RESUMEN
When the clinician is faced with an infant with a skull fracture and there is no history of injury, or the history is provided only by a caretaker, the available data would indicate that a simple linear parietal skull fracture without any accompanying neurologic injury is possible from a fall of at least three feet onto a hard surface. Any more serious, multiple or complex injuries should be treated as suspect and investigated by social services and law enforcement. The clinician should refrain from making any dogmatic statements about what may or may not have occurred. We simply do not have the data to say anything further. It is up to social services and the legal system to investigate and decide if child abuse has occurred.
Asunto(s)
Maltrato a los Niños/diagnóstico , Anamnesis , Hueso Parietal/lesiones , Fracturas Craneales/etiología , Humanos , Lactante , MasculinoRESUMEN
OBJECTIVES: Social support for abused women may reduce the impact of abuse on mental health, yet few studies have addressed this issue. We wish to determine associations between intimate partner violence (IPV) and mental health outcomes and to assess the protective role of abuse disclosure and support on mental health among abused women. METHODS: A cross-sectional survey was conducted of 1152 women, ages 18-65, recruited from family practice clinics from 1997 through 1999. They were screened for IPV during a brief in-clinic interview, and physical and mental health status was assessed in a follow-up interview. RESULTS: IPV, defined as sexual, physical, or psychological abuse, was associated with poor perceived mental and physical health, substance abuse, symptoms of posttraumatic stress disorder (PTSD), current depression, anxiety, and suicide ideation/actions. Among women experiencing IPV and controlling for IPV frequency, higher social support scores were associated with a significantly reduced risk of poor perceived mental health (adjusted relative risk [aRR] 0.5, 95% confidence interval [CI] 0.3, 0.6) and physical health (aRR 0.6, 95% CI 0.5, 0.8), anxiety (aRR 0.3, 95% CI 0.2, 0.4), current depression (aRR 0.6, 95% CI 0.5, 0.8), PTSD symptoms (aRR 0.5, 95% CI 0.4, 0.8), and suicide attempts (aRR 0.6, 95% CI 0.4, 0.9). CONCLUSIONS: Healthcare providers can be instrumental in identifying IPV and helping women develop skills, resources, and support networks to address IPV. Physicians, family, or friends may provide needed social support.
Asunto(s)
Salud Mental , Apoyo Social , Maltrato Conyugal/prevención & control , Maltrato Conyugal/estadística & datos numéricos , Adolescente , Adulto , Distribución por Edad , Anciano , Intervalos de Confianza , Estudios Transversales , Recolección de Datos , Femenino , Humanos , Persona de Mediana Edad , Prevalencia , Medición de Riesgo , Factores de RiesgoRESUMEN
BACKGROUND: For women experiencing partner violence, women health care visits represent opportunities for physicians and patients to address intimate partner violence (IPV), a significant health threat for women. OBJECTIVES: The objectives were to estimate rates of physician documentation of IPV in medical records; characterize IPV+ women most likely to have IPV documented; and determine whether IPV screening increased IPV documentation. METHODS: Subjects were women ages 18-65 receiving primary care in two large family practice clinics. All were screened for IPV by study staff using a modified Index of Spouse Abuse and the Women's Experience with Battering scales. We selected and abstracted medical records for all women experiencing current IPV (N = 144) and a random sample of women never experiencing IPV (N = 147). RESULTS: Of 144 women screened as currently experiencing IPV, 14.7% were documented. Women most likely to have IPV documented were Caucasian, with higher WEB scores, and more likely to have an event that could trigger posttraumatic stress syndrome. Although the majority (41/56) of women currently in physically violent relationships did not plan to disclose IPV, those disclosing were significantly more likely to have IPV documented and documentation occurred after screening for 60% of women experiencing IPV. CONCLUSION: IPV screening increased documentation. IPV screening can provide the opportunity for patients to disclose IPV. Physicians then have the opportunity to compassionately connect patients with appropriate resources.