Interpersonal violence and violent re-injury in the Northern Territory

Rising to the challenge: The motivation to champion routine intimate partner violence screening in rural emergency departments

OBJECTIVE

To understand the motivations of champions who worked to bring about system and practice change that supported routine screening for intimate partner violence (IPV) in two rural emergency departments (EDs).

INTRODUCTION

Practice changes are required to achieve routine and effective identification and response to IPV. Nurses play a significant role in affecting such practice change. This paper identifies the motivations of champions in the ED setting who successfully brought about such change.

SETTING

The EDs of two Level 5 tertiary hospitals within a rural Local Health District (LHD) of New South Wales, Australia.

PARTICIPANTS

Twenty-three individuals who identified as champions and worked to introduce routine IPV screening in two rural hospital EDs.

DESIGN

Qualitative longitudinal semi-structured interviews employing a process of constant comparison and an interpretive framework to analyse data thematically. Interviews were carried out between June and August 2017 and again between July and August 2019.

RESULTS

Over the period of the study, routine screening was established, and screening rates steadily increased from a low baseline to a significantly higher rate. Three aspects of champion motivation emerged from the analysis: formation of an identity as a champion, making a difference to a significant social justice issue and providing quality and community-relevant care.

CONCLUSIONS

This study is the first study to report on champions and their motivation as they supported IPV practice change in the ED. The findings highlight the capacity for innovation in rural health services, with important implications for other settings looking to translate similar programs. Understanding motivating factors may assist in improved utilisation and support for champions. This is vital if champions are to bring about required practice change within their service and ensure the needs of individuals experiencing IPV are effectively met.

Recidivism after orthopaedic trauma has diminished over time

PURPOSE

The purpose was to analyze our trauma population during two periods to assess for predictors of recidivism.

METHODS

Prior (2007-2011, n = 879) and recent (2014-2019, n = 954) orthopaedic trauma patients were reviewed. Recidivists were those returning with an unrelated injury. Recidivism rates were compared, and factors associated with recidivism were identified.

RESULTS

Recidivism decreased: 18.7% to 14.3% (p = 0.01). Mean age and sex of the two cohorts were not different. Recent recidivists were more likely to sustain gunshot wound (GSW) injuries (22.1% vs 18.9%, p = 0.09), and mental illness was more common (56.6% vs 28.1%, p < 0.0001). The recent recidivist population was less often married (12.9% vs 23.8%, p = 0.03), and both recidivist groups were often underinsured (Medicaid or uninsured: (60.6% vs 67.0%)).

CONCLUSION

Recidivism diminished, although more GSW and mental illness were seen. Recidivists are likely to be underinsured. The changing profile of recidivists may be attributed to socioeconomic trends and new programs to improve outcomes after trauma.

Complex early childhood experiences: Characteristics of Northern Territory children across health, education and child protection data

Early identification of vulnerable children to protect them from harm and support them in achieving their long-term potential is a community priority. This is particularly important in the Northern Territory (NT) of Australia, where Aboriginal children are about 40% of all children, and for whom the trauma and disadvantage experienced by Aboriginal Australians has ongoing intergenerational impacts. Given that shared social determinants influence child outcomes across the domains of health, education and welfare, there is growing interest in collaborative interventions that simultaneously respond to outcomes in all domains. There is increasing recognition that many children receive services from multiple NT government agencies, however there is limited understanding of the pattern and scale of overlap of these services. In this paper, NT health, education, child protection and perinatal datasets have been linked for the first time. The records of 8,267 children born in the NT in 2006-2009 were analysed using a person-centred analytic approach. Unsupervised machine learning techniques were used to discover clusters of NT children who experience different patterns of risk. Modelling revealed four or five distinct clusters including a cluster of children who are predominantly ill and experience some neglect, a cluster who predominantly experience abuse and a cluster who predominantly experience neglect. These three, high risk clusters all have low school attendance and together comprise 10-15% of the population. There is a large group of thriving children, with low health needs, high school attendance and low CPS contact. Finally, an unexpected cluster is a modestly sized group of non-attendees, mostly Aboriginal children, who have low school attendance but are otherwise thriving. The high risk groups experience vulnerability in all three domains of health, education and child protection, supporting the need for a flexible, rather than strictly differentiated response. Interagency cooperation would be valuable to provide a suitably collective and coordinated response for the most vulnerable children.

Repeat assault injuries: A scoping review of the incidence and associated risk factors

OBJECTIVE

Individuals who experience assault are at high risk of being re-assaulted. Our objective was to identify reported incidences of re-assault and associated risk factors to better inform prevention strategies.

METHODS

We conducted a scoping review and searched databases (MEDLINE, PsychINFO, CINAHL, Cochrane Reviews, and Scopus) and grey literature. We performed abstract and full-text screening, and abstracted incidence of re-assault and information related to age, sex, socioeconomic status, mental illness, and incarceration.

RESULTS

We included 32 articles. Studies varied based on setting where index assaults were captured (n=18 inpatient only, n=13 emergency department or inpatient, n=1 other). Reported incidences ranged from 0.8% over one month to 62% through the lifetime. Important risk factors identified include young age, low socioeconomic status, racialized groups, history of mental illness or substance use disorder, and history of incarceration.

CONCLUSIONS

Rates of re-assault are high and early intervention is necessary for prevention. We identified notable risk factors that require further in-depth analysis, including sex, gender and age-stratified analyses.

POLICY IMPLICATIONS

Key risk factors identified should inform timely and targeted intervention strategies for prevention.

Disadvantaged by More Than Distance: A Systematic Literature Review of Injury in Rural Australia

Rural populations experience injury-related mortality and morbidity rates 1.5 times greater than metropolitan residents. Motivated by a call for stronger epidemiological evidence around rural injuries to inform prevention, a systematic review of peer-reviewed literature published between January 2010 and March 2021 was undertaken to explore the epidemiology of rural injury and associated risk factors in Australia. A subsequent aim was to explore definitions of rurality used in injury prevention studies. There were 151 papers included in the review, utilizing 23 unique definitions to describe rurality. People living in rural areas were more likely to be injured, for injuries to be more severe, and for injuries to have greater resulting morbidity than people in metropolitan areas. The increase in severity reflects the mechanism of rural injury, with rural injury events more likely to involve a higher energy exchange. Risk-taking behavior and alcohol consumption were significant risk factors for rural injury, along with rural cluster demographics such as age, sex, high socio-economic disadvantage, and health-related comorbidities. As injury in rural populations is multifactorial and nonhomogeneous, a wide variety of evidence-based strategies are needed. This requires funding, political leadership for policy formation and development, and implementation of evidence-based prevention interventions.

Factors associated with experiencing reassault in Ontario, Canada: a population-based analysis

BACKGROUND

Individuals who experience a violence-related injury are at high risk for subsequent assault. The extent to which characteristics of initial assault are associated with the risk and intensity of reassaults is not well described yet essential for planning preventive interventions. We sought to describe the incidence of reassault and associated risk factors in Ontario, Canada.

METHODS

In this population-based retrospective cohort study using linked health and demographic administrative databases, we included all individuals discharged from an emergency department or hospitalised with a physical assault between 1 April 2005 and 30 November 2016 and followed them until 31 December 2016 for reassault. A sex-stratified Andersen-Gill recurrent events analysis modelled associations between sociodemographic and clinical risk factors and reassault.

RESULTS

271 522 individuals experienced assault (mean follow-up=6.4 years), 24 568 (9.0%) of whom were reassaulted within 1 year, 45 834 (16.9%) within 5 years and 52 623 (19.4%) within 10 years. 40 322 (21%) males and 12 662 (17%) females experienced reassault over the study period. Groups with increased rates of reassault included: those aged 13-17 years versus older adults (age 65+) (males: relative rate (RR) 2.16; 95% CI 1.96 to 2.38; females: RR 2.79; 95% CI 2.39 to 3.26)), those living in rural areas versus urban (males: RR 1.22; 95% CI 1.19 to 1.24; females: RR 1.32; 95% CI 1.27 to 1.37) and individuals with a history of incarceration versus without (males: RR 2.38; 95% CI 2.33 to 2.42; females: RR 2.57; 95% CI 2.48 to 2.67).

CONCLUSION

One in five who are assaulted experience reassault. Those at greatest risk include youth, those living in rural areas, and those who have been incarcerated, with strongest associations among females. Timely interventions to reduce the risk of experiencing reassault must consider both sexes in these groups.