Objectives. —To summarize the methods and findings of studies examining the prevalence of violence against pregnant women and to synthesize these findings by comparing study characteristics for studies with similar and dissimilar results. Data Sources. —MEDLINE, POPLINE, Psychological Abstracts, and Sociological Abstracts databases were searched for all articles pertaining to violence during pregnancy for the period 1963 through August 1995. Study Selection. —Thirteen studies were selected on the basis of specific criteria: a sample with initially unknown violence status; a clear statement of research question(s), with focus on measuring the prevalence of violence; descriptions of the sample, data source, and data collection methods; and data from the United States or another developed country. Data Extraction. —Relevant data were extracted to compare studies by study description, methods, and results. Data Synthesis. —Evidence from the studies we reviewed indicates that the prevalence of violence during pregnancy ranges from 0.9% to 20.1%. Measures of violence, populations sampled, and study methods varied considerably across studies, and these factors may affect prevalence estimates. Studies that asked about violence more than once during detailed in-person interviews or asked later in pregnancy (during the third trimester) reported higher prevalence rates (7.4%20.1%). The lowest estimate was reported by women who attended a private clinic and responded to a self-administered questionnaire provided to them by a person who was not a health care provider. Conclusions. —Violence may be a more common problem for pregnant women than some conditions for which they are routinely screened and evaluated. Future research that more accurately measures physical violence during pregnancy would contribute to more effective design and implementation of prevention and intervention strategies. ( JAMA . 1996;275:1915-1920)

Prevalence of Violence Against Pregnant Women

In today's multicultural society, assuring quality health care for all persons requires that physicians understand how each patient's sociocultural background affects his or her health beliefs and behaviors. Cross-cultural curricula have been developed to address these issues but are not widely used in medical education. Many curricula take a categorical and potentially stereotypic approach to "cultural competence" that weds patients of certain cultures to a set of specific, unifying characteristics. In addition, curricula frequently overlook the importance of social factors on the cross-cultural encounter. This paper discusses a patient-based cross-cultural curriculum for residents and medical students that teaches a framework for analysis of the individual patient's social context and cultural health beliefs and behaviors. The curriculum consists of five thematic units taught in four 2-hour sessions. The goal is to help physicians avoid cultural generalizations while improving their ability to understand, communicate with, and care for patients from diverse backgrounds.

/pdf/cross-cultural-primary-care-a-patient-based-approach-2fviyempgv.pdf

Cross-cultural primary care: a patient-based approach

Encounters between physicians and patients from different cultural backgrounds are becoming commonplace. Physicians strive to improve health outcomes and increase quality of life for every patient, yet these discordant encounters appear to be a significant factor, beyond socioeconomic barrie

A strategy to reduce cross-cultural miscommunication and increase the likelihood of improving health outcomes.

BACKGROUND: Child abuse and wife abuse are linked. Studies indicate 30% to 59% of mothers of children reported for child abuse also are battered. In homes where domestic violence occurs, the children are at increased risk of physical abuse or neglect. Children who witness battering of their mothers are at risk for psychosocial sequelae including developmental delays and posttraumatic stress disorder. OBJECTIVE: To determine pediatric emergency medicine fellows' level of preparedness to respond to battered mothers, and to assess obstacles and attitudinal barriers to their effective response. STUDY DESIGN: Self-reported written survey. METHODS: A 30-item anonymous questionnaire was mailed to 162 pediatric emergency medicine fellows in the United States and Canada in 1995. A response rate of 77.2% (n = 125) was achieved. RESULTS: Before fellowship, 97.6% of respondents had training (including formal courses, conferences, and direct patient contact) on child abuse/neglect although only 29.6% received similar instruction on woman battering. There was a marked disparity between patient contact experience for child abuse/neglect and woman battering throughout training. Before fellowship, 89/122 (73%) reported direct involvement in at least 10 cases of child abuse/neglect. Seventy-one (57.3%) of 124 fellows had not handled any cases of woman battering before fellowship; 106/124 (85.5%) had been directly involved in fewer than 10 cases. During fellowship 81 (67.5%) of 120 respondents had been involved in at least 10 cases of child abuse/neglect and 46/120 (38.3%) had handled at least 20 cases. In contrast, 72 (73.5%) of the 98 responding fellows had not handled any cases of woman battering during fellowship. Furthermore, 86/100 fellows reported no formal training on woman battering in their fellowship curricula. Only 5/118 (4.2%) reported having protocols in place for responding to battered women in the pediatric emergency department. Items most frequently selected from a list of potential obstacles to responding to battered women included: lack of a protocol (82/113), lack of formal training in the field (103/118), and lack of experience with woman battering cases (100/117). The majority, 75/118 (63.6%), believed that responding to battered mothers did not belong in the preview of pediatrics. Potential attitudinal barriers confirmed with the greatest frequency included: frustration that nothing could be done and lack of time to respond appropriately to battered mothers in the pediatric emergency department. CONCLUSIONS: Battered mothers are rarely identified in the pediatric emergency department even though the physicians report handling a significant number of child abuse/neglect cases. Education on domestic violence, including the implications of woman battering for childrens' health, should be incorporated in the training curricula of pediatric emergency department physicians to raise awareness of the need to explore for the presence of concurrent abuse in both children and their mothers. Identifying battered women through their children will impact greatly on the welfare of both mother and child. Language: en

Response to Battered Mothers in the Pediatric Emergency Department: A Call for an Interdisciplinary Approach to Family Violence

Significant disparities exist in health care based on race. Even when controlling for socioeconomic factors, minorities still have lower rates of utilization for certain procedures, higher mortality rates, and differences in usual source of care. There are a multitude of causes for these disparities, including differences based on access to care, the patient-doctor relationship, and insurance status. This article addresses possible factors that account for persistent disparities in health based on race and suggests approaches to remedying these disparities. Although many studies have been done on this topic, further research is needed to examine factors specifically in the emergency department setting.

https://onlinelibrary.wiley.com/doi/pdf/10.1197/S1069-6563%2803%2900501-3

Racial and Ethnic Disparities in Health: An Emergency Medicine Perspective

Joint Commission on Accreditation of Healthcare Organizations standards to improve care for victims of abuse.

As cultural and ethnic diversity increase within American society, physicians face new challenges in recognizing patients' culturally defined expectations about medical care and the cultural/ethnic dictates that influence physician-patient interactions. Patients present to practitioners with many mores related to concepts of disease and illness, intergenerational communication, decision-making authority, and gender roles. In addition, many cultural groups follow folk medicine traditions, and an increasing number of Americans seek treatment by practitioners of alternative therapies before seeking traditional western medical attention. To facilitate patient assessments, enhance compliance with health care instructions, and thus achieve the best possible medical outcomes and levels of satisfaction, practitioners must acknowledge and respect the cultural differences patients bring to medical care environments.

Scott Cj

Papers

Joint Commission on Accreditation of Healthcare Organizations standards to improve care for victims of abuse.

Enhancing patient outcomes through an understanding of intercultural medicine: guidelines for the practitioner.