397 research outputs found

    Identification and initial response to children\u27s exposure to intimate partner violence: A qualitative synthesis of the perspectives of children, mothers and professionals

    Get PDF
    Objectives: To synthesise evidence on the acceptable identification and initial response to children\u27s exposure to intimate partner violence (IPV) from the perspectives of providers and recipients of healthcare and social services. Design: We conducted a thematic synthesis of qualitative research, appraised the included studies with the modified Critical Appraisal Skills Programme checklist and undertook a sensitivity analysis of the studies scored above 15. Data sources: We searched eight electronic databases, checked references and citations and contacted authors of the included studies. Eligibility criteria: We included qualitative studies with children, parents and providers of healthcare or social services about their experiences of identification or initial responses to children\u27s exposure to IPV. Papers that have not been peer-reviewed were excluded as well as non-English papers. Results: Searches identified 2039 records; 11 studies met inclusion criteria. Integrated perspectives of 42 children, 212 mothers and 251 professionals showed that sufficient training and support for professionals, good patient-professional relationship and supportive environment for patient/clients need to be in place before enquiry/disclosure of children\u27s exposure to IPV should occur. Providers and recipients of care favour a phased enquiry about IPV initiated by healthcare professionals, which focuses on \u27safety at home\u27 and is integrated into the context of the consultation or visit. Participants agreed that an acceptable initial response prioritises child safety and includes emotional support, education about IPV and signposting to IPV services. Participants had conflicting perspectives on what constitutes acceptable engagement with children and management of safety. Sensitivity analysis produced similar results. Conclusions: Healthcare and social service professionals should receive sufficient training and ongoing individual and system-level support to provide acceptable identification of and initial response to children\u27s exposure to IPV. Ideal identification and responses should use a phased approach to enquiry and the WHO Listen, Inquire about needs and concerns, Validate, Enhance safety and Support principles integrated into a trauma-informed and violence-informed model of care

    Disruption of a primary health care domestic violence and abuse service in two London boroughs: interrupted time series evaluation

    Get PDF
    Background: Domestic violence and abuse (DVA) is experienced by about 1/3 of women globally and remains a major health concern worldwide. IRIS (Identification and Referral to Improve Safety of women affected by DVA) is a complex, system-level, training and support programme, designed to improve the primary healthcare response to DVA. Following a successful trial in England, since 2011 IRIS has been implemented in eleven London boroughs. In two boroughs the service was disrupted temporarily. This study evaluates the impact of that service disruption. Methods: We used anonymised data on daily referrals received by DVA service providers from general practices in two IRIS implementation boroughs that had service disruption for a period of time (six and three months). In line with previous work we refer to these as boroughs B and C. The primary outcome was the number of daily referrals received by the DVA service provider across each borough over 48 months (March 2013–April 2017) in borough B and 42 months (October 2013–April 2017) in borough C. The data were analysed using interrupted-time series, non-linear regression with sensitivity analyses exploring different regression models. Incidence Rate Ratio (IRR), 95% confidence intervals and p-values associated with the disruption were reported for each borough. Results: A mixed-effects negative binomial regression was the best fit model to the data. In borough B, the disruption, lasted for about six months, reducing the referral rate significantly (p = 0.006) by about 70% (95%CI = (23,87%)). In borough C, the three-month service disruption, also significantly (p = 0.005), reduced the referral rate by about 49% (95% CI = (18,68%)). Conclusions: Disrupting the IRIS service substantially reduced the rate of referrals to DVA service providers. Our findings are evidence in favour of continuous funding and staffing of IRIS as a system level programme

    Use of emergency contraception among women with experience of domestic violence and abuse:a systematic review

    Get PDF
    Abstract Background Exposure to domestic violence and abuse (DVA) results in a reduction of women’s use of regular contraceptives. This evidence suggests that women exposed to DVA are more likely to have unprotected sexual intercourse and therefore may use more emergency contraception (EC) than those women who are not exposed to DVA. We aimed to test this hypothesis through evaluating the evidence for an association between exposure to DVA and use of EC. Methods We systematically searched eight electronic databases from inception until December 2017, checked references and citations, and contacted corresponding authors. Primary studies that evaluated the association between exposure to DVA and use of EC were included. Two reviewers were involved in screening, data extraction, quality assessment and analysis. We evaluated the quality of included studies with the adapted Newcastle-Ottawa Scale. We used tables and descriptive text to summarise and synthesise the data. Odds ratios (ORs) and 95% confidence intervals (CIs) for each estimate of the association between DVA and use of EC were plotted on a forest plot. Results Our search retrieved 1216 records of which six studies with 15,297 women were included. Five studies were observational; one study included intervention on the outcome (advance supply of EC). All studies were at high risk of bias. Four studies provided evidence of an association between DVA and EC use – ORs from 1.51 (95% CI 1.13, 2.02) to 6.50 (95% CI 4.15, 10.17). Two studies found no evidence of a such association – ORs 0.46 (95% CI 0.11, 1.96) and 0.76 (95% CI 0.29, 1.98). The latter differed by how the authors recruited participants, measured EC use and adjusted for confounders. Conclusions This systematic review provides some evidence of increased use of EC among women exposed to DVA. Request for EC can indicate possible exposure to DVA. Therefore, each consultation for EC could be an appropriate context for clinical enquiry about DVA and signposting/referral to specialist DVA services. Protocol registration PROSPERO CRD42017058221

    Ethical challenges in global research on health system responses to violence against women: a qualitative study of policy and professional perspectives.

    Get PDF
    BACKGROUND: Studying global health problems requires international multidisciplinary teams. Such multidisciplinarity and multiculturalism create challenges in adhering to a set of ethical principles across different country contexts. Our group on health system responses to violence against women (VAW) included two universities in a European high-income country (HIC) and four universities in low-and middle-income countries (LMICs). This study aimed to investigate professional and policy perspectives on the types, causes of, and solutions to ethical challenges specific to the ethics approval stage of the global research projects on health system responses to VAW. METHODS: We used the Network of Ethical Relationships model, framework method, and READ approach to analyse qualitative semi-structured interviews (n = 18) and policy documents (n = 27). In March-July 2021, we recruited a purposive sample of researchers and members of Research Ethics Committees (RECs) from the five partner countries. Interviewees signposted policies and guidelines on research ethics, including VAW. RESULTS: We developed three themes with eight subthemes summarising ethical challenges across three contextual factors. The global nature of the group contributed towards power and resource imbalance between HIC and LMICs and differing RECs' rules. Location of the primary studies within health services highlighted differing rules between university RECs and health authorities. There were diverse conceptualisations of VAW and vulnerability of research participants between countries and limited methodological and topic expertise in some LMIC RECs. These factors threatened the timely delivery of studies and had a negative impact on researchers and their relationships with RECs and HIC funders. Most researchers felt frustrated and demotivated by the bureaucratised, uncoordinated, and lengthy approval process. Participants suggested redistributing power and resources between HICs and LMICs, involving LMIC representatives in developing funding agendas, better coordination between RECs and health authorities and capacity strengthening on ethics in VAW research. CONCLUSIONS: The process of ethics approval for global research on health system responses to VAW should be more coordinated across partners, with equal power distribution between HICs and LMICs, researchers and RECs. While some of these objectives can be achieved through education for RECs and researchers, the power imbalance and differing rules should be addressed at the institutional, national, and international levels. Three of the authors were also research participants, which had potential to introduce bias into the findings. However, rigorous reflexivity practices mitigated against this. This insider perspective was also a strength, as it allowed us to access and contribute to more nuanced understandings to enhance the credibility of the findings. It also helped to mitigate against unequal power dynamics

    Trauma-informed approaches to primary and community mental health care: protocol for a mixed-methods systematic review

    Get PDF
    Introduction Exposure to different types of psychological trauma may lead to a range of adverse effects on trauma survivors, including poor mental and physical health, economic, social and cognitive functioning outcomes. Trauma-informed (TI) approaches to care are defined as a service system grounded in and directed by an understanding of how trauma affects the survivors’ neurological, biological, physiological and social development. TI service system involves training of all staff, service improvements and sometimes screening for trauma experiences. The UK started incorporating TI approaches into the National Health Service. While policies recommend it, the evidence base for TI approaches to healthcare is not well established. We aim to conduct a systematic review to synthesise evidence on TI approaches in primary and community mental healthcare globally. Methods and analysis We will undertake a systematic search for primary studies in Medline, Embase, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, Cochrane library, websites of organisations involved in the development and implementation of TI approaches in healthcare, and databases of thesis and dissertation. Included studies will be in English published between 1990 and February 2020. Two reviewers will independently perform study selection with data extraction and quality appraisal undertaken by one reviewer and checked for accuracy by a second reviewer. A results-based convergent synthesis will be conducted where quantitative (narratively) and qualitative (thematically) evidence will be analysed separately and then integrated using another method of synthesis. We set up a trauma survivor group and a professional group to consult throughout this review. Ethics and dissemination There is no requirement for ethical approval for this systematic review as no empirical data will be collected. The findings will be disseminated through a peer-reviewed publication, scientific and practitioner conferences, and policy briefings targeted at local and national policy makers

    Survey of Period Variations of Superhumps in SU UMa-Type Dwarf Novae. VIII: The Eighth Year (2015-2016)

    Full text link
    Continuing the project described by Kato et al. (2009, arXiv:0905.1757), we collected times of superhump maxima for 128 SU UMa-type dwarf novae observed mainly during the 2015-2016 season and characterized these objects. The data have improved the distribution of orbital periods, the relation between the orbital period and the variation of superhumps, the relation between period variations and the rebrightening type in WZ Sge-type objects. Coupled with new measurements of mass ratios using growing stages of superhumps, we now have a clearer and statistically greatly improved evolutionary path near the terminal stage of evolution of cataclysmic variables. Three objects (V452 Cas, KK Tel, ASASSN-15cl) appear to have slowly growing superhumps, which is proposed to reflect the slow growth of the 3:1 resonance near the stability border. ASASSN-15sl, ASASSN-15ux, SDSS J074859.55+312512.6 and CRTS J200331.3-284941 are newly identified eclipsing SU UMa-type (or WZ Sge-type) dwarf novae. ASASSN-15cy has a short (~0.050 d) superhump period and appears to belong to EI Psc-type objects with compact secondaries having an evolved core. ASASSN-15gn, ASASSN-15hn, ASASSN-15kh and ASASSN-16bu are candidate period bouncers with superhump periods longer than 0.06 d. We have newly obtained superhump periods for 79 objects and 13 orbital periods, including periods from early superhumps. In order that the future observations will be more astrophysically beneficial and rewarding to observers, we propose guidelines how to organize observations of various superoutbursts.Comment: 123 pages, 162 figures, 119 tables, accepted for publication in PASJ (including supplementary information

    Large scale nested stellar discs in NGC 7217

    Full text link
    NGC7217 is an unbarred early-type spiral galaxy having a multi-segment exponential light profile and a system of starforming rings of the unknown origin; it also possesses a circumnuclear gaseous polar disc. We analysed new long slit spectroscopic data for NGC7217 and derived the radial distributions of its stellar population parameters and stellar and gaseous kinematics up to the radius of r~100 arcsec (~8 kpc). We performed the dynamical analysis of the galaxy by recovering its velocity ellipsoid at different radii, and estimated the scaleheights of its two exponential discs. The inner exponential stellar disc of NGC7217 appears to be thin and harbours intermediate age stars (t(SSP) ~ 5 Gyr). The outer stellar disc seen between the radii of 4 and 7 kpc is very thick (z0 = 1...3 kpc), metal-poor, [Fe/H]<-0.4 dex, and has predominantly young stars, t(SSP) = 2 Gyr. The remnants of minor mergers of gas-rich satellites with an early-type giant disc galaxy available in the GalMer database well resemble different structural components of NGC7217, suggesting two minor merger events in the past responsible for the formation of the inner polar gaseous disc and large outer starforming ring. Another possibility to form the outer ring is the re-accretion of the tidal streams created by the first minor merger.Comment: Accepted to MNRAS, 12 pages, 10 figure
    • …
    corecore