The Prosecution of Child Sexual Abuse Cases Legal Issues Related to Child Advocacy

Sexual abuse of children has recently been recognized as a social and legal problem, although the phenomenon has probably been present throughout the history of humankind. Child and adolescent psychiatric and mental health nurses must be aware of the legal implications of assessing, diagnosing or treating child victims of sexual abuse. The focus of this paper is on the legal implications of protecting children from sexual abuse, procedures for prosecuting perpetrators of child sexual abuse, and the constitutional implications of reform.     

Radiography after orthognathic surgery. Part I. Normal appearance

Osteotomies of the mandible and/or maxilla (orthognathic surgery) are common procedures for correcting facial defects. Radiographs of these patients are routinely obtained, and the radiologist must be aware of the normal postoperative appearance as well as surgical complications that may occur. This article presents the common surgical procedures done (sagittal split, vertical subcondylar, genioplasty mandibular osteotomies; and Le Fort I and mid-palatal split maxillary osteotomies) and the routine appearance of uncomplicated procedures on posteroanterior skull and panoramic radiographs. The metallic immobilization devices and orthodontic appliances are also described.     

Changing Interactions Between Physician Trainees and the Pharmaceutical Industry: A National Survey

BACKGROUND

Increasingly, medical school policies limit pharmaceutical representatives’ access to students and gifts from drugmakers, but little is known about how these policies affect student attitudes toward industry.

OBJECTIVE

To assess interactions between trainees and the pharmaceutical industry, and to determine whether learning environment characteristics influence students’ practices and attitudes.

DESIGN, PARTICIPANTS

We conducted a cross-sectional survey with a nationally-representative sample of first- and fourth-year medical students and third-year residents, stratified by medical school, including ≥ 14 randomly selected trainees at each level per school.

MAIN MEASURES

We measured frequency of industry interactions and attitudes regarding how such interactions affect medical training and the profession. Chi-squared tests assessed bivariate linear trend, and hierarchical logistic regression models were fitted to assess associations between trainees’ attitudes and their schools’ National Institutes of Health (NIH) funding levels and American Medical Student Association (AMSA) PharmFree Scorecard grades reflecting industry-related conflict of interest policies.

KEY RESULTS

Among 1,610 student (49.3 % response rate) and 739 resident (43.1 %) respondents, industry-sponsored gifts were common, rising from 33.0 % (first-year students) to 56.8 % (fourth-year students) and 54 % (residents) (p?<?0.001). These gifts included meals outside the hospital (reported by 5 % first-year students, 13.4 % fourth-year students, 27.5 % residents (p?<?0.001)) and free drug samples (reported by 7.4 % first-year students, 14.1 % fourth-year students, 14.3 % residents (p?<?0.001)). The perception that industry interactions lead to bias was prevalent, but the belief that physicians receive valuable education through these interactions increased (64.1 % to 67.5 % to 79.8 %, p?<?0.001). Students in schools receiving more NIH funding reported industry gifts less often (OR?=?0.51, 95 % CI: 0.38–0.68, p?<?0.001), but the strength of institutional conflict of interest policies was not associated with this variable.

CONCLUSIONS

Despite recent policy changes, a substantial number of trainees continue to receive gifts from pharmaceutical representatives. We found no relation between these outcomes and a school’s policies concerning interactions with industry.     

Evaluation of a workplace hemochromatosis screening program

Hemochromatosis is a common inherited disorder of iron metabolism with significant health consequences for the employed population. Although screening for hemochromatosis has been recommended, workplace screening programs remain uncommon. In the first year of a newly initiated corporate screening program, 1968 employees were tested. The screening algorithm included measurement of serum iron and transferrin and subsequent ferritin levels in those employees with elevated iron/transferrin ratios. Thirteen percent of men and 21% of women had elevated iron/transferrin ratios. Of these, 14 men and 2 women had elevated ferritin levels. Of these 16, three had liver biopsies and all three have hemochromatosis. The cost of the screening program was $27,850. The cost per diagnosis was $9283 and the cost per year of life saved was $928. These costs compare very favorably with other common workplace screening programs. Several barriers to obtaining definitive diagnoses on all patients with a positive screening result were identified; strategies to overcome these barriers would further enhance the cost effectiveness of the program. We conclude that workplace hemochromatosis screening is highly cost effective and should be incorporated into health promotion/disease prevention programs.     

Self-reported legal needs of women with or at risk for HIV infection

Women at risk for human immunodeficiency virus (HIV) infection are often poor and members of racial or ethnic minorities. In addition to legal concerns that might be common among persons with similar sociodemographic characteristics, HIV infection adds the potential of possible stigma and discrimination, as well as the prospect of illness and increased mortality. To determine women's perceptions of need for and access to legal services and whether such perceptions are affected by HIV infection, from November 1993 through September 1995 we interviewed 509 women with or at risk for HIV infection by virtue of injection drug use or high-risk sexual behaviors in New York and Baltimore, Maryland. A majority of women, regardless of HIV serostatus, reported current or future needs for legal assistance with government benefits. More than 25% reported needing current or future legal help with housing, debts, arrangements for care of children, a will, and advance directives. Substantial minorities of women reported other legal needs. HIV-positive women were significantly more likely to report anticipated future need for help with paternal custody or visitation, current need in making a will, and anticipated future assistance with advance directives. For most items, a majority of women thought they knew where to receive help. However, among women reporting a current need, only a minority actually were receiving legal assistance. This study suggests that the extent of legal needs among women with or at risk for HIV infection is substantial, and that few receive legal assistance. With few exceptions, at least for women early in the course of illness, HIV infection does not appear to alter the pattern or extent of legal needs. There are dramatic differences, regardless of HIV status, between expectation and reality in women's access to legal services. Members of the HER Study group are listed in the Appendix. Supported by cooperative agreements U64/CCU206798 and U64/CCU306802 with the Centers for Disease Control and Prevention. During the study, Paula DiStabile was supported by the Skadden Fellowship Foundation and sponsored by New York Lawyers for the Public Interest, New York, New York. Presented, in part, at the HIV Infection in Women Conference, February 22–24, 1995, Washington, DC.