Biomechanical properties of shoes and risk of falls in older adults.

OBJECTIVES: To determine the relationships between the biomechanical properties of shoes worn in a cohort of healthy older adults and the risk of falling. DESIGN: Nested case-control study, comparing biomechanical measurements of shoes worn by those who reported a fall with measurements of shoes worn by age- and sex-matched nonfallers engaged in broadly similar activities. SETTING: On-site measurements where falls occurred. PARTICIPANTS: A cohort of 1,371 older adults, of whom 327 reported a fall and 327 served as age- and sex-matched controls. MEASUREMENTS: Shoe measurements related to lateral stability (heel height and width, critical tipping angle), foot position sense (heel-collar height, sole thickness, and sole flexibility), and the shoe/surface interface (foresole material, shoe-to-ground coefficient of friction, sole contact area). RESULTS: Greater heel height was associated with increased risk of a fall (P for trend=.03), whereas greater sole contact area was associated with reduced risk (P for trend=.005). Shoe characteristics related to foot position sense bore little apparent relation to fall risk. Coefficients of friction of 0.5 or greater were observed in 93% of shoes measured, indicating that very few were excessively slippery. CONCLUSION: Certain measurable properties of shoes were found to be significantly related to risk of falls in older adults. Wearing shoes with low heels and large contact area may help older adults reduce the risk of a fall in everyday settings and activities.

Footwear style and risk of falls in older adults.

OBJECTIVES: To determine how the risk of a fall in an older adult varies in relation to style of footwear worn. DESIGN: Nested case-control study. SETTING: Group Health Cooperative, a large health maintenance organization in Washington state. PARTICIPANTS: A total of 1,371 adults aged 65 and older were monitored for falls over a 2-year period; 327 qualifying fall cases were compared with 327 controls matched on age and sex. MEASUREMENTS: Standardized in-person examinations before fall occurrence, interviews about fall risk factors after the fall occurred, and direct examination of footwear were conducted. Questions for controls referred to the last time they engaged in an activity broadly similar to what the case was doing at the time of the fall. RESULTS: Athletic and canvas shoes (sneakers) were the styles of footwear associated with lowest risk of a fall. Going barefoot or in stocking feet was associated with sharply increased risk, even after controlling for measures of health status (adjusted odds ratio=11.2, 95% confidence interval (CI)=2.4-51.8). Relative to athletic/canvas shoes, other footwear was associated with a 1.3-fold increase in the risk of a fall (95% CI=0.9-1.9), varying somewhat by style. CONCLUSION: Contrary to findings from gait-laboratory studies, athletic shoes were associated with relatively low risk of a fall in older adults during everyday activities. Fall risk was markedly increased when participants were not wearing shoes.

Behavioral problems among children whose mothers are abused by an intimate partner.

OBJECTIVES: To determine the association between children's exposure to maternal intimate partner violence (IPV) and behavior problems as measured by the parent report version of the Child Behavior Checklist (CBCL). METHODS: The study population was comprised of 167 2- to 17-year-old children of Seattle women with police-reported or court-reported intimate partner abuse. The CBCL normative population served as the comparison group. Risk of behavior problems was calculated among the exposed children, in the presence and absence of a history of reported child maltreatment, relative to the normative population. Multiple logistic regression served as the primary method of analysis. RESULTS: Children exposed to maternal IPV were more likely to have borderline to clinical level scores on externalizing (i.e., aggressive, delinquent) behavior (RR=1.6, 95% CI: 1.2, 2.1) and total behavioral problems (RR=1.4, 95% CI: 1.1, 1.9) compared to the CBCL normative sample after adjusting for age and sex. Children who were exposed to maternal IPV and were victims of child maltreatment were more likely to receive borderline to clinical level scores on internalizing (i.e., anxious, depressed) behaviors (RR=2.6, 95% CI: 1.5, 3.6), externalizing (i.e., aggressive, delinquent) behaviors (RR=3.0, 95% CI: 1.9, 4.0) and total behavioral problems (RR=2.1, 95% CI: 1.2, 3.2) compared to the CBCL normative sample after adjusting for age and sex. CONCLUSIONS: Exposure to maternal IPV is significantly associated with child behavioral problems both in the presence and absence of co-occurring child maltreatment. Appropriate attention to the mental health of children living in households with IPV is needed.

Resolution of depression among victims of intimate partner violence: is cessation of violence enough?

The objective of this article is to assess the effect of abuse cessation on depressive symptoms among women abused by a male intimate partner. This prospective cohort study of Seattle women with a history of intimate partner violence (IPV) who were classified by history of abuse and abuse status at 3 month, 9 month, and 2 year follow-up interviews. Relative risks (RR) were calculated using generalized estimating equations. Among subjects with a history of psychological abuse only, cessation of abuse was associated with a nonsignificant reduction in the likelihood of depression compared to subjects whose abuse continued (aRR = 0.88; 95%CI: 0.75,1.03). Among subjects with a history of physical/sexual abuse and psychological abuse, cessation of physical/sexual abuse only was associated with a 27% decline, and cessation of both types of abuse was associated with a 35% decline in the likelihood of depression (aRR = 0.73, 95%CI: 0.63,0.86; and aRR = 0.65; 95%CI: 0.55,0.76; respectively). Cessation of abuse among victims of IPV is associated with a decreased prevalence of depression.

Do protection orders affect the likelihood of future partner violence and injury?

BACKGROUND: Approximately 20% of U.S. women who experience intimate partner violence (IPV) annually obtain a civil protection order (CPO). The effect of these orders on future abuse has been estimated in only a few studies, with mixed results. The objective of this study was to assess the effect of a CPO on the risk of future self-reported IPV and injury. METHODS: In this prospective cohort study of 448 adult female Seattle WA residents with IPV between October 1997 and December 1998, interviews were conducted at baseline, 5 months, and 9 months after the index incident. Odds ratios (ORs) estimated risks of contact; unwelcome calls or visits; threats; weapon threats; psychological, sexual, or physical abuse or injury; and abuse-related medical care among women who obtained a CPO after the index incident, compared with those who did not. RESULTS: Women who obtained a CPO following the index IPV incident had significantly decreased risk of contact by the abuser (OR=0.4); weapon threats (OR=0.03); injury (OR=0.3); and abuse-related medical care (OR=0.2) between the first and second follow-up interviews. Stronger decreases in risk were seen among women who had maintained the CPO throughout follow-up, which were significant for contact by the abuser (OR=0.2); weapon threats (OR=0.02); psychological abuse (OR=0.4); sexual abuse (OR=0.2); physical abuse (OR=0.3); injury (OR=0.1); and abuse-related medical care (OR=0.1) between first and second follow-up interviews. CONCLUSIONS: CPOs are associated with decreased likelihood of subsequent physical and nonphysical IPV.

Civil protection orders and risk of subsequent police-reported violence.

CONTEXT: Approximately 1.5 million US women experience intimate partner violence annually. Approximately 20% of these women obtain civil protection orders, but the effectiveness of such orders in preventing future violence is unclear. OBJECTIVE: To assess associations between obtaining a protection order and risk of subsequent police-reported intimate partner violence. DESIGN, SETTING, AND SUBJECTS: Retrospective cohort study of 2691 adult female residents of Seattle, Wash, with an incident of male intimate partner violence reported to the Seattle Police Department between August 1, 1998, and December 31, 1999. MAIN OUTCOME MEASURE: Relative risk (RR) of police-reported physical and psychological abuse in the 12 months following the index incident according to protection order status (temporary protection order, usually in effect for 2 weeks; permanent protection order, usually in effect for 12 months; or no protection order). RESULTS: Overall rates of police-reported physical and psychological abuse in the 12 months of follow-up were 13.5 per 100 person-years and 12.3 per 100 person-years, respectively. After controlling for cohabitation at time of index incident and index incident offense type, women with temporary protection orders in effect were more likely than women without protection orders to be psychologically abused (RR in the first 6 months after the index incident, 4.0; 95% confidence interval [CI], 2.2-7.2; RR in the entire 12 months after the index incident, 4.9; 95% CI, 2.8-8.6), while women with permanent protection orders in effect were less likely than those without orders to be physically abused (RR in the first 6 months, 0.4; 95% CI, 0.1-1.1; RR in the entire 12 months, 0.2; 95% CI, 0.1-0.8). CONCLUSIONS: Permanent, but not temporary, protection orders are associated with a significant decrease in risk of police-reported violence against women by their male intimate partners.

Academic and school health issues among children exposed to maternal intimate partner abuse.

OBJECTIVE: To determine the association between children's exposure to maternal intimate partner violence (IPV) and academic problems and school health concerns. DESIGN: The study population consisted of 153 children aged 5 to 16 years who attended public school and whose mothers experienced police- or court-reported IPV. The comparison group consisted of public school peers of the exposed children. Generalized linear modeling using a binomial distribution and log-link function served as the primary method of analysis. SETTING: Urban public school district. MAIN OUTCOME MEASURES: The occurrence of academic problems and type-specific school nurse visits during the 1-year study period. RESULTS: Children whose mothers experienced IPV were more likely to be suspended from school (relative risk [RR], 1.8; 95% confidence interval [CI], 1.2-1.7) and to have had frequent non-suspension-related absences (RR, 1.6; 95% CI, 1.0-2.3) than comparison children after adjusting for relevant confounders. Intimate partner violence-exposed children were more likely to have a school nurse visit for social or emotional complaints (RR, 2.2; 95% CI, 1.3-3.9), a visit that resulted in being sent home from school (RR, 1.6; 95% CI, 1.1-2.3), or a visit that led to referral to the school speech pathologist (RR, 7.5; 95% CI, 1.9-29.6) relative to comparison schoolchildren after adjusting for relevant confounders. CONCLUSIONS: Children's exposure to maternal IPV is significantly associated with the occurrence of academic problems and school health concerns. Describing the increased risk of the academic and health problems exhibited by IPV-exposed children relative to nonexposed children offers the possibility of improving the likelihood that clinicians will identify the woman who experienced abuse and her children, and promote referral to appropriate resources.