Hispanic versus white, non-Hispanic physician medical practices in Colorado.

The purpose of the study was to extend the scope of earlier research on minority physicians attending to the needs of the poor and their own ethnicity by contrasting practice characteristics of Hispanic doctors in Colorado with those of their white, non-Hispanic counterparts. It was found that Hispanic physicians spent more hours per week in direct patient care, were more likely to have a primary care specialty, and were less often specialty board certified than white, non-Hispanic doctors. Hispanic generalists established practices in areas in which the percentages of the population that were (1) below poverty level, (2) Hispanic, (3) Hispanic and below poverty level, and (4) white, non-Hispanic, and below poverty level were greater than in areas in which white, non-Hispanic primary care physicians practiced. These findings argue for special provision to admit ethnic minorities to undergraduate and graduate medical education programs.

Erroneous concerns about child sexual abuse.

AIM: To assess the incidence and nature of concerns about sexual abuse, with particular reference to erroneous concerns of sexual abuse made by children. METHODS: A review of case notes of all child sexual abuse reports to the Denver Department of Social Services over 12 months. Cases were put into four groups: substantiated, not sexual abuse, inconclusive and erroneous accounts by children. RESULTS: 551 cases were reviewed. Forty-three percent were substantiated, 21% were inconclusive and 34% were not considered to be abuse cases. There were 14 (2.5%) erroneous concerns emanating from children. They comprised three cases of allegations made in collusion with a parent, three cases where an innocent event was misinterpreted as sexual abuse and eight cases (1.5%) of false allegations of sexual abuse. CONCLUSION: Erroneous concern of sexual abuse from children are uncommon. The four categories of concern in this study, in contrast to the simple classification of substantiated and unsubstantiated, provide a means of encouraging open minded assessments of the typical concerns which a child protection agency receives.

Multi-method assessment of access to primary medical care in rural Colorado.

The objectives of this study include conducting an analysis of access to primary medical care in rural Colorado through simultaneous consideration of primary care physician-to-population and distance-to-nearest provider indices. Analyses examined the potential development and implications of excessively large, perhaps unmanageable patient caseloads that might result from every rural Coloradoan's exclusive use of the nearest generalist physician as a regular source of care. Using American Medical Association Physician Masterfile data for 1995 and coordinates for latitude and longitude from U.S. Census files (Census of Population and Housing, 1990), the authors calculated distance to the nearest primary care physician for residents of each of the 1,317 block groups in Colorado's 52 rural counties. Caseloads for each generalist physician were computed assuming the population used the nearest provider for care. Straight-line mileage to primary medical care was modest for rural Coloradoans--a median distance of 2.5 miles. Almost two-thirds (65 percent) of the population resided within 5 miles, and virtually all residents (99 percent) were within 30 miles of a generalist physician. However, had everyone traveled the shortest possible distance to care, demand for service from many of the 343 primary care doctors in rural regions of the state would have been overwhelming. The results of simultaneous application of distance-to-care and provider-to-population techniques unrestricted by geographic boundaries depict access to primary medical care and corresponding consumer difficulty more fully than in previous studies. Further combination of methods of needs assessment such as those used in this analysis may better inform the future efforts of organizations mandated to address health care underservice in rural areas.

Physical abuse of children: an update.

Now, more than ever, physicians must be willing to suspect child abuse and report their concerns. New information from the past decade warns us that reports of violence against children continue to increase. We are learning that MRI imaging of the head may, in some cases, help date subdural hematomas, but long-term developmental follow-up studies of "shaken" infants are lacking. Intentional thoracic and abdominal injuries carry a high mortality. Finally, new information in the field of child abuse-in particular, physical abuse-is slow to come. Lack of funding for basic medical child abuse research and lack of trained researchers in the field are the two most important barriers. Preventive intervention at the community and family level needs to be supported by both the pediatrician and the local and national government leaders. As the U.S. Advisory Board on Child Abuse and Neglect says, "We need to make it as easy for parents to pick up the telephone and get help before they abuse their child as it is now for their neighbor or physician to pick up the telephone and report them after it has happened." Child health practitioners may be in the best position to implement such a policy.

Trends in a national sample of sexually abusive youths.

OBJECTIVE: To describe sociodemographic factors pertinent to sexually abusive youths, to define common characteristics of the offending behaviors and victims, and to identify issues relevant to treatment recommendations. METHOD: The Uniform Data Collection system (UDCS), developed by the National Adolescent Perpetrator Network, provided data from 90 contributors in 30 states on more than 1,600 juveniles referred to them for specialized evaluation and/or treatment following a sexual offense. The UDCS comprises four separate structured questionnaires that collect both factual information and clinical impressions. RESULTS: Physical and sexual abuse, neglect, and loss of a parental figure were common in these youths' histories. Twenty-two percent of the youths, who had been victims of sexual abuse, reported that the perpetrator of their own sexual abuse was female. The youths committed a wide range of sexual offenses, with twice as many of the referring offenses involving female victims than male victims. CONCLUSION: The discovery of sexually abusive youths across both urban and rural areas supports the need for comprehensive service delivery and a continuum of treatment services to be available in all communities.

From battered children to family violence: what lessons should we learn?

Child abuse is an ancient problem but one that has grown alarmingly in the United States in the last few decades. Once the problem of child abuse was recognized in the 1960s, mandatory reporting was instituted to develop public health mechanisms for intervention. But the approaches taken then were inadequate, and as sexual abuse of children was acknowledged, social service agencies gradually devolved from providing help to simply investigating, a trend that has contributed to the present emergency situation. Proper knowledge of how best to treat and prevent child abuse is scarce; this makes it harder to base an educational program in family violence on sound evidence. Also, public awareness of child abuse is far ahead of efforts to intervene and prevent it. Neither federal nor state laws have clear policies about what child protection strategies should be, which inhibits professionals who are attempting to deal with the problem. National guidelines and resources are needed, although efforts to solve the problem are best approached on a local level. Any teaching program on child abuse should discuss the policy alternatives, and any group that is helping children and their families must agree on a policy to guide its work. The author maintains that the child protection system should be run not by county or state governments but by the private and public health care system because this system has greater financial resources, has a tradition of scientific inquiry, and is still perceived as a "helping" system.(ABSTRACT TRUNCATED AT 250 WORDS)

Physical abuse of children: an update.

Now, more than ever, physicians must be willing to suspect child abuse and report their concerns. New information from the past decade warns us that reports of violence against children continue to increase. We are learning that MRI imaging of the head may, in some cases, help date subdural hematomas, but long-term developmental follow-up studies of "shaken" infants are lacking. Intentional thoracic and abdominal injuries carry a high mortality. Finally, new information in the field of child abuse--in particular, physical abuse--is slow to come. Lack of funding for basic medical child abuse research and lack of trained researchers in the field are the two most important barriers. Preventive intervention at the community and family level needs to be supported by both the pediatrician and the local and national government leaders. As the U.S. Advisory Board on Child Abuse and Neglect says, "We need to make it as easy for parents to pick up the telephone and get help before they abuse their child as it is now for their neighbor or physician to pick up the telephone and report them after it has happened." Child health practitioners may be in the best position to implement such a policy.