International genome-wide meta-analysis identifies new primary biliary cirrhosis risk loci and targetable pathogenic pathways.

Primary biliary cirrhosis (PBC) is a classical autoimmune liver disease for which effective immunomodulatory therapy is lacking. Here we perform meta-analyses of discovery data sets from genome-wide association studies of European subjects (n=2,764 cases and 10,475 controls) followed by validation genotyping in an independent cohort (n=3,716 cases and 4,261 controls). We discover and validate six previously unknown risk loci for PBC (Pcombined<5 × 10(-8)) and used pathway analysis to identify JAK-STAT/IL12/IL27 signalling and cytokine-cytokine pathways, for which relevant therapies exist

“Crisis is often when it comes out”: CATS workers’ experiences of sexual assault disclosures in crisis psychiatric settings

Deposited with permission of the author. © 2006 Elizabeth McLindonCrisis Assessment and Treatment Service (CATS) workers are often the first point of contact between an individual and the mental health system, thus these mental health professionals are the gatekeepers to further mental health service use and referral to other service sectors. Among the users of mental health services, there is an overrepresentation of women who have been the victim/survivors of sexual assault while research documents that these service users have a predominantly negative experience of disclosing, in other words, talking about sexual assault to mental health workers. The aim of this study was to explore the research question – what are the ways in which CATS workers understand their response to victim/survivors who disclose sexual assault in psychiatric crisis service settings? To achieve this aim, fifteen CATS workers from a Melbourne metropolitan service took part in a small scale, feminist based, exploratory study utilising a qualitative and quantitative survey design. Key findings of this research were that firstly, a majority of participants do not feel well equipped to respond to disclosures of sexual assault; secondly, workers indicated the need for training in this area; thirdly some participants held misconceptions about sexual assault including the lack of a gendered understanding; fourthly, some workers expressed a problematic understanding of trauma and awareness of how to effectively respond to a disclosure of sexual assault; and, finally, this study found minimal communication between CATS and specialist sexual assault services. The implications of these findings highlight the need for sexual assault training; a review of CATS role in relation to women disclosing sexual assault; and the need for cross-sectoral practice

"It happens to clinicians too”: The prevalence, impact and implications of domestic and family violence against health professional women

© 2020 Elizabeth Veronica-Mary McLindonDomestic and family violence (DFV) is a major health and social issue in Australia and across the globe. It affects people of all ages and walks of life, predominantly women and children. DFV is associated with a range of harms and impacts, and more frequent utilisation of health services is one. Consequently, health professionals find themselves at the frontline of responding to the health sequelae of violence and trauma in the family. However, healthcare is a gendered profession, where the majority of employees are women. How commonly DFV affects Australian women working in healthcare, and what, if any, association there is between a health professional’s personal experience of DFV and their clinical care of patients accessing healthcare for DFV, is not known. An additional gap in the evidence-base is understanding the needs and perspectives of both survivor health professionals and key stakeholders about the role of the healthcare workplace in supporting survivor staff, not just patients. To address these research gaps, the aim of this PhD study was to investigate the prevalence, clinical care impacts and workplace implications of DFV against an Australian population of women nurses, doctors and allied health professionals. This study utilised a combined methodological approach to collect both quantitative and qualitative data. The first phase of the project was a descriptive, cross-sectional survey of health professionals at a large Australian tertiary maternity hospital, in which 471 health professional women participated (45.0% response rate). Phase two followed, and individual and group interviews were conducted with 18 hospital managers and other key stakeholders. The original contributions of this thesis to new knowledge was the finding that DFV was common in the lives of the health professional women in this study: intimate partner violence (IPV) had affected one in ten (11.5%, 43) women during the last 12-months, and one third (33.6%, 146) of women since the age of sixteen. Sexual violence by an intimate partner was reported by 12.1% (51) of health professional women. Overall, just under half (45.2%, 212) of the participating health professional women had experienced IPV or violence from another family member (including childhood witnessing of DFV) across the life course. The second original finding of this study was that a health professional’s experience of DFV appeared to facilitate clinical care of survivor patients. Specifically, exposure to DFV was positively associated with preparedness to care for survivor patients through greater uptake of professional DFV training, more sensitive attitudes about survivors and more frequent access of information with which to resource survivor patients. The final original knowledge contribution was how hospital workplaces can best support their survivor staff, drawing on the perspectives and experiences of both survivor health professional women (n=93) and hospital managers (n=18). Survivors wanted their workplace to understand that DFV had affected them and to support both their individual needs and recovery as well as their professional capacity to respond to survivor patients. Managers recognised the imperative of a hospital workplace to ensure the availability of multifaceted support for survivor staff, and suggested mechanisms for this. Safety emerged as a key barrier to a more supportive workplace for survivor staff; participants were clear that occupational violence could render a workplace physically unsafe, and fear or uncertainty about how a disclosure of DFV would be responded to affected feelings of emotional safety. The findings of this thesis are presented across three publications. The results indicate that the cumulative trauma burden in Australian health professional women’s lives is high. That burden is added to by the risk of vicarious trauma that all health professionals face in a role where listening to patient histories of trauma and violence is routine. However, the survivors in this study did not present as enduringly vulnerable; on the contrary, they self-reported an informed and sensitive readiness to respond to patients with whom they have DFV in common. This research indicates the efficacy of a trauma and violence-informed framework to underscore and strengthen a recovery-orientated hospital response towards both survivor staff and patients

“Counteract the gaslighting” – a thematic analysis of open-ended responses about what women survivors of intimate partner sexual violence need from service providers

Abstract Background Intimate partner sexual violence (IPSV) is a prevalent but misunderstood form of gender-based violence with significant impacts women’s health and well-being. Research suggests that IPSV has a specific context and unique impacts, but little is known about how to tailor service responses. To address this gap, we explored help-seeking experiences and needs among IPSV survivors after disclosure. Methods This study draws on qualitative data from a subsample of women who participated in a cross-sectional survey about the service needs of intimate partner violence survivors. Women who reported IPSV and provided information about IPSV-specific help-seeking needs after disclosure were included in the analysis. Open-ended text responses of 37 IPSV survivors were analysed using thematic analysis. Results IPSV was invisible and silenced in service responses. Three themes suggest potential ways forward. In the first theme, ‘Don’t dismiss it’, women needed providers to take their disclosures seriously and listen to the significant impacts of IPSV on their well-being and safety. In the second theme, ’See the bigger picture’, women needed service providers to understand that IPSV fits into broader patterns of abuse, and that psychological abuse and coercive control impacts women’s ability to consent. In the third theme, ‘counteract the gaslighting’, women needed providers to educate them about the continuum of IPSV and help them label IPSV as a form of violence. Conclusions Our exploratory findings extend the limited evidence base on IPSV and highlight a need for further in-depth research to explore a tailored approach to supporting IPSV survivors. To avoid contributing to the silencing of IPSV survivors, service responses should recognise the harmful and sexualised nature of IPSV, challenge cultural stereotypes that minimise IPSV, and understand that co-occurring psychological abuse may exacerbate shame and prevent women from articulating the source of their distress

Sustainability of identification and response to domestic violence in antenatal care: The SUSTAIN Study

This project set out to understand and support the integration of evidence-based, effective screening, risk assessment and first-line response to domestic violence (DV) into the complex system of antenatal care. It built on existing resources and research to focus on women assessed as currently in lower risk situations, who are often not in contact with DV services but attended health services for pregnancy