Intimate partner violence, depression, PTSD, and use of mental health resources among ethnically diverse black women.

This study examined exposure to violence and risk for lethality in intimate partner relationships as factors related to co-occurring MH problems and use of mental health (MH) resources among women of African descent. Black women with intimate partner violence (IPV) experiences (n = 431) were recruited from primary care, prenatal or family planning clinics in the United States and the U.S. Virgin Islands. Severity of IPV was significantly associated with co-occurring MH problems, but was not associated with the use of MH resources among African-American women. Risk for lethality and co-occurring problems were also not significantly related to the use of resources. African Caribbean women with severe physical abuse experiences were significantly less likely to use resources. In contrast, severity of physical abuse was positively associated with the use of resources among Black women with mixed ethnicity. Severe IPV experiences are risk factors for co-occurring MH problems, which in turn, increases the need for MH services. However, Black women may not seek help for MH problems. Thus, social work practitioners in health care settings must thoroughly assess women for their IPV experiences and develop tailored treatment plans that address their abuse histories and MH needs.

Accounting for Multiple Nonfatal Strangulation in Intimate Partner Violence Risk Assessment.

Nonfatal strangulation is a prevalent, underreported, and dangerous form of intimate partner violence (IPV). It is particularly important to assess for strangulation among abused women as this form of violence may not leave visible injury. The most severe negative physical and mental health consequences of strangulation appear to be dose-related, with those strangled multiple times or to the point of altered consciousness at higher risk of negative sequelae. This research examines the relationship between multiple strangulation, loss of consciousness due to strangulation, and risk of future near-fatal violence to modify the Danger Assessment (DA) and the Danger Assessment for Immigrant women (DA-I), IPV risk assessments intended to predict near-fatal and fatal violence in intimate relationships. Data from one study (n = 619) were used to modify the DA to include an item on multiple strangulation or loss of consciousness due to strangulation. Data from an independent validation sample (n = 389) were then used to examine the predictive validity of the updated DA and DA-I. The updated version of the DA predicts near-fatal violence at 7-8 months follow-up significantly better than the original DA. Adding multiple strangulation or loss of consciousness to the DA-I increased the predictive validity slightly, but not significantly. The DA and DA-I are intended to be used as a collaboration between IPV survivors and advocates as tools for education and intervention. Whether or not an IPV survivor has been strangled, she should be educated about the dangerous nature of strangulation and the need for medical intervention should her partner use strangulation against her. This evidence-based adaptation of the DA and DA-I may assist practitioners to assess for and intervene in dangerous IPV cases.

Posterior mini-incision technique for hamstring anterior cruciate ligament reconstruction graft harvest.

PURPOSE: This study presents a new approach to hamstring graft harvest. The hypothesis tested was that this approach, the posterior mini-incision technique, would result in (1) consistent semitendinosus (ST) and gracilis (Gr) tendon identification, (2) consistent identification and sectioning of the accessory semitendinosus tendon, (3) virtual elimination of the risk of cutting hamstring grafts short, (4) excellent safety, and (5) a small anterior incision with excellent cosmesis. TYPE OF STUDY: Surgical technique. METHODS: Two-hundred three consecutive primary hamstring anterior cruciate ligament reconstructions were performed in skeletally mature patients using this technique. Of these, 185 were located and 175 were clinically evaluated. Follow-up was 24 to 113 months. Ninety patients completed a brief cosmesis questionnaire. Seven fresh-frozen knees were dissected. The locations of the ST and Gr tendons were identified in the popliteal fossa along a medial-to-lateral axis for purposes of incision placement. The location of the accessory ST was documented and the distance from the posterior incision to the popliteal artery was measured. RESULTS: There were no complications referable to graft harvest. No tendon was cut short. The posterior graft harvest mini-incision and the anterior tibial fixation/tibial tunnel mini-incisions were each usually about 1 inch in length. Cosmesis evaluation showed that 80% of patients thought their incisions looked better than the incisions of others they had seen who had had anterior cruciate ligament reconstruction. None thought them worse. Cosmesis was important to a majority of patients. CONCLUSIONS: The posterior mini-incision technique facilitated safe, rapid hamstring graft harvest and virtually eliminated the risk of cutting tendons short. Cosmesis was excellent, and was important to patients. LEVEL OF EVIDENCE: Level V.

Stability results of hamstring anterior cruciate ligament reconstruction at 2- to 8-year follow-up.

PURPOSE: The purpose of this study was to test the hypothesis that hamstring (HS) anterior cruciate ligament (ACL) reconstructions using EndoButton (Smith & Nephew, Andover, MA) femoral and whipstitch/screw tibial fixation can produce a high rate of objective stability in a population of reconstructed patients with low morbidity. TYPE OF STUDY: Case series. METHODS: We retrospectively reviewed 153 consecutive primary HS ACL reconstructions in skeletally mature patients without other ligament reconstructions. All knees had EndoButton femoral and whipstitch/screw tibial fixation; 139 patients were located and 133 were tested. Thirteen were geographically distant and tested subjectively only. Evaluations included KT-1000 testing; radiographs; and Noyes, Lysholm, and Single Assessment Numeric Evaluation (SANE) ratings. Follow-up was 24 to 104 months (mean, 54.4 months). RESULTS: There were no graft failures. No patient had rupture of an implanted graft. No patient had repeat surgery for instability; 96.9% of reconstructions had maximum manual side-to-side differences of < or =3 mm, 85.7% had < or =2 mm; 3% of the knees had a 4-mm difference; none had > or =5-mm difference. There was no objective stability difference between male and female patients and no deterioration in results with increasing follow-up time. Median ratings were: Noyes, 94; Lysholm, 94.5; and SANE, 90. Radiographs showed that no EndoButtons had migrated. No EndoButton or tibial screw had to be removed due to symptoms from the implant. One hundred eighteen of 120 patients had full extension; the other 2 patients had a 2 degrees flexion loss. One patient required repeat arthroscopy for arthrofibrosis but had full range of motion at follow-up. There were no deep knee infections. One patient had a superficial wound infection requiring intravenous antibiotics. One patient had a calf deep vein thrombosis that resolved with treatment. CONCLUSIONS: Hamstring ACL reconstructions can produce (1) reliable, durable stability in both males and females with no graft failures, (2) good clinical ratings, (3) excellent range of motion, and (4) low morbidity, without hardware problems. LEVEL OF EVIDENCE: Level IV, Case Series.

Intimate partner violence among African American and African Caribbean women: prevalence, risk factors, and the influence of cultural attitudes.

BACKGROUND: Women of African descent are disproportionately affected by intimate partner abuse; yet, limited data exist on whether the prevalence varies for women of African descent in the United States and those in the US territories. OBJECTIVE: In this multisite study, we estimated lifetime and 2-year prevalence of physical, sexual, and psychological intimate partner abuse (IPA) among 1,545 women of African descent in the United States and US Virgin Islands (USVI). We also examined how cultural tolerance of physical and/or sexual intimate partner violence (IPV) influences abuse. DESIGN: Between 2009 and 2011, we recruited African American and African Caribbean women aged 18-55 from health clinics in Baltimore, MD, and St. Thomas and St. Croix, USVI, into a comparative case-control study. Screened and enrolled women completed an audio computer-assisted self-interview. Screening-based prevalence of IPA and IPV were stratified by study site and associations between tolerance of IPV and abuse experiences were examined by multivariate logistic regression analysis. RESULTS: Most of the 1,545 screened women were young, of low-income, and in a current intimate relationship. Lifetime prevalence of IPA was 45% in St. Thomas, 38% in St. Croix, and 37% in Baltimore. Lifetime prevalence of IPV was 38% in St. Thomas, 28% in St. Croix, and 30% in Baltimore. Past 2-year prevalence of IPV was 32% in St. Thomas, 22% in St. Croix, and 26% in Baltimore. Risk and protective factors for IPV varied by site. Community and personal acceptance of IPV were independently associated with lifetime IPA in Baltimore and St. Thomas. CONCLUSIONS: Variance across sites for risk and protective factors emphasizes cultural considerations in sub-populations of women of African descent when addressing IPA and IPV in given settings. Individual-based interventions should be coupled with community/societal interventions to shape attitudes about use of violence in relationships and to promote healthy relationships.

Patterns of Violence Against Women: A Latent Class Analysis.

This study examined patterns of nine types of violence against women (VAW) and associated mental health problems. The following self-reported, lifetime violence victimization was examined among 1424 employed women: (1) childhood physical abuse, (2) childhood sexual abuse, (3) physical abuse between parents/guardians during childhood, (4) psychological intimate partner violence (IPV), (5) physical IPV, (6) sexual IPV, (7) adult physical or sexual assault by a non-intimate partner, (8) physical workplace violence, and (9) psychological workplace violence. Latent class analysis was used to identify homogenous patterns, called "classes," of women's "yes/no" responses to experiencing these types of violence. The best model consisted of 4-classes characterized by the following probabilities: low violence (class 1: 63.1%), high psychological and physical IPV (class 2: 15.6%), high physical and psychological workplace violence (class 3: 12.4%), and moderate to high childhood abuse (class 4: 9.0%). When compared to class 1 (low violence), membership in classes 2 (IPV) and 4 (childhood abuse) was associated with screening positive for depression in the past week at baseline after controlling for the influence of demographic characteristics on class membership. Also, when compared to class 1 (low all), membership in class 2 (IPV) was associated with greater odds of screening positive for posttraumatic stress disorder in the past month at the six month follow-up assessment. Findings document distinct patterns of VAW and associated proximal and distal mental health outcomes. Implications for interventions aimed to improve employed women's health are discussed.

Workplace violence: prevalence and risk factors in the safe at work study.

OBJECTIVE: Nurses face one of the highest rates of reported workplace violence (WPV). This research examined the prevalence of WPV and demographic, work-related, and adult and childhood abuse histories as risk factors for WPV among 2166 nurses/nursing personnel across four health care institutions in one US metropolitan area. METHODS: Using data from an online cross-sectional survey, multivariate logistic regression was utilized to determine risk factors for physical and psychological WPV. RESULTS: Almost one-third (30%) of nurses/nursing personnel experienced WPV (19.4% physical, 19.9% psychological). Risk factors included being a nurse, white, male, working in the emergency department, older age, longer employment, childhood abuse, and intimate partner violence. CONCLUSIONS: Adult and childhood abuse histories have not been considered in previous large-scale investigations, but were significant risk factors along with other previously identified risk factors for WPV.