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D K Runyan

Publications and source records attributed to D K Runyan.

28 records · Page 2Linked to original sources
PubMed1985

The diagnosis and evaluation of child maltreatment.

Child maltreatment continues to be one of the most common and most difficult problems seen in the emergency room. An early estimate indicated that up to 10% of children under age 6 seen in emergency departments have some form of nonaccidental injury. Recent data suggest that approximately 1% of the child population are victims of maltreatment each year. Many of these cases involve only subtle signs and have great potential to pass undetected. This article provides a review of the various forms of maltreatment, with emphasis on the key points involved in the history, physical examination, and management. The protocol for evaluating maltreatment from the North Carolina Memorial Hospital is presented. This framework will aid the physician in the crucial first step of identifying maltreatment, which, along with diligent follow-up and the assistance of the available social services, offers the best hope for further prevention.

Bone and Bones↗
PubMed1985

Foster care for child maltreatment: impact on delinquent behavior.

Previous reports of child maltreatment sequelae have not systematically examined the effects of societal intervention. A historical cohort study has been undertaken to examine the impact of one intervention, foster care, on the subsequent development of juvenile delinquency among child victims. One hundred fourteen foster children, aged 11 to 18 years, in foster care for three or more years, and who were in foster care as a result of maltreatment were studied. A comparison cohort was composed of 106 victims of maltreatment who were left in their family home; these children were similar to the children in foster care with regard to age, race, sex, and year of diagnosis. Cohort differences in maternal education, type of abuse, history of prior maltreatment, sex, and race were controlled in the analysis. Foster children committed 0.050 crimes per person-year after age 11 years; home care children committed 0.059 crimes per person-year after age 11 years (P greater than .2). Foster children were more likely to have committed criminal assault. Among foster children, increased number of foster home placements correlated with increased number of delinquency convictions. Overall, there appears to be no support for the idea that foster care is responsible for a significant portion of later problems encountered by victims of maltreatment.

Adolescent↗
PubMed1985

Foster care for child maltreatment. II. Impact on school performance.

At least 150,000 children currently reside in foster care in the United States because of child maltreatment. Nearly 15% of all confirmed maltreatment reports record foster care as one of the acute interventions. Yet, the impact of foster care has been largely unexamined. We conducted a historical cohort study of the impact of foster care on subsequent school performances for 114 children placed in foster care because of maltreatment. A comparison cohort was constituted of 106 maltreated children who were similar in age, race, sex, and year of diagnosis but who were left in their homes after report. School records were reviewed for 96 of the foster care children and 69 of the home care children. School attendance had improved for both groups at the time of follow-up nearly 8 years later. Children in school at the time of report who were then placed in foster care missed an average of 15.6% of the school year prior to the report compared with missing only 3.48% of the most recent school year. The children from the comparison group missed an average of 8.5% of the school year prior to their index maltreatment report and 7.2% of their most recent year in school. Forty-four percent of the foster care group achieved average or above average grades on follow-up compared with the passing rate for the home care group of 32% (P = .17). The foster care children were more likely to receive special education services. Overall, both groups were doing poor work in school an average of 8 years after maltreatment report. There appears to be no evidence for a significant rehabilitative effect of foster care as measured by subsequent school performance.

Absenteeism↗
PubMed1983

The pre-participation examination of the young athlete. Defining the essentials.

Examination of published reports and expert recommendations about appropriate pre-participation examinations of young athletes reveals widespread disagreement about objectives, format, and content. This review and commentary examines current evidence and proposes a more modest routine athletic physical. Even without requiring evidence of careful science and methodologic rigor, few of the traditional parts of the physical for the athlete are found to have evidence of utility. Some newly suggested orthopedic maneuvers may ultimately prove useful. Definitive recommendations await evaluation, using appropriate and careful methodology.

Adolescent↗
PubMed1982

Determinants of foster care placement for the maltreated child.

This study examined the records of the North Carolina Central Registry of Child Abuse and Neglect to determine which social, family, and child characteristics were most influential in the decision to place a child in foster care. These records contained all theoretically relevant factors as well as demographic data. Analysis included the computation of odds ratios for foster care for each of 250 variables. A maximum likelihood logistic regression model was constructed to obtain the independent and cumulative contribution of each factor. Some expected variables such as parental stress factors (substance abuse) and types of abuse (burns and scalds) placed a child at a significant risk for placement in foster care (p less than 0.01). However, less obvious factors such as referral source (law enforcement agencies) or geographic area also placed children at risk. Overall, the model explained little of the variance of these decisions (R2 = 0.168) and poorly predicted placement (sensitivity 66.3 per cent, specificity 74.6 per cent). Using existing data, we were unable to adequately describe the decision process in selecting foster care.

Adolescent↗
PubMed1981

Determinants of foster care placement for the maltreated child.

This study examined the records of the North Carolina Central Registry of Child Abuse and Neglect to determine which social, family, and child characteristics were most influential in the decision to place a child in foster care. These records contained all theoretically relevant factors as well as demographic data. Analysis included the computation of odds ratios for foster care for each of 250 variables. A maximum likelihood logistic regression model was constructed to obtain the independent and cumulative contribution of each factor. Some expected variables such as parental stress factors (substance abuse) and types of abuse (burns and scalds) placed a child at a significant risk for placement in foster care (p less than 0.01). However, less obvious factors such as referral source (law enforcement agencies) or geographic area also placed children at risk. Overall, the model explained little of the variance of these decisions (R2 = 0.168) and poorly predicted placement (sensitivity 66.3 per cent, specificity 74.6 per cent). Using existing data, we were unable to adequately describe the decision process in selecting foster care.

Child↗
PubMedDate not supplied

Vaginal Chlamydia trachomatis infection in children with sexual contact.

To determine whether vaginal infections with Chlamydia trachomatis in children were associated with sexual contact, 50 children ages 1 to 12 years with a history of sexual contact and 34 children without such a history were studied. Vaginal, throat and rectal cultures for C. trachomatis and Neisseria gonorrhoeae were performed in all children. Three children with sexual contact and none of the children without a history of sexual contact had vaginal infections. The three infected children were asymptomatic and only one had had vaginal intercourse. None of the 10 children with a history of sexual contact and gonorrheal vaginitis had C. trachomatis isolated. Although C. trachomatis vaginal infections as detected by vaginal cultures are infrequent, we recommend that all girls being evaluated for sexual contact be routinely cultured for C. trachomatis so that those infected can be treated.

Child↗