Development of the Woman Abuse Screening Tool for use in family practice.

BACKGROUND: This study developed a screening tool for use by family physicians to identify and assess women patients experiencing emotional and/or physical abuse by their partner. METHODS: An initial set of eight questions developed for the Woman Abuse Screening Tool (WAST) was completed by both abused and non-abused women. Participants were also asked to indicate their comfort in answering the questions in both research and family practice contexts. They also completed the Abuse Risk Inventory and a demographic questionnaire. Analysis of the WAST included 1) standard assessment of the validity and reliability of the measure and 2) examination of the efficacy of further reducing the number of questions on the WAST for screening purposes. RESULTS: The final samples of abused (n = 24) and non-abused women (n = 24) differed significantly on a number of demographic and abuse variables. After eliminating one of the original items, a strong single factor structure was identified for the WAST that accounted for 85% of the total variance in responses to the WAST items. The WAST was found to be a highly reliable measure; coefficient alpha was estimated at.95. The scale also demonstrated construct and discriminant validity. The abused women reported being less comfortable responding to the WAST questions, in both the research and family practice contexts, than the non-abused women. The two WAST questions the abused women reported being most comfortable with were used to construct the WAST-Short for initial screening purposes. The WAST-Short correctly classified 100% of the non-abused women and 91.7% of the abused women. CONCLUSIONS: The WAST demonstrated good reliability and validity and discriminated between abused and non-abused women. Development of the WAST-Short provides physicians with a relatively unobtrusive screening tool for assessing abuse. The use of additional WAST questions can be used to further explore the possibility that a woman patient is experiencing abuse by her partner. Further study includes field testing the WAST in the family practice setting.

Identifying and treating wife abuse.

BACKGROUND: Wife abuse, acknowledged as a critical problem in our society, is often undetected by family physicians. The purpose of this study was to identify the problems and potential solutions encountered by family physicians in the identification and treatment of wife abuse in London, Ontario. METHODS: Family physicians in London were recruited to participate in four focus groups. The groups' discussions were audiotaped and transcribed. The transcripts were analyzed using qualitative methodology to determine relevant themes. RESULTS: Thirty-two physicians (16 male and 16 female) participated in the focus groups. The majority were in group practice (81%). The average number of years in practice was 11.75. An analysis of the focus group session identified two major clinical themes with subcategories: (1) physician issues (ie, identification, treatment); and (2) patient issues (ie, barriers to identification, symptom presentation). CONCLUSIONS: The focus groups served as an effective method to engage family physicians in isolating their own as well as their patients' difficulties in confronting this serious problem.

Application of the Woman Abuse Screening Tool (WAST) and WAST-short in the family practice setting.

BACKGROUND: Our study objectives were to assess the validity and reliability of the Woman Abuse Screening Tool (WAST) in the general population within the family practice setting; to determine the comfort levels of family physicians administering the WAST, their perceptions of its ability to help them identify abused women, and their willingness to continue using it in practice; and to determine the self-reported comfort of patients being asked the WAST questions by their family physicians. METHODS: We included a stratified random sample of 20 physicians practicing in both urban and rural settings drawn from 400 family physicians in London, Ontario, Canada, and the surrounding area. These physicians administered the WAST to 10 to 15 eligible and consenting patients during the course of regular care. Following the physician-patient encounter, patients were asked to complete both a measure about their comfort in being asked each of the WAST questions and the Abuse Risk Inventory (ARI). RESULTS: Scores on the WAST correlated well with those on the ARI. The reliability of the WAST among this sample was demonstrated by a coefficient alpha of 0.75. With the WAST-Short (the first 2 questions of the WAST), 26 of the 307 patients screened (8.5%) were identified as experiencing abuse. The physicians were comfortable administering the WAST to their women patients, and 91% of the patients reported being comfortable or very comfortable when asked the WAST questions by their family physician. CONCLUSIONS: The WAST was found to be a reliable and valid measure of abuse in the family practice setting, with both patients and family physicians reporting comfort with it being part of the clinical encounter.

Diagnosing wife assault.

With the prevalence of wife assault quite high, family doctors will see battered women and their families in the office. However, the identification of the problem is often missed due to women's reluctance to explain their problem and physicians' hesitancy in exploring the possibility and lack of awareness of the prevalence of abuse. The importance of the family doctor's role in identifying the problem and referring the family to appropriate community resources is discussed. Possible explanations for the physician's difficulty in making the diagnosis are considered.

Clumsy children. Primer on developmental coordination disorder.

The common assumption that children "grow out of" clumsiness is not supported by studies carried out over the last 15 years. About 6% of children lack the motor coordination to perform age-appropriate tasks. Greater awareness of this developmental coordination disorder will improve the rate of identification. Family physicians should incorporate questions about motor skills into their assessments of preschool children.

Requirement of acetyl-coenzyme A carboxylase kinase for coenzyme A.

Phosphorylation and inactivation of acetyl-coenzyme A (CoA) carboxylase by acetyl-CoA carboxylase kinase in the presence of ATP and Mg2+ requires coenzyme A. Coenzyme A did not enhance the phosphorylation of alternative substrates of the carboxylase kinase such as protamine or histones. Analogs of coenzyme A were also effective in stimulating the inactivation of carboxylase. The KA of CoA for stimulated carboxylase inactivation was 25 microM. The presence of coenzyme A did not alter the Km of the carboxylase kinase for its substrates, ATP and acetyl-CoA carboxylase. Fluorescence binding studies showed that CoA binds to carboxylase but not to the kinase. The KD of CoA binding to carboxylase is 27 microM. These results indicate that coenzyme A, acting on acetyl-CoA carboxylase, may play an important role in the regulation of the covalent modification mechanism for acetyl-CoA carboxylase.

Phosphorylation and activation of acetyl-coenzyme A Carboxylase kinase by the catalytic subunit of cyclic AMP-dependent protein kinase.

The catalytic subunit of cyclic AMP-dependent protein kinase stimulates the inactivation of acetyl-coenzyme A (CoA) carboxylase by acetyl-CoA carboxylase kinase. The stimulated inactivation of carboxylase is due to activation of carboxylase kinase by the catalytic subunit. Activation of carboxylase kinase activity is accompanied by the incorporation of 0.6 mol of phosphate per mole of carboxylase kinase. Addition of the regulatory subunit of cyclic AMP-dependent protein kinase prevents the activation of carboxylase kinase. Phosphorylation and activation of carboxylase kinase has no effect on the Km for ATP, but decreases the Km for acetyl-CoA carboxylase from 93 to 45 nM. Inactivation of carboxylase by the carboxylase kinase requires the presence of coenzyme A even when the activated carboxylase kinase is used. Acetyl-CoA carboxylase is not phosphorylated or inactivated by the catalytic subunit of cyclic AMP-dependent protein kinase.

Purification and properties of a kinase which phosphorylates and inactivates acetyl-CoA carboxylase.

A protein kinase which phosphorylates and inactivates acetyl-CoA carboxylase has been purified to apparent homogeneity from rat liver. The kinase was found to exist in two forms: bound to carboxylase in a complex or in a free form that is in different stages of aggregation over a wide range of molecular weights. The purification of the kinase involved first partial purification of acetyl-CoA carboxylase through polyethylene glycol precipitation and DEAE-cellulose chromatography. The kinase was then separated from acetyl-CoA carboxylase by Sepharose 2B chromatography. The molecular weight of the kinase subunit was 170,000 as determined by sodium dodecyl sulfate-gel electrophoresis. The incorporation of 1 mol of phosphate/mole of carboxylase subunit caused complete inactivation of the carboxylase. Acetyl-CoA carboxylase, inactivated by the kinase, can be dephosphorylated and reactivated when incubated with phosphorylase phosphatase. The Km values of the kinase for acetyl-CoA carboxylase and ATP are 90 nM and 20 microM, respectively. The kinase was found to be cyclic AMP-independent, but activated by CoA. The protein kinase can phosphorylate acetyl-CoA carboxylase, protamine, and histones, but could not act on hydroxymethylglutaryl-CoA reductase or phosphorylase b.

Sense and sensitivity: developing a gender issues perspective in medical education.

As part of a larger project focused on integrating women's health issues and gender issues into undergraduate medical education in Canada, the question of what is actually meant by a "gender issues perspective" in medical education was explored. Clinical experience, discussions with colleagues, and exposure to a variety of medical education resources reinforced the complexity of the subject and demonstrated the difficulty in making amorphous ideas concrete. Eight dimensions encompass the key concepts underlying a gender issues perspective. Practical applications highlight the usefulness of these suggested dimensions in making sense of and bringing sensitivity to this complex subject.

Medical faculty's views and experiences of parental leave: a collaborative study by the Gender Issues Committee, Council of Ontario Faculties of Medicine.

OBJECTIVES: To examine medical faculty's actual and ideal parental leave arrangements with the aim of informing policy decisions. Leave lengths, effect on career, financial arrangements, and availability of temporary replacements were explored. METHODS: All medical faculty (6387) in Ontario, Canada were surveyed by mail and asked about parental leave experiences since 1990. Responses of men and women were compared as were those of leave takers and the entire group. RESULTS: Thirty-two percent (n = 996) of the 3107 respondents were women and 68% (n = 2067) were men. Ninety-eight percent (n = 317) of new mothers had taken maternity leave, while only 21% (n = 159) of new fathers had. Both paid and unpaid leave was generally shorter than that allowed by law or identified as ideal. Parental leave had a somewhat negative effect on the careers of all faculty. Women were more worried than men about the effect of their absence on colleagues' work and more generous with ideal leave length and funding. Temporary replacement of leave takers was central to an effective leave policy. CONCLUSIONS: Institutional and academic culture may cause new parents to take suboptimal leave despite legislation allowing more. A change in the work environment is required for medicine to offer its teachers what it teaches--that infants benefit from nurturing, nursing, and stability early in life.

Survey of parental-leave policies and experiences in Ontario academic departments of psychiatry.

OBJECTIVE: To analyze psychiatrists' self-reports on a survey of faculty parental leaves conducted in 5 Ontario faculties of medicine. METHOD: A self-report questionnaire was mailed to all Ontario academic medical faculty members requesting information on demographics, parenting status, knowledge of parental-leave policies, personal and collegial experience of recent parental leave, and opinions about ideal parental-leave policies. RESULTS: The survey yielded a 48.6% response rate (3104 respondents). Of the respondents, 318 (10.2%) were academic psychiatrists and 113 (35.5%) of them had or adopted children since 1990. Of the 113 recent parents, 59 (53.2%) did not know their official university parental-leave policy. Fifty-one (48.1%) psychiatrists had recently taken parental leave (30 female, 21 male). Of these, females (26, 86.7%) were more likely than males (0%) to take more than 8 weeks' leave (P = 0.001). The income paid during parental leave was highly variable. Although 192 (64.4%) psychiatrists recommended that temporary replacements be hired and 175 (59.1%) recommended that the replacements be paid from a common faculty risk pool, replacements were hired for only 7 (13.7%) recent leaves. This replacement rate for psychiatry parental leaves was the second lowest of 8 medical specialties. Several leave takers felt that the leave negatively affected their research (32, 32.7%), administration (24, 23.3%), overall career course (23, 21.5%), colleagues' workload (27, 26.2), clinical work (19, 18.3%), teaching (18, 17.3%) and colleagues' attitudes toward them (11, 10.4%). Although 220 (71.5%) academic psychiatrists recommended paid leave to the primary caregiver for 16 or more weeks, 88 (28.6%) recommended less than the 17-week national standard. For secondary caregivers, 202 (66.0%) academic psychiatrists recommended a paid leave of 1-8 weeks, but 63 (20.6%) recommended paid leave for less than 1 week. One hundred and fifty-four psychiatrists (53.1%) recommended that parental-leave income be composed of usual income excluding clinical earnings, a less generous recommendation than that suggested by academic physicians in family medicine, pediatrics, internal medicine, and surgery. CONCLUSIONS: The lack of knowledge of parental-leave policies and the variability in income and duration of parental leaves among Ontario academic psychiatrists call for the development, transmission, and implementation of equitable policies. Common faculty risk pools should be established to pay temporary replacements for parental leaves to facilitate the hiring of replacements and to avoid overburdening remaining colleagues. Strategies to allow new parents to continue their career development, especially in research, need further attention. There are clear discrepancies between what psychiatrists believe to be the vital role of early parenting in child development and what they recommend and provide with regard to parental leave for their colleagues. These discrepancies become more evident when compared with the more generous policies and practices in several other medical specialties.

Regulation of rat liver acetyl-CoA carboxylase. Stimulation of phosphorylation and subsequent inactivation of liver acetyl-CoA carboxylase by cyclic 3':5'-monophosphate and effect on the structure of the enzyme.

The effects of citrate and cyclic AMP on the rate and degree of phosphorylation and inactivation of rat liver acetyl-CoA carboxylase were examined. High citrate concentrations (10 to 20 mM), which are generally used to stabilize and activate the enzyme, inhibit phosphorylation and inactivation of carboxylase. At lower concentrations of citrate, the rate and degree of phosphorylation are increased. Furthermore, phosphorylation and enzyme inactivation are affected by cyclic AMP under these conditions. At high citrate concentrations, cyclic AMP has little or no effect on inactivation and phosphorylation of acetyl-CoA carboxylase. Phosphorlation and inactivation of carboxylase is accompanied by depolymerization of the polymeric form of the enzyme into intermediate and protomeric forms. Depolymerization of carboxylase requires the transfer of the gamma-phosphate group from ATP to carboxylase. Inactivation occurs in the absence of CO2, which indicates that phosphorylation of the enzyme is the cause of inactivation and depolymerization, i.e. carboxylation of the enzyme is not responsible for inactivation of the enzyme.

Gonorrhea in homosexual men.

Extragenital gonorrhea was seen in 65% of 54 cases of gonorrhea in 43 homosexual men attending a venereal diseases clinic between 1974 and 1977; in 21 cases the infection was extragenital only. This type of gonorrhea was often asymptomatic and was associated with a high rate of failure of initial treatment in 6 of the 50 cases in which the patient returned for follow-up assessment, and in 5 of the 6 the persistent infection was extragenital. Syphillis was seen concomitantly or had previously occurred in 6 of the 54 cases. Fifteen of 28 cases of primary, secondary or early latent syphilis seen in men during the same study period had occurred in homosexuals. Appropriate testing for extragenital gonorrhea and for syphilis is important in homosexual men who present for examination, and homosexuality with the possibility of extragenital gonorrhea should be considered in a man with syphilis of recent onset.

[Screening for violence against women. Validation and feasibility studies of a French screening tool]. / Dépistage de la violence faite aux femmes. Epreuves de validation et de fiabilité d'un instrument de mesure français.

OBJECTIVE: To replicate, in a Francophone community, our prior work determining the reliability and validity of the full Woman Abuse Screening Tool (WAST) and a two-item version (WAST-Short). DESIGN: Questionnaires completed by abused and nonabused women. SETTING: Two women's shelters in Francophone communities in Ontario and Quebec and participants' homes or workplaces. PARTICIPANTS: A convenience sample of 25 abused women currently residing in two women's shelters and a convenience sample of 21 women who reported they were not abused. MAIN OUTCOME MEASURES: Women's responses to French versions of the WAST, the Abuse Risk Inventory (ARI), and comfort in answering the questions were compared. Also, the reliability and validity of French versions of WAST and WAST-Short were assessed. RESULTS: Abused (n = 23) and not abused (n = 21) women were demographically similar. A strong single-factor structure that accounted for 81% of total variance in the French WAST items was identified. The French WAST was found to be highly reliable with a coefficient alpha of .95 and demonstrated construct and discriminant validity. The WAST-Short correctly classified all the nonabused women and 78.7% of the abused women. The abused women reported feeling less comfortable responding to the WAST questions than the nonabused women. CONCLUSION: The French version of the WAST demonstrated good reliability and validity and discriminated between known samples of abused and nonabused women. Even though the French WAST-Short did not perform as well as the English version, results of this study support further evaluation of the WAST for screening women in Francophone or bilingual family practice settings.

Persistence of antibody and response to booster dose of Haemophilus influenzae type b polysaccharide diphtheria toxoid conjugate vaccine in infants immunized at 9 to 15 months of age.

At approximately 2 years of age, 27 infants previously immunized at 9 to 15 months of age with two doses of polyribosylribitol phosphate-diphtheria toxoid conjugate vaccine (PRP-D) and 23 infants immunized with polyribosylribitol phosphate (PRP) vaccine were given a single injection of PRP-D. Pre- and post-immunization sera were obtained. No serious local or systemic reactions were observed. The PRP-D recipients had a geometric mean anti-PRP antibody level of 4.8 micrograms/ml 1 month after the second primary injection, retained 1.2 microgram/ml 1 year later, and had a level of 71 micrograms/ml after the booster immunization. In contrast, PRP recipients had a geometric mean level of 0.083 microgram/ml 1 month after the second primary injection, retained 0.042 microgram/ml 1 year later, and after a single dose of PRP-D at approximately 2 years of age had a geometric mean level of 8.6 micrograms/ml. The significantly higher antibody response in the prior PRP-D recipients suggests the recall of immunologic memory induced by the PRP-D vaccine.