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PURPOSE: Physicians fail to identify the majority of domestic violence victims, even though they are often the first and only individuals to whom a victim may present. The present study was designed to assess primary care physicians' recognition of and attitudes toward domestic violence. METHOD: Of the 148 primary care physicians in three midwestern counties, all the women and a random sample of the men were included in the survey, for a total of 83. A seven-page questionnaire was developed that contained items about demographics and practice characteristics, and questions about the following aspects of domestic violence: knowledge, attitudes, importance, and prevalence in practice; attitudes toward responsibility; current practices and protocols used; level of education and domestic violence received; and opinions on how best to distribute information and/or education concerning domestic violence. The questionnaire was mailed in 1994. Follow-up was conducted through phone calls, remailings, and visits to the physicians' offices. Responses were examined using chi-square tests and two-tailed t-tests. RESULTS: The response rate was 63% (52 of 83); 53% of those responding were family physicians and 47% were general internists; 34% were women. Although all of the physicians agreed that finding and treating domestic violence is important, less than half agreed that domestic violence was a significant problem in their patient populations. Almost 96% of the physicians believed that more should be done to educate physicians about domestic violence, and 94% agreed that domestic violence should be included in a doctor's professional medical training; yet nearly half said they would not participate in a domestic violence forum. Even though 41% noted that they had received some type of formal education about domestic violence, 57% felt that their medical education had inadequately prepared them to deal with domestic violence, and less than 25% reported that they had been trained to diagnose domestic violence. The family physicians and the female physicians had received more education about domestic violence and were more comfortable addressing domestic-violence situations. The older physicians were less comfortable addressing domestic violence and were less likely to agree that education about domestic violence should be a part of medical training. CONCLUSION: Interventions by the medical community to increase physician awareness of domestic violence and available treatment resources are necessary, and domestic-violence information should be included in formal medical curricula.
STUDY OBJECTIVE: To determine whether recognition of domestic violence in the emergency department is affected by restructuring of the ED chart to include a specific question about domestic violence, to evaluate whether training concerning domestic violence further increases its recognition, and to develop a profile of women who present to the ED as a result of domestic violence. METHODS: We collected prospective data on all females aged 15 to 70 years who presented to an urban Level I trauma center during a 3-month period. Two keywords were used to define domestic violence: (1) mechanism (eg, kicked, hit, pushed) and (2) perpetrator (eg, current/former boyfriend, spouse). We used the first month to define the baseline number of domestic violence cases. We modified charts in the second and third months (intervention months) to include, "Is the patient a victim of domestic violence?" In addition, the third month included a 1-hour educational lecture on the identification of domestic violence in the ED. RESULTS: We identified 123 cases of domestic violence from a survey population of 4,073: 25 (2.0%) in the baseline month, 49 (3.4%) in the chart-modification month, and 49 (3.6%) in the education month. The proportion of cases identified during the intervention months was 1.8 times higher than during the control month (relative risk [RR], 1.78; 95% confidence interval [CI], 1.15 to 2.75), but did not differ between each other (RR, 1.06; 95% CI, .72 to 1.57). Women identified as domestic violence cases ranged in age from 15 to 61 years (median, 28.5 years). Most of the identified domestic violence patients presented with a triage classification of assault (54.5%), trauma (8.1%), or abdominal complaints (7.3%). Triage complaint differed for domestic violence and non-domestic violence cases (chi 2 = 830; P < .0001). Nearly one third of domestic violence patients (31.7%) presented between 11 PM and 6:59 AM, compared with 19.0% of non-domestic violence patients (chi 2 = 12.4; P = .005). CONCLUSION: Modification of the chart significantly increased the recognition rate of domestic violence. An education intervention did not significantly improve this rate. The profile of a woman presenting to the ED differs from those of other women with respect to chief complaint and time of presentation.
BACKGROUND: Domestic violence affects many women during their lifetime. Children living in homes where they are or have been exposed to violence are at increased risk for adverse outcomes. The American Academy of Pediatrics, the American Academy of Family Practice, and the American College of Obstetrics/Gynecology have recently joined in recommending routine screening of all families for the presence of domestic violence. We present our experience with an office-based domestic violence screening questionnaire. METHODS: A series of four child safety questionnaires (designed for parents of infant, preschool-age, school-age, and adolescent patients), which included specific questions about domestic violence, was given to all mothers presenting to a university out-patient general pediatric clinic. The questionnaires, offered in both English and Spanish, were reviewed for the presence of domestic violence exposure, usually at the time of the clinic visit. The number of women who reported either current or past exposure to domestic violence as disclosed by this active screening process was compared to the number discovered prior to the use of these questionnaires. RESULTS: Prior to the use of active screening with a child safety questionnaire, five cases of domestic violence were identified in our clinic population of approximately 5000 children over a 3 month period. Active screening of this population with a parent questionnaire resulted in the identification of 69 cases of current domestic violence exposure (2% of those screened) during each of 2 years of screening. Use of the child safety questionnaire was associated with a significantly increased odds of detecting current domestic violence (OR = 3.6, 95% CI [1.4, 9.1], P = 0.007), with 72% [26-84%] of the cases identified being attributable to the use of the questionnaire. Of children screened, 2% were currently exposed to domestic violence, and 13% had been exposed to past domestic violence. Thus a total of 15% of our patient population has been exposed to domestic violence in their homes. CONCLUSION: Children in our clinic population are frequently exposed to domestic violence. Active screening for the presence of current or past domestic violence through the use of a parent questionnaire resulted in a significant increase in our ability to identify such families and provide appropriate referral information.
Human preferences can shape the genetic evolution of other species via conservation practices, public health actions, and domestication. While the dynamics of domestication have been explored in depth through empirical and theoretical analyses, few studies have analyzed models for the coevolution of human cultural preferences with the genetics of a domesticate population. Humans shape the fitness landscape of domesticate populations both intentionally and unconsciously, by selecting for desirable traits and modifying environments; in turn, changes in domesticate phenotypes can affect the cultural preferences in the domesticator population. We present a model for the dynamics of domestication which includes interactions between genetic evolution, cultural transmission, and selective pressures. The model includes forms of selection due to culturally transmitted domesticator preferences that can affect the dynamics of domesticate genetic variants, which then affect the dynamics of domesticators. Equilibria with simultaneous genetic and cultural polymorphisms may exist, and may occur under apparent heterozygote disadvantage in the domesticate. Stable quasiperiodic cycles in both domesticates and domesticators are also possible.
BACKGROUND: A recent high-profile murder case and the passage of the Unborn Victims of Violence Act have focused policymakers' attention on domestic violence against pregnant women and new mothers. The link between men's alcohol consumption and spousal abuse has led some to suggest that more stringent alcohol regulations could ameliorate domestic violence. AIM OF STUDY: (i) To examine the correlation between men's alcohol consumption and domestic violence against new mothers and test how sensitive the correlation is to assumptions about unobserved heterogeneity, (ii) To test whether higher liquor taxes and more stringent alcohol control regulations are associated with a lower incidence of domestic abuse. METHODS: Using the Fragile Families and Child Wellbeing Study, I estimate ordinary least squares, bivariate probit, two-stage least squares, and fixed effects models to test the relationship between alcohol consumption and domestic violence. RESULTS: My findings suggest that while there is a strong positive association between men's alcohol consumption and the commission of domestic violence against new mothers, this correlation is highly sensitive to assumptions about unobservables. There is little evidence that higher liquor taxes or more stringent alcohol regulations will significantly reduce domestic violence. DISCUSSION AND LIMITATIONS: The empirical results suggest evidence for an 'unobserved bum hypothesis' That is, unobservable characteristics of the father may be correlated with both the likelihood that he abuses pregnant women (or new mothers) and that he drinks heavily. While the findings of this paper cannot rule out the possibility that men's alcohol consumption has some effect on domestic violence, there is little evidence to suggest that the impact is large in magnitude. Moreover, there is little evidence that higher liquor taxes or stricter alcohol supply regulations reduce the incidence of domestic abuse. However, greater policy heterogeneity across states and over time would be beneficial in further exploring this issue. IMPLICATIONS FOR HEALTH POLICY: Alcohol regulations, such as higher liquor taxes, are rather ineffective policies at reducing domestic violence against pregnant women and new mothers. Moreover, because policies that regulate alcohol availability or tax its consumption will harm non-violent drinkers, such policies may also be target inefficient. Rather than using non-credible, indirect mechanisms such as alcohol regulation, increasing criminal penalties for harming pregnant women or their unborn children may be a more direct method reducing domestic violence. IMPLICATIONS FOR FURTHER RESEARCH: Future research that attempts to estimate the impact of alcohol consumption on the likelihood of domestic violence must carefully consider how unobservables may impact both drinking and abuse. Future work should utilize a longer panel dataset with greater within-state alcohol policy variation to allow for more robust tests of the impact of alcohol regulations on the prevalence of domestic violence.
BACKGROUND: Implementation of screening guidelines for domestic violence has been challenging. The multifaceted "systems model" may provide an effective means to improve domestic violence screening, identification, and intervention in the healthcare setting. METHODS: We developed: (1) a systems model approach using tools for effective referral, evaluation, and reporting of domestic violence; (2) materials for distribution to female patients; (3) training for social service and mental health clinicians to provide domestic violence evaluation; and (4) strong links to the community. SETTING: A nonprofit, managed care facility in Richmond, California. PARTICIPANTS: Staff and members of the managed care plan. MAIN OUTCOME MEASURES: (1) Increased screening for domestic violence by clinicians; (2) increased awareness of the healthcare facility as a resource for domestic violence assistance; and (3) increased member satisfaction with the health plan's efforts to address domestic violence. RESULTS: The number of clinician referrals and patient self-referrals to an on-site domestic violence evaluator increased more than twofold. A pre-intervention and post-intervention phone survey of members seen for routine checkup showed an increase in member recall of being asked about domestic violence. After intervention, statistically significant increases were seen in members' perception that the health plan was concerned about the health effects of domestic violence (p<0.0001) and about members' satisfaction with the health plan's efforts to address this issue (p<0.0001). CONCLUSIONS: A systems model approach improved domestic violence services in a managed care health setting within 1 year and affected clinicians' behavior as well as health plan members' experience. This successful implementation makes it possible to address critical research questions about the impact of a healthcare intervention for victims of domestic violence in a managed healthcare setting.
BACKGROUND: The domestication of plants and animals was extremely important anthropologically. Previous studies have revealed a general tendency for populations of livestock species to include deeply divergent maternal lineages, indicating that they were domesticated in multiple, independent events from genetically discrete wild populations. However, in water buffalo, there are suggestions that a similar deep maternal bifurcation may have originated from a single population. These hypotheses have rarely been rigorously tested because of a lack of sufficient wild samples. To investigate the origin of the domestic yak (Poephagus grunnies), we analyzed 637 bp of maternal inherited mtDNA from 13 wild yaks (including eight wild yaks from a small population in west Qinghai) and 250 domesticated yaks from major herding regions. RESULTS: The domestic yak populations had two deeply divergent phylogenetic groups with a divergence time of > 100,000 yrs BP. We here show that haplotypes clustering with two deeply divergent maternal lineages in domesticated yaks occur in a single, small, wild population. This finding suggests that all domestic yaks are derived from a single wild gene pool. However, there is no clear correlation of the mtDNA phylogenetic clades and the 10 morphological types of sampled yaks indicating that the latter diversified recently. Relatively high diversity was found in Qinghai and Tibet around the current wild distribution, in accordance with previous suggestions that the earliest domestications occurred in this region. Conventional molecular clock estimation led to an unrealistic early dating of the start of the domestication. However, Bayesian estimation of the coalescence time allowing a relaxation of the mutation rate are better in agreement with a domestication during the Holocene as supported by archeological records. CONCLUSION: The information gathered here and the previous studies of other animals show that the demographic histories of domestication of livestock species were highly diverse despite the common general feature of deeply divergent maternal lineages. The results further suggest that domestication of local wild prey ungulate animals was a common occurrence during the development of human civilization following the postglacial colonization in different locations of the world, including the high, arid Qinghai-Tibetan Plateau.
BACKGROUND: Research shows that domestic violence against women in the United States is common, and the prevalence of domestic violence is high among Native American women. Victims of domestic violence can benefit from appropriate office intervention and referral. This study examined the effect of administrative and legal requirements on screening for domestic violence in Indian Health Service (IHS) hospitals and clinics. METHODS: A questionnaire was mailed using the total design method to all IHS hospitals and clinics regarding activities related to domestic violence: screening; policies and procedures; presence of committees; staff training; and state and tribal mandatory reporting requirements. RESULTS: The response rate was 65%. Eighty-eight (62%) of 142 facilities screen for domestic violence. A facility was more likely to screen if it had policies and procedures for domestic violence. Ninety-one (64%) of sites had policies and procedures for domestic violence. Less than one half these sites evaluated the use of these policies and procedures. Hospitals were more likely to have policies and procedures than clinics, as were sites administered by the IHS, rather than those administered by tribal contract. Fifty-eight (40.8%) facilities indicated 18 states have mandatory domestic violence reporting requirements. Thirty-three (23.2%) facilities indicated 31 different tribes mandate reporting of domestic violence. Forty-two (29.6%) facilities reported mandatory staff training in at least one topic related to domestic violence in the past year. CONCLUSIONS: Domestic violence policies and procedures promote screening for this important health care problem.
OBJECTIVE: To assess the prevalence of domestic violence in pregnancy when midwives are trained to enquire about it routinely. DESIGN: A cross sectional study during a period after midwives had been trained to routinely enquire about it and a retrospective case note survey at an earlier period. SETTING: The maternity services of Guy's and St Thomas' NHS Hospital Trust in South London. SAMPLE: Women aged 16 and over booking for maternity care between 14th September 1998 and 21st January 1999. METHODS: Midwives were required to routinely enquire about domestic violence at booking, 34 weeks of gestation and postpartum (within 10 days) using a series of structured questions. MAIN OUTCOME MEASURES: The lifetime and annual rates of domestic violence. The prevalence of domestic violence in pregnancy. RESULTS: The prevalence of domestic violence in pregnancy was 1.8% at booking, 5.8% at 34 weeks of gestation and 5.0% at 10 days postpartum. Eight hundred and ninety-two women were asked about domestic violence on at least one occasion, of whom 22 (2.5%) reported domestic violence in pregnancy. Two hundred and sixty-five maternity notes were reviewed for the retrospective case note survey and one (0.37%) case of domestic violence in pregnancy was identified. Routine questioning increased the rate of detection of domestic violence by 2.1% (95% CI = 0.1-3.4%; P= 0.03). The lifetime prevalence of domestic violence was 13%, and 6.4% in the previous 12 months. CONCLUSIONS: Routine enquiry for domestic violence can increase the rate of detection in maternity settings, thereby providing an opportunity for women to access help early.
OBJECTIVES: To measure the prevalence of domestic violence among women attending general practice; test the association between experience of domestic violence and demographic factors; evaluate the extent of recording of domestic violence in records held by general practices; and assess acceptability to women of screening for domestic violence by general practitioners or practice nurses. DESIGN: Self administered questionnaire survey. Review of medical records. SETTING: General practices in Hackney, London. PARTICIPANTS: 1207 women (>15 years) attending selected practices. MAIN OUTCOME MEASURES: Prevalence of domestic violence against women. Association between demographic factors and domestic violence reported in questionnaire. Comparison of recording of domestic violence in medical records with that reported in questionnaire. Attitudes of women towards being questioned about domestic violence by general practitioners or practice nurses. RESULTS: 425/1035 women (41%, 95% confidence interval 38% to 44%) had ever experienced physical violence from a partner or former partner and 160/949 (17%, 14% to 19%) had experienced it within the past year. Pregnancy in the past year was associated with an increased risk of current violence (adjusted odds ratio 2.11, 1.39 to 3.19). Physical violence was recorded in the medical records of 15/90 (17%) women who reported it on the questionnaire. At least 202/1010 (20%) women objected to screening for domestic violence. CONCLUSIONS: With the high prevalence of domestic violence, health professionals should maintain a high level of awareness of the possibility of domestic violence, especially affecting pregnant women, but the case for screening is not yet convincing.
BACKGROUND: It has been suggested that domestic violence is not only highly prevalent and associated with significant morbidity, but that it is also overlooked by medical practitioners. Despite this, few studies have focused on domestic violence in the South African setting, so that there is a paucity of data here on its prevalence, phenomenology, and associated psychopathology. METHODS: Sixteen general practitioners from the South African Sentinel Practitioner Research Network (SASPREN) screened all their female patients aged 18 years or older for a 3-month period (N = 1,050). A sociodemographic questionnaire was completed, and symptoms of post-traumatic stress disorder (PTSD) and major depression were assessed, both in subjects with a history of domestic violence and in a control group without such a history. RESULTS: 21.5% of patients reported a history of domestic violence at screening. Patients and controls did not differ significantly in terms of age or race. However, patients with a history of domestic violence were significantly more likely to be married, not to have begun a high-school education, and to be working outside the home. Both PTSD and major depression were significantly more common in patients with a history of domestic violence (35.3% and 48.2%, respectively) than in controls (2.6% and 11.4%, respectively). Compared with other patients reporting domestic violence, those with either PTSD or major depression were subjected to more violence and were more likely to report a suicide attempt. CONCLUSION: In a large, diverse population of adult female patients presenting to a range of general practitioners in South Africa, there was a high prevalence of reported domestic violence. A significant association was found between domestic violence and both PTSD and major depression, with these diagnoses indicative of increased severity of abuse and increased morbidity. Routine screening by medical practitioners of all female patients for a history of domestic violence seems warranted, and patients with a history of domestic violence should be assessed for PTSD and depression.
Chloroplast DNA polymorphisms were studied by PCR sequencing and PCR-restriction fragment length polymorphism in 165 accessions of domesticated landraces of common bean from Latin America and the USA, 23 accessions of weedy beans, and 134 accessions of wild beans covering the entire geographic range of wild Phaseolus vulgaris. Fourteen chloroplast haplotypes were identified in wild beans, only five of which occur also in domesticated beans. The chloroplast data agree with those obtained from analyses based on morphology and isozymes and with other DNA polymorphisms in supporting independent domestications of common bean in Mesoamerica and the Andean region and in demonstrating a founder effect associated with domestication in each region. Andean landraces have been classified into three different racial groups, but all share the same chloroplast haplotype. This suggests that common bean was domesticated once only in South America and that the races diverged post-domestication. The haplotype found in Andean domesticated beans is confined to the southern part of the range of wild beans, so Andean beans were probably domesticated somewhere within this area. Mesoamerican landraces have been classified into four racial groups. Our limited samples of Races Jalisco and Guatemala differ from the more widespread and commercially important Races Mesoamerica and Durango in types and/or frequencies of haplotypes. All four Mesoamerican races share their haplotypes with local wild beans in parts of their ranges. Independent domestications of at least some of the races in Mesoamerica and/or conversion of some locally adapted wild beans to cultigens by hybridization with introduced domesticated beans, followed by introgression of the "domestication syndrome" seem the most plausible explanations of the chloroplast and other molecular data.
Archaeological remains indicate that the origin of western agriculture occurred in a brief period about 10,500 years ago in a region of the Middle East known as the Fertile Crescent, where the wild progenitors of several key agricultural cereal species are endemic. Domestication entailed the appearance of agronomic traits such as seed size and threshability. For a representative sample of 20 domesticated barley (Hordeum vulgare) lines, including 13 two-rowed and 7 six-rowed varieties, we determined the haplotypes at seven loci-Adh2, Adh3, Amy1, Dhn9, GAPDH, PEPC and WAXY encompassing 5,616 bases per line-and compared them to the haplotypes at the same loci for 25 wild forms (Hordeum spontaneum) collected within and outside the Fertile Crescent. In comparisons of wild versus domesticated barley, the number of haplotypes (70 vs. 17), average nucleotide diversity, pi, (0.0077 vs. 0.0028), and Watterson's theta at silent sites (0.0104 vs. 0.0028) was reduced in domesticated lines. Two loci, Amy1 and PEPC, were monomorphic in domesticated lines; Amy1 and GAPDH produced significant values of Tajima's D. At GAPDH, pi was slightly higher in domesticated than wild forms, due to divergent high-frequency haplotypes; for the remaining six loci, 87% of nucleotide diversity has been lost in the domesticated forms. Bottlenecks acting on neutrally evolving loci either during the domestication process, during subsequent breeding, or both, are sufficient to account for reduced diversity and the results of Tajima's test, without the need to evoke selection at these loci. Phylogenetic networks data uncover distinct wild and domesticated barley genotypes and suggest that barley may have been domesticated in the Jordan valley. Because, based on AFLP data, the domesticated Turkish cultivars had a genetic basis as large as that present in large germplasm collections, all comparisons provided in this paper are of general value more than being restricted to the Turkish barley germplasm.
Although sunflower was long thought to be the product of a single domestication in what is now the east-central United States, recent archaeological and genetic evidence have suggested the possibility of an independent origin of domestication, perhaps in Mexico. We therefore used hypervariable chloroplast simple-sequence repeat markers to search for evidence of a possible Mexican origin of domestication. This work resulted in the identification of 45 chloroplast haplotypes from 26 populations across the range of wild sunflower as well as 3 haplotypes from 15 domesticated lines, representing both primitive and improved cultivars. The 3 domesticated haplotypes were characterized by 1 primary haplotype (found at a frequency of 6.7% in the wild) as well as 2 rare haplotypes, which are most likely the products of mutation or introgression. One of these rare haplotypes was not observed in the wild, bringing the total number of haplotypes identified to 46. A principal coordinate analysis revealed the presence of 3 major haplotype clusters, one of which contained the primary domesticated haplotype, the 2 rare domesticated variants, as well as haplotypes found across much of the range of wild sunflower. The Mexican haplotypes, on the other hand, fell well outside of this cluster. Although our data do not provide insight into the specific location of sunflower domestication, the relative rarity of the primary domesticated haplotype in the wild, combined with the dissimilarity between this haplotype and those found in the Mexican populations surveyed, provides further evidence that the extant domesticated sunflowers are the product of a single domestication event somewhere outside of Mexico.
Hospital workers completed a questionnaire on domestic and professional working conditions and health symptoms. Workers were asked to estimate the number of domestic work hours, and the degree of sharing of laundry, cleaning, meal preparation and childcare. Responses from the 532 women workers showed an average professional work week of 31.2 hours and an average domestic work week of 19.2 hours. The length of the domestic work week increased with the number of children, and the degree of sharing diminished. Among couples with children, the reported length of the domestic work week correlated highly with an index calculated from the degree of sharing of domestic tasks, and the number and ages of children. Exhaustion and insomnia were associated with work speed and shift work, respectively, at the hospital job, but also with the number of hours of domestic work. Backache, which was related to lifting weights in the workplace, was not associated with the number of reported hours of domestic work. Due to errors in formulating some questions, the study underestimates total hours of domestic work, and, probably, effects of domestic work on health. However, it is the first North American study to show the combined effects of domestic work and paid work on physical health symptoms among women.