Workplace Violence against Nurses Working at Private Teaching Hospitals of Kathmandu: A Descriptive Cross-sectional Study.

INTRODUCTION: Workplace violence in hospitals is a global concern and is considered as a major occupational hazard for all health care providers including the nurses. The aim of this study was to assess the status of workplace violence against nurses at hospitals in Kathmandu and determine the actions taken to investigate its cause. METHODS: A descriptive cross-sectional study was conducted among a convenient sample of 100 registered nurses employed in Nepal Medical College and Teaching Hospital, and Kathmandu Medical College and Teaching Hospital. All eligible nurses who were willing to participate irrespective of their academic fulfilment, from all different shifts and of age below 45 years were included. Data were collected using a structured questionnaire and analysed using SPSS software. Ethical approval was taken from the Institutional Review Committee (IRC) of Nepal Medical College and Kathmandu Medical College. RESULTS: Among 100 participants, the prevalence of workplace violence was 72 (72%) (62.13-80.52, 95% Confidence Interval). Verbal abuse accounted to 50 (69.44%), followed by physical violence accounting 17 (23.61%). Action was taken to investigate the causes of both physical violence 5 (29.41%) and verbal abuse 2 (4%) by the hospital administration 3 (60%) in physical violence and 2 (100%) in verbal abuse and police 2 (40%) in physical violence. CONCLUSIONS: The study reveals a troubling reality, as the vast majority of nurses reported experiencing various forms of violence in their workplace. So, addressing this issue immediately could protect nurses' well-being and ensure quality care which benefits both healthcare professionals and patients.

Wellbeing and illbeing in women exposed to physical and sexual violence during peripregnancy: a population-based longitudinal study.

Background: Physical and sexual violence against pregnant women have been associated with detrimental mental health outcomes for victims. Few studies have examined both positive (wellbeing) and negative (illbeing) mental health indicators in the same sample. Additionally, the literature assessing mental health based on different forms of violence is limited.Objective: To compare both wellbeing (life satisfaction) and illbeing (anxiety and depression) trajectories between non-victimized and victims of physical, sexual and both forms of violence that occurred during or shortly before pregnancy. Further, we analyse whether social support moderates these trajectories.Method: This longitudinal study is based on the Norwegian Mother, Father and Child Cohort, including the period from early pregnancy to toddlerhood (3 years). We compared wellbeing and illbeing trajectories of non-victims (n = 73,081), victims of physical abuse (n = 1076), sexual abuse (n = 683), and both forms of abuse (n = 107) using Growth Curve Modelling. Finally, social support was included as a moderator of wellbeing and illbeing trajectories.Results: Results indicated that victims scored systematically lower in wellbeing and higher in illbeing. Exposure to violence did not significantly change the wellbeing trajectory, pointing to similar developments in wellbeing among victims and non-victims for the considered period. On the other hand, different trajectories in illbeing occurred between victims and non-victims, as well as between victimized groups. Victims experienced greater change in illbeing scores, with a steeper decrease in illbeing compared to non-victims. Both victims and non-victims returned to respective baseline scores 3 years after birth. All women benefited from social support, but victims of physical abuse were particularly protected by social support.Conclusions: There is an alarming persistence of mental health problems in women exposed to violence during peripregnancy. Different forms of violence differentially impact women's mental health. Social support is beneficial among all pregnant women.

Victims of peripregnancy violence score systematic lower in wellbeing over time than non-victims. However, the wellbeing trajectories among victims and non-victims are similar.On the other hand, illbeing (anxiety and depression) trajectories differ for non-victims and victims of physical, sexual and both forms of violence. All women decreased their levels of illbeing from pregnancy to the first 6 months postpartum, but victims had a steeper decrease during this period compared to non-victims.All women benefited from social support, but victims of physical abuse were particularly protected by social support.

Gender-related stigma toward individuals with a history of sexual or physical violence in childhood.

BACKGROUND: Stigma is a key barrier to disclosing traumatic experiences of violence in childhood with adverse consequences for help-seeking behaviour. Disclosing behavior differs by gender and the form of violence experienced. However, there is a lack of comprehensive studies that address societal perceptions of males and females with a history of sexual or physical violence in childhood. Therefore, our aim is to focus on the impact of gender on the perception of individuals who experienced sexual or physical violence in childhood. METHODS: We conducted a study on a representative sample of the German general population in terms of age and gender. Participants were randomly assigned to brief case vignettes addressing sexual or physical violence in childhood. Analyses base on a sample of n = 659 individuals (50.1% female). Stigma was assessed through examining respondents' readiness to address specific traumas in conversation and respondents' attitudes toward the individuals in the vignettes. Mann-Whitney U tests were applied to check for differences between female and male victims and survivors as well as female and male respondents. RESULTS: Our results reveal that male victims and survivors face higher negative stereotypes (harm, unpredictability) and evoke communication barriers more often when compared to female victims and survivors, especially in male respondents. Sexual violence is associated with more distinct gender differences than physical violence. CONCLUSIONS: Findings reflect greater stigma toward male victims and survivors of sexual violence than female ones. Men had a greater tendency to stigmatize - especially toward their same-gender peers. Socially ingrained gender roles may act as a basis for different communication cultures and the notion of victim-perpetrator constellations in which males are not envisaged as victims.

Prevalence of physical, psychological and sexual intimate partner violence among women of reproductive age during COVID-19 in Ethiopia: a systematic review and meta-analysis.

Introduction: COVID-19 preventive measures such as stay at home and isolation leads to violence against women. Intimate partner violence (IPV) is one of the common violence during this pandemic. This study aimed to assess the prevalence of physical, psychological and sexual intimate partner violence among reproductive age women during COVID-19 in Ethiopia. Materials and Methods: Electronic databases such as PubMed, Google Scholar and African journals online and studies available from the occurrence of the pandemic to April 2023 were searched. Two researchers collected the data and independently performed the methodological quality assessment. To pool the collected data for each outcome with 95% confidence interval (CI), DerSimonian-Laird random effects meta-analysis was used. Publication bias was measured by Doi plot LFK index and Egger's test. Stata version 14.0 (StataCorp, College Station, Texas, USA) software was used for statistical analysis. Results: A total of seven studies reported the prevalence of intimate partner violence among women in reproductive age during COVID-19, and the pooled prevalence of physical intimate partner violence was 22% (95% CI [0.12-0.32], I2 = 98.9%, tau2 = 0.0184, p < 0.001). The pooled prevalence of psychological intimate partner violence was 28% (95% CI [0.18-0.37], I2 = 98.1%, tau2 = 0.0142, p < 0.001). The pooled prevalence of sexual intimate partner violence was 23% (95% CI [0.13-0.34], I2 = 99.1%, tau2 = 0.0208, p < 0.001). Conclusions: During COVID-19 reproductive age women in Ethiopia were affected by intimate partner violence. Physical, psychological and sexual intimate partner violence were reported, and their prevalence was high due to the pandemic. Future studies on impact of COVID-19 on IPV among reproductive age women should be conducted in nationwide to make more comprehensive conclusion. PROSPERO registration number: CRD42023417628.

Interpersonal violence against transgender and cisgender women in Brazilian municipalities: trends and characteristics. / Violência interpessoal em mulheres transgêneras e cisgêneras nos municípios brasileiros: tendências e características.

Violence against women is characterised by male symbolic domination underpinned by patriarchy and expressing gender inequality in society. This study examined reporting of interpersonal violence against cisgender and transgender women 20 to 59 years old in Brazilian municipalities, from 2015 to 2021. This repeat panel study used data from the information system, and time-trend analysis by the Prais-Winsten method. A total of 605,983 notifications were eligible, 1.8% of which involved transgender women. Notifications regarding cisgender women were recorded in 84.8% of the municipalities and transgender women, in 31.7%. Notifications involved predominantly women who were younger (71.9%) and black (55.3%), and proportionally more transgender women (p<0.001). Most notifications were of physical violence (84.8%), followed by psychological violence (40.1%), which was higher among cisgender women (p<0.001) and at shorter intervals among transgender women (ß=-0.71; p=0.005). Notifications of violence still do not reflect the realities, particularly as regards transgender women. Psychological violence, however, which usually starts the cycle of aggression, now ranks second among notifications in Brazil, despite conservative reverses of recent years.

A violência contra mulher caracteriza-se pela dominação simbólica masculina com pilares no patriarcado, expressando a desigualdade de gênero existente na sociedade. O objetivo deste estudo é analisar a notificação de violência interpessoal em mulheres cisgêneras e transgêneras, de 20 a 59 anos, nos municípios brasileiros, no período de 2015 a 2021. Trata-se de estudo do tipo painéis repetidos, utilizando dados do sistema de informação, e análise de tendência temporal pelo método Prais-Winsten. Foram elegíveis 605.983 notificações, sendo 1,8% de transgêneras. As notificações foram registradas em 84,8% dos municípios para mulheres cisgêneras e 31,7% para transgêneras. Houve predomínio em jovens (71,9%) e negras (55,3%), sendo proporcionalmente maior entre as transgêneras (p<0,001). A maioria das notificações foi de violência física (84,8%); seguida de violência psicológica (40,1%), sendo maior nas cisgêneras (p<0,001) e com redução no período para as transgêneras (ß=-0,71; p=0,005). A notificação de violência ainda não reflete a realidade, em particular para mulheres transgêneras. A violência psicológica, entretanto, que costuma ser o início do ciclo de agressão, já ocupa o segundo lugar entre as notificações no país, apesar dos retrocessos vivenciados nos últimos anos.

Characteristics of blunt and penetrating trauma among victims of physical violence: A retrospective study.

BACKGROUND: A significant number of referrals to the emergency departments is due to violence and conflict leading to serious injuries and death. The increasing number of such cases highlights the urgent need for investigating victimization of physical violence. AIM: The purpose of this study was to determine the frequency of demographic and clinical characteristics in victims of violence and classify them based on penetrating or blunt trauma. METHODS: The data of the patients who had been the victims of violence in 2020 were extracted from the Trauma Registry System(TRS) of the Guilan Road Trauma Research Center(GTRC). All analyses were performed using SPSS software version 24. The significance level was considered less than 0.05. RESULTS: There was a significant difference in the type of violence-related trauma in different age groups (P < 0.001), based on sex (P = 0.002), and marital status (P = 0.012). A significant difference also existed between the trauma type and clinical variables including smoking (P = 0.032), history of alcohol drinking (P = 0.005), and other substance use (P = 0.002), the anatomical location of injury (P < 0.001) and therapeutic interventions (p < 0.001(. CONCLUSION: Most of the clients of the violence suffered from blunt trauma, the severity of which was mild, and they were treated supportively without the need for surgery. Blunt trauma was seen more in women, divorcees, over 40 years and non-smokers. Penetrating trauma was observed more in lower limb injuries and alcohol and amphetamine users. Prevention programs and educational interventions should be programmed for the society long before men alcohol and amphetamine abusers reach their fourth decade of life. Accurately recording the type of physical violence, and the weapon used, and determining the injury severity score in TRS can lead to more reliable results in researching the field of violence issues.

The prevalence of physical and verbal violence among emergency medicine physicians in military hospitals vs non-military hospitals, Jeddah, Saudi Arabia: multi-center cross-sectional study.

INTRODUCTION: In healthcare settings, physical and verbal attacks are commonly encountered in the workplace among healthcare providers. Patients and patients' relatives and friends have been reported to be the perpetrators of workplace violence. Among all healthcare settings, emergency department (ED) have been designated as high-risk settings for violence, where more than one-quarter of emergency physicians reported that they were victims of physical assault. This study aimed to report the prevalence of workplace violence against emergency medicine physicians in military and non-military hospitals in Jeddah city. METHODOLOGY: A cross-sectional design has been used in this study. An electronic questionnaire was developed through the Google Form Platform and it included demographic data, the occurrence of verbal or physical violence in the workplace to participants, how many times they experienced this violence, the time of incidents, the location either inside or outside the hospital, whether the perpetrators were mostly patients, patient families, or friends, and whether they reported any violence or not. Categorical variables were used to describe frequencies and percentages, while descriptive statistics such as mean and 95% Confidence Interval (95% CI) were used to summarize the scale variables. P < 0.05 was considered for statistically significant differences. RESULTS: Among the 100 participants, 76 experienced either physical or verbal violence, or both. The remaining 24 did not experience any sort of violence. 83% of the physicians who have been physically violated were working in non-military hospitals. Of the 72 participants who had experienced verbal violence, 51 (70.8%) were working in a non-military hospital, while 21 (29.2%) were in a military hospital. The most common reason for not reporting was that the participants felt that reporting the violence incidence was useless. Moreover, 92% of participants chose "Train healthcare workers to deal with violent attacks" as a suggested helpful factor in decreasing the number of work-related violence. In addition, "Education of the public" and "Raising awareness of healthcare workers" were chosen as helpful factors as well by 91% and 90% of participants, respectively. CONCLUSION: This revealed that physicians in non-military hospitals experience higher levels of violence compared to their military counterparts. However, it is concerning that instances of violence are substantially under-reported across both military and non-military healthcare facilities.

Posttraumatic stress disorder following childhood sexual and physical abuse: a study protocol for an 11-week randomised controlled trial comparing imaginal exposure and imagery rescripting.

Background: There is a vast amount of evidence supporting the effectiveness of trauma-focused cognitive-behavioral therapy in treating posttraumatic stress disorder (PTSD). However, it remains unclear which specific treatment is most effective for patients with PTSD following childhood sexual and physical abuse (CSPA). Although Imaginal Exposure (IE) has proven highly effective in treating PTSD and is widely acknowledged as a standard method, Imagery Rescripting (IR) may be more suitable for CSPA-related PTSD. IR not only addresses fear but also targets other emotions and cognitions associated with childhood maladaptive schemas. Preliminary findings suggest lower drop-out rates for IR compared to IE, but no Randomized Controlled Trial (RCT) currently assesses the effectiveness of IR for CSPA-related PTSD.Objective: This article presents a study protocol designed to investigate the optimal treatment (IE or IR) for individuals with CSPA-related PTSD and explore predictors of treatment success.Method: In our study protocol, we suggest the inclusion of 173 patients (N = 64 in IR, N = 64 in IE, and N = 45 in the waitlist condition). The therapy procedures for both IE and IR will consist of 16 sessions lasting 90 min each, with treatment durations of 11 weeks. Measurements take place at baseline, at start of treatment, 11 weeks after the start of treatment (after 16 sessions) and at follow-up at 26 weeks after the last session. A mixed regression will be used to compare the three active conditions before and after measurement.Results: This article serves as a study protocol. The results are not yet available but they will be presented in a subsequent article.Conclusion: This study protocol outlines a RCT which will be the first to provide information on the effectiveness of IR versus IE versus a control group in CSPA-related PTSD.Trial registration: Netherlands Trial Register NTR 4817. Registered 26 September 2014.

This study protocol is designed to enhance the clinical treatment for individuals (aged 18 and above) experiencing posttraumatic stress disorder (PTSD) resulting from childhood sexual and physical abuse (CSPA) occurring before the age of 16.Within this protocol, the efficacy of two PTSD interventions ­ Imagery Rescripting (IR) and Imaginal Exposure (IE) ­ will be systematically compared, both against each other and a control group.The secondary objective of this study protocol is to investigate potential predictors of treatment success, including factors such as tonic immobility, dissociation, heart rate variability, measures of autonomic arousal, personality disorders, and the quality of therapeutic alliance.

Physical, Sexual, and Intimate Partner Violence Among Transgender and Gender-Diverse Individuals.

Importance: Transgender and gender-diverse (TGD) communities experience disproportionate levels of violence, yet due to limitations in measuring TGD identity, few state-representative estimates are available. Objective: To assess gender identity differences in experiences of violence among adults. Design, Setting, and Participants: Cross-sectional data from the 2023 California Violence Experiences (CalVEX) survey, weighted to provide state-representative estimates, was used to assess associations between gender identity and past-year experiences of violence among adults 18 years and older. Data were analyzed from June to December 2023. Exposure: Gender identity (cisgender women, cisgender men, transgender women, transgender men, and nonbinary individuals). Main Outcomes and Measures: Experience of physical violence (including physical abuse and threat or use of a weapon), sexual violence (verbal sexual harassment, homophobic or transphobic slurs, cyber and physically aggressive sexual harassment, and forced sex), and intimate partner violence (IPV; emotional, physical, or sexual violence) using age-adjusted logistic regression. Results: In total 3560 individuals (weighted cumulative response rate, 5%) completed the 2023 CalVEX survey, with 1978 cisgender women, 1431 cisgender men, 35 transgender women, 52 transgender men, and 64 nonbinary respondents (mean [SD] age, 47.1 [17.5] years; 635 [17%] were Asian, 839 [37%] were Hispanic, and 1159 [37%] were White). Past-year physical violence was reported by 22 transgender men (43%), 9 transgender women (24%), and 9 nonbinary respondents (14%). Past-year sexual violence was reported by 23 transgender men (42%), 11 transgender women (14%), and 31 nonbinary respondents (56%). Compared with cisgender women, transgender women and transgender men had greater risk of past-year physical violence (any form) (transgender women adjusted incidence rate ratio [AIRR], 6.7; 95% CI, 2.5-18.2; transgender men AIRR, 9.7; 95% CI, 5.3-17.7), as well as past-year IPV (any form) (transgender women AIRR, 3.2; 95% CI, 1.3-8.0; transgender men AIRR, 6.7; 95% CI, 4.0-11.3). Relative to cisgender women, transgender men (AIRR, 3.0; 95% CI, 1.7-5.1) and nonbinary respondents (AIRR, 3.3; 95% CI, 2.1-5.2) had greater risk of past-year sexual violence (any form). Conclusions and Relevance: In this survey study of adults in California, results showed that TGD individuals, especially transgender men, are at higher risk of experiencing all forms of violence relative to cisgender women. Results highlight the need for gender-affirming violence prevention and intervention services as well as policies that protect TGD individuals from discriminatory violence.

Fractura craneal deprimida congénita ("fractura ping-pong") en neonatos como diagnóstico diferencial de maltrato físico / Congenital depressed skull fracture ("ping-pong" fracture) in newborn infants as a differential diagnosis of physical abuse

Las fracturas con hundimiento de cráneo sin una explicación clara sobre su origen orientan al traumatismo con un objeto romo y a la sospecha de maltrato infantil. En el caso de los bebés recién nacidos, su corta edad es un factor de vulnerabilidad y obliga a una exhaustiva evaluación. Ante la sospecha de maltrato infantil, resulta importante evaluar los diagnósticos diferenciales para realizar la intervención más adecuada posible. Es necesario evitar tanto intervenciones excesivas como omitir la intervención que sea necesaria. Las fracturas craneales deprimidas congénitas, descritas como "fracturas pingpong", son raras (0,3 a 2/10 000 partos). Pueden aparecer sin antecedentes traumáticos o en partos instrumentalizados. Se describe en este artículo el caso de un recién nacido con una fractura ping-pong como ejemplo de una fractura no intencional.

Depressed skull fractures without a clear explanation as to their origin point to trauma with a blunt object and suspected child abuse. In the case of newborn infants, their young age is a vulnerability factor and requires an exhaustive assessment. When child abuse is suspected, an assessment of the differential diagnoses is required to make the most appropriate intervention possible. Both an excessive intervention and an omission of a necessary intervention should be avoided. Congenital depressed skull fractures, described as "ping-pong fractures", are rare (0.3 to 2/10 000 births). They may appear without any trauma history or in instrumentalized childbirth. Here we describe the case of a newborn infant with a ping-pong fracture as an example of an accidental fracture.

Prevalence, predictors, and consequences of workplace violence among female healthcare workers in tertiary care hospitals: A cross-sectional study in Pakistan.

OBJECTIVE: To determine the prevalence, predictors and perpetrators of violence, and its impact on the mental health of female healthcare workers. METHODS: The cross-sectional study was conducted from June to October 2022 at three tertiary care hospitals after approval from the ethics review board of Rawalpindi Medical University, Rawalpindi, Pakistan, and comprised female healthcare workers, including doctors, nurses and paramedical staff. Data was collected regarding workplace violence using a structured questionnaire adopted from literature. The incidence of verbal, physical and sexual violence in the preceding 12 months was noted, and predictors were analysed. Data was analysed using SPSS 25. RESULTS: Of the 140 subjects with an age range of 16-60 years, verbal violence was experienced by 102(72.9%) and physical violence by 26(18.6%), while verbal and physical forms of sexual violence were reported by 33(23.6%) and 13(9.3%), respectively. Those in the Medicine department had significantly lower odds of experiencing verbal violence compared to those from the Surgery department (adjusted odds ratio=0.223; 95% confidence interval: 0.078-0.036; p=0.005). Those in the Emergency department had significantly greater odds of experiencing physical violence compared to those in Surgery (adjusted odds ratio=8.716; 95% confidence interval: 1.693-44.87; p=0.01). Violence had a significant detrimental impact on the mental health of female healthcare workers (p<0.05). CONCLUSIONS: Violence was found to be prevalent in the healthcare sector, specifically in stressful and critical-care departments, like Emergency and Surgery.

Medicolegal analysis of physical violence toward physicians in Egypt.

This study analyzed physical violence against physicians in Egypt from a medicolegal perspective. 88%, 42%, and 13.2% of participants were exposed to verbal, physical, and sexual violence. Concerning the tools of violence, 75.2% of attackers used their bodies. Blunt objects (29.5%), sharp instruments (7.6%), and firearm weapons (1.9%) were used. The commonest manners of attacks were pushing/pulling (44.8%), throwing objects (38.1%), and fists (30.5%). Stabbing (4.8%) and slashing (2.9%) with sharp instruments were also reported. Traumas were mainly directed towards upper limbs (43.8%), trunks (40%), and heads (28.6%). Considering immediate effects, simple injuries were reported that included contusions (22.9%), abrasions (16.2%), and cut wounds (1.9%). Serious injuries included firearm injuries (4.8%), internal organs injuries (3.8%), fractures (2.9%), and burns (1.9%). Most (90.5%) of injuries healed completely, whereas 7.6% and 1.9% left scars and residual infirmities, respectively. Only 14.3% of physicians proceeded to legal action. The current study reflects high aggression, which is disproportionate to legal actions taken by physicians. This medicolegal analysis could guide protective measures for healthcare providers in Egypt. In addition, a narrative review of studies from 15 countries pointed to violence against physicians as a worldwide problem that deserves future medicolegal analyses.

Does parental use of harsh discipline and punishment in response to ambiguous child situations vary by child physical abuse risk?

BACKGROUND/OBJECTIVES: The present study investigated the extent to which fathers and mothers at high-risk and low-risk for child physical abuse (CPA) differed in their use of harsh discipline and punishment when presented ambiguous child situations (situations where differences in positive and negative valences are close to zero). PARTICIPANTS/METHODS: High-risk for CPA parents (N = 74: fathers, n = 41; mothers, n = 33) and low-risk parents (N = 178: fathers, n = 91; mothers, n = 87) were asked to indicate their likelihood of using harsh verbal discipline (HVD), harsh physical discipline (HPD), and punishment (i.e., retributive harm separate from HVD and HPD) after viewing each of eighteen ambiguous child situations. RESULTS: As expected, high-risk, compared to low-risk, for CPA parents were significantly (ps < 0.001) more likely to use HVD (d = 0.546), HPD (d = 0.595), and punishment (d = 0.564). Overall, fathers, relative to mothers, were significantly more likely to use HVD (d = 0.261) and HPD (d = 0.238). For punishment, however, there was no significant parental role (father, mother) difference (d = 0.136). CONCLUSIONS: Since in everyday living situations many child behaviors are ambiguous, the findings that parents, especially high-risk for CPA parents, use harsh discipline and punishment when encountering ambiguous child situations suggest that non-contingent harsh child-related parental behaviors may be frequent in the lives of some children. The findings that parents may use non-contingent discipline and punishment suggest the need to explore whether, when these parenting behaviors occur, they increase the likelihood of negative child outcomes.

Emergency Department Triage Chief Complaints Among Children Evaluated for Physical Abuse Concerns.

OBJECTIVES: The aims of this study were to describe chief complaints provided at emergency department triage for young children ultimately given a diagnosed with injuries concerning for physical abuse and compare chief complaints by hospital child protection team assessment (abuse most likely, accident most likely, undetermined) among children younger than 2 years who were the subject of a report to child protective services. METHODS: This is a retrospective review of children evaluated by the child protection team at an urban children's hospital over a 5-year period. Children younger than 2 years who were the subject of a report to child protective services for suspected physical abuse were included. Chief complaints noted in emergency department triage notes were categorized as follows: 1, medical sign or symptom; 2, accidental trauma incident; 3, identified injury; 4, concern for abuse; or 5, multiple unrelated complaints. Child protection team assessments were categorized as follows: 1, abuse most likely; 2, accident most likely; or 3, undetermined. We used descriptive statistics and tests of association (χ 2 , Fisher exact, Kruskal-Wallis). RESULTS: Median age of the 422 children included was 4.9 months. Child protection team assessment was abuse most likely in 44%, accident most likely in 23%, and undetermined in 34%. Chief complaints in the overall sample were 39% medical, 29% trauma incident, 16% injury, 10% abuse concern, and 6% multiple unrelated. When the abuse most likely and accident most likely groups were compared, medical chief complaints were more common in the former (47% vs 19%, P < 0.001), whereas trauma incident chief complaints were more common in the latter (19% vs 64%, P < 0.001). Most common medical complaints in the abuse most likely group were altered mental status, abnormal limb use, swelling, pain, apnea, and vomiting. CONCLUSION: Many children found to have injuries concerning for abuse (47%) present without mention of trauma, injury, or abuse concern as part of the chief complaint. Our findings suggest important topics to include in training physicians about recognition of abuse.

Effect of Routine Child Physical Abuse Screening Tool on Emergency Department Efficiency.

OBJECTIVES: Physical abuse is a significant cause of morbidity and mortality for children. Routine screening by emergency nurses has been proposed to improve recognition, but the effect on emergency department (ED) workflow has not yet been assessed. We sought to evaluate the feasibility of routine screening and its effect on length of stay in a network of general EDs. METHODS: A 2-question child physical abuse screening tool was deployed for children <6 years old who presented for care in a system of 27 general EDs. Data were compared for the 6 months before and after screening was deployed (4/1/2019-10/2/2019 vs 10/3/2019-3/31/2020). The main outcome was ED length of stay in minutes. RESULTS: There were 14,133 eligible visits in the prescreening period and 16,993 in the screening period. Screening was completed for 13,404 visits (78.9%), with 116 (0.7%) screening positive. The mean ED length of stay was not significantly different in the prescreening (95.9 minutes) and screening periods (95.2 minutes; difference, 0.7 minutes; 95% CI, -1.5, 2.8). Among those who screened positive, 29% were reported to child protective services. On multivariable analysis, implementation of the screening tool did not impact overall ED length of stay. There were no significant differences in resource utilization between the prescreening and screening periods. CONCLUSIONS: Routine screening identifies children at high risk of physical abuse without increasing ED length of stay or resource utilization. Next steps will include determining rates of subsequent serious physical abuse in children with or without routine screening.

Association between threat-related adverse childhood experiences and chronic lung diseases in a middle and older aged population: A cross-sectional and longitudinal study in China.

OBJECTIVES: We investigated the association between threat-related adverse childhood experiences (ACEs) and the risk of chronic lung diseases (CLDs). METHODS: The data used for this study were extracted from the China Health and Retirement Longitudinal Study (CHARLS), a nationally representative survey of respondents recruited from 450 villages/urban communities in 28 provinces. Threat-related ACEs were constructed using five adverse factors: household substance abuse, physical abuse, domestic violence, unsafe neighbourhood, and bullying). Participants were divided into three groups according to their number of threat-related ACEs at baseline and at follow-up. The association between threat-related ACEs and CLD prevalence in the cross-sectional study was calculated using logistic regression models. The association between threat-related ACEs and CLD onset was evaluated using Cox proportional regression models in the cohort study. Potential confounders were considered in both the cross-sectional and cohort studies. RESULTS: The CLD prevalence in the total population, no exposure group, exposure to one threat-related ACE, and exposure to at least two threat-related ACEs were 10.07% (1320/13104), 9.20% (665/7232), 10.89% (421/3865), and 11.66% (234/2007), respectively. Exposure to one threat-related ACE (OR: 1.23, 95% CI: 1.07-1.41) and exposure to at least two threat-related ACEs (OR: 1.31, 95% CI: 1.11-1.55) were significantly associated with higher CLD prevalence rates. The cohort study included 11,645 participants. During the 7-year follow-up, 738 CLD incidents were identified. Similarly, exposure to one threat-related ACE (HR: 1.20, 95% CI: 1.01-1.43) and at least two threat-related ACEs (HR: 1.64, 95% CI: 1.35-2.00) were significantly associated with a higher CLD incidence risk. CONCLUSIONS: Exposure to threat-related ACEs was significantly associated with a higher CLD prevalence risk and onset. It is crucial to identify individuals who have encountered childhood threats and prioritise the monitoring of their pulmonary function.

Characteristics of physical violence against pregnant women - analysis of medico-legal data and literature review.

OBJECTIVES: Pregnancy is a period which is especially sensitive to physical violence and its aftermath. Subjecting a pregnant woman to violence can have negative effects on both the mother as well as the child. In Poland, there are programs, such as the Blue Card, aimed at protection against violence, however the phenomenon is underestimated. MATERIAL AND METHODS: Documentation covering forensic examinations carried out at the request of the police or privately at the Department of Forensic Medicine in Poznan in the years 2015-2020 was analyzed. Out of 7,689 cases, 22 were concluded to meet the criteria of violence against pregnant women. The cases were then further analyzed, consideration of the victim's age, professional status, relations with the perpetrator, form of physical violence, and medical assistance. RESULTS: The average age of the women at the time of the incident was 31.1 years. In 90.1% of the cases, the perpetrator was a known man, usually a current or former partner. The most common injuries were abrasions and bruises, while the most common locations of injuries were the head, neck, and arms. The most common forms of violence were grappling, kicking, and hitting with an open hand. Over 72% of the women sought medical attention after the incident. CONCLUSIONS: There is a need for educational programs concerning the effects of violence during pregnancy and ways to help. Gynecologists and midwives play an especially important role, by having direct contact with the patient, thus being able to quickly identify victims of violence and take actions to secure safe environment for the woman and the child.

Explaining how childhood physical abuse and physical neglect influence adult depression: An analysis with multiple sequential mediators.

BACKGROUND: Substantial evidence indicates that experiencing physical abuse and neglect during childhood significantly elevates the likelihood of developing depression in adulthood. Nevertheless, there remains a dearth of understanding regarding the mechanisms underpinning this correlation. OBJECTIVE: In this study, we aimed to examine the associations of childhood physical abuse and physical neglect with depression using follow-up data from UK Biobank and quantified the contribution of smoking, insomnia, and BMI in these associations. PARTICIPANTS AND SETTINGS: This study included 144,704 participants (64,168 men and 80,536 women) from UK Biobank, most of whom were white (97 %). METHODS: Physical abuse and physical neglect were measured using two items of Childhood Trauma Screener (CTS). Data on the incidence of depression were obtained from primary care, hospital inpatient records, self-reported medical conditions, and death registries. We used a sequential mediation analysis based on the "g-formula" approach to explore the individual and joint effects of potential mediators. RESULTS: The depression incidence rate was 1.85 per 1000 person-years for men and 2.83 per 1000 person-years for women, respectively. Results of Cox proportional risk regression showed that physical abuse (HRs: 1.39-1.53, P < 0.001) and physical neglect (HRs: 1.43-1.60, P < 0.001) are associated with depression. Smoking, insomnia, and BMI together mediated 3 %-26 % of the associations. CONCLUSIONS: These findings contribute to our understanding of how physical abuse and physical neglect influence depression. Furthermore, a more effective reduction in the burden of depression can be achieved by managing modifiable mediators.

Relationship of domestic violence with pregnancy symptoms and pregnancy experience in Iranian pregnant women: a cross-sectional study.

OBJECTIVE: Violence has had adverse effects on the physical and psychological dimensions of pregnant women. This study was conducted with the aim of determining the relationship of domestic violence with pregnancy symptoms and pregnancy experience. DESIGN: In this cross-sectional study, pregnant women were selected through two-stage cluster sampling method. Data were collected using the domestic violence questionnaire of the WHO, pregnancy symptoms inventory (PSI) and pregnancy experience scale (PES). To determine the relationship between domestic violence with pregnancy symptoms and pregnancy experience, adjusted general linear model was used in multivariate analysis. SETTING: Health centres in Urmia-Iran in 2022. PARTICIPANTS: 415 pregnant women. RESULTS: The frequency of emotional, physical and sexual violence was 86.0%, 67.7% and 79.5%, respectively. The mean (SD) of PSI was 49.45 (14.38) with attainable score of 0-123 and PES including happiness and worry was 14.32 (6.48) and 16.21 (2.51) with attainable score of 0-30, respectively. Based on the adjusted general linear model, the mean score of PSI in women who experienced physical violence (mild (p<0.001) and moderate (p<0.001)); sexual violence (mild (p<0.001), moderate (p<0.001) and severe (p<0.001)); and emotional violence (mild (p<0.001), moderate (p=0.002) and severe (p<0.001)) was significantly higher than women without experiencing violence. The mean score of happiness during pregnancy in women who experienced physical violence (moderate (p=0.011)) and emotional violence (mild (p<0.001), moderate (p=0.002) and severe (p<0.001)) was significantly lower than women without experience of violence. Also, the mean score of worry scores in women with experience of sexual violence (mild (p=0.001) and moderate (p=0.012)) and emotional violence (mild (p<0.001), moderate (p<0.001)) and severe (p<0.001)) was significantly higher than women without experiencing violence. CONCLUSION: Considering the relationship between violence and pregnancy symptoms and pregnancy experiences, it is necessary to use appropriate strategies to prevent violence in pregnant women.