The EmpaTeach intervention for reducing physical violence from teachers to students in Nyarugusu Refugee Camp: A cluster-randomised controlled trial.

BACKGROUND: School-based violence prevention interventions offer enormous potential to reduce children's experience of violence perpetrated by teachers, but few have been rigorously evaluated globally and, to the best of our knowledge, none in humanitarian settings. We tested whether the EmpaTeach intervention could reduce physical violence from teachers to students in Nyarugusu Refugee Camp, Tanzania. METHODS AND FINDINGS: We conducted a 2-arm cluster-randomised controlled trial with parallel assignment. A complete sample of all 27 primary and secondary schools in Nyarugusu Refugee Camp were approached and agreed to participate in the study. Eligible students and teachers participated in cross-sectional baseline, midline, and endline surveys in November/December 2018, May/June 2019, and January/February 2020, respectively. Fourteen schools were randomly assigned to receive a violence prevention intervention targeted at teachers implemented in January-March 2019; 13 formed a wait-list control group. The EmpaTeach intervention used empathy-building exercises and group work to equip teachers with self-regulation, alternative discipline techniques, and classroom management strategies. Allocation was not concealed due to the nature of the intervention. The primary outcome was students' self-reported experience of physical violence from teachers, assessed at midline using a modified version of the ISPCAN Child Abuse Screening Tool-Child Institutional. Secondary outcomes included student reports of emotional violence, depressive symptoms, and school attendance. Analyses were by intention to treat, using generalised estimating equations adjusted for stratification factors. No schools left the study. In total, 1,493 of the 1,866 (80%) randomly sampled students approached for participation took part in the baseline survey; at baseline 54.1% of students reported past-week physical violence from school staff. In total, 1,619 of 1,978 students (81.9%) took part in the midline survey, and 1,617 of 2,032 students (79.6%) participated at endline. Prevalence of past-week violence at midline was not statistically different in intervention (408 of 839 students, 48.6%) and control schools (412 of 777 students, 53.0%; risk ratio = 0.91, 95% CI 0.80 to 1.02, p = 0.106). No effect was detected on secondary outcomes. A camp-wide educational policy change during intervention implementation resulted in 14.7% of teachers in the intervention arm receiving a compressed version of the intervention, but exploratory analyses showed no difference in our primary outcome by school-level adherence to the intervention. Main study limitations included the small number of schools in the camp, which limited statistical power to detect small differences between intervention and control groups. We also did not assess the test-retest reliability of our outcome measures, and interviewers were unmasked to intervention allocation. CONCLUSIONS: There was no evidence that the EmpaTeach intervention effectively reduced physical violence from teachers towards primary or secondary school students in Nyarugusu Refugee Camp. Further research is needed to develop and test interventions to prevent teacher violence in humanitarian settings. TRIAL REGISTRATION: clinicaltrials.gov (NCT03745573).

Middle School Effects of the Dating Matters® Comprehensive Teen Dating Violence Prevention Model on Physical Violence, Bullying, and Cyberbullying: a Cluster-Randomized Controlled Trial.

Few comprehensive primary prevention approaches for youth have been evaluated for effects on multiple types of violence. Dating Matters®: Strategies to Promote Healthy Teen Relationships (Dating Matters) is a comprehensive teen dating violence (TDV) prevention model designed by the Centers for Disease Control and Prevention and evaluated using a longitudinal stratified cluster-randomized controlled trial to determine effectiveness for preventing TDV and promoting healthy relationship behaviors among middle school students. In this study, we examine the prevention effects on secondary outcomes, including victimization and perpetration of physical violence, bullying, and cyberbullying. This study examined the effectiveness of Dating Matters compared to a standard-of-care TDV prevention program in 46 middle schools in four high-risk urban communities across the USA. The analytic sample (N = 3301; 53% female; 50% Black, non-Hispanic; and 31% Hispanic) consisted of 6th-8th grade students who had an opportunity for exposure to Dating Matters in all three grades or the standard-of-care in 8th grade only. Results demonstrated that both male and female students attending schools implementing Dating Matters reported 11% less bullying perpetration and 11% less physical violence perpetration than students in comparison schools. Female Dating Matters students reported 9% less cyberbullying victimization and 10% less cyberbullying perpetration relative to the standard-of-care. When compared to an existing evidence-based intervention for TDV, Dating Matters demonstrated protective effects on physical violence, bullying, and cyberbullying for most groups of students. The Dating Matters comprehensive prevention model holds promise for reducing multiple forms of violence among middle school-aged youth. ClinicalTrials.gov Identifier: NCT01672541.

Educational, psychosocial, and protection outcomes of child- and youth-focused programming with Somali refugees in Dollo Ado, Ethiopia.

Child- and youth-friendly spaces have become a common feature of emergency humanitarian provision. This study reports on the outcomes of child and youth learning centres (CYLCs) in Ethiopia's Buramino Camp established for those fleeing conflict in Somalia. Eighty-five youths completed baseline assessments shortly after arrival and follow-up assessments three to six months later. Caregivers of 106 younger children completed similar appraisals. 693 children attending the CYLCs completed pre- and post-educational assessments, which indicated major gains-significant at p<0.0001-in both literacy (younger children, t=9.06; youth, t=13.87) and numeracy (younger children, t=13.94; youths, t=17.10). Children's CYLC attendance increased reports of met needs among caregivers (t=2.53, p<0.05) and youths (t=2.57, p<0.05), and, among caregivers but not youths, significantly moderated protection concerns (t=2.39, p<0.05, and t=-1.90, p=0.06, respectively). There was general improvement in psychosocial well-being over time for all children; CYLC attendance predicted greater reductions in reported difficulties only among younger children (t=2.51, p<0.05).

Sharing reports about domestic violence and abuse with general practitioners: a qualitative interview study.

BACKGROUND: Domestic violence and abuse (DVA) is common and damaging to health. UK national guidance advocates a multi-agency response to DVA, and domestic homicide reviews consistently recommend improved information-sharing between agencies. Identification of patients experiencing DVA in general practice may come from external information shared with the practice, such as police incident reports and multi-agency risk assessment conference (MARAC) reports. The aim of this study was to explore the views of general practitioners (GPs) and the police about sharing reports about DVA with GPs. METHODS: Qualitative semi-structured interviews were conducted with GPs, police staff and a partnership manager. Participants were located across England and Wales. Thematic analysis was undertaken. RESULTS: Interviews were conducted with 23 GPs, six police staff and one former partnership manager. Experiences of information-sharing with GPs about DVA varied. Participants described the relevance and value of external reports to GPs to help address the health consequences of DVA and safeguard patients. They balanced competing priorities when managing this information in the electronic medical record, namely visibility to GPs versus the risk of unintended disclosure to patients. GPs also spoke of the judgements they made about exploring DVA with patients based on external reports, which varied between abusive and non-abusive adults and children. Some felt constrained by short general practice consultations. Some police and GPs reflected on a loss of control when information about DVA was shared between agencies, and the risk of unintended consequences. Both police and GPs highlighted the importance of clear information and a shared understanding about responsibility for action. CONCLUSION: GPs regarded external reports about DVA as relevant to their role, but safely recording this information in the electronic medical record and using it to support patients required complex judgements. Both GPs and police staff emphasised the importance of clarity of information and responsibility for action when information was shared between agencies about patients affected by DVA.

A Video-Based DT-SVM School Violence Detecting Algorithm.

School bullying is a serious problem among teenagers. School violence is one type of school bullying and considered to be the most harmful. As AI (Artificial Intelligence) techniques develop, there are now new methods to detect school violence. This paper proposes a video-based school violence detecting algorithm. This algorithm first detects foreground moving targets via the KNN (K-Nearest Neighbor) method and then preprocesses the detected targets via morphological processing methods. Then, this paper proposes a circumscribed rectangular frame integrating method to optimize the circumscribed rectangular frame of moving targets. Rectangular frame features and optical-flow features were extracted to describe the differences between school violence and daily-life activities. We used the Relief-F and Wrapper algorithms to reduce the feature dimension. SVM (Support Vector Machine) was applied as the classifier, and 5-fold cross validation was performed. The accuracy was 89.6%, and the precision was 94.4%. To further improve the recognition performance, we developed a DT-SVM (Decision Tree-SVM) two-layer classifier. We used boxplots to determine some features of the DT layer that are able to distinguish between typical physical violence and daily-life activities and between typical daily-life activities and physical violence. For the remainder of activities, the SVM layer performed a classification. For this DT-SVM classifier, the accuracy reached 97.6%, and the precision reached 97.2%, thus showing a significant improvement.

Improving empathy with motivational strategies in batterer intervention programmes: Results of a randomized controlled trial.

OBJECTIVES: Empathy (i.e., the ability to decode emotions, as well as cognitive and emotional empathy) is involved in moral reasoning, prosocial behaviour, social and emotional adequacy, mood and behaviour regulation. Hence, alterations in these functions could reduce behaviour control and the adoption of specific types of violence such as intimate partner violence (IPV). Although interventions for IPV perpetrators focus on reducing IPV risk factors and increasing protective factors to prevent this kind of violence, the study of the effectiveness of these programmes in promoting changes in empathy (cognitive and emotional) has been neglected. DESIGN: Hence, the main aim of this study was to compare the effectiveness of two different modalities of IPV intervention programmes (Standard Batterer Intervention Programs [SBIP] vs. SBIP + Individualized Motivational Plan [IMP]) in promoting empathic improvements after both interventions. METHOD: Participants were randomly assigned to receive SBIP (n = 40) or SBIP + IMP (n = 53). The effectiveness of the intervention in the total sample and the group effects were evaluated with general linear model repeated-measures ANOVA. RESULTS: Results revealed that only the IPV perpetrators who received the SBIP + IMP were more accurate in decoding emotional facial signals and presented better cognitive empathy (perspective taking) after the intervention programme. CONCLUSIONS: Our study reinforces the view that different modalities of IPV intervention might lead to different cognitive outcomes after the intervention. Thus, these results may help professionals to develop specific intervention programmes focused on improving cognitive abilities in order to reduce IPV recidivism. PRACTITIONER POINTS: Interventions for batterers' neglected empathic changes after these programmes. Not enough randomized controlled trials for these kinds of interventions. An improvement in the ability to decode emotions after the intervention programme. An improvement in cognitive empathy (perspective taking) after the intervention programme. Different modalities of IPV intervention might lead to different cognitive outcomes after the intervention.

Assessing risk for inpatient physical violence in a female forensic psychiatric sample - comparing HCR-20v2 with the female additional manual to the HCR-20v2.

Purpose and aim: Out from the sparse literature on risk assessment for violence committed by women the Female Additional Manual (FAM) was developed to be a complement to the HCR-20v2. The aim of this study was to investigate and compare the psychometrics of the HCR-20v2 with and without the FAM on risk for inpatient physical violence for female forensic psychiatric patients. Methods: The participants were 100 female patients admitted to forensic psychiatric care in a high-security clinic, assessed by clinicians with the HCR-20v2 during their admission. Researchers performed the FAM, both retrospectively and prospectively. The follow-up period was 12 months before being discharged. Results: Four main results were found; first, many risk factors were present although the summary risk ratings were mainly low to moderate. Secondly, the reliability was in general good, where the HCR-20v2 mainly showed higher reliability without than with the FAM, indicating that FAM risk factors did equal or did not contribute to a higher reliability. Third, the internal validity was higher for the HCR-20v2 than for the FAM. Risk factors correlated stronger with the summary risk ratings for the HCR-20v2 than for the FAM. Fourth, the validity for inpatient physical violence was high for the total score of both the HCR-20v2 and the FAM, but contradictory to previous finding the validity for summary risk ratings was not significant. Conclusions: The results support the use of HCR-20v2 when assessing risk for inpatient violence for female forensic psychiatric patients, but with only some support for adding or changing risk factors according to the FAM.

Associations between child physical abuse potential, observed maternal parenting, and young children's emotion regulation: Is participation in Early Head Start protective?

Clinicians working with Early Head Start (EHS) families consider family well-being and positive parent-child relationships as foundational to school readiness. Understanding the links between risk factors and these dimensions of family engagement can inform clinical decision-making, as risk assessments are used to tailoring program services. The current study examined the associations between high risk, or potential, for child physical abuse and both parenting quality and children's emotion regulation (ER) during toddlerhood; EHS participation was examined as a buffer. The sample included EHS-eligible mothers of infants (N = 80) drawn from one site of the EHS Research and Evaluation Project. Associations were tested between mothers' potential for child physical abuse, measured during infancy, and observed maternal sensitivity, positive regard, harshness, and children's ER skills at child ages 1 and 2 years. Results indicated that high potential for child physical abuse was associated with lower positive regard at age 1 and lower ER skills at age 2. EHS participation operated as a buffer on each of these associations. Implications for screening for child physical abuse potential and the constructs it represents in clinical settings as well as how EHS can promote family engagement are discussed.

Los clínicos que trabajan con familias del Programa de Comienzo Temprano (Early Head Start - EHS) consideran el bienestar familiar y las positivas relaciones entre progenitor y niño como aspectos fundamentales para estar listo para la escuela (US DHHS, 2011). El poder comprender las conexiones entre los factores de riesgo y estas dimensiones de la participación familiar puede servir de base para la toma de decisiones clínicas, ya que las evaluaciones de riesgo se usan para amoldar los servicios del programa. El presente estudio examinó las asociaciones entre el alto riesgo, o riesgo potencial, del abuso físico del niño y tanto la calidad de la crianza como la regulación de la emoción por parte del niño durante la primera etapa de la niñez; se examinó la participación en EHS como mediadora. El grupo muestra incluía madres de infantes elegibles para EHS (N = 80) quienes formaban parte de un mismo Proyecto de Investigación y Evaluación del Programa de Comienzo Temprano. Se pusieron a prueba las asociaciones entre el potencial de las madres de abuso físico del niño, medidas durante la infancia, y las observaciones de sensibilidad materna, consideraciones positivas, dureza, y las habilidades de regulación de la emoción del niño a la edad de 1 y 2 años del niño. Los resultados indicaron que el alto potencial de abuso físico del niño estaba asociado con más bajas consideraciones positivas a la edad de 1 año, así como con las más bajas habilidades de regulación de la emoción a la edad de 2 años. La participación en EHS funcionó como mediadora en cada una de estas asociaciones. Se discuten las implicaciones para detectar el potencial de abuso físico del niño y la estructura que representa en escenarios clínicos, y también cómo EHS puede promover la participación familiar.

Les cliniciens travaillant avec des familles du programme américain de Early Head Start (EHS) familles considèrent le bien-être familial et des relations parent-enfants positives comme étant les fondations de la préparation au cadre scolaire (US DHHS, 2011). Le fait de comprendre les liens entre les facteurs de risque et ces dimensions de l'engagement familial peut informer la prise de décision clinique, comme les évaluations de risque sont utilisées pour adapter les services de programmes. Cette étude s'est penchée sur les liens entre le risque élevé, ou potentiel, de maltraitance physique de l'enfant et à la fois la qualité du parentage et la régulation d'émotion des enfants durant la petite enfance; la participation à l'EHS étant examinée comme tampon. L'échantillon a inclus des mères de nourrissons étant admissible à l'EHS (N = 80), tiré d'un site du Projet de Recherche et d'Evaluation du EHS. Les associations ont été testées entre le potentiel de maltraitance physique de l'enfant par les mères, mesuré durant la très petite enfance, et la sensibilité maternelle observée, l'égard positif, la dureté, et les compétences de régulation de l'émotion des enfants aux âges de 1 et 2 ans. Les résultats indiquent qu'un fort potentiel de maltraitance de l'enfant était lié à un égard positif plus bas à l'âge de 1 ans, et à des compétences de régulation de l'émotion moins élevées à l'âge de 2 ans. La participation à l'EHS a servi de tampon dans chacune de ces associations. Les implications pour le dépistage de potentiel de maltraitance physique de l'enfant et pour les constructions qu'il représente dans les contextes cliniques, ainsi que la manière dont l'EHS peut promouvoir un engagement familial sont discutées.

Violence against women: Affecting factors and coping methods for women.

OBJECTIVE: To determine women's exposure to domestic violence, it's affecting factors and coping methods. METHODS: The descriptive, cross-sectional study was conducted from September to December 2017 and comprised married women living in Kesan, a district in the Turkish province of Edirne. A self-generated questionnaire was used to gather sociodemographic data and women's exposure to domestic violence. SPSS 16 was used to analyse data. RESULTS: Of the 586 subjects, 321(55%) were aged up to 40 years, while 265(45%) were aged 41 years or more. Domestic violence was reported by 156(26.6%) women. Beating ranked first among physical violence behavior reported by 83(14.2%) subjects. Name-calling and yelling ranked first among verbal violence behaviour reported by 118(20.1%). Keeping women at a certain distance rankedfirst among emotional violence behaviour, reported by 95(16.2%). Not purchasing the fundamental needs of the home ranked first among the economic violence behaviour, reported by 38(6.5%). Finally, 14(2.4%) reported being physically forced to engage in a sexual act, which ranked first among sexual violence behaviour. From among the women abused, 114(66.7%) women said violence occurred because of the instant anger of their partners, and 69(44.2%)said they did not apply to any officialinstitution for help. CONCLUSIONS: Women preferred to remain silent about domestic violence. There is a need to introduce urgent prevention programmes to end domestic violence.

Implementation of the Good School Toolkit in Uganda: a quantitative process evaluation of a successful violence prevention program.

BACKGROUND: The Good School Toolkit, a complex behavioural intervention designed by Raising Voices a Ugandan NGO, reduced past week physical violence from school staff to primary students by an average of 42% in a recent randomised controlled trial. This process evaluation quantitatively examines what was implemented across the twenty-one intervention schools, variations in school prevalence of violence after the intervention, factors that influence exposure to the intervention and factors associated with students' experience of physical violence from staff at study endline. METHODS: Implementation measures were captured prospectively in the twenty-one intervention schools over four school terms from 2012 to 2014 and Toolkit exposure captured in the student (n = 1921) and staff (n = 286) endline cross-sectional surveys in 2014. Implementation measures and the prevalence of violence are summarised across schools and are assessed for correlation using Spearman's Rank Correlation Coefficient. Regression models are used to explore individual factors associated with Toolkit exposure and with physical violence at endline. RESULTS: School prevalence of past week physical violence from staff against students ranged from 7% to 65% across schools at endline. Schools with higher mean levels of teacher Toolkit exposure had larger decreases in violence during the study. Students in schools categorised as implementing a 'low' number of program school-led activities reported less exposure to the Toolkit. Higher student Toolkit exposure was associated with decreased odds of experiencing physical violence from staff (OR: 0.76, 95%CI: 0.67-0.86, p-value< 0.001). Girls, students reporting poorer mental health and students in a lower grade were less exposed to the toolkit. After the intervention, and when adjusting for individual Toolkit exposure, some students remained at increased risk of experiencing violence from staff, including, girls, students reporting poorer mental health, students who experienced other violence and those reporting difficulty with self-care. CONCLUSIONS: Our results suggest that increasing students and teachers exposure to the Good School Toolkit within schools has the potential to bring about further reductions in violence. Effectiveness of the Toolkit may be increased by further targeting and supporting teachers' engagement with girls and students with mental health difficulties. TRIAL REGISTRATION: The trial is registered at clinicaltrials.gov , NCT01678846, August 24th 2012.

Violence in Brazilian schools: Analysis of the effect of the #Tamojunto prevention program for bullying and physical violence.

A randomized controlled trial was conducted with 6637 7th- and 8th-grade students in 72 public schools in 6 Brazilian cities to evaluate the effects of the European drug prevention program Unplugged, called #Tamojunto in Brazil. This article evaluates the effects of #Tamojunto on the prevention of bullying and physical violence. Baseline data were collected from both intervention and control groups prior to program implementation. Follow-up data collection was performed 9 and 21 months later. Generalized estimating equations were used to evaluate changes in the reporting of receiving or practicing bullying and physical violence over time. The program was found to reduce the likelihood of receiving bullying, particularly in the stratum of girls aged 13-15 years at the 9-month follow-up time point. The effect was not sustained at 21 months. There was no significant effect for practicing bullying and for receiving or practicing physical violence.

[Epidemiological, clinical and forensic physical violence against women in Tambacounda (Senegal)]. / Aspects épidémiologiques, cliniques et judiciaires des violences physiques faites aux femmes dans la région de Tambacounda (Sénégal).

INTRODUCTION: To contribute to the fight against physical violence against women, this work aimed to make a 10-year review of cases treated at the Regional Court of Tambacounda. METHODOLOGY: This observational, retrospective, descriptive and analytical study was conducted from 15 October 2014 to 15 April 2015. It covered all the court records of victims of intentional injury from 2006 to 2015. The data was entered and analyzed using Epi info 3.3.2 software. RESULTS: In all, 113 cases were treated. The mean age was 26.5±10.08 years for victims versus 32.5±13.8 years for the aggressors. The victims were all female, and 77.9% of offenders were male. The assaults took place mostly during the day (57.5%), and especially in the homes of victims (61.0%), in the street (16.8%) in the bush (12.4%). The consultation period was less than 24hours for 54.9% of the victims. Clinical examination differentiated: fractures (15%); contusions (13.5%); penetrating wounds (10.6%); bruises (9.7%); eye injuries (7.9%); broken teeth (7.9%); diffuse pains (7.1%), 6.2% polytrauma (6.2%), and 5.3% of trauma on pregnancies. Among the violence, 33.6% were domestic; 11.5% were associated with rape (7.1%); psychological violence (3.6%); rape and death threat (1.8%). Rape was statistically more common among child victims [OR=10.7 (3.2-35.5)] and/or educated victims [OR=5.8 (1.7-19.9)] and aggression in the bush [OR=7.5 (2.2 to 14.2)]. The attackers were lonely and imprisoned in 94.7% and 73.5% of cases respectively. The sentence was firm imprisonment for 89.2% of cases. CONCLUSION: In Tambacounda, health and judicial authorities should enhance public awareness concerning the risk of violence. The extension of this type of study to the national level would have enabled better orientation of control strategies against this scourge.

Justice or Injustice: a History and Critique of the New York State Justice Center for the Protection of People with Special Needs.

The creation of the New York State Justice Center for the Protection of People with Special Needs ("Justice Center") was announced with great fanfare in 2013. Its goal is laudable: strengthening and standardizing "the safety net for vulnerable persons, adults and children alike, who are receiving care from New York's human service agencies and programs." Its jurisdiction is broad: covering residential and non-residential programs and provider agencies that come within the purview of six state oversight agencies, namely, the Office of Mental Health, the Office for People with Developmental Disabilities, the Office of Alcohol and Substance Abuse Services, the Office of Children and Family Services, the Department of Health, and the State Education Department. Its powers are comprehensive: investigating allegations of abuse, neglect, and significant incidents, and disciplining individuals and agencies pursuant to administrative authority. In addition, it can prosecute crimes of neglect and abuse pursuant to criminal prosecutorial authority. Given that over 270,000 vulnerable children and adults live in residential facilities overseen by the state and that numerous other individuals receive services from "day programs operated, licensed[,] or certified by the state[,]" the creation of the Justice Center is consistent with New York's history of oversight of vulnerable individuals. The state has overseen various state and municipal programs and private organizations that have addressed the needs of vulnerable individuals practically since New York's first poorhouse opened in 1736. The development of that oversight has been a series of responses to perceived deficiencies of an existing system, and the creation of the Justice Center is, much in the same way, a response to a 2011 study commissioned by the Governor to examine the treatment and care of vulnerable adults. The Justice Center's jurisdiction reflects a departure, however, from traditional oversight. State administrative and regulatory review has been carried out by specialized state agencies established during the late nineteenth and twentieth centuries to address specific categories of individuals receiving care and treatment according to their needs. Residential and day treatment programs, as well as their custodians and employees, have been disciplined for abuse and neglect in accordance with state regulations created by these agencies. Criminal prosecutions have also been referred to county district attorneys. The Justice Center unites all specialized agencies, all vulnerable individuals with diverse needs, and all custodians and employees trained to meet those needs under one additional layer of uniform rules and regulations, with potential administrative discipline, civil liability, and criminal prosecution also under the same umbrella. This article explores the history of state oversight in New York and the departure represented by the Justice Center. This article first traces the early history of oversight. It then discusses the role of the Commission on Quality of Care for the Mentally Disabled, an antecedent organization similar to the Justice Center. Next, it examines the Justice Center itself. Last, this article concludes with some reflections on the Center.

Applying a participatory approach to the promotion of a culture of respect during childbirth.

Disrespect and abuse (D&A) during facility-based childbirth is a topic of growing concern and attention globally. Several recent studies have sought to quantify the prevalence of D&A, however little evidence exists about effective interventions to mitigate disrespect and abuse, and promote respectful maternity care. In an accompanying article, we describe the process of selecting, implementing, and evaluating a package of interventions designed to prevent and reduce disrespect and abuse in a large urban hospital in Tanzania. Though that study was not powered to detect a definitive impact on reducing D&A, the results showed important changes in intermediate outcomes associated with this goal. In this commentary, we describe the factors that enabled this effect, especially the participatory approach we adopted to engage key stakeholders throughout the planning and implementation of the program. Based on our experience and findings, we conclude that a visible, sustained, and participatory intervention process; committed facility leadership; management support; and staff engagement throughout the project contributed to a marked change in the culture of the hospital to one that values and promotes respectful maternity care. For these changes to translate into dignified care during childbirth for all women in a sustainable fashion, institutional commitment to providing the necessary resources and staff will be needed.

Mitigating disrespect and abuse during childbirth in Tanzania: an exploratory study of the effects of two facility-based interventions in a large public hospital.

BACKGROUND: There is emerging evidence that disrespect and abuse (D&A) during facility-based childbirth is prevalent in countries throughout the world and a barrier to achieving good maternal health outcomes. However, much work remains in the identification of effective interventions to prevent and eliminate D&A during facility-based childbirth. This paper describes an exploratory study conducted in a large referral hospital in Dar es Salaam, Tanzania that sought to measure D&A, introduce a package of interventions to reduce its incidence, and evaluate their effectiveness. METHODS: After extensive consultation with critical constituencies, two discrete interventions were implemented: (1) Open Birth Days (OBD), a birth preparedness and antenatal care education program, and (2) a workshop for healthcare providers based on the Health Workers for Change curriculum. Each intervention was designed to increase knowledge of patient rights and birth preparedness; increase and improve patient-provider and provider-administrator communication; and improve women's experience and provider attitudes. The effects of the interventions were assessed using a pre-post design and a range of tools: pre-post questionnaires for OBD participants and pre-post questionnaires for workshop participants; structured interviews with healthcare providers and administrators; structured interviews with women who gave birth at the study facility; and direct observations of patient-provider interactions during labor and delivery. RESULTS: Comparisons before and after the interventions showed an increase in patient and provider knowledge of user rights across multiple dimensions, as well as women's knowledge of the labor and delivery process. Women reported feeling better prepared for delivery and provider attitudes towards them improved, with providers reporting higher levels of empathy for the women they serve and better interpersonal relationships. Patients and providers reported improved communication, which direct observations confirmed. Additionally, women reported feeling more empowered and confident during delivery. Provider job satisfaction increased substantially from baseline levels, as did user reports of satisfaction and perceptions of care quality. CONCLUSIONS: Collectively, the outcomes of this study indicate that the tested interventions have the potential to be successful in promoting outcomes that are prerequisite to reducing disrespect and abuse. However, a more rigorous evaluation is needed to determine the full impact of these interventions.

International Olympic Committee consensus statement: harassment and abuse (non-accidental violence) in sport.

Despite the well-recognised benefits of sport, there are also negative influences on athlete health, well-being and integrity caused by non-accidental violence through harassment and abuse. All athletes have a right to engage in 'safe sport', defined as an athletic environment that is respectful, equitable and free from all forms of non-accidental violence to athletes. Yet, these issues represent a blind spot for many sport organisations through fear of reputational damage, ignorance, silence or collusion. This consensus statement extends the 2007 IOC Consensus Statement on Sexual Harassment and Abuse in Sport, presenting additional evidence of several other types of harassment and abuse-psychological, physical and neglect. All ages and types of athletes are susceptible to these problems but science confirms that elite, disabled, child and lesbian/gay/bisexual/trans-sexual (LGBT) athletes are at highest risk, that psychological abuse is at the core of all other forms and that athletes can also be perpetrators. Harassment and abuse arise from prejudices expressed through power differences. Perpetrators use a range of interpersonal mechanisms including contact, non-contact/verbal, cyber-based, negligence, bullying and hazing. Attention is paid to the particular risks facing child athletes, athletes with a disability and LGBT athletes. Impacts on the individual athlete and the organisation are discussed. Sport stakeholders are encouraged to consider the wider social parameters of these issues, including cultures of secrecy and deference that too often facilitate abuse, rather than focusing simply on psychopathological causes. The promotion of safe sport is an urgent task and part of the broader international imperative for good governance in sport. A systematic multiagency approach to prevention is most effective, involving athletes, entourage members, sport managers, medical and therapeutic practitioners, educators and criminal justice agencies. Structural and cultural remedies, as well as practical recommendations, are suggested for sport organisations, athletes, sports medicine and allied disciplines, sport scientists and researchers. The successful prevention and eradication of abuse and harassment against athletes rests on the effectiveness of leadership by the major international and national sport organisations.

Silence, shame and abuse in health care: theoretical development on basis of an intervention project among staff.

As health care exists to alleviate patients' suffering it is unacceptable that it inflicts unnecessary suffering on patients. We therefore have developed and evaluated a drama pedagogical model for staff interventions using Forum Play, focusing on staff's experiences of failed encounters where they have perceived that the patient felt abused. In the current paper we present how our preliminary theoretical framework of intervening against abuse in health care developed and was revised during this intervention. During and after the intervention, five important lessons were learned and incorporated in our present theoretical framework. First, a Forum Play intervention may break the silence culture that surrounds abuse in health care. Second, organizing staff training in groups was essential and transformed abuse from being an individual problem inflicting shame into a collective responsibility. Third, initial theoretical concepts "moral resources" and "the vicious violence triangle" proved valuable and became useful pedagogical tools during the intervention. Four, the intervention can be understood as having strengthened staff's moral resources. Five, regret appeared to be an underexplored resource in medical training and clinical work.The occurrence of abuse in health care is a complex phenomenon and the research area is in need of theoretical understanding. We hope this paper can inspire others to further develop theories and interventions in order to counteract abuse in health care.

Public Health Information Delivery in the Emergency Department: Analysis of a Kiosk-Based Program.

BACKGROUND: Because more than one-third of the U.S. population visits an emergency department (ED) any given year, public health interventions in the ED can have major population-level impacts. OBJECTIVES: We determined ED patients' interest in receiving information via kiosk on common, chronic conditions for which education and preventive screening could offer public health benefit and to assess what topical information patients are interested in receiving. METHODS: This is a secondary analysis of survey data from an ED pilot program December 2011 to April 2012. Main outcome measures were patients' interests in receiving information on health topics via kiosk module. RESULTS: More than half of the 4351 patients indicated interest in receiving information on at least one health topic, including high blood pressure (30%), depression (21%), diabetes (18%), sexually transmitted diseases (11%), drug abuse (6%), and physical abuse (3%). African-American patients were more likely to be interested in receiving information on high blood pressure (odds ratio [OR] 2.7, 95% confidence interval [95% CI] 2.2-3.2]), depression (OR 1.3, 95% CI 1.1-1.6), diabetes/sugar (OR 2.2, 95% CI 1.8-2.8), drug abuse (OR 1.4, 95% CI 1.0-1.9), and sexually transmitted diseases (OR 2.6, 95% CI 1.9-3.7). Participants >55 years of age were more likely to desire information on high blood pressure and diabetes (age 55-64 years: OR 4.0, 95% CI 3.1-5.1; age >64 years: OR 4.4, 95% CI 3.2-6.2). Patients who were interested in receiving public health information were more likely to be older, African American, and male (p < 0.05). CONCLUSIONS: Interest in obtaining kiosk-delivered education on hypertension predominated. Kiosks are versatile tools that could be used in ED settings to provide health education services.

Safeguarding the child athlete in sport: a review, a framework and recommendations for the IOC youth athlete development model.

Participation in sport has many physical, psychological and social benefits for the child athlete. A growing body of evidence indicates, however, that sport participation may have inherent threats for the child's well-being. The subject of safeguarding children in sport has seen an increase in scientific study in recent years. In particular, there is increasing emphasis on identifying who is involved in abuse, the context of where it occurs and the identification of the various forms of abuse that take place in the sporting domain. Safeguarding principles developed by the International Safeguarding Children in Sport Founders Group are presented along with 8 underlying pillars which underpin the successful adoption and implementation of safeguarding strategies. This safeguarding model is designed to assist sport organisations in the creation of a safe sporting environment to ensure that the child athlete can flourish and reach their athletic potential through an enjoyable experience. The aim of this narrative review is to (1) present a summary of the scientific literature on the threats to children in sport; (2) introduce a framework to categorise these threats; (3) identify research gaps in the field and (4) provide safeguarding recommendations for sport organisations.