Violence in primary care: prevalence and follow-up of victims.

BACKGROUND: Primary care physicians underestimate the prevalence of domestic violence and community violence. Victims are therefore at risk of further episodes of violence, with psychological and physical consequences. We used an interview to assess the prevalence of domestic and community violence among Swiss natives and foreigners. In a follow-up study, we evaluated the consequences of the interview for the positive patients. METHODS: We evaluated the prevalence of violence by use of a questionnaire in an interview, in an academic general internal medicine clinic in Switzerland. In a follow-up, we evaluated the consequences of the interview for positive patients. The participants were 38 residents and 446 consecutive patients. Questionnaires were presented in the principal language spoken by our patients. They addressed sociodemographics, present and past violence, the security or lack of security felt by victims of violence, and the patients' own violence. Between 3 and 6 months after the first interview, we did a follow-up of all patients who had reported domestic violence in the last year. RESULTS: Of the 366 patients included in the study, 36 (9.8%) reported being victims of physical violence during the last year (physicians identified only 4 patients out of the 36), and 34/366 (9.3%) reported being victims of psychological violence. Domestic violence was responsible for 67.3% of the cases, and community violence for 21.8%. In 10.9% of the cases, both forms of violence were found. Of 29 patients who reported being victims of domestic violence, 22 were found in the follow-up. The frequency of violence had diminished (4/22) or the violence had ceased (17/22). CONCLUSION: The prevalence of violence is high; domestic violence is more frequent than community violence. There was no statistically significant difference between the Swiss and foreign patients' responses related to the rates of violence. Patients in a currently violent relationship stated that participating in the study helped them and that the violence decreased or ceased a few months later.

Factors affecting hospital admission and recovery stay duration of in-patient motor victims in Spain

Hospital expenses are a major cost driver of healthcare systems in Europe, with motor injuries being the leading mechanism of hospitalizations. This paper investigates the injury characteristics which explain the hospitalization of victims of traffic accidents that took place in Spain. Using a motor insurance database with 16.081 observations a generalized Tobit regression model is applied to analyse the factors that influence both the likelihood of being admitted to hospital after a motor collision and the length of hospital stay in the event of admission. The consistency of Tobit estimates relies on the normality of perturbation terms. Here a semi-parametric regression model was fitted to test the consistency of estimates, concluding that a normal distribution of errors cannot be rejected. Among other results, it was found that older men with fractures and injuries located in the head and lower torso are more likely to be hospitalized after the collision, and that they also have a longer expected length of hospital recovery stay.

Comparative analysis of the frequency and the severity of diagnosed lesions between pedestrians struck by motor vehicles and other blunt trauma mechanisms victims

ABSTRACTObjective:to compare the frequency and the severity of diagnosed injuries between pedestrians struck by motor vehicles and victims of other blunt trauma mechanisms.Methods:retrospective analysis of data from the Trauma Registry, including adult blunt trauma patients admitted from 2008 to 2010. We reviewed the mechanism of trauma, vital signs on admission and the injuries identified. Severity stratification was carried using RTS, AIS-90, ISS e TRISS. Patients were assigned into group A (pedestrians struck by motor vehicle) or B (victims of other mechanisms of blunt trauma). Variables were compared between groups. We considered p<0.05 as significant.Results:a total of 5785 cases were included, and 1217 (21,0%) of which were in group A. Pedestrians struck by vehicles presented (p<0.05) higher mean age, mean heart rate upon admission, mean ISS and mean AIS in head, thorax, abdomen and extremities, as well as lower mean Glasgow coma scale, arterial blood pressure upon admission, RTS and TRISS. They also had a higher frequency of epidural hematomas, subdural hematomas, subarachnoid hemorrhage, brain swelling, cerebral contusions, costal fractures, pneumothorax, flail chest, pulmonary contusions, as well as pelvic, superior limbs and inferior limbs fractures.Conclusion:pedestrian struck by vehicles sustained intracranial, thoracic, abdominal and extremity injuries more frequently than victims of other blunt trauma mechanism as a group. They also presented worse physiologic and anatomic severity of the trauma.

The Global War on Terrorism in the Horn of Africa

Ever since Siad Barre’s regime was toppled in the beginning of the 1990’s Somalia has been without an effective central government. As a result Somalia has remained in an anarchic condition of state collapse for nearly two decades. This anarchy has often been put forward as a potential breeding ground for terrorism. As a response to this threat the United States has undertaken several policies, initiatives, and operations in the Horn of Africa generally and in Somalia specifically. In this descriptive study a twofold analysis has been undertaken. First, conditions in present day Somalia as well as Somali history have been analyzed to evaluate the potential Somalia holds as a terrorist base of operations or a recruiting- or staging area. Second, US strategies and actions have been analyzed to evaluate the adequacy of the US response to the threat Somalia poses in terms of terrorism. Material for the analyses have been derived from anthropological, political, and security studies dealing with Somalia. This material has been augmented by a wide range of news coverage, western and non-western. Certain different US policy documents from different levels have been chosen to represent US strategies for the Global War on Terrorism. Because Somali social institutions, such as the clan system, hold great weight in Somali society, Somalia is a difficult area of operations for terrorist networks. In addition the changing nature of Somali alliances and the tangled webs of conflict that characterize present day Somalia aggravate the difficulties that foreign terrorist networks would encounter in Somalia, would they choose to try to utilize it in any great extent. The US has taken potential terrorism threats in Africa and specifically Somalia very seriously. US actions in Somalia have mainly focused on apprehending or neutralizing terror suspects. Such policies, coupled with backing the Ethiopian invasion of Somalia may have actually turned out increasing Somalia’s terror potential.

Is there more to restorative justice than mere compliance to procedural justice? : a qualitative reflection from the victims' point of view

Une multitude de recherches évaluatives ont démontré que les victimes de crime, qu’elles soient victimes d’un crime contre les biens ou contre la personne, apprécient l’approche réparatrice. Cependant, nous sommes toujours à la recherche des facteurs théoriques qui expliqueraient la satisfaction des victimes en ce qui concerne leur expérience avec les interventions réparatrices. La recherche décrite dans cette thèse concerne l’exploration des facteurs contribuant à la satisfaction des victimes de crime avec l’approche réparatrice ainsi que ses liens avec la théorie de justice procédurale. Selon la théorie de justice procédurale, la perception de justice n’est pas uniquement associée à l’appréciation du résultat d’une intervention, mais également à l’appréciation de la procédure, et que la procédure et le résultat peuvent être évalués de façon indépendante. Les procédures qui privilégient la confiance, la neutralité et le respect, ainsi que la participation et la voix des parties sont plus appréciées. Notre objectif de recherche était d’explorer l’analogie entre l’appréciation de la justice réparatrice et le concept de justice procédurale. En outre, nous avons voulu déterminer si la justice réparatrice surpasse, en termes de satisfaction, ceux prévus par la théorie de justice procédurale. Nous avons également examiné la différence dans l’appréciation de l’approche réparatrice selon le moment de l’application, soit avant ou après adjudication pénale. Ainsi, nous avons exploré le rôle d’une décision judiciaire dans l’évaluation de l’approche réparatrice. Pour répondre à nos objectifs de recherche, nous avons consulté des victimes de crime violent au sujet de leur expérience avec l’approche réparatrice. Nous avons mené des entrevues semi-directives avec des victimes de crime violent qui ont participé à une médiation auteur-victime, à une concertation réparatrice en groupe ou aux rencontres détenus-victimes au Canada (N=13) et en Belgique (N=21). Dans cet échantillon, 14 répondants ont participé à une intervention réparatrice avant adjudication judiciaire et 14 après adjudication. Nous avons observé que l’approche réparatrice semble être en analogie avec la théorie de justice procédurale. D’ailleurs, l’approche réparatrice dépasse les prémisses de la justice procédurale en étant flexible, en offrant de l’aide, en se concentrant sur le dialogue et en permettant d’aborder des raisons altruistes. Finalement, le moment de l’application, soit avant ou après adjudication, ne semble pas affecter l’appréciation des interventions réparatrices. Néanmoins, le rôle attribué à l’intervention réparatrice ainsi que l’effet sur l’évaluation du système judiciaire diffèrent selon le moment d’application. Les victimes suggèrent de continuer à développer l’approche réparatrice en tant que complément aux procédures judiciaires, plutôt qu’en tant que mesure alternative. Les témoignages des victimes servent la cause de l’offre réparatrice aux victimes de crime violent. L’offre réparatrice pourrait aussi être élargie aux différentes phases du système judiciaire. Cependant, la préférence pour l’approche réparatrice comme complément aux procédures judiciaires implique la nécessité d’investir également dans la capacité du système judiciaire de répondre aux besoins des victimes, tant sur le plan de la procédure que sur le plan du traitement par les autorités judiciaires.

On the troublesome relationship of feminism and terrorism: representing the female terrorist in contemporary art

This paper analyses tendencies in debates about cultural representations of terrorism to assume that artists make critical interventions, while the mass media circulates stereotypes. Some recent feminist analyses of female terrorist acts have re-instituted essentialist arguments in which violence and terrorism is described as inherently masculine, while women are by nature pacifist, so that femininity is the antithesis of militarism. More progressive analyses mostly tend to expose the circulation of stereotypes and their gender bias, in order to protest the misrepresentation of women in violence. These analyses do not construct alternative accounts. Through an analysis of two works by artists Hito Steyerl and Sharon Hayes, the paper argues that some of the moves to re-image the question of women, violence and agency have already been made in contemporary art practices. Through analysing legacies of terrorism and feminism, it becomes possible to rethink the question of agency, militancy and the nature of political art. The paper appears in an edited interdiscplinary collection arising from a conference at Universität der Bundeswehr in Munich. It relates to wider projects involving collaborations with Birkbeck and Edinburgh on representations of terrorism and on violence and contemporary art.

Here come the Salafis: the framing of Al-Qaeda's ideology within terrorism research

The purpose of the paper is to analyse different narratives about al Qaeda (AQ) in Terrorism Studies, and to demonstrate the methodological and empirical problems associated with them. It demonstrates that AQ as it emerges within Terrorism Studies is more of an artefact of preconceived notions about fundamentalist ideology than the result of rigid empirical research.

Police Interviews with Victims and Suspects of Violent and Sexual Crimes : Interviewee's experiences and interview outcomes

The police interview is one of the most important investigative tools that law enforcement has close at hand, and police interview methods have changed during the twentieth century. A good police interview is conducted in the frame of the law, is governed by the interview goal, and is influenced by facilitating factors that may affect the elicited report. The present doctoral dissertation focuses on police interviews in cases of very serious crimes of violence and sexual offences. Results reveal crime victims’ and perpetrators’ experiences of being interviewed and police officers’ attitudes towards conducting interviews related to traumatizing crimes. Study 1 revealed that when police officers interviewed murderers and sexual offenders, the interviewees perceived attitudes characterized by either dominance or humanity. Police interviews marked by dominance and suspects’ responses of anxiety were mainly associated with a higher proportion of denials, whereas an approach marked by humanity, and responses of being respected were significantly associated with admissions. In line with Study 1, the victims of rape and aggravated assault in Study 2 also revealed the experience of two police interview styles, where an interviewing style marked by dominance and responses of anxiety was significantly associated with crime victims’ omissions of information. Moreover, a humanitarian interviewing style, and crime victims’ feelings of being respected and co-operative, was significantly related to crime victims providing all information from painful events. Special squad police officers’ attitudes towards interviewing crime victims, in Study 3, also showed a humanitarian approach and two dominant approaches, one affective and the other refusing. The attitude towards interviewing suspects of crimes in focus revealed humanitarian and dominant interviewing attitudes, and an approach marked by kindness. The present thesis shows that, during their entire career, an overwhelming majority of the special squad police officers have experienced stressful events during patrol as well as investigative duty. Results show that symptoms from stressful event exposures and coping mechanisms are associated with negative attitudes towards interviewing suspects and supportive attitudes towards crime victim interviews. Thus, experiences from stressful exposures may automatically activate ego-defensive functions that automatically generate dominant attitudes. Moreover, it is important to offer police officers who have been exposed to stressful events the opportunity to work through their experiences, for example, through debriefing procedures. After debriefings, police officers are better prepared to meet crime victims and suspects and, through conscious closed-loop processes, to conduct police interviews without awaking ego-defensive functions.

Feelings of revenge, retaliation motive, and posttraumatic stress reactions in crime victims

Individuals with posttraumatic stress disorder (PTSD) are often said to experience strong feelings of revenge. However, there is a need for confirmatory empirical studies. Therefore, in a study of 174 victims of violent crimes, the relation between feelings of revenge and posttraumatic stress reactions was investigated. Feelings of revenge were correlated with intrusion and hyperarousal but not with avoidance. Feelings of revenge explained incremental variance of intrusion and hyperarousalwhen the variance explained by victimological variables was controlled. The retaliation motive implied in feelings of revenge did not account for the relation between feelings of revenge and posttraumatic stress reactions. However, the relation was moderated by the time since victimization. Therefore, feelings of revenge must presumably be regarded as a maladaptive coping reaction to experienced injustice, but not in the first period after victimization.

Do trials of perpetrators retraumatize crime victims?

Attendance at trials of perpetrators could be retraumatizing for crime victims suffering from posttraumatic stress disorder. To investigate this hypothesis, two studies were conducted in which retraumatization was defined as a significant increase in posttraumatic stress reactions. A cross-sectional study of 137 victims of rape and nonsexual assault revealed that trial variables do virtually not predict posttraumatic stress reactions at a time several years after trial.Alongitudinal study of 31 victims of rape and nonsexual assault revealed intraindividual stability of posttraumatic stress reactions for the time interval from a few weeks before the trial to a few weeks after the trial; in addition, interindividual stability was high. The results of both studies do not support the retraumatization hypothesis, which should therefore be used with caution.

Secondary victimization of crime victims by criminal proceedings

It is conceivable that criminal proceedings cause psychological harm to the crime victims involved, that is, cause secondary victimization. To investigate this hypothesis, negative and positive effects of criminal proceedings were investigated, as perceived by 137 victims of violent crimes who were involved in trials several years previously. Trial outcome and procedure variables were measured as potential causes of secondary victimization. Results show a high proportion of victims reporting overall negative effects. Powerful predictors were outcome satisfaction and procedural justice, but not subjective punishment severity, interactional justice, and psychological stress by criminal proceedings. The practical implications of the results pertain to whether victims should be advised to report the crime to the police or not, and to appropriate prevention and intervention measures of secondary victimization by criminal proceedings.

An intervention mapping approach: Identification of human trafficking victims by health professionals

Background. Today modern day slavery is known as human trafficking and is a growing pandemic that is a grave human rights violation. Estimates suggest that 12.3 million people are working under conditions of force, fraud or coercion. Working toward eradication is a worthy effort; it would free millions of humans from slavery, mostly women and children, as well as uphold basic human rights. One tactic to eradicating human trafficking is to increase identification of victims among those likely to encounter victims of human trafficking.^ Purpose. This study aims to develop an intervention that improves certain stakeholders' ability, in the health clinic setting, to appropriately identify and report victims of human trafficking to the National Human Trafficking Resource Center.^ Methods. The Intervention Mapping (IM) process was used by program planners to develop an intervention for health professionals. This methodology is a six step process that guides program planners to develop an intervention. Each step builds on the others through the execution of a needs assessment, and the development of matrices based on performance objectives and determinants of the targeted health behavior. The end product results in an ecological, theoretical, and evidence based intervention.^ Discussion. The IM process served as a useful protocol for program planners to take an ecological approach as well as incorporate theory and evidence into the intervention. Consultation with key informants, the planning group, adopters, implementers, and individuals responsible for institutionalization also contributed to the practicality and feasibility of the intervention. Program planners believe that this intervention fully meets recommendations set forth in the literature.^ Conclusions. The intervention mapping methodology enabled program planners to develop an intervention that is appropriate and acceptable to the implementer and the recipients.^

Policy implications of public health workforce development for disaster preparedness in the United States

Public health efforts were initiated in the United States with legislative actions for enhancing food safety and ensuring pure drinking water. Some additional policy initiatives during the early 20th century helped organize and coordinate relief efforts for victims of natural disasters. By 1950's the federal government expanded its role for providing better health and safety to the communities, and its disaster relief activities became more structured. A rise in terrorism related incidents during the late 1990's prompted new proactive policy directions. The traditional policy and program efforts for rescue, recovery, and relief measures changed focus to include disaster preparedness and countermeasures against terrorism.^ The study took a holistic approach by analyzing all major disaster related policies and programs, in regard to their structure, process, and outcome. Study determined that United States has a strong disaster preparedness agenda and appropriate programs are in place with adequate policy support, and the country is prepared to meet all possible security challenges that may arise in the future. The man-made disaster of September 11th gave a major thrust to improve security and enhance preparedness of the country. These new efforts required large additional funding from the federal government. Most existing preparedness programs at the local and national levels are run with federal funds which is insufficient in some cases. This discrepancy arises from the fact that federal funding for disaster preparedness programs at present are not allocated by the level of risks to individual states or according to the risks that can be assigned to critical infrastructures across the country. However, the increased role of the federal government in public health affairs of the states is unusual, and opposed to the spirit of our constitution where sovereignty is equally divided between the federal government and the states. There is also shortage of manpower in public health to engage in disaster preparedness activities, despite some remarkable progress following the September 11th disaster.^ Study found that there was a significant improvement in knowledge and limited number of studies showed improvement of skills, increase in confidence and improvement in message-mapping. Among healthcare and allied healthcare professionals, short-term training on disaster preparedness increased knowledge and improved personal protective equipment use with some limited improvement in confidence and skills. However, due to the heterogeneity of these studies, the results and interpretation of this systematic review may be interpreted with caution.^

Intimate victims : a study of violence among friends and relatives.

"Written by Harold R. Lentzner and Marshall M. DeBerry."

Job uncertainty and personal control during downsizing: A comparison of survivors and victims

This study developed and tested a model of job uncertainty for survivors and victims of downsizing. Data were collected from three samples of employees in a public hospital, each representing three phases of the downsizing process: immediately before the announcement of the redeployment of staff, during the implementation of the downsizing, and towards the end of the official change programme. As predicted, levels of job uncertainty and personal control had a direct relationship with emotional exhaustion and job satisfaction, In addition, there was evidence to suggest that personal control mediated the relationship between job uncertainty and employee adjustment, a pattern of results that varied across each of the three phases of the change event. From the perspective of the organization's overall climate, it was found that levels of job uncertainty, personal control and job satisfaction improved and/or stabilized over the downsizing process. During the implementation phase, survivors experienced higher levels of personal control than victims, but both groups of employees reported similar levels of job uncertainty. We discuss the implications of our results for strategically managing uncertainty during and after organizational change.