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Child Abuse & Neglect Jul 2024Several studies have explored the mechanisms of intergenerational transmission of child maltreatment (ITCM), which also involves care-experienced parents; however, what...
BACKGROUND
Several studies have explored the mechanisms of intergenerational transmission of child maltreatment (ITCM), which also involves care-experienced parents; however, what is less explored is their direct experience, especially regarding resilience processes.
OBJECTIVE
Developing the theoretical framework of ITCM through an exploration of the perspectives of those who appear to have interrupted it.
PARTICIPANTS AND SETTING
A sample of 27 Italian parents - with experience in foster and/or residential care - who have broken the ITCM, completed an in-depth interview between May 2021 and February 2023.
METHODS
A Constructivist Grounded Theory (Charmaz, 2014) approach was adopted in carrying out the interviews, which focused on daily experiences of parenting (Morgan, 2011) and on factors perceived as supporting ITCM interruption. Data were analyzed using open, focused and theoretical coding; the analysis itself was discussed with a consultive board of care-experienced parents.
RESULTS
The study highlighted important aspects that, from parents' perspectives, play a role in breaking ITCM: for instance, how their parenting experience is a challenging process of constructing what they term 'zero family'. Furthermore, starting a family from scratch requires coming to terms with the past, re-imagining oneself as a parent, and managing the complexity of everyday life despite such tensions.
CONCLUSIONS
The results throw light on how the transition to parenthood itself is perceived as a significant developmental opportunity for the interruption of ITCM. However, many problems persist, foregrounding the relevance of discussing possible supports to strengthen parenting agency and skills. Such a discussion should therefore be increasingly informed by ecological approaches and parents' perspectives (also on everyday practices and life contexts), thus avoiding the risk of pathologizing responses.
Topics: Humans; Female; Male; Adult; Parents; Child; Italy; Intergenerational Relations; Grounded Theory; Child Abuse; Parenting; Middle Aged; Child, Preschool; Qualitative Research; Adolescent; Foster Home Care
PubMed: 38761718
DOI: 10.1016/j.chiabu.2024.106855 -
BMC Primary Care May 2024The PRICOV-19 study aimed to assess the organization of primary health care (PHC) during the COVID-19 pandemic in 37 European countries and Israel; and its impact on...
BACKGROUND
The PRICOV-19 study aimed to assess the organization of primary health care (PHC) during the COVID-19 pandemic in 37 European countries and Israel; and its impact on different dimensions of quality of care. In this paper, we described measures taken by public PHC centers in Greece. Additionally, we explored potential differences between rural and non-rural settings.
METHODS
The study population consisted of the 287 public PHC centers in Greece. A random sample of 100 PHC centers stratified by Health Region was created. The online questionnaire consisted of 53 items, covering six sections: general information on the PHC center, patient flow, infection prevention, information processing, communication to patients, collaboration, and collegiality.
RESULTS
Seventy-eight PHC centers (78%) - 50 rural and 28 non-rural - responded to the survey. Certain measures were reported by few PHC centers. Specifically, the use of online messages about complaints that can be solved without a visit to the PHC center (21% rural; and 31% non-rural PHC centers), the use of video consultations with patients (12% rural; and 7% non-rural PHC centers), and the use of electronic medical records (EMRs) to systematically identify the list of patients with chronic conditions (5% rural; and 10% non-rural PHC centers) were scarcely reported. Very few PHC centers reported measures to support identifying and reaching out to vulnerable population, including patients that may have experienced domestic violence (8% rural; and 7% non-rural PHC centers), or financial problems (26% rural; and 7% non-rural PHC centers). Providing administrative documents to patients through postal mail (12% rural; and 21% non-rural PHC centers), or regular e-mail (11% rural; and 36% non-rural PHC centers), or through a secured server (8% rural; and 18% non-rural PHC centers) was rarely reported. Finally, providing information in multiple languages through a PHC website (12% rural PHC centers only), or an answering machine (6% rural PHC centers only), or leaflets (3% rural PHC centers only; and for leaflets specifically on COVID-19: 6% rural; and 8% non-rural PHC centers) were lacking in most PHC centers.
CONCLUSION
Our study captured measures implemented by few PHC centers suggesting potential priority areas of future improvement.
Topics: COVID-19; Humans; Greece; Primary Health Care; Universal Health Insurance; Surveys and Questionnaires; Rural Health Services; Pandemics; SARS-CoV-2; Quality of Health Care
PubMed: 38760684
DOI: 10.1186/s12875-024-02392-7 -
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