"Our services are not the same": the impact of the COVID-19 pandemic on care interactions in women's shelters.

BACKGROUND: Guidelines and regulations in response to the COVID-19 pandemic have significantly impacted the health care sector. We explore these impacts in the gender-based violence (GBV) services sector and, more specifically, in the context of women's shelters. METHODS: Using an interpretive description and integrated knowledge mobilization approach, we interviewed 8 women's shelter clients, 26 staff, and conducted focus groups with 24 Executive Directors. RESULTS: We found that pandemic responses challenged longstanding values that guide work in women's shelters, specifically feminist and anti-oppressive practices. Physical distancing, masking, and closure of communal spaces intended to slow or stop the spread of the novel coronavirus created barriers to the provision of care, made it difficult to maintain or create positive connections with and among women and children, and re-traumatized some women and children. Despite these challenges, staff and leaders were creative in their attempts to provide quality care, though these efforts, including workarounds, were not without their own challenges. CONCLUSIONS: This research highlights the need to tailor crisis response to sector-specific realities that support service values and standards of care.

Navigating multiple pandemics: A critical analysis of the impact of COVID-19 policy responses on gender-based violence services.

COVID-19 illustrated what governments can do to mobilise against a global threat. Despite the strong governmental response to COVID-19 in Canada, another 'pandemic', gender-based violence (GBV), has been causing grave harm with generally insufficient policy responses. Using interpretive description methodology, 26 interviews were conducted with shelter staff and 5 focus groups with 24 executive directors (EDs) from GBV service organizations in Ontario, Canada. Five main themes were identified and explored, namely that: (1) there are in fact four pandemics at play; (2) the interplay of pandemics amplified existing systemic weaknesses; (3) the key role of informal partnerships and community support, (4) temporary changes in patterns of funding allocation; and (5) exhaustion as a consequence of addressing multiple and concurrent pandemics. Implications and recommendations for researchers, policy makers, and the GBV sector are discussed.

"We're so limited with what we actually can do if we follow all the rules": a qualitative study of the impact of COVID-19 public health protocols on violence against women services.

BACKGROUND: Violence against women (VAW) is a major public health problem that grew worse during the COVID-19 pandemic. While all services were impacted by changing pandemic guidance, VAW shelters, as congregate settings with multiple funders and regulators, faced unique challenges. METHODS: We conducted a qualitative analysis of interviews with 26 women's shelter staff and eight women accessing care, as well as 10 focus groups (five each at two time points approximately a year apart) involving 24 leaders from VAW and related services in Ontario, Canada. RESULTS: We identified eight overlapping themes specific to government and public health COVID-19 regulations and their application in women's shelters. Overall, inconsistency or lack of clarity in rules, and how they were communicated, caused significant stress for women using, and staff providing, services. Staff and leaders were very concerned about rules that isolated women or replicated other aspects of abusive relationships. Women wanted to understand what options were available and what was expected of them and their children in these spaces. Leaders sought clarity and consistency from their various government funders, and from public health authorities, in the face of ever-evolving directives. As in the broader public, there was often the perception that the rules did not apply equally to everyone, for example, for women of colour using VAW services, or those whose first language was not English. CONCLUSIONS: In the absence of consistent pandemic guidance and how to implement it, many VAW services devised tailored solutions to balance safety from COVID-19 with women's physical and emotional safety from abuse and its impacts. However, this was difficult and exhausting. A key policy implication is that women's shelters are a distinct form of congregate housing; they are very different in terms of services provided, size, type and age of facilities from other congregate settings and this must be reflected in public health directives. Better communication and synchronization of policies among government funders and public health authorities, in consultation with VAW sector leaders, would mean protocols tailored to minimize harm to women and children while protecting health and safety.

A Genderfluid Approach to Aesthetic Language in Dermatology.

Dermatologists are in a unique position to help transgender and non-binary individuals achieve an appearance that corresponds to their identity. Minimally invasive procedures for gender affirmation are relatively safe and customizable, providing an increasingly favorable treatment niche for these patients.1-4.

Successful, Easy to Access, Online Publication of COVID-19 Data During the Pandemic, New York City, 2020.

Making public health data easier to access, understand, and use makes it more likely that the data will be influential. Throughout the COVID-19 pandemic, the New York City (NYC) Department of Health and Mental Hygiene's Web-based data communication became a cornerstone of NYC's response and allowed the public, journalists, and researchers to access and understand the data in a way that supported the pandemic response and brought attention to the deeply unequal patterns of COVID-19's morbidity and mortality in NYC. (Am J Public Health. 2021;111(S3):S193-S196. https://doi.org/10.2105/AJPH.2021.306446).

Impacts of trauma- and violence-informed care education: A mixed method follow-up evaluation with health & social service professionals.

OBJECTIVES: Trauma- and violence-informed care (TVIC) creates safety by understanding the impacts of trauma on health and behavior, and the intersecting impacts of structural and interpersonal violence. This study examined the impact, 1-2 years later, of TVIC professional education. DESIGN, SAMPLE AND MEASUREMENTS: We conducted a mixed method descriptive follow-up evaluation (online survey, n = 67, and semi-structured interviews, n = 7) with health and social service providers, leaders and researchers who attended TVIC workshops. Participants were asked how the workshop impacted their thinking, actions and perceptions of organizational changes. RESULTS: Participants reported greater impact on attitudes than on behaviors. The most common change in awareness and thinking related to better understanding of the links among trauma, pain and substance use. Practice changes included more active listening and empathy, less use of jargon and less judgement in care encounters. Participants linked these practices to better care interactions, and more trust, openness and satisfaction among service users. CONCLUSION: Educating health professionals and others (e.g. educators) about trauma, violence, and discrimination is not easy. TVIC education can help shift potentially stigmatizing attitudes which can then precipitate practice change. These approaches are emerging as an important way to improve health and quality of life.

Five Waves of an Online HIV Self-Test Giveaway in New York City, 2015 to 2018.

BACKGROUND: HIV self-tests increase HIV status awareness by providing convenience and privacy, although cost and access may limit use. Since 2015, the New York City (NYC) Health Department has conducted 5 waves of an online Home Test Giveaway. METHODS: We recruited adult cisgender men who have sex with men (MSM) and transgender and gender-nonconforming (TGNC) individuals who had sex with men, who were living in NYC, not previously HIV diagnosed, and using paid digital advertisements (4-8 weeks per wave). Eligible respondents were e-mailed a code to redeem on the manufacturer's website for a free HIV self-test and an online follow-up survey ~2 months later. For key process and outcome measures, we present means across 5 waves. RESULTS: Across the 5 waves of Home Test Giveaway, there were 28,921 responses to the eligibility questionnaire: 17,383 were eligible, 12,182 redeemed a code for a free HIV self-test, and 7935 responded to the follow-up survey (46% of eligible responses). Among eligible responses, approximately half were Latino/a (mean, 32%) or non-Latino/a, black (mean, 17%). Mean report of never testing before was 16%. Among 5903 follow-up survey responses who reported test use, 32 reported reactive results with no known previous diagnosis (0.54%), of whom 78% reported receiving confirmatory testing. Report of likelihood of recommending the Home Test Giveaway to friends was high (mean, 96%). CONCLUSIONS: We recruited diverse NYC MSM and TGNC and distributed a large number of HIV self-tests to them. Among respondents who reported newly reactive tests, the majority reported confirmatory testing. This seems to be one acceptable way to reach MSM and TGNC for HIV testing, including those who have never tested before.

Identifying children exposed to maltreatment: a systematic review update.

BACKGROUND: Child maltreatment affects a significant number of children globally. Strategies have been developed to identify children suspected of having been exposed to maltreatment with the aim of reducing further maltreatment and impairment. This systematic review evaluates the accuracy of strategies for identifying children exposed to maltreatment. METHODS: We conducted a systematic search of seven databases: Medline, Embase, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, Cochrane Libraries, Sociological Abstracts and the Education Resources Information Center. We included studies published from 1961 to July 2, 2019 estimating the accuracy of instruments for identifying potential maltreatment of children, including neglect, physical abuse, emotional abuse, and sexual abuse. We extracted data about accuracy and narratively synthesised the evidence. For five studies-where the population and setting matched known prevalence estimates in an emergency department setting-we calculated false positives and negatives. We assessed risk of bias using QUADAS-2. RESULTS: We included 32 articles (representing 31 studies) that evaluated various identification strategies, including three screening tools (SPUTOVAMO checklist, Escape instrument, and a 6-item screening questionnaire for child sex trafficking). No studies evaluated the effects of identification strategies on important outcomes for children. All studies were rated as having serious risk of bias (often because of verification bias). The findings suggest that use of the SPUTOVAMO and Escape screening tools at the population level (per 100,000) would result in hundreds of children being missed and thousands of children being over identified. CONCLUSIONS: There is low to very low certainty evidence that the use of screening tools may result in high numbers of children being falsely suspected or missed. These harms may outweigh the potential benefits of using such tools in practice (PROSPERO 2016:CRD42016039659).

Patient satisfaction and our clinical experience with 459 microfocused ultrasound treatments.

PURPOSE: Microfocused ultrasound (MFUS) is a safe and effective method for noninvasive skin tightening. Previous clinical studies demonstrate a 60-100% patient satisfaction after MFUS. We used an anonymous online platform after MFUS to assess patient satisfaction. DESIGN: Patients treated with MFUS between January 2013 and 2016 were invited to complete an anonymous online survey at least 4 months post-treatment. Patients were asked to rate improvement in skin tightening as none (0%), mild (0-25%), moderate (26-50%), significant (51-75%), or dramatic (76-100%) and treatment satisfaction as disappointed, neutral, satisfied, or extremely satisfied. SUMMARY: Between January 2013 and 2016, 253 patients received 459 MFUS treatments at our center. A total of 83 surveys were received with data. Nearly 80% of responders reported at least mild improvement, with 14.5% indicating significant improvement, 27.7% indicating moderate, 37.3% indicating mild, and 20.5% indicating none. In addition, 53.1% of responders reported being satisfied or extremely satisfied with the results. 44.6% of responders did not feel treatment results met expectations. CONCLUSION: Patient satisfaction with elective cosmetic procedures is an important indicator of success. Our current study demonstrates a high response rate, with almost 80% of responders indicating at least mild tightening with MFUS treatment. Interestingly, only 53.1% of patients reported satisfaction after treatment, a lower satisfaction rate than reported in previous non-anonymous studies and lower than patients report in our office follow-up appointments. This discrepancy may be due to gratitude bias. Anonymous surveys likely provide a more accurate assessment of patients' perceptions and will improve physician's future counseling efforts. Lasers Surg. Med. 51:495-499, 2019. © 2019 Wiley Periodicals, Inc.

Current Reports on Perinatal Intimate Partner Violence.

PURPOSE OF REVIEW: The purpose of this study was to review the literature on perinatal intimate partner violence, focusing on recent knowledge to guide mental health professionals on the best approaches to identify and treat women exposed to perinatal intimate partner violence. RECENT FINDINGS: Risk factors have been broadened from individual victim and perpetrator factors to include relationship, community, and societal factors which interact together. Better information is now available on how to identify, document, and treat women exposed to violence around the time of conception, pregnancy, and the postpartum period. Recent information helps psychiatrists and other mental health professionals assist women exposed to violence related to the perinatal period; however, further research is needed to provide improved evidence for optimal interventions for better patient outcomes.

A Qualitative Study of Challenges and Opportunities in Mobilizing Research Knowledge on Violence Against Women.

Background Effective delivery of interventions by health and social services requires research-based knowledge which identifies the causes and consequences of violence against women. Methods to effectively share new knowledge with violence against women decision-makers remain under studied. Purpose This paper examines how new research-based knowledge-namely, the lack of efficacy of health-care screening for exposure to intimate partner violence against women-is received by stakeholders in the violence against women field. Methods Data from 10 stakeholder group discussions ( N = 86) conducted during a knowledge-sharing forum were analyzed to assess how stakeholders responded to the new knowledge. Results Participant reactions ranged from full acceptance to significant resistance to the research findings. We suggest themes that help explain these reactions, including the context and content of our findings and their epistemological match to participants' experiences and beliefs, and the perceived value of research evidence, compared to other forms of knowledge. Conclusions Violence against women is a complex psycho-social phenomenon, and people with an interest in this field bring diverse and even conflicting perspectives regarding its causes, consequences, and potential solutions.

"Blaming the Flowers for Wilting": Idealized Aging in a Health Charity Video.

Amid growing concern about the graying population, an emerging theme in public health discourse is that of "successful aging." In this article, we use a governmentality lens to analyze a Canadian health promotion video, titled "Make Health Last: What Will Your Last 10 Years Look Like?" and viewers' responses to its message. The video presents starkly different scenarios of the last decade of life, conveying a neo-liberal rationality in which health in old age is positioned as a matter of individual choice. Our analysis suggests that while viewers generally support the video's message of personal responsibility for health, some are uneasy about implied claims that age-related illness can be prevented by choosing to be healthy. We argue that the video's simplistic messaging about health in later life raises disturbing questions about health promotion campaigns that deny the "normal" aging body and blame the elderly for "deciding" not to remain youthful and healthy.

Gender Differences in Workplace Disclosure and Supports for Domestic Violence: Results of a Pan-Canadian Survey.

Although domestic violence is increasingly identified as a workplace issue, little is known about workplace supports and the role of gender in workplace disclosure experiences. Using a subset of 2,831 people who experienced domestic violence, we examined (a) who discloses at work and to whom, and reasons for not disclosing; (b) helpfulness of disclosure recipients, including types of supports received; and (c) overall outcomes of disclosing, including negative consequences. Data were analyzed using descriptive statistics and content analysis. More than 40% of participants disclosed domestic violence at work, usually to coworkers or supervisors. They received various supports which were generally seen as helpful. Although not common, negative consequences of disclosure were reported. Men were less likely to disclose, but few other gender differences emerged. Implications for improving workplace supports are discussed.

An Evaluation of Efficacy and Tolerability of Novel Enzyme Exfoliation Versus Glycolic Acid in Photodamage Treatment.

BACKGROUND: Glycolic acid acts by chemical destruction of adhesions between skin cells to exfoliate superficial skin layers and excess pigmentation. It is well known to improve the appearance of photoaged skin, but is associated with varying degrees of skin irritation. Hydrolyzed salmon roe proteins destroy cell adhesions enzymatically with potentially less irritation than acid treatments. This double-blind prospective study assesses the efficacy and tolerability of hydrolyzed roe versus glycolic acid, and glycolic acid with citric acid. METHODS: 75 female subjects with mild to moderate photodamage, all skin types, and ages 31-70 years, were enrolled. In this 12 week study of twice daily self-treatments, patients were assigned to one of 3 groups; Group 1 (n-19) was assigned hydrolyzed roe cream, Group 2 (n=17), 4% glycolic acid, or Group 3 (n-16), 8% glycolic acid plus 2% citric acid. All patients used the same mild face wash and SPF 30 sunscreen throughout the study. Patients were evaluated at weeks 0, 8 and 12 for objective and subjective tolerability, improvement in photodamage by VISIA Complexion Analysis, modified Packman and Gans method, Visual Analog Scale (VAS), and answered an opinion questionnaire. RESULTS: Group 1 improved in skin clarity from a VAS 44.1 to 55.7 (P=0.0317) at week 12. VISIA mean scores correlated with office evaluation showing improvement in brown spots from 453 to 417 (P = 0.0115) at 12 weeks. Group 2 improved in superficial fine lines at week 8 (-5.9, P=0.0428) and week 12 (-9.1, P=0.0019). Group 3 improved at week 12 in skin clarity (11.5, P = 0.0469) and skin roughness (-13.3, P = 0.0426), and in hyperpigmentation at week 8 (-9.4, P = 0.0462) and week 12 (-14.6, P= 0.0019). CONCLUSION: Topical hydrolyzed roe protein used twice daily improves skin clarity. It has good tolerability with fewer instances of stinging and burning than the other glycolic acid containing creams. Patient's opinions of the 3 products were similar.

'My health is not a job': a qualitative exploration of personal health management and imperatives of the 'new public health'.

BACKGROUND: There is an increasing push in Western healthcare for people to 'manage' their health, a key aspect of what has been called the 'new public health'. It has been argued that this 'personal health management' - informal work done to monitor, inform, or influence one's health - may be a burden, with potential to contribute to poor health outcomes. However, there is little research actually examining perceptions of personal health management and the 'burden' of these activities, particularly for generally healthy individuals. METHODS: We conducted exploratory qualitative interviews with 30 generally healthy men and women about their perceptions and experiences of personal health management. Questions focused on health behaviours (e.g., information seeking), as well as feelings about these behaviours and perceptions of the time dedicated to health. Audio-recorded interviews were transcribed and analyzed qualitatively using NVivo 10. Where appropriate, quantitative codes were applied and descriptive statistics are reported alongside qualitative findings. RESULTS: Participants were generally satisfied with the amount of time spent on their health and few perceived personal health management as a burden. Many participants took issue with the concept of 'work' being associated with health and stressed the importance of taking personal responsibility for health. CONCLUSIONS: Our findings suggest that generally healthy people have internalised the notion of the 'new public health' and accepted the imperative of personal health responsibility. On the one hand, this bodes well for healthy individuals; their positive attitude may lead to better health outcomes, and the manageable amount of time spent suggests personal health management is unlikely to cause negative health consequences associated with stress. On the other hand, our findings may indicate that other factors, such as social determinants of health, are ignored in health promotion efforts and that those who cannot manage their own health may fall further behind. Future research should continue to explore the time people spend 'working' for their health, and how they perceive and respond to 'new public health' imperatives.

Strategies to promote uptake and use of intimate partner violence and child maltreatment knowledge: an integrative review.

BACKGROUND: Intimate partner violence (IPV) and child maltreatment (CM) are major social and public health problems. Knowledge translation (KT) of best available research evidence has been suggested as a strategy to improve the care of those exposed to violence, however research on how best to promote the uptake and use of IPV and CM evidence for policy and practice is limited. Our research asked: 1) What is the extent of IPV/CM-specific KT research? 2) What KT strategies effectively translate IPV/CM knowledge? and 3) What are the barriers and facilitators relevant to translating IPV/CM-specific knowledge? METHODS: We conducted an integrative review to summarize and synthesize the available evidence regarding IPV/CM-specific KT research. We employed multiple search methods, including database searches of Embase, CINAHL, ERIC, PsycInfo, Sociological Abstracts, and Medline (through April, 2013). Eligibility and quality assessments for each article were conducted by at least two team members. Included articles were analyzed quantitatively using descriptive statistics and qualitatively using descriptive content analysis. RESULTS: Of 1230 identified articles, 62 were included in the review, including 5 review articles. KT strategies were generally successful at improving various knowledge/attitude and behavioural/behavioural intention outcomes, but the heterogeneity among KT strategies, recipients, study designs and measured outcomes made it difficult to draw specific conclusions. Four key themes were identified: existing measurement tools and promising/effective KT strategies are underused, KT efforts are rarely linked to health-related outcomes for those exposed to violence, there is a lack of evidence regarding the long-term effectiveness of KT interventions, and authors' inferences about barriers, facilitators, and effective/ineffective KT strategies are often not supported by data. The emotional and sometimes contested nature of the knowledge appears to be an important barrier unique to IPV/CM KT. CONCLUSIONS: To direct future KT in this area, we present a guiding framework that highlights the need for implementers to use/adapt promising KT strategies that carefully consider contextual factors, including the fact that content in IPV/CM may be more difficult to engage with than other health topics. The framework also provides guidance regarding use of measurement tools and designs to more effectively evaluate and report on KT efforts.

Microfocused ultrasound for skin tightening.

The demand for noninvasive skin tightening procedures is increasing as patients seek safe and effective alternatives to aesthetic surgical procedures of the face, neck, and body. Over the past decade, radiofrequency and infrared laser devices have been popularized owing to their ability to deliver controlled heat to the dermis, stimulate neocollagenesis, and effect modest tissue tightening with minimal recovery. However, these less invasive approaches are historically associated with inferior efficacy so that surgery still remains the treatment of choice to address moderate to severe tissue laxity. Microfocused ultrasound was recently introduced as a novel energy modality for transcutaneous heat delivery that reaches the deeper subdermal connective tissue in tightly focused zones at consistent programmed depths. The goal is to produce a deeper wound healing response at multiple levels with robust collagen remodeling and a more durable clinical response. The Ulthera device (Ulthera, Inc, Meza, AZ), with refined microfocused ultrasound technology, has been adapted specifically for skin tightening and lifting with little recovery or risk of complications since its introduction in 2009. As clinical parameters are studied and optimized, enhanced efficacy and consistency of clinical improvement is expected.