<?xml version="1.0" encoding="utf-8"?>
<recommendedContent xmlns="http://api.mspoke.com">
    <recommendedItem id="20100101_19_405"
                     title="Difficult Childhood Lingers in the Mind (CME/CE)"
                     score="0.011"
                     href="http://www.medpagetoday.com/Psychiatry/GeneralPsychiatry/tb/18312?impressionId=1265795607627"
                     
      &lt;p&gt;Adversities faced in childhood have effects on mental health far into the future, researchers affirmed.&lt;/p&gt;
&lt;p&gt;Mental illness in adulthood was increasingly likely the more traumas faced in childhood, Ronald C. Kessler, PhD, of Harvard, and colleagues reported in the February issue of the &lt;em&gt;Archives of General Psychiatry&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;Childhood difficulties potentially explained 32.4% of all the psychiatric disorders examined, they said, based on analyses of the National Comorbidity Survey Replication.&lt;/p&gt;
&lt;p&gt;Adversities relating to family dysfunction  --  substance-abusing parents, sexual or physical abuse in the home, neglect, etc.  --  appeared to have the strongest link to onset and persistence of psychiatric disorders, they reported.&lt;/p&gt;
&lt;p&gt;These findings match folk wisdom and decades of research into the negative effects of child maltreatment, commented John McGrath, MD, PhD, of the Queensland Centre for Mental Health Research in Wacol, Australia, and colleagues in an accompanying editorial.&lt;/p&gt;
&lt;p&gt;But the lack of specificity between certain exposures to particular mental health outcomes  --  such as the death of one&apos;s mother leading to depression  --  was notable, the editorialists said.&lt;/p&gt;
&lt;p&gt;&quot;Thus, childhood trauma upsets the orderly psychological and biological cascades of development, leaving the affected individual at increased risk of a wide range of adverse mental health outcomes,&quot; they wrote.&lt;/p&gt;
&lt;p&gt;Rather than continue to rehash the epidemiology, it&apos;s time to focus on prevention and intervention, McGrath&apos;s group emphasized.&lt;/p&gt;
&lt;p&gt;&quot;It is unrealistic to think that we could protect all children from all adversities, but can we identify factors that bolster resilience and focus our efforts on the most vulnerable subgroups?&quot; they asked.&lt;/p&gt;
&lt;p&gt;The researchers examined joint associations of 12 retrospectively reported childhood adversities with lifetime incidence of disorders meeting Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria in the National Comorbidity Survey Replication I, a cross-sectional survey of a nationally-representative sample of adults in 9,282 American households.&lt;/p&gt;
&lt;p&gt;Among the respondents, 53.4% reported at least one childhood adversity, most commonly parental divorce (17.5%), family violence (14.0%), family economic problems (10.6%), and parental mental illness (10.3%).&lt;/p&gt;
&lt;p&gt;These adversities were all individually and significantly linked to first onset of psychiatric disorders with odds ratios of 1.5 to 1.9 for dysfunctional family factors (physical abuse, sexual abuse, neglect, parental mental illness, parental substance abuse, parental criminality, or family violence) and 1.0 to 1.5 for other factors like life-threatening childhood physical illness, extreme poverty, parental divorce, or loss of or separation from parents.&lt;/p&gt;
&lt;p&gt;Despite some apparent but not significantly meaningful variation in type of adversity with type of psychiatric disorder, the researchers said they could rule out that all types were the same for future mental health risk (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.001).&lt;/p&gt;
&lt;p&gt;Problems tended to cluster, though. Among people who faced one adversity in childhood, 51.2% to 95.1% faced others as well, depending on the adversity.&lt;/p&gt;
&lt;p&gt;Risk of mental illness rose with number of issues faced in childhood from an odds ratio of 1.3 for one up to 3.4 for six and 3.2 for seven or more adversities.&lt;/p&gt;
&lt;p&gt;&quot;This subadditive pattern has important implications for intervention because it means that prevention or amelioration of only a single childhood adversity in youths exposed to many childhood adversities is unlikely to have important preventive effects,&quot; the researchers wrote.&lt;/p&gt;
&lt;p&gt;Overall, childhood adversities were projected to account for 44.6% of childhood-onset disorders, 32.0% of adolescent-onset disorders, and 28.6% of adult-onset disorders.&lt;/p&gt;
&lt;p&gt;The researchers also looked at persistence through the second part of the National Comorbidity Survey Replication which went beyond just core diagnostic assessment in 5,692 respondents.&lt;/p&gt;
&lt;p&gt;In a complex multivariate interactive analysis, childhood adversity from dysfunctional family factors appeared significantly linked to persistence in a given year (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.001) whereas the number of factors was not significant.&lt;/p&gt;
&lt;p&gt;These significant factors were parental mental illness, physical abuse, sexual abuse, and neglect, but they carried modest effects individually with odds ratios of 1.2.&lt;/p&gt;
&lt;p&gt;But in one simulation, not being exposed to childhood trauma would only increase the time since the most recent episode of psychiatric illness by 1.6%, suggesting &quot;quite modest&quot; substantive importance in determining persistence.&lt;/p&gt;
&lt;p&gt;&quot;These results indirectly suggest that the public health implications of childhood adversities are greater for primary than for secondary prevention because the associations of childhood adversities with disorder onset are much stronger than the associations with persistence,&quot; Kessler&apos;s group wrote.&lt;/p&gt;
&lt;p&gt;The researchers cautioned that recall bias may have limited their study such that the results could be considered an &quot;upper bound&quot; for the real association and that the study could not prove causality.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The National Comorbidity Survey Replication is supported by a grant from the National Institute of Mental Health with supplemental support from the National Institute on Drug Abuse, the Substance Abuse and Mental Health Services Administration, a grant from the Robert Wood Johnson Foundation, and the John W. Alden Trust.&lt;/p&gt;&lt;p&gt;The analyses were supported by a grant from the NIMH; the John D. and Catherine T. MacArthur Foundation; the Pfizer Foundation; grants from the U.S. Public Health Service; an award from the Fogarty International Center; the Pan American Health Organization; Eli Lilly; Ortho-McNeil Pharmaceutical; GlaxoSmithKline; and Bristol-Myers Squibb.&lt;/p&gt;&lt;p&gt;Kessler reported financial conflicts of interest with GlaxoSmithKline, Kaiser Permanente, Pfizer, sanofi-aventis, Shire Pharmaceuticals, Wyeth-Ayerst, Eli Lilly, Bristol-Myers Squibb, Johnson &amp;amp; Johnson Pharmaceuticals, and Ortho-McNeil Pharmaceutical.&lt;/p&gt;&lt;p&gt;The editorialists reported no conflicts of interest.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_355"
                     title="Obesity Delays Puberty in Boys (CME/CE)"
                     score="0.009"
                     href="http://www.medpagetoday.com/Pediatrics/Obesity/tb/18235?impressionId=1265795607627"
                     
      &lt;p&gt;Unlike overweight girls, who tend to enter puberty early, overweight and obese boys in the U.S. may begin puberty later than thin boys, according to one of the first longitudinal studies of weight and timing of puberty in males.&lt;/p&gt;
&lt;p&gt;At 11.5 years, boys with the highest body mass index (mean BMI z score=1.84) were 165% more likely to be prepubertal than the thinnest boys (95% CI 1.05 to 6.61; &lt;em&gt;P&lt;/em&gt;=0.04), researchers reported online in the Feb. 1 &lt;em&gt;Archives of Pediatrics and Adolescent Medicine&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;&quot;This longitudinal study provides further evidence that higher BMI during early and middle childhood is not associated with earlier pubertal onset in boys, contrary to what is seen in girls,&quot; Joyce M. Lee, MD, MPH, of the University of Michigan, and colleagues wrote.&lt;/p&gt;
&lt;p&gt;&quot;In fact, higher BMI in earlier childhood may be associated with and precede later onset of puberty among a population-based sample of U.S. boys.&quot;&lt;/p&gt;
&lt;p&gt;Rates of obesity among American girls and boys have nearly tripled since the 1960s, prompting concerns about the effect of excess weight on growth and development. Most research has focused on obese girls, who appear to reach puberty earlier than thin girls. A recent cross-sectional study suggested that, unlike their female counterparts, overweight boys may develop later.&lt;/p&gt;
&lt;p&gt;To further explore this relationship, Lee and colleagues analyzed the records of 401 boys from diverse socioeconomic backgrounds in ten regions of the U.S., using data from the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development. The participants were full-term, only children born in 1991.&lt;/p&gt;
&lt;p&gt;The data included height and weight measurements of the children from ages 2 to 12 years and a visual assessment of whether the children had begun puberty, using Tanner genitalia staging, at 9.5, 10.5, and 11.5 years. Boys were defined as prepubertal if they were Tanner stage 1 at 11.5 years old and were otherwise categorized as pubertal.&lt;/p&gt;
&lt;p&gt;Among the participants, 14.4% were overweight (BMI &amp;#8805; 85th and &amp;lt;95th percentiles) and 19.4% were obese (BMI&amp;#8805;95th percentile) at age 11.5. Overall, 49 boys (12.2%) were prepubertal at age 11.5 years by Tanner genitalia staging.&lt;/p&gt;
&lt;p&gt;The authors wrote that their findings have important implications for understanding sex differences in physiological mechanisms of puberty.&lt;/p&gt;
&lt;p&gt;They noted that puberty is regulated by the gonadotropin-releasing hormone axis for both girls and boys, but it&apos;s unclear why such different associations between body fat and the timing of pubertal onset would exist between the sexes.&lt;/p&gt;
&lt;p&gt;&quot;Given the recent childhood obesity epidemic, additional studies are needed to further investigate the epidemiological link between body fat and pubertal initiation and progression in boys as well as the physiological mechanisms responsible,&quot; they concluded.&lt;/p&gt;
&lt;p&gt;The authors were unable to analyze the data based on race, because most of the children in the study were white. They also noted that BMI is a surrogate measure of overall body fat, and that study has found that the relationship between body fat and BMI varies depending on race. They also recommended that future studies use multiple methods of determining whether children have entered puberty.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study was funded by the National Institute of Child Health and Human Development and the American Heart Association.&lt;/p&gt;&lt;p&gt;The authors reported no financial conflicts of interest.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_266"
                     title="Domestic Abuse May Affect Reproductive Freedom (CME/CE)"
                     score="0.003"
                     href="http://www.medpagetoday.com/PrimaryCare/DomesticViolence/tb/18120?impressionId=1265795607627"
                     
      &lt;p&gt;In some abusive relationships, men may use strategies to force women to become pregnant, including sabotaging their birth control, researchers reported.&lt;/p&gt;
&lt;p&gt;In a cross-sectional study of women treated at five family clinics across northern California, about 20% of women said that their partner tried to coerce them into having a child, Elizabeth Miller, MD, of the University of California Davis, and colleagues reported online in the journal &lt;em&gt;Contraception&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;Beyond outright coercion, abusive partners also engaged in birth control sabotage, for example, poking holes in condoms and flushing birth control pills down the toilet.&lt;/p&gt;
&lt;p&gt;&quot;It was stunning to have this many women seeking reproductive health services saying, &apos;this has happened to me,&apos;&quot; Miller said.&lt;/p&gt;
&lt;p&gt;To investigate a possible link between domestic violence and forced pregnancy, the researchers conducted a survey of 1,278 women ages 16 to 29 who sought care at the five family planning clinics in northern California.&lt;/p&gt;
&lt;p&gt;More than half of the women surveyed  --  53%  --  reported physical or sexual partner violence.&lt;/p&gt;
&lt;p&gt;Approximately a third of the women who reported partner violence also reported pregnancy coercion or birth control sabotage.&lt;/p&gt;
&lt;p&gt;Altogether, the effect of both partner violence and reproductive control nearly doubled a woman&apos;s odds of unintended pregnancy (OR 1.99, 95% CI 1.11 to 3.58).&lt;/p&gt;
&lt;p&gt;Both pregnancy coercion and birth control sabotage were separately associated with unintended pregnancy as well (OR 1.83, 95% CI 1.36 to 2.46 and OR 1.58, 95% CI 1.14 to 2.20, respectively).&lt;/p&gt;
&lt;p&gt;&quot;The findings suggest that pregnancy coercion and birth control sabotage may be an aspect of partner violence that, given its relevance to reproductive health, should be identified by providers in clinical settings,&quot; the authors wrote.&lt;/p&gt;
&lt;p&gt;Among the reasons men would want their partners to bear children: &quot;It ranges from things like wanting to leave a legacy, to a straightforward desire for attachment, to having absolute control over her body,&quot; Miller said. &quot;There are all of these elements to it.&quot;&lt;/p&gt;
&lt;p&gt;Aisha Mays, MD, director of the Teen and Young Adult Clinic at San Francisco General Hospital who was not involved in the study, said pregnancy coercion is a growing problem that has been around for &quot;quite some time&quot; but is just now being recognized as a major health issue.&lt;/p&gt;
&lt;p&gt;&quot;It&apos;s about power and control,&quot; Mays said. &quot;It&apos;s another way of saying, &apos;this girl&apos;s taken, this girl&apos;s mine.&apos;&quot;&lt;/p&gt;
&lt;p&gt;Mays said she has seen cases in which a young mother who has a child with another partner will be forced by her new boyfriend to have another baby with him.&lt;/p&gt;
&lt;p&gt;It&apos;s also a way for males to make their partners more dependent on them, according to Amy Bonomi, PhD, MPH, of Ohio State University.&lt;/p&gt;
&lt;p&gt;&quot;Women in abusive relationships are sometimes forced to bear children as a means to keep them dependent on their partner and sometimes as a means to justify additional  --  and sometimes more severe  --  abuse,&quot; Bonomi said.&lt;/p&gt;
&lt;p&gt;Miller said the findings emphasize the need for family planning clinics to provide intervention programs to combat both reproductive control and partner violence.&lt;/p&gt;
&lt;p&gt;Key strategies include advising women about &quot;invisible&quot; forms of birth control such as injectable and intrauterine contraceptives, as well as easy access to emergency contraception.&lt;/p&gt;
&lt;p&gt;&quot;If we can identify that reproductive control is going on,&quot; Miller said, &quot;we can offer the woman methods for birth control that the partner can&apos;t mess with.&quot;&lt;/p&gt;
&lt;p&gt;Mays added that physicians and counselors should talk about women&apos;s empowerment with regard to reproduction during reproductive health visits.&lt;/p&gt;
&lt;p&gt;&quot;It tends to be left out,&quot; Mays said. &quot;We talk about getting the prescription [for birth control] and its side effects. But we really need to have a discussion around whether the girl is feeling ready for sex.&quot;&lt;/p&gt;
&lt;p&gt;The study was limited by its cross-sectional design, which &quot;precludes conclusions concerning temporality regarding associations observed among pregnancy coercion, birth control sabotage, and intimate partner violence with unintended pregnancy.&quot; Miller et al said additional studies are needed to clarify the chronology of reproductive control and partner violence, and how those factors might combine to affect risk for unintended pregnancy.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study was supported by grants from the National Institute of Child Health and Human Development, a UC Davis Health System Research Award, and a Building Interdisciplinary Research Centers in Women&apos;s Health award.&lt;/p&gt;&lt;p&gt;The researchers reported no conflicts of interest.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;&lt;p&gt;&lt;em&gt;This article was developed in collaboration with ABC News. &lt;/em&gt;&lt;img src=&quot;http://www.medpagetoday.com/upload/2009/10/1/14357_1.jpg&quot; mce_src=&quot;http://www.medpagetoday.com/upload/2009/10/1/14357_1.jpg&quot; alt=&quot;&quot;&gt;&lt;/p&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_261"
                     title="Scrubbing Away Germs Can Backfire on Backsides (CME/CE)"
                     score="0.001"
                     href="http://www.medpagetoday.com/Pediatrics/GeneralPediatrics/tb/18121?impressionId=1265795607627"
                     
      Rashes from toilet seats are once again afflicting American children, and the rare condition is often misdiagnosed, which may delay proper treatment.&lt;br&gt;
&lt;br&gt;That&apos;s the conclusion from a report based of five-cases of toilet-seat contact dermatitis investigated by researchers at Johns Hopkins University School of Medicine and reported in the Jan. 25 issue of &lt;em&gt;Pediatrics&lt;/em&gt;.&lt;br&gt;
&lt;br&gt;While toilet-seat dermatitis is commonly thought to result from allergies to wooden seats, the report concludes that another source is plastic toilet seats cleaned with harsh detergents.&lt;/p&gt;
&lt;p&gt;&quot;This case series and previous reports have documented that toilet-seat dermatitis is much more common than previously recognized in the U.S. and around the world,&quot; Bernard A. Cohen, MD, and colleagues wrote.&lt;/p&gt;
&lt;p&gt;&quot;Furthermore, the incidence of this condition is rising in North America because of a resurgent popularity of exotic-wood toilet seats and frequent use of detergents that contain highly irritant/sensitizing compounds such as quaternary ammonium compounds, phenol, formaldehyde, etc. in public restrooms.&quot;&lt;/p&gt;
&lt;p&gt;Of the cases analyzed by the authors, two occurred in the U.S. and the other three occurred in India.&lt;/p&gt;
&lt;p&gt;Both U.S. cases were girls, a 6-year-old who had a rash for over two years before it was correctly diagnosed and a 10-year-old whose rash lasted for a year. In both cases, the rashes seemed to worsen during the school year when the girls were using school restrooms. The younger girl&apos;s dermatitis twice became infected with methicillin-resistant &lt;em&gt;Staphylococcus aureus &lt;/em&gt;and required treatment with antibiotics.&lt;/p&gt;
&lt;p&gt;After doctors determined the rashes were the result of contact with toilet seats and instructed the girls to use toilet-seat covers and apply moisturizers and topical steroids to the affected areas, the eruptions cleared up within a few weeks.&lt;/p&gt;
&lt;p&gt;The cases in India included a 14-month old boy and two girls, 12 and 10.&lt;/p&gt;
&lt;p&gt;The boy and the 12-year-old girl were both initially misdiagnosed with ringworm and unsuccessfully treated with clotrimazole cream. The other girl was unsuccessfully treated with ayurvedic and homeopathic topical medications before doctors diagnosed toilet-seat dermatitis. Two of the children were instructed to use soaps that only exacerbated the problem.&lt;/p&gt;
&lt;p&gt;In all three cases, the rashes cleared up with some combination of topical steroids, using toilet-seat covers, replacing the household toilet seat, and limiting time on the toilet.&lt;/p&gt;
&lt;p&gt;The authors distinguished between two types of toilet-seat dermatitis: allergic contact dermatitis, the better described form of the condition, in which a patient develops allergy to wooden toilet seats, and irritant contact dermatitis, in which the rashes result from contact with harsh detergents used on plastic toilet seats.&lt;/p&gt;
&lt;p&gt;They noted that detergents used in public restrooms and in hospitals are potentially more irritating to the skin than those used at home and that alkaline detergents are more likely to cause skin irritation than acidic detergents, because they perturb the body&apos;s natural acidic environment.&lt;/p&gt;
&lt;p&gt;Toilet-seat dermatitis was first identified as an external skin rash in 1927. Exposure to wooden toilet seats and associated varnish, lacquers, and paints led to sensitization and development of an allergic contact dermatitis.&lt;/p&gt;
&lt;p&gt;The condition nearly disappeared in the U.S. in 1980s and 1990s, after public facilities and homeowners in the U.S. changed from wooden to plastic toilet seats and sanitary seat covers became readily available.&lt;/p&gt;
&lt;p&gt;However, in recent years the number of cases has grown as a result of homeowners installing toilet seats made of exotic woods and the increased use of harsh toilet seat detergents.&lt;/p&gt;
&lt;p&gt;Most reports have focused on adults with rashes, but little previous attention has focused on the condition in children. &quot;In this case series we describe toilet-seat contact dermatitis in children and underscore a typical history and physical findings that we hope will aid clinicians in recognizing this disease,&quot; the authors wrote.&lt;/p&gt;
&lt;p&gt;&quot;It is important to underscore that regular use of toilet-seat covers is the key to success in treatment,&quot; the authors wrote. &quot;Such seat covers can be purchased at any major retailer such as Walmart or online.&lt;/p&gt;
&lt;p&gt;As an alternative, newspaper cutouts could be used to provide barrier protection. Although it is possible to develop an allergy to toilet-seat covers, none have been reported thus far in the literature.&quot;&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The authors reported no sources of funding or financial conflicts of interest.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_236"
                     title="Prenatal Counseling Reduces Domestic Violence (CME/CE)"
                     score="-0"
                     href="http://www.medpagetoday.com/OBGYN/DomesticViolence/tb/18085?impressionId=1265795607627"
                     
      &lt;p&gt;Pregnant African-American women who received counseling to improve their physical and psychological health and safety were less likely to be the victims of domestic violence during pregnancy and postpartum, a new study found.&lt;/p&gt;
&lt;p&gt;Women who received the cognitive and behavioral integrated intervention were less likely to experience recurrent episodes of intimate partner violence victimization (OR 0.48, 95% CI 0.29 to 0.80), according to a report in the Jan. 21 issue of &lt;em&gt;Obstetrics &amp;amp; Gynecology&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;Counseled women who had reported previous minor intimate partner violence were significantly less likely to experience further episodes during pregnancy (OR 0.48, 95% CI 0.26 to 0.86) and after they gave birth (OR 0.56, 95% CI 0.34 to 0.93).&lt;/p&gt;
&lt;p&gt;Furthermore, counseled women were less likely to give birth very preterm (&amp;lt;33 weeks gestation) than mothers who received no counseling (1.5% versus 6.6% respectively; &lt;em&gt;P&lt;/em&gt;=0.03), and the babies of counseled women had a longer mean gestational age at delivery.&lt;/p&gt;
&lt;p&gt;&quot;A relatively brief intervention during pregnancy had discernible effects on intimate partner violence and pregnancy outcomes,&quot; Michele Kiely, DrPH, of Eunice Kennedy Shriver National Institute of Child Health and Human Development, and colleagues wrote.&lt;/p&gt;
&lt;p&gt;&quot;Screening for intimate partner violence as well as other psychosocial and behavioral risks and incorporating similar interventions in prenatal care is strongly recommended.&quot;&lt;/p&gt;
&lt;p&gt;Intimate partner violence is a pattern of assault and coercion that includes the threat or infliction of physical, sexual, or psychological abuse.&lt;/p&gt;
&lt;p&gt;Approximately 4.8 million episodes of intimate partner violence occur every year in the U.S. in women 18 years and older, according to the CDC.&lt;/p&gt;
&lt;p&gt;Victims are at higher risk for a range of psychobehavioral and health problems, including complications during pregnancy and adverse pregnancy outcomes, such as preterm delivery and low birth weight.&lt;/p&gt;
&lt;p&gt;Kiely and colleagues set out to determine whether a cognitive behavioral intervention administered during pregnancy could reduce intimate partner violence and improve birth outcomes in a population of African-American residents of Washington, DC.&lt;/p&gt;
&lt;p&gt;Of the 1,044 women enrolled in the study between July 2001 and October 2003, 521 were randomly assigned to receive the intervention and 523 to receive usual care. At an initial interview, 336 of the women reported intimate partner violence victimization in the past year, evenly divided between the intervention group and usual care.&lt;/p&gt;
&lt;p&gt;The women in the intervention group received individually tailored counseling and information that addressed the problems they reported.&lt;/p&gt;
&lt;p&gt;The counselors provided information about the types of abuse and the cycle of violence and assessed the level of danger to which the women were exposed.&lt;/p&gt;
&lt;p&gt;They discussed preventive options the women might consider, such as filing a protection order, and the development of a safety plan. The women also received a list of community resources and information on the health risks of smoking and how to cope with depression.&lt;/p&gt;
&lt;p&gt;The complete intervention included eight prenatal sessions delivered during routine prenatal care visits, and researchers conducted follow-up interviews over the phone with the women.&lt;/p&gt;
&lt;p&gt;They found that women in the intervention group who had previously experienced severe intimate partner violence showed a significant reduction in episodes after giving birth (OR 0.39, 95% CI 0.18 to 0.82) and that women who experienced physical violence specifically showed significant reductions by their first follow-up prenatal visit (OR 0.49, 95% CI 0.27 to 0.91) and postpartum (OR 0.47, 95% CI 0.27 to 0.82).&lt;/p&gt;
&lt;p&gt;&quot;There is evidence that this intervention for pregnant African-American women reduced intimate partner violence victimization during pregnancy and improved pregnancy outcome,&quot; the authors wrote.&lt;/p&gt;
&lt;p&gt;&quot;If generalizable, our results should encourage healthcare providers and third party payers to go beyond screening for psychosocial and behavioral risks to providing services during prenatal care to address such risks. The potential cost savings associated with reduction of births within the highest risk category may be substantial.&quot;&lt;/p&gt;
&lt;p&gt;The authors cautioned that the study was not designed to test whether the intervention was effective at reducing adverse pregnancy outcomes but rather focused on reducing psychobehavioral risks.&lt;/p&gt;
&lt;p&gt;They also noted that only 59% of the women in the intervention group completed all eight sessions, indicating that as a group they were only modestly committed to participating in the program.&lt;/p&gt;
&lt;p&gt;Further improvements to the intervention strategy could be made to address other issues, such as alcohol and drug use, they wrote. &quot;Had we addressed these, we might have been even more successful,&quot; they concluded.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study was funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development and the National Center on Minority Health and Health Disparities.&lt;/p&gt;&lt;p&gt;The authors reported no financial conflicts of interest.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
</recommendedContent>