Exploring the Utility of a Novel Approach of Evaluating Application of a Validated Violence Risk Assessment Instrument.

Mental health nurses are often responsible for assessment/management of inpatient aggression. Validated instruments such as the Dynamic Appraisal of Situational Aggression (DASA), can aid risk assessment. However, limited attention has been paid to evaluating nurses' ability to administer risk assessment instruments. An entrustable professional activity may offer way of evaluating risk assessment clinical activities. DASA trainers' perceptions of the value and utility of an EPA were explored via collection of data through focus groups, with 17 participants from six countries. Thematic analysis was conducted to analyze the data. Three themes were interpreted: (1) DASA trainers-a way of knowing and being (2) An EPA-something you did not know you need until you see it; (3) The DASA-EPA supports the need for training and importance of integrity in assessment. Trainers engaged in innovative ways to ensure training is suitable and responsive to needs of nurses and their setting. Participants understood how an EPA could be used to evaluate DASA administration, monitor DASA use, provide feedback, and highlight the importance of training to ensure best practice.

Understanding nightmares after traumatic events in Detroit (UNiTED): prospective associations with interpersonal violence and posttraumatic stress disorder symptoms.

ABSTRACTBackground: Research suggests trauma-related nightmares (TRNs) during the acute aftermath of trauma may contribute to posttraumatic stress disorder (PTSD). However, it is unknown who is most vulnerable to TRNs, which is critical to identify at-risk patients toward whom early nightmare-focused treatments can be targeted to prevent PTSD.Objective: We tested trauma type (interpersonal violence [e.g. assault] vs non-interpersonal trauma [e.g. motor vehicle collision]) as a risk factor for TRNs in a predominantly low-income, Black, urban sample in Detroit, MI, USA.Method: We recruited patients from the intensive care unit following traumatic injury (N = 88; Mage = 39.53 ± SD 14.31 years, 67.0% male, 67.0% Black, 47.7% annual income ≤ $20,000) and administered surveys at three post trauma timepoints: one week (T1), one month (T2; n = 61), and two months (T3; n = 59). Trauma type was assessed at T1 via electronic medical records. Participants reported the extent to which their dreams' content was similar to the trauma for which they were hospitalized across T1-T3. Participants then completed the PTSD Checklist for DSM-5 at T3.Results: TRNs were more prevalent over time among patients exposed to interpersonal violence (80%) vs non-interpersonal trauma (48.7%, p = .005). Patients hospitalized for interpersonal violence faced greater odds for TRNs across timepoints relative to non-interpersonal trauma patients (Odds Ratio = 4.95, p = .021). TRNs, in turn, prospectively predicted PTSD symptoms such that TRNs at T2 presaged more severe PTSD at T3 (p = .040, ηp2 = .31), above and beyond T1 PTSD status.Conclusions: This prospective study provides first evidence that interpersonal violence exposure is a robust risk factor for TRNs, which prospectively contribute to PTSD symptom development. Early intervention on TRNs after interpersonal violence exposure may decrease PTSD risk. Future studies are encouraged to use ambulatory methods to capture nightmares sooner after they occur.

Interpersonal violence exposure is a risk factor for trauma-related nightmaresTrauma-related nightmares predict PTSD symptoms, above and beyond baseline PTSDTreating nightmares early after interpersonal violence may decrease PTSD risk.

Analysis of reported cases of repeated violence in Espírito Santo.

OBJECTIVES: Identify the frequency of recurrent violence in cases reported in Espírito Santo and the associated factors. METHODS: Cross-sectional study. Which included data on violence in Espírito Santo from 2011 to 2018, from the Notifiable Diseases Information System, and, Statistical analyzes were performed using the chi-square test and Poisson regression. RESULTS: 54.2% (N:14.966) of reported cases of violence are repeated, and higher prevalences were associated with female sex (PR:1.54), child (PR: 1.29) or elderly victims (PR: 1.25), the presence of disabilities/disorders (PR:1.42) and occurrence in urban/peri-urban areas (PR: 1.10). Furthermore, there is a greater frequency of injuries caused by a single aggressor (PR: 1.20), man (PR: 1.28), aged 25 or over (PR: 1.09), known to the victim (PR: 2.81) and at home (PR: 1.69). CONCLUSION: The reported cases of violence showed a high frequency of recurrence, and were associated with the studied characteristics of the victim, the aggressor and the event.

Adult Caretaker Engagement and School Connectedness and Association with Substance Use, Indicators of Emotional Well-Being and Suicide Risk, and Experiences with Violence Among American Indian or Alaska Native High School Students - Youth Risk Behavior Survey, United States, 2023.

The strength of American Indian and Alaska Native (AI/AN) communities comes from generations of Indigenous traditions, language, culture, and knowledge. These strengths have been challenged by a complex set of systemic, structural, and social factors related to historical and intergenerational trauma that affects the health of AI/AN communities. Furthermore, AI/AN population health data often are inaccurate because of analytic coding practices that do not account for multiracial and ethnic AI/AN identification and inadequate because of statistical suppression. The 2023 national Youth Risk Behavior Survey included a supplemental sample of AI/AN high school students. Coding of race and ethnicity was inclusive of all AI/AN students, even if they also identified as another race or as Hispanic or Latino, providing comprehensive data on health behaviors and experiences among AI/AN high school students nationwide. Adult caretaker engagement and school connectedness and their association with 13 health behaviors and experiences were examined, including five types of current substance use, four indicators of emotional well-being and suicide risk, and four types of violence. Pairwise t-tests and adjusted prevalence ratios from logistic regression models identified significant associations between exposure and outcome variables. Among AI/AN students, having an adult who always tried to meet their basic needs, high parental monitoring, and high school connectedness were associated with lower prevalence of certain measures of substance use, poor emotional well-being and suicide risk, and violence. Compared with non-AI/AN students, the prevalence of current electronic vapor product use, current marijuana use, attempted suicide, and experience of sexual violence was higher among AI/AN students.This report presents the most comprehensive, up-to-date data on substance use, indicators of emotional well-being and suicide risk, and experiences with violence among AI/AN high school students nationwide. The findings suggest the importance of engaged household adults and school connectedness in promoting emotional well-being and preventing substance use, suicide-related behavior, and experiences of violence among AI/AN students. Understanding the historical context and incorporating Indigenous knowledge when developing interventions focused on AI/AN youths are critical to ensure such interventions are successful in improving AI/AN health and well-being.

Disparities in School Connectedness, Unstable Housing, Experiences of Violence, Mental Health, and Suicidal Thoughts and Behaviors Among Transgender and Cisgender High School Students - Youth Risk Behavior Survey, United States, 2023.

Transgender high school students (those whose gender identity differs from their sex assigned at birth) experience disparate health outcomes and challenges in school, including violence and discrimination, compared with cisgender students (those whose gender identity aligns with their sex assigned at birth). Until recently, population-based data describing the experiences of transgender students and students questioning whether they are transgender (questioning) have been limited. In 2023, the national Youth Risk Behavior Survey assessed transgender identity, providing the first nationally representative data about transgender students. This report describes the demographic characteristics of transgender and questioning high school students and examines differences in the prevalence of experiences of violence, poor mental health, suicidal thoughts and behaviors, school connectedness, and unstable housing among transgender, questioning, and cisgender high school students nationwide. In 2023, 3.3% of U.S. high school students identified as transgender, and 2.2% identified as questioning. Transgender and questioning students experienced a higher prevalence of violence, poor mental health, suicidal thoughts and behaviors, and unstable housing, and a lower prevalence of school connectedness than their cisgender peers. Compared with 8.5% of cisgender male students, 25.3% of transgender students and 26.4% of questioning students skipped school because they felt unsafe. An estimated 40% of transgender and questioning students were bullied at school, and 69% of questioning students and 72% of transgender students experienced persistent feelings of sadness or hopelessness, a marker for experiencing depressive symptoms. Approximately 26% of transgender and questioning students attempted suicide in the past year compared with 5% of cisgender male and 11% of cisgender female students. Intervention opportunities for schools to create safer and more supportive environments for transgender and questioning students can help address these disparities. The findings of this report suggest that more effort is necessary to ensure that the health and well-being of youths who are socially marginalized is prioritized.

Physical Activity Behaviors and Negative Safety and Violence Experiences Among High School Students - Youth Risk Behavior Survey, United States, 2023.

Schools are in a unique position to offer opportunities for students to be physically active throughout the school day and promote health and well-being. However, experiences that threaten safety or perceptions of safety might affect students' physical activity behaviors. Using the 2023 national Youth Risk Behavior Survey, six physical activity behaviors and five negative safety and violence experiences were examined from a nationally representative sample of U.S. high school students. This report updates national estimates for physical activity behaviors overall and by sex, grade, race and ethnicity, and sexual identity. In addition, associations between negative experiences and physical activity behaviors were examined, stratified by sex, via unadjusted and adjusted prevalence ratios. Regardless of negative safety and violence experiences, male students had a higher prevalence of meeting aerobic, muscle-strengthening, and both aerobic and muscle-strengthening physical activity guidelines compared with female students. In adjusted models among female students, a positive association was observed between being threatened or injured with a weapon at school and meeting the aerobic guideline, meeting the muscle-strengthening guideline, and playing on ≥1 sports team. Among male students, positive associations were observed between witnessing neighborhood violence and meeting the aerobic guideline and the muscle-strengthening guideline. A negative association was observed between attending physical education classes on all 5 days and witnessing neighborhood violence among female students and being bullied electronically among male students. Physical activity might serve as a mechanism that students employ to cope with negative safety and violence experiences. Understanding current physical activity behaviors among students with these negative experiences will be useful for school leaders, teachers, and public health practitioners who influence physical activity infrastructure and programming in schools and work to support safe, supportive, and inclusive school environments for student health. Although future research is needed to further explore these associations, physical activity continues to be an important behavior to prioritize for adolescent health in the school setting.

User-Centered Design for Designing and Evaluating a Prototype of a Data Collection Tool to Submit Information About Incidents of Violence Against Sex Workers: Multiple Methods Approach.

Background: Sex workers face an epidemic of violence in the United States. However, violence against sex workers in the United States is underreported. Sex workers hesitate to report it to the police because they are frequently punished themselves; therefore, an alternative for reporting is needed. Objective: We aim to apply human-centered design methods to create and evaluate the usability of the prototype interface for ReportVASW (violence against sex worker, VASW) and identify opportunities for improvement. Methods: This study explores ways to improve the prototype of ReportVASW, with particular attention to ways to improve the data collection tool. Evaluation methods included cognitive walkthrough, system usability scale, and heuristic evaluation. Results: End users were enthusiastic about the idea of a website to document violence against sex workers. ReportVASW scored 90 on the system usability scale. The tool scored neutral on consistency, and all other responses were positive toward the app, with most being strong. Conclusions: Many opportunities to improve the interface were identified. Multiple methods identified multiple issues to address. Most changes are not overly complex, and the majority were aesthetic or minor. Further development of the ReportVASW data collection tool is worth pursuing.

Traumatic Tympanic Membrane Perforation in Children: A Descriptive Cross-sectional Study.

INTRODUCTION:   TTraumatic perforation of the tympanic membrane in pediatric population is often encountered in primary  otolaryngologic clinics or in the emergency department. The objective of the  study was to find out the clinical presentation of traumatic tympanic membrane perforation in the pediatric population. METHODS: A cross-sectional study was done from February, 2023 to February, 2024 after obtaining the ethical approval from the Institutional Review Board (2023/114). All the patients aged less than 18 years and presenting with traumatic tympanic membrane perforation were included in the study. Collected data was entered and analysed using Microsoft Excel. Patients were evaluated for demographics, mechanism of trauma and clinical characteristics of ear drum perforation in children. RESULTS: A total of 384 children aged less than 18 years were included in the study among which 267 (69.53%) were males. Physical assault 109 (28.39%) was the most common cause of tympanic membrane perforation. The most common symptom at the time of presentation was ear block/hearing loss 208 (54.16%). Conductive hearing loss was present in 214 (55.73%) children. CONCLUSION: Traumatic perforation of the tympanic membrane resulted mostly from the blunt force trauma especially in male children.

Economic Cost of US Older Adult Assault Injuries.

This economic evaluation uses nationwide public health data to evaluate incidence and economic costs of homicides and nonfatal assault injuries among US adults aged 60 years or older.

Supporting parents and caregivers: mapping and scoping review of experiences in Europe and central Asia

This report provides an overview of parenting support programmes in Europe and central Asia, based on a mapping and scoping review of parenting programmes that was conducted in 2023. The report provides an analysis of the scale, scope and target groups of parenting support interventions, the trends and features of parenting approaches, and a selection of case studies highlighting parenting programmes with a strong evidence base and emerging programmes that offer unique or specialized approaches.

Functional Impairment in Individuals Exposed to Violence Based on Electronical Forensic Medical Record Mining and Their Profile Identification: Controlled Observational Study.

BACKGROUND: Little is known about the functional consequences of violence when directly assessed as a primary outcome, and even less about how consistently these consequences are evaluated in a judicial context. The World Health Organization (WHO) highlighted the importance of a functional approach to health in 2001 with the release of the International Classification of Functioning, Disability, and Health (ICF). In most European countries, forensic physicians assess individuals exposed to violence to evaluate the outcomes of violence, providing certified medical evidence for magistrates' sentencing decisions. This evaluation involves a mix of objective, subjective, and contextual elements, such as reported symptoms of fear, pain, and details of the assault. Quantifying these subjective elements with scales could enhance their interpretation and application in a judicial context. OBJECTIVE: This study aims to (1) characterize and (2) assess 6 scales measuring subjective elements of functional impairment among individuals exposed to violence. METHODS: We conducted a retrospective study that included individuals exposed to violence examined in a French department of forensic medicine over 12 months. A typology of violence encountered in medical settings was built based on the mining of electronic health records and the use of pattern recognition algorithms. The optimal number of violence types was determined using a robust and stable clustering approach, involving sample resampling and a multimetric scheme. Patients were then paired according to their homogeneous profiles, and the intra- and interrater reproducibility of the scales was evaluated. RESULTS: All pain, fear, and life threat scales were significantly associated with higher functional impairment, suggesting that these measures contribute to the overall assessment of functional impairment. The intra- and interrater reproducibility of scales among similar situations of violence was measured, ranging from mild to good, with coefficients of concordance between 0.46-0.66 and 0.43-0.66, respectively. Individuals reporting intimate partner violence showed higher scores in both fear and perception of a life threat during the assault and medical interview, while individuals reporting battery by multiple unknown assailants presented higher scores only in perception of a life threat during the assault. We identified 5 remarkably stable profiles of situations of violence, consistent with clinical practice. CONCLUSIONS: Pain, fear, and life threat scales were related to functional impairment according to expert knowledge and demonstrated fair reproducibility under real-life conditions for similar situations of violence. Subjective elements related to functional impairment in individuals exposed to violence can be quantified using Likert scales during medical interviews.

Intergenerational Chain of Violence, Adverse Childhood Experiences, and Elder Abuse Perpetration.

Importance: It is widely known that individuals with adverse childhood experiences (ACEs) have an increased risk of abusing their own children, thereby perpetuating the cycle of violence. However, the association between ACEs and elder abuse perpetration has not been fully examined. Objective: To examine the association between ACEs and elder abuse and the mediating factors. Design, Setting, and Participants: This cross-sectional study used data collected via the self-administered Japan COVID-19 and Society Internet Survey from September 12 to October 19, 2022. Men and women aged 20 to 64 years who responded to related questions were included. Data were analyzed from July 2023 to April 2024. Exposures: ACEs, defined as the experience of any of 7 items-interpersonal loss (parental loss and parental divorce), family psychopathology (parental mental disease and violence in family), abuse (physical and psychological abuse), and neglect-before the age of 18 years. Main Outcomes and Measures: The primary outcome was the perpetration of physical and/or psychological abuse against an older person (aged ≥65 years) self-reported via questionnaire. The direct and indirect effect estimates were determined using logistic regression analyses. Results: Of a total of 13 318 participants (mean [SD] age, 41.1 [12.1] years; 6634 female [49.8%]), 1133 (8.5%) reported perpetrating violence against older adults. Compared with individuals without ACEs, the odds ratios (ORs) for perpetrating violence were 3.22 (95% CI, 2.74-3.79) for those with 1 ACE and 7.65 (95% CI, 6.41-9.13) for those with 2 or more ACEs. In the mediation analysis, factors with large indirect effect estimates included depression (OR, 1.13; 95% CI, 1.11-1.14; proportion mediated [PM], 18.6%), mental illness other than depression (OR, 1.12; 95% CI, 1.10-1.14; PM, 17.3%), and self-rated health (OR, 1.04; 95% CI, 1.03-1.05; PM, 6.0%). Conclusions and Relevance: These findings suggest that intergenerational cycles of violence may extend to any vulnerable group, not only children but also older adults. Further research into the prevention of ACEs and breaking these cycles of violence is warranted.

Exploring client violence during home visits: a qualitative study of perceptions and experiences of Israeli nurses.

BACKGROUND: Home care provides an excellent opportunity for personalizing treatment as nurses see patients in their natural environment. Along with its many advantages, the home care environment carries unique risks, as nurses are usually alone, without the protection and security provided by primary care clinics. There are no accurate data in Israel on the scope and characteristics of client violence against nurses during home visits. We conducted a qualitative study to investigate the nature of client violence faced by Israeli nurses during home visits, to gain insights into their perceptions and experiences, and to contribute to the development of effective policies and strategies to combat client violence in the healthcare sector. METHODS: Twenty-seven female nurses from primary care clinics, who were exposed to client violence during a home visit, were interviewed using a semi-structured interview guide. The interviews were transcribed and analyzed, and categories and themes were extracted. RESULTS: Most nurses interviewed experienced at least three incidents of client violence, the most common of which was verbal abuse. The nurses perceived that the location of the encounter between the nurse and the patient in the patient's natural surroundings, rather than within the controlled boundaries of a clinic, contributes to the risk of violence. Violence affected the nurses' professional decisions. The nurses reported that their organization had no established guidelines or instructions for safely conducting home visits, they were not provided with protective or security measures for emergencies, nor did they perceive that they had sufficient training to deal with client violence in clients' homes. CONCLUSIONS: Nurses encounter a range of challenges that make it difficult for them to deal with client violence during home visits, affecting their personal safety and professional decisions. Their ability to manage such situations is shaped by a complex interplay of personal and organizational factors and requires a range of strategies and resources to effectively address them.

Best Practices in the Nursing Care of Patients With Injuries From Violence: An Integrative Review.

BACKGROUND: The number of patients who have experienced violence is increasing worldwide. These patients have specific psychosocial and forensic needs and can present unique challenges to the health care workers caring for them. OBJECTIVE: To identify best practices for the care of patients with injuries from violence in the emergency department or inpatient setting. METHODS: The framework for integrative reviews by Whittemore and Knafl was used to conduct a literature search in MEDLINE, CINAHL, and ProQuest Nursing and Allied Health databases. Fourteen qualitative, quantitative, and mixed-methods studies from peer-reviewed journals were included in the review. RESULTS: Themes included identifying patients as survivors of intimate partner violence or child abuse, the need to collect forensic evidence, the need for emotional support of patients and their loved ones, support for health care workers caring for patients with injuries from violence, prevention of further violence, and the challenges of caring for patients with injuries from violence with concurrent substance use disorders. Best practices for these aspects of care are summarized on the basis of literature analysis. CONCLUSION: Screening procedures are needed to identify survivors of intimate partner violence and child abuse. Forensic evidence preservation policies should be in place. For survivors of sexual assault, a sexual assault nurse examiner should be available. Hospital systems should provide psychosocial resources for patients' and health care workers' mental health, implement violence reduction programs, and provide bias training. More research is needed to determine efficacy of care models and best practice.

Violent attitudes in Portugal and Canada: Measurement invariance and psychometric properties of the Evaluation of Violence Questionnaire.

Theory and evidence suggest that attitudes toward violence are relevant for the explanation, prediction, and reduction of violent behavior. The purpose of the present study was to adapt a measure of violent attitudes-the Evaluation of Violence Questionnaire (EVQ)-for use in Portugal, test the cross-country equivalence, and test the validity of both versions. We found the expected one-factor structure, high internal consistency, and cross-country measurement invariance for the Portuguese and original EVQ with men in Portugal (N = 320) and Canada (N = 298). We also found the expected pattern of correlations with measures of more versus less theoretically relevant constructs: both versions of the EVQ showed the strongest correlations with overall aggression and reactive aggression; slightly lower correlations with proactive aggression; negative correlations with self-control; and the smallest correlations with self-esteem. Our results support the equivalence, reliability, and validity of the Portuguese and original versions of the EVQ.

[Psychotraumatic consequences of coercive control]. / Conséquences psychotraumatiques du contrôle coercitif.

Coercive control is a process of violence in which one person acts in such a way as to subject the other to persistent controlling behavior. In the majority of cases, these are men, and the targets are their spouses and children. The psychotraumatic consequences are innumerable, and need to be understood before they can be identified and treated. The repercussions of coercive control are numerous, whether somatic, psychological, familial, social, professional or academic. This article describes the psychotraumatic consequences for both the victim and the children.

Violence tendency and internet addiction in adolescents.

OBJECTIVE: The aim of this study was to determine the relationship between internet addiction and violence tendency in adolescent students and the factors affecting violence tendency. METHODS: The research was conducted on 2,648 middle school students in Turkey. A socio-demographic form, the Young Internet Addiction Scale, and the Violence Tendency Scale were used to collect data. The data were analyzed using descriptive statistics and multiple regression analysis. RESULTS: It was determined that there was a significant positive relationship between the Young Internet Addiction Scale and the Violence Tendency Scale. Age has a positive effect on violence tendency levels. CONCLUSION: These findings suggest that the variables of age and internet addiction contribute to the occurrence of violence tendency. Psychiatric nurses should plan trainings and evaluate its effectiveness to raise awareness.

Evaluation of stabbing assault injuries in a tertiary emergency department: a retrospective observational study.

BACKGROUND: Approximately 458,000 victims were deceased from intentional violence in 2021. A stabbing assault causes 25% of homicides. The study aims to evaluate injury patterns, trauma scores, radiological findings, types of treatment, and outcomes of stab assault patients admitted to a tertiary emergency department (ED). METHODS: This is a retrospective observational study of stabbing injury patients in the ED of Hacettepe University, Turkey. The sites and patterns of injury, radiological findings, treatment methods, consultations, and complications are acquired from the patient's files. Trauma scores and frequency of outcomes, such as the need for surgery, hospitalization, or mortality, were calculated for all patients. RESULTS: Among the 648 patients, 564 (87%) were male. The median age was 28 (interquartile range [IQR]:13). The commonly injured body parts were the extremities (75%), thorax (21.9%), and abdomen (16.9%). The median RTS was 7,84 (IQR:0), and the median ISS was 2 (IQR:3). The fluid was detected in 13 of 88 patients by FAST, solid organ injuries in 21 patients, and gastric and intestinal injuries in 11 patients by abdominal CT. One hundred sixty-one patients underwent moderate and major surgery. Complications developed in 13 patients. 74,4% of the patients (n = 482) were treated in ED and 21.8% (n = 141) of patients were hospitalized in wards, 2.3% (n = 15) in intensive care unit and 1.5% (n = 10) patients died. GCS, RTS, and probability of survival (Ps) were significantly lower, and ISS was significantly higher in deceased patients and patients who needed erythrocyte replacement. CONCLUSION: The majority of stab wounds were detected in extremities, but severe and lethal stabbing injuries were on the thorax and abdomen. In thoracoabdominal stabbing injuries, x-rays and FAST can be ineffective in detecting critical and fatal injuries. Therefore, thoracic and abdominal CT should be planned early to detect possible causes of death and make a timely and accurate diagnosis. Lower GCS, RTS, and Ps or higher ISS scores were related to the need for erythrocyte replacement.