Experiences of violence during the COVID-19 pandemic among people who use drugs in a Canadian setting: a gender-based cross-sectional study.

OBJECTIVES: People who use drugs (PWUD) experience disproportionately high rates of violent victimization. Emerging research has demonstrated that the COVID-19 pandemic has exacerbated violence against some priority populations (e.g., women), however there is limited research examining the impact of the pandemic on the experiences of violence of PWUD. METHODS: Using data collected between July and November 2020 from three prospective cohort studies of PWUD in Vancouver, Canada, we employed multivariable logistic regression stratified by gender to identify factors associated with recent experiences of violence, including the receipt of COVID-19 emergency income support. RESULTS: In total, 77 (17.3%) of 446 men, and 54 (18.8%) of 288 women experienced violence in the previous six months. Further, 33% of men and 48% of women who experienced violence reported that their experience of violence was intensified since the COVID-19 pandemic began. In the multivariable analyses, sex work (Adjusted Odds Ratio [AOR] = 2.15, 95% confidence interval [CI]: 1.06-4.35) and moderate to severe anxiety or depression (AOR = 3.00, 95% CI: 1.37-6.57) were associated with experiencing violence among women. Among men, drug dealing (AOR = 1.93, 95%CI: 1.10-3.38), street-based income sources (AOR = 1.93, 95%CI: 1.10-3.38), homelessness (AOR = 2.54, 95%CI: 1.40-4.62), and regular employment (AOR = 2.97, 95% CI: 1.75-5.04) were associated with experiencing violence. CONCLUSION: Our study results suggest economic conditions and gender were major factors associated with experiencing violence among our sample of PWUD during COVID-19. These findings highlight criminalization of drug use and widespread socioeconomic challenges as barriers to addressing violence among PWUD during periods of crisis.

Inter(national) recommendations to face violence against women and girls in COVID-19 pandemic. / Recomendações inter(nacionais) para enfrentamento a violências contra mulheres e meninas na pandemia de COVID-19.

This article is an integral part of the research "Violence in the context of COVID-19: global challenges and vulnerabilities", which proposes a critical reflection on situations of gender-based violence increased by social distancing protocols, required by the COVID-19 pandemic. Based on a 2020 literature survey, we have analyzed recommendations made by researchers and institutions from different countries around the world, with the aim of systematizing and disseminating strategies to deal with this scenario. The material is organized into two thematic areas, namely: gender policies and intersectoral actions; and strategies to face violence against women and children in the health and social work field. The recommendations are focused on the development of actions by States/governments, service networks and society in general. Part of the recommendations suggest increasing or adapting existing surveillance actions and part of them contribute with creative proposals, guiding promotional and preventive actions at an individual and collective level. The adoption of teleassistance, media campaigns raising awareness that violence is unjustifiable and the development of reporting strategies through signs and codes have been reiterated in the literature.

Este artigo é parte da pesquisa "As violências no contexto da COVID-19: desafios e vulnerabilidades globais", que propõe uma reflexão crítica acerca das situações de violências de gênero potencializadas pelos protocolos de distanciamento social requeridos pela pandemia de COVID-19. A partir de levantamento bibliográfico do ano de 2020, analisamos recomendações de pesquisadores e instituições de diferentes partes do mundo, com o objetivo de sistematizar e disseminar estratégias para lidar com este cenário. O material está organizado em dois eixos temáticos: políticas de gênero e ações intersetoriais; e estratégias de enfrentamento às violências contra mulheres e crianças no campo da saúde e da assistência social. As recomendações estão centradas no desenvolvimento de ações por Estados/governos, redes de atendimento e sociedade em geral. Parte das recomendações sugere aumentar ou adequar as ações de vigilância já existentes, e parte contribui com propostas criativas, norteando ações promotoras e preventivas em nível individual e coletivo. A adoção de teleatendimento, campanhas midiáticas de conscientização de que a violência é injustificável e desenvolvimento de estratégias de denúncia por meio de sinais e códigos foram reiteradas pela literatura.

Predictive care: a protocol for a computational ethnographic approach to building fair models of inpatient violence in emergency psychiatry.

INTRODUCTION: Managing violence or aggression is an ongoing challenge in emergency psychiatry. Many patients identified as being at risk do not go on to become violent or aggressive. Efforts to automate the assessment of risk involve training machine learning (ML) models on data from electronic health records (EHRs) to predict these behaviours. However, no studies to date have examined which patient groups may be over-represented in false positive predictions, despite evidence of social and clinical biases that may lead to higher perceptions of risk in patients defined by intersecting features (eg, race, gender). Because risk assessment can impact psychiatric care (eg, via coercive measures, such as restraints), it is unclear which patients might be underserved or harmed by the application of ML. METHODS AND ANALYSIS: We pilot a computational ethnography to study how the integration of ML into risk assessment might impact acute psychiatric care, with a focus on how EHR data is compiled and used to predict a risk of violence or aggression. Our objectives include: (1) evaluating an ML model trained on psychiatric EHRs to predict violent or aggressive incidents for intersectional bias; and (2) completing participant observation and qualitative interviews in an emergency psychiatric setting to explore how social, clinical and structural biases are encoded in the training data. Our overall aim is to study the impact of ML applications in acute psychiatry on marginalised and underserved patient groups. ETHICS AND DISSEMINATION: The project was approved by the research ethics board at The Centre for Addiction and Mental Health (053/2021). Study findings will be presented in peer-reviewed journals, conferences and shared with service users and providers.

Ethical reporting of research on violence against women and children: a review of current practice and recommendations for future guidelines.

Changes in research practice during the COVID-19 pandemic necessitates renewed attention to ethical protocols and reporting for data collection on sensitive topics. This review summarises the state of ethical reporting among studies collecting violence data during early stages of the pandemic. We systematically searched for journal publications from the start of the pandemic to November 2021, identifying 75 studies that collected primary data on violence against women and/or violence against children. We developed and applied a 14-item checklist of best practices to assess the transparency of ethics reporting and adherence to relevant global guidelines on violence research. Studies reported adhering to best practices on 31% of scored items. Reporting was highest for ethical clearance (87%) and informed consent/assent (84/83%) and lowest for whether measures to promote interviewer safety and support (3%), for facilitating referrals for minors and soliciting participant feedback were in place (both 0%). Violence studies employing primary data collection during COVID-19 reported on few ethical standards, obscuring stakeholder ability to enforce a 'do no harm' approach and to assess the reliability of findings. We offer recommendations and guidelines to improve future reporting and implementation of ethics within violence studies.

Conducting Violence and Mental Health Research with Female Sex Workers during the COVID-19 Pandemic: Ethical Considerations, Challenges, and Lessons Learned from the Maisha Fiti Study in Nairobi, Kenya.

Conducting violence and mental health research during the COVID-19 pandemic with vulnerable groups such as female sex workers (FSWs) required care to ensure that participants and the research team were not harmed. Potential risks and harm avoidance needed to be considered as well as ensuring data reliability. In March 2020, COVID-19 restrictions were imposed in Kenya during follow-up data collection for the Maisha Fiti study (n = 1003); hence data collection was paused. In June 2020, the study clinic was re-opened after consultations with violence and mental health experts and the FSW community. Between June 2020 and January 2021, data were collected in person and remotely following ethical procedures. A total of 885/1003 (88.2%) FSWs participated in the follow-up behavioural-biological survey and 47/47 (100%) participated in the qualitative in-depth interviews. A total of 26/885 (2.9%) quantitative surveys and 3/47 (6.4%) qualitative interviews were conducted remotely. Researching sensitive topics like sex work, violence, and mental health must guarantee study participants' safety and privacy. Collecting data at the height of COVID-19 was crucial in understanding the relationships between the COVID-19 pandemic, violence against women, and mental health. Relationships established with study participants during the baseline survey-before the pandemic-enabled us to complete data collection. In this paper, we discuss key issues involved in undertaking violence and mental health research with a vulnerable population such as FSWs during a pandemic. Lessons learned could be useful to others researching sensitive topics such as violence and mental health with vulnerable populations.

Violence against healthcare workers in the middle of a global health crisis: what is it about policy and what to learn from international comparison?

Introduction: Violence against healthcare workers is a global health problem threatening healthcare workforce retention and health system resilience in a fragile post-COVID 'normalisation' period. In this perspective article, we argue that violence against healthcare workers must be made a greater priority. Our novel contribution to the debate is a comparative health system and policy approach. Methods: We have chosen a most different systems comparative approach concerning the epidemiological, political, and geographic contexts. Brazil (under the Bolsonaro government) and the United Kingdom (under the Johnson government) serve as examples of countries that were strongly hit by the pandemic in epidemiological terms while also displaying policy failures. New Zealand and Germany represent the opposite. A rapid assessment was undertaken based on secondary sources and country expertise. Results: We found similar problems across countries. A global crisis makes healthcare workers vulnerable to violence. Furthermore, insufficient data and monitoring hamper effective prevention, and lack of attention may threaten women, the nursing profession, and migrant/minority groups the most. There were also relevant differences. No clear health system pattern can be identified. At the same time, professional associations and partly the media are strong policy actors against violence. Conclusion: In all countries, muchmore involvement from political leadership is needed. In addition, attention to the political dimension and all forms of violence are essential.

Caring Knowledge as a Strategy to Mitigate Violence against Nurses: A Discussion Paper.

Violence against nurses is a disturbing trend in healthcare that has reached epidemic proportions globally. These violent incidents can result in physical and psychological injury, exacerbating already elevated levels of stress and burnout among nurses, further contributing to absenteeism, turnover, and intent to leave the profession. To ensure the physical and mental well-being of nurses and patients, attention to the development of strategies to reduce violence against nurses must be a priority. Caring knowledge-rooted in the philosophy of care-is a potential strategy for mitigating violence against nurses in healthcare settings. We present what caring knowledge is, analyze its barriers to implementation at the health system and education levels and explore potential solutions to navigate those barriers. We conclude how the application of models of caring knowledge to the nurse-patient relationship has the potential to generate improved patient safety and increased satisfaction for both nurses and patients.

Challenges, Successes, and the Future of Firearm Injury Prevention.

Policy Points Firearm injury is a leading cause of death in the United States, with fatality rates increasing 34.9% over the past decade (2010-2020). Firearm injury is preventable through multifaceted evidence-based approaches. Reviewing past challenges and successes in the field of firearm injury prevention can highlight the future directions needed in the field. Adequate funding, rigorous and comprehensive data availability and access, larger pools of diverse and scientifically trained researchers and practitioners, robust evidence-based programming and policy implementation, and a reduction in stigma, polarization, and politicization of the science are all needed to move the field forward.

Surveillance for Violent Deaths - National Violent Death Reporting System, 48 States, the District of Columbia, and Puerto Rico, 2020.

Problem/Condition: In 2020, approximately 71,000 persons died of violence-related injuries in the United States. This report summarizes data from CDC's National Violent Death Reporting System (NVDRS) on violent deaths that occurred in 48 states, the District of Columbia, and Puerto Rico in 2020. Results are reported by sex, age group, race and ethnicity, method of injury, type of location where the injury occurred, circumstances of injury, and other selected characteristics. Period Covered: 2020. Description of System: NVDRS collects data regarding violent deaths obtained from death certificates, coroner and medical examiner records, and law enforcement reports. This report includes data collected for violent deaths that occurred in 2020. Data were collected from 48 states (all states with exception of Florida and Hawaii), the District of Columbia, and Puerto Rico. Forty-six states had statewide data, two additional states had data from counties representing a subset of their population (35 California counties, representing 71% of its population, and four Texas counties, representing 39% of its population), and the District of Columbia and Puerto Rico had jurisdiction-wide data. NVDRS collates information for each violent death and links deaths that are related (e.g., multiple homicides, homicide followed by suicide, or multiple suicides) into a single incident. Results: For 2020, NVDRS collected information on 64,388 fatal incidents involving 66,017 deaths that occurred in 48 states (46 states collecting statewide data, 35 California counties, and four Texas counties), and the District of Columbia. In addition, information was collected for 729 fatal incidents involving 790 deaths in Puerto Rico. Data for Puerto Rico were analyzed separately. Of the 66,017 deaths, the majority (58.4%) were suicides, followed by homicides (31.3%), deaths of undetermined intent (8.2%), legal intervention deaths (1.3%) (i.e., deaths caused by law enforcement and other persons with legal authority to use deadly force acting in the line of duty, excluding legal executions), and unintentional firearm deaths (<1.0%). The term "legal intervention" is a classification incorporated into the International Classification of Diseases, Tenth Revision, and does not denote the lawfulness or legality of the circumstances surrounding a death caused by law enforcement.Demographic patterns and circumstances varied by manner of death. The suicide rate was higher for males than for females. Across all age groups, the suicide rate was highest among adults aged ≥85 years. In addition, non-Hispanic American Indian or Alaska Native (AI/AN) persons had the highest suicide rates among all racial and ethnic groups. Among both males and females, the most common method of injury for suicide was a firearm. Among all suicide victims, when circumstances were known, suicide was most often preceded by a mental health, intimate partner, or physical health problem or by a recent or impending crisis during the previous or upcoming 2 weeks. The homicide rate was higher for males than for females. Among all homicide victims, the homicide rate was highest among persons aged 20-24 years compared with other age groups. Non-Hispanic Black (Black) males experienced the highest homicide rate of any racial or ethnic group. Among all homicide victims, the most common method of injury was a firearm. When the relationship between a homicide victim and a suspect was known, the suspect was most frequently an acquaintance or friend for male victims and a current or former intimate partner for female victims. Homicide most often was precipitated by an argument or conflict, occurred in conjunction with another crime, or, for female victims, was related to intimate partner violence. Nearly all victims of legal intervention deaths were male, and the legal intervention death rate was highest among men aged 35-44 years. The legal intervention death rate was highest among AI/AN males, followed by Black males. A firearm was used in the majority of legal intervention deaths. When a specific type of crime was known to have precipitated a legal intervention death, the type of crime was most frequently assault or homicide. When circumstances were known, the three most frequent circumstances reported for legal intervention deaths were as follows: the victim's death was precipitated by another crime, the victim used a weapon in the incident, and the victim had a substance use problem (other than alcohol use).Other causes of death included unintentional firearm deaths and deaths of undetermined intent. Unintentional firearm deaths were most frequently experienced by males, non-Hispanic White (White) persons, and persons aged 15-24 years. These deaths most frequently occurred while the shooter was playing with a firearm and were precipitated by a person unintentionally pulling the trigger. The rate of deaths of undetermined intent was highest among males, particularly among AI/AN and Black males, and among adults aged 30-54 years. Poisoning was the most common method of injury in deaths of undetermined intent, and opioids were detected in nearly 80% of decedents tested for those substances. Interpretation: This report provides a detailed summary of data from NVDRS on violent deaths that occurred in 2020. The suicide rate was highest among AI/AN and White males, whereas the homicide rate was highest among Black male victims. Intimate partner violence precipitated a large proportion of homicides for females. Mental health problems, intimate partner problems, interpersonal conflicts, and acute life stressors were primary circumstances for multiple types of violent death. Public Health Action: Violence is preventable, and states and communities can use data to guide public health action. NVDRS data are used to monitor the occurrence of violence-related fatal injuries and assist public health authorities in developing, implementing, and evaluating programs, policies, and practices to reduce and prevent violent deaths. For example, the Colorado Violent Death Reporting System (VDRS), Kentucky VDRS, and Oregon VDRS have used their VDRS data to guide suicide prevention efforts and generate reports highlighting where additional focus is needed. In Colorado, VDRS data were used to examine the increased risk for suicide among first and last responders in the state. Kentucky VDRS used local data to highlight how psychological and social effects of the COVID-19 pandemic might increase risk for suicide, particularly among vulnerable populations. Oregon VDRS used their data to develop a publicly available data dashboard displaying firearm mortality trends and rates in support of the state's firearm safety campaign. Similarly, states participating in NVDRS have used their VDRS data to examine homicide in their state. Illinois VDRS, for example, found that state budget cuts were associated with notable increases in homicides among youths in Chicago. With an increase of participating states and jurisdictions, this report marks progress toward providing nationally representative data.

Continuities, discontinuities and transformations in the psychotherapy of a psychotic adolescent during the time of coronavirus.

The author describes the evolution of the psychotherapy of a psychotic adolescent in the period when the pandemic induced their national authorities to impose lockdown. The difficulty of coming to terms with an ever-present reality that proved to be distressing for both the patient and the analyst, as well as with the violence and rapidity with which the external situation developed, leading to a change in the therapy setting, are at the heart of the reflections in this paper. The "choice" of whether to continue the sessions over the phone determined the emergence of some distinctive issues related to discontinuity and to the impossibility of relying on visual perception. However, to the analyst's surprise, it also favoured the possibility of working through the meaning of some autistic mental areas which, up to that moment, had never really been accessible to verbalization. Questioning the meaning of these changes, the author develops a broader reflection about the way that, for analysts and patients, modifications in the frames of our daily lives and clinical practice have enabled the deployment of undifferentiated parts of the personality which had previously been secretly deposited in the "body" of the setting and therefore were inaccessible.

Analysis of primary care of victims of interpersonal and self inflicted violence during the COVID-19 pandemic.

OBJECTIVES: to analyze the epidemiological profile of aggression victims admitted at the emergency room on a trauma hospital during the COVID-19 pandemic, to compare these data in different restriction periods and with prepandemic data from the same service. METHODS: cross-sectional study with probabilistic sampling using medical records of patients who were victims of aggression admitted at the hospital between June 2020 and May 2021. In addition to the epidemiological variables, other variables collected were the current restriction level, mechanism of aggression, resulting injuries and the Revised Trauma Score (RTS). The data was compared between the three restriction levels and the proportion of attendances during the study period was compared with the pre-pandemic study (December 2016 to February 2018). RESULTS: the average age was 35.5 years, 86.1% of the patients were male and 61.6% of the attendances were due to blunt injury. The highest average of attendances per day occurred during the "yellow" restriction level (2.9), however there was no significant difference when comparing the restriction periods two by two. There was also no significant difference either in the analysis of the standardized residuals of the proportions of aggressions or the mechanism of aggression in the pre-pandemic and pandemic periods. CONCLUSIONS: there was a predominance of attendances due to blunt trauma and in young male patients. There was no significant difference between the average daily attendance for aggression during the three restriction levels and between the proportion of attendances in the pre-pandemic and pandemic period.

Confronting situations of violence against children and adolescents from the perspective of Guardianship Counselors.

OBJECTIVE: To describe the potentialities and limits in confronting situations of violence against children and adolescents seen from the perspective of Guardianship Counselors. METHOD: Qualitative research, developed with 18 Guardianship Counselors from two municipalities in the central region of the State of Rio Grande do Sul, Brazil. Data were generated between June and July 2021, using the focus group technique, and were subjected to thematic content analysis. RESULTS: The following were identified as potentialities for combating violence against children and adolescents: denunciations; networking; and media coverage. As limits, we have: naturalization of violence; pandemic of the Covid-19; de-structuring of the intersectoral network; lack of training; and difficulty in developing preventive actions. CONCLUSION: The Guardianship Councilors require training to act in cases of violence against children and adolescents, as well as support from other sectors, such as health, education, public safety, and social assistance, in order to fully attend to these cases.

Violence and quality of life of women socially isolated due to COVID-19: a cross-sectional study / Violência e qualidade de vida de mulheres isoladas socialmente por COVID-19: estudo transversal / Violencia y calidad de vida de mujeres en aislamiento social por COVID-19: un estudio transversal

OBJETIVO: avaliar a relação entre a violência e a qualidade de vida de mulheres isoladas socialmente em decorrência da COVID-19. MÉTODO: estudo transversal, quantitativo, desenvolvido em Campina Grande ­ PB, Brasil. A amostra constituiu-se de mulheres maiores de 18 anos, em isolamento social pela COVID-19. Utilizaram-se três instrumentos para coleta de dados, estes analisados por meio de estatística descritiva e inferencial, sendo adotado significância p<0,05. RESULTADOS: houve predominância de mulheres com baixa qualidade de vida (53,1%) e vítimas de violência psicológica (61,1%). A relação da violência física, psicológica e geral apresentou significância estatística entre todos os domínios de qualidade de vida nos testes de correlação de Spearman (p<0,05) e de comparação de Mann Whitney (p<0,05). CONCLUSÃO: o desfecho da violência física e psicológica relaciona-se de forma negativa nos aspectos físicos, psicológicos, relações sociais e meio ambiente da qualidade de vida de mulheres isoladas socialmente em decorrência da COVID-19.

OBJECTIVE: to assess the relationship between violence and the quality of life of women socially isolated due to COVID-19. METHOD: a cross-sectional, quantitative study was developed in Campina Grande ­ PB, Brazil. The sample comprised women over 18 years in social isolation due to COVID-19. Three instruments were used for data collection, and descriptive and inferential analyses were carried out, with a significance of p<0.05. RESULTS: there was a predominance of women with low quality of life (53.1%) and victims of psychological violence (61.1%). The relationship between physical, psychological, and general violence achieved statistical significance in all quality of life domains in the Spearman correlation test (p<0.05) and the Mann-Whitney test (p<0.05). CONCLUSION: the outcome of physical and psychological violence is negatively related to the physical, psychological, social relationships, and environmental aspects of the quality of life of women socially isolated due to COVID-19.

OBJETIVO: evaluar la relación entre violencia y calidad de vida de mujeres en aislamiento social a causa del COVID-19. MÉTODO: estudio transversal, cuantitativo, desarrollado en Campina Grande ­ PB, Brasil. La muestra estuvo compuesta por mujeres mayores de 18 años en aislamiento social a causa del COVID-19. Se utilizaron tres instrumentos para recolección de datos y se realizaron análisis descriptivos e inferenciales, con una significancia de p<0,05. RESULTADOS: hubo predominio de mujeres con baja calidad de vida (53,1%) y víctimas de violencia psicológica (61,1%). La relación entre violencia física, psicológica y general alcanzó significación estadística en todos los dominios de calidad de vida en la prueba de correlación de Spearman (p<0,05) y la prueba de Mann-Whitney (p<0,05). CONCLUSIÓN: el resultado de la violencia física y psicológica se relaciona negativamente con aspectos físicos, psicológicos, de relaciones sociales y ambientales de calidad de vida de mujeres en aislamiento social a causa del COVID-19.

Mental health concerns during the COVID-19 pandemic as revealed by helpline calls.

Mental health is an important component of public health, especially in times of crisis. However, monitoring public mental health is difficult because data are often patchy and low-frequency1-3. Here we complement established approaches by using data from helplines, which offer a real-time measure of 'revealed' distress and mental health concerns across a range of topics4-9. We collected data on 8 million calls from 19 countries, focusing on the COVID-19 crisis. Call volumes peaked six weeks after the initial outbreak, at 35% above pre-pandemic levels. The increase was driven mainly by fear (including fear of infection), loneliness and, later in the pandemic, concerns about physical health. Relationship issues, economic problems, violence and suicidal ideation, however, were less prevalent than before the pandemic. This pattern was apparent both during the first wave and during subsequent COVID-19 waves. Issues linked directly to the pandemic therefore seem to have replaced rather than exacerbated underlying anxieties. Conditional on infection rates, suicide-related calls increased when containment policies became more stringent and decreased when income support was extended. This implies that financial relief can allay the distress triggered by lockdown measures and illustrates the insights that can be gleaned from the statistical analysis of helpline data.

The time is now: advancing shared risk and protective factor approaches to injury and violence prevention.

Using a shared risk and protective factor (SRPF) approach to prevention acknowledges a shift in the ways we work. The fundamental question at the root of our efforts should no longer be how we address a single, specific public health issue. Instead, we should be asking how we can develop a system that supports well-being holistically. We should be striving to increase the resources to which people have access in a way that proactively prevents multiple public health issues, improves the context in which people live out their lives, and develops a broad spectrum of resilience.The fields of injury and violence prevention (IVP) and public health are at a critical juncture to address the true causes of injuries and violence. It is imminently vital for all stakeholders across IVP to work upstream and align funding, interventions, and evaluations in ways that embrace SRPF approaches. The value of this approach is multifold: it tackles multiple population health outcomes through multisector interventions, it positively impacts social determinants of health; it is sustainable and it maximises financial resources. While theoretical buy-in for the SRPF approach is high, there remain challenges in the field to operationalise such an approach. The time is now for the field to collectively embrace an SRPF approach and rally together to strengthen the evidence base. Researchers, practitioners, funders and national organisations must align their goals in prioritising upstream, primary prevention through addressing SRPF to enhance public health infrastructure and reduce societal inequities.

Violence against health care workers in rural areas of Sindh, Pakistan.

OBJECTIVE: To determine the magnitude of violence against healthcare workers in a rural setting, and the consequences of this violence on their personal and professional lives. METHODS: The descriptive, quantitative, cross-sectional study was conducted in 4 rural districts of the Sindh province of Pakistan from February to December 2019, and comprised healthcare workers, including doctors, nurses, support staff and field workers. Data was collected using a structured questionnaire. Data was analysed using SPSS 22. RESULTS: Of the 1622 subjects, 929(57.3%) were males and 693(42.7%) were females. The overall mean age was 35.55+/-10.05 years. The largest cluster was that of doctors 396(24.4%), followed by technicians 202(12.5%). Overall, 522(32.2%) subjects had a professional experience of 1-5 years. Violence at workplace in any form was experienced by 693(42.7%) subjects. Verbal violence had been experienced by 396(24.4%) subjects, while 228(14.1%) had witnessed it. The corresponding numbers for physical violence were 122(7.5%) and 22(1.4%). Verbal violence was more prevalent compared to physical violence (p<0.01). The major effect was that the healthcare workers remained alert 537(33.1%), felt frustrated 524(32.3%) and disturbed 503(31%). Also, 272(16.8%) subjects were planning to migrate or quit the profession. CONCLUSIONS: Violence was found to be a significant issue in rural Sindh.

Improving family functioning and reducing violence in the home in North Kivu, Democratic Republic of Congo: a pilot cluster-randomised controlled trial of Safe at Home.

OBJECTIVE: To test the effectiveness of the Safe at Home programme which was developed to improve family well-being and prevent multiple forms of violence in the home. DESIGN: Waitlisted pilot cluster randomised controlled trial. SETTING: North Kivu, Democratic Republic of Congo. PARTICIPANTS: 202 heterosexual couples. INTERVENTION: The Safe at Home programme. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was family functioning, with secondary outcomes of past-3 month co-occurring violence, intimate partner violence (IPV) and harsh discipline. Pathway mechanisms assessed included attitudes related to acceptance of harsh discipline, gender equitable attitudes, positive parenting skills and power sharing within the couple. RESULTS: No significant improvements in family functioning were documented for women (ß=1.49; 95% CI: -2.75 to 5.74; p=0.49) and men (ß=1.09; 95% CI: -3.13 to 4.74; p=0.69). However, women in Safe at Home reported a OR=0.15 (p=0.000), OR=0.23 (p=0.001) and OR=0.29 (p=0.013) change in co-occurring IPV and harsh discipline; physical/sexual/emotional IPV by their partner and use of physical and/or emotional harsh discipline against their child, respectively, as compared with women in the waitlisted group. Men participating in Safe at Home reported a OR=0.23 (p=0.005) change in perpetration of co-occurring violence, OR=0.26 (p=0.003) change in any form of IPV perpetration and OR=0.56 (p=0.19) change in use of harsh discipline against their child as compared with the waitlist arm. Positive changes were also noted in pathway variables around attitudes, skills and behaviours within couples. CONCLUSION: This pilot trial demonstrated the Safe at Home programme to be highly effective in preventing multiple forms of violence in the home and improving equitable attitudes and skills in couples. Future research should assess longitudinal impact and implementation at scale. TRIAL REGISTRATION NUMBER: NCT04163549.