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Biomedical subjects

P K Jaudes

Publications and source records attributed to P K Jaudes.

13 recordsLinked to original sources
PubMed1996

Criminal prosecution of child sexual abuse cases.

To describe the outcome of prosecuting alleged intrafamilial/caretaker child sexual abuse, the authors evaluated charts for 1986-1988 at La Rabida Children's Hospital and Research Center in Chicago, plus police records for Area V, Chicago for 1986-1987. The state's attorney's office provided data on outcome of legal proceedings. Of 451 allegations, 324 (72%) were formally designated as probable sexual abuse cases, and 269 (83%) alleged perpetrators were identified. Complaints (77 felonies, 29 misdemeanors, and 30 juvenile charges) were initiated by the police for preliminary hearings against 136 (51%) persons. Of the felony charges, 66 (85.7%) resulted in indictments, and 11 (14.3%) in dismissal of charges by judge or grand jury. Thirty-two (48.5%) of those indicted pleaded guilty, 24 (36%) went to trial; 16 (67%) were found guilty, and 8 (12%) had charges dismissed. Therefore, of the 77 felony complaints initiated, 48 (62%) ended in convictions and 29 (38%) in dismissals or not-guilty verdicts. Only 24 (5%) of the original allegations resulted in trials. Although 30% of allegations and 51% of alleged perpetrators ended up in court, only 17% of the original 451 allegations were prosecuted for a felony. For felony indictments, 36% of victims appeared in court. Forty-three of 48 persons found guilty served time (mean sentencing time, 6.8 years). The mean time from initial hearing to final disposition was 321 days and was significantly longer if the accused either went to trial (501 vs. 236 days) or was found guilty or pleaded guilty (353 vs. 254 days for not-guilty verdicts). The authors conclude that very few children (5%) have to appear as witnesses in court, as most cases are resolved by plea bargaining, and that resolution by trial can take 12 to 16 months.

Child↗
PubMed1996

Sexual abuse evaluations in the emergency department: is the history reliable?

The authors assessed agreement on perpetrator identification obtained at two interviews of child victims of sexual abuse. We reviewed charts for 141 children who had undergone both a screening interview by an emergency department physician and an investigative interview by an interdisciplinary team specializing in child sexual abuse evaluation. For 107 (76%) cases, information was consistent; for instance, identification occurred at both interviews or at neither interview. Of the 38 children not identifying the perpetrator at the screening interview, 17 (45%) made disclosure at the investigative interview. Children who made disclosure only at the investigative interview were more likely to have refused to speak to the physician in the emergency department (p = .001). No significant differences were found when data for interview site and perpetrator identification were analyzed by gender of child, time interval between assault and screening interview, time interval between the two interviews, relationship of the alleged perpetrator to the child, performance of the investigative interview on an inpatient versus outpatient basis, and report of genital contact. In conclusion, perpetrator identification obtained during emergency department screening interviews usually agreed with information obtained at the subsequent investigative interview. The investigative interview was most helpful in identification of perpetrators when the child was not the source of the history obtained in the emergency department.

Child↗
PubMed1995

Association of drug abuse and child abuse.

OBJECTIVE: To show that children born to mothers who used drugs during pregnancy were at a higher risk of subsequent abuse or neglect than were children from the general population. METHODOLOGY: This is a retrospective-prospective study of abuse experiences of children born at an urban medical center between January 1985 and December 1990 to women who used illicit drugs during pregnancy. Children exposed in-utero to drugs were identified using results of toxicology screens from birth and maternal records. Evidence of abuse was obtained from the State Central Registry of Abuse and Neglect. The registry contained information on all reported abuses or neglects, the types, findings, and outcomes of the investigations of reported cases. The outcome measure was whether the children had been abused or not during the study period. RESULTS: One hundred and fifty-five (30.2%) of the 513 children exposed in-utero to drugs were reported as abused or neglected and 102 (19.9%) had substantiated reports giving a rate of 84 abuse and neglect cases per 1,000 years of exposure. The yearly substantiated abuse rates varied, the lowest being 30 cases per 1,000 years of exposure in 1986 and the highest 107 cases per 1,000 in 1987. This rate was two to three times that of children living in the same geographic area in the south side of Chicago. Neglect was reported in 72.6% of cases, with the toddlers being the most vulnerable to abuse and neglect. Natural parents were responsible for maltreatment 88% of the time. On logistic regression analysis, the risk of abuse of children increased 1.56-fold (Confidence Interval = 1.25-2.01) that of nonabusing parents among women who had completed high school education or had some college education and 1.80-fold among women with previous planned abortion, after controlling for confounding variables. Other sociodemographic variables of the child or mother did not significantly increase the odds of abuse. CONCLUSIONS: Infants exposed in-utero to drugs have a higher than expected risk of subsequent abuse compared to children in the general population.

Adolescent↗
PubMed1992

Interdisciplinary evaluations of alleged sexual abuse cases.

Children who are alleged to have been sexually abused often go through gruelling interrogations to relate their experiences to adults and, even then, most are not viewed as reliable sources of information. The Victim Sensitive Interviewing Program (VSIP) was initiated to decrease the number of interviews endured by a child who allegedly had been sexually abused. The program brought together the disciplines involved in the evaluation of these cases: hospital-based social worker and pediatrician, state child protective agency worker, police, and assistant state's attorney. This team established a protocol for an investigative interview to be conducted by a team member. Pre-VSIP sexual abuse evaluations from 1985 and 1986 (38) were compared with VSIP evaluations (226) from 1987 and 1988. There was no significant difference between the two groups in relation to gender or age of victim, physical symptoms, physical findings, sexually transmitted diseases present, age of perpetrator, or length of stay in hospital. However, there were significant differences between the two groups in (1) number of interviews, 11% pre-VSIP vs 79% VSIP receiving only one interview (P less than .001); (2) number of interviewers, 24% pre-VSIP vs 88% VSIP were interviewed by only one interviewer (P less than .001); (3) indicated cases of sexual abuse, 68% pre-VSIP vs 88% VSIP (P less than .006); (4) identification of the perpetrator, 71% pre-VSIP vs 85% VSIP (P less than .035); and (5) charges pressed if perpetrator identified, 33% pre-VSIP vs 60% VSIP (P less than .010). It is concluded that interdisciplinary evaluations of alleged sexual abuse in children not only decreased the number of interviews a child must undergo but also increased the likelihood of indicated cases, identification of the perpetrator, and charges being pressed. Therefore, it is strongly recommended that interdisciplinary teams be formed to assess alleged sexual abuse in children.

Adolescent↗
PubMed1990

Child sexual abuse: who goes home?

The purpose of this study was to ascertain the factors which influence custody change in cases of children who have been sexually abused. Of 180 children admitted to La Rabida Children's Hospital and Research center with a suspicion of having been sexually abused, 138 met the state's criteria for proven sexual abuse, and 30% of those children had a sexually transmitted disease. One-third of the children with proven abuse were under 4 years of age. Of the children with proven abuse, ultimately 40% had a custody change. Only an initial outcry of abuse was associated with an increased probability of a change in custody. A change in custody was not found to be related to the patient's age, sex, the perpetrator's relation to the child or access to the home, the presence of sexually transmitted disease, whether the child was also physically abused, or whether the child had had developmental delay. These data suggest an absence of any discernible guidelines in the juvenile court's decision concerning custody change of a sexually abused child.

Adolescent↗
PubMed1987

The medical and psychosocial needs of children entering foster care.

The estimated three to four hundred thousand children in foster care represent a population at high risk for medical and psychosocial problems. Their problems are compounded by the lack of adequate resources available to them while in foster care. This study provided a medical and psychosocial screening of 149 abused and neglected children entering the foster care system. The goal was to generate a profile of the medical and psychosocial needs of children entering the foster care system as a first step toward development of a better health care delivery system. Results indicated that these children have a much greater incidence of chronic medical conditions, are likely to weigh significantly less and be significantly shorter than the general population, require significant amounts of medical sub-specialty care, have a high incidence of developmental delays, and major deficits in adaptive behavior and have a large number of behavioral problems often associated with psychiatric disorders. Results are discussed in terms of the development of a regional model to effectively manage the health care needs of children entering foster care.

Adolescent↗
PubMed1986

Neglect of chronically ill children.

Child neglect is the most prevalent form of maltreatment; more children die of neglect than of abuse. Neglect has been found to be more prevalent than physical abuse among the population of children with chronic illnesses. Data from a retrospective chart review illustrate the ways in which neglect affected 61 children with chronic illnesses. Types of neglect include medical care neglect, educational neglect, abandonment, emotional neglect, and physical neglect. The state Child Protection Agency was notified of neglect in 67 instances. Two children died subsequent to neglect. Sixteen children were abandoned; 12 of these children were abandoned in the hospital. More than half (37) of the reports resulted in change of custody for these children. All of these children suffered from short-term morbidity and some from long-term morbidity due to neglect. Neglect can be a serious and consequential problem for children with chronic illness.

Chicago↗
PubMed1986

Differences among physicians in the treatment of children with vomiting.

Vomiting is a common pediatric problem. In the absence of a specific condition, the recommended treatment for children with vomiting is clear liquids. We surveyed four groups of physicians to determine who uses this recommended treatment. The groups were: board certified pediatricians (BCP), board certified family practitioners (BCFP), practitioners with pediatric training but without board certification (NBCP), and practitioners without pediatric training (NPT). The questionnaire listed ten treatment choices for each of four different age groups: less than 1, 1-5, 6-10, and greater than 10 years. In all age groups, the percentages of clear liquid treatments prescribed by physicians with pediatric training were higher than the percentages prescribed by physicians without pediatric training (NPT). The opposite pattern was shown for prescribed milk and drug treatments. Treatments other than clear liquid can be ineffective or dangerous, especially to children less than 1. More information about treatment of children with vomiting may be needed by all physicians, particularly those without pediatric training.

Child↗
PubMed1985

The handicapped child and child abuse.

For a group of children with handicaps, growth and development are also affected by abuse or neglect. Our understanding of the problems of the abused, handicapped child emerges from experience with 37 children with cerebral palsy who have been maltreated, coupled with a review of the literature in related areas. We identify the following four problems as crucial to the study of abuse and neglect to the child with handicaps: (1) abuse that causes handicaps, (2) abuse that occurs to the handicapped child, (3) compromises in care that can occur when the handicapped child becomes involved with the medical and legal systems, and (4) arrangements for foster care or other out-of-home placement for the child with handicaps. We conclude that the very systems designed to protect and care for the child often fail, leaving the handicapped child without opportunity to reach developmental potential. In light of our observations, we recommend that the pediatrician not only be aware of the existence of abuse and neglect in the population of handicapped children, but also serve in the dual role of coordinator of services and advocate for these children.

Brain Injuries↗
PubMed1984

Comparison of radiography and radionuclide bone scanning in the detection of child abuse.

The battered child syndrome consists of a constellation of signs that may be either apparent or covert. Radiographic documentation of unexplained or difficult-to-detect fractures is an important means of establishing a basis for legal intervention in child abuse. One hundred ten children were evaluated with either radiographic surveys or bone scans, and 50 children had both roentgenograms and bone scans. In 40% of the children there was at least one fracture whereas 20% had between two and seven fractures. Among the children who received both skeletal surveys and bone scans, 41 fractures were detected: skeletal survey detected 52% and bone scan detected 88% of those fractures. Children with fractures were more likely to be placed in foster homes than to be returned to the original environment. The presence of single v multiple fractures did not alter the probability of foster placement. It was concluded that fracture documentation is important in determining whether to place abused children in foster homes. Both skeletal surveys and radionuclide bone scanning had high false-negative values. When either test is initially negative and blatant signs of physical abuse are present, both tests should be performed to ensure the greatest probability of fracture detection.

Adolescent↗
PubMedDate not supplied

Outcomes for infants exposed in utero to illicit drugs.

The study reported here sought to determine whether substance-exposed infants who are maltreated have a higher risk of out-of-home placement than substance-exposed children who are not abused and rejected, as well as a higher risk of death than children in the general population. In a sample of 513 infants born at a Chicago medical center from 1985 through 1990, 480 (93.6%) had complete sociodemographic data available for analysis. Identifying data were used to search the Illinois death registry and a computerized central registry of child abuse reports. Both out-of-home placement and death were distinctly more likely if children had been exposed to drugs and maltreated. Such children should be closely followed.

Case-Control Studies↗