Harsh Truth: Do Healthcare Providers Silence Women Who Experience Intimate Partner Violence

Background: Globally, one-third of women experience abuse from their intimate partners. Since intimate partner violence (IPV) creates a chronic stress environment, affected women suffer from several physical and mental stress-related disorders for which they seek healthcare services in higher proportion to that of non-abused women. Although affected women seek help for the consequences of IPV, addressing the cause, is an important responsibility of healthcare providers. This study aimed to explore how healthcare providers may contribute to silencing of women who have experienced IPV. Subjects and Methods: This was an integrative review. We performed a systematic search of eight databases for articles published between 2007 and 2018. We identified 4507 publications. We included the English language articles that focused on adult women between 18 and 49 years of age, explored the issue of silencing of women who have experienced IPV, and followed a primary research study design. Two reviewers screened the articles using the web application, Rayyan. Quality was assessed using Joanna Briggs Institute Critical Appraisal tools. Results: Five articles were selected for analysis. The findings revealed that healthcare providers might play a significant role in silencing women’s suffering from abuse. Affected women’s unwillingness to act as their own agent in healthcare settings or disclose experiences of IPV was associated with healthcare provider’s inadequate or inappropriate response. Lack of affirmation, validation, and inability to make women feel accepted were the main factors which silenced women who experienced IPV. Both individual-level factors, such as shame, fear, humiliation, hope, and relationship dynamics, and community-level factors, such as cultural norms, and values, seemed to precede the factors related to healthcare providers. Conclusion:A socioecological understanding of the factors influencing silencing of women who have experienced IPV is required. A health care model which takes into consideration the contributing factors at various ecological levels of influence is imperative to guide healthcare providers towards the development of best practices in caring with women who have experienced violence in their intimate relationships. Keywords: intimate, partner, violence, health care, provide

La perspectiva de ama de casa brasileña sobre la vida con diabetes mellitus tipo 2

The purpose of this study is to present an understanding of the experience of Brazilian homemakers with type 2 diabetes mellitus (DM2). A descriptive exploratory design was used and semi-structured interviews were conducted with 25 Brazilian homemakers concerning their experience. The interviews were recorded, transcribed, and the resulting text was analyzed using the sequential step method. Data converged to one dominant category, "constructing one's identity in the family context", which is comprised of three categories: gender differences; day-to-day concerns; and incongruity between knowledge and behavior related to DM2. These findings suggest that participants construct their identities within the family context and that their experience of living with DM2 is integral to their self-identification as wives and mothers. This, in turn, has implications for the design and implementation of programs to assist women in managing DM2 effectively.El propósito de este estudio es comprender la experiencia de las amas de casa brasileñas con la diabetes mellitus tipo 2 (DM2). Se empleo un abordaje exploratorio descriptivo, donde participaron de las entrevistas 25 amas de casa de Brasil acerca de su experiencia con el DM. Las entrevistas fueron grabadas, transcritas y el texto resultante se analizó mediante el método secuencial de cuatro etapas: aprensión, síntesis, teorización y transferencia. Los datos se reunieron en un tema dominante: "construyendo su identidad en el contexto familiar", que se compone de tres sub-temas: las diferencias de género, las preocupaciones del cotidiano y la incongruencia entre el conocimiento y el comportamiento relacionado con DM2. Estos hallazgos sugieren que los participantes construyen su propia identidad dentro del contexto familiar y que su experiencia de vivir con DM2 es parte integral de su identificación como esposas y madres. Esto, a su vez, tiene implicaciones para el planeamiento e implementación de programas para ayudar a las mujeres para administrar con eficacia la DM2.O objetivo deste estudo foi compreender a experiência de donas de casa brasileiras com diabetes mellitus tipo 2 (DM2). Foi utilizada abordagem descritiva exploratória, e entrevistas semiestruturadas foram realizadas com 25 donas de casa, abordando sua experiência com o DM2. As entrevistas foram gravadas, transcritas e o texto resultante foi analisado usando-se o método de etapas sequenciais. Os dados convergiram para um tema dominante construindo sua identidade no contexto da família, composto por três subtemas: diferenças de gênero, preocupações do dia a dia e incongruência, entre conhecimento e comportamento, relacionada ao DM2. Esses achados sugerem que as participantes constroem sua identidade no contexto da família e que a experiência de viver com DM2 é parte integrante de sua identificação como esposa e mãe. Esses resultados têm implicações para o planejamento e a implementação de programas que contribuam para que as mulheres gerenciem seu DM2 de forma eficaz

Effects of trauma-related cues on pain processing in posttraumatic stress disorder: an fMRI investigation

Background: Imaging studies of pain processing in primary psychiatric disorders are just emerging. This study explored the neural correlates of stress-induced analgesia in individuals with posttraumatic stress disorder (PTSD). It combined functional magnetic resonance imaging (fMRI) and the traumatic script-driven imagery symptom provocation paradigm to examine the effects of trauma-related cues on pain perception in individuals with PTSD. Methods: The study included 17 patients with PTSD and 26 healthy, trauma-exposed controls. Participants received warm (nonpainful) or hot (painful) thermal stimuli after listening to a neutral or a traumatic script while they were undergoing an fMRI scan at a 4.0 T field strength. Results: Between-group analyses revealed that after exposure to the traumatic scripts, the blood oxygen level–dependent (BOLD) signal during pain perception was greater in the PTSD group than the control group in the head of the caudate. In the PTSD group, strong positive correlations resulted between BOLD signal and symptom severity in a number of brain regions previously implicated in stress-induced analgesia, such as the thalamus and the head of the caudate nucleus. Trait dissociation as measured by the Dissociative Experiences Scale correlated negatively with the right amygdala and the left putamen. Limitations: This study included heterogeneous traumatic experiences, a different proportion of military trauma in the PTSD versus the control group and medicated patients with PTSD. Conclusion: These data indicate that in patients with PTSD trauma recall will lead in a state-dependent manner to greater activation in brain regions implicated in stress-induced analgesia. Correlational analyses lend support to cortical hyperinhibition of the amygdala as a function of dissociation

Global research priorities for interpersonal violence prevention: A modified Delphi study

© 2017, World Health Organization. All rights reserved. Objective To establish global research priorities for interpersonal violence prevention using a systematic approach. Methods Research priorities were identified in a three-round process involving two surveys. In round 1, 95 global experts in violence prevention proposed research questions to be ranked in round 2. Questions were collated and organized according to the four-step public health approach to violence prevention. In round 2, 280 international experts ranked the importance of research in the four steps, and the various substeps, of the public health approach. In round 3, 131 international experts ranked the importance of detailed research questions on the public health step awarded the highest priority in round 2. Findings In round 2, “developing, implementing and evaluating interventions” was the step of the public health approach awarded the highest priority for four of the six types of violence considered (i.e. child maltreatment, intimate partner violence, armed violence and sexual violence) but not for youth violence or elder abuse. In contrast, “scaling up interventions and evaluating their cost-effectiveness” was ranked lowest for all types of violence. In round 3, research into “developing, implementing and evaluating interventions” that addressed parenting or laws to regulate the use of firearms was awarded the highest priority. The key limitations of the study were response and attrition rates among survey respondents. However, these rates were in line with similar priority-setting exercises. Conclusion These findings suggest it is premature to scale up violence prevention interventions. Developing and evaluating smaller-scale interventions should be the funding priority

All Our Babies Cohort Study: recruitment of a cohort to predict women at risk of preterm birth through the examination of gene expression profiles and the environment

<p>Abstract</p> <p>Background</p> <p>Preterm birth is the leading cause of perinatal morbidity and mortality. Risk factors for preterm birth include a personal or familial history of preterm delivery, ethnicity and low socioeconomic status yet the ability to predict preterm delivery before the onset of preterm labour evades clinical practice. Evidence suggests that genetics may play a role in the multi-factorial pathophysiology of preterm birth. The All Our Babies Study is an on-going community based longitudinal cohort study that was designed to establish a cohort of women to investigate how a women's genetics and environment contribute to the pathophysiology of preterm birth. Specifically this study will examine the predictive potential of maternal leukocytes for predicting preterm birth in non-labouring women through the examination of gene expression profiles and gene-environment interactions.</p> <p>Methods/Design</p> <p>Collaborations have been established between clinical lab services, the provincial health service provider and researchers to create an interdisciplinary study design for the All Our Babies Study. A birth cohort of 2000 women has been established to address this research question. Women provide informed consent for blood sample collection, linkage to medical records and complete questionnaires related to prenatal health, service utilization, social support, emotional and physical health, demographics, and breast and infant feeding. Maternal blood samples are collected in PAXgene™ RNA tubes between 18-22 and 28-32 weeks gestation for transcriptomic analyses.</p> <p>Discussion</p> <p>The All Our Babies Study is an example of how investment in clinical-academic-community partnerships can improve research efficiency and accelerate the recruitment and data collection phases of a study. Establishing these partnerships during the study design phase and maintaining these relationships through the duration of the study provides the unique opportunity to investigate the multi-causal factors of preterm birth. The overall All Our Babies Study results can potentially lead to healthier pregnancies, mothers, infants and children.</p

Sexuality and Mental Health of Pakistani-Descent Adolescent Girls living in Canada: Perceptions and Recommendations

In Canada, the demands of female immigrant adolescents in terms of sexual health are largely unmet and have grown significantly in recent years. According to studies, racialized immigrant adolescents are less likely than non-immigrant adolescents to be knowledgeable about sexual and reproductive health and to use resources for sex education and related services. This difference seems to be related to socio-cultural and religious practices in Pakistani immigrant adolescents. This paper intends to explain the viewpoints of female adolescents of first- or second-generation Pakistani descent who reside in Canada with regard to their development of sexuality and psychological well-being. Moreover, this paper also describes how female adolescents perceive the necessity to support their sexuality as they go through the adolescent stage. Individual interviews and timelines were created using qualitative interpretative descriptive design. We included 21 female adolescents of first- or second-generation Pakistani ethnicity using a purposive sample. Data analysis was performed using a thematic analysis. The findings indicate that immigrant adolescent girls received conflicting messages about sexuality from their parents which impacted their psychological well-being. Additionally, survey participants noted that prejudice, exclusion from sex education classes, and a lack of sexual health information contributed to social isolation, health care avoidance, and poor mental health outcomes like melancholy and anxiety among adolescent girls. The absence of sexuality-related communication with parents and the scarcity of medical professionals who can relate to and address the needs and realities of immigrants may have an impact on the participants’ experiences. Female immigrant girls also spoke up on the need for open, honest, and stigma-free conversations as well as for the need to end the taboo around the subject of sexuality. This study used principles from both intersectionality and postmodern feminist theories to increase our understanding of the interplay between the experiences of developing sexuality and overall well-being in female immigrant adolescents of Pakistani descent. It is crucial to involve, listen to, and incorporate female adolescents’ voices when planning and implementing interventions to support healthy sexuality among immigrant adolescents.Nursing, School ofReviewedFacult

Effects of trauma-related cues on pain processing in posttraumatic stress disorder: an fMRI investigation

Background: Imaging studies of pain processing in primary psychiatric disorders are just emerging. This study explored the neural correlates of stress-induced analgesia in individuals with posttraumatic stress disorder (PTSD). It combined functional magnetic resonance imaging (fMRI) and the traumatic script-driven imagery symptom provocation paradigm to examine the effects of trauma-related cues on pain perception in individuals with PTSD. Methods: The study included 17 patients with PTSD and 26 healthy, trauma-exposed controls. Participants received warm (nonpainful) or hot (painful) thermal stimuli after listening to a neutral or a traumatic script while they were undergoing an fMRI scan at a 4.0 T field strength. Results: Between-group analyses revealed that after exposure to the traumatic scripts, the blood oxygen level–dependent (BOLD) signal during pain perception was greater in the PTSD group than the control group in the head of the caudate. In the PTSD group, strong positive correlations resulted between BOLD signal and symptom severity in a number of brain regions previously implicated in stress-induced analgesia, such as the thalamus and the head of the caudate nucleus. Trait dissociation as measured by the Dissociative Experiences Scale correlated negatively with the right amygdala and the left putamen. Limitations: This study included heterogeneous traumatic experiences, a different proportion of military trauma in the PTSD versus the control group and medicated patients with PTSD. Conclusion: These data indicate that in patients with PTSD trauma recall will lead in a state-dependent manner to greater activation in brain regions implicated in stress-induced analgesia. Correlational analyses lend support to cortical hyperinhibition of the amygdala as a function of dissociation

Comparing the feasibility, acceptability, clinical-, and cost-effectiveness of mental health e-screening to paper-based screening on the detection of depression, anxiety, and psychosocial risk in pregnant women: a study protocol of a randomized, parallel-group, superiority trial

Abstract Background Stress, depression, and anxiety affect 15% to 25% of pregnant women. However, substantial barriers to psychosocial assessment exist, resulting in less than 20% of prenatal care providers assessing and treating mental health problems. Moreover, pregnant women are often reluctant to disclose their mental health concerns to a healthcare provider. Identifying screening and assessment tools and procedures that are acceptable to both women and service providers, cost-effective, and clinically useful is needed. Methods/Design The primary objective of this randomized, parallel-group, superiority trial is to evaluate the feasibility and acceptability of a computer tablet-based prenatal psychosocial assessment (e-screening) compared to paper-based screening. Secondary objectives are to compare the two modes of screening on: (1) the level of detection of prenatal depression and anxiety symptoms and psychosocial risk; (2) the level of disclosure of symptoms; (3) the factors associated with feasibility, acceptability, and disclosure; (4) the psychometric properties of the e-version of the assessment tools; and (5) cost-effectiveness. A sample of 542 women will be recruited from large, primary care maternity clinics and a high-risk antenatal unit in an urban Canadian city. Pregnant women are eligible to participate if they: (1) receive care at one of the recruitment sites; (2) are able to speak/read English; (3) are willing to be randomized to e-screening; and (4) are willing to participate in a follow-up diagnostic interview within 1 week of recruitment. Allocation is by computer-generated randomization. Women in the intervention group will complete an online psychosocial assessment on a computer tablet, while those in the control group will complete the same assessment in paper-based form. All women will complete baseline questionnaires at the time of recruitment and will participate in a diagnostic interview within 1 week of recruitment. Research assistants conducting diagnostic interviews and physicians will be blinded. A qualitative descriptive study involving healthcare providers from the recruitment sites and women will provide data on feasibility and acceptability of the intervention. We hypothesize that mental health e-screening in primary care maternity settings and high-risk antenatal units will be as or more feasible, acceptable, and capable of detecting depression, anxiety, and psychosocial risk compared to paper-based screening. Trial registration ClinicalTrials.gov Identifier: NCT01899534