Global and regional estimates of violence against women: prevalence and health effects of intimate partner violence and non-partner sexual violence.
01 Jan 2013-
TL;DR: In this article, the authors present the first global systematic review of scientific data on the prevalence of two forms of violence against women: violence by an intimate partner (intimate partner violence) and sexual violence by someone other than a partner.
Abstract: This report presents the first global systematic review of scientific data on the prevalence of two forms of violence against women: violence by an intimate partner (intimate partner violence) and sexual violence by someone other than a partner (non-partner sexual violence). It shows for the first time global and regional estimates of the prevalence of these two forms of violence using data from around the world. Previous reporting on violence against women has not differentiated between partner- and nonpartner violence.
Citations
More filters
Mohammad H. Forouzanfar1, Lily Alexander, H. Ross Anderson, Victoria F Bachman1 +733 more•Institutions (289)
TL;DR: The Global Burden of Disease, Injuries, and Risk Factor study 2013 (GBD 2013) as discussed by the authors provides a timely opportunity to update the comparative risk assessment with new data for exposure, relative risks, and evidence on the appropriate counterfactual risk distribution.
5,668 citations
01 Jan 2016
TL;DR: The comparative risk assessment framework developed for previous iterations of the Global Burden of Disease Study 2015 was used to estimate attributable deaths, disability-adjusted life-years (DALYs), and trends in exposure by age group, sex, year, and geography for 79 behavioural, environmental and occupational risks or clusters of risks from 1990 to 2015.
Abstract: BACKGROUND
The Global Burden of Diseases, Injuries, and Risk Factors Study 2015 provides an up-to-date synthesis of the evidence for risk factor exposure and the attributable burden of disease. By providing national and subnational assessments spanning the past 25 years, this study can inform debates on the importance of addressing risks in context.
METHODS
We used the comparative risk assessment framework developed for previous iterations of the Global Burden of Disease Study to estimate attributable deaths, disability-adjusted life-years (DALYs), and trends in exposure by age group, sex, year, and geography for 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks from 1990 to 2015. This study included 388 risk-outcome pairs that met World Cancer Research Fund-defined criteria for convincing or probable evidence. We extracted relative risk and exposure estimates from randomised controlled trials, cohorts, pooled cohorts, household surveys, census data, satellite data, and other sources. We used statistical models to pool data, adjust for bias, and incorporate covariates. We developed a metric that allows comparisons of exposure across risk factors-the summary exposure value. Using the counterfactual scenario of theoretical minimum risk level, we estimated the portion of deaths and DALYs that could be attributed to a given risk. We decomposed trends in attributable burden into contributions from population growth, population age structure, risk exposure, and risk-deleted cause-specific DALY rates. We characterised risk exposure in relation to a Socio-demographic Index (SDI).
FINDINGS
Between 1990 and 2015, global exposure to unsafe sanitation, household air pollution, childhood underweight, childhood stunting, and smoking each decreased by more than 25%. Global exposure for several occupational risks, high body-mass index (BMI), and drug use increased by more than 25% over the same period. All risks jointly evaluated in 2015 accounted for 57·8% (95% CI 56·6-58·8) of global deaths and 41·2% (39·8-42·8) of DALYs. In 2015, the ten largest contributors to global DALYs among Level 3 risks were high systolic blood pressure (211·8 million [192·7 million to 231·1 million] global DALYs), smoking (148·6 million [134·2 million to 163·1 million]), high fasting plasma glucose (143·1 million [125·1 million to 163·5 million]), high BMI (120·1 million [83·8 million to 158·4 million]), childhood undernutrition (113·3 million [103·9 million to 123·4 million]), ambient particulate matter (103·1 million [90·8 million to 115·1 million]), high total cholesterol (88·7 million [74·6 million to 105·7 million]), household air pollution (85·6 million [66·7 million to 106·1 million]), alcohol use (85·0 million [77·2 million to 93·0 million]), and diets high in sodium (83·0 million [49·3 million to 127·5 million]). From 1990 to 2015, attributable DALYs declined for micronutrient deficiencies, childhood undernutrition, unsafe sanitation and water, and household air pollution; reductions in risk-deleted DALY rates rather than reductions in exposure drove these declines. Rising exposure contributed to notable increases in attributable DALYs from high BMI, high fasting plasma glucose, occupational carcinogens, and drug use. Environmental risks and childhood undernutrition declined steadily with SDI; low physical activity, high BMI, and high fasting plasma glucose increased with SDI. In 119 countries, metabolic risks, such as high BMI and fasting plasma glucose, contributed the most attributable DALYs in 2015. Regionally, smoking still ranked among the leading five risk factors for attributable DALYs in 109 countries; childhood underweight and unsafe sex remained primary drivers of early death and disability in much of sub-Saharan Africa.
INTERPRETATION
Declines in some key environmental risks have contributed to declines in critical infectious diseases. Some risks appear to be invariant to SDI. Increasing risks, including high BMI, high fasting plasma glucose, drug use, and some occupational exposures, contribute to rising burden from some conditions, but also provide opportunities for intervention. Some highly preventable risks, such as smoking, remain major causes of attributable DALYs, even as exposure is declining. Public policy makers need to pay attention to the risks that are increasingly major contributors to global burden.
FUNDING
Bill & Melinda Gates Foundation.
3,920 citations
Jeffrey D. Stanaway1, Ashkan Afshin1, Emmanuela Gakidou1, Stephen S Lim1 +1050 more•Institutions (346)
TL;DR: This study estimated levels and trends in exposure, attributable deaths, and attributable disability-adjusted life-years (DALYs) by age group, sex, year, and location for 84 behavioural, environmental and occupational, and metabolic risks or groups of risks from 1990 to 2017 and explored the relationship between development and risk exposure.
2,910 citations
Book•
[...]
26 May 2011
TL;DR: The author considers Kant's claims about the good AUTONOMY and CATEGORICAL IMPERATIVES, as well as the duality of Subjectivism and Non-COGNITIVISM, and the role of language in this development.
Abstract: PART FOUR: COMMENTARIES HIKING THE RANGE HUMANITY AS AN END IN ITSELF A MISMATCH OF METHODS HOW I AM NOT A KANTIAN PART FIVE: RESPONSES ON HIKING THE RANGE ON HUMANITY AS AN END IN ITSELF ON A MISMATCH OF METHODS HOW THE NUMBERS COUNT SCANLONIAN CONTRACTUALISM THE TRIPLE THEORY PART SIX: NORMATIVITY ANALYTICAL NATURALISM AND SUBJECTIVISM NON-ANALYTICAL NATURALISM THE TRIVIALITY OBJECTION NATURALISM AND NIHILISM NON-COGNITIVISM AND QUASI-REALISM NORMATIVITY NORMATIVE TRUTHS METAPHYSICS EPISTEMOLOGY RATIONALISM AGREEMENT NIETZSCHE WHAT MATTERS MOST APPENDICES WHY ANYTHING? WHY THIS? THE FAIR WARNING VIEW SOME OF KANT'S ARGUMENTS FOR HIS FORMULA OF UNIVERSAL LAW KANT'S CLAIMS ABOUT THE GOOD AUTONOMY AND CATEGORICAL IMPERATIVES KANT'S MOTIVATIONAL ARGUMENT ON WHAT THERE IS Notes to Volume Two References Bibliography Index
799 citations
TL;DR: Evidence regarding the epidemiology on gender differences in prevalence, incidence, and course of depression, and factors possibly explaining the gender gap are summarized.
754 citations
References
More filters
TL;DR: An issue concerning the criteria for tic disorders is highlighted, and how this might affect classification of dyskinesias in psychotic spectrum disorders.
Abstract: Given the recent attention to movement abnormalities in psychosis spectrum disorders (e.g., prodromal/high-risk syndromes, schizophrenia) (Mittal et al., 2008; Pappa and Dazzan, 2009), and an ongoing discussion pertaining to revisions of the Diagnostic and Statistical Manuel of Mental Disorders (DSM) for the upcoming 5th edition, we would like to take this opportunity to highlight an issue concerning the criteria for tic disorders, and how this might affect classification of dyskinesias in psychotic spectrum disorders.
Rapid, non-rhythmic, abnormal movements can appear in psychosis spectrum disorders, as well as in a host of commonly co-occurring conditions, including Tourette’s Syndrome and Transient Tic Disorder (Kerbeshian et al., 2009). Confusion can arise when it becomes necessary to determine whether an observed movement (e.g., a sudden head jerk) represents a spontaneous dyskinesia (i.e., spontaneous transient chorea, athetosis, dystonia, ballismus involving muscle groups of the arms, legs, trunk, face, and/or neck) or a tic (i.e., stereotypic or patterned movements defined by the relationship to voluntary movement, acute and chronic time course, and sensory urges). Indeed, dyskinetic movements such as dystonia (i.e., sustained muscle contractions, usually producing twisting and repetitive movements or abnormal postures or positions) closely resemble tics in a patterned appearance, and may only be visually discernable by attending to timing differences (Gilbert, 2006).
When turning to the current DSM-IV TR for clarification, the description reads: “Tic Disorders must be distinguished from other types of abnormal movements that may accompany general medical conditions (e.g., Huntington’s disease, stroke, Lesch-Nyhan syndrome, Wilson’s disease, Sydenham’s chorea, multiple sclerosis, postviral encephalitis, head injury) and from abnormal movements that are due to the direct effects of a substance (e.g., a neuroleptic medication)”. However, as it is written, it is unclear if psychosis falls under one such exclusionary medical disorder. The “direct effects of a substance” criteria, referencing neuroleptic medications, further contributes to the uncertainty around this issue. As a result, ruling-out or differentiating tics in psychosis spectrum disorders is at best, a murky endeavor.
Historically, the advent of antipsychotic medication in the 1950s has contributed to the confusion about movement signs in psychiatric populations. Because neuroleptic medications produce characteristic movement disorder in some patients (i.e. extrapyramidal side effects), drug-induced movement disturbances have been the focus of research attention in psychotic disorders. However, accumulating data have documented that spontaneous dyskinesias, including choreoathetodic movements, can occur in medication naive adults with schizophrenia spectrum disorders (Pappa and Dazzan, 2009), as well as healthy first-degree relatives of chronically ill schizophrenia patients (McCreadie et al., 2003). Taken together, this suggests that movement abnormalities may reflect pathogenic processes underlying some psychotic disorders (Mittal et al., 2008; Pappa and Dazzan, 2009).
More specifically, because spontaneous hyperkinetic movements are believed to reflect abnormal striatal dopamine activity (DeLong and Wichmann, 2007), and dysfunction in this same circuit is also proposed to contribute to psychosis, it is possible that spontaneous dyskinesias serve as an outward manifestation of circuit dysfunction underlying some schizophrenia-spectrum symptoms (Walker, 1994). Further, because these movements precede the clinical onset of psychotic symptoms, sometimes occurring in early childhood (Walker, 1994), and may steadily increase during adolescence among populations at high-risk for schizophrenia (Mittal et al., 2008), observable dyskinesias could reflect a susceptibility that later interacts with environmental and neurodevelopmental factors, in the genesis of psychosis.
In adolescents who meet criteria for a prodromal syndrome (i.e., the period preceding formal onset of psychotic disorders characterized by subtle attenuated positive symptoms coupled with a decline in functioning), there is sometimes a history of childhood conditions which are also characterized by suppressible tics or tic like movements (Niendam et al., 2009). On the other hand, differentiating between tics and dyskinesias has also complicated research on childhood disorders such as Tourette syndrome (Kompoliti and Goetz, 1998; Gilbert, 2006).
We propose consideration of more explicit and operationalized criteria for differentiating tics and dyskinesias, based on empirically derived understanding of neural mechanisms. Further, revisions of the DSM should allow for the possibility that movement abnormalities might reflect neuropathologic processes underlying the etiology of psychosis for a subgroup of patients. Psychotic disorders might also be included among the medical disorders that are considered a rule-out for tics.
Related to this, the reliability of movement assessment needs to be improved, and this may require more training for mental health professionals in movement symptoms. Although standardized assessment of movement and neurological abnormalities is common in research settings, it has been proposed that an examination of neuromotor signs should figure in the assessment of any patient, and be as much a part of the patient assessment as the mental state examination (Picchioni and Dazzan, 2009).
To this end it is important for researchers and clinicians to be aware of differentiating characteristics for these two classes of abnormal movement. For example, tics tend to be more complex than myoclonic twitches, and less flowing than choreoathetodic movements (Kompoliti and Goetz, 1998). Patients with tics often describe a sensory premonition or urge to perform a tic, and the ability to postpone tics at the cost of rising inner tension (Gilbert, 2006). For example, one study showed that patients with tic disorders could accurately distinguish tics from other movement abnormalities based on the subjective experience of some voluntary control of tics (Lang, 1991). Another differentiating factor derives from the relationship of the movement in question to other voluntary movements. Tics in one body area rarely occur during purposeful and voluntary movements in that same body area whereas dyskinesia are often exacerbated by voluntary movement (Gilbert, 2006). Finally, it is noteworthy that tics wax and wane in frequency and intensity and migrate in location over time, often becoming more complex and peaking between the ages of 9 and 14 years (Gilbert, 2006). In the case of dyskinesias among youth at-risk for psychosis, there is evidence that the movements tend to increase in severity and frequency as the individual approaches the mean age of conversion to schizophrenia spectrum disorders (Mittal et al., 2008).
As revisions to the DSM are currently underway in preparation for the new edition (DSM V), we encourage greater attention to the important, though often subtle, distinctions among subtypes of movement abnormalities and their association with psychiatric syndromes.
67,017 citations
TL;DR: In this article, a revised Conflict Tactics Scales (the CTS2) is proposed to measure psychological and physical attacks on a partner in a marital, cohabiting, or dating relationship.
Abstract: This article describes a revised Conflict Tactics Scales (the CTS2) to measure psychological and physical attacks on a partner in a marital, cohabiting, or dating relationship; and also use of negotiation. The CTS2 has (a) additional items to enhance content validity and reliability; (b) revised wording to increase clarity and specificity; (c) better differentiation between minor and severe levels of each scale; (d) new scales to measure sexual coercion and physical injury; and (e) a new format to simplify administration and reduce response sets. Reliability ranges from .79 to .95. There is preliminary evidence of construct validity.
6,142 citations
"Global and regional estimates of vi..." refers methods in this paper
...Assistant Director General Family, Women and Children’s Health World Health Organization Oleg Chestnov Assistant Director General Noncommunicable Diseases and Mental Health World Health Organization Peter Piot Director and Professor of Global Health, London School of Hygiene & Tropical Medicine Prevalence and health effects of intimate partner violence and non-partner sexual violence 1 AIDS acquired immunodeficiency syndrome aOR adjusted odds ratio CDC Centers for Disease Control and Prevention CES-D Centre for Epidemiological Studies Depression Scale CI confidence interval CINAHL Cumulative Index to Nursing and Allied Health Literature CTS Conflict Tactics Scale DHS Demographic and Health Survey DSM-IV Diagnostic and statistical manual of mental disorders, fourth edition GBD Global Burden of Disease GENACIS Gender, alcohol and culture: an international study HIV human immunodeficiency virus IMEMR Index Medicus for the WHO Eastern Mediterranean Region IMSEAR Index Medicus for the WHO South-East Asia Region IVAWS International Violence Against Women Survey LSHTM London School of Hygiene and Tropical Medicine OR odds ratio PTSD post-traumatic stress disorder RHS reproductive health survey (CDC) SAMRC South African Medical Research Council STI sexually transmitted infection USA United States of America WHO World Health Organization WPRIM Western Pacific Region Index Medicus Abbreviations 2 Global and regional estimates of violence against women “There is one universal truth, applicable to all countries, cultures and communities: violence against women is never acceptable, never excusable, never tolerable.”...
[...]
...The Conflict Tactics Scale (CTS) (20) has been widely used in the United States of America (USA) and elsewhere to document the prevalence of physical partner violence, framing violent acts in the context of relationship conflict....
[...]
...The Conflict Tactics Scale (CTS) (20 ) has been widely used in the United States of America (USA) and elsewhere to document the prevalence of physical partner violence, framing violent acts in the context of relationship conflict....
[...]
...The WHO multi-country study on women’s health and domestic violence against women (21) and the violence against women module of the DHS (22 ) are adapted versions of the CTS that also ask about a set of behaviourally specific acts that women experience, without framing the questions as gradations of relationship conflict, but rather as independent acts in a constellation of experiences Section 1: Methodology 10 Global and regional estimates of violence against women encompassing partner violence....
[...]
...Straus MA et al. The revised conflict tactics scales (CTS2)....
[...]
TL;DR: Research on the mental and physical health sequelae of intimate partner violence is reviewed and increased assessment and interventions for intimate partner Violence in health-care settings are recommended.
3,615 citations
"Global and regional estimates of vi..." refers background in this paper
...Some women try to manage the negative consequences of abuse through the use of alcohol, prescription medication, tobacco or other drugs (13, 14)....
[...]
TL;DR: The MAST responses of 15 subjects who were found to be alcoholic in the record search were analyzed to determine where the screening failures had occurred and recommendations are made for reducing the number of such "falsė negatives."
Abstract: The Michigan Alcoholism Screening Test (MAST), devised to provide a consistent, quantifiable, structured interview instrument to detect alcoholism, consists of 25 questions that can be rapidly administered. Five groups were given the MAST: hospitalized alcoholics, a control group, persons convicted of drunk driving, persons convicted of drunk and disorderly behavior, and drivers whose licenses were under review. The validity of the MAST was assessed by searching the records of legal, social, and medical agencies and reviewing the subjects' driving and criminal records. The MAST responses of 15 subjects who were found to be alcoholic in the record search were analyzed to determine where the screening failures had occurred. Recommendations are made for reducing the number of such "falsė negatives."
3,422 citations
TL;DR: Men and women everywhere have the right to live their lives and raise their children free from the fear of violence, and to help them enjoy that right by making it clearly understood that violence is preventable, and by working together to identify and address its underlying causes.
Abstract: WHO Violence cuts short the lives of millions of people across the world each year, and damages the lives of millions more. It knows no boundaries of geography, race, age or income. It strikes at children, young people, women and the elderly. It finds its way into homes, schools and the workplace. Men and women everywhere have the right to live their lives and raise their children free from the fear of violence. We must help them enjoy that right by making it clearly understood that violence is preventable, and by working together to identify and address its underlying causes.
3,282 citations
"Global and regional estimates of vi..." refers background in this paper
...There is growing consensus on how to measure exposures to different forms of interpersonal violence, with most work focusing on the measurement of violence by an intimate partner (15, 16)....
[...]