Trauma Exposure Among Women in the Pacific Rim

Purpose Healthcare professionals who provide services in the immediate or long‐term aftermath of traumatic events need to understand the nature and frequency of traumatic events in the lives of women. However, research on trauma exposure in women has only recently begun to assess events other than intimate partner and sexual violence and has not supported direct statistical comparison of cross‐national and cross‐cultural data. The purpose of this descriptive, correlational study was to describe and compare trauma exposure prevalence and type in community‐based samples of women in the United States, Colombia, and Hong Kong. Design Women were recruited through posted notices at community health sites, snowball sampling, and online advertisements (N = 576). The Life Stressor Checklist‐Revised (total score range 0 to 30) was used to determine the type and prevalence of trauma exposure. Data were collected by native language members of the research team. Methods Descriptive statistics were used to summarize demographic characteristics and trauma exposure for the total sample and each community‐based sample (location). Between‐location differences were tested using Fisher\u27s exact tests for categorical measures and general linear models with pairwise a posteriori least squares t‐test for continuous measures. Responses to open‐ended questions were translated and categorized. Findings Over 99% of women in the total sample reported at least one traumatic life event. The mean number of traumatic life events per participant was 7, ranging from 0 to 24. Although there was consistency in the most commonly reported trauma exposures across locations, the rates of specific events often differed. Conclusions Historical, political, geographic, and cultural factors may explain differences in trauma exposure among women in the four locations studied. Clinical Relevance This study offers relevant knowledge for providers in diverse locations who provide services to women who have experienced traumatic events and provides evidence for the need for future research to further enhance knowledge of trauma exposure among women, and on the effects of trauma in women\u27s lives

Pregnancy and Intimate Partner Violence: Risk Factors, Severity, and Health Effects

The current study compares female victims of intimate partner violence (IPV) who were and were not victimized during pregnancy. Victims of pregnancy violence are more likely to report having experienced all forms of violence, particularly severe forms, and have higher odds of experiencing several postviolence indicators of severity and adverse health consequences. The significance of predictors disappears in a post hoc analysis controlling for proxies of battering behavior (i.e., repeated and severe violence), suggesting that victims who experience violence during pregnancy may be more likely to be in a current intimate relationship with an abuser who inflicts repeated and severe IPV

Social media in health science education: an international survey

Background: Social media is an asset that higher education students can use for an array of purposes. Studies have shown the merits of social media use in educational settings; however, its adoption in health science education has been slow, and the contributing reasons remain unclear. Objective: This multidisciplinary study aimed to examine health science students’ opinions on the use of social media in health science education and identify factors that may discourage its use. Methods: Data were collected from the Universitas 21 “Use of social media in health education” survey, distributed electronically among the health science staff and students from 8 universities in 7 countries. The 1640 student respondents were grouped as users or nonusers based on their reported frequency of social media use in their education. Results: Of the 1640 respondents, 1343 (81.89%) use social media in their education. Only 462 of the 1320 (35.00%) respondents have received specific social media training, and of those who have not, the majority (64.9%, 608/936) would like the opportunity. Users and nonusers reported the same 3 factors as the top barriers to their use of social media: uncertainty on policies, concerns about professionalism, and lack of support from the department. Nonusers reported all the barriers more frequently and almost half of nonusers reported not knowing how to incorporate social media into their learning. Among users, more than one fifth (20.5%, 50/243) of students who use social media “almost always” reported sharing clinical images without explicit permission. Conclusions: Our global, interdisciplinary study demonstrates that a significant number of students across all health science disciplines self-reported sharing clinical images inappropriately, and thus request the need for policies and training specific to social media use in health science education

Promoting resilience for HIV prevention in female sex workers in Hong Kong: a randomised controlled trial

Background: Female sex workers are considered a reservoir of HIV and their psychological health has a role to play in HIV infections. In China, commercial sex workers were reported to account for nearly 50% of heterosexual transmission of HIV. Therefore, HIV prevention targeted at mental health could be an innovative strategy in controlling the infection. We aimed to provide an evidence-based resilience-promoting intervention targeting mental health and ultimately safe sexual practices of female sex workers. Methods: This randomised controlled trial was done at three Hong Kong non-governmental organisations, namely Action for REACH OUT, JJJ Association, and the Society of Rehabilitation and Crime Prevention. Participants in this study were women (aged ≥18 years) who had worked as a sex worker in the previous 6 months. We randomly assigned participants to either intervention or usual care (control) according to a predetermined, computer-generated randomisation list. Both group facilitator and partcipants were unmasked to the group allocation, but an independent researcher who was masked to the treatment allocation administered the questionnaires. About half of the participants were permanent residents of Hong Kong whereas the other half were from mainland China. The six-session resilience-promoting intervention was designed to improve the coping skills, self-esteem, and self-efficacy (i.e. the belief of an individuals’ ability to control their actions to achieve desired goal), as measured by Brief-COPE, the Rosenberg Self-esteem Scale, and the Generalised Self- efficacy Scale of female sex workers. Questionnaires were administered by an independent assessor at baseline, post-treatment, and at 3-months follow-up. Participants in the control group received standard service, which included outreach visits, screening for HIV or sexually transmitted infections, and social activities provided by non-governmental organisations. The primary outcome of this study was the resilience scores measured by Connor-Davidson Resilience Scale. We analysed the differences between the two groups using the intention-to-treat analysis. This study was approved by the University of Hong Kong/Hospital Authority Hong Kong West Cluster Internal Review Board (UW 12-220). Verbal informed consent was obtained from all participants. Findings: 127 female sex workers were randomly assigned: 64 joined the control group and 63 joined intervention group. There were significant differences on the score on resilience, self-esteem, and mental health status between groups at post-intervention and 3- month follow-up. We found that condom use in the intervention group at 3-month follow-up was improved compared with the control group. After controlling for marital status and family size, improved resilience scores were associated with intervention group assignment (odds ratio 2∙95 [95% CI 1∙19–7∙35]; p=0∧021) and self-efficacy (1∧13 [1∧03–1∧24]; p=0∧006). Interpretation: Our findings suggest that resilience-promoting intervention programme was effective in improving the mental health status among Chinese female sex workers. This programme is an innovative approach to HIV prevention by promoting both psychological well-being and safe sex for this high-risk population. Funding: Council for the AIDS Trust Fund and General Research Grant, Research Grants Council, HKSAR

Advance Care Planning in China

Objectives • Describe the interprofessional components of this project. • Describe the attitude of advance care planning among Chinese healthcare professionals

Prevalence of Dating Partner Violence and Suicidal Ideation Among Male and Female University Students Worldwide

This paper presents findings from the International Dating Violence study regarding the prevalence of physical assault, sexual coercion, and suicidal ideation among university students and explores the relationships between suicidal ideation and dating violence. Nearly 16,000 university students from 22 sites in 21 countries were recruited through convenience sampling. The results showed that although there were large differences between countries, the lowest rates of dating violence were still quite high. Male and female students were remarkably similar in the proportion of those who physically assaulted a partner or reported being a victim of sexual coercion. Correlation analysis revealed that perpetrators and victims of physical assault had an increased rate of suicidal ideation. Depression accounted for the relationship between dating violence and suicidal ideation. This study highlights a need for the development of universal screening and targeted services for violence, depression, and suicide prevention. © 2008 American College of Nurse-Midwives.postprin

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

ALS-associated missense and nonsense TBK1 mutations can both cause loss of kinase function

Mutations in TBK1 have been linked to amyotrophic lateral sclerosis (ALS). Some TBK1 variants are nonsense and are predicted to cause disease through haploinsufficiency, however many other mutations are missense with unknown functional effect. We exome sequenced 699 familial ALS patients and identified 16 TBK1 novel or extremely rare protein changing variants. We characterised a subset of these: p.G217R, p.R357X and p.C471Y. Here we show that the p.R357X and p.G217R both abolish the ability of TBK1 to phosphorylate two of its kinase targets, IRF3 and OPTN and to undergo phosphorylation. They both inhibit binding to OPTN and the p.G217R, within the TBK1 kinase domain, reduces homodimerisation, essential for TBK1 activation and function. Lastly, we show that the proportion TBK1 that is active (phosphorylated) is reduced in five lymphoblastoid cell lines derived from patients harbouring heterozygous missense or in-frame deletion TBK1 mutations. We conclude that missense mutations in functional domains of TBK1 impair the binding and phosphorylation of its normal targets, implicating a common loss of function mechanism, analogous to truncation mutations

New information on risk factors

Emerging strategies for preventing and addressing elder abuse