Carolyn J. Sachs

Risk factors for femicide in abusive relationships: results from a multisite case control study.

OBJECTIVES This 11-city study sought to identify risk factors for femicide in abusive relationships. METHODS Proxies of 220 intimate partner femicide victims identified from police or medical examiner records were interviewed, along with 343 abused control women. RESULTS Preincident risk factors associated in multivariate analyses with increased risk of intimate partner femicide included perpetrators access to a gun and previous threat with a weapon, perpetrators stepchild in the home, and estrangement, especially from a controlling partner. Never living together and prior domestic violence arrest were associated with lowered risks. Significant incident factors included the victim having left for another partner and the perpetrators use of a gun. Other significant bivariate-level risks included stalking, forced sex, and abuse during pregnancy. CONCLUSIONS There are identifiable risk factors for intimate partner femicides.

Stalking and Intimate Partner Femicide

An 18-item stalking inventory and personal interviews with knowledgeable proxy informants and victims of attempted femicide were used to describe the frequency and type of intimate partner stalking that occurred within 12 months of attempted and actual partner femicide. One hundred forty-one femicide and 65 attempted femicide incidents were evaluated. The prevalence of stalking was 76% for femicide victims and 85% for attempted femicide victims. Incidence of intimate partner assault was 67% for femicide victims and 71% for attempted femicide victims. A statistically significant association existed between intimate partner physical assault and stalking for femicide victims as well as attempted femicide victims. Stalking is revealed to be a correlate of lethal and near lethal violence against women and, coupled with physical assault, is significantly associated with murder and attempted murder. Stalking must be considered a risk factor for both femicide and attempted femicide, and abused women should be so advised.

Workplace Violence in Emergency Medicine: Current Knowledge and Future Directions

BACKGROUND Workplace violence (WPV) has increasingly become commonplace in the United States (US), and particularly in the health care setting. Assaults are the third leading cause of occupational injury-related deaths for all US workers. Among all health care settings, Emergency Departments (EDs) have been identified specifically as high-risk settings for WPV. OBJECTIVE This article reviews recent epidemiology and research on ED WPV and prevention; discusses practical actions and resources that ED providers and management can utilize to reduce WPV in their ED; and identifies areas for future research. A list of resources for the prevention of WPV is also provided. DISCUSSION ED staff faces substantially elevated risks of physical assaults compared to other health care settings. As with other forms of violence including elder abuse, child abuse, and domestic violence, WPV in the ED is a preventable public health problem that needs urgent and comprehensive attention. ED clinicians and ED leadership can: 1) obtain hospital commitment to reduce ED WPV; 2) obtain a work-site-specific analysis of their ED; 3) employ site-specific violence prevention interventions at the individual and institutional level; and 4) advocate for policies and programs that reduce risk for ED WPV. CONCLUSION Violence against ED health care workers is a real problem with significant implications to the victims, patients, and departments/institutions. ED WPV needs to be addressed urgently by stakeholders through continued research on effective interventions specific to Emergency Medicine. Coordination, cooperation, and active commitment to the development of such interventions are critical.

A comparison of pulse oximetry and respiratory rate in patient screening

OBJECTIVE To examine how well respiratory rate correlates with arterial oxygen saturation status as measured by pulse oximetry, and determine whether respiratory rate measurements detect oxygen desaturation reliably. METHODS Respiratory rate (RR) and oxygen saturation (SaO2) were measured prospectively on 12,096 consecutive adult emergency department triage patients at a university medical center. Respiratory rate was measured by counting ausculated breath sounds for 1 min. Pulse oximetry was used to measure SaO2. Measurements were analysed by age (with one group for 18-19 year olds, groups for every 10 yr from age 20 to age 60, and groups for every 5 yr for subsequent ages). Pearson correlation coefficients were calculated for each age group as well as the weighted average coefficient. Cases having oxygen saturation below 90% were examined to determine how frequently they exhibited increased RR (increased RRs were defined as any rate in the upper five percentile by age. RESULTS Correlation coefficients ranged from 0.379 to -0.465 with a weighted mean of -0.160. Coefficients for ages 18 through 70 years (representing 10,740 patients) all had magnitude < 0.252. Overall, only 33% of subjects with oxygen saturation below 90% exhibited increased RR. CONCLUSIONS Respiratory rate measurements correlate poorly with oxygen saturation measurements and do not screen reliably for desaturation. Patients with low SaO2 do not usually exhibit increased RR. Similarly, increased RR is unlikely to reflect desaturation.

A Population-Based Survey Assessing Support for Mandatory Domestic Violence Reporting by Health Care Personnel

SUMMARY Background: State laws mandating health care personnel to contact police when treating patients injured as a result of domestic violence are controversial. Attitudes toward these laws have been studied in select groups, but never in a large population-based sample. Methods: We measured support for mandatory reporting (MR) among 845 women in 11 cities who participated in a telephone survey assessing risk factors for intimate partner violence. Abused women were over-sampled to create equal groups (427 abused and 418 non-abused); results are presented stratified by abuse status or weighted based on prevalence of abuse among women who were screened. Results: The estimated prevalence of physical violence or threat of physical violence from an intimate partner during the past two years was 11.7%; 72% (95% CI = 69%–75%) of women supported MR. Abused women were significantly less likely to support MR compared to non-abused women (59% versus 73%, p < 0.01). Reasons that endorsed support included: victims would find it easier to get help (81%) and would like health care personnel to call the police (68%). Reasons that endorsed opposition included: victims would be less likely to disclose abuse (77%), would resent someone else having control (61%), and reporting would increase the risk of perpetrator retaliation (44%). Conclusions: Most women support mandatory reporting by health care personnel. However, abused women were significantly less supportive than those not abused.

Failure of the Mandatory Domestic Violence Reporting Law to Increase Medical Facility Referral to Police

STUDY OBJECTIVE To assess the effect of Californias 1994 mandatory domestic violence reporting law on Los Angeles Sheriffs Department dispatches to medical facilities for domestic violence incidents. METHODS This ecological time-trend study analyzed data from the Los Angeles Sheriffs Department for the period January 1, 1993, to December 31, 1995. All 26,051 dispatches for domestic violence offenses during the study period were analyzed. The outcome measures were changes in biweekly department dispatches for domestic violence offenses resulting from the implementation of the mandatory domestic violence reporting law adjusted for seasonal variation and the Simpson/Goldman murders. RESULTS The percentage of biweekly dispatches to medical facilities for domestic violence offenses did not increase in response to the law (beta = -.0072, P = .095). Total domestic violence dispatches increased significantly after the Simpson/Goldman murders but not after passage of the law (beta = 82.7, P < .0001 versus beta = -10.1, P = .2205). CONCLUSION The mandatory domestic violence reporting law in California did not increase medical personnel reporting of domestic violence situations to the Sheriffs Department during the 2 years after its implementation.

Validation Set Correlates of Anogenital Injury after Sexual Assault

OBJECTIVES Forensic investigators remain unsure exactly why some sexual assault victims display acute injury while others do not. This investigation explores potential reasons for these differential findings among female victims. METHODS This cross-sectional analysis examined data from consecutive female sexual assault victims, at least 12 years old, who agreed to a forensic exam between November 1, 2002, and November 30, 2006. Exams utilized colposcopy, anoscopy, macrodigital imaging, and toluidine blue dye to delineate anogenital injury (AGI), which was defined as the presence of recorded anogenital abrasions, tears, or ecchymosis. Demographic variables of the victim, including sexual experience and reproductive parity, and assault characteristics were recorded in the database for bivariate and multivariate analysis with AGI. RESULTS Forty-nine percent of the initial 3,356 patients displayed AGI. Of this total, 2,879 cases included complete data for all variables and were included in the multivariate logistic regression model. A statistically significant increased risk for AGI was noted with: educational status (odds ratio [OR] 1.53, 95% CI = 1.25 to 1.87); vaginal or attempted penetration using penis (OR 2.29, 95% CI = 1.74 to 3.01), finger (OR 1.61, 95% CI = 1.88 to 1.94), or object (OR 3.19, 95% CI = 1.52 to 6.68); anal-penile penetration (OR 2.00, 95% CI = 1.57 to 2.54); alcohol involvement (OR 1.25, 95% CI = 1.04 to 1.50); and virgin status of victim (OR 1.38, 95% CI = 1.11 to 1.71). Victims were less likely to display AGI with a longer postcoital interval (OR 0.50, 95% CI = 0.39 to 0.65) and increased parity (OR 0.76, 95% CI = 0.57 to 0.99). CONCLUSIONS Approximately half the patients displayed AGI. This rate is higher than earlier studies, but consistent with current investigations utilizing similar injury detection methods. The correlates of injury found reinforce the findings of prior studies, while prompting questions for future study.

The Association Between Professional Football Games and Domestic Violence in Los Angeles County

This article explores the association between professional football games and domestic violence (DV) by performing an ecological time trend analysis of Los Angeles Sheriff Departments (LASD) data from January 1, 1993, to December 31, 1995. Mean weekly DV dispatch increase in the 1993-1994 football season was 69% during nonfootball season compared with 100% during football season (p = 0.09), 147% during playoff weeks, and 264% during Super Bowl (SB) week. Mean weekly increase over the entire time period was 63% during nonfootball season compared with 74% during total football season (p = 0.26), 74% during playoff weeks, and 101% during SB weeks. Overall, authors failed to observe a statistically significant association between DV police dispatches and the timing of professional football in Los Angeles County. Impressive increases in dispatches, however, were noted during the 1993-1994 playoff and Super Bowl weeks that could not be tested due to insufficient sample size.

Impact of participation in a community-based intimate partner violence prevention program on medical students: A multi-center study

BackgroundPhysicians are generally poorly trained to recognize, treat or refer adolescents at risk for intimate partner violence (IPV). Participation in community programs may improve medical students’ knowledge, skills, and attitudes about IPV prevention.ObjectiveTo determine whether the experience of serving as educators in a community-based adolescent IPV prevention program improves medical students’ knowledge, skills, and attitudes toward victims of IPV, beyond that of didactic training.ParticipantsOne hundred and seventeen students attending 4 medical schools.DesignStudents were randomly assigned to didactic training in adolescent IPV prevention with or without participation as educators in a community-based adolescent IPV prevention program. Students assigned to didactic training alone served as community educators after the study was completed.MeasurementKnowledge, self-assessment of skills and attitudes about intimate partner violence and future plans to pursue outreach work.ResultsThe baseline mean knowledge score of 10.25 improved to 21.64 after didactic training (p ≤ .001). Medical students in the “didactic plus outreach” group demonstrated higher levels of confidence in their ability to address issues of intimate partner violence, (mean = 41.91) than did students in the “didactic only” group (mean = 38.94) after controlling for initial levels of confidence (p ≤ .002).ConclusionsExperience as educators in a community-based program to prevent adolescent IPV improved medical students’ confidence and attitudes in recognizing and taking action in situations of adolescent IPV, whereas participation in didactic training alone significantly improved students’ knowledge.

Intimate partner violence in the medical school curriculum: approaches and lessons learned.

The UCLA curriculum model educates students about intimate partner violence by integrating the topic into existing preclinical and clinical course work and offering elective experiences for interested students. Virtual Mentor is a monthly bioethics journal published by the American Medical Association.