Intimate partner violence (IPV) and preeclampsia among Peruvian women

OBJECTIVE: Mounting evidence supports the view that intimate partner violence (IPV) is an important cause of maternal mortality. Some, but not all, prior studies suggest that IPV is associated with increased risks of maternal medical conditions such as hypertensive disorders of pregnancy which are leading causes of maternal mortality worldwide. We assessed the relation between IPV and risk of preeclampsia among Peruvian women. STUDY DESIGN: We conducted a case-control study at two large hospitals in Lima, Peru. Preeclampsia cases were 339 women with pregnancy-induced hypertension and proteinuria (i.e., preeclampsia). Controls were 337 normotensive women. Information concerning women's exposure to physical and emotional violence during pregnancy was collected during in-person interviews conducted after delivery and while patients were in hospital. Odds ratios (OR) and 95% confidence intervals (CI) were estimated from logistic regression models. RESULTS: The prevalence of IPV was 43.1% among cases and 24.3% among controls. Compared with those reporting never exposure to IPV during pregnancy, women reporting any exposure had a 2.4-fold increased risk of preeclampsia (OR=2.4; 95% CI: 1.7-3.3). The association was strengthened slightly after adjusting for maternal age, parity and pre-pregnancy adiposity (OR=2.7; 95% CI: 1.9-3.9). Emotional abuse in the absence of physical violence was associated with a 3.2-fold (95% CI: 2.1-4.9) increased risk of preeclampsia. Emotional and physical abuse during pregnancy was associated with a 1.9-fold increased risk of preeclampsia (95% CI: 1.1-3.5). CONCLUSIONS: IPV among pregnant women is common and is associated with an increased risk of preeclampsia. These data support recent calls for coordinated global health efforts to prevent violence against women.     

建立中药材盲样检验机制 有效预防以权谋私

从建立管理制度、完善工作程序、编制作业文件、加强运行监督等方面介绍了药品检验机构新近运行的中药材盲样检验机制,详细介绍了中药材盲样检验工作流程,对中药材盲样检验机制在药品检验机构廉政建设中有效预防以权谋私的作用进行了简要论述。     

Mental health, demographic, and risk behavior profiles of pregnant survivors of childhood and adult abuse

Our objective was to address the gap in knowledge about the extent to which perinatal mental health and risk behaviors are associated with childhood and adult experiences of abuse that arises because of barriers to screening and disclosure about past and current abuse. Survey data from an ongoing study of the effects of posttraumatic stress on childbearing were used to describe four groups of nulliparous women: those with no abuse history, adult abuse only, childhood abuse only, and abuse that occurred during both periods. The rates of abuse history disclosure were higher in the research context than in the clinical settings. Mental health morbidity and risk behaviors occurred in a dose-response pattern with cumulative abuse exposure. Rates of current posttraumatic stress disorder ranged from 4.1% among those never abused to 11.4% (adult only), 16.0% (childhood only), and 39.2% (both periods). Women abused during both periods also were more likely to be using tobacco (21.5%) and drugs (16.5%) during pregnancy. We conclude that mental health and behavioral risk sequelae affect a significant portion of both childhood and adult abuse survivors in prenatal care. The integration into the maternity setting of existing evidence-based interventions for the mental health and behavioral sequelae of abuse is needed.     

Intimate partner violence screening and brief intervention: experiences of women in two New Zealand Health Care Settings

The identification of intimate partner violence (IPV) against women as a public health problem has led to routine health care site– based screening and brief intervention policies. However, there is a lack of evidence supporting the usefulness and safety of such policies. Our objective was to ascertain the acceptability, usefulness, and harm of a brief health care site– based screening intervention. In this qualitative study, semistructured interviews were conducted with 36 women several weeks after a standardized screening intervention in either an emergency department (adult and paediatric) or primary health care setting. The majority of women (97%) welcomed the IPV screening intervention and perceived it as nonthreatening and safe. The women reported no increased risk of harm because of the screening. The responses showed that the intervention had a therapeutic and educational quality, and the attitude and approach of the person asking the intervention questions was critical to a positive outcome. Women without a history of violence cautioned that IPV screening may be offensive to those who are abused, whereas those who reported abuse thought IPV screening was essential “to stop it [from] happening.” Our findings challenge concerns that IPV screening is offensive to women and increases their potential for danger. Participants were appreciative of the opportunity to tell their abuse stories in a safe and supportive context, and challenged the health care system to implement IPV screening, asking “What took you so long?”     

Disclosure and health-seeking behaviour following intimate partner violence before and during pregnancy in Flanders, Belgium: a survey surveillance study

OBJECTIVES: The objectives were to estimate the prevalence of physical and sexual intimate partner violence (IPV) among a regional sample of the general obstetric population as the lifetime prevalence, as the 1-year period prevalence before pregnancy, and as the prevalence during the index pregnancy; to assess the rates of disclosure and help-seeking behaviour with IPV; and to determine the acceptability of screening for IPV. STUDY DESIGN: A multi-centred survey surveillance study was carried out among pregnant women attending five large hospitals in the province of East Flanders, Belgium as a regional probability sample of the general obstetric population. Data were collected through an anonymous, written questionnaire that included the Abuse Assessment Screen and additional questions on the circumstances of the most recent episode of physical or sexual violence, on disclosure and help-seeking behaviour, on reporting assault to the police, and on the acceptability of routine screening for IPV. RESULTS: The sampling frame consisted of 1362 women who received the questionnaire at the antenatal service during a 2-month study period, of which 537 (mean age 29.4 years, S.D. 4.09) returned the envelope (response rate 39.4%). The lifetime prevalence of IPV was estimated to be 10.1% (95% CI 7.7-13.0%) and the period prevalence of IPV during pregnancy and/or in the year preceding pregnancy 3.4% (95% CI 2.1-5.4%). There was a significant difference in the reported lifetime prevalence of IPV between women attending with a partner and those who came to the prenatal visit unattended by their partner in particular (6.8% versus 13.9%, p=0.010). Overall, only 19.2% (23 out of 120) and as few as 6.6% (4 out of 61) of the victims of physical and sexual abuse respectively sought medical care by consulting a general practitioner, gynaecologist, or an emergency department. Routine screening for IPV by a general practitioner or gynaecologist was found to be largely acceptable. CONCLUSIONS: In our highly medicalised society, women experiencing partner violence rarely disclose abuse to the widely available health care services, unless they are directly asked about it, which appears an acceptable practice. Hence, there is a definite need to improve women's awareness regarding abuse and their help-seeking behaviour at a public health level.     

Physical injury from intimate partner violence: measurement strategies and challenges

Physical injury that occurs as a result of intimate partner violence needs to be treated to relieve pain, promote healing, and prevent infection. Detection of physical injury is an important component of the forensic examination because of its role in criminal justice proceedings. Better detection and measurement techniques are needed to quantify physical injuries and advance the science. This article addresses current practices of injury identification, challenges in injury measurement, and future directions for research.     

Conceptual crises and the addictions: A philosophy of science perspective

This article examines the field of addictions and suggests that it is in the midst of a conceptual crisis. As a result of its immaturity, the addiction's field evidences energy, naivete, curiosity, intensely conflicting and polarized explanations of its identity and purpose, anomalous research findings, and few “facts”. From a philosophy of science perspective, these characteristics are considered as indicators of the developmental stages that are associated with the evolotion of scientific disciplines. A philosophy of science perspective is applied to the history of the substance abuse field and the consequent implications examined. A discussion of normal science, language, the role of paradigms, and scientific reductionism is included.     

浅谈医学技术给人类社会带来的不良影响

对现代医学技术给人类社会带来的各种不良影响进行了探讨,以期引起人们对该问题的重视,防止医学技术的滥用。     

Complex Pathophysiology of Abusive Head Trauma with Poor Neurological Outcome in Infants

Abusive head trauma (AHT) in infants, especially acute subdural hematoma, has an extremely poor outcome. The most decisive and important finding is the appearance of a widespread low-density area on head computed tomography. This phenomenon was traditionally thought to be caused by cerebral ischemia. However, many other pathophysiological abnormalities have been found to be intricately involved. Recent studies have found that status epilepticus and hyperperfusion injures are the major causes. Another serious problem associated with AHT is cardiopulmonary arrest (CPA). Many infants are reported to visit to the hospital with CPA, and its pathophysiology has not been fully elucidated. This paper examines the background of these pathological conditions and associated factors and elucidate the pathophysiological mechanisms resulting in poor outcomes in AHT. In addition to the intensity of assault on the head, the peculiar pathophysiological characteristics in infants, as well as the social background specific to child abuse, are found to be associated with poor outcome.