"Nenhuma Pessoa Idosa Merece Passar por Isso": Compreensão da Violência para Mulheres Gerontes / "Ninguna Persona Adulta Mayor Merece Pasar Por Esto": Comprensión de la Violencia para las Mujeres Adultas Mayores / "No Elderly Person Deserves to Go Through This": Understanding Violence Towards Elderly Women

Resumo Introdução: A violência contra idosos é um fenômeno crescente, ocasionando prejuízos à saúde, com diferentes desfechos e consequências às vítimas. A chance de idosas sofrerem-na no âmbito familiar supera a dos homens, sendo o gênero um fator de risco considerável. Objetivo: Analisar a compreensão da violência contra pessoas idosas segundo mulheres gerontes. Metodologia: Pesquisa descritiva com abordagem qualitativa desenvolvida com 22 idosas de uma comunidade no estado da Paraíba, Brasil, escolhidas por conveniência. Utilizou-se para coleta de dados entrevistas semiestruturadas, processadas pelo software Iramuteq, com posterior Análise de Conteúdo. Resultados: Foram evidenciadas cinco classes: ciclo de violência; rede de apoio ao idoso vítima de violência; Vivência de situações violentas; violência financeira; e simbologia da violência na sociedade, as quais denotam compreensão da violência envolvendo os diferentes tipos. Apoiam-se nos fatores da vivência familiar, cultura e outros, consubstanciando o profissional de saúde como fundamental para o desfecho. O gênero influenciou no que concerne ao olhar lançado sobre a violência física e psicológica, bem como na relevância dada às equipes de saúde para identificação de ocorrências e prevenção de possíveis danos. Conclusão: Os diversos tipos de violência contra a pessoa idosa foram reconhecidos, incluindo fatores individuais, comunitários e sociais no ciclo violento. Além disso, associaram o envelhecimento a maior suscetibilidade para sofrer violência, independente da tipologia. Destaca-se a potencialidade do serviço de saúde na assistência à pessoa idosa vítima de violência, elucidando casos e atuando precocemente para interrupção dos ciclos perpetrados, exigindo a necessidade constante de atualização profissional para lidar com situações detectadas.

Resumen Introducción: La violencia contra las personas adultas mayores es un fenómeno creciente, que causa daños a la salud, con diferentes desenlaces y consecuencias para las víctimas. La posibilidad de que las mujeres adultas mayores la sufran en el ámbito familiar supera la de los hombres, siendo el género un factor de riesgo considerable. Objetivo: Analizar la comprensión de la violencia contra las personas mayores según las mujeres adultas mayores. Metodología: Investigación descriptiva con enfoque cualitativo desarrollada con 22 mujeres adultas mayores de una comunidad en el estado de Paraíba, Brasil, elegidas por conveniencia. Para la recolección de datos, se utilizaron entrevistas semiestructuradas, procesadas por el software Iramuteq, con posterior análisis de contenido. Resultados: Se evidenciaron cinco tipos de violencia: ciclo de la violencia, red de apoyo población adulta mayor víctima de violencia, experimentar situaciones violentas, violencia financiera y simbología de la violencia en la sociedad, que denotan la comprensión de la violencia de diferentes tipos. Estas ideas están respaldadas en los factores de la experiencia familiar, la cultura y otros, donde la persona profesional de la salud se identifica como fundamental para el cuidado y apoyo. El género influyó en la mirada lanzada sobre la violencia física y psicológica, así como en la relevancia dada a los equipos de salud para la identificación de sucesos y la prevención de posibles daños. Conclusión: Se han reconocido los diversos tipos de violencia contra las personas mayores, incluidos los factores individuales, comunitarios y sociales en el ciclo de violencia. Además, asociaron el envejecimiento con una mayor susceptibilidad a sufrir violencia, independientemente de la tipología. Destaca la potencialidad del servicio de salud en la asistencia a la persona mayor víctima de violencia, mediante la identificación de casos y la actuación temprana para la interrupción de los ciclos perpetrados. De manera que, se evidencia la necesidad constante de actualización profesional para hacer frente a situaciones detectadas.

Abstract Introduction: Violence against the elderly is a growing phenomenon, causing damage to health, with different outcomes and consequences to the victims. The possibility of elderly women suffering it in the family context surpasses that of men, with gender being a considerable risk factor. Objective: To analyze the understanding of violence against the elderly according to elderly women. Method: Descriptive research with a qualitative approach developed with 22 elderly women from a community in the state of Paraíba, Brazil, chosen for convenience. The data collection was based on semi-structured interviews, processed by the Iramuteq software, with subsequent Content Analysis. Results: Five classes of violence against the elderly were evidenced: cycle of violence; support network for the elderly victims of violence; experience of violent situations; financial violence; and symbolism of violence in society, which denote an understanding of violence involving the different types. They are based on the factors of family experience, culture, and others, placing the health professional as a fundamental element for care and support. Gender influenced the perspective on physical and psychological violence, as well as the relevance given to health teams for the identification of occurrences and the prevention of possible damage. Conclusion: The various types of violence against the elderly have been recognized, including individual, community, and social factors in the violent cycle. In addition, they associated aging with greater susceptibility to suffering violence, regardless of the typology. It highlights the potential of the health service in assisting the elderly victim of violence, elucidating cases, and acting early to interrupt the cycles perpetrated, requiring the constant need for professional updating to deal with detected situations.

Exploring the Interplay of Intergenerational Transmission, Structural Inequalities, and Relative Resources in Domestic Violence: Evidence From a Nationally Representative Dataset.

Domestic violence persists as a significant social challenge affecting a considerable number of women globally. Some scholars have ascribed the inclination toward domestic violence to a "cycle of violence" spanning generations, while others have pointed out structural inequalities. Feminist researchers contend that a comprehensive understanding necessitates exploration within the social and institutional realms of gender inequality. While each of these perspectives contributes significantly to comprehending domestic violence, individually, they might not unveil the complete causal narrative. This study endeavors to address this gap by proposing an integrated model to elucidate domestic violence in the context of Türkiye, examining (a) the correlation between growing up in a violent household and the susceptibility to domestic violence, (b) the interrelation between structural factors and the vulnerability to domestic violence, and (c) the connection between a woman's advantageous position in terms of the couple's relative resources and the likelihood of experiencing domestic violence. To achieve this objective, multivariate micro-level analyses were conducted using nationally representative data from the 2014 Research on Domestic Violence Against Women in Türkiye. The outcomes affirm the significance of all three approaches, highlighting the value of integrated methodologies for a more profound comprehension of the etiology of domestic violence. This insight is crucial for the development of effective prevention programs. Furthermore, the findings highlight intra-parental violence exposure as the most robust risk factor or predictor for subsequent involvement in violent intimate relationships. As the initial study in Türkiye encompasses early-life experiences, structural inequalities, and the relative resources of couples, this research is poised to contribute significantly to the existing body of literature on domestic violence.

Protective and risk factors of workplace violence against nurses: A cross-sectional study.

AIMS: To describe how workplace violence (WPV) is experienced by nurses in hospitals and community services and identify protective and risk factors. METHODS: An online cross-sectional national study was conducted from January to April 2021 in Italy. Hospitals and community services were involved in the study. The survey combined the adapted and validated Italian version of the Violence in Emergency Nursing and Triage (VENT) questionnaire, which explores the episodes of WPV experienced during the previous 12 months, the Practice Environment Scale of the Nursing Work Index (PES-NWI) and some additional questions about staffing levels extracted from a previous RN4CAST study. Nurses working in all clinical settings and community services were invited to participate in the survey. Descriptive and inferential statistics were used for data analysis. We adhered to the STROBE reporting guidelines. RESULTS: A total of 6079 nurses completed the survey, 32.4% (n = 1969) had experienced WPV in the previous 12 months, and 46% (n = 920) reported WPV only in the previous week. The most significant protective factors were nurses' age, patients' use of illegal substances, attitude of individual nurses and considering effective the organization's procedures for preventing and managing episodes of violence. The most significant risk factors included workload, recognizing violence as an inevitable part of the job, patients' cultural aspects and patients' agitated behaviour. The frequency of WPV was significantly higher in certain areas, such as the emergency department and in mental health wards. CONCLUSION: Workplace violence (WPV) against nurses is a very frequent and concerning issue, especially in hospitals and community services. Based on our findings, integrated and multimodal programmes for prevention and management of WPV are recommended. More attention and resources need to be allocated to reduce WPV by improving the quality of nurses' workplace environment and implementing violence-free policies for hospitals. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Impact Workplace verbal and physical violence is a widespread phenomenon, both in hospital and community settings, and even during COVID-19 pandemic. This problem is exacerbated by the lack of effective reporting systems, fear of retaliation and the tendency to consider violence as an inevitable part of the job. The characteristics of professionals, patients, work environment and organizational factors are involved in the spread of workplace violence, determining its multifactorial nature. Integrated and multimodal programmes to prevent and manage of workplace violence are probably the only way to effectively counteract workplace violence against nurses. Healthcare policymakers, managers of hospital and community services need to proactively prevent and effectively manage and monitor episodes of violence. Nurses need to feel protected and safeguarded against any form of verbal or physical violence, to provide high-quality care in a totally safe environment. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Project GRIP: An Illustration of Participatory Action Research with Communities of People Who Own and Use Firearms.

Firearm-related injury and mortality prevention strategies are often incompatible with and potentially ineffective for the very populations at risk. Such incompatibility is reflective of a cultural disconnect between investigators and prevention specialists and those who own and use firearms. The current paper describes Project GRIP, a research study that was guided by the principles of Participatory Action Research (PAR). We present the project as a case-example and demonstration of how PAR principles can inform an approach to partner with firearm owners in injury prevention research. Though PAR is a general approach and not a set of techniques, we describe the strategies we used in the hopes that they may be useful for investigators using PAR with firearm owners. We discuss the project and our approach across different stages of the process, including entering into PAR with firearm owners, building partnerships, developing a shared vision, mutual understanding, and co-learning, building and maintaining positive relationships, and executing the project tasks. The PAR approach and the intentional emphasis on partnership is, in our opinion, vital to ensuring that the perspectives of firearm owners are incorporated into the research literature so that more ecologically valid and potentially effective injury and mortality prevention strategies can be developed and disseminated.

A participatory and comprehensive intervention to improve violence prevention in two high-risk occupations: effect and process evaluation of a stepped wedge cluster randomised trial.

BACKGROUND: Work-related violence committed by clients, patients, and customers represents a major occupational health risk for employees that needs to be reduced. METHODS: We tested a comprehensive violence prevention intervention involving active participation of both employees and managers in the Prison and Probation Service (PPS) and on psychiatric wards in Denmark. We used a stepped wedge cluster randomised controlled trial design. We measured the degree of implementation of the intervention by registration of fidelity, reach, and dose and used a mixed-effects regression analysis to estimate the effects of the intervention. RESULTS: We recruited 16 work units for the intervention, but three work units dropped out. The average implementation rate was 73%. In the psychiatric wards, the intervention led to statistically significant improvements in the primary outcome (an increase in the degree to which managers and employees continuously work on violence prevention practices based on their registration and experiences), but none statistically significant improvements in any of the secondary outcomes. In the PPS units, the intervention did not lead to a statistically significant improvement in the primary outcome, but to statistically significant improvements in three secondary outcomes. CONCLUSION: Most work units were able to carry out the intervention as planned. The intervention showed mixed results regarding the primary outcome. Nevertheless, the results indicate improvements also in the sector where a change in the primary outcome was not achieved. The results point at that a participatory and comprehensive approach could be a viable way of working with violence prevention in high-risk workplaces. TRIAL REGISTRATION: ISRCTN86993466: 20/12/2017.

Mechanical trauma in children and adolescents in Berlin.

Management of severe pediatric trauma remains challenging. Injury patterns vary according to patient age and trauma mechanism. This study analyzes trauma mechanisms in deceased pediatric patients. Fatal pediatric trauma cases aged 0-18 years who underwent forensic autopsy in the Federal State of Berlin, Germany, between 2008 until 2018 were enrolled in this retrospective study. Autopsy protocols were analyzed regarding demographic characteristics, trauma mechanisms, injury patterns, resuscitation measures, survival times as well as place, and cause of death. 71 patients (73% male) were included. Traffic accidents (40%) were the leading cause of trauma, followed by falls from height > 3 m (32%), railway accidents (13%), third party violence (11%) and other causes (4%). While children under 14 years of age died mostly due to traumatic brain injury (59%), polytrauma was the leading cause of death in patients > 14 years (55%). Other causes of death were hemorrhage (9%), thoracic trauma (1%) or other (10%). A suicidal background was proven in 24%. In the age group of > 14 years, 40% of all mortalities were suicides. Cardiopulmonary resuscitation was carried out in 39% of all patients. 42% of the patients died at the scene. Children between 0 and 14 years of age died most frequently from traumatic brain injury. In adolescents between 14 and 18 years of age, polytrauma was mostly the cause of death with a high coincidence of suicidal deaths. The frequency of fatal traffic accidents and suicides shows the need to improve accident and suicide prevention for children and adolescents.

Peace through health: traditional medicine meditation in the prevention of collective stress, violence, and war.

In the midst of global armed conflicts, notably the Israel-Hamas and Ukraine-Russia wars, there is an urgent need for innovative public health strategies in peacebuilding. The devastating impact of wars, including mortality, injury, disease, and the diversion of healthcare resources, necessitates effective and durable interventions. This perspective aligns with WHO recommendations and examines the role of evidence-based meditation from Ayurveda and Yoga in public health to mitigate collective stress and prevent collective violence and war. It highlights the Transcendental Meditation program, recognized for reducing stress, with contemporary evidence supporting its effectiveness in mental health, mind-body disorders, cardiovascular disease, and public health. Empirical studies with cross-cultural replications indicate that these Traditional Medicine meditation practices can reduce collective stress and prevent collective violence and war activity while improving quality of life. The mechanisms of group meditation in mitigating collective violence are explored through public health models, cognitive neuroscience, population neuroscience, quantum physics principles, and systems medicine. This perspective suggests that Transcendental Meditation and the advanced TM-Sidhi program, as a component of Traditional Medicine, can provide a valuable platform for enhancing societal well-being and peace by addressing brain-based factors fundamental to collective stress and violence.

Alcohol-related liver disease: A global perspective.

Alcohol-associated liver disease (ALD) represents one of the deadliest yet preventable consequences of excessive alcohol use. It represents 5.1 % of the global burden of disease, mainly involving the productive-age population (15-44 years) and leading to an increased mortality risk from traffic road injuries, suicide, violence, cardiovascular disease, neoplasms, and liver disease, among others, accounting for 5.3 % of global deaths. Daily alcohol consumption, binge drinking (BD), and heavy episodic drinking (HED) are the patterns associated with a higher risk of developing ALD. The escalating global burden of ALD, even exceeding what was predicted, is the result of a complex interaction between the lack of public policies that regulate alcohol consumption, low awareness of the scope of the disease, late referral to specialists, underuse of available medications, insufficient funds allocated to ALD research, and non-predictable events such as the COVID-19 pandemic, where increases of up to 477 % in online alcohol sales were registered in the United States. Early diagnosis, referral, and treatment are pivotal to achieving the therapeutic goal in patients with alcohol use disorder (AUD) and ALD, where complete alcohol abstinence and prevention of alcohol relapse are expected to enhance overall survival. This can be achieved through a combination of cognitive behavioral, motivational enhancement and pharmacological therapy. Furthermore, the appropriate use of available pharmacological therapy and implementation of public policies that comprehensively address this disease will make a real difference.

Who is killing South African men? A retrospective descriptive study of forensic and police investigations into male homicide.

Not much is known about the perpetrators of male homicide in South Africa, which has rates seven times the global average. For the country's first ever male homicide study we describe the epidemiology of perpetrators, their relationship with victims and victim profiles of men killed by male versus female perpetrators. We conducted a retrospective descriptive study of routine data collected through forensic and police investigations, calculating victim and perpetrator homicide rates by age, sex, race, external cause, employment status and setting, stratified by victim-perpetrator relationships. For perpetrators, we reported suspected drug and alcohol use, prior convictions, gang-involvement and homicide by multiple perpetrators. Perpetrators were acquaintances in 63% of 5594 cases in which a main perpetrator was identified. Sharp objects followed by guns were the main external causes of death. The highest rates were recorded in urban informal areas among unemployed men across all victim-perpetrator relationship types. Recreational settings including bars featured prominently. Homicides clustered around festive periods and weekends, both of which are associated with heavy episodic drinking. Perpetrator alcohol use was reported in 41% of homicides by family members and 50% by acquaintances. Other drug use was less common (9% overall). Of 379 men killed by female perpetrators, 60% were killed by intimate partners. Perpetrator alcohol use was reported in approximately half of female-on-male murders. Female firearm use was exclusively against intimate partners. No men were killed by male intimate partners. Violence prevention, which in South Africa has mainly focused on women and children, needs to be integrated into an inclusive approach. Profiling victims and perpetrators of male homicide is an important and necessary first step to challenge prevailing masculine social constructs that men are neither vulnerable to, nor the victims of, trauma and to identify groups at risk of victimisation that could benefit from specific interventions and policies.

Healers that hurt: a scoping review of media reports of cases of rape in healthcare settings.

BACKGROUND: Sexual assault occurring within healthcare settings represents a significant breach of public trust. This scoping review aimed to highlight the profile of people raped, those who committed the rape within the health facilities, and the legal actions taken to resolved cases. METHODS: Media-reported data on incidents of rape in healthcare settings were collected. The search was conducted in May and June 2023, focusing on English-language publications with accessible full texts. Reports that lacked information on the survivors or incidents that occurred outside of healthcare settings were excluded. Descriptive statistics were used to summarize the categories of the collected publications, and graphical representations were employed for visualization purposes. RESULTS: A total of 62 cases were retrieved, originating from Africa (n = 17; 27.4%), Europe (n = 14; 22.6%), Southeast Asia (n = 14; 22.6%), the Americas (n = 11; 17.7%), the Western Pacific Region (n = 5; 8.1%) and Eastern Mediterranean region (n = 1; 1.6%). In addition, 69 individuals were implicated in 59 cases. They were 31 doctors (44.9%), 17 (24.6%) nurses, four (5.8%) nurse/healthcare assistants, three (4.3%) cleaners/ward boy, two (2.9%) traditional medical doctors, and two (2.9%) security guards. Others included six (8.7%) staff members without designations and one (1.4%) ambulance driver. All perpetrators were male, ranging in age from 22 to 67 years. There were 66 victims identified in the 62 cases with age ranging from 2 to 92 years. Except for one case, all victims were female, and all but one case were patients. Most assaults occurred in consulting rooms/clinics (n = 21; 31.8%), 16 (24.2%) happened under sedation, and six (9.1%) were repeatedly raped, Survivors typically reported the cases the police (n = 12; 19.4%), family/friends (n = 11; 17.7%) or to hospital authorities (n = 10; 16.1%). Out of the 69 perpetrators, 19 (30.6%) were imprisoned with sentences ranging from 12 months to an indefinite period and one (1.6%) received a death sentence. CONCLUSION: The raping of patients by healthcare providers within healthcare settings calls for urgent and extensive measures. Stakeholders in healthcare management need to prioritize raising awareness about the problem, implement robust prevention and reporting strategies, and create healthcare environments that are safe, respectful, and supportive for all individuals seeking care.

Outcomes of substance use and sexual power among adolescent girls and young women in Cape Town: Implications for structural and cultural differences.

Adolescent girls and young women (AGYW) in South Africa experience contextual barriers to HIV risk reduction including incomplete schooling, unintended pregnancy, substance use, and gender-based violence. A cluster randomised trial in Cape Town allocated 24 Black and Coloured communities to a gender-focused HIV risk-reduction intervention or HIV testing, with 500 AGYW total enrolled. We evaluated intervention efficacy by comparing mean differences overall, by community population group (Black and Coloured) and among those with structural barriers based on neighbourhood, education, and employment (n = 406). Both arms reported reductions in alcohol, cannabis, and condomless sex, with no intervention efficacy overall. Among AGYW with barriers, intervention participants reported fewer days of methamphetamine use at 6 months (t(210) = 2·08, p = ·04). In population group analysis, we found intervention effects on alcohol and sexual communication. Intervention participants in Black communities had fewer days of alcohol use at 12 months (t(136) = 2·10, p = ·04). Sexual discussion (t(147) = -2·47, p = ·02) and condom negotiation (t(146) = -2·51, p = ·01) increased for intervention participants at 12 months in Coloured communities. Gender-focused interventions must address population group differences and intersecting barriers to decrease substance use and increase education, skills, and sexual health protection.

Prevention of alcohol exposed pregnancies in Europe: the FAR SEAS guidelines.

INTRODUCTION: Drinking during pregnancy is the leading cause of birth defects and child developmental disorders in Europe. The adverse effects of drinking during pregnancy may include physical, behavioural and cognitive problems, known collectively as fetal alcohol spectrum disorders (FASD). Evidence-based comprehensive recommendations at the European level on how to implement preventive and treatment policies to reduce alcohol-exposed pregnancies are needed. FAR SEAS, a tendered service contract (number 20,187,106) awarded by the European Commission, aimed at developing guidelines to respond to this knowledge gap. METHODS: FAR SEAS recommendations were built on (1) a two-phase review of interventions, (2) an international expert consultation, and (3) a pilot study on prevention of FASD conducted in the Mazovia region of Poland. The review of interventions included nineteen electronic open access databases, several repositories of grey literature and a key informant consultation covering most European Union (EU) countries and an additional guidelines search. After triangulating sources, 94 records were collected. Experts contributed in the design of the research questions, addressing the gaps in the literature and reviewing the recommendations formulated. The Polish pilot added nuances from real world practice to the formulated recommendations, resulting in the final set of guidelines for dissemination. RESULTS: The FAR SEAS Guidelines comprise 23 recommendations grouped into different topics areas of policies, communication strategies, screening, brief intervention and referral to treatment, treatment and social services. The recommendations highlight the need to respect women's autonomy and avoid discrimination and stigmatization; using universal screening for women of childbearing age, including detection of other psychosocial risks (such as domestic violence); and individualized, comprehensive and multidisciplinary supportive interventions for those who require it, such as those with alcohol use disorders, including women's partners. Policies to prevent FASD should be multicomponent, and public health communication should combine information about the risks together with self-efficacy messages to promote changes. CONCLUSIONS: The FAR SEAS guidelines are a tool to support policy-makers and service managers in implementing effective programmes to reduce prenatal alcohol exposure among general and at-risk population groups. FASD prevention has to involve comprehensive and multi-level evidence-based policies and practice, with services and activities tailored to the needs of women at differing levels of risk, and with due attention to reducing stigma.

Development and implementation of a worksite-based intervention to improve mothers' knowledge, attitudes, and skills in sharing information with their adolescent daughters on preventing sexual violence: lessons learned in a developing setting, Sri Lanka.

BACKGROUND: Sexual violence among adolescents has become a major public health concern in Sri Lanka. Lack of sexual awareness is a major reason for adverse sexual health outcomes among adolescents in Sri Lanka. This study was intended to explore the effectiveness of a worksite-based parent-targeted intervention to improve mothers' knowledge, and attitudes on preventing sexual violence among their adolescent female offspring and to improve mother-daughter communication of sexual violence prevention with the family. METHODS: "My mother is my best friend" is an intervention designed based on previous research and behavioral theories, to help parents to improve their sexual communication skills with their adolescent daughters. A quasi-experimental study was conducted from August 2020 to March 2023 in randomly selected two Medical Officer of Health (MOH)areas in Kalutara district, Sri Lanka. Pre and post-assessments were conducted among a sample of 135 mothers of adolescent girls aged 14-19 years in both intervention and control areas. RESULTS: Out of the 135 mothers who participated in the baseline survey, 127 mothers (94.1%) from the intervention area (IA) physically participated in at least one session of the intervention. The worksite-based intervention was effective in improving mothers' knowledge about adolescent sexual abuse prevention (Difference in percentage difference of pre and post intervention scores in IA and CA = 4.3%, p = 0.004), mother's attitudes in communicating sexual abuse prevention with adolescent girls (Difference in percentage difference of pre and post intervention scores in IA and CA = 5.9%, p = 0.005), and the content of mother-daughter sexual communication (Difference in percentage difference of pre and post intervention scores in IA and CA = 27.1%, p < 0.001). CONCLUSIONS AND RECOMMENDATIONS: Worksite-based parenting program was effective in improving mothers' knowledge about sexual abuse prevention among adolescent daughters and in improving the content of mother-daughter communication about sexual abuse prevention. Developing appropriate sexual health programs for mothers of different ethnicities, and cultures using different settings is important. Conduction of need assessment programs to identify the different needs of mothers is recommended.

Exploring linkages: addressing the relationship between the climate crisis and HIV prevention with recommendations for emerging pre-exposure prophylaxis programs.

Short- and long-term impacts of the climate crisis continue to be felt across the public health landscape. Many individuals marginalized by the climate crisis also navigate a higher likelihood of exposure to HIV. By understanding this relationship, we can better position HIV prevention, and pre-exposure prophylaxis (PrEP) programs specifically, to meet user needs in communities experiencing the effects of the climate crisis. In support, we propose four recommendations for mitigating the impact of the climate crisis on those who may benefit from PrEP: (1) leverage existing and emerging research and lived experience to intentionally target and appropriately reach individuals affected by the climate crisis who may need or want PrEP; (2) emphasize the need for more climate-resilient PrEP products within the research and development pipeline; (3) build a continued understanding of the role of the climate crisis-HIV relationship in product introduction through national collaboration; and (4) strengthen the integration of PrEP service delivery and response to intimate partner violence. The PrEP market is set for rapid expansion with the introduction of new prevention methods to enable choice. To be comprehensively responsive to potential PrEP users, we must consider and address how the climate crisis changes not only the environmental landscape, but the prevention ecosystem.

The Role of Childhood Violence in Adult Victimization Among Women Experiencing Homelessness in Spain.

Persons experiencing homelessness represent one of the principal manifestations of the phenomenon of social exclusion, with homeless women constituting a group in a particularly vulnerable situation. The article analyzed the experience of violence in childhood and adolescence, and its implications in terms of violence experienced as an adult, in a sample of women experiencing homelessness in Madrid (Spain) (n = 138). All participants were of legal age and had spent the night before the interview in a shelter or other facility for the homeless, on the street, in public spaces or in places not suitable for sleeping. Information was gathered through a structured interview. The results show that the interviewees had experienced a high percentage of physical, psychological, and/or sexual violence, both in their childhood and adolescence and throughout their lives, with a strong correlation between the experience of violence in childhood and the experience of violence in adulthood, particularly sexual assaults, intimate partner violence, and sex work. The experience of childhood sexual abuse among women experiencing homelessness appears to have had particularly negative consequences in adulthood. Public policies, prevention programs, and care mechanisms with a gendered perspective must be implemented, aimed at reducing the number and intensity of situations of violence experienced by women and girls at risk of social exclusion or in a homeless situation.

Childhood Violence, High School Academic Environment, and Adult Alcohol Use Among Latinas and Black Women: A Structural Equation Modeling Study.

OBJECTIVE: Young Latinas and Black women drink less than women of other racial/ethnic groups but experience more alcohol-related problems in midlife. This study aims to identify modifiable factors to prevent adult onset of alcohol use disorder (AUD) in this population. METHODS: Data were collected at six time points as part of the Harlem Longitudinal Development Study from 365 Latinas (47%) and Black (53%) women (mean age at time 1 = 14, standard deviation 1.3). Structural equation modeling was used to test hypothesized pathways from childhood physical and sexual abuse to AUD via depressive mood, anxiety disorders, and somatic complaints in the 20s. We also tested the moderation effect of the high school academic environment by including in the structural equation model two latent variable interaction terms between the school environment and each of the abuse variables. RESULTS: Childhood physical and sexual abuse was positively associated with depressive mood, anxiety disorders, and somatic complaints when participants were in the 20s. Depressive mood mediated childhood abuse and AUD when women were in the 30s. The high school academic environment attenuated the effect of physical, but not sexual abuse, on depressive mood (ß = -0.59, B = -9.38, 95% CI [-14.00, -4.76]), anxiety symptoms (ß = -0.61, B = -14.19, 95% CI [-21.76, -6.61]), appetite loss (ß = -0.41, B = -10.52, 95% CI [-15.61, -5.42]), and sleeplessness (ß = -0.50, B = -9.56, 95% CI [-13.95, -5.17]) in the early 20s. CONCLUSIONS: Our findings underscore the need to invest in early violence prevention interventions and in education to ensure equitable access to quality, academically oriented, and safe schools.

Peer and land-based approaches for fostering empowering and healthy relationships with Indigenous and northern young people in the Northwest Territories.

Indigenous and Northern women in Canada experience high rates of intimate partner violence (IPV), and this is particularly true in the Northwest Territories (NWT). Adolescents are also at increased risk of IPV, which has far-reaching, lifelong effects. Indigenous youth are particularly vulnerable to IPV due to ongoing effects of intergenerational trauma caused by colonialism, racism and residential school legacies. We explored attitudes towards IPV and the healthy relationship knowledge, skills, and experiences among participants of Fostering Open eXpression among Youth (FOXY) and Strength, Masculinities, and Sexual Health (SMASH) Peer Leader Retreats in the NWT. Multi-method approaches included quantitative surveys youth completed before and immediately following retreats. Quantitative analysis from retreats (2018-2021) included 240 participants aged 12-19 (mean age 14.5) who reported ever having an intimate partner. Most were from the FOXY program (64.2%), Indigenous (69.6%) and heterosexual (66.4%). Qualitative methods included Focus Group Discussions (FGD) (n = 69) conducted with peer leaders and apprentices (n = 311) and youth and adult staff (n = 14 FGDs, n = 165 participants). We thematically analysed FGDs to explore healthy relationship knowledge and skills, alongside paired t-tests to examine pre/post retreat changes in attitudes towards IPV. Qualitative findings suggest that leadership and embodied learning were effective in equipping youth with violence prevention and healthy relationship skills. While young women were committed to sharing knowledge and skills about healthy relationships in their communities, young men resonated with values of respect and appreciated support to identify and express emotions. Participants across programmes demonstrated their belief that healthy intimate relationships have communal, relational and intergenerational benefits. Quantitatively, we found a statistically significant reduction in attitudes accepting of IPV among young women, but no changes were noted among young men. Findings contribute to emergent evidence on strengths-based, culturally-responsive IPV prevention programming. Components of effective IPV prevention programming with young men merit further exploration.

Supporting the applicability and transferability of the "Sortir Ensemble & Se Respecter" program in France / Accompagner l'applicabilité et la transférabilité du programme « Sortir Ensemble & Se Respecter ¼ en Frances

INTRODUCTION: The prevention of intimate partner violence (IPV) among young people is a major challenge for public policies. Nevertheless, there are a few prevention programs that have proven effective in France. "Sortir Ensemble & Se Respecter" (SE&SR) is a Swiss adaptation of "Safe Dates," an American intervention program that has reduced violent behavior by young perpetrators and victims of IPV alike. The aim of this article is to analyze the applicability and "potential transferability" of SE&SR in France. METHODS: We described the SE&SR intervention by explaining the intervention theory, the key functions (i.e., the "ingredients" allowing the SE&SR program to work), and we commented on its applicability from a perspective of adapting and transferring it to the French context. We used the ASTAIRE tool and the FIC (key functions, implementation, context) approach. RESULTS: The intervention theory highlighted various factors, acting at the individual level (i.e., beliefs/representations, knowledge, life skills) and at the level of the living environment (i.e., facilities welcoming young people; families; public policies; networks of actors), that can prevent IPV among young people. Ten key functions have been identified, revealing the "skeleton" of the Swiss intervention. We drew on these results to comment on the intervention's applicability, with a view to transferability, specifying the contextual elements to consider before implementing SE&SR in France. CONCLUSION: This study aims to make the process of evaluating applicability, with a view to transferring an evidence-based program to the French context, more accessible.

Introduction: La prévention des violences dans les relations amoureuses (VRA) chez les jeunes est un enjeu fort des politiques publiques. Néanmoins, il existe peu de programmes de prévention ayant fait la preuve de leur efficacité en France. « Sortir Ensemble & Se Respecter ¼ (SE&SR) est une adaptation suisse de « Safe Dates ¼, un programme d'intervention américain qui a montré des résultats en matière de réduction des comportements violents tant du côté des jeunes victimes que des auteurs. L'objectif de cet article est d'analyser l'applicabilité et la « potentielle transférabilité ¼ de SE&SR en France. Méthodes: L'approche adoptée consistait à décrire l'intervention SE&SR en explicitant la théorie d'intervention, les fonctions clés (soit les « ingrédients ¼ permettant que le programme SE&SR fonctionne) et en proposant des commentaires d'applicabilité en vue d'une transférabilité adaptée au contexte français. L'outil ASTAIRE et la démarche FIC ont été utilisés. Résultats: La théorie d'intervention a mis en évidence différents facteurs, agissant au niveau individuel (i.e. connaissances, croyances/représentations, compétences psychosociales) et au niveau des milieux de vie (i.e. structures accueillant les jeunes, familles, politiques publiques/réseaux d'acteurs), qui peuvent prévenir les VRA chez les jeunes. Dix fonctions clés ont été identifiées, dégageant le « squelette ¼ de l'intervention suisse. À la suite de ces résultats, des commentaires d'applicabilité en vue d'une transférabilité ont permis de préciser les éléments de contexte à prendre en compte avant la mise en œuvre de SE&SR en France. Conclusion: Cette étude souhaite rendre accessibles les process d'applicabilité en vue d'une transférabilité d'un programme probant en contexte français.

Barriers and facilitators of the reporting by family doctors of cases of domestic violence - a qualitative study across Portugal.

BACKGROUND: Domestic violence (DV) is a serious and prevalent public health problem with devastating consequences for the victims and their families. Whilst the number of cases reported to the authorities has risen in recent years, many victims still chose not to present a complaint. In Portugal, to address this, DV became a public crime. As victims of DV present multiple health problems and frequently seek professional help, family doctors are in a privileged position to detect and report cases of DV to the authorities. However, little is known about what motivates these professionals to report or not the DV cases they encounter in their practice to the authorities. METHODS: We conducted semi-structured interviews with family doctors from all regional health administrations of continental Portugal. Interviews occurred between July 2020 and September 2022, were conducted in person or remotely, audio recorded, transcribed, and analysed using thematic analysis. Content analysis was conducted to assess the agreement or disagreement regarding mandatory reporting in each of the themes and subthemes. RESULTS: Fifty-four family doctors took part in this study (n = 39 women, n = 15 men). The main themes that arose from the analysis were: "Barriers related to the physician's activity," "Barriers related to the victim or aggressor," "Facilitators related to the physician's activity," "Facilitators related to the victim or aggressor." Although different barriers were described, most doctors agreed with the mandatory reporting of DV cases. CONCLUSIONS: Family doctors encounter multiple barriers and facilitators when considering reporting a DV case to the authorities. The results of this study can help develop new interventions to address the barriers described by the doctors, increasing their compliance with mandatory reporting, the protection of victims and the just persecution of the aggressor.

Community-Level Factors As Positive and Negative Correlates of Sexual Aggression Perpetration Among Adolescent Boys.

Often, perpetrators of sexual violence first aggress in their teens. Presently, very little is known about environmental factors that may influence adolescents' engagement in sexual aggression. Drawing upon data collected at 27 high schools in the Northeast United States, this study is the first to test the association between community-level factors and male adolescents' sexual aggression. A series of backward linear regressions determined that 10 of 19 community variables were associated with males' sexual aggression, which were then used to generate a ratio of positive to negative correlates of sexual aggression for each high school. In multilevel analyzes, as hypothesized, the ratio of positive to negative correlates was positively associated with schools' sexual aggression perpetration rates. We discuss the study's implications for future sexual assault research and prevention interventions.