Evaluation of an integrated intervention to reduce psychological distress and intimate partner violence in refugees: Results from the Nguvu cluster randomized feasibility trial.

INTRODUCTION: The complex relationship between intimate partner violence and psychological distress warrants an integrated intervention approach. In this study we examined the relevance, acceptability, and feasibility of evaluating a multi-sectoral integrated violence- and mental health-focused intervention (Nguvu). METHODS: We enrolled 311 Congolese refugee women from Nyarugusu refugee camp in Tanzania with past-year intimate partner violence and elevated psychological distress in a feasibility cluster randomized trial. Women were recruited from local women's groups that were randomized to the Nguvu intervention or usual care. Participants from women's groups randomized to Nguvu received 8 weekly sessions delivered by lay refugee incentive workers. Psychological distress, intimate partner violence, other wellbeing, and process indicators were assessed at baseline and 9-weeks post-enrollment to evaluate relevance, acceptability, and feasibility of implementing and evaluating Nguvu in refugee contexts. RESULTS: We found that Nguvu was relevant to the needs of refugee women affected by intimate partner violence. We found reductions in some indicators of psychological distress, but did not identify sizeable changes in partner violence over time. Overall, we found that Nguvu was acceptable and feasible. However, challenges to the research protocol included baseline imbalances between study conditions, differential intervention completion related to intimate partner violence histories, differences between Nguvu groups and facilitators, and some indication that Nguvu may be less beneficial for participants with more severe intimate partner violence profiles. CONCLUSIONS: We found evidence supporting the relevance of Nguvu to refugee women affected by partner violence and psychological distress and moderate evidence supporting the acceptability and feasibility of evaluating and implementing this intervention in a complex refugee setting. A definitive cluster randomized trial requires further adaptations for recruitment and eligibility screening, randomization, and retention. TRIAL REGISTRATION: ISRCTN65771265, June 27, 2016.

Recognising and responding to intimate partner violence using telehealth: Practical guidance for nurses and midwives.

AIMS: To synthesise the current, global evidence-informed guidance that supports nurses and midwives to recognise and respond to intimate partner violence (IPV), and how these practices can be translated from face-to-face encounters to care that is delivered through telehealth. BACKGROUND: COVID-19-related social and physical distancing measures increase the risk for individuals who are socially isolated with partners who perpetuate violence. Providing support through telehealth is one strategy that can mitigate the pandemic of IPV, while helping patients and providers stay safe from COVID-19. DESIGN AND METHODS: In this discursive paper, we describe how practical guidance for safely recognising and responding to IPV in telehealth encounters was developed. The ADAPT-ITT (Assessment, Decisions, Administration, Production, Topical Experts, Integration, Testing, Training) framework was used to guide the novel identification and adaptation of evidence-informed guidance. We focused on the first six stages of the ADAPT-ITT framework. CONCLUSIONS: This paper fills a gap in available guidance, specifically for IPV recognition and response via telehealth. We present strategies for prioritising safety and promoting privacy while initiating, managing or terminating a telehealth encounter with patients who may be at risk for or experiencing IPV. Strategies for assessment, planning and intervention are also summarised. System-level responses, such as increasing equitable access to telecommunication technology, are also discussed. RELEVANCE TO CLINICAL PRACTICE: Integrating innovative IPV-focused practices into telehealth care is an important opportunity for nurses and midwives during the current global COVID-19 pandemic. There are also implications for future secondary outbreaks, natural disasters or other physically isolating events, for improving healthcare efficiency, and for addressing the needs of vulnerable populations with limited access to health care.

Adverse Childhood Experiences, Trauma Symptoms, Mindfulness, and Intimate Partner Violence: Therapeutic Implications for Marginalized Men.

Adverse childhood experiences (ACEs) and trauma symptoms have been linked with intimate partner violence (IPV) perpetration and victimization among men, yet the field lacks depth in several key areas hampering progress toward violence intervention. Specifically, posttraumatic stress disorder (PTSD) dominates the field's scope of trauma symptoms under study, limiting understanding of other manifestations of trauma especially among men. Furthermore, most research focuses exclusively on men's physical IPV perpetration and rarely focuses on other types of IPV, severity of violence, or men's victimization. Also, few studies examine potential protective factors grounded in the ACE framework, such as mindfulness, among clinical populations. Finally, most research has not focused on men of color, despite some racial/ethnic minority groups disproportionate rates of IPV exposure. Therefore, the relationships between IPV frequency and severity (psychological, physical, injury) and ACEs, PTSD, trauma symptomology (separate from PTSD), and mindfulness self-efficacy were examined in a sample of 67 predominantly low-income men of color in a batterer intervention program. More than half of the sample (51.5%) reported exposure to four or more ACEs, and 31.1% met the clinical cutoff for a probable PTSD diagnosis. Higher ACE scores predicted increased rates for nearly all types of self-reported IPV perpetration and victimization. PTSD symptoms and complex trauma symptom severity together explained between 13% and 40% of IPV outcomes, and each was uniquely associated with certain types of self-reported IPV victimization and perpetration frequency and severity. Mindfulness self-efficacy was associated with decreased self-report psychological IPV perpetration and victimization frequency and severity. Clinical implications relevant to marginalized men are reviewed, including screening, training, and potential therapeutic interventions.

Las experiencias adversas en la infancia (EAI) y los síntomas de trauma se han asociado con la perpetración de violencia de pareja y la victimización entre los hombres, sin embargo, el ámbito carece de profundidad en varias áreas clave que obstaculizan el avance hacia la intervención en la violencia. Específicamente, el trastorno por estrés postraumático (TEPT) domina el alcance de los síntomas de trauma del ámbito estudiado, lo cual limita la comprensión de otras manifestaciones de trauma, especialmente entre los hombres. Además, la mayoría de las investigaciones se centran exclusivamente en la perpetración de violencia física de pareja por parte de los hombres y rara vez se centra en otros tipos de violencia de pareja, en la gravedad de la violencia o en la victimización de los hombres. Además, pocos estudios analizan posibles factores protectores basados en el marco de las EAI, como la conciencia plena, entre las poblaciones clínicas. Finalmente, la mayoría de las investigaciones no se han centrado en los hombres de color, a pesar de algunos índices desmesurados de exposición a la violencia de pareja de grupos raciales/étnicos minoritarios. Por lo tanto, se analizó la relación entre la frecuencia de la violencia de pareja y la gravedad de esta (psicológica, física, lesiones) y las EAI, el TEPT, la sintomatología del trauma (aparte del TEPT), y la autoeficacia de la conciencia plena en una muestra de 67 hombres de color, predominantemente de bajos recursos, en un programa de intervención para golpeadores. Más de la mitad de la muestra (el 51, 5 %) informó exposición a cuatro o más EAI y el 31, 1 % alcanzó el umbral de decisión clínica para un diagnóstico probable de TEPT. Los puntajes más altos de EAI predijeron índices mayores de casi todos los tipos de perpetración de violencia de pareja y victimización autoinformadas. Los síntomas de TEPT y la gravedad de los síntomas de trauma complejo explicaron juntos entre el 13 % y el 40 % de los resultados de la violencia de pareja, y cada uno estuvo asociado exclusivamente con ciertos tipos de gravedad y frecuencia de la victimización y la perpetración de violencia de pareja autoinformadas. La autoeficacia de la conciencia plena estuvo asociada con una menor victimización y perpetración autoinformadas de la frecuencia y la gravedad de la violencia psicológica de pareja. Se revisan las implicancias clínicas relevantes para los hombres marginados, entre ellas, la evaluación, la capacitación y las posibles intervenciones terapéuticas.

"Made Me Feel Connected": A Qualitative Comparative Analysis of Intimate Partner Violence Routine Screening Pathways to Impact.

Intimate partner violence (IPV) routine screening is widely implemented, yet the evidence for pathways to impact remains unclear. Of the 32 abused women interviewed 16 weeks after antenatal IPV screening, 24 reported positive impact, six reported nil positive impact, and two reported negative impact. Using qualitative comparative analysis (QCA), key conditions for positive impact were care in asking, and support and validation from the midwife. Lack of these and lack of continuity of care were relevant to nil positive impact. Benefits included naming the abuse, connection, unburdening, taking steps to safety, and enabling informed care. Disclosure was not required for positive impact.

Advocacy With Survivors of Intimate Partner Violence: What It Is, What It Isn't, and Why It's Critically Important.

Survivors of intimate partner violence arrive at the doors of domestic violence (DV) programs with a wide variety of needs, including long-term safety and healing, housing, economic stability, health and well-being, and community connection. Although some DV programs offer holistic approaches to survivors, many focus the vast majority of their attention and resources on providing emotional support and safety planning rather than advocating with survivors for their access to needed resources and opportunities. Although services focused on emotional support and safety planning are important, they alone are not likely to result in the life changes that many survivors are seeking. Programs that provide genuine advocacy for survivors-defined as partnering with them to represent their rights and interests while linking them to concrete resources, protections, and opportunities-have been found to be effective and well received. Although an early pillar of DV programs, this type of advocacy has fallen by the wayside in many agencies. In this article, the authors make a case for re-invigorating advocacy efforts designed to improve the life circumstances of survivors. We argue that such efforts will make DV programs more relevant and sought after by a wider range of survivors and that agencies will see real change occur at both the individual and community levels.

Factors associated with IPV victimisation of women and perpetration by men in migrant communities of Nepal.

This paper aims to describe the prevalent forms of intimate partner violence (IPV), and the factors associated with IPV among women and men living in the two migrant communities of Baglung district, Nepal. 357 adult women and men were enrolled following a family model, interviewing young married women with daughter-in-law status in the home, their husbands, and mothers-in-law and fathers-in-laws using an electronic questionnaire. Random effects regression modelling compared men and women, as well as young married women with daughter-in-law status and older women with mothers-in-law with status. 28.6% of women had ever experienced physical and/or sexual violence by an intimate partner compared to 18.2% of men ever perpetrated these forms of violence against their wives. Being older, male controlling behaviour and poor relations with husband increased women's IPV in their lifetime while perceptions that the mother-in-law is kind were protective. Being ashamed of being unemployed and childhood trauma were associated with men perpetrating IPV in their lifetime. Borrowing money or food increased young married women's lifetime IPV risk while mother-in-law cruelty and male control increased older married women's lifetime IPV exposure. Factors associated with IPV in the past year among men were being younger, job seeking, experiences of childhood trauma and depression exposure among men while difficulty accessing money for emergencies, holding inequitable gender attitudes, and depression was associated with women's increased IPV exposure. Unemployment stress, holding inequitable gender attitudes and mother-in-law kindness were associated with young women's increased IPV risk and hunger, mother-in-law cruelty and depression with older women's IPV risk. There is a need to critically challenge harmful social and gender norms by using approaches that are sensitive to young married women's position and unequal gender relations in the family. IPV prevention interventions need to employ a holistic approach that combines changing social and gender norms and improving socioeconomic conditions of women living in migrant communities.

Ending Intimate Partner Violence (IPV) and Locating Men at Stake: An Ecological Approach.

Interventions for ending intimate partner violence (IPV) have not usually provided integrated approaches. Legal and social policies have the duty to protect, assist and empower women and to bring offenders to justice. Men have mainly been considered in their role as perpetrators to be subjected to judicial measures, while child witnesses of violence have not been viewed as a direct target for services. Currently, there is a need for an integrated and holistic theoretical and operational model to understand IPV as gender-based violence and to intervene with the goal of ending the fragmentation of existing measures. The EU project ViDaCS-Violent Dads in Child Shoes-which worked towards the deconstruction and reconstruction of violence's effects on child witnesses, has given us the opportunity to collect the opinions of social workers and child witnesses regarding violence. Therefore, the article describes measures to deal with IPV, proposing functional connections among different services and specific preventative initiatives. Subsequently, this study will examine intimate partner violence and provide special consideration to interventions at the individual, relational, organizational and community levels. The final goal will be to present a short set of guidelines that take into account the four levels considered by operationalizing the aforementioned ecological principles.

Association between violence during pregnancy and preterm birth and low birth weight in Colombia: Analysis of the demographic and health survey.

To explore the association between low birth weight and preterm birth with violence during pregnancy, we conducted a cross-sectional study by using the 2010 Colombian Demographic and Health Survey. We conducted bivariate analyses, binomial logistic regression, and stratified models by age, and 14,520 women were included. There was no association between violence and low birth weight. Nonetheless, an association with preterm birth in women aged over 35 was observed (OR 1.98, 95%CI 1.23, 3.17). Prenatal care appeared to be a protective factor for both outcomes. This research unexpectedly showed that supplementation with folic acid and iron was associated with preterm birth.

Exposure to violence in breast cancer patients: systematic review.

RESULTS: The nine studies included were reviewed under two titles as descriptive and qualitative. Based on the results of six descriptive studies, it was determined that the majority of these studies focused on violence and abuse in childhood; depression is high among breast cancer patients exposed to violence; healing is unfavorably influenced among breast cancer patients exposed to spouse violence or abuse/violence in childhood; physical, emotional and functional welfare/comforts are restricted and quality of life is low during disease process; there is positive correlation between advanced-stage cancer and history of violence; they hesitate to ask the clinical staff for support. Although breast cancer women underreport the violence they have been exposed to, a study stated that 55% of women are exposed to violence after being diagnosed with breast cancer. Results of the three qualitative study revealed that violence is the field of "taboo" among breast cancer patients and they reconsider the "life", "relationship-origin stress", "social support" and "importance of breast for herself" over the disease process. CONCLUSION: In conclusion, it is underlined that giving care becomes difficult, maintenance of treatment fails, and quality of life is decreased in breast cancer patients exposed to violence.

Associations between poverty, mental health and substance use, gender power, and intimate partner violence amongst young (18-30) women and men in urban informal settlements in South Africa: A cross-sectional study and structural equation model.

Research suggests that poverty is a key driver of intimate partner violence (IPV), however detailed analysis suggests that this relationship is not clear, either for women's experience or men's perpetration of IPV. We explored associations between poverty and IPV using cross-sectional data from the Stepping Stones and Creating Futures cluster randomized control trial, in urban informal settlements in Durban, South Africa, with young (18-30) people. Using logistic regression and structural equation modelling we assess associations between poverty and women's experience and men's perpetration of physical and/or sexual IPV in the past 12 months. 680 women and 677 men were recruited into the study between September 2015 and September 2016. The analyses highlight how specific forms or measures of poverty intersecting with gender identities shape IPV. For men we found indicators of economic provision were associated with IPV perpetration, while for women food-insecurity was key to IPV experience. We also found similarities between women and men. First, food-insecurity and childhood traumas shaped pathways to substance misuse and poor mental health that increased IPV. Second, there was a resilience pathway in both models, whereby those with more education had increased gender equitable attitudes and fewer controlling behaviours, which reduced IPV. Interventions to reduce IPV need to work to reduce household food insecurity, but these need to be combined with gender transformative interventions. Interventions should also focus on reducing the impact of mental health and substance misuse. Finally, working to increase educational attainment is a long-term critical intervention to reduce IPV. TRIAL REGISTRATION: NCT03022370. Registered 13 January 2017, retrospectively registered.

[Intimate partner violence: treatment profile in urgent and emergency care services in Brazilian state capitals, 2014]. / Violência por parceiro íntimo: perfil dos atendimentos em serviços de urgência e emergência nas capitais dos estados brasileiros, 2014.

The study aimed to describe the treatment profile for victims of intimate partner violence in urgent and emergency care services in the Brazilian Unified National Health System (SUS) and to investigate differences between the sexes. A descriptive study was performed with data from a survey performed by the System for Surveillance of Accidents and Violence (VIVA Survey), conducted in 86 urgent and emergency care services in 25 state capitals in 2014. All 506 cases of intimate partner violence were included, with 69.9% female victims and 65% from 20 to 39 years of age. Black individuals predominated (70% of females and 82.8% of males, p = 0.005). Lack of paid work was more frequent in female victims (50.4%) compared to males (24.1%), while alcohol consumption was more frequent in males (47.9%) compared to females (21.9%) (p < 0.001). The most common means of aggression against female victims was physical force or beating (70.9%), followed by use of sharp objects (14.5%), while for male victims it was sharp objects (48.7%), followed by physical force or beating (31.6%). Male individuals were identified as the aggressors by 97.6% of the female victims and 11.8% of the males (p < 0.001). The victim's residence was the main site of violence (69.6% of female victims and 74.4% of males; p = 0.622). Most victims were females, while most aggressors were males. Differences between the sexes may reflect cultural patterns and emphasize the need to investigate gender in addition to biological sex.

O estudo teve como objetivo descrever o perfil dos atendimentos a vítimas de violência por parceiro íntimo em serviços de urgência e emergência vinculados ao Sistema Único de Saúde (SUS) e investigar diferenças entre os sexos. Foi realizado estudo descritivo com dados do inquérito que compõe o Sistema de Vigilância de Acidentes e Violências (VIVA Inquérito), realizado em 86 serviços de urgência e emergência de 25 capitais, em 2014. Foram incluídos todos os 506 casos de violência por parceiro íntimo, 69,9% do sexo feminino e 65% de 20 a 39 anos de idade. Em ambos os sexos, predominaram pessoas de cor da pele negra (70% no feminino e 82,8% no masculino, p = 0,005). A ausência de atividade remunerada foi mais frequente entre indivíduos do sexo feminino (50,4%), em relação ao masculino (24,1%), enquanto o consumo de bebida alcoólica foi mais frequente no sexo masculino (47,9%) em comparação ao feminino (21,9%) (p < 0,001). O meio de agressão mais frequente entre as vítimas do sexo feminino foi força corporal/espancamento (70,9%), seguido por objeto perfurocortante (14,5%), enquanto naquelas do sexo masculino, foi objeto perfurocortante (48,7%), seguido por força corporal/espancamento (31,6%). Indivíduos do sexo masculino foram apontados como agressores por 97,6% das vítimas do feminino e 11,8% do masculino (p < 0,001). A residência foi o principal local de ocorrência das violências (69,6% no sexo feminino e 74,4% no masculino; p = 0,622). A maioria das vítimas era do sexo feminino, enquanto o sexo masculino se destacou entre os agressores. As diferenças encontradas entre os sexos possivelmente refletem padrões culturais e evidenciam a necessidade de investigar o gênero, além do sexo biológico.

El estudio tuvo como objetivo describir el perfil de la atención a víctimas de violencia de género en servicios de urgencia y emergencia, vinculados al Sistema Único de Salud (SUS), e investigar diferencias entre sexos. Se realizó un estudio descriptivo con datos de la investigación que forma parte del Sistema de Vigilancia de Accidentes y Violencia (Encuesta VIVA), realizado en 86 servicios de urgencias y emergencias de 25 capitales, en 2014. Se incluyeron 506 casos de violencia de género, un 69,9% del sexo femenino, con un 65% de entre 20 a 39 años de edad. En ambos sexos, predominaron personas con color de piel negro (70% en el caso femenino y 82,8% en el masculino, p = 0,005). La ausencia de actividad remunerada fue más frecuente entre individuos del sexo femenino (50,4%), en relación con el masculino (24,1%), mientras el consumo de bebida alcohólica fue más frecuente en el sexo masculino (47,9%), en comparación con el femenino (21,9%) (p < 0,001). El medio de agresión más frecuente con las víctimas del sexo femenino fue la fuerza corporal/golpes (70,9%), seguido del objeto cortopunzante (14,5%), mientras que con las del sexo masculino, fue objeto punzante (48,7%), seguido de fuerza corporal/golpes (31,6%). Individuos del sexo masculino fueron señalados como agresores por un 97,6% de las víctimas del femenino y un 11,8% del masculino (p < 0,001). La residencia fue el principal lugar de ocurrencia de las violencias (69,6% en el sexo femenino y 74,4% en el masculino; p = 0,622). La mayoría de las víctimas era de sexo femenino, mientras el sexo masculino se destacó entre los agresores. Las diferencias encontradas entre los sexos posiblemente reflejan patrones culturales y evidencian la necesidad de investigar el género, además del sexo biológico.

Adoption, penetration, and effectiveness of a secondary risk screener for intimate partner violence: Evidence to inform screening practices in integrated care settings.

OBJECTIVE: Veterans Health Administration (VHA) has implemented screening for past-year intimate partner violence (IPV) in some healthcare facilities along with secondary screening of risk for severe violence among those screening positive in order to facilitate follow-up care for high-risk patients. We evaluated the adoption, penetration, and effectiveness of secondary screening as a tool to facilitate timely follow-up services. METHODS: Retrospective review of medical records (screening and healthcare use) of 774 women screening positive for past-year IPV (IPV+) at 11 facilities nationwide from April 2014-April 2016. Chi-square and t-tests examined factors related to secondary screening. RESULTS: Three of eleven (27.3%) facilities that implemented primary IPV screening adopted secondary screening. At adopting sites, 56.4% eligible (i.e., IPV+) women received secondary screening. Among 185 IPV+ women who completed secondary screening, 33.0% screened positive for severe IPV. Screening positive during secondary screening was associated with higher rate of psychosocial care within 60 days (73.8% vs. 54.0% of IPV+ patients screening negative; p < .05), posttraumatic stress disorder diagnosis (31.1% vs. 15.3%; p < .05), and being physically threatened or harmed (>50% vs. <15%; p < .001). CONCLUSIONS: Secondary risk assessment following IPV screening may expedite access to psychosocial follow-up care in integrated healthcare settings. However, program uptake needs to be enhanced.

Violência por parceiro íntimo: perfil dos atendimentos em serviços de urgência e emergência nas capitais dos estados brasileiros, 2014 / Intimate partner violence: treatment profile in urgent and emergency care services in Brazilian state capitals, 2014 / Violencia de género: perfil de atención en servicios de urgencia y emergencia en las capitales de estados brasileños, 2014

Resumo: O estudo teve como objetivo descrever o perfil dos atendimentos a vítimas de violência por parceiro íntimo em serviços de urgência e emergência vinculados ao Sistema Único de Saúde (SUS) e investigar diferenças entre os sexos. Foi realizado estudo descritivo com dados do inquérito que compõe o Sistema de Vigilância de Acidentes e Violências (VIVA Inquérito), realizado em 86 serviços de urgência e emergência de 25 capitais, em 2014. Foram incluídos todos os 506 casos de violência por parceiro íntimo, 69,9% do sexo feminino e 65% de 20 a 39 anos de idade. Em ambos os sexos, predominaram pessoas de cor da pele negra (70% no feminino e 82,8% no masculino, p = 0,005). A ausência de atividade remunerada foi mais frequente entre indivíduos do sexo feminino (50,4%), em relação ao masculino (24,1%), enquanto o consumo de bebida alcoólica foi mais frequente no sexo masculino (47,9%) em comparação ao feminino (21,9%) (p < 0,001). O meio de agressão mais frequente entre as vítimas do sexo feminino foi força corporal/espancamento (70,9%), seguido por objeto perfurocortante (14,5%), enquanto naquelas do sexo masculino, foi objeto perfurocortante (48,7%), seguido por força corporal/espancamento (31,6%). Indivíduos do sexo masculino foram apontados como agressores por 97,6% das vítimas do feminino e 11,8% do masculino (p < 0,001). A residência foi o principal local de ocorrência das violências (69,6% no sexo feminino e 74,4% no masculino; p = 0,622). A maioria das vítimas era do sexo feminino, enquanto o sexo masculino se destacou entre os agressores. As diferenças encontradas entre os sexos possivelmente refletem padrões culturais e evidenciam a necessidade de investigar o gênero, além do sexo biológico.

Abstract: The study aimed to describe the treatment profile for victims of intimate partner violence in urgent and emergency care services in the Brazilian Unified National Health System (SUS) and to investigate differences between the sexes. A descriptive study was performed with data from a survey performed by the System for Surveillance of Accidents and Violence (VIVA Survey), conducted in 86 urgent and emergency care services in 25 state capitals in 2014. All 506 cases of intimate partner violence were included, with 69.9% female victims and 65% from 20 to 39 years of age. Black individuals predominated (70% of females and 82.8% of males, p = 0.005). Lack of paid work was more frequent in female victims (50.4%) compared to males (24.1%), while alcohol consumption was more frequent in males (47.9%) compared to females (21.9%) (p < 0.001). The most common means of aggression against female victims was physical force or beating (70.9%), followed by use of sharp objects (14.5%), while for male victims it was sharp objects (48.7%), followed by physical force or beating (31.6%). Male individuals were identified as the aggressors by 97.6% of the female victims and 11.8% of the males (p < 0.001). The victim's residence was the main site of violence (69.6% of female victims and 74.4% of males; p = 0.622). Most victims were females, while most aggressors were males. Differences between the sexes may reflect cultural patterns and emphasize the need to investigate gender in addition to biological sex.

Resumen: El estudio tuvo como objetivo describir el perfil de la atención a víctimas de violencia de género en servicios de urgencia y emergencia, vinculados al Sistema Único de Salud (SUS), e investigar diferencias entre sexos. Se realizó un estudio descriptivo con datos de la investigación que forma parte del Sistema de Vigilancia de Accidentes y Violencia (Encuesta VIVA), realizado en 86 servicios de urgencias y emergencias de 25 capitales, en 2014. Se incluyeron 506 casos de violencia de género, un 69,9% del sexo femenino, con un 65% de entre 20 a 39 años de edad. En ambos sexos, predominaron personas con color de piel negro (70% en el caso femenino y 82,8% en el masculino, p = 0,005). La ausencia de actividad remunerada fue más frecuente entre individuos del sexo femenino (50,4%), en relación con el masculino (24,1%), mientras el consumo de bebida alcohólica fue más frecuente en el sexo masculino (47,9%), en comparación con el femenino (21,9%) (p < 0,001). El medio de agresión más frecuente con las víctimas del sexo femenino fue la fuerza corporal/golpes (70,9%), seguido del objeto cortopunzante (14,5%), mientras que con las del sexo masculino, fue objeto punzante (48,7%), seguido de fuerza corporal/golpes (31,6%). Individuos del sexo masculino fueron señalados como agresores por un 97,6% de las víctimas del femenino y un 11,8% del masculino (p < 0,001). La residencia fue el principal lugar de ocurrencia de las violencias (69,6% en el sexo femenino y 74,4% en el masculino; p = 0,622). La mayoría de las víctimas era de sexo femenino, mientras el sexo masculino se destacó entre los agresores. Las diferencias encontradas entre los sexos posiblemente reflejan patrones culturales y evidencian la necesidad de investigar el género, además del sexo biológico.

Caracterização dos casos de violência física contra mulheres notificados na Bahia / Characterization of cases of physical violence against women notified in Bahia

Introdução:A violência é um fenômeno social e histórico na humanidade que acarreta impactos diretos sobre a saúde, por meio de lesões físicas ou emocionais, traumas e mortes, representando um problema de saúde pública no Brasil e no mundo. Nesse sentido exige formulação de políticas específicas e organização de práticas e de serviços peculiares ao setor de saúde integral à mulher a fim de se prestar uma assistência integral e humanizada. Objetivo:descrever os casos de violência física (VF) contra a mulher notificados ao Sistema de Informação de Agravos de Notificação (SINAN) na Bahia, nos anos de 2009 a 2014. Material e Métodos: estudo descritivo, transversal, utilizando-se dados secundários do SINAN, referentes a violência física praticada contra mulheres na Bahia, no período de 2009 à 2014. Resultados: foram notificados 9590 casos de VF contra mulheres na faixa etária entre 20 a 39 anos (56%), pertencentes às raças parda e negra (58,5%), com ensino fundamental incompleto (20,9%); o ato era praticado com maior frequência pelo cônjuge (24,2%), na residência das vítimas (52,2%), utilizando-se a força corporal e/ou espancamento (67,2%). Conclusão: A violência é um fenômeno frequente no cotidiano das mulheres e seu enfrentamento ainda é um desafio, havendo a necessidade de revisão das políticas públicas nacionais e internacionais que embora tenham avançado na garantia de punição do agressor, ainda carece de maior assistência holística e integral após as denúncias.

Introduction: Violence is a social and historical phenomenon in mankind that has a direct impact on health, through physical or emotional injuries, trauma and death, representing a public health problem in Brazil and in the world, requiring the formulation of specific policies and organization of practices and services peculiar to the integral health sector for women in order to provide comprehensive and humanized assistance. Objective: To describe the cases of physical violence (FV) against women notified to the Notification of Invalidity Information System (SINAN) in Bahia from 2009 to 2014. Material and methods: a descriptive, cross-sectional study using secondary data of SINAN, referring to the physical violence practiced against women in Bahia from 2009 to 2014. Results: 9,590 cases of FV were reported against women in the age group between 20 and 39 years old (56%), belonging to the brown and black races (58.5%), with incomplete elementary education (20.9%); (52.2%), using corporal force and / or beating (67.2%), was the most frequently practiced by the spouse (24.2%). Conclusion: Violence is a frequent phenomenon in women's daily lives and their confrontation is still a challenge, and there is a need to review national and international public policies that, although they have advanced the guarantee of punishment of the aggressor, still require greater holistic and integral assistance after the denunciations.

Depression, alcohol use, and intimate partner violence among outpatients in rural Uganda: vulnerabilities for HIV, STIs and high risk sexual behavior.

BACKGROUND: Intimate partner violence (IPV), alcohol use, and depression are key vulnerabilities for HIV in Uganda, and taken together may have a synergistic effect on risk. Our objective was to investigate the associations between depression, IPV, and alcohol use and HIV-risk indicators among a sample of outpatients in rural Uganda, and the effect of co-occurrence of these factors on HIV-risk indicators. METHODS: In a structured interview we collected data on high-risk sexual behavior, depression symptoms, emotional and physical IPV, and alcohol use, as well as a blood sample for HIV and syphilis tests and a urine sample for chlamydia and gonorrhea tests from 325 male and female outpatients receiving provider-initiated HIV testing and counseling (PITC) at a public hospital outpatient clinic in rural Uganda. We used logistic regression and generalized linear modeling to test independent associations between depression, IPV, and alcohol use and HIV-risk indicators, as well as the effect of co-occurrence on HIV-risk indicators. RESULTS: Twelve percent of men and 15% of women had two or more of the following conditions: depression, IPV, and alcohol use; another 29% of men and 33% of women had 1 condition. Each condition was independently associated with HIV risk behavior for men and women, and for women, depression was associated with testing positive for HIV or a sexually transmitted infection (STI). Men with one condition (AOR 2.32, 95% CI 1.95-2.77) and two or more conditions (AOR 12.77, 95% CI 7.97-20.47) reported more high risk sex acts compared to those with no potential co-occurring conditions. For men, experiencing two or more conditions increased risky sex more than one alone (χ 2 24.68, p < 0.001). Women experiencing one condition (AOR 3.33, 95% CI 137-8.08) and two co-occurring conditions (AOR 5.87, 95% CI 1.99-17.35) were more likely to test positive for HIV or an STI and women with two co-occurring conditions were also at increased risk for risky sex (AOR 2.18, 95% CI 1.64-2.91). We also found preliminary evidence suggesting synergistic effects between depression and emotional IPV and between alcohol use and depression. CONCLUSIONS: This study demonstrates the co-occurrence of depression, IPV, and alcohol use in men and women in an outpatient setting in rural Uganda. The co-occurrence of these factors was associated with greater HIV risk, highlighting the need for a more holistic approach to HIV prevention and care research and programming.

Should violence services be integrated within abortion care? A UK situation analysis.

The prevalence of violence against women worldwide raises the question of the desirability and feasibility of integrating interpersonal violence (IPV) services within abortion care. By examining present services and context in an Inner London borough in the UK, this situation analysis explored the hypothesis that an established, integrated, health-based service (comprising raised awareness, staff training in routine IPV enquiry and referral to a community-based in-reach IPV service) would be transferable into abortion services. Four sources of qualitative data investigated views on integrating services: key stakeholder in-depth interviews including with providers of abortion and IPV services and commissioners and IPV survivors with past abortion service use (3 user, 15 provider); qualitative analysis of the open-ended part of a survey of current abortion service users with and without experience of IPV; feedback from an interactive workshop and data from field observations. While there was consensus among all informants that women experiencing IPV and seeking abortion have unidentified, unaddressed needs, how any intervention might be organised to address these needs was contested; thus questions remain about whether, when and how to raise the topic of IPV and what to offer. Two major anxieties surfaced: a practical concern in terms of interrupting a streamlined abortion service that suits the majority of staff and patients, and a conceptual concern about risk of stigmatising abortion seekers as 'victims in crisis'. Thus, our findings indicate: when integrating IPV interventions into abortion services, local context, the integrity of separate pathways, and women's safety and agency must be considered, especially when abortion rights are under attack. Novel approaches are required and should be researched.

Intimate partner violence, psychopathology and the women with schizophrenia in an outpatient clinic South-South, Nigeria.

BACKGROUND: Women with schizophrenia are a vulnerable risk group for intimate partner violence (1PV). There are few surveys that highlight the pattern, prevalence and association of IPV with psychopathology in these vulnerable group of women in South-South Nigeria. The aim of the study was to survey the forms, prevalence and association of Intimate partner violence with psychopathology. METHOD: The study was a cross-sectional survey of 77 female patients diagnosed with schizophrenia who were outpatients at the Federal Neuro-psychiatric Hospital, Calabar, Cross-River State in South-South region of Nigeria. RESULTS: A total of 58 out of 77 (75 %) reported at least a form of IPV, Verbal abuse was the most prevalent form of IPV reported by participants (73 %, n = 56). Women who were younger were more likely to report verbal and sexual assault at p < 0.05. A shorter length of intimate relationship was significantly associated with sexual assault at p < 0.05. Sexual assault, verbal and physical abuse were significantly associated with higher mean score on the Brief Psychiatric Rating Scale at p = 0.01. CONCLUSION: The study highlighted the high rate of various forms of IPV among women with schizophrenia. Sexual assault, verbal and physical abuse were strongly associated with psychopathology. There is a need to identify risk of IPV among this vulnerable group by routine enquiry by clinicians' and plan therapy accordingly. Holistic management is needed in management of victims in their care.

Associations between Forced Sexual Initiation, HIV Status, Sexual Risk Behavior, Life Stressors, and Coping Strategies among Adolescents in Nigeria.

OBJECTIVES: Some individuals experience their first sexual intercourse through physically forced sex, which affects the way they experience and cope with stress. We examined differences in sexual risk behavior, experience of stressors, and use of stress-coping strategies among adolescents in Nigeria based on their history of forced sexual initiation and HIV status. METHODS: We analyzed data from 436 sexually active 10-19-year-old adolescents recruited through a population-based survey from 12 Nigerian states. Using Lazarus and Folkman's conceptual framework of stress and coping, we assessed if adolescents who reported forced sexual initiation were more likely to report HIV sexual risk practices, to report as stressors events related to social expectations, medical care and body images, and loss and grief, and to use more avoidance than adaptive coping strategies to manage stress. We also assessed if HIV status affected experience of stressors and use of coping strategies. RESULTS: Eighty-one adolescents (18.6%) reported a history of forced sexual initiation; these participants were significantly more likely to report anal sex practices (OR: 5.04; 95% CI: 2.14-11.87), and transactional sex (OR: 2.80; 95% CI: 1.56-4.95). Adolescents with no history of forced sexual initiation were more likely to identify as stressors, life events related to social expectations (OR: 1.03; 95% CI: 0.96-1.11) and loss and grief (OR: 1.34; 95% CI: 0.73-2.65), but not those related to medical care and body images (OR: 0.63; 95% CI: 0.34-1.18). They were also more likely to use adaptive responses (OR: 1.48; 95% CI: 0.62-3.50) than avoidance responses (OR: 0.90; 95% CI: 0.49-1.64) to cope with stress, though these differences were not significant. More adolescents with a history of forced sexual initiation who were HIV positive identified as stressors, life events related to medical care and body images (p = 0.03) and loss and grief (p = 0.009). Adolescents reporting forced sexual initiation and HIV-negative status were significantly less likely to use religion as a coping strategy (OR: 0.28; 95% CI: 0.09-0.83). CONCLUSION: History of forced sexual initiation and HIV status affected perception of events as stressors and use of specific coping strategies. Our study findings could inform best practice interventions and policies to prevent and address forced sexual initiation among adolescents in Nigeria and other countries.

Empowerment, intimate partner violence and skilled birth attendance among women in rural Uganda.

BACKGROUND: There is limited research on how the empowerment of women and intimate partner violence (IPV) are associated with skilled birth attendance (SBA) among rural women in Uganda. Therefore, the aim of this paper was to investigate the association between women's empowerment, their experience of IPV and SBA in rural Uganda. METHODS: Using data from the Uganda Demographic and Health Survey (UDHS), we selected 857 rural women who were in union, had given birth in the last 5 years preceding the survey and were selected for the domestic violence (DV) module. Frequency distributions were used to describe the background characteristics of the women and their partners. Pearson's chi-squared (χ (2)) tests were used to investigate the associations between SBA and women's empowerment; and partners' and women's socio-demographic factors including sexual violence. Multivariable logistic regression analyses were used to examine the association between SBA and explanatory variables. RESULTS: More than half (55 %) of the women delivered under the supervision of skilled birth attendant. Women's empowerment with respect to participation in household decision-making, property (land and house) (co)ownership, IPV, and sexual empowerment did not positively predict SBA among rural women in Uganda. Key predictors of SBA were household wealth status, partners' education, ANC attendance and parity. CONCLUSIONS: For enhancement of SBA in rural areas, there is a need to encourage a more comprehensive ANC attendance irrespective of number of children a woman has; and design interventions to enhance household wealth and promote men's education.

Female veterans' preferences for counseling related to intimate partner violence: Informing patient-centered interventions.

OBJECTIVE: Female veterans are at high risk for intimate partner violence (IPV). A critical issue in the provision of health care to women who experience IPV is the delivery of effective brief counseling interventions that address women's unique needs. We aimed to identify female veterans' priorities and preferences for healthcare-based IPV counseling. METHOD: A 2014 Web-based survey was administered to a national sample of US female veterans. Among 411 respondents (75% participation rate), 55% (n=226) reported IPV during their lifetime. These women identified priorities for the content focus of IPV-related counseling and preferences for the delivery of these services. RESULTS: Women prioritized counseling that focuses on physical safety and emotional health, with learning about community resources being a relatively lower priority. Participants preferred counseling to focus specifically on enhancing coping skills and managing mental health symptoms. In addition, women want counseling to be individualized and preferred the option to meet with a counselor immediately following disclosure. Affordable services and attention to privacy concerns were of paramount importance in the context of IPV-related counseling. CONCLUSION: These findings can inform patient-centered brief counseling interventions for women who experience IPV, which may ultimately reduce health disparities and violence among this population.