The mental health of staff at violence against women organizations during the COVID-19 pandemic: Findings from a mixed-methods study of service providers in Canada's largest city.

OBJECTIVES: Staff at violence against women (VAW) organizations provide essential services for survivors of violence. The increase in VAW during the COVID-19 pandemic placed additional pressures on VAW staff. We investigated the impacts of the pandemic on the mental health of VAW staff in the Greater Toronto Area to inform recommendations for policy and practice. METHODS: We conducted a community-based, mixed-methods study on the processes, experiences, and outcomes of adapting VAW programming during the pandemic using a sequential explanatory approach. Throughout 2021, we conducted a survey of direct support and leadership staff who worked on VAW services ("VAW staff") followed by semi-structured interviews with VAW staff purposively sampled from the survey. We descriptively analyzed quantitative survey data on the mental health of 127 VAW staff. We then applied thematic analysis to qualitative data from 18 interviews with VAW staff. We used the qualitative data to support interpretation and enrich the quantitative findings regarding staff mental health. RESULTS: In the survey, 81% of leadership and 61% of direct support staff indicated that their work was more distressing during the pandemic. Participants reported moderate symptoms of vicarious trauma and mild symptoms of anxiety and depression. We generated three themes from the qualitative data to help explain these findings: (1) challenges related to changing work environments; (2) distress over not meeting client needs; and (3) difficulties in adapting self-care strategies in response to pandemic stressors. CONCLUSION: VAW organizations require increased resources and flexible funding to hire and retain more staff to respond to higher and more complex caseloads during public health emergencies. With more structural supports in place, VAW organizations could create more time and space to develop their trauma-informed organizational practices: for example, establishing a culture of connection and learning among staff virtually and in-person and facilitating a range of self-care opportunities.

RéSUMé: OBJECTIFS: Le personnel des organisations de lutte contre la violence envers les femmes (VEF) fournit des services essentiels aux survivantes de la violence. L'augmentation de la VEF pendant la pandémie de COVID-19 a exercé des pressions supplémentaires sur le personnel de la VEF. Nous avons étudié les impacts de la pandémie sur la santé mentale du personnel de la VEF dans la région du Grand Toronto afin de formuler des recommandations pour les politiques et les pratiques. MéTHODES: Nous avons mené une étude communautaire basée sur des méthodes mixtes sur les processus, les expériences et les résultats de l'adaptation des programmes de VEF pendant la pandémie, en utilisant une approche explicative séquentielle. Tout au long de l'année 2021, nous avons mené une enquête auprès personnel de première ligne et des cadres travaillant sur les services de VEF (personnel de VEF), suivie d'entretiens semi-structurés avec un échantillon intentionnel de ce personnel tiré de l'enquête. Nous avons analysé de manière descriptive les données quantitatives de l'enquête sur la santé mentale de 127 membres du personnel de VEF. Nous avons ensuite appliqué une analyse thématique aux données qualitatives provenant de 18 entretiens avec le personnel de VEF. Nous avons utilisé les données qualitatives pour soutenir l'interprétation et enrichir les résultats quantitatifs concernant la santé mentale du personnel. RéSULTATS: Dans l'enquête, 81 % des cadres et 61 % du personnel de première ligne ont indiqué que leur travail était plus stressant pendant la pandémie. Les participants ont signalé des symptômes modérés de traumatisme indirect et des symptômes légers d'anxiété et de dépression. Nous avons dégagé trois thèmes à partir des données qualitatives pour aider à expliquer ces résultats : (1) défis liés aux environnements de travail changeants; (2) détresse liée à l'incapacité de répondre aux besoins des clients; et (3) difficultés à adapter les stratégies de soins personnels en réponse aux facteurs de stress de la pandémie. CONCLUSION: Les organisations de VEF ont besoin de ressources accrues et de financements flexibles pour recruter et retenir plus de personnel afin de répondre à des charges de travail plus élevées et plus complexes pendant les urgences de santé publique. Avec davantage de soutiens structurels en place, les organisations de VEF pourraient dégager plus de temps et d'espace pour développer leurs pratiques organisationnelles tenant compte des traumatismes. Par exemple, établir une culture de connexion et d'apprentissage entre le personnel, à la fois virtuellement et en personne, et faciliter une gamme d'opportunités de soins personnels.

Recommendations for Canada's National Action Plan to End Gender-Based Violence: perspectives from leaders, service providers and survivors in Canada's largest city during the COVID-19 pandemic. / Recommandations pour le Plan d'action national pour mettre fin à la violence fondée sur le genre : points de vue de dirigeants, de fournisseurs de services et de survivantes dans la plus grande ville du Canada pendant la pandémie de COVID-19.

INTRODUCTION: The Canadian government has committed to a national action plan (NAP) to address violence against women (VAW). However, a formalized plan for implementation has not been published. Building on existing recommendations and consultations, we conducted the first formal and peer-reviewed qualitative analysis of the perspectives of leaders, service providers and survivors on what should be considered in Canada's NAP on VAW. METHODS: We applied thematic analysis to qualitative data from 18 staff working on VAW services (11 direct support, 7 in leadership roles) and 10 VAW survivor participants of a community-based study on VAW programming during the COVID-19 pandemic in the Greater Toronto Area (Ontario, Canada). RESULTS: We generated 12 recommendations for Canada's NAP on VAW, which we organized into four thematic areas: (1) invest into VAW services and crisis supports (e.g. strengthen referral mechanisms to VAW programming); (2) enhance structural supports (e.g. invest in the full housing continuum for VAW survivors); (3) develop coordinated systems (e.g. strengthen collaboration between health and VAW systems); and (4) implement and evaluate primary prevention strategies (e.g. conduct a gender-based and intersectional analysis of existing social and public policies). CONCLUSION: In this study, we developed, prioritized and nuanced recommendations for Canada's proposed NAP on VAW based on a rigorous analysis of the perspectives of VAW survivors and staff in Canada's largest city during the COVID-19 pandemic. An effective NAP will require investment in direct support organizations; equitable housing and other structural supports; strategic coordination of health, justice and social care systems; and primary prevention strategies, including gender transformative policy reform.

Cerebral venous sinus thrombosis after gender reassignment surgery.

BACKGROUND: Many factors have been implicated in the etiology of cerebral venous sinus thrombosis (CVT). These include head injury, cancer, infections (sepsis, sinusitis, and mastoiditis), coagulopathies, pregnancy, systemic lupus erythematosus, and dehydration. CASE SUMMARY: We present the case of a patient who received long-term estrogen therapy for approximately 15 years after feminizing genitoplasty. The patient experienced a CVT with an excellent clinical outcome. A similar case has not been reported in the literature. CONCLUSION: Because CVT may be associated with morbidity, mortality, and risks from the complications and treatments of the condition, further research is needed to clarify the factors that may contribute to the long-term risk of CVT in patients receiving long-term estrogen therapy after feminizing genitoplasty.

Increased mortality rate associated with chikungunya epidemic, Ahmedabad, India.

In 2005-2006, Réunion Island in the Indian Ocean reported approximately 266,000 cases of chikungunya; 254 were fatal (case-fatality rate 1/1,000). India reported 1.39 million cases of chikungunya fever in 2006 with no attributable deaths; Ahmedabad, India, reported 60,777 suspected chikungunya cases. To assess the effect of this epidemic, mortality rates in 2006 were compared with those in 2002-2005 for Ahmedabad (population 3.8 million). A total of 2,944 excess deaths occurred during the chikungunya epidemic (August-November 2006) when compared with the average number of deaths in the same months during the previous 4 years. These excess deaths may be attributable to this epidemic. However, a hidden or unexplained cause of death is also possible. Public health authorities should thoroughly investigate this increase in deaths associated with this epidemic and implement measures to prevent further epidemics of chikungunya.

HIV-infected inpatients in the HAART era: how do hepatitis C virus coinfected patients differ?

We compared the demographics and clinical characteristics of HIV-infected patients with and without hepatitis C virus (HCV) coinfection hospitalized at Cook County Hospital, Chicago, Illinois, from October 1999 through September 2000. Two hundred three (40%) of the 510 patients were coinfected with HCV. HCV coinfected patients were less likely to be on highly active antiretroviral therapy (HAART) and were frequently hospitalized with higher CD4 counts for non-HIV-related medical problems including complications of liver disease.