Urgent care-seeking and injury severity for intimate partner violence during COVID-19: a Canadian retrospective chart review

BACKGROUND

Early reports raised alarms that intimate partner violence (IPV) increased during the COVID-19 pandemic, but initial studies showed that visits to emergency departments (EDs) decreased. This study assessed the impact of the prolonged pandemic and its associated restrictions on both rates of urgent care-seeking and injury severity for IPV.

METHODS

Data from the Kingston Health Sciences Centre's (KHSC) ED were utilized to compare IPV presentations during 'Pre-COVID' (December 17, 2018 - March 16, 2020) and 'COVID' (March 17, 2020 - June 16, 2021), as well as three periods of heightened local restrictions: 'Lockdown-1' (March 17 - June 12, 2020), 'Lockdown-2' (December 26, 2020 - February 10, 2021) and 'Lockdown-3' (April 8 - June 2, 2021). The primary outcomes were incidence rate of IPV visits and injury severity, which was assessed using the Clinical Injury Extent Score (CIES) and Injury Severity Score (ISS).

RESULTS

A total of 128 individuals were included. This sample had mean age of 34 years, was comprised of mostly women (97%), and represented a variety of intimate relationship types. Some individuals presented multiple times, resulting in a total of 139 acute IPV presentations. The frequency of IPV visits during COVID was similar to the Pre-COVID time period (67 vs. 72; p = 0.67). Incidence rate was 13% higher during COVID, though this difference was non-significant (6.66 vs. 5.90; p = 0.47). IPV visit frequency varied across lockdown periods (11 in Lockdown-1, 12 in Lockdown-2 and 6 in Lockdown-3), with the highest incidence rate during Lockdown-2 (12.71). There were more moderate and severe injuries during COVID compared to Pre-COVID, but mean CIES was not statistically significantly different (1.91 vs. 1.69; p = 0.29), nor was mean ISS (11.88 vs. 12.52; p = 0.73).

CONCLUSIONS

During the 15-months following the start of COVID-19, there were small, but non-significant increases in both incidence rate and severity of IPV presentations to the KHSC ED. This may reflect escalation of violence as pandemic restrictions persisted and requires further investigation.

Enhanced deposition of radon daughter nuclei in the vicinity of power frequency electromagnetic fields

We report the attraction of radon daughter nuclei in normal domestic room air to everyday sources of power frequency electromagnetic fields. TASTRAK plastic track detectors were used to measure alpha-emission from the radon (222Rn) daughters 218Po and 214Po close to 50-Hz mains frequency power cables and domestic appliance leads. We observed that wires carrying mains frequency potential attract radon daughter nuclei in a manner visually similar to the attraction of iron filings to a magnet. Increased deposition of up to a factor of 18 was observed. Further experiments designed to simulate the effect of overhead power lines at ground level showed large scale variations in local plateout and airborne concentration of radon daughters. The effects appear to be due to interactions of the electric component of the EM-field with both the ultrafine and attached fraction of radon daughter aerosols. Three mechanisms have been examined. First, aerosols instantaneously polarize in sympathy with the electric component of an applied mains frequency EM-field and as a result may migrate up strong E-field gradients. This effect is however quite weak and may only affect larger aerosols in strong field gradients. Second, charged aerosols oscillate in a 50-Hz field and in the case of the ultrafine fraction this may lead to significantly increased plateout. Third, there is the possibility that oscillation of charged aerosols induces fluctuations in the magnitude of the instantaneous charges carried and this results in a diffusive-like motion along the field lines. The effect on dose to body organs is considered. Enhanced plateout on the skin is likely, increasing the dose to the basal layer. The dose to internal organs is governed initially by inhalation and lung deposition of radon daughters. Therefore increased local concentration in room air could lead to increased dose by inhalation. E-fields are heavily attenuated by the human body and body values in tissue of no more than 10(-4) of the external field strength have been suggested. Nevertheless calculations suggest that under exposure to strong external fields this may still be sufficient to alter the deposition pattern of the charged component of the ultrafine fraction in the bronchial region. In contrast it is unlikely that internal electric fields could significantly affect the attached radon daughters. In this context the lack of measurements of residual E-fields in the cavities of the mouth, pharyngeal and bronchial regions is of considerable importance and should be addressed. We believe that the observations may have implications for the apparent enigma that there is no persuasive biological evidence to show that power frequency electromagnetic fields can influence any of the accepted stages in carcinogenesis. On the contrary, the observations show that EM-fields can concentrate in their vicinity a cocktail of radon daughter nuclei, a known carcinogen, and presumably other potentially harmful agents.

Immunohistochemical differences between intracranial germinomas and their gonadal equivalents. An immunoperoxidase study of germ cell tumors with epithelial membrane antigen, cytokeratin, and vimentin

Twenty-six intracranial germ cell tumours (11 germinomas, 10 teratomas, 2 endodermal sinus tumours, 1 teratocarcinoma, and 2 undifferentiated embryonal carcinomas) and 26 gonadal germ cell tumours (13 testicular seminomas, 2 ovarian dysgerminomas, 9 ovarian teratomas, and 2 myometrial choriocarcinomas) were studied by immunoperoxidase with monoclonal antibodies (MAbs) against epithelial membrane antigen (EMA), cytokeratin, and vimentin. Typical tumour cells in three of the 11 germinomas (two of the latter being situated in the posterior fossa) expressed both EMA and cytokeratin, whereas those in the seminomas and dysgerminomas did not. In one seminoma, a few multinucleated giant cells expressed cytokeratin. In three of seven germinomas, vimentin-positive tumour cells were found, but all seminomas and dysgerminomas were negative. In the other forms of intracranial and gonadal germ cell tumours, epithelial and mesenchymal elements displayed the expected patterns of immunoreactivity to the respective determinants. The immunoperoxidase differences between the intracranial germinomas and their gonadal equivalents indicate that, in the former, early epithelial or mesenchymal differentiation of the primordial germ cells may be present. The findings draw attention to the heterogeneous cellular composition of these otherwise morphologically homogeneous-appearing tumours and, especially in the posterior fossa, to their transitional links to the immature teratomas.

Autoimmune phenomena in ocular cicatricial pemphigoid

Twelve patients with various stages of ocular cicatricial pemphigoid were studied. Tear volumes measured by Schirmer tests and visual acuities were generally reduced in proportion to disease severity. Mannitol-positive staphylococcus was recovered from 67% (16/24) of the eyelids cultured. Immunoglobulins were bound to the basement membrane of clinically involved conjunctivae in 67% of the patients (8/12). Eighty percent (8/10) of the clinically normal conjunctivae had no immunoglobulins bound to the basement membrane or epithelium, further reinforcing the importance of tissue-fixed immunoglobulins in the pathogenesis of this condition. Four of eight patients with immunoglobulins bound to basement membrane also had C3 complement bound to basement membrane. Acute disease may be associated with the presence of complement in the conjunctiva. In addition, three of the eight patients with basement membrane staining, and three without, showed marked epithelial intercellular and intracellular staining for immunoglobulins. Indirect immunofluorescence of patients' sera showed no circulating antibodies to basement membrane, but three patients had circulating antibodies directed to the conjunctival epithelium in an intercellular or intracellular location. No significant association of ocular pemphigoid with other circulating autoantibodies. HLA aantigens, or abnormal serum immunoglobulin levels was realized.