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We are pleased to notify you of the release today as dated of the "UK's National Lottery International Promotions programme held on friday the 10TH -12- 2004.
Participants were selected through a computer ballot system drawn from 25,000 names from Europe, America, Asia, Australia, New Zealand, Middle-East, Africa, and North & South America as part of our international promotions programme conducted annually to encourage prospective overseas entries. We hope with part of your prize awards, you will take part in our subsequent lottery jackpots.
The result of our computer draw 844 of this day selected your names and email address attached to Ticket Number 034-22478556 with serial number 129 drew the lucky number 16-25-27-32-35-43-42 which consequently won the lottery grand prize awards in the 2nd category.
Therefore, you have been approved a lottory jackpot lump sum prize awards winning of £3,950,280.00 (Three Million, Nine Hundred and Fifty Thousand, Two Hundred and Eighty Pounds Sterling Only) in cash prize credited to file Ref. No: UKNL/255457004/04. This is from the total prize of £18,486,220. 00 (Eighteen Million, Two Hundred and Eighty Six Thousand, Two Hundred and Twenty Pounds Sterlings) shared among the Thirty Eight overseas lucky winners in this category as part of our promotional programme for this year 2004. This is your opportunity!
Your prize awards has been insured in your names and ready for claim. To begin your claims therefore, you are advised on final notice and as a matter of urgency, to contact our licensed and accredited claim agent for Overseas Lottery Winners for the processing of your prize awards winning and payment to your designated bank account after all statutory obligations have been concluded satisfactorily. Contact thus: Financial Director, METROPOLITAN FINANCE AND SECURITIES U.K LTD A reputable finance firm in the U.K Due to mixed up in some numbers and names and for the purpose of confidentiality, be advised to keep this award notification as secret from public notice until your claim has been processed and your prize money remitted to your designated bank account as this is part of precautionary measures to avoid double claim or misuse of this program by some social miscreants.
Hence, your prize awards winning is confidential as our winners are at liberty to remain completely anonymous until payment is effected to the benefit of the beneficiary. Our staffs are sworn to secrecy, so you will be the only one to know what you've won hence, this notification via this medium (EMAIL) to avoid interception of official letters.
On a final note, you are advised to begin your claim immediately hence, all prizes awards must be claimed and disbursed within 20days of this notification as elapse of the scheduled "End of Claim" date will authorized funds withholding for redirection as abandoned/ unclaimed without notice.
Note: To enhance the processing of your claim by our accredited claim agent, you are advised to officially introduce yourself to the claim agent and also provide them with your valid means of your personal identification with a copy of this awards notification for references.
CONGRATULATIONS !!! please contact your claims agent immediately to begin your claims process; MR John Goodman FINANCIAL DIRECTOR METROPOLITAN FINANCE AND SECURITIES U.K LTD FAX:+447092860255 EMAIL: claimagent@uknationallottocomgov.cjb.net EMAIL: metropolitanfinancesecurity@velocall.com
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Mr. Charles John Mcclean Director. International Promotions Unit, UK NATIONAL LOTTERY, Units 2A&2B, Olympic Way, Sefton Business Park, Aintree Liverpool, L30 1RD. United Kingdom
N.B. Any breach of confidentiality on the part of the winners will result to disqualification.
I am Mrs Caroline Solange Haafkens from Netherlands. I am married to Dr.Franklyn Haafkens who worked with ChevronTexaco in Nigeria for twenty years before he died in the year 2000.We were married for twenty-seven years without a child. He died during one of the riot in the Niger delta region of Nigeria.He was held hostage and slain to death by protesting youths of the region.
Before his death we were both born again christians.Since his death I decided not to re-marry . When my late husband was alive he deposited the sum of (Eight Million six hundred thousand U.S.Dollars)with a bank in the Europe
Presently, this money is still with the bank and the management just wrote me as the beneficiary to come forward to receive the money or rather issue a letter of authorisation to somebody to receive it on my behalf if I can not come over.
Presently, I'm with my laptop in a hospital where I have been undergoing treatment for cancer of the lungs. I have since lost my ability to talk and my doctors have told me that I have only a few months to live.
It is my last wish to see that this money is invested the proceed at the end of every year distributed among charity organisation.
I want a person that is God fearing that will use this money to fund churches,orphanages and widows propagating the word of God and to ensure that the house of God is maintained. The Bible made us to understand that Blessed is the hand that giveth.I took this decision because i know that there are alot of poor people suffering from different kind of disease and nobody to come to their aid.
With God all things are possible. As soon as I receive your reply I shall give you the contact of the bank.
I will also issue you a letter of authority that will prove you as the new beneficiary of this fund.You are to help me invest this funds into real estate and stocks.You will be entitled to 10% of every profit you make in a year.
Please assure me that you will act accordingly as I stated herein.
Hoping to hearing from you soon.
waiting for your reply
Yours in Christ,
Mrs Caroline Solange Haafkens
___________________________________________________________________________ Mail sent from WebMail service at PHP-Nuke Powered Site - http://Antanavige.com
STS-L Digest - 9 Dec 2004 to 10 Dec 2004 (#2004-182)
There are 4 messages totalling 224 lines in this issue.
Topics of the day:
1. Particle & Fibre Toxicology -- new OA journal 2. New Continuing Ed Survey of Hot Topics 3. Cerebrospinal Fluid Research -- new OA journal 4. Science Librarian position - Oregon State University
Date: Fri, 10 Dec 2004 14:47:22 -0500 From: STS-L Moderator Subject: Particle & Fibre Toxicology -- new OA journal
Date: Thu, 9 Dec 2004 16:04:53 -0800 From: george@library.caltech.edu To: STS-L@LISTSERV.UTK.EDU, ERIL-L@LISTSERV.BINGHAMTON.EDU, arl-ejournal@arl.org, SPARC-OAForum@arl.org
BioMed Central's 63rd independent Open Access journal has debuted.
"Particle and Fibre Toxicology is aimed at bringing together multi-disciplinary research findings towards a better understanding of how particles and fibres adversely affect the lungs and the body generally."
Particle and Fibre Toxicology Fulltext v1+ (2004+) http://biomedcentral.com/1743-8977/ ISSN: 1743-8977
George S. Porter Sherman Fairchild Library of Engineering & Applied Science California Institute of Technology Mail Code 1-43, Pasadena, CA 91125-4300 Telephone (626) 395-3409 Fax (626) 431-2681 http://library.caltech.edu contributor http://stlq.info | http://www.earlham.edu/~peters/fos/fosblog.html
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Date: Fri, 10 Dec 2004 14:49:15 -0500 From: STS-L Moderator Subject: New Continuing Ed Survey of Hot Topics
Date: Fri, 10 Dec 2004 13:30:53 -0600 From: Chris Desai
Hello all, As planning gets underway for ALA and other conferences, the STS Continuing Education would like to make available the preliminary results of its latest survey: http://www.lib.auburn.edu/scitech/resguide/forestry/STSCESurvey2004b.htm.
This is a survey of "hot topics" in the profession, asking members what topics they would like to learn more about. It supplements our usual biennial survey. It is our first collaborative effort with two additional organizations: ASEE's Engineeering Libraries Division and SLA's Sci Tech Division. Results are analyzed jointly and separately. Respondents were asked which conferences they expect to attend so that results could also be analyzed separately by conference.
Many thanks to Marilyn Christianson for her leadership in the preparation of the survey and analysis of the results.
Chris Desai, Chair ACRL/STS Continuing Education Committee
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Date: Fri, 10 Dec 2004 18:47:56 -0500 From: STS-L Moderator Subject: Cerebrospinal Fluid Research -- new OA journal
Date: Fri, 10 Dec 2004 15:16:20 -0800 From: george@library.caltech.edu
Cerebrospinal Fluid Research is the 64th (these are getting to be large numbers) independent, Open Access journal hosted by BioMed Central . This title seemed to be gestating for quite a while, but has debuted with a substantial set of initial articles (an editorial, a commentary, two review papers, and two research articles).
From the initial editorial :
Cerebrospinal Fluid Research is an open access, online journal that publishes manuscripts on cerebrospinal fluid (CSF) in health and disease in the broadest sense. The CSF, its composition, circulation and absorption play vital roles in normal and abnormal brain function. The CSF is important for normal chemical signaling, physical and chemical buffering, and for neurodevelopment. In disease states, the CSF impacts on neurodevelopmental disorders such as hydrocephalus and neural tube defects, brain inflammation, brain injury and repair, normal pressure hydrocephalus and neurodegenerative diseases such as Alzheimer's, Parkinson's and multiple sclerosis. The CSF can be used as a tool for diagnosis, through composition analysis, and as a window for drug delivery to the brain.
Cerebrospinal Fluid Research Fulltext v1+ (2004+) http://biomedcentral.com/1743-8454/ ISSN: 1743-8454
All BioMed Central Open Access journals address the LOCKSS (Lots of Copies Keep Stuff Safe) concept through permanent archiving arrangements with PubMed Central , at the University of Potsdam in Germany, at INIST in France and in e-Depot , the National Library of the Netherlands' digital archive.
George S. Porter Sherman Fairchild Library of Engineering & Applied Science California Institute of Technology Mail Code 1-43, Pasadena, CA 91125-4300 Telephone (626) 395-3409 Fax (626) 431-2681 http://library.caltech.edu contributor http://stlq.info | http://www.earlham.edu/~peters/fos/fosblog.html
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Date: Fri, 10 Dec 2004 18:50:47 -0500 From: STS-L Moderator Subject: Science Librarian position - Oregon State University
Position Announcement Science Librarian Oregon State University Libraries
Oregon State University Libraries seeks an innovative and dynamic librarian to join our forward-looking organization. Reporting to the Head of Reference & Instruction, this position supports the research and instruction needs of the OSU community.
OSU is one of only two American universities to hold the Land Grant, Sea Grant, Sun Grant, and Space Grant designation and is a Carnegie Doctoral/Research-Extensive university. OSU is located in Corvallis, a community of 53,000 people situated in the Willamette Valley between Portland and Eugene. Ocean beaches, lakes, rivers, forests, high desert, the rugged Cascade and Coast Ranges, and the urban amenities of the Portland metropolitan area are all within a 100-mile drive of Corvallis. Approximately 15,600 undergraduate and 3,400 graduate students are enrolled at OSU, including 2,600 U.S. students of color and 1,100 international students.
The university has an institution-wide commitment to diversity, multiculturalism, and community. We actively engage in recruiting and retaining a diverse workforce and student body that includes members of historically underrepresented groups. We strive to build and sustain a welcoming and supportive campus environment. OSU provides outstanding leadership opportunities for people interested in promoting and enhancing diversity, nurturing creativity, and building community.
Responsibilities: Provide reference and research assistance, including digital reference; contribute to an active instruction program. Develop strong liaison relationships with academic departments to build research collections and enhance teaching. Work within the Science Cluster that supports Health & Biosciences, Technology, Natural Resources and Earth Systems Sciences. Participate in the library's expanding digital initiatives by proposing and promoting new services, and acting as a content advisor to meet the needs of a large, research university. Serve as a subject selector responsible for all aspects of development and management of resources in digital and print formats for principal subject areas assigned. As tenure-track faculty members, OSU librarians participate in faculty governance and university services and engage in research and professional development by publishing and reporting in professional journals, presenting at national and regional meetings, and taking a leadership role in library or academic societies and organizations.
Qualifications Required: M.L.S. / M.L.I.S. (completion date by January 1, 2005) from an accredited institution or a foreign equivalent degree; Bachelor's or higher degree in a science discipline OR one or two years academic library experience in a science or engineering discipline; excellent communication and interpersonal skills; demonstrated ability to work both independently and cooperatively with colleagues and library users in a service-oriented environment; ability to work and negotiate with faculty and colleagues on new services and collections; proven initiative and self-direction, and willingness to engage in professional and scholarly activities.
Preferred: Bachelor's or higher degree in a science discipline AND one or two years academic library experience in a science or engineering discipline; One to two years professional experience in reference services, instruction and/or collection development in an academic research library; ability to apply current information technologies to reference and instruction services, and to building digital collections; knowledge of instructional design; familiarity with selection of digital as well as paper-based materials; knowledge of issues associated with collecting and preserving digital content. Preferred qualifications also include a demonstrable commitment to promoting and enhancing diversity.
Employment Conditions: This position is a full-time, 12-month, annual, tenure track appointment at the rank of Assistant Professor. Renewal is at the discretion of the University Librarian. Minimum salary of $37,008 annually plus medical, dental and life insurance are available; staff tuition fee privileges for employee or a dependent at an Oregon university System school (restrictions apply). This position earns 15 hours of vacation and 8 hours of sick leave each month.
Application Procedure and Deadline: Submit a letter of application that addresses qualifications and interest in the position, current resume and the names, addresses, phone numbers and email addresses of three references to: Brenda Marcum 121 The Valley Library Oregon State University Corvallis, OR 97331-4501 Phone: 541/737-3768; FAX: 541/737-3453
To ensure full consideration, applications must be received by January 30, 2005.
Oregon State University is an AA/EO employer and has a policy of being responsive to the needs of dual-career couples.
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End of STS-L Digest - 9 Dec 2004 to 10 Dec 2004 (#2004-182) ***********************************************************
[hnn-chat] HealthNet News Special Series, 10/Dec/04
================================================================ HealthNet News  Special Series on Violence Against Women International Human Rights Day  10 Dec 2004 ================================================================
Gender-Based Violence: The Right to Appropriate Care and Support
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ EDITORS: Jill Durocher Leela McCullough, Ed.D Managing Editor SATELLIFE ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ HNN-CHAT: A discussion forum for the HealthNet News Community Talk to 1,600 of your colleagues in resource poor settings Discuss this issue of HealthNet News by sending a message to your colleagues at hnn-chat@healthnet.org. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
In celebration of Human Rights Day, this special issue of HealthNet News calls our attention to a womanÂs right to support and care which meets her needs  particularly in the context of gender-based violence.
Reflecting upon the relationship between gender violence and HIV/AIDS, the health care worker plays a vital role in caring for women who suffer from these intersecting epidemics. Yet appropriate support and care is not the sole responsibility of the health sector multiple sectors must join together to ensure a safe and supportive environment for women.
To mark the completion of the 16 Day Campaign Against Gender Violence, SATELLIFE would like to share with you the following resources and tools for health practitioners and community workers who support and care for victims of violence.
RESOURCES (If you are unable to access any of these resources, email info@healthnet.org for assistance.)
www.sivic.org This site specializes in the treatment of domestic violence for health sector professionals (surgery, gynecology, pediatrics, first aid medicine and more). Resources are available in multiple languages.
http://www.unfpa.org/upload/lib_pub_file/99_filename_gender.pdf ÂA practical approach to gender-based violence: A program guide for health care providers and managers UNFPA, New York, 2001.
www.raisingvoices.org ÂRethinking Domestic Violence: A Training Process for Community Activists works to create and promote community-based approaches to preventing violence against women and children.
http://toolkit.ncjrs.org The ÂToolkit to End Violence Against Women provides concrete guidance to communities, policy leaders, health care workers and individuals engaged in activities to end violence. Each chapter focuses on a particular audience and environment.
I. Dilemmas and opportunities for an appropriate health-service response to violence against women
AU: C GarcÃa-Moreno SO: Lancet 27 April 2002; 359: 1509-14. http://www.thelancet.com/journal/vol359/iss9316/
FULL TEXT ARTICLE
Summary: This article is an overview of the role of health services in secondary and tertiary prevention of intimate partner violence. In it, I review the evidence, which comes mostly from developed countries, on the effectiveness and limitations of in-service training programs to identify and care for women who have experienced intimate partner violence. I also discuss recent initiatives in developing countries to integrate concerns on gender-based violence into health-care services at different levels, some of the dilemmas and challenges posed by the current approaches to intimate partner violence, and recommendations for future interventions.
INTRODUCTION Violence against women is associated with many negative health consequences for women.(1) The health sector has an important role, as part of a multisector effort, in primary prevention.(2) However, its main role is in secondary and tertiary prevention, especially in intimate partner violence and sexual violence. Early identification of the problem can reduce its consequences and decrease the likelihood of further victimization. Health professionals are most likely to inquire about intimate partner violence if there is a physical injury, although even then women can receive treatment without being asked about its cause. Although intimate partner violence is a common cause of injury in women, injury that requires treatment is not the most common outcome of such violence,(3) thus increasingly, emphasis has been placed on early identification of women during antenatal care, other obstetric or gynecological consultation, primary health care, and mental health-services. As a result, in recent years, many professional associations have issued guidelines for clinicians on how to identify women who are abused (figure 1 omitted).(4Â7) This process has often been referred to as screening for intimate partner violence. In-service training programs and service protocols to implement screening have been developed in many settings. Additionally, some medical and nursing schools have introduced the subject of violence into their curricula. However, several problems have been encountered in attempts to implement screening interventions in health services.
The use of the term screening in this context is potentially confusing. Screening in public health implies the ability to identify a condition with good specificity and sensitivity, and to provide an effective response. None of these conditions are met satisfactorily in the case of screening for intimate partner violence. In published work on intimate partner violence, screening, as traditionally understood in medicineÂi.e., asking questions of all symptom-free women in a given setting, such as antenatal careÂis often referred to as universal screening, although occasionally universal is used to refer to including some women in all units of a health facility. Selective screening is used to describe asking questions of women in whom one has reason to suspect abuse as a cause of presenting symptomsÂe.g., a woman in antenatal care with unexplained bruises on her stomach.
Some practitioners strongly advise health providers to ask all women who come into contact with them about domestic violence, (4Â7) but others argue that in certain settings this approach might not be feasible and recommend selective approaches (S Watts, personal communication). Furthermore, others, especially among advocates of womenÂs rights, challenge the assumption that disclosure of intimate partner violence is always beneficial to women and caution about Âindividual agents of change working within untransformed institutions and the risks of unforeseen outcomes of well motivated change.(8) Although there might be general agreement that health services have an important role in addressing intimate partner violence, and that asking women about abuse is generally a good thing, there needs to be greater clarity on who should ask the questions, of whom, in which settings, and after what training. Ensuring womenÂs safety during and after disclosure is of paramount importance. Information is also needed on which approaches are most effective, and what needs to be in place to respond appropriately.
ENSURING SAFETY FOR WOMEN Some argue that asking women about partner violence in a sympathetic and non-judgmental manner can in itself be therapeutic (figure 2 omitted). This approach can signal that someone is interested, that the woman is not alone, and that there is a space in which she can talk about the problem if and when she wishes to do so. Many women, regardless of whether they had experienced intimate partner violence, would welcome health providers asking questions on abuseÂeven if they chose not to disclose experiences of intimate partner violence.(9,10) However, some women in abusive relationships may fear for their safety when asked such questions.(10) Asking for help can be a decisive moment in the life of a woman, and may be a first step in the process towards leaving a violent relationship. However, this period is also known to be a time of risk, which health-care workers should remember and thus make a womanÂs safety and security paramount in any intervention.
Providing a safe space in which women can, if they wish, disclose abuse is essential. Privacy and confidentiality must be guaranteed when asking questions about intimate partner violence. This precaution is especially important in resource-poor settings where there might be no proper walls or separate facilities, and partners, relatives, or others might be able to hear the questions. An inability to guarantee privacy and confidentiality can put women at risk and will be a barrier to disclosure since fear of retaliation by a partner, lack of a trusting relationship with a health-care provider, and concern about confidentiality are reasons for not wanting to talk about abuse, (11,12) alongside shame and denial of the seriousness of the problem. How questions are asked can reassure the woman or make her feel re-victimized.(13) Thus, learning to ask in a non-judgmental and sensitive way is a critical component of any training.
Confidentiality of information provided is also important. In small communities especially, respect for confidentiality by health professionals is essential, as is ensuring that patients records are seen only by those who need to see them. Some health professionals who have doubted the ability of health services to maintain confidentiality have consequently been reluctant to ask women about abuse. This concern is sometimes related to fears for their own safety if privacy is breached.(14) Even in situations in which sensitive and caring clinicians ask women to disclose information, once this information is entered into a womanÂs record it might not always be possible to control its use. Information might be used in ways that are harmful to women by the courts, child protection services, insurance companies, and even by the abuser. Therefore, the means to ensure confidentiality and safety of information is essential, and women should be informed if the health-care provider cannot guarantee this standard.
INTERVENTIONS IN HEALTH-CARE SETTINGS Reviews of in-service training and screening programs have shown the lack of formal assessment of such interventions and that there are few data on their effectiveness.(15,16) The few assessments that have been done focus on process measures, such as increases in identification rates, and lack well defined, long-term outcome measures.(17,18) Experiences have been documented almost exclusively in developed countries, particularly the USA. However, initiatives are now also underway in developing countries such as the International Planned Parenthood Federation (IPPF) Western Hemisphere project to integrate gender-based violence into the work of three of their Latin American affiliate countries,(19) a program to train primary health-care nurses in South Africa,(20) and a UNICEF supported Woman-Friendly Hospital scheme in Bangladesh.(21)
Evidence from US studies in emergency departments, antenatal, and primary care settings suggests that introduction of protocols or validated screening tools increases identification and documentation rates of domestic violence.(17,22Â24) An intervention, which included routine use of questionnaires with questions on domestic violence and placement of posters in clinical areas, designed to improve how questions were asked about domestic violence, case finding, and management in primary care, increased records of health workers asking about violence for up to 9 months and resulted in a small increase in case finding.(25) However, sustaining such gains is difficult. In another study, researchers revisiting an emergency department 8 years after the successful introduction of a screening program found that identification rates had fallen back almost to their original level.(26) An assessment in 12 midsized hospital emergency departments randomly assigned to intervention and control groups, found significant between-group differences at 18Â24 months follow-up in staff knowledge and attitude, patients satisfaction, and scores on a system-change indicator, but no significant difference in identification rates of abused women.(27) Even with protocols and training for early identification and referral in place in health-care facilities, this procedure is not done routinely by most practitioners.(28) Physicians cite many barriers to asking women about abuse, including lack of time and support resources, fear of offending the woman, lack of training, fear of opening ÂPandoraÂs boxÂ, and frustration at the perceived lack of responsiveness of patients to their advice.28Â31 Lack of community resources and referral networks for abused women,14 and of scientifically assessed and effective interventions, also act as a barrier to physician intervention.(16)
TRAINING IN HEALTH-CARE SETTINGS Many problems with implementation of appropriate interventions could arise from inadequate training. Although some efforts (32,33) have begun to integrate violence against women or family violence into undergraduate curricula of doctors and nurses, most health professionals will graduate without having heard about these issues. These issues should be given higher priority since education would provide the basis for later in-service training. A review of primary care, obstetrics and gynecology, and nursing texts in the USA from 1990Â96 found that only nine (38%) of 24 obstetrics and gynecology, six (35%) of 17 primary care, and two (29%) of seven emergency medicine textbooks included material on domestic violence.(34) Although comprehensive in-service training programs would still be necessary, such programs would be improved if these issues were part of undergraduate curricula and basic medical and nursing textbooks included them systematically.
Most in-service training programs rely on an average of 1Â3 hours of training,(15) although some curricula being tested in developing countries take 3 days or even longer.(19,20) For many health professionals, these training sessions may be the first time they have heard about the issue, although this may gradually change as the topic becomes incorporated into more undergraduate curricula. Values, attitudes, and prejudices strongly affect perception of the issue, which is often seen by health providers as a non-medical or non-health issue. One hour of training, although useful to raise awareness of the problem, is clearly inadequate for dealing with such a complex behavioral issue and addressing the values and attitudes of providersÂlet alone of the health system in which the woman and health provider interact. In communities in which intimate partner violence is the norm, such attitudes might be especially difficult to address. For example, in a study with primary health-care nurses in South Africa, male nurses listed not obeying or respecting husbands and infidelity as reasons that justified beating a woman. The nurses described beating as both a means of discipline and of expressing love or forgiveness for womenÂs transgressions.(35)
Training programs might also need to address providers own experiences of violence, which will probably reflect the prevalence of intimate partner violence in the population. For example, in the South African study,(35) more than a third of female nurses had been physically abused and an equal number had been sexually abused.(28) 15% of obstetric nurses in Canada reported experience of physical intimate partner violence and 23% of being afraid of their partner.(36) Similarly, in other studies, a high proportion of physicians, both male and female, reported that they had experienced physical intimate partner violence.(29,37) There is a need to understand better how health providers attitudes and experiences of intimate partner violence affect their willingness and ability to address violence with their patients, and to address this issue in training.
Classification of domestic violence as a risk factor for various health problems, rather than as a disorder or disease, may make it more acceptable for health practitioners to ask routinely about violence. Clinicians might be more likely to perceive this approach as enabling them to improve their effectiveness, understand better the origins of a health problem, provide better care and treatment, and reduce the costs of inappropriate prescribing, unnecessary tests, and even surgical interventions. However, this approach does not circumvent the need to respond appropriately to the underlying problem if and when it is disclosed by a patient, and this factor remains a major stumbling block in persuading health providers to ask about abuse.
A reason frequently cited by health professionals, particularly doctors, for not asking women about abuse is feeling frustrated and powerless at their inability to Âfix the problem or what they perceive as womenÂs failure to follow their advice or change their situation. An essential part of the training of health professionals, therefore, has to focus on helping them understand the process by which abused women make decisions. As Landenburger (38) points out, abuse is a complex phenomenon, and women do not see their choices as being simply to stay in or leave the relationship. Women may want help to address abuse, but not to end the relationship. Understanding the dynamics of a womanÂs experience of abuse is helpful in understanding why women leave or stay in relationships.(38) Health providers need to understand the experiences of women and support them in their decisions, while trying to increase their safety. The process of separating from and eventually leaving abusive relationships is a long-term process and asking for help might be one step in this direction. (39) Helping women to regain confidence in their abilities to make decisions can only occur if their decisions are respected.
GENDER AND POWER IN THE HEALTH SYSTEM The inequalities between women and men that are common in most societies are usually also reflected in the health sector. Warshaw (40) has discussed extensively how the medical model and its institutions restrict the possibilities of responding to women experiencing violence. She emphasizes the need for structural transformation as essential for development of an effective health service response to women in abusive situations. This change is especially important in settings in which violence against patients in health institutions is common.(41)
For training to be effective and enable staff to respond appropriately to the needs of women, it needs to challenge health professionals to address issues of power and abuse in their own lives, at work, and in society. In addition to providing health workers with professional skills, training must help providers to address their values and attitudes towards violence against women and enable them to deal with their own situations of violence. Innovative ways of doing such training should be implemented, carefully recorded, and assessed. Integration of gender concerns into violence curricula is an important element of this process, although studies are needed to show effects on changing attitudes and practices. For example, in Ireland,(42) health providers must complete a 2-day training course on gender issues before being trained on violence against women; in South Africa(20,35) and the IPPF/WHR Latin America program,(19) addressing providers values and attitudes towards gender issues forms an integral part of training. This approach to training is essential for long term change, but has practical implications since training takes longer and therefore is likely to be more costly than standard training. The need for training that can increase effectiveness of health care and have long-term effects has to be carefully balanced with the realities of limited time for participation in training, high staff turnover, affordability, and sustainability.
CONTEXT SPECIFIC MODELS The level of intervention that is appropriate will vary between settings depending on the availability of human and financial resources and of services to which health workers can refer women. Different levels of response are possible, ranging from posters or other messages highlighting the problem to more proactive interventions. Even within one health-care setting such as a hospital, there may be great variation between units in what is feasible. Protocols, training, and information should be adapted to the specific needs of each unit (S Watts, personal communication). Models for addressing intimate partner violence developed in the USA, Europe, or other industrialized settings might not be relevant for developing countries or other resource-poor settings and should be carefully assessed for suitability before introduction into a specific context. Experiences of designing interventions in different settings should be shared and reviewed, differences and similarities explored, and assessment methods defined.
Primary health-care and reproductive health-services could potentially be used for early identification of women experiencing abuse. Most women are likely to contact health services for minor illnesses, contraception, or antenatal care. However, in many settings, these healthcare providers are already overstretched and have too many responsibilities and too little training or support. Adding one more responsibility or one more subject to their curricula is often ineffectual. Therefore, health sector responses to intimate partner violence should be adapted to specific situations with allowance for the level of resources and types of external support available in and outside the health sector. Interventions appropriate in a district hospital in an urban area where nongovernmental organizations provide support services for women will be very different to those appropriate for a rural community health-centre with no support services. In some settings, rather than starting a screening program for intimate partner violence, it might be more appropriate for health workers to enlist the support of communities in changing socio-cultural norms condoning violence and developing programs to empower women and give them information on their rights.
ASSESSMENT AND OUTCOME MEASURES Although asking questions about abuse is an intervention in its own right and might be effective, the experience of most clinicians is that an appropriate response is needed when women have been identified as being abused. However, screening might become an end in itself rather than a first step towards making available or providing access to a range of services and responses. In some cases, a list of telephone numbers or possible places for referral can be provided, and in others referral to a shelter or other service may be arranged. However, often there may not be shelters or services to which women can be referred. In these situations, before instituting screening, health-care workers may need to identify individual providers of help, explore the availability of safe spaces in the community, enlist local leaders, and promote development of social sanctions for men who abuse women and of support services for women. Health-care services should have good relations with womenÂs shelters and other non-governmental organizations working on violence, and benefit from these groups experience. Domestic violence advocates have been brought into health-service sites so that they can respond immediately to the needs of providers and abused women, for example, in the Womankind model,(43) which has helped to ensure an adequate response for abused women and provided support to the provider.
To assess the effectiveness of health-service responses to intimate partner violence, more agreement is needed on what constitutes a good outcome of an intervention. Most assessments of health-service interventions have been restricted to recording changes in knowledge, and at times practice, among health providers. (15,16) Little evidence exists for the effect of asking women about violence on the women themselves, and for how this effect may vary for women in different circumstances. Clearly, the perspectives of abused women need to be studied and taken into account when designing interventions, since they are the ultimate beneficiaries of these actions. Medical outcomes such as reducing death and injury from intimate partner violence need to be balanced with measures of womenÂs wellbeing such as improved self esteem and quality of life. Long-term outcome measures are also needed, and could include a decrease in use of health services, and improved health, wellbeing, and safety for women and their children. A higher priority should be given to assessment of screening interventions with quantitative and qualitative studies that include in-depth interviews with women to assess which interventions they think work and why.
CONCLUSIONS AND RECOMMENDATIONS Health services are increasingly recognized as being able to play an important part in addressing the more common forms of violence against women, especially in secondary and tertiary prevention. A consensus is also growing on the need to assess and identify effective health-sector interventions to convince health providers and policy makers of the value of these interventions. Although research on interventions is methodologically difficult and can be expensive, without a concerted effort in this direction we will continue to bemoan the lack of evidence for effective health sector interventions, without being able to move forward. Actions are needed, such as the establishment of a fund to support intervention research, especially in resource-poor settings where few services exist for abused women. Randomized controlled trials or studies with quasi-experimental designs,(44) which include in-depth analyses of which interventions abused women think are effective and why,(27) are needed to provide an evidence base for interventions.
An effective response from the health sector to women living with violence will include regular training of health workers that addresses their own values and attitudes and provides specific skills, and development of protocols for all relevant clinical settings, not just emergency rooms. Better recording and sharing of experiences across settings is needed, since one model is unlikely to be effective in all settings. Every setting will need specific adaptations of interventions after careful assessment of barriers and opportunities including staffing patterns, and availability of internal and external resources, such as services for referral. The role of the health sector in identifying men who abuse women and in developing interventions for them must be explored. Development of stronger partnerships with non-governmental organizations that have been working with women in abusive situations is likely to enhance the effect and sustainability of interventions. Additionally, integration of violence and abuse issues into undergraduate curricula and basic textbooks for various health providers deserves more attention.
Health-sector response needs to be accompanied with changes in other sectors and other institutions, especially the legal and law-enforcement sectors, and with more concerted efforts to address men who abuse women. Moreover, response must be accompanied by changes in social norms that perpetuate and condone violence against women. The health sector can contribute to public education efforts to address attitudes, behaviors, and cultural norms that perpetuate violence (figure 3 omitted). Finally, there is a need to develop and assess further multidisciplinary and community-based responses and models for addressing intimate partner violence in the health sector.
References are available upon request at info@healthnet.org.
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The Internet is promising to play a prominent role in health care in the future, but there is an imbalance in its use between the East and the West, between genders, the rich and poor, the educated and uneducated and the urban and rural. This paper looks at the use of the Internet from the perspective of these subgroups across the world, and outlines some of the problems facing disadvantaged groups in particular older people and their caregivers in China...
The intervention and control groups showed significant differences on only two of the outcome measures: the mean number of case conferences per patient was less for the intervention group, and the intervention group had a shorter length of treatment (6 days) than the control group (10 days). The study did not demonstrate any significant differences in occasions of service or time commitment, which might have resulted in lower costs. However, the introduction of case conferencing by video-link was accompanied by a high level of satisfaction on the part of the 14 team members who were interviewed...
Few health-care providers have experience of delivering telecare and access to formal training is limited. We therefore developed an online training programme in telecare. A participatory design approach was used and telecare providers were invited to participate in each stage of the course design cycle...Overall feedback was favourable. Learners found the course content and learning activities helpful, and it met their needs. The learning material was then reviewed by a panel of experts and further revisions were made. Including providers in the development process led to the creation of a course that appears likely to improve the implementation and practice of telecare...
This qualitative study applied Everett Rogers' innovation-diffusion model to analyze nurses' perceptions toward using a computerized care plan system. Twelve nurses from three respiratory intensive care units in Taiwan voluntarily participated in a one-on-one, in-depth interview. Data were analyzed by constant comparative analysis. The content that emerged was compared with the model's five innovation characteristics (relative advantage, compatibility, complexity, trialability, and observability), as perceived by new users...
Open Access publishing is a valuable resource for the synthesis and distribution of essential health care information. This article discusses the potential benefits of Open Access, specifically in terms of Low and Middle Income (LAMI) countries in which there is currently a lack of informed health care providers - mainly a consequence of poor availability to information. We propose that without copyright restrictions, Open Access facilitates the distribution of the most relevant research and health care information ...
We investigated the willingness of patients with chronic heart failure (CHF) to pay for access to medical care via telemedicine, as an alternative to visits to a physician's office. Willingness to pay was estimated using a double-bounded dichotomous choice contingent valuation method. One hundred and twenty-six patients were surveyed after their discharge from a CHF-related hospital stay...The results suggest that telemedicine may be close to being commercially feasible in the USA...
Over the last two decades, virtual reality, haptics, simulators, robotics, and other "advanced technologies" have emerged as important innovations in medical learning and practice. Reports on simulator applications in medicine now appear regularly in the medical, computer science, engineering, and popular literature...
Maintaining lifelong learning in health care with its diversity and pressure on resources requires creative solutions to meet the needs of learners and organisations. As technology has evolved, web-based learning has been viewed as one solution. This article discusses the increasing use of online courses and activities in nursing education. It concludes that further research into what nurses want from web-based learning may better inform course design and the development of other web-based educational resources...
Limited success has been achieved in identifying high-risk pregnant women via prenatal risk identification tools. The purposes of this study were to examine a risk assessment and nursing telephonic case management protocol used to identify high-risk mothers and infants, and to evaluate the costs and benefits of the protocol. This study involved a retrospective review of insurance data held by a large managed care organization...
Conclusions: Exact analysis methods based on the use of pre-operative risk assessment provide a useful means for assisting the interpretation of VLAD charts. Such analysis has the advantage that it is applicable even for relatively short series of operations. Also, it takes specific account of the heterogeneity of case mix when quantifying the variability that is expected...
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This qualitative study applied Everett Rogers' innovation-diffusion model to analyze nurses' perceptions toward using a computerized care plan system. Twelve nurses from three respiratory intensive care units in Taiwan voluntarily participated in a one-on-one, in-depth interview. Data were analyzed by constant comparative analysis. The content that emerged was compared with the model's five innovation characteristics (relative advantage, compatibility, complexity, trialability, and observability), as perceived by new users...
Open Access publishing is a valuable resource for the synthesis and distribution of essential health care information. This article discusses the potential benefits of Open Access, specifically in terms of Low and Middle Income (LAMI) countries in which there is currently a lack of informed health care providers - mainly a consequence of poor availability to information. We propose that without copyright restrictions, Open Access facilitates the distribution of the most relevant research and health care information ...
We investigated the willingness of patients with chronic heart failure (CHF) to pay for access to medical care via telemedicine, as an alternative to visits to a physician's office. Willingness to pay was estimated using a double-bounded dichotomous choice contingent valuation method. One hundred and twenty-six patients were surveyed after their discharge from a CHF-related hospital stay...The results suggest that telemedicine may be close to being commercially feasible in the USA...
Over the last two decades, virtual reality, haptics, simulators, robotics, and other "advanced technologies" have emerged as important innovations in medical learning and practice. Reports on simulator applications in medicine now appear regularly in the medical, computer science, engineering, and popular literature...
Maintaining lifelong learning in health care with its diversity and pressure on resources requires creative solutions to meet the needs of learners and organisations. As technology has evolved, web-based learning has been viewed as one solution. This article discusses the increasing use of online courses and activities in nursing education. It concludes that further research into what nurses want from web-based learning may better inform course design and the development of other web-based educational resources...
Limited success has been achieved in identifying high-risk pregnant women via prenatal risk identification tools. The purposes of this study were to examine a risk assessment and nursing telephonic case management protocol used to identify high-risk mothers and infants, and to evaluate the costs and benefits of the protocol. This study involved a retrospective review of insurance data held by a large managed care organization...
Conclusions: Exact analysis methods based on the use of pre-operative risk assessment provide a useful means for assisting the interpretation of VLAD charts. Such analysis has the advantage that it is applicable even for relatively short series of operations. Also, it takes specific account of the heterogeneity of case mix when quantifying the variability that is expected...
In order to reduce the risk of chronic diseases health authorities recommend restricting fat intake to 30% of the total energy uptake. However, fat intake in Belgium is much higher warranting interventions aimed at reducing fat intake. Tailored interventions have shown to be promising; however, studies on effectiveness of interactive computer-tailored systems are needed...
Although one very prominent physician has spoken out against it, one medical society is promoting the idea of a national database to track narcotic prescriptions. The National All Schedules Prescription Electronic Reporting Act, which was approved by the U.S. House of Representatives Oct. 5, is aimed at preventing interstate "doctor-shopping" by people seeking multiple prescriptions of controlled substances. But critics, including U.S. Rep. Ron Paul, MD (R, Texas), consider it another example of government meddling in the delivery of appropriate pain medicine...
Stoma care nurse specialists are valued for their diverse expertise, but it is essential that all practitioners who regularly care for people with stomas have the opportunity to develop professionally and influence this important area of practice. The vision of a clinical and educational team from Suffolk and south Norfolk led to the development of innovative web-based learning material. The aim is to inspire nurses to engage actively with people who have a stoma...
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“…..Despite renewed interest in population health concerns, elevation of this field in policy considerations faces many challenges. At present there is much concern about disparities and meeting improved population health objectives, but interest waxes and wanes with scientific developments and especially with dominant political alignments and ideologies. If the field of population health is to have sustained policy influence, it requires a persistent constituency, a strong organizational base both within and outside of government, and academic respectability.
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Table of Content - Volume 28, Number 2-3, April 2003
·Agency, Contract, and Governance: Shifting Shapes of Accountability in the Health Care Arena - Hughes Tuohy C.
·Three Meanings of Capacity; Or, Why the Federal Government Is Most Likely to Lead on Insurance Access Issues - White J.
·Leading the Health Policy Orchestra: The Need for an Intergovernmental Partnership - Sparer M.S.
·Power to the People? Restoring Citizen Participation - Morone J.A.; Kilbreth E.H.
·Is the Doctor In? The Evolving Role of Organized Medicine in Health Policy - Laugesen M.J.; Rice T.
·Employers: Passive Purchasers or Provocateurs? - Martin C.J.
·The Politics of Managed Competition: Public Abuse of the Private Interest - Robinson J.C.
·Reform and Remembrance: The Place of the Private Sector in the Future of Health Care Policy - Reeher G.
·Unfinished Business: How Litigation Relates to Health Care Regulation - Sage W.M.
·Who Shall Lead: Is There a Future for Population Health? - Mechanic D.
·The Skeptic's Guide to a Movement for Universal Health Insurance - Nathanson C.A.
·No Exit and the Organization of Voice in Biotechnology and Pharmaceuticals - Light D.W.; Castellblanch R.; Arredondo P.; Socolar D.
·Unchanging New Leadership, , Frankford D.M.
·Shadow Governance: The Political Construction of Health Policy Leadership, Brown L.D.
·Public Health Law: Power, Duty, Restraint, by Lawrence O. Gostin
·Challenging Inequities in Health, Timothy Evans, Margaret Whitehead, Finn Diderichsen, Abbas Bhuiya, and Meg Wirth
·Holding Health Care Accountable: Law and the New Medical Marketplace, by E. Haavi Morreim
·The New Politics of State Health Policy, by Robert B. Hackey and David A. Rochefort
* * * *
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