Male Victims of Domestic Violence and Their History of Perpetrating Violence

Abstract. Objective: To determine whether male victims of domestic violence have similar rates of violence perpetration compared with men evaluated in the ED with other causes of injury. Methods: Case-control retrospective ED record review with linkage to police department records. Cases were identified by ICD code N-code 995.81 (adult maltreatment syndrome) over a 4-year period (January 1, 1991, to December 31, 1994) at one urban trauma center. Medical records were reviewed to confirm that the assailant was an intimate female partner. Controls were identified by E-codes 880–888 (unintentional falls) and matched by age, race, and date of visit. All names were linked to police department record information regarding arrests for domestic violence perpetration, nonaggravated assaults, aggravated assaults, firearms violations, and driving under the influence of alcohol (DUI). This information was reported without patient identifiers. Comparisons between cases and controls were made with x² analysis. Results: Forty-five cases and 45 controls were identified. The cases were injured by unarmed fights, E960 (31%); cuttings, E966 (33%); blunt objects, E968.2 (31%); and bites, E968.8 (5%). Median age (interquartile range) for cases was 32 (25.75, 38.25) years and for controls was 31 (25, 36.5) years. Median follow-up (interquartile range) of police records after ED visit was 45 (37, 50) months for cases and 45 (36.75, 51) months for controls. Fifty-one percent of the cases had arrests for domestic violence perpetration vs 22.2% of the controls (p = 0.009). Forty-four percent of the cases had been arrested for nonaggravated assaults vs 20.0% of the controls (p = 0.024). There was no statistical difference between the cases and controls in arrests for aggravated assaults (13.3% vs 4.4%), firearm violations (22.2% vs 17.8%), or DUIs (35.6% vs 20%). Conclusion: Men who present to the ED with injuries inflicted by their female partners have a high rate of domestic violence perpetration. This information calls into question whether many male “victims” of domestic violence are injured in self-defense by the female “victim.” Also, injury by a female partner may be a useful indicator to identify batterers, so they can be referred by appropriate resources.     

Characteristics of Family Violence Victims Presenting to Emergency Departments in Hong Kong

Background

The Emergency Department (ED) has been shown to be a valuable location to screen for family violence.

Study Objective

To investigate the characteristics of family violence victims presenting to EDs in a Chinese population in Hong Kong.

Methods

This study examined a retrospective cohort of patients presenting to the Accident and Emergency Departments of three regional hospitals in the Kwai Tsing district of Hong Kong for evaluation and management of physical injuries related to family violence during the period of January 1, 1997 to December 31, 2008.

Results

A total of 15,797 patients were assessed. The sample comprised cases of intimate partner violence (IPV; n = 10,839), child abuse and neglect (CAN; n = 3491), and elder abuse (EA; n = 1467). Gender differences were found in patterns of ED utilization among the patients. The rates of readmission were 12.9% for IPV, 12.8% for CAN, and 8.9% for EA. Logistic regression showed that being male, being discharged against medical advice, and arriving at the hospital via ambulance were the common factors associated with readmission to the EDs for patients victimized by IPV and CAN.

Conclusion

This study investigates the victim profile of a large cohort of a Chinese population, providing a unique data set not previously released in this cultural or medical system. The findings give insights to early identification of victims of family violence in the EDs and suggest that screening techniques focused on multiple forms of family violence would improve identification of violence cases. Multidisciplinary collaboration between health, legal, and social service professionals is also warranted to meet the various needs of victims and to reduce hospital readmissions.     

History of Domestic Violence among Male Patients Presenting to an Urban Emergency Department

OBJECTIVE: To establish the prevalence of domestic violence committed by women against male patients presenting to an urban ED for any reason. METHODS: This was a prospective survey in which male patients of legal age presenting to the ED over a 13-week period were interviewed. Patients answered a series of six questions adapted from the George Washington University Universal Violence Prevention Screening Protocol. Patients who could not speak English, those refusing to participate, those unable to give informed consent, and those meeting regional criteria for major trauma were excluded. RESULTS: Of 866 male patients interviewed, 109 (12.6%) had been the victims of domestic violence committed by a female intimate partner within the preceding year. Victims were more likely to be younger, single, African American, and uninsured. The most common forms of assault were slapping, grabbing, and shoving (60.6% of victims). These were followed by choking, kicking, biting, and punching (48.6%), or throwing an object at the victim (46.8%). Thirty-seven percent of cases involved a weapon. Seven percent of victims described being forced to have sex. Nineteen percent of victims contacted the police; 14% required medical attention; 11% pressed charges or sought a restraining order; and 6% pursued follow-up counseling. CONCLUSIONS: Almost 13% of men in this sample population had been victims of domestic violence committed by a female intimate partner within the previous year. Further attention to the recognition and management of domestic violence committed by women against men may be warranted.     

Domestic Violence: Diurnal Mismatch between Need and Availability of Services

Objective: To determine whether a diurnal discordance exists between need and availability of services for victims of domestic violence.
Methods: A consecutive sample of women presenting to a municipal hospital ED with physical injuries suspected to be related to domestic violence were entered into a registry. Date and time of presentation and perceived need for services information were collected from all patients who answered affirmatively a screening question for domestic violence and whose conditions did not preclude administration of the data collection instrument. The Social Service Departments of all of the 53 911–receiving hospitals in New York City were contacted to ascertain availability of social services for victims of domestic violence by time of day.
Results: Twenty-eight of 32 (88%; 95% CI: 71%, 97%) victims of domestic violence presented to the ED during hours other than weekday 9 am to 5 pm. Of these, 63% desired counseling, 32% lacked a safe place to go, and 82% had children. Of those who had children, 48% were concerned for the children's safety. In hospital social services were universally available weekday daytime (9 AM to 5 pm) but were available in only 11 % of hospitals (95% CI: 4%, 23%) at other times.
Conclusion: Approximately nine of ten victims of domestic violence presented to the ED during hours when only about one hospital in ten can provide the special services these patients require. A marked diurnal mismatch appears to exist between availability of domestic violence services in New York City and the need for these services as measured by a representative sample drawn from an ED population.     

Patient Factors Associated with Failure to Diagnose Tuberculosis in the Emergency Department

Background

Emergency department (ED) presentation of pulmonary tuberculosis (TB) can be highly atypical and an ED visit might be the only health care interaction for high-risk patients.

Objective

Our objective was to identify patient factors associated with discharge without a diagnosis of TB during an infectious ED visit.

Methods

The study population consisted of 150 patients from 2000 to 2009 with 190 infectious ED visits. Patients were initially identified from the state registry of confirmed TB cases and epidemiological characteristics were identified prospectively during case investigation. A retrospective review was performed for clinical characteristics of visits dichotomized according to whether the diagnosis of TB was made during the ED visit.

Results

Analysis revealed that 77% of all infectious-patient visits ended with a diagnosis of TB. A TB diagnosis was more likely when patients presented with pulmonary or infectious chief complaints, endorsed cough, subjective fever, chills, dyspnea, previous TB infection, or had an abnormal lung examination or chest x-ray study. Patients were significantly less likely to be diagnosed with TB when they were unresponsive during clinical evaluation or when they reported a history of both homelessness and any substance abuse during the last year. In addition, these characteristics were independent predictors of nondiagnosis when traditional TB risk factors or abnormal vital signs were considered.

Conclusions

Patients with atypical presentations, as well as those who were unresponsive or reported a history of homelessness and substance abuse, were at greater risk for nondiagnosis of TB during an infectious ED visit.     

Detection of Domestic Violence by a Domestic Violence Advocate in the ED

Background: The current domestic violence (DV) literature has evaluated the incidence and prevalence of DV via written surveys and verbal questioning performed by a variety of health care professionals. Objectives: We sought to examine the prevalence of DV as obtained by a full-time, trained DV advocacy coordinator using direct patient interviewing in our emergency department (ED), and to compare our results with the published literature. Methods: The DV advocacy coordinator randomly selected and interviewed female patients presenting to the ED with various complaints during daytime hours. Participation was voluntary, and patients were excluded if they were too ill or injured to answer questions. We performed a retrospective review of data obtained through our DV advocacy coordinator's screening interviews of female patients presenting to the ED over a period of 1 year. Acute incidence and lifetime prevalence of DV was determined and compared to results reported in the literature. Results: The domestic violence advocacy coordinator screened a total of 1550 patients over the study period. Domestic violence incidence and lifetime prevalence as detected by the coordinator was determined to be 4.8% (95% confidence interval [CI] 3.9–6.0%) and 27.5% (95% CI 25.3–29.8%), respectively. Conclusions: Although the lifetime DV prevalence of 27.5% uncovered by our trained DV advocacy coordinator is similar to other reports, the acute incidence of 4.8% is higher than most other reported results using personal interviews. The use of a trained DV coordinator may improve detection rates of domestic violence in the ED.     

Lateral Violence in the Perioperative Setting

Lateral violence is disruptive, bullying, intimidating, or unsettling behavior that occurs between nurses in the workplace.The perioperative setting fosters lateral violence because of the inherent stress of performing surgery; high patient acuity; a shortage of experienced personnel; work demands; and the restriction and isolation of the OR, which allows negative behaviors to be concealed more easily.Lateral violence affects nurses' health and well-being and their ability to care for patients. Interventions to reduce lateral violence include empowerment of staff members and zero tolerance for lateral violence. AORN J 89 (April 2009) 688-696. © AORN, Inc, 2009.     

工作家庭冲突及其在护理管理领域的研究现状

文章对工作家庭冲突的定义、常用测量工具和国内外研究现状进行综述,并总结了工作家庭冲突的影响因素,结合我国护理专业特点提出平衡工作家庭关系的措施。     

临床儿科护士职业认同水平与护理冲突的相关性研究

目的调查临床儿科护士职业认同的总体水平,并分析其与护理冲突的相关性。方法采用护士职业认同评定量表、组织冲突量表和工作-家庭冲突量表对149名临床儿科护士进行调查。结果临床儿科护士职业认同总分为(99.40±18.55)分,处于中等水平;管理冲突和工作家庭冲突与临床儿科护士职业认同总分呈负相关(P0.01或P0.05)。结论建议护理管理者针对影响因素,加强针对性、规范化培训,以提高临床儿科护士的职业认同水平,稳定护理队伍,提高护理队伍的整体素质水平。     

Violence in the care of adult persons with intellectual disabilities

Background. Violence, for example physical, psychological, financial and sexual abuse and neglect, exists and is an under‐reported problem in caring situations involving adult persons with intellectual disabilities and their caregivers, where both parties can be seen as victims and perpetrators. Aims and objectives. To investigate violent situations involving Swedish adult persons with intellectual disabilities and their caregivers in group‐dwellings. Design. A total population‐based survey. Methods. A questionnaire, including violence towards adults with intellectual disabilities and violence towards staff members during 1 year, was sent to all staff members (n = 164) from 17 care settings for adults with intellectual disabilities with a response rate of 74%. Results. Thirty‐five per cent of 122 respondents admitted they had been implicated in or witnessed a violent incident towards an adult person with intellectual disabilities and 14% of the staff members admitted they themselves had been the perpetrators. Sixty‐one per cent of the staff members described various situations when they were exposed to violence from an adult person with intellectual disabilities. Physical violence was most frequently reported. Most of the aggression occurred in helping situations when persons with intellectual disabilities did not co‐operate or when both actors reacted with violence. The violent situations led the staff members to feel powerless and inadequate. In order to cope they discussed with each other or with the manager. Conclusions. Violence seems to be accepted as a natural part of the daily care for adult persons with intellectual disabilities. Most of the violence is physical and psychological and occurs in close helping situations. Relevance to clinical practice. Supportive interventions, i.e. supervision for the staff members and training of communication skills individually or in group for the adults with intellectual disabilities.     

77例哮喘患儿家庭情况调查与分析

本研究应用自拟的家庭情况调查问卷，对77例哮喘患儿和70名健康儿童的学习成绩、性格、生长发育及家庭情况进行了调查，探讨了儿童哮喘对患儿及家庭的影响和家庭应对，以及家庭对健康教育的需求情况，结果表明，哮喘对患儿的生长发育与学习成绩、对父母的体力、父母的工作、家庭经济、家庭关系等有显著影响；而家庭成员互相支持、分担照顾孩子的负担、接受医护人员关于疾病的建议等都是家庭对儿童哮喘积极的应对行为；家庭对哮喘的知识需求重点在治疗方法和预防保健知识方面，并乐以向医护人员咨询的形式获得。     

Institution-Specific Factors Associated With Family Medicine Residency Match Rates

Phenomenon: Existing research provides little specific evidence regarding the association between public and private medical school curricular settings and the proportion of medical students matching into family medicine careers. Institutional differences have been inadequately investigated, as students who match into family medicine are often consolidated into the umbrella of primary care along with those matching in internal medicine and pediatrics. However, understanding medical school contexts in relation to career choice is critical toward designing targeted strategies to address the projected shortage of family physicians. This study examines factors associated with family medicine residency match rates and the extent to which such factors differ across medical school settings. Approach: We combined data from a survey of 123 departments of family medicine with graduate placement rates reported to the American Academy of Family Physicians over a 2-year period. Chi-square/Fisher's Exact texts, t tests, and linear regression analyses were used to identify factors significantly associated with average match rate percentages. Findings: The resulting data set included 85% of the U.S. medical schools with Departments of Family Medicine that reported 2011 and 2012 residency match rates in family medicine. Match rates in family medicine were higher among graduates of public than private medical schools—11% versus 7%, respectively, t(92) = 4.00, p < .001. Using a linear regression model and controlling for institutional type, the results indicated 2% higher match rates among schools with smaller annual clerkship enrollments (p = .03), 3% higher match rates among schools with clerkships lasting more than 3 to 4 weeks (p = .003), 3% higher match rates at schools with at least 1 family medicine faculty member in a senior leadership role (p = .04), and 8% lower match rates at private medical schools offering community medicine electives (p < .001, R² = .48), F(6, 64) = 9.95, p < .001. Three additional factors were less strongly related and varied by institutional type—informal mentoring, ambulatory primary care learning experiences, and institutional research focus. Insights: Educational opportunities associated with higher match rates in family medicine differ across private and public medical schools. Future research is needed to identify the qualitative aspects of educational programming that contribute to differences in match rates across institutional contexts. Results of this study should prove useful in mitigating physician shortages, particularly in primary care fields such as family medicine.     

Family Structure in Norwegian Families of Children with Disabilities

Background The idea that raising a child with disabilities has a negative impact on the parents’ relationship is still widely accepted despite contradictory research findings. This article addresses the impact of raising a child with disabilities on family structure in the present Norwegian context. Method Family demographics were collected at two stages during the childhood of children with physical, intellectual or multiple disabilities born 1993–1995 (1999, n = 603 and 2003, n = 489). These figures were compared with the corresponding data for all children (Statistics Norway, Children Statistics). Results The family structures of children with disabilities were fairly similar to those of the typical family. Slightly fewer children with disabilities had siblings and a higher proportion of the parents of children with disabilities were married or cohabiting. The type or degree of impairment was not found to have any impact on family structure. Conclusions The results suggest that family structure in families raising a child with a disability is similar to other families. Whether this should only be seen as positive is discussed, as is whether the disability may produce a stronger feeling of obligation to stay together.