Applying an Ecological Framework to Factors Associated With Non-Spousal Sexual Assault Among Women in Canada

An ecological framework is useful for understanding how individual, relationship, community, and societal level factors can affect women's vulnerability to sexual assault. However, most studies have focused on examining individual and relationship factors only, due to measurement challenges and a lack of data at the societal level. The purpose of this study was to use data from a nationally representative victimization survey to identify salient predictors of sexual assaults not committed by common-law or marital partners among women across all levels of the ecological framework. Out of 16,738 female respondents, 1.9% (n = 319) experienced one or more incidents of non-spousal sexual assault in the 12 months preceding the survey. Logistic regression modeling indicated that at the individual level, statistically significant factors associated with non-spousal sexual assault included age, Indigenous status, marital status, mental disability, education, main activity, and homelessness or precarious housing. Relationship level predictors of non-spousal sexual assault were a history of child sexual abuse and witnessing violence between parents. Community level predictors were a weak sense of belonging in the local community, low likelihood that neighbors would contact police if they witnessed family violence in the respondents' home, and high likelihood that neighbors would contact police if they witnessed other criminal behavior. Societal level factors were perceptions that local police do a poor job promptly responding to calls, perceptions that local police do a poor job treating people fairly, and having experienced discrimination in the previous 5 years. The results demonstrated that community and societal level factors are critical components of an ecological framework and are important to understanding and addressing the many factors which are independently associated with vulnerability to sexual assault.

Development and evaluation of a social inclusion framework for a comprehensive hospital-based elder abuse intervention

A framework of social inclusion can promote equity and aid in preventing and addressing the abuse of older adults. Our objective was to build a social inclusion framework for a comprehensive hospital-based elder abuse intervention being developed. Potential components of such a framework, namely, health determinants and guiding principles, were extracted from a systematic scoping review of existing responses (e.g., interventions, protocols) to elder abuse and collated. These were subsequently rated for their importance to the elder abuse intervention by a panel of violence experts and further evaluated by a panel of elder abuse experts. The final social inclusion framework comprised 12 health determinants each representing factors underpinning susceptibility for abuse in aging populations: history of trauma/abuse, communication needs, disability, health status, mental capacity, social support, culture, language, sexuality, religion, gender identity, and socioeconomic status. The framework also comprised 19 guiding principles each encompassing considerations for equitable engagement with older adults (e.g., All older adults have the right to self-determination, All older adults have the right to be safe, All older adults are assumed competent unless determined otherwise). Integrating this social inclusion framework into the design and delivery of an elder abuse intervention could empower older adults, while at the same time ensuring that practices and policies are tailored to meet their unique and varying needs.

Hemodialysis Infection Prevention Protocols Ontario-Shower Technique (HIPPO-ST): A Pilot Randomized Trial

INTRODUCTION

We developed the Hemodialysis Infection Prevention Protocols Ontario-Shower Technique (HIPPO-ST) to permit hemodialysis (HD) patients with central venous catheters (catheters) to shower without additional infection risk. Our primary objective was to determine the feasibility of conducting a parallel randomized controlled trial (RCT) to evaluate the impact of HIPPO-ST on catheter-related bacteremia (CRB) in adult HD patients.

METHODS

Adult HD patients using catheters were recruited from 11 HD units. Patients were randomized to receive HIPPO-ST or standard care and were followed up for 6 months. Only CRB-outcome assessors were blinded. For the study to be considered feasible, 4 of 5 feasibility outcomes, each with its own statistical threshold for success, must have been achieved.

RESULTS

A total of 68 patients were randomized (33 HIPPO-ST and 35 control) and were followed up to 6 months. Of 5 measures of feasibility, 4 were achieved: (1) accurate CRB rate documented (threshold: κ level >0.80); (2) 97.8% (279/285) of satellite HD patients with catheters were screened (threshold: >95%); (3) 88% (23/26) in the HIPPO-ST arm were successfully educated by 6 months (threshold: >80%); and (4) 0% (0/29) patients in the control arm were "contaminated," that is, using HIPPO-ST (threshold: <5%). However, only 44.2% (72/163) of eligible patients consented to participate (threshold: >80%). The rate of CRB was similarly low in HIPPO-ST and control groups (0.68 vs. 0.88/1000 catheter days).

DISCUSSION

This HIPPO-ST pilot study demonstrated the feasibility of the larger HIPPO-ST study, especially given the high levels of education success with the HIPPO-ST arm and the low levels of contamination in the control arm.

The economics of hemodialysis catheter-related infection prophylaxis

Hemodialysis central venous catheter (CVC) use is associated with the highest morbidity, mortality, and cost of all types of hemodialysis vascular access. CVC-related infection drives much of the cost associated with CVC use. The magnitude of the cost associated with CVC-related infection varies depending on the type and severity of that infection; however, estimates of the total direct and indirect costs associated with hospitalizations due to hemodialysis CVC-related infections range from 17,000 USD to 32,000 USD per episode. Thus, it is critically important, to not only have effective strategies to limit CVC-related infection but also evaluate whether these strategies are an efficient use of resources. Prophylactic strategies can be considered economically efficient only if the value of its implementation and the corresponding drop in infection rate offer greater value than standard care. The optimal CVC-related infection prophylaxis strategy should work to limit infection risk with minimal risk, inconvenience, and discomfort to the patient, and at minimal cost. The aim of this review was to examine the clinical and economic impact of some commonly described interventions used for CVC infection prophylaxis.