Violence at work: the experience of general practice receptionists

Receptionists act as intermediaries between the General Practitioner and the public, and are often involved in conflicts between the GP and a demanding patient. However there is a paucity of research in this area. The aim of this study was to quantify the extent of violence directed towards GP receptionists and to categorise the type, frequency and impact of such aggression in two health board areas. A postal questionnaire was designed, piloted and sent to 400 randomly selected receptionists in the former Northern Area Health Board and the Western Health Board. We found that 62% (n= 168) of receptionists experienced violence in the past. 99% (n=166) had experienced verbal abuse while 31% (n=52) had experienced threats of physical abuse. 6% (n= 10) experienced physical abuse. In most cases the perpetrator was the patient 98% (n= 160). 28% (n=75) of practices had a practice policy for dealing with violence while only 13% (n=34) of receptionists received education on dealing with violence. This study shows that violence is a major problem among GP receptionists in Ireland. Aggression during the day is a regular feature for a GP receptionist. There is a higher reporting of violence in the Northern Area Health Board compared to the Western Health Board. We suggest that further education, research and practice policy development is needed to help target this problem and improve the overall quality of healthcare.     

Gender-based violence, alcohol use, and sexual risk among female patrons of drinking venues in Cape Town, South Africa

Gender-based violence is a well-recognized risk factor for HIV infection among women. Alcohol use is associated with both gender-based violence and sexual risk behavior, but has not been examined as a correlate of both in a context of both high HIV risk and hazardous drinking. The purpose of this paper is to examine the association between recent abuse by a sex partner with alcohol and sexual risk behavior among female patrons of alcohol serving venues in South Africa. Specifically, the aim of this study is to determine whether sexual risk behaviors are associated with gender-based violence after controlling for levels of alcohol use. We surveyed 1,388 women attending informal drinking establishments in Cape Town, South Africa to assess recent history of gender-based violence, drinking, and sexual risk behaviors. Gender-based violence was associated with both drinking and sexual risk behaviors after controlling for demographics among the women. A hierarchical logistic regression analysis showed that after controlling for alcohol use sexual risk behavior remained significantly associated with gender-based violence, particularly with meeting a new sex partner at the bar, recent STI diagnosis, and engaging in transactional sex, but not protected intercourse or number of partners. In South Africa where heavy drinking is prevalent women may be at particular risk of physical abuse from intimate partners as well as higher sexual risk. Interventions that aim to reduce gender-based violence and sexual risk behaviors must directly work to reduce drinking behavior.     

HIV-related violence

Statistics are seldom recorded on the incidence of HIV-related verbal or physical abuse. The New York Gay and Lesbian Anti-Violence Project (AVP), and San Francisco's Community United Against Violence are the only known programs to recognize and collect data on HIV-related violence. Psychological abuse, physical battery, harassment, and rape are all signs of domestic violence. Reluctance to report bias crimes is thought to stem from fear of discrimination and further violence. In addition, some community members are concerned that partner notification laws may foster more household violence, or discourage people from being tested. The repercussions of violence against people with HIV is evident, often resulting in depression, lack of sleep, and non-adherence to medication. Those victimized by violent situations can seek assistance in New York from AVP, which provides resources, counseling, legal aid and advocacy for victims. AVP also provides guidance and support through the process of criminal prosecution, and formulating a safety plan. A list of organizations that can assist victims of violence is provided, which includes contact information for each.     

Reducing Sexual Risk Behavior Among High-Risk Couples in Northern India

Background

With a population of 1.1 billion, India is considered to be a country in which effective prevention interventions could contain the development of a human immunodeficiency virus (HIV) epidemic. Heterosexual transmission accounts for 85 % of the extant HIV infections.

Purpose

This study sought to assess the feasibility of conducting a group, culturally tailored behavioral intervention and its impact on sexual barrier use, self-efficacy, knowledge, conflict resolution, and coping among high-risk heterosexual couples in Northern India.

Method

This pilot study was conducted at the Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India from February 2008 to January 2009. Thirty sexually active high-risk couples were drawn from a convenience sample of PGIMER patients attending infectious disease and family planning clinics. Couples participated in 1 month of three weekly gender-concordant behavioral intervention groups and were individually administered assessments preintervention and post-intervention. The intervention was tailored to the Northern Indian context and addressed sexual barrier use, human immunodeficiency virus (HIV)/sexually transmitted infection transmission, and cognitive behavioral skill building focusing on sexual negotiation and communication.

Results

The participants had a mean age of 32 years (men) and 29 years (women), and the majority had at least 10 years of education. At baseline, the majority reported inconsistent condom use (<100 % of the time; 64 % of women, 59 % of men). Post-intervention, nearly all participants reported consistent condom use (100 % of the time; 100 % of men, 97 % of women). Participants also reported decreased verbal aggression, increased self-efficacy, and increased HIV-related knowledge, and women increased their use of positive coping tactics.

Conclusions

The results highlight the potential to successfully utilize a group intervention to discuss sensitive issues such as sexual risk behavior among both men and women. Strategies to improve condom use and communication without increasing intimate partner violence in high-risk couples may be an important adjunct to preventing the development of a generalized epidemic in India.     

Vulnerability to intimate partner violence and poor mental health in the first 4-year postpartum among mothers reporting childhood abuse: an Australian pregnancy cohort study

The purpose of this study was to investigate intergenerational patterns of abuse and trauma and the health consequences for women in the early childbearing years. A prospective pregnancy cohort of 1507 nulliparous women (≦24 weeks gestation) were recruited in Melbourne, Australia, 2003–2005. Follow-up was scheduled in late pregnancy, 3-, 6- and 12-month and 4-year postpartum. Childhood abuse was retrospectively reported at 4-year postpartum using the Child Maltreatment History Self Report. Intimate partner violence (IPV) was assessed at 1- and 4-year postpartum with the Composite Abuse Scale. Maternal depressive symptoms were assessed in all follow-ups using the Edinburgh Postnatal Depression Scale. Multivariable logistic regression was used to examine associations between childhood abuse, maternal mental health and IPV. Childhood abuse was reported by 41.1 % of women. In the 4 years after having their first child, 28.2 % of women reported IPV, 25.2 % depression and 31.6 % anxiety. Childhood abuse was associated with odds of depression or anxiety 1.5–2.6 times greater and 1.8–3.2 times greater for IPV. Childhood physical abuse remained significantly associated with depression and anxiety in pregnancy and postpartum after adjusting for IPV and stressful life events, while sexual abuse remained significantly associated only with anxiety. Women who begin childbearing with a history of childhood abuse are more vulnerable to IPV and poor mental health. All health care services and agencies in contact with children, young people and families should have adequate training to identify trauma associated with abuse and IPV and provide first line supportive care and referral.     

Examining Bidirectional Pathways Between Exposure to Political Violence and Adolescent Adjustment in Northern Ireland

Research on social ecologies of political violence has been largely confined to cross-sectional tests of the impact of political violence on child adjustment, limiting perspectives on more nuanced causal pathways, including tests of reciprocal relations between exposure to political violence and child adjustment. Based on a four-wave longitudinal study, this research breaks new ground in assessing bidirectional relations between exposure to political violence in the form of experience with sectarian antisocial behavior and adolescents’ adjustment problems. The study included 999 mother–adolescent dyads selected from working-class neighborhoods in Belfast ranked in the bottom quartile in terms of social deprivation in Northern Ireland, with approximately 35–40 families recruited to participate from each neighborhood. Across the four annual waves of data, adolescents (52% female) were 12.18 (SD = 1.82), 13.24 (SD = 1.83), 13.62 (SD = 1.99), and 14.66 (SD = 1.96) years old. Cross-lagged path models were tested through R package lavaan with full information maximum likelihood. Reflecting a reciprocal pathway, adjustment problems related to higher reports of experience with sectarian antisocial behavior 1 year later. Boys’ experience with sectarian antisocial behavior related to greater adjustment problems 1 year later, but this reciprocal path did hold for the girls. These findings offer promising directions toward better modeling of dynamic relations between exposure to political violence and adolescent adjustment over time.     

Partner violence, partner notification, and women's decisions to have an HIV test

OBJECTIVES: Reports of partner violence against HIV-positive women after they have disclosed their serostatus have led some to reassess partner notification strategies and to speculate that fear of partner violence following partner notification may influence women's HIV testing decisions. We studied whether associations exist between women's declining to have an HIV test and history of partner violence, fear of partner violence, previous experience with partner notification, or beliefs about partner notification. METHODS: In this cross-sectional study, we interviewed women seen at Newark and Miami sexually transmitted disease clinics. The women were at least 18 years old, not known to be HIV positive, not tested for HIV in the previous 3 months, and offered HIV testing during the clinic visit. Women who declined testing were compared with women who accepted. RESULTS: Of 490 participants (89% of eligible women), 16% reported partner violence in the past year, and 28% declined HIV testing. Declining the test was not significantly (p >.05) associated with history or fear of partner violence, previous experience with partner notification, or beliefs about partner notification. When specifically asked, only 2 women responded that their declining the test was related to fear that their partner or partners might harm them if the women tested positive. CONCLUSIONS: Among women seen at these clinics, we did not find evidence that declining the HIV test was strongly influenced by partner violence, previous experience with partner notification, or beliefs about partner notification. However, many women reported partner violence. Therefore, providers should assess the potential for partner violence and be prepared to make appropriate referrals.     

Etiology and clinical features of 229 cases of bloodstream infection among Chinese HIV/AIDS patients: a retrospective cross-sectional study

Bloodstream infections (BSIs) are prevalent among people living with HIV/AIDS. The etiology varies in different regions and different periods. We aimed to survey the etiological and clinical features of BSIs in HIV patients in mainland China. We assessed all HIV patients with a positive blood culture in a Chinese teaching hospital from September 2009 through December 2014. We excluded those with specimens likely to have been contaminated. We used Pearson’s chi-squared test to measure the differences in characteristics among subgroups of different pathogens. Among 2442 Chinese HIV-seropositive inpatients, 229 (9.38 %) experienced BSIs. The most common pathogens detected included Cryptococcus neoformans (22.7 %), Penicillium marneffei (18.8 %), Mycobacterium tuberculosis (15.3 %), and non-tuberculous mycobacterium (14.8 %). 30/229 (13.1 %) HIV patients with BSIs had a poor prognosis. BSIs are prevalent in hospitalized patients with HIV/AIDS in China. Fungi and mycobacteria are the predominant pathogens.     

Adolescent girls' perception about their ability to safely offer HIV self-test kits to sexual partners: a feasibility study in Siaya County,Kenya

BackgroundAdolescent girls (AG) in sub-Saharan Africa are at elevated risk of acquiring HIV, yet few know the HIV status of their sexual partners. Interventions to promote testing among partners are urgently needed.ObjectivesTo explore AG''s perceived ability to safely distribute HIV self-tests to their partners, if partners would self-test, and how to minimize partner violence.MethodsWe recruited HIV-negative AG ages 15–19 years with a partner of unknown HIV status or who tested negative >6 months previously. Using mixed-methods for data collection and regression and inductive thematic analysis for quantitative and qualitative analysis, respectively, we determined factors associated with the study objectives.ResultsWe enrolled 101 AG, median age 17.3 years, sexual debut 15–16 years, and 54.5% reported ≥2 lifetime partners. Most participants (95.0%) would offer self-tests to their partners and 95.1% reported high-to-moderate chance their partner would self-test. No participant attribute was associated with perceived ability to offer self-test or likelihood of partner testing. To avoid violence, AG recommended politeness, indirect approach, voluntariness, and highlighting advantages of self-testing.ConclusionsAG believe they can safely distribute self-tests to their partners, and most partners would self-test, expanding utility of HIV self-tests to include partners of AG.     

Prevalence and predictors of occupational violence and aggression towards GPs: a cross-sectional study.

Occupational violence and aggression are common in general practice. This study examined occupational violence and aggression against GPs in terms of prevalence and predictive factors, such as sex of GP, and practice location. Over half of the GPs sampled had experienced at least one form of violence and aggression; more female than male GPs experienced sexual harassment; and there was no difference in the number of metropolitan and rural GPs who had experienced violence and aggression. Predictors emerged for verbal abuse, intimidation, physical abuse, and sexual harassment.     

Using an online survey to assess knowledge of HIV in general and testing specifically among black and white college students

BACKGROUND: Although there have been studies examining HIV knowledge among college population, current study is the first providing comparable information on HIV knowledge in general and testing specifically via online surveys among black and white college students. METHODS: Blacks (N=222) were recruited from 15 historically black college and universities (HBCUs) and whites (N=335) from a traditionally white institution. RESULTS: The majority of the students were aged 18-24 years. Reliability of the overall knowledge scale showed good internal consistency for both samples (alpha=0.70). Students overall scored higher on items related to HIV/AIDS in general (81.5% correct) and lower on items related to HIV testing (71.6% correct), with no significant difference between groups. However, blacks rated significantly higher on their subjective (or "perceived") HIV general knowledge (item mean 3.55 vs. 3.26) and testing specific knowledge (item mean 3.13 vs. 2.54) (p<0.01). Results showed that blacks were 6.9 times more likely to have been tested for HIV. Subjective HIV testing knowledge (OR=2.9) and nonheterosexual orientation (OR=3.2) were also significant predictors to prior testing behavior. CONCLUSIONS: The knowledge scale assessed via the Internet demonstrated satisfactory reliabilities among diverse college students. Data showed that HBCU black students perceived significant higher knowledge levels, despite results showing similar knowledge scores as white students. Results have implications on HIV prevention among students attending their race/ethnic dominant institutions.     

Posttraumatic Stress,Family Functioning,and Externalizing in Adolescents Exposed to Violence: A Moderated Mediation Model

Exposure to community violence disproportionately impacts low-income, minority youth and is associated with posttraumatic stress symptoms and maladaptive adjustment. This study investigates whether posttraumatic stress mediates the relation between exposure to community violence and externalizing symptoms and the moderating role of family cohesion and daily family support in buffering these effects on later externalizing. Low-income, African American 7th-grade students (M age = 12.57 years; N = 254) from high-crime neighborhoods participated in a 2-year longitudinal study measuring the effects of community violence exposure. The students completed questionnaires administered by research staff over 5 consecutive days for each year of the study. Family cohesion and daily family support exhibited a significant buffering effect for several outcomes. Posttraumatic stress significantly mediated the effect of witnessing community violence on subsequent aggression. The strength of these indirect effects depended on level of family cohesion. The findings provide evidence in support of interventions provided at both individual and family levels. Mental health providers working with this population should be aware of the intertwined nature of exposure to community violence, posttraumatic stress, and subsequent maladaptive outcomes.     

HIV testing among young adults and older adolescents in the setting of acute substance abuse treatment

OBJECTIVES: To examine the feasibility and acceptance of HIV testing among youth in acute substance abuse treatment. METHODS: Youth, aged 18 to 25 years old, in state-funded inpatient detoxification completed a confidential demographic/risk behavior questionnaire, and were offered a choice of no testing, serum-based testing, or oral fluid (Orasure, Epitope, Inc., Beaverton, OR, U.S.A.) HIV testing. RESULTS: In all, 74% of 204 participants accepted HIV testing. In a multivariate model, female gender (odds ratio [OR], 0.32; 95% confidence interval [CI] 0.14-0.74) and having been recently tested (OR, 0.11; 95% CI, 0.05-0.26) were independently associated with refusing testing. Recent sexual activity (OR, 5.4; 95% CI, 1.5-20.4), recent use of methamphetamines (speed) or a combination of cocaine and heroin (speedball) (OR, 3.8; 95% CI, 1.6-9.0), and a recent perceived risk for HIV (OR, 4.6; 95% CI, 1.9-10.9) were independently associated with test acceptance. Thus, 150 of 150 (100%) chose the Orasure test. Overall, 64.6% (97 of 150) of those tested received their results, but among participants requiring a follow-up appointment to learn test results, only 9.2% (8 of 87) returned. CONCLUSIONS: HIV testing is feasible and acceptable in this population. All patients preferred Orasure testing to a serum enzyme-linked immunosorbent assay (ELISA). Most youth tested in detoxification will only learn their results if they are provided during treatment. Rapid HIV testing with same-day results could improve follow-up rates.     

The Changing face of HIV in Latin America and the Caribbean

Latin America and the Caribbean (LAC) is a region with similarities and important disparities. In recent years LAC has witnessed achievements, with HIV prevalence rates relatively stable for LA and decreasing for the Caribbean. However average values hide differences. General population HIV prevalence in LAC is 0.4 % on average. In the Caribbean there are fewer new HIV infections but HIV prevalence among adults exceeds 1 % in several countries. It is estimated that 31 % of adults living with HIV in LA and 52 % of adults in the Caribbean are women. Unprotected sex is the main route of HIV transmission in LAC. Men who have sex with men and transgender women are the populations with the highest prevalence (10.6 % and 17.7 % respectively); however other key populations such as female sex workers (4.9 %), drug users (range 1 %-49.7 % for intravenous drug users), prisoners and indigenous populations are also important. LAC has the highest anti-retroviral treatment coverage of any low- and middle-income region in the world, but women and children are less likely than men to receive treatment. There is an important pending agenda to address the gaps in information, prevention, and care for HIV in LAC.     

Prevalence of hepatitis B virus and hepatitis C virus in patients with human immunodeficiency virus infection in central China

Co-infection of hepatitis B virus (HBV) and/or hepatitis C virus (HCV) with human immunodeficiency virus (HIV) has an adverse effect on liver disease progression. This study investigated the prevalence of HBV and/or HCV co-infection in HIV-infected patients in Central China. A total of 978 HIV-infected patients from Hunan Province were enrolled. HBV serum markers, anti-hepatitis-C-virus antibody (anti-HCV), HBV DNA, and HBV genotypes were analyzed. The prevalence of hepatitis B surface antigen (HBsAg) and anti-HCV in HIV-infected patients was 19.4 % and 62.4 %, respectively. The prevalence of anti-HCV in HIV-positive intravenous drug users was 93.6 %. Among HBsAg-positive patients, 88.1 % were found to have at least one HBV serum marker. The rates of HIV mono-infection, HBV/HIV dual infection, HCV/HIV dual infection, and HBV/HCV/HIV triple infection were 30.4 %, 7.2 %, 50.2 %, and 12.2 %, respectively. Antibody to HBsAg (Anti-HBs) was more common in anti-HCV-positive than anti-HCV-negative patients (53.3 % vs 40.2 %, P = 0.000), but isolated hepatitis B core antibody (anti-HBc) was more common in anti-HCV-negative than anti-HCV-positive patients (24.2 % vs 12.3 %, P = 0.000). Hepatitis B e antigen (HBeAg) and sexual transmission were independent risk factors for active HBV replication. Intravenous drug use and male sex were independent risk factors, but old age and presence of HBeAg were independent protective factors for anti-HCV. Co-infection of HBV and/or HCV with HIV infection is common in central China. HCV status is associated with anti-HBs and isolated anti-HBc in co-infected patients.     

3620名农村中学生暴力遭遇及其行为问题研究

目的:探讨农村中学生暴力遭遇与行为问题的相互关系。方法:采用横断面研究方法,对3620名随机选择的农村中学生进行问卷调查。农村中学生暴力遭遇调查和行为问题评定分别采用WHO暴力遭遇调查问卷和Achenbach儿童行为自陈量表(CBCL)。结果:3620名被调查的农村中学生,1225人(33.8%)在过去一年中经历过暴力遭遇;农村中学生行为问题检出率为14.3%(519/3620),暴力遭遇组行为问题检出率(22.4%)高于非暴力遭遇组(10.9%)(2χ=99.21,P<0.01),各行为问题因子,包括社交退缩、躯体诉述、焦虑抑郁、交往不良、思维问题、注意力问题、违纪行为、攻击性行为、自我身份等9个因子,暴力遭遇组检出率均高于非暴力遭遇组,且差别均具有统计学意义(P<0.05或P<0.01)。将农村中学生暴力遭遇可能的影响因素,如人口学因素、家庭背景、个人学习成绩等作为控制变量,进行logistic逐步回归分析,结果显示:与农村中学生暴力遭遇有关的行为问题因子,为躯体诉述、交往不良、思维问题、违纪行为、攻击性行为等因子。结论:农村中学生暴力遭遇者行为问题检出率显著高于非暴力遭遇者,暴力遭遇与其自身的行为问题有关。     

High-risk sexual behavior in Los Angeles: who receives testing for HIV?

No recent population-based data on HIV testing in people with high-risk sexual behavior are available. We sought predictors of testing using data from the 1997 Los Angeles County Health Survey, a random-digit telephone survey of 8004 county households. An estimated 2.3 million (35.5%) adults were tested for HIV in the past 2 years and approximately 370,000 (5.6%) engaged in high-risk sexual behavior (defined as having > or =2 partners in the past 12 months and not always using condoms). Among high-risk persons, an estimated 46% of heterosexual men, 56% of heterosexual women, and 72% of men who had sex with men (MSM) were tested for HIV. In a multivariable model of high-risk people, both heterosexual men (odds ratio [OR], 0.31; 95% confidence interval [CI], 0.16-0.61) and women (OR, 0.41; 95% CI, 0.19-0.87) had significantly lower proportions of testing than MSM. Although African Americans and Hispanics had significantly higher testing proportions than whites overall among all county residents, those reporting high-risk sexual behavior did not test at higher proportions. We conclude that the proportion of adults with high-risk sexual behavior tested for HIV is higher than almost a decade ago. However, testing among this group remains suboptimal. Future public health campaigns should intensify efforts to encourage HIV testing among this population.     

Caregiver insightfulness and young children’s violence exposure: testing a relational model of risk and resilience

ABSTRACT

This study employed a relational post-traumatic stress frame to explore the co-contribution of young children’s exposure to violence and caregiver insightfulness on child behavioral outcomes in a high-risk, non-referred sample of caregivers and preschoolers (n = 64; mean age 3.83 years, SD = .77). Caregiver insightfulness did not have a main effect on child outcomes but did moderate the relation between violence exposure and child behavior across all observed outcomes. Violence-exposed children with non-insightful caregivers demonstrated higher caregiver-rated internalizing and externalizing behaviors and observer-rated negative affect than all other groups. Among children not exposed to violence, insightfulness was not related to children’s behavior problems or negative affect, suggesting violence-specific processes. Though cross-sectional, results suggest that the effects of violence and caregiver insightfulness on child outcomes are contingent on one another and that caregiver insightfulness may play a protective role in contexts of violence.     

湖南省实习期医学生受虐状况调查

目的 了解医学院校学生在临床实习期期间虐待的发生情况.方法 按照分层随机抽样的方法选取湖南省6所医学院校的8家直属、附属医院共312名实习医学生为调查对象,采用Shizuko Nagata- Kobayashi的医学实习生虐待调查表进行回顾性调查.结果 在医学生虐待的5种类型中,言语虐待事件发生的频率最高(n=210,...     

HIV Testing: Current Practice and Future Directions

New approaches to expanding HIV testing and effective treatment and the wider availability of rapid testing technology have created new opportunities for achieving national and global HIV testing goals. In spite of HIV testing expansion in many settings, growing evidence of the prevention benefits of HIV testing, and the development of new, cost-effective approaches to HIV testing service provision, formidable obstacles to HIV testing expansion persist. Inequitable testing coverage exists within and across countries. While the proportion of people with HIV aware of their status is about 80 % in the U.S., the majority of HIV-infected persons in Africa are unaware of their status. Testing of most-at-risk populations, couples, children, and adolescents pose still unresolved policy and programmatic challenges. Future directions for HIV testing include rapid testing technology and detection of acute HIV infection, self-testing expansion, and partner notification. Expanded routine HIV screening and widespread testing is a public health imperative to reach national and international HIV prevention and treatment goals.