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Lucea MB, Ramirez A, Martino N. Barriers to Seeking Healthcare Services After Sexual Assault: A Scoping Review. JOURNAL OF FORENSIC NURSING 2024:01263942-990000000-00093. [PMID: 38912876 DOI: 10.1097/jfn.0000000000000493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/25/2024]
Abstract
BACKGROUND Sexual violence by an intimate partner or by a stranger remains highly prevalent in the United States. Yet, the use of post-sexual-assault health care is still underutilized. Persons in vulnerable populations such as immigrants, LGBTQIA+, and Black women may experience additional barriers to care. OBJECTIVE We sought to determine the extant research in this area, the methodologies used, and whether specific barriers exist for seeking sexual assault services. We sought to understand if barriers differed for vulnerable populations. INCLUSION CRITERIA Peer-reviewed literature published before September 2023, written in English, conducted in the United States, and that included survivors of sexual violence and explored barriers to seeking care postassault (i.e., sexual assault nurse examiners) were included in the review. METHODS Preferred Reporting Items for Systematic Reviews and Meta-analyses Extension for Scoping Reviews protocols were followed. PubMed, Scopus, CINAHL, PsycINFO, and PTSDpubs databases were used to identify literature that met the inclusion criteria, from which we selected 14 publications. RESULTS Much of the literature employed qualitative or mixed methods designs. Several studies focused on underserved minority groups, including immigrant women, Black women, and homeless youth. Common barriers existed on the intrapersonal, interpersonal, organizational, community, and societal levels. CONCLUSION The literature provided substantive context for the multilevel barriers, all contributing to survivors remaining silent rather than seeking much-needed help. Although there is a need for additional research on barriers to sexual assault services specifically, the extant research supports strengthening multilevel, alternative approaches to deliver much-needed services.
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Affiliation(s)
- Marguerite B Lucea
- Author Affiliations:Department of Nursing, College of Health Professions, Towson University
| | - Andrea Ramirez
- Department of Forensic Science, Fischer College of Math and Sciences, Towson University
| | - Natalie Martino
- Department of Audiology, College of Health Professions, Towson University
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Çelik P, Çelik Ş, Hastaoğlu F, Mollaoğlu M. Multicenter evaluation to determine the deficiencies of emergency nurses in forensic case management. Int Emerg Nurs 2024; 74:101440. [PMID: 38599009 DOI: 10.1016/j.ienj.2024.101440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 02/13/2024] [Accepted: 03/10/2024] [Indexed: 04/12/2024]
Abstract
INTRODUCTION Emergency services are the first places where victims and/or perpetrators of different types of violence are brought for medical treatment. Emergency service nurses are the first health workers who first encounter with the forensic case, first communicate and are in an important position in the rapid and accurate continuation of the forensic process. In this study, it was aimed to determine the level of knowledge of emergency department nurses regarding the management of forensic cases. METHODS The study was a cross-sectional, descriptive. Ninety-eight emergency nurses working in the emergency departments of three different public hospitals in the same province participated in the study. Study data were collected with the "Nurse Personal Information Form" and the "Knowledge Levels of Nurses related to the Approaches to Forensic Cases Questionnaire". RESULTS 70.4 % of the nurses participating in the study were women, their mean age was (X ± SD = 27.36 ± 5.21). It is seen that 87.8 % of the nurses have a total working time in the emergency unit between 1 and 5 years and 11.2 % have received training on forensic nursing. "Total Knowledge Score" of undergraduate graduate nurses The mean score was higher and there was a significant difference between the groups (p > 0.05). The nurses who received in-service training and forensically evaluated all cases admitted to the emergency department had a higher mean score in the "Knowledge Score Regarding the Duties of Nurses Regarding Forensic Cases" mean was higher and there was a significant difference between the groups (p > 0.05). CONCLUSION We recommend the use of institutional guides/protocols together with in-service training for emergency nurses to provide medically and legally correct forensic care and to have sufficient knowledge.
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Affiliation(s)
- Pelin Çelik
- Department of Health Programs, Vocational School of Health Services, Sivas Cumhuriyet University, Sivas, Turkey.
| | - Şimşek Çelik
- Department of Emergency Faculty of Medicine, Sivas Cumhuriyet University, Sivas, Turkey.
| | - Fatma Hastaoğlu
- Department of Health Programs, Vocational School of Health Services, Sivas Cumhuriyet University, Sivas, Turkey.
| | - Mukadder Mollaoğlu
- Department of Nursing, Faculty of Health Sciences, Sivas Cumhuriyet University, Sivas, Turkey.
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Caswell RJ, Ross JDC, Maidment I, Bradbury-Jones C. Providing a Supportive Environment for Disclosure of Sexual Violence and Abuse in a Sexual and Reproductive Healthcare Setting: A Realist Review. TRAUMA, VIOLENCE & ABUSE 2023; 24:2661-2679. [PMID: 35762535 DOI: 10.1177/15248380221111466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Background: Sexual and reproductive healthcare services (SRHS) are an environment where medical care relevant to sexual violence and abuse (SV) is available. However, barriers to disclosure need to be overcome to allow timely access to this care. There is limited research identifying and explaining how interventions remove barriers and create a safe and supportive environment for disclosure. The purpose of this review was to develop and refine theories that explain how, for whom and in what context SRHS facilitate disclosure. Methods: Following published realist standards we undertook a realist review. After focussing the review question and identifying key contextual barriers, articles pertaining to these were identified using a traditional systematic database search. This strategy was supplemented with iterative searches. Results: Searches yielded 3172 citations, and 28 articles with sufficient information were included to develop the emerging theories. Four evidence-informed theories were developed proposing ways in which a safe and supportive environment for the disclosure of SV is enabled in SRHS. The theories consider how interventions may overcome barriers surrounding SV disclosure at individual, service-delivery and societal levels. Conclusions: Benefits of SRHS engagement with health promotion and health activism activities to address societal level barriers like lack of service awareness and stereotypic views on SV are presented. Although trauma informed practice and person-centred care were central in creating a safe and supportive environment for disclosure the review found them to be poorly defined in this setting.
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Affiliation(s)
- Rachel J Caswell
- Department of Sexual Health and HIV Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Jonathan D C Ross
- Department of Sexual Health and HIV Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Ian Maidment
- School of Life and Health Sciences, Aston University, Birmingham, UK
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The Chain of Custody in the Era of Modern Forensics: From the Classic Procedures for Gathering Evidence to the New Challenges Related to Digital Data. Healthcare (Basel) 2023; 11:healthcare11050634. [PMID: 36900637 PMCID: PMC10000967 DOI: 10.3390/healthcare11050634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 02/04/2023] [Accepted: 02/16/2023] [Indexed: 02/25/2023] Open
Abstract
The purpose of this work is to renew the interest and attention for the chain of custody in forensic medicine, its establishment and maintenance, protecting the integrity and validity of evidence as well as to analyze how over time the establishment of the chain of custody and the collection of evidence has evolved also in function of the advent of technology and the use of electronic devices connected to the network. The analysis of the various aspects of the chain of custody demonstrates how necessary it is for the professional figures involved in the phases of the investigation (especially those who manage the evidence and who have, therefore, designated the assignment) to know the procedures to follow, trace the movement and the handling of objects subjected to seizure, also for the purposes of toxicological and/or histological investigations. The knowledge of interferences or complications helps to reduce errors and safeguard the validity of the evidence, assuring the proceeding judicial authority that the evidence is authentic and that it is, in other words, the same evidence seized at the scene of the crime. Furthermore, the issue is particularly felt today, with the recent need to guarantee the originality of digital data. Following a careful review and analysis of the literature currently available in this regard, it is worth adding that further efforts are needed to formulate internationally validated guidelines, harmonizing the different reference criteria in forensic science and medical areas, given the current absence of good international practices valid in the field and applicable both in the case of physical evidence and in the case of seizure of digital evidence.
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Skjælaaen K, Nesvold H, Brekke M, Sare M, Landaas ET, Mdala I, Olsen AO, Vallersnes OM. Sexually transmitted infections among patients attending a sexual assault centre: a cohort study from Oslo, Norway. BMJ Open 2022; 12:e064934. [PMID: 36456026 PMCID: PMC9716778 DOI: 10.1136/bmjopen-2022-064934] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES We estimate the prevalence of sexually transmitted infection (STI) among patients after sexual assault, assess the possible value of azithromycin prophylaxis, and identify risk factors for assault-related STI and for not presenting at follow-up. DESIGN Prospective observational cohort study. SETTING Sexual assault centre in Oslo, Norway. PARTICIPANTS 645 patients, 602 (93.3%) women and 43 (6.7%) men, attending the centre from May 2017 to July 2019. OUTCOME MEASURES Microbiological testing at the primary examination and at follow-up consultations after 2, 5 and 12 weeks. Estimated relative risk for assault-related STI and for not presenting at follow-up. RESULTS At primary examination, the prevalence of genital chlamydia was 8.4%, Mycoplasma genitalium 6.4% and gonorrhoea 0.6%. In addition, the prevalence of bacterial STI diagnosed at follow-up and possibly from the assault was 3.0% in total: 2.5% for M. genitalium, 1.4% for genital chlamydia and 0.2% for gonorrhoea. This prevalence did not change when azithromycin was no longer recommended from January 2018. There were no new cases of hepatitis B, hepatitis C, HIV or syphilis. We found no specific risk factors for assault-related STI. Patients with previous contact with child welfare service less often presented to follow-up (relative risk (RR) 2.0 (95% CI 1.1 to 3.5)), as did patients with a history of sex work (RR 3.6 (1.2 to 11.0)) or substance abuse (RR 1.7 (1.1 to 2.7)). CONCLUSIONS Most bacterial STIs were diagnosed at the primary examination, hence not influenced by prophylaxis. There was no increase in bacterial STI diagnosed at follow-up when azithromycin prophylaxis was not routinely recommended, supporting a strategy of starting treatment only when infection is diagnosed or when the patient is considered at high risk. Sex work, substance abuse and previous contact with child welfare services were associated with not presenting to follow-up. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Registry (NCT03132389).
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Affiliation(s)
- Katarina Skjælaaen
- Department of General Practice, University of Oslo, Oslo, Norway
- Oslo Sexual Assault Centre, City of Oslo Health Agency, Oslo, Norway
| | - Helle Nesvold
- Oslo Sexual Assault Centre, City of Oslo Health Agency, Oslo, Norway
| | - Mette Brekke
- Department of General Practice, University of Oslo, Oslo, Norway
| | - Miriam Sare
- Department of Microbiology, Oslo University Hospital, Oslo, Norway
| | - Elisabeth Toverud Landaas
- Department of Microbiology, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ibrahimu Mdala
- Department of General Practice, University of Oslo, Oslo, Norway
| | - Anne Olaug Olsen
- Department of Community Medicine and Global Health, University of Oslo, Oslo, Norway
- Department of Infection Control and Vaccine, Norwegian Institute of Public Health, Oslo, Norway
| | - Odd Martin Vallersnes
- Department of General Practice, University of Oslo, Oslo, Norway
- Oslo Accident and Emergency Outpatient Clinic, City of Oslo Health Agency, Oslo, Norway
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Intimate-partner violence and its association with symptoms of depression, perceived health, and quality of life in the Himalayan Mountain Villages of Gilgit Baltistan. PLoS One 2022; 17:e0268735. [PMID: 36129925 PMCID: PMC9491585 DOI: 10.1371/journal.pone.0268735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 05/08/2022] [Indexed: 11/19/2022] Open
Abstract
Study objectives We aimed to estimate the prevalence of intimate partner violence (IPV) and associated risk factors in married women in rural villages of Gilgit Baltistan in Pakistan. Methods A cross-sectional design to assess the magnitude and factors associated with IPV in a random sample of 789 married women aged 18–49 years. A World Health Organization screening instrument was used to assess the presence of IPV in the previous 12 months. A locally validated instrument was adopted to identify self-reported symptoms of major depression according to the DSM IV. Trained nurses obtained socio-demographic and reproductive history through structured interviews. Bivariate and multivariable logistic regression analyses were used to estimate prevalence and identify significant predictors of IPV. Results The mean age of the participants was 38.3 years (SD: ±12.8). The prevalence of IPV in women was 22.8% (95% Confidence Interval: 20.0–25.9), 18.5% in pregnant women (95% CI: 11.7–27.9) and significantly associated with depression in 55.1% of IPV cases. Husband education level (college/higher) (Adjusted Odds Ratio: 0.40; 95%CI: 0.22–0.70) and high household income (AOR: 0.44; 95% CI: 0.29–0.68) were protective against IPV. Increase in age (AOR;1.02; 95% CI: 1.01–1.02) and poor relationship with mother-in-law increased the risk of IPV (AOR = 2.85; 95% CI: 1.90–4.28). IPV was positively associated with symptoms of depression (AOR = 1.97; 95% CI:1.39–2.77), poor perceived quality of life (AOR = 3.54; 95% CI: 1.90–6.58) and poor health (AOR = 2.74; 95% CI: 1.92–3.92). Conclusion IPV is substantial public health burden significantly associated with depressive symptoms, poor perceived health and the quality of life.
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Davies K, Spence R, Cummings E, Cross M, Horvath MAH. Understanding sexual violence and factors related to police outcomes. Front Psychol 2022; 13:977318. [PMID: 36118446 PMCID: PMC9477140 DOI: 10.3389/fpsyg.2022.977318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 07/25/2022] [Indexed: 11/24/2022] Open
Abstract
In the year ending March 2020, an estimated 773,000 people in England and Wales were sexually assaulted. These types of crimes have lasting effects on victims’ mental health, including depression, anxiety, and post-traumatic stress disorder. There is a large body of literature which identifies several factors associated with the likelihood of the victim reporting a sexual assault to the police, and these differences may be due to rape myth stereotypes which perpetuate the belief that rape is only “real” under certain conditions. Less is known, however, about the effect these rape myths and stereotypes have on the investigation process itself and the subsequent police outcomes assigned to sex offences. This study aimed to address this gap, providing a profile of all RASSO (rape and serious sexual offences) committed over a 3-year period in one English police force, the police outcomes of these offences, and whether any offences, suspect, or victim variables were associated with different outcomes, in particular the decision to charge or cases where victims decline to prosecute. In line with previous research, the majority of victims were female while the majority of suspects were male, and the most frequent victim–suspect relationship was acquaintance, followed by partner/ex-partner. Charge outcomes were more likely in SSOs and less in rape offences, more likely with stranger offences and less likely than offences committed by partners/ex-partners and relatives, and some non-white suspects were more likely to be charged than suspects of other ethnicities, including white suspects. Victim attrition was more likely in cases where the suspect was a partner or ex-partner and least likely where the suspect was a stranger, more likely in SSOs than in rape cases, and more likely when the victim ethnicity was “other”. Law enforcement should be aware of the potential biases, both relating to rape myths and stereotypes and to the biased treatment of victims and suspects based on demographic characteristics, and work to eliminate these to ensure a fairer and more effective RASSO investigative process.
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Affiliation(s)
- Kari Davies
- Department of Psychology, Bournemouth University, Poole, United Kingdom
- *Correspondence: Kari Davies, ; orcid.org/0000-0003-1782-7437
| | - Ruth Spence
- Centre for Abuse and Trauma Studies, Middlesex University London, London, United Kingdom
| | - Emma Cummings
- Department of Psychology, Carleton University, Ottawa, ON, Canada
| | - Maria Cross
- Institute for Social Justice & Crime, University of Suffolk, Ipswich, United Kingdom
| | - Miranda A. H. Horvath
- Institute for Social Justice & Crime, University of Suffolk, Ipswich, United Kingdom
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Short NA, Tungate AS, Bollen KA, Sullivan J, D'Anza T, Lechner M, Bell K, Black J, Buchanan J, Reese R, Ho JD, Reed GD, Platt MA, Riviello RJ, Rossi CH, Martin SL, Liberzon I, Rauch SAM, Kessler RC, Nugent N, McLean SA. Pain is common after sexual assault and posttraumatic arousal/reactivity symptoms mediate the development of new or worsening persistent pain. Pain 2022; 163:e121-e128. [PMID: 34224498 DOI: 10.1097/j.pain.0000000000002329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 04/22/2021] [Indexed: 11/26/2022]
Abstract
ABSTRACT Clinically significant new or worsening pain (CSNWP) is a common, yet often overlooked, sequelae of sexual assault. Little is known regarding factors influencing the development of CSNWP in sexual assault survivors. The current study used data from a recently completed prospective study to evaluate whether posttraumatic alterations in arousal and reactivity in the early aftermath of sexual assault influence the transition from acute to clinically significant new or worsening persistent pain. Women ≥ 18 years of age (n = 706) presenting for emergency care after sexual assault to 13 emergency care sites were enrolled in the study. Women completed assessments at the time of presentation as well as at 1 week (n = 706, 100%) and 6 weeks (n = 630, 91%). Nearly 70% of women reported CSNWP at the time of emergency care (n = 475, 69%), which persisted to 6 weeks in approximately 2 in 5 survivors (n = 248, 41%). A structural equation model adjusted for age, race, past trauma exposure, and preassault pain levels suggested that posttraumatic alterations in arousal/reactivity symptoms 1 week after assault partially mediated the transition from acute to persistent CSNWP. A significant portion (41%) of women sexual assault survivors develop CSNWP 6 weeks postassault. Posttraumatic arousal/reactivity symptoms in the early aftermath of assault contribute to CSNWP development; such symptoms are potential targets for secondary preventive interventions to reduce chronic postassault pain.
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Affiliation(s)
- Nicole A Short
- Institute for Trauma Recovery, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Departments of Anesthesiology and
| | - Andrew S Tungate
- Institute for Trauma Recovery, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Departments of Anesthesiology and
| | - Kenneth A Bollen
- Psychology and Neuroscience, and Sociology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Jenyth Sullivan
- Institute for Trauma Recovery, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Departments of Anesthesiology and
| | - Teresa D'Anza
- Albuquerque SANE Collaborative, Albuquerque, NM, United States
| | - Megan Lechner
- Emergency Deprtment, UC Health Memorial Hospital, Colorado Springs, CO, United States
| | - Kathy Bell
- Tulsa Forensic Nursing Services, Tulsa, OK, United States
| | | | - Jennie Buchanan
- Department of Emergency Medicine, Denver Health, Denver, CO, United States
| | - Rhiannon Reese
- Crisis Center of Birmingham, Birmingham, AL, United States
| | - Jeffrey D Ho
- Department of Emergency Medicine, Hennepin Healthcare, Minneapolis, MN, United States
| | - Gordon D Reed
- Department of Emergency Medicine, Christiana Care, Newark, DE, United States
| | - Melissa A Platt
- Department of Emergency Medicine, University of Louisville, Louisville, KY, United States
| | - Ralph J Riviello
- Department of Emergency Medicine, University of Texas Health San Antonio, TX, United States
| | | | - Sandra L Martin
- Department of Maternal and Child Health, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Israel Liberzon
- Department of Psychiatry, Texas A&M University, Bryan, TX, United States
| | - Sheila A M Rauch
- Department of Psychiatry, Emory University, Atlanta, GA, VA Atlanta Healthcare System, Atlanta, GA, United States
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, United States
| | - Nicole Nugent
- Departments of Psychiatry and Human Behavior, Pediatrics, and Emergency Medicine, Brown University, Providence, RI, United States
| | - Samuel A McLean
- Institute for Trauma Recovery, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Departments of Anesthesiology and
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Covers MLV, Karst W, Bicanic IAE. Development of multidisciplinary sexual assault centres in the Netherlands. Eur J Psychotraumatol 2022; 13:2127475. [PMID: 36212117 PMCID: PMC9542602 DOI: 10.1080/20008066.2022.2127475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Background: The professional approach of sexual assault victims has changed since the 1970s: from a fragmented model to a centralised 'gate management model', where multiple disciplines offer collaborative services at one central location. Like other countries across the globe, the Netherlands took steps towards an integrated, multi-agency support framework for victims of sexual assault. Objective: The objective of this paper was threefold: (1) to describe the development of the multidisciplinary Sexual Assault Centres (SAC) in the Netherlands, (2) to assess the characteristics of victims who attended the SAC, and the services they used (3) to analyse Strengths, Weaknesses, Opportunities, and Threats of the current framework (SWOT). Method: The development of the national network of SAC was described. Data on victims presenting at the SACs were routinely collected between 1st January 2016 and 31st December 2020. This data from the sixteen sites was combined and analysed. Also, a SWOT analysis of the SAC was performed. Results: The SAC was established between 2012 and 2018. From 2016 through 2020 almost 16,000 victims of sexual assault contacted one of the 16 SACs. The data show a steady increase in yearly cases, with a consistently high use of medical and psychological services. The SAC has several strengths, such as its accessibility, and opportunities, such as increasing media attention, that underline its quality and relevance. However, the SAC's inability to reach certain minority groups and the current financial structure are its main weakness and threat. Conclusions: Despite the growing number of victims attending the SAC and the increasing awareness of the benefits of an immediate multidisciplinary response to sexual assault, there are still deficiencies in the SAC. The SAC continues to work on these deficiencies in order to optimise efficient and effective care for all victims of sexual assault.
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Affiliation(s)
- Milou L V Covers
- National Psychotrauma Centre for Children and Youth, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Wouter Karst
- Department of Forensic Medicine, Section Forensic Pediatrics, Netherlands Forensic Institute, Ministry of Justice and Security, The Hague, the Netherlands
| | - Iva A E Bicanic
- National Psychotrauma Centre for Children and Youth, University Medical Centre Utrecht, Utrecht, the Netherlands
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Sexual Assault. Fam Med 2022. [DOI: 10.1007/978-3-030-54441-6_29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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[Postexposure prophylaxis after sexual assault]. Med Klin Intensivmed Notfmed 2021; 116:627-634. [PMID: 34533583 DOI: 10.1007/s00063-021-00864-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 07/22/2021] [Accepted: 07/29/2021] [Indexed: 11/27/2022]
Abstract
Relevant exposure to important infectious pathogens can occur during sexual assault. If there is a latent period between exposure and illness due to an infection with pathogens, a postexposure prophylaxis can effectively inhibit the infection. In the present review article possible postexposure prophylaxis treatment for tetanus, hepatitis B, HIV and hepatitis A are discussed with a focus on the time window within which a specific regimen should be started and in which temporal order. These recommendations are based on the epidemiologic conditions in Germany. Moreover, the two most frequent sexually transmitted bacterial infections, namely Neisseria gonorrhoea and Chlamydia trachomatis are presented, as victims of sexual assault in particular often do not return for control investigations in an outpatient setting.
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Henin S, Black LP. Understanding the long-term trauma of sexual assault patients. J Am Coll Emerg Physicians Open 2021; 2:e12490. [PMID: 34263251 PMCID: PMC8254595 DOI: 10.1002/emp2.12490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 06/07/2021] [Indexed: 11/07/2022] Open
Affiliation(s)
- Sally Henin
- Forensic Nursing ServicesMemorial Hermann Health SystemHoustonTexasUSA
| | - Lauren Page Black
- Department of Emergency MedicineDivision of ResearchUniversity of Florida College of Medicine – JacksonvilleJacksonvilleFloridaUSA
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Baert S, Gilles C, Van Belle S, Bicanic I, Roelens K, Keygnaert I. Piloting sexual assault care centres in Belgium: who do they reach and what care is offered? Eur J Psychotraumatol 2021; 12:1935592. [PMID: 34367523 PMCID: PMC8317926 DOI: 10.1080/20008198.2021.1935592] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Sexual assault (SA) is highly prevalent in Belgium. In order to mitigate the negative consequences for victims of acute SA, Sexual Assault Care Centres (SACCs) were piloted from October 2017 to October 2018 in three Belgian hospitals. SACCs offer medical and psychological care, forensic examination and the possibility to report to the police at the SACC. OBJECTIVE Aiming to improve SACC services, we quantitatively assessed the number and characteristics of victims attending the SACC, the SA they experienced, and the care they received over 12 months upon admission. METHOD Data on victims presenting at the SACC were routinely collected in electronic patient files by the SACC personnel between 25 October 2017 and 31 October 2019. These data were analysed in IBM SPSS Statistics 25. RESULTS Within the first year 931 victims attended the SACCs. Mean age was 24.5 years (SD = 12.8), and one-third were under 18. The majority were female (90.5%) and 63.1% presented for rape. About one-third of the victims were considered vulnerable due to previous SA (35.6%), prior psychiatric consultation (38.7%) or disability (8.5%). The assailant was known to the victim in 59.2% of the cases. Of all SACC presentations, 35.2% self-referred to the SACC while 40.9% were referred by the police. Two out of three victims attended the SACC within 72 h post-assault. Respectively 74.7% of victims received medical care, 60.6% a forensic examination, 50.2% psychological care, and 68.7% reported to the police. CONCLUSION Despite the absence of promotion campaigns, the SACCs received a high number of victims during the pilot year. Use of acute and follow-up services was high, although new approaches to offer more accessible psychological support should be explored. The big proportion of vulnerable victims warrants careful monitoring and adaptation of care pathways.
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Affiliation(s)
- Saar Baert
- Department of Public Health and Primary Care, International Centre for Reproductive Health, Ghent University, Ghent, Belgium
| | - Christine Gilles
- Department of Obstetrics and Gynecology, Saint-Pierre University Hospital Brussels, Brussels, Belgium
| | - Sara Van Belle
- Department of Public Health, Institute of Tropical Medicine Antwerp, Antwerp, Belgium
| | - Iva Bicanic
- National Psychotrauma Center for Children and Youth, University Medical Center, Utrecht, The Netherlands
| | - Kristien Roelens
- Department of Human Structure and Repair, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Ines Keygnaert
- Department of Public Health and Primary Care, International Centre for Reproductive Health, Ghent University, Ghent, Belgium
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Short NA, Lechner M, McLean BS, Tungate A, Black J, Buchanan J, Reese R, Ho J, Reed G, Platt M, Riviello R, Rossi C, Nouhan P, Phillips C, Martin SL, Liberzon I, Rauch SA, Bollen K, Kessler RC, McLean SA. Health care utilization by women sexual assault survivors after emergency care: Results of a multisite prospective study. Depress Anxiety 2021; 38:67-78. [PMID: 33032388 PMCID: PMC7785610 DOI: 10.1002/da.23102] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 08/10/2020] [Accepted: 08/22/2020] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Approximately, 100,000 US women receive emergency care after sexual assault each year, but no large-scale study has examined the incidence of posttraumatic sequelae, receipt of health care, and frequency of assault disclosure to providers. The current study evaluated health outcomes and service utilization among women in the 6 weeks after sexual assault. METHODS Women ≥18 years of age presenting for emergency care after sexual assault to twelve sites were approached. Among those willing to be contacted for the study (n = 1080), 706 were enrolled. Health outcomes, health care utilization, and assault disclosure were assessed via 6 week survey. RESULTS Three quarters (76%) of women had posttraumatic stress, depression, or anxiety, and 65% had pain. Less than two in five reported seeing health care provider; receipt of care was not related to substantive differences in symptoms and was less likely among Hispanic women and women with a high school education or less. Nearly one in four who saw a primary care provider did not disclose their assault, often due to shame, embarrassment, or fear of being judged. CONCLUSION Most women receiving emergency care after sexual assault experience substantial posttraumatic sequelae, but health care in the 6 weeks after assault is uncommon, unrelated to substantive differences in need, and limited in socially disadvantaged groups. Lack of disclosure to primary care providers was common among women who did receive care.
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Affiliation(s)
- Nicole A. Short
- Institute for Trauma Recovery, University of North Carolina at Chapel Hill, NC
| | | | - Benjamin S. McLean
- Institute for Trauma Recovery, University of North Carolina at Chapel Hill, NC
| | - Andrew Tungate
- Institute for Trauma Recovery, University of North Carolina at Chapel Hill, NC
| | | | | | | | | | | | | | | | | | | | | | - Sandra L. Martin
- Institute for Trauma Recovery, University of North Carolina at Chapel Hill, NC
| | | | | | - Kenneth Bollen
- Institute for Trauma Recovery, University of North Carolina at Chapel Hill, NC
| | | | - Samuel A. McLean
- Institute for Trauma Recovery, University of North Carolina at Chapel Hill, NC
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Draughon Moret JE, Sheridan DJ, Wenzel JA. "Reclaiming Control" Patient Acceptance and Adherence to HIV Post-Exposure Prophylaxis Following Sexual Assault. Glob Qual Nurs Res 2021; 8:23333936211046581. [PMID: 35187201 PMCID: PMC8851138 DOI: 10.1177/23333936211046581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 08/27/2021] [Indexed: 11/17/2022] Open
Abstract
Sexual assault is an irrefutable trauma; an insult to the autonomy of the person forced into sexual acts. Sexual assault sequelae range from physical injury and acute traumatic stress, to pregnancy and sexually transmitted infections, including human immunodeficiency virus (HIV). HIV post-exposure prophylaxis (HIV PEP) following sexual assault may decrease the likelihood of HIV transmission. Many patients seeking healthcare post-sexual assault either do not initiate HIV PEP or do not complete the 28-day medication regimen. In this qualitative interpretive description, we interviewed sexual assault patients (N=11) about HIV PEP discussions/reactions, attitudes and understanding related to HIV and PEP, and barriers and facilitators of HIV PEP acceptance and adherence. Participants described a process of losing and reclaiming control throughout post-assault care and follow-up; and how this affected HIV PEP-related decision-making. Most HIV PEP decisions were described as a process of reclaiming control over one outcome while simultaneously losing control of another.
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Affiliation(s)
- Jessica E Draughon Moret
- Faculty of the Betty Irene Moore School of Nursing in Sacramento, University of California Davis, Davis, CA, USA
| | - Daniel J Sheridan
- Faculty of the School of Nursing in Baltimore, Johns Hopkins University, Baltimore, MD, USA
| | - Jennifer A Wenzel
- Faculty of the School of Nursing in Baltimore, Johns Hopkins University, Baltimore, MD, USA
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16
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Koenig KL, Benjamin SB, Beÿ CK, Dickinson S, Shores M. Emergency Department Management of the Sexual Assault Victim in the COVID Era: A Model SAFET-I Guideline From San Diego County. J Emerg Med 2020; 59:964-974. [PMID: 32951933 PMCID: PMC7498374 DOI: 10.1016/j.jemermed.2020.07.047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 06/29/2020] [Accepted: 07/25/2020] [Indexed: 11/17/2022]
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic has contributed to an increase in intimate partner violence (IPV), posing challenges to health care providers who must protect themselves and others during sexual assault examinations. Victims of sexual assault encountered in prehospital and emergency department (ED) settings have legal as well as medical needs. A series of procedures must be carefully followed to facilitate forensic evidence collection and law enforcement investigation. A literature review detected a paucity of published guidance on the management of sexual assault patients in the ED, and no information specific to COVID-19. Objective Investigators sought to update the San Diego County sexual assault guidelines, created in collaboration with health care professionals, forensic specialists, and law enforcement, through a consensus iterative review process. An additional objective was to create a SAFET-I Tool for use by frontline providers during the COVID-19 pandemic. Discussion The authors present a novel SAFET-I Tool that outlines the following five components of effective sexual assault patient care: stabilization, alert system activation, forensic evidence consideration, expedited post-assault treatment, and trauma-informed care. This framework can be used as an educational tool and template for agencies interested in developing or adapting existing sexual assault policies. Conclusions There is a lack of clinical guidance for ED providers that integrates the many aspects of sexual assault patient care, particularly during the COVID-19 pandemic. A SAFET-I Tool is presented to assist emergency health care providers in the treatment and advocacy of sexual assault patients during a period with increasing rates of IPV.
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Affiliation(s)
- Kristi L Koenig
- County of San Diego, Health and Human Services Agency, Emergency Medical Services, San Diego, California; Department of Emergency Medicine, University of California Irvine, Orange, California
| | - Stephanie B Benjamin
- University of California San Diego Health, San Diego Health, San Diego, California
| | | | - Sue Dickinson
- County of San Diego, Health and Human Services Agency, Emergency Medical Services, San Diego, California
| | - Michelle Shores
- Palomar Heath, Forensic Health Services, Escondido, California
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Coverdale J, Roberts LW, Balon R, Beresin EV, Guerrero APS, Louie AK, Aggarwal R, Morreale MK, Brenner AM. #MeToo and Female Patients with Major Mental Disorders: What Should Academic Psychiatry Do? ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2020; 44:11-15. [PMID: 31664690 DOI: 10.1007/s40596-019-01136-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 10/09/2019] [Indexed: 06/10/2023]
Affiliation(s)
| | | | | | | | | | | | | | | | - Adam M Brenner
- University of Texas Southwestern Medical Center, Dallas, TX, USA
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Topçu ET, Erek Kazan E, Büken E. Healthcare Personnel's Knowledge and Management of Frequently Encountered Forensic Cases in Emergency Departments in Turkey. JOURNAL OF FORENSIC NURSING 2020; 16:29-35. [PMID: 32068677 DOI: 10.1097/jfn.0000000000000275] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Emergency department (ED) personnel frequently encounter incidents related to crime, violence, and suspicious injuries. The aim of this descriptive study was to determine the knowledge levels of ED healthcare personnel in their handling of frequently encountered forensic cases. METHODS A cross-sectional descriptive study composed of ED healthcare personnel at all state, education and research, and university hospitals with EDs, located in Ankara, Turkey, was completed. Participants at the 15 hospitals in question were interviewed via a questionnaire developed by the researchers. RESULTS Three hundred fifty healthcare personnel who worked agreed to participate in the study. The results show that ED healthcare personnel have less knowledge than expected of the right way to handle frequently encountered forensic cases. Very few of the healthcare professionals who participated in the study had received any training or education in the field of forensic nursing. Among participants, postgraduates, health professionals educated in forensic nursing, and healthcare staff who used additional resources to understand forensic cases, and those who had evaluated cases that presented to the ED as forensic cases, had significantly higher levels of knowledge. IMPLICATIONS This study supports the need for professional development in forensic nursing, such as in-service training, and curriculum development for a certificate in forensic nursing to enhance the practical training of healthcare professionals who work in EDs.
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Affiliation(s)
- Emine Tuğba Topçu
- Author Affiliations: Faculty of Health Sciences, Nursing Department, Yildirim Beyazit University
| | - Ebru Erek Kazan
- Author Affiliations: Faculty of Health Sciences, Nursing Department, Yildirim Beyazit University
| | - Erhan Büken
- Faculty of Medicine, Forensic Medicine Department, Başkent University
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Torres-de la Roche LA, Krentel H, Devassy R, de Wilde MS, Leicher L, De Wilde RL. Surgical repair of genital injuries after sexual abuse. GMS INTERDISCIPLINARY PLASTIC AND RECONSTRUCTIVE SURGERY DGPW 2019; 8:Doc14. [PMID: 31728263 PMCID: PMC6838733 DOI: 10.3205/iprs000140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Introduction: Genital injuries occur in half of cases of sexual assault through digital or penile penetration as well as the use of objects. Women aged >45 years are more likely to have physical injury and anogenital lesions, transmission of STI and HIV. This review focuses on the evidence about surgical reconstruction of the pelvic floor anatomy of adolescents and adult women sexually assaulted during adolescence or adulthood. Method: A systematic literature search was performed in PubMed and Orbis plus for articles published in English and German from June 2008 to June 2018. The literature search was performed in October 2018 by topic combining the following Medical Subject Headings: genital trauma, genital injuries, sexual assault, rape, surgical repair, treatment. Results: 34 records of descriptive studies were identified and 16 full-text articles were included in the present review. Due to the limited number of articles retrieved, articles were not excluded based on methodological design. Superficial genital lesions are common and usually left untreated. For deep vaginal or anal lacerations, intraperitoneal bleeding is usually assessed by means of and additional CT scan or diagnostic colposcopy, cystoscopy, rectoscopy and laparoscopy. Complete reconstruction of the injured is done after. To prevent rectovaginal fistula and uncomplicated primary wound healing a temporary colostomy can be performed. Conclusion: Although most of genital injuries due to sexual assault do not require any major surgical intervention, there is a lack of good quality evidence regarding the best diagnostic and surgical approach to restore deep lesions of genital organs as well lack evidence on contributors to poor wound healing. Therefore, clinical protocols that standardize examination as well as surgical management are encouraged to be developed.
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Affiliation(s)
| | - Harald Krentel
- Clinic for Obstetrics and Gynecology. St. Anna Hospital, Herne, Germany
| | - Rajesh Devassy
- Dubai London Clinic and Specialty Hospital, Dubai, United Arab Emirates
| | - Maya Sophie de Wilde
- University Hospital for Gynecology, Pius Hospital, Carl von Ossietzky University, Oldenburg, Germany
| | - Lasse Leicher
- University Hospital for Gynecology, Pius Hospital, Carl von Ossietzky University, Oldenburg, Germany
| | - Rudy Leon De Wilde
- University Hospital for Gynecology, Pius Hospital, Carl von Ossietzky University, Oldenburg, Germany
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Sepeng NV, Makhado L. Present practices of rape care management in Thuthuzela Care Centres of the North West Province. JOURNAL OF PSYCHOLOGY IN AFRICA 2019. [DOI: 10.1080/14330237.2019.1677057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Nombulelo Veronica Sepeng
- Faculty of Health Sciences, Prinshof Campus, School of Health Care Sciences, University of Pretoria, Pretoria, South Africa
| | - Lufuno Makhado
- Research Office, School of Health Sciences, University of Venda, Thohoyandou, South Africa
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21
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Abstract
The diagnosis and treatment of sexually transmitted infections is a crucial component of providing evidence-based care in the emergency department. Understanding how to make the diagnosis and implement effective treatment is essential to maintaining and improving public health. Providers should also be adept at giving care to sexual assault survivors and seeking out the expertise of specially trained professionals within networks known as SANE, SAFE, or SART. These networks are critical to providing standardized care to sexual assault patients. Prophylaxis remains a key element for the prevention of sexually transmitted infections in all patients who are considered high risk.
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Affiliation(s)
- Denise McCormack
- Department of Emergency Medicine, Albert Einstein College of Medicine, Jacobi Medical Center, 1400 Pelham Parkway South, Bronx, NY 10461, USA.
| | - Kathryn Koons
- Jacobi-Montefiore Emergency Medicine Residency, 1400 Pelham Parkway South, Bronx, NY 10461, USA
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22
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Denov M, Piolanti A. Mothers of children born of genocidal rape in Rwanda: Implications for mental health, well-being and psycho-social support interventions. Health Care Women Int 2019; 40:813-828. [PMID: 31084535 DOI: 10.1080/07399332.2019.1571593] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
We explored the reality of mothers of children born of rape during the Rwandan genocide, particularly as it related to psychological well-being, stigma, recovery, and discussed relevant issues for mental health and psycho-social support interventions. Forty-four mothers participated in semi-structured qualitative interviews. Participants reported long-term psychological impacts resulting from sexual violence. Stigmatization and rejection from family and community aggravated psychological distress and affected their capacity to recover. Given participants' demonstrated capacity to overcome adversity, culturally appropriate mental health interventions are needed to promote well-being and social reintegration of mothers who bore children born of rape, while reducing stigmatization.
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Affiliation(s)
- Myriam Denov
- School of Social Work, McGill University , Montreal , QC , Canada
| | - Antonio Piolanti
- Department of Psychology, University of Bologna , Bologna , Italy
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23
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24
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Gilles C, Manigart Y, Rousseau C, Libois A, Gennotte AF, Rozenberg S. Implementation of a protocol and staff educational sessions improves the care of survivors of sexual assault. Maturitas 2019; 124:39-42. [PMID: 31097177 DOI: 10.1016/j.maturitas.2019.03.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 03/03/2019] [Accepted: 03/06/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVE We previously conducted an audit of the care provided for survivors of sexual violence seen at our emergency department and observed that 90% of them did not receive optimal care. This study analysed whether the implementation of a new protocol and educational sessions for staff increased the proportion of such patients who received optimal medical care. METHODS A computerized chart detailing a new care protocol was developed specifically for rape survivors. Educational sessions focusing on the use of the new protocol were organized for healthcare providers. We then conducted another audit that reviewed retrospectively the charts of all survivors of sexual violence who were cared for at a public university hospital. MAIN OUTCOME MEASURE Optimal medical care was defined as including systematic investigations for sexually transmitted diseases, and the provision of prophylactic antibiotics, a pregnancy test, emergency contraception, and psychological and medical follow-up. RESULTS We analysed the charts of 362 survivors of sexual violence and observed that all of the required procedures were completed for 337 patients (93%) and the required preventive measures were provided to 325 patients (90%). CONCLUSION After the implementation of the new protocol and educational sessions, the proportion of survivors who received optimal medical care increased from 10% to 90%. Nevertheless, optimal management also implies social, psychological and legal support. We hope that the establishment of specialist sexual assault centres will further improve management.
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Affiliation(s)
- Christine Gilles
- Department of Obstetrics and Gynecology, CHU Saint Pierre, Université Libre de Bruxelles and Vrije Univesiteit Brussel, rue Haute 322, 1000, Brussels, Belgium; Infectious Diseases, CHU Saint Pierre, Université Libre de Bruxelles and Vrije Univesiteit Brussel, rue Haute 322, 1000, Brussels, Belgium
| | - Yannick Manigart
- Department of Obstetrics and Gynecology, CHU Saint Pierre, Université Libre de Bruxelles and Vrije Univesiteit Brussel, rue Haute 322, 1000, Brussels, Belgium; Infectious Diseases, CHU Saint Pierre, Université Libre de Bruxelles and Vrije Univesiteit Brussel, rue Haute 322, 1000, Brussels, Belgium
| | - Charlotte Rousseau
- Department of Obstetrics and Gynecology, CHU Saint Pierre, Université Libre de Bruxelles and Vrije Univesiteit Brussel, rue Haute 322, 1000, Brussels, Belgium
| | - Agnès Libois
- Infectious Diseases, CHU Saint Pierre, Université Libre de Bruxelles and Vrije Univesiteit Brussel, rue Haute 322, 1000, Brussels, Belgium
| | - Anne Françoise Gennotte
- Infectious Diseases, CHU Saint Pierre, Université Libre de Bruxelles and Vrije Univesiteit Brussel, rue Haute 322, 1000, Brussels, Belgium
| | - Serge Rozenberg
- Department of Obstetrics and Gynecology, CHU Saint Pierre, Université Libre de Bruxelles and Vrije Univesiteit Brussel, rue Haute 322, 1000, Brussels, Belgium.
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Ludes B, Geraut A, Väli M, Cusack D, Ferrara D, Keller E, Mangin P, Vieira DN. Guidelines examination of victims of sexual assault harmonization of forensic and medico-legal examination of persons. Int J Legal Med 2018; 132:1671-1674. [PMID: 29468380 DOI: 10.1007/s00414-018-1791-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 02/09/2018] [Indexed: 10/18/2022]
Abstract
Sexual assault is a complex situation with medical, psychological, and legal aspects. Forensic experts play a major role in terms of forensic and gynecological medical examination and evidence collection in order to maintain the chain of custody. Victims should be examined by a specially trained medico-legal examiner in order to avoid multiple examinations in the surroundings that do not meet minimum health standards. The evolution and treatment of sexual assault victims are time-intensive and should optimally be provided by a team that includes a forensic medical doctor. These guidelines will be of interest to forensic medical doctors who will have responsibility for the examination and assessment of victims of sexual violence and can be used as a day-to-day service document and/or a guide to develop health service for victims of sexual violence.
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Affiliation(s)
- B Ludes
- France Institut National de la Transfusion Sanguine, France Institut Médico-Légal, Université Paris-Descartes, Paris, France.
| | - A Geraut
- Université de Strasbourg, Institut de Médecine légale, 11 rue Humann, 67085, Strasbourg Cedex, France
| | - M Väli
- Forensic Medicine of the University of Tartu, Ravila 19, Tartu, Estonia.,Estonian Forensic Science Institute, Tervise 30, Tallinn, Estonia
| | - D Cusack
- University College Dublin, Dublin, Ireland.,Medical Bureau of Road Safety, Dublin, Ireland.,, County Kildare, Ireland
| | - D Ferrara
- Legal Medicine and Forensic Toxicology, School of Medicine, International Academy of Legal Medicine, University of Padova, Padova, Italy
| | - E Keller
- Department of Forensic and Insurance Medicine, Semmelweis University, Ulloi Str 93, Budapest, 1091, Hungary
| | - P Mangin
- University Center of Legal Medicine, Geneva-Lausanne, Chemin de la Vuliette 4, 1000, Lausanne 25, Switzerland
| | - D N Vieira
- Forensic Medicine and Forensic Sciences, Faculdade de Medicina da Universidade de Coimbra, University of Coimbra, Rua Larga, 3004-504, Coimbra, Portugal
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Emergency Contraception. Nurs Womens Health 2017; 21:506-508. [PMID: 29223214 DOI: 10.1016/s1751-4851(17)30328-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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27
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Scott J, Mullen C, Rouhani S, Kuwert P, Greiner A, Albutt K, Burkhardt G, Onyango M, VanRooyen M, Bartels S. A qualitative analysis of psychosocial outcomes among women with sexual violence-related pregnancies in eastern Democratic Republic of Congo. Int J Ment Health Syst 2017; 11:64. [PMID: 29075319 PMCID: PMC5648419 DOI: 10.1186/s13033-017-0171-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 09/30/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sexual violence is prevalent in eastern Democratic Republic of Congo (DRC) and has potentially devastating psychosocial consequences. Previous studies have reported on sexual violence and its impact on the mental health of survivors, but there are few studies conducted among women with sexual violence-related pregnancies (SVRPs). Women with SVRPs may be at greater risk of complex psychosocial outcomes, including social stigmatization. This study aimed to describe psychosocial outcomes among this subgroup of sexual violence survivors in order to inform future interventions. METHODS A mixed methods study was conducted in Bukavu, DRC in 2012 among adult women who self-reported an SVRP and either (1) were currently raising a child from an SVRP (parenting group) or (2) had terminated an SVRP (termination group). This manuscript presents qualitative findings from the mixed methods study. Participants were recruited using respondent-driven sampling and a proportion engaged in semi-structured qualitative interviews conducted by trained female interviewers. Thematic content analysis was conducted and key themes were identified. RESULTS In total, 55 women were interviewed, of whom 38 were in the parenting group and 17 in the termination group. Women with SVRPs experienced a myriad of emotional responses as they navigated their social environments following the SVRPs. Negative reactions, including social stigmatization and/or social rejection, toward women with SVRPs and toward children born from SVRPs were important influences on psychological well-being. Women expressed both internalized emotionality intertwined with externalized experiences in the social environment. Many women demonstrated resilience, or what could be termed post-traumatic growth, identifying avenues of agency to advance the social conditions for women. CONCLUSIONS The findings from the qualitative study, and in particular, the respondents' needs and suggested strategies, may be useful to inform future research, programs, and policies for women with SVRPs in eastern DRC. Future research could move beyond cross-sectional assessments to utilize innovative research methodologies to assess processes of psychological adaptation among women with SVRPs. Multi-dimensional psychosocial programs for women with SVRPs should consider basic needs such as shelter, food, and health care within the broader framework of trauma-informed care. Participatory programming, guided by beneficiaries, could provide further avenues for agency to advance social conditions for women with SVRPs in eastern DRC.
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Affiliation(s)
- Jennifer Scott
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Kirstein 3rd Floor, Boston, MA 02215 USA
- Division of Women’s Health, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115 USA
- Harvard Humanitarian Initiative, 14 Story Street, Cambridge, MA 02138 USA
- Harvard Medical School, 25 Shattuck Street, Boston, MA 02115 USA
| | - Colleen Mullen
- Department of Psychiatry, One Boston Medical Center Place, Boston Medical Center, Boston, MA 02118 USA
- Department of Psychiatric Emergency Services for Cambridge/Somerville, Boston Medical Center, Boston, MA USA
| | - Shada Rouhani
- Harvard Humanitarian Initiative, 14 Story Street, Cambridge, MA 02138 USA
- Harvard Medical School, 25 Shattuck Street, Boston, MA 02115 USA
- Department of Emergency Medicine, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115 USA
| | - Philipp Kuwert
- Department of Psychiatry and Psychotherapy, and HELIOS-Hansehospital Stralsund, University of Greifswald, Greifswald, Germany
| | - Ashley Greiner
- Harvard Humanitarian Initiative, 14 Story Street, Cambridge, MA 02138 USA
| | - Katherine Albutt
- Harvard Humanitarian Initiative, 14 Story Street, Cambridge, MA 02138 USA
- Harvard Medical School, 25 Shattuck Street, Boston, MA 02115 USA
- Department of Surgery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114 USA
| | - Gillian Burkhardt
- Harvard Humanitarian Initiative, 14 Story Street, Cambridge, MA 02138 USA
- Department of Obstetrics and Gynecology, Boston University School of Medicine, 85 East Concord Street, Boston, MA 02115 USA
- Department of Obstetrics and Gynecology, University of New Mexico, MSC 10 5582, Albuquerque, NM 87131 USA
| | - Monica Onyango
- Department of Global Health, Boston University School of Public Health, 801 Massachusetts Avenue, 3rd floor, Boston, MA 02118 USA
| | - Michael VanRooyen
- Harvard Humanitarian Initiative, 14 Story Street, Cambridge, MA 02138 USA
- Harvard Medical School, 25 Shattuck Street, Boston, MA 02115 USA
- Department of Emergency Medicine, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115 USA
- Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115 USA
| | - Susan Bartels
- Harvard Humanitarian Initiative, 14 Story Street, Cambridge, MA 02138 USA
- Harvard Medical School, 25 Shattuck Street, Boston, MA 02115 USA
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, 190 Pilgrim Road, Boston, MA 02215 USA
- Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115 USA
- Department of Emergency Medicine, Queen’s University, 76 Stuart Street, Kingston, ON K7L 2V7 Canada
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Delgadillo DC. When There is No Sexual Assault Nurse Examiner: Emergency Nursing Care for Female Adult Sexual Assault Patients. J Emerg Nurs 2017; 43:308-315. [DOI: 10.1016/j.jen.2016.11.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 11/03/2016] [Accepted: 11/23/2016] [Indexed: 10/19/2022]
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Crawford-Jakubiak JE, Alderman EM, Leventhal JM, Flaherty EG, Idzerda S, Legano L, Leventhal JM, Lukefahr JL, Sege RD, Braverman PK, Adelman WP, Alderman EM, Breuner CC, Levine DA, Marcell AV, O’Brien RF. Care of the Adolescent After an Acute Sexual Assault. Pediatrics 2017; 139:peds.2016-4243. [PMID: 28242861 DOI: 10.1542/peds.2016-4243] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Sexual violence is a broad term that encompasses a wide range of sexual victimizations. Since the American Academy of Pediatrics published its last policy statement on sexual assault in 2008, additional information and data have emerged about sexual violence affecting adolescents and the treatment and management of the adolescent who has been a victim of sexual assault. This report provides new information to update physicians and focuses on the acute assessment and care of adolescent victims who have experienced a recent sexual assault. Follow-up of the acute assault, as well as prevention of sexual assault, are also discussed.
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Affiliation(s)
- James E. Crawford-Jakubiak
- Pediatrics, University of California San Francisco School of Medicine, and Center for Child Protection, University of San Francisco Benioff Children’s Hospital, Oakland, California
| | - Elizabeth M. Alderman
- Department of Pediatrics, Division of Adolescent Medicine, Director, Pediatrics Residency Program, The Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York; and
| | - John M. Leventhal
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut
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Sexual Assault. Fam Med 2017. [DOI: 10.1007/978-3-319-04414-9_29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Adult and Adolescent Sexual Assault Patients in the Emergency Care Setting. JOURNAL OF FORENSIC NURSING 2017; 13:91-93. [PMID: 28525434 DOI: 10.1097/jfn.0000000000000154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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Methods and Approaches to HIV Prevention. J Assoc Nurses AIDS Care 2016; 28:19-24. [PMID: 27751633 DOI: 10.1016/j.jana.2016.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 09/13/2016] [Indexed: 11/22/2022]
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Jain S, Oldenburg CE, Mimiaga MJ, Mayer KH. High Levels of Concomitant Behavioral Health Disorders Among Patients Presenting for HIV Non-occupational Post-exposure Prophylaxis at a Boston Community Health Center Between 1997 and 2013. AIDS Behav 2016; 20:1556-63. [PMID: 25689892 DOI: 10.1007/s10461-015-1021-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A paucity of information regarding mental health exists for patients presenting for HIV non-occupational post-exposure prophylaxis (nPEP). We reviewed electronic medical records of 894 adult nPEP patients seen at a large Boston community health center between 1997 and 2013. Of 821 patients with consensual sexual exposures, 88.3 % were men who have sex with men, and 40.0 % had a mental health diagnosis. Diagnoses included: depression (24.4 %), anxiety (21.9 %), attention deficit disorder (7.8 %), post-traumatic stress disorder (3.3 %), and psychotic disorders (3.3 %). Of 129 patients with substance use disorders, alcohol dependence (65.9 %) and crystal methamphetamine (43.4 %) predominated. Unprotected receptive anal intercourse was associated with psychotic disorders (aOR = 4.86; 95 %CI:1.76-13.5) and substance use disorders (aOR = 1.89; 95 %CI:1.28-2.80). Substance use at the time of exposure was associated with: depression (aOR = 1.95; 95 %CI:1.36-2.80), anxiety (aOR = 2.22; 95 %CI:1.51-3.25), attention deficit disorder (aOR = 1.96; 95 %CI:1.18-3.27), and substance use disorder (aOR = 4.78; 95 %CI:3.30-6.93). Mental illness should be screened for and addressed at nPEP visits to optimize HIV risk-reduction.
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Affiliation(s)
- Sachin Jain
- Division of Infectious Diseases, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, USA.
| | - Catherine E Oldenburg
- The Fenway Institute, Fenway Health, Boston, USA
- Department of Epidemiology, Harvard School of Public Health, Boston, USA
| | - Matthew J Mimiaga
- The Fenway Institute, Fenway Health, Boston, USA
- Department of Epidemiology, Harvard School of Public Health, Boston, USA
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, USA
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Nonoccupational Postexposure Human Immunodeficiency Virus Prophylaxis: Acceptance Following Sexual Assault. Nurs Res 2016; 65:47-54. [PMID: 26657480 DOI: 10.1097/nnr.0000000000000122] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Nonoccupational postexposure prophylaxis (nPEP) for HIV following sexual assault may decrease the likelihood of HIV transmission. OBJECTIVE The purpose of this exploratory chart review study was to examine factors associated with patients accepting post-sexual assault nPEP at three forensic nurse examiner programs in urban settings. METHODS Forensic nursing charts of patients presenting for acute sexual assault care were reviewed as part of a mixed-methods study. RESULTS Patients assaulted by more than one or an unknown number of assailants were over 12 times more likely to accept the offer of nPEP (adjusted odds ratio [aOR] = 12.66, 95% CI [2.77, 57.82]). In cases where no condom was used (aOR = 8.57, 95% CI [1.59, 46.10]) or when any injury to the anus or genitalia was noted (aOR = 4.10, 95% CI [1.57, 10.75]), patients were more likely to accept nPEP. Patients with any injury to the face or head were less likely to initiate nPEP (aOR = 0.32, 95% CI [0.11, 0.97]). DISCUSSION This study is an important first step in understanding factors associated with nPEP acceptance after sexual assault.
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Rouhani SA, Scott J, Burkhardt G, Onyango MA, Haider S, Greiner A, Albutt K, VanRooyen M, Bartels SA. A quantitative assessment of termination of sexual violence-related pregnancies in eastern Democratic Republic of Congo. Confl Health 2016; 10:9. [PMID: 27053946 PMCID: PMC4822240 DOI: 10.1186/s13031-016-0073-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 02/19/2016] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Sexual violence is prevalent in eastern Democratic Republic of Congo (DRC), and has resulted in sexual violence-related pregnancies (SVRPs). Despite restrictive laws, women may seek to terminate SVRPs; however, there are limited data on termination of SVRPs. METHODS A mixed methods study was conducted in 2012 in Bukavu, DRC. Adult women who self-reported an SVRP and termination of that SVRP were recruited using respondent-driven sampling (RDS). Trained female interviewers verbally administered a quantitative survey to all participants and a semi-structured qualitative survey to a subset. Quantitative data on characteristics and complications of pregnancy termination, including mental health outcomes, were analyzed using SAS. RESULTS In total, 86 women completed quantitative surveys. Most SVRPs (93 %) involved two or more assailants; 73 % occurred while in captivity. Most women (82 %) terminated the SVRPs at 3 months gestation or earlier; 79 % reported one attempt at pregnancy termination and 21 % more than one attempt. The most common methods of termination were an oral medicine (55 %) or herb (35 %); cimpokolo (31 %) and quinine (18 %) were most frequently reported. These methods were accessed through friends (37 %), healthcare providers (18 %), family (16 %), or self-obtained (12 %). Following the termination, 79 % of women reported subsequent physical symptoms, including abdominal pain (74 %), bleeding (47 %), vaginal discharge (35 %) and fever (18 %); 44 % sought medical care for their symptoms. Varied emotional responses to the termination were reported and included relief (34 %), anxiety (21 %), anger (19 %), guilt (19 %), and regret (10 %). At the time of the study, many women met symptom criteria for post-traumatic stress disorder (57 %), depression (50 %), and generalized anxiety disorder (33 %). CONCLUSION Most women terminated SVRPs using medications or herbs not recognized as evidence-based methods of pregnancy termination and sought these methods outside of the formal healthcare sector. These data suggest that access to safe abortion methods is needed for women with SVRPs in DRC. Physical symptoms and emotional reactions related to the termination varied. While it is not possible to differentiate the impacts of sexual violence, SVRP, and pregnancy termination on mental health outcomes, the findings highlight the complex needs of women with SVRPs and opportunities for integrative health services.
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Affiliation(s)
- Shada A. Rouhani
- />Harvard Humanitarian Initiative, Cambridge, MA USA
- />Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, MA USA
- />Harvard Medical School, Boston, MA USA
| | - Jennifer Scott
- />Harvard Humanitarian Initiative, Cambridge, MA USA
- />Harvard Medical School, Boston, MA USA
- />Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA USA
- />Division of Women’s Health, Brigham and Women’s Hospital, Boston, MA USA
| | - Gillian Burkhardt
- />Harvard Humanitarian Initiative, Cambridge, MA USA
- />Department of Obstetrics and Gynecology, Boston University School of Medicine, Boston, MA USA
| | - Monica A. Onyango
- />Department of Global Health, Boston University School of Public Health, Boston, MA USA
| | - Sadia Haider
- />Department of Obstetrics and Gynecology, University of Illinois at Chicago, Chicago, USA
| | - Ashley Greiner
- />Harvard Humanitarian Initiative, Cambridge, MA USA
- />Harvard Medical School, Boston, MA USA
- />Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA USA
| | - Katherine Albutt
- />Harvard Humanitarian Initiative, Cambridge, MA USA
- />Harvard Medical School, Boston, MA USA
- />Department of Surgery, Massachusetts General Hospital, Boston, MA USA
| | - Michael VanRooyen
- />Harvard Humanitarian Initiative, Cambridge, MA USA
- />Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, MA USA
- />Harvard Medical School, Boston, MA USA
- />Harvard School of Public Health, Boston, MA USA
| | - Susan A. Bartels
- />Harvard Humanitarian Initiative, Cambridge, MA USA
- />Harvard Medical School, Boston, MA USA
- />Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA USA
- />Department of Emergency Medicine, Queen’s University, Kingston, Canada
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Perry R, Murphy M, Rankin KM, Cowett A, Harwood B. Practices Regarding Rape-related Pregnancy in U.S. Abortion Care Settings. Womens Health Issues 2015; 26:67-73. [PMID: 26621607 DOI: 10.1016/j.whi.2015.10.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 10/27/2015] [Accepted: 10/28/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE We aimed to explore current practices regarding screening for rape and response to disclosure of rape-related pregnancy in the abortion care setting. METHODS We performed a cross-sectional, nonprobability survey of U.S. abortion providers. Individuals were recruited in person and via emailed invitations to professional organization member lists. Questions in this web-based survey pertained to providers' practice setting, how they identify rape-related pregnancy, the availability of support services, and their experiences with law enforcement. Providers were asked their perceptions of barriers to care for women who report rape-related pregnancy. RESULTS Surveys were completed by 279 providers (21% response rate). Most respondents were female (93.1%), and the majority were physicians in a clinical role (69.4%). One-half (49.8%) reported their practice screens for pregnancy resulting from rape, although fewer (34.8%) reported that screening is the method through which most patients with this history are identified. Most (80.6%) refer women with rape-related pregnancy to support services such as rape crisis centers. Relatively few (19.7%) have a specific protocol for care of women who report rape-related pregnancy. Clinics that screen were 79% more likely to have a protocol for care than centers that do not screen. Although the majority (67.4%) reported barriers to identification of women with rape-related pregnancy, fewer (33.3%) reported barriers to connecting them to support services. CONCLUSION Practices for identifying and providing care to women with rape-related pregnancy in the abortion care setting are variable. Further research should address barriers to care provision, as well as identifying protocols for care.
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Affiliation(s)
- Rachel Perry
- Department of Obstetrics and Gynecology, University of Illinois at Chicago College of Medicine, Chicago, Illinois.
| | - Molly Murphy
- Department of Community Health Sciences, University of Illinois at Chicago, School of Public Health, Chicago, Illinois
| | - Kristin M Rankin
- Department of Community Health Sciences, University of Illinois at Chicago, School of Public Health, Chicago, Illinois
| | - Allison Cowett
- Department of Obstetrics and Gynecology, University of Illinois at Chicago College of Medicine, Chicago, Illinois
| | - Bryna Harwood
- Department of Obstetrics and Gynecology, University of Illinois at Chicago College of Medicine, Chicago, Illinois
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Inter-relationships between sexual abuse, female sexual function and childbirth. Midwifery 2015; 31:1087-95. [DOI: 10.1016/j.midw.2015.07.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Revised: 06/13/2015] [Accepted: 07/20/2015] [Indexed: 12/31/2022]
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Han JS, Cho SJ, Bae SM. Factors Associated with Disclosure of Sexual Abuse of Children and Adolescent Victims. Soa Chongsonyon Chongsin Uihak 2015. [DOI: 10.5765/jkacap.2015.26.3.176] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Sathirareuangchai S, Phobtrakul R, Phetsangharn L, Srisopa K, Petchpunya S. Comparative study of spermatozoa detection using the genital swab versus bedside smear slide technique in sexual assault patients. J Forensic Leg Med 2015; 35:69-72. [PMID: 26344463 DOI: 10.1016/j.jflm.2015.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 07/26/2015] [Accepted: 08/05/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND Specimen collection from sexual assault victims is an essential part of practice in forensic medicine. Semen analysis is a forensic test used to confirm sexual contact. Two methods of specimen collection were compared in this study: the genital swab and bedside slide smear. MATERIALS AND METHODS A retrospective chart review was performed in the Division of Clinical Forensic Medicine, Siriraj Hospital, Thailand. Data were collected on microscopic spermatozoa detection in the external and internal genitalia, the time interval from assault to visit, and the history of condom use and genital cleansing. McNemar's test was used for comparison between the genital swab and bedside slide smear techniques. RESULTS In total, 724 case files from 2009 to 2013 were reviewed. The genital swab technique yielded a higher detection rate than did the bedside slide smear technique in both the external genitalia (37.0% vs. 31.8%, respectively) and internal genitalia (40.8% vs. 34.1%, respectively). Collection of a genital swab only missed positive cases in 4%-6% of negative swabs. When considering both the external and internal genitalia, the genital swab still yielded a higher rate of positive results than did the slide smear (45.9% vs. 39.0%, respectively). Examination of the victim within the first 3 days produced the highest spermatozoa detection rate (46.3%). CONCLUSIONS The genital swab is the preferred specimen collection method for spermatozoa detection in adult sexual assault victims. However, collection of both a swab and slide specimen may be considered in some cases. Collection of specimens later than 3 days after the assault greatly decreases the rate of spermatozoa detection.
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Affiliation(s)
- Sakda Sathirareuangchai
- Department of Forensic Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand.
| | - Rattana Phobtrakul
- Department of Forensic Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Ladda Phetsangharn
- Department of Forensic Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Kamontip Srisopa
- Department of Forensic Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Saowarat Petchpunya
- Department of Forensic Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
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Scott J, Rouhani S, Greiner A, Albutt K, Kuwert P, Hacker MR, VanRooyen M, Bartels S. Respondent-driven sampling to assess mental health outcomes, stigma and acceptance among women raising children born from sexual violence-related pregnancies in eastern Democratic Republic of Congo. BMJ Open 2015; 5:e007057. [PMID: 25854968 PMCID: PMC4390729 DOI: 10.1136/bmjopen-2014-007057] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Assess mental health outcomes among women raising children from sexual violence-related pregnancies (SVRPs) in eastern Democratic Republic of Congo and stigma toward and acceptance of women and their children. DESIGN Participants were recruited using respondent-driven sampling. SETTING Bukavu, Democratic Republic of Congo in 2012. PARTICIPANTS 757 adult women raising children from SVRPs were interviewed. A woman aged 18 and older was eligible for the study if she self-identified as a sexual violence survivor since the start of the conflict (∼1996), conceived an SVRP, delivered a liveborn child and was currently raising the child. A woman was ineligible for the study if the SVRP ended with a spontaneous abortion or fetal demise or the child was not currently living or in the care of the biological mother. INTERVENTION Trained female Congolese interviewers verbally administered a quantitative survey after obtaining verbal informed consent. OUTCOME MEASURES Symptom criteria for major depressive disorder, post-traumatic stress disorder, anxiety and suicidality were assessed, as well as stigma toward the woman and her child. Acceptance of the woman and child from the spouse, family and community were analysed. RESULTS 48.6% met symptom criteria for major depressive disorder, 57.9% for post-traumatic stress disorder, 43.3% for anxiety and 34.2% reported suicidality. Women who reported stigma from the community (38.4%) or who reported stigma toward the child from the spouse (42.9%), family (31.8%) or community (38.1%) were significantly more likely to meet symptom criteria for most mental health disorders. Although not statistically significant, participants who reported acceptance and acceptance of their children from the spouse, family and community were less likely to meet symptom criteria. CONCLUSIONS Women raising children from SVRPs experience symptoms of mental health disorders. Programming addressing stigma and acceptance following sexual violence may improve mental health outcomes in this population.
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Affiliation(s)
- Jennifer Scott
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Division of Women's Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Humanitarian Initiative, Cambridge, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Shada Rouhani
- Harvard Humanitarian Initiative, Cambridge, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Ashley Greiner
- Harvard Humanitarian Initiative, Cambridge, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Department of General Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Katherine Albutt
- Harvard Humanitarian Initiative, Cambridge, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Department of General Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Philipp Kuwert
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, HELIOS Hansehospital Stralsund, Stralsund, Germany
| | - Michele R Hacker
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA
| | - Michael VanRooyen
- Harvard Humanitarian Initiative, Cambridge, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard School of Public Health, Boston, Massachusetts, USA
| | - Susan Bartels
- Harvard Humanitarian Initiative, Cambridge, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Department of General Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard School of Public Health, Boston, Massachusetts, USA
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Kernbach-Wighton G, Banaschak S, Madea B, Pollak S, Thierauf-Emberger A, Tsokos M, Geserick G, Schmeling A, Saternus KS. Klinische Rechtsmedizin und forensisch-klinische Untersuchungen. Rechtsmedizin (Berl) 2015. [DOI: 10.1007/978-3-662-43500-7_6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Johnson LM. Sexual Assault. Fam Med 2015. [DOI: 10.1007/978-1-4939-0779-3_29-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Bicanic IAE, Hehenkamp LM, van de Putte EM, van Wijk AJ, de Jongh A. Predictors of delayed disclosure of rape in female adolescents and young adults. Eur J Psychotraumatol 2015; 6:25883. [PMID: 25967381 PMCID: PMC4429257 DOI: 10.3402/ejpt.v6.25883] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2014] [Revised: 03/30/2015] [Accepted: 04/13/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Delayed disclosure of rape has been associated with impaired mental health; it is, therefore, important to understand which factors are associated with disclosure latency. The purpose of this study was to compare various demographics, post-rape characteristics, and psychological functioning of early and delayed disclosers (i.e., more than 1-week post-rape) among rape victims, and to determine predictors for delayed disclosure. METHODS Data were collected using a structured interview and validated questionnaires in a sample of 323 help-seeking female adolescents and young adults (12-25 years), who were victimized by rape, but had no reported prior chronic child sexual abuse. RESULTS In 59% of the cases, disclosure occurred within 1 week. Delayed disclosers were less likely to use medical services and to report to the police than early disclosers. No significant differences were found between delayed and early disclosers in psychological functioning and time to seek professional help. The combination of age category 12-17 years [odds ratio (OR) 2.05, confidence intervals (CI) 1.13-3.73], penetration (OR 2.36, CI 1.25-4.46), and closeness to assailant (OR 2.64, CI 1.52-4.60) contributed significantly to the prediction of delayed disclosure. CONCLUSION The results point to the need of targeted interventions that specifically encourage rape victims to disclose early, thereby increasing options for access to health and police services.
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Affiliation(s)
- Iva A E Bicanic
- National Psychotraumacenter for Children and Youth, University Medical Center Utrecht, Utrecht The Netherlands;
| | - Lieve M Hehenkamp
- National Psychotraumacenter for Children and Youth, University Medical Center Utrecht, Utrecht The Netherlands
| | - Elise M van de Putte
- Department of Paediatrics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Arjen J van Wijk
- Department of Behavioral Sciences, ACTA, University of Amsterdam and VU University, Amsterdam, The Netherlands
| | - Ad de Jongh
- Department of Behavioral Sciences, ACTA, University of Amsterdam and VU University, Amsterdam, The Netherlands.,School of Health Sciences, Salford University, Manchester, United Kingdom
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Practical guidance for nonoccupational postexposure prophylaxis to prevent HIV infection: an editorial review. AIDS 2014; 28:1545-54. [PMID: 24785956 DOI: 10.1097/qad.0000000000000301] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Postexposure prophylaxis (PEP) with antiretroviral medication has been used as an HIV-prevention strategy for nearly 20 years. The fact that approximately 50 000 new HIV infections occur in the United States each year reflects marked underutilization of nonoccupational PEP (NPEP). There have been several advances in NPEP in the past 10 years. Clinical trials from different countries have demonstrated better tolerability, completion rates, and fewer drug-drug interactions with newer antiretroviral agents. Notably, there has been a shift from zidovudine-based to tenofovir-based regimens. Three-drug therapy is now favored for all potential HIV exposures. More recently, the US Public Health Service and the New York State Department of Health recommended tenofovir/emtricitabine and raltegravir as the first-line regimen universally for PEP. Advances in HIV testing technology may also allow shorter duration of follow-up HIV testing after a high-risk exposure. This review will discuss challenges with previously recommended regimens, newer potential candidate agents and the rationale for using them, intervals for laboratory monitoring, and cost considerations for NPEP. NPEP can be viewed as an educable moment and a potential bridge to preexposure prophylaxis, as part of a combination prevention package, for those who are likely to have recurrent higher-risk exposures. Thus, risk-reduction counseling should be an integral aspect of NPEP.
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Abstract
Reproductive-aged victims of sexual assault are at risk of unintended pregnancy, sexually transmitted infections, and mental health conditions, including posttraumatic stress disorder. Health care providers should screen routinely for a history of sexual assault and offer victims both emergency contraception and sexually transmitted infection prophylaxis. The health care provider who examines victims of sexual assault has a responsibility to comply with state and local statutory or policy requirements for the use of evidence-gathering kits.
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Bicanic I, Snetselaar H, De Jongh A, Van de Putte E. Victims' use of professional services in a Dutch sexual assault centre. Eur J Psychotraumatol 2014; 5:23645. [PMID: 24959327 PMCID: PMC4064247 DOI: 10.3402/ejpt.v5.23645] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2013] [Revised: 04/02/2014] [Accepted: 05/05/2014] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Prior research endorsed the establishment of sexual assault centres in the Netherlands because of the potential benefit for victims' mental recovery. In 2012, the first Dutch sexual assault centre was founded at the University Medical Center Utrecht. The aim of the centre is to provide 24/7 coordinated and integrated services (i.e., medical, forensic, and psychological) in one location. OBJECTIVE The purpose of the present study was to describe demographic, background, and assault characteristics of victims seen at the centre within one week post-assault, and their use of post-assault services in order to improve current services. METHOD From January 2012 to September 2013, prospective data of 108 patients were collected. To describe the population included, frequency counts and proportions were generated for categorical variables. RESULTS The mean age was 21.3 years (SD=9.8). Most victims were female (91.7%). A large proportion of victims reported background characteristics known to increase the risk for post-traumatic stress disorder (PTSD) and revictimisation such as prior sexual abuse (32.4%), pre-existing use of mental health services (45.4%), and not living with both biological parents (61.7%). Most patients (88.9%) consulted the centre within 72 hours post-assault. The uptake of services was high: 82.4% received emergency medical care, 61.7% underwent a forensic-medical exam, 34% reported to the police, and 82.4% utilised psychological services. CONCLUSION To prevent revictimisation and PTSD, current psychological services could be improved with immediate trauma-focused treatments. Current forensic services may be improved with the use of standard top to toe forensic-medical examinations for both children and adults.
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Affiliation(s)
- Iva Bicanic
- National Psychotrauma Center for Children and Youth, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Hanneke Snetselaar
- National Psychotrauma Center for Children and Youth, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Ad De Jongh
- Department of Behavioral Sciences, Academic Centre for Dentistry in Amsterdam (ACTA), University of Amsterdam and VU University in Amsterdam, Amsterdam, the Netherlands
- School of Health Sciences, Salford University, Manchester, United Kingdom
| | - Elise Van de Putte
- Department of Paediatrics, University Medical Center Utrecht, Utrecht, the Netherlands
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Sharma P, Unnikrishnan MK, Sharma A. Sexual violence in India: addressing gaps between policy and implementation. Health Policy Plan 2014; 30:656-9. [DOI: 10.1093/heapol/czu015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2014] [Indexed: 11/12/2022] Open
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Draughon JE, Anderson JC, Hansen BR, Sheridan DJ. Nonoccupational postexposure HIV prophylaxis in sexual assault programs: a survey of SANE and FNE program coordinators. J Assoc Nurses AIDS Care 2014; 25:S90-S100. [PMID: 24103741 PMCID: PMC3947353 DOI: 10.1016/j.jana.2013.07.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2012] [Accepted: 07/12/2013] [Indexed: 11/26/2022]
Abstract
This cross-sectional study describes sexual assault nurse examiner (SANE)/forensic nurse examiner (FNE) program practices related to HIV testing, nonoccupational postexposure prophylaxis (nPEP), and common barriers to offering HIV testing and nPEP. A convenience sample of 174 SANE/FNE programs in the United States and Canada was drawn from the International Association of Forensic Nurses database, and program coordinators completed Web-based surveys. Three fourths of programs had nPEP policies, 31% provided HIV testing, and 63% offered nPEP routinely or upon request. Using χ(2) and Fisher's exact tests, a greater proportion of Canadian programs had an nPEP protocol (p = .010), provided HIV testing (p = .004), and offered nPEP (p = .0001) than U.S.-based programs. Program coordinators rated providing pre- and/or posttest counseling and follow-up as the most important barrier to HIV testing, and medication costs as the most important barrier to providing nPEP. Our results indicate HIV-related services are offered inconsistently across SANE/FNE programs.
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Sudupe Moreno A. Age differences among victims of sexual assault: A comparison between children, adolescents and adults. J Forensic Leg Med 2013; 20:465-70. [DOI: 10.1016/j.jflm.2013.02.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2012] [Accepted: 02/05/2013] [Indexed: 10/27/2022]
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Affiliation(s)
- Susan A Bartels
- Faculty, Harvard Humanitarian Initiative, Cambridge, Massachusetts, USA
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