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Health Policy and Planning Jun 2024Domestic violence (DV) is a global prevalent health problem leading to adverse health consequences, yet health systems are often unprepared to address it. This article... (Comparative Study)
Comparative Study
Domestic violence (DV) is a global prevalent health problem leading to adverse health consequences, yet health systems are often unprepared to address it. This article presents a comparative synthesis of the health system's pre-conditions necessary to enable integration of DV in health services in Brazil, Nepal, Sri Lanka and occupied Palestinian Territories (oPT). A cross-country, comparative analysis was conducted using a health systems readiness framework. Data collection involved multiple data sources, including qualitative interviews with various stakeholders; focus-group discussions with women; structured facility observations; and a survey with providers. Our findings highlight deficiencies in policy and practice that need to be addressed for an effective DV response. Common readiness gaps include unclear and limited guidance on DV, unsupportive leadership coupled with limited training and resources. Most providers felt unprepared, lacked guidance and felt unsupported and unprotected by managers and their health system. While in Brazil most providers felt they should respond to DV cases, many in Sri Lanka preferred not to. Such organizational and service delivery challenges, in turn, also affected how health providers responded to DV cases leaving them not confident, uncertain about their knowledge and unsure about their role. Furthermore, providers' personal beliefs and values on DV and gender norms also impacted their motivation and ability to respond, prompting some to become 'activists' while others were reluctant to intervene and prone to blame women. Our synthesis also pointed to a gap in women's use of health services for DV as they had low trust in providers. Our conceptual framework demonstrates the importance of having clear policies and highlights the need to engage leadership across every level of the system to reframe challenges and strengthen routine practices. Future research should also determine the ways in which women's understanding and needs related to DV help-seeking are addressed.
Topics: Humans; Female; Nepal; Domestic Violence; Sri Lanka; Focus Groups; Brazil; Health Personnel; Delivery of Health Care; Qualitative Research; Male; Interviews as Topic; Adult; Leadership
PubMed: 38758072
DOI: 10.1093/heapol/czae032 -
BJPsych Bulletin May 2024This cross-sectional study, carried out from 2021 to 2022, investigated the factors associated with domestic violence in 400 Brazilian pregnant women during the COVID-19...
AIMS AND METHOD
This cross-sectional study, carried out from 2021 to 2022, investigated the factors associated with domestic violence in 400 Brazilian pregnant women during the COVID-19 pandemic. Violence was assessed with the World Health Organization's Violence Against Women questionnaire and the Abuse Assessment Screen. Demographic, socioeconomic, obstetric, lifestyle and mental health data were collected.
RESULTS
Violence at any time in their lives was reported by 52.2% of the women, and psychological violence was the most prevalent type (19.5%). Violence was associated with being single and mental health changes. Pregnant women exposed to any lifetime violence and psychological violence were, respectively, 4.67 and 5.93 times more likely to show mental health changes compared with women with no reported violence.
CLINICAL IMPLICATIONS
Training health professionals involved in prenatal care in the early detection of single women and women with mental health changes could be important in preventing domestic violence.
PubMed: 38757198
DOI: 10.1192/bjb.2024.43 -
Health Affairs Scholar Apr 2024In May 2023, the White House released the National Plan to End Gender-Based Violence, which includes intimate partner or domestic violence (DV). Based on 20 years of...
In May 2023, the White House released the National Plan to End Gender-Based Violence, which includes intimate partner or domestic violence (DV). Based on 20 years of experience in California, this commentary provides detailed examples of 2 DV prevention strategies: interrupting intergenerational transmission and addressing macrolevel drivers. Family-strengthening approaches to prevention and justice and increasing economic security are key. Insight into regional policies and programs can inform implementation of the national plan and DV prevention in other states and localities.
PubMed: 38756178
DOI: 10.1093/haschl/qxae034 -
PloS One 2024Parents are an obvious, but underutilized player in the prevention of child sexual abuse (CSA). A handful of universal parent-focused prevention programs have emerged,...
Parents are an obvious, but underutilized player in the prevention of child sexual abuse (CSA). A handful of universal parent-focused prevention programs have emerged, however, the evidence for these programs is mixed and the programs suffer ubiquitously from barriers to implementation (e.g., poor engagement, low participation) thereby limiting public health impact. To combat these barriers and improve evidence, researchers previously developed and tested a selective parent-focused CSA prevention program. While promising, the selective approach still leaves a gap in the prevention landscape-parents from the universal audience. However, there appear to be no standardized methods to inform this type of adaptation-interventions designed as universal or selective have primarily been delivered as such. This study sought to adapt the selective curriculum for a universal audience and examined the acceptability and feasibility of the program for evaluation in a future trial. Using mixed methods, N = 31 parents (i.e., primary caregiver for a child under 13) completed pre- and post-workshop surveys followed by a brief individual interview conducted via Zoom. Interviews, coded using content analysis methods, focused on three themes: parents as agents of prevention (e.g., prior action, confidence), curriculum (e.g., content, design), and engagement (e.g., future marketing and promotion). Overall participants' mean score on CSA-related awareness and intention to use protective behavioral strategies increased. The participants found the curriculum highly acceptable noting strengths in the content and design. All told, the results of this pilot study suggest the acceptability and feasibility of examining the efficacy of the universal parent-focused curriculum in a larger trial. Procedural challenges, such as bots in recruitment, identify areas of caution in design of the larger trial and a roadmap for others seeking to adapt selective programs for universal audiences.
Topics: Humans; Pilot Projects; Child Abuse, Sexual; Female; Male; Child; Parents; Adult; Curriculum; Middle Aged; Surveys and Questionnaires
PubMed: 38753647
DOI: 10.1371/journal.pone.0302982 -
European Journal of Midwifery 2024Many elements of life can affect sexual health; thus, healthcare professionals require good knowledge of sexual medicine to encounter patients with these issues. We...
INTRODUCTION
Many elements of life can affect sexual health; thus, healthcare professionals require good knowledge of sexual medicine to encounter patients with these issues. We aimed to study final-year medical and midwifery students' self-reported knowledge of factors associated with sexuality and their knowledge of how to evaluate and treat/counsel patients with sexual problems. In addition, educational interests regarding sexual medicine were assessed.
METHODS
In a cross-sectional study, a web-based questionnaire was distributed to final-year medical (n=233) and midwifery (n=131) students graduating between December 2018 and May 2019 in Finland.
RESULTS
Both student groups self-reported insufficient knowledge of how to consider sexuality in mentally ill patients, how to encounter victims of domestic violence/sexual abuse, and how multiculturalism affects sexuality. In addition, compared to the midwifery students, the medical students were more likely to self-report insufficient knowledge of the basics of sexual pleasure and treating the lack of it (p<0.001), including how to treat sexual problems due to relationship problems (p<0.001) or chronic diseases (p=0.015). Although several educational areas of interest arose, both student groups had two mutual most desirable educational interests: 1) reasons for dyspareunia and its treatment, n=117/233 (50.2%) for medical students, and n=60/131 (45.8%) for midwifery students; and 2) lack of sexual desire and its treatment, n=100/233 (42.9%) for medical students, and n=55/131 (42.0%) for midwifery students.
CONCLUSIONS
In both student groups, the self-reported knowledge of sexual medicine was insufficient. Thus, more education on sexual medicine should be included in the curricula of medical and midwifery education.
PubMed: 38751863
DOI: 10.18332/ejm/186401 -
PloS One 2024Violence against children in schools harms the affected children, limits their learning and educational attainment, and extends its harms to families and the broader...
Violence against children in schools harms the affected children, limits their learning and educational attainment, and extends its harms to families and the broader communities. However, to date, comparable cross-country data on violence against children in schools has not been available. We utilize the Violence Against Children and Youth Surveys (VACS) to estimate school-related violence against children in seven countries (Honduras, Kenya, Malawi, Nigeria, Tanzania, Uganda, and Zambia). Leveraging the unique comparability of the surveys, we are able to estimate both physical and sexual violence experienced in childhood and adolescence among youth aged 13-24. Where possible, we also disaggregate by gender and perpetrator type. Overall, within our sample seven countries, we find that 12.11-44.63% of females and 14.28-53.85% of males experienced at least one form of violence. Males experience higher levels of school-related violence and a significant portion of this is due to experiencing physical violence perpetrated by male classmates.
Topics: Humans; Male; Female; Schools; Adolescent; Cross-Sectional Studies; Prevalence; Young Adult; Violence; Kenya; Uganda; Nigeria; Tanzania; Surveys and Questionnaires; Malawi; Zambia; Child; Child Abuse
PubMed: 38748656
DOI: 10.1371/journal.pone.0301833 -
Research Square Apr 2024In the big data era, integrating diverse data modalities poses significant challenges, particularly in complex fields like healthcare. This paper introduces a new...
In the big data era, integrating diverse data modalities poses significant challenges, particularly in complex fields like healthcare. This paper introduces a new process model for multimodal Data Fusion for Data Mining, integrating embeddings and the Cross-Industry Standard Process for Data Mining with the existing Data Fusion Information Group model. Our model aims to decrease computational costs, complexity, and bias while improving efficiency and reliability. We also propose "disentangled dense fusion," a novel embedding fusion method designed to optimize mutual information and facilitate dense inter-modality feature interaction, thereby minimizing redundant information. We demonstrate the model's efficacy through three use cases: predicting diabetic retinopathy using retinal images and patient metadata, domestic violence prediction employing satellite imagery, internet, and census data, and identifying clinical and demographic features from radiography images and clinical notes. The model achieved a Macro F1 score of 0.92 in diabetic retinopathy prediction, an R-squared of 0.854 and sMAPE of 24.868 in domestic violence prediction, and a macro AUC of 0.92 and 0.99 for disease prediction and sex classification, respectively, in radiological analysis. These results underscore the Data Fusion for Data Mining model's potential to significantly impact multimodal data processing, promoting its adoption in diverse, resource-constrained settings.
PubMed: 38746100
DOI: 10.21203/rs.3.rs-4277992/v1 -
European Journal of Psychotraumatology 2024While several studies documented a positive correlation between childhood maltreatment severity and dissociation severity, it is currently unknown whether specific...
While several studies documented a positive correlation between childhood maltreatment severity and dissociation severity, it is currently unknown whether specific dissociative symptoms cluster together among individuals with childhood trauma histories ranging from none to severe. We aimed to explore symptom constellations across the whole spectrum of dissociative processing from patients with severe dissociative disorders to healthy controls and relate these to maltreatment severity and sociodemographic characteristics. We employed latent profile analysis to explore symptom profiles based on five subscales, measuring absorption, depersonalization, derealization, somatoform and identity alteration, based on the 20 items of the German short version of the Dissociative Experiences Scale-II (20) in a large aggregate sample ( = 3,128) overrepresenting patients with trauma-related disorders. We then related these profiles to maltreatment severity as measured by the five subscales of the Childhood Trauma Questionnaire as well as sociodemographic characteristics. Based on the five FDS subscales, six clusters differentiated by symptom severity, but not symptom constellations, were identified. Somatoform dissociation varied in accordance with the remaining symptom clusters. The cluster with the highest overall symptom severity entailed nearly all subjects diagnosed with Dissociative Identity Disorder and was characterized by extreme levels of childhood maltreatment. Both abuse and neglect were predictive of cluster membership throughout. The higher the severity of dissociative processing in a cluster, the more subjects reported high severity and multiplicity of childhood maltreatment. However, some subjects remain resilient to the development of dissociative processing although they experience extreme childhood maltreatment.
Topics: Humans; Dissociative Disorders; Female; Male; Adult; Surveys and Questionnaires; Adult Survivors of Child Abuse; Middle Aged; Adverse Childhood Experiences; Child Abuse; Germany; Psychiatric Status Rating Scales; Child
PubMed: 38739008
DOI: 10.1080/20008066.2024.2348345 -
Science & Justice : Journal of the... May 2024Child abuse is a serious concern that can cause the death of a child. In such cases the medico-legal evidence is often pivotal but complex, drawing across multiple...
Child abuse is a serious concern that can cause the death of a child. In such cases the medico-legal evidence is often pivotal but complex, drawing across multiple medical disciplines and techniques. One key specialism is histopathology, which is considered the gold standard for estimating the age of individual fractures. Another is micro-CT imaging, which can visualise the location of trauma across the body. This case report demonstrates how micro-CT was used to contextualise the histological evidence in the Criminal Justice Proceedings of a fatal child abuse case. This was achieved by overlaying the aged fracture evidence from histopathology onto the visuals rendered from micro-CT imaging. The case was a suspected child abuse of a deceased 1-month old infant who was reported unresponsive by their parents. The child was taken to hospital where they were pronounced dead. Suspicion was raised and post-mortem imaging confirmed head trauma and rib fractures, and the case was escalated for a forensic investigation. This case report details how the micro-CT imaging was merged with the gold standard of histopathology for visualisation of trauma, and how the court presentation was planned alongside Senior Investigating Officers and various medical experts. The presentation was used in court by the histopathologist to present the evidence. The resulting presentation provided additional clarity to jury members regarding the location, severity, frequency, and timings of the injuries. From the perspective of the investigating police force, the resulting presentation was crucial in ensuring understanding of the medico-legal evidence of how the infant died. The prosecuting lawyer noted that combining the histological and micro-CT evidence in this way allowed the evidence to be presented in a sensitive, clear, and impactful manner.
Topics: Humans; Child Abuse; X-Ray Microtomography; Infant; Rib Fractures; Male; Forensic Pathology
PubMed: 38735666
DOI: 10.1016/j.scijus.2024.04.001 -
Child Abuse & Neglect Jul 2024The darknet hosts an increasing number of hidden services dedicated to the distribution of child sexual abuse material (CSAM). Given that by contributing CSAM to the...
Why do users continue to contribute to darknet Child Sexual Abuse Material forums? Examining social exchange, social capital, and social learning explanations using digital forensic artifacts.
BACKGROUND
The darknet hosts an increasing number of hidden services dedicated to the distribution of child sexual abuse material (CSAM). Given that by contributing CSAM to the forum members subject themselves to criminal prosecution, questions regarding the motivation for members contributing to darknet CSAM forums arise.
OBJECTIVE
Building on insights gained from research into clearnet communities, here we examine the extent to which social incentives generated by the online CSAM community may explain members' posting behavior on darknet CSAM forums.
PARTICIPANTS AND SETTING
We analyze digital forensic artifacts on the online behavior of members of a darknet CSAM forum that was shut down by law enforcement agencies in July 2015.
METHODS
We apply group-based trajectory modelling (GBTM), social network analysis, and mixed-effect survival models.
RESULTS
Applying GBTM three posting trajectories can be distinguished. Social network analyses finds the reply network to be more centralized than predicted by chance. Mixed-effect survival models show positive associations between the length of members' first post and the time since members' first registration on the forum and subsequent posting. Contrarily, the number of replies received appears to mitigate subsequent posting.
CONCLUSIONS
Findings show posting activity on the forum to be concentrated in a minority of forum members who show posting trajectories that are both frequent and persistent. Results further suggest persistence in posting is motivated by social identity and, to a lesser extent, differential association processes.
Topics: Humans; Child Abuse, Sexual; Child; Social Learning; Social Capital; Social Network Analysis; Social Networking; Social Media; Female; Male; Law Enforcement
PubMed: 38735124
DOI: 10.1016/j.chiabu.2024.106815