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PubMed2001

Domestic abuse in the emergency department: can a risk profile be defined?

OBJECTIVES: The main purpose of this study was to determine whether any clinical or demographic characteristics could identify adult female patients presenting to the emergency department (ED) with a history of domestic abuse. A second objective was to describe the frequency, types, and severity of this abuse. METHODS: This study was a crosssectional survey of 611 women conducted in an academically-affiliated, urban ED. Domestic abuse was described as "recent" (within the preceding 12 months) or "lifetime" (recent or past). This included emotional, physical, and sexual abuse. RESULTS: Recent (7.9%, n = 48) and lifetime (38%, n = 232) domestic abuse was reported. For recently abused women, violence had been severe (87.5%, n = 42) and was associated with 1) trauma (OR 5.4, 95% CI = 2.6 to 11.6), 2) obstetrical and gynecological syndromes (OR 5.6, 95% CI = 2.4 to 13.2), and 3) psychiatric symptoms and substance use (OR 7.3, 95% CI = 2.4 to 22.0). The sensitivities and positive predictive values of these risk factors individually (<27.1% and <25.0%, respectively) and in aggregate (56.3% and 20.9%, respectively) were low. These indicators predicted only 27 (56.3%) of recently abused women. Lifetime domestic violence was more likely in homeless women (OR 5.8, 95% CI = 2.2 to 15.0), although less likely in immigrants (OR 0.4, 95% CI = 0.3 to 0.7). CONCLUSIONS: Clinical presentations and demographic characteristics of women presenting to the ED may not be sensitive or predictive indicators of domestic abuse. In the absence of typical clinical or demographic findings, asking all women in the ED about domestic abuse remains a necessary priority.

Adult↗

PubMed2004

Risk factors for recent domestic physical assault in patients presenting to the emergency department.

OBJECTIVE: To identify risk factors for physical or sexual assault as a result of domestic violence in patients presenting to the ED. METHODS: Backward prevalence study of two urban teaching hospital emergency departments measuring the 1-year period prevalence, acute incidence of ED presentation and risk factors of domestic physical assault. RESULTS: Of the 1326 patients (62% female) completing the study, 115 (9% CI 7%, 10%) reported assault by a partner or ex-partner within the preceding 12 months and 31 (2% CI 1.6%, 2.3%) reported domestic physical assault as the cause of their presentation. Risk factors for recent domestic physical assault included female gender (prevalence rate ratio, (PRR) 1.5 CI 1.0 2.2), age 17 to < 25 years (PRR 6.8 CI 1.7 27.7) or 25 to < 35 years (PRR 5.7 CI 1.4 23.0), past presentation to an ED for assault (PRR 2.5 CI 1.7 3.7) and a past history of child abuse (PRR 2.2 CI 1.5 3.1). There was no association between health service utilization or mental illness and the reporting of recent domestic physical assault. CONCLUSION: The study characterizes ED patients at high risk of injury from domestic violence.

Adolescent↗

PubMed1999

Markers for domestic violence in women.

OBJECTIVE: To determine injury patterns and characteristics specific to domestic violence in women who present to the accident and emergency (A&E) department. DESIGN: A retrospective case note review of all female assaults over a one year period. The subjects were women who disclosed that their injuries were due to assaults by either a current or a previous male partner. Controls were female assault victims not injured by domestic violence. SETTING: A medium sized urban A&E department. RESULTS: There were 500 female assaults out of 48,169 new attendances. Domestic violence was disclosed in 103 cases. The following features were significantly associated with domestic violence in women: multiple injuries (p < 0.001) (especially to the head and arms), fractures (p < 0.05), loss of consciousness (p < 0.05), abdominal injuries (p < 0.05), pregnancy (p = 0.01), injury occurring on "stairs" (p = 0.01), and general practitioner referral (p < 0.01). CONCLUSIONS: Women who have been assaulted are more likely to have been injured during domestic violence if they sustain multiple injuries (including fractures), abdominal injuries, have lost consciousness, or have been referred by their general practitioner. These markers may help medical staff to identify more cases of undisclosed domestic violence. The markers need to be tested further in a prospective study.

Adolescent↗

PubMed2006

The association between domestic violence and self harm in emergency medicine patients.

AIMS: This study compared rates of self harm among victims of domestic assault presenting to an emergency department (ED) with those rates among other ED patients. It also explored the temporal and numeric relation between domestic assaults and self harm. METHODS: A retrospective matched cohort study was conducted using the medical records of a single ED. The cases were patients who had presented to the ED as a consequence of domestic assault. Two control groups matched for age, sex, and Cambridge postcode were randomly generated from the ED patient list. The second control group cases were also matched for postcode sector as a surrogate approximate for socioeconomic status in addition to age and sex. Cases and controls were followed up between November 1996 and 1 October 2004 documenting the number and timing of episodes of self harm reported in the study period. RESULTS: Altogether, 294 cases and 558 controls were followed up. Patients suffering domestic assault were more likely to present with self harm than controls (RR 3.6 95% CI 2.1-6.5). This effect appeared to be independent of deprivation. Patients suffering domestic assault had more ED contacts than controls. There was a moderate correlation between the number of episodes of self harm and number of assaults (Spearman's rho 0.3 p<0.001). Socioeconomic status was a poor predictor of self harm. Emergency physicians should consider asking about suicidal ideation in victims of domestic assault.

Adult↗

PubMed2006

Police attitudes toward domestic violence offenders.

Police attitudes are important in facilitating a sense of safety and comfort in women seeking justice-system support for protection from partner violence. This study examined police attitudes toward sanctions and treatment for domestic violence offenders compared with other violent and nonviolent offenders. In addition, police attitudes toward domestic violence offenders who do and do not use substances were examined. Officers from one city police department (n = 315) participated in a survey. Results indicate there is a trend toward attitudes that treatment, rather than sanctions, was more appropriate for domestic violence offenders. In addition, officers rated the use of sanctions higher for domestic violence offenders who abuse alcohol or drugs compared with domestic violence offenders who did not abuse alcohol or drugs. Understanding police attitudes toward domestic violence offenders may have implications for police training and victim services in facilitating the use of the justice system in protecting women from partner violence.

Adult↗

PubMed2000

Identifying domestic violence within inpatient hospital admissions using medical records.

This paper examines incidences of domestic violence among hospitalized patients identified as being victims of domestic violence. Specifically, we focus on defining the type and cost of domestic violence and identifying demographic characteristics of individuals at risk for domestic violence. Data for this paper were abstracted from the 1994 HCUP-3 data set. Findings from these data suggest that identifying incidences of domestic violence is very complex and difficult. The primary diagnosis of those who are victims of domestic violence range from broken bones and bruises to chronic and acute illness to mental illness. Finally, non-white populations are approximately two times more likely to be identified as victims of physical violence than whites and as age increases the likelihood of being identified as a victim of physical violence decreases.

Adolescent↗

PubMed2002

Women referred for on-site domestic violence services in a managed care organization.

BACKGROUND: Limited data about victims of domestic violence in health care settings hinder development of appropriate services. A comprehensive program was established in a managed care organization to increase identification and referral of domestically abused female patients. METHODS: Female victims of domestic abuse were referred to a trained social worker for further assessment. Information about the women was obtained from clinical consultation forms; initial interviews conducted by social workers; a survey administered to a convenience sample of women seen by the program; and medical chart review. RESULTS: Of 265 women who agreed to a domestic violence referral, 177 (67%) were contacted for further evaluation. The study sample was ethnically diverse and included female victims seen for routine care, women who had been assaulted, women who had depression, and women with various somatic symptoms. Responses from 51 of the 177 women showed the most cited reasons for accepting referral were unhappiness with current situation, wanting to leave or change the situation, concern about children who witnessed abuse, and the suggestion by a health care practitioner that the patient's symptoms could be related to the abuse. Most reported having symptoms of depression in the previous year. CONCLUSIONS: Comprehensive programs in the health care setting can increase identification of victims of domestic abuse. This descriptive report provides a greater understanding of victims of domestic abuse, their presentation in the medical setting, their motivation for accepting referral, and issues which affect their recovery. Links between health care and community resources are necessary for effective intervention.

Adult↗

PubMed2005

Domestic violence: a tragedy behind the doors.

OBJECTIVE: To explore the prevalence, type, frequency and causes of domestic marital violence among Turkish women in a socio-economically developed metropolitan setting. METHODS: A cross-sectional study was performed in 2003. All married women, aged 18 years and over, who were visiting any of the 50 primary health care units for different purposes were asked to participate in the study. Of 1427 asked, 1010 gave consent and completed face-to-face interviews. Multiple correspondence analysis, and logistic regression were used for statistical analyses. RESULTS: Domestic violence was statistically significantly associated with educational level. Illiterate women reported marital abuse 2.6 times more than university or more educated women. No statistically significant relationship was observed between domestic marital violence and women's age or occupation, marital duration or family income. The most frequently reported type of violence was physical, followed by psychological. Among women reporting domestic violence, those with the lowest educational level and income were experiencing all types of domestic violence frequently. CONCLUSION: Placing more importance on educating girls could be a key component of preventing domestic violence.

Adult↗

PubMed2006

The culture of domestic violence advocacy: values of equality/behaviors of control.

Domestic violence advocacy is a culture unto itself. The themes it addresses, in combination with the dominant frames of discourse (Fairclough 1989) used in the daily conversations of advocates and their supporters, contribute to the stagnation of domestic violence advocacy as a profession and stunt its ability to address the non-homogenous, culturally diverse group of men, women and children living under the tyranny of violence within their homes. Social and political ties to funding institutions and government agencies reify existing concepts about domestic violence education and allow little opportunity for improvement. This article details the methodology and findings of a qualitative, ethnographic research project conducted at an undisclosed domestic violence agency. Qualitative results were analyzed using methods of grounded theory, discourse analysis and narrative analysis. Results revealed four major discourse themes that contribute to the current culture of domestic violence advocacy: (1) systemic contributions to the normalization of crisis, (2) cultural contradictions between paradigms and practice of domestic violence advocacy (3) ambiguity over the line between childhood and adulthood and (4) assumptions about "victim-hood".

Adult↗

PubMed2004

Socioeconomic factors and processes associated with domestic violence in rural Bangladesh.

CONTEXT: Although the pervasiveness of domestic violence against women in Bangladesh is well documented, specific risk factors, particularly those that can be affected by policies and programs, are not well understood. METHODS: In 2001-2002, surveys, in-depth interviews and small group discussions were conducted with married women from six Bangladeshi villages to examine the types and severity of domestic violence, and to explore the pathways through which women's social and economic circumstances may influence their vulnerability to violence in marriage. Women's odds of experiencing domestic violence in the past year were assessed by logistic regression analysis. RESULTS: Of about 1,200 women surveyed, 67% had ever experienced domestic violence, and 35% had done so in the past year. According to the qualitative findings, participants expected women with more education and income to be less vulnerable to domestic violence; they also believed (or hoped) that having a dowry or a registered marriage could strengthen a women's position in her marriage. Yet, of these potential factors, only education was associated with significantly reduced odds of violence; meanwhile, the odds were increased for women who had a dowry agreement or had personal earnings that contributed more than nominally to the marital household. Women strongly supported educating their daughters, but pressures remain to marry them early, in part to avoid high dowry costs. CONCLUSIONS: In rural Bangladesh, women's social and economic circumstances may influence their risk of domestic violence in complex and contradictory ways. Findings also suggest a disconnect between women's emerging expectations and their current realities.

Adolescent↗

PubMed1999

Domestic violence before and after alcoholism treatment: a two-year longitudinal study.

OBJECTIVE: An initial study of 88 male alcoholics and their wives had shown that domestic violence decreased significantly in the year following a behavioral marital therapy (BMT) alcoholism treatment program (see J. Cons. Clin. Psychol. 63: 256-262, 1995). To determine if violence reductions were stable, the present study examined domestic violence during the second year following BMT for the 75 (of the original 88) couples who provided 2-year follow-up data on violence. METHOD: The prevalence and frequency of domestic violence were assessed for 75 male alcoholics and their wives at entry to and at 1 and 2 years after completing BMT. Data on frequency and consequences of alcoholics' drinking were collected for the 2-year follow-up period. Comparison rates of domestic violence for a demographically matched nonalcoholic sample were derived from a nationally representative survey of violence in American families. RESULTS: Husband-to-wife violence occurred in nearly two-thirds of cases in the year before BMT. For both the first and second year after BMT, violence was significantly reduced and the extent of violence was associated with the extent of the alcoholics' drinking. Frequency of posttreatment drinking was positively correlated with violence, and remitted alcoholics no longer had elevated domestic violence levels when compared with matched controls whereas relapsed alcoholics did. Analyses using various assumptions about violence for the 13 cases without violence data showed that sample attrition did not invalidate the present results. CONCLUSIONS: These results indicate that domestic violence decreased after BMT alcoholism treatment. Further, among remitted alcoholics, violence returned to the level experienced by other American families, in the same way that other aspects of marital, family and psychosocial functioning improve after successful treatment of alcoholism.

Adult↗

PubMed2006

Effects of domestic violence on perinatal and early-childhood mortality: evidence from north India.

OBJECTIVE: We examined the effect of physical violence during pregnancy on perinatal and early-childhood mortality. METHODS: We estimated the prevalence of domestic violence during pregnancy among a population-based sample of 2199 women in Uttar Pradesh, India. We used a survival regression model to examine the risks for perinatal, neonatal, postneonatal, and early-childhood (aged 1-3 years) mortality by mother's exposure to domestic violence, after we controlled for other sociodemographic and maternal health behavior risk factors. RESULTS: Eighteen percent of the women in our study experienced domestic violence during their last pregnancy. After we adjusted for other risk factors, births among mothers who had experienced domestic violence had risks for perinatal and neonatal mortality that were 2.59 (95% confidence interval [CI]=1.35, 4.95) and 2.37 (95% CI=1.21, 4.62) times higher, respectively, than births among mothers who had not experienced violence. We found no significant associations between domestic violence and either postneonatal or early-childhood mortality. CONCLUSIONS: Domestic violence is a significant risk factor for perinatal and neonatal mortality.

Cause of Death↗

PubMed2005

Domestic violence: a study among a group of Turkish women.

OBJECTIVES: With this study we attempt to explore the reality of domestic violence, its prevalence, type and frequency among a group of Turkish women. METHODS: This study was performed between October 2000 and May 2001 in the fourth largest city in Turkey. All women over the age of 15, who visited any of 50 health centres in different districts for different purposes, were asked to participate in the study. 506 of the participants who gave their consent were taken as a study group, and printed questionnaires were filled in during face-to-face interviews. RESULTS: 297 (58.7%) of the participants had experienced domestic violence at least once in their lifetime. The male partner was the primary violent person (49.5%), followed by mother and/or father (14.1%). The type of violence seen most was a combination of physical and psychological violence (45.5%). More than half of the women (58.6%) were experiencing domestic violence frequently and continuously. Reasons given for this violent behaviour were economic hardship (18.9%), followed by alcohol consumption by the violent person (18.5%), and inadequate family relations (15.8%). Of the victims 43.8% accepted this violence, but 26.6% reacted with violence. Women were not willing to abandon their relationships despite marital violence, because of their children (48.2%). Women's and men's higher educational attainments did indicate a decrease in the prevalence of domestic violence. CONCLUSION: Reasons for continuing the abusive relationship and the effectiveness of the scarce support resources should be evaluated more seriously. The potential role of the primary healthcare provider in eliminating barriers for identification and assessment of domestic violence should not be forgotten. Otherwise, domestic violence will still remain a 'family matter', hidden and neglected.

Adolescent↗

PubMed1998

Coxiellosis in domestic and wild birds from Japan.

Serological evidence of infection with Coxiella burnetii was found in 41 (2%) of 1,951 domestic birds and in 167 (19%) of 863 wild birds from 17 and 5 prefectures in Japan, respectively, by microagglutination (MA) test. The bacteriological evidence of the infection was found in 17 (41%) of 41 domestic birds and 37 (22%) of 167 wild birds by the nested polymerase chain reaction (PCR). In addition, C. burnetii was isolated from five each of serum, spleen and fecal specimens from five jungle crows (Corvus macrorhynchos) (whose sera were positive by both the MA test and PCR) by inoculating laboratory mice. Domestic quail (Coturnix coturnix japonica) (3%), domestic muscovy ducks (Cairina moschata) (3%), domestic chickens (2%), domestic mallards (Anas platyrhynchos domesticus) (2%), carrion crows (Corvus corone) (37%), jungle crows (35%), and wild rock doves (Columba livia) (6%) showed serologic evidence of experience with C. burnetii. There was a tendency for a high prevalence among birds living and/or feeding in close proximity to infected livestock. This suggests that these birds are one of the less important links in maintaining the whole cycle of C. burnetii infection.

Agglutination Tests↗

PubMed1999

The impact of federal and state laws on children exposed to domestic violence.

Until recently, few federal and state laws specifically addressed the needs of children in families in which there is domestic violence. Yet, many laws, particularly in the areas of domestic violence, family law, child welfare, welfare reform, and immigration, can have profound effects on the well-being of these children. The growing understanding by legislators and policymakers of the potential harms of domestic violence to children has resulted in recent years in statutory changes, particularly at the state level. However, laws that are enacted and implemented with inadequate knowledge of the complex dynamics of domestic violence and the unique issues battered parents and their children face may have unintended negative consequences for the children these laws are designed to protect. Collaboration across public and private social service agencies and domestic violence training for court personnel are examples of efforts that can bridge this knowledge gap and increase the likelihood that the protective intent of the laws is carried out in practice. This article analyzes current and proposed federal and state civil laws to better understand their potential impact on children affected by domestic violence. A companion article by Lemon in this journal issue examines court decisions related to these laws.

Child↗

PubMed1999

Health care system responses to children exposed to domestic violence.

The health care system has only recently adopted protocols and training to enable practitioners to identify and respond to victims of domestic violence. Currently, most hospitals have domestic violence protocols in place, although training in the use of protocols is less routine. However, because the provision of health care focuses on the treatment of the individual, the well-being of the children of adult domestic violence victims has received little attention in adult health care settings. Pediatricians do not routinely receive training in domestic violence identification and do not see responding to battered mothers as within the purview of their practice. Innovative programs in children's hospitals in Boston, Massachusetts, and San Diego, California, recognize that the safety of children is integrally tied to the safety of their mothers. These programs identify abused children whose mothers are the victims of domestic violence and provide advocacy and support that allow mothers and children to remain together in most instances. Little is known about the health impacts of teen dating violence, and opportunities for screening exist in the settings where teens receive health care. Likewise, prenatal visits provide regularized opportunities for domestic violence screening. Integrating the health care needs of mothers and children from violent households will require continued and expanded training, collaboration with community institutions, and improvements in insurance reimbursements to cover the costs of needed services.

Adult↗

PubMed2003

The prevalence of domestic violence in pregnant women.

OBJECTIVE: To determine the prevalence of domestic violence in a population of pregnant women. DESIGN: Questionnaire survey. SETTING: Antenatal booking clinic in a north of England hospital. POPULATION: Five hundred consecutive women were included. METHODS: Anonymous confidential questionnaire to women who were not accompanied by their partners. MAIN OUTCOME MEASURES: Disclosure of a past history of physical, emotional or sexual abuse. RESULTS: Four hundred and seventy-five questionnaires were returned (95% response rate). The prevalence of domestic violence was 17%. Domestic violence was highest in the age group 26-30 years and boyfriends were the main perpetrators. Punching and slapping were the most common pattern of violence, and 10% of women experiencing domestic violence had had forced sexual activity. CONCLUSIONS: The prevalence of domestic violence in a cohort of pregnant women in the north of England was 17%. Consideration should be given for routine screening for domestic violence in pregnancy to institute effective intervention strategies.

Adolescent↗

PubMed1995

Volumetric analysis of brain structures, especially of the visual system in wild and domestic turkeys (Meleagris gallopavo).

The total brain volume, the volumes of the main brain subdivisions and regions belonging to the visual system of wild and domestic turkeys of either sex were measured and related to body weight. Using allometric methods sex-related reductions in brain size from wild to domesticated state was examined. Male domestic turkeys have 29% and female domestic turkeys 24% less brain volume. The total reduction of the brain size results from decreases of the brain subdivisions and structures of functional systems at various degree. The general reduction of prosencephalic brain parts is greater (males: 35%, females: 30%) than that of the rhombencephalon (males: 21%, females: 14%). Visual brain structures are reduced by 25% in males and 22% in females. The tertiary areas of this system have more decreased than secondary and primary visual targets. It was also shown that differences in size are accompanied by changes in the proportions of the brain. Telencephalic brain parts are relatively smaller in domestic turkeys. Different decreases in brain size of diverse species from wild to domestic state are regarded as processes of functional adaptation that is controlled by intensive breeding.

Animals↗