Context Matters: Assessing the Association Between Area Deprivation and the Severity of Injury and Types of Domestic Violence Victimization Among Women.

OBJECTIVES: To analyze the association between social determinants of health (SDOH), as measured by the Area Deprivation Index (ADI), and the severity of injury and types of domestic violence (DV) victimization among women (≥18 years of age) in Milwaukee, Wisconsin. METHODS: Neighborhood ADI data from the American Community Survey (2014-2018) were merged with Milwaukee Police Department DV data (2013-2017). ADI included multiple SDOH domains (education, employment, income/poverty, and housing quality). Types of DV were classified using an adaptation of the FBI-Uniform Crime Reporting-Hierarchy Rule, including Crimes Against Persons (homicide/negligent manslaughter, sexual assault/rape, and aggravated battery/assault). Chi-square, Anova tests, and logistic regression analyses were performed using Stata v.14.2; p-values ≤ .05 were considered statistically significant. FINDINGS: Except for aggravated battery/assault (OR: 1.003, 95% CI: 1.001-1.010), there was no statistically significant relationship between neighborhood disadvantage and DV victimization in 21,095 DV incidents between 2013 and 2017. Adjusted model results indicate that with each increase in neighborhood disadvantage (by ADI), there was a 1.003 increase in the likelihood for aggravated battery/assault (OR: 1.003, 95% CI: 1.001-1.005). Severity of DV injury was not significantly associated with ADI (OR: 1.002, 95% CI: 0.999-1.004). However, non-Hispanic Black women were 1.3 times more likely than non-Hispanic Whites to be victims of aggravated battery/assault (OR: 1.321, 95% CI: 1.189-1.469). Hispanic women were more likely than non-Hispanic Whites to sustain a more severe injury (OR: 0.841, 95% CI: 0.732-0.970]). CONCLUSION: The likelihood of DV-aggravated battery/assault increased with neighborhood deprivation, and significant associations (and highly lopsided prevalence) were found in types of DV victimization by race/ethnicity, with non-Hispanic Black women experiencing higher prevalence than others. This study adds to the body of knowledge by looking at how macro-level neighborhood-SDOH characteristics influence women's exposure to various forms of DV victimization and demonstrated the feasibility of linking law enforcement DV data to SDOH metrics, providing context for law enforcement DV victimizations.

Screening and intervention for intimate partner violence in healthcare settings: creating sustainable system-level programs.

Among the barriers to routine screening for intimate partner violence (IPV) are time constraints, a lack of protocols and policies, and departmental philosophies of care that may conflict with IPV screening recommendations. To address these barriers, systems-level interventions are needed; in this article, we describe one model that may overcome these obstacles. We discuss how this systemic approach may best be implemented in both out-patient clinics and emergency departments (EDs) and note that evidence for its success will be required.

Does neighborhood environment differentiate intimate partner femicides from other femicides?

We examined the association between neighborhood-level factors and intimate partner femicide (IPF) using Wisconsin Violent Death Reporting System (WVDRS) data and Wisconsin Coalition Against Domestic Violence (WCADV) reports, in concert with neighborhood-level information. After controlling for individual characteristics, neighborhood-level disadvantage was associated with a decreased likelihood of IPF status, as compared with other femicides, whereas neighborhood-level residential instability was associated with an increased likelihood of IPF status. Neighborhood plays a role in differentiating IPFs from other femicides in our study area. Our findings demonstrate the importance of multilevel strategies for understanding and reducing the burden of intimate partner violence.

Neighborhood environment and intimate partner violence: a systematic review.

Intimate partner violence (IPV) is an important global public health problem, affecting women across the life span and increasing risk for a number of unfavorable health outcomes. Typically conceptualized as a private form of violence, most research has focused on individual-level risk markers. Recently, more scholarly attention has been paid to the role that the residential neighborhood environment may play in influencing the occurrence of IPV. With research accumulating since the 1990s, increasing prominence of the topic, and no comprehensive literature reviews yet undertaken, it is time to take stock of what is known, what remains unknown, and the methods and concepts investigators have considered. In this article, we undertake a comprehensive, systematic review of the literature to date on the relationship between neighborhood environment and IPV, asking, "what is the status of scholarship related to the association between neighborhood environment and IPV occurrence?" Although the literature is young, it is receiving increasing attention from researchers in sociology, public health, criminology, and other fields. Obvious gaps in the literature include limited consideration of nonurban areas, limited theoretical motivation, and limited consideration of the range of potential contributors to environmental effects on IPV--such as built environmental factors or access to services. In addition, explanations of the pathways by which place influences the occurrence of IPV draw mainly from social disorganization theory that was developed in urban settings in the United States and may need to be adapted, especially to be useful in explaining residential environmental correlates of IPV in rural or non-U.S. settings. A more complete theoretical understanding of the relationship between neighborhood environment and IPV, especially considering differences among urban, semiurban, and rural settings and developed and developing country settings, will be necessary to advance research questions and improve policy and intervention responses to reduce the burden of IPV.

Achieving safety and integrity in conducting research with intimate partner violence survivors.

In their paper, Burge et al. (see record 2014-23812-001) describe an innovative methodology for studying real-time antecedents to intimate partner violence (IPV), as well as the methods employed to ensure the safety of research participants. Over a 12-week timespan, 200 women in moderately violent relationships were asked to make daily phone calls, using a password-protected, interactive voice response system, to provide information about new violence and abuse, and the circumstances that surrounded it. The article details the many safety procedures employed. The authors report that only 2 women were withdrawn from the study for safety reasons. In addition, in post-participation interviews, many participants reported on the increased safety they experienced as a result of participating in the study. These results are discussed in the commentary as part of a growing trend that shows that studies that have well-designed safety procedures in place may actually constitute a kind of inadvertent but effective intervention for abuse survivors in healthcare settings. Implications of such procedures for continued research development in this area, as well as for designing and evaluating innovative health care-based IPV interventions are discussed.

Characteristics of the residential neighborhood environment differentiate intimate partner femicide in urban versus rural settings.

PURPOSE: A growing body of work examines the association between neighborhood environment and intimate partner violence (IPV). As in the larger literature examining the influence of place context on health, rural settings are understudied and urban and rural residential environments are rarely compared. In addition, despite increased attention to the linkages between neighborhood environment and IPV, few studies have examined the influence of neighborhood context on intimate partner femicide (IPF). In this paper, we examine the role for neighborhood-level factors in differentiating urban and rural IPFs in Wisconsin, USA. METHODS: We use a combination of Wisconsin Violent Death Reporting System (WVDRS) data and Wisconsin Coalition Against Domestic Violence (WCADV) reports from 2004 to 2008, in concert with neighborhood-level information from the US Census Bureau and US Department of Agriculture, to compare urban and rural IPFs. FINDINGS: Rates of IPF vary based on degree of rurality, and bivariate analyses show differences between urban and rural victims in race/ethnicity, marital status, country of birth, and neighborhood characteristics. After controlling for individual characteristics, the nature of the residential neighborhood environment significantly differentiates urban and rural IPFs. CONCLUSIONS: Our findings suggest a different role for neighborhood context in affecting intimate violence risk in rural settings, and that different measures may be needed to capture the qualities of rural environments that affect intimate violence risk. Our findings reinforce the argument that multilevel strategies are required to understand and reduce the burden of intimate violence, and that interventions may need to be crafted for specific geographical contexts.

The development and evaluation of community health competencies for family medicine.

BACKGROUND: There is an increasing emphasis on teaching community-responsive care and population health in medical education. This focus requires a multidimensional perspective on community health that examines the determinants, ranges, and variations of health status and disease in the community as a whole. DESCRIPTION: The Department of Family and Community Medicine at the Medical College of Wisconsin sought to strengthen the community health curriculum in its residency programs by developing a core set of competencies in community health as well as a service-learning model to teach residents about community needs and strengths. EVALUATION: A common core curriculum was developed and evaluated based on these competencies. CONCLUSION: Residents who have mastered these competencies will be capable of functioning more effectively as community-responsive physicians.

Preparing the next generation of physicians: medical school and residency-based intimate partner violence curriculum and evaluation.

Medical schools and postgraduate residency programs have largely included intimate partner violence (IPV) in their curricula. There is presently disagreement on the optimal model for implementing such training and the amount of time to be devoted to IPV. There is considerable overlap in the general content and teaching methods that focus on enhancing medical knowledge, professional attitudes, and clinical skills for asking about and responding to patient reports of IPV. Curricular evaluations have generally supported the idea that training increases knowledge, attitudes, and skills. However, a number of methodological issues preclude firm conclusions. There is a need for more randomized, controlled studies, better quasi-experimental designs, posttraining follow-up intervals, and demonstrations of actual clinical behavioral competency. Despite the latter concerns, however, the future shows promise that the next generation of physicians will understand and accept IPV and its health effects on their patients as constituting an important health issue that they will comfortably address.

Typology of reactions to intimate partner violence among men and women arrested for partner violence.

This study examined behavioral and emotional responses to partner-initiated violence reported by men and women court-ordered to domestic violence counseling. Respondents provided Likert-type ratings of behavioral and emotional responses to their partners' initiated violence. Cluster analysis to determine heterogeneity of emotional and behavioral responses resulted in a three-cluster solution. The profile for Cluster 1, predominantly male, showed no specific behavioral or emotional reaction pattern. Cluster 2 respondents, evenly split between males and females, but comprising a high proportion of all of the female participants, reported frequently doing what the partner wanted and attempting to escape. Emotional responses experienced by Cluster 2 respondents were anger, insult, and fear. Cluster 3, predominantly male, reported a frequent tendency to use force in response and escape when their partners initiated physical violence. Emotionally, Cluster 3 participants reported experiencing high levels of anger and insult, and relatively low levels of fear and low levels of amusement. Implications of these findings for development of gender-based intervention strategies will be discussed.

We've had training, now what? Qualitative analysis of barriers to domestic violence screening and referral in a health care setting.

The present study assesses barriers to identification and referral of domestic violence (DV) victims by staff at a health care institution following a 3-hr DV training program in which 752 health care providers participated. Focus groups are conducted with staff in hospital departments that serve a high volume of women. Responses to focus group questions identify system-wide and individual hospital department barriers. These barriers have implications for health care organizations trying to implement DV screening protocols through training alone to change staff behavior in diverse clinical settings. Limitations of this study and future research recommendations are also discussed.

Men's and women's use of intimate partner violence in clinical samples: toward a gender-sensitive analysis.

Early research with nationally representative samples suggested that women reported initiating violence as often as men. Such research has been criticized as focusing only on participation rates, and not assessing gender differences in impact, context, and motivation for using partner violence. Furthermore, research with nationally representative samples has been largely a-theoretical and may lack relevance to those working with clinical samples. Research with clinical populations has begun to address gender similarity and differences in the commission and experience of partner violence. The present article reviews research on men's and women's partner violence using a model for examining such gender differences that incorporates key elements of partner violence, including initiation of the overall pattern of partner violence, proportional initiation rates of violent episodes, physical and mental health impacts of partner violence, behavioral and emotional responses to partner-initiated violence, motivations for using partner violence, and fearfulness of partner-initiated violence. The review concludes that, within and across clinical samples, women are disproportionately victimized by partner violence compared to men. Implications for research, clinical programs, and policy development are discussed.

Domestic violence among male and female patients seeking emergency medical services.

Gender differences among a cohort of injured patients seeking emergency medical services were examined with respect to their experiences as perpetrators and/or victims of domestic violence. Contextual issues, including violence initiation, emotional and behavioral responses to partner-initiated violence, and injury frequency and severity were analyzed. Women reported male partner-initiated violence more frequently than men reported female partner-initiated violence. Behavioral responses to partner initiated violence varied. Women were more likely to report using force back and to involve law enforcement. Women were more likely to be injured in a domestic assault over their lifetime, within the last year, and at the time of recruitment. Comparison of injury severity revealed that women reported higher rates of injuries than men in all possible severity categories. Women also reported experiencing more fear than men during partner-initiated violence, as well as being subjected to larger numbers of dominating and controlling behaviors, and greater intimidation secondary to their partner's size. Understanding contextual differences in partner violence for women and men has significant implications for policy development, identification, treatment, and referral of patients identified as living in violent relationships.

Avoidance of multiple pregnancy by use of single embryo transfer.

The benefits of single embryo transfer (SET) for both mother and child are evident. Already twin pregnancies constitute a relatively serious problem exemplified by the incidence of cerebral palsy, which will increase significantly as well as a risk for premature birth. Selective embryo reduction in countries where this is allowed may be one way to acutely solve the situation. In the beginning the use of natural cycle in vitro fertilization (IVF) avoided the problem, but with the introduction of controlled ovarian hyperstimulation predominantly by use of gonadotrophins in the early 1980ies the temptation to replace more than 1 embryo at a time became too strong. SET with maintenance of acceptable pregnancy rates can only be achieved if tools (improved morphological criteria, biomarkers, preimplantation genetic screening) to select the most viable/normal embryos are at hand together with improved cryopreservation procedures. In reports from Finland and Belgium already 5 years ago, elective single embryo transfer (eSET) was shown to reach almost the same success rates as double embryo transfer (DET) in selective patient groups (age under 37, good quality embryos). The indications for eSET have increased during the last years. In Finland the initiative came from the IVF clinics while in Sweden a legislative process (in act from January 2003) resulted in the recommendation that eSET should be used in the vast majority of the IVF cycles. In both these Nordic countries around 60% of the transfers are today eSET and the multiple pregnancy rate below 10% with no triplets. From an economical point of view, it is of course evident that multiple pregnancies with the numerous potential complications should be avoided altogether. Countries where IVF is included in the government health insurance will thus most likely show the way towards an even more successful, safer and cheaper treatment of infertile couples in the future.

Internalization of cellular fragments in a human embryo: time-lapse recordings.

An observation is reported of internalization of a cellular fragment into a blastomere from a human embryo, as documented by time-lapse photography. The fragment, created during the first mitotic cleavage was reabsorbed into one of the mother blastomeres in less than 5 min. The time-lapse sequence, shown here as a series of still photographs, provides the first direct evidence that cellular fragments in human embryos can 'disappear' during the culture period, a phenomenon that is common in human IVF. The time-lapse sequence itself may be viewed on the internet at www.rbmonline.com/Article/633.

Preimplantation genetic diagnosis (PGD): the Gothenburg experience.

BACKGROUND: A program for preimplantation genetic diagnosis of pre-embryos from patients with hereditary disorders was set up in our unit at Sahlgrenska University Hospital in 1994. The majority of the patients were carriers of X-chromosome linked disorders; a few patients were translocation carriers. In this paper we describe our experiences of our first 36 cycles, 30 gender determinations and six analyses of embryos with possible translocations. METHODS: Conventional hormone replacement treatment with intracytoplasmic sperm injection to fertilize the eggs followed by blastomere biopsy and fluorescent in situ hybridization at the eight cell stage was used for sexing as well as detection of translocations. RESULTS: Out of the 30 cycles in 13 patients for gender determination, blastomere biopsies could be carried out in 25 cycles. Transfer of normal female embryos (XX) was performed in 18 cycles, resulting in five pregnancies (pregnancy rate 27.8%) and an implantation rate of 20% per transfer. Three girls have been born. Hence the take home baby rate was 16.7% per transfer and 10% per started cycle. Six cycles (three patients) for detection of translocations in embryos were performed. Diagnosis was possible in four cycles. Transfer of normal embryos was carried out in one cycle. No pregnancy was achieved. CONCLUSION: Successful PGD in its clinical application demands close collaboration between a large group of specialists. Even so, the success rate is considerably lower than after conventional IVF or ICSI procedures. Taking into account the stress caused to the parents facing late interruption of pregnancy following conventional prenatal diagnosis we are convinced that this technique is well worthwhile continuing and refining.

Ultrastructure of human blastocyst-endometrial interactions in vitro.

The interactions of seven human blastocysts with cultured endometrial cells were investigated by light microscopy and transmission electron microscopy. Trophoblastic-endometrial contact was observed at the lateral border of endometrial epithelial cells where trophoblast and endometrial epithelial cells shared apical junctional complexes and desmosomes. The first sign of penetration was invasion of a trophoblastic cytoplasmic protrusion between endometrial epithelial cells. In broad contact areas, lateral displacement of endometrial epithelial cells and formation of a peripheral pseudostratified epithelium were observed. When trophoblastic cells were interposed fully among endometrial epithelial cells, they formed a penetration cone and appeared to dislodge endometrial epithelial cells from the stromal compartment. A single penetration cone only was found in each specimen. Endometrial or trophoblastic degeneration was not observed. Formation of multinucleate (>/= three nuclei per cell) trophoblast cells was not observed, but many cells displayed areas with abrupt disappearance of well-defined plasma membranes, which is indicative of syncytium formation. In this study, adhesion and penetration occurred at the same time. The human blastocysts penetrated the endometrial surface epithelium by intrusive penetration. Epithelial penetration was achieved primarily by cellular syncytiotrophoblast-like cells and the first indications of syncytium formation were observed simultaneously with penetration of the epithelium.

Predictors of treatment dropout from a spouse abuse abatement program.

This study evaluated predictors of dropout among men who began and attended at least 1 session of a cognitive-behavioral, skills training oriented spouse abuse abatement counseling program. Based on prior research, a number of demographic, criminal justice, partner violence pattern, and personality characteristics were studied. Dropout prediction was assessed at 2 phases of program participation, during assessment (early drop) and during intervention (late drop). Overall, few of the variables studied predicted dropout. Early dropout was predicted by high rates of police contact for violent crimes, failure to self-report an alcohol problem, and paranoid personality characteristics. Late dropout was predicted by both high and moderate levels of police contact for violent crimes, and borderline personality characteristics. An Age x Violent Crime interaction suggested that young violent offenders are more likely to complete treatment. The overall model accounted for only 7.15% of the variance. Clinical and research implications are discussed.

The position of the metaphase II spindle cannot be predicted by the location of the first polar body in the human oocyte.

When performing intracytoplasmic sperm injection (ICSI) on human oocytes, the injection is traditionally made at the 3 o'clock position, with the first polar body (PB) at the 12 or 6 o'clock position. This has been based on the assumption that the second meiotic metaphase II (MII) spindle lies in close proximity to the first PB. The objective of this study was to document the actual spatial relationship between the first PB and the MII spindle both in in-vivo matured (fresh) human MII oocytes and in oocytes matured in vitro. We found that the MII spindle was, on average, not located directly adjacent to the PB. The in-vivo group (n = 54) showed a mean deviation of the MII spindle from the position of the PB of 41. 7 degrees and the in-vitro group 26.6 degrees (n = 43). The difference between the angle of the two groups was statistically significant (P = 0.005), indicating that the lateral displacement of the first PB is only partly due to the denuding procedure during ICSI, because the in-vitro matured oocytes were denuded before extrusion of the first PB. The majority of the MII spindles in both groups were found in the same hemisphere as the first PB, suggesting that care should be taken to avoid damaging the MII spindle by inserting the ICSI needle in the other half of the oocyte.

A simplified ultrasound based infertility investigation protocol and its implications for patient management.

PURPOSE: To evaluate whether a simplified infertility investigation protocol, focusing on the use of hysterocontrast sonography (HyCoSy), one blood test, and a semen analysis, would be sufficient as an initial screening test to select couples for specific treatment. METHODS: The infertile couples underwent gynaecological examination, cervical sampling for cytology and Chlamydia trachomatis culture, B-mode transvaginal ultrasonography and basic hormonal analyses followed by a HyCoSy, and a semen analysis. A preliminary diagnosis was made for all patients. A management plan for treatment was suggested when possible; otherwise further examinations were recommended. The data were stored for later analysis and the routine investigation protocol was then adhered to and a final diagnosis and treatment were decided upon. RESULTS: Agreement between the diagnosis based on HyCoSy and our routine protocol was present in 74% of cases (N = 73). In 13% (N = 13) there was partial agreement. In 36% the HyCoSy based protocol was considered sufficient to suggest treatment. CONCLUSIONS: A simplified approach may lead to a significant reduction in both the time and cost of investigating an infertile couple.