Reported cases of child sexual abuse in Zambia between 2011 and 2014.
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Barely three months into the new year and we are happy to announce a monumental milestone reached - 150 million downloads.
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\n\nThank you for making IntechOpen your place of learning, sharing, and discovery, and here’s to 150 million more!
\n\n\n\n\n'}],latestNews:[{slug:"webinar-introduction-to-open-science-wednesday-18-may-1-pm-cest-20220518",title:"Webinar: Introduction to Open Science | Wednesday 18 May, 1 PM CEST"},{slug:"step-in-the-right-direction-intechopen-launches-a-portfolio-of-open-science-journals-20220414",title:"Step in the Right Direction: IntechOpen Launches a Portfolio of Open Science Journals"},{slug:"let-s-meet-at-london-book-fair-5-7-april-2022-olympia-london-20220321",title:"Let’s meet at London Book Fair, 5-7 April 2022, Olympia London"},{slug:"50-books-published-as-part-of-intechopen-and-knowledge-unlatched-ku-collaboration-20220316",title:"50 Books published as part of IntechOpen and Knowledge Unlatched (KU) Collaboration"},{slug:"intechopen-joins-the-united-nations-sustainable-development-goals-publishers-compact-20221702",title:"IntechOpen joins the United Nations Sustainable Development Goals Publishers Compact"},{slug:"intechopen-signs-exclusive-representation-agreement-with-lsr-libros-servicios-y-representaciones-s-a-de-c-v-20211123",title:"IntechOpen Signs Exclusive Representation Agreement with LSR Libros Servicios y Representaciones S.A. de C.V"},{slug:"intechopen-expands-partnership-with-research4life-20211110",title:"IntechOpen Expands Partnership with Research4Life"},{slug:"introducing-intechopen-book-series-a-new-publishing-format-for-oa-books-20210915",title:"Introducing IntechOpen Book Series - A New Publishing Format for OA Books"}]},book:{item:{type:"book",id:"5942",leadTitle:null,fullTitle:"Current Topics in Anemia",title:"Current Topics in Anemia",subtitle:null,reviewType:"peer-reviewed",abstract:"This book deals with a very common condition, anemia, which might interest not only the physicians but also other healthcare professionals and researchers dealing with anemic patients. The objective of this book was to collect and compile up-to-date information from reputable researchers of different countries of the world to disseminate the latest information about the common types of anemia in some specific physiological and pathological conditions including pathophysiology and the use of algorithms as a tool to minimize the laboratory tests and accurate diagnosis of the underlying cause. In total, there are 13 chapters in this book where the authors shared their research findings and real-life experiences in managing their patients with anemia.",isbn:"978-953-51-3775-7",printIsbn:"978-953-51-3774-0",pdfIsbn:"978-953-51-4000-9",doi:"10.5772/66061",price:119,priceEur:129,priceUsd:155,slug:"current-topics-in-anemia",numberOfPages:282,isOpenForSubmission:!1,isInWos:null,isInBkci:!1,hash:"85b91f77e277d6cea5a324b9f2431687",bookSignature:"Jesmine Khan",publishedDate:"February 7th 2018",coverURL:"https://cdn.intechopen.com/books/images_new/5942.jpg",numberOfDownloads:26734,numberOfWosCitations:11,numberOfCrossrefCitations:12,numberOfCrossrefCitationsByBook:1,numberOfDimensionsCitations:27,numberOfDimensionsCitationsByBook:1,hasAltmetrics:0,numberOfTotalCitations:50,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"November 28th 2016",dateEndSecondStepPublish:"December 19th 2016",dateEndThirdStepPublish:"September 18th 2017",dateEndFourthStepPublish:"October 18th 2017",dateEndFifthStepPublish:"December 18th 2017",currentStepOfPublishingProcess:5,indexedIn:"1,2,3,4,5,6",editedByType:"Edited by",kuFlag:!1,featuredMarkup:null,editors:[{id:"140755",title:"Dr.",name:"Jesmine",middleName:null,surname:"Khan",slug:"jesmine-khan",fullName:"Jesmine Khan",profilePictureURL:"https://mts.intechopen.com/storage/users/140755/images/system/140755.jpeg",biography:"Jesmine Khan is affiliated with the Faculty of Medicine, Universiti Teknologi MARA (UiTM), Malaysia as an Associated Professor. She obtained her MBBS degree from Mymensingh Medical College, Dhaka University, Bangladesh. She has special interest in nutrition and acquired her PhD degree in surgical nutrition from Osaka University Graduate School of Medicine, Osaka, Japan. She has vast experience in teaching at home and abroad. She is active in writing, has published numerous articles in scientific journals, works as an editorial board member and reviewer of academic journals and is involved in nutrition related research and activities. Her research interest also includes the intestinal barrier in health and disease. \nShe has vast experience in teaching at home and abroad. She is active in writings, has published numerous articles in scientific journals, works as an editorial board member and a reviewer of academic journals, and is involved in nutrition-related research and activities.",institutionString:"Universiti Teknologi MARA",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"1",totalChapterViews:"0",totalEditedBooks:"2",institution:{name:"Universiti Teknologi MARA",institutionURL:null,country:{name:"Malaysia"}}}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,coeditorOne:null,coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"1046",title:"Infectious Diseases",slug:"infectious-diseases"}],chapters:[{id:"55455",title:"Iron Deficiency Anaemia",doi:"10.5772/intechopen.69048",slug:"iron-deficiency-anaemia",totalDownloads:1710,totalCrossrefCites:1,totalDimensionsCites:1,hasAltmetrics:0,abstract:"Iron deficiency anaemia as the most common nutrition disorder has only marginal reduction globally during recent decades, with the highest burden in pregnant women and young children. Insufficient iron storage and/or excessive loss of iron are common causes of iron deficiency anaemia. Therefore, understanding the complexity of the regulatory network required to maintain iron homeostasis and identifying the functional variants associated with iron metabolism should be fundamental and crucial to control and treat the iron deficiency anaemia. Sensitive and inexpensive measures to distinguish iron deficiency anaemia from the other kinds of anaemia should be developed for precise treatment. Original disease treatments combined with oral or intravenous iron therapy are key approaches in clinical practices. The integrated, multifactorial and multi‐sectoral approach with food‐based strategy and iron supplementation as the leading public health inventions is required to achieve iron deficiency anaemia control target. This chapter will focus on the advanced knowledge associated with iron metabolism, disease burden and health consequences of iron deficiency anaemia in different life course, newly parameters development in the diagnosis of iron deficiency anaemia, therapy choice in clinical practice and public health strategies to reduce iron deficiencies in high‐burden areas.",signatures:"Lingxia Zeng, Leilei Pei, Chao Li and Hong Yan",downloadPdfUrl:"/chapter/pdf-download/55455",previewPdfUrl:"/chapter/pdf-preview/55455",authors:[{id:"203270",title:"Prof.",name:"Hong",surname:"Yan",slug:"hong-yan",fullName:"Hong Yan"},{id:"203870",title:"Dr.",name:"Lingxia",surname:"Zeng",slug:"lingxia-zeng",fullName:"Lingxia Zeng"},{id:"204201",title:"Dr.",name:"Leilei",surname:"Pei",slug:"leilei-pei",fullName:"Leilei Pei"},{id:"204202",title:"Dr.",name:"Chao",surname:"Li",slug:"chao-li",fullName:"Chao Li"}],corrections:null},{id:"56441",title:"Megaloblastic Anemia",doi:"10.5772/intechopen.70063",slug:"megaloblastic-anemia",totalDownloads:1713,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Megaloblastic anemia is a multisystem disorder, which can easily be diagnosed with high index of suspicion and by correct application of its pathogenetic mechanisms. Any factor inhibiting deoxyribonucleic acid (DNA) synthesis, drugs (medications), infections like human immunodeficiency virus (HIV) and gas like nitrous oxide will cause megaloblastosis. However, poor diet, problems with absorption, transportation and metabolism of the vitamins, as well as factors that increase demand and ultimately exhaust the store of the vitamins like chronic hemolytic states, pregnancy, malignancies happen to be the commonest causes of megaloblastic anemia. A complete blood count, blood and marrow films review reflect the typical pathognomonic cytologic appearance of megaloblastic anemia. Logically selected biochemical tests help in establishing diagnosis through determination of serum levels of both folate and cobalamin and assessment of the metabolites, which are considered to be more sensitive and specific. Also, full endoscopic studies are required to confirm the presence of disorders of gastrointestinal tract responsible for impaired absorption. Clinical features are subtle and widely varied. It is highly amenable to therapy once the primary cause is established and managed. Appropriate replacement therapy of deficient nutrient, cobalamin or folate or both, easily corrects anemia. Pernicious anemia often requires lifelong therapy with parenteral cobalamin.",signatures:"Olaniyi John Ayodele",downloadPdfUrl:"/chapter/pdf-download/56441",previewPdfUrl:"/chapter/pdf-preview/56441",authors:[{id:"202764",title:"Dr.",name:"John",surname:"Olaniyi",slug:"john-olaniyi",fullName:"John Olaniyi"}],corrections:null},{id:"56773",title:"Iron Deficiency Anemia in Children",doi:"10.5772/intechopen.69774",slug:"iron-deficiency-anemia-in-children",totalDownloads:2622,totalCrossrefCites:2,totalDimensionsCites:5,hasAltmetrics:0,abstract:"Iron deficiency and iron deficiency anemia remain a major and global public health problem that affects particularly infants, young children, and women of childbearing age in developing countries. The prevalence of iron deficiency anemia is still common in industrialized countries despite efforts to improve public awareness and strengthen programs for the prevention and control of iron deficiency. The most common risk factors for iron deficiency in early childhood are rapid growth, perinatal risk factors, poor dietary intake, and gastrointestinal blood loss due to excessive consumption of cow’s milk. Iron deficiency and iron deficiency anemia cause a wide variety of symptoms and changes in many different tissues. The most concerning consequences of iron deficiency in children are the alterations of cognitive, motor, and behavioral performance. Persistent neurocognitive changes despite iron repletion have increased the importance of prevention and early detection of iron deficiency. The main principles of treatment include investigation and elimination of the underlying cause, iron supplementation, improvement of nutrition, and education of the patient and family. Oral iron supplements are desirable as first-line therapy. Follow-up is very important to confirm the diagnosis and to ensure that anemia is adequately treated.",signatures:"Jelena Roganović and Ksenija Starinac",downloadPdfUrl:"/chapter/pdf-download/56773",previewPdfUrl:"/chapter/pdf-preview/56773",authors:[{id:"204443",title:"Prof.",name:"Jelena",surname:"Roganovic",slug:"jelena-roganovic",fullName:"Jelena Roganovic"},{id:"204546",title:"Dr.",name:"Ksenija",surname:"Starinac",slug:"ksenija-starinac",fullName:"Ksenija Starinac"}],corrections:null},{id:"55610",title:"Iron Deficiency Anemia and Pregnancy",doi:"10.5772/intechopen.69114",slug:"iron-deficiency-anemia-and-pregnancy",totalDownloads:2187,totalCrossrefCites:1,totalDimensionsCites:1,hasAltmetrics:0,abstract:"Iron deficiency is the most common nutritional deficiency in the world with immense public health consequences. It has a complex etiology and prolonged imbalance between dietary intake, absorption, and body needs which leads to iron deficiency anemia. If developed during pregnancy, it significantly alters pregnancy outcomes. Low birth weight is one of the main features, and those infants are at increased risk of developing anemia later in life. Along with widely recommended and practiced supplementation during pregnancy, proper combination of foods remain the best way for an optimal absorption of iron. Dietary iron is directly related to the total dietary energy intake, but depending on the type of its dietary source, maximum absorption is up to 40% of the total intake. Plant foods, the basis of everyday diet, contain significant number of dietary factors that inhibit iron absorption in the gut. Therefore, planning a well-balanced diet in order to achieve maximum absorption of iron from foods can be challenging. Pregnancy, especially its earliest period, is considered as the critical window in fetal programing, an ideal time frame to reduce risk factors for a number of health conditions in a newborn. Healthy pregnancy should be observed as a prerequisite for a healthier society.",signatures:"Ines Banjari",downloadPdfUrl:"/chapter/pdf-download/55610",previewPdfUrl:"/chapter/pdf-preview/55610",authors:[{id:"203069",title:"Dr.",name:"Ines",surname:"Banjari",slug:"ines-banjari",fullName:"Ines Banjari"}],corrections:null},{id:"57666",title:"Anemia in Women of Reproductive Age",doi:"10.5772/intechopen.71520",slug:"anemia-in-women-of-reproductive-age",totalDownloads:1600,totalCrossrefCites:1,totalDimensionsCites:3,hasAltmetrics:0,abstract:"Anemia is a common condition in women of childbearing age which is associated with wide spread hyperplastic processes in the uterus (leiomyomas, etc.) and abnormal and/or abundant uterine bleeding (AUB). Our study has considered the main causes of bleeding and the therapy aimed on limiting the amount of blood loss, as well as preoperative treatment of iron deficiency in women with uterine leiomyomas, planning for pregnancy. The combination of anemia with other abnormalities in the woman’s health status is associated with complications during pregnancy such as premature births, the birth of small children and failure of the formation of neural tube in iron deficiency and hypoxia. During the treatment of iron deficiency anemia (IDA) with saline iron, we noted severity and pain in the stomach in 11.9% of patients, nausea in 13.1%, constipation in 21.4%, and diarrhea in 7.1% of women. Such complications did not occur while treating with ferric iron. The use of drugs Iron III hydroxide polymaltozate in women after the end of lactation resulted in normalization of the blood hemoglobin within 30 days and the number of erythrocytes and of serum ferritin by the 90th day.",signatures:"Alina V. Solovyova, Viola Gace, Kristina S. Ermolenko and Vadim A.\nKhorolskiy",downloadPdfUrl:"/chapter/pdf-download/57666",previewPdfUrl:"/chapter/pdf-preview/57666",authors:[{id:"218728",title:"Prof.",name:"Alina",surname:"Solovyeva",slug:"alina-solovyeva",fullName:"Alina Solovyeva"},{id:"218751",title:"Dr.",name:"Viola",surname:"Gace",slug:"viola-gace",fullName:"Viola Gace"}],corrections:null},{id:"56798",title:"Nutritional Anemia in Elderly Patients of Developed Countries",doi:"10.5772/intechopen.70566",slug:"nutritional-anemia-in-elderly-patients-of-developed-countries",totalDownloads:1472,totalCrossrefCites:1,totalDimensionsCites:1,hasAltmetrics:0,abstract:"In this chapter, we report and discuss the current literature of nutrient-deficiency anemia, also called nutritional anemia, in elderly patients in developed countries. For this purpose, a review of medical literatures was conducted searching PubMed, textbooks of hematology, internal medicine and geriatrics, and information collected from international meetings were also included. The term nutrient deficiency or nutritional anemia covers any anemia, defined by a hemoglobin level <13 g/dL (<130 g/L) in men and <12 g/dL (<120 g/L) in women, resulting from a deficiency of materials essential for erythropoiesis. Patients with nutritional anemia often have mild to moderate anemia, with hemoglobin levels between 8 and 10 g/dL (80 and 100 g/L). In practice, nutritional anemia represents one-third of all anemia in elderly patients. About two-third of nutritional anemia is associated with iron deficiency and most of those cases are the result of chronic blood loss from gastrointestinal lesions. The remaining cases of nutritional anemia are usually associated with vitamin B12 (cobalamin), most frequently related to food-cobalamin malabsorption (especially in case of atrophic gastritis), and Biermer’s disease (pernicious anemia); and/or vitamin B9 (folate) deficiency, most frequently related to inadequate dietary intake or malnutrition, several drugs (as methotrexate, cotrimoxazole) and chronic alcohol intake. In clinical practice, recognition of these disorders and deficiencies is essential for optimal treatment (nutrient-deficiency replacement).",signatures:"Emmanuel Andrès",downloadPdfUrl:"/chapter/pdf-download/56798",previewPdfUrl:"/chapter/pdf-preview/56798",authors:[{id:"143493",title:"Prof.",name:"Emmanuel",surname:"Andrès",slug:"emmanuel-andres",fullName:"Emmanuel Andrès"}],corrections:null},{id:"55526",title:"Anemia and IBD: Current Status and Future Prospectives",doi:"10.5772/intechopen.69203",slug:"anemia-and-ibd-current-status-and-future-prospectives",totalDownloads:1468,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Anemia is a common complication of inflammatory bowel disease (IBD), usually recognized at diagnosis and during flare‐ups. However, the exact prevalence of anemia associated to IBD (IBD‐A) is unknown. Despite its major clinical relevance and quality of life impact in both adult and pediatric IBD patients, it has been for long time neglected. It is mostly multifactorial, being a unique example of the combination of chronic iron deficiency (ID) and anemia of chronic disease (ACD). The current management of IBD‐A represents a paradigm shift in clinical practice, involving several challenges. A pro‐active approach is recommended and with the new generation of available iron compounds and recent guidelines, the ultimate goal will be the improvement of the patients’ quality of life. Sound data are still lacking, concerning the best treatment/prevention approach for IDA/ID. Based on current evidence, oral iron therapy might be preferred in mild IDA, whereas intravenous iron may be advantageous in more severe IDA/flaring IBD. Long‐term prospective clinical trials are needed, to optimize treatment schedule and to better define the clinical and hematological long‐term outcomes, both in adults and in children. They should demonstrate the efficacy, safety, and tolerance profile of different available iron formulas, as well as their cost‐efficacy ratio.",signatures:"Ana Isabel Lopes and Sara Azevedo",downloadPdfUrl:"/chapter/pdf-download/55526",previewPdfUrl:"/chapter/pdf-preview/55526",authors:[{id:"165035",title:"Dr.",name:"Ana Isabel",surname:"Lopes",slug:"ana-isabel-lopes",fullName:"Ana Isabel Lopes"},{id:"209347",title:"M.D.",name:"Sara",surname:"Azevedo",slug:"sara-azevedo",fullName:"Sara Azevedo"}],corrections:null},{id:"56075",title:"Anemia in Chronic Kidney Disease and After Kidney Allotransplantation (Systematic Review)",doi:"10.5772/intechopen.69746",slug:"anemia-in-chronic-kidney-disease-and-after-kidney-allotransplantation-systematic-review-",totalDownloads:1356,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Anemia in chronic kidney disease (CKD) has been recognized as a separate independent risk factor of cardiovascular (CV) events. The aim of the review is to provide a literature summary concerning early diagnosis and treatment of anemia in CKD that may be useful for clinicians and contribute to decrease CV mortality. Literature searches were made in such major databases as: PubMed, Medline, Embase, Cochrane Library, CINAHL, Wiley Online Library, Scopus, Web of Science, e-library, and website of WHO. This search encompassed original articles, systematic reviews, and meta-analyses relevant to CKD and anemia over recent 15 years. A total of 54 references from 562 reviewed articles were selected as they met to the search criteria (anemia and CKD, including diabetes mellitus, systemic diseases and post-transplant anemia). The publications included 27 randomized controlled trials, 20 experimental studies representing new data on the links of CKD anemia and cardiovascular risk markers (cytokines, Klotho, fibroblast growth factor (FGF-23), hyperglycemia, hypoalbuminemia and some others), 4 systematic reviews and 3 clinical practice guidelines. The main attention was devoted to the analysis of the studies provided an early diagnosis of anemia, an ability to minimize the factors contributing to its severity that have allowed to improve CV and total outcomes and to reduce costs of hospital treatment of CKD patients with anemia.",signatures:"Yuriy S. Milovanov, Lidia V. Lysenko (Kozlovskaya), Ludmila Y.\nMilovanova, Victor Fomin, Nikolay A. Mukhin, Elena I. Kozevnikova,\nMarina V. Taranova, Marina V. Lebedeva, Svetlana Y. Milovanova,\nVasiliy V. Kozlov and Aigul Zh. Usubalieva",downloadPdfUrl:"/chapter/pdf-download/56075",previewPdfUrl:"/chapter/pdf-preview/56075",authors:[{id:"200575",title:"Prof.",name:"Yuriy",surname:"Milovanov",slug:"yuriy-milovanov",fullName:"Yuriy Milovanov"},{id:"207621",title:"Dr.",name:"Marina",surname:"Taranova",slug:"marina-taranova",fullName:"Marina Taranova"}],corrections:null},{id:"58839",title:"The Pattern of Anemia in Lupus",doi:"10.5772/intechopen.71293",slug:"the-pattern-of-anemia-in-lupus",totalDownloads:2001,totalCrossrefCites:1,totalDimensionsCites:2,hasAltmetrics:0,abstract:"Anemia is a frequent incident for patients with systemic lupus erythematosus (SLE), its incidence being reported as 18–80%. Anemia of chronic disease (ACD) is the most common hematological syndrome in the evolutionary context of SLE. In anemia of the chronic disease, cytokines stimulate the production of hepcidin, an acute phase protein, which destroys ferroportin produced by hepatocytes. As a result, Fe (iron) is not able to come out from the erythrocytes and macrophages and is trapped within them. Anemias from chronic disease are usually hypoproliferative processes. This chapter reviews the correlation between systemic lupus erythematosus and anemia of chronic disease in general (but iron-deficiency anemia in particular). This text reviews different important methods of examination used to diagnose the pathological process of lupus as an immune disease and of the hematopoietic system some of these methods include (general blood analysis, Coombs test, serum iron, hematocrit etc.). Furthermore, it will discuss the physiopathological mechanism of anemic syndrome in systemic lupus erythematosus and the changes of the immune system. In conclusion, the relevance of anemia (independent of its cause) is estimated as being both a short-term activity of the disease and long-term prognostic factor for the evolution of SLE.",signatures:"Elena Samohvalov and Sergiu Samohvalov",downloadPdfUrl:"/chapter/pdf-download/58839",previewPdfUrl:"/chapter/pdf-preview/58839",authors:[{id:"202751",title:"Ph.D.",name:"Elena",surname:"Samohvalov",slug:"elena-samohvalov",fullName:"Elena Samohvalov"}],corrections:null},{id:"56821",title:"Severe Malarial Anemia (SMA) Pathophysiology and the Use of Phytotherapeutics as Treatment Options",doi:"10.5772/intechopen.70411",slug:"severe-malarial-anemia-sma-pathophysiology-and-the-use-of-phytotherapeutics-as-treatment-options",totalDownloads:1717,totalCrossrefCites:3,totalDimensionsCites:7,hasAltmetrics:0,abstract:"Hemolytic anemia results when red blood cells (RBCs) are destroyed prematurely by a number of agents. Obligate intracellular parasites like the Plasmodium species proliferate by infecting RBCs, growing through different stages of their life cycles, expanding their population to unsustainable numbers and eventually rupturing the cell membranes in order to transmit and infect new RBCs. In this manner, more RBCs are infected by the parasites and destroyed together with some nonparasitized cells. Membranes of RBCs are altered and deformed by parasite antigens expressed on the surfaces of both parasitized and nonparasitized cells, which lead to their premature phagocytosis and destruction by the reticuloendothelial system. Parasites and the hemoglobin waste products produced by them are released when the RBCs burst. Activated leukocytes take up the hemoglobin waste (hemozoin which is a polymerized heme), which stimulates the innate immune system leading to the synthesis and secretion of pro- and anti-inflammatory cytokines, chemokines, growth factors and mediators. Together with the destruction of RBCs in malaria, imbalance between pro- and anti-inflammatory events results in the modification of erythroid cell proliferation leading to severe malarial anemia (SMA) and other pathophysiologies of malaria. While current malarial management is targeted at the destruction of the parasite, it is the malaria-related pathophysiology (disease aspect of malaria) like severe malarial anemia that results in the high malaria morbidity and mortality. Antidisease approaches promise to be more effective at malarial management. Triterpenes with antioxidant, pro-oxidant, anti-inflammatory and antiparasitic effect show effects at retarding and abrogating severe malarial anemia. Asiatic acid, amongst other triterpenes like oleanolic acid, masilinic acid administered through oral or transdermal route improves severe malaria anaemia providing promise in the management of malaria pathophysiology.",signatures:"Greanious Alfred Mavondo and Mayibongwe Louis Mzingwane",downloadPdfUrl:"/chapter/pdf-download/56821",previewPdfUrl:"/chapter/pdf-preview/56821",authors:[{id:"202805",title:"Prof.",name:"Alfred Mavondo-Nyajena Mukuwa",surname:"Greanious",slug:"alfred-mavondo-nyajena-mukuwa-greanious",fullName:"Alfred Mavondo-Nyajena Mukuwa Greanious"},{id:"211762",title:"Dr.",name:"Mzingaye Maibongwe Louis",surname:"Mzingwane",slug:"mzingaye-maibongwe-louis-mzingwane",fullName:"Mzingaye Maibongwe Louis Mzingwane"}],corrections:null},{id:"57436",title:"Influence of Hepcidin in the Development of Anemia",doi:"10.5772/intechopen.71476",slug:"influence-of-hepcidin-in-the-development-of-anemia",totalDownloads:1442,totalCrossrefCites:0,totalDimensionsCites:3,hasAltmetrics:0,abstract:"Anemia presents a global public health problem. It is related to several factors, ranging from deficiency in nutrients from food to genetic alterations in iron absorption and metabolism. In this context, hepcidin is a peptide molecule that regulates iron homeostasis. Hepcidin is synthesized, in part, by hepatocytes. In physiological conditions, increased serum transferrin, serum iron, inflammation, and erythropoiesis trigger stimuli that promote hepcidin antimicrobial peptide (HAMP) gene transcription and hepcidin synthesis. However, in pathological situations, an overexpression of hepcidin occurs, an increase in the plasma concentration that damages the organism. Hepcidin contributes to the pathogenesis of iron deficiency anemia, anemia of inflammation, in hemoglobinopathies. Then, there is a restriction of the availability of iron to the tissues and the formation of new erythroid precursors, with the consequent development of anemia.",signatures:"Cadiele Oliana Reichert, Filomena Marafon, Débora Levy, Luciana\nMorganti Ferreira Maselli, Margarete Dulce Bagatini, Solange Lúcia\nBlatt, Sérgio Paulo Bydlowski and Celso Spada",downloadPdfUrl:"/chapter/pdf-download/57436",previewPdfUrl:"/chapter/pdf-preview/57436",authors:[{id:"89691",title:"Dr.",name:"Sérgio",surname:"Bydlowski",slug:"sergio-bydlowski",fullName:"Sérgio Bydlowski"},{id:"172916",title:"Prof.",name:"Celso",surname:"Spada",slug:"celso-spada",fullName:"Celso Spada"},{id:"204066",title:"Ms.",name:"Cadiele",surname:"Reichert",slug:"cadiele-reichert",fullName:"Cadiele Reichert"},{id:"222432",title:"Ms.",name:"Filomena",surname:"Marafon",slug:"filomena-marafon",fullName:"Filomena Marafon"},{id:"222433",title:"Dr.",name:"Débora",surname:"Levy",slug:"debora-levy",fullName:"Débora Levy"},{id:"222434",title:"Dr.",name:"Luciana",surname:"Morganti Ferreira Maselli",slug:"luciana-morganti-ferreira-maselli",fullName:"Luciana Morganti Ferreira Maselli"},{id:"222435",title:"Prof.",name:"Margarete Dulce",surname:"Bagatini",slug:"margarete-dulce-bagatini",fullName:"Margarete Dulce Bagatini"},{id:"222436",title:"Prof.",name:"Solange Lúcia",surname:"Blatt",slug:"solange-lucia-blatt",fullName:"Solange Lúcia Blatt"}],corrections:null},{id:"56750",title:"Laboratory Approach to Anemia",doi:"10.5772/intechopen.70359",slug:"laboratory-approach-to-anemia",totalDownloads:6123,totalCrossrefCites:2,totalDimensionsCites:4,hasAltmetrics:0,abstract:"Anemia is a major cause of morbidity and mortality worldwide and can be defined as a decreased quantity of circulating red blood cells (RBCs). The epidemiological studies suggested that one-third of the world’s population is affected with anemia. Anemia is not a disease, but it is instead the sign of an underlying basic pathological process. However, the sign may function as a compass in the search for the cause. Therefore, the prediagnosis revealed by thorough investigation of this sign should be supported by laboratory parameters according to the underlying pathological process. We expect that this review will provide guidance to clinicians with findings and laboratory tests that can be followed from the initial stage in the anemia search.",signatures:"Ebru Dündar Yenilmez and Abdullah Tuli",downloadPdfUrl:"/chapter/pdf-download/56750",previewPdfUrl:"/chapter/pdf-preview/56750",authors:[{id:"183998",title:"Ph.D.",name:"Ebru",surname:"Dündar Yenilmez",slug:"ebru-dundar-yenilmez",fullName:"Ebru Dündar Yenilmez"},{id:"209103",title:"Prof.",name:"Abdullah",surname:"Tuli",slug:"abdullah-tuli",fullName:"Abdullah Tuli"}],corrections:null},{id:"56234",title:"Foods Produced with Cowpea Flour as a Strategy to Control Iron Deficiency Anemia in Children",doi:"10.5772/intechopen.69892",slug:"foods-produced-with-cowpea-flour-as-a-strategy-to-control-iron-deficiency-anemia-in-children",totalDownloads:1325,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Cowpeas (Vigna unguiculata L. Walp) are widely distributed throughout the world, being a relatively cheap source of protein and energy, but underutilized in most countries. The World Health Organization (WHO) estimated that about 1.62 billion people are affected by anemia and that preschool children are the most affected, with a prevalence of 47.4%. Several countries have stepped up efforts to reduce iron deficiency anemia by supplementing iron, as well as universal fortification of foods with iron and other micronutrients and vitamins. Parallel to these programs, several intervention studies were carried out with the same objective, using various forms of food fortification/enrichment aimed at the control of anemia. Fortification/food enrichment has contributed to the reduction of the prevalence of anemia. 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Wager",authors:[{id:"86601",title:"Dr.",name:"Françoise",middleName:null,surname:"Lapierre",fullName:"Françoise Lapierre",slug:"francoise-lapierre"}]},{id:"37142",title:"Use of Physical Restraints in Neurosurgery: Guide for a Good Practice",slug:"use-of-physical-restraints-in-neurosurgery-guide-for-a-good-practice",signatures:"Ayten Demir Zencirci",authors:[{id:"75863",title:"Associate Prof.",name:"Ayten",middleName:null,surname:"Demir Zencirci",fullName:"Ayten Demir Zencirci",slug:"ayten-demir-zencirci"}]}]}],publishedBooks:[{type:"book",id:"1244",title:"Spine Surgery",subtitle:null,isOpenForSubmission:!1,hash:"9ea5cece2b7ea45907a75de2cc8955f9",slug:"spine-surgery",bookSignature:"Kook Jin Chung",coverURL:"https://cdn.intechopen.com/books/images_new/1244.jpg",editedByType:"Edited by",editors:[{id:"113935",title:"Dr.",name:"Kook Jin",surname:"Chung",slug:"kook-jin-chung",fullName:"Kook Jin Chung"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"5234",title:"Trauma, Tumors, Spine, Functional Neurosurgery",subtitle:null,isOpenForSubmission:!1,hash:"58640694ad7cbb2e82d217935b12f243",slug:"from-bench-to-bedside-trauma-tumors-spine-functional-neurosurgery",bookSignature:"Francesco Signorelli",coverURL:"https://cdn.intechopen.com/books/images_new/5234.jpg",editedByType:"Edited by",editors:[{id:"74494",title:"Dr.",name:"Francesco",surname:"Signorelli",slug:"francesco-signorelli",fullName:"Francesco Signorelli"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"8339",title:"Neurosurgical Procedures",subtitle:"Innovative Approaches",isOpenForSubmission:!1,hash:"32ead2c9d075e8762721f52b7ea22b51",slug:"neurosurgical-procedures-innovative-approaches",bookSignature:"Alba Scerrati and Pasquale De Bonis",coverURL:"https://cdn.intechopen.com/books/images_new/8339.jpg",editedByType:"Edited by",editors:[{id:"182614",title:"Dr.",name:"Alba",surname:"Scerrati",slug:"alba-scerrati",fullName:"Alba Scerrati"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"10723",title:"Brachial Plexus Injury",subtitle:"New Techniques and Ideas",isOpenForSubmission:!1,hash:"94c1a38f1ee7a078ee6ec640360c39f2",slug:"brachial-plexus-injury-new-techniques-and-ideas",bookSignature:"Jörg Bahm",coverURL:"https://cdn.intechopen.com/books/images_new/10723.jpg",editedByType:"Edited by",editors:[{id:"78207",title:"Prof.",name:"Jörg",surname:"Bahm",slug:"jorg-bahm",fullName:"Jörg Bahm"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"690",title:"Gamma Knife Radiosurgery",subtitle:null,isOpenForSubmission:!1,hash:"adb45f5be8b65b622ee009c0e5ebe34c",slug:"gamma-knife-radiosurgery",bookSignature:"David Mathieu",coverURL:"https://cdn.intechopen.com/books/images_new/690.jpg",editedByType:"Edited by",editors:[{id:"76960",title:"Dr.",name:"David",surname:"Mathieu",slug:"david-mathieu",fullName:"David Mathieu"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}}],publishedBooksByAuthor:[{type:"book",id:"1244",title:"Spine Surgery",subtitle:null,isOpenForSubmission:!1,hash:"9ea5cece2b7ea45907a75de2cc8955f9",slug:"spine-surgery",bookSignature:"Kook Jin Chung",coverURL:"https://cdn.intechopen.com/books/images_new/1244.jpg",editedByType:"Edited by",editors:[{id:"113935",title:"Dr.",name:"Kook Jin",surname:"Chung",slug:"kook-jin-chung",fullName:"Kook Jin Chung"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}}]},onlineFirst:{chapter:{type:"chapter",id:"76450",title:"Counseling Sexually Abused Children: Lessons from Ghana and Zambia",doi:"10.5772/intechopen.97413",slug:"counseling-sexually-abused-children-lessons-from-ghana-and-zambia",body:'
The concept of counseling explains how individuals who feel less able to resolve their own problems resort to help in order to solve their challenges [1]. Associated with help seeking is the client’s belief that he will receive assistance that will help him understand things that bother him such as complex and confusing emotions experienced during an event (e.g. abuse), receive alternatives, make informed decisions and move on generally in positive meaningful ways. Thus, the chance of successful counseling outcome may be higher, where needed support is provided and children’s ability to overcome sexual abuse has been found to be dependent on timely psychological interventions [2].
This study adopts World Health Organisation’s (WHO) definition of child sexual abuse as the involvement of a child in sexual activity that he or she does not fully comprehend, is unable to give informed consent to, or for which the child is not developmentally prepared and cannot give consent, or that violates the laws or social taboos of society. The scourge of child sexual abuse (CSA) has been on the increase world over, Ghana and Zambia inclusive, with millions of children being sexually abused every year. In 2004 WHO reported that the global prevalence rate of child sexual abuse [3] was an estimated 150 million girls and 73 million boys under the age of 18 years who were victims of rape or other forms of sexual violence; that between 1 and 21 percent of women were victims of sexual abuse before the age of 15. By 2010, CSA was estimated at 34.4% of global violence cases [2].
Some of the earliest studies on child sexual abuse in Africa [4] reported on cases of child sexual abuse at a Cape Town Hospital with victims ranged from 2 to 12 years with the majority being females. In Malawi, [5] described 20 cases of child sexual abuse, which were presented at the Department of Obstetrics and Gynaecology, University of Malawi, between 1995 and 1997. Half of the victims were less than ten years old [5]. estimated that these cases were merely the tip of the iceberg, and were reported due to the serious injury caused in the rape of very young children. Research on the occurrence of child sexual abuse by [6] reports that one in four girls and one in ten boys is a victim of CSA. In Zimbabwe, CSA studies show that, among unmarried sexually active youths, 52.2% had experienced forced sexual intercourse at least once and 37.4% of the first sexual intercourse was forced on them [7].
Child sexual abuse is recognised as a traumatic experience that can have a number of adverse effects on victims [8] citing [9, 10] and that these children generally reveal significant problems in diverse areas of functioning including but not limited to affect, behaviour, cognition and interpersonal relationships [11, 12].
Research has established a correlation between counseling and other forms of psychosocial support in promoting well-being of people. Although psychosocial supports have been used to investigate individuals’ experiences in adverse circumstances, there is a gap in the literature regarding the use of counseling to overcome CSA experiences. While we are inspired by the possibilities offered by the vast literature on CSA, research suggests that psychosocial supports such as counseling services for victims of CSA are unsatisfactory [13, 14] in a number of government institutions globally. A need, therefore, exists for effective treatment through counseling children who have experienced CSA [8]. The purpose of this study, therefore, is to explore how counseling as one if not the most crucial psychosocial support is used to assist victims of CSA in Victims Support Units (VSU) of the police services of Ghana and Zambia.
We connect our study to the works of [15] on the concept of trauma recovery of individuals to provide the theoretical basis for this work [15] developed a three stage model that has been used to treat trauma survivors during rehabilitation process. The model provides a useful set of goals for treatment providers regardless of theoretical orientation. Herman’s model gives an in-depth description of the healing process of people who struggle with a number of problems relating to abusive or past traumatic experiences. The three stages of this process are (1) the establishment of safety, (2) remembrance and mourning, and (3) reconnection. This process is not typically linear; there are often advances, regressions, and impasses. It has, however, been suggested that many people do not complete all three stages during their recovery [16].
Establishing safety is the first step in the treatment of trauma because no intervention can succeed without the survivor feeling safe. Safety includes protection from violence and maltreatment by other people, basic needs being met such as medical care, financial security, safe living environments, adequate food and sleep, legal protection, and a supportive social network. Research established that torture and other forms of trauma can cloud an individual’s sense of security and safety especially when trauma is experienced in childhood [16, 17]. Re-establishing safety is important in the development of relationships that can be beneficial in the process of recovery for victims of child sexual abuse.
In the remembrance and mourning stage [15] the survivor constructs a narrative of his or her experiences in a therapeutic relationship. This inspires the need for CSA victims to receive counseling on report of abuse. The reconstructive disclosure of traumatic experience has been examined widely in theory and research. Cognitive-behavioural therapy that focuses on exposure to memories and emotions has been found to be a powerful method of treating PTSD with survivors of sexual assault [18].
In the reconnection stage, the focus is on building a future and empowerment. Once the past has been assimilated, the victim can focus on developing a more resilient and complete identity. The trauma victim strives to make a meaningful life through trust and hope that were developed during the first two stages of the recovery. The victim, now a survivor, may have a desire to help others who have been victimised similarly and to prevent future victimisation by raising public awareness through educational, legal, and political activism.
Trauma counseling is thus, geared towards assisting persons recover from overwhelming stress to functioning productively. This is where the traumatic individuals move from the ability to disclose and be believed to be provided help that empowers and strengthens. Drawing from these theories, the following questions guided the study:
What is the nature of the counseling services provided to children who report their sexual abuse experiences?
What are the challenges associated with counseling services offered to victims?
This research was qualitative in approach. Given the sensitivity of the topic, the denial of perpetrators, silence that mostly surrounds the knowledge of the canker, and the stigma often attached to the victims, qualitative methods were deemed appropriate. This study employed the qualitative Narrative Approach (NA) [19] to understand the nature, benefits and challenges of counseling services provided to victims of Child Sexual Abuse. Critical to the NA is active listening and its ability to externalise the problem beyond the person(s) and the world so as to liberate them from the control of the problem and develop power to address them. Thus, through the narrative discourse, individuals can gain the power to address their own trauma by positioning a ‘named problem’ (e.g. penetration, fondling). The narrative approach that employs disclosure with strong affinity with attending skills such as listening, questioning and probing, resonates well with Herman’s stages of recovery from traumatic experiences.
The study was set in the Central Region of Ghana and the Lusaka province of Zambia. Ghana police service in the Central Region has seven divisions, thirty-two districts and ninety-nine police stations/posts. The Region also has Police Command and Staff College for Senior Officers at Winneba [20, 21]. The Regional Headquarters has 10 DOVVSU units/desks under its command [22]. Available statistics from DOVVSU suggest a downward trend in cases of child sexual abuse since 2002 (from 820 in 2002 to 670 by the end of 2005) though there is doubt about the reliability of these data [23]. The figures quoted by [23] however, were only on rape. A year earlier, [24, 25] reported that the evidence of sexual exploitation in Ghana is significant and that DOVVSU records indicate that every year quite a number of children and adolescents go through series of sexual abuse. They indicated that reported cases of defilement and rape of children and adolescents were: 1001–2002; 905–2003; 930–2004; 937–2005; 1772–2006. In addition to statistical records of reported cases of child sexual abuse, the Central Region was of interest due to recent public outcry of the rise in teenage pregnancy and social media circulations of sexual abuse against school girls (kitchen stool episode).
In the case of Zambia, according to [24], it is alleged that, majority of children who are sexually abused are females. Between 2011 and 2014, Zambia Police Victim Support Unit annual reports show a steady increase in cases of CSA from 1,939 cases in 2011 to 4,039 cases in 2014 (see Table 1 above: Zambia Police 2011 to 2014 Annual Reports).
Reported cases of child sexual abuse in Zambia between 2011 and 2014.
Purposive and criterion-based sampling strategies were employed to contribute to the overall understanding of the topic [26]. In all, 112 participants were recruited from 15 police stations across the Central Region of Ghana and Lusaka Province in Zambia. The criteria for selection were that participants were children, aged between 8 to 18 years, had a history of sexual abuse, reported their abuse to the VSUs of the police and were predominantly English-speaking. In Ghana, the principal researcher and one research assistant collected data while the principal researcher and two assistants gathered data in Zambia. The cases were selected purposively from the police dockets between 2011 and 2016 and victims and their parents located per the address in the dockets. Many victims could not be traced as they have either left their addresses given at the time of the report of abuse or the given addresses could not be traced.
In Ghana, interviews were held with a total of 55 participants made up of 20 girls, 20 officers from seven DOVVSU desks as well as 15 parents. In Zambia, a total number of 57 participants were recruited into the study. This includes 20 VSU officers from 8 provinces, 20 victims and 17 parents of victims.
In both countries, we started with engagement of police officers in charge of abuse cases then hooked in children identified and parents. There were initial challenges of recruitment as some identified parents were not willing to participate nor allowed their children to participate. With a lot of sensitization (one-on-one explanations on the challenges of CSA and the benefits of therapeutic methods) on the need to speak about the issue, some parents got involved and allowed their children to participate. Of the 15 parents from Ghana, 14 were females and only one male while parents from Zambia were all females. In all, parents from both countries comprise 25 mothers, one father, and six caregivers. From both Ghana and Zambia, there were no records of counseling services provided to victims though victims records were available.
The interview activities were conducted mostly under trees or nearby empty classrooms around victims’ homes and schools. When a victim was identified, the researcher spent time to explain the rationale, and ethical issues of the study to them. In both countries, participants were informed of the purpose of the research and discussed the meaning of ‘sexual abuse’ to include fondling, touching, forced sex, defilement and sex without consent. Interview questions covered the: a) nature of the counseling services provided and received, b) operational challenges in receiving and providing counseling services, and c) views on benefits of counseling to victims. In all, each interview with victims and parents lasted approximately 50 minutes while that of VSU officers lasted for about 1 hour.
The data collection process took a total of four and six weeks to complete in Ghana and Zambia respectively. Responses of the interviews were manually recorded by the principal investigators. After data were manually written, they were typed and printed out. Data were then cleaned through proof reading and corrections. Manual coding was done to identify confirming and disconfirming themes within and across narratives. The data were coded with acronyms to promote confidentiality and anonymity. Data were thus coded GPO (Ghana) and ZPO (Zambia) for VSU officers and followed by the assigned number of the participant.
Ethical considerations and trustworthiness of the data and research process were achieved through triangulation of data with all three sets of categories of participants. Participants, especially victims and parents, had the opportunity to corroborate or otherwise the statements provided at the VSU offices. By these, data were cleaned and ready for thematic analysis.
The results of the study were structured into five main sections: background characteristics, nature of counseling, approaches to counseling, challenges, benefits, and the way forward.
The summary of sexual abuse cases made in the Ghana and Zambia (selected regions) police dockets and files recorded from 2011 to 2016 were 223 and 345 cases respectively. Of this total number of cases, 105 were initially identified regarding their age at the time of abuse, perpetrator characteristics, and their English-speaking ability. However, only 40 were found and included in this research. Of the 40 cases analysed, 36 (90%) involved victims less than 16 years of age. All victims were females. The mean age of victims was 12.1 years. The youngest victim was 9 year of age and the oldest was 17 years. Seven had experienced sexual abuse more than once and five had re-experienced sexual abuse after their initial abuse reported to the police. Twenty-two (55%) of the victims were school pupils at the time of the abuse. Of this 22, 18 victims became school drop outs as a result of sexual abuse related issues. Of the school drop outs, twelve sexual abuse incidents resulted in pregnancy in both countries.
Most perpetrators were adults. In 36 (90.0%) cases, the perpetrators were less than 30 years of age. Most of the child sexual abuse cases were intra-familial. Of the 40 cases studied, eight victims were raped and or defiled by their fathers, twelve by uncles, six by cousins, four by brothers, four boyfriends, and six by unknown persons. This finding confirms other studies that most rape and defilement incidents are perpetrated by people known to victims and who are usually male family members [2].
Narratives revealed two types of sexual abuse reports: direct and indirect. Direct reported cases are cases where victims and or their parents lodged complaint following an abuse and this could be following the abuse immediately or later. The indirect reported cases were cases which were not originally reported due to the sexual abuse. Rather, parents/caregivers often accompany victims to lodge complaints of neglect and or denial of pregnancy where interrogations revealed that the girls were impregnated through sexual abuse. About 60% of the cases were indirect reported cases while about 40% account for direct sexual abuse reports. This finding confirms [27] affirmation that, children rarely disclose sexual abuse immediately after the event. Out of the 40 victim participants, 27 (67.5%) pregnancies cases were recorded. Fifteen (37.5%) of the victims had been defiled more than once. Pregnancies were found mostly among 14 year olds and above who were defiled by intra-familial offenders.
The level of education and or professional training of officers is presented in Table 2 below.
Type of academic qualification | |||||
---|---|---|---|---|---|
Country | 2nd Degree | 1st Degree | Diploma | Certificates | Sub-total |
Zambia | — | 1 | 5 | 15 | 20 |
Ghana | 3 | 6 | 6 | 5 | 20 |
Educational and professional qualification of VSU officers.
Source: Authors Construct, 2018.
Table 2 above indicates that of the 20 VSU officers from Ghana, 3 hold 2nd degree, 6 had 1st degree, 6 hold diploma and 5 hold certificates. Of these, was also reading law at the time of this study. From Zambia, VSU officer holds 1st degree; five hold diploma and 15 have certificates. Additionally, 20 VSU officers from both countries received certificates from various workshops attended broadly on gender and child abuse issues for capacity building.
Data revealed that in both Ghana and Zambia, VSU officers were not adequately trained in counseling especially in the area of CSA. It must be mentioned, however that, some of the officers who indicated having a certificate did not necessarily undergo formal training in counseling, but were rather referring to certificate of attendance obtained from workshops.
Under this theme we explored the general approaches, techniques and skills in counseling that VSU officers used in providing support to victims who reported their abuse. VSU officers disclosed that they lacked professional counseling skills. It was found that counseling was rarely offered in some VSU in both countries. VSU officers confirmed that:
Similar narratives abound in the data. Narratives above imply that though officers were aware of the essence of counseling they lack the requisite training to practice. They therefore engage victims and their families in what they think best by resorting mostly to advice giving on medical and legal processes leaving out the psychological and emotional assistance that victims need.
Results show that there were various services offered to victims of CSA to help reduce their trauma. These could be classified as: trauma counseling, individual counseling and group counseling.
VSU officers try their best to handle sexual abuse cases brought before them. Regarding cases reported, VSU officers first and foremost try to secure the victim’s safety and then encourage disclosure of abuse. Under this approach, two stages of trauma counseling were identified. These are: establishing safety and security of victims, and encouraging disclosure (remembering and mourning).
In addressing the issue of the nature of counseling services provided to victims, narratives reveal that officers usually try to provide safety nets as the first step to providing counseling.
Some victims corroborated this:
This approach by VSU officers in providing safety and security for victims is entrenched in the first stage of trauma counseling [15]. Depending on the perpetrator characteristics, officers provide safety where some children were taken to shelters or social welfare homes for protection and to reduce revictimization. This resonates with [28] that sexually abused children generally need safety upon disclosure.
Disclosure of abuse was seen as one fundamental phenomenon in the healing process. When victims report their abuse they are requested to disclose. Data reveal that in most cases, the reports made by non-offending parents are quite incongruent with the disclosure of victims. One officer noted:
To overcome the stress of remembering and mourning, the victim needs to narrate his or her experiences in depth with great detail. The goal is to modify the traumatic memories so they become more meaningful in the person’s life and less anxiety provoking. As the narrative develops, the memories become less disjointed, more depersonalised and more coherent. With this emotional reworking and cognitive restructuring, the memories become more manageable and the significance of the trauma changes from a story of victimisation to one of dignity and agency [16]. Once the victim is able to emotionally and cognitively process the traumatic experiences, he or she is then able to mourn the losses experienced during the abuse. Victims face the reality that they may never regain what they have lost. Herman [15] argued that with the new story, the intrusive and hyper-arousal symptoms subside.
Associated with reporting and disclosure is the issue of power imbalance. The police stations do not seem to provide a safe environment that promotes disclosure. Ironically, while the officers were interested in providing safety from perpetrators, their own personalities and immediate environments smack of insecurity and impact on effective disclosure.
In most cases, officers attempt to re-unite victims with their families especially with their non-offending parents or caregivers. This is as the result of lack of shelter and other logistics in handling the victims. Officers revealed:
This reconnection is thus exigent on the prevailing circumstances in the VSU offices. One finds it difficult to assess whether reconnection to the families has positive outcome for the victims or not as VSU officers have no means of follow-up on cases. This study thus, revealed that the reconnection stage of Herman’s model was woefully completed. Victims were not reconnected in the real sense of recovery geared towards healing and empowerment. At best their reconnections could be described as disposal.
This is normally done with victims in the same office with their parents and other VSU officers. Narratives reveal that for lack of space and other logistics, VSU officers carry out their counseling activities right in the same office with other colleagues. One stated
The term individual counseling is used interchangeably with taking victims’ statements and asking probing questions for clarification. Through observation and narratives, it was revealed that the individual counseling provided was short of appropriateness. With individual counseling done in the same office with other officers and visitors coming in and out, then the counseling environment is not conducive enough to uphold the principles of confidentiality and to promote disclosure.
Data indicate that group counseling referred to in this context is when victims and their non-offending parents or caregivers are provided some advice on seeking medical treatment, legal procedures and general advice on how to prevent being re-victimised.
Group dynamics such as purpose of group formation, theme, and other characteristics were not considered. Group counseling was offered in a form of family therapy usually with non-offending parent or family members.
Regarding the approach to counseling, it was found that the counseling that was provided (if at all) that could best be described as group counseling was used in all service (VSU) centers. The counseling provided here is more advice giving especially regarding victims’ right to legal assistance, medical treatment, and how victims could ovoid revictimization, and parental protection and provision. Advice on legal procedures and investigations: victims and their parents were also provided needed information on legal opportunities available to them. An officer explained:
In addition to the approaches used, officers also employed some basic counseling skills such as encouragement, reassurance, and rapport. However, cognitive behavioural counseling techniques skills like assertiveness training, empathising, role-play, art therapy and belief of victims’ stories were found missing. These were considered very important in reducing the grief and confusion that children abused normally go through thus, paving way for healing.
On barriers associated with counseling service provision, the following subthemes emerged: lack of skilled personnel, lack of logistics, late reporting of cases, family interference, lack of safe and conducive environment coupled with presence of power relations, inadequate time and sessions among others.
Data reveal that VSU officers perceived themselves as inadequate in providing counseling services to victims. They, however, bemoan their lack of professional training and capacity. It was noted that in both countries, VSU officers have no psychological tests to administer to victims, they do not have any structured system or documents to use such as intake form upon report of an abuse.
Direct observation and in-depth interview report indicated that the VSU officers lacked capacity in terms of resources for their work. Apart from the units in the regional capitals of the study sites in both countries with one and two computers each in Ghana and Zambia respectively, the VSU desks in the study regions had no computers and therefore no database of cases before them. The police dockets were managed manually by using notebooks and files. Officers did not have filing cabinets. These challenges were acknowledged by the officers at the units. One officer indicated:
There were also no vehicles assigned to the VSUs in the study sites in Ghana. However, the Lusaka headquarters unit had one vehicle for investigation of cases. This was however bemoaned as woefully inadequate.
These reports were corroborated by VSUs from Ghana:
Many victims did not report the offence until later when they fell ill or got pregnant and the men refuse responsibility.
Late reporting or indirect reporting of Child Sexual Abuse cases makes it difficult for victims to receive any form of counseling (if any) from VSU officers. This finding resonates with other research that, sexually abused children rarely disclose sexual abuse immediately after the event [27].
The constant appeals by family members to withdraw the cases from the courts do not only thwart the efforts of the courts to prosecute offenders, it also cuts short whatever counseling interventions that VSU officers could offer the victims since the withdrawals mark the end of victims’ visit to the station for further assistance. One officer bemoaned:
These narratives point to the administrative challenges faced by VSU officers. In all, victims were provided first aid counseling. Police dockets revealed that most cases were discontinued. In most cases parents or caregivers request for withdrawal of cases to be settled at home. About 90% of reported cases were not followed up by parents and since the police have no means of following up, the cases die naturally and the courts closed dockets on them. Feedbacks on settlement were not provided by parents. The settlement of defilement cases outside court violates the very spirit and letter of the law on defilement [29] because rape under laws of both countries is a first degree felony [27].
Regarding benefits of counseling for victims, the following were some of the subthemes: need for professional training; assurance that will lead to disclosure, anxiety and fear reductioning, promoting healing, and empowering victims; non-belief of victim’s story and lack of privacy and confidentiality were seen as immediate issues that could be addressed to pave way for effective counseling of victims. The following narratives are revealing:
Though some victims feel less threatened by their disclosure to the police the same sense of lack of security prevents detailed disclosure and hinders recovery. This finding corroborates conclusion drawn by [30] that distrust of, and poor experience with, state authorities and public services contributed to individuals abused not seeking help.
This study attempted to explore the counseling services provided to children who report their sexual abuse to the police in Ghana and Zambia. The study found that, although group counseling was used as treatment for victims of CSA, it did not follow group dynamics and was offered without individual counseling. It also revealed that some clients needed individual treatment before they were ready for group therapy. The study found among others that children in both countries were provided family therapy rather than individual and group counseling that would have been more helpful for disclosure, connecting, and healing. It also found that though some victims expressed happiness that their abuses have been reported and heard, lack of counseling training and power imbalances inhibit officers’ efforts.
The study concludes that though police officers use some skills, more is needed to provide comprehensive and effective counseling to CSA victims. When children receive adequate counseling immediately after abuse they do immediate damage repair both of their psychological and social “self”.
While this study expands knowledge on CSA and counseling services, it also significantly, seeks to influence policy and suggest ways by which effective interventions mechanisms can support victims of CSA in both countries.
The study recommends that Police services in both countries should sponsor VSU officers to do professional training in counseling in order to provide effective counseling for abused individuals. Additionally, it is recommended that counseling professionals should help design a framework or protocols to use in providing integrated trauma counseling services for abused children. It further recommends that the service in both countries should team up with universities which offer counseling programs to offer periodic capacity training for their staff. And finally, officers should be linked with professional counsellors at universities to refer abuse cases for treatment.
An earlier version of this article was presented at the World Education Research Association Annual Meeting at Cape Town, South Africa in August 2018. We are grateful to the following institutions for allowing us to conduct this research: the DOVVSU Central Region Police Headquarters of the Ghana Police Service, the Zambian Lusaka Police Service, and all our participants.
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She has published more than 100 papers and abstracts in many reputed international journals and conferences and served as reviewer and editor for several academic associations.",institutionString:"University of Southern California",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"2",totalChapterViews:"0",totalEditedBooks:"4",institution:{name:"University of Southern California",institutionURL:null,country:{name:"United States of America"}}},equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"9629",title:"Electroencephalography",subtitle:"From Basic Research to Clinical Applications",isOpenForSubmission:!1,hash:"8147834b6c6deeeec40f407c71ad60b4",slug:"electroencephalography-from-basic-research-to-clinical-applications",bookSignature:"Hideki Nakano",coverURL:"https://cdn.intechopen.com/books/images_new/9629.jpg",editedByType:"Edited 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Applications",isOpenForSubmission:!1,hash:"a3479e76c6ac538aac76409c9efb7e41",slug:"neuroimaging-neurobiology-multimodal-and-network-applications",bookSignature:"Yongxia Zhou",coverURL:"https://cdn.intechopen.com/books/images_new/9347.jpg",editedByType:"Edited by",editors:[{id:"259308",title:"Dr.",name:"Yongxia",middleName:null,surname:"Zhou",slug:"yongxia-zhou",fullName:"Yongxia Zhou"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"8938",title:"Inhibitory Control Training",subtitle:"A Multidisciplinary Approach",isOpenForSubmission:!1,hash:"bd82354f3bba4af5421337cd42052f86",slug:"inhibitory-control-training-a-multidisciplinary-approach",bookSignature:"Sara Palermo and Massimo Bartoli",coverURL:"https://cdn.intechopen.com/books/images_new/8938.jpg",editedByType:"Edited by",editors:[{id:"233998",title:"Ph.D.",name:"Sara",middleName:null,surname:"Palermo",slug:"sara-palermo",fullName:"Sara Palermo"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"6998",title:"Synucleins",subtitle:"Biochemistry and Role in Diseases",isOpenForSubmission:!1,hash:"2b4b802fec508928ce8ab9deebd1375f",slug:"synucleins-biochemistry-and-role-in-diseases",bookSignature:"Andrei Surguchov",coverURL:"https://cdn.intechopen.com/books/images_new/6998.jpg",editedByType:"Edited by",editors:[{id:"266540",title:"Dr.",name:"Andrei",middleName:null,surname:"Surguchov",slug:"andrei-surguchov",fullName:"Andrei Surguchov"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}}],booksByTopicTotal:65,seriesByTopicCollection:[],seriesByTopicTotal:0,mostCitedChapters:[{id:"46296",doi:"10.5772/57398",title:"Physiological Role of Amyloid Beta in Neural Cells: The Cellular Trophic Activity",slug:"physiological-role-of-amyloid-beta-in-neural-cells-the-cellular-trophic-activity",totalDownloads:5886,totalCrossrefCites:18,totalDimensionsCites:31,abstract:null,book:{id:"3846",slug:"neurochemistry",title:"Neurochemistry",fullTitle:"Neurochemistry"},signatures:"M. del C. Cárdenas-Aguayo, M. del C. Silva-Lucero, M. Cortes-Ortiz,\nB. Jiménez-Ramos, L. Gómez-Virgilio, G. Ramírez-Rodríguez, E. Vera-\nArroyo, R. Fiorentino-Pérez, U. García, J. Luna-Muñoz and M.A.\nMeraz-Ríos",authors:[{id:"42225",title:"Dr.",name:"Jose",middleName:null,surname:"Luna-Muñoz",slug:"jose-luna-munoz",fullName:"Jose Luna-Muñoz"},{id:"114746",title:"Dr.",name:"Marco",middleName:null,surname:"Meraz-Ríos",slug:"marco-meraz-rios",fullName:"Marco Meraz-Ríos"},{id:"169616",title:"Dr.",name:"Maria del Carmen",middleName:null,surname:"Cardenas-Aguayo",slug:"maria-del-carmen-cardenas-aguayo",fullName:"Maria del Carmen Cardenas-Aguayo"},{id:"169857",title:"Dr.",name:"Maria del Carmen",middleName:null,surname:"Silva-Lucero",slug:"maria-del-carmen-silva-lucero",fullName:"Maria del Carmen Silva-Lucero"},{id:"169858",title:"Dr.",name:"Maribel",middleName:null,surname:"Cortes-Ortiz",slug:"maribel-cortes-ortiz",fullName:"Maribel Cortes-Ortiz"},{id:"169859",title:"Dr.",name:"Berenice",middleName:null,surname:"Jimenez-Ramos",slug:"berenice-jimenez-ramos",fullName:"Berenice Jimenez-Ramos"},{id:"169860",title:"Dr.",name:"Laura",middleName:null,surname:"Gomez-Virgilio",slug:"laura-gomez-virgilio",fullName:"Laura Gomez-Virgilio"},{id:"169861",title:"Dr.",name:"Gerardo",middleName:null,surname:"Ramirez-Rodriguez",slug:"gerardo-ramirez-rodriguez",fullName:"Gerardo Ramirez-Rodriguez"},{id:"169862",title:"Dr.",name:"Eduardo",middleName:null,surname:"Vera-Arroyo",slug:"eduardo-vera-arroyo",fullName:"Eduardo Vera-Arroyo"},{id:"169863",title:"Dr.",name:"Rosana Sofia",middleName:null,surname:"Fiorentino-Perez",slug:"rosana-sofia-fiorentino-perez",fullName:"Rosana Sofia Fiorentino-Perez"},{id:"169864",title:"Dr.",name:"Ubaldo",middleName:null,surname:"Garcia",slug:"ubaldo-garcia",fullName:"Ubaldo Garcia"}]},{id:"58070",doi:"10.5772/intechopen.72427",title:"MRI Medical Image Denoising by Fundamental Filters",slug:"mri-medical-image-denoising-by-fundamental-filters",totalDownloads:2564,totalCrossrefCites:17,totalDimensionsCites:30,abstract:"Nowadays Medical imaging technique Magnetic Resonance Imaging (MRI) plays an important role in medical setting to form high standard images contained in the human brain. MRI is commonly used once treating brain, prostate cancers, ankle and foot. The Magnetic Resonance Imaging (MRI) images are usually liable to suffer from noises such as Gaussian noise, salt and pepper noise and speckle noise. So getting of brain image with accuracy is very extremely task. An accurate brain image is very necessary for further diagnosis process. During this chapter, a median filter algorithm will be modified. Gaussian noise and Salt and pepper noise will be added to MRI image. A proposed Median filter (MF), Adaptive Median filter (AMF) and Adaptive Wiener filter (AWF) will be implemented. The filters will be used to remove the additive noises present in the MRI images. The noise density will be added gradually to MRI image to compare performance of the filters evaluation. The performance of these filters will be compared exploitation the applied mathematics parameter Peak Signal-to-Noise Ratio (PSNR).",book:{id:"6144",slug:"high-resolution-neuroimaging-basic-physical-principles-and-clinical-applications",title:"High-Resolution Neuroimaging",fullTitle:"High-Resolution Neuroimaging - Basic Physical Principles and Clinical Applications"},signatures:"Hanafy M. Ali",authors:[{id:"213318",title:"Dr.",name:"Hanafy",middleName:"M.",surname:"Ali",slug:"hanafy-ali",fullName:"Hanafy Ali"}]},{id:"41589",doi:"10.5772/50323",title:"The Role of the Amygdala in Anxiety Disorders",slug:"the-role-of-the-amygdala-in-anxiety-disorders",totalDownloads:9671,totalCrossrefCites:4,totalDimensionsCites:28,abstract:null,book:{id:"2599",slug:"the-amygdala-a-discrete-multitasking-manager",title:"The Amygdala",fullTitle:"The Amygdala - A Discrete Multitasking Manager"},signatures:"Gina L. Forster, Andrew M. Novick, Jamie L. Scholl and Michael J. Watt",authors:[{id:"145620",title:"Dr.",name:"Gina",middleName:null,surname:"Forster",slug:"gina-forster",fullName:"Gina Forster"},{id:"146553",title:"BSc.",name:"Andrew",middleName:null,surname:"Novick",slug:"andrew-novick",fullName:"Andrew Novick"},{id:"146554",title:"MSc.",name:"Jamie",middleName:null,surname:"Scholl",slug:"jamie-scholl",fullName:"Jamie Scholl"},{id:"146555",title:"Dr.",name:"Michael",middleName:null,surname:"Watt",slug:"michael-watt",fullName:"Michael Watt"}]},{id:"26258",doi:"10.5772/28300",title:"Excitotoxicity and Oxidative Stress in Acute Ischemic Stroke",slug:"excitotoxicity-and-oxidative-stress-in-acute-ischemic-stroke",totalDownloads:7157,totalCrossrefCites:6,totalDimensionsCites:25,abstract:null,book:{id:"931",slug:"acute-ischemic-stroke",title:"Acute Ischemic Stroke",fullTitle:"Acute Ischemic Stroke"},signatures:"Ramón Rama Bretón and Julio César García Rodríguez",authors:[{id:"73430",title:"Prof.",name:"Ramon",middleName:null,surname:"Rama",slug:"ramon-rama",fullName:"Ramon Rama"},{id:"124643",title:"Prof.",name:"Julio Cesar",middleName:null,surname:"García",slug:"julio-cesar-garcia",fullName:"Julio Cesar García"}]},{id:"62072",doi:"10.5772/intechopen.78695",title:"Brain-Computer Interface and Motor Imagery Training: The Role of Visual Feedback and Embodiment",slug:"brain-computer-interface-and-motor-imagery-training-the-role-of-visual-feedback-and-embodiment",totalDownloads:1439,totalCrossrefCites:13,totalDimensionsCites:23,abstract:"Controlling a brain-computer interface (BCI) is a difficult task that requires extensive training. Particularly in the case of motor imagery BCIs, users may need several training sessions before they learn how to generate desired brain activity and reach an acceptable performance. A typical training protocol for such BCIs includes execution of a motor imagery task by the user, followed by presentation of an extending bar or a moving object on a computer screen. In this chapter, we discuss the importance of a visual feedback that resembles human actions, the effect of human factors such as confidence and motivation, and the role of embodiment in the learning process of a motor imagery task. Our results from a series of experiments in which users BCI-operated a humanlike android robot confirm that realistic visual feedback can induce a sense of embodiment, which promotes a significant learning of the motor imagery task in a short amount of time. We review the impact of humanlike visual feedback in optimized modulation of brain activity by the BCI users.",book:{id:"6610",slug:"evolving-bci-therapy-engaging-brain-state-dynamics",title:"Evolving BCI Therapy",fullTitle:"Evolving BCI Therapy - Engaging Brain State Dynamics"},signatures:"Maryam Alimardani, Shuichi Nishio and Hiroshi Ishiguro",authors:[{id:"11981",title:"Prof.",name:"Hiroshi",middleName:null,surname:"Ishiguro",slug:"hiroshi-ishiguro",fullName:"Hiroshi Ishiguro"},{id:"231131",title:"Dr.",name:"Maryam",middleName:null,surname:"Alimardani",slug:"maryam-alimardani",fullName:"Maryam Alimardani"},{id:"231134",title:"Dr.",name:"Shuichi",middleName:null,surname:"Nishio",slug:"shuichi-nishio",fullName:"Shuichi Nishio"}]}],mostDownloadedChaptersLast30Days:[{id:"29764",title:"Underlying Causes of Paresthesia",slug:"underlying-causes-of-paresthesia",totalDownloads:192666,totalCrossrefCites:3,totalDimensionsCites:7,abstract:null,book:{id:"1069",slug:"paresthesia",title:"Paresthesia",fullTitle:"Paresthesia"},signatures:"Mahdi Sharif-Alhoseini, Vafa Rahimi-Movaghar and Alexander R. Vaccaro",authors:[{id:"91165",title:"Prof.",name:"Vafa",middleName:null,surname:"Rahimi-Movaghar",slug:"vafa-rahimi-movaghar",fullName:"Vafa Rahimi-Movaghar"}]},{id:"63258",title:"Anatomy and Function of the Hypothalamus",slug:"anatomy-and-function-of-the-hypothalamus",totalDownloads:4558,totalCrossrefCites:6,totalDimensionsCites:12,abstract:"The hypothalamus is a small but important area of the brain formed by various nucleus and nervous fibers. Through its neuronal connections, it is involved in many complex functions of the organism such as vegetative system control, homeostasis of the organism, thermoregulation, and also in adjusting the emotional behavior. The hypothalamus is involved in different daily activities like eating or drinking, in the control of the body’s temperature and energy maintenance, and in the process of memorizing. It also modulates the endocrine system through its connections with the pituitary gland. Precise anatomical description along with a correct characterization of the component structures is essential for understanding its functions.",book:{id:"6331",slug:"hypothalamus-in-health-and-diseases",title:"Hypothalamus in Health and Diseases",fullTitle:"Hypothalamus in Health and Diseases"},signatures:"Miana Gabriela Pop, Carmen Crivii and Iulian Opincariu",authors:null},{id:"57103",title:"GABA and Glutamate: Their Transmitter Role in the CNS and Pancreatic Islets",slug:"gaba-and-glutamate-their-transmitter-role-in-the-cns-and-pancreatic-islets",totalDownloads:3478,totalCrossrefCites:3,totalDimensionsCites:9,abstract:"Glutamate and gamma-aminobutyric acid (GABA) are the major neurotransmitters in the mammalian brain. Inhibitory GABA and excitatory glutamate work together to control many processes, including the brain’s overall level of excitation. The contributions of GABA and glutamate in extra-neuronal signaling are by far less widely recognized. In this chapter, we first discuss the role of both neurotransmitters during development, emphasizing the importance of the shift from excitatory to inhibitory GABAergic neurotransmission. The second part summarizes the biosynthesis and role of GABA and glutamate in neurotransmission in the mature brain, and major neurological disorders associated with glutamate and GABA receptors and GABA release mechanisms. The final part focuses on extra-neuronal glutamatergic and GABAergic signaling in pancreatic islets of Langerhans, and possible associations with type 1 diabetes mellitus.",book:{id:"6237",slug:"gaba-and-glutamate-new-developments-in-neurotransmission-research",title:"GABA And Glutamate",fullTitle:"GABA And Glutamate - New Developments In Neurotransmission Research"},signatures:"Christiane S. Hampe, Hiroshi Mitoma and Mario Manto",authors:[{id:"210220",title:"Prof.",name:"Christiane",middleName:null,surname:"Hampe",slug:"christiane-hampe",fullName:"Christiane Hampe"},{id:"210485",title:"Prof.",name:"Mario",middleName:null,surname:"Manto",slug:"mario-manto",fullName:"Mario Manto"},{id:"210486",title:"Prof.",name:"Hiroshi",middleName:null,surname:"Mitoma",slug:"hiroshi-mitoma",fullName:"Hiroshi Mitoma"}]},{id:"35802",title:"Cross-Cultural/Linguistic Differences in the Prevalence of Developmental Dyslexia and the Hypothesis of Granularity and Transparency",slug:"cross-cultural-linguistic-differences-in-the-prevalence-of-developmental-dyslexia-and-the-hypothesis",totalDownloads:3601,totalCrossrefCites:2,totalDimensionsCites:7,abstract:null,book:{id:"673",slug:"dyslexia-a-comprehensive-and-international-approach",title:"Dyslexia",fullTitle:"Dyslexia - A Comprehensive and International Approach"},signatures:"Taeko N. Wydell",authors:[{id:"87489",title:"Prof.",name:"Taeko",middleName:"N.",surname:"Wydell",slug:"taeko-wydell",fullName:"Taeko Wydell"}]},{id:"58597",title:"Testosterone and Erectile Function: A Review of Evidence from Basic Research",slug:"testosterone-and-erectile-function-a-review-of-evidence-from-basic-research",totalDownloads:1331,totalCrossrefCites:2,totalDimensionsCites:2,abstract:"Androgens are essential for male physical activity and normal erectile function. Hence, age-related testosterone deficiency, known as late-onset hypogonadism (LOH), is considered a risk factor for erectile dysfunction (ED). This chapter summarizes relevant basic research reports examining the effects of testosterone on erectile function. Testosterone affects several organs and is especially active on the erectile tissue. The mechanism of testosterone deficiency effects on erectile function and the results of testosterone replacement therapy (TRT) have been well studied. Testosterone affects nitric oxide (NO) production and phosphodiesterase type 5 (PDE-5) expression in the corpus cavernosum through molecular pathways, preserves smooth muscle contractility by regulating both contraction and relaxation, and maintains the structure of the corpus cavernosum. Interestingly, testosterone deficiency has relationship to neurological diseases, which leads to ED. Testosterone replacement therapy is widely used to treat patients with testosterone deficiency; however, this treatment might also induce some problems. Basic research suggests that PDE-5 inhibitors, L-citrulline, and/or resveratrol therapy might be effective therapeutic options for testosterone deficiency-induced ED. Future research should confirm these findings through more specific experiments using molecular tools and may shed more light on endocrine-related ED and its possible treatments.",book:{id:"5994",slug:"sex-hormones-in-neurodegenerative-processes-and-diseases",title:"Sex Hormones in Neurodegenerative Processes and Diseases",fullTitle:"Sex Hormones in Neurodegenerative Processes and Diseases"},signatures:"Tomoya Kataoka and Kazunori Kimura",authors:[{id:"219042",title:"Ph.D.",name:"Tomoya",middleName:null,surname:"Kataoka",slug:"tomoya-kataoka",fullName:"Tomoya Kataoka"},{id:"229066",title:"Prof.",name:"Kazunori",middleName:null,surname:"Kimura",slug:"kazunori-kimura",fullName:"Kazunori Kimura"}]}],onlineFirstChaptersFilter:{topicId:"18",limit:6,offset:0},onlineFirstChaptersCollection:[{id:"81646",title:"Cortical Plasticity under Ketamine: From Synapse to Map",slug:"cortical-plasticity-under-ketamine-from-synapse-to-map",totalDownloads:15,totalDimensionsCites:0,doi:"10.5772/intechopen.104787",abstract:"Sensory systems need to process signals in a highly dynamic way to efficiently respond to variations in the animal’s environment. For instance, several studies showed that the visual system is subject to neuroplasticity since the neurons’ firing changes according to stimulus properties. This dynamic information processing might be supported by a network reorganization. Since antidepressants influence neurotransmission, they can be used to explore synaptic plasticity sustaining cortical map reorganization. To this goal, we investigated in the primary visual cortex (V1 of mouse and cat), the impact of ketamine on neuroplasticity through changes in neuronal orientation selectivity and the functional connectivity between V1 cells, using cross correlation analyses. We found that ketamine affects cortical orientation selectivity and alters the functional connectivity within an assembly. These data clearly highlight the role of the antidepressant drugs in inducing or modeling short-term plasticity in V1 which suggests that cortical processing is optimized and adapted to the properties of the stimulus.",book:{id:"11374",title:"Sensory Nervous System - Computational Neuroimaging Investigations of Topographical Organization in Human Sensory Cortex",coverURL:"https://cdn.intechopen.com/books/images_new/11374.jpg"},signatures:"Ouelhazi Afef, Rudy Lussiez and Molotchnikoff Stephane"},{id:"81582",title:"The Role of Cognitive Reserve in Executive Functioning and Its Relationship to Cognitive Decline and Dementia",slug:"the-role-of-cognitive-reserve-in-executive-functioning-and-its-relationship-to-cognitive-decline-and",totalDownloads:23,totalDimensionsCites:0,doi:"10.5772/intechopen.104646",abstract:"In this chapter, we explore how cognitive reserve is implicated in coping with the negative consequences of brain pathology and age-related cognitive decline. Individual differences in cognitive performance are based on different brain mechanisms (neural reserve and neural compensation), and reflect, among others, the effect of education, occupational attainment, leisure activities, and social involvement. These cognitive reserve proxies have been extensively associated with efficient executive functioning. We discuss and focus particularly on the compensation mechanisms related to the frontal lobe and its protective role, in maintaining cognitive performance in old age or even mitigating the clinical expression of dementia.",book:{id:"11742",title:"Neurophysiology",coverURL:"https://cdn.intechopen.com/books/images_new/11742.jpg"},signatures:"Gabriela Álvares-Pereira, Carolina Maruta and Maria Vânia Silva-Nunes"},{id:"81488",title:"Aggression and Sexual Behavior: Overlapping or Distinct Roles of 5-HT1A and 5-HT1B Receptors",slug:"aggression-and-sexual-behavior-overlapping-or-distinct-roles-of-5-ht1a-and-5-ht1b-receptors",totalDownloads:19,totalDimensionsCites:0,doi:"10.5772/intechopen.104872",abstract:"Distinct brain mechanisms for male aggressive and sexual behavior are present in mammalian species, including man. However, recent evidence suggests a strong connection and even overlap in the central nervous system (CNS) circuitry involved in aggressive and sexual behavior. The serotonergic system in the CNS is strongly involved in male aggressive and sexual behavior. In particular, 5-HT1A and 5-HT1B receptors seem to play a critical role in the modulation of these behaviors. The present chapter focuses on the effects of 5-HT1A- and 5-HT1B-receptor ligands in male rodent aggression and sexual behavior. Results indicate that 5-HT1B-heteroreceptors play a critical role in the modulation of male offensive behavior, although a definite role of 5-HT1A-auto- or heteroreceptors cannot be ruled out. 5-HT1A receptors are clearly involved in male sexual behavior, although it has to be yet unraveled whether 5-HT1A-auto- or heteroreceptors are important. Although several key nodes in the complex circuitry of aggression and sexual behavior are known, in particular in the medial hypothalamus, a clear link or connection to these critical structures and the serotonergic key receptors is yet to be determined. This information is urgently needed to detect and develop new selective anti-aggressive (serenic) and pro-sexual drugs for human applications.",book:{id:"10195",title:"Serotonin and the CNS - New Developments in Pharmacology and Therapeutics",coverURL:"https://cdn.intechopen.com/books/images_new/10195.jpg"},signatures:"Berend Olivier and Jocelien D.A. Olivier"},{id:"81093",title:"Prehospital and Emergency Room Airway Management in Traumatic Brain Injury",slug:"prehospital-and-emergency-room-airway-management-in-traumatic-brain-injury",totalDownloads:49,totalDimensionsCites:0,doi:"10.5772/intechopen.104173",abstract:"Airway management in trauma is critical and may impact patient outcomes. Particularly in traumatic brain injury (TBI), depressed level of consciousness may be associated with compromised protective airway reflexes or apnea, which can increase the risk of aspiration or result in hypoxemia and worsen the secondary brain damage. Therefore, patients with TBI and Glasgow Coma Scale (GCS) ≤ 8 have been traditionally managed by prehospital or emergency room (ER) endotracheal intubation. However, recent evidence challenged this practice and even suggested that routine intubation may be harmful. This chapter will address the indications and optimal method of securing the airway, prehospital and in the ER, in patients with traumatic brain injury.",book:{id:"11367",title:"Traumatic Brain Injury",coverURL:"https://cdn.intechopen.com/books/images_new/11367.jpg"},signatures:"Dominik A. Jakob, Jean-Cyrille Pitteloud and Demetrios Demetriades"},{id:"81011",title:"Amino Acids as Neurotransmitters. The Balance between Excitation and Inhibition as a Background for Future Clinical Applications",slug:"amino-acids-as-neurotransmitters-the-balance-between-excitation-and-inhibition-as-a-background-for-f",totalDownloads:19,totalDimensionsCites:0,doi:"10.5772/intechopen.103760",abstract:"For more than 30 years, amino acids have been well-known (and essential) participants in neurotransmission. They act as both neuromediators and metabolites in nervous tissue. Glycine and glutamic acid (glutamate) are prominent examples. These amino acids are agonists of inhibitory and excitatory membrane receptors, respectively. Moreover, they play essential roles in metabolic pathways and energy transformation in neurons and astrocytes. Despite their obvious effects on the brain, their potential role in therapeutic methods remains uncertain in clinical practice. In the current chapter, a comparison of the crosstalk between these two systems, which are responsible for excitation and inhibition in neurons, is presented. The interactions are discussed at the metabolic, receptor, and transport levels. Reaction-diffusion and a convectional flow into the interstitial fluid create a balanced distribution of glycine and glutamate. Indeed, the neurons’ final physiological state is a result of a balance between the excitatory and inhibitory influences. However, changes to the glycine and/or glutamate pools under pathological conditions can alter the state of nervous tissue. Thus, new therapies for various diseases may be developed on the basis of amino acid medication.",book:{id:"10890",title:"Recent Advances in Neurochemistry",coverURL:"https://cdn.intechopen.com/books/images_new/10890.jpg"},signatures:"Yaroslav R. 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Endotheliitis of CNS vessels can lead to vessel occlusion and stroke. COVID-19 can also result in cerebral hemorrhage and sinus thrombosis possibly related to changes in clotting behavior. Vaccination is most important to prevent COVID-19 in the nervous system. 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