Maternal domestic violence screening in an office-based pediatric practice

BACKGROUND

Maternal domestic violence (MDV) screening by pediatricians is not well-studied. Objectives. To determine the practicality and dynamics of routine MDV screening in a private pediatric office and to determine the rate of MDV in Upper Cape Cod, Massachusetts.

SETTING

A 3-pediatrician, private pediatric office in Falmouth, Massachusetts.

PARTICIPANTS

Mothers of children aged 1 month to 10 years scheduled to undergo a well-child visit between February 7 and July 7, 2000.

INTERVENTION

Completion of an 11-item questionnaire related to violence.

RESULTS

Seven hundred sixty-six families were scheduled for well visits. Five hundred ninety-two eligible mothers presented to the office. Five hundred fifty-three completed questionnaires were returned (71.2%). The rate of MDV was 2.5% in current relationships (95% confidence interval [CI]: 1.4-4.3), 14.7% in past relationships (95% CI: 11.9-18.0), and 16.5% overall (95% CI: 13.5-19.9). Increased incidence of MDV was associated with the following variables: 1) harm to a child (odds ratio [OR]: 57.3, 95% CI: 7.3-1232.4), 2) being in a relationship other than a first marriage (OR: 4.6, 95% CI: 2.7-7.8), 3) having been previously asked about MDV (OR: 3.5, 95% CI: 2.1-6.1), 4) having 4 or more children (OR: 3.1, 95% CI: 1.6-6.1), 5) Women, Infants, and Children's program eligibility (OR: 3.0, 95% CI: 1.8-5.0), 6) having public insurance (ie, Medicaid or Children's Medical Security Plan) (OR: 2.2, 95% CI: 1.3-3.7), 7) a history of failure to present for a scheduled well-child visit (no-show; OR: 2.0, 95% CI: 1.0-4.2) and 8) anonymous questionnaire completion (OR: 1.7, 95% CI: 1.0-2.9). Thirty-two and one-half percent (32/91, 95% CI: 25.6-46.0) of mothers with a history of MDV recall having previously been asked about this by a health professional, compared with 16.9% overall (93/551, 95% CI: 13.9-20.3). Eighty-two and eight tenths (82.8) percent (457/552, 95% CI: 79.3-85.8) of mothers favored pediatricians asking about MDV.

DISCUSSION

This information was gathered within the context of normal work hours in a busy office. No additional staff were required. Hence, routine MDV screening appears feasible. The results suggest that a documented history of child abuse in a family makes it very likely that the mother has also been abused. However, child abuse among abused mothers is probably underreported. Furthermore, because most mothers favor domestic violence screening, concerns about lack of acceptance of maternal screening at pediatric visits seem to be unfounded. Screening may actually increase satisfaction with care. In addition, families who do not show up for appointments are at higher risk. Therefore, screening only at well visits will miss an important group.

CONCLUSIONS

Maternal domestic violence screening at well-child visits is practical in a private pediatric office setting. Current rates of screening are low; however, most mothers favor such screening. Furthermore, MDV screening should also be offered on a catch-up basis for those who miss well-child visits, as is currently recommended for immunizations.

Diabetes in the Seneca Indians. Plasma insulin responses to oral carbohydrate

In a group of adult Seneca Indians living in Western New York, 14 per cent were discovered to have previously diagnosed diabetes, and 20 per cent of the remainder had a plasma glucose of 200 mg. per 100 ml. or greater one hour after oral carbohydrate. This report describes the glucose and insulin responses to oral carbohydrate in fifty of these subjects who were not previously known to have diabetes during initial testing.

On the basis of the results of a two-hour oral glucose tolerance test, forty-six subjects were classified into “diabetic” or “normal” categories. Four persons formed an intermediate group. The diabetics differed from the normals in that (1) they were older and more obese, though even the normal population was significantly obese, and (2) the mean fasting plasma insulin level was three times greater and the insulin response to oral glucose two and one-half times greater than in normals. When diabetics were subdivided on the basis of obesity or degree of glucose intolerance, no significant differences in insulin secretion could be detected. A group of diabetic subjects with a degree of obesity comparable to that of normal subjects still demonstrated two-fold increases in both fasting and postglucose insulin levels.

The elevated insulin levels of diabetics can be explained only in part by co-existent obesity and suggest the presence of insulin resistance associated with diabetes in these Indians.