Epidemiology of Trauma History and Body Pain: A Retrospective Study of Community-Based Australian Women.

OBJECTIVE: To assess whether body pain was associated with different trauma histories (physical injury vs. interpersonal injury [IPI]) within Australian women, along with body pain and trauma history associations with biological and psychological (biopsycho) confounders. METHODS: A retrospective cross-sectional analysis was conducted on the Australian Longitudinal Study on Women's Health (ALSWH) 1973-1978 birth cohort wave 6 data. Relevant life events were categorized into two types of traumatic experience and included as exposure variables in a multinomial regression model for body pain subgroups. Also, subgroup analyses considered trauma and pain effects and interactions on biopsycho burden. RESULTS: The unadjusted multinomial regression model revealed that a history of physical injury was found to be significantly associated with body pain severity, as was a history of IPI trauma. After the model was adjusted to include biopsycho confounders, the association between IPI and body pain was no longer significant, and post hoc analysis revealed the relationship was instead mediated by biopsycho confounders. Women with a history of IPI and body pain were also found to have the greatest biopsycho (physical functioning, stress, anxiety, and depression) burden. DISCUSSION: The relationship between IPI and body pain was found to be mediated by biopsycho burden, whereas the relationship between physical injury and body pain was not. Also, a history of IPI was associated with a greater biopsycho burden than was a history of physical injury. These results suggest there is clinical value in considering the comprehensive trauma history of patients with pain when developing their biopsychosocial model of care.

Medical education too: sexual harassment within the educational context of medicine - insights of undergraduates.

BACKGROUND: Assessment of the presence and characteristics of sexual harassment in academic medicine is a global issue. Only limited international data are available so far. METHODS: Aim: To assess the extent of sexual harassment and identify the perpetrators in the student population of the medical school of Münster, Germany. A survey was undertaken, using the Medical Women's International Association sexual harassment questionnaire translated into German. The anonymous online questionnaire was sent as a link to all medical undergraduates at Münster Medical School via a mailing list between 1 October and 30 November 2018. Identifying or potentially identifying data were not collected. Data were analysed by descriptive statistical methods such as categorical variables. Baseline characteristics, e.g. answers by male or female medical students, were correlated with their individual sexual harassment experiences and perpetrator groups by means of univariate analysis. RESULTS: A total of 2162 medical students were asked to participate, with 623 (28.8%) completing the survey. Sexual harassment is a significant issue among medical students at Münster Medical School with over half (58.9%) of all undergraduates being exposed to sexually harassing behaviour. In total, 31.8% of all participants reported having experienced unwanted physical sexual contact such as unwanted physical touching, with 87.6% of the victims being female. Overall, 41.3% personally experienced verbal sexual harassment of which 87.4% were female. Furthermore, 8.5% of undergraduates faced forced sexual contact such as oral, anal or vaginal penetration, intercourse and rape, with all victims being female. Perpetrators in these cases were mostly male medical superiors (7.0%) and male patients (18.3%). In general, most perpetrators were patients, followed by medical superiors and educators, and less frequently by colleagues. CONCLUSIONS: Sexual harassment in medical education and the medical workplace is a significant problem in a German medical school. Most students experiencing sexual harassment are females. Female students also experience the more serious forms of sexual harassment more often.

Student dignity during work-integrated learning: a qualitative study exploring student and supervisors' perspectives.

While University students increasingly participate in work-integrated learning (WIL), their dignity is often violated during WIL. The current literature is limited in so far as it typically focuses on student perspectives within healthcare contexts and does not use the concept of 'dignity'. Instead, this study explored student and supervisor perspectives on student dignity during WIL across healthcare and non-healthcare disciplines. Research questions included: What are: (1) types of student dignity experiences and patterns by groups; (2) factors contributing to experiences; (3) consequences of experiences? Sixty-five semi-structured interviews were conducted using narrative interviewing techniques with 30 supervisors and 46 students from healthcare (medicine, nursing and counselling) and non-healthcare (business, law and education) disciplines. Data were analyzed using framework analysis. Nine common narrative types were identified within 344 stories: verbal abuse, right for learning opportunities, care, inclusion, reasonable expectations, right for appropriate feedback, equality, trust, and right to be informed. Factors contributing to dignity experiences and consequences were often at the individual level (e.g. student/supervisor characteristics). We found some salient differences in perceptions of experiences between students and supervisors, but few differences between healthcare and non-healthcare disciplines. This study extends WIL research based on student perspectives in healthcare, and provides practice and further research guidance to enhance student dignity during WIL.

#MindinBody - feasibility of vigorous exercise (Bikram yoga versus high intensity interval training) to improve persistent pain in women with a history of trauma: a pilot randomized control trial.

BACKGROUND: The neurobiology of persistent pain shares common underlying psychobiology with that of traumatic stress. Modern treatments for traumatic stress often involve bottom-up sensorimotor retraining/exposure therapies, where breath, movement, balance and mindfulness, are used to target underlying psychobiology. Vigorous exercise, in particular Bikram yoga, combines many of these sensorimotor/exposure therapeutic features. However, there is very little research investigating the feasibility and efficacy of such treatments for targeting the underlying psychobiology of persistent pain. METHODS: This study was a randomized controlled trail (RCT) comparing the efficacy of Bikram yoga versus high intensity interval training (HIIT), for improving persistent pain in women aged 20 to 50 years. The participants were 1:1 randomized to attend their assigned intervention, 3 times per week, for 8 weeks. The primary outcome measure was the Brief Pain Inventory (BPI) and further pain related biopsychosocial secondary outcomes, including SF-36 Medical Outcomes and heart rate variability (HRV), were also explored. Data was collected pre (t0) and post (t1) intervention via an online questionnaire and physiological testing. RESULTS: A total of 34 women were recruited from the community. Analyses using ANCOVA demonstrated no significant difference in BPI (severity plus interference) scores between the Bikram yoga (n = 17) and the HIIT (n = 15). Women in the Bikram yoga group demonstrated significantly improved SF-36 subscale physical functioning: [ANCOVA: F(1, 29) = 6.17, p = .019, partial eta-squared effect size (ηp2) = .175 and mental health: F(1, 29) = 9.09, p = .005, ηp2 = .239; and increased heart rate variability (SDNN): F(1, 29) = 5.12, p = .013, ηp2 = .150, scores compared to the HIIT group. Across both groups, pain was shown to decrease, no injuries were experienced and retention rates were 94% for Bikram yoga and 75% for HIIT . CONCLUSIONS: Bikram yoga does not appear a superior exercise compared to HIIT for persistent pain. However, imporvements in quality of life measures and indicator of better health were seen in the Bikram yoga group. The outcomes of the present study suggest vigorous exercise interventions in persistent pain cohorts are feasible. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ( ACTRN12617001507370 , 26/10/2017).

Adverse Childhood Experiences and Healthcare Costs in Adult Life.

The current study aims to present the prevalence of adverse childhood experiences and examine the healthcare costs associated with primary, allied, and specialist healthcare services. The Australian Longitudinal Study on Women's Health is a general health survey of four nationally representative age cohorts. The current study uses 20 years of survey and administrative data (1996-2015) from the cohort born 1973-1978. Overall, 41% of women indicated at least one category of childhood adversity. The most commonly reported type of childhood adversity was having a household member with a mental illness (16%), with the most commonly reported ACES category being psychological abuse (17%). Women who had experienced adversity in childhood had higher healthcare costs than women who had not experienced adversity. The healthcare costs associated with experiences of adversity in childhood fully justify a comprehensive policy and practice review.

Paramedic Students' Knowledge, Attitudes, and Preparedness to Manage Intimate Partner Violence Patients.

BACKGROUND: Intimate partner violence (IPV) refers to abuse transpiring between people in an intimate relationship. Intimate partner violence is a leading cause of morbidity and mortality for women that paramedics frequently report encountering and yet paramedics rarely receive formal education or training to manage. The response of paramedics to IPV is likely to be directed by their individual knowledge, attitudes, and preparedness; all of which are currently unknown. This study aimed to measure paramedic students' knowledge, attitudes, and preparedness to manage IPV patients, and provides baseline data to inform the development of contemporary curricula. METHODS: We surveyed a cohort of paramedic students from two Australian universities using the Modified Physician REadiness to Manage Intimate partner violence Survey (PREMIS). Internal consistency of previously identified scales was calculated and multiple linear regression was used to measure the association between previous training, knowledge, attitudes, and preparation. RESULTS: We received 260 surveys (80.5% response rate). Results show that actual knowledge, perceived knowledge, and preparedness to manage IPV patients were low. Students with previous training reported higher perceived knowledge (p <.05) and preparedness (p <.01). Participants reported low self-efficacy, confidence, and preparation to manage IPV patients and demonstrated mostly neutral attitudes toward women and patients. CONCLUSIONS: Results indicate students require increased IPV education. Education should improve knowledge and preparedness to recognize and refer IPV patients, as well as change neutral and inappropriate attitudes. Incorporating such education and training into the paramedic curricula may improve the preparedness of practitioners, resulting in an improved response to IPV patients.

A systematic review of intimate partner violence educational interventions delivered to allied health care practitioners.

CONTEXT: Intimate partner violence (IPV) is a significant cause of morbidity and mortality in women worldwide. Numerous health organisations have called for increased education for health care practitioners who encounter IPV patients and the first clinical guidelines for health services responding to IPV were recently published. This renewed focus has created a need to examine the current evidence for IPV education so that it may inform the next generation of educational interventions. OBJECTIVES: This study was designed to examine the effects of IPV educational interventions on the knowledge, attitudes, skills and behaviours of allied health care practitioners (AHCPs). METHODS: We conducted a systematic search of multiple databases up to the end of May 2015. We selected studies that included IPV educational interventions for AHCPs and that measured knowledge, attitude, skill or behavioural outcomes. Studies were evaluated based on methodological quality, education context and outcome measurement. RESULTS: We found 2757 articles from which 18 were selected for inclusion. Study participants included nurses, dentists, social workers and paramedics. Educational interventions ranged widely in length, delivery format and topics covered. Findings indicate that improvements in some knowledge, attitudes, skills and behaviours are associated with education, although the lack of high-quality studies indicates that conclusions should be treated with caution. CONCLUSIONS: Future studies should be conducted using rigorous methodology and validated instruments to measure evidence-based outcomes and should target a wider range of AHCPs. Recommendations are provided on education content and delivery, study methodology and outcome measurement based on insights gained from selected studies.

General practice service use and satisfaction among female survivors of childhood sexual abuse.

BACKGROUND: Because childhood sexual abuse (CSA) and adult violence are associated with poorer physical and mental health of women, our aim was to investigate the associations between CSA, adult violence experiences and general practice service use and satisfaction in a community sample of Australian women aged 28-33 years. METHODS: Data of 9058 women from the 1973-78 cohort who completed Survey 4 of the Australian Longitudinal Study on Women's Health were analysed. RESULTS: Logistic regressions conducted indicated that after controlling for demographic variables, women with experiences of lifetime violence were more likely to have higher general practice service use compared to those without violence experiences. CSA was not associated with an increase in service use but was significantly associated with a decrease in service satisfaction. This find-ing remained significant even when they visited the general practice more frequently. DISCUSSION: Implementing trauma-informed care is suggested as a way to improve the satisfaction of this patient group with complex needs.

Women survivors of child abuse - don't ask, don't tell.

BACKGROUND: Rates of disclosure of child abuse by women survivors are low, and general practitioners seldom ask women about such history. This study explored the experiences of women survivors: child abuse disclosure, GP service use and thoughts on being asked about their abuse experiences. METHODS: A cross-sectional study containing quantitative and qualitative questions was conducted with 108 women child abuse survivors. RESULTS: Only 5% of the women disclosed their child abuse to their GP and 19% were asked about their child abuse history. More than half of the women (58%) asked reported feeling hopeful or relieved and none reported feeling offended. DISCUSSION: Rates of child abuse inquiry by GPs and disclosures by women survivors remain low. With the majority of women survivors reporting feeling relieved and none offended when asked about their child abuse experiences, GPs should consider asking women who present to their practice about such experiences: This may facilitate early intervention.

Sexual trauma in women - the importance of identifying a history of sexual violence.

BACKGROUND: One in three women in Australia will experience sexual violence at some time in their life. Although these women use health services more than nonvictimised women, they may not receive the holistic care they need if their sexual trauma history is not known. OBJECTIVE: This article discusses the importance of opportunistically identifying a history of sexual violence in women presenting to general practice in order to provide optimal healthcare and avoid iatrogenic retraumatisation. DISCUSSION: A history of sexual violence is associated with an increased incidence of long term physical and psychological health problems, psychosocial difficulties, risk taking behaviours and premature death. Most survivors do not disclose a history of sexual violence to their doctors. Without this context, their ongoing health issues may not be fully understood, leading to suboptimal care. A safe environment is vital to support disclosure. General practitioners are well placed to identify, support and treat and/or appropriately refer women with a history of sexual violence. Priorities in management include addressing the pervasive long term consequences of sexual violence, encouraging preventive care and avoiding inadvertent retraumatisation.

Medical journal covers--an analysis of gendered images and how these might influence best practice.

BACKGROUND: Images convey a concept or message to their audience. In medical communications, social expectations and stereotypes can be transferred through language, images and practices just as they can in the lay press. Most medical journals utilise images on their front covers, with the aim of enticing readers to open the journal. OBJECTIVE: This article explores the use of image on the covers of two medical journals. It investigates the concepts of gender and the patient-doctor relationship used in these images through a content analysis. DISCUSSION: While the images investigated are engaging and sometimes amusing, we explore meanings beyond our engagement as a viewer. The discussion focuses on the need for promotion of best practice, in words and pictures, to model best professional practice.

Paramedics as a New Resource for Women Experiencing Intimate Partner Violence.

Intimate partner violence (IPV) has a major impact on the health and well-being of women. The need for a coordinated response from health care professions encountering IPV patients is well established, and guidelines for individual health care professions are needed. Paramedics are believed to frequently encounter IPV patients, and this study aims to create a guideline to direct their response based on expert opinion. A clinical guideline for paramedics was created using current evidence and recommendations from health agencies. A panel of family violence researchers and service delivery experts such as physicians, family violence support agencies, and police commented on the guideline via a Policy Delphi Method to obtain consensus agreement. A total of 42 experts provided feedback over three rounds resulting in 100% consensus. Results include clinical indicators to recognize IPV patients in the prehospital environment, a description of how paramedics should discuss IPV with patients, recommended referral agencies and pathways, and appropriate documentation of case findings. This study has created the first comprehensive, consensus-based guideline for paramedics to recognize and refer IPV patients to care and support. The guideline could potentially be modified for use by ambulance services worldwide and can be used as the basis for building the capacity of paramedics to respond to IPV, which may lead to increased referrals to care and support.

"Universal Precautions": perinatal touch and examination after childhood sexual abuse.

BACKGROUND: Childhood sexual abuse is a common experience of Australian women with 1 woman in 3 reporting unwanted sexual activity, and 1 in 10 reporting attempted or penetrative sexual abuse before 16 years of age. The objective of this study was to explore women's responses to perinatal professional touch and examination of themselves and their babies. METHODS: Eighteen women were interviewed using an in-depth semistructured qualitative method. Interviews were recorded and transcribed. The interviews were coded and thematically analyzed, using NVivo to assist with data management. To ensure rigor, four initial interviews were coded by a second researcher and discrepancies resolved. RESULTS: Two key themes were identified by childhood sexual abuse survivors as important in improving service provision: safety issues for survivors and their babies in the clinical encounter and ways of making service provision safer. CONCLUSIONS: Childhood sexual abuse survivors experienced pain, dissociation, fear, blame, helplessness, and guilt in their encounters with health care practitioners. These experiences led to the development of a set of "Universal Precautions" for perinatal professionals responding to women and their children.

Qualitative study of breastfeeding after childhood sexual assault.

Childhood sexual assault (CSA) is a common experience for women. Little research has explored the breastfeeding experience of CSA survivors who successfully breastfeed. The objective of this study is to explore the experience of successful breastfeeding with mothers with a history of CSA. Eleven women are interviewed after responding to a community-based advertisement. The women self-identify as having experienced CSA by a family member. Semistructured interviews are conducted by the author. Interviews are transcribed, coded, and analyzed for themes. Four key themes are identified: enhancement of the mother- baby relationship, validation of the maternal body, splitting of the breasts' dual role as maternal and sexual objects, and exposure and control when breastfeeding in public. Healthcare professionals should be aware of these maternal issues when promoting breastfeeding and counseling breastfeeding women.

Factors associated with workplace violence in paramedics.

INTRODUCTION: The majority of research that has explored workplace violence has focused on establishing the prevalence of violence in different settings. In general, there is a paucity of research that explores factors that may predict or increase the risk of experiencing violence in the workplace. OBJECTIVE: The aim of this research was to determine predictors of violence for paramedics. METHODS: A questionnaire was developed that focused on paramedics' experiences with six forms of violence: verbal abuse, property damage/theft, intimidation, physical abuse, sexual harassment, and sexual assault. The questionnaire was distributed randomly to paramedics throughout rural Victoria and metropolitan South Australia, and completed and returned anonymously. RESULTS: Predictors emerged for verbal abuse, intimidation, sexual harassment, and sexual abuse. Specifically, gender was the only predictor of intimidation, sexual harassment, and sexual assault. Paramedic qualifications, how they responded to a call-out, and hours per week in direct patient contact emerged as a predictor of verbal abuse. CONCLUSIONS: Certain factors predict or predispose paramedics to workplace violence. The need for workplace violence education and training is imperative for the prevention of violence, as well as for its management.

The psychometric properties of an intimate partner violence education outcome measure.

BACKGROUND: The need for increased education on intimate partner violence (IPV) for healthcare practitioners has been well established. Most Australian healthcare practitioners are educated at university, where educational interventions could be delivered to students. Specific IPV outcome measurement instruments demonstrating sound psychometric properties would enable accurate evaluation of educational interventions to ensure effectiveness. METHODS: The psychometric properties of the Modified Physician REadiness to Manage Intimate partner violence Scale (Modified PREMIS) were measured when delivered to a cohort of Australian paramedic and nursing students, performing principal component analysis, and evaluating dimensionality, internal consistency, and test-retest reliability. RESULTS: In total, 260 responses were received, participants were primarily paramedicine students (85.0%) with the remainder double degree nursing and paramedicine students (15.0%). Actual and Perceived Knowledge and Perceived Preparation subscales demonstrated variable validity and reliability. Principal component analysis of opinion items revealed a 5-factor solution, with identified subscales demonstrating mostly low internal consistency (Cronbach's alpha between 0.47 and 0.80). Correlations between subscales demonstrated few significant correlations above r = 0.3 which may indicate problems with construct validity. Medium to high test-retest reliability was found for subscales with spearman's rho values between 0.63 and 0.88. CONCLUSIONS: The scale did not demonstrate robust psychometric properties and some items may not be appropriate for use with Australian healthcare student cohorts. Pending revisions and subsequent psychometric appraisal the instrument should be used with caution; however an updated instrument may contribute as a valuable tool for IPV educational research and this paper provides several findings which may be of use when revising the scale.

Evaluating the Feasibility and Effectiveness of an Australian Safety Planning Smartphone Application: A Pilot Study Within a Tertiary Mental Health Service.

OBJECTIVE: The purpose of this study was to examine the feasibility and effectiveness of a suicide prevention smartphone application. METHOD: Thirty-six non-Aboriginal Australians aged between 16 and 42 years (67% female) were recruited from a tertiary mental health service where they were receiving treatment for suicide risk. Participants were asked to use the BeyondNow safety planning smartphone application to manage their suicide safety plan during a 2-month trial, as an adjunct to treatment as usual. A survey battery designed to measure feasibility and effectiveness of the smartphone app plus treatment as usual intervention was completed at baseline and follow-up. RESULTS: A vast majority of participants used the app to view and edit their safety plans and reported that the app was easy to use. A reduction was observed in participant severity and intensity of suicide ideation, and suicide-related coping increased significantly. No significant changes were observed in suicide resilience. CONCLUSIONS: The BeyondNow safety planning smartphone application was shown to be feasible and effective as an adjunct to mental health treatment among patients at risk of suicide.

Staff conceptualisations of elder abuse in residential aged care: A rapid review.

OBJECTIVE: The purpose of this rapid review was to explore how residential aged care staff conceptualise and identify elder abuse. METHODS: English-language publications, between 2000 and 2017, about elder abuse in residential aged care in developed countries were sought from three academic databases. Only perspectives on staff-to-resident and resident-to-resident abuse were included. RESULTS: Over 2000 articles were screened, and 19 journal articles were included in the review. A wide range of abusive behaviours was identified, but there was little common understanding of what constituted elder abuse. Furthermore, disparities in conceptualisations were greater for certain types of abuse (e.g. verbal, psychological and caregiving). CONCLUSION: Elder abuse in residential aged care was conceptualised and identified by staff in diverse and different ways. This lack of common understanding hinders the development of effective interventions and prevention strategies, which include staff education and training as well as significant structural and institutional changes.

Prevalence and predictors of occupational violence and aggression towards GPs: a cross-sectional study.

Occupational violence and aggression are common in general practice. This study examined occupational violence and aggression against GPs in terms of prevalence and predictive factors, such as sex of GP, and practice location. Over half of the GPs sampled had experienced at least one form of violence and aggression; more female than male GPs experienced sexual harassment; and there was no difference in the number of metropolitan and rural GPs who had experienced violence and aggression. Predictors emerged for verbal abuse, intimidation, physical abuse, and sexual harassment.