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

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 essay attempts to reflect on these issues and help professionals in making decisions.

Effectiveness of a treatment programme for immigrants who committed gender-based violence against their partners / Efectividad de un programa de tratamiento con inmigrantes que ejercen violencia de género contra la pareja

Background: In recent years, the number of immigrant perpetrators who attend treatment programmes for partner violence has increased. In this study, the effectiveness of a psychological treatment programme for immigrant men who have committed a gender-based violent crime was evaluated. Methods: The sample was composed of 300 individuals (150 immigrants and 150 citizens) who received treatment in the batterer intervention programme developed in Pamplona (Navarra). A twog roup design was used (immigrants and citizens) with multiple, repeated evaluations (pre-treatment, post-treatment, and 12-month follow-up). Results: Results showed the usefulness of the programme, with no statistically significant differences in the success and improvement rates observed between the immigrant and citizen patient groups. Post-treatment success rate was 34.6% both in the immigrant group and the citizen group. The improvement rate was 51.3% in both groups. Results at 12- month follow up were nearly the same. The combined rate of success and improvement was 87.3% among immigrants and 86.6% among citizens. In addition, the associated psychopathologic symptoms exhibited significant improvement. Conclusions: The tested programme was shown to be effective in the treatment of immigrant batterers (AU)

Antecedentes: en este artículo se evalúa la efectividad de un programa de tratamiento psicológico para hombres inmigrantes que han cometido un delito de violencia de género. Método: se contó con una muestra de 300 sujetos (150 inmigrantes y 150 nacionales), que recibieron tratamiento en el programa de intervención con maltratadores que se desarrolla en Pamplona (Navarra). Se utilizó un diseño de dos grupos (inmigrantes y nacionales), con medidas de evaluación múltiples y repetidas (pretratamiento, postratamiento y seguimiento de 12 meses). Resultados: los resultados mostraron la utilidad del programa, sin que hubiera diferencias estadísticamente significativas en la tasa de éxito y de mejoría de los pacientes inmigrantes y nacionales. La tasa de éxito en el postratamiento fue del 34,6% tanto en el grupo de inmigrantes como en el grupo de nacionales. La tasa de mejoría fue del 51,3% también en ambos grupos. Los resultados a los 12 meses de seguimiento fueron prácticamente iguales. La tasa combinada de éxito y mejoría fue del 87,3% entre los inmigrantes y del 86,6% entre los nacionales. Además, se produjo una mejoría significativa en la sintomatología psicopatológica asociada. Conclusiones: el programa puesto a prueba mostró su eficacia en el tratamiento de maltratadores inmigrantes (AU)

Profesionales de atención primaria de Madrid y violencia de pareja hacia la mujer en el año 2010 / Workers in primary health care and partner violence against women

Fundamentos: La morbilidad asociada a la violencia de pareja hacia la mujer (VPHM) justifica que sus víctimas acudan reiteradamente a los centros de salud. La accesibilidad y continuidad asistencial hacen de la atención primaria (AP) el lugar idóneo para su detección y primer abordaje. Sin embargo, los datos reflejan las dificultades de los/as profesionales para lograr este fin. El objetivo es analizar el nivel de conocimientos, opiniones, barreras organizativas percibidas y propuestas de mejora de los profesionales de AP. Método: Estudio transversal descriptivo realizado mediante una encuesta anónima y autoadministrada durante los meses de agosto y septiembre de 2010, dirigida a todos/as profesionales de AP del área 8 de Madrid. Se realizó un análisis descriptivo de variables y la X2 para comparar las respuestas obtenidas. Resultados: Tasa de respuesta 170 (21,4%). 118 (70,7%) profesionales creen que este es un problema importante y 154(91,7%) que habitualmente pasa desapercibido. 91(55,2%) conocen las obligaciones legales que tienen cuando la detectan. 73(51,8%) piensan que existen barreras organizativas. Entre ellas: presión asistencial 50(29%), falta de formación específica 40(23,5%), desconocimiento del procedimiento a seguir 20(11,8%) y de las competencias de cada profesional 12(7%). Conclusiones: El nivel de conocimientos medio para todas las categorías profesionales estudiadas, excepto para trabajo social que es alto. Los/as profesionales de AP consideran que la VPHM es un problema importante que pasa desapercibido. La mitad de ellos/as conocen las obligaciones legales que conlleva la detección. Existen barreras organizativas y estereotipos(AU)

Background: Morbidity associated to partner violence against women (PVAW) justify these patients repeated visits to Health Services. Primary Care is the ideal place for detectión and first aid, due to its easy accesibility and continuated assistance. Nevertheless, numbers show important difficulties to achieve this goal. Our aimis to find out the level of knowledge, opinions, awareness about organizacional barriers and improvement proposals suggested by the workers of primary care. Method: Cross-sectional descriptive study using an anonymous and voluntary survey during the months of August and September 2010, targeted to all professionals who performtheir work in a Primary Care Area of Madrid. We made a descriptive analysis of variables and used chi2 to compare the answers. Results: Answer rate is 170 (21.4%). There are stereotypes regarding battered woman and perpetrador. 118 (70.7%) professionals believe that this is a major problem and 154 (91.7%) that usually goes unnoticed. 91 (55.2%) know their legal commitments. 73 (51.8%) think that there are organizational barriers, among them: the burden of care 50(29%), lack of specific training 40(23.5), lack of knowledge about the procedure to be followed 20(11.8%) and about the professional responsabilities 12 (7%). Conclusions: All profesional categoríes showed an average level of knowledge, except for social workers that was high. Primary Care workers think that PVAWis an important issue that usually goes unnoticed. Half of them know the legal commitments o detección. There are organizacional barriers and stereotypes(AU)

Conocimientos sobre violencia de género de la población que consulta en Atención Primaria / Knowledge of gender-based violence in the population seen in Primary Care

Objetivo: Determinar conocimientos y actitudes hacia la violencia de género de la población consultante en Atención Primaria y su relación con factores sociodemográficos y experiencias personales.DiseñoEstudio descriptivo transversal.EmplazamientoCentros de Salud urbanos.ParticipantesPacientes ≥ 18 años que acuden a consulta de Atención Primaria.Mediciones principalesSe utilizó un cuestionario que incluía preguntas relativas a conocimientos, actitudes y experiencias vividas en relación con la violencia de género y en el ámbito doméstico, y que también recogía edad, sexo, nivel de estudios, estado civil y detección de experiencias personales de violencia de género mediante la versión corta del Woman Abuse Screening Tool (WAST).ResultadosRespondieron 673 personas, de 18-86 años, con un 68% de mujeres. Solo un 18,2% tenía un adecuado conocimiento sobre quién se considera que ejerce la violencia de género. La mitad de los participantes consideraban que la violencia de género incluía lesiones físicas, psicológicas, cohibición de libertad y violación. A través de un análisis de regresión logística se encontró una asociación independiente con el conocimiento de la respuesta correcta sobre qué es la violencia de género del estado civil, siendo menos probable en los casados con respecto a los viudos (OR: 0,28; IC 95%: 0,11-0,72) considerar que la violencia de género implica lesión física (OR: 2,55; IC 95%: 1,28-5,08), pero no lesiones psicológicas (OR: 0,52; IC 95%: 0,28-0,96), y no dar la respuesta correcta sobre qué es la violencia doméstica (OR: 0,06; IC 95%: 0,03-0,12).ConclusionesExiste una gran dispersión en las respuestas con relación a qué consideran los pacientes que es la violencia de género y qué aspectos abarca(AU)

Objective: To determine the knowledge and attitudes towards gender-based violence in the Primary Care patient population and their relationship with sociodemographic factors and personal experience.DesignA descriptive, cross-sectional study.SettingUrban Health Centres.ParticipantsPatients ≥18 years-old who were seen in a Primary Care clinic.Materials and methodA questionnaire was used that included questions associated with knowledge, attitudes and experience of gender-based violence in the domestic environment. Variables such as, age, sex, education level, marital state were recorded, as well as the detection of personal experiences of Gender-Based Violence using the short Woman Abuse Screening Tool (WAST).ResultsA total of 673 people, from 18- 86 years, responded, of which 68% were women. Only 18.2% had sufficient knowledge on who is considered to exercise gender-based violence. Half of the participants believed that gender-based violence included physical and psychological injuries, inhibition of freedom and rape. In the logistic regression analysis an independent relationship was found with the knowledge of the correct response on what is gender-based violence by marital state, being less likely in married people as regards widowers (OR: 0.28; CI 95%: 0.11-0.72), to consider that gender-based violence involves physical injury (OR: 2.55; CI 95%: 1.28-5.08), but not psychological injury (OR: 0.52; CI 95%: 0.28-0.96), and not giving the correct response on what is domestic violence (OR:0.06; CI 95%: 0.03-0.12).ConclusionsThere is a wide variation in the results as regards what patients believe gender-based violence is and what aspects it covers(AU)

Pre-hospital provider recognition of intimate partner violence.

The leading risk factor of morbidity and mortality in Victorian women aged between 15 and 45 years is intimate partner violence (IPV) (approximately 8 times than that of smoking). Paramedics are frequently the first point of contact for victims of IPV. Due to this unique viewpoint, paramedics have the advantage of potentially identifying and reporting IPV, which can then result in early intervention. This article will summarise the literature regarding pre-hospital provider knowledge of IPV.

Dilemmas in intimate partner violence.

Intimate partner violence (IPV), usually men's violence against women, appears universal. It may be associated with pregnancy, but this may be because pregnant women receive more medical attention. Violence may cause bruises, abrasions, and cuts, but its extremes include hospitalization, death, and suicide. IPV is often disclosed when women are asked why they feel in poor health or depressed. A legal dilemma arises when healthcare providers consider that intervention such as law-enforcement is appropriate, but patients refuse approval. Patients may fatalistically accept violence, or fear loss of support for their children and themselves if their partners are held in custody. Legal reforms, such as punishing spousal rape, may provide some protection of women's autonomy. Ethical dilemmas concern intervention without patients' approval, and whether treating violent injuries without taking preventive action breaches the principle to Do No Harm. Professional advocacy and social action have been urged to expose and reduce IPV.

La formación de los/as profesionales de la salud para afrontar la violencia contra las mujeres en la pareja / How to train health professionals to deal with domestic violence

La violencia contra las mujeres en la pareja es, de acuerdo con la consideración de la Organización Mundial de la Salud (OMS), un problema social y sanitario de primera magnitud y que requiere acción urgente y prioritaria de los/as profesionales de la salud. El objetivo de este trabajo es analizar la percepción sobre este problema, su frecuencia, su gravedad y sus causas en un colectivo de alumnado universitario de ciencias de la salud como futuros/as profesionales implicados/as. Se analizan estas percepciones en 175 estudiantes de Psicología y Enfermería a quienes se administró una entrevista ad hoc y el “Inventario de Pensamientos Distorsionados sobre la Mujer y la Violencia” (Echeburúa y Fernández-Montalvo, 1997).Los resultados muestran que este alumnado tiene entre sí más semejanzas que diferencias y que su consideración de este problema es similar a la de la población general, valorándolo como problema social inaceptable y grave, que ocurre frecuentemente y donde tienen un peso importante diversas causas individuales y sociales. Se analizan las implicaciones de estos resultados (AU)

According to the World Health Organization (WHO), domestic violence is a major social and health problem requiring crying and priority action from health care professionals. The objective of this paper is to analyze how these professionals perceive this problem, its prevalence, seriousness and causes when they are university students. Perception of a sample of 175 university students, including Psychology and Nursing, was analyzed. An ad hoc interview and the “Inventory of Distorted Thoughts about Women and Violence” (Echeburúa and Fernandez-Montalvo,1997) were administered. The results show that both groups of students have more similarities than differences and that their consideration of this problem is similar to the one of the general population. They regard it as an unacceptable and serious social problem occurring frequently, where diverse individual and social causes play a role. The implications of these results are finally analyzed (AU)

Battered woman syndrome: empirical findings.

The construct of Battered Woman Syndrome (BWS) has been conceptualized as a subcategory of posttraumatic stress disorder (PTSD). It is composed of the following symptoms: (a) re-experiencing the battering as if it were reoccurring even when it is not, (b) attempts to avoid the psychological impact of battering by avoiding activities, people, and emotions, (c) hyperarousal or hypervigilance, (d) disrupted interpersonal relationships, (e) body image distortion or other somatic concerns, and (f) sexuality and intimacy issues. This article presents empirical data derived from administering the Battered Woman Syndrome Questionnaire (BWSQ) to women of four countries--United States, Spain, Greece, and Russia. The data support a theory of BWS.

Telephone survey respondents' reactions to questions regarding interpersonal violence.

Concerns have been raised regarding the appropriateness of asking about violence victimization in telephone interviews and whether asking such questions increases respondents' distress or risk for harm. However, no large-scale studies have evaluated the impact of asking such questions during a telephone interview. This study explored respondents' reactions to questions regarding violence in two large recently completed telephone surveys. After respondents were asked about violence, they were asked if they thought surveys should ask such questions and whether they felt upset or afraid because of the questions. In both surveys, the majority of respondents (regardless of their victimization history) were willing to answer questions about violence and were not upset or afraid because of the questions. More than 92% of respondents thought such questions should be asked. These results challenge commonly held beliefs and assumptions and provide some assurance to those concerned with the ethical collection of data on violent victimization.

The risk of partner aggression research: impact of laboratory couples conflict protocols on participants.

The impact of male-to-female intimate partner violence (IPV) research on participants is unknown. A measure of impact was given to participants in an IPV study to assess systematically the impact of completing questionnaires, engaging in conflict conversations, and being interviewed individually about anger escalation and de-escalation during the conversations. Participants completed a six-question, Likert-scaled impact measure. Both male and female participants rated the impact of the study as helpful to them personally and to their relationships. Female participants rated different segments of the study as more helpful to themselves and their relationships, while male participants did not find any segment of the study to have a different impact than other segments.

Identifying bioethics learning needs: a survey of Canadian emergency medicine residents.

OBJECTIVES: Emergency medicine (EM) postgraduate training programs must prepare residents for the ethical challenges of clinical practice. Bioethics curricula have been developed for EM residents, but they are based on expert opinion rather than resident learning needs. Educational interventions based on identified learning needs are more effective at changing practice than interventions that are not. The goal of this study was to identify the bioethics learning needs of Canadian EM residents. METHODS: A survey-based needs assessment of Canadian EM residents was performed between July 2000 and June 2001. Residents were asked to identify their learning needs by rating bioethics topics and by relating their clinical experiences. Physicians and nurses who work with residents were surveyed in a similar manner and also asked to identify the residents' bioethics learning needs. RESULTS: A total of 129 EM residents (77% of eligible residents), 94 physicians, and 87 nurses responded. Residents, physicians, and nurses all identified issues in end-of-life care as the greatest bioethics learning needs of the residents. Other areas identified as learning needs included negotiating consent, capacity assessment, truth telling, and breaking bad news. A learning need identified by nurses, but not residents, was the manner in which residents interact with patients and colleagues. CONCLUSIONS: This needs assessment provides valuable information about the ethical challenges EM residents encounter and the ethical issues they believe they have not been prepared to face. This information should be used to direct and shape ethics education interventions for EM residents.

Domestic violence against women with cancer: examples and review of the literature.

Over a recent 3-month period in our oncology practice, we became aware of multiple patients reporting domestic abuse. We present three selected cases, review the literature on domestic violence, and explore issues of diagnosis and management in a cancer population. Domestic violence against cancer patients may be more common than initially appreciated, and further awareness and research are indicated.