Traumatic physical health consequences of intimate partner violence against women: what is the role of community-level factors?

<p>Abstract</p> <p>Background</p> <p>Intimate partner violence (IPV) against women is a serious public health issue with recognizable direct health consequences. This study assessed the association between IPV and traumatic physical health consequences on women in Nigeria, given that communities exert significant influence on the individuals that are embedded within them, with the nature of influence varying between communities.</p> <p>Methods</p> <p>Cross-sectional nationally-representative data of women aged 15 - 49 years in the 2008 Nigeria Demographic and Health Survey was used in this study. Multilevel logistic regression analysis was used to assess the association between IPV and several forms of physical health consequences.</p> <p>Results</p> <p>Bruises were the most common form of traumatic physical health consequences. In the adjusted models, the likelihood of sustaining bruises (OR = 1.91, 95% CI = 1.05 - 3.46), wounds (OR = 2.54, 95% CI = 1.31 - 4.95), and severe burns (OR = 3.20, 95% CI = 1.63 - 6.28) was significantly higher for women exposed to IPV compared to those not exposed to IPV. However, after adjusting for individual- and community-level factors, women with husbands/partners with controlling behavior, those with primary or no education, and those resident in communities with high tolerance for wife beating had a higher likelihood of experiencing IPV, whilst mean community-level education and women 24 years or younger were at lower likelihood of experiencing IPV.</p> <p>Conclusions</p> <p>Evidence from this study shows that exposure to IPV is associated with increased likelihood of traumatic physical consequences for women in Nigeria. Education and justification of wife beating were significant community-level factors associated with traumatic physical consequences, suggesting the importance of increasing women's levels of education and changing community norms that justify controlling behavior and IPV.</p

Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700

A North London Pilot Survey to Assess the Need for a Medical Device in Diagnosing Chronic Rhinosinusitis in Primary Care

Introduction and Objectives: A pilot study to evaluate the need for a medical device in primary care to help diagnose chronic rhinosinusitis (CRS) from other causes of nasal obstruction. Significant delays in the diagnosis and treatment of CRS in UK secondary care cause long-term detrimental effects on the patient. / Method: A questionnaire-based survey was conducted at a General Practitioner (GP) General Update course in November 2017 attended by 134 GPs from North London, our major referral base. 105 questionnaires were completed: 83 in person and 22 subsequently online. Qualitative interviews were conducted with a North London focus group in order to construct the questionnaire and thermatic analysis performed. / Results: The response rate was 78% (105/134). 56% reported diagnosing CRS as moderately difficult. 95% would invest in a medical device to help diagnose CRS from other causes of nasal obstruction. Most are unaware of the 2012 EPOS CRS guidelines for diagnosis (84%) and instead use local guidelines. Over two-thirds (69%) refer fewer than 20% of patients to secondary care and most (80%) do so within 6 months. The recurring theme following thermatic analysis was the need for a nurse-led nasal blockage clinic in primary care in order to maximise adoption of such a medical device. This would better utilise GP time and improve patient satisfaction. / Conclusion: A medical device facilitating diagnosis of CRS could play an important role in primary care, in a nurse-led clinic setting. This would save valuable GP resources and reduce unnecessary referrals to secondary care. This study demonstrates that the majority of GPs refer their medical refractory CRS patients to secondary care in a timely fashion. However it does not explain the current delay in secondary care treatment in the UK and instead this maybe more related to patient dissatisfaction and non-compliance in their nasal blockage journey