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Background: Globally, women 15–24 years are at heightened risk of sexual violence victimization, a risk factor for adverse mental, physical, and behavioral health outcomes. Sexual violence is common at universities and most often perpetrated by men, yet few evidence-based prevention strategies targeting men have been tested in low- and middle-income countries. GlobalConsent is a six-module, web-based educational program adapted from an efficacious U.S.-based program. Nine months post-treatment in a randomized trial in Vietnam, GlobalConsent reduced men's sexually violent behavior (odds ratio [OR] = 0.71, 95%CI 0.50–1.00) and increased prosocial intervening behavior (OR = 1.51, 1.00–2.28) relative to an attention-control. Evidence regarding optimal implementation strategies for scale up is needed. Methods: We will randomize six medical universities in North, Central, and South Vietnam to deliver GlobalConsent using two different packages of implementation strategies that vary in intensity. Higher-intensity strategies will include greater (1) pre- and post-implementation engagement with university leaders and faculty and (2) greater pre-implementation outreach, follow-up, and incentives for students to promote engagement and completion of GlobalConsent. Higher intensity universities will receive additional training and support for their added activities. We will compare implementation drivers and outcomes, intervention effectiveness, and cost-effectiveness across the two implementation bundles. Our mixed-methods comparative interrupted time series design includes (1) qualitative interviews and quantitative surveys with university leaders and implementation teams to assess implementation barriers and facilitators; (2) repeated surveys with leaders and faculty, implementation teams, and male students to assess multilevel implementation drivers and outcomes; (3) repeated surveys with male students to assess behavioral outcomes (sexual violence and intervening behavior) and mediating variables (knowledge, attitudes, affect, and capacities); and (4) time diaries and cost tracking to assess cost-effectiveness of the two implementation-strategies bundles. Discussion: This project is the first to assess packages of implementation strategies to deliver an efficacious web-based sexual violence prevention program for undergraduate men across all regions of Vietnam and synergizes with a violence-prevention training initiative (D43TW012188). This approach will produce rigorous evidence about how to disseminate GlobalConsent nationally, which holds promise to reduce gender-based health inequities linked to sexual violence as GlobalConsent is brought to scale. Trial registration: NCT06443541. Retrospectively registered with ClinicalTrials.gov. Registered on June 05, 2024. [ABSTRACT FROM AUTHOR]

AbstractBackgroundAdaptations are often made to evidence-based practices (EBPs) by systems, organizations, and/or service providers in the implementation process. The degree to which core elements of an EBP can be maintained while allowing for local adaptation is unclear. In addition, adaptations may also be needed at the system, policy, or organizational levels to facilitate EBP implementation and sustainment. This paper describes a study of the feasibility and acceptability of an implementation approach, the Dynamic Adaptation Process (DAP), designed to allow for EBP adaptation and system and organizational adaptations in a planned and considered, rather than ad hoc, way. The DAP involves identifying core elements and adaptable characteristics of an EBP, then supporting implementation with specific training on allowable adaptations to the model, fidelity monitoring and support, and identifying the need for and solutions to system and organizational adaptations. In addition, this study addresses a secondary concern, that of improving EBP model fidelity assessment and feedback in real-world settings.MethodsThis project examines the feasibility, acceptability, and utility of the DAP; tests the degree to which fidelity can be maintained using the DAP compared to implementation as usual (IAU); and examines the feasibility of using automated phone or internet-enabled, computer-based technology to assess intervention fidelity and client satisfaction. The study design incorporates mixed methods in order to describe processes and factors associated with variations in both how the DAP itself is implemented and how the DAP impacts fidelity, drift, and adaptation. The DAP model is to be examined by assigning six regions in California (USA) to either the DAP (n = 3) or IAU (n = 3) to implement an EBP to prevent child neglect.DiscussionThe DAP represents a data-informed, collaborative, multiple stakeholder approach to maintain intervention fidelity during the implementation of EBPs in the field by providing support for intervention, system, and organizational adaptation and intervention fidelity to meet local needs. This study is designed to address the real-world implications of EBP implementation in public sector service systems and is relevant for national, state, and local service systems and organizations.

Objective: Dating violence is a significant health problem among youth that leads to adverse health outcomes, including injuries. Reciprocal violence (perpetrated by both partners) is associated with increased injury in adults, but very little is known about the prevalence and context for reciprocal violence, as well as injury rates, among youth. We sought to determine the prevalence and scope of reciprocal dating violence and injury occurrence among urban youth in a high-risk community.Methods: Analyses were based on data from the Youth Violence Survey, conducted in 2004, and administered to over 80% of public school students in grades 7, 9, 11, and 12 (N=4,131) in a high-risk, urban school district. The current analyses were restricted to those who reported dating in the past year and who also reported any dating violence (n=1,158). Dating violence was categorized as reciprocal (the participant reported both violence perpetration and victimization) and non-reciprocal (the participant report either violence perpetration or victimization, but not both). Results: Dating violence reciprocity varied by sex. Girls who reported any dating violence were more likely to report reciprocal dating violence (50.4%) than were boys (38.9%). However, reciprocity did not vary by race/ethnicity or grade level. Reciprocal dating violence was more common among participants who reported more frequent violence experiences. Reciprocal violence was also associated with greater injury occurrences relative to non-reciprocal relationships (10.1% versus 1.2%).Conclusion: Reciprocal dating violence is common among adolescents and leads more often to injury outcomes. In particular, relationships in which boys report reciprocal violence against their partner appear to lead to more frequent injury occurrences. These findings underscore the importance of addressing dating violence and factors that increase risk for reciprocal violence and therefore exacerbate injury occurrence. [West J Emerg Med. 2010; 11(3): 265-269.]

This study examined the persistent perpetration of physical intimate partner violence (IPV) across relationships. Based on the National Longitudinal Study on Adolescent Health, data were analyzed on 6,446 young adults, who reported on two recent relationships. Frequency and logistic regression analyses were used to examine the persistence of physical IPV perpetration across relationships and the predictors of persistent perpetration. Among individuals who perpetrated physical violence in their first relationship, 29.7% persisted in their perpetration in the second relationship and 70.3% desisted. Significant predictors of persistent physical IPV in the final multi-variate model were as follows: IPV frequency in the first relationship, age, living together versus apart in the subsequent relationship, respondent being better educated than the partner, and being an IPV victim in second relationship. The persistence of physical IPV across relationships was relatively low, with desistance being much more common. Factors specific to the second relationship were the strongest predictors of persistence. (Contains 4 tables.)

Objectives: Since the late 1980s, there has been a strong theoretical focus on psychological and social influences of perpetration of child sexual abuse. This paper presents the results of a review and meta-analysis of studies examining risk factors for perpetration of child sexual abuse published since 1990. Method: Eighty-nine studies published between 1990 and April of 2003 were reviewed. Risk factors were classified into one of the following six broad categories: family factors, externalizing behaviors, internalizing behaviors, social deficits, sexual problems, and attitudes/beliefs. Sex offenders against children (SOC) were compared to three comparison groups identified within the 89 studies: sex offenders who perpetrated against adults (SOA), non-sex offenders, and non-offenders with no history of criminal or sexual behavior problems. Results: Results for the six major categories showed that SOC were not different from SOA (all d between -0.02 and 0.14) other than showing lower externalizing behaviors (d = -0.25). Sex offenders against children were somewhat different from non-sex offenders, especially with regard to sexual problems and attitudes (d = 0.83 and 0.51). Sex offenders against children showed substantial differences from non-offenders with medium sized effects in all six major categories (d's range from 0.39 to 0.58). Conclusion: Child sex offenders are different from non-sex offenders and non-offenders but not from sex offenders against adults. Practice implications: This study suggests that the presence of general risk factors may lead to a variety of negative behavioral outcomes, including the perpetration of child sexual offending. Family factors were strongly related to the perpetration of child sex offending (vs. non-sexual offending or non-offending) and may be valuable intervention points for interrupting the development of child sex offending, as well as other negative behaviors. Other potential points for intervention may focus on the development of appropriate social and emotional skills that contribute to sexual offending. (Contains 9 tables.)

Although many of the pioneers of behavior analysis thought on a large scale and encouraged others to do so, most behavior analytic projects have remained small scale. The intent of this article is to urge the application of behavior analytic principles on a large scale. This article begins with a brief history of applied behavior analysis. It then describes some early behavior analysts who thought big and describes several examples of large-scale behavioral projects. It then shows how behavior analysis fits well with the public health model and describes how behavior analytic principles can be implemented broadly to combat public health problems. The article ends with some practical advice for behavior analysts on how to think big and speculates on the future of behavior analysis.

Examined how parent-adolescent communication about initiating sex and using condoms influenced the relationship between peer norms and behavior among African American and Hispanic adolescents. Found that peer norms were more strongly related to behavior among adolescents who had not discussed sex or condoms. Communication was also related to teens naming a parent as the best information source about sex. (Author/KB)

Thrombocytopenia is a platelet count of less than 150 × 103 per μL and can occur from decreased platelet production, increased destruction, splenic sequestration, or dilution or clumping. Patients with a platelet count greater than 50 × 103 per μL are generally asymptomatic. Patients with platelet counts between 20 and 50 × 103 per μL may have mild skin manifestations such as petechiae, purpura, or ecchymosis. Patients with platelet counts of less than 10 × 103 per μL have a high risk of serious bleeding. Although thrombocytopenia is classically associated with bleeding, there are conditions in which bleeding and thrombosis can occur, such as antiphospholipid syndrome, heparin-induced thrombocytopenia, and thrombotic microangiopathies. Patients with isolated thrombocytopenia in the absence of systemic illness most likely have immune thrombocytopenia or drug-induced thrombocytopenia. In stable patients being evaluated as outpatients, the first step is to exclude pseudothrombocytopenia by collecting blood in a tube containing heparin or sodium citrate and repeating the platelet count. If thrombocytopenia is confirmed, the next step is to distinguish acute from chronic thrombocytopenia by obtaining or reviewing previous platelet counts. Patients with acute thrombocytopenia may require hospitalization. Common causes that require emergency hospitalization are heparin-induced thrombocytopenia, thrombotic microangiopathies, and the hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome. Common nonemergency causes of thrombocytopenia include drug-induced thrombocytopenia, immune thrombocytopenia, and hepatic disease. Transfusion of platelets is recommended when patients have active hemorrhage or when platelet counts are less than 10 × 103 per μL, in addition to treatment (when possible) of underlying causative conditions. It is important to ensure adequate platelet counts to decrease bleeding risk before invasive procedures; this may also require a platelet transfusion. Patients with platelet counts of less than 50 × 103 per μL should adhere to activity restrictions to avoid trauma-associated bleeding. [ABSTRACT FROM AUTHOR]