The pandemic paradox: The consequences of COVID-19 on domestic violence

Kelly P. Reducing Violence Against Women and Girls in the Arab League: A Systematic Review of Preventive Interventions

The UN's Sustainable Development Goal #5 (Gender Equity) includes violence against women and girls (VAWG), considering it as a violation of the rights of women and girls. The variety of risk factors for VAWG in Arab countries suggests the need to identify effective interventions to guide practitioners and policy makers. A systematic review of preventive interventions across the Arab League examined the outcomes of VAWG. Authors registered the study on the prospective register of systematic reviews database. Authors conducted the search for evidence up to 2023. Database searching identified 1,502 studies and after application of the eligibility criteria, 17 studies remained for inclusion. Quality appraisal used the Mixed Methods Appraisal Tool. Evidence emerged from eight Arab countries. Interventions occurred at the primary, secondary, and tertiary levels of prevention. However, only two studies employed interventions using more than one level of prevention, which considered systems strengthening and the development of community solidarity networks. The evidence revealed a lack of clear evaluation and evidence for the effectiveness of interventions and prevention alongside reactive approaches, with no evidence as to how systems may reduce or prevent VAWG. One main issue is patriarchal dominance in Arab countries creating the lack of a collective female voice in any of the evidence. However, Arab countries can change with support. Achieving the UN's Sustainable Development Goal #5 by 2030 means interventions and programs need to include more than one prevention level, consider systems and include the collective female voice.

The Experiences of Post-Separation Survivors of Domestic Violence During the Covid-19 Pandemic: Findings From a Qualitative Study in the United Kingdom

Post-separation for domestic violence (DV) survivors is known to be a period of heightened risk of domestic homicide. Evidence points to increased rates of DV during the Covid-19 pandemic, with specific challenges in help-seeking from DV services, yet studies that capture this qualitatively are still emerging. This UK study investigated the experiences of 21 separated DV survivors (all women) during the Covid-19 pandemic. Inductive, thematic analysis highlighted participants' psychological distress, isolation, fear of Covid-19 transmission, and detachment from support networks. The findings reflect the interconnected nature of adversities experienced by DV survivors and the exacerbation of these due to the insidious, multifaceted, and synergistic impacts of DV and the pandemic.

The shame of sexual violence towards women in rural areas

This perspective paper presents a discussion around the issues of sexual violence (SV) in rural and remote areas and the associated discourses of shame. The authors propose that shame of SV adds additional trauma to survivors, further impacting survivors' mental health which may be exacerbated in rural areas. Shame is a complex emotion that can result in increased feelings of guilt, humiliation, and embarrassment. Shame has been identified as an underlying risk factor and a mechanism for post-assault mental health problems. We propose it can be particularly pronounced for women subjected to sexual assault in rural or remote areas. This paper will explore the link between SV and shame, explain how shame attached to SV may be used as an informal social control mechanism for women, particularly in rural and remote areas, and discuss the role of health practitioners, particularly mental health nurses, who play a key role in supporting people impacted by SV. SV is an insidious social phenomenon that can have profound consequences for individuals, families, and communities. Addressing shame and stigma is a crucial component of supporting survivors of SV in rural and remote areas. There is a need for targeted community-led interventions and responsive support services to address the complex and multifaceted issues contributing to SV in rural and remote communities.

Impacts of COVID-19 on Intimate Partner Violence Service Provision

COVID-19 policies like stay-at-home orders impacted intimate partner violence (IPV) service provision in Alberta. Using intersectionality and qualitative semi-structured interviews, this article situates IPV and access to services and supports within multiple overlapping factors such as race, gender, class, and ethnic minority status. Two main themes were identified. First, the challenges within IPV service provision reflect the sectors' traditional and binary understanding and response to violence. Second, the move to virtual services brought challenges related to access to telecommunication facilities and zoom fatigue. Thematic analysis also shows the impact of the pandemic in a sector with existing structural/institutional challenges. We conclude by recommending a multi-level intersectional approach to IPV service provision in Alberta.

Childhood exposure to domestic violence: can global estimates on the scale of exposure be obtained using existing measures?

Purpose

Childhood exposure to domestic violence and abuse (DVA) can lead to major short- and long-term effects on the victim. Despite this, there is no accepted measure for children's experiences, with most existing measures being validated only in high income countries and not in low- and middle- income countries. As a result, international statistics are not comparable. This paper seeks to critically appraise existing measures and discuss whether any are fit-for-purpose on a global scale.

Method

The COSMIN PROMs approach was followed to critically appraise and compare the appropriateness of measures. A comprehensive literature search was undertaken in seven journal databases for measures mentioned in formally peer-reviewed articles exploring childhood exposure to DVA.

Results

A literature search resulted in the identification of 10 measures and, following criteria to only keep original measures and remove modifications, four measures which have been validated cross-culturally are discussed in detail in line with the COSMIN PROMs criterion: The Child Exposure to Domestic Violence Scale, Children's Perception of Interparental Conflict Scale, Juvenile Victimization Questionnaire and The Violence Exposure Scale for Children. Strengths and limitations of each are discussed, along with any validations undertaken not in the country of origin.

Conclusion

Despite childhood exposure to DVA being an urgent research priority worldwide, the current measures to explore the extent of the issue are not validated cross-culturally, leading to concerns about comparisons across different population groups. The development and implementation of interventions to reduce the levels and effects of exposure relies heavily on cross-cultural comparisons, which may indicate different strategies are needed in different contexts. The lack of these validated comparisons is constraining advances, and the paper advocates for further efforts to be made in this regard.

Exploring the effects of COVID-19-related traumatic events on the mental health of university students in Brazil: A cross-sectional investigation

University students are vulnerable to mental health issues during their academic lives. During the COVID-19 pandemic, university students faced mental distress due to lockdowns and the transition to e-learning. However, it is not known whether these students were also affected specifically by COVID-19-related traumatic events. This study examined the impact of COVID-19-related traumatic events on 2277 university students from two federal institutions of higher education in Brazil. The university students completed an online questionnaire covering demographics, lifestyle habits, health characteristics, COVID-19-related traumatic events, and depression, anxiety, and stress symptoms. The results showed that an increased intensity of COVID-19-related traumatic events was positively associated with stress, anxiety, and depressive symptoms, and each specific type of event was associated with these symptoms. In addition, we found a negative association between these symptoms and male sex and age and a positive association with having or having had a history of cardiovascular, respiratory, neurological, or mental disorders or another disease diagnosed by a physician. In conclusion, this study emphasizes the heightened risk of mental health issues in university students in the face of COVID-19-related traumatic events. Women, young people and people who have or have had a history of disease were the most vulnerable to mental health issues during the COVID-19 pandemic.

Routine Sensitive Enquiry of Adult Interpersonal Trauma in Community Mental Health Teams: An Audit of the Initial Assessment Tool

This audit aimed to evaluate the utility of the Initial Assessment Tool (IAT) in documenting routine sensitive enquiry of adult interpersonal trauma within three Community Mental Health Teams (CMHTs) in North-East Glasgow. In addition, it sought to evaluate if disclosures informed patient risk assessments and if patients were signposted to additional support services. 57% of 90 IATs had evidence of routine sensitive enquiry. Of 51 casefiles with evidence of routine sensitive enquiry, 61% had evidence of the information informing their risk assessments and 14% had documented recommendations of support organisations. The IAT appeared able to assist clinicians with routine sensitive enquiry in adulthood. However, there may be advantage in supporting staff understanding of how to ask questions to specific populations and to use this information to inform treatment planning. Given the prevalence of adult interpersonal trauma experienced by patients presenting to CMHTs, trauma-informed approaches to care should be implemented.

Aftermath of COVID-19: Exploring the Perception of Violence Against Women in the Middle East and North Africa

This article explores the perception of violence against women (VAW) in the Middle East and North Africa in the aftermath of the COVID-19 pandemic using Arab Barometer VI parts 1 and 3 (N = 12,548). Results showed that men and social conservatism were less likely to perceive that the VAW in the community had increased. For religious people, the odds of perceiving violence in the community were higher. Individuals whose jobs were interrupted because of the COVID-19 outbreak were more likely to perceive VAW in the community has increased compared to individuals whose jobs were not interrupted. The strongest predictor of the perception of increased VAW in the community because of COVID-19 was the current economic situation of the country. Those who perceived the economic situation of the country as bad were 1.6 times more likely to believe that VAW has increased. Government handling of the crisis and overall government performance increased the odds of perceiving that VAW has increased. Investigating correlates of VAW as the consequence of the COVID-19 pandemic is crucial because it helps governments, emergency services, and community leaders develop strategies of prevention for future disasters and improve community and institutional reactions.

Social Support and Associated Factors Among Men and Women in Pre-COVID Substance Use Treatment

Low levels of social support are related to negative health outcomes, representing further obstacles to recovery from substance use disorder (SUD). This study examined relationships among stressors, symptoms and social support in 124 women and 102 men engaged in two outpatient public sector substance use treatment programs. Multiple linear regression analyses were utilized to assess relationships between variables of interest and social support. Men reported significantly lower social support than women. Food insecurity was associated with lower social support for men (β= -13.6 [95% CI -26.7, -0.4], p = 0.04). When examining emotional support and tangible aid, victimization history was related to lower support (both types) for women while food insecurity was associated with lower support (both types) for men. Depression was related to lower emotional support among both men and women. Substance use treatment programs should explicitly target social support and related stressors to facilitate recovery for the individuals they serve.

Perceptions of risk and coping strategies during the COVID-19 pandemic among women and older adults

The world's health, economic, and social systems have been adversely impacted by the COVID-19 pandemic. With lockdown measures being a common response strategy in most countries, many individuals were faced with financial and mental health challenges. The current study explored the effect of the COVID-19 pandemic on the psychological well-being, perception of risk factors and coping strategies of two vulnerable groups in Malaysia, namely women and older adults from low-income households (USD592). A purposive sample of 30 women and 30 older adults was interviewed via telephone during Malaysia's Movement Control Order (MCO) regarding the challenges they faced throughout the pandemic. Thematic analysis was subsequently conducted to identify key themes. The themes identified from the thematic analysis indicated a degree of overlap between both groups. For women, seven themes emerged: 1) Psychological challenges due to COVID-19 pandemic, 2) Family violence, 3) Finance and employment related stress and anxiety, 4) Women's inequality and prejudice, 5) Coping strategies, 6) Professional support, and 7) Women's empowerment. Similarly, there were six themes for the older adults: 1) Adverse emotional experiences from COVID-19, 2) Threats to health security, 3) Loss of social connections, 4) Government aid to improve older adults' psychological well-being, 5) Psychological support from family members and pets, and 6) Self-reliance, religion, and spirituality. The findings provide valuable information on the specific burdens faced by these groups, and support psychological interventions and mitigations that would be appropriate to improve well-being during the recovery phase.

Racial inequities in homicide rates and homicide methods among Black and White women aged 25-44 years in the USA, 1999-2020: a cross-sectional time series study

BACKGROUND

In the USA, Black women aged 25-44 years are disproportionately murdered compared with their White counterparts. Despite ongoing efforts to reduce racial and structural inequities, the result of these efforts remains unclear, particularly in light of the COVID-19 pandemic.

METHODS

This study examined a cross-sectional time series of homicide death rates, by race, from the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research system. We included data for women aged 25-44 years between 1999 and 2020 among 30 states in the USA. Homicide death was classified using underlying cause and multiple cause of death codes; mortality rates were calculated per 100 000 based on US Census Bureau population sizes. Homicide methods were classified as firearm, cutting or piercing, and other. Firearm homicides were compared with other homicides with logistic regression including covariates of race, time, and their interaction. We report odds ratios and 95% CIs.

FINDINGS

In 2020, the homicide rate among Black women was 11·6 per 100 000, compared with 3 per 100 000 among White women. This inequity has persisted over time and is virtually unchanged since 1999. Homicide inequities vary across US states; in 11 states, racial inequities have increased since 1999. The racial inequity was greatest in Wisconsin, where in 2019-20, Black women aged 25-44 years were 20 times more likely to die by homicide than White women. Homicide by firearm is increasing in frequency; women in the USA had 2·44 (95% CI 2·14-2·78) times the odds of homicide involving firearms in 2019-20 compared with 1999-2003. Firearm homicide deaths are disproportionately concentrated among Black women in every region in the USA.

INTERPRETATION

Our findings suggest that there is an urgent need to address homicide inequities among Black and White women in the USA. Enacting federal legislation that reduces gun access is a crucial step. Policy makers must address long-standing structural factors that underpin elevated gun violence by implementing sustainable wealth-building opportunities; developing desegregated, mixed income and affordable housing; and increasing green spaces in communities where Black women largely reside.

FUNDING

National Institute of Mental Health of the National Institutes of Health.

The COVID-19 pandemic and Australian parents with young children at risk of interparental conflict

BACKGROUND

The COVID-19 pandemic has created many challenges for families across the world, with those who have recently had a baby particularly vulnerable to increased stress Study Aim: The current study aimed to explore the experiences of the COVID-19 pandemic of families who have recently had a baby in Melbourne, Australia.

METHODS

Interviews were conducted with sixteen parents participating in a family-based intervention during early parenthood and seven clinicians who delivered the program.

RESULTS

Parents and clinicians described impacts of the pandemic on parent and family functioning included mental health concerns, stress and irritability, feelings of isolation, and increased relationship tension. Parents discussed coping strategies used during the crisis, including activities with their family, connecting with others, trying to stay positive, and self-care activities such as spending time outdoors. Both parents and clinicians acknowledged the importance of mental health and parenting support during and following the pandemic, and for these services to be promoted and easily accessible.

DISCUSSION

The study highlights the mental health and parenting support needs of families during times of crisis and emphasises the importance of early intervention for families exhibiting poor communication and relationship tension.

Did physical aggression in women increase during the novel coronavirus 2019 (COVID-19) pandemic? A perspective of facial trauma

PURPOSE

The present study aimed to assess whether there was an increase in physical aggression in women treated in Belo Horizonte, Minas Gerais, through the mandatory quarantine.

METHODS

Data from a cross-sectional study were collected and analyzed, from March 1 to December 31, 2020. Additionally, data from the same period the previous year were collected for comparison.

RESULTS

Of the etiologies reviewed for 2020, physical aggression had the highest percentage increase (+ 4.9%) and was the only etiology that showed a significant difference (p = 0.045). The mean age of the included patients was 34.05 years in 2019 and 33.97 in 2020, and most of the women had facial fractures, with nasal fractures being the most frequent, followed by jaw fractures. There was a significant increase (p = 0.34) in the conservative treatment of fractures from 2019 (48.6%) to 2020 (71.7%) and a minor (p = 0.088) increase in aggression toward intimate partners (2019, 40.9%; 2020, 63.9%).

CONCLUSION

Physical aggression against women increased during the period of mandatory social isolation that resulted from the COVID-19 pandemic. Health professionals, including emergency services professionals, must be trained to identify victims and refer them to specialized care.

"Safety Is Elusive:" A Critical Discourses Analysis of Newspapers' Reporting of Domestic Violence During the Coronavirus Pandemic

The COVID-19 pandemic exacerbated incidences of domestic violence (DV). The framing of DV within media sources contributes to the public's understanding of DV. Using critical discourse analysis (CDA), this paper explores representations of safety within newspapers' reporting of DV during the pandemic. The sample included newspaper articles (n = 31) from U.S. newspapers. The analysis involved multiple rounds of coding and employing "structured questions." These articles depicted limited courses of action for DV survivors and represented safety as unattainable. Safety was constructed in four ways: homes are unsafe, social services are overburdened, government failures, and the elusiveness of safety. These discursive formations provide insight regarding "idealized" social responses to DV.

Perceived Impact of COVID-19 on Cyberabuse, Sexual Aggression, and Intimate Partner Violence Among U.S. Young Adults

Quarantine guidelines that arose with the COVID-19 pandemic limited opportunities for social interaction, raising concerns about increases in intimate partner violence and cyberabuse while simultaneously restricting access to help. The current study assessed increases in cyberabuse, sexual aggression, and intimate partner violence victimization and perpetration during the first year of the COVID-19 pandemic in a U.S. nationally representative sample of young adults ages 18 to 35, recruited from a probability-based household panel. Data were collected between November 2020 and May 2021. Descriptive analyses were conducted to assess the prevalence of any self-reported increase in cyberabuse, sexual aggression, or intimate partner victimization or perpetration during the COVID-19 pandemic. Logistic regression models were run for each outcome measuring any increase compared to no increase. Approximately one in ten U.S. young adults ages 18 to 35 reported experiencing an increase in cyberabuse victimization (12.6%) and cyberabuse perpetration (8.9%) during the pandemic. Similar proportions were observed for increased sexual aggression victimization (11.8%) and perpetration (9.0%). More than one in five respondents (21.4%) reported that their intimate partner was more physically, sexually, or emotionally aggressive toward them during the pandemic. Conversely, 16.2% of respondents reported that they were more physically, sexually, or emotionally aggressive themselves toward an intimate partner, compared to their behavior before the onset of the pandemic. Having an intimate partner and staying at home more than usual during the pandemic were protective factors for both cyberabuse and sexual aggression victimization. Respondent age, education, and race and ethnicity were not associated with increased victimization or perpetration of cyberabuse or sexual aggression. However, women reported lower odds of increased sexual aggression perpetration than men. These findings improve understanding of changes to interpersonal abuse and associated risk factors during a period of social disruption.

Help-Seeking and Service Utilization Among Survivors of Intimate Partner Violence in Michigan During the COVID-19 Pandemic

This study explores formal and informal intimate partner violence (IPV) service use among women and transgender/nonbinary individuals in the state of Michigan during the COVID-19 pandemic. A total of 14.8% (N = 173) of participants experienced IPV during this period, and 70% utilized at least one formal IPV service (13.3%). Up to 22% of survivors reported wanting to seek formal help but not doing so due to fear of partner reprisal, contracting COVID-19, or COVID-related service reductions. White, pregnant, and part-time-employed survivors were most likely to seek informal help. Older, higher-income, white, part-time-employed, pregnant, and non-essential worker survivors were most likely to seek formal help.

The Combined Outcomes of the COVID-19 Pandemic and a Collapsing Economy on Mental Well-Being: A Cross-Sectional Study

Objective: This study aimed to examine the outcomes of COVID-19 and a collapsing economy on the mental well-being (MWB) of the general Lebanese population. Methods: A cross-sectional study was conducted online in May 2020 and enrolled 502 adults. Results: Mental well-being had a mean of 14.80 (14.37; 15.24). A lower MWB was associated with female gender (beta=-1.533 [-2.324; -0.743]), university education (beta=-2.119 [-3.353;-0.885]), fear of COVID-19 (beta=-0.131 [-0.199; -0.063]), fear of poverty (beta=-0.232 [-0.402;-0.063]), verbal violence at home (beta=-3.464 [-5.137; -1.790]), and chronic disease (beta=-1.307 [-2.283; -0.330]). Better family satisfaction (beta=0.380 [0.235; 0.525]) and better financial situation (beta=0.029 [0.003; 0.055]) were significantly correlated with better MWB. In the subsample of workers/looking for a job, additional factors affected MWB: physical exercise (beta =1.318 [0.370; 2.265]) was associated with better QOL, while being a previous waterpipe smoker, being self-employed before the crisis (beta=-1.22 [-2.208;-0.231]), working from home since the economic crisis (-1.853 [-3.692; -0.013]), and worrying about the long-term effects of the crisis on one's employment status (beta=-0.433 [-0.650; -0.216]) were associated lower MWB. It is noteworthy that closure of the institution yielded a borderline result (B = -1.2; p = .094), while the fear of COVID-19 was not significantly associated with MWB (B = -0.054; p =0.192). Conclusion: This study showed that, during the pandemic, economic and other factors, directly or indirectly related to COVID-19, significantly affected quality of life. The fear of COVID-19 and fear of poverty mainly impacted the MWB of the general population. However, the fear of COVID-19 lost its significance among workers, who reported that factors negatively affecting their MWB are directly related to their employment and the already collapsing economy in Lebanon.

The Global Landscape of Domestic Violence against Women during the COVID-19 Pandemic: A Narrative Review

The coronavirus disease (COVID-19) pandemic has led to an alarming increase in domestic violence against women owing to lockdown measures and limited access to support services. This article provides insights into the global prevalence of domestic violence, barriers to seeking help, its impact on women and children, and the best practices implemented worldwide. Domestic violence encompasses various forms of abuse; many young women experience partner violence. Barriers to seeking help include fear, financial constraints, lack of awareness of available services, and distrust among stakeholders. The consequences of domestic violence affect the mental health of both mothers and children. Countries have increased shelter funding and developed innovative protocols to reach survivors and address this issue. However, the healthcare sector's involvement in addressing domestic violence has been limited. This review advocates collaboration among healthcare institutions and government bodies. Key recommendations include utilizing telehealth services, implementing comprehensive training programs, establishing effective referral systems, enhancing health education, developing a domestic violence registry, improving the responses of law enforcement and justice systems through healthcare integration, promoting data sharing, and conducting further research. Healthcare systems should recognize domestic violence as a public health concern and detect, prevent, and intervene in cases to support survivors.

Domestic Violence in the Context of the COVID-19 Pandemic: A Synthesis of Systematic Reviews

The current systematic meta-review aimed to map out, characterize, analyze, and synthesize the overarching findings of systematic reviews on domestic violence (DV) in the context of COVID-19. Specifically, a systematic meta-review was conducted with three main objectives: (1) to identify what types and aspects of DV during COVID-19 have been reviewed systematically to date (research trends), (2) to synthesize the findings from recent systematic reviews of the theoretical and empirical literature (main findings), and (3) to discuss what systematic reviewers have proposed about implications for policy and practice as well as for future primary research (implications). We identified, appraised, and synthesized the evidence contained in systematic reviews by means of a so-called systematic meta-review. In all, 15 systematic reviews were found to be eligible for inclusion in the current review. Thematic codes were applied to each finding or implication in accordance with a set of predetermined categories informed by the DV literature. The findings of this review provide clear insight into current knowledge of prevalence, incidence, and contributing factors, which could help to develop evidence-informed DV prevention and intervention strategies during COVID-19 and future extreme events. This systematic meta-review does offer a first comprehensive overview of the research landscape on this subject. It allows scholars, practitioners, and policymakers to recognize initial patterns in DV during COVID-19, identify overlooked areas that need to be investigated and understood further, and adjust research methods that will lead to more robust studies.

Surviving pandemic control measures: The experiences of female sex workers during COVID-19 in Nairobi, Kenya

At the beginning of the COVID-19 pandemic, the Kenya Ministry of Health instituted movement cessation measures and limits on face-to-face meetings. We explore the ways in which female sex workers (FSWs) in Nairobi were affected by the COVID-19 control measures and the ways they coped with the hardships. Forty-seven women were randomly sampled from the Maisha Fiti study, a longitudinal study of 1003 FSWs accessing sexual reproductive health services in Nairobi for an in-depth qualitative interview 4-5 months into the pandemic. We sought to understand the effects of COVID-19 on their lives. Data were transcribed, translated, and coded inductively. The COVID-19 measures disenfranchised FSWs reducing access to healthcare, decreasing income and increasing sexual, physical, and financial abuse by clients and law enforcement. Due to the customer-facing nature of their work, sex workers were hit hard by the COVID-19 restrictions. FSWs experienced poor mental health and strained interpersonal relationships. To cope they skipped meals, reduced alcohol use and smoking, started small businesses to supplement sex work or relocated to their rural homes. Interventions that ensure continuity of access to health services, prevent exploitation, and ensure the social and economic protection of FSWs during times of economic strain are required.

Quality midwifery care during the COVID-19 pandemic in Bangladesh: A focus group study with midwives, nurses, and midwifery educators

INTRODUCTION

Bangladesh has made remarkable strides in the development of the midwifery profession. However, the COVID-19 pandemic has had profound effects on healthcare systems worldwide, including those related to reproductive, perinatal, and maternal health. Given the recent advancements in the midwifery field in Bangladesh, it is crucial to examine the pandemic's impact on existing barriers and the capacity of midwifery professionals to deliver high-quality care. The aim of this study is to describe the possibility of midwives being able to provide quality midwifery care in Bangladesh during the COVID-19 pandemic.

METHODS

To gather insights, data were collected from July to October 2020 via four qualitative focus group discussions online; 23 actively practicing midwives, nurses specializing in midwifery care, and midwifery educators, participated. The data analysis employed reflexive thematic analysis.

RESULTS

The COVID-19 crisis posed significant threats to women's safety and health, with lockdowns exacerbating gender inequalities in society. Midwives faced added challenges due to their relatively low professional status and increased workloads. Insufficient policy implementation further compromised midwives' safety. Fear of contracting the virus and working during their free time also raised concerns about the quality of care provided. Nevertheless, the pandemic provided opportunities for midwives to demonstrate their ability to deliver independent midwifery care in Bangladesh.

CONCLUSIONS

The pandemic underscored the importance of creating respectful and dignified working conditions for midwives. It revealed that professional midwives can work independently when provided with the necessary space and a supportive work environment. This opens the door for the implementation of a midwifery-led care model. Further research is recommended to investigate the medical safety and efficacy of independent midwifery care in the context of Bangladesh.

M-health Apps and Physical and Mental Health Outcomes of Sexual Minorities

Given the assigned health inequalities faced by sexual minorities, it is fitting to assess whether m-health could be associated with better health-related outcomes for these sexual minorities. The present study examines associations between m-physical and m-mental health apps and sexual minorities' physical and mental health status in Greece. The study utilized three waves of panel data collected in 2018, 2019, and 2020. The findings indicated associations between the use of m-physical and m-mental health apps and increased physical and mental health status for sexual minorities. The work concludes that m-health could enhance informational capabilities associated with increased levels of physical and mental health for sexual minorities. Indeed, the study found that, during the COVID-19 pandemic, sexual minorities experienced physical and mental health deteriorations. Interestingly, the estimates indicated that the association between the use of m-physical and m-mental health apps and increased mental health status for sexual minorities was stronger during the COVID-19 pandemic than before. The study suggests that tracking health-related information through m-health apps during periods of increased uncertainty could be associated with better health prevention and management. If m-health apps can alleviate adverse physical and mental health symptoms for sexual minorities, their potential should be considered.

Healing After Violence: The Effect of Perception of Social Support on Posttraumatic Growth in Female University Students

This study investigated the Turkish validity and reliability of the Healing After Gender-based Violence Scale (GBV-Heal) and the relationship between social support perception, posttraumatic growth in university students who are victims of gender-based violence. The study sample consisted of 167 female students who experienced gender-based violence. The Turkish version of GBV-Heal of Kaiser-Meyer-Olkin value was 0.892; the Bartlett Sphericity Test result was determined as χ2  =  195,053, and the obtained variables were found suitable for factor analysis. Perception of social support related to post-violence healing in female university students is effective on posttraumatic growth.

Service evaluation of an independent domestic violence advocate post in a children's hospital

Domestic violence and abuse (DVA) has detrimental effects on the health and well-being of children and young people exposed to it, whether they witness or experience it. The introduction of independent domestic violence advocates in UK hospitals has enhanced the safety of victims of DVA. In 2020-2021 an independent domestic violence advocate post was piloted at a children's hospital for one year, the advocate's role being to train hospital staff and support women who had experienced DVA. A service evaluation showed that the training and support provided by the independent domestic violence advocate had benefits for women, children and staff. It also confirmed that the commissioning of services for children exposed to DVA is often underfunded and overshadowed by the provision of support to adults.

Family Functioning and Community Resilience During the COVID-19 Lockdown Period in Turkey

The COVID-19 outbreak has left families with many adverse effects that can disrupt functioning. The aim of this study was to evaluate the associations between family functioning and community resilience during the COVID-19 lockdown. An online survey was conducted with community-dwelling adult people (n= 411) based on quantitative descriptive-correlational research. According to the results, families show dysfunctional trends during the COVID-19 outbreak (%56), especially in affective involvement, problem-solving, and behavior control categories. Community resilience was positively associated with family functioning. Also, income dissatisfaction, use of social services, and social trust were determined as predictors of family functioning in the COVID-19 lockdown. Further research and social work practices in public health to address the family system as a whole should be evaluated and interventions aiming at community resilience should be designed to increase families' functioning during the pandemics.

Receptivity towards Remote Service Delivery among Social Work Clients and Practitioners during COVID Times: A Systematic Review

PURPOSE

This systematic review aims to identify and synthesize the available evidence on the receptivity toward, perceived advantages and challenges of remote service delivery among social work clients and practitioners during the context of COVID-19.

METHOD

Two electronic databases were searched from 2020 to 2022. Identified papers were screened against the established eligibility criteria, yielding 15 papers. Two additional papers were further identified through hand-search. As heterogeneity of studies was high, a narrative synthesis was performed to summarize the overall evidence.

RESULTS

Our review provides evidence that remote service delivery holds the potential to increase access to services among selected client populations as well as promote a sense of empowerment for clients and opportunities for practice enhancement for practitioners.

DISCUSSION & CONCLUSION

The findings from our study highlighted the need for innovative solutions and practical considerations for ongoing remote service, including the careful considerations of social work clients' and practitioners' suitability, the need for provision of training and ongoing support to optimize practitioners' well-being. As the delivery of services transition to face-to-face or remain remote, further research is needed to assess the promise of remote practice in optimizing overall service delivery, while maintaining client-reported satisfaction.

Think global, act local: using a translocal approach to understand community-based organisations' responses to planetary health crises during COVID-19

Little is known on how community-based responses to planetary health crises, such as the COVID-19 pandemic, can integrate concerns about livelihoods, equity, health, wellbeing, and the environment. We used a translocal learning approach to co-develop insights on community-based responses to complex health and environmental and economic crises with leaders from five organisations working with communities at the front line of intersecting planetary health challenges in Finland, India, Kenya, Peru, and the USA. Translocal learning supports collective knowledge production across different localities in ways that value local perspectives but transcend national boundaries. There were three main findings from the translocal learning process. First, thanks to their proximity to the communities they served, community-based organisations (CBOs) can quickly identify the ways in which COVID-19 might worsen existing social and health inequities. Second, localised CBO actions are key to supporting communities with unique challenges in the face of systemic planetary health crises. Third, CBOs can develop rights-based, ecologically-minded actions responding to local priorities and mobilising available resources. Our findings show how solutions to planetary health might come from small-scale community initiatives that are well connected within and across contexts. Locally-focused globally-aware actions should be harnessed through greater recognition, funding, and networking opportunities. Globally, planetary health initiatives should be supported by applying the principles of subsidiarity and translocalism.

The Impact of COVID-19 Pandemic on Intimate Partner Violence (IPV) Against Women

Intimate partner violence (IPV) is a global public health crisis associated with adverse physical, psychological, economic, and social consequences. Studies on the impact of COVID-19 on IPV against women are scarce. This study aimed to understand the impact of COVID-19 on IPV against women. Google Scholar, PubMed, and the Cochrane Library were searched using the MeSH terms intimate partner violence, COVID-19, and women. Exclusion criteria were male-partner, elder, and child abuse and studies that targeted specific groups such as cancer, HIV, and substance abuse. Two independent reviewers completed the title, abstract screening, and review of selected articles. Thirteen out of 647 articles met the inclusion criteria. IPV against women increased in nine countries (Spain, United States, Nigeria, Ethiopia, Turkey, Peru, Bangladesh, Czech Republic, and the Democratic Republic of Congo); one country showed no change in gender-based violence among adolescent girls and young women (Kenya); and one study reported a decrease in IPV reporting by victims (United States). Policies made to mitigate the pandemic created unintended consequences that exacerbated risk factors for IPV against women. Lessons learned from COVID-19 must be used to develop policy-level support and response services to mitigate IPV against women amid a pandemic and other human crises.

Domestic violence against women has increased during the COVID-19 pandemic: A perspective paper about the need for change to current and future practice

The COVID-19 outbreak led to widespread disruption and stress to people's lives. Concern about the escalation of domestic violence (DV) rates and related mental health issues soon emerged following the implementation of strategies aimed at curbing the spread of the virus. This perspective paper presents an overview of the issues, argues for greater recognition of the link between DV against women and serious emotional distress, and the need for greater awareness and knowledge about DV among mental health professionals. While we acknowledge that men also experience DV, their rates are much lower than for women and in this paper our focus is on women.

Domestic violence against Iranian women during the Covid-19 lockdown: A cross-sectional study

Background and Aims

Despite the fact that public health measures such as social isolation can help control the coronavirus disease 2019 (Covid-19) pandemic, these procedures may contribute to elevated levels of stress and escalate various forms of violence against women. The current study aimed to estimate the prevalence of domestic violence and identify factors associated with domestic violence during the Covid-19 lockdown among married women attending healthcare centers in Iran.

Methods

This cross-sectional study, conducted between 2020 and 2021, focused on a sample of 5317 married women who sought healthcare services within urban centers across five major cities in Iran. Sampling was done through a multistage cluster method. The Revised Conflict Tactics Scales (CTS2) were used to assess levels of violence. The collected data was analyzed using descriptive and inferential statistics, including independent sample t-test, Chi-square, and multiple logistic regression) with the SPSS software version 22.

Results

During the Covid-19 lockdown, psychological violence was reported by 66.7% of women (95% confidence interval [CI], 65.44%-67.98%), physical violence by 44.8% (95% CI, 43.43%-46.10%), sexual violence by 28.8% (95% CI, 27.60%-30.03%), and injury by 24.5% (95% CI, 23.39%-25.70%). The multiple logistic regression showed several significant factors associated with domestic violence. These included low levels of social support (p < 0.001), shorter duration of marriage (p < 0.001), unemployment of both women (p < 0.007) and their spouses (p < 0.001), poor economic status (p < 0.001), as well as substance abuse by the husband, including alcohol (p < 0.001) and drug abuse (p < 0.01), and smoking (p < 0.01).

Conclusion

The findings highlighted the magnitude of domestic violence against women during the Covid-19 lockdown. It is crucial to implement comprehensive strategies that encompass preventive and responsive measures to address domestic violence not only during lockdowns but also in the post-lockdown period.

Healthcare workers' perceptions of sexual violence during the COVID-19 pandemic in the Eastern Cape

BACKGROUND

The South African government implemented lockdown restrictions in order to prevent the spread of the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2).

AIM

This study explored the effects of the coronavirus disease 2019 (COVID-19) pandemic on sexual violence in the Eastern Cape province through the lens of healthcare workers' (HCWs) experiences.

SETTING

A Thuthuzela care centre in the Eastern Cape province, South Africa.

METHODS

This qualitative study brings together the findings from thematic analysis of semi-structured interviews conducted among 11 purposively selected HCWs in May 2022.

RESULTS

Overall, three themes emerged from the study: the effects of COVID-19 on sexual violence, profile of the survivors and recommendations for combating sexual violence in the region. Most respondents believed that the COVID-19 pandemic caused a surge in the incidence of sexual violence, although all acknowledged that movement restrictions affected reporting. The participants treated mostly black women and children's survivors, who experienced physical injuries simultaneously. The respondents' narratives revealed that educational campaigns targeting boys and men could reduce sexual violence in the region. In addition, it was recommended that stricter laws and harsher penalties would serve as deterrents for perpetrators of sexual violence in the country.

CONCLUSION

The COVID-19 lockdown restrictions exposed the vulnerabilities of black women and children to sexual violence in the study setting. Educational programmes aimed at re-orientating boys and men in both rural and urban communities should be implemented.Contributions: This study provides an insight into the perceived effect of the COVID-19 pandemic on sexual violence in the Amathole district and South Africa.

Evidence generation for sustained impact in the response to gender-based violence: lessons from the SRHR Africa Trust Zimbabwe

Gender-based violence (GBV) is a pervasive problem in Zimbabwe, affecting women and girls. The types of GBV that are prevalent in Zimbabwe include sexual violence, intimate partner violence, and child marriage. The issue of evidence generation remains crucial in developing interventions that are tailor-made for GBV response. In an attempt to build pathways for the strengthening of GBV programming and to influence policy change, the Sexual and Reproductive Health and Rights (SRHR) Africa Trust (SAT) Zimbabwe conducted a secondary data review of GBV cases recorded in 2018 and 2019 in collaboration with the Zimbabwe Republic Police (Victim Friendly Unit) to understand the incidence of and the driving factors underlying GBV in Zimbabwe, including context-specific information with regard to sexual violence and an overview of perpetrator types. The study proffered recommendations that focus on the importance of improving GBV reporting and programming in Zimbabwe. The study establishes that the driving factors for physical violence include poverty, infidelity, and alcohol and drug abuse, while sexual violence is perpetrated by intimate partners and close relatives, among other driving factors.

Characterizing the impacts of public health control measures on domestic violence services: qualitative interviews with domestic violence coalition leaders

BACKGROUND

Prior to the availability of pharmaceutical control measures, non-pharmaceutical control measures, including travel restrictions, physical distancing, isolation and quarantine, closure of schools and workplaces, and the use of personal protective equipment were the only tools available to public health authorities to control the spread of COVID-19. The implementation of these non-pharmaceutical control measures had unintended impacts on the ability of state and territorial domestic violence coalitions to provide services to victims.

METHODS

A semi-structured interview guide to assess how the COVID-19 pandemic impacted service provision and advocacy generally, and how COVID-19 control measures specifically, created barriers to services and advocacy, was developed, pilot tested, and revised based on feedback. Interviews with state and territorial domestic violence coalition executive directors were conducted between November 2021 and March 2022. Transcripts were inductively and deductively coded using both hand-coding and qualitative software.

RESULTS

Forty-five percent (25 of 56) of state and territorial domestic violence coalition executive directors representing all 8 National Network to End Domestic Violence (NNEDV) regions were interviewed. Five themes related to the use of non-pharmaceutical pandemic control measures with impacts on the provision of services and advocacy were identified.

CONCLUSIONS

The use of non-pharmaceutical control measures early in the COVID-19 pandemic had negative impacts on the health and safety of some vulnerable groups, including domestic violence victims. Organizations that provide services and advocacy to victims faced many unique challenges in carrying out their missions while adhering to required public health control measures. Policy and preparedness plan changes are needed to prevent unintended consequences of control measure implementation among vulnerable groups as well as to identify lessons learned that should be applied in future disasters and emergencies.

Domestic and Community Violence in Greece After the First COVID-19 Quarantine: A Clinical Forensic Approach

Many scientists expressed their concerns regarding the impact of COVID-19-related quarantine measures on interpersonal violence, mainly concerning children and intimate partners, as well as other negative psychological effects. During early 2020, free circulation in Greece was prohibited for 42 days, up until May 4th. The aim of our study was to investigate characteristics of bodily harm allegation cases referred to the Department of Forensic Medicine and Toxicology of the Medical School of the National and Kapodistrian University of Athens, Greece, during the first month succeeding free circulation re-establishment in the broader Attica region. We also aimed to detect any possible differences regarding bodily harm allegations by comparing the corresponding time period of 2019. A decrease in community violence (CV) allegations, especially youth violence incidents, was observed in 2020. Females' victimization, as well as allegations against strangers, were also decreased. No differences were observed concerning the injury mechanism. Victims of 2020 filed the allegations faster and, thus, were examined almost one day earlier than their 2019 counterparts. During lockdown, domestic violence (DV) hotline reporting was significantly increased, but paradoxically DV cases referred to our Department were decreased. In Greece, the legislators did not foresee any specific exemption from circulation restriction for DV victims attempting to escape abuse. Our results revealed a small, but notable, impact on non-fatal interpersonal violence.

Tracking demands for seeking psychological help before and during the COVID-19 pandemic: a quanti-qualitative study

The COVID-19 pandemic has placed unprecedented burdens on individuals and communities around the world. The isolation, fear, and uncertainty caused by the virus has led to increased rates of anxiety, depression, and other mental health issues. The pandemic has also had a disproportionate impact on individuals and communities with low income and socioeconomic status.ObjectiveTo shed light on the consequences of the pandemic on individuals from minorities and low-income areas, we investigate the main reasons that led patients who were referred to a social clinic of a private university in Rio de Janeiro to seek psychological treatment before (2019) and during the pandemic (2020 and 2021).MethodsWe conducted a quanti-qualitative study with a lexical analysis that evaluated 549 complaint forms of patients seeking treatment in these two distinct periods. Our analyses included descending hierarchical analysis (DHA) and correspondence factor analysis (CFA).ResultsFamily dynamics and communication factors play a dominant role in the reason for seeking therapy and psychological treatment. Additionally, our study suggested an increase in anxiety and panic attacks among other mental health issues associated with grief and losses during the pandemic years.ConclusionBased on these analyses, we can begin to identify a few changes in the main demand and redirection of complaints of patients during the period of COVID-19.

Facing the Shadow Pandemic: Correlation and Trend Analyses of Violence Reports from Women to the Italian National Anti-Violence Number during 2021

OBJECTIVES

To help to tackle gender-based violence against women in the aftermath of COVID-19 or other potential crisis situations, as recommended by the European Institute for Gender Equality, the present study aims to investigate the relationship between calls to the National Anti-violence Number (NAN) and the socio-sanitary pandemic factors during 2021, a period in which the scenario changed due to containment measures that gradually allowed women to emerge from the condition of isolation. In addition, the present work aims to identify significant changes in the number of calls to NAN during the progression of the pandemic in 2021.

METHODS

Using Italian Civil Protection Department data on the socio-sanitary pandemic factors (defined by daily number of cases, swabs, deaths, hospitalizations, dismissions, intensive care unit hospitalizations, people isolated at home, and quarantine after 15 and 30 days) and NAN data. Correlation analyses, a joinpoint regression analysis, and Granger causality tests were performed.

RESULTS

The number of calls correlated with the daily number of cases, swabs, deaths, hospitalizations, dismissions, intensive care unit hospitalizations, and quarantine after 15 and 30 days. The identified joinpoints showed significant changes in the number of daily anti-violence calls during the year. Furthermore, we found evidence of a significant causality between daily hospitalizations, daily home quarantined, daily dismissed patients, and calls to NAN.

CONCLUSIONS

The results underline the influence of containment measures on the increased access to NAN, suggesting the need for a greater implementation of social and psychological support services in other potential crisis situations.

COVID-19 and sexual violence against women: A qualitative study about young people and professionals' perspectives in Spain

There is an increasing awareness of the magnitude of different forms of sexual violence (SV), especially in relation to youth. The COVID-19 pandemic has also had a negative impact on different forms of violence against women. In this study, we aim to analyse SV in the COVID-19 lockdown among young people and SV-related services from the perspective of professionals and young people from different sectors in Spain with responsibilities in attending SV and other forms of violence against women-related. A qualitative content analysis was performed on semi-structured interviews with 23 women and men aged 18 to 24 and 15 professionals working with youth and/or in violence against women or sexual violence related services. The sample was from northern, eastern and central regions of Spain. According to the professionals' experience, the COVID-19 lockdown lessened their ability to work on violence prevention. Both informants perceived that sexual violence had decreased in public spaces whereas it increased in digital ones and noticed the silence surrounding violent situations had deepened. However, they differed regarding its impact on sexual violence within intimate partners, mainly due to the lack of awareness of this problem among young men. In regard to violence against women and sexual violence, our results highlight the need to develop protocols for action and improve resource accessibility in crisis contexts.

Violence and Abuse: A Pandemic Within a Pandemic

INTRODUCTION

During the COVID-19 pandemic, as society struggled with increasing disease burden, economic hardships, and with disease morbidity and mortality, governments and institutions began implementing stay-at-home or shelter-in-place orders to help stop the spread of the virus. Although well-intentioned, one unintended adverse consequence was an increase in violence, abuse, and neglect.

METHODS

We reviewed the literature on the effect the pandemic had on domestic violence, child and elder abuse and neglect, human trafficking, and gun violence. In this paper we explore common themes and causes of this violence and offer suggestions to help mitigate risk during ongoing and future pandemics. Just as these forms of violence primarily target at-risk, vulnerable populations, so did pandemic-related violence target marginalized populations including women, children, Blacks, and those with lower socioeconomic status. This became, and remains, a public health crisis within a crisis. In early 2021, the American College of Emergency Physicians (ACEP) Public Health and Injury Committee was tasked with reviewing the impact the pandemic had on violence and abuse as the result of a resolution passed at the 2020 ACEP Council meeting.

CONCLUSION

Measures meant to help control the spread of the COVID-19 pandemic had many unintended consequences and placed people at risk for violence. Emergency departments (ED), although stressed and strained during the pandemic, remain a safety net for survivors of violence. As we move out of this pandemic, hospitals and EDs need to focus on steps that can be taken to ensure they preserve and expand their ability to assist victims should another pandemic or global health crisis develop.

COVID-19-Related Stress and Its Association with Intimate Partner Violence Perpetration and Victimization

Intimate partner violence (IPV) is a pervasive issue, and during the COVID-19 pandemic, it has been speculated that the prevalence rates of IPV increased. This paper aims to understand how pandemic-specific distress was related to experiencing and perpetrating IPV. Using self-reported survey data from 371 individuals living in the United States, this study used multiple logistic regressions to examine how reports of distress related to working from home, working outside the home, isolation, stay-at-home orders, mask mandates, physical and mental health, finances, interpersonal relationships, taking care of children, and online learning for children, as well as reports of partner conflict regarding COVID-19, were associated with physical, psychological, and sexual IPV perpetration and victimization. Our results indicated that distress related to family relationships, taking care of children, and COVID-19 as a source of conflict were all associated with an increased risk of IPV victimization, while distress related to mask mandates and friendships was associated with a decreased risk. Distress related to physical health, family relationships, taking care of children, and COVID-19 being a source of conflict were associated with an increased risk of IPV perpetration, while distress related to mental health and friendships was associated with a decreased risk. Implications for researchers and clinicians are discussed.

Use of technology in evidence-based programs for child maltreatment and its impact on parent and child outcomes

Introduction

Technology has been used in evidence-based child maltreatment (CM) programs for over a decade. Although advancements have been made, the extent of the application of technology in these programs, and its influence on parental and child outcomes, remains unclear within the context of changes that emerged because of the COVID-19 pandemic. This scoping review provides a contextualized overview and summary of the use of technology in evidence-based parenting and child programs serving families impacted by child maltreatment and the effects of technology-enhanced programs on target outcomes.

Materials and methods

Using Arksey and O'Malley's methodological framework, we searched seven databases to identify peer-reviewed and grey literature published in English from 2000 to 2023 on evidence-based programs, according to the California Evidence-Based Clearinghouse (CEBC), that included technological supports for two populations: at-risk parents for child maltreatment prevention, and children and youth 0-18 years exposed to child maltreatment. All study designs were included.

Results

Eight evidence-based parenting programs and one evidence-based child trauma program were identified as using technology across a total of 25 peer-reviewed articles and 2 peer-reviewed abstracts meeting inclusion criteria (n = 19 on parent-level programs; n = 8 on child-level programs). Four studies were published in the context of COVID-19. Two main uses of technology emerged: (1) remote programmatic delivery (i.e., delivering all or part of the program virtually using technology) and (2) programmatic enhancement (i.e., augmenting program content with technology). Improvements across parenting and child mental health and behavioral outcomes were generally observed.

Discussion

Technology use in evidence-based child maltreatment programs is not new; however, the small sample since the start of the COVID-19 pandemic in this review that met inclusion criteria highlight the dearth of research published on the topic. Findings also suggest the need for the inclusion of implementation outcomes related to adoption and engagement, which could inform equitable dissemination and implementation of these programs. Additional considerations for research and practice are discussed.

Tightened social distancing measures and increased violence during the COVID-19 pandemic in South Korea

Introduction

In 2020, the South Korean government introduced social distancing measures, varied by region, to address the pandemic. We captured variations in social distancing measures among regions in South Korea and investigated the association between the stringency of measures and the increased incidence of violence.

Methods

Incidence reports from calls to violence hotlines, including school and domestic violence and sexual harassment, from 2016 to 2021 were retrieved. The regional per capita incidence rates for each violence hotlines were calculated. Difference-in-difference design with fixed effects was used to elucidate different trends in the incidence rate of violence between regions with stringent social distancing measures and regions with looser measures.

Results

Social distancing measures led to a decreased incidence rate of school violence and an increased incidence rate of domestic violence and sexual harassment. Different trends in the incidence of violence were noted between regions with strict social distancing measures and regions with more lenient measures. Tightened measures caused surges in domestic violence and sexual harassment.

Conclusion

Social distancing measures have been an inevitable mitigation strategy against virus transmission throughout the pandemic. However, women residing in tightened social distancing measures, in particular urban areas, need more support against domestic violence.

Assessing safe and personalised maternity and neonatal care through a pandemic: a case study of outcomes and experiences in two trusts in England using the ASPIRE COVID-19 framework

BACKGROUND

The COVID-19 pandemic has resulted in profound and far-reaching impacts on maternal and newborn care and outcomes. As part of the ASPIRE COVID-19 project, we describe processes and outcome measures relating to safe and personalised maternity care in England which we map against a pre-developed ASPIRE framework to establish the potential impact of the COVID-19 pandemic for two UK trusts.

METHODS

We undertook a mixed-methods system-wide case study using quantitative routinely collected data and qualitative data from two Trusts and their service users from 2019 to 2021 (start and completion dates varied by available data). We mapped findings to our prior ASPIRE conceptual framework that explains pathways for the impact of COVID-19 on safe and personalised care.

RESULTS

The ASPIRE framework enabled us to develop a comprehensive, systems-level understanding of the impact of the pandemic on service delivery, user experience and staff wellbeing, and place it within the context of pre-existing challenges. Maternity services experienced some impacts on core service coverage, though not on Trust level clinical health outcomes (with the possible exception of readmissions in one Trust). Both users and staff found some pandemic-driven changes challenging such as remote or reduced antenatal and community postnatal contacts, and restrictions on companionship. Other key changes included an increased need for mental health support, changes in the availability and uptake of home birth services and changes in induction procedures. Many emergency adaptations persisted at the end of data collection. Differences between the trusts indicate complex change pathways. Staff reported some removal of bureaucracy, which allowed greater flexibility. During the first wave of COVID-19 staffing numbers increased, resolving some pre-pandemic shortages: however, by October 2021 they declined markedly. Trying to maintain the quality and availability of services had marked negative consequences for personnel. Timely routine clinical and staffing data were not always available and personalised care and user and staff experiences were poorly captured.

CONCLUSIONS

The COVID-19 crisis magnified pre-pandemic problems and in particular, poor staffing levels. Maintaining services took a significant toll on staff wellbeing. There is some evidence that these pressures are continuing. There was marked variation in Trust responses. Lack of accessible and timely data at Trust and national levels hampered rapid insights. The ASPIRE COVID-19 framework could be useful for modelling the impact of future crises on routine care.

Family support, anger and aggression in health workers during the first wave of the pandemic

Introduction

Anger is considered as one of the basic human emotions, constituting the affective component of aggression. In the first year of the pandemic, the intense pressure on healthcare workers resulted in the deterioration of their psychosocial problems.

Objective

The aim of this study is to investigate the relationship between family support, anger, and aggression.

Methods

The present study included physicians and nurses who completed an online survey of Dimensions of Anger Reactions-5 (DAR-5), a Brief Aggression Questionnaire (BAQ) and a Family Support Scale (FSS). Before completing the questionnaires, participants were asked to state their gender, years of work, age, and profession.

Results

Fifty-three men and 190 women participated in the study. Almost one-third of the participants had a positive score on the DAR-5 scale. Male participants displayed lower DAR-5 scores compared to women. Female participants displayed lower FSS scores compared to men, but higher scores when compared with earlier measures. Regression showed that 15.2% of the variance in BAQ scores can be explained by DAR-5 scores, with an additional 3.8% explained by FSS scores, while an additional 2.3% is explained by years of working experience. Mediation analysis highlighted the role of family support as a negative mediator in the DAR-5 and BAQ relationship.

Conclusion

During the first year of the pandemic, there was an increase in the sense of family support among female health workers. One-third of the participants displayed increased anger scores. Family support acts as a mediator by preventing anger derailing into aggression. In healthcare worker support programs, it seems necessary to entail a specific section on anger management.

Major trauma presentations and patient outcomes in English hospitals during the COVID-19 pandemic: An observational cohort study

BACKGROUND

Single-centre studies suggest that successive Coronavirus Disease 2019 (COVID-19)-related "lockdown" restrictions in England may have led to significant changes in the characteristics of major trauma patients. There is also evidence from other countries that diversion of intensive care capacity and other healthcare resources to treating patients with COVID-19 may have impacted on outcomes for major trauma patients. We aimed to assess the impact of the COVID-19 pandemic on the number, characteristics, care pathways, and outcomes of major trauma patients presenting to hospitals in England.

METHODS AND FINDINGS

We completed an observational cohort study and interrupted time series analysis including all patients eligible for inclusion in England in the national clinical audit for major trauma presenting between 1 January 2017 and 31 of August 2021 (354,202 patients). Demographic characteristics (age, sex, physiology, and injury severity) and clinical pathways of major trauma patients in the first lockdown (17,510 patients) and second lockdown (38,262 patients) were compared to pre-COVID-19 periods in 2018 to 2019 (comparator period 1: 22,243 patients; comparator period 2: 18,099 patients). Discontinuities in trends for weekly estimated excess survival rate were estimated when lockdown measures were introduced using segmented linear regression. The first lockdown had a larger associated reduction in numbers of major trauma patients (-4,733 (21%)) compared to the pre-COVID period than the second lockdown (-2,754 (6.7%)). The largest reductions observed were in numbers of people injured in road traffic collisions excepting cyclists where numbers increased. During the second lockdown, there were increases in the numbers of people injured aged 65 and over (665 (3%)) and 85 and over (828 (9.3%)). In the second week of March 2020, there was a reduction in level of major trauma excess survival rate (-1.71%; 95% CI: -2.76% to -0.66%) associated with the first lockdown. This was followed by a weekly trend of improving survival until the lifting of restrictions in July 2020 (0.25; 95% CI: 0.14 to 0.35). Limitations include eligibility criteria for inclusion to the audit and COVID status of patients not being recorded.

CONCLUSIONS

This national evaluation of the impact of COVID on major trauma presentations to English hospitals has observed important public health findings: The large reduction in overall numbers injured has been primarily driven by reductions in road traffic collisions, while numbers of older people injured at home increased over the second lockdown. Future research is needed to better understand the initial reduction in likelihood of survival after major trauma observed with the implementation of the first lockdown.

Informal settlements, Covid-19 and sex workers in Kenya

This paper highlights the challenges faced by female sex workers living and working in the urban informal settlements in Nairobi, Kenya, during the Covid-19 outbreak and the aftermath of the pandemic. Using data collected through phone interviews during the immediate crisis, we document the experiences of urban poor sex workers, illustrating the acute problems they faced, including precarious housing with the reality of eviction and demolition. The paper highlights the ramifications of the Covid-19 crisis for the sex industry and predominantly women working within this informal, illegal economy. Through our empirical data we illustrate how the nature of selling sex has changed for sex workers in this context, increasing risks of violence including police abuses. We argue that examining the Covid-19 crisis through the lens of one the most marginalised populations graphically highlights how the pandemic has and will continue to deepen pre-existing structural urban inequalities and worsen public health outcomes among the urban poor. Sex worker communities are often located at the intersections of structural inequalities of gender, class, race and nation and the socio-spatial fragmentations of how they live make them some of the most vulnerable in society. We close with comments in relation to sexual citizenship, exclusionary state practices and the feminisation of urban poverty.

Intimate Partner Violence During COVID-19 Restrictions: A Study of 30 Countries From the I-SHARE Consortium

Intimate partner violence (IPV) causes substantial physical and psychological trauma. Restrictions introduced in response to the COVID-19 pandemic, including lockdowns and movement restrictions, may exacerbate IPV risk and reduce access to IPV support services. This cross-sectional study examines IPV during COVID-19 restrictions in 30 countries from the International Sexual HeAlth and REproductive Health (I-SHARE) study conducted from July 20th, 2020, to February, 15th, 2021. IPV was a primary outcome measure adapted from a World Health Organization multicountry survey. Mixed-effects modeling was used to determine IPV correlates among participants stratified by cohabitation status. The sample included 23,067 participants from 30 countries. A total of 1,070/15,336 (7.0%) participants stated that they experienced IPV during COVID-19 restrictions. A total of 1,486/15,336 (9.2%) participants stated that they had experienced either physical or sexual partner violence before the restrictions, which then decreased to 1,070 (7.0%) after the restrictions. In general, identifying as a sexual minority and experiencing greater economic vulnerability were associated with higher odds of experiencing IPV during COVID-19 restrictions, which were accentuated among participants who were living with their partners. Greater stringency of COVID-19 restrictions and living in urban or semi-urban areas were associated with lower odds of experiencing IPV in some settings. The I-SHARE data suggest a substantial burden of IPV during COVID-19 restrictions. However, the restrictions were correlated with reduced IPV in some settings. There is a need for investing in specific support systems for survivors of IPV during the implementation of restrictions designed to contain infectious disease outbreaks.

Professionals' Perspectives on the Effects of the COVID-19 Pandemic among Child and Adolescent Victims of Domestic Violence Living in the Portuguese Residential Foster Care System

The COVID-19 pandemic had several negative impacts on child and adolescent victims of domestic violence, especially on those who lived in the residential foster care system. The main goal of the present study was to understand these negative impacts through the perspectives of professionals in Portuguese residential foster care structures using both individual interviews and an online survey. One hundred and three professionals aged between 22 and 64 years (M = 38.39; SD = 8.34) participated in the online survey (86 females and 17 males). Of those, seven professionals, four females and three males aged between 29 and 49 years (M = 38.43, SD = 7.50), were also interviewed. According to the participants, the conditions imposed by the COVID-19 pandemic contributed adversely not only to the increase in domestic violence against children and adolescents but also to the aggravation of the conditions children and adolescents living in the Portuguese residential foster care system were exposed to, namely concerning family relationships, access to resources and services, and institutional dynamics. The results suggest the necessity to develop standard procedures to cope with pandemic situations in the residential foster care system.

Gender-based violence against women during the COVID-19 pandemic: recommendations for future

BACKGROUND

Gender-based violence (GBV) includes any physical, sexual, psychological, economic harms, and any suffering of women in the form of limiting their freedom in personal or social life. As a global crisis, COVID-19 has exposed women to more violence, which requires serious actions. This work aims to review the most critical dimensions of the GBV against women, effective factors on it, and strategies for combating it during the COVID-19 pandemic in order to provide recommendations for future pandemics.

METHODS

This study was conducted based on PRISMA-ScR. First, PubMed, Embase, Scopus, Web of Science, ProQuest, and Google Scholar were searched in April 2021 with no time limitation and location using the related keywords to COVID-19 and GBV. The searched keywords were COVID-19, gender-based violence, domestic violence, sexual violence, women, violence, abuse, and their synonyms in MESH and EMTREE. Duplicates were removed, titles and abstracts were screened, and then the characteristics and main results of included studies were recorded in the data collection form in terms of thematic content analysis.

RESULTS

A total of 6255 records were identified, of which 3433 were duplicates. Based on inclusion criteria 2822 titles and abstracts were screened. Finally, 14 studies were eligible for inclusion in this study. Most of these studies were conducted in the United States, the Netherlands, and Iran, mostly with interventional and qualitative methods.

CONCLUSIONS

Strengthening ICT infrastructure, providing comprehensive government policies and planning, government economic support, social support by national and international organizations should be considered by countries worldwide. It is suggested that countries provide sufficient ICT infrastructure, comprehensive policies and planning, economic support, social support by collaboration between national and international organizations, and healthcare supporting to manage incidence of GBV against women in future pandemics.

Experiencing Moral Distress Within the Intimate Partner Violence & Sexual Assault Workforce

Purpose

Moral distress (MD) refers to the psychological disequilibrium that emerges when institutional policies and/or practices conflict with an individual's professional values and ethics. MD has been interrogated frequently in health care and ancillary medical settings, and has been identified as a critical barrier to enhanced organizational climate and patient care. However, little work has investigated experiences of MD among members of the intimate partner violence (IPV) and sexual violence (SV) workforce.

Methods

This study investigates MD in a sample of IPV and SV service providers via secondary analysis of 33 qualitative interviews conducted with service providers in the summer and fall of 2020 as the COVID-19 pandemic response was unfolding.

Results

Qualitative content analysis revealed multiple overlapping vectors of MD experienced by IPV and SV service providers related to institutional resource constraints, providers working beyond their capacity and/or competency, shifting responsibilities within service agencies creating burdens among staff; and breakdowns in communication. Impacts of these experiences at individual, organizational, and client levels were identified by participants.

Conculsions

The study uncovers the need for further investigation of MD as a framework within the IPV/SV field, as well as potential lessons from similar service settings which could support IPV and SV agencies in addressing staff experiences of MD.

Environmental concerns and bioaccumulation of psychiatric drugs in water bodies - Conventional versus biocatalytic systems of mitigation

The COVID-19 pandemic has brought increments in market sales and prescription of medicines commonly used to treat mental health disorders, such as depression, anxiety, stress, and related problems. The increasing use of these drugs, named psychiatric drugs, has led to their persistence in aquatic systems (bioaccumulation), since they are recalcitrant to conventional physical and chemical treatments typically used in wastewater treatment plants. An emerging environmental concern caused by the bioaccumulation of psychiatric drugs has been attributed to the potential ecological and toxicological risk that these medicines might have over human health, animals, and plants. Thus, by the application of biocatalysis-assisted techniques, it is possible to efficiently remove psychiatric drugs from water. Biocatalysis, is a widely employed and highly efficient process implemented in the biotransformation of a wide range of contaminants, since it has important differences in terms of catalytic behavior, compared to common treatment techniques, including photodegradation, Fenton, and thermal treatments, among others. Moreover, it is noticed the importance to monitor transformation products of degradation and biodegradation, since according to the applied removal technique, different toxic transformation products have been reported to appear after the application of physical and chemical procedures. In addition, this work deals with the discussion of differences existing between high- and low-income countries, according to their environmental regulations regarding waste management policies, especially waste of the drug industry.