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PubMed2006

A practice-centered intervention to increase screening for domestic violence in primary care practices.

BACKGROUND: Interventions to change practice patterns among health care professionals have had mixed success. We tested the effectiveness of a practice centered intervention to increase screening for domestic violence in primary care practices. METHODS: A multifaceted intervention was conducted among primary care practice in North Carolina. All practices designated two individuals to serve as domestic violence resources persons, underwent initial training on screening for domestic violence, and participated in 3 lunch and learn sessions. Within this framework, practices selected the screening instrument, patient educational material, and content best suited for their environment. Effectiveness was evaluated using a pre/post cross-sectional telephone survey of a random selection of female patients from each practice. RESULTS: Seventeen practices were recruited and fifteen completed the study. Baseline screening for domestic violence was 16% with a range of 2% to 49%. An absolute increase in screening of 10% was achieved (range of increase 0 to 22%). After controlling for clustering by practice and other patient characteristics, female patients were 79% more likely to have been screened after the intervention (OR 1.79, 95% CI 1.43-2.23). CONCLUSION: An intervention that allowed practices to tailor certain aspects to fit their needs increased screening for domestic violence. Further studies testing this technique using other outcomes are needed.

Adult↗

PubMed2003

Perceptions of domestic abuse in same-sex relationships and implications for criminal justice and mental health responses.

Male and female university students (N = 171) read scenarios describing a domestic abuse incident that systematically varied the sex of victim and perpetrator to produce four between-participants conditions. Results were consistent with and extended previous findings about perceptions of heterosexual domestic abuse to include gay and lesbian domestic abuse. Findings suggest that participant perceptions of abuse in same-sex and heterosexual relationships are similar. Where they differ, the differences have significant implications: (a) participants considered male against female abuse to be more serious than same-sex domestic abuse, (b) participants were more likely to recommend that the victim press charges in male against female abuse than in same-sex domestic abuse, (c) participants perceived same-sex victims to be less believable than heterosexual victims, and (d) victim believability was correlated with sentencing recommendations. Implications for criminal justice and mental health intervention are considered. Directions for future research are outlined.

Criminal Law↗

PubMed1998

Prevalence of adult domestic violence among women seeking routine care in a Native American health care facility.

OBJECTIVES: The purpose of this study was to determine the prevalence of, and sociodemographic factors associated with, adult domestic violence within a Native American community. METHODS: Adult women in the community were surveyed. RESULTS: Of 371 eligible women, 341 (92%) were surveyed. Among respondents, 179 reported a history of at least 1 episode of domestic violence. Fifty-six (16.4%) reported violence within the previous 12 months. Age under 40 years and living in a household receiving governmental financial assistance were independently associated with 1-year prevalence of adult domestic violence. CONCLUSIONS: Adult domestic violence is prevalent within this Native American community. Additional research is required to characterize further the relationship between domestic violence and socioeconomic status.

Adolescent↗

PubMed2003

Domestic elder abuse and the law.

OBJECTIVES: The authors evaluated the impact of state adult protective service legislation on rates of investigated and substantiated domestic elder abuse. METHODS: Data were collected on all domestic elder abuse reports, investigations, and substantiations for each US state and the District of Columbia for 1999. State statutes and regulations pertaining to adult protective services were reviewed. RESULTS: There were 190 005 domestic elder abuse reports from 17 states, a rate of 8.6 per 1000 elders; 242 430 domestic elder abuse investigations from 47 states, a rate of 5.9; and 102 879 substantiations from 35 states, a rate of 2.7. Significantly higher investigation rates were found for states requiring mandatory reporting and tracking of numbers of reports. CONCLUSIONS: Domestic elder abuse documentation among states shows substantial differences related to specific aspects of state laws.

Aged↗

PubMed2001

Postexposure rabies prophylaxis protocol for domestic animals and epidemiologic characteristics of rabies vaccination failures in Texas: 1995-1999.

OBJECTIVE: To determine whether postexposure rabies prophylaxis (PEP) in domestic animals, as mandated by the state of Texas, has continued to be effective and to evaluate PEP and preexposure rabies vaccination failures from 1995 through 1999. DESIGN: Retrospective study. ANIMALS: 830 unvaccinated domestic animals (621 dogs, 78 horses, 71 cats, and 60 cattle) that received PEP and 4 animals (3 dogs and 1 horse) that had preexposure rabies vaccination failure. PROCEDURE: Zoonotic incident case reports from 1995 through 1999 were reviewed for information regarding unvaccinated domestic animals that received PEP according to state protocol after exposure to a rabid animal; reports were also reviewed for information regarding preexposure rabies vaccination failures. The PEP recommendations were to immediately vaccinate the animal against rabies, isolate the animal for 90 days, and administer booster vaccinations during the third and eighth weeks of the isolation period. Rabies vaccines used in the PEP protocol were administered via the route prescribed by the USDA. RESULTS: From 1995 through 1999, 830 animals received PEP; 4 failures were recorded. Additionally, 4 preexposure rabies vaccination failures were recorded. CONCLUSIONS AND CLINICAL RELEVANCE: Results of this study indicate that an effective PEP protocol for unvaccinated domestic animals exposed to rabies includes immediate vaccination against rabies, a strict isolation period of 90 days, and administration of booster vaccinations during the third and eighth weeks of the isolation period. This PEP schedule has proven to be effective for control of rabies in domestic animals.

Animals↗

PubMed2003

Rabies in mongooses and domestic rats in the southern province of Sri Lanka.

OBJECTIVES: To determine the prevalence of rabies in free roaming mongooses and domestic rats in the Southern Province of Sri Lanka, and determine the different species of mongooses and domestic rats that could be reservoirs of rabies infection. DESIGN: A descriptive cross-sectional study during the period July-September 1999. SETTING: The Southern Province of Sri Lanka. STUDY POPULATION: Fifty mongooses roaming in gardens (excluding the wildlife protected zones), and 100 domestic rats found inside houses from the Divisional Secretariats in Galle, Matara and Hambantota districts. SAMPLE COLLECTION AND TESTING: The animals were trapped and speciated. After decapitation, the head was cooled immediately and brought to the Medical Research Institute (MRI) with minimum delay. The fluorescent antibody test (FAT) was done on the dissected brains at the Department of Rabies, MRI. RESULTS: Of the mongooses caught, 32 were brown mongooses and 18 ruddy mongooses. Eleven mongooses were found to be positive for rabies antigen. All domestic rats examined (common Sri Lankan house rats 76, Indian house mice 17, brown rats 7) were found to be negative for rabies antigen. CONCLUSIONS: Rabies exists in mongooses in the Southern Province. Both brown and ruddy mongooses were found to be reservoirs. The domestic rats were unlikely to be reservoirs of rabies infection in this province.

Animals↗

PubMed2000

The perpetrators of domestic violence.

There has been little useful research in recent years into those who perpetrate domestic violence. Domestic violence is always anchored in a social context in which the aspirations of men and women are dealt with unequally. The majority of perpetrators of domestic violence are men. Perpetrators are often young, troubled, unemployed, and of low self-esteem; they have often experienced abuse (of various types) themselves. However, these factors do not justify their abusive behaviour. General practitioners and other health workers have a responsibility to broach the subject of domestic violence with both perpetrators and victims. They are in a key position to break the silence that allows it to continue. Programs for stopping domestic violence can be effective for those who are motivated to change their behaviour and see the programs through to completion.

Confidentiality↗

PubMed1994

Fatal pneumonia following inoculation of healthy bighorn sheep with Pasteurella haemolytica from healthy domestic sheep.

In a series of three experiments, isolates of Pasteurella haemolytica biotype A, serotype 2, ribotype reference WSU-1, from healthy domestic sheep, were inoculated intratracheally into eight bighorn sheep (Ovis canadensis canadensis) and seven domestic sheep with doses of bacteria ranging from 5.3 x 10(8) to 8.6 x 10(11) colony forming units. Seven of eight inoculated bighorn sheep died from acute pneumonia within 48 hr of inoculation, whereas all seven domestic sheep inoculated with comparable or greater doses of bacteria remained healthy. One contact control bighorn sheep also died 6 days after its penmates received P. haemolytica. Three other noncontact control bighorn sheep remained healthy during the experiments. Pasteurella haemolytica biotype A, serotype 2, ribotype reference WSU-1 in the inocula was recovered from one or more tissues from all bighorns that died; whereas, it was not detected in any bighorn sheep before inoculation. Three different ribotypes of P. haemolytica A2 were recovered from bighorn sheep; however, only the ribotype reference WSU-1 in the domestic sheep-origin inoculum was recovered from all dead bighorn sheep, and was not recovered from bighorn sheep that survived the experiments. Thus, a relatively nonpathogenic and common isolate of P. haemolytica from healthy domestic sheep was lethal in bighorn sheep under experimental conditions.

Animals↗

PubMedDate not supplied

Fighting the "silent epidemic". Hospital launches comprehensive program against domestic violence.

In 1991, when Sacred Heart Medical Center, Spokane, WA, launched its Domestic Violence Task Force, the group's members soon discovered that few U.S. hospitals had policies on domestic violence. So they created one. They decided to address three interrelated areas: public education, professional education, and the care of patients who are domestic violence victims. First, the group wrote a booklet introducing the public to the battering phenomenon. Second, to show medical professionals how to identify battering victims and intervene on their behalf, the group produced a video and organized conferences and training sessions. Third, the task force rewrote hospital policy to ensure appropriate treatment for patients who are victims of domestic violence. Other organizations, including the U.S. Air Force, are using the task force's video. Sacred Heart has been given several awards for its work against battering. The task force is currently developing guidelines on domestic violence in the workplace.

Audiovisual Aids↗

PubMed1999

What happens when health practitioners report domestic violence injuries to the police? A study of the law enforcement response to injury reports.

This study was undertaken to learn whether law enforcement agencies in California ("agencies") have standard policies and procedures in place for responding to reports of domestic violence injuries from health practitioners ("HP reports"), and to describe the variation in policies and procedures across agencies. Using a structured interviewing tool with closed- and open-ended questions, a survey was taken of domestic violence experts from 39 agencies throughout California. Forty-one agencies were asked to participate in the study. Interviews were completed with 39. Almost all agencies reported that they have standard procedures in place for responding to HP reports when the reports are made by telephone. Agencies handle written HP reports differently than telephone HP reports. HP reports constitute a very small proportion of agencies' overall domestic violence caseloads. Emergency departments are the usual source of HP reports. Although the law requires both an immediate telephone report and a written report, fewer than one quarter of sampled agencies always received both types of HP reports. Most agencies use standard response protocols when reports of domestic violence incidents are made by telephone, whether the reporting party is a health practitioner or someone else. Written HP reports do not fit into the agencies' usual response protocol for domestic violence situations. Because agencies' protocols are best suited to situations requiring prompt dispatch of an investigating officer, only reports made by telephone have the opportunity to promote an effective law enforcement response.

California↗

PubMed2000

Physician awareness of domestic violence: does continuing medical education have an impact?

One hundred currently practicing physicians were surveyed regarding screening and management of domestic violence to determine whether mandatory continuing medical education (CME) is likely to increase awareness of and response to domestic violence. The authors surveyed 25 family physicians and 25 obstetrician/gynecologists in each of two states, Florida and New Jersey. In addition, they polled 26 family practice residents in the University of Medicine and Dentistry of New Jersey-School of Osteopathic Medicine program. Practices with a female physician were four times more likely to screen for domestic violence than practices with all male physicians. No difference existed in screening between family physicians and obstetrician/gynecologists; physicians in Florida and those in New Jersey; or attending physicians and family practice residents. Findings indicate that Florida's mandatory CME law does not appear to have made an impact on the management of domestic violence. Practices with a female physician were more likely to screen for domestic violence.

Curriculum↗

PubMed1999

Prevalence and effects of child exposure to domestic violence.

In recent years, researchers have focused attention on children who are exposed to domestic violence. Although presently there are no scientifically credible estimates of the national prevalence of children exposed to domestic violence, existing data suggest that large numbers of American children are affected. This article discusses the limitations of current databases and describes a promising model for the collection of reliable and valid prevalence data, the Spousal Assault Replication Program, which uses data collected through collaboration between police and university researchers. Research examining the effects of childhood exposure to domestic violence is also limited by a range of methodological problems. Despite this, however, sufficient evidence from the body of studies exists to conclude that such exposure has adverse effects. The specific effects may differ depending on a host of variables, such as the children's ages, the nature and severity of the violence, the existence of other risk factors in the children's lives (for example, poverty, parental substance abuse), and whether the children are also directly physically abused. In general, childhood exposure to domestic violence can be associated with increased display of aggressive behavior, increased emotional problems such as depression and/or anxiety, lower levels of social competence, and poorer academic functioning. A scientifically credible body of research on the prevalence and effects of childhood exposure to domestic violence is necessary to promote the development of effective interventions and to permit the proper channeling of public and private funds. This article identifies some of the steps that can be taken to build the research capacity necessary to obtain the needed data.

Child↗

PubMed2000

Interventions that help victims of domestic violence. A qualitative analysis of physicians' experiences.

BACKGROUND: The barriers physicians face when providing care to victims of domestic violence are well detailed in the literature, but few studies provide insight into how physicians overcome these barriers. Our goal was to describe the domestic violence interventions used by physicians who are committed to providing quality health care to battered women. METHODS: We conducted 6 focus groups with 45 San Francisco Bay Area physicians who had intervened with victims of domestic violence. The sessions were audiotaped and transcribed. We constructed, through constant comparison, a template of open codes to identify themes that emerged from the data. RESULTS: Our analysis revealed that physicians viewed validation (ie, providing messages to the patients that they are worth caring about) as the foundation of intervention. Other interventions included labeling the abuse as abuse; listening and being nonjudgmental; documenting, referring, and safety planning; using a team approach; and prioritizing domestic violence in the health care environment. Physicians described a range of rewards for intervening with victims, from seeing a patient change her entire life to subtle shifts in the way a woman thinks of her relationship and herself. CONCLUSIONS: Our study offers insight into how physicians can intervene to help victims of domestic violence. Recent interview and survey studies of battered women support the physician interventions described.

Adult↗

PubMed2001

A survey of domestic violence in a university emergency department.

OBJECTIVES: To determine prevalence of domestic violence among female patients presenting to the department. METHODS: An anonymous survey distributed to female patients presenting over a 30-day period. RESULTS: Response rate was 12.5% (190 of 1,516). Forty-four percent of respondents reported being a victim of domestic violence in the past Seventy-nine percent knew where to get help, and 64% would report it. Eight percent reported their visit to the department resulted from domestic violence. CONCLUSIONS: Prevalence of domestic violence from the sample was similar to previously reported rates. Physicians and nurses generally inquired when patients presented resulting from domestic violence, but screening rates need improvement.

Adult↗

PubMed2000

Domestic violence: identifying the deadly silence.

In the past decade, domestic violence, or intimate partner violence (IPV), has become recognized as a serious public health issue in the United States (2, 13). This devastating abuse affects 3 to 4 million individuals every year in this country alone (6, 7, 14). Millions more are affected due to the children and family who witness the abuse. Each year 3.3 million children witness domestic partner abuse and 50 to 70 percent of the perpetrators also abuse their children (7, 1). Domestic violence is a leading cause of serious injury to women, killing as many as 4,000 women each year (14, 2). Twenty-five percent of the murders in this country are related to domestic violence (14). Domestic violence represents the largest segment of unreported crime in the United States (2).

Child↗

PubMed2002

Domestic violence screening in the emergency department of an urban hospital.

Victims of domestic violence appeal to the health care system through emergency room visits for injuries related to violent episodes or for proxy care for other complaints. Screening for persons who are at high risk for violence or who are victims of violence has not been performed in emergency rooms when patients present for care, nor have all health care professionals been educated in the ways to ask the questions and assess the patients. The questions for identifying domestic violence victims have not been routinely asked on admission to the emergency department, and documentation of this information is not consistent. The purpose of this survey study was to identify the numbers and characteristics of adult victims of domestic violence who present to the emergency department of an urban community medical center during a 1 0-day period to estimate the extent of the domestic violence in the community served by the acute care facility. Findings demonstrated that emergency department staff had difficulty asking the questions, and the responsibility for the screening was relegated to the triage nurse. Questions were not asked of each adult presenting to the emergency department, and health care staff identified various reasons for their resistance. Although only 12% of persons were screened and only during the hours of 0700 through 1900, positive screens for physical abuse were found in 24.6% (n = 20) of the 81 women screened. Routine screening of all patients and sensitivity to the needs of those who have experienced domestic violence are integral to prevention and safety of those who are victimized. Injury prevention programs can then be instituted in the community with the collaborative efforts of local citizen groups and the health care facility.

Academic Medical Centers↗

PubMedDate not supplied

Identification of domestic violence in the emergency department.

Domestic violence is a commonly occurring problem in society that is likely to be encountered, whether recognized or not, by every nurse in practice today. Domestic violence knows no barriers and is present in all ethnic, racial, religious, educational, and socioeconomic levels. Millions of Americans suffer emotional and physical scars from nonfatal violence, and approximately 25,000 individuals die, annually, as a result of intentional homicide (Ellis, 1999). Failure to identify victims of abuse can result in a continuation of the abuse, frequent returns to the health care setting with vague medical complaints, severe injury, rape, and/or death. With the high prevalence of domestic violence in our society, it is imperative that research nurses focus not only on the treatment of the victims but also on issues that assist nurses in the identification of abuse. This study used a quasi-experimental approach and determined that a stimulus (button) worn by nursing staff in the emergency department did not increase the number of reported domestic violence incidences. However, the research did demonstrate the importance of the nursing assessment. When the nursing staff directly asked questions about domestic violence during their initial assessment, more victims of abuse were identified.

Adolescent↗

PubMedDate not supplied

[The effect of the domestication of Norway rats and silver foxes on the serotonin S1A- and S2-receptors of the brain].

The specific radioligand binding of serotonin 5-HT1A and 5-HT2 receptors was determined in the frontal cortex and in the hypothalamus of Norway rats and silver foxes. Aggressive wild rats and silver foxes and animals selected for many generations for nonaggressive behavior towards man (domestication) were compared. The binding of the 5-HT1A receptors was found to be significantly higher in domesticated Norway rats and lower in domesticated foxes than in aggressive animals. The specific binding of the 5-HT2 receptors was found to be similar in aggressive and domesticated animals, both in rats and foxes. The data obtained indicate the involvement of 5-HT1A receptors in the hypothalamus into the process of domestication.

Aggression↗