The accuracy of substituted judgments is associated with multiple clinically apparent patient and surrogate factors. This information can help clinicians identify conditions under which substituted judgments are likely to be accurate or inaccurate and can help target populations for education designed to improve the accuracy of surrogate decision making.

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This study sought to determine the risk of low birth weight from intimate partner abuse. The case-control design was used in a purposively ethnically stratified multisite sample of 1,004 women interviewed during the 72 hours after delivery between 1991 and 1996. Abuse was determined by the Index of Spouse Abuse and a modification of the Abuse Assessment Screen. Separate analyses were conducted for 252 full term and 326 preterm infants. The final multiple logistic regression models were constructed to determine relative risk for low birth weight after controlling for other complications of pregnancy. Physical and nonphysical abuse as determined by the Index of Spouse Abuse were both significant risk factors for low birth weight for the full term infants but not the preterm infants on a bivariate level. However, the risk estimates decreased in significance in the adjusted models. Although today's short delivery stays make it difficult to assess for abuse, it is necessary to screen for domestic violence at delivery, especially for women who may not have obtained prenatal care. The unadjusted significant risk for low birth weight that became nonsignificant when adjusted suggests that other abuse-related maternal health problems (notably low weight gain and poor obstetric history) are confounders (or mediators) that help to explain the relation between abuse and low birth weight in full term infants.

Feeding patterns by mothers and child acceptance of food were measured in a Peruvian village to determine changes on days when children had diarrhea as compared to days of convalescence and health. Morbidity surveillance identified 40 children, aged 4-36 months, with diarrhea. Children were followed using twelve-hour in-home structured observations during two to four days each of diarrhea, convalescence, and health. Using scales of maternal encouragement to eat and child acceptance of food and cumulative logistic regression analyses, maternal encouragement to eat decreased significantly during convalescence compared to diarrheal days (OR: 0.54, 90% CI: 0.35, 0.82) and health compared to diarrhea (OR: 0.65, 90% CI: 0.46, 0.93). In contrast, child acceptance of food increased during health compared to diarrhea (OR: 1.55, 90% CI: 1.02, 2.35). Results illustrate the importance of carefully examining the behavioral aspects of nutritional intake. Decreases in intake during diarrhea are due to anorexia and not withdrawal of food by mothers. In response to reductions in child appetite during illness, mothers are more likely to encourage children to eat, while they tend to become more passive feeders after the diarrhea has stopped. Program efforts should focus on messages to feed children more actively especially after diarrhea episodes, when appetite levels increase.