Community Assault Research Articles

Intersection of Community Violence and Prenatal Substance Exposure: A Spatiotemporal Analysis.

Maternal substance use during pregnancy is a known risk factor for poor birth outcomes and lifelong health consequences. In addition, exposure to domestic and community violence can be associated with adverse birth outcomes. Due to limited research examining public health challenges linked to prenatal substance exposure (PSE)/neonatal abstinence syndrome (NAS) at the population level, we examined possible geographic and temporal intersections between (1) community violence and PSE/NAS, and (2) community gun violence and PSE/NAS. We conducted a study using abstracted records of neonates born at a tertiary referral hospital from 2012 to 2019 having a diagnosis code for PSE/NAS (n = 1,523). Cases of community violence were identified using a hospital-based Trauma Registry during the 2012 to 2019 period (n = 1,580). We identified zones of spatial clustering and geographic overlap between community violence and PSE/NAS using emerging hot spot analysis. Geographic and temporal clustering of PSE/NAS occurred. PSE/NAS had statistically significant zones of overlap with community assault cases (New Hot Spot 15 zones, Consecutive 5 zones, Sporadic Hot Spot 62 zones with a p < 0.01). PSE/NAS also clustered with community gun violence (New Hot Spot 11 zones, Consecutive Hot Spot 90 zones, Intensifying Hot Spot 13 zones, Sporadic Hot Spot 20 zones with a p < 0.01). Spatiotemporal overlap occurred between community violence and the adverse neonatal event of PSE/NAS. By allocating resources to identified geographic areas of increased risk, the health of vulnerable communities can be improved. · PSE/NAS geographically and temporally clusters with community violence.. · PSE/NAS geographically and temporally clusters with community gun violence.. · Resources should be provided to communities with increased risk.. · By allocating resources, communities members' health can be improved..

Suffering and Survival: The Experience of Dutch Women in Japanese Internment Camps in Java, 1941–45

ABSTRACT: The case of Dutch women imprisoned in Japanese internment camps in Java, 1941-45, is a little known chapter within the well-known context of the Second World War. This article deciphers the possibilities of their experience by examining two temporally distinct sets of sources from the women's perspectives. The first comprises a series of ego-documents and interviews written during the war and just after it, and the second is a collection of sources from the 1990s onwards, in the form of memoir, oral history, and children's testimonies spoken in front of the Japanese Embassy in The Hague in 2005. In the spaces and inconsistencies between these two sets of testimony a diverse and complex picture of female experience is found across three predominant themes: motherhood, female community, and sexual assault. Each section is an insight into how agency is sought when agency is denied, how the women held themselves, organized themselves, and supported and fought against one another within a regime indifferent to whether they lived or died.

Incidence and factors associated with being a victim of community assault; retrospective review of medical records in an Emergency Centre.

IntroductionCommunity assault is an interpersonal violence frequently seen in the emergency centres around South Africa. Its aim is to inflict serious injuries to a suspected perpetrator. Data has not been published in Mamelodi Regional Hospital setting whereas the cases have been observed in the emergency centre (EC). The study objectives were to determine the incidence and factors associated with being a victim of community assault in the EC in a regional hospital in Pretoria and clinical outcomes.MethodsWe retrospectively reviewed the medical records of adult patients who were treated for assault in the EC of Mamelodi Regional Hospital between 5 March 2017 and 5 March 2018. EC electronic registries and medical file were used to identify all patients who presented with body injuries due to assault.ResultsOnly 807 of 1070 medical records had complete data on the exposure variables of study interest. Of the 807 participants who presented with body injury due to assault, 77 (9.544% (95% CI 7.52 to 11.57)) were due to community assault. The majority of the victims were young adults, of male gender and not married. More than half of the participants were unemployed. Young adult age doubled the odds of being a victim of community assault odds ratio (OR) 2.19 (95% CI 1.02 to 4.70). The odds of being a victim of community assault for males were 11 times the odds of females OR 11.30 (95% CI 2.74 to 46.49). Of the 77 victims of community assault, 45 (58%) were admitted, 25 (32%) were discharged after receiving treatment, 6 (8%) refused treatment and 1 (1%) died.DiscussionWe describe the incidence of, and factors associated with, community assault in the EC of Mamelodi Regional Hospital in Pretoria. Our findings suggest that a modest incidence rate of being a victim of community assault. Young adult males are mostly the target victims of community and non-community assault. Further research is needed to understanding factors precipitating community assault and to test potential community and non-community assault prevention interventions, targeting young adult males.

Mob Justice in South Africa: A comparison of blunt trauma secondary to community and non-community assaults

BackgroundThe phenomenon of extrajudicial “mob justice” and community assault (CA) has been documented in news reports and anecdotes from a number of low- and middle-income countries, but there is little literature on its burden on trauma systems. This study reviews a single center's management of CA victims and compares the spectrum of injuries seen following mob assault with those sustained via other forms of interpersonal violence (IPV). MethodsClinical data, injury details, and mortality among injured patients (age≥18) hospitalized in a South African tertiary referral center from 2012-2018 were abstracted. Patients with penetrating injury or missing ISS were excluded. CA was determined at time of admission by either self-designation or by patients’ escorts. Univariate analyses compared the presentation and outcomes for CAs and non-CAs. ResultsOverall, CA constituted 5% of total trauma admissions and 8% of IPV-related admissions during the study period. Of 1,323 incidents of blunt injury following IPV, 239 (18%) were CAs. One in two CA victims (n=119, 50%) were struck by an identifiable weapon. Patients injured in CA were more frequently male (97% vs 85%), presented with ISS>15 (28% vs 21%), and had a shock index>0.9 (25% vs 19%) compared to non-CA (all p<0.001). Rates of operative intervention, ICU admission, and mortality did not differ (all p>0.05). CAs were more likely to be complicated by acute kidney injury (9% vs 1%, p<0.001) but less likely to involve neurologic complications (3% vs 10%. P<0.001) compared to non-CAs. Acute kidney injury in CA showed a pattern of significant musculocutaneous injury with rhabdomyolysis. ConclusionCA contributes considerably to the high rates of IPV in a single South African center. Victims of such assaults sustain more severe injury with unique mechanisms and subsequent complications. This evidence supports the need to strengthen local governance and improve law enforcement efforts to prevent such violence.

Major interpersonal violence cases seen in a Pretoria academic hospital over a one-year period, with emphasis on community assault cases.

IntroductionInterpersonal violence cases make up a significant portion of the trauma cases seen in emergency centres in South Africa. Community assaults are extremely violent attacks on suspected perpetrators by members of the community aimed at inflicting serious injury. The aim of this study was to profile the major interpersonal violence cases at Kalafong Hospital with emphasis on the community assaults and how this group compares with non- community assaults regarding demographics, surgical intervention and mortality.MethodsA retrospective analysis was conducted of the major interpersonal violence cases seen over a one-year period (1 January 2016 to 31 December 2016) at Kalafong Hospital, Pretoria, South Africa. Data was manually collected and entered into a Microsoft Excel spreadsheet. The Stata 13 statistical program was used for data analysis.ResultsDuring the study period, a total of 578 cases were analysed. Penetrating trauma accounted for 446 (77.2%) cases and blunt trauma for 132 (22.8%) cases. The number of community assault cases was 75 (12.9%). A total of 28 deaths were recorded during this period. Community assaults accounted for 13 (46.4%) of these deaths. Community assault cases had a significantly higher mortality compared to non-community assault cases with 17.3% versus 3%; Odds ratio 6.82 (95% CI 3.04–15.33, p < 0.001). The community assault group also showed a statistically significant difference in the intensive care admission rate with 15.3% compared to 6.9% in the interpersonal violence cases; Odds ratio 2.41 (CI 1.07–5.43, p = 0.028).ConclusionCommunity assault cases may present with similar demographics when compared to non-community assault cases, but the difference in disposition and outcome was highlighted in this study with a higher intensive care unit admission rate and a higher mortality rate. A multi-centre follow-up study is recommended to compare demographics across Pretoria and to monitor trends in this subgroup of interpersonal violence cases.

The Promise Initiative: Promoting a trauma-informed police response to sexual assault in a mid-size Southern community.

A mixed-methods study details a multidisciplinary team's efforts to assess and transform police response to sexual assault in a mid-size community. A police department-wide survey (n = 331) determined baseline levels of officer exposure to trauma-informed training, rape myth acceptance, and awareness of community and nationwide sexual assault movements to understand officer attitudes towards factors influencing sexual assault investigations. These data, in conjunction with SAMHSA's (2012) trauma-informed assumptions, were leveraged to develop and adopt trauma-informed policies that would enhance the police department's response to sexual assault. At baseline, few officers reported receiving trauma-informed interviewing training (21.8%) or having knowledge of local SAK, #MeToo, or #TimesUp movements (10.0%, 7.2%, 3.9%, respectively). Chi-square analyses suggested officer knowledge of community SAK movement, personal investment in learning about sexual assault, and understanding of trauma were higher in officers with versus without training; of concern, officers with more sexual assaults on their caseload were more likely to endorse rape myths. Training understanding was related to lower rape myth acceptance. Policy changes, including adding trauma-informed training to the Police Academy, were implemented by the MDT to promote a system-wide trauma-informed approach to sexual assault and ensure community safety.

Hyperlactataemia with acute kidney injury following community assault: cause or effect?

Crush injury is a common presenting clinical problem in South African trauma patients, causing acute kidney injury (AKI). It has been theorised previously that the AKI was not due to an anaerobic phenomenon. A previous local study noted the presence of a mild hyperlactataemia among patients with crush syndrome, but the significance and causes of this was not fully explored. This study aimed to examine the incidence of hyperlactataemia in patients with crush syndrome presenting to a busy emergency department (ED) in rural South Africa. The study was conducted at Edendale Hospital in KwaZulu-Natal province in South Africa from 1 June 2016 to 31 December 2017. All patients from the ED who had sustained a crush injury secondary to a mob assault were included in the study. Patients with GCS on arrival of < 13 or polytrauma were excluded from analysis. The primary outcome of interest was the presence of hyperlactataemia (> 2.0mmol/L) on presentation. The Kidney Disease Improving Global Outcomes (KDIGO) criteria were used to diagnose and stage AKI as a secondary outcome. A total of 84 patients were eligible for analysis. Sixty-nine (82%) patients presented with hyperlactataemia. The median serum lactate was 4.9mmol/L (IQR 2.3-7.2mmol/L). Fifteen (18%) patients were diagnosed with AKI on presentation according to serum creatinine. Ten patients were diagnosed as Stage 1, three were Stage 2 and two Stage 3 AKI respectively. There was no difference in the incidence of AKI in patients with or without hyperlactataemia (p = 0.428). Time from injury to presentation was a median 365 minutes (IQR 180-750 minutes). Six (7%) patients were admitted to high care unit and nine (11%) were admitted to the intensive care unit (ICU). No patients died within 48 hours of admission. Two patients received renal replacement therapy during the first 48 hours of admission to hospital. Hyperlactataemia is a common feature of patients presenting to the ED following crush syndrome secondary to beatings received during interpersonal violence. The origin of this hyperlactataemia is currently unknown. Further research needs to be conducted into the origin of the hyperlactataemia and its clinical significance. In this cohort, the utilisation of RRT was low but the incidence of AKI was high and developed rapidly following the injury. The utilisation of RRT also needs to be further studied in larger patient populations in South Africa to make local clinical recommendations for use.

Advanced radiological investigations and findings amongst community assault victims admitted to a tertiary South African hospital

Community assault (CA) has been increasing in certain Cape Town suburbs over the past decade. There are limited CA-related imaging data. The aim of this study was to review CA-related advanced radiological investigations and findings at a Level 1 South African Trauma Centre. A retrospective study at Tygerberg Hospital, Cape Town, from 1 January through 30 June 2013. All advanced radiological investigations performed on CA victims at the time of admission were retrieved and analysed by patient demographics, imaging investigations and radiological findings. Sixty-two patients (n=62) with a median age of 25 years were included; CT brain was acquired in 90% (n=56) and was abnormal in 68% (n=42). Craniofacial fractures were demonstrated in 60% (n=37), with involvement of the paranasal sinuses in 32% (n=20) and the base of skull in 19% (n=12). Almost half (n=28/62; 45%) had intracranial haemorrhage, which was intra-axial in 36% (n=22/62), extra-axial in 34% (n=21/62) and both intra- and extra-axial in 23% (n=14/62). Cerebral oedema was present in 29% (n=18/62), with herniation in 10% (n=6/62). Non-cranial CT was acquired in 52% (n=32/62), of whom 19 (n=19/32; 59%) also underwent CT brain. CT abdomen was acquired in approximately a quarter of the cohort (n=16/62, 26%), demonstrating abnormalities in 15 (24%). Fifteen cervical spine CTs were performed (n=15/62; 24%) demonstrating no acute bony injury. We recommend a high index of suspicion for severe intracranial injury in CA victims and urgent tertiary referral of those with a depressed level of consciousness. Prospective work is required to determine the long-term outlook for survivors.

The Experience of Sexual Stigma and the Increased Risk of Attempted Suicide in Young Brazilian People from Low Socioeconomic Group.

This study was intended to analyze the intersection of experience of sexual stigma low-socioeconomic status, and suicide attempt amongst young Brazilians (11–24 years old). In each of the data collection periods (2004–2006: n = 7185; 2010–2012: n = 2734), participants completed a questionnaire-based instrument. Network analysis provided support for a Minority Stress Model, oriented around whether participants had experienced sexual stigma. Although suicide attempts decreased by 20% for participants who had not experienced sexual stigma, there was a 60% increase for those who had experienced sexual stigma. Of particular note were the increases in rates of reported community and familial physical assault, molestation, and rape for those who had experienced sexual stigma. An analysis of centrality statistics demonstrated that both experiences of this Minority Stress Model were fundamentally different, and that those disparities increased over the time frame observed in this study. At the center of this model, shortest paths statistics exhibited a direct conditioned connection between experiencing sexual stigma and suicide attempts. We discuss the social and historical contexts that contributed to these dynamics, and emphasize the need for policy change.

Revictimized Adult Women: Perceptions of Mental Health Functioning and Associated Services

In this study, using a sample of adult women (N = 418) from various environments, mental health outcomes and perceptions about different types of support following childhood and adulthood sexual and physical violence were assessed. The respondents were from three locations: general community, state prison, and sexual assault and domestic violence service providers. A cluster analysis based on victimization experiences was conducted; subsequent analyses showed that women who endured more types of abuse had more self-reported mental health difficulties. Somewhat paradoxically, women who utilized more therapeutic services held more negative perceptions of their mental health functioning, while use of tangible services had no significant association. Those who found therapeutic services helpful had significantly higher self-reported concurrent mental health functioning.

A 10-year review of fatal community assault cases at a regional forensic pathology facility in Cape Town, South Africa.

An increase in autopsied community assault (CA) fatalities was observed at the Tygerberg Forensic Pathology Services (FPS), Cape Town, South Africa (SA). There is a paucity of information on the incidence and prevalence of these cases in SA. To determine the patterns and trends of injuries sustained in so-called CA fatalities. A retrospective and descriptive study was conducted. Fatal CA cases admitted to the Tygerberg FPS over the 10-year period 1 January 2003-31 December 2012 were reviewed. Data were collected from autopsy/postmortem reports, contemporaneous notes, attached hospital records, the South African Police Services (SAPS) 180 form (completed by the SAPS representative) and other FPS documentation. A total of 424 cases of fatal CA were seen during the study period, with an annual increase between 2003 and 2007 and a second peak in 2012. The cause of death in most cases was multiple injuries (42.0%), with blunt-force trauma being the basis of most injuries sustained. The area with the greatest burden of injury was the township of Mfuleni (73 CA deaths per 100,000 population). There was a predominance of males, with only one female fatality recorded. Adequate policing in prevalent areas is essential to address unnecessary loss of life and the burden imposed by these cases on the criminal justice system and healthcare services.

Community v. non-community assault among adults in Khayelitsha, Western Cape, South Africa: a case count and comparison of injury severity.

Community assault (CA) or vigilantism is widespread in the township of Khayelitsha, Cape Town, South Africa (SA). Anecdotal evidence suggests that victims of CA are worse off than other assault cases. However, scientific data on the rate and severity of CA cases are lacking for SA. To contribute to CA prevention and management strategies by estimating the rate of CA among adults in Khayelitsha and comparing the injury severity and survival probability between cases of CA and other assault (non-CA) cases. We studied four healthcare centres in Khayelitsha during July - December 2012. A consecutive case series was conducted to capture all CA cases during this period. A retrospective folder review was performed on all cases of CA and on a control group of non-CA cases to compare injury severity and estimate survival probability. A total of 148 adult cases of CA occurred (case rate 1.1/1 000 person-years) over the study period. The Injury Severity Scores (ISSs) in the CA group were significantly higher than in the non-CA group (p < 0.001), with a median (interquartile range) ISS of 3 (2 - 6) in CA cases v. 1 (1 - 2) in non-CA cases. Comparison between the CA v. non-CA groups showed that a Glasgow Coma Scale < 15 (20.1% v. 5.4%, respectively), referral to the tertiary hospital (33.8% v. 22.6%, respectively), and crush syndrome (25.7% v. 0.0%, respectively) were all more common in CA cases. Survival probabilities were similar in both groups (CA v. non-CA 99.2% v. 99.3%, respectively). The rate of CA among adults in Khayelitsha is high, and the severity of injuries sustained by CA victims is substantially higher than in other assault cases.

Development and preliminary validation of a screen for interpersonal childhood trauma experiences among school-going youth in Durban, South Africa

This paper describes the development and preliminary validation of the Developmental Trauma Inventory (DTI), which is a 36-item, retrospective, self-administered screen for interpersonal childhood trauma experiences developed specifically for the South African context. Preliminary validation of the inventory was conducted using a sample of 720 school-going adolescents attending a high school in the Durban Metropolitan area (South Africa). Factor analysis produced the best fit for a 10-factor model (emotional abuse, community assault, domestic assault, poverty, witnessing community violence, witnessing domestic violence, indecent assault, domestic neglect, rape, and domestic injury). Contrary to expectations, items relating to loss and separation (e.g. death of a parent) did not produce a clear factor structure. Identified scales had good internal consistency (0.70 to 0.81), low factor inter-correlations, and high concurrent criterion-related validity in the sense that all scales were significantly correlated with scores on clinical measures of post-traumatic stress disorder (PTSD) and/or complex PTSD. These findings provide preliminary support for the utility of DTI in the South African context.

Charles Chesnutt’s Dilemma: Professional Ethics, Social Justice, and Domestic Feminism in The Marrow of Tradition

Only the Black Woman can say 'when and where I enter, in the quiet, undisputed dignity of my womanhood, without violence and without suing or special patronage, then and there the whole Negro race enters with me.' --Anna Julia Cooper, A Voice from the South Over the past decade there has been an explosion of interest in Charles Chesnutt's work, reclaiming his multifaceted narratives and stunning stylistic strategies as he strove to give voice to black aspirations in an increasingly segregated America. Unlike his earlier dialect tales, which were enthusiastically reviewed in the white press, The Marrow of Tradition, his 1901 novel known to be a fictional recreation of the Wilmington, North Carolina race riot of 1898 in which at least nineteen black men and women were murdered, received only a lukewarm response at its publication. (1) William Dean Howells called it a bitter, bitter book and others commented on its lack of artistry (Pickens 49, 82). Recent criticism, however, has reclaimed and reevaluated the novel, giving particular attention to the stylistic inventiveness of one of its several plots, and exploring the possible meanings of his text for the white audience we know was his primary target (Chesnutt 50). Chesnutt's complex narrative invites such a focus. Its private, plot, introduced and developed in the early chapters, traces the legacy of slavery through a host of minor characters: Colonel and Tom Delamere, Sandy (Delamere's lifelong servant), Olivia Carteret and her Aunt Polly, and Josh Green (a sharecropper's son who had promised his mother he would kill the man who lynched his father), reaching its climax when Sandy is accused of murdering Aunt Polly. With the rescue of the innocent Sandy by the Colonel and the banishment of Delamere's son, who is exposed as the true murderer, this plot line seems resolved. However, two other parallel narratives remain unfinished as Tom slinks off the page. In the novel's concluding chapters, the and worlds of postbellum Wellington as well as their respective racial and gender relations emerge more clearly. The public and apparently major plot involves the white leaders of Wellington (Major Carteret, General Belmont, and McBane, a slave driver turned entrepreneur), as they try to reestablish their political supremacy in a town threatened by the success of the Fusion party with the collapse of Reconstruction and the growing ascendancy of Jim Crow. Their manipulations end in an outbreak of white violence against the black population. Paralleling both the and plots is the novel's professional narrative which traces the return to Wellington of black physician Dr. Miller from his medical studies with his mixed-race wife Janet (half sister to Carteret's wife Olivia) and their son to establish a medical practice and build a black hospital. It is Miller's standing and Janet's familial connections that allow them to circulate, though not penetrate, through the white community and provide a glimpse into the instability of the racial and social order that governs the town. After the freeing of Sandy and the subsequent outbreak of white violence, the and plot lines converge. When no white doctor is available to treat Major and Olivia Carteret's sickly child, Dodie, they solicit help from Dr. Miller. Only then do the Carterets learn that the white mob, instigated by Carteret, has killed the Millers' only son. Balanced against the novel's opening chapters, these concluding chapters also occur in a private, domestic setting: the Miller home, where Janet stands beside the body of her murdered son. Standard critical readings of The Marrow of Tradition focus on the Delamere-Sandy sentimental narrative and the public, realistic plot that overtly condemns the white community's assault on the black. But they steer clear of the professional plot and the concluding two chapters by claiming that they are ambiguous; after all, at the end of the novel, we do not know if Dr. …