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Jul 17

Be Human Stop Child Abuse : Vol 24, 17th July, 2013

Intimate partner violence

Short surveys for practicing clinicians — Several variations of short questions have been developed for use in the course of a patient visit. Following tools have high sensitivity and specificity:

  1. Food should be properly cooked for the right time and at the right temperature.
  2. HITS (Hurt, Insult, Threaten, Scream) (English and Spanish versions)
  3. STaT (Slapped, Threatened, and Throw)
  4. HARK (Humiliation, Afraid, Rape, Kick)
  5. CTQ-SF (Modified Childhood Trauma Questionnaire–Short Form)
  6. WAST (Woman Abuse Screen Tool)

It is essential to avoid frightening, intimidating, or shaming a patient.

Patients who have been involved with Intimate partner violence are likely to be extremely vulnerable and may misinterpret the provider’s best intentions. The Massachusetts Medical Society has proposed the following caveats.

Avoid using terms like “victim,” “abused,” or “battered” – instead, mirror the patient’s own word choices or use words like “hurt,” “frightened,” or “treated badly.”

Do not inquire about abuse in the presence of the partner, friends, or family members.

Do not disclose or discuss your concerns with the patient’s partner.

Do not ask the patient what he or she did to bring on the abuse.

Do not ask why the patient has not left the partner, or why they may have returned to the batterer.

A meta-analysis of qualitative studies identified the following expectations of women in regard to assessment for Intimate partner violence

Healthcare professionals who are nonjudgmental and compassionate

Assurance of confidentiality

Recognition of the complexities of violence and the difficulty of a quick resolution

Avoidance of “medicalizing” the issue

Discussion that is not rushed or hurried

Confirmation that the violence is undeserved

Supportive listening and feedback to bolster the patient’s confidence

Ability to progress at their own pace

No pressure to disclose, leave the relationship, or press charges

Shared decision-making and respect for the patient’s decisions

Psychological conditions associated with Intimate partner violence include:

Depression

Suicidality

Anxiety and panic disorder

Eating disorder

Substance use

Post traumatic stress disorder

Dissociative disorders

Victims of intimate partner violence are found among people of all ages, socioeconomic classes, ethnicities, gender identities, and sexual preferences.

Risk factors: Younger age, female, lower socioeconomic status, family history or personal history of violence.

Certain aspects of the history or observations made during the clinical encounter should heighten the clinician’s suspicion of IPV include:

An inconsistent explanation of injuries.

Delay in seeking treatment.

Frequent emergency department or urgent visits.

Missed appointments.

For pregnant women, late initiation of prenatal care.

Repeated abortions.

Medication nonadherence.

Inappropriate affect. Victims may appear jumpy, fearful, or cry readily. They may avoid eye contact and seem evasive or hostile.

Overly attentive or verbally abusive partner.

Apparent social isolation.

Reluctance to undress, have a genital or rectal examination, or difficulty with these examinations.

Indicators of Intimate Partner Violence in Emergency Departments

Intimate partner violence (IPV) is a serious, preventable public health problem affecting more than 32 million Americans.

IPV affects both sexes but women are more often victims than men. Lifetime estimates for IPV involving women in the United States range from 22 to 39 percent.

In countries around the world, 10 to 69 percent of women report physical assault by an intimate partner at some time in their life.

The term “intimate partner violence” describes actual or threatened psychological, physical, or sexual harm by a current or former partner or spouse. IPV can occur among heterosexual or same-sex couples and does not require sexual intimacy.

Among 5514 assault-related ED visits for women, 1530 visits were IPV related; 2040 were non-IPV related. Among 9476 assault-related visits for men, these frequencies were 395 and 2878, respectively. Among women, occurrence in the home (adjusted odds ratio (AOR) 12.8), head injury (AOR 1.6), and sexual violence (AOR 0.4) distinguished IPV- from non-IPV-related assaults. Among men, occurrence in the home (AOR 25.9) and alcohol use (AOR 2.0) distinguished IPV- from non-IPV-related assaults.

Source: Yau RK, Stayton CD, Davidson LL, J Emerg Med. 2013 Jul 8. pii: S0736-4679(13)00463-0.

Adolescent Sexuality

Young women reach puberty and sexual maturity at earlier age than ever.

In US 50% of high school youth report having had sexual contact and 33% being currently sexually active.

In US prevalence of sexually active adolescent increases with age rising from 33% in 9th Grade to 63% in 12th Grade.

In US 25% of sexually transmitted infection each year occur in your people aged 15 to 24 years.

In US human HPV infection, Chlamydia and trichomoniasis account of 90% of STIS in this age group.

In US 25% of young women aged between 14-19 years are infected with at least one of the four common STIS (HPV, Chlamydia infection, trichononiasis)

Approximately 5% of teens identify as lesbian, gay or bi-sexual.

Adolescent with both male and female sexual partners have higher rates of unprotected sex, teen dating violence and forced sex.

Gender identity is an individual innate sense of the male, female or somewhere in between.

Gender expression is how gender is presented to the outside world but does not necessarily co-relate with gender identity.  The gender role in society’s expectations and attitude, behavior and personality trade typically based on biologic sex.

Sexual orientation refers to an individual pattern of physical and emotional arousal and the gender of persons to whom an individual is physically or sexually attracted.

Middle adolescent means age between 15 to 18 years.

cammo

CMAAO

IMA
IMA

eMedinewS

Dr Vinay Aggarwal, President, Elect CMAAO

Dr K Vijayakumar (National President) IMA

Dr N Saini (Secretary General) IMA

Dr M Pillai (Chairman Organising Committee)

Dr D R Rai (Organising Secretary)

Dr S Arulrhaj (Chairman Scientific Committee)

Dr KK Aggarwal (Co-Chairman & Editor)

  1. Dear Sir, Nice updates. Regards:Dr SP Mishra

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