Hidden consequences of state violence: spinal cord injuries in Soweto, South Africa

Many spinal cord injured people in Soweto are victims of direct, repressive state violence, such as police shootings. All of them are victims of the indirect structural violence that is institutionalized against both blacks and disabled people in South Africa. SCI people in Soweto are therefore subject to two sources of disadvantage and exclusion. This paper describes a survey of 88 SCI Sowetans. Their lives are marked by poverty and social isolation. Their experiences bring into sharp focus some of the concrete and hidden results of apartheid as a violent and disabling system.     

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.     

Fatal and nonfatal injuries related to violence in Washington workplaces, 1992

This study describes injuries related to assaults and violence that occurred in Washington State workplaces in 1992. Nonfatal injuries are emphasized. High-risk industries and occupations are described. Fatalities caused by work-related violence were identified using the 1992 U.S. Department of Labor Bureau of Labor Statistics (BLS) Census of Fatal Occupational Injuries. Nonfatal injuries were identified using the BLS Annual Survey of Occupational Injuries and Illnesses and the Washington State workers' compensation system. Thirteen occupational fatalities resulted from assaults or violent acts in 1992. BLS data identified 784 nonfatal injuries that resulted in one or more day off work; workers' compensation data identified 2,395 claims. Industries experiencing the highest claim rates were Social Services (148 per 10,000) and Health Services (106 per 10,000). Nonfatal violent injuries were common and appeared to have different risk factors than fatal injuries. Industries in which injuries occurred were often predictable and suggested specific strategies for prevention efforts. © 1996 Wiley-Liss. Inc.     

Age-related differences in work injuries: a multivariate, population-based study

BACKGROUND: Many population-based studies find that the rate of work injuries is higher among adolescent and young adult workers compared to older adults. The present study examines age-related differences in work injuries, with an emphasis on adjusting for the potential confounding effects of job characteristics. METHODS: Age-related differences in work injuries were examined in a representative sample of 56,510 working Canadians aged 15 years and over. Respondents reported work-related injuries and job characteristics (e.g., occupation) in the past 12 months. Total hours worked in the past year were computed for each worker and accounted for in the logistic regressions. Analyses were stratified by gender. RESULTS: For men, adjusting for job characteristics substantially reduced, but did not eliminate the elevated risk status of adolescent and young adult workers. For women, only young adult women showed an elevated risk of work injury with job characteristics controlled. CONCLUSIONS: This is one of the few multivariate studies specifically examining contributors to age-related differences in work injuries in a population-based sample of workers. The substantial reduction in age-work injury association in the fully adjusted model suggests that differences in the types of jobs young workers hold play a critical role in their high-risk status.     

Armed violence: a health problem, a public health approach

At the World Health Assembly in 1996, the World Health Organization (WHO) declared violence "a leading worldwide public health problem" and called for public health strategies to address it. The WHO's call to action, as well as an international political movement that is gaining strength, has helped galvanize health professionals in many countries to employ the tools of public health and their medical skills to better understand the causes of violence, to use research findings to influence policy, and to animate statistics with a human face. This paper reviews the scope of the problem, with a focus on armed violence with small arms and light weapons. It presents a history of International Physicians for the Prevention of Nuclear War's (IPPNW) involvement in this issue. A case example from IPPNW/Zambia demonstrates how health community involvement can raise awareness about armed violence and its risk factors, and influence policy changes.     

A data mining approach in home healthcare: outcomes and service use

Background  

The purpose of this research is to understand the performance of home healthcare practice in the US. The relationships between home healthcare patient factors and agency characteristics are not well understood. In particular, discharge destination and length of stay have not been studied using a data mining approach which may provide insights not obtained through traditional statistical analyses.     

Adolescents exposed to physical violence in the community: a survey in Brazilian public schools.

OBJECTIVE: To determine the proportion of adolescents who have been exposed to physical violence in the city of Porto Alegre, Brazil. METHODS: Fifty-two Porto Alegre public schools that offer basic primary education (grades 1 to 8) were selected through a random sampling process stratified according to school size. In May-November 2000 a screening survey that identifies exposure to violence--experienced personally, witnessed, or knowing victims of violent acts--was administered to all students who were attending a randomly selected 8th grade class in each of the 52 schools. RESULTS: The total number of adolescents included in the analysis was 1,193, representing 10.3% of the students enrolled in 8th grade classes in the city's public school system. On average, each adolescent had been exposed to 19.8 incidents of violence (standard deviation (SD) = 8.5): 2.0 incidents personally experienced (SD = 2.1), 8.5 incidents witnessed (SD = 4.0), and 9.3 knowing a victim of an incident of violence (SD = 4.1). In our sample, the variables of being male (P < 0.0001), being in an older age group (P < 0.001), and not living with both parents (P < 0.001) were independently associated with exposure to more incidents of violence. CONCLUSIONS: We found a high prevalence of incidents of violence among the adolescents in our sample in Porto Alegre. Considering the particular burden inflicted by violent acts on adolescents, health professionals must develop effective approaches to activity identifying, intervening in, and preventing community violence.     

Health work in MERCOSUR: a Brazilian approach

MERCOSUR Member Countries (Brazil, Argentina, Paraguay, Uruguay, and Venezuela) have viewed the regional integration process and management of work and education in health as a concern for government, considering the health sector's specificities. Key issues are professional accreditation and harmonization of current legislation. This article discusses initiatives in the Permanent MERCOSUR Forum related to work in the health field. The Forum serves as a space for dialogue between various actors: Ministry of Health, health workers, and professional boards, with the aim of supporting the work by the Sub-Commission on Professional Development and Practice, under MERCOSUR Working Sub-Group 11, Health, aiding in the formulation of health management and education policies. The current challenge involves the creation of mechanisms for implementing joint actions to solve problems in the regulation of professional practice, especially in municipalities along the borders between MERCOSUR countries.     

Physical violence against Brazilian children and adolescents: a 4-year study

Objective

To investigate and compare differences in physical aggression among children and adolescents.

Subjects and methods

A cross-sectional study of victims of violence by physical aggression was conducted in a Forensic Unit that attends such victims. Reports of violence containing complete information were gathered for 164 children and 788 adolescents. Data were collected from the information contained in these reports.

Results

The results of the multivariate logistic regression model analysis indicated that five of the nine factors investigated showed a statistically significant association with children or adolescents. Female children were more likely to be associated with cases of violence [OR: 2.90, 95 % CI (1.88, 4.44)] in the domestic environment [OR: 6.55, 95 % CI (4.37, 9.82)]. Among adolescents, boys were more likely to be involved, and group violence was more frequent. The injuries sustained by both children and adolescents affected more than one body area. Separately, the head and face were the most affected.

Conclusion

Differences were encountered between the factors investigated for children and adolescents, emphasizing the complexity of the issue in the juvenile age group. Efforts to combat and prevent violence require specific guidelines for both children and adolescents. There is also a need to develop qualitative approaches that foster an understanding of this issue from a new perspective.

     

Geographic, demographic, and socioeconomic differences in quality of data on cause of death in Brazilian elders

This study identifies geographic, demographic, and socioeconomic differences in the quality of data on underlying causes of death in the Brazilian elderly population. We used three quality indicators: the proportion of ill-defined causes, the proportion of unspecified causes, and the two proportions combined. We analyzed the main ill-defined and unspecified causes and the association between these indicators and individual characteristics on death certificates (DC) and characteristics of the municipalities. Unspecified causes exceed ill-defined causes, and both increase with age. Schooling, race, size of municipality, and per capita GDP were associated with quality of data (especially with ill-defined as compared to unspecified causes). Having received medical care decreased the odds of cause of death being recorded as ill-defined and increased the odds of unspecified records. Programs to improve quality of information on death certificates should focus on ill-defined and unspecified causes in the elderly.     

Marginalization and symbolic violence in a world of differences: war and parallels to nursing practice

Abstract Marginalization has been used as a guiding concept for nursing research, theory and practice. Its properties have been identified and updated in 1994 and 1999, respectively. This article re‐examines marginalization, considering it to be a concept that changes with pivotal historical events. The events of September 11, 2001, and the war between the US/UK and Iraq are such pivotal events. The notion of the linguistic habitus and symbolic violence as outlined by Bourdieu provide new insights about the dynamics of marginalization. Specifically noted is the marginalization of persons and cultures based on their designation by the current US administration, and as interpreted through mainstream media, as actual or potential ‘terrorists’. A parallel situation in nursing is discussed, beginning with nursing's own marginality, related to the dynamics of symbolic violence. Nursing is argued to be vulnerable to having essential words and practices co‐opted by dominant institutions and altered in meaning, that is, made incongruent with the discipline's emphasis on core values of confidentiality, equity and care. In response to marginalization and exteriorization those affected can use voice and testimony to ‘recreate the centre’. Suggestions for protecting our practices and philosophy are included.     

Networks and social capital: a relational approach to primary healthcare reform

Collaboration among health care providers and across systems is proposed as a strategy to improve health care delivery the world over. Over the past two decades, health care providers have been encouraged to work in partnership and build interdisciplinary teams. More recently, the notion of networks has entered this discourse but the lack of consensus and understanding about what is meant by adopting a network approach in health services limits its use. Also crucial to this discussion is the work of distinguishing the nature and extent of the impact of social relationships – generally referred to as social capital. In this paper, we review the rationale for collaboration in health care systems; provide an overview and synthesis of key concepts; dispel some common misconceptions of networks; and apply the theory to an example of primary healthcare network reform in Alberta (Canada). Our central thesis is that a relational approach to systems change, one based on a synthesis of network theory and social capital can provide the fodation for a multi-focal approach to primary healthcare reform. Action strategies are recommended to move from an awareness of 'networks' to fully translating knowledge from existing theory to guide planning and practice innovations. Decision-makers are encouraged to consider a multi-focal approach that effectively incorporates a network and social capital approach in planning and evaluating primary healthcare reform.     

Socioeconomic inequality of cancer mortality in the United States: a spatial data mining approach

Background  

The objective of this study was to demonstrate the use of an association rule mining approach to discover associations between selected socioeconomic variables and the four most leading causes of cancer mortality in the United States. An association rule mining algorithm was applied to extract associations between the 1988–1992 cancer mortality rates for colorectal, lung, breast, and prostate cancers defined at the Health Service Area level and selected socioeconomic variables from the 1990 United States census. Geographic information system technology was used to integrate these data which were defined at different spatial resolutions, and to visualize and analyze the results from the association rule mining process.