Friday, February 8, 2013

Doctors urged to screen women for domestic abuse

By Monte Morin, Los Angeles Times
January 21, 20138:02 p.m.

Asking standard questions of female patients of childbearing age shows a 'moderate net benefit' and little risk, a federal advisory panel says.

Women of childbearing age should undergo screening for domestic violence and other forms of abuse while visiting their doctor or clinic, according to a recommendation published online Monday by an influential panel of medical experts that advises the federal government.
That recommendation, published in the Annals of Internal Medicine, marks a significant change from 2004 when the U.S. Preventive Services Task Force found insufficient evidence to support screenings for so-called intimate partner violence, or IPV.
Now, citing new evidence, the task force said that screening women for IPV with a list of standard questions showed a "moderate net benefit," while the risks associated with disclosing abuse were small.

"The bottom line is that more research is needed on how primary-care clinicians can effectively screen and protect all populations, including older and vulnerable adults, middle-aged women, men and children from abuse and violence," said Dr. David Grossman, a Seattle pediatrician and task force member.

The guidelines apply only to women aged 14 to 46 who do not show obvious signs of physical or sexual abuse that would otherwise prompt questions from healthcare providers. Though the report acknowledged that women of childbearing age were not the only people who suffered abuse at the hands of former or current intimate partners, evidence was still insufficient to recommend broader screenings, the authors said.
If abuse is confirmed, physicians should provide patients with, or refer them to, intervention services, the panel said. Such services include counseling, home visits, information cards, community service referrals and mentor programs.
In a separate draft statement addressing child maltreatment, task force members said there wasn't enough evidence to recommend how clinicians could prevent abuse among children who lacked obvious symptoms.
Intimate partner violence includes physical violence, sexual abuse, psychological abuse, stalking and reproductive coercion — intimidation that increases the risk of unplanned pregnancy. The Centers for Disease Control and Preventionestimates that nearly 31% of women and 26% of men have experienced IPV in their lifetimes. Immediate health consequences include injury, death, sexually transmitted diseases, unintended pregnancy, psychological distress and premature births.
Screening for domestic violence is recommended by the American Congress of Obstetricians and Gynecologists for women of all ages. Other organizations, such as the American Medical Assn., encourage physicians to inquire about abuse in all patients as part of medical history, but do not recommend a specific screening format or list of questions.
Monday's recommendation by the task force could possibly steer organizations toward adopting a more standardized protocol, according to some healthcare providers.
"This is very significant," said Eric Ferrero, a Planned Parenthood spokesman who was not involved in the study. "It's just good practice to know a patient's health history, and we have been conducting screenings for a number of years. Hopefully, with this recommendation, it will be done more broadly."
In the case of Planned Parenthood, which treats about 3 million patients in 800 facilities, IPV screenings were sometimes the first time that patients spoke of or even acknowledged abuse, Ferrero said. "We know, at least anecdotally, that this first discussion has led some women to leave an abusive relationship."
The task force recommendation was based on a review of dozens of studies and interviews with more than 30,000 people. Screenings were conducted several ways. Some women were questioned face to face by their healthcare provider and others performed self-screenings, answering questions on either a computer or a printed questionnaire.

Mental Disorders Linked With Domestic Violence, Study Says

By Randy Dotinga Wednesday, January 2, 2013 

WEDNESDAY, Jan. 2 (HealthDay News) -- People diagnosed with mental illness are more likely than others to be victims of domestic violence, a new analysis finds.

Previous research has linked depression to domestic violence, but this review looks at a possible link between mental illness overall and domestic abuse in men and women.

"In this study, we found that both men and women with mental health problems are at an increased risk of domestic violence," senior study author Louise Howard, a professor at King's College London's Institute of Psychiatry, said in a college news release.

"The evidence suggests that there are two things happening: Domestic violence can often lead to victims developing mental health problems, and people with mental health problems are more likely to experience domestic violence," Howard said.

The review, published recently in the journal PLoS One, examines statistics from 41 studies worldwide. It finds that women with symptoms of depression were 2.5 times more likely to have experienced domestic violence over their lifetimes than those in the general population, while those with anxiety disorders were more than 3.5 times more likely to have suffered domestic abuse. The extra risk grew to seven times more likely among those with post-traumatic stress disorder.

Women with other conditions, such as obsessive compulsive disorder, eating disorders, schizophrenia and bipolar disorder were also at higher risk, as were men with all types of mental disorders.
"Mental health professionals need to be aware of the link between domestic violence and mental health problems, and ensure that their patients are safe from domestic violence and are treated for the mental health impact of such abuse," said Howard.

Domestic abuse can be physical, psychological, sexual, financial or emotional and include overly controlling or coercive behavior.

SOURCE: King's College London, England, news release, Dec. 26, 2012

Monday, February 6, 2012

Posttraumatic stress disorder (PTSD) associated with elevated hemoglobin A1c levels in low-income blacks with diabetes

US Department of Health & Human Services:

CHRONIC DISEASE:  Posttraumatic stress disorder (PTSD) associated with elevated hemoglobin A1c levels in low-income blacks with diabetes

The frequency of posttraumatic stress disorder (PTSD) ranges from 10 to more than 50 percent in urban primary care settings where the prevalence of trauma is high. There is also growing evidence that PTSD is linked with chronic disease, such as diabetes and heart disease, and with poorer health outcomes. In fact, a recent study found that PTSD was significantly associated with a hemoglobin (Hb) A1c level (a marker of diabetes control) greater than 7 percent among low-income minorities. The researchers recruited men and women with type 2 diabetes from four community-based primary care clinics in Harlem, New York City. In addition to demographic information, participants were screened for depressive symptoms and for lifetime PTSD. A total of 103 adults were included in the final analysis. Within the group, 12 percent had lifetime full PTSD, while another 12 percent had sub-threshold PTSD. Those with lifetime PTSD were significantly more likely to have an HbA1c level of greater than 7 percent compared to patients not experiencing PTSD symptoms.

The most common sources of trauma were childhood physical abuse (22 percent) and the death of a child (18 percent). Patients with PTSD were also more likely to suffer from depressive symptoms and to be taking a psychiatric medication. In addition to PTSD, patients with HbA1c levels above 7 percent had diabetes for 15 or more years and were more likely to be taking insulin. The researchers encourage physicians to consider a diagnosis of PTSD in low-income patients with diabetes who are experiencing poor glucose control. The study was supported in part by the Agency for Healthcare Research and Quality (T32 HS00066).

See "Associations between posttraumatic stress disorder and hemoglobin A1c in low-income minority patients with diabetes," by Samantha A. Miller, M.D., M.S., Carol A. Mancuso, M.D., Carla Boutin-Foster, M.D., M.S., and others in General Hospital Psychiatry 33, pp. 116-122, 2011.

HEALTHDAY: Ob-Gyns Should Screen for Domestic Abuse: Experts

Intimate partner violence can be psychological or physical, occurs at all levels of society

By Robert Preidt

TUESDAY, Jan. 24 (HealthDay News) -- Obstetricians and gynecologists should screen all patients for intimate partner violence, including during prenatal visits, according to new recommendations from the American College of Obstetricians and Gynecologists.

In addition, ob-gyns should offer patients support, and have referral and resource information on hand to give to patients who are victims of abuse.

Intimate partner violence includes physical injury, psychological abuse, sexual assault, progressive isolation, stalking, deprivation, intimidation and reproductive coercion. The goal of these behaviors is to establish control over a partner.

The violence can occur among both heterosexual and same-sex partners and at every level of society, regardless of age, gender, income levels, race, ethnicity, religion or educational background, according to a news release from the college.

About one in four women has been physically and/or sexually assaulted by a current or former partner, and nearly 324,000 pregnant women are abused by their partners each year in the United States, researchers have found.

Intimate partner violence has been linked to poor pregnancy outcomes, including poor weight gain, infection, fetal injury, preterm delivery, low birth weight and stillbirth.

Signs and symptoms that a woman is experiencing violence include physical injuries, chronic headaches, chronic pelvic pain, irritable bowel syndrome, and recurrent vaginal infections. Violence is often linked to depression, anxiety, substance abuse, unintended pregnancy and suicide.

"Women of all ages experience intimate partner violence, but it is most prevalent among reproductive-age women," Dr. Maureen Phipps, chair of the college's Committee on Health Care for Underserved Women, said in the news release. "We have a prime opportunity to identify and help women who are being abused by incorporating this screening into our routine office visits with each and every patient."

The recommendations are published in the February issue of the journal Obstetrics & Gynecology.

SOURCE: American College of Obstetricians and Gynecologists, news release, Jan. 23, 2012

CDC: National Intimate Partner and Sexual Violence Survey

CDC’s National Intimate Partner and Sexual Violence Survey (NISVS) is an ongoing, nationally-representative telephone survey that collects detailed information on sexual violence, stalking, and intimate partner violence victimization of adult women and men in the United States. The survey collects data on past-year experiences of violence as well as lifetime experiences of violence. The 2010 survey is the first year of the survey and provides baseline data that will be used to track trends in sexual violence, stalking and intimate partner violence. CDC developed NISVS to better describe and monitor the magnitude of these forms of violence in the United States.

Highlights of 2010 Findings

Sexual violence, stalking, and intimate partner violence are widespread in the United States. The findings in this report underscore the heavy toll of this violence, the immediate impacts of victimization, and the lifelong health consequences.

Women are disproportionally affected by sexual violence, intimate partner violence and stalking.
  • 1.3 million women were raped during the year preceding the survey.
  • Nearly 1 in 5 women have been raped in their lifetime while 1 in 71 men have been raped in their lifetime.
  • 1 in 6 women have been stalked during their lifetime. 1 in 19 men have experienced stalking in their lifetime.
  • 1 in 4 women have been the victim of severe physical violence by an intimate partner while 1 in 7 men experienced severe physical violence by an intimate partner.
  • 81% of women who experienced rape, stalking or physical violence by an intimate partner reported significant short or long term impacts related to the violence experienced in this relationship such as Post-Traumatic Stress Disorder (PTSD) symptoms and injury while 35% of men report such impacts of their experiences.
  • Women who had experienced rape or stalking by any perpetrator or physical violence by an intimate partner in their lifetime were more likely than women who did not experience these forms of violence to report having asthma, diabetes, and irritable bowel syndrome.
  • Men and women who experienced these forms of violence were more likely to report frequent headaches, chronic pain, difficulty with sleeping, activity limitations, poor physical health and poor mental health than men and women who did not experience these forms of violence.
Female victims of intimate partner violence experienced different patterns of violence than male victims.
  • Female victims experienced multiple forms of these types of violence; male victims most often experienced physical violence.
The majority of this victimization starts early in life.
  • Approximately 80% of female victims experienced their first rape before the age of 25 and almost half experienced the first rape before age 18 (30% between 11-17 years old and 12% at or before the age of 10).
  • About 35% of women who were raped as minors were also raped as adults compared to 14% of women without an early rape history.
  • 28% of male victims of rape were first raped when they were 10 years old or younger.
Overall, lifetime and one year estimates for sexual violence, stalking and intimate partner violence were alarmingly high for adult Americans; with IPV alone affecting more than 12 million people each year. Women
are disproportionately impacted. They experienced high rates of severe intimate partner violence, rape and
stalking, and long-term chronic disease and other health impacts such as PTSD symptoms. NISVS also shows that most rape and IPV is first experienced before age 24, highlighting the importance of preventing this violence before it occurs to ensure that all people can live life to their fullest potential.

    HealthDay: Neurologists Should Screen Patients for Abuse: Experts

    People with certain disorders might be more vulnerable to violence, says American Academy of Neurology

    By Robert Preidt
    Wednesday, January 25, 2012

    WEDNESDAY, Jan. 25 (HealthDay News) -- Neurologists should screen their patients for abuse by family members, caregivers or other people, the American Academy of Neurology says in a new position statement.

    Problems to look for include elder, sexual, child, financial and emotional abuse; bullying, cyberbullying and violence.

    Certain neurologic disorders, such as Parkinson's disease, Alzheimer's disease or stroke, may raise the risk for abuse and neglect, the academy said.

    The statement outlines 10 principles for neurologists to use when meeting with patients. These include integrating questions about abuse into a patient's medical history and routinely checking patients for past and ongoing violence.

    The academy is also offering free training to members interested in learning how to deal with domestic violence issues in their communities.

    "Neurologists see patients with neurologic disorders that may make them more susceptible to abuse or neglect. They also see patients with neurologic issues that may be either directly or indirectly related to mistreatment," statement lead author Dr. Elliott Schulman, of Lankenau Medical Center in Wynnewood, Penn., said in an academy news release.

    More than 90 percent of all injuries caused by intimate partner violence occur to the head, face or neck and can result in traumatic brain injury, according to the statement.

    It also noted that people with neurologic disorders such as stroke, Alzheimer's disease or Parkinson's disease may be at increased risk for abuse and neglect.

    "By routinely asking about violence and abuse, the neurologist increases the opportunity for both identifying ongoing abuse and intervening when appropriate," Schulman said. "In addition to further physical and emotional harm, consequences of not asking about abuse might include failure of treatments and, when children are exposed to abuse, perpetuation of the cycle of abuse from generation to generation."

    The statement appears Jan. 25 in the online issue of the journal Neurology.

    SOURCE: American Academy of Neurology, news release, Jan. 18, 2012

    Study: Child abuse bigger threat than SIDS

    4,600 children hospitalized with serious injuries 

    updated 2/6/2012 10:14:15 AM ET

    MSNBC: Nearly 4,600 U.S. children were hospitalized with broken bones, traumatic brain injury and other serious damage caused by physical abuse in 2006, according to a new report.

    Babies younger than one were the most common victims, with 58 cases per 100,000 infants. That makes serious abuse a bigger threat to infant safety than SIDS, or sudden infant death syndrome, researchers say in the report.

    "There is a national campaign to prevent SIDS," said Dr. John Leventhal of Yale University, who led the new study. "We need a national campaign related to child abuse where every parent is reminded that kids can get injured."

    The new study, published Monday in the journal Pediatrics, is the first broad U.S. estimate of serious injuries due to child abuse.

    Based on data from the 2006 Kids' Inpatient Database, the last such numbers available, Leventhal's team found that six out of every 100,000 children under 18 were hospitalized with injuries ranging from burns to wounds to brain injuries and bone fractures.

    The children spent an average of one week in the hospital; 300 of them died.

    The rate of abuse was highest among children under one, particularly if they were covered by Medicaid, the government's health insurance for the poor. One out of every 752 of those infants landed in the hospital due to maltreatment.

    "Medicaid is just a marker of poverty, and poverty leads to stress," said Leventhal, who is the medical director of the Yale-New Haven Children's Hospital Child Abuse Program.

    Last year, a study from four U.S. states showed a clear spike in abusive brain injuries following the financial crash in late 2007, a finding researchers chalked up to the added pressure on parents.

    Mom's hug revives baby that was pronounced dead
    In that study, too, toddlers appeared to be at higher risk. That led researchers to suggest the maltreatment might have been triggered by crying.

    If a caretaker shakes a baby violently to make him or her stop crying, they can cause "shaken baby syndrome," in which the brain bumps up against the skull and starts bleeding.

    Leventhal said babies may also be more vulnerable that older kids.

    "The most serious injuries tend to be in the younger kids," he told Reuters Health.

    Home birth advocate dies in childbirth
    The researchers estimate that the hospitalizations cost about $73.8 million in 2006, although that's only a fraction of the overall cost of abuse to society.

    "This is a serious problem that affects young children," said Leventhal, whose team is now examining more recent data to refine the findings. "We need to figure out a way to help parents do better."

    Copyright 2012 Thomson Reuters.