Impact of the first national COVID-19 lockdown on referral of women experiencing domestic violence and abuse in England and Wales

Abstract Background The COVID-19 pandemic, with the related lockdown periods to curb transmission, has made it harder for survivors of domestic violence and abuse (DVA) to disclose abuse and access support services. Our study describes the impact of the first COVID-19 wave and the associated national lockdown in England and Wales on the referrals from general practice to the IRIS (Identification and Referral to Improve Safety) DVA programme. We compare this to the change in referrals in the same months in the previous year, during the school holidays in the three years preceding the pandemic and the period just after the first COVID-19 wave. School holiday periods were chosen as a comparator, since families, including the perpetrator, are together, affecting access to services. Methods We used anonymised data on daily referrals received by the IRIS DVA service in 33 areas from general practices over the period April 2017-September 2020. Interrupted-time series and non-linear regression were used to quantify the impact of the first national lockdown in March-June 2020 comparing analogous months the year before, and the impact of school holidays (01/04/2017-30/09/2020) on number of referrals, reporting Incidence Rate Ratio (IRR), 95% confidence intervals and p-values. Results The first national lockdown in 2020 lead to reduced number of referrals to DVA services (27%,95%CI=(21%,34%)) compared to the period before and after, and 19% fewer referrals compared to the same period in the year before. A reduction in the number of referrals was also evident during the school holidays with the highest reduction in referrals during the winter 2019 pre-pandemic school holiday (44%,95%CI=(32%,54%)) followed by the effect from the summer of 2020 school holidays (20%,95%CI=(10%,30%)). There was also a smaller reduction (13%-15%) in referrals during the longer summer holidays 2017–2019; and some reduction (5%-16%) during the shorter spring holidays 2017–2019. Conclusions We show that the COVID-19 lockdown in 2020 led to decline in referrals to DVA services. Our findings suggest an association between decline in referrals to DVA services for woman experiencing DVA and prolonged periods of systemic closure proxied here by both the first COVID-19 national lockdown or school holidays. This highlights the need for future planning to provide adequate access and support for people experiencing DVA during future national lockdowns and during the school holidays.

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Disruption of a primary health care domestic violence and abuse service in two London boroughs: interrupted time series evaluation

10.21203/rs.2.14588/v5 ◽

2020 ◽

Author(s):

Jasmina Panovska-Griffiths ◽

Alex Hardip Sohal ◽

Peter Martin ◽

Estela Barbosa Capelas ◽

Medina Johnson ◽

...

Keyword(s):

Domestic Violence ◽

Time Series ◽

Service Providers ◽

Interrupted Time Series ◽

Referral Rate ◽

System Level ◽

Health Concern ◽

Service Disruption ◽

The Impact ◽

Domestic Violence And Abuse

Abstract Background Domestic violence and abuse (DVA) is experienced by about 1/3 of women globally and remains a major health concern worldwide. IRIS (Identification and Referral to Improve Safety of women affected by DVA) is a complex, system-level, training and support programme, designed to improve the primary healthcare response to DVA. Following a successful trial in England, since 2011 IRIS has been implemented in eleven London boroughs. In two boroughs the service was disrupted temporarily. This study evaluates the impact of that service disruption.Methods We used anonymised data on daily referrals received by DVA service providers from general practices in two IRIS implementation boroughs that had service disruption for a period of time (six and three months). In line with previous work we refer to these as boroughs B and C. The primary outcome was the number of daily referrals received by the DVA service provider across each borough over 48 months (March 2013-April 2017) in borough B and 42 months (October 2013-April 2017) in borough C. The data were analysed using interrupted-time series, non-linear regression with sensitivity analyses exploring different regression models. Incidence Rate Ratio (IRR), 95% confidence intervals and p-values associated with the disruption were reported for each borough.Results A mixed-effects negative binomial regression was the best fit model to the data. In borough B, the disruption, lasted for about six months, reducing the referral rate significantly (p=0.006) by about 70% (95%CI=(23%,87%)). In borough C, the three-month service disruption, also significantly (p=0.005), reduced the referral rate by about 49% (95% CI=(18%,68%)). Conclusions Disrupting the IRIS service substantially reduced the rate of referrals to DVA service providers. Our findings are evidence in favour of continuous funding and staffing of IRIS as a system level programme.

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Disruption of a primary health care domestic violence and abuse service in two London boroughs: interrupted time series evaluation

10.21203/rs.2.14588/v4 ◽

2020 ◽

Author(s):

Jasmina Panovska-Griffiths ◽

Alex Hardip Sohal ◽

Peter Martin ◽

Estela Barbosa Capelas ◽

Medina Johnson ◽

...

Keyword(s):

Domestic Violence ◽

Time Series ◽

Service Providers ◽

Interrupted Time Series ◽

Referral Rate ◽

System Level ◽

Health Concern ◽

Service Disruption ◽

The Impact ◽

Domestic Violence And Abuse

Abstract Background Domestic violence and abuse (DVA) is experienced by about 1/3 of women globally and remains a major health concern worldwide. IRIS (Identification and Referral to Improve Safety of women affected by DVA) is a complex, system-level, training and support programme, designed to improve the primary healthcare response to DVA. Following a successful trial in England, since 2011 IRIS has been implemented in eleven London boroughs. In two boroughs the service was disrupted temporarily. This study evaluates the impact of that service disruption.Methods We used anonymised data on daily referrals received by DVA service providers from general practices in two IRIS implementation boroughs that had service disruption for a period of time (six and three months). In line with previous work we refer to these as boroughs B and C. The primary outcome was the number of daily referrals received by the DVA service provider across each borough over 48 months (March 2013-April 2017) in borough B and 42 months (October 2013-April 2017) in borough C. The data were analysed using interrupted-time series, non-linear regression with sensitivity analyses exploring different regression models. Incidence Rate Ratios (IRRs), 95% confidence intervals and p-values associated with the disruption were reported for each borough.Results A mixed-effects negative binomial regression was the best fit model to the data. In borough B, the disruption, lasted for about six months, reducing the referral rate significantly (p=0.006) by about 70% (95%CI=(23%,87%)). In borough C, the three-month service disruption, also significantly (p=0.005), reduced the referral rate by about 49% (95% CI=(18%,68%)). Conclusions Disrupting the IRIS service substantially reduced the rate of referrals to DVA service providers. Our findings are evidence in favour of continuous funding and staffing of IRIS as a system level programme.

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Changes in the Use of Broad-Spectrum Antibiotics after Cefepime Shortage: a Time Series Analysis

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.05560-11 ◽

2011 ◽

Vol 56 (2) ◽

pp. 989-994 ◽

Cited By ~ 12

Author(s):

C. Plüss-Suard ◽

A. Pannatier ◽

C. Ruffieux ◽

A. Kronenberg ◽

K. Mühlemann ◽

...

Keyword(s):

Time Series ◽

Pseudomonas Aeruginosa ◽

Broad Spectrum ◽

Interrupted Time Series ◽

Antibiotic Policy ◽

Content Type ◽

Broad Spectrum Antibiotics ◽

Before And After ◽

Alternative Antibiotic ◽

The Impact

ABSTRACTThe original cefepime product was withdrawn from the Swiss market in January 2007 and replaced by a generic 10 months later. The goals of the study were to assess the impact of this cefepime shortage on the use and costs of alternative broad-spectrum antibiotics, on antibiotic policy, and on resistance ofPseudomonas aeruginosatoward carbapenems, ceftazidime, and piperacillin-tazobactam. A generalized regression-based interrupted time series model assessed how much the shortage changed the monthly use and costs of cefepime and of selected alternative broad-spectrum antibiotics (ceftazidime, imipenem-cilastatin, meropenem, piperacillin-tazobactam) in 15 Swiss acute care hospitals from January 2005 to December 2008. Resistance ofP. aeruginosawas compared before and after the cefepime shortage. There was a statistically significant increase in the consumption of piperacillin-tazobactam in hospitals with definitive interruption of cefepime supply and of meropenem in hospitals with transient interruption of cefepime supply. Consumption of each alternative antibiotic tended to increase during the cefepime shortage and to decrease when the cefepime generic was released. These shifts were associated with significantly higher overall costs. There was no significant change in hospitals with uninterrupted cefepime supply. The alternative antibiotics for which an increase in consumption showed the strongest association with a progression of resistance were the carbapenems. The use of alternative antibiotics after cefepime withdrawal was associated with a significant increase in piperacillin-tazobactam and meropenem use and in overall costs and with a decrease in susceptibility ofP. aeruginosain hospitals. This warrants caution with regard to shortages and withdrawals of antibiotics.

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Professionals’ views on working in the field of domestic violence and abuse during the first wave of COVID-19: a qualitative study in the Netherlands

BMC Health Services Research ◽

10.1186/s12913-021-06674-z ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Nicole E. van Gelder ◽

Ditte L. van Haalen ◽

Kyra Ekker ◽

Suzanne A. Ligthart ◽

Sabine Oertelt-Prigione

Keyword(s):

Domestic Violence ◽

The Netherlands ◽

Working Conditions ◽

Critical Evaluation ◽

Physical Contact ◽

Structured Interviews ◽

Online Tools ◽

The Impact ◽

Domestic Violence And Abuse

Abstract Background The COVID-19 pandemic and lockdown evoked great worries among professionals in the field of domestic violence and abuse (DVA) as they expected a rise of the phenomenon. While many countries reported increased DVA, the Netherlands did not. To understand this discrepancy and the overall impact of the lockdown on DVA support services, we interviewed DVA professionals about their experiences with DVA during the rise of COVID-19, the impact of the lockdown on clients and working conditions, and views on eHealth and online tools. Methods Semi-structured interviews were conducted among 16 DVA professionals with various specializations. This data was analyzed using open thematic coding and content analysis. Results Most professionals did not see an increase in DVA reports but they did notice more severe violence. They experienced less opportunities to detect DVA and worried about their clients’ wellbeing and the quality of (online) care. Furthermore, their working conditions rapidly changed, with working from home and online, and they expressed frustration, insecurity and loneliness. Professionals feel eHealth and online tools are not always suitable but they do see them as an opportunity to increase reach and maintain services when physical contact is not possible. Conclusion This study suggests DVA was probably under-detected during the lockdown rather than not having increased. The Dutch system heavily relies on professionals to detect and report DVA, suggesting a need for critical evaluation of the accessibility of professional help. Professionals experienced significant challenges and should themselves be supported psychologically and in their changed work practices to maintain their ability to aid survivors.

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Effect of 11 September 2001 on suicide and homicide in England and Wales

The British Journal of Psychiatry ◽

10.1192/bjp.183.3.207 ◽

2003 ◽

Vol 183 (3) ◽

pp. 207-212 ◽

Cited By ~ 34

Author(s):

Emad Salib

Keyword(s):

Suicidal Ideation ◽

Social Cohesion ◽

Suicide Rate ◽

England And Wales ◽

Female Suicide ◽

Inverse Effect ◽

Group Integration ◽

Before And After ◽

External Threat ◽

The Impact

BackgroundThe tragic events of 11 September 2001 and televised scenes of the terrorists' homicidal and suicidal acts could have had an impact on the behaviour of some people, who harbour suicidal ideation or homicidal tendencies.AimsTo assess the effect of 11 September 2001 on the rate of suicide and homicide in England and Wales.MethodAnalysis of the number of suicides (ICD–9 codes: E950–E959), undetermined injury deaths (E980–E989) and homicides (E960–E969) in England and Wales in the 12 weeks before and after 11 September 2001 and during a similar period in the previous two years.ResultsThe number of suicides reported in the month of September 2001 was significantly lower than other months in the same year and any September of the previous 22 years in England and Wales. A suicide reduction in men, regardless of age, occurred in the week starting Tuesday 11 September 2001. A reduction in female suicide occurred during the four weeks following the attack. There was no evidence of a similar effect on homicide.ConclusionsThe tragic events of 11 September 2001 appear to have had a brief but significant inverse effect on suicide. The finding of this study supports Durkheim's theory that periods of external threat create group integration within society and lower the suicide rate through the impact on social cohesion.

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Vancomycin Use: Room for Improvement Among Hospitalized Children

Journal of Pharmacy Practice ◽

10.1177/0897190016635478 ◽

2016 ◽

Vol 30 (3) ◽

pp. 296-299 ◽

Cited By ~ 8

Author(s):

Jessica Gillon ◽

Meng Xu ◽

James Slaughter ◽

M. Cecilia Di Pentima

Keyword(s):

Real Time ◽

Interrupted Time Series ◽

Antibiotic Use ◽

Hospitalized Children ◽

Interrupted Time Series Analysis ◽

Prospective Audit ◽

Children's Hospitals ◽

Children’S Hospitals ◽

Before And After ◽

The Impact

Introduction: The use of vancomycin is common among hospitalized children. We sought to evaluate the impact of prospective audit with real-time feedback on vancomycin use and pharmacy costs. Methods: Vancomycin use was evaluated at Monroe Carell Jr Children’s Hospital at Vanderbilt (MCJCHV) before and after the implementation of prospective audit with intervention and feedback to providers in 2012. Antibiotic use was compared to academic children’s hospitals with established antimicrobial stewardship programs (ASPs). Two similar pediatric academic institutions without an ASP were used as nonintervention controls. Analysis of monthly days of antibiotic therapy (DoT) per 1000 patient-days was performed by interrupted time series analysis. Results: Monthly vancomycin use decreased from 114 DoTs/1000 patient-days to 89 DoTs/1000 patient-days ( P < .0001). We did not find significant differences in the slope of change in vancomycin use between MCJCHV and institutions with ASPs either before or after the intervention ( P = .86 and P = .71, respectively). When compared to children’s hospitals without ASPs, the use of vancomycin was significantly lower at MCJCHV ( P < .001). Conclusion: The use of vancomycin at academic children’s hospitals with an ASP is declining. In our experience, prospective audit with real-time intervention and feedback to providers significantly reduced the use and costs associated with vancomycin.

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Transit-oriented economic development: The impact of light rail on new business starts in the Phoenix, AZ Region, USA

Urban Studies ◽

10.1177/0042098017724119 ◽

2017 ◽

Vol 55 (13) ◽

pp. 2838-2862 ◽

Cited By ~ 15

Author(s):

Kevin Credit

Keyword(s):

Service Sector ◽

Interrupted Time Series ◽

Light Rail ◽

Initial Increase ◽

New Business Formation ◽

Before And After ◽

New Business ◽

Quasi Experimental ◽

And Control ◽

The Impact

This article examines the impact of Phoenix’s light rail system, which opened in 2008, on new firm formation in specific industries. Individual business data from 1990–2014 are used in a quasi-experimental adjusted-interrupted time series (AITS) regression to compare the impact of the transit system’s construction on new business starts in ‘treatment’ and ‘control’ areas before and after the opening of the line. Findings show that the transit adjacency is worth an 88% increase in knowledge sector new starts, a 40% increase in service sector new starts and a 28% increase in retail new starts at the time the system opened, when compared with automobile-accessible control areas. However, the light rail also appears to suffer from a ‘novelty factor’– after the initial increase in new establishment activity in adjacent block groups, the effect diminishes at the rate of 8%, 6% and 7% per year, respectively. The results also provide insight into the spatial extent of light rail impacts to new business formation, with areas 1 mile from stations observing 21% fewer retail new business starts and 12% fewer knowledge sector new starts than areas within a quarter of a mile of stations.

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Transformation of the Tanzania Medical Store Department through Global Fund support: lessons learned from the field

10.1101/2020.04.14.20065813 ◽

2020 ◽

Author(s):

Patrick Githendu ◽

Linden Morrison ◽

Rosemary Silaa ◽

Sai Pothapregada ◽

Sarah Asiimwe ◽

...

Keyword(s):

Global Fund ◽

Interrupted Time Series ◽

Lessons Learned ◽

Interrupted Time Series Analysis ◽

Monthly Basis ◽

Quantitative And Qualitative Research ◽

Before And After ◽

Multi Stakeholder ◽

Health Commodities ◽

The Impact

AbstractBackgroundThe Tanzania government sought support from The Global Fund to Fight AIDs, Tuberculosis and Malaria (Global Fund) to reform its Medical Stores Department (MSD), with the aim of improving performance. Our study aimed to assess the impact of the reforms and document the lessons learned.MethodsWe applied quantitative and qualitative research methods to assess the impact of the reforms. The quantitative part entailed a review of operational and financial data covering the period before and after the implementation of the reforms. We applied interrupted time series analysis to determine the change in average availability of essential health commodities at health zones. Qualitative data was collected through 41 key informant interviews. Participants were identified through stakeholder mapping, purposive and snowballing sampling techniques, and responses were analyzed through thematic content analysis.ResultsAvailability of essential health commodities increased significantly by 12.6% (95%CI, 9.6-15.6), after the reforms and continued to increase on a monthly basis by 0.2% (95%CI, 0.0-0.3) relative to the preintervention trend. Sales increased by 56.6% while the cost of goods sold increased by 88.6% between 2014/15 and 2017/18. Surplus income increased by 56.4% between 2014/15 and 2017/18, with reductions in rent and fuel expenditure. There was consensus among participants that the reforms, were instrumental in improving performance of MSD.ConclusionMany positive results were realized through the reforms at MSD. However, despite the progress, there were risks such as the increasing government receivable that could jeopardize the gains. Multi-stakeholder efforts are necessary, to sustain the progress and expand public health.

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Prescribing Variation in General Practices in England Following a Direct Healthcare Professional Communication on Mirabegron

10.20944/preprints201809.0076.v1 ◽

2018 ◽

Author(s):

Frank Moriarty ◽

Shegufta Razzaque ◽

Ronald McDowell ◽

Tom Fahey

Keyword(s):

Healthcare Professional ◽

Interrupted Time Series ◽

Professional Communication ◽

European Medicines Agency ◽

Area Deprivation ◽

Safety Issues ◽

Practice Characteristics ◽

Before And After ◽

Prescribing Behaviour ◽

General Practices

Introduction Pharmacovigilance may detect safety issues after marketing of medications, and this can result in regulatory action such as direct healthcare professional communications (DHPC). DHPC can be effective in changing prescribing behaviour, however the extent to which prescribers vary in their response to DHPC is unknown. This study aims to explore changes in prescribing and prescribing variation among GP practices following a DHPC on the safety of mirabegron, a medication to treat overactive bladder (OAB). Methods This is an interrupted time series study of English GP practices from 2014-2017. NHS Digital provided monthly statistics on aggregate practice-level prescribing and practice characteristics (practice staff and registered patient profiles, Quality & Outcomes Framework indicators, and deprivation of the practice area). The primary outcome was monthly mirabegron items as a percentage of all OAB drug items. The exposure was a DHPC issued by the European Medicines Agency in September 2015. Variation between practices in mirabegron prescribing before and after the DHPC was assessed using the systematic component of variation (SCV). Multilevel segmented regression with random effects quantified the change in level and trend of prescribing after the DHPC. Practice characteristics were assessed for their association with a reduction in prescribing following the DHPC. Results This study included 7,408 practices. During September 2015, 88.9% of practices prescribed mirabegron and mirabegron composed a mean of 8.2% (SD 6.8) of OAB items. Variation between practices was classified as very high and the median SCV did not change significantly (p=0.11) in the 6 months after the September 2015 DHPC (12.4) compared to before (11.6). Before the DHPC, there was a monthly trend of 0.294 (95%CI, 0.287, 0.301) percentage points increase in mirabegron percentage. There was no significant change in the month immediately after the DHPC (-0.023, 95% CI -0.105 to 0.058) however there was a significant reduction in trend (-0.036, 95% CI -0.049 to -0.023). Higher numbers of registered patients and patients aged ≥65 years, and practice area deprivation were associated with having a significant decrease in level and slope of mirabegron prescribing post-DHPC. Conclusion Variation in mirabegron prescribing was high over the study period and did not change substantively following the DHPC. There was no immediate prescribing change post-DHPC, although the monthly growth did slow. Knowledge of the degree of variation in and determinants of response to safety communications may allow those that do not change prescribing to be provided with additional supports.

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Police Officers Do Not Need More Training; But Different Training. Policing Domestic Violence and Abuse Involving Children: A Rapid Review

Journal of Family Violence ◽

10.1007/s10896-021-00325-x ◽

2021 ◽

Author(s):

Annemarie Millar ◽

Michael Saxton ◽

Carolina Øverlien ◽

Ruth Elliffe

Keyword(s):

Domestic Violence ◽

Police Officers ◽

Professional Competence ◽

Rapid Review ◽

Empirical Literature ◽

Police Response ◽

Final Sample ◽

The Impact ◽

Domestic Violence And Abuse

AbstractAlthough the police have been identified as a key service provider when responding to domestic violence and abuse (DVA), very few studies have investigated their response in relation to children. This review aims to examine children’s experiences of police response in the context of DVA and to explore how the police understand and respond to children living with DVA. A rapid review of the empirical literature on the police response to DVA involving children was undertaken. PsycINFO, Web of Science and ProQuest were searched. Studies with a qualitative element, concerning children under 18 with experience of police involvement, or police experiences of children, in the context of DVA were included. The final sample comprised of six studies. Using reflexive thematic analysis, four key themes emerged in relation to children: children’s experiences of DVA; fear, uncertainty, and mistrust of police; confronting “childism”: a matter of children’s rights; and going beyond empathy: equality and justice. Regarding the police, three key themes emerged: variability in police response; limited view of police role; lack of professional competence. The findings underscore the need for awareness raising and an urgent review of the training officers receive regarding the impact of DVA on children. They also highlight the pivotal role of police when responding to DVA where children are present, as well as to advance the frontiers of research by including not only adults and professionals but also the most vulnerable DVA victim: the child.

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