Expert Perspectives on Intimate Partner Violence Power and Control in Pediatric Healthcare Settings.

OBJECTIVE: Childhood exposure to intimate partner violence (IPV) is a pervasive public health epidemic with profound impact on child health. While past work has demonstrated how abusive partners exert control over IPV survivors in a variety of settings (eg workplace, courts, home), scant research has examined how IPV power and control behaviors manifest themselves in pediatric healthcare settings. In this study, we explore the perspectives of pediatric IPV experts about: (1) behaviors used by abusive partners to control IPV survivors in pediatric healthcare settings; (2) how controlling behaviors impact healthcare access and quality; and (3) recommendations for the pediatric healthcare team. METHODS: Individual semi-structured interviews were conducted with pediatric IPV experts recruited through snowball sampling. Interviews were individually coded by two research team members and analyzed using thematic analysis. RESULTS: Twenty-eight pediatric IPV experts participated. Participants described several types of controlling behaviors including limiting healthcare access, dominating conversations during medical visits, controlling medical decision making, and manipulating perceptions of the healthcare team. Participants acknowledged the challenges of recognizing controlling behaviors and provided several recommendations to addressing behaviors such as leveraging the expertise of multidisciplinary teams. CONCLUSIONS: Participants described how abusive partners may attempt to control or discredit their partners in pediatric healthcare settings, using subtle behaviors that may be easily missed by the healthcare team. These results set the stage for further research and clinical practice innovation including triangulating the findings with IPV survivors, examining how frequently these behaviors occur, and developing multidisciplinary IPV training for the pediatric healthcare team.

The Effect of Early Knowledge of Respiratory Syncytial Virus Positivity on Medical Decision Making and Throughput Time Within the Pediatric Emergency Department.

OBJECTIVE: The aim of this study was to evaluate whether early knowledge of respiratory syncytial virus (RSV) positivity by rapid triage-based testing protocol improved emergency department (ED) throughput time and decreased ED ancillary testing and antibiotic administration. METHODS: A retrospective cohort study was performed of ED patients aged 2 to 12 months, presenting November 1 to March 31 for the years 2008-2013. Included patients presented with fever and upper respiratory tract symptoms. Patients were excluded if they tested positive for influenza, had chronic underlying medical problems, or were admitted or transferred from an outside facility or if no RSV result was documented. The study group was compared with infants who tested negative for RSV by the triage-based protocol and were diagnosed as having (1) bronchiolitis and (2) a viral illness. RESULTS: Of 899 patients tested for RSV within triage, the study included 713 (79%); 231 (35.3%) tested positive for RSV. When comparing children diagnosed as having bronchiolitis, there was no statistically significant difference between RSV positive and negative in ED throughput time, ED administered antibiotics, or chest radiographs, urine analyses, blood cultures, or lumbar punctures obtained. When comparing children diagnosed as having a viral illness, RSV-positive patients had less chest radiographs, urine analysis, and blood cultures performed. CONCLUSIONS: Identifying the virus responsible for bronchiolitis through a triage-based protocol does not decrease ED throughput time, antibiotic administration, or chest radiographs, urine analysis, or blood cultures obtained. In infants presenting with upper respiratory tract symptoms and fever, knowing RSV infectivity through a triage-based protocol does significantly decrease chest radiographs, urine analysis, and blood cultures obtained.

Accessing General and Sexual Healthcare: Experiences of Urban Youth.

Urban adolescents face many barriers to health care that contribute to health disparities in rates of sexually transmitted infections (STIs) and unintended pregnancy. Designing interventions to increase access to health care is a complex process that requires understanding the perspectives of adolescents. We conducted six focus groups to explore the attitudes and beliefs about general and sexual health care access as well as barriers to care among urban, economically disadvantaged adolescents. Participants first completed a written survey assessing health behaviors, health care utilization, and demographics. The discussion guide was based on the Theory of Planned Behavior and its constructs: attitudes, subjective norms, and perceived behavioral control. Transcripts of group discussions were analyzed using directed content analysis with triangulation and consensus to resolve differences. Fifty youth participated (mean age 15.5 years; 64% female; 90% African American). Many (23%) reported missed health care in the previous year. About half (53%) reported previous sexual intercourse; of these, 35% reported no previous sexual health care. Youth valued adults as important referents for accessing care as well as multiple factors that increased comfort such as good communication skills, and an established relationship. However, many reported mistrust of physicians and identified barriers to accessing care including fear and lack of time. Most felt that accessing sexual health care was more difficult than general care. These findings could inform future interventions to improve access to care and care-seeking behaviors among disadvantaged youth.

Risk factors for dating violence among adolescent females presenting to the pediatric emergency department.

BACKGROUND: Intimate partner violence (IPV) among the adolescent population is an increasing concern. This study was designed to assess the prevalence, associated risk factors, and best ways to identify IPV among teens presenting to a pediatric emergency room. METHODS: This prospective, convenience study was conducted in a busy, pediatric emergency department. Young women, aged 15 years to 21 years, presenting with any chief complaint were enrolled. Adolescents completed a verbally assisted survey, and responses were recorded. Surveys consisted of three sections: demographic information, an eight-item date violence screening tool, and a risk factor assessment tool. Teens who screened positive for IPV were offered immediate social services assistance. Analysis was performed to compare youth risk factors between young women who were screened positive and negative for IPV. All eight of the date violence screening questions were reviewed to analyze whether a set of questions were consistently positive in all the teens who were screened. RESULTS: A total of 246 of 270 (91%) approached were enrolled. The prevalence of IPV was 36.6%. Many of the risk-taking behaviors assessed correlated with dating violence. The most significant included having tried alcohol (odds ratio [OR], 2.4; confidence interval [CI], 1.3-4.4), having ridden in a car with a partner who was doing drugs (OR, 2.4; CI, 1.1-5.0) or alcohol (OR, 2.5; CI, 1.0-6.3), fighting with peers (OR, 3.5; CI, 1.6-7.8), and history of sexually transmitted disease (OR, 2.2; CI, 1.2-4.2). Four questions were identified that detected 99% of positive screens for adolescent dating violence. CONCLUSIONS: IPV among female adolescents presenting to a pediatric emergency department is high. Certain risk-taking behaviors are correlated with adolescent dating violence. Four specific questions, if asked in this setting, can capture teens at risk.

Obesity: influence on length of hospital stay for the pediatric burn patient.

Childhood obesity is a major public health problem in the United States and is associated with numerous comorbidities. The relationship of obesity to risk of traumatic injury and recovery has been described, although not in depth. In adults with burns, obesity has been linked to negative impact on functional outcomes as well as increased mortality. Less is known about the impact of obesity on children with burns. The primary objective of this study was to determine the effect of obesity on length of hospital stay (LOS) among admitted pediatric burn patients. A secondary objective was to compare the difference in burn characteristics between obese and nonobese burn patients. To explore these questions, a retrospective cohort study of patients aged 0 to 18 years admitted to a children's hospital burn unit between February 1, 2000, and September 30, 2006 was performed. For the purposes of this study, obesity was defined as weight-for-length (<2 years of age) or body mass index (> or =2 years of age) > or =95th percentile for age and gender. Patients who had concomitant, nonburn injuries were not included in the study. LOS was measured in days, and an initial univariate analysis examined the association of clinical and demographic factors with LOS. To adjust for confounding, those factors that were found to be significantly associated with LOS were entered into a stepwise linear regression. A total of 528 patients were included in the study group, 17.4% of whom were obese. Obese patients were more likely to suffer a burn of a high-risk anatomic area (72.8% vs 60.8%). Median LOS for obese patients was significantly higher than nonobese (9.3 vs 7.1 days, P < .05). In the adjusted model, factors significantly associated with LOS included total body surface area burned, percent full thickness burn, Medicaid insurance status, and obesity. After controlling for these factors, obese children had a 6.5% longer LOS than nonobese children. This interesting finding raises the question of which factors are responsible for the increased length of stay for obese children hospitalized with burns. Investigating factors such as rate of complications, slower healing, or greater functional impairment may shed light on this finding.