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Objective To establish global research priorities for interpersonal violence prevention using a systematic approach. Methods Research priorities were identified in a three-round process involving two surveys. In round 1, 95 global experts in violence prevention proposed research questions to be ranked in round 2. Questions were collated and organized according to the four-step public health approach to violence prevention. In round 2,280 International experts ranked the importance of research in the four steps, and the various substeps, ofthe public health approach. In round 3,131 international experts ranked the importance of detailed research questions on the public health step awarded the highest priority In round 2. Findings In round 2, 'developing, Implementing and evaluating interventions' was the step of the public health approach awarded the highest priority for four of the six types, of violence considered (i.e. child maltreatment, intimate partner violence, armed violence and sexual violence) but not for youth violence or elder abuse. In contrast, 'scaling up interventions and evaluating their cost-effectiveness' was ranked lowest for all types of violence. In round 3, research into' developing, implementing and evaluating interventions' that addressed parenting or laws to regulate the use of firearms was awarded the highest priority. The key limitations of the study were response and attrition rates among survey respondents. However, these rates were in line with similar priority-setting exercises. Conclusion These findings suggest It is premature to scale up violence prevention interventions. Developing and evaluating smaller-scale interventions should be the funding priority. Objectif Definir les priorites mondiales de recherche pour la prevention de la violence Interpersonnelle a l'aide d'une approche systematique. Methodes Les priorites de recherche ont ete etablies au cours d'un processus en trois cycles, comprenant deux questionnaires. Durant le premier cycle, 95 experts mondiaux dans le domaine de la prevention de la violence ont propose des questions de recherche, qui seraient classees au cours du deuxieme cycle. Ces questions ont ete rassemblees et organisees suivant l'approche en quatre etapes de la prevention de la violence axee sur la sante publique. Lors du deuxieme cycle du processus, 280 experts Internationaux ont classe parordre d'importance les recherches concernant les quatre etapes et les differentes sous-etapes de cette approche axee sur la sante publique. Au cours du troisieme cycle, 131 experts internationaux ont classe par ordre d'importance des questions de recherche detaillees sur l'etape consideree comme prioritaire au cycle no. 2. Resultats Lors du deuxieme cycle, <> etait l'etape de l'approche de sante publique jugee prioritaire pour quatre des six types de violence consideres (a savoir maltraitance de l'enfant, violence a l'encontre du partenaire intime, violence armee et violence sexuelle) mais non pour la violence chez les jeunes ou la maltraitance des personnes agees. A l'inverse, <> etait juge comme letape la moins importante pour tous les types de violence. Lors du troisieme cycle, <> relatives au role des parents ou aux lois reglementant l'utilisation des armes a feu etait considere comme le domaine de recherche prioritaire. Les principales limitations de l'etude etaient les taux de reponse et d'abandon de l'etude par les repondants. Ces taux etalent toutefois comparables a ceux d'exercices similaires de definition de priorites. Conclusion Ces resultats laissent entendre qu'il est premature d'etendre les interventions de prevention de la violence. La priorite de financement devrait porter sur l'elaboration et l'evaluation d'interventions de moindre ampleur. Objetivo Establecer prioridades de investigacion globales para la prevencion de la violencia interpersonal mediante el uso de un enfoque sistematico. Metodos Se identificaron las prioridades de investigacion en un proceso de tres etapas que incluia dos encuestas. En la primera etapa, 95 expertos mundiales en la prevencion de la violencia propusieron preguntas de investigacion para su clasificacion en la segunda etapa. Las preguntas se recopilaron y organizaron segun el enfoque de salud publica de cuatro fases sobre la prevencion de la violencia. En la segunda etapa, 280 expertos internacionales clasificaron la importancia de la Investigacion en cuatro fases, y en distintas subfases, del enfoque de salud publica. En la tercera fase, 131 expertos internacionales clasificaron la importancia de las preguntas de investigacion detalladas sobre la fase de salud publica que, en la segunda fase, se consideraron de mayor prioridad. Resultados En la segunda etapa, la fase de'desarrollo, implementacion y evaluacion de Intervenciones' fue la que se considero de mayor prioridad del enfoque de salud publica para cuatro de los seis tipos de violencia considerados (esto es, maltrato infantil, violencia conyugal, violencia armada y violencia sexual), pero no para la violencia juvenil o el abuso de ancianos. Sin embargo, la fase de 'incremento de las intervenciones y evaluacion de su rentabilidad' obtuvo la menor calificacion de todos los tipos de violencia. En la tercera etapa, la Investigacion sobre la fase de'tiesarrollo, Implementacion y evaluacion de intervenciones' que abordo la paternidad o las leyes para regular el uso de las armas de fuego se considero la de mayor prioridad. Las limitaciones fundamentales del estudio fueron las tasas de respuesta y abandono entre los encuestados. No obstante, dichas tasas concordaron con los ejercicios de prioridad similar. Conclusion Los resultados sugieren que aun es pronto para ampliar las intervenciones para prevenir la violencia. La mayor prioridad deberia ser el desarrollo y la evaluacion de intervenciones a menor escala., Introduction Almost half a million people are victims of homicide every year (1) and one in three women has experienced violence from an intimate partner at some point during her [...]

Background: Imaging studies of pain processing in primary psychiatric disorders are just emerging. This study explored the neural correlates of stress-induced analgesia in individuals with posttraumatic stress disorder (PTSD). It combined functional magnetic resonance imaging (fMRI) and the traumatic script-driven imagery symptom provocation paradigm to examine the effects of trauma-related cues on pain perception in individuals with PTSD. Methods: The study included 17 patients with PTSD and 26 healthy, trauma-exposed controls. Participants received warm (nonpainful) or hot (painful) thermal stimuli after listening to a neutral or a traumatic script while they were undergoing an fMRI scan at a 4.0 T field strength. Results: Between-group analyses revealed that after exposure to the traumatic scripts, the blood oxygen level-dependent (BOLD) signal during pain perception was greater in the PTSD group than the control group in the head of the caudate. In the PTSD group, strong positive correlations resulted between BOLD signal and symptom severity in a number of brain regions previously implicated in stress-induced analgesia, such as the thalamus and the head of the caudate nucleus. Trait dissociation as measured by the Dissociative Experiences Scale correlated negatively with the right amygdala and the left putamen. Limitations: This study included heterogeneous traumatic experiences, a different proportion of military trauma in the PTSD versus the control group and medicated patients with PTSD. Conclusion: These data indicate that in patients with PTSD trauma recall will lead in a state-dependent manner to greater activation in brain regions implicated in stress-induced analgesia. Correlational analyses lend support to cortical hyperinhibition of the amygdala as a function of dissociation., Introduction Despite evidence that pain preferentially recruits affective pain systems in patients with chronic pain (1-3) and strong epidemiological links between disorders of mood, anxiety and chronic pain, (4) imaging [...]

Objective: Palliative, end-of-life care (PEOLC) providers are poorly resourced in addressing the needs of patients with mental health challenges, and the dying experiences of this cohort—particularly those with a comorbid, chronic and persistent mental illness (CPMI)—are poorly documented. We sought to explore the experiences of PEOLC providers with regard to caring for patients with mental health challenges, and gather insights into ways of improving accessibility and quality of PEOLC for these patients. Method: Twenty providers of PEOLC, from different disciplines, took part in semi structured interviews. The data were coded and analyzed using a reflexive, inductive-deductive process of thematic analysis. Results: The most prominent issues pertained to assessment of patients and differential diagnosis of CPMI, and preparedness of caregivers to deliver mental health interventions, given the isolation of palliative care from other agencies. Among the assets mentioned, informal relationships with frontline caregivers were seen as the main support structure, rather than the formal policies and procedures of the practice settings. Strategies to improve mental health care in PEOLC centered on holistic roles and interventions benefiting the entire palliative population, illustrating the participants saw little point in compartmentalizing mental illness, whether diagnosed or not. Conclusions: Continuity of care and personal advocacy can significantly improve quality of life for end-of-life patients with mental health challenges, but bureaucracy and disciplinary siloing tend to isolate these patients and their caregivers. Improved interdisciplinary connectivity and innovative, hybridized roles encompassing palliation and psychiatry are 2 strategies to address this disconnect, as well as enhanced training in core mental health care competencies for PEOLC providers. [ABSTRACT FROM AUTHOR]

Abstract Background Research has shown that exposure to interpersonal violence is associated with poorer mental health outcomes. Understanding the impact of interpersonal violence on mental health in the early postpartum period has important implications for parenting, child development, and delivery of health services. The objective of the present study was to determine the impact of interpersonal violence on depression, anxiety, stress, and parenting morale in the early postpartum. Methods Women participating in a community-based prospective cohort study (n = 1319) completed questionnaires prior to 25 weeks gestation, between 34–36 weeks gestation, and at 4 months postpartum. Women were asked about current and past abuse at the late pregnancy data collection time point. Postpartum depression, anxiety, stress, and parenting morale were assessed at 4 months postpartum using the Edinburgh Postnatal Depression Scale, the Spielberger State Anxiety Index, the Cohen Perceived Stress Scale, and the Parenting Morale Index, respectively. The relationship between interpersonal violence and postpartum psychosocial health status was examined using Chi-square analysis (p Results Approximately 30% of women reported one or more experience of interpersonal violence. Sixteen percent of women reported exposure to child maltreatment, 12% reported intimate partner violence, and 12% reported other abuse. Multivariable logistic regression analysis found that a history of child maltreatment had an independent effect on depression in the postpartum, while both child maltreatment and intimate partner violence were associated with low parenting morale. Interpersonal violence did not have an independent effect on anxiety or stress in the postpartum. Conclusion The most robust relationships were seen for the influence of child maltreatment on postpartum depression and low parenting morale. By identifying women at risk for depression and low parenting morale, screening and treatment in the prenatal period could have far-reaching effects on postpartum mental health thus benefiting new mothers and their families in the long term.

Although there is literature that describes coping strategies of women who experience intimate partner violence (IPV), the definitions of common coping strategies and the two-dimensional model of coping styles (emotion-or problem-focused) may not fully delineate how these women manage their day-to-day lives. Using an Interpretive Description method and feminist standpoint principles, in-depth interviews were conducted with 40 Thai women regarding how they managed living in the context of IPV. Data were analyzed using an iterative thematic analysis procedure. In this study, the highly changeable and adaptive strategies use by participants could not be easily categorized into emotion-or action/problem-focused. Indeed, the strategies used by Thai women in this study were better described as survival focused. Based on our analysis, the process of managing their day-to-day life in the context of IPV revealed six major themes: keeping silent, disconnect between the fantasy of love and reality, seeking emotional support, ambivalence surrounding leaving, living with negative emotions, and despair and suicide. An undercurrent that was woven throughout multiple themes was the dominant lens of motherhood through which women made day-to-day decisions. These data also highlight the specific impacts that Thai society and religious beliefs have on increasing the risk of IPV and maintaining its duration. All levels of government, religious leaders, and public policy makers must engage in intersectoral initiatives to make public what is now private. Social and health service providers must create safe spaces where women can disclose IPV and where they can get funded multilevel supports to help them live independent of violence. The participants' stories give voice to why Thai health professionals need to fully engage with women to understand the past and current contexts of women's lives and how their experiences impact their health. [ABSTRACT FROM AUTHOR]

Abstract Background Preterm birth is the leading cause of perinatal morbidity and mortality. Risk factors for preterm birth include a personal or familial history of preterm delivery, ethnicity and low socioeconomic status yet the ability to predict preterm delivery before the onset of preterm labour evades clinical practice. Evidence suggests that genetics may play a role in the multi-factorial pathophysiology of preterm birth. The All Our Babies Study is an on-going community based longitudinal cohort study that was designed to establish a cohort of women to investigate how a women's genetics and environment contribute to the pathophysiology of preterm birth. Specifically this study will examine the predictive potential of maternal leukocytes for predicting preterm birth in non-labouring women through the examination of gene expression profiles and gene-environment interactions. Methods/Design Collaborations have been established between clinical lab services, the provincial health service provider and researchers to create an interdisciplinary study design for the All Our Babies Study. A birth cohort of 2000 women has been established to address this research question. Women provide informed consent for blood sample collection, linkage to medical records and complete questionnaires related to prenatal health, service utilization, social support, emotional and physical health, demographics, and breast and infant feeding. Maternal blood samples are collected in PAXgene™ RNA tubes between 18-22 and 28-32 weeks gestation for transcriptomic analyses. Discussion The All Our Babies Study is an example of how investment in clinical-academic-community partnerships can improve research efficiency and accelerate the recruitment and data collection phases of a study. Establishing these partnerships during the study design phase and maintaining these relationships through the duration of the study provides the unique opportunity to investigate the multi-causal factors of preterm birth. The overall All Our Babies Study results can potentially lead to healthier pregnancies, mothers, infants and children.

Road traffic injuries in Thailand are the major cause of death and disabilities in young adults. The presence of shock plays an important role in clinical outcomes. This cross-sectional study aimed to determine the incidence of shock and to identify factors predicting the presence of shock on discharge from the emergency department in patients sustaining moderate to serious road traffic injuries in Thailand. Five hundred and three patients (N=503), who scored at least 16 on the Injury Severity Score on admission to an emergency department were recruited. Population and contextual variables were collected from patients' medical records and patients and triage nurses' interviews. Two standardized tools were used to measure the severity of injury and the presence of shock. Data analyses included descriptive statistics, univariate analysis and multivariate logistical regression. Results indicated that the majority of patients were males, wearing no safety devices and had consumed alcohol prior to driving their motorcycle. The incidence of shock on discharge from the emergency department to the operating room, intensive care unit or general ward was 35%. Transport time, injury severity, shock on arrival and time spent in the emergency department all made significant contributions to whether patients were in shock on discharge from the emergency department. Our findings suggest that emergency nurses should perform routine ongoing calculation of Modified Shock Index scores for monitoring the moderately to severely injured. Further studies examining the superiority of the Modified Shock Index over cardiorespiratory parameters alone could provide evidence to consider the inclusion of this Index into best practice guidelines. [ABSTRACT FROM AUTHOR]