Emergency Care Provision for; and Psychological Distress in; Survivors of Domestic Violence

"Background : This study aimed (i) to ascertain the number of treatment referrals and information about protection orders given to survivors of domestic violence presenting for emergency trauma care; as reported at the one-month visit; (ii) to obtain a profile of violent incidents and injuries; and (iii) to assess self-esteem and posttraumatic and depressive symptomatology in the aftermath of injury.Methods : A survey of 62 participants presenting in the acute aftermath of domestic violence (as defined by the Domestic Violence Act of 1998) was conducted over 12 weeks at the Trauma and Resuscitation Unit of a Level One trauma centre in an urban public hospital in South Africa.1 Following informed consent; face-to-face structured interviews were conducted during admission and a month later. The following instruments were administered at baseline: a Demographic and Injury Questionnaire; the Beck Depression and Rosenberg Self-Esteem Inventories; and the Davidson Trauma Scale. A psychosocial questionnaire was administered at the one-month follow-up. Results : Fifty-eight per cent of the participants were female and 42 were male. Seventy-four per cent of the perpetrators were male. Ninety-five per cent of the participants said that no health professional had informed them about where or how they could find help. Although all were seriously injured; 76 of the participants said only the researcher had asked about their experience. Sixty-six per cent of the cases of domestic violence were related to intimate partner violence. Overall; subjects displayed high levels of depressive and post-traumatic stress symptomatology that had neither been treated nor adequately referred. Conclusion Even though domestic violence poses significant health threats and costs to the health system; it appears to be a neglected area of South African health care. Health professionals should at least be able to identify and intervene within the ""open window"" period when psychosocial opportunities are pivotal."

Adolescent sexual orientation and suicide risk: evidence from a national study.

OBJECTIVES: Sexual orientation has been a debated risk factor for adolescent suicidality over the past 20 years. This study examined the link between sexual orientation and suicidality, using data that are nationally representative and that include other critical youth suicide risk factors. METHODS: Data from the National Longitudinal Study of Adolescent Health were examined. Survey logistic regression was used to control for sample design effects. RESULTS: There is a strong link between adolescent sexual orientation and suicidal thoughts and behaviors. The strong effect of sexual orientation on suicidal thoughts is mediated by critical youth suicide risk factors, including depression, hopelessness, alcohol abuse, recent suicide attempts by a peer or a family member, and experiences of victimization. CONCLUSIONS: The findings provide strong evidence that sexual minority youths are more likely than their peers to think about and attempt suicide.

Ascites fluid as a possible origin for hyperfibrinolysis in advanced liver disease.

OBJECTIVES: Advanced liver disease is associated with both exaggerated fibrinolysis and with ascites. This study was undertaken to determine whether fibrinolytic activity exists in the ascites fluid of patients with liver disease and to see whether such activity is associated with evidence of plasma fibrinolysis. METHODS: Both the ascites fluid and plasma from 15 patients with cirrhotic ascites (group A) were evaluated for markers of fibrinolysis: fragment D-dimer, plasminogen, fibrinogen, and fibrin split products. In addition, the euglobulin lysis time, a test highly specific for fibrinolysis, was evaluated in the ascites fluid samples. As a control group, the plasma from 15 cirrhotic patients without ascites (group B) was evaluated for markers of fibrinolysis. RESULTS: In group A, elevated fragment D-dimer and fibrin split products were uniformly found in ascites fluid in concentrations that would be considered pathologically elevated if in plasma. Ascites fluid was also depleted, compared with plasma, of both plasminogen and fibrinogen. These results, along with the short euglobulin lysis time in 83% of the patients, suggest that increased fibrinolytic activity is present in ascites fluid. In 93% of these patients, plasma D-dimer was elevated. The mean plasma plasminogen was also low in these patients. In group B, only 33% of patients had elevated plasma D-dimer. CONCLUSIONS: Ascites fluid has fibrinolytic activity. Because ascites fluid reenters the systemic circulation via the thoracic duct, via a natural peritoneovenous shunt, ascites fluid warrants serious consideration as a pathological fluid that contributes to the systemic fibrinolytic state found in the majority of our patients with ascites.

Nonlinear cell response to strong electric fields.

The response of living cells to externally applied electric fields is of widespread interest. In particular, the intensification of electric fields across cell membranes is believed to be responsible, through membrane rupture and reversible membrane breakdown processes, for certain types of tissue damage in electrical trauma cases which cannot be attributed to Joule heating. Large elongated cells such as skeletal muscle fibres are particularly vulnerable to such damage. Previous theoretical studies of field intensification across cell membranes in such cells have assumed the membrane current to be linear in the applied field (Ohmic membrane conductivity) and were limited to sinusoidal applied fields. In this paper, we investigate a simple model of a long cylindrical cell, corresponding to nerve or skeletal muscle cells. Employing the electroquasistatic approximation, a system of coupled first-order differential equations for the membrane electric field is derived which incorporates arbitrary time dependence in the external field and nonlinear membrane response (non-Ohmic conductivity). The behaviour of this model is investigated for a variety of applied fields in both the linear and highly nonlinear regimes. We find that peak membrane fields predicted by the nonlinear model are approximately twice as intense, for low-frequency electrical trauma conditions, as those of the linear theory.

Smart teens don't have sex (or kiss much either).

PURPOSE: To examine the relationship between an intelligence measure and a wide spectrum of partnered sexual activity ranging from holding hands to sexual intercourse among adolescents. METHOD: Analyses are based on two separate samples of adolescents. The core sample of the National Longitudinal Study of Adolescent Health (Add Health) includes approximately 12,000 adolescents enrolled in the 7th to 12th grades. The Biosocial Factors in Adolescent Development projects followed approximately 100 white males and 200 black and white females over 3- and 2-year periods, respectively. Both studies used the Peabody Picture Vocabulary Test (PPVT) as an intelligence measure, and confidential self-reports of sexual activity. Logistic regression models were used to examine the relationship between PPVT scores and coital status in Add Health data; proportional hazard models were used to examine the timing of initiation of noncoital and coital activities as a function of PPVT scores in the Biosocial Factors sample. RESULTS: Controlling for age, physical maturity, and mother's education, a significant curvilinear relationship between intelligence and coital status was demonstrated; adolescents at the upper and lower ends of the intelligence distribution were less likely to have sex. Higher intelligence was also associated with postponement of the initiation of the full range of partnered sexual activities. An expanded model incorporating a variety of control and mediator variables was tested to identify mechanisms by which the relationship operates. CONCLUSIONS: Higher intelligence operates as a protective factor against early sexual activity during adolescence, and lower intelligence, to a point, is a risk factor. More systematic investigation of the implications of individual differences in cognitive abilities for sexual activities and of the processes that underlie those activities is warranted.

You don't bring me anything but down: adolescent romance and depression.

What accounts for the sex difference in depression that emerges during the period of adolescence? We propose that females become more depressed than males in adolescence partly as a consequence of their involvement in romantic relationships. Using two waves of data from the National Longitudinal Study of Adolescent Health (N = 8,181), a study which began interviewing respondents in 1994, we compare change in levels of depression for adolescents with and without romantic involvement between interviews. Our results suggest that males and females who become romantically involved between interviews experience a larger increase in depression than their counterparts who do not; however, females experience a larger increase in depression than males in response to romantic involvement. Our results suggest that females' greater vulnerability to romantic involvement explains a large part of the emerging sex difference in depression during adolescence.

Apolipoprotein E-deficient mice have increased susceptibility to focal cerebral ischemia.

Recent evidence suggests that apolipoprotein E (ApoE) plays a role in neurologic disease. This experiment compared the neurologic and histologic outcome of ApoE-deficient mutant and wild-type mice subjected to a 60- or 90-minute episode of middle cerebral artery filament occlusion and a recovery interval of 24 hours. With 60 minutes of ischemia, there was no mortality. Apolipoprotein E-deficient mice had larger infarcts (cortex: ApoE deficient = 20 mm3 +/- 12, wild-type = 9 +/- 7 mm3, P = 0.03; subcortex: ApoE deficient = 22 +/- 7 mm3, wild-type = 16 +/- 7 mm3, P = 0.07). Hemiparesis was less severe in wild-type animals (P = 0.02). After 90 minutes of ischemia, mortality in ApoE-deficient mice (n = 10) was 40% versus 0% in wild-type mice (n = 10; P = 0.09). Intraparenchymal hemorrhage was found in 3 of the 4 dead mice. No difference in cortical (ApoE deficient = 37 +/- 8 mm3; wild-type = 31 +/- 18 mm3; P = 0.49) or subcortical (ApoE deficient = 30 +/- 11 mm3; wild-type = 32 +/- 18 mm3; P = 0.78) infarct volumes was present among survivors. ApoE-deficient mice had a prolonged activated partial thromboplastin time and increased fibrinogen concentration. This data supports the hypothesis that apolipoprotein E plays a role in the pathophysiology of ischemic brain damage.

Plasma levels of factors II, VII and X and their relationship to the international normalized ratio during chronic warfarin therapy.

Monitoring of oral anticoagulant therapy is usually undertaken with the prothrombin time (PT), which is influenced by factors II, X, and VII. A number of studies have suggested that the prothrombin (factor II) level may be the most important determinant of the therapeutic efficacy of these drugs. Although some studies suggest that oral anticoagulants induce a similar residual level of plasma vitamin K-dependent proteins, others have called this into question. We therefore measured plasma levels of factors II, X, and VII in 50 patients undergoing chronic Warfarin therapy. The plasma levels of factors II, X, and VII were significantly different. Although the factor X levels of all plasmas were < 30%, levels of factors II and VII were > 30% in 14% and 50% of the samples, respectively. Multivariable analysis showed factor II levels to be the least significant of the three factors measured in determining the international normalized ratio of plasma or whole blood. Thus, plasma levels of the vitamin K-dependent coagulation factors are not equal in patients on chronic Warfarin therapy. If factor II (prothrombin) levels are indeed the major determinants of the therapeutic efficacy of Warfarin, alternative means of monitoring that more accurately reflects prothrombin levels should be evaluated.

Evidence for intragenic recombination within a novel genetic marker that distinguishes mussels in the Mytilus edulis species complex.

We have used the polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP) techniques to design two genetic markers for blue mussels in the Mytilus edulis species complex. Both of these markers target the gene encoding the mussel polyphenolic adhesive protein. The first marker, Glu-5', is highly differentiated among and can be used to identify the three blue mussel species, M. edulis, M. galloprovincialis and M. trossulus. The second marker, Glu-3', can identify M. edulis and M. galloprovincialis. Using these markers we have demonstrated that hybrid mussels from Whitsand Bay, UK carry alleles for this gene that are the products of intragenic recombination. The high frequency (10 per cent) of these recombinant alleles within the hybrid population suggests that recombination is fairly frequent within this gene or that hybridization between M. edulis and M. galloprovincialis is substantial and has been occurring over considerable evolutionary time. The two novel genetic markers, Glu-5' and Glu-3' will be invaluable in additional studies regarding the importance of hybridization among blue mussels.

The safety of digital mobile cellular telephones with minute ventilation rate adaptive pacemakers.

In vitro tests suggest that rate adaptive pacemakers using changes in transthoracic impedance to vary pacing rate may be affected by digital mobile telephones. Electromagnetic fields generated by digital mobile telephones (Global System for Mobile [GSM]) represent a potential source of electromagnetic interference (EMI) for the Telectronics META rate adaptive pacemakers, which use transthoracic impedance as a sensor to determine changes in minute ventilation. Sixteen implanted Telectronics META pulse generators were exposed to 25-W simulated GSM transmissions (900-MHz carrier pulsed at 2, 8, and 217 Hz with a pulse width of 0.6 ms) and the antenna of a 2-W digital mobile telephone (900-MHz, 217-Hz pulse, 0.6-ms pulse width). The 12 dual and four single chamber devices were programmed to maximum sensitivity and assessed in unipolar and bipolar settings and rate adaptive and nonrate adaptive modes. In all cases of EMI, testing was repeated at lower, more routinely set bipolar sensitivity levels. At maximum sensitivity, 11 of 16 devices displayed no evidence of EMI. Brief ventricular triggering occurred in 2, a brief pause in 1, a combination of both in 1, and a brief episode of pacemaker-mediated tachycardia in 1. With pulse generators programmed to more routine sensitivities, only one device displayed rare single beat ventricular triggering. No changes in minute ventilation rate adaptive pacing were observed. At maximum unipolar sensitivities, the META series of rate adaptive pacemakers are resistant to clinically important EMI from digital mobile telephones. Set at routine sensitivities, these devices perform reliably in the presence of digital mobile telephones.

Compatibility and activity of enoxaparin sodium in 0.9% sodium chloride injection for 48 hours.

The stability of enoxaparin sodium in 0.9% sodium chloride injection in polyvinyl chloride (PVC) containers was studied. Triplicate solutions of 120 mg (1.2 mL) of enoxaparin (as the sodium salt) and 98.8 mL of 0.9% sodium chloride injection were prepared in 250-mL PVC containers and stored at room temperature (20-22 degrees C). Samples were taken immediately after preparation and at 0.25, 0.5, 0.75, 1, 4, 12, 16, 24, and 48 hours. Inspections for color change and precipitation were performed with a clarity inspection station and a magnifying glass. Samples of the three admixtures were evaluated in duplicate for pharmacologic activity by an automated coagulation heparin assay. Throughout the 48-hour study period, the enoxaparin admixtures were free of color change, evolution of gas, and precipitates. The pharmacologic activity of enoxaparin in the PVC containers remained > 94% of the initial measured activity for 48 hours. Enoxaparin 1.2 mg/mL (as the sodium salt) in 0.9% sodium chloride injection in PVC containers was stable for up to 48 hours at 20-22 degrees C.

Specific absorption rate levels measured in a phantom head exposed to radio frequency transmissions from analog hand-held mobile phones.

Electric fields (E-fields) induced within a phantom head from exposure to three different advanced mobile phone system (AMPS) hand-held telephones were measured using an implantable E-field probe. Measurements were taken in the eye nearest the phone and along a lateral scan through the brain from its centre to the side nearest the phone. During measurement, the phones were positioned alongside the phantom head as in typical use and were configured to transmit at maximum power (600 mW nominal). The specific absorption rate (SAR) was calculated from the in situ E-field measurements, which varied significantly between phone models and antenna configuration. The SARs induced in the eye ranged from 0.007 to 0.21 W/kg. Metal-framed spectacles enhanced SAR levels in the eye by 9-29%. In the brain, maximum levels were recorded at the measurement point closest to the phone and ranged from 0.12 to 0.83 W/kg. These SARs are below peak spatial limits recommended in the U.S. and Australian national standards [IEEE Standards Coordinating Committee 28 (1991): C95.1-1991 and Standards Australia (1990): AS2772.1-1990] and the IRPA guidelines for safe exposure to radio frequency (RF) electromagnetic fields [IRPA (1988): Health Phys 54:115-123]. Furthermore, a detailed thermal analysis of the eye indicated only a 0.022 degrees C maximum steady-state temperature rise in the eye from a uniform SAR loading of 0.21 W/kg. A more approximate thermal analysis in the brain also indicated only a small maximum temperature rise of 0.034 degrees C for a local SAR loading of 0.83 W/kg.

Mobile telephones interfere with medical electrical equipment.

Electromagnetic interference in medical electrical equipment has not been a serious problem in recent years even with the proliferation of analogue mobile phones and two-way handheld radios. With the introduction of GSM digital mobile phones into Australia we have conducted measurements and found that, within 2m, the electric fields from digital mobile phones can exceed the immunity level of 7 V/m recommended by the US Food and Drug Administration (FDA) for medical electrical equipment. Current analogue mobile phones were shown to produce electric fields that exceed the 7 V/m level only at relatively shorter distances. In another test, both analogue and digital mobile phones were operated close to a range of typical medical electrical equipment. It was found that existing equipment generally meets the FDA standard, but digital mobile phones caused a variety of artefacts and alarm conditions. This problem must be addressed by the medical engineering profession; in the meantime, nursing and other staff should be educated to recognise these problems and restrictions must be placed upon the use of mobile phones in hospitals.

Abdominal vagotomy decreases the satiating potency of CCK-8 in sham and real feeding.

To compare the effect of total abdominal vagotomy on the satiating potency of cholecystokinin COOH-terminal octapeptide (CCK-8) in sham feeding and real feeding, we administered CCK-8 intraperitoneally (2, 4, and 8 micrograms/kg) 1 min before a sham feeding or real feeding intake test. CCK-8 was at least as potent for inhibiting intake during sham feeding as it was during real feeding. Total abdominal vagotomy decreased the satiating potency of all three doses of CCK-8 equally in both feeding conditions. These results are consistent with the proposal that abdominal vagal afferent fibers are as necessary for the mediation of the satiating effect of CCK-8 in sham feeding as they are in real feeding.

Estimates of absorption of radiofrequency radiation by the embryo and fetus during pregnancy.

This paper reports that the specific absorption rate induced in the embryo or fetus can exceed that recommended for the general public when the mother is exposed to radiofrequency radiation at the occupational limits. This result applies to two-tiered radiofrequency radiation standards where a factor of 5 differentiates occupational and nonoccupational exposure limits. Using simple axisymmetric geometries for the pregnant worker, and assuming plane wave exposures, a finite element method provides estimates of prenatal exposure. Various layered shapes are used to model skin, fat, uterus, blood, embryonic, and fetal tissues. Applying current exposure limits given by IRPA, ANSI, and SAA, the results indicate that overexposures to the embryo or fetus can occur from early pregnancy at 80-100 MHz, and in late pregnancy across the range 300-1500 MHz.

Implanted medical devices in workers exposed to radio-frequency radiation.

This paper discusses the management of radio-frequency radiation workers who have implanted medical devices which may be adversely affected by such radiation fields. The implants include orthopedic devices, cardiac pacemakers, and cochlear implants, but exclude dental work. The effect of radio-frequency radiation on the devices may be to increase heat load and/or produce signal interference. The mechanics of interaction are outlined and protocols for managing cases are described. The implications for safety standards are discussed.

Microwave cataract and litigation: a case study.

This paper gives details of a recent court case conducted in Australia concerning a compensation claim made by a radar technician for subcapsular posterior cataracts allegedly caused by exposure to microwave radiation. A discussion of some relevant material, including the likely invalidation of certain in vivo ocular exposures due to the use of a metallic cannula and the relevance of in vitro exposures of rat lenses, are presented. The key findings of the court are also summarized. The ruling of the court was that it was probable that the level of microwave exposure did not cause, or accelerate the development of, the cataracts or contribute to doing so. Consequently, the claim was dismissed.