Episodes Of Physical Abuse Research Articles

The link between hearing impairment and child maltreatment among Aboriginal children in the Northern Territory of Australia: is there an opportunity for a public health approach in child protection?

BackgroundInternational studies provide evidence of an association between child disabilities, including hearing impairment (HI), and child maltreatment. There are high prevalences of ear disease with associated HI, and child maltreatment among Australian Aboriginal children, but the link between HI and child maltreatment is unknown. This study investigates the association between HI and child maltreatment for Aboriginal children living in the Northern Territory (NT) of Australia.MethodsThis was a retrospective cohort study of 3895 Aboriginal school-aged children (born between 1999 and 2008) living in remote NT communities. The study used linked individual-level information from health, education and child protection services. The outcome variables were child maltreatment notifications and substantiations. The key explanatory variable, HI, was based on audiometric assessment. The Kaplan–Meier estimator method was used in univariate analysis; Cox proportional hazards regression was used in multivariable analysis.ResultsA majority of the study cohort lived in very remote (94.5%) and most disadvantaged (93.1%) regions. Among all children in the study cohort, 56.1% had a record of either HI or unilateral hearing loss (UHL), and for those with a history of contact with child protection services (n = 2757), 56.7% had a record of HI/UHL (n = 1564). In the 1999–2003 birth cohort, by age 12 years, 53.5% of children with a record of moderate or worse HI had at least one maltreatment notification, compared to 47.3% of children with normal hearing. In the 2004–2008 cohort, the corresponding results were 83.4 and 71.7% respectively. In multivariable analysis, using the full cohort, children with moderate or worse HI had higher risk of any child maltreatment notification (adjusted Hazard Ratios (adjHR): 1.16, 95% CI:1.04–1.30), notification for neglect (adjHR:1.17, 95% CI:1.04–1.31) and substantiation (adjHR:1.20, 95% CI:1.04–1.40), than children with normal hearing. In the 2004–2008 birth cohort, children with moderate or worse HI had higher risk of a substantiated episode of physical abuse (adjHR:1.47, 95% CI:1.07–2.03) than children with normal hearing.ConclusionOur findings demonstrate the urgent need for HI and child maltreatment prevention strategies through raised community awareness and inter-agency collaboration. Effective information-sharing between service providers is a critical first step to a public health approach in child protection.

Violence towards personnel in out-of-hours primary care: A cross-sectional study

Objective. To investigate (1) the prevalence of occupational violence in out-of-hours (OOH) primary care, (2) the perceived cause of violence, and (3) the associations between occupation, gender, age, years of work, and occupational violence. Design. A cross-sectional study using a self-administered postal questionnaire. Setting. Twenty Norwegian OOH primary care centres. Subjects. Physicians, nurses, and others with patient contact at OOH primary care centres, 536 responders (75% response rate). Main outcome measures. Verbal abuse, threats, physical abuse, sexual harassment. Results. In total, 78% had been verbally abused, 44% had been exposed to threats, 13% physically abused, and 9% sexually harassed during the last 12 months. Significantly more nurses were associated with verbal abuse (OR 3.85, 95% confidence interval 2.17–6.67) after adjusting for gender, age, and years in OOH primary care. Males had a higher risk for physical abuse (OR 2.36, CI 1.11–5.05) and higher age was associated with lower risk for sexual harassment (OR 0.28, CI 0.14–0.59), when adjusted for background variables. Drug influence and mental illness were the most frequently perceived causes for the last occurring episode of physical abuse, threats, and verbal abuse. Conclusion. This first study on occupational violence in Norwegian OOH primary care found that a substantial number of health care workers experience occupational violence from patients or visitors. The employer should take action to prevent occupational violence in OOH primary care.

Domestic violence and forced sex among the urban poor in South India: implications for HIV prevention.

This article examined the prevalence of physical and sexual violence among 1,974 married women from 40 low-income communities in Chennai, India. The authors found a 99% and 75% lifetime prevalence of physical abuse and forced sex, respectively, whereas 65% of women experienced more than five episodes of physical abuse in the 3 months preceding the survey. Factors associated with violence after multivariate adjustment included elementary/middle school education and variables suggesting economic insecurity. These domestic violence rates exceed those in prior Indian reports, suggesting women in slums may be at increased risk for HIV and other sexually transmitted infections.

A Single Belief as a Maintaining Factor in a Case of Obsessive-Compulsive Disorder

A severe case of obsessive-compulsive disorder with 30-year chronicity was successfully treated with 7 sessions of cognitive therapy. The client, a 38-year-old male, was diagnosed as OCD by two independent clinicians. The cognitive treatment model targeted a central obsessional belief concerning the utility of the OCD. Once this single belief central to his compulsive behaviors had been dismantled, the client ceased to perceive his compulsive behaviors as useful and this led to a complete remission of symptoms at post-treatment which was maintained at 6-month and 3-year follow-up. The strategies included linking the content of the intrusion to the feared consequences and subsequent appraisals in order to specify the maintaining belief and comparing the past to the current functionality of the belief. The treatment procedure may be generalizable across other types of OCD. Keywords: obsessive-compulsive beliefs; cognitive therapy Cognitive models of obsessive-compulsive disorder (OCD) have emphasized the importance of addressing underlying assumptions and beliefs in the treatment of OCD (Salkovskis, 1999), particularly those leading to misinterpretations of significance of intrusions. However, the cognitive behavioral treatment of choice for OCD still centers around the behavioral techniques of exposure and response prevention with the addition of cognitive challenge and reality testing of anticipated consequences and appraisals. Although Ladouceur, Leger, Rheaume, and Dube (1996) reported a single case in which cognitive correction of a sense of inflated responsibility produced significant improvement of symptoms, and Freeston, Leger, and Ladouceur (2001) have also noted the plausibility of treating OCD with cognitive therapy, there are few studies reporting the successful treatment of OCD using cognitive therapy alone. The tcurrent case-study report illustrates the successful use of brief cognitive therapy in the case of OCD with a single maintaining belief. Case Report Mr. C. was a 38-year-old male who participated in a controlled study on treatment of OCD. He had been diagnosed with severe OCD and moderate generalized anxiety disorder with no other Axis I or II comorbidity. His rituals were overwhelming and affected most parts of his life. At the time of intake, he had suicidal ideations and suffered from insomnia. He reported having received no previous treatment for his OCD. As a child, his father who was an alcoholic (he described him as a "sociopath") abused him psychologically, physically, and sexually. At age 7, during an episode of physical abuse against his mother, he hid in a wardrobe and started counting and singing aloud so he would not hear his mother's screams. He stayed there until the abusive episode was over and this ritual helped him to lower his anxiety. At the beginning of his adolescence, he acquired the belief that he was at-risk of becoming like his father and this thought produced very high levels of anxiety. He recalled from that day onward how he decided to do everything to protect himself from becoming a vioknt and abusive person. Consequently, he started to perform rituals that were contrary to his father's personality. For example, he became perfectionistic and excessively organized which he perceived as contrary to his father's disorganized personality. This perfectionist behavior was reinforced by his teachers in school and maintained up to university level He also developed superstitious rituals such as stepping over sidewalk lines and always passing around posts to the right. These formed a counterpart to his obsessively organized self-control, since this was a way in which he sought control of extraneous events. These superstitions were intended to prevent a misfortune. Over time, his compulsions permeated all aspects of his life including work, family, and leisure times, although he managed to stay functional Assessment Measures and Procedures Diagnostic assessment was carried out by two independent clinicians using the Anxiety Disorders Interview Schedule-DSM-IV (ADIS-IV; Di Nardo, Brown, & Barlow, 1994) and the Yale-Brown Obsessive-Compulsive Scale (YBOCS; Goodman et al. …

Domestic violence reported by women attending a sexually transmitted disease clinic.

Domestic violence occurs across all social, demographic, and economic strata of society, though women who report it are disproportionately young, unmarried, live with a male friend or family member other than a husband, engage in substance abuse, and are poor. To assess the prevalence of domestic violence among a sample of women presenting for care at a sexually transmitted disease (STD) clinic, and to identify behavioral and clinical correlates of domestic violence in this group. Women attending an inner-city STD clinic were asked to complete a self-administered questionnaire that ascertained demographic, clinical, and behavioral information. Questions regarding recent and lifetime physical and verbal abuse by a social intimate were included. Standard diagnostic tests and therapy for a variety of genitourinary infections were provided when indicated as a matter of routine care. Three hundred and seventy-five female clinic attendees completed the questionnaire. One hundred and forty one (37.6%) women reported ever having experienced physical assault by an intimate, and 123 (32.8%) reported verbal threats of violence. Fifty-eight (15.5%) women reported at least one episode of physical abuse in the year preceding participation. A report of physical violence was associated with drug use, STD history, and a history of a serious medical condition (P < 0.05). The high prevalence of domestic violence among women seeking care at an inner-city STD clinic suggests that these sites may be important for the detection of abuse victims. Clinic staff should be trained to inquire about domestic violence. On-site or referred resources (e.g., legal, social, clinical) should be made available to these women.

Adverse consequences of intimate partner abuse among women in non-urban domestic violence shelters

Objective: This study examined the health consequences of having experienced both sexual and physical abuse relative to women experiencing physical abuse but not sexual abuse. Methods: A cross-sectional study was conducted among 203 women seeking refuge in battered women’s shelters. Controlling for sociodemographics, logistic regression analyses were conducted to assess the consequences of experiencing both sexual and physical abuse. Results: Compared to women experiencing physical abuse, women experiencing both sexual and physical abuse were more likely to have a history of multiple sexually transmitted diseases (STDs) in their abusive relationships, have had an STD in the past 2 months, be worried about being infected with HIV, use marijuana and alcohol to cope, attempt suicide, feel as though they had no control in their relationships, experience more episodes of physical abuse in the past 2 months, rate their abuse as more severe, and be physically threatened by their partner when they asked that condoms be used. Conclusions: Given the prevalence of adverse health outcomes, domestic violence shelters could counsel women to avoid using alcohol/drugs as a coping strategy, educate women about alternative healthy coping strategies, counsel women about methods of STD prevention that they can control, and provide STD screening and treatment.