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

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

Fanon's Police Inspector.

Frantz Fanon practiced psychiatry in a colonized Algeria during its struggle for independence. In his 1961 work The Wretched of the Earth, Fanon described cases from his treatment of Algerian nationalists and French colonists. I present one of Fanon's cases as an ethical inquiry into posttraumatic stress disorder (PTSD). A French police inspector, who is employed in torture, visits Fanon with symptoms of PTSD after escalating domestic violence. The patient asks Fanon "to help him torture … with a total peace of mind." Is it possible to treat the inspector in a meaningful way? More broadly, how might researchers and clinicians balance collective responsibilities to individual symptoms and social conditions? The answer depends on how trauma is framed: as disorder of meaning-making or circuit dysfunction, as individual illness or social rupture, as potentially gendered and racialized. These framings can reveal different views on the allocation of responsibility for the causation, expression and management of PTSD. I do not propose that it is inherently immoral to modify traumatic memories; nor do I question the efficacy of individual interventions. Rather, I ask whether PTSD has a social meaning that transcends individual comfort in decision making about erasure. What do individual interventions accomplish in the absence of concurrent political and social transformations? I argue that a holistic understanding of PTSD entails a set of social obligations: to address at its root political, gendered, and racialized violence, to repudiate occupations centered on exploitative manipulation of individuals and cultures, and to social change that prioritizes these commitments.

Violência contra crianças na perspectiva de profissionais de saúde: reconhecimento e proteção em suas atividades hospitalares / La violencia infantil en la perspectiva de los profesionales sanitarios: reconocimiento y protección en sus actividades profesionales / Violence against child in the perspective of health professionals: protection and acknowledgment in their care activities / La violència infantil en la perspectiva dels professionals sanitaris: reconeixement i protecció en les seves activitats professionals

O objetivo deste trabalho é verificar a percepção e a compreensão de profissionais de saúde sobre violência e proteção de crianças atendidas em um hospital geral universitário. Foram realizadas entrevistas semiestruturadas com dezoito profissionais de saúde. A abordagem relatada para as situações de violência varia desde o envolvimento até o descaso. Poucos entrevistados tiveram contato com o tema durante a sua formação profissional. A mãe foi identificada como a principal pessoa responsável pelas crianças, mas também como a principal agente de violência. Na perspectiva dos entrevistados, a criança só estará protegida se tiver uma família estruturada. A percepção e a compreensão dos profissionais em relação à violência e proteção de crianças são heterogêneas, modificando-se conforme a sua área de atuação.

El objetivo de este trabajo es verificar la percepción y comprensión de los profesionales sanitarios sobre la violencia y la protección de niños y niñas ingresados en un hospital universitario. Se realizaron entrevistas semiestructuradas a dieciocho profesionales sanitarios. Los niveles de involucramiento de los profesionales en las situaciones de violencia van desde el compromiso a la negligencia. Algunos profesionales tuvieron contacto con estos temas durante su formación profesional. La madre ha sido identificada como la principal responsable del cuidado de niños y niñas y como la persona activamente responsable por ellos. Desde la perspectiva de los entrevistados, los niños sólo estarán protegidos si tienen una familia estructurada. Las percepciones y concepciones de los profesionales de la salud son heterogéneas y se modifican de acuerdo al campo de especialización

The aim is to verify the health professionals' perceptions, and understandings about violence and protection of children admitted in a Teaching Hospital. It was performed semi structured interviews with eighteen health professionals. The account on situations cited by the professional went since engagement until negligence. A few health professional had contact with the content along their professional education. The mother has been identified as a main person who is responsible for the care of the children, and with the person who is actively responsible for it. In the perspective of interviewed, the child will be protected just if he/she has a structured family. The health professionals' perceptions, and understandings are heterogeneous, and modified accordingly with the field of specialization

L'objectiu d'aquest treball és verificar la percepció i comprensió dels professionals sanitaris sobre la violència i la protecció de nens i nenes ingressats en un hospital universitari. Es van realitzar entrevistes semiestructurades a divuit professionals sanitaris. El nivell d'implicació dels professionals en les situacions de violència van des del compromís a la negligència. Alguns professionals van tenir contacte amb aquests temes durant la seva formació professional. La mare ha estat identificada com la principal responsable de la cura de nens i nenes i com la persona activament responsable dels mateixos. Des de la perspectiva dels entrevistats, els nens només estaran protegits si tenen una família estructurada. Les percepcions i concepcions dels professionals de la salut són heterogènies i es modifiquen d'acord amb la seva especialitat

Parents' Perceptions of Answering a Survey on Violence Against Children.

The effects of participation in research is an important ethical question in studies involving human participants. In research concerning violence, the common presumption is that participation is especially harmful for those who have personally experienced violence. In this article, parents' perceptions of answering a violence-related survey are analyzed based on free-text comments. A total of 3,170 parents responded to the survey about their violent behavior toward their child (ages 0-12), and 45% (2,047) of those reflected on their perceptions of answering the survey. These answers are analyzed using a thematic analysis. In addition to describing the perceptions, the associations between perceptions and experiences of violence are analyzed. The vast majority of the participants perceived participating in answering as being positive. Negative perceptions, such as distress, were also reported, but these perceptions were mostly reported together with positive perceptions, especially among those who personally had experienced violence.

The Morality of Men Convicted of Domestic Violence: How It Supports the Maintenance of the Moral Self-Concept.

The phenomenon of abuse toward women is a prevalent social problem in most societies. In the present work, we take into consideration the abusive man's point of view with particular reference to the sphere of their morality and set as aims: (a) to show that high levels of self-deception are mediating between an extreme moral worldview, called moral absolutism, and a functional high moral self-concept, (b) to analyze the relation of the five moral foundations (Harm, Fairness, Ingroup, Authority, and Purity) with this moral absolutism, and (c) to test a comprehensive model of the relationships between the individuated variables in the preceding hypotheses. Participants are 264 men convicted of domestic violence offenses, who, having begun court-mandated psychological treatment lasting 12 weeks, have filled out a self-report questionnaire during the second meeting. The results reveal that (a) self-deception is as a full mediator between moral absolutism and moral self-concept in men convicted of domestic violence and in such a way that the more they felt right about their moral beliefs, the more they deceived themselves, and the more they felt good about themselves, (b) the moral foundations could be explaining moral absolutism understood as a rigid moral vision of the world, and (c) the tested model produces satisfying fit indices. Finally, we discuss the applied implications, for example, a key role can be played by the family and the school: Moral socialization begins within the family and there finds the first push that will accompany it the rest of life.

The ongoing violence against women: Female Genital Mutilation/Cutting.

Female Genital Mutilation/Cutting (FGM/C) comprises different practices involving cutting, pricking, removing and sometimes sewing up external female genitalia for non-medical reasons. The practice of FGM/C is highly concentrated in a band of African countries from the Atlantic coast to the Horn of Africa, in areas of the Middle East such as Iraq and Yemen, and in some countries in Asia like Indonesia. Girls exposed to FGM/C are at risk of immediate physical consequences such as severe pain, bleeding, and shock, difficulty in passing urine and faeces, and sepsis. Long-term consequences can include chronic pain and infections. FGM/C is a deeply entrenched social norm, perpetrated by families for a variety of reasons, but the results are harmful. FGM/C is a human rights issue that affects girls and women worldwide. The practice is decreasing, due to intensive advocacy activities of international, national, and grassroots agencies. An adolescent girl today is about a third less likely to be cut than 30 years ago. However, the rates of abandonment are not high enough, and change is not happening as rapidly as necessary. Multiple interventions have been implemented, but the evidence base on what works is lacking. We in reproductive health must work harder to find strategies to help communities and families abandon these harmful practices.

Ethical Issues in Maternal-Fetal Care Emergencies.

Ethical issues that arise in the care of pregnant women are challenging to physicians, especially in critical care situations. By familiarizing themselves with the concepts of medical ethics in obstetrics, physicians will become more capable of approaching complex ethical situations with a clear and structured framework. This review discusses ethical approaches regarding 3 specific scenarios: (1) the life of the fetus versus the life of the mother and situations of questionable maternal decision making; (2) withdrawal of care in a brain-dead pregnant patient; and (3) domestic violence and the pregnant patient.

Aspectos éticos en la atención sanitaria de la violencia de género / Ethical issues in health care of gender violence

La violencia de género es un problema de salud que, en ocasiones, causa controversias éticas en la consulta del médico de familia. Probablemente, el conflicto más importante se produce cuando una paciente que admite haber sido maltratada por su pareja, apelando a la confidencialidad, solicita que no se emita un parte de lesiones. Además, pueden producirse otras situaciones problemáticas. Este trabajo pretende ser una reflexión sobre estas eventualidades para contribuir a ayudar al profesional en la toma de decisiones (AU)

Gender violence is a health problem that occasionally gives rise to ethical dilemmas for the family doctor. One of the most important conflict is probably when a patient admits to being abused by her partner, but appeals to keep the information confidential, and refuses to present an injury report. There also other problematic situations. This essayattempts to reflect on these issues and help professionals in making decisions (AU)

Ethical issues in family violence research in healthcare settings.

Research ethics is always important. However, it is especially crucial with sensitive research topics such as family violence. The aim of this article is to describe and discuss some crucial issues regarding intimate partner violence and child maltreatment, based on the authors' own research experiences. We focus on and discuss examples concerning the definition of family violence, research design, ethical approval, participant recruitment and safety and data collection and processing. During the research process, the significance of teamwork is emphasized. Support provided by the participants to each other and support given by experienced researchers within the team is very important for high ethical standards.

Domestic violence dilemma in the dental clinic.

A case is presented where a dentist recognizes physical abuse of a patient. Although legally the dentist must report such cases, the patient asks that this not be done. Statistics are presented regarding the prevalence and consequences of abuse, and one potential response is suggested.

Violencia de género: ¿mejoramos? / Domestic Violence: Are we improving?

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Perceptions about safety and risks in gender-based violence research: implications for the ethics review process.

Does research on gender-based violence (GBV) pose greater than minimal risk to researchers and participants? This question needs to be understood particularly in light of hesitancy by Institutional Review Boards to approve research on GBV. The safety and risks of doing GBV studies and the implications for the ethical review process have not been a focus of much research. This qualitative study collected data through in-depth interviews with 12 experienced GBV researchers from various countries and a desk review. This paper explores researchers' interpretation of and meanings of the safety recommendations as provided in the WHO guidelines and whether there is empirical evidence on the presence of risks and safety concerns unique to GBV research. Informants raised a number of safety concerns about GBV research, yet in the interviews there were very few examples of problems having occurred, possibly because of the precautions applied. This paper argues that the notion that GBV studies carry greater than minimal risk when ethics precautions are followed is based on speculation, not evidence. It highlights the need for empirical evidence to support assertions of risk in research.

Victim blaming and exoneration of the perpetrator in domestic violence: the role of beliefs in a just world and ambivalent sexism

The existence of domestic violence is closely linked to several ideological factors that include sexism and other beliefs about society in general, namely the belief in a just world. In this study, which involved 485 people of both sexes aged between 18 and 70 years, we analyzed the influence of these ideological variables of the perceivers and characteristics of the situation on judgments of a gender aggression – blaming the victim and exonerating the perpetrator. Results showed differences in the reactions of observers depending on the cause that triggered the aggression. Participants blamed the victim and exonerated the aggressor more when no cause of the aggression was mentioned than when a cause was mentioned (the woman wanted to separate, to see an old male friend, or simply to take a trip with her female friends). We also found clear effects of hostile sexism and just world beliefs on the dependent variables. Results showed that the influence of just world beliefs depended on the fact of mention or not a cause for the aggression (AU)

La existencia de violencia doméstica está estrechamente relacionada con una serie de factores ideológicos entre los que se encuentran el sexismo y otras creencias sobre la sociedad en general como son las creencias en el mundo justo. En este estudio, en el que participaron 485 personas de ambos sexos con edades comprendidas entre los 18 y 70 años, se analizó la influencia que en los juicios sobre una agresión de género (culpar a la víctima y minimizar la importancia de la agresión) tenían tanto algunas variables ideológicas de los perceptores como ciertas características de la situación. Los resultados mostraron diferencias en las reacciones de los observadores en función de la causa desencadenante de la agresión descrita. Los participantes culparon más a la víctima y exoneraban más al agresor cuando no se presentaba causa de la agresión que cuando la causa era mencionada (la mujer quería separarse, iba a ver a un viejo amigo o simplemente hacer un viaje con amigas). También se obtuvieron claros efectos del sexismo hostil y de las creencias en el mundo justo en las variables dependientes. Los resultados mostraron que la influencia de las creencias en el mundo justo dependía del hecho de mencionar o no la posible causa de la agresión (AU)

Recent intimate partner violence as a prenatal predictor of maternal depression in the first year postpartum among Latinas.

The study aims to determine if recent intimate partner violence (IPV) is a prenatal risk factor for postpartum depression (PPD) among pregnant Latinas seeking prenatal care. A prospective observational study followed Latinas from pregnancy through 13 months postpartum. Prenatal predictors of PPD included depression, recent IPV exposure, remote IPV exposure, non-IPV trauma history, poverty, low social support, acculturation, high parity, and low education. Postpartum depression was measured at 3, 7, and 13 months after birth with the Beck's Depression Inventory-Fast Screen. Strength of association was evaluated using bivariate and multivariable odds ratio analysis. Subjects were predominantly low income, monolingual Spanish, and foreign-born, with mean age of 27.7. Recent IPV, prenatal depression, non-IPV trauma, and low social support were associated with greater likelihood of PPD in bivariate analyses. Recent IPV and prenatal depression continued to show significant association with PPD in multivariate analyses, with greater odds of PPD associated with recent IPV than with prenatal depression (adjusted OR = 5.38, p < 0.0001 for recent IPV and adjusted OR = 3.48, p< 0.0001 for prenatal depression). Recent IPV exposure is a strong, independent prenatal predictor of PPD among Latinas. Screening and referral for both IPV and PPD during pregnancy may help reduce postpartum mental health morbidity among Latinas.

[Interfamilial violence, medicolegal and ethical aspects]. / Les aspects médico-légaux et déontologiques des violences intraconjugales.

Domestic or interfamilial violence--which is certainly not confined to disadvantaged social or cultural classes--is a process in which one partner carries against his spouse within the framework of private and privileged relationship (marriage, cohabitation, etc.), aggressive, violent and destructive behavior. All sectors of society are affected, whether urban or rural, and regardless of education or ethnic origin or religion. Such violence particularly affects women, but there are also violence perpetrated against men. This violence can take many forms, but we will only consider here the forensic clinical aspects, emphasizing the relevant legislation and medical ethics.

Principales manifestaciones de la violencia intrafamiliar en pacientes de la tercera edad, como factor de riesgo para la conservación de la salud. Hospital Universitario Clínico Quirúrgico Comandante Faustino Pérez Hernández: junio 2008-junio 2009 / Main manifestations of the intra familial violence in elder patients, as a risk fact to preserve health. Faustino Pérez Hernández University's Hospital june 2008-June 2009

We carried out a descriptive longitudinal study, in the Teaching Clinic Surgical Hospital Comandante Faustino Pérez, of the province of Matanzas, in the period from June 2008 to June 2009, on the behavior of intra familial violence in elder patients, entering the services of Geriatrics, Internal Medicine and Urology for health reasons. The general objective of this study was diagnosing the main characteristics and manifestations of the intra familial violence. The sample was formed by 50 patients, fulfilling the selection criteria that are, being elder patients entering the before-mentioned services because of different somatic alterations, and giving their verbal and written consent to participate in the investigation. The sample selection criteria answered the objective of the study and the characteristics of the investigation. We used the non probabilistic method intentionally, based on the willfulness, confidentiality and anonymity, because of the special characteristics of the subjects of the study. Currently, the intra familial violence is a serious social and health problem, because its sequels affect the physical and psychological health of the people, being children, women and elder people the most vulnerable social groups. That was the reason of this research, showing the magnitude of this problem and its social repercussion, and also the disturbances it causes in human health. The method used to collect the information was a questionnaire validated by other authors. The results demonstrated that all the studied patients showed manifestations of intra familial violence, and that its consequences have influence on their physical and psychological health. The conclusions were based in the form violence takes, with a predominance of the psychological one. Besides that, it was stated the necessity of developing diagnostic studies on this problem among this vulnerable group, to prevent and adequately attend this phenomena when it is discovered...(AU)