A. Gender differences
From the result of our study, most of the victims are females22; however, perpetrators of domestic violence are mainly males.41 Intimate partner violence accounts for most of the domestic violence cases in both genders.41 A previous study on Injury pattern and Risk Factor of Intimate partner violence by Lin et al.42 revealed only 7% are male victims and 93% are female victims. Both female and male victims have high recidivism rate. Dispute, in a heterosexual relationship, is the main cause of domestic violence for mature men and women. Marriage constitutes of two completely different person come from two distinct families. Different life styles and upbringings cause couples to have disagreements. Thus, much marital violence are caused by discrepancies of opinions due to different habit or background. Beating with fists and hands tend to be the result of argument, but are all minor injuries with low AIS and ISS scores.
Of all domestic violence victims, about twenty percent are males.
Statistics from Domestic Violence and Sexual Assault Prevention Committeeshows that the numbers of male victims are increasing on the average of 25% every year for the past 6 years (http://www.
dspc.moi.gov.tw). There is an increase of male victims filing domestic violence reports as compared to previous studies.
In the early 1920, agriculture played an important part of Taiwanese
exhibiting the superiority of men beyond women. Man carried the sole source of the family income. Women in the 1920’s were treated as properties of men. Therefore after marrying a man, all properties belonging to the women will be owned by the man. In the past, laws favored men. If women got divorced, all the properties and children all belong to the husband.
In the 50’s and 60’s, women are expected from the in-laws to live with the husband’s parents and also take over the majority of the housework.
Thus, this submissive behavior encourages the dominant power of men in the household. Unable to adapt to the new married life, women are often targets of physical and mental abuse of domestic violence.43
As time goes by, there was no major change. The property systems of couple had dramatic change in June 3, 1985, Properties can be registered in different name but the husband still has the power to control all the properties. It is not until June 28, 2002, the civil law re-enforced equality between men and women, which women gained legal control of their properties. Now the social structure has changed, fewer couples are living with their parents-in-law. Without the pressure from the parents-in-law, wives are more willing to express their feelings and fight for more freedom that may offend men’s pride. As a result, instead of the women being main target of DV, men can be victims of domestic violence as well.
As the society progresses, the era of men working outside and women staying at home have interchanged. Dual-earning couples become the mainstream of the society. Men no longer control the power of
economy in the house. There is an increasing number of female boss at work, therefore, women no longer find themselves in a vulnerable situation in society and homes. Men not only have to compete with each other but also have to compete with women career wise. Due to the economic depression, many people are forced to take an early retirement and possible lay-off. When men are unemployed, women become the sole source of financial income for the family; therefore, causing the men to be emotionally distressed of financial burden. As a result of this new feminist movement and women being more educated, men no longer play the dominating part in families and society.
B. Age differences
Age is an important risk factor for domestic violence. Most vulnerable victims fall in the youngest age due to the fact that they have the worst GCS and highest ISS. Youngsters and elderly are often defenseless when they are physically assaulted. 40 Discipline seems to be the most common reason of domestic violence in the youngest group.
Under influence of alcohol abuse can cause devastating consequences to the victims of domestic violence. 35
As part of the Asian tradition, parents start teaching their children filial piety since the first day of birth. All parents have great ambitions and high expectations for their children. To discipline kids often means to use force, therefore resulting in beating. Traditional Asian parents feel that only through beating when disciplining, this form of actions will stay in the children’s long term memory. Therefore, children will not make the
same mistakes again. Force as a disciplinary action now evolves into child abuse. This is completely different in Europe or America. In the western countries, parents who discipline children with excessive force or violence will be prosecuted and may serve a sentence, depending on the country.
Age plays an important factor on their behavior. Little boys are different from little girl. Boys are more playful which can easily upset their caretaker either mother or father or any relatives. On the other hand, little girls behave better which reduce their risk of being beating by their parents or care takers. 44
Male victims under 18 years old come to the hospital most often accompanied by family or friends. It is believed that the parents come to hospital intentionally to conceal any evidence of domestic violence and to prevent children from revealing signs of domestic violence.
Perpetrators of male victims under 18 years old are mostly victims’
parents. Youngest group are physically febrile compared to adults;
therefore, they are most vulnerable in a domestic violence situation.
When violence occurs, children are more severely injured than in other age groups.38, 44
C. Combination of age differences and gender differences
Elderly males are sent to emergency department of our hospital by ambulances. Since males have shorter life expectancy than females, they tend to have more medical and health issues when they grow older.
When men are working, they have to engage lots of social activities which need to smoke cigarette and drink alcohol. So they will have heart attack and cerebral vascular accident eventually. When they are bed-ridden after a stroke, siblings of victims have to care daily activity.
Long term care of such patient is a very tiresome labor. Therefore, elderly males are often victims of neglect. 37
When serious medical issues arise, they will then be sent to emergency department for medical attention.
In the male group of age 19-40 years, more perpetrators are male.
As part of nature, men are more aggressive than women. Men lacking skill of communication become very rebellious when they encounter conflict. They are easily angered and had fight with family especially with their father and brothers. Fist no longer can hurt their opponents therefore they will use knife as weapon of domestic violence instead.
Firearms are easily and legally possessed in the United States. Intimate partner homicide/suicide was most often perpetrated by middle-aged to older, married men, who used a firearm.45 As result of all these, the ISS and AIS are higher in this group. The recidivism rate is also low in this group. Once they had fight with their brothers and father, men will move out and have a new family. Therefore less conflict happened when they have lesser time getting together
D. Limitations
There are some notable limitations in this study. First, some
unmeasured factors such as selection bias and recall bias might confound the result of our study because this is a retrospective study. Reports of domestic violence usually are recorded by social workers and nurses after the event had happened and victims had been examined by emergency physician. Some victims may even report several days after the event had happened. There is no way to tell if the victim is telling the truth or lying. Second, our study population was relative small. The
population of male victims is relative small compared to female victims.
Smallest changes can either under- or over-estimate the result of our study. Finally, this study was conducted in a single institution.
Several hospitals had refused to cooperate due to they have their own studies to be published. The generalization of this study result was restrained due to the complexity among various health care systems and health care providers, as well as the specific study population. But Wanfang municipal hospital is the only medical center located in
southern part of Taipei city. Even citizens from Taipei County and all over the country came to our hospital for medical attention. So its validity is unquestionable.
Chapter VI Conclusion
The result of this study shows that age difference is the most important factor affecting the different genders of domestic violence.
Gender differences also have great influence in domestic violence. Male victims of domestic violence are increasing annually. Young boy and elderly man are at high risk of domestic violence. Perpetrators are fathers and sons of the victims.
Currently most resources have emphasis on female victims.
Different help resources and prevention programs should be provided to different group of victims. Early recognition of the difference may give the society better understanding of the domestic violence issue. This may lead to the reduction of rate of domestic violence in bother genders.
When the number of domestic violence decreases, the society will be a more harmonious environment.
Domestic violence is a serious crime that is enacted by both men and women with different socioeconomic classes, culture, and race. The need still exists for more future research on screening outcomes, acceptability, and effective interventions.
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31
Table 1-3 Glasgow Coma Scale
item Scale
Eye opening (E)
Spontaneous 4
To call 3
To pain 2
None 1
Motor response (M)
Obeys commands 6
Localizing to pain 5
Normal flexion (Withdrawal) 4 Abnormalflexion (Decorticate) 3 Extension (Decerebrate) 2 None (Flaccid) 1 Verbal response (V)
Oriented 5
Confused 4
Inappropriate words 3
Incomprehensible sounds 2
None 1
33
Table 1-4 Abbreviated Injury Scale (AIS)
A.I.S SCORE 1
Cervical spine strain with no fracture
Unconsciousness ＜1hr with neurologic deficit Fracture base of skull
Comminuted compound or depressed vault fracture
Pneumoencephalus
Contusion cerebrum（＜30cc;＜4 ㎝ diameter;
midline shift＜5 ㎜）
Major lac. external carotid, vetebral A.＃;
jugular V.
Compression fracture ＞20% anterior height Dislocation/fracture lamina body, pedicle, facet of C-spine
34
LeFort III fracture with blood loss ＞20% by volume
＞4 rib fractures, on one side Lung contusion/laceration, unilateral$
Compression fracture ＞20% anterior height Dislocation/fracture lamina body, pedicle, facet o f T-spine
Spinal cord contusion with transient neurologic signs
Flail chest with lung contusion Tracheal, Main stem bronchus
Flail chest, bilateral or ＜15 y/o Tracheal, Main stem bronchus
35
penis/vagina/vulva/testis/ovary Contusion/superf. lac. Minor lac. internal, external iliac V.
Dislocation or fracture of spinous/
Minor lac. common iliac, or other named A./V.
Intimal tear of celiac A.
Major lac. internal, external iliac V.
Retroperitoneal hematoma
Compression fracture ＞20% anterior height Dislocation/fracture lamina body, pedicle, facet of L-spine
Spinal cord contusion with transient neurologic signs
Intimal tear/minor lac. abdominal aorta
Minor lac. of celiac A.
Major lac. common iliac or other named A./V. Min lac. brachial, other named A.
＊Add AIS 1 to
Degloving arm, forearm, finger, thigh, calf, toe
Muscle lac. of upper extremity Laceration median, radial, ulnar,
Degloving hand, palm, knee, ankle, sole, foot Below knee or upper extremity amputation Comminuted pelvic fracture
Fractured femur Sciatic nerve laceration Intimal tear/minor lac. femoral A.
Major lac. axillary, brachial, popliteal, other named A.;
axillary, brachial, popliteal, femoral, other named V.
36
EXTERNAL
Abrasions/contusions/superf. PI ＜10cm on hand/face;
＜20cm on body
Avulsion＜25 cm2 on hand/ face; ＜ 100cm2on body
PI with tissue loss＞25 cm2 on face/
hands;＞100 cm2 on body
Massive destruction of both skull and brain Brain stem laceration/crush/PI
Decapitation
Cord crush/laceration with or without fracture C3 or above THORAX
I.S.S BODY REGION A.I.S SCORE SOUARED
HEAD/NECK
37
Table 1-5 Injury Severity Score (ISS)
外傷嚴重度分數（ISS）
輕度頸椎壓迫性骨折<20% 頸椎 lamina body/pedicle/
facet脫位或骨折
小腦挫傷<15cc 直徑<3cm 硬腦膜上或下出血<50cc<1cm 厚 硬腦膜上或下出血>50cc 蜘蛛網膜下出血 腦內出血<30cc 腦內出血>30cc
38
39
40
41
42 燒燙傷 1度灼傷 <100%BSA；
2。灼傷 <10%BSA
2。灼傷 10-19%BSA；3。灼傷
<10%BSA
全身超過 20%血液流 失；2。或 3。灼傷 20-29%BSA@
2。或 3。灼傷 30-39%BSA@ 2。或 3。灼傷 40-89%BSA@
高伏特電擊,無肌肉壞死 高伏特電擊+肌肉壞死 輕度吸入性灼傷(<20%
carboxyhemoglobulin)
中度吸入性灼傷(20~40%
carboxyhemoglobulin)
重度吸入性灼傷(>40%
carboxyhemoglobulin)
體溫 36~34℃ 33~32℃ 31~30℃ 28~29℃ ≦27℃；
註：有 @ 記號之灼傷，若年齡<5 歲，或包含臉、手、生殖器，AIS 加 1 分。
6分的情形:2。或 3。灼傷面積>90%BSA；高伏特電擊合併心臟停止
43
Baker et. al.在西元 1974 年由簡易外傷分數簡易外傷分數簡易外傷分數(Abbreviated Injury Scale,AIS)發展出一套用來評估外傷嚴重度及預後的計算方法，稱為外傷嚴重度分數簡易外傷分數 外傷嚴重度分數外傷嚴重度分數外傷嚴重度分數 (Injury Severity Score, ISS)。由於傷患剛受傷時狀況未明，任何小誤差都可能導致 ISS 偏差，所以不適合用在事故現場評估檢傷，但當傷患徹底檢
Baker et. al.在西元 1974 年由簡易外傷分數簡易外傷分數簡易外傷分數(Abbreviated Injury Scale,AIS)發展出一套用來評估外傷嚴重度及預後的計算方法，稱為外傷嚴重度分數簡易外傷分數 外傷嚴重度分數外傷嚴重度分數外傷嚴重度分數 (Injury Severity Score, ISS)。由於傷患剛受傷時狀況未明，任何小誤差都可能導致 ISS 偏差，所以不適合用在事故現場評估檢傷，但當傷患徹底檢