Clinical assessment of parents in child protection cases: an empirical analysis.

We investigated the content and legal relevance of clinical evaluations of parents conducted in child abuse and neglect cases. The sample consisted of 190 mental health evaluation reports, randomly selected from major providers, that had been completed on parents involved in a large, urban juvenile court system. We coded evaluations on 170 objective and qualitative characteristics in order to assess for criteria recommended in the forensic literature. We compared evaluations across groups categorized by type (e.g., psychological, psychiatric, bonding/parenting, substance abuse) and where the assessments were performed (outside or inside the court). We found numerous substantive failures to meet those criteria for forensic relevance. Evaluations of parents typically were completed in a single session, rarely included a home visit, used few if any sources of information other than the parent, often cited no previous written reports, rarely used behavioral methods, stated purposes in general rather than specific terms, emphasized weaknesses over strengths in reporting results, and often neglected to describe the parent's caregiving qualities or the child's relationship with the parent. Some relevant differences were evident across assessment groups, pointing to examples of more thorough, parenting-specific evaluation practices. We recommend ways to improve current practices in forensic parenting assessment.

Case ascertainment for state-based birth defects registries: characteristics of unreported infants ascertained through birth certificates and their impact on registry statistics in New York state.

Cases in the New York State Congenital Malformations Registry are reported by hospitals and physicians. This study was undertaken to determine whether case finding should be expanded to include routine matching of Vital Records files to the registry in order to identify unreported children. Matching of children who were born in 1983-86 and who had a congenital malformation noted on their birth certificate yielded 2837 children who were not in the registry. The hospital of record was asked to submit a registry report if the child's medical record contained a congenital malformation. Medical records for 1267 (45%) of these children indicated that the child was normal, with no mention of a malformation. Medical records could not be located for 137. Registry reports were submitted for 1433, 67 of whom were subsequently found in the registry, leaving 1366 bona fide new cases. These new cases differ significantly from registry cases for a number of birth certificate variables and type of congenital malformation. The birth certificate cases were more likely than registry cases to have only one malformation and to have only a minor malformation. The 1366 new cases comprised 2.1% of all registry cases for 1983-86. Their addition increased the statewide prevalence of major malformations by 1.7% from 416.5 to 423.4 per 10 000 livebirths. Except for anencephaly, the prevalence of specific malformations was not altered measurably by the addition of these cases. Lengthy and continuous follow-up was required to obtain registry reports. The small number of cases found does not seem to justify the amount of resources that would be required to use birth certificates routinely to augment case finding in New York State.

Incidence of low birth weight among Love Canal residents.

The incidence of low birth weight among white live-born infants from 1940 through 1978 was studied in various sections of the Love Canal. A statistically significant excess was found in the historic swale area from 1940 through 1953, the period when various chemicals were dumped in this disposal site. Potential confounding factors such as medical-therapeutic histories, smoking, education, maternal age, birth order, length of gestation, and urban-rural difference did not appear to account for this observation. Low birth weight rates were comparable to those of upstate New York from 1954 through 1978, the period when there was no deposition of chemical wastes.

Infant leukemia and paternal exposure to motor vehicle exhaust fumes.

The children of fathers who work in gas stations, automobile or truck repair, and aircraft maintenance appear to be at increased risk for acute leukemia during their first year of life. The odds ratio was found to be about 2.5 overall, but risk appears to be greater for female offspring. A decline in sex ratio was observed for the three decades of the study, with the lowest ratio observed from 1969 through 1978. These preliminary findings suggest that exposure to one or more of the components of exhaust fumes might be of etiologic importance for this malignancy. The limitations of this investigation are discussed.

Lymphomas and occupational benzene exposure.

There was a significant excess of deaths caused by major lymphomas in men employed in occupations where benzene and/or coal tar fractions are used. The increase in risk was limited to those who were 45 years of age and older at death, an observation which is consistent with the possibility that chronic exposure might be important. Evidence from other studies suggests that benzene may adversely affect the immunological system.

Immunity in Hodgkin's disease: importance of age at exposure.

A relatively common viral agent of low virulence and infectivity might be of etiologic importance in Hodgkin's disease. Age at initial exposure is a major determinant of the outcome of infection (immunity versus clinical disease) and the different epidemiologic patterns for this lymphoma observed internationally. Early exposure, particularly when it occurs in persons from high birth ranks, is associated with a relatively durable immunity. In contrast a delay in initial exposure, also mediated by family factors, results in higher clinical disease-to-immunity ratio. The large male excess in childhood Hodgkin's disease might be due to some sex-linked environmental factor operating early in life and the greater frequency of an asymptomatic carrier state in this sex.

Non-occupational exposure to asbestos and malignant mesothelioma in females.

A study of the occupational histories of 52 females with malignant mesothelioma and certain of their relatives, carried out to measure the risk of this disorder attributable to indirect asbestos exposure, showed that a significantly greater number of husbands and fathers of cases than of controls worked in asbestos-related industries, and the relative risk for this factor was 10. The frequency of parental cancer, especially gastrointestinal malignancy, was also significantly greater for cases than for their controls. This raises the possibility of a genetic predisposition to malignant mesothelioma.

Epidemiologic and histologic patterns of Hodgkin's disease in blacks.

The epidemiologic pattern for Hodgkin's disease in blacks from two different communities in the United States was characterized by higher childhood rates and significantly lower rates in the young adult and older age groups than for whites. In addition, a significantly greater number of black patients belonged to low occupational groups. These observations and the different epidemiologic patterns for blacks in Southern Transvaal, South Africa, and other countries suggest that the natural history of Hodgkin's disease might be strongly influenced by social milieu. The variability in Rye subtype distribution, particularly for whites and blacks in the young adult and other age groups raise the possibility that age related environmental factors might be important in the histologic reactivity of the host.

Angiosarcoma of the liver: an epidemiologic survey.

Diagnosed from 1970 through 1975, the annual incidence rate for angiosarcoma of the liver among residents of New York State (excluding New York City) was 0.25 per million. A case-control study indicated that direct exposure to arsenic, vinyl chloride (VC), and thorium dioxide was a significantly important factor in the etiology of this disorder (P less than 0.02). Direct exposure to these chemicals could not be demonstrated for 19 (73%) of the 26 study patients. The fact that 5 of these patients lived nearer to VC fabrication or polymerization plants than did their matched controls lent some support to the hypothesis that indirect modes of exposure, not specifically related to occupation, might be important in the etiology of this disorder.

Childhood lymphatic leukemia: prenatal seasonality and possible association with congenital varicella.

A statistically significant seasonality by month of birth, which differed for children diagnosed as having acute lymphatic leukemia in the under 2, 2-3 and 4-9-year age groups, was observed in urban counties of upstate New York. This suggested that the mothers of patients diagnosed in these three age groups might have been exposed to leukemogenic factors during different trimesters, but with each trimester consisting of the same specific group of months. Since a similar birth-month seasonality was not observed in rural regions, it seemed likely that leukemogenic factors might operate with a greater regularity in urban areas. Using these observations and reported trends for acute leukemia in the United States and New York State (excluding New York City), an effort was made to determine whether varicella, influenza, rubeola or rubella had similar epidemiologic features. Only varicella manifested both the urban-rural differences in seasonality and concomitant variations in time trends that were comparable to reported mortality trends for acute leukemia. Rank correlation coefficients for varicella and lymphatic leukemia incidence rates by month were also statistically significant when leukemia cases diagnosed in the three age groups and born in urban countries, were placed in the month of their appropriate trimesters. A retrospective search of varicella case records identified 63 instances of this viral disease complicating pregnancy. Three children resulting from these pregnancies subsequently developed acute lymphatic leukemia.