Who gets protection orders for intimate partner violence?

BACKGROUND: It is unknown how victims of intimate partner violence (IPV) who seek civil protection orders differ from IPV victims who do not. METHODS: To compare characteristics of women with and without protection orders, 448 women with police or court contact for an IPV incident in Seattle, Washington, were interviewed. Data collected included demographic characteristics of the subject and her abuser, abuse history, and the subject's mental and physical health. RESULTS: IPV victims who obtained protection orders were more likely than victims without protection orders to be employed full-time, be pregnant, be married, aged over 24, and less likely to be involved with perpetrator at index incident. The perpetrators for both groups were similar, and the majority had a current or previous alcohol/drug problem and a previous criminal history. Both groups of victims had been psychologically and physically abused during the previous year and nearly all had symptoms of depression. However, at the index incident, women who sought protection orders were less likely to be physically assaulted or injured, but more likely to have family members or friends physically assaulted. CONCLUSIONS: Financial independence and abuse of family or friends are important factors associated with the decision to seek a protection order in IPV.     

Who gets radiotherapy?

This study investigated the use of radiotherapy for patients perceived to be unsuitable for curative therapy. Patients were grouped according to whether their cancer was considered curable or incurable and whether they received radical or palliative schedules of radiotherapy. The latter group was further evaluated to clarify current practice, to examine the problems in establishing guidelines for treatment and as a basis for prospective audit. Results confirmed that therapy guidelines within the unit were in line with national practice. Changes in standard therapy were proposed in view of resource limitations and recent results from other surveys. A second audit in 1989, together with a formal costing exercise, showed a reduction in the median number of fractions per course in both patient groups. This study suggests that palliative radiotherapy was used selectively for patients likely to receive significant benefit, and that consensus management was practised, and influenced, by informal internal audit. Results highlighted decision-making problems in the management of advanced non-metastasised cancer; confirmed doubts about the advisability of establishing rigid guidelines in palliative therapy; and clarified some of the difficulties in conducting meaningful cost-benefit analyses in this area.     

Who gets hospitalized for influenza pneumonia in Thailand? Implications for vaccine policy

Risk factor information for severe complications of interpandemic influenza is needed to inform vaccine policy in Thailand. We identified patients with lab-confirmed influenza who were hospitalized with pneumonia during September 2003 to August 2004. Among the 80 case-patients identified through a population-based pneumonia surveillance system in eastern Thailand, cases were 6.2 and 11.1 times more likely to be among persons<1 year old and >75 years old, respectively, compared with the overall population. Cases were also 7.6 times more likely to have chronic respiratory disease. In Thailand, the young, elderly, and those with chronic disease were at high risk for hospitalized pneumonia from influenza.     

Intimate partner violence: what are physicians' perceptions?

BACKGROUND: Intimate partner violence (IPV) is common in primary care; 11% to 22% of women experienced physical abuse in the past year. Older women experience IPV as well, but it is often undetected. This study examined primary care providers' awareness about IPV in older women, including their screening practices and management. METHODS: Interviews and focus groups were conducted with 44 primary care providers. Thematic analysis was used to identify common themes. RESULTS: Providers fell along a continuum of thoroughness for identifying and managing IPV in older women, ranging from suboptimal to thorough identification of IPV and suboptimal to thorough management of the patient. In addition to the barriers commonly reported about IPV screening in younger women, providers described limited understanding of the diagnoses commonly associated with IPV, frustration with older women's unwillingness to disclose problems and ask for help, and limited community services that accommodate older women with IPV. Providers recommended that communities sponsor public awareness campaigns about IPV as a problem for all women and that aging and IPV agencies work together. CONCLUSIONS: Continued provider training about IPV should include information on identifying older victims and appropriate management options. Participants stressed the importance of community efforts to raise awareness and improve resources available for older women who are victims of IPV.     

Who should be screened for postpartum anemia? An evaluation of current recommendations

The authors evaluated the utility of selective screening criteria for postpartum anemia developed by the Centers for Disease Control and Prevention (CDC) versus criteria developed among low-income women using prevalence-based screening principles. Pregnant women in Raleigh, North Carolina, were followed up to the postpartum visit in 1997-1999 (n = 345). Prevalence of postpartum anemia was 19.1%. Independent risk markers, arrived at through multivariate logistic regression, were multiparity (odds ratio (OR) = 1.5, 95% confidence interval (CI): 0.8, 2.9), obesity (OR = 3.0, 95% CI: 1.6, 5.5), anemia at 24-29 weeks' gestation (OR = 2.3, 95% CI: 1.2, 4.4), anemia before delivery (OR = 3.4, 95% CI: 1.8, 6.7), and not exclusively breastfeeding (OR = 2.8, 95% CI: 1.0, 7.7). Risk scores were calculated by counting risk markers present. Likelihood ratios were determined for all possible risk scores of our algorithm and CDC's algorithm. Anemia screening decisions differed depending on clinic anemia prevalence. For example, if low test thresholds are assumed, when clinic prevalence is 10%, women with risk scores >3 on the authors' algorithm and >0 on CDC's algorithm should be screened. The authors' algorithm, in combination with prevalence information, can save clinics more money than CDC's current algorithm because a broader range of likelihood ratios was obtained, indicating a better ability to distinguish high- from low-risk women. However, if resources are available, universal screening should be considered in high-prevalence settings.     

Mandatory reporting of intimate partner violence: safety or retaliatory abuse for women?

We wished to ascertain abused women's perspectives on mandatory reporting of intimate partner violence. A consecutive sample of 161 abused women accessing the criminal justice system were asked six questions. Most women (81%) thought there should be a law making the nurse or doctor report the abuse, with less than half of the women (45%) reporting they would have been at greater risk for abuse following a mandatory report. Although these 161 abused women support mandatory reporting of partner abuse, it remains unclear if such a law would deter further abuse. Outcome and evaluation studies of mandatory reporting laws are urgently needed.     

Are fewer women smoking during pregnancy?

OBJECTIVE: To determine whether pregnancy-smoking rates have changed in last decade. METHODS: Retrospective cohort study of 67,395 pregnancies in Kansas City over 2 epochs, 1993-1997 and 1998-2002, using computer files of birth certificates. RESULTS: Overall pregnancy-smoking rates decreased from 18.1% (95% CI=17.7-18.5%) to 14.2% (13.8-14.5%). Among smokers, there was a distribution shift toward light smoking; light [39% (38.9-40.3%) vs 49% (47.6-50.4%)], moderate [36.8% (34.8%-38.8%) vs 34.4% (32.1-36.7%)], and heavy [23.1% (21.9-26.3%) vs 16.6% (14-19.1%)]. CONCLUSIONS: The results suggest decreasing heavier smoking. However, the trend toward light smoking suggests decreasing self-reporting. These findings highlight the dilemma in using self-reports for public health policy and emphasize the importance of antismoking socialization for all pregnancies.     

Is praziquantel therapy safe during pregnancy?

Schistosomiasis control programmes are generally based on mass distribution of praziquantel (PZQ). This approach has been further strengthened by studies that demonstrated reduction in schistosomiasis-related morbidity following regular use of PZQ. Many women were excluded from this therapy when pregnant. Since a high degree of parity is achieved in many schistosomiasis-endemic regions, excluded women often miss treatment and consequently the beneficial effect of this therapy. This study investigated the effect of PZQ therapy on pregnancy in the Gezira region of Sudan. As part of the Blue Nile Health Project, more than 320 000 individuals received annual treatment with PZQ from 1980 to1990. The present study reviewed the treatment records of all women between 1990 and 1995 in four villages. Eighty-eight of 637 women interviewed had received PZQ during their pregnancy. The outcome and the effect of PZQ therapy on their offspring were compared with a group of 549 women who had not received the drug during pregnancy. There were no significant differences between the two groups in the rate of abortion or preterm deliveries. No congenital abnormalities were noted by clinical examination in any of the babies born to either group. This retrospective study suggested that PZQ therapy is safe during pregnancy.     

Spoilt for choice? Cross-sectional study of care-seeking for health problems during pregnancy in Mumbai slums

This study considers care-seeking patterns for maternal morbidity in Mumbai's slums. Our objectives were to document women's self-reported symptoms and care-seeking, and to quantify their choice of health provider, care-seeking delays and referrals between providers. The hypothesis that care-seeking sites for maternal morbidity mirror those used for antenatal care was also tested. We analysed data for 10,754 births in 48 slum areas and interviewed mothers about their illnesses and care-seeking during pregnancy. Institutional care-seeking was high across the board (>80%), and higher for 'trigger' symptoms suggestive of complications (>88%). Private-sector care was preferred, and increased with socio-economic status, although public providers also played an important role. Most women sought treatment at the same site they received their antenatal care, most were treated within 2 days, and less than 2% were referred to other providers. Our findings suggest that poor women in Mumbai recognise symptoms of obstetric complications and the need for health care. However, that more than 80% also sought care for minor conditions implies that the tendency to seek institutional care for serious conditions reflects a broader picture of care-seeking for all illnesses. The role of private health-care providers needs greater recognition, and further research is required on provider motivations and behaviour.     

Spoilt for choice? Cross-sectional study of care-seeking for health problems during pregnancy in Mumbai slums

Abstract

This study considers care-seeking patterns for maternal morbidity in Mumbai's slums. Our objectives were to document women's self-reported symptoms and care-seeking, and to quantify their choice of health provider, care-seeking delays and referrals between providers. The hypothesis that care-seeking sites for maternal morbidity mirror those used for antenatal care was also tested. We analysed data for 10,754 births in 48 slum areas and interviewed mothers about their illnesses and care-seeking during pregnancy. Institutional care-seeking was high across the board (>80%), and higher for ‘trigger’ symptoms suggestive of complications (>88%). Private-sector care was preferred, and increased with socio-economic status, although public providers also played an important role. Most women sought treatment at the same site they received their antenatal care, most were treated within 2 days, and less than 2% were referred to other providers. Our findings suggest that poor women in Mumbai recognise symptoms of obstetric complications and the need for health care. However, that more than 80% also sought care for minor conditions implies that the tendency to seek institutional care for serious conditions reflects a broader picture of care-seeking for all illnesses. The role of private health-care providers needs greater recognition, and further research is required on provider motivations and behaviour.