Children who witness violence: what services do they need to heal?

Children are witnesses to violence far too often in their daily lives. To elicit information on the needs of children and adolescents living in the United States who have witnessed violence in their homes, neighborhoods, or communities, we held focus groups with mothers who have survived interpersonal violence and whose family included child witnesses to violence (CWV), professionals who work with families affected by violence, and with adolescents who have witnessed violence. Based on four separate focus group discussions held in Massachusetts, involving a total of 45 participants, recommendations for screening, programming, and the development of healing interventions are offered to mental health professionals.

Health disparities among health care workers.

In this article we describe the process of an interdisciplinary case study that examined the social contexts of occupational and general health disparities among health care workers in two sets of New England hospitals and nursing homes. A political economy of the work environment framework guided the study, which incorporated dimensions related to market dynamics, technology, and political and economic power. The purpose of this article is to relate the challenges encountered in occupational health care settings and how these could have impacted the study results. An innovative data collection matrix that guided small-group analysis provided a firm foundation from which to make design modifications to address these challenges. Implications for policy and research include the use of a political and economic framework from which to frame future studies, and the need to maintain rigor while allowing flexibility in design to adapt to challenges in the field.

Adapting and testing the Appraisal of Violent Situation scales.

The purpose of this study was to test the psychometric properties of a vertical version of horizontally oriented three Appraisal of Violent Situation scales that elicit women's subjective appraisals of severity, dangerousness, and controllability of violence. Construct validity of the vertical scale eliciting 64 abused women's perceptions of severity of violence experienced was supported by a low to modest correlation between that scale and the Severity of Violence Against Women Scale. Concurrent validity between the horizontal and vertical versions of the scales was demonstrated with a subsample of 26 abused women completing both. Results provide preliminary support for the revised scales.

Using technology to expedite screening and intervention for domestic abuse and neglect.

OBJECTIVE: In response to escalation of community violence, the U.S. Department of Commerce funded Home Health VNA (HHVNA), serving the Merrimack River valley communities in Massachusetts and New Hampshire, for a project demonstrating innovative use of technology in screening for abuse and neglect. DESIGN: All health care providers in the HHVNA were trained in screening through tools loaded on their personal digital assistants. SAMPLE: The sample was comprised of patients served by HHVNA during the study period. INTERVENTION: When a patient screened positive, the health care provider mobilized resources, including social workers, the office of elder services, or the local department of social services office for same-day follow-up. OUTCOMES: Screening for abuse and neglect was mainstreamed into routine care. Health care providers noted significant reduction in redundant domestic abuse data collection. The close communication networks created enabled health care providers to mobilize resources, initiating same-day in-depth social work assessment and referrals to appropriate community agencies. Health care providers now transmit selected encrypted health information and mandated reports to official agencies. CONCLUSIONS: Wedding technology with health care professionals' skills and knowledge can move prevention of and early intervention for domestic abuse and neglect to a new level of efficacy.

Creating a community coalition to address violence.

Building a community-wide coalition to address violence evolved out of a five-year federally funded project on abuse during pregnancy. The setting for this coalition building is Haverhill, Massachusetts, a city of about 60,000, located northeast of Boston in the Merrimack River Valley. For nearly eight years, representatives of more than 30 agencies and institutions have been meeting monthly and creating programs and strategies to address violence in homes, schools, and neighborhoods, and designing interventions for children witnessing this violence. The purpose of this article is to describe the process of coalition building and provide an analysis of this work.

Graduate students' experiences with standardized patients as adjuncts for teaching pelvic examinations.

PURPOSE: To explore graduate nurse practitioner students' perceptions of their experiences when learning to perform pelvic examinations in the laboratory and performing them in subsequent clinical rotations. One group was taught by faculty with voluntary peer examination, and the other two groups were taught by standardized patients (SPs). DATA SOURCES: Surveys with open- and closed-ended (responses on Likert scales) items administered twice during 3 consecutive years to students enrolled in an advanced health assessment course. CONCLUSIONS: All groups reported feeling anxious while learning pelvic exam techniques and in subsequent clinical experiences. SPs provided immediate feedback to students, decreased their feelings of anxiety, and increased their confidence in performing examinations. Students who were taught pelvic examination techniques by SPs rated their learning experiences more positively and reported a better understanding of exam techniques than students who learned to perform exams by voluntary examination of classmates. IMPLICATIONS FOR PRACTICE: Graduate nursing programs should consider locating and using SP programs for teaching pelvic examinations in advanced health assessment courses. Although more cost-effective, voluntary peer examination was a less effective teaching method.

Infrarenal aortic diameter predicts all-cause mortality.

OBJECTIVE: To assess the relationship between infrarenal aortic diameter and subsequent all-cause mortality in men aged 65 years or older. METHODS AND RESULTS: Aortic diameter was measured using ultrasound in 12 203 men aged 65 to 83 years as part of a trial of screening for abdominal aortic aneurysms. A range of cardiovascular risk factors was also documented. Mortality over the next 3 to 7 years was assessed using record linkage. Initial aortic diameter was categorized into 10 intervals, and the relationship between increasing diameter and subsequent mortality was explored using Cox proportional hazard models. Median diameter increased from 21.4 mm in the youngest men to 22.1 mm in the oldest men. The cumulative all-cause mortality increased in a graded fashion with increasing aortic diameter. Using the diameter interval 19 to 22 mm as the reference, the adjusted hazard ratio for all-cause mortality increased from 1.26 (95% CI: 1.09, 1.44; P=0.001) for aortic diameters of 23 to 26 mm to 2.38 (95% CI: 1.22, 4.61; P=0.011) for aortic diameters of 47 to 50 mm. Analysis of causes of death indicated that cardiovascular disease was an important contributor to this increase. CONCLUSIONS: Infrarenal aortic diameter is an independent marker of subsequent all-cause mortality.