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The purposes of this study were to evaluate the extent of exposure, knowledge and attitudes of prehospital care providers (PCPs) and hospital care providers (HCPs) to elder abuse and neglect. A 20-question survey was designed to determine the providers' perception, knowledge and ability to identify patients that were potential victims of elder abuse and/or neglect. The surveys were distributed at four Maryland statewide conferences during 2006. A total of 645 surveys were distributed at the start of the individual conferences and 400 completed surveys were returned. Of the respondents, 272 (68.2%) were PCP (emergency medical services=EMSs) and 127 (31.8%) were HCP. During the past 12 months, 51.3% of those surveyed did not have reason to suspect any patients were exposed to abuse or neglect, although 60.5% admitted little or no contact with the elderly. In an attempt to determine respondent's ability to recognize potential abuse and neglect patients, scenario-type questions were used. Respondents believed a decubital ulcer (bedsore) was a positive indicator (83.5%) of abuse/neglect and 92.8% indicated that the elderly could suffer from injuries similar to "shaken-baby syndrome". When questioned about skin bruises as a possible indicator of abuse, only 69.3% of the respondents identified it as a possible sign of abuse. Seventy-one percent of respondents indicated that burns are not common in the elderly and could be another sign of elder abuse. One-in-three providers indicated they would suspect other reasons (dementia, depression, etc.) for the report of a sexual assault in an elderly patient. Eighty-nine percent of providers were aware that healthcare providers in the State of Maryland are required to report suspected elder and vulnerable patient abuse and/or neglect to law enforcement or social services' agencies. When asked to define elder abuse as a medical or social problem, 25.0% of providers stated that it was a social problem. Over 95% of the providers suspected the existence of abuse, neglect and domestic violence among the elderly were not rare events. In Maryland, there are a limited number of specific educational programs dealing with abuse and neglect of the elderly. A statewide training program is needed to ensure PCP and HCP can recognize the signs and symptoms of elder abuse and neglect, and to ensure that the providers are aware of their legal requirements for reporting the abuse to the proper state or local agencies.
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PMID:Recognition and perception of elder abuse by prehospital and hospital-based care providers. 1816 Jan 15

This article describes the experiences with depression of women with young children living in ethnically and culturally diverse, low-income communities. A qualitative ethnographic design using a focus group process was implemented in 15 communities. Despite great diversity in ethnic and cultural backgrounds, these women of color reported similar experiences with depression and described: a range of social risk factors, including domestic violence, isolation, language barriers, and difficulties with schools and other public systems; lack of access to high quality, culturally competent health and mental health services; reliance primarily on informal systems of care--relatives, friends, peers--in dealing with their depression, although many also reported good relationships with primary care practitioners. They identified: the specialty mental health sector as one to which they seldom turned for assistance, citing stigma, lack of insurance coverage, cultural beliefs, and attitudes of providers as barriers; a number of strategies for outreach and engagement with mental health providers; qualitative measures of maternal depression among women with young children; and, strategies for reaching and engaging culturally diverse mothers.
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PMID:Depression among low-income women of color: qualitative findings from cross-cultural focus groups. 1823 57

Limited data exist on the unique, additive, and interactive effects of exposure to domestic and community violence on children's functioning, particularly in community samples. This study examined relations between children's violence exposure, at home and in the community, and symptoms of externalizing and internalizing problems. Parents reported on domestic violence in the home, and children reported on community violence. Concurrent child functioning was measured through parent and teacher reports on the Child Behavior Checklist (CBCL) and child self-reports on the Children's Depression Inventory. A multi-ethnic sample of 117 children, aged 8 to 12 years, and their parents and teachers participated. Community violence was related to all measures of children's adjustment, whereas exposure to domestic violence was related only to CBCL externalizing problems. Teacher reports of child aggression were predicted by child age, community violence, and the interaction of community and domestic violence. Implications for research and clinical intervention are discussed.
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PMID:Exposure to domestic and community violence in a nonrisk sample: associations with child functioning. 1827 24

Researchers have shown that mood and sense of control over one's life are significantly affected by testimony and other forms of disclosure and that learning to control breathing has positive effects on mood and anxiety. This preliminary experiment tests whether African American and European American abused women who give testimony about their experiences of intimate partner violence and learn how to use yogic breathing techniques have reduced feelings of depression. Results indicate that learning yogic breathing techniques alone and combined with giving testimony significantly reduces feelings of depression. Recasting women as authorities on domestic violence and teaching them how to calm their minds by focusing on yogic breathing may be simple and effective ways to help women take control over their bodies and lives.
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PMID:A preliminary investigation of the effects of giving testimony and learning yogic breathing techniques on battered women's feelings of depression. 1831 69

This paper advances conceptualization of maternal distress following incarceration. We utilized a multiple case study methodology based on interviews with 10 mothers who demonstrated various permutations of "the triple threat" (depression, domestic violence, and substance abuse; Arditti & Few, 2006). Findings suggest that depressive symptomology persisted and worsened for mothers in our study and that maternal distress was indicative not only of women's psychological state, but also a relational and situational construct that embodied women's core experience. Maternal distress was largely characterized by health challenges, dysfunctional intimate relationships, loss related trauma, guilt and worry over children, and economic inadequacy. Further, maternal distress seemed to be intensified by the punitive traumatic context of prison and lessened by rehabilitation opportunities as well as support by kin and probation officers after reentry. Recommendations for clinicians and professionals who work with reentry mothers center around the need to alleviate maternal distress and better address women's emotional and physical health needs during incarceration and reentry.
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PMID:Maternal distress and women's reentry into family and community life. 1883 9

Hundreds of thousands of Darfur people affected by the Sudanese genocide have fled to Cairo, Egypt, in search of assistance. Collaborating with Africa and Middle East Refugee Assistance (AMERA), the authors conducted a mental health care needs assessment among Darfur refugees in Cairo. Information was collected using individual and focus group interviews to identify gaps in mental health care and develop understandings of emotional and relationship problems. The refugee mental health care system has a piecemeal structure with gaps in outpatient services. There is moderate to severe emotional distress among many Darfur refugees, including symptoms of depression and trauma, and interpersonal conflict, both domestic violence and broader community conflict, elevated relative to pregenocide levels. Given the established relationships between symptoms of depression/traumatic stress and interpersonal violence, improving mental health is important for both preventing mental health decompensation and stemming future cycles of intra- and intergroup conflict.
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PMID:Darfur refugees in Cairo: mental health and interpersonal conflict in the aftermath of genocide. 1894 17

Violence against women is a global phenomenon that cuts across all social and economic classes, it has recently drawn attention in the medical field as a leading cause of preventable morbidity and mortality. The present study was carried out to estimate the prevalence of domestic violence, to identify socio-demographic and behavioral risk factors and to investigate the relationship between the women's psychological health status and violence exposure. This is a comparative cross-sectional study using a multistage random sampling technique. The sample comprised 500 women aged 18-50y. Data was collected via a structured interview questionnaire including the socio-demographic characteristics of the women and their husbands, some of the husbands' habits, attitude and history of chronic illnesses. Also, the questionnaire assesses different forms of domestic violence, women's reaction to it and its consequences on psychological well-being of women. A depression anxiety scale was used to assess the women's psychological status. The study revealed that the overall prevalence of domestic violence among the studied group was (62.2%); the commonest form (74.0%) was psychological abuse, followed by social (26.8%) one, then the physical (22.4%) and lastly sexual abuse (19.6%). On studying the socio-demographic variables, a significantly higher percentage of younger ( pound 30 years) non-educated, low income and those having any property ownership were more exposed to violence. Also exposure to abuse was more prevalent among women whose husbands were young, non-educated, skilled workers, drug abuser, with positive history of family troubles and chronic illness. The majority of women reported that they react to violence by crying loudly or screaming, while a minority may seek medical care or call the police. Regarding the psychological effect of violence exposure, the most common effects were anxiety (69.2%) and depression (52.2%), with a highly statistically significant difference with exposure in every form of domestic violence. Conclusion & Recommendations: The overall prevalence of domestic violence was relatively high and was predominantly of the psychological form. Women abuse had serious health effects on the women's health mainly her psychological well being. The study recommends practicing compulsory pre-marital counseling and offering health educational sessions in schools, universities and health units to all expected couples about marital and family life and provision of routine screening for domestic violence in primary care.
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PMID:Determinants and health consequences of domestic violence among women in reproductive age at zagazig district, egypt. 1899 5

The Child Depression Inventory (CDI), a self-report instrument that measures depressive symptomatology in children, has been shown to have adequate construct validity (Kovacs, 1983, 1992). However, limited research has been conducted with minority children and adolescents. In the present study, the construct validity of the Spanish-language version of the Child Depression Inventory (CDI-S) ages 8-12 years (N = 100). The CDI was developed by Maria Kovacs (1992) and has been a widely used instrument for screening depression in children. Fifty of the children had witnessed domestic violence (secondary victims of domestic violence) and received psychological services for victims of domestic violence, and fifty had not witnessed domestic violence. To identify the group of non-victims of domestic violence, their mothers completed the Conflict Tactic Scale (CIS). The CDI is a self-report instrument used to measure symptoms of depression. A confirmatory factor analysis was performed including the 27 items that make up the instrument, using principal component analysis as the extraction method and Varimax rotations. This analysis revealed that the CDI measures five dimensions of depression in the child. However, differences were found in the factor structure of the Spanish CDI when compared with the original version. Additionally, its internal consistency was documented.
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PMID:Psychometric properties of the Spanish-language child depression inventory with Hispanic children who are secondary victims of domestic violence. 1943 71

Individual and family characteristics that predict resilience among children exposed to domestic violence (DV) were examined. Mother-child dyads (n = 190) were assessed when the children were 2, 3, and 4 years of age. DV-exposed children were 3.7 times more likely than nonexposed children to develop internalizing or externalizing problems. However, 54% of DV-exposed children maintained positive adaptation and were characterized by easy temperament (odds ratio [OR] = .39, d = .52) and nondepressed mothers (OR = 1.14, d = .07), as compared to their nonresilient counterparts. Chronic DV was associated with maternal depression, difficult child temperament, and internalizing or externalizing symptoms. Results underscore heterogeneous outcomes among DV-exposed children and the influence of individual and family characteristics on children's adaptation.
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PMID:Resilience among children exposed to domestic violence: the role of risk and protective factors. 1946 11

The education of physical therapists must prepare them for autonomous practice providing culturally appropriate care. Models are available to guide curricular changes for cultural competence but little is available on methods to assess the outcomes. This article describes two methods to measure outcomes of cultural competence instruction in physical therapy education. These methods are the integrated standardised patient examination (ISPE) and a refugee screening program. These outcomes will determine how cultural curricular changes will drive student learning. The ISPE assesses cultural competence in a simulated clinical setting, utilising standardised patients (SP), who are trained lay people, to portray particular medical conditions. Patient concerns such as depression, anger, silence, cultural barriers, signs of domestic violence, etc. that students may not be exposed to in clinical experiences can be portrayed in the ISPE and assessed against defined standards of cultural competence. A refugee screening programme allows students to practice culturally appropriate care and measures outcomes of the cultural curriculum. Students meet with recent refugees while using a translator to obtain a health history and complete a systems review. Students discuss the results of their screening and make recommendations to the refugee and the primary physician. Students complete a debriefing questionnaire about the experience and their academic preparation.
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PMID:Beginning with the end in mind: evaluating outcomes of cultural competence instruction in a doctor of physical therapy programme. 1947 32


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