2006－2013年全国伤害监测系统中因暴力就诊病例特征分析

目的 了解全国伤害监测暴力门/急诊病例的分布特征,为制定相关政策提供依据.方法 利用全国伤害监测系统(NISS)2006-2013年监测数据,分析暴力病例占伤害病例构成趋势、人口社会学特征、暴力事件基本情况及临床信息构成情况.结果 2006-2013年暴力病例占所有伤害病例的比例呈下降趋势;2013年暴力病例50 333人,男性36 049人,女性14 284人,暴力病例文化程度为初中和高中者分别占41.2％和27.3％; 24.0％的暴力发生时间是在22:00至次日02:59;0 ～4岁组及≥65岁组暴力发生在家中的比例分别为30.2％和28.5％,高于其他年龄组.结论 暴力的干预应同时关注针对女性和男性的暴力,重视家庭暴力中虐待儿童和老年人的问题,进一步普及高等教育,鼓励居民在22:00前入睡.     

Workplace violence in a large correctional health service in New South Wales, Australia: a retrospective review of incident management records

ABSTRACT: BACKGROUND: Little is known about workplace violence among correctional health professionals. This study aimed to describe the patterns, severity and outcomes of incidents of workplace violence among employees of a large correctional health service, and to explore the help-seeking behaviours of staff following an incident. METHODS: The study setting was Justice Health, a statutory health corporation established to provide health care to people who come into contact with the criminal justice system in New South Wales, Australia. We reviewed incident management records describing workplace violence among Justice Health staff. The three-year study period was 1/7/2007-30/6/2010. RESULTS: During the period under review, 208 incidents of workplace violence were recorded. Verbal abuse (71%) was more common than physical abuse (29%). The most (44%) incidents of workplace violence (including both verbal and physical abuse) occurred in adult male prisons, although the most (50%) incidents of physical abuse occurred in a forensic hospital. Most (90%) of the victims were nurses and two-thirds were females. Younger employees and males were most likely to be a victim of physical abuse. Preparing or dispensing medication and attempting to calm and/or restrain an aggressive patient were identified as 'high risk' work duties for verbal abuse and physical abuse, respectively. Most (93%) of the incidents of workplace violence were initiated by a prisoner/patient. Almost all of the incidents received either a medium (46%) or low (52%) Severity Assessment Code. Few victims of workplace violence incurred a serious physical injury - there were no workplace deaths during the study period. However, mental stress was common, especially among the victims of verbal abuse (85%). Few (6%) victims of verbal abuse sought help from a health professional. CONCLUSIONS: Among employees of a large correctional health service, verbal abuse in the workplace was substantially more common than physical abuse. The most incidents of workplace violence occurred in adult male prisons. Review of the types of adverse health outcomes experienced by the victims of workplace violence and the assessments of severity assigned to violent incidents suggests that, compared with health care settings in the community, correctional settings are fairly safe places in which to practice.     

Physician beliefs about victims of spouse abuse and about the physician role

Our purpose was to measure the beliefs of physicians about victims of spouse abuse and to examine factors related to holding positive (e.g., supportive) and negative beliefs about providing services to victims of domestic violence. This was a total site sample of 150 physicians (76 responded; RR 51%), surveyed at one time, practicing in a large general hospital and the surrounding urban/periurban area. Four specialities are represented: emergency medicine, family practice, obstetrics-gynecology, and psychiatry. Three aspects of beliefs are measured: beliefs toward physician role in assisting victims of spouse abuse, beliefs about victims of spouse abuse, and beliefs about resources available to physicians to assist victims of spouse abuse. Almost all (97%) physicians believe it is part of their role to assist victims of domestic violence. Almost one third (30%) hold victim-blaming attitudes toward victims of spouse abuse, and the majority (70%) do not believe that they have the resources available to them to assist victims of domestic violence. Being female, younger, practicing obstetrics-gynecology, and having fewer years in practice are all significantly related to holding supportive (positive) beliefs. The majority of negative beliefs held are about resource availability. Hence, training programs may need to be developed locally for physicians and tailored to individual community characteristics. Training programs should also emphasize the importance of understanding the victims of spouse abuse and of not blaming the victims for the violence.     

Domestic violence: a life-span approach to assessment and intervention

Domestic violence affects millions of Americans, many of whom deny or refuse to admit that that they are victims of abuse. Assessing patients at risk for domestic violence is a critical aspect of providing comprehensive primary care. As social agents, with moral and ethical responsibility, primary care providers must advocate for clients in the fight against domestic violence. Primary health care agencies must adopt uniform policies that assure that all women, children, and elders at risk for abuse are screened using a simple tool that becomes part of the primary care record. Screening for abuse should become part of an annual screening process, not unlike screening patients for high blood pressure or high cholesterol. If patients are suspected of being abused, document this on the problem list so subsequent providers will know to explore the possibility of abuse with patients. Multiple forms of abuse occur in families, and signs of abuse are usually subtle in nature. Abuse may be the reason for failed office visits, noncompliance with medications, depression, and other unexplained physical and psychological signs and symptoms. If we fail to ask, we will never know how many of our patients are victims of abuse and in need of our help.     

A population-based survey assessing support for mandatory domestic violence reporting by health care personnel

BACKGROUND: State laws mandating health care personnel to contact police when treating patients injured as a result of domestic violence are controversial. Attitudes toward these laws have been studied in select groups, but never in a large population-based sample. METHODS: We measured support for mandatory reporting (MR) among 845 women in 11 cities who participated in a telephone survey assessing risk factors for intimate partner violence. Abused women were oversampled to create equal groups (427 abused and 418 non-abused); results are presented stratified by abuse status or weighted based on prevalence of abuse among women who were screened. RESULTS: The estimated prevalence of physical violence or threat of physical violence from an intimate partner during the past two years was 11.7%; 72% (95% CI = 69%-75%) of women supported MR. Abused women were significantly less likely to support MR compared to non-abused women (59% versus 73%, p < 0.01). Reasons that endorsed support included: victims would find it easier to get help (81%) and would like health care personnel to call the police (68%). Reasons that endorsed opposition included: victims would be less likely to disclose abuse (77%), would resent someone else having control (61%), and reporting would increase the risk of perpetrator retaliation (44%). CONCLUSIONS: Most women support mandatory reporting by health care personnel. However, abused women were significantly less supportive than those not abused.     

Domestic violence: the Lebanese experience

OBJECTIVES: To estimate the prevalence of domestic violence among women presenting to primary health care facilities in Lebanon; to identify presenting symptoms and responses to varied forms of violence; and to examine variables associated with domestic violence. STUDY DESIGN/METHODS: A cross-sectional survey of all women presenting to four primary health care centres in different geographic areas of Lebanon from September 2002 to October 2002. A questionnaire was administered in interview format. The following information was collected from participants: demographic characteristics, perceived health status, prior exposure and responses to domestic violence, and characteristics of the perpetrators. RESULTS: Of the 1418 participants, 494 (35%) reported experiencing domestic violence and 307 (22%) had family members who had been exposed to domestic violence. Among the women exposed to violence, verbal abuse or insult was most common (88%) followed by physical violence (66%); 57% reported their experiences to family, friends or authorities, whereas the remainder kept silent. Women who were exposed to domestic violence had higher frequencies of reported physical symptoms than those who were not exposed. Generally, the perpetrators were spouses who had demographic backgrounds comparable to their wives. Multiple regression analyses showed that women's education levels, work status, health status, and familial violence predicted domestic violence. CONCLUSIONS: Women readily talk about their abuse when asked. The rate of domestic violence is high among Lebanese women and is a significant health issue. Additional research is needed to better understand the extent of the problem and to develop more effective reporting methods.     

Domestic violence among Druze women in Israel as reflected by health status and somatization level

Women with a history of physical or emotional abuse demonstrate a higher incidence of medical disorders but may be reluctant to disclose the abuse to health care providers. The present study explored whether measures of health status may serve as an indication of violence against women. Sixty-two Druze women (18-50 years old) completed health status (SF-36 survey), somatization (Brief Symptom Inventory-BSI), and abuse (the Abuse Assessment Screen-AAS) questionnaires during a visit to the family physician in the community primary care clinic. Higher somatization symptoms and diminished health status were associated with severity of violence. Results attest to the value of these measures as an additional indirect device for screening victims of domestic violence in general and among traditional societies in particular.     

A Population-Based Survey Assessing Support for Mandatory Domestic Violence Reporting by Health Care Personnel

SUMMARY

Background: State laws mandating health care personnel to contact police when treating patients injured as a result of domestic violence are controversial. Attitudes toward these laws have been studied in select groups, but never in a large population-based sample.

Methods: We measured support for mandatory reporting (MR) among 845 women in 11 cities who participated in a telephone survey assessing risk factors for intimate partner violence. Abused women were over-sampled to create equal groups (427 abused and 418 non-abused); results are presented stratified by abuse status or weighted based on prevalence of abuse among women who were screened.

Results: The estimated prevalence of physical violence or threat of physical violence from an intimate partner during the past two years was 11.7%; 72% (95% CI = 69%–75%) of women supported MR. Abused women were significantly less likely to support MR compared to non-abused women (59% versus 73%, p < 0.01). Reasons that endorsed support included: victims would find it easier to get help (81%) and would like health care personnel to call the police (68%). Reasons that endorsed opposition included: victims would be less likely to disclose abuse (77%), would resent someone else having control (61%), and reporting would increase the risk of perpetrator retaliation (44%).

Conclusions: Most women support mandatory reporting by health care personnel. However, abused women were significantly less supportive than those not abused.     

Voluntary abortion and domestic violence among women attended at a public maternity hospital of Salvador-BA

Quantitative study in order to study domestic violence in women with induced abortion. Interviews were conducted with 147 women hospitalized for induced abortion in a public maternity hospital in Salvador, Bahia. The subjects are characterized by mostly women, black, poorly educated, economically dependent on spouses, experienced psychological abuse, physical and sexual abuse committed by their spouses. Almost half of the women were victims of domestic violence during the current pregnancy, and that was the reason for inducing abortion for 67% of them. The study reveals an association between experience of domestic violence and induced abortion. As mental health consequences, they developed symptoms of post trauma stress disorder. It is necessary that the health professionals consider the cues to identify domestic violence as a health problem associated with induced abortion, which requires a transformation on the training model, including domestic violence as a health issue.     

Recommendations of the Polish Gynecological Society concerning child sexual abuse

The World Health Organisation defines child sexual abuse as the involvement of a child in sexual activity that he or she does not fully comprehend, is unable to give informed consent to, or for which the child is not developmentally prepared and cannot give consent, or that violates the laws or social taboos of society. Child sexual abuse is evidenced by this activity between a child and an adult or another child who by age or development is in a relationship of responsibility, trust or power, the activity being intended to gratify or satisfy the needs of the other person. It is estimated that in the world on average one in 3-4 women and one in 6-10 men were victims of sexual abuse in childhood. In Poland, according to the estimates of the Child's Rights Protection Committee, approximately 20% of girls and 5-6% of boys under the age of 15 years has suffered sexual abuse. In 2007 there was an increase in violence victims in all age categories, but the most alarming data concerned minors under 13 years. Girls fall victim to sexual abuse three times more frequently than boys. Sexual abuse of boys frequently involves violence. Data show that there are fewer women than men who execute such actions against a minor. Most victims (49-84%) know the perpetrator, and approximately 14-20% of acts of violence take place within the family. This article presents recommendations of the Polish Gynecological Society concerning procedures in cases of suspected sexual abuse of children.     

Are men and women equally violent to intimate partners?

Violence against women is a significant public health issue. One form of violence against women, intimate partner abuse or domestic violence, is prevalent in Australia. In this article, we summarise the main theoretical and methodological debates informing prevalence research in this area. We explain why studies finding equivalent victimisation and perpetration rates between the sexes are conceptually and methodologically flawed and why coercion and control are fundamental to the definition and measurement of partner abuse. We conclude that while male victims of partner abuse certainly exist, male victims of other forms of male violence are more prevalent. A focus on gendered risk of violence in public health policy should target male-to-male public violence and male-to-female intimate partner abuse.     

Determinants and health consequences of domestic violence among women in reproductive age at zagazig district, egypt

Violence against women is a global phenomenon that cuts across all social and economic classes, it has recently drawn attention in the medical field as a leading cause of preventable morbidity and mortality. The present study was carried out to estimate the prevalence of domestic violence, to identify socio-demographic and behavioral risk factors and to investigate the relationship between the women's psychological health status and violence exposure. This is a comparative cross-sectional study using a multistage random sampling technique. The sample comprised 500 women aged 18-50y. Data was collected via a structured interview questionnaire including the socio-demographic characteristics of the women and their husbands, some of the husbands' habits, attitude and history of chronic illnesses. Also, the questionnaire assesses different forms of domestic violence, women's reaction to it and its consequences on psychological well-being of women. A depression anxiety scale was used to assess the women's psychological status. The study revealed that the overall prevalence of domestic violence among the studied group was (62.2%); the commonest form (74.0%) was psychological abuse, followed by social (26.8%) one, then the physical (22.4%) and lastly sexual abuse (19.6%). On studying the socio-demographic variables, a significantly higher percentage of younger ( pound 30 years) non-educated, low income and those having any property ownership were more exposed to violence. Also exposure to abuse was more prevalent among women whose husbands were young, non-educated, skilled workers, drug abuser, with positive history of family troubles and chronic illness. The majority of women reported that they react to violence by crying loudly or screaming, while a minority may seek medical care or call the police. Regarding the psychological effect of violence exposure, the most common effects were anxiety (69.2%) and depression (52.2%), with a highly statistically significant difference with exposure in every form of domestic violence. Conclusion & Recommendations: The overall prevalence of domestic violence was relatively high and was predominantly of the psychological form. Women abuse had serious health effects on the women's health mainly her psychological well being. The study recommends practicing compulsory pre-marital counseling and offering health educational sessions in schools, universities and health units to all expected couples about marital and family life and provision of routine screening for domestic violence in primary care.     

Barriers and facilitators of disclosing domestic violence to the healthcare service: A systematic review of qualitative research

Domestic violence victims are in frequent contact with the healthcare service yet rarely disclose. Therefore, it is critical to understand victims' experiences and perceptions regarding disclosure in healthcare settings. The goal of this review is to provide an updated synthesis of qualitative research identifying barriers and facilitators, advice, and positive and negative outcomes of adult victims' disclosure of domestic violence to healthcare professionals (HCPs). A systematic search of PsychINFO, CINAHL and Web of Science was conducted in January 2018. Thirty-four eligible studies were identified, including 783 domestic violence victims (781 females). Formal quality assessment indicated variable study quality. Barriers of disclosure included negative HCPs attitudes, victims' perceptions of safety and concerns about the consequences of disclosing. Facilitators of disclosing included a positive relationship with the HCP, HCPs directly asking victims about abuse, and HCPs ensuring that the environment is safe and disclosure is confidential. Victims advised increased awareness of HCPs reactions to disclosure and avoiding mirroring their perpetrators minimization. HCPs were encouraged to engage in direct questioning and maintain a supportive and secure environment. Positive and negative outcomes of abuse were identified, such as being able to leave the abuser or, on the other hand, the victims' situation not changing. Our results indicate that barriers for disclosure of domestic violence in healthcare settings persist despite the widespread implementation of policies and guidelines to counter them. Based on these findings, we provide recommendations for clinical practice and future research to help improve disclosure in healthcare settings.     

Interventions that help victims of domestic violence. A qualitative analysis of physicians' experiences

BACKGROUND: The barriers physicians face when providing care to victims of domestic violence are well detailed in the literature, but few studies provide insight into how physicians overcome these barriers. Our goal was to describe the domestic violence interventions used by physicians who are committed to providing quality health care to battered women. METHODS: We conducted 6 focus groups with 45 San Francisco Bay Area physicians who had intervened with victims of domestic violence. The sessions were audiotaped and transcribed. We constructed, through constant comparison, a template of open codes to identify themes that emerged from the data. RESULTS: Our analysis revealed that physicians viewed validation (ie, providing messages to the patients that they are worth caring about) as the foundation of intervention. Other interventions included labeling the abuse as abuse; listening and being nonjudgmental; documenting, referring, and safety planning; using a team approach; and prioritizing domestic violence in the health care environment. Physicians described a range of rewards for intervening with victims, from seeing a patient change her entire life to subtle shifts in the way a woman thinks of her relationship and herself. CONCLUSIONS: Our study offers insight into how physicians can intervene to help victims of domestic violence. Recent interview and survey studies of battered women support the physician interventions described.     

Health care providers' missed opportunities for preventing femicide.

BACKGROUND: Homicide of women (femicide) by intimate partners is the most serious form of violence against women. The purpose of this analysis of a larger multisite study was to describe health care use in the year prior to murder of women by their intimate partner in order to identify opportunities for intervention to prevent femicide. METHODS: A sample of femicide cases was identified from police or medical examiner records. Participants (n = 311) were proxy informants (most often female family members) of victims of intimate partner femicide from 11 U.S. cities. Information about prior domestic abuse and use of health care and other helping agencies for victims and perpetrators was obtained during structured telephone interviews. RESULTS: Most victims had been abused by their partners (66%) and had used health care agencies for either injury or physical or mental health problems (41%). Among women who had been pregnant during the relationship, 23% were beaten by partners during pregnancy. Among perpetrators with fair or poor physical health, 53% had contact with physicians and 15% with fair or poor mental health had seen a doctor about their mental health problem. Among perpetrators with substance problems, 5.4% had used alcohol treatment programs and 5.7% had used drug treatment programs. CONCLUSIONS: Frequent contacts with helping agencies by victims and perpetrators represent opportunities for the prevention of femicide by health care providers.     

Domestic violence and sexually transmitted diseases: the experience of prenatal care patients.

OBJECTIVES: The authors analyzed interview responses of patients at a prenatal care clinic to explore whether women who had been victims of sexual and physical abuse were more likely than non-victimized women to have experienced a sexually transmitted disease (STD). METHODS: A consecutive sample of 774 prenatal patients of a large health department in North Carolina were interviewed concerning a variety of health issues, including violence and STDs. Logistic regression analysis was used to model the women's STD status as a function of their experiences of sexual and physical abuse, controlling for several potentially confounding factors. RESULTS: Thirty percent of the women reported having experienced at least one STD, with the most common infections being chlamydia and gonorrhea. Twenty-eight percent of the women reported having been victims of abuse; 16% reported physical abuse only, while 12% reported both physical and sexual abuse. The majority of violence was domestic in nature, perpetrated by the victims' husbands, boyfriends, male friends, and relatives. After controlling for confounding variables, the authors found that women who reported both physical and sexual abuse were significantly more likely to have experienced STDs than non-victims (odds ratio [OR] = 2.25; 95% confidence interval [CI] 1.37, 3.69). The logistic regression analysis also showed a relationship of borderline statistical significance between non-sexual physical abuse and STDs. CONCLUSIONS: Health care providers should routinely screen patients for both abuse and STDs, and they should assist identified women in accessing appropriate health, social, and legal services.     

Domestic violence as a health issue

This issue of the National Women's Health Report focuses on violence against women, specifically violence in the household. It contains four main articles namely: domestic violence as a health issue; facts and fallacies of domestic violence; physical assessment of battered women; and awareness of domestic violence. The first article discusses the formal recognition of domestic violence as a public health issue and various measures taken to reduce its incidence. Such strategies include establishing hospital protocols for victims of abuse and increasing awareness on battering in the nursing profession. The second article briefly describes the Domestic Violence Awareness Month, which is held every October. The third article talks about certain facts on domestic violence. It points out how patterns of abuse occur within the family and describes certain actions to protect the future generation from domestic violence. Insights into the physical assessment of battered women were provided in the fourth article. A follow-up report on the one-day conference titled "Violence Against Women" was also presented.     

Physicians' response to victims of domestic violence: toward a model of care

Even though current domestic violence guidelines, such as those published by the AMA in 1992, attempt to relieve physicians of the "full burden of intervention," they continue to call upon physicians to play a large role in identifying, intervening in, and following up on case of partner abuse. In this paper, we define a limited domestic violence role for physicians which furthers the direction recommended by the AMA and which complements exemplary programs. We propose simplifying and limiting physicians' tasks to Asking patients about abuse; providing Validating messages, acknowledging that battering is wrong and confirming patient worth; Documenting presenting signs, symptoms, and disclosures; and Referring victims to domestic violence specialists (AVDR). By drawing on the literature and our own experience, we show how focusing the physician's role on these four taks is consistent with exemplary programs and expands on ideas put forth by experts for addressing domestic violence in health care settings; reduces barriers for physician interventions with victims; offers a realistic approach for physicians, reducing unrealistic educational demands; and complements managed care trends in contemporary health care.