Hip abductor muscle volume in hip osteoarthritis and matched controls.

OBJECTIVE: Hip abductor muscle strength and function is negatively impacted by the presence of hip osteoarthritis (OA). This study aimed to quantify differences in hip abductor muscle volume, fatty infiltration and strength in a unilateral hip OA population when compared to a control group. Impact of radiographic severity of OA on these variables was also examined. METHODS: Volumes of gluteus maximus (GMax), medius (GMed) minimus (GMin) and tensor fascia lata (TFL) was measured using MRI and muscle volume asymmetry between limbs was calculated. Fatty infiltrate within muscles was graded using the Goutallier classification system. Hip abduction and rotation strength was tested using a dynamometer. Differences between groups or limbs were analysed using t-tests and differences in fatty infiltration using non-parametric tests. RESULTS: A statistically significant decrease in muscle volume was identified in GMax (P < 0.01), GMed (P < 0.02) and GMin (P < 0.01) on the affected side in the OA group compared to both the contralateral side and the control group and differences were related to severity of OA. Hip abduction and internal rotation strength was reduced in the OA group. Increased levels of fatty infiltration were identified in the affected limbs of the OA group for GMax (P = 0.01) and GMin (P = 0.04). CONCLUSION: Gluteal muscle atrophy, increased gluteal fatty infiltration and hip strength deficits were evident in the affected hips of OA participants. Since severity of OA was related to the extent of atrophy and fatty deposits, rehabilitation programs targeting these muscles could reverse or halt the progression of these structural and functional deficits.

The effect of fathers or father figures on child behavioral problems in families referred to child protective services.

This study examines some possible effects of the presence and quality of parent-child interaction of fathers and father figures on the behavior of young children in a sample of families reported to child protective services. Whereas the presence or absence of a father or father figure seemed to make little difference in child behavioral problems at age 4, lower levels of aggression and depression were observed for children by age 6 if an adult male in some form of father-like relationship was present in the child's life. When controlling for mother's ethnicity, child's gender, the number of referrals to child protective services, and the presence of domestic violence, the direct effect of a father/father figure was no longer significant but remained in the multivariate models as a significant interaction term.

Father involvement and children's functioning at age 6 years: a multisite study.

Research suggests that fathers' involvement in their children's lives is associated with enhanced child functioning. The current study examined (a) whether presence of a father was associated with better child functioning, (b) whether children's perceptions of fathers' support was associated with better functioning, and (c) whether the above association was moderated by the father's relationship to the child, the child's race, and the child's gender. Participants included 855 six-year-old children and their caregivers. Father presence was associated with better cognitive development and greater perceived competence by the children. For children with a father figure, those who described greater father support had a stronger sense of social competence and fewer depressive symptoms. The associations did not differ by child's gender, race, or relationship to the father figure. These findings support the value of fathers' presence and support to their children's functioning. Priorities for future research include clarifying what motivates fathers to be positively involved in their children's lives and finding strategies to achieve this.

Data-based organizational change: the use of administrative data to improve child welfare programs and policy.

Administrative databases hold the potential to have a significant impact on the development of effective child welfare programs and policies. This article discusses the strengths and weaknesses of administrative databases, issues with their implementation and data analysis, and effective presentation of their data at different levels in child welfare organizations.

Neural network modeling of risk assessment in child protective services.

The advantages of using neural network methodology for the modeling of complex social science data are demonstrated, and neural network analysis is applied to Washington State Child Protective Services risk assessment data. Neural network modeling of the association between social worker overall assessment of risk and the 37 separate risk factors from the State of Washington Risk Assessment Matrix is shown to provide case classification results superior to linear or logistic multiple regression. The improvement in case prediction and classification accuracy is attributed to the superiority of neural networks for modeling nonlinear relationships between interacting variables; in this respect the mathematical framework of neural networks is a better approximation to the actual process of human decision making than linear, main effects regression. The implications of this modeling advantage for evaluating social science data within the framework of ecological theories are discussed.

Alternative responses to child protective services: emerging issues and concerns.

PROBLEM: Increased calls to "do something" about child protective services (CPS) have resulted in proposals or new "paradigms" for services to at-risk or abusive families. These new paradigms call for the reform or revamping of CPS through the development of a community-based alternative response to some reports of child abuse and/or neglect. METHOD: This article reports on outcomes for 1,263 "low" risk CPS referrals diverted to a community-based alternative response system. Data on child, family, and case characteristics and services provided are presented as well as outcomes associated with re-referral and placement post service provision. RESULTS: The risk level and severity of some of the referrals to alternative response systems seems inappropriately high. The rates of re-referral were similar for families who did or did not engage in assessment services, and were highest for families where domestic violence was present. CONCLUSIONS: Criteria for diversion to community alternatives to CPS must be clearly articulated and applied. Both CPS and alternative response system workers must have the skills required to address a family's recognition of the problem and degree of motivation to engage in problem resolution, and to understand their relationship to continued risk of CA/N.

The extent and consequences of child maltreatment.

Specific, accurate understanding of the extent of maltreatment in American society, the nature of the maltreatment that occurs, and the consequences it has for children are crucial to inform policies regarding child protection and to guide the design of prevention and treatment programs. This article examines how child abuse and neglect are defined and discusses the controversies that surround that definition, which attracts attention because it justifies government intervention to stop actions by parents or caregivers that seriously harm children. The article also presents statistics indicating how widespread maltreatment is, reviews research on the characteristics of families that are more prone to abuse or neglect, and summarizes knowledge about the impact of maltreatment on children. Finally, it mentions the efforts of public child protective services agencies to responsibly ration calls on their limited resources by using risk-assessment approaches to target scarce services to the children who need them the most.

Risk assessment as a practice method in child protective services.

This article offers an overview of the development of risk assessment and its purpose and goals, a summary of research on risk assessment to date, and suggestions regarding future research. This overview indicates that the use of risk assessment is a widespread phenomenon, with differing goals and purposes. Research on risk assessment confirms the lack of conceptual clarity and the difficulty of incorporating it into a child protective services system that emphasizes findings of abuse and/or neglect as the key to continuing involvement in the system.

Decision-making in child protective services: a comparison of selected risk-assessment systems.

The use of structured risk-assessment systems by child protective services has increased dramatically during the past ten years. Versions of the Illinois CANTS 17B, the Washington Assessment of Risk Matrix, and the Child at Risk Field System have been put into use in some form in 23 states [Berkowitz 1991]. Despite this widespread acceptance, workload pressures, uncertain reliability and validity of the instruments, and the need for a knowledgeable and well-trained casework staff have limited the models' usefulness once implemented.