Hilde Grimstad

Pregnancy and delivery for women with a history of child sexual abuse

OBJECTIVE To study whether women with a history of child sexual abuse are at increased risk of delivering low birth weight infants. Secondary aims were to study smoking habits, obstetric complications, health care use, and health complaints during pregnancy among women with a history of child sexual abuse. METHOD In a case control study, 82 women with birth of a low birth weight infant (< 2500 g) (cases) and 91 women with birth of a normal birth weight infant (controls) were interviewed about experiences of child sexual abuse. RESULTS Fourteen percent of the women disclosed a history of child sexual abuse involving at least genital touch. Birth of a low birth weight infant was not associated with a history of child sexual abuse (OR 1.03, 95% CI .44-2.40). More women with a history of child sexual abuse were smokers during pregnancy (56% vs. 31%) compared with nonabused women. Abused women reported lower age at menarche and sexual debut. Nonscheduled contacts with the antenatal care clinic and discomfort during pregnancy were more frequent among abused women when controlled for low birth weight. CONCLUSIONS Women who delivered low birth weight infants were not more likely to have experienced child sexual abuse than women who delivered nonlow birth weight infants. Abused women were unemployed and daily smokers more often than nonabused women. Some of the abused women reported more health complaints, and more use of health care services during pregnancy, but did not have more obstetric complications during pregnancy and delivery.

Prevalence of physical and sexual abuse before and during pregnancy among Swedish couples

BACKGROUND To estimate the prevalence of threats and actual acts of physical and sexual abuse during pregnancy. METHODS Two hundred and seven pregnant Swedish women married to or cohabiting with Swedish men were randomly selected from three antenatal clinics in the city of Göteborg, Sweden. A standardized questionnaire was used for personal interviews about the womens experience of physical and sexual abuse by a husband or a boyfriend at some point in the past, during the last year and during current pregnancy. RESULTS Twenty-seven point five percent of the women reported that they had been exposed to physical violence at some point in the past by their husband/boyfriend. Twenty-four and a half percent of the women had experienced some form of threat, physical or sexual violence during the last year. At some time (once or more) during their current pregnancy, the proportions of women who had been exposed to the following categories of violence, were as follows: 14.5%-symbolic violence, 14.5%-threats of mild violence, 2.9%-threats of moderate violence, 2.9%-threats of serious violence, 11%-mild violence, 4.3%-minor violence, 2.4%-moderate violence, 4.3%-serious violence and 3.3%-sexual violence. CONCLUSIONS This study demonstrates that a considerable number of women had experienced threats, physical and sexual abuse during pregnancy. There is an obvious need for screening of experience of domestic violence among pregnant women to enhance the safety of women and their unborn babies.

Physical abuse and low birthweight: a case‐control study

Objective To examine whether physical abuse of a woman by her partner was associated with low birthweight.

Medical students’ cognitive and affective attitudes towards learning and using communication skills – a nationwide cross-sectional study

Aims: We wanted to explore cognitive and affective attitudes towards communication skills among students in Norwegian medical schools. Method: 1833 (60% response rate) medical students at the four medical schools in Norway filled in questionnaires by the end of term in May 2003. The Communication Skills Attitudes Scale (CSAS) was used for assessing affective and cognitive attitudes separately. Results and conclusions: Medical students have positive attitudes towards learning and using communication skills. Cognitive and affective attitudes displayed different patterns. Being female and having worked in the health services before admission to the medical school predicted more positive scores both towards cognitive and affective attitudes. Having worked as a junior doctor during medical school predicted more positive cognitive attitudes. Cognitive attitudes towards communication skills did not vary significantly between year groups in any of the medical schools. Scores reflecting affective attitudes gradually fell for each year in all schools, but rose again in the final year in two of them. Implications for curriculum design are discussed.

Same description, different values. How service users and providers define patient and public involvement in health care.

Background  Patient and public involvement in health care is important, but the existing definitions of the concept do not integrate the stakeholders’ own perceptions.

Anxiety, physical abuse, and low birth weight

Background. Physical and sexual abuse has been associated with adverse pregnancy outcome in some studies. One cause may be physical trauma; others may be indirect, such as stress, anxiety, smoking or drug use in pregnancy. The aim of the present study was to assess the relationships among anxiety, history of abuse and low birth weight. Methods. We performed a case control study comprising 85 women who delivered low birth weight (<2500 g) babies (cases) and 92 women with higher birth weight babies (control group). All mothers were interviewed. We assessed the extent of abuse using the Conflict Tactics Scale, and that of anxiety using the Trait-Anxiety Inventory. Results. Women with low birth weight babies were not more likely to have higher scores on the anxiety scale or to have a history of abuse. On the other hand, mothers with a history of abuse had higher anxiety scores and more often smoked in pregnancy. Conclusion. Anxiety could be the intermediate factor between abuse and smoking in pregnancy.

Prevalence of sexual, physical and emotional abuse in the Norwegian mother and child cohort study

BackgroundAbuse of women occurs in every society of the world. Increased information about the prevalence in industrialized countries, like Norway, is required to make strategies to prevent abuse. Our aim was to investigate the prevalence of self-reported sexual, physical and emotional abuse in a large obstetric population in Norway, and the associations between exposure to adult abuse, socio-demographics and other characteristics.MethodsOur study is based on the Norwegian Mother and Child (MoBa) Cohort study, conducted by the Norwegian Institute of Public Health. The current study included 65,393 women who responded to two extensive postal questionnaires during pregnancy. Any adult abuse is defined as being exposed to one or more types of adult abuse, any child abuse is defined as being exposed to one or more types of child abuse, and any lifetime abuse is defined as being exposed to abuse either as a child and/or as an adult. Perpetrators were categorized as known or stranger.ResultsOverall, 32% of the women reported any lifetime abuse, 20% reported any adult abuse, 19% reported any child abuse and 6% reported abuse both as adults and as children. Emotional abuse was the most frequently reported type of abuse both as adults (16%) and children (14%). Adult sexual abuse was reported by 5% and child sexual abuse by 7%. Physical abuse was reported by 6% as adults and by 6% as children. Approximately 30% of those reporting adult or child abuse reported exposure to two or three types of abuse. Five percent of the women reported exposure to any abuse during the last 12 months. For all types of abuse, a known perpetrator was more commonly reported. Logistic regression showed that being exposed to child abuse, smoking and drinking alcohol in the first trimester of pregnancy, living alone, and belonging to the eldest age group were significantly associated with being exposed to any adult abuse.ConclusionThe reported prevalence of any lifetime abuse was substantial in our low-risk pregnant population. Antenatal care is an opportunity for clinicians to ask about experiences of abuse and identify those at risk.

Abuse history and health risk behaviors in pregnancy

STUDY OBJECTIVE To study the relation between a history of physical abuse and consumption of cigarettes and alcohol during pregnancy. METHODS In a case-control study, 83 women who delivered a low birthweight (<2500 g) infant (cases) and 92 women with a newborn with birthweight > or =2500 g (controls) were interviewed about a history of sexual abuse, physical abuse by a partner, and about health behaviors during pregnancy. RESULTS In all, 46 (26%) had a history of abuse. Birth of a low birthweight infant was not associated with a history of abuse. At time of first prenatal visit 35% of the women were daily smokers, 50%) of the abused and 29%, of the nonabused were smokers. An abuse history was associated with daily smoking when controlled for educational level (OR 2.29, 95%, CI 1.08-4.85). Ninety (51%) of the women reported consumption of alcohol during pregnancy. Abuse was associated with alcohol consumption in pregnancy when controlled for educational level (OR 2.57, 95% CI 1.22-5.39). CONCLUSIONS Alcohol and tobacco use during pregnancy were associated with a history of abuse. Health care professionals should consider this potential correlation when use of tobacco and alcohol in pregnancy is brought up.

A few more minutes make a difference? The relationship between content and length of GP consultations

Abstract Objectives. To investigate the relationship between the length of a medical consultation in a general practice setting and the biopsychosocial information obtained by the physician, and to explore the characteristics of young physicians obtaining comprehensive, especially psychosocial information. Design. A prospective, longitudinal follow-up study. Setting. Videotaped consultations with standardized patients on two occasions were scored for the amount of biopsychosocial information obtained. Consultation length was recorded in minutes. Subjects. Final-year (T-1) medical school students (n = 111) participated in the project. On completion of their internship one and a half years later (T-2), 62 attended a second time, as young physicians. Main outcome measures. Content lists. Results. Pearsons r correlations between content and length at T-1 and T-2 were 0.27 and 0.66, respectively (non-overlapping confidence intervals). Psychosocial content increased significantly when consultations exceeded 13 minutes (15 minutes scheduled). Physicians using more than 13 minutes had previously, as hospital interns, perceived more stress in the emergency room and had worked in local hospitals. Conclusions. A strong association was found between consultation length and information, especially psychosocial information, obtained by the physicians at internship completion. This finding should be considered by faculty members and organizers of the internship period. Further research is needed to detect when, during the educational process, increased emphasis on communication skills training would be most beneficial for students/residents, and how the medical curriculum and internship period should be designed to optimize young physicians’ use of time in consultations.

The short-term effect on alliance and satisfaction of using patient feedback scales in mental health out-patient treatment. A randomised controlled trial

BackgroundThe main aim was to investigate the effect of using two brief feedback scales in mental health out-patient treatment six weeks after starting treatment, compared to treatment as usual. Hypotheses were that use of feedback scales would improve treatment alliance and patient satisfaction.MethodsAn open parallel-group randomised controlled trial was conducted in an out-patient unit in a mental health hospital in Central Norway. Eight therapists trained in using the feedback scales in the Partners for Change Outcome Management System (PCOMS) treated the intervention group. Seventeen therapists treated the controls, providing treatment without using feedback scales. The main outcome measures were treatment alliance and patient satisfaction.ResultsSeventy-five patients participated. There were no differences between the groups in the intention to treat (ITT) analyses on alliance (mean difference = 0.08, 95% CI −0.44, 0.59, p = 0.760) or satisfaction (mean difference = 0.24, 95% CI −1.85, 2.32, p = 0.819), and no statistically significant differences between the groups in the per protocol (PP, n = 58) analyses on alliance (mean difference = 0.32, 95% CI −0.84, 3.16, p = 0.137) or satisfaction (mean difference = 1.16, 95% CI −0.84, 3.16, p = 0.248) six weeks after the treatment started. The effect size in favour of the PCOMS group increased from 0.07 for alliance and 0.06 for satisfaction in the intention to treat analysis to 0.40 on alliance and 0.31 for satisfaction in the per protocol analysis. Among the other outcomes, the PCOMS group had better motivation for treatment (estimated mean difference ITT: 0.29, 95% CI 0.00 to 0.57, p = 0.05, PP: 0.28, 95% CI 0.04, 0.52, p = 0.024).ConclusionSix weeks after starting treatment, there were no effects on alliance and satisfaction from using two brief feedback scales. Since the per protocol analyses showed higher effect sizes, future investigations in a larger study with longer follow-up are warranted.