Summary Background Elder abuse is recognised worldwide as a serious problem, yet quantitative syntheses of prevalence studies are rare. We aimed to quantify and understand prevalence variation at the ...global and regional levels. Methods For this systematic review and meta-analysis, we searched 14 databases, including PubMed, PsycINFO, CINAHL, EMBASE, and MEDLINE, using a comprehensive search strategy to identify elder abuse prevalence studies in the community published from inception to June 26, 2015. Studies reporting estimates of past-year abuse prevalence in adults aged 60 years or older were included in the analyses. Subgroup analysis and meta-regression were used to explore heterogeneity, with study quality assessed with the risk of bias tool. The study protocol has been registered with PROSPERO, number CRD42015029197. Findings Of the 38 544 studies initially identified, 52 were eligible for inclusion. These studies were geographically diverse (28 countries). The pooled prevalence rate for overall elder abuse was 15·7% (95% CI 12·8–19·3). The pooled prevalence estimate was 11·6% (8·1–16·3) for psychological abuse, 6·8% (5·0–9·2) for financial abuse, 4·2% (2·1–8·1) for neglect, 2·6% (1·6–4·4) for physical abuse, and 0·9% (0·6–1·4) for sexual abuse. Meta-analysis of studies that included overall abuse revealed heterogeneity. Significant associations were found between overall prevalence estimates and sample size, income classification, and method of data collection, but not with gender. Interpretation Although robust prevalence studies are sparse in low-income and middle-income countries, elder abuse seems to affect one in six older adults worldwide, which is roughly 141 million people. Nonetheless, elder abuse is a neglected global public health priority, especially compared with other types of violence. Funding Social Sciences and Humanities Research Council of Canada and the WHO Department of Ageing and Life Course.
Abstract
Background
A recent study has shown that close to one in six older adults have experienced elder abuse in a community setting in the past year. It is thought that abuse in institutions is ...just as prevalent. Few systematic evidence of the scale of the problem exists in elder care facilities. The aim of this review is to conduct a systematic review and meta-analysis of the problem in institutional settings and to provide estimates of the prevalence of elder abuse in the past 12 months.
Methods
Fourteen academic databases and other online platforms were systematically searched for studies on elder abuse. Additionally, 26 experts in the field were consulted to identify further studies. All studies were screened for inclusion criteria by two independent reviewers. Data were extracted, and meta-analysis was conducted. Self-reported data from older residents and staff were considered separately.
Results
Nine studies met the inclusion criteria from an initial of 55 studies identified for review. Overall abuse estimates, based on staff reports, suggest that 64.2% of staff admitted to elder abuse in the past year. There were insufficient studies to calculate an overall prevalence estimate based on self-reported data from older residents. Prevalence estimates for abuse subtypes reported by older residents were highest for psychological abuse (33.4%), followed by physical (14.1%), financial (13.8%), neglect (11.6%), and sexual abuse (1.9%).
Conclusions
The prevalence of elder abuse in institutions is high. Global action to improve surveillance and monitoring of institutional elder abuse is vital to inform policy action to prevent elder abuse.
To synthesize recent evidence from systematic and comprehensive reviews on the effectiveness of universal and selective child maltreatment prevention interventions, evaluate the methodological ...quality of the reviews and outcome evaluation studies they are based on, and map the geographical distribution of the evidence.
A systematic review of reviews was conducted. The quality of the systematic reviews was evaluated with a tool for the assessment of multiple systematic reviews (AMSTAR), and the quality of the outcome evaluations was assessed using indicators of internal validity and of the construct validity of outcome measures.
The review focused on seven main types of interventions: home visiting, parent education, child sex abuse prevention, abusive head trauma prevention, multi-component interventions, media-based interventions, and support and mutual aid groups. Four of the seven - home-visiting, parent education, abusive head trauma prevention and multi-component interventions - show promise in preventing actual child maltreatment. Three of them - home visiting, parent education and child sexual abuse prevention - appear effective in reducing risk factors for child maltreatment, although these conclusions are tentative due to the methodological shortcomings of the reviews and outcome evaluation studies they draw on. An analysis of the geographical distribution of the evidence shows that outcome evaluations of child maltreatment prevention interventions are exceedingly rare in low- and middle-income countries and make up only 0.6% of the total evidence base.
Evidence for the effectiveness of four of the seven main types of interventions for preventing child maltreatment is promising, although it is weakened by methodological problems and paucity of outcome evaluations from low- and middle-income countries.
A growing body of research identifies the harmful effects that adverse childhood experiences (ACEs; occurring during childhood or adolescence; eg, child maltreatment or exposure to domestic violence) ...have on health throughout life. Studies have quantified such effects for individual ACEs. However, ACEs frequently co-occur and no synthesis of findings from studies measuring the effect of multiple ACE types has been done.
In this systematic review and meta-analysis, we searched five electronic databases for cross-sectional, case-control, or cohort studies published up to May 6, 2016, reporting risks of health outcomes, consisting of substance use, sexual health, mental health, weight and physical exercise, violence, and physical health status and conditions, associated with multiple ACEs. We selected articles that presented risk estimates for individuals with at least four ACEs compared with those with none for outcomes with sufficient data for meta-analysis (at least four populations). Included studies also focused on adults aged at least 18 years with a sample size of at least 100. We excluded studies based on high-risk or clinical populations. We extracted data from published reports. We calculated pooled odds ratios (ORs) using a random-effects model.
Of 11 621 references identified by the search, 37 included studies provided risk estimates for 23 outcomes, with a total of 253 719 participants. Individuals with at least four ACEs were at increased risk of all health outcomes compared with individuals with no ACEs. Associations were weak or modest for physical inactivity, overweight or obesity, and diabetes (ORs of less than two); moderate for smoking, heavy alcohol use, poor self-rated health, cancer, heart disease, and respiratory disease (ORs of two to three), strong for sexual risk taking, mental ill health, and problematic alcohol use (ORs of more than three to six), and strongest for problematic drug use and interpersonal and self-directed violence (ORs of more than seven). We identified considerable heterogeneity (I2 of >75%) between estimates for almost half of the outcomes.
To have multiple ACEs is a major risk factor for many health conditions. The outcomes most strongly associated with multiple ACEs represent ACE risks for the next generation (eg, violence, mental illness, and substance use). To sustain improvements in public health requires a shift in focus to include prevention of ACEs, resilience building, and ACE-informed service provision. The Sustainable Development Goals provide a global platform to reduce ACEs and their life-course effect on health.
Public Health Wales.
Global Status Report on Violence Prevention 2014 Mikton, Christopher R., PhD; Butchart, Alexander, PhD; Dahlberg, Linda L., PhD ...
American journal of preventive medicine,
05/2016, Letnik:
50, Številka:
5
Journal Article
Recenzirano
Odprti dostop
Introduction Interpersonal violence affects millions of people worldwide, often has lifelong consequences, and is gaining recognition as an important global public health problem. There has been no ...assessment of measures countries are taking to address it. This report aims to assess such measures and provide a baseline against which to track future progress. Methods In each country, with help from a government-appointed National Data Coordinator, representatives from six to ten sectors completed a questionnaire before convening in a consensus meeting to decide on final country data; 133 of 194 (69%) WHO Member States participated. The questionnaire covered data, plans, prevention measures, and victim services. Data were collected between November 2012 and June 2014, and analyzed between June and October 2014. Global and country-level homicides for 2000–2012 were also calculated for all 194 Members. Results Worldwide, 475,000 people were homicide victims in 2012 and homicide rates declined by 16% from 2000 to 2012. Data on fatal and, in particular, non-fatal forms of violence are lacking in many countries. Each of the 18 types of surveyed prevention programs was reported to be implemented in a third of the 133 participating countries; each law was reported to exist in 80% of countries, but fully enforced in just 57%; and each victim service was reported to be in place in just more than half of the countries. Conclusions Although many countries have begun to tackle violence, serious gaps remain, and public health researchers have a critical role to play in addressing them.
Summary Background Globally, at least 93 million children have moderate or severe disability. Children with disabilities are thought to have a substantially greater risk of being victims of violence ...than are their non-disabled peers. Establishment of reliable estimates of the scale of the problem is an essential first step in the development of effective prevention programmes. We therefore undertook a systematic review and meta-analysis to synthesise evidence for the prevalence and risk of violence against children with disabilities. Methods For this systematic review and meta-analysis, we searched 12 electronic databases to identify cross-sectional, case-control, or cohort studies reported between Jan 1, 1990, and Aug 17, 2010, with estimates of prevalence of violence against children (aged ≤18 years) with disabilities or their risk of being victims of violence compared with children without disabilities. Findings 17 studies were selected from 10 663 references. Reports of 16 studies provided data suitable for meta-analysis of prevalence and 11 for risk. Pooled prevalence estimates were 26·7% (95% CI 13·8–42·1) for combined violence measures, 20·4% (13·4–28·5) for physical violence, and 13·7% (9·2–18·9) for sexual violence. Odds ratios for pooled risk estimates were 3·68 (2·56–5·29) for combined violence measures, 3·56 (2·80–4·52) for physical violence, and 2·88 (2·24–3·69) for sexual violence. Huge heterogeneity was identified across most estimates ( I2 >75%). Variations were not consistently explained with meta-regression analysis of the characteristics of the studies. Interpretation The results of this systematic review confirm that children with disabilities are more likely to be victims of violence than are their peers who are not disabled. However, the continued scarcity of robust evidence, due to a lack of well designed research studies, poor standards of measurement of disability and violence, and insufficient assessment of whether violence precedes the development of disability, leaves gaps in knowledge that need to be addressed. Funding WHO Department of Violence and Injury Prevention and Disability.
Summary Background About 15% of adults worldwide have a disability. These individuals are frequently reported to be at increased risk of violence, yet quantitative syntheses of studies of this issue ...are scarce. We aimed to quantify violence against adults with disabilities. Methods In this systematic review and meta-analysis, we searched 12 electronic databases to identify primary research studies published between Jan 1, 1990, and Aug 17, 2010, reporting prevalence estimates of violence against adults (aged mainly ≥18 years) with disabilities, or their risk of violence compared with non-disabled adults. We included only studies reporting violence occurring within the 12 months before the study. We assessed studies with six core quality criteria, and pooled data for analysis. Findings Of 10 663 references initially identified, 26 were eligible for inclusion, with data for 21 557 individuals with disabilities. 21 studies provided data suitable for meta-analysis of prevalence of violence, and ten for meta-analysis of risks of violence. Pooled prevalence of any (physical, sexual, or intimate partner) recent violence was 24·3% (95% CI 18·3–31·0) in people with mental illnesses, 6·1% (2·5–11·1) in those with intellectual impairments, and 3·2% (2·5–4·1) in those with non-specific impairments. We identified substantial heterogeneity in most prevalence estimates ( I2 >75%). We noted large uncertainty around pooled risk estimates. Pooled crude odds ratios for the risk of violence in disabled compared with non-disabled individuals were 1·50 (95% CI 1·09–2·05) for all studies combined, 1·31 (0·93–1·84) for people with non-specific impairments, 1·60 (1·05–2·45) for people with intellectual impairments, and 3·86 (0·91–16·43) for those with mental illnesses. Interpretation Adults with disabilities are at a higher risk of violence than are non-disabled adults, and those with mental illnesses could be particularly vulnerable. However, available studies have methodological weaknesses and gaps exist in the types of disability and violence they address. Robust studies are absent for most regions of the world, particularly low-income and middle-income countries. Funding WHO Department of Violence and Injury Prevention and Disability.
The abuse of older women appears to be a significant problem. Developing a better understanding of the extent of the problem is an important step toward preventing it. We conducted a global ...systematic review and meta-analysis of existing prevalence studies, in multiple languages, that occurred in the community settings from inception to June 26, 2015, in order to determine the extent of abuse against women aged 60 years and over. To disentangle the wide variations in prevalence estimates, we also investigated the associations between prevalence estimates and studies’ demographic and methodological characteristics. A total of 50 studies were included in the meta-analysis. The combined prevalence for overall elder abuse in the past year was 14.1% (95% confidence interval (CI) 11.0, 18.0). Pooled prevalence for psychological abuse was 11.8% (95% CI 9.2%, 14.9%), neglect was 4.1% (95% CI 2.7%, 6.3%), financial abuse was 3.8% (95% CI 2.5%, 5.5%), sexual abuse was 2.2% (95% CI 1.6%, 3.0%), and physical abuse was 1.9% (95% CI 1.2%, 3.1%). The studies included in the meta-analysis for overall abuse were heterogeneous indicating that significant differences among the prevalence estimates exist. Significant associations were found between prevalence estimates and the following covariates: World Health Organization–defined regions, countries’ income classification, and sample size. Together, these covariates explained 37% of the variance. Although robust prevalence studies are sparse in low- and middle-income countries, about 1 in 6, or 68 million older women experience abuse worldwide. More work is needed to understand the variation in prevalence rates and implications for prevention.
Abstract Despite numerous studies identifying a broad range of harms associated with the use of spanking and other types of physical punishment, debate continues about its use as a form of ...discipline. In this commentary, we recommend four strategies to move the field forward and beyond the spanking debate including: 1) use of methodological approaches that allow for stronger causal inference; 2) consideration of human rights issues; 3) a focus on understanding the causes of spanking and reasons for its decline in certain countries; and 4) more emphasis on evidence-based approaches to changing social norms to reject spanking as a form of discipline. Physical punishment needs to be recognized as an important public health problem.
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