Intimate partner violence prevalence and HIV risks among women receiving care in emergency departments: implications for IPV and HIV screening

Objective: To examine (1) the prevalence of experiencing physical, injurious and sexual intimate partner violence (IPV) and (2) the associations between HIV risks and different types of IPV among women receiving care in an inner city emergency department (ED). Methods: A cross-sectional survey that elicited self-reported HIV risks and IPV among a random sample of 799 women receiving ED care. Multiple logistic regression was used to examine the associations between HIV risk and IPV, with covariance adjustment for potentially confounding sociodemographics. Results: 49.6% of the women reported a history of any form (ie, minor and severe type) of physical, injurious and/or sexual IPV, 15% severe sexual coercion (rape) over life time and 11.8% IPV in the past 6 months. Women who reported engaging in sex with a HIV-infected partner or an injecting drug user (IDU), having multiple partners in the past 12 months and injecting drugs were significantly more likely to have experienced any form of physical/injurious IPV, severe physical/injurious IPV and any form of sexual IPV in the past 6 months. In addition, women with multiple partners in the past 12 months and women who reported injecting drugs were significantly more likely to indicate having experienced a severe form of sexual IPV in the past 6 months. Conclusion: For many women receiving care in EDs, IPV and several HIV risk behaviours are frequent, co-occurring health problems. HIV testing and routine IPV inquiry in ED settings offer an important opportunity to identify women who are affected by these overlapping epidemics and refer them to appropriate treatment services

Posttraumatic Stress Disorder and HIV Risk Among Poor, Inner-City Women Receiving Care in an Emergency Department

Objectives. We examined the associations between posttraumatic stress disorder (PTSD) and HIV risk behaviors among a random sample of 241 low-income women receiving care in an urban emergency department. Methods. We recruited participants from the emergency department waiting room during randomly selected 6-hour blocks of time. Multivariate analyses and propensity score weighting were used to examine the associations between PTSD and HIV risk after adjustment for potentially confounding sociodemographic variables, substance use, childhood sexual abuse, and intimate partner violence. Results. A large majority of the sample self-identified as Latina (49%) or African American (44%). Almost one third (29%) of the participants met PTSD criteria. Women who exhibited symptoms in 1 or more PTSD symptom clusters were more likely than women who did not to report having had sex with multiple sexual partners, having had sex with a risky partner, and having experienced partner violence related to condom use in the preceding 6 months. Conclusions. The high rate of PTSD found in this sample and the significant associations between PTSD symptom clusters and partner-related risk behaviors highlight the need to take PTSD into account when designing HIV prevention interventions for low-income, urban women

Guidance for Structuring a Pediatric Intermediate Care Unit.

The purpose of this policy statement is to update the 2004 American Academy of Pediatrics clinical report and provide enhanced guidance for institutions, administrators, and providers in the development and operation of a pediatric intermediate care unit (IMCU). Since 2004, there have been significant advances in pediatric medical, surgical, and critical care that have resulted in an evolution in the acuity and complexity of children potentially requiring IMCU admission. A group of 9 clinical experts in pediatric critical care, hospital medicine, intermediate care, and surgery developed a consensus on priority topics requiring updates, reviewed the relevant evidence, and, through a series of virtual meetings, developed the document. The intended audience of this policy statement is broad and includes pediatric critical care professionals, pediatric hospitalists, pediatric surgeons, other pediatric medical and surgical subspecialists, general pediatricians, nurses, social workers, care coordinators, hospital administrators, health care funders, and policymakers, primarily in resource-rich settings. Key priority topics were delineation of core principles for an IMCU, clarification of target populations, staffing recommendations, and payment