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Biomedical subjects

H M Bauer

Publications and source records attributed to H M Bauer.

At least 19 recordsLinked to original sources
PubMed2001

A population-based assessment of human rights abuses committed against ethnic Albanian refugees from Kosovo.

OBJECTIVES: This study assessed patterns of displacement and human rights abuses among Kosovar refugees in Macedonia and Albania. METHODS: Between April 19 and May 3, 1999, 1180 ethnic Albanian refugees living in 31 refugee camps and collective centers in Macedonia and Albania were interviewed. RESULTS: The majority (68%) of participants reported that their families were directly expelled from their homes by Serb forces. Overall, 50% of participants saw Serb police or soldiers burning the houses of others, 16% saw Serb police or soldiers burn their own home, and 14% witnessed Serb police or soldiers killing someone. Large percentages of participants saw destroyed mosques, schools, or medical facilities. Thirty-one percent of respondents reported human rights abuses committed against their household members, including beatings, killings, torture, forced separation and disappearances, gunshot wounds, and sexual assault. CONCLUSIONS: The present findings confirm that Serb forces engaged in a systematic and brutal campaign to forcibly expel the ethnic Albanian population of Kosovo. In the course of these mass deportations, Serb forces committed widespread abuses of human rights against ethnic Albanians.

Adolescent↗
PubMed2001

The factors associated with disclosure of intimate partner abuse to clinicians.

OBJECTIVE: Our goal was to identify the prevalence, determinants of, and barriers to clinician-patient communication about intimate partner abuse. STUDY DESIGN: We conducted telephone interviews with a random sample of ethnically diverse abused women. POPULATION: We included a total of 375 African American, Latina, and non-Latina white women aged 18 to 46 years with histories of intimate partner abuse who attended 1 of 3 primary care clinics in San Francisco, California, in 1997. OUTCOMES MEASURED: We measured the relevance and determinants of past communication with clinicians about abuse and barriers to communication. RESULTS: Forty-two percent (159) of the patients reported having communicated with a clinician about abuse. Significant independent predictors of communication were direct clinician questioning about abuse (odds ratio [OR]=4.6; 95% confidence interval [CI] 3.2-6.6), and African American ethnicity (OR=1.8; 95% CI, 1.1-2.9). Factors associated with lack of communication about abuse included immigrant status (OR=0.6; 95% CI, 0.3-1.0) and patient concerns about confidentiality (OR=0.7; 95% CI, 0.5-0.9). Barriers significantly associated with lack of communication were patients' perceptions that clinicians did not ask directly about abuse, beliefs that clinicians lack time and interest in discussing abuse, fears about involving police and courts, and concerns about confidentiality. CONCLUSIONS: Clinician inquiry appears to be one of the strongest determinants of communication with patients about partner abuse. Other factors that need to be addressed include patient perceptions regarding clinicians' time and interest in discussing abuse, fear of police or court involvement, and patient concerns about confidentiality.

Adolescent↗
PubMed2000

Prevalence and determinants of intimate partner abuse among public hospital primary care patients.

OBJECTIVE: To determine the prevalence, sociodemographic determinants, and depression correlates of intimate partner abuse among an ethnically diverse population of women patients. DESIGN: Cross-sectional telephone survey in English and Spanish of a random sample of women patients aged 18 to 46 years. SETTING: Three public hospital primary care clinics (general internal medicine, family medicine, and obstetrics/gynecology) in San Francisco, Calif. PARTICIPANTS: We interviewed 734 (74%) of the 992 eligible participants. Thirty-one percent were non-Latina white, 31% African American, and 36% Latina. MEASUREMENTS AND MAIN RESULTS: Using questions adapted from the Abuse Assessment Screen, we determined recent and lifetime history of physical, sexual, and psychological abuse. Overall, 15% reported recent abuse by an intimate partner (in the preceding 12 months); lifetime prevalence was 51%. Recent abuse was more common among women aged 18 to 29 years (adjusted odds ratio [OR] 2.1; 95% confidence interval [CI], 1.2 to 3.7), non-Latinas (adjusted OR, 1.7; 95% CI, 1.0 to 2.9), and unmarried women (adjusted OR, 1.65; 95% CI, 1.0 to 2.7). The prevalence of abuse did not differ by education, employment, or medical insurance status of the women. Compared with women with no history of abuse, a greater proportion of recently abused women reported symptoms of depression (adjusted OR, 3.5; 95% CI, 2.2 to 5.5). CONCLUSIONS: Because a substantial proportion of women patients in primary care settings are abused, screening for partner abuse and depression is indicated. In contrast to other studies, lower socioeconomic status was not associated with partner abuse history.

Adolescent↗
PubMed2000

Barriers to health care for abused Latina and Asian immigrant women.

This study identifies social, political, and cultural barriers to help seeking from health care organizations faced by abused Latina and Asian immigrant women. Qualitative data were collected through four semistructured ethnic-specific focus group interviews with 28 abused Latina and Asian immigrant women. Participants who had suffered intimate partner abuse were recruited through urban community-based organizations in San Francisco, California. Sociopolitical barriers to help seeking and patient-provider communication included social isolation, language barriers, and, for some, discrimination and fears of deportation. Sociocultural barriers included dedication to the children and family unity, shame related to the abuse, and the cultural stigma of divorce. Abused Latina and Asian immigrant women face significant social, cultural, and political barriers to patient-provider communication and help seeking. Medical and social service providers and policy makers may improve the quality of care for these women by understanding and addressing these barriers.

Adult↗
PubMed1999

Screening and intervention for intimate partner abuse: practices and attitudes of primary care physicians.

CONTEXT: Although practice guidelines encouraging the screening of patients for intimate partner abuse have been available for several years, it is unclear how well and in which circumstances physicians adhere to them. OBJECTIVE: To describe the practices and perceptions of primary care physicians regarding intimate partner abuse screening and interventions. DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional survey of a stratified probability sample of 900 physicians practicing family medicine, general internal medicine, and obstetrics/gynecology in California. After meeting exclusion criteria, 582 were eligible for participation in the study. MAIN OUTCOME MEASURE: Reported abuse screening practices in a variety of clinic settings, based on a 24-item questionnaire, with responses compared by physician sex, practice setting, and intimate partner abuse training. RESULTS: Surveys were completed by 400 (69%) of the 582 eligible physicians, including 149 family physicians, 115 internists, and 136 obstetrician/gynecologists. Data were weighted to estimate the practices of primary care physicians in California. An estimated majority (79%; 95% confidence interval [CI], 75%-83%) of these primary care physicians routinely screen injured patients for intimate partner abuse. However, estimated routine screening was less common for new patient visits (10%; 95% CI, 7%-13%), periodic checkups (9%; 95% CI, 6%-12%), and prenatal care (11%; 95% CI, 7%-15%). Neither physician sex nor recent intimate partner abuse training had significant effects on reported new patient screening practices. Obstetrician/gynecologists (17%) and physicians practicing in public clinic settings (37%) were more likely to screen new patients. Internists (6%) and physicians practicing in health maintenance organizations (1%) were least likely to screen new patients. Commonly reported routine interventions included relaying concern for safety (91%), referral to shelters (79%) and counseling (88%), and documentation in the medical chart (89%). Commonly cited barriers to identification and referral included the patients' fear of retaliation (82%) and police involvement (55%), lack of patient disclosure (78%) and follow-up (52%), and cultural differences (56%). CONCLUSIONS: These findings suggest that primary care physicians are missing opportunities to screen patients for intimate partner abuse in a variety of clinical situations. Further studies are needed to identify effective intervention strategies and improve adherence to intimate partner abuse practice guidelines.

Attitude of Health Personnel↗
PubMed1999

Virginity examinations in Turkey: role of forensic physicians in controlling female sexuality.

CONTEXT: Although the Turkish Medical Association has deemed "virginity examinations" a form of gender-based violence, women in Turkey are often subjected to such examinations by forensic physicians for both legal and social reasons. Little is known about these physicians' role and attitudes in this practice. OBJECTIVES: To assess forensic physicians' experiences and attitudes regarding virginity examinations in Turkey and suggest potential solutions to the problems identified. DESIGN: Cross-sectional self-administered survey. SETTING: Surveys were completed during the Forensic Science Congress held in Kusadasi in April 1998 as well as in urban academic and medical practice settings between April and October 1998. PARTICIPANTS: Of 158 physicians who practice, are formally trained in, or are in training for forensic medicine, 118 completed the survey (response rate, 74.7%). MAIN OUTCOME MEASURES: Frequency and circumstances of conducting virginity examinations, opinions regarding beneficial and adverse consequences of these examinations, and recommendations for changing the practice, as measured by a 100-item questionnaire. RESULTS: Overall, survey respondents reported conducting 5901 examinations in the previous 12 months; 4045 were conducted because of alleged sexual assault and 1856 for social reasons. Although 68% of forensic physicians indicated that they believed virginity examinations are inappropriate in the absence of an allegation of sexual assault, 45% had conducted examinations for social reasons. The majority of the respondents (93%) agreed that the examinations are psychologically traumatic for the patient. In addition, more than half (58%) reported that at least 50% of patients undergo examinations against their will. CONCLUSIONS: Nearly half of forensic physicians in Turkey conduct virginity examinations for social reasons despite beliefs that such examinations are inappropriate, traumatic to the patient, and often performed against the patient's will. Physicians' participation in such practices is inconsistent with principles of bioethics and international human rights.

Attitude↗
PubMed1999

Mandatory reporting of intimate partner violence to police: views of physicians in California.

OBJECTIVES: This study examined physicians' perspectives on mandatory reporting of intimate partner violence to police. METHODS: We surveyed a stratified random sample of California physicians practicing emergency, family, and internal medicine and obstetrics/gynecology. RESULTS: An estimated 59% of California primary care and emergency physicians (n = 508, 71% response rate) reported that they might not comply with the reporting law if a patient objects. Primary care physicians reported lower compliance. Most physicians agreed that the legislation has potential risks, raises ethical concerns, and may provide benefits. CONCLUSIONS: Physicians' stated noncompliance and perceived negative consequences raise the possibility that California's mandatory reporting law is problematic and ineffective.

Adult↗
PubMed1998

Women's health and human rights in Afghanistan.

CONTEXT: During the past 20 years, social and political upheavals have disrupted the way of life in Afghanistan. The Taliban regime, a radical Islamic movement that took control of Kabul in September 1996, has had extraordinary health consequences for Afghan women. OBJECTIVE: To assess the health and human rights concerns and conditions of women living in Kabul under the Taliban regime. SETTING: Residences in Kabul; refugee camps and residences in Pakistan. DESIGN: A cross-sectional survey of women who lived in Kabul, prior to September 1996, when the Taliban took control. PARTICIPANTS: A total of 160 women participated, including 80 women currently living in Kabul and 80 Afghan women who had recently migrated to Pakistan. MAIN OUTCOME MEASURES: Self-reported changes in physical and mental health, access to health care, war-related trauma, human rights abuses, and attitudes toward women's human rights. RESULTS: The median age of respondents was 32 years (range, 17-70 years); median formal education was 12 years, and 136 (85%) of respondents had lived in Kabul for at least 19 years. Sixty-two percent (99/180) reported that they were employed before the Taliban takeover; only 32 (20%) were employed during their last year in Kabul. The majority of all women reported a decline in physical and mental health status (71% [113/160] and 81% [129/160], respectively) and reported a decline in access to health care (62% [99/160]) during the last 2 years living in Kabul. Many of the women reported symptoms that met diagnostic criteria for posttraumatic stress disorder (42% [67/160]), demonstrated evidence of major depression (97% [155/160]), and had significant anxiety symptoms (86% [137/160]). Eighty-four percent (134/160) of women reported 1 family member or more killed in war. Sixty-nine percent (111/160) reported that they or a family member had been detained and abused by Taliban militia, and 68% (108/160) reported extremely restricted social activities. Almost all (96%) expressed support for women's human rights. CONCLUSIONS: The current health and human rights status of women described in this report suggests that the combined effects of war-related trauma and human rights abuses by Taliban officials have had a profound effect on Afghan women's health. Moreover, support for women's human rights by Afghan women suggests that Taliban policies regarding women are incommensurate with the interests, needs, and health of Afghan women.

Adolescent↗
PubMed1998

Factors affecting patient-physician communication for abused Latina and Asian immigrant women.

BACKGROUND: Domestic violence is one of today's most serious health issues. Abused Latina and Asian immigrant women face unique barriers to the discussion of abuse with health care providers. This research was undertaken to identify any provider-related factors that may affect patient-provider communication for these women. METHODS: Qualitative data were collected using semistructured focus group interviews with abused Latina and Asian immigrant women. Participants were recruited through urban community-based organizations. Twenty-eight immigrant women with histories of domestic violence participated in four focus groups: two groups of Latina women and two groups of Asian women. Iterative readings by independent researchers identified provider-related factors affecting patient-provider communication. RESULTS: The study participants identified the provider behaviors that demonstrate trust, compassion, and understanding as elements that improve patient-provider communication. In addition, participants wanted providers to initiate discussions about partner abuse. CONCLUSIONS: Improved understanding of factors that may affect abused immigrant patients' communication may assist health care providers in offering meaningful support and assistance to these patients. Providers, administrators, policy makers, and educators should consider these factors when developing policy, protocols, and educational curricula for a variety of health care settings.

Adolescent↗
PubMed1998

Patient attitudes about mandatory reporting of domestic violence. Implications for health care professionals.

As of January 1994, California physicians are required to report to police all patients who are suspected to be victims of domestic violence. This article describes the results from a focus group study of abused women (n = 51) that explored their experiences with and perspectives on medical care. The eight focus groups included two Latina (total n = 14), two Asian (total n = 14), two African-American (total n = 9), and two Caucasian (total n = 14) groups of women who had been the victims of domestic abuse within the previous 2 years. The women were recruited through community-based organizations in the San Francisco Bay Area. With regard to physician reporting of domestic violence to police, five themes were identified: fear of retaliation by the abuser, fear of family separation, mistrust of the legal system, desire for police protection, and preference for confidentiality and autonomy in the patient-health professional relationship. Our results indicate that mandatory reporting may pose a threat to the safety and well-being of abused women and may create barriers to their seeking help and communicating with health care professionals about domestic violence.

Adult↗
PubMed1996

Breaking the silence. Battered women's perspectives on medical care.

OBJECTIVE: To determine the barriers to identification and management of domestic violence from the battered women's perspective. DESIGN: Qualitative research methods using semistructured focus groups. SETTING: Urban and suburban community-based organizations serving women and their families in the San Francisco Bay (Calif) area. PARTICIPANTS: Fifty-one women with histories of domestic violence comprised eight focus groups divided as follows: two groups of Latino (n=14), two groups of white (n=14), Asian (n=14), and two groups of African-American (n=9) women. RESULTS: Participants from all ethnic groups identified major factors that affect identification and management of battered women in the health care setting. Factors that interfere with patient disclosure included threats of violence from the partner, embarrassment, adherence to gender roles, concerns about police involvement and lack of trust in the health care provider. One factor that predisposed a woman to seek help from providers was a need for the providers to exhibit compassion, awareness, and respect for the patient's need to make the final decisions about her situation. Most participants said that providers should take the initiative to ask directly about domestic violence, establish a supportive patient-provider relationship, and refer battered women to available community resources. The major institutional barriers to using the health care system included the high cost of medical care and long waiting periods. CONCLUSIONS: Many battered women experience social, institutional, and provider barriers to obtaining help from the health care system for problems related to domestic violence. Providers as well as institutions can overcome these barriers through an understanding of the social context of domestic violence and the victim's needs. Identification may be improved through a trusting patient-provider relationship and by direct questioning about domestic violence.

Adolescent↗
PubMed1995

Comparative analysis of human papillomavirus detection by PCR and non-isotopic in situ hybridisation.

AIMS--To assess the relative diagnostic performance of the polymerase chain reaction (PCR) and non-isotopic in situ hybridisation (NISH) and to correlate these data with cytopathological assessment. METHODS--Paired analysis of human papillomavirus (HPV) detection was performed by PCR and NISH on exfoliated cervical cells from 122 women attending a routine gynaecological examination. PCR amplification followed by generic and HPV type specific hybridisation was compared with NISH on a parallel cervical smear. RESULTS--Overall, 32 cases were positive by NISH and 61 positive by PCR. Of the 105 cases in which both PCR and NISH were interpretable, 76 (26%) were normal smears, 20 of which were HPV positive by NISH and 37 (49%) by PCR. Of 17 borderline smears, two were NISH positive and 12 PCR positive. Eight of nine smears containing koilocytes were positive by NISH and seven by PCR. Of three dyskaryotic smears, none were NISH and two were PCR positive. The concordance of NISH and PCR in these samples was 57%. To assess sampling error, NISH and PCR were performed on an additional 50 cases using aliquots from the same sample. This increased the concordance between assays to 74%. Filter hybridisation of PCR products with the cocktail of probes used in NISH (under low and high stringency conditions) demonstrated that several cases of NISH positivity could be accounted for by cross-hybridisation to HPV types identified by PCR but not present in the NISH probe cocktail. CONCLUSIONS--Sampling error and potential cross-hybridisation of probe and target should be considered in interpretation of these techniques. PCR is more sensitive because it provides for the amplification of target DNA sequences. In addition, the PCR assay utilised in this study detects a wider range of HPV types than are contained in the cocktails used for NISH. However, PCR assays detect viral DNA present both within cells and in cervical fluid whereas NISH permits morphological localisation.

Cervix Uteri↗
PubMed1994

Identification and assessment of known and novel human papillomaviruses by polymerase chain reaction amplification, restriction fragment length polymorphisms, nucleotide sequence, and phylogenetic algorithms.

The identification and taxonomy of papillomaviruses has become increasingly complex, as approximately 70 human papillomavirus (HPV) types have been described and novel HPV genomes continue to be identified. Methods and corresponding DNA sequence data bases were designed for the reliable identification of mucosal HPV genomes from clinical specimens. HPVs are identified by the amplification of a fragment of the L1 region by consensus primer polymerase chain reaction (PCR) and subsequent hybridization or restriction fragment length polymorphism analysis. L1 PCR fragments may be further characterized by nucleotide sequencing. Conservation of 30 (of 151) predicted amino acids identifies HPV genomic fragments, and nucleotide sequence alignments allow calculation of their phylogenetic relatedness. Sequence differences > 10% from any known HPV type suggest a novel HPV type. Phylogenetic relationships with known HPV types may permit predictions of biology. With these criteria, 10 PCR fragments were identified that would qualify as new genital HPV types after complete genomic isolation.

Amino Acid Sequence↗
PubMed1993

Epidemiologic evidence showing that human papillomavirus infection causes most cervical intraepithelial neoplasia.

BACKGROUND: Experimental studies have provided strong evidence that human papillomavirus (HPV) is the long-sought venereal cause of cervical neoplasia, but the epidemiologic evidence has been inconsistent. PURPOSE: Given improvements in HPV testing that have revealed a strong link between sexual activity history and cervical HPV infection, we conducted a large case-control study of HPV and cervical intraepithelial neoplasia (CIN) to evaluate whether sexual behavior and the other established risk factors for CIN influence risk primarily via HPV infection. METHODS: We studied 500 women with CIN and 500 control subjects receiving cytologic screening at Kaiser Permanente, a large prepaid health plan, in Portland, Ore. The established epidemiologic risk factors for CIN were assessed by telephone interview. We performed HPV testing of cervicovaginal lavage specimens by gene amplification using polymerase chain reaction with a consensus primer to target the L1 gene region of HPV. Unconditional logistic regression analysis was used to estimate relative risk of CIN and to adjust the epidemiologic associations for HPV test results to demonstrate whether the associations were mediated by HPV. RESULTS: The case subjects demonstrated the typical epidemiologic profile of CIN: They had more sex partners, more cigarette smoking, earlier ages at first sexual intercourse, and lower socioeconomic status. Statistical adjustment for HPV infection substantially reduced the size of each of these case-control differences. Seventy-six percent of cases could be attributed to HPV infection; the results of cytologic review suggested that the true percentage was even higher. Once HPV infection was taken into account, an association of parity with risk of CIN was observed in both HPV-negative and HPV-positive women. CONCLUSION: The data show that the great majority of all grades of CIN can be attributed to HPV infection, particularly with the cancer-associated types of HPV. IMPLICATIONS: In light of this conclusion, the investigation of the natural history of HPV has preventive as well as etiologic importance.

Adolescent↗
PubMed1991

Determinants of genital human papillomavirus infection in young women.

Carcinoma of the cervix has several well-established epidemiologic risk factors, including multiple sexual partners and early age at first intercourse. Human papillomavirus (HPV) infection appears to have an etiologic role in the development of cervical neoplasia, but evidence linking HPV infection to known risk factors for cervical cancer has been inconsistent. The lack of expected correlations may be due to the inaccuracy of HPV assays previously used. A polymerase chain reaction DNA amplification method for the detection of HPV was used to investigate the determinants of genital HPV infection in a cross-sectional sample of 467 women attending a university health service. In contrast to studies using less accurate detection methods, the risk factors for HPV infection found here were consistent with those for cervical neoplasia. The risk of HPV infection was strongly and independently associated with increasing numbers of sexual partners in a lifetime, use of oral contraceptives, younger age, and black race. Age at first intercourse, smoking, and history of a prior sexually transmitted disease were correlated with, but not independently predictive of, HPV infection. These results demonstrate that the key risk factors for cervical carcinoma are strongly associated with genital HPV infection. This correlation suggests that HPV has an etiologic role in cervical neoplasia and reaffirms the sexual route of HPV transmission.

Adolescent↗
PubMed1991

Comparison of Southern blot hybridization and polymerase chain reaction methods for the detection of human papillomavirus DNA.

A methodologic study was performed to compare the polymerase chain reaction (PCR) and Southern blot hybridization, two commonly used testing strategies for the detection of human papillomavirus (HPV) infection. Three laboratories tested masked aliquots of exfoliated cervical cell specimens obtained from 120 women by cervicovaginal lavage. The study population included 32 women with condylomatous atypia or cervical intraepithelial neoplasia and 88 control women with no known history of cervical neoplasia. Two laboratories used PCR with different sets of consensus primers for HPV detection. The third laboratory used low-stringency Southern blot hybridization to identify all HPV types, followed by high-stringency Southern and/or dot blot hybridization to confirm specific HPV types. One of the PCR primer sets detected HPV types with a differential efficiency that was not predicted by analysis of DNA sequences or direct testing of HPV-containing plasmids. In contrast, the second PCR primer set was shown to be a much broader consensus system, detecting the same HPV types as Southern blotting, though requiring much less clinical specimen. Over 80% of women with cervical intraepithelial neoplasia or condylomatous atypia were found to be HPV infected both by Southern blotting and by the second PCR primer set. Among the control women, 11% were HPV positive by Southern blotting, while 31% were positive with the second set of primers. Most of the HPV infections found only by PCR were not due to HPV type 6, 11, 16, 18, 31, 33, or 45. These known HPV types were uncommon among normal women in the study population, even as determined by the PCR method.

Base Sequence↗