OBJECTIVE:To increase our understanding of how intimate partner abuse may limit women's reproductive choices.METHODS:Findings were obtained from a larger study involving interviews with 38 women participating in a hospital-based domestic violence program. We asked participants whether and in what ways their abusive partners had limited their ability to choose whether or not to have children. Content analysis was used to identify main themes.RESULTS:Thirteen (34%) participants reported that partners had limited their ability to choose whether or not to have children. Seven of these women described tactics to try to get them to have children, and 7 reported being pressured or forced to have abortions (1 woman reported both). Two women underwent sterilization in response to the abuse. Four of the 13 women reported contradictory behaviors by their partners around family planning, such as not allowing birth control, then demanding that the participant terminate the pregnancy.CONCLUSION:Women described several ways in which their abusive partners controlled or attempted to control their reproductive lives that have received little or no prior attention. Further studies are needed to determine the prevalence and consequences of these behaviors, particularly the extent to which women in abusive relationships feel coerced into sterilization or abortion.
OBJECTIVES:To present the prevalence of gun ownership among batterers and describe their self-reported use of guns to threaten intimate partners.METHODS:We used multivariate methods to analyze data from 8529 men enrolled in Massachusetts certified batterer intervention programs between 1999 and 2003.RESULTS:Seven percent of the sample reported owning guns during the past 3 years. Recent gun owners were 7.8 times more likely than non-gun-owners to have threatened their partners with guns. Gun owners and non-gun-owners were equally likely to have threatened their partners with knives. Batterers reported using guns to threaten their partners in 4 ways, including 1) threatening to shoot them; 2) cleaning, holding, or loading a gun during an argument; 3) threatening to shoot a pet or person the victim cared about; and 4) shooting a gun during an argument with a victim. Identified risk markers for threatening an intimate partner with a gun included substance abuse, homicidal behavior, making knife threats, and gun ownership in the 3 years preceding assessment.CONCLUSION:Among batterers, owning a gun is highly correlated with using a gun to threaten an intimate partner. Legal restrictions that prohibit batterers from owning and possessing firearms should be enforced consistently. Detailed contextual information about the circumstances in which batterers use guns to threaten intimate partners and potential protective and risk factors relevant to firearm use by batterers should be explored.
OBJECTIVES We aimed to determine whether there were differences in women veteran's health status and use of health care services by type of rape that occurred during military service. METHODS We conducted a national cross-sectional survey of women veterans who served in Vietnam and subsequent eras and were listed in Department of Veterans Affairs comprehensive women's health care registries. We used structured telephone interviews to gather socioeconomic information, violence history, use of outpatient health care services, and health status for a random sample, stratified by region and era of service. RESULTS Five hundred forty women completed the interview, 28% of whom reported being raped during military service. Nineteen percent reported a single rape, 5% reported repeated rape (range 2-36), and 5% reported gang rape. Women who reported repeated and gang rapes had significantly impaired physical and emotional health compared with women with a single or no rape (p < or = .05). Repeatedly raped women were more likely to use inpatient and outpatient mental health services (p < or = .05). Gang-rape survivors reported the most severe impairment in physical functioning and general health and demonstrated a trend to seek outpatient medical services. CONCLUSIONS Simply asking a woman if she has been raped is not sufficient to detect the level of consequences. More than a decade after military discharge, women who experienced repeated or gang rape during their military service had significant impairment of physical and emotional health compared with women with no or a single rape. The differential health effects associated with severe violence supports the public health importance of sexual violence screening, treatment, and prevention.
OBJECTIVE To explore forms of immigration-related partner abuse and examine the association of such abuse and immigration status with physical and sexual intimate partner violence (IPV) among South Asian women residing in greater Boston. METHOD Cross-sectional survey data on demographics,immigration status, immigration-related partner abuse, IPV, and health were collected from immigrant South Asian women currently in relationships with men (n=189). In-depth interviews were conducted with immigrant South Asian women with histories of IPV (n=23). The majority of women in both the quantitative and qualitative studies were Indian (96% and 65%), not US citizens (69% and 83%), and highly educated (48% and 39% reported postgraduate training). Logistic regression analyses adjusted for related demographics and 95% confidence intervals were used to assess quantitative data. Qualitative data were assessed via a grounded theory approach. RESULTS The odds of reporting IPV (23% of the sample)were higher for women who reported that their partners refused to change their immigration status (OR 7.8; CI 1.4, 44.6) or threatened them with deportation (OR 23.0; CI 4.5, 118.8) and for those on spousal dependent visas (OR 2.8; CI 1.1, 7.4) than they were for other women. Abused women interviewed also described how their partners used immigration laws prohibiting them from working or petitioning for status change to limit their autonomy. CONCLUSION Immigration policies that prevent women on spousal visas from working and petitioning to change their status increase women's vulnerability to partner abuse. Such legal barriers may constitute human rights violations and should be reformed to protect immigrant battered women and their children.
OBJECTIVE:To discover how community-based family physicians notify patients of test results and whether there are differences based on sex, length of time in practice, reimbursement status, employment status,or percentage of practice in managed care.METHODS:We mailed a survey to 500 randomly selected members of the South Carolina chapter of the American Academy of Family Physicians. All analyses were preformed using SASTM version 8.2. Both descriptive and inferential statistics were used to analyze the collected data.RESULTS:A total of 367 physicians responded (73% response rate). The main outcome variable was the time each physician spent notifying patients of test results: a mean of 20.86 +/- 18.3 minutes per day(range 0-120 minutes/day). Women physicians and those with more than 75% managed care were significantly more likely to spend more than the median time notifying patients of test results.CONCLUSION:Physicians vary in the amount of time they spend notifying patients of their test results, with female physicians and those with more than 75% of their practice in managed care spending more time than do male physicians and physicians with less managed care.
This paper summarizes the barriers to abortion in the United States, including the determination of viability, cost and insurance coverage, waiting periods and parental consent laws, restrictions on medical abortion, provider unavailability, harassment, targeted regulation of abortion providers laws, refusal clauses, anti choice laws, and the fetal legal rights movement. Federally subsidized abstinence-only sex education, which has not been shown to decrease the rate of unintended pregnancy (and may increase it), has expanded and access to a full range of contraceptive options has been limited. The policies of the current and past administrations have strengthened barriers to abortion both at home and abroad. Preserving women's right to choose will require improved public and professional education, legislative and legal efforts, and advocacy by physicians and other health care professionals.
OBJECTIVETo investigate the effect of exposure to damp housing on respiratory symptoms in women and men.METHODWe examined sex differences in the relationship between damp housing and respiratory symptoms in a cross-sectional survey of 1988 adults, 18 to 74 years of age, using a self-administered questionnaire. We used chi (2) and t-tests to test associations between potential risk factors and respiratory symptoms in men and women. We used multiple logistic regression modelling to determine adjusted odds ratios for several possible symptoms and home dampness. All multivariate analyses were stratified by sex.RESULTSMen had a significantly higher prevalence of chronic wheeze compared with women. The prevalence of chronic wheeze, wheeze with shortness of breath, and allergy were higher for women reporting damp housing compared with those not reporting damp housing. No significant associations between damp housing and respiratory symptoms were found in men.CONCLUSIONThese data raise the possibility that women may be more susceptible to the effects of damp housing than men are.
OBJECTIVE To describe maternal deaths and 10-year trends in maternal mortality in New York City. METHODS All maternal deaths reported by surveillance of vital records (bearing ICD-9 codes 630-676) in New York City between 1989 and 1998 were studied. Were viewed death certificates and medical and autopsy records to collect age, race/ethnicity, country of birth, marital status, education level, residence at time of death, cause of death, and outcome of pregnancy. Trends analysis for maternal mortality rates was conducted, stratified by race. We conducted univariate and multivariate analysis to identify risk factors for maternal death. RESULTS Two hundred forty-three maternal deaths were reported, for an average maternal mortality rate (MMR) of 18.4 deaths per 100,000 live births during this period. Although the overall MMR decreased from 17.4 in 1989 to 13.7 in 1998, the MMR varied widely during the period with a non significant trend (x2 for trend 2.09, p=.15). However, the individual MMR for whites and blacks decreased significantly from 1989 to 1998. The black-white MMR ratio remained high throughout this period and varied from 2.2 in 1994 to 14.8 in 1998. Women who were 35 years of age or older or non-Hispanic black had an increased risk of a pregnancy-related death. The leading causes of death were hemorrhage, embolism, and infection. CONCLUSION Racial disparity in maternal mortality is a cause for concern in New York City. Further studies of maternal mortality are needed to develop interventions to reduce the MMR and the black-white gap.
conferences, meetings, and symposia, because we know that we don’t know everything. We know some things, and we have skills, expertise, or experience in some areas. So, we share what we do know with one another. And what we don’t know also brings us to these events ... to learn from each other: networking or working our net. Not the net (Internet), which certainly overflows with more information than we ever may want or need. But our net, of colleagues and contacts, even family and friends – people we know well and others whom we will choose to get to know – if we want to be in the know and develop professionally and personally. That is what draws us from our Dilbert cubicles, laboratories, and classrooms. For although the net can connect us with the world outside our professional realms, it is the personal, face-to-face connections we make that are vital to charge and recharge our batteries, to stimulate us intellectually. Consider: • Do you equate networking with the “old boys’ club”? • Do you think that networking is just “schmoozing,” or worse, a selfish, what-can-you-do-for-me process? • Do you think that it is a term for (male) bragging? Wayne Baker, a professor at the University of Michigan Business School, debunks some myths about networking. • Myth: Tough-minded business people do not value networking and relationship building, because its “soft skills” cannot be quantified. Fact: Numerous scientific studies show that those who network well are more effective, better paid, promoted faster, healthier, happier – even live longer! And, according to one study, 75% of us get our jobs this way. • Myth: Professional success depends primarily on technical skills, training, and abilities. Fact: Successful leaders are the best relationship builders, and relationship building becomes even more significant as we advance in our careers. • Myth: Rugged individuals win. Fact: We are all connected, and the more vibrant our networks, the more empowered we are. Networking represents our richest resource, what Baker terms “social capital.” If our network is well built and well developed, we can derive information, ideas, leads, opportunities, financial capital, power, emotional support, goodwill, trust, and cooperation. Executive Leadership in Academic Medicine (ELAM), a core program of the Institute for Women’s Health and Leadership at Drexel University College of Medicine, strongly promotes networking as a primary critical skill for the women medical and dental school faculty participants preparing themselves for professional advancement. ELAM provides its participants with many networking opportunities. The women work in small groups to develop bonds to connect them with their classmates long after the program ends. From their intersession assignment to interview their institution’s key leaders, ELAM fellows get to know these individuals while learning about broader Networking Lessons for Women Professionals – Connecting the Dots, Building Matrices PROFESSIONAL DEVELOPMENT
Despite international efforts to halt the practice of female genital mutilation (FGM), the number of African girls and women undergoing the procedure is not declining as rapidly as international observers had hoped when the World Health Organization began focusing attention on the practice in the 1960s. This article focuses on the psychological effects of FGM through the example of a patient who had undergone the procedure in childhood and now felt that her closed appearance was "normal" and that to be opened would be "abnormal." Western advocates must educate themselves about the various cultural forces that lead to FGM in order to help women who have undergone the procedure heal psychologically, thereby breaking the pattern of abuse from generation to generation.
Bipolar I disorder occurs in approximately 1% of the adult population, and it affects women and men equally. Women develop bipolar II disorder, bipolar depression, mixed mania, and a rapid-cycling course of illness more commonly than men and are at greater risk of such comorbid conditions as alcohol use problems, thyroid disease, medication-induced obesity, and migraine headaches. The treatment of bipolar disorder remains challenging. Although lithium reduces symptoms and prevents recurrence with good efficacy, a significant number of patients stop taking it. Furthermore, several anticonvulsants and antidepressants are prescribed off label for acute episodes and prophylaxis despite the lack of adequate research support. Psychotherapy may alleviate mania or depression and improve treatment compliance, yet its ability to prevent relapse remains uncertain. Changes throughout the reproductive cycle also have an impact on the onset and presentation of bipolar symptoms and the choice of treatment. This article provides an overview of common presentations and comorbidities, along with approaches to evaluation and treatment of women with bipolar disorder.
BACKGROUND:The demographic and socioeconomic profile of medical school classes has implications for where people choose to practise and whether they choose to treat certain disadvantaged groups. We aimed to describe the demographic and socioeconomic characteristics of first-year Canadian medical students and compare them with those of the Canadian population to determine whether there are groups that are over- or underrepresented. Furthermore, we wished to test the hypothesis that medical students often come from privileged socioeconomic backgrounds.METHODS:As part of a larger Internet survey of all students at Canadian medical schools outside Quebec, conducted in January and February 2001, first-year students were asked to give their age, sex, self-described ethnic background using Statistics Canada census descriptions and educational background. Postal code at the time of high school graduation served as a proxy for socioeconomic status. Respondents were also asked for estimates of parental income and education. Responses were compared when possible with Canadian age-group-matched data from the 1996 census.RESULTS:Responses were obtained from 981 (80.2%) of 1223 first-year medical students. There were similar numbers of male and female students (51.1% female), with 65% aged 20 to 24 years. Although there were more people from visible minorities in medical school than in the Canadian population (32.4% v. 20.0%) (p < 0.001), certain minority groups (black and Aboriginal) were underrepresented, and others (Chinese, South Asian) were overrepresented. Medical students were less likely than the Canadian population to come from rural areas (10.8% v. 22.4%) (p< 0.001) and were more likely to have higher socioeconomic status, as measured by parents' education (39.0% of fathers and 19.4% of mothers had a master's or doctoral degree, as compared with 6.6% and 3.0% respectively of the Canadian population aged 45 to 64), parents' occupation (69.3% of fathers and 48.7% of mothers were professionals or high-level managers, as compared with 12.0% of Canadians) and household income (15.4% of parents had annual household incomes less than $40,000, as compared with 39.7% of Canadian households; 17.0% of parents had household incomes greater than $160,000, as compared with 2.7% of Canadian households with an income greater than $150,000). Almost half (43.5%) of the medical students came from neighbourhoods with median family incomes in the top quintile (p < 0.001). A total of 57.7% of the respondents had completed 4 years or less of postsecondary studies before medical school, and 29.3% had completed 6 or more years. The parents of the medical students tended to have occupations with higher social standing than did working adult Canadians; a total of 15.6% of the respondents had a physician parent.INTERPRETATION:Canadian medical students differ significantly from the general population, particularly with regard to ethnic background and socioeconomic status.
This article provides practical advice about foods and dietary supplements that are beneficial for the health of older people. Overweight and obesity are among the most common nutrition-related disorders in older people. A plant-based diet is associated with reduced risk of chronic diseases such as obesity, cardiovascular disease, cancer, and diabetes. Vitamin B12 deficiency is prevalent in older adults, but there are misconceptions about the causes, consequences, and treatments. Diminished synthesis of vitamin D in the skin that occurs with aging and poor dietary intake contribute to the high prevalence of poor vitamin D status in older adults. Vitamin D deficiency is associated with chronic disorders beyond poor bone health. Supplements containing vitamin B12 and vitamin D will help older adults meet their needs for these key nutrients.
OBJECTIVE:To compare women who use Department of Veterans Affairs (VA) health care providers only with women who use VA and non-VA providers (dual users).METHODS:An anonymous survey was mailed to women veterans randomly sampled from 10 VA medical centers in 3 states. We measured reports of dual use of VA and non-VA providers according to the VA provider's gender, provision of routine gynecological care by VA provider, use of VA women's clinic, and overall satisfaction with VA care. Multiple logistic regression analyses were performed with adjustment for patient demographics, health status, VA service connection status, and clustering by site to determine what factors influenced dual use of providers.RESULTS:In the fully adjusted logistic regression model, provision of routine gynecological care by VA providers (odds ratios [OR] 0.37; 95% confidence intervals [CI] 0.22, 0.60) and use of VA women's clinics (OR 0.56; CI 0.35, 0.90) were strongly associated with a lower likelihood of dual use. Dissatisfaction with care (OR 1.88; CI 1.04,3.41) and higher income (OR 1.89; CI 1.32, 2.71) were also associated with an increased likelihood of dual use. Having a female VA provider was not associated with dual use.CONCLUSIONS:Women veterans' use of VA and non-VA providers is influenced by the scope of clinical services and dissatisfaction with those services. VA clinics should either promote routine gynecological care within primary care clinic settings or pair traditional primary care with VA women's clinics to enhance coordination and comprehensiveness and, thus, reduce fragmentation of care for veteran women.
OBJECTIVE:The objectives of the current study are to delineate nonpsychiatric illness associated with posttraumatic stress disorder (PTSD) in order to inform services and interventions for traumatized patients in medical and public health settings. The current report examines sex differences in nonpsychiatric illnesses associated with PTSD in a nationally representative sample. Analyses account for the roles of poverty and major depression, 2 factors strongly linked to both health status and PTSD.METHOD:Data on 2835 men and 3042 women from the National Comorbidity Survey were analyzed to obtain adjusted odds ratios for the risk of medical conditions and the types of medical conditions associated with PTSD for men and women.RESULTS:Women and men with PTSD were more than twice as likely to experience at least 1 current nonpsychiatric medical condition as were women and men without PTSD, even when age, socioeconomic status, and major depression were adjusted for. Depression and income below the poverty level were associated with additional risk of nonpsychiatric conditions among women, but not among men.CONCLUSIONS:PTSD is associated with significant nonpsychiatric illness. The relationship between PTSD and current health conditions is similar for men and women, but depression and poverty, which frequently co-occur with PTSD, define a subset of disadvantaged women with significant health and mental health service needs. Interventions for this population must address the full range of both psychiatric and nonpsychiatric illness.
Elder abuse is a growing public health problem in the United States, with research suggesting that women may be at higher risk of abuse than men are. Laws on elder abuse have emerged over the recent decades, with nearly all states requiring mandatory reporting of suspected elder abuse cases. Physicians play key roles in helping their elder patients; they are often the only accessible individuals outside a frail elderly patient's family circle and are therefore in an ideal position to detect, manage, and prevent elder abuse. Unfortunately, they are not living up to their potential for reporting elder abuse. Physicians must confront and overcome barriers to detecting and reporting in order to provide appropriate care to elderly patients. This article defines elder abuse, outlines barriers to detecting and reporting elder abuse, provides an overview of the existing elder abuse laws, discusses the dilemmas surrounding mandatory reporting, and offers suggestions on how to manage cases of suspected abuse.
OBJECTIVE We conducted this study to identify residents' limitations in screening for, documenting, and managing domestic violence (DV) and to focus future educational interventions. METHODS We administered a detailed survey to 103 internal medicine residents from 4 university-affiliated programs to ascertain their attitudes about and practices in screening for, documenting, and managing DV. RESULTS Most residents agreed that DV is a significant health care problem (87%) and one in which physicians can intervene effectively (77%), yet 37% reported not screening for DV. Residents who said they do not screen reported a variety of mitigating factors, from uncertainty about how to screen for and manage DV, to fear of insulting or angering the patient. Eighty-two percent stated that they would document DV in the chart, but 51% had reasons for not documenting DV, ranging from fear that the patient's partner might harm the patient or the physician to concern that the patient may not be telling the truth. Fifty-seven percent of residents said they would ask about DV more often if state law mandated it. When asked to choose which management interventions were helpful or unhelpful, many residents made incorrect, potentially injurious choices. CONCLUSION Many residents reported beliefs and practices that could inhibit optimal care of DV victims. Educational interventions should be directed at remedying residents' gaps in knowledge and attitudes to improve screening for, documenting, and managing DV.
A case is presented in which an uninsured woman sought care at a medical clinic and then an emergency room, where she was ultimately diagnosed with early cervical cancer. Although cervical cancer at this stage carries an excellent prognosis, the patient was unable to pay for the diagnostic testing, surgery, and additional treatment that she needed and was therefore told that she would be treated in an emergency situation only. The ethics of providing care in a health care system that makes no provision for care of the indigent is discussed, with consideration of obligations of individual physicians as well as of institutions to care for the sick. A single-payer system is advocated as a solution to the problem of providing care to the under- and uninsured.
Reproductive and sexual health (RSH) education is a key component of most family planning programs around the world and is particularly important for adolescents, for whom parenthood is more likely to have difficult or dangerous health outcomes. A lack of comprehensive RSH education targeted at adolescents may augment the poor outcomes associated with early pregnancy by creating barriers to optimal care. This article discusses the creation of the Centro de Medicina Reproductiva y Desarrollo Integral de la Adolescencia clinic, a comprehensive adolescent reproductive health center in Santiago de Chile, and its RSH education programs. In particular, the role of the physician in originating and leading the RSH education efforts, the controversy associated with RSH education in Chile, and the effects of comprehensive RHS education on the local and regional adolescent populations are discussed.
