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Mileva B, Goshev M, Georgieva M, Tsranchev II, Alexandrov A. Self-Mutilation: A Way to Protect Yourself From a Committed Crime or to Gain Personal Benefits. Cureus 2023; 15:e48085. [PMID: 38046479 PMCID: PMC10689981 DOI: 10.7759/cureus.48085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2023] [Indexed: 12/05/2023] Open
Abstract
Self-mutilation refers to the state in which a person deliberately hurts himself without the intention to commit suicide but with the motive of some personal gain. Four cases are described in the current study with four different personal motives - drug supply, accusation of intimate partner violence, confrontation of parental prohibition, and a way to hide and escape from a committed crime. Evaluating the injuries due to self-mutilation might be challenging due to atypical lesions and well-structured false stories when the victim has some level of competency. Careful analysis of the victim's story and a thorough evaluation of the sustained injuries are needed. If doubts about artificial injuries exist, immediate consultation with a forensic pathologist is required.
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Affiliation(s)
- Biliana Mileva
- Department of Forensic Medicine and Deontology, Medical University Sofia, Sofia, BGR
| | - Metodi Goshev
- Department of Forensic Medicine and Deontology, Medical University Sofia, Sofia, BGR
| | - Mihaela Georgieva
- Department of Forensic Medicine and Deontology, Medical University Sofia, Sofia, BGR
| | - Ivan I Tsranchev
- Department of Forensic Medicine and Deontology, Medical University of Plovdiv, Plovdiv, BGR
| | - Alexandar Alexandrov
- Department of Forensic Medicine and Deontology, Medical University Sofia, Sofia, BGR
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Hotez E, Yang B, Chua KJ, Smith AM, Lee C, Delgado D, Weimer A. Preliminary Pilot-Testing of Intimate Partner Violence Screening for Transgender and Gender Diverse (TGD) Individuals in Med-Peds and Family Medicine. Cureus 2023; 15:e43983. [PMID: 37746480 PMCID: PMC10516247 DOI: 10.7759/cureus.43983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 08/16/2023] [Indexed: 09/26/2023] Open
Abstract
INTRODUCTION Transgender and gender diverse (TGD) individuals, comprised of those whose gender identity does not correspond with the sex they were assigned at birth, represent approximately 1.4 million people in the U.S., with a higher prevalence among those 18-24 years old. TGD individuals experience high levels of intimate partner violence (IPV), which leads to disproportionately negative mental and physical health outcomes for this population. As a result, there is a resounding need to connect TGD populations to health-promoting services, supports and resources. Med-Peds and Family Medicine clinics may be particularly well-positioned to support these efforts due to physicians' focus on transitional-aged youth and young adults under 30. METHODS The current manuscript reports on processes and outcomes related to a quality improvement (QI) initiative that aimed to test the feasibility and acceptability of implementing IPV screening within both a Med-Peds and a Family Medicine specialty clinic serving TGD populations in Los Angeles, CA. This QI initiative included screeners that capture IPV in cisgender/non-TGD populations (Humiliation, Afraid, Rape, Kick [HARK]) as well as in TGD populations specifically (IPV-T). We utilized a mixed-methods approach to both quantify and qualify responses to existing IPV screening as well as informal feedback from clinic "champions" in each clinic. RESULTS Quantitative and qualitative findings from this QI initiative, featuring both general and TGD-specific IPV screening measures with 140 TGD individuals, elucidated several important processes that can support effective IPV screening and referral to supports and services. These include the importance of interdisciplinary teams, the utility of an iterative approach to screener roll-out, and the essential role of solidifying a referral process in these efforts. This project additionally shed light on the potential utility and challenges of implementing both general and TGD-specific IPV screening measures. Our pilot test did not support the necessity of a TGD-specific IPV screener for identifying and responding to IPV in this population, yet additional data is critical to generate more conclusive recommendations. CONCLUSION We recommend larger-scale data collection efforts to evaluate the utility of integrating general and TGD-specific screeners into clinic workflows to ensure optimal health promotion for the TGD population in Med-Peds and Family Medicine clinics.
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Affiliation(s)
- Emily Hotez
- General Internal Medicine, University of California Los Angeles David Geffen School of Medicine, Los Angeles, USA
| | - Bridgette Yang
- Community Health Sciences, University of California Los Angeles Fielding School of Public Health, Los Angeles, USA
| | - Kristine J Chua
- Anthropology, University of California Santa Barbara, Santa Barbara, USA
| | - Andrew M Smith
- General Internal Medicine, University of California Los Angeles David Geffen School of Medicine, Los Angeles, USA
| | - Cameron Lee
- General Internal Medicine, University of California Los Angeles David Geffen School of Medicine, Los Angeles, USA
| | - Daniela Delgado
- Department of Medicine, University of California Los Angeles David Geffen School of Medicine, Los Angeles, USA
| | - Amy Weimer
- General Internal Medicine, University of California Los Angeles David Geffen School of Medicine, Los Angeles, USA
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Skoczek AC, Haggag A. Neurological Complications Secondary to Intimate Partner Violence: A Brief Review and Case of Posterior Cerebral Artery Cerebrovascular Accident Following Domestic Abuse. Cureus 2023; 15:e42823. [PMID: 37664282 PMCID: PMC10473264 DOI: 10.7759/cureus.42823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 07/31/2023] [Indexed: 09/05/2023] Open
Abstract
Intimate partner violence (IPV) is a growing public health concern, with millions of individuals experiencing IPV each year. Consequences of IPV include psychological disturbances, changes in physical health, and in extreme cases, severe disablement or death. Here, we describe a case of a patient who experienced IPV, leading to a variety of neurological symptoms, and was diagnosed with a posterior cerebral artery (PCA) cerebrovascular accident (CVA) 10 days later. While cases of traumatic brain injury leading to CVA, or stroke, have been documented, there is currently limited reported literature on the neurological complications, specifically stroke, secondary to IPV in adults. Due to this limited reporting, future studies on IPV will be needed to fully understand the long-term neurological complications that may occur.
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Affiliation(s)
- Alexandra C Skoczek
- Medicine, Edward Via College of Osteopathic Medicine - Auburn, Huntsville, USA
| | - Akram Haggag
- Internal Medicine, Crestwood Medical Center, Huntsville, USA
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Agarwal S, Prasad R, Mantri S, Chandrakar R, Gupta S, Babhulkar V, Srivastav S, Jaiswal A, Wanjari MB. A Comprehensive Review of Intimate Partner Violence During Pregnancy and Its Adverse Effects on Maternal and Fetal Health. Cureus 2023; 15:e39262. [PMID: 37342735 PMCID: PMC10278872 DOI: 10.7759/cureus.39262] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 05/20/2023] [Indexed: 06/23/2023] Open
Abstract
Intimate partner violence (IPV) is a significant public health issue that affects many women, including pregnant women. The aim of this comprehensive review is to examine the prevalence of IPV during pregnancy and its adverse effects on maternal and fetal health. IPV during pregnancy can take various forms, including physical, sexual, emotional, and financial abuse. The consequences of IPV during pregnancy can be severe, with adverse effects on maternal and fetal health including an increased risk of preterm birth, low birth weight (LBW), fetal injury, maternal depression, anxiety, post-traumatic stress disorder (PTSD), and even maternal death. Identifying women experiencing IPV during pregnancy and providing appropriate support and care can help mitigate the adverse effects on maternal and fetal health. The review also discusses various interventions and strategies that can be used to prevent IPV during pregnancy, such as screening and counseling for IPV, training healthcare providers to identify and manage IPV during pregnancy, and providing resources and support for women who experience IPV. Overall, the review highlights the need for increased awareness, research, and resources to prevent and address IPV during pregnancy and to promote the health and well-being of women and their infants.
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Affiliation(s)
- Sristy Agarwal
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Rersearch, Wardha, IND
| | - Roshan Prasad
- Medicine and Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Saket Mantri
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Rashi Chandrakar
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Shalvi Gupta
- Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Vaishnavi Babhulkar
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Reserach, Wardha, IND
| | - Samriddhi Srivastav
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Arpita Jaiswal
- Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Mayur B Wanjari
- Research and Development, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Kidman R, Breton E, Behrman J, Kohler HP. A prospective study on adverse childhood experiences and HIV-related risk among adolescents in Malawi. AIDS 2022; 36:2181-2189. [PMID: 36083145 PMCID: PMC9671836 DOI: 10.1097/qad.0000000000003377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Adverse childhood experiences have been robustly associated with poor sexual health in later life. In low-income countries, there is growing evidence that children experience greater adversity than those in higher income countries. Research suggests this may contribute to later sexual risk taking and HIV infection, though most studies to date have been cross-sectional. DESIGN We use longitudinal data on adolescents to examine the temporal relationship between adversity and HIV-related behavioral and biological outcomes. METHODS We interviewed 1878 adolescents living in Malawi in 2017-2018 (age 10-16) and again in 2021 (age 13-20). Adolescents completed the Adverse Childhood Experience - International Questionnaire. HIV-risk was assessed through both behavioral (e.g. condom use) and biological (HIV and herpes simplex virus 2 [HSV2] infection) outcomes. ordinary least squares (OLS) and logistic multivariate regression models are used to explore associations between adversity and HIV risk. RESULTS In longitudinal analyses, adverse childhood experiences (ACEs) were significantly associated with intimate partner violence and girls' behavioral risk scores only. HIV incidence was too low to model; there were no significant associations with HSV2. In cross-sectional analyses, ACEs were additionally associated with an early sexual debut, lack of condom use, a greater number of sexual partnerships, and sexually transmitted infection symptoms. CONCLUSIONS Our findings emphasize the importance of collecting prospective data: results from longitudinal and cross-sectional analyses drew qualitatively different conclusions. Cross-sectional analyses may not be accurate representations of longitudinal processes. However, they suggest that recent adversity and distress drives HIV-related behavior, perhaps more than early adversity. Interventions that combat emotional abuse or peer violence during adolescence could potentially reduce HIV risk.
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Affiliation(s)
- Rachel Kidman
- Program in Public Health and Department of Family, Population and Preventive Medicine Stony Brook University (State University of New York), Stony Brook, New York
| | | | - Jere Behrman
- Departments of Economics and Sociology, Population Aging Research Center and Population Studies Center
| | - Hans-Peter Kohler
- Department of Sociology, Population Aging Research Center and Population Studies Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Tiwari A, Chan CLW, Ho RTH, Tsao GSW, Deng W, Hong AWL, Fong DYT, Fung HYKY, Shin Pang EP, Cheung DST, Ma JLC. Effect of a qigong intervention program on telomerase activity and psychological stress in abused Chinese women: a randomized, wait-list controlled trial. BMC Complement Altern Med 2014; 14:300. [PMID: 25127878 PMCID: PMC4138386 DOI: 10.1186/1472-6882-14-300] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2014] [Accepted: 08/04/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND Abused women, who suffer from chronic psychological stress, have been shown to have shorter telomeres than never abused women. Telomere shortening is associated with increased risk of cell death, and it is believed that adopting health-promoting behaviors can help to increase the activity of telomerase, an enzyme that counters telomere shortening. Qigong is an ancient Chinese mind-body integration, health-oriented practice designed to enhance the function of qi, an energy that sustains well-being. Therefore, an assessor-blind, randomized, wait-list controlled trial was developed to evaluate the effect of a qigong intervention on telomerase activity (primary objective) and proinflammatory cytokines, perceived stress, perceived coping, and depressive symptoms (secondary objectives) in abused Chinese women. METHODS/DESIGN A total of 240 Chinese women, aged ≥ 18 years, who have been abused by an intimate partner within the past three years will be recruited from a community setting in Hong Kong and randomized to receive either a qigong intervention or wait-list control condition as follows: the qigong intervention will comprise (i) a 2-hour group qigong training session twice a week for 6 weeks, (ii) a 1-hour follow-up group qigong exercise session once a week for 4 months, and (iii) a 30-minute self-practice qigong exercise session once a day for 5.5 months. The wait-list control group will receive qigong training after the intervention group completes the program. Upon completion of the qigong intervention program, it is expected that abused Chinese women in the intervention group will have higher levels of telomerase activity and perceived coping and lower levels of proinflammatory cytokines, perceived stress, and depressive symptoms than will abused Chinese women in the wait-list control group. DISCUSSION This study will provide information about the effect of qigong exercise on telomerase activity and chronic psychological stress in abused Chinese women. The findings will inform the design of interventions to relieve the effects of IPV-related psychological stress on health. Also, the concept that health-promoting behaviors could slow down cellular aging might even motivate abused women to change their lifestyles. TRIAL REGISTRATION Current Controlled Trials NCT02060123. Registered February 6, 2014.
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Affiliation(s)
- Agnes Tiwari
- />School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 4/F, William M.W. Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong
| | - Cecilia Lai Wan Chan
- />Department of Social Work and Social Administration, The University of Hong Kong, The Centennial Campus, The University of Hong Kong, Room 534, Jockey Club Tower, Pokfulam, Hong Kong
| | - Rainbow Tin Hung Ho
- />Department of Social Work and Social Administration, The University of Hong Kong, The Centennial Campus, The University of Hong Kong, Room 534, Jockey Club Tower, Pokfulam, Hong Kong
| | - George Sai Wah Tsao
- />Department of Anatomy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Faculty of Medicine Building, 21 Sassoon Road, Pokfulam, Hong Kong
| | - Wen Deng
- />School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 4/F, William M.W. Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong
| | - Athena Wai Lin Hong
- />School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 4/F, William M.W. Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong
| | - Daniel Yee Tak Fong
- />School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 4/F, William M.W. Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong
| | | | - Emily Pei Shin Pang
- />School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 4/F, William M.W. Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong
| | - Denise Shuk Ting Cheung
- />School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 4/F, William M.W. Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong
| | - Joyce Lai Chong Ma
- />Department of Social Work, The Chinese University of Hong Kong, Level 4&5, T.C. Cheng Building, United College, Shatin, New Territories Hong Kong
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Fernandez-Botran R, Miller JJ, Burns VE, Newton TL. Correlations among inflammatory markers in plasma, saliva and oral mucosal transudate in post-menopausal women with past intimate partner violence. Brain Behav Immun 2011; 25:314-21. [PMID: 20888902 PMCID: PMC3025073 DOI: 10.1016/j.bbi.2010.09.023] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2010] [Revised: 09/24/2010] [Accepted: 09/26/2010] [Indexed: 01/11/2023] Open
Abstract
The relationship between psychosocial factors and an increased risk for disease has been related to a heightened pro-inflammatory status reflected in increased circulating levels of pro-inflammatory cytokines and/or C-reactive protein (CRP). Routinely, epidemiological studies rely on measurements of inflammatory markers in serum or plasma, but the use of biological fluids such as saliva or oral mucosal transudate (OMT) may offer potential advantages. This study investigated correlations among plasma CRP and levels of IL-6 and soluble IL-6 receptor (sIL-6R) in plasma, saliva and OMT in a population of middle aged women with histories of past intimate partner violence (IPV). A total of 67 women without existing chronic diseases participated in the study, which included two visits each in which psychological tests were administered, and blood, saliva and OMT samples were collected. Although significantly higher plasma CRP levels were found in past IPV sufferers compared to controls, there were no significant differences in IL-6 or sIL-6R levels in plasma, saliva or OMT between the two groups. There were only relatively modest correlations between IL-6 levels in plasma and those in saliva or OMT and between plasma IL-6 and CRP levels. A significant correlation between IL-6 and sIL-6R levels in both saliva and OMT, but not in plasma, was also detected. No significant correlations were found between levels of IL-6 in saliva or OMT and periodontal health measures. Results indicate that IL-6 and sIL-6R levels in saliva or OMT do not closely reflect those in plasma, and therefore are not a good surrogate for systemic levels.
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Affiliation(s)
- Rafael Fernandez-Botran
- Department of Pathology and Laboratory Medicine, University of Louisville, Louisville, KY 40292, United States.
| | - James J. Miller
- Department of Pathology and Laboratory Medicine, University of Louisville, Louisville, KY 40292
| | - Vicki E. Burns
- School of Nursing, University of Louisville, Louisville, KY 40292
| | - Tamara L. Newton
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, KY 40292
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Caetano R, Ramisetty-Mikler S, Harris TR. Neighborhood characteristics as predictors of male to female and female to male partner violence. J Interpers Violence 2010; 25:1986-2009. [PMID: 20040713 PMCID: PMC2948065 DOI: 10.1177/0886260509354497] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
This article examines the association between neighborhood characteristics at the census tract-level, couples' perceived neighborhood social cohesion and informal social control, and male-to-female (MFPV) and female-to-male (FMPV) partner violence in the United States. Data come from a second wave of interviews (2000) with a national sample of couples 18 years of age and older who were first interviewed in 1995. The path analysis shows that poverty is associated with perceived social cohesion and perceived social control as hypothesized. However, there is no significant mediation effect for social control or social cohesion on any type of violence. In the path analysis, Black ethnicity is associated with social cohesion, which is associated with MFPV. Intimate partner violence (IPV), as a form of domestic violence, may not be as concentrated in high-poverty neighborhoods as criminal violence. IPV may be more determined by personal and dyadic characteristics than criminal violence.
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Affiliation(s)
- Raul Caetano
- University of Texas School of Public Health, Dallas Regional Campus, USA.
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Fishman PA, Bonomi AE, Anderson ML, Reid RJ, Rivara FP. Changes in health care costs over time following the cessation of intimate partner violence. J Gen Intern Med 2010; 25:920-5. [PMID: 20414736 PMCID: PMC2917667 DOI: 10.1007/s11606-010-1359-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2009] [Revised: 01/19/2010] [Accepted: 03/18/2010] [Indexed: 11/30/2022]
Abstract
BACKGROUND Research has documented greater health care costs attributable to intimate partner violence (IPV) among women during and after exposure. However, no studies have determined whether health care costs for abused women return to baseline levels at some point after their abuse ceases. OBJECTIVE We examine whether health care costs among women exposed to IPV converge with those of non-abused women during a 10-year period following the end of exposure. DESIGN Retrospective cohort analysis. SETTING Group Health Cooperative, a large integrated health care system in the Pacific Northwest. PARTICIPANTS Random sample of English-speaking women aged 18-64 enrolled within Group Health and who participated in a telephone survey between June 2003 and August 2005. MEASUREMENTS Total health care costs over an 11-year period from January 1, 1992 to December 31, 2002 were compiled using automated health plan data and comparisons made among women exposed to IPV since age 18 and those who never experienced IPV. IPV included physical, sexual, or psychological violence involving an intimate partner, and was assessed using five questions from the Behavioral Risk Factor Surveillance System. RESULTS Relative to women with no IPV history, total health care costs were significantly higher during IPV exposure, costs that were sustained for 3 years following the end of exposure. By the 4th year following the end of exposure to IPV, health care costs among IPV-exposed women were similar to non-abused women, and this pattern held for the remainder of the 10-year study period. CONCLUSIONS Policy makers should consider the ongoing needs of victims following abuse exposure. Interventions to reduce the prevalence of IPV or to mitigate the impact of IPV have the potential to reduce the rate of growth of health care costs.
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Affiliation(s)
- Paul A Fishman
- Group Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA 98101, USA.
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