Background: Many women are affected by anxiety and depression after armed conflict in low and middle income countries, yet there are few scalable options for their mental health care. We aimed to evaluate the effectiveness of a brief group psychological intervention for women in a conflict-affected setting in rural Swat, Pakistan.
This trial showed robust acceptance in the local settings with delivery by non-specialists under supervision by local trained females. The trial paves the way for further adaptation and exploration of the outcomes through larger-scale implementation and definitive randomised controlled trials in the local settings.
► Main reasons among hospital HCW's included reaction of attendants to adverse outcomes, impatient behavior of patients and attendants, delay in care and lack of facilities ► Among ambulance workers, main reasons included delay in arrival and shifting of the patient and lack of facilities to provide good quality pre-hospital emergency care ► Among field healthcare workers, misconception of vaccines was the main reason. ► This study proposes interventions according to main reasons of violence.What do the findings imply?► The findings of the study provide directions for different healthcare settings on how to protect HCW's. ► The essential interventions required are increasing resources to provide good quality of care, introducing policies to improve responsiveness to patient's needs, training HCW's in communication and deescalation skills and introducing educational and regulatory measures to improve patient and attendant behavio
AbsTrACTObjectives To determine the magnitude and determinants of violence against healthcare workers (HCWs) and to identify the predominant types and causes of violence experienced by them.Methodology A cross-sectional survey based on structured questionnaire adopted from previous surveys and qualitative data was conducted in 4 large cities and 12 districts in 3 provinces of Pakistan. The survey covered 8579 from all cadres of HCWs, including doctors, nurses, technicians, support staff, ambulance workers, vaccinators, lady health visitors, midwives and lady health workers (LHWs). The predictors of overall violence experienced, physical violence experienced and verbal violence experienced were separately analysed for tertiary care hospitals, secondary care hospitals, primary care hospitals and field-level HCWs. Logistic regression was used to compute adjusted ORs with 95% CIs for the association of different factors with the violence experienced. results More than one-third (38.4%) reported having experienced any form of violence in the last 6 months. Verbal violence was the most commonly experienced form (33.9%), followed by physical violence (6.6%). The main reasons for physical violence were death of patients (17.6%), serious condition of patients (16.6%) and delay in care (13.4%). Among the different types of field HCWs, emergency vehicle operators were significantly more likely to experience verbal violence compared with LHWs (adjusted OR=1.97; 95% CI 1.31 to 2.94; p=0.001). Among hospital HCWs, those working in private hospitals were significantly less likely to experience physical violence (adjusted OR=0.52; 95% CI 0.38 to 0.71; p=0.001) and verbal violence (adjusted OR=0.57; 95% CI 0.48 to 0.68
Recently the World Health Organization (WHO) has highlighted the need to strengthen mental health systems following emergencies, including natural and manmade disasters. Mental health services need to be informed by culturally attuned evidence that is developed through research. Therefore, there is an urgent need to establish rigorous ethical research practice to underpin the evidence‐base for mental health services delivered during and following emergencies.
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