A Description of Midlife Women Experiencing Intimate Partner Violence Using Electronic Medical Record Information

BACKGROUND:

Intimate partner violence (IPV) is an important health problem affecting women of all ages, but is often not addressed during healthcare visits.

PURPOSE:

To use electronic records of diagnoses and telephone advice calls to describe the clinical patterns of midlife women experiencing IPV.

MATERIALS AND METHODS:

Using case-control methodology, women with an ICD9 diagnosis of IPV were chosen from those enrolled in 2005-2006 in Kaiser Permanente Northern California (KPNC) and matched on visit date, age, and facility with women without such a diagnosis. The study population was divided into subsets: ages 45-53 years (318 cases, 1588 controls); ages 54-64 years (200 cases, 1000 controls). Diagnoses and symptoms reported by phone that were significantly related to the cases compared with the controls were identified using multivariate logistic regression.

RESULTS:

Among women aged 45-53 years, diagnoses of anxiety and of psychiatric problems and calls for head injury, mental health problems, and sexually transmitted diseases were associated with IPV. Among women aged 54-64 years, diagnoses of anxiety and other psychiatric problems, injuries (other than head and neck), urinary tract infection (UTI), headache, and calls for mental health problems were associated with IPV. Among all women aged 45-64 years, history of prior IPV was strongly associated with subsequent diagnosis of IPV.

CONCLUSIONS:

Information available in the electronic health record of women who have been identified as experiencing IPV can be used to identify patterns of symptoms and diagnosis among midlife women. These patterns can potentially be used to improve identification of IPV in this age group. In addition to screening of all women for IPV, the presence of psychiatric problems, injuries, headache, and UTI and prior experience of IPV should prompt additional focused clinical inquiry about IPV in midlife women.

Full article at:   http://goo.gl/8DoQRT

By:   Eaton A1, Temkin TL2, Fireman BH1, McCaw BR3, Kotz KJ3, Amaral D2, Bhargava R2.

• 11 Division of Research, Kaiser Permanente Northern California , Oakland, California.
• 22 Appointment and Advice Call Center, Kaiser Permanente Northern California , Oakland, California.
• 33 Family Violence Prevention Program, Kaiser Permanente Northern California , Oakland, California. 

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health

Screening & Treatment of Maternal Genitourinary Tract Infections in Early Pregnancy to Prevent Preterm Birth in Rural Sylhet, Bangladesh

Background

Approximately half of preterm births are attributable to maternal infections, which are commonly undetected and untreated in low-income settings. Our primary aim is to determine the impact of early pregnancy screening and treatment of maternal genitourinary tract infections on the incidence of preterm live birth in Sylhet, Bangladesh. We will also assess the effect on other adverse pregnancy outcomes, including preterm birth (stillbirth and live birth), late miscarriage, maternal morbidity, and early onset neonatal sepsis.

Methods/Design

We are conducting a cluster randomized controlled trial that will enroll 10,000 pregnant women in Sylhet district in rural northeastern Bangladesh. Twenty-four clusters, each with ~4000 population (120 pregnant women/year) and served by a community health worker (CHW), are randomized to: 1) the control arm, which provides routine antenatal and postnatal home-based care, or 2) the intervention arm, which includes routine antenatal and postnatal home-based care plus screening and treatment of pregnant women between 13 and 19 weeks of gestation for abnormal vaginal flora (AVF) and urinary tract infection (UTI). CHWs conduct monthly pregnancy surveillance, make 2 antenatal and 4 postnatal home visits for all enrolled pregnant women and newborns, and refer mothers or newborns with symptoms of serious illness to the government sub-district hospital. In the intervention clusters, CHWs perform home-based screening of AVF and UTI. Self-collected vaginal swabs are plated on slides, which are Gram stained and Nugent scored. Women with AVF (Nugent score ≥4) are treated with oral clindamycin, rescreened and retreated, if needed, after 3 weeks. Urine culture is performed and UTI treated with nitrofurantoin. Repeat urine culture is performed after 1 week for test of cure. Gestational age is determined by maternal report of last menstrual period at study enrollment using prospectively completed study calendars, and in a subset by early (<20 week) ultrasound. CHWs prospectively collect data on all pregnancy outcomes, maternal and neonatal morbidity and mortality.

Implications/Discussion

Findings will enhance our understanding of the burden of AVF and UTI in rural Bangladesh, the impact of a maternal screening-treatment program for genitourinary tract infections on perinatal health, and help formulate public health recommendations for infection screening in pregnancy in low-resource settings.

Below:  Map of Sylhet District, Bangladesh and unions participating in the Projahnmo MIST trial

Full article at:  http://goo.gl/1YIxkG

By:  Anne CC Lee¹², Mohammad A. Quaiyum³, Luke C. Mullany², Dipak K. Mitra², Alain Labrique², Parvez Ahmed³, Jamal Uddin⁴, Iftekhar Rafiqullah⁴, Sushil DasGupta³, Arif Mahmud², Emilia H. Koumans⁵, Parul Christian², Samir Saha⁴, Abdullah H. Baqui^2* andfor the Projahnmo Study Group

¹Department of Pediatric Newborn Medicine, Brigham and Women’s Hospital, 75 Francis Street, Boston 02115, MA, USA

²Department of International Health, International Center for Maternal and Newborn Health; Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore 21205, MD, USA

³International Centre for Diarrheal Diseases- Bangladesh, Centre for Reproductive Health, Mohakhali, Dhaka 1212, Bangladesh

⁴Department of Microbiology, Child Health Research Foundation, Dhaka Shishu Hospital, Sher-E-Banglanagar, Dhaka 1207, Bangladesh

⁵Center for Disease Control, 1600 Clifton Road, Atlanta 30329, GA, USA

More at:  https://twitter.com/hiv_insight

And:        http://twitter.com/Prison_Health

Appropriate Antibiotic Use for Patients with Complicated Urinary Tract Infections in 38 Dutch Hospital Departments: A Retrospective Study of Variation & Determinants

Appropriate antibiotic use in patients with complicated urinary tract infections can be measured by a valid set of nine quality indicators (QIs). We evaluated the performance of these QIs in a national setting and investigated which determinants influenced appropriate antibiotic use. For the latter, we distinguished patient, department and hospital characteristics, including organizational interventions aimed at improving the quality of antibiotic use (antibiotic stewardship elements).

A retrospective, observational multicentre study included 1964 patients (58 % male sex) with a complicated urinary tract infection treated at Internal Medicine and Urology departments of 19 Dutch university and non-university hospitals. Data of 50 patients per department were extracted from medical charts. QI performance scores were calculated using previously constructed algorithms. Department and hospital characteristics were collected using questionnaires filled in by an internal medicine physician and an urologist. Regression analysis was performed to identify determinants of QI performance. Clustering at department and hospital level was taken into account through inclusion of random effects in a multi-level model.

Median QI performance of departments varied between 31 % (‘Treat urinary tract infection in men according to local guideline’) and 77 % (‘Perform urine culture’). The patient characteristics non-febrile urinary tract infection, female sex and presence of a urinary catheter were negatively associated with performance on many QIs. The presence of an infectious diseases physician and an antibiotic formulary were positively associated with ‘Prescribe empirical therapy according to guideline’. No other department or hospital characteristics, including stewardship elements, were consistently associated with better QI performance.

A large inter-department variation was demonstrated in the appropriateness of antibiotic use. In particular certain patient characteristics (more than department or hospital characteristics) influenced the quality of antibiotic use. Some, but not all antibiotic stewardship elements did translate into better QI performance.

Below:  Department performance scores on the QIs. Box-percentiles plots show the proportional distribution. Departments are indicated by vertical black lines ( | ). The box contains 90 percent of all departments. The median and the 30th and 70th percentiles are marked with a vertical blue line

Full article at:   http://goo.gl/G1oV8Z

By:  V. Spoorenberg^1*, S. E. Geerlings¹, R. B. Geskus², T. M. de Reijke³, J. M. Prins¹ and M. E. J. L. Hulscher^4*

¹Department of Internal Medicine, Division of Infectious Diseases, Centre for Infection and Immunity Amsterdam, Academic Medical Centre, Amsterdam, The Netherlands

²Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Centre, Amsterdam, The Netherlands

³Department of Urology, Academic Medical Centre, Amsterdam, The Netherlands

⁴Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands

 

More at:  https://twitter.com/hiv_insight

And: http://twitter.com/Prison_Health

Urinary Tract Infection in Young Healthy Women Following Heterosexual Anal Intercourse: Case Reports

Urinary tract infections (UTIs) are among the most common bacterial infections in outpatient clinical settings globally. Young healthy women are at highest risk of community-acquired UTI. While uncomplicated UTI is not life-threatening, it is associated with high morbidity and treatment costs. 

The pathogenesis of urinary tract infection in young healthy women is complex. It is influenced by a number of host biological and behavioural factors and virulence of the uropathogen. The infecting uropathogens in community-acquired UTI originate from the fecal flora, E. coli being the most predominant, accounting for 80-90% of these UTIs. Vaginal colonization with uropathogens, a pre-requisite for bladder infection may be facilitated by sexual intercourse, which has been shown to be a strong risk factor and predictor of UTI. 

While majority of studies have explored the association between heterosexual vaginal intercourse and UTI in healthy young women, the possible association with heterosexual receptive anal intercourse has not received adequate attention despite evidence of high prevalence globally. 

This paper presents two young healthy married women who had severe UTI following heterosexual anal intercourse and discusses possible association thereof. Understanding the risk factors for UTI and identification of possible predisposing conditions in a particular individual are important in guiding therapeutic approaches and preventive strategies. 

Cognisant of reportedly high prevalence of various sexual practices including receptive heterosexual anal intercourse and their impact on individuals' health, details on sexual history should always be enquired into in young women presenting with genito-urinary complaints.

Full PDF article at: http://goo.gl/iNfRQi

By: Lema VM.

  

More at:  https://twitter.com/hiv_insight