Violence against Women: An Exploration of the Physical and Mental Health Trends among Immigrant and Refugee Women in Canada

Violence against women is a serious health and social problem for women worldwide. Researchers have investigated the broad physical and mental health consequences of violence against women but few have focused on immigrant and refugee women. We assessed the history of violence and the impairment of physical and mental health among 60 women participants from the Iranian and Sri Lankan Tamil communities in Toronto, Canada. Our survey findings revealed that the participants had experienced various types of violence throughout their lifespan, with psychological abuse by a spouse/partner occurring most frequently in the past 12 months. Commonly reported types of abuse included insulting, criticizing, and intimidation by partner (psychological abuse); slapping, hitting, and shoving (physical abuse); and forced sexual intercourse and sexually degrading acts (sexual abuse) by a partner/spouse. We found that a substantial proportion of the participants also had experienced physical and mental health impairment, which could be a result of the various types of violence they had experienced throughout their lifespan. Research and practice implications are provided

The assessment needs to go hand-in-hand with the debriefing: the importance of a structured coaching debriefing in understanding and applying a positive psychology strengths assessment

Objectives: Despite extensive empirical evidence supporting the use of strengths, minimal research has been conducted on the practical application of strengths tools. The objective of this study was to test the impact of a structured debriefing following completion of Realise2, an online strengths assessment, in relation to strengths application (Linley, Willars & Biswas-Diener, 2010). Design: The study utilised a qualitative design. Semi-structured interviews were employed and thematic analysis was used to identify themes representing the participant’s experience (Braun & Clarke, 2006). Method: The 20 participants were a mixture of middle and senior managers from a global travel organisation. All participants completed the Realise2 strengths assessment and a structured debriefing with a qualified coach. Following the debriefing, each participant completed a semi-structured interview to determine how the debriefing impacted their understanding and utilisation of the assessment findings. Results: The results show that the debriefing was associated with engendering action, enhancing selfefficacy and stimulating psychological development. Conclusions: The study found that all 20 participants benefited from having a structured debriefing after completing a strengths assessment. The debriefing led to a greater understanding and utilisation of the strengths assessment. This pairing has practical implications for those involved in strengths-based coaching and development. In addition, limitations of the study are discussed and areas for future research suggested

'Trauma' and the lives of women refugees in resettlement

'Trauma' has emerged as a central defining construct within professional and popular discussions on refugee health. Refugees are considered to be at risk for psychological distress due to traumatic events experienced in the context of conflict and natural disasters in their countries of origin as well as in the context of exile. Following migration, life in resettlement is often an unstable process marked by poverty, social exclusion, as well as poor health status. The importance of 'trauma' in the discussions on refugee health has left health professionals struggling to make sense of and react to groups of people now defined as 'traumatised'. However, we have little understanding of how trauma is understood, experienced and addressed by individuals, their advocates and the service provider's impacts upon the experiences of refugees in resettlement. Juxtaposing information from three distinct sources, I examine the discourse(s) surrounding refugees and health in resettlement, focusing upon the definitions and meanings attached to the issue of 'trauma'. The analysis draws on 16 qualitative interviews with health and social care professionals, qualitative 'resettlement history' interviews with 25 women refugees, as well as an examination of a selected body of authoritative knowledge (academic articles and conference reports) in the UK. At the heart of this analysis are contrasting perspectives in relation to the dominant paradigms of psychiatry, the metes and bounds of localised frameworks of distress, and the margins of socio-political action and interpretation. Definitions of trauma as a psychiatric disorder have implications for the clinical and social care responses of health professionals. In turn, women refugees are encouraged to engage with psychiatric systems of care and to learn a new language of distress that is psychologically informed, and may be distant from the socio-cultural context of their lives in resettlement. At the same time, the construct of 'trauma' has significance in the context of political asylum, where a diagnosis of , trauma tis ed' may be perceived as evidence supporting asylum claims. The highly politicised context of resettlement raises issues of social justice, which are interspersed with notions of trauma, as professionals seek to reconcile ideas of testimony and therapeutic interventions. These ways of seeing trauma rely upon the use of conventional Western notions of mental health and well-being that are grounded in a psychiatric paradigm and make use of related clinical strategies. Particular emphasis is placed upon the value of 'talk' as a means of achieving recovery. The women interact with popular and professional discourses on trauma in their daily lives. How they perceive and respond to these discourses (whether accepting it in whole, in part or rejecting it) offers insights into the meaning of trauma in resettlement and the coping strategies they employ in response to a psychological framing of their experiences.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

New lives, new challenges: access to intimate partner violence services for portuguese-speaking immigrant women

Intimate partner violence is a global health issue and the most common form of violence experienced by women. This study explored barriers to accessing help to Intimate partner violence related health services among Portuguese-speaking immigrant women in Toronto, Canada. Exploratory study conducted by a survey and focus group discussions with 12 Portuguese-speaking immigrant women. Results clarify the struggles faced by Portuguese-speaking immigrant women and their pathways to care and help-seeking. Participants reported that the fear of being deported, obtaining evidence of abuse, and lack of language-specific services were the key barriers to seeking help. When available, language-specific community-based services, along with faith and religion, were noted as key factors that supported women’s resilience. Nurses who provide care and services to women who are dealing with Intimate partner violence should rethink the scope of their advocacy actions toward addressing these structural barriers by building alliances with organizations to better serve and protect women in such vulnerable situations

Proposed guidelines to evaluate scientific validity and evidence for genotype-based dietary advice

Nutrigenetic research examines the effects of inter-individual differences in genotype on responses to nutrients and other food components, in the context of health and of nutrient requirements. A practical application of nutrigenetics is the use of personal genetic information to guide recommendations for dietary choices that are more efficacious at the individual or genetic subgroup level relative to generic dietary advice. Nutrigenetics is unregulated, with no defined standards, beyond some commercially adopted codes of practice. Only a few official nutrition-related professional bodies have embraced the subject, and, consequently, there is a lack of educational resources or guidance for implementation of the outcomes of nutrigenetic research. To avoid misuse and to protect the public, personalised nutrigenetic advice and information should be based on clear evidence of validity grounded in a careful and defensible interpretation of outcomes from nutrigenetic research studies. Evidence requirements are clearly stated and assessed within the context of state-of-the-art ‘evidence-based nutrition’. We have developed and present here a draft framework that can be used to assess the strength of the evidence for scientific validity of nutrigenetic knowledge and whether ‘actionable’. In addition, we propose that this framework be used as the basis for developing transparent and scientifically sound advice to the public based on nutrigenetic tests. We feel that although this area is still in its infancy, minimal guidelines are required. Though these guidelines are based on semiquantitative data, they should stimulate debate on their utility. This framework will be revised biennially, as knowledge on the subject increases

Newborn Sequencing in Genomic Medicine and Public Health

The rapid development of genomic sequencing technologies has decreased the cost of genetic analysis to the extent that it seems plausible that genome-scale sequencing could have widespread availability in pediatric care. Genomic sequencing provides a powerful diagnostic modality for patients who manifest symptoms of monogenic disease and an opportunity to detect health conditions before their development. However, many technical, clinical, ethical, and societal challenges should be addressed before such technology is widely deployed in pediatric practice. This article provides an overview of the Newborn Sequencing in Genomic Medicine and Public Health Consortium, which is investigating the application of genome-scale sequencing in newborns for both diagnosis and screening

Punitive restoration and restorative justice.

Criminal justice policy faces the twin challenges of improving our crime reduction efforts while increasing public confidence. These challenges are exacerbated by the fact that at least some measures popular with the public are counterproductive to greater crime reduction. How to achieve greater crime reduction without sacrificing public confidence? While restorative justice approaches offer a promising alternative to traditional sentencing with the potential to achieve these goals, they suffer from several serious obstacles, not least their relatively limited applicability, flexibility, and public support. Punitive restoration is a new and distinctive idea about restorative justice modeled on an important principle of stakeholding, which states that those who have a stake in penal outcomes should have a say about them. Punitive restoration is restorative insofar as it aims to achieve the restoration of rights infringed or threatened by criminal offences. Punitive restoration is punitive insofar as the available options for this agreement are more punitive than found in most restorative justice approaches, such as the option of some form of hard treatment. Punitive restoration sheds new light on how we may meet the twin challenges of improving our efforts to reduce reoffending without sacrificing public confidence, demonstrating how restorative practices can be embedded deeper within the criminal justice system

Safety and efficacy of the ChAdOx1 nCoV-19 vaccine (AZD1222) against SARS-CoV-2: an interim analysis of four randomised controlled trials in Brazil, South Africa, and the UK.

BACKGROUND: A safe and efficacious vaccine against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), if deployed with high coverage, could contribute to the control of the COVID-19 pandemic. We evaluated the safety and efficacy of the ChAdOx1 nCoV-19 vaccine in a pooled interim analysis of four trials. METHODS: This analysis includes data from four ongoing blinded, randomised, controlled trials done across the UK, Brazil, and South Africa. Participants aged 18 years and older were randomly assigned (1:1) to ChAdOx1 nCoV-19 vaccine or control (meningococcal group A, C, W, and Y conjugate vaccine or saline). Participants in the ChAdOx1 nCoV-19 group received two doses containing 5 × 1010 viral particles (standard dose; SD/SD cohort); a subset in the UK trial received a half dose as their first dose (low dose) and a standard dose as their second dose (LD/SD cohort). The primary efficacy analysis included symptomatic COVID-19 in seronegative participants with a nucleic acid amplification test-positive swab more than 14 days after a second dose of vaccine. Participants were analysed according to treatment received, with data cutoff on Nov 4, 2020. Vaccine efficacy was calculated as 1 - relative risk derived from a robust Poisson regression model adjusted for age. Studies are registered at ISRCTN89951424 and ClinicalTrials.gov, NCT04324606, NCT04400838, and NCT04444674. FINDINGS: Between April 23 and Nov 4, 2020, 23 848 participants were enrolled and 11 636 participants (7548 in the UK, 4088 in Brazil) were included in the interim primary efficacy analysis. In participants who received two standard doses, vaccine efficacy was 62·1% (95% CI 41·0-75·7; 27 [0·6%] of 4440 in the ChAdOx1 nCoV-19 group vs71 [1·6%] of 4455 in the control group) and in participants who received a low dose followed by a standard dose, efficacy was 90·0% (67·4-97·0; three [0·2%] of 1367 vs 30 [2·2%] of 1374; pinteraction=0·010). Overall vaccine efficacy across both groups was 70·4% (95·8% CI 54·8-80·6; 30 [0·5%] of 5807 vs 101 [1·7%] of 5829). From 21 days after the first dose, there were ten cases hospitalised for COVID-19, all in the control arm; two were classified as severe COVID-19, including one death. There were 74 341 person-months of safety follow-up (median 3·4 months, IQR 1·3-4·8): 175 severe adverse events occurred in 168 participants, 84 events in the ChAdOx1 nCoV-19 group and 91 in the control group. Three events were classified as possibly related to a vaccine: one in the ChAdOx1 nCoV-19 group, one in the control group, and one in a participant who remains masked to group allocation. INTERPRETATION: ChAdOx1 nCoV-19 has an acceptable safety profile and has been found to be efficacious against symptomatic COVID-19 in this interim analysis of ongoing clinical trials. FUNDING: UK Research and Innovation, National Institutes for Health Research (NIHR), Coalition for Epidemic Preparedness Innovations, Bill & Melinda Gates Foundation, Lemann Foundation, Rede D'Or, Brava and Telles Foundation, NIHR Oxford Biomedical Research Centre, Thames Valley and South Midland's NIHR Clinical Research Network, and AstraZeneca

Safety and efficacy of the ChAdOx1 nCoV-19 vaccine (AZD1222) against SARS-CoV-2: an interim analysis of four randomised controlled trials in Brazil, South Africa, and the UK

Background A safe and efficacious vaccine against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), if deployed with high coverage, could contribute to the control of the COVID-19 pandemic. We evaluated the safety and efficacy of the ChAdOx1 nCoV-19 vaccine in a pooled interim analysis of four trials. Methods This analysis includes data from four ongoing blinded, randomised, controlled trials done across the UK, Brazil, and South Africa. Participants aged 18 years and older were randomly assigned (1:1) to ChAdOx1 nCoV-19 vaccine or control (meningococcal group A, C, W, and Y conjugate vaccine or saline). Participants in the ChAdOx1 nCoV-19 group received two doses containing 5 × 1010 viral particles (standard dose; SD/SD cohort); a subset in the UK trial received a half dose as their first dose (low dose) and a standard dose as their second dose (LD/SD cohort). The primary efficacy analysis included symptomatic COVID-19 in seronegative participants with a nucleic acid amplification test-positive swab more than 14 days after a second dose of vaccine. Participants were analysed according to treatment received, with data cutoff on Nov 4, 2020. Vaccine efficacy was calculated as 1 - relative risk derived from a robust Poisson regression model adjusted for age. Studies are registered at ISRCTN89951424 and ClinicalTrials.gov, NCT04324606, NCT04400838, and NCT04444674. Findings Between April 23 and Nov 4, 2020, 23 848 participants were enrolled and 11 636 participants (7548 in the UK, 4088 in Brazil) were included in the interim primary efficacy analysis. In participants who received two standard doses, vaccine efficacy was 62·1% (95% CI 41·0–75·7; 27 [0·6%] of 4440 in the ChAdOx1 nCoV-19 group vs71 [1·6%] of 4455 in the control group) and in participants who received a low dose followed by a standard dose, efficacy was 90·0% (67·4–97·0; three [0·2%] of 1367 vs 30 [2·2%] of 1374; pinteraction=0·010). Overall vaccine efficacy across both groups was 70·4% (95·8% CI 54·8–80·6; 30 [0·5%] of 5807 vs 101 [1·7%] of 5829). From 21 days after the first dose, there were ten cases hospitalised for COVID-19, all in the control arm; two were classified as severe COVID-19, including one death. There were 74 341 person-months of safety follow-up (median 3·4 months, IQR 1·3–4·8): 175 severe adverse events occurred in 168 participants, 84 events in the ChAdOx1 nCoV-19 group and 91 in the control group. Three events were classified as possibly related to a vaccine: one in the ChAdOx1 nCoV-19 group, one in the control group, and one in a participant who remains masked to group allocation. Interpretation ChAdOx1 nCoV-19 has an acceptable safety profile and has been found to be efficacious against symptomatic COVID-19 in this interim analysis of ongoing clinical trials