Effectiveness of Restraining Orders on Domestic Violence - Robert A. Wascher, M.D.

Health Briefs

Dr_Robert_Wascher August 2 , 2002

by Robert A. Wascher, M.D., F.A.C.S.

Effectiveness of Restraining Orders on Domestic Violence
Approximately 1.5 million American women experience domestic violence every year, and about 20% of such women will seek restraining orders. The effectiveness of such restraining orders is unclear. In this week’s Journal of the American Medical Association, a study of 2,691 women who had experienced domestic violence was undertaken. The women evaluated in this study were divided into three groups: those who had obtained a temporary restraining order against their abusive partner, those who had obtained a permanent restraining order, and those who did not seek any restraining order. During the 12 months following the initial reported incident of domestic abuse, the women who had subsequently obtained a temporary restraining order were almost 5 times as likely to be abused again as the women who did not seek any type of restraining order. However, the women who obtained permanent restraining orders were, in turn, 80% less likely to be abused again as the women who did not seek any restraining orders. The study’s authors concluded that permanent, but not temporary, restraining orders are associated with a significant reduction in the incidence of repeat domestic violence against women.

Bone Marrow Cells Improve Blood Flow in Vascular Disease
In the current issue of the journal Lancet is an intriguing study that looked at the ability of bone marrow cells to restore blood flow to the legs of people with poor circulation. The authors extracted a sample of bone marrow from each study patient, separated out the different types of cells found in the marrow, and then injected a specific type of bone marrow cell, called mononuclear cells, into the calf muscles of the affected legs. Four weeks after the injections, the researchers found evidence of improved blood flow and tissue oxygenation in those patients who had their calf muscles injected with the bone marrow cells. The ability to walk without experiencing leg pain (due to inadequate blood flow) was also significantly improved following injection of the mononuclear cells. All of these improvements were substantial, and were still present 6 months after the study began.

The authors believe that the bone marrow mononuclear cells are able to act as stem cells for blood vessels in the legs, and that such cells can also secrete proteins that stimulate additional blood vessel growth in oxygen-starved tissues. This is a very exciting study which needs to be replicated with larger numbers of patients. The simplicity and minimal risk of injecting a person’s own bone marrow cells into the muscles of the leg make this approach very compelling when compared to the current surgical approaches to the difficult problem of peripheral vascular disease.

Intestinal Hormone Kills Appetite
A recently discovered hormone that is secreted in the intestines of mice (peptide YY3-36) has been found to play a potentially important role in appetite control. The hormone appears to be released after eating a meal, and is secreted in proportion to the amount of calories contained in each meal. A new study in the journal Nature suggests that this newly discovered hormone may play a key role in generating the sensation of satiety (lack of hunger) that follows a meal in most people. When injected into rats in this study, the hormone significantly reduced food intake and weight gain. Moreover, the researchers found clear evidence that this satiety hormone directly inhibited the brain centers in the hypothalamus that control appetite and feeding behavior. When the hormone was injected into human volunteers, caloric intake decreased by one-third over the following 24 hours.

After the disappointing outcomes in previous studies that looked at the hormone leptin, this new study raises the hope that an effective new treatment for overeating and obesity might be feasible in the foreseeable future. Larger scale studies of the effects, both good and bad, of this intestinal hormone on humans still need to be performed, but this small and very preliminary study is very exciting nonetheless.

Botulinum Toxin & Post-Stroke Spasticity
The muscle paralyzing effect of botulinum toxin has made this substance an unlikely therapeutic drug. Today, it is most commonly used by cosmetic surgeons and dermatologists to temporarily paralyze the facial muscles that accentuate the wrinkles around our eyes and mouth. As reported in the current issue of the New England Journal of Medicine, researchers have used injections of botulinum toxin into the muscles of the wrists and fingers of patients who were left with spastic limbs after suffering a stroke. Spastic tightening of the muscles in the hands and fingers following a stroke often renders such limbs at least partially useless. In this study, botulinum toxin injections significantly improved the subjects’ ability to perform personal hygiene activities and dress themselves. Botulinum injections also reduced the painful tightening of spastic limbs and improved flexibility. This is an intriguing new application of botulinum toxin, and may prove to be of very substantial importance to stroke victims who have been left with painful and useless spastic limbs. While the improvement in function was modest overall, and while stroke-induced paralysis is not helped by botulinum injections, this study still represents a very important and potentially useful advance in the care of patients who have experienced stroke-related complications.

Dr. Robert A. Wascher

Dr. Robert A. Wascher is a senior research fellow in molecular & surgical oncology at the John Wayne Cancer Institute in Santa Monica, CA