin regimen was employed in these patients (see DOSAGE AND ADMINISTRATION ). In this study, patients adjusted their insulin regimen based on pre- and post-meal glucose monitoring. Symlin plus insulin treatment for 6 months resulted in a baseline-subtracted mean HbA1c reduction of ?v-0. These changes were accomplished with reductions in doses of total, short-acting, and long-acting insulin (?v-6. The efficacy of a range of Symlin doses was evaluated in several placebo-controlled and open-label clinical trials conducted in patients with type 1 diabetes. Based on results obtained in these studies, the recommended dose of Symlin for patients with type 1 diabetes is 30 mcg or 60 mcg administered immediately prior to major meals. Three, long-term (26 to 52 week), randomized, double-blind, placebo-controlled studies of Symlin were conducted in patients with type 1 diabetes (N=1717). Two of these studies allowed only minimal insulin adjustments in order to isolate the Symlin effect; in the third study, insulin adjustments were made according to standard medical practice. Demographic and baseline characteristics for the 1179 Symlin-treated patients were as follows: mean baseline HbA1c range was 8. Symlin or placebo was added to existing insulin therapies. Table 3 summarizes the composite results across these studies for patients assigned to the 30 or 60 mcg dose after 6 months of treatment. Table 3: Mean (SE) Change in HbA1c, Weight, and Insulin at 6 Months in the Double-Blind, Placebo-Controlled Studies in Patients With Type 1 DiabetesIn a cohort of 73 patients who completed two years of Symlin treatment the baseline-subtracted HbA1c and weight changes were: ?v-0. A dose-titration study of Symlin was conducted in patients with type 1 diabetes. Patients with relatively good baseline glycemic control (mean HbA1c = 8. Other baseline and demographics characteristics were: mean age of 41 years, mean duration of diabetes of 20 years, mean BMI of 28 kg/m2. Symlin was initiated at a dose of 15 mcg and titrated upward at weekly intervals by 15-mcg increments to doses of 30 mcg or 60 mcg, based on whether patients experienced nausea. Once a tolerated dose of either 30 mcg or 60 mcg was reached, the Symlin dose was maintained for the remainder of the study (Symlin was administered before major meals). During Symlin titration, the insulin dose (mostly the short/rapid-acting insulin) was reduced by 30-50% in order to reduce the occurrence of hypoglycemia. Once a tolerated Symlin dose was reached, insulin dose adjustments were made according to standard clinical practice, based on pre- and post-meal blood glucose monitoring. By 6 months of treatment, patients treated with Symlin and insulin and patients treated with insulin and placebo had equivalent reductions in mean HbA1c (?v-0. Symlin-treated patients used less total insulin (?v-11. An open-label study of Symlin was conducted in patients with type 1 diabetes who were unable to achieve glycemic targets using insulin alone. A flexible-dose insulin regimen was employed in these patients after Symlin titration was completed (see DOSAGE AND ADMINISTRATION ). In this study, patients adjusted their insulin regimen based on pre- and post-meal glucose monitoring. Symlin daily dosage was 30 mcg or 60 mcg with major meals. Symlin plus insulin reduced HbA1c and body weight from baseline at 6 months by a mean of 0. These changes in glycemic control and body weight were achieved with reductions in doses of total, short-acting, and long-acting insulin (?v-12. Symlin is given at mealtimes and is indicated for:Type 1 diabetes, as an adjunct treatment in patients who use mealtime insulin therapy and who have failed to achieve desired glucose control despite optimal insulin therapy. Type 2 diabetes, as an adjunct treatment in patients who use mealtime insulin therapy and who have failed to achieve desired glucose control despite optimal insulin therapy, with or without a concurrent sulfonylurea agent and/or metformin. Symlin is contraindicated in patients with any of the following:a known hypersensitivity to Symlin or any of its components, including metacresol;a confirmed diagnosis of gastroparesis;hypoglycemia unawareness. Symlin therapy should only be considered in patients with insulin-using type 2 or type 1 diabetes who fulfill the following criteria:have failed to achieve adequate glycemic control despite individualized insulin management;are receiving ongoing care under the guidance of a healthcare professional skilled in the use of insulin and supported by the services of diabetes educator(s).

This set of assumptions often presents serious obstacles for victims as they attempt to cope with their experience and recovery cheap 1 mg detrol with amex. If a woman agrees to allow a man to pay for dinner detrol 1 mg low cost, drinks, etc. Sex is not an implied payback for dinner or other expense no matter how much money has been spent. Acquaintance rape is committed by men who are easy to identify as rapists. Women are often raped by "normal" acquaintances who resemble "regular guys. Rape occurs when one is forced to have sex against their will, whether they have decided to fight back or not. Intimate kissing or certain kinds of touching mean that intercourse is inevitable. Men are capable of exercising restraint in acting upon sexual urges. Most women lie about acquaintance rape because they have regrets after consensual sex. Acquaintance rape really happens - to people you know, by people you know. Drinking or dressing in a sexually appealing way are not invitations for sex. Women who subscribe to "traditional" views of men occupying a position of dominance and authority relative to women (who are seen as passive and submissive) may be at increased risk. In a study where the justifiability of rape was rated based on fictional dating scenarios, women with traditional attitudes tended to view the rape as acceptable if the women had initiated the date (Muehlenhard, in Pirog-Good and Stets, 1989). Drinking alcohol or taking drugs appears to be associated with acquaintance rape. Koss (1988) found that at least 55 percent of the victims in her study had been drinking or taking drugs just before the attack. Women who are raped within dating relationships or by an acquaintance are seen as "safe" victims because they are unlikely to report the incident to authorities or even view it as rape. Not only did a mere five percent of the women who had been raped in the Koss study report the incident, but 42 percent of them had sex again with their assailants. The company one keeps may be a factor in predisposing women to an increased risk of sexual assault. An investigation of dating aggression and the features of college peer groups (Gwartney-Gibbs & Stockard, in Pirog-Good and Stets, 1989) supports this idea. The results indicate that those women who characterized the men in their mixed-sex social group as occasionally displaying forceful behavior towards women were significantly more likely themselves to be victims of sexual aggression. Being in familiar surroundings does not provide security. Just as with the victim, it is not possible to clearly identify individual men who will be participants in acquaintance rape. As a body of research begins to accumulate, however, there are certain characteristics which increase the risk factors. Acquaintance rape is not typically committed by psychopaths who are deviant from mainstream society. It is often expressed that direct and indirect messages given to boys and young men by our culture about what it means to male (dominant, aggressive, uncompromising) contribute to creating a mindset which is accepting of sexually aggressive behavior. Such messages are constantly sent via television and film when sex is portrayed as a commodity whose attainment is the ultimate male challenge. Buying into stereotypical attitudes regarding sex roles tends to be associated with justification of intercourse under any circumstances. Other characteristics of the individual seem to facilitate sexual aggression. Research designed to determine traits of sexually aggressive males (Malamuth, in Pirog-Good and Stets, 1989) indicated that high scores on scales measuring dominance as a sexual motive, hostile attitudes towards women, condoning the use of force in sexual relationships, and the amount of prior sexual experience were all significantly related to self-reports of sexually aggressive behavior. Furthermore, the interaction of several of these variables increased the chance that an individual had reported sexually aggressive behavior. The inability to appraise social interactions, as well as prior parental neglect or sexual or physical abuse early in life may also be linked with acquaintance rape (Hall & Hirschman, in Wiehe and Richards, 1995). Finally, taking drugs or alcohol is commonly associated with sexual aggression. Of the men who were identified as having committed acquaintance rape, 75 percent had taken drugs or alcohol just prior to the rape (Koss, 1988). The consequences of acquaintance rape are often far-reaching. Once the actual rape has occurred and has been identified as rape by the survivor, she is faced with the decision of whether to disclose to anyone what has happened. In a study of acquaintance rape survivors (Wiehe & Richards, 1995), 97 percent informed at least one close confidant. The percentage of women who informed the police was drastically lower, at 28 percent.