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Chen CX, Rogers SK, Li R, Hinrichs RJ, Fortenberry JD, Carpenter JS. Social Determinants of Health and Dysmenorrhea: A Systematic Review. THE JOURNAL OF PAIN 2024; 25:104574. [PMID: 38788887 PMCID: PMC11347097 DOI: 10.1016/j.jpain.2024.104574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 05/14/2024] [Accepted: 05/16/2024] [Indexed: 05/26/2024]
Abstract
Social determinants of health play a key role in health disparities. Dysmenorrhea is a highly prevalent and impactful public health problem affecting reproductive-age females. Systematically examining social determinants of health (SDoH) in dysmenorrhea is important for identifying gaps in the literature and informing research, policy, and clinical practice to reduce the public health burden associated with dysmenorrhea. The purpose of this systematic review was to synthesize the literature on SDoH and dysmenorrhea. The review protocol was prospectively registered. We searched Medline, EMBASE, CINAHL, PsycINFO, Scopus, and Google Scholar through February 2024 using search strategies informed by the literature. Screening of the articles, data extraction, and risk-of-bias (RoB) assessment were conducted independently by at least 2 reviewers on the Covidence platform. Among 2,594 unique records screened, 166 met eligibility criteria and were included for data extraction and RoB assessment. Evidence suggests traumatic experiences, toxic environmental exposures, female genital mutilation, job-related stress, lack of menstrual education, and low social support were associated with worse dysmenorrhea outcomes. However, evidence was equivocal regarding the relationships between dysmenorrhea outcomes and SDoH factors, including socioeconomic status, geographical location, race/ethnicity, employment, and religion. Nearly all articles (99.4%) had a high or very high overall RoB. The relationships between SDoH and dysmenorrhea outcomes were often inconsistent and complicated by heterogeneous study populations and methodologies. More rigorous research examining SDoH in dysmenorrhea is needed to inform policy and clinical practice. PERSPECTIVE: This systematic review synthesizes evidence linking SDoH and dysmenorrhea. The relationships between SDoH and dysmenorrhea were often equivocal and complicated by heterogeneous study populations and methodologies. We identify directions for future research and SDoH factors that could be addressed clinically (eg, trauma, menstrual education, and occupational stress).
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Affiliation(s)
- Chen X Chen
- Indiana University School of Nursing, Indianapolis, Indiana.
| | - Sarah K Rogers
- Department of Psychology, School of Science, Indiana University Purdue University-Indianapolis, Indianapolis, Indiana
| | - Rui Li
- Seattle Children's Research Institute, Seattle, Washington; Department of Anesthesiology and Pain Medicine, School of Medicine, University of Washington, Seattle, Washington
| | - Rachel J Hinrichs
- Indiana University Indianapolis, University Library, Indianapolis, Indiana
| | - J Dennis Fortenberry
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
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Wellmann AM, Costa D. Sexual and reproductive health outcomes of women who experienced violence in Germany: Analysis of the German health interview and examination survey for adults (DEGS1). PLoS One 2024; 19:e0305992. [PMID: 39121172 PMCID: PMC11315302 DOI: 10.1371/journal.pone.0305992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 06/07/2024] [Indexed: 08/11/2024] Open
Abstract
OBJECTIVES Violence against women is a widespread public health concern with severe effects to women's sexual and reproductive health, including higher risks for miscarriage or stillbirth, unintended pregnancy and induced abortion. This study examined the association between women exposure to physical violence, psychological violence and sexual and reproductive health outcomes (contraceptive use, miscarriage or stillbirth and abortion) in Germany. METHODS This study used a cross-sectional research design to analyze data on violence against women and sexual and reproductive health (SRH) outcomes collected through the German Health Interview and Examination Survey for Adults, Wave 1, between 2008 and 2011 (n = 3149 women, aged 18-64 years). Multivariable logistic regression models were used to assess the association between experiences of violence among women and the presence of sexual and reproductive health outcomes, considering the influence of socio-demographic and health-related factors (age, marital status, socioeconomic status, social support, number of children, alcohol consumption, health status, chronic conditions). RESULTS Three associations remained significant (p<0.05) in fully-adjusted models: (i) exposure to physical violence by a parent or caregiver and birth control pill utilization (aOR, adjusted Odds Ratio, 95% CI: 1.36, 1.02-1.81) (ii) exposure to physical violence since the age of 16 and miscarriage or stillbirth (aOR, 95%CI: 1.89, 1.17-3.04); and (iii) exposure to psychological violence by a parent or caregiver and abortion (aOR, 95%CI: 1.87, 1.30-2.70). CONCLUSIONS The results suggest that adult German women who experienced physical or psychological violence since the age of 16, including violence perpetrated by a parent or caregiver, were more likely to report miscarriage or stillbirth and abortion. Direct assessment of violence experiences against women should be conducted by healthcare professionals in clinical encounters, particularly by obstetrics and gynaecological specialists, for the prevention of women´s adverse sexual and reproductive health outcomes. Furthermore, violence should be treated as a major public health concern and addressed through a multisectoral approach, involving the healthcare and educational sectors, researchers and relevant policymakers.
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Affiliation(s)
- Antonia Marie Wellmann
- Department of Population Medicine and Health Services Research, School of Public Health, Bielefeld University, Bielefeld, Germany
- Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ), Eschborn, Germany
| | - Diogo Costa
- Department of Population Medicine and Health Services Research, School of Public Health, Bielefeld University, Bielefeld, Germany
- Research Centre for Human Development (CEDH), Faculty of Education and Psychology, Universidade Católica Portuguesa, Porto, Portugal
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Lee J, Dhauna J, Silvers JA, Houston MH, Barnert ES. Therapeutic Dance for the Healing of Sexual Trauma: A Systematic Review. TRAUMA, VIOLENCE & ABUSE 2023; 24:2143-2164. [PMID: 35466836 DOI: 10.1177/15248380221086898] [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: 06/14/2023]
Abstract
Therapeutic dance has been increasingly used as a treatment modality for sexual trauma, yet its evidence-based efficacy has not yet been catalogued. We therefore conducted a systematic review to summarize the existing evidence for therapeutic dance as an intervention for healing after sexual trauma. We searched 5 major databases to identify intervention studies on the use of therapeutic dance for individuals with histories of sexual trauma. Studies were included based on the following criteria: 1) the study involves individuals who have been exposed to sexual trauma; 2) the study reports on any form of dance as a therapeutic intervention; and 3) the study reports on dance intervention outcomes. A total of 1,686 sources were identified. Of these, 11 articles met eligibility criteria and were assessed. Reported outcomes were extracted and organized into emergent domains. We found that therapeutic dance acts upon three broad domains-affect, self, and interpersonal relationships - and can be delivered in diverse settings. Across the studies, dance showed benefits on outcomes. However, a significant weakness of the current peer-reviewed literature is the lack of robust empirical intervention research on dance therapy. Overall, the emerging literature suggests that therapeutic dance is a potential intervention for those who have experienced sexual trauma. The review findings presented here can be used to inform practitioners and systems of care targeted for those who have been subject to sexual trauma.
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Affiliation(s)
- Joyce Lee
- Department of Pediatrics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Janeet Dhauna
- Department of Pediatrics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Jennifer A Silvers
- Department of Psychology, University of California Los Angeles, Los Angeles, CA, USA
| | | | - Elizabeth S Barnert
- Department of Pediatrics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
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Selai C, Elmalem MS, Chartier-Kastler E, Sassoon N, Hewitt S, Rocha MF, Klitsinari L, Panicker JN. Systematic review exploring the relationship between sexual abuse and lower urinary tract symptoms. Int Urogynecol J 2023; 34:635-653. [PMID: 35751671 PMCID: PMC9947020 DOI: 10.1007/s00192-022-05277-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 06/03/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Patients presenting with lower urinary tract symptoms (LUTS) may report a history of sexual abuse (SA), and survivors of SA may report LUTS; however, the nature of the relationship is poorly understood. The aim of this review is to systematically evaluate studies that explore LUT dysfunction in survivors of SA. METHODS A systematic literature search of six databases, Cochrane Database of Systematic Reviews, MEDLINE, EMBASE, CINAHL, AMED, and PsycINFO, was performed. The last search date was June 2021 (PROSPERO CRD42019122080). Studies reporting the prevalence and symptoms of LUTS in patients who have experienced SA were included. The literature was appraised according to the PRISMA statement. The quality of the studies was assessed. RESULTS Out of 272 papers retrieved, 18 publications met the inclusion criteria: studies exploring LUTS in SA survivors (n=2), SA in patients attending clinics for their LUTs (n=8), and cross-sectional studies (n=8). SA prevalence ranged between 1.3% and 49.6%. A history of SA was associated with psychosocial stressors, depression, and anxiety. LUTS included urinary storage symptoms, voiding difficulties, voluntary holding of urine and urinary tract infections. Most studies were of moderate quality. Assessment of SA and LUTS lacked standardisation. CONCLUSIONS The review highlights the need for a holistic assessment of patients presenting with LUTS. Although most of the studies were rated as being of 'moderate' quality, the evidence suggests the need to provide a "safe space" in clinic for patients to share sensitive information about trauma. Any such disclosure should be followed up with further assessment.
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Affiliation(s)
- Caroline Selai
- UCL Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology, Queen Square, London, WC1N 3BG, UK.
- Department of Uro-Neurology, The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK.
| | - Michael S Elmalem
- UCL Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology, Queen Square, London, WC1N 3BG, UK
- UCL Department of Brain Repair and Rehabilitation, Queen Square Institute of Neurology, Queen Square, London, UK
| | - Emmanuel Chartier-Kastler
- Department of Urology, Academic Hospital Pitié-Salpêtrière, Medical School, Sorbonne University, AP-HP, 47-83, Bd de l'Hôpital, 75651, Paris cedex 13, France
| | - Natalia Sassoon
- UCL Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - Sam Hewitt
- UCL Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - Maria Francisca Rocha
- UCL Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - Larisa Klitsinari
- UCL Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - Jalesh N Panicker
- Department of Uro-Neurology, The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
- UCL Department of Brain Repair and Rehabilitation, Queen Square Institute of Neurology, Queen Square, London, UK
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Smith NE, Thompson KM, McCall TC. Physician Assistants' Training and Self-Perceived Competencies to Work with Survivors of Intimate Partner Violence. J Physician Assist Educ 2022; 33:284-290. [PMID: 36409236 DOI: 10.1097/jpa.0000000000000458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
INTRODUCTION The purpose of this research was to assess physician assistant (PA) education and training on the diagnosis, management, and treatment of survivors of intimate partner violence (IPV), as well as perceived current vs. desired skills in tasks related to the management and treatment of IPV. METHODS Participants in 2 studies included a convenience sample of attendees at an annual PA conference (study 1) and PAs in the United States who were randomly selected to be administered an online survey related to their PA practice (study 2). RESULTS In 2 studies, PAs reported low perceived competence to treat and manage patients who are survivors of IPV. More than half of the respondents (51.2%) had received training to work with survivors of IPV. Almost 3 in 5 indicated that they felt adequately prepared, and almost 3 in 10 regularly asked patients about IPV. Gaps between current and desired perceived skills to treat and manage survivors of IPV were larger among PAs who had previous training related to IPV compared with PAs with no prior training. DISCUSSION Guidance for PA educators may improve PA education and increase competencies among new PAs. Without more substantial guidance from an accrediting body, PA programs are left responsible for implementing IPV curriculum. Professional associations as well as constituent and specialty organizations that provide continuing medical education have an equally important role in strengthening skills and abilities among PAs.
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Affiliation(s)
- Noël E Smith
- Noël E. Smith, MA, is the senior director of PA and Industry Research and Analysis at the American Academy of PAs in Alexandria, Virginia
- Katherine M. Thompson, PA-C, is a physician assistant for Providence and consults as a forensic examiner for IPV Educators, LLC, in North Bend, Washington
- Timothy C. McCall, PhD, is director of research for the National Association of County and City Health Officials in Washington, DC, and director of health sciences undergraduate courses, Department of Clinical Research and Leadership, at George Washington University in Washington, DC
| | - Katherine M Thompson
- Noël E. Smith, MA, is the senior director of PA and Industry Research and Analysis at the American Academy of PAs in Alexandria, Virginia
- Katherine M. Thompson, PA-C, is a physician assistant for Providence and consults as a forensic examiner for IPV Educators, LLC, in North Bend, Washington
- Timothy C. McCall, PhD, is director of research for the National Association of County and City Health Officials in Washington, DC, and director of health sciences undergraduate courses, Department of Clinical Research and Leadership, at George Washington University in Washington, DC
| | - Timothy C McCall
- Noël E. Smith, MA, is the senior director of PA and Industry Research and Analysis at the American Academy of PAs in Alexandria, Virginia
- Katherine M. Thompson, PA-C, is a physician assistant for Providence and consults as a forensic examiner for IPV Educators, LLC, in North Bend, Washington
- Timothy C. McCall, PhD, is director of research for the National Association of County and City Health Officials in Washington, DC, and director of health sciences undergraduate courses, Department of Clinical Research and Leadership, at George Washington University in Washington, DC
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Walker N, Beek K, Chen H, Shang J, Stevenson S, Williams K, Herzog H, Ahmed J, Cullen P. The Experiences of Persistent Pain Among Women With a History of Intimate Partner Violence: A Systematic Review. TRAUMA, VIOLENCE & ABUSE 2022; 23:490-505. [PMID: 32945245 DOI: 10.1177/1524838020957989] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Women experience persistent pain at higher rates than men; however, women are less likely to be provided with adequate or appropriate care and more likely to have their pain experiences dismissed. The purpose of this review is to consider the complex interaction of the biopsychosocial factors in the experience of persistent pain in order to inform improved models of care. Given persistent pain is among the most frequently reported health consequences of intimate partner violence (IPV), this review focused on studies exploring the association between persistent pain and IPV. Three reviewers independently and systematically searched seven databases. Qualitative and quantitative studies describing the association between IPV and persistent pain published between January 2000 and June 2018 were included. Twelve studies met the inclusion criteria. The included studies demonstrated that a history of IPV places an additional burden on women who experience persistent pain that cannot be explained by an underlying psychological condition. Health care practitioners should be aware of this phenomena to ensure diagnosis, assessment, and treatment plans are targeted accordingly. Future policy directives and research should account for and seek to elucidate this additional burden.
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Affiliation(s)
- Natasha Walker
- School of Population Health, 7800University of New South Wales, Sydney, New South Wales, Australia
- 211065The George Institute for Global Health, Sydney, New South Wales, Australia
- University of Newcastle, New South Wales, Australia
| | - Kristen Beek
- School of Population Health, 7800University of New South Wales, Sydney, New South Wales, Australia
| | - Huan Chen
- The George Institute for Global Health, Beijing, China
| | - Jie Shang
- The George Institute for Global Health, Beijing, China
| | - Sally Stevenson
- The Illawarra Women's Health Centre, Warilla, New South Wales, Australia
| | - Karen Williams
- South Coast Private Hospital, Wollongong, New South Wales, Australia
| | - Hayley Herzog
- 211065The George Institute for Global Health, Sydney, New South Wales, Australia
- Silver School of Social Work, New York University, NY, USA
| | - Jareen Ahmed
- The University of Sydney, New South Wales, Australia
| | - Patricia Cullen
- School of Population Health, 7800University of New South Wales, Sydney, New South Wales, Australia
- 211065The George Institute for Global Health, Sydney, New South Wales, Australia
- Ngarruwan Ngadju, First Peoples Health and Wellbeing Research Centre, Australian Health Services Research Institute, University of Wollongong, New South Wales, Australia
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Güvenç R, Hacıoğlu Yıldırım M, Yıldırım EA. The overlooked relationship between subtle partner sexual violence and sexual dysfunction? SEXUAL AND RELATIONSHIP THERAPY 2022. [DOI: 10.1080/14681994.2022.2043548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Rengin Güvenç
- Hospital for Psychiatry, Neurology and Neurosurgery, University of Health Sciences Bakirkoy Prof. Dr. Mazhar Osman Research and Training, Bakırköy, İstanbul, Turkey
| | - Münevver Hacıoğlu Yıldırım
- Hospital for Psychiatry, Neurology and Neurosurgery, University of Health Sciences Bakirkoy Prof. Dr. Mazhar Osman Research and Training, Bakırköy, İstanbul, Turkey
| | - Ejder Akgün Yıldırım
- Hospital for Psychiatry, Neurology and Neurosurgery, University of Health Sciences Bakirkoy Prof. Dr. Mazhar Osman Research and Training, Bakırköy, İstanbul, Turkey
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Vicard-Olagne M, Pereira B, Rougé L, Cabaillot A, Vorilhon P, Lazimi G, Laporte C. Signs and symptoms of intimate partner violence in women attending primary care in Europe, North America and Australia: a systematic review and meta-analysis. Fam Pract 2022; 39:190-199. [PMID: 34448843 DOI: 10.1093/fampra/cmab097] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Intimate partner violence (IPV) is a prevalent yet underdiagnosed health issue, and primary care practitioners are in a unique front-line position to provide care and counsel for the victims. OBJECTIVE To identify the signs and symptoms of women exposed to IPV who attended primary care, regardless motive of consultation. METHODS Systematic review and meta-analysis on Cochrane, PubMed, Embase and CINAHL between 1946 and 2020. Eligible studies had to be original quantitative research, on women aged >15 years, attending primary care settings in Europe, North America and Australia and interviewed on their status as victims of IPV and on their signs and symptoms. RESULTS Of 1791 articles identified, 57 were selected. Associations were found between IPV and signs and symptoms of depression [19 studies: overall odds ratio (OR) = 3.59, 95% confidence interval (CI; 2.7-4.7, I2 = 94.6%)], anxiety [9 studies: overall OR = 2.19, 95% CI (1.75-2.73, I2 = 84%)], gynaecological and/or sexually transmitted infections [6 studies: overall OR = 2.82, 95% CI (2.1-3.8, I2 = 41%)] and combination of somatic symptoms [5 studies: standard mean deviation = 0.795, 95% CI (0.62-0.97, I2 = 0%)]. CONCLUSIONS Women exposed to IPV may present with clinical symptoms and signs other than bodily injury. Policy implications knowing these symptoms presented by women victims of IPV can help GPs identify and treat them. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42018089857.
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Affiliation(s)
- Mathilde Vicard-Olagne
- Faculty of Medicine, EA7280, Department of General Practice, Clermont Auvergne University, Clermont-Ferrand F-63001
| | - Bruno Pereira
- Clinical Research and Innovation Department, University Hospital-Clermont-Ferrand, Clermont-Ferrand F-63001
| | - Laure Rougé
- Faculty of Medicine, EA7280, Department of General Practice, Clermont Auvergne University, Clermont-Ferrand F-63001
| | - Aurélie Cabaillot
- Faculty of Medicine, Inserm 1107, Neuro-Dol, Observatoire Français des Médicaments Antalgiques (OFMA), Department of General Practice
| | - Philippe Vorilhon
- Clinical Research and Innovation Department, University Hospital-Clermont-Ferrand, Clermont-Ferrand F-63001.,Faculty of Medicine, UPU ACCePT, Department of General Practice, Clermont Auvergne University, Clermont-Ferrand F-63001
| | - Gilles Lazimi
- Faculty of Medicine, Department of General Practice, Pierre et Marie Curie University, Paris F-75005, France
| | - Catherine Laporte
- Faculty of Medicine, EA7280, Department of General Practice, Clermont Auvergne University, Clermont-Ferrand F-63001.,Clinical Research and Innovation Department, University Hospital-Clermont-Ferrand, Clermont-Ferrand F-63001
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10
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#metoo? The association between sexual violence history and parturients' gynecological health and mental well-being. Arch Gynecol Obstet 2021; 304:385-393. [PMID: 33527173 DOI: 10.1007/s00404-021-05977-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 01/19/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE Sexual violence is a global health problem. We aimed to evaluate the association between self-reported history of sexual violence and parturients' health behaviors, focusing on routine gynecological care, and mental well-being. METHODS This was a retrospective questionnaire-based study, including mothers of newborns delivered at the "Soroka" University Medical Center (SUMC). Participants were asked to complete three validated questionnaires, including: screening for sexual violence history (SES), post-traumatic stress disorder (PDS) and post-partum depression (EPDS). Additionally, a demographic, pregnancy and gynecological history data questionnaire was completed, and medical record summarized. Multiple analyses were performed, comparing background and outcome variables across the different SES severity levels. Multivariable regression models were constructed, while adjusting for confounding variables. RESULTS The study included 210 women. Of them, 26.3% (n = 57) reported unwanted sexual encounter, 23% (n = 50) reported coercion, 1.8% (n = 4) assault and attempted rape, and 1.4% (n = 3) reported rape. A significant association was found between sexual violence history and neglected gynecological care, positive EPDS screening, and reporting experiencing sexual trauma. Several multivariable regression models were constructed, to assess independent associations between sexual violence history and gynecological health-care characteristics, as well as EPDS score. Sexual violence history was found to be independently and significantly associated with a negative relationship with the gynecologist, avoidance of gynecological care, sub-optimal routine gynecological follow-up, and seeking a gynecologist for acute symptoms (adjusted OR = 0.356; 95% CI 0.169-0.749, adjusted OR = 0.369; 95% CI 0.170-0.804, adjusted OR = 2.255; 95% CI 1.187-4.283, and adjusted OR = 2.113; 95% CI 1.085-4.111, respectively), as well as with the risk of post-partum depression (adjusted OR = 4.46; 95% CI 2.03-9.81). All models adjusted for maternal age and ethnicity. CONCLUSION Sexual violence history is extremely common among post-partum women. It is independently associated with post-partum depression, neglected gynecological care, a negative relationship with the gynecologist, and with reporting of experiencing sexual trauma. Identifying populations at risk and taking active measures, may reduce distress and improve emotional well-being and family function.
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11
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Panisch LS, Tam LM. The Role of Trauma and Mental Health in the Treatment of Chronic Pelvic Pain: A Systematic Review of the Intervention Literature. TRAUMA, VIOLENCE & ABUSE 2020; 21:1029-1043. [PMID: 30599814 DOI: 10.1177/1524838018821950] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Chronic pelvic pain (CPP) is a widespread health issue with unclear etiology that has been linked to a history of trauma among women. This condition is known to be highly comorbid with, and potentially exacerbated by psychiatric conditions, as well as other gynecological concerns and functional pain syndromes. Many comorbid conditions are also related to a history of trauma, and cases of CPP with comorbidity are known to be resistant to treatment. While the prevalence of a traumatic history among females with CPP has been established, less is known about how the role of trauma is addressed in the intervention literature. The purpose of this systematic review was to explore how the role of trauma, and to a lesser extent, mental health, is addressed in modern intervention studies for females with CPP. All qualitative and quantitative studies providing primary or secondary results of an intervention for females with CPP published between January 1998 and May 2018 were included and coded independently by two reviewers. Twenty-eight articles met inclusion criteria. Of these, none focused exclusively on patients with a history of trauma; one study implicitly focused on trauma-specific symptoms as an outcome, while two studies screened patients for a history of trauma. Of the 10 studies with a focus on mental health, only three simultaneously addressed trauma. To address this gap in the literature, future studies can prioritize intervention designs that place emphasis on the role of trauma in regard to patient characteristics and outcome variables.
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Affiliation(s)
- Lisa S Panisch
- Steve Hicks School of Social Work, University of Texas at Austin, Austin, TX, USA
| | - Lauren M Tam
- Steve Hicks School of Social Work, University of Texas at Austin, Austin, TX, USA
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Sexual assault as a risk factor for gynaecological morbidity: An exploratory systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol 2020; 255:222-230. [DOI: 10.1016/j.ejogrb.2020.10.038] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 10/12/2020] [Accepted: 10/14/2020] [Indexed: 12/19/2022]
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Panisch LS. Conceptualizations of dissociation and somatization in literature on chronic pelvic pain in women: A scoping review. EUROPEAN JOURNAL OF TRAUMA & DISSOCIATION 2020. [DOI: 10.1016/j.ejtd.2019.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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An Integrated, Trauma-Informed Care Model for Female Survivors of Sexual Violence: The Engage, Motivate, Protect, Organize, Self-Worth, Educate, Respect (EMPOWER) Clinic. Obstet Gynecol 2020; 133:803-809. [PMID: 30870277 DOI: 10.1097/aog.0000000000003186] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This article describes the Engage, Motivate, Protect, Organize, self-Worth, Educate, Respect (EMPOWER) Clinic for Survivors of Sex Trafficking and Sexual Violence located at Gouverneur Health in New York, New York, as a model for integrated gynecologic and psychiatric care of survivors of sexual and gender-based violence. Although patients with a history of sexual trauma often have critical health needs that persist long after the traumatic event, most existing services for survivors of sexual violence focus solely on the provision of acute care immediately after the violence has occurred. There are very few clinics in the United States dedicated to managing the significant long-term medical consequences and sequelae of sexual violence in a trauma-informed setting. We report on best practices for the provision of trauma-sensitive medical care to this patient population based on those employed at the EMPOWER Clinic. In particular, we outline some of the unique considerations for treating survivors relating to taking a patient history, conducting the physical and gynecologic examinations, ensuring confidentiality, and managing legal issues. Finally, we reflect on the challenges faced in sustaining the EMPOWER Clinic and the importance of the existence of a clinic dedicated to this specific population.
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Ades V, Goddard B, Pearson Ayala S, Greene JA. Caring for long term health needs in women with a history of sexual trauma. BMJ 2019; 367:l5825. [PMID: 31640984 DOI: 10.1136/bmj.l5825] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Veronica Ades
- NYU School of Medicine, Department of Obstetrics & Gynecology, New York, NY, USA
| | | | | | - Judy A Greene
- NYU School of Medicine, Department of Psychiatry, New York, NY, USA
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Hegarty K, Tarzia L. Identification and Management of Domestic and Sexual Violence in Primary Care in the #MeToo Era: an Update. Curr Psychiatry Rep 2019; 21:12. [PMID: 30734100 DOI: 10.1007/s11920-019-0991-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE OF REVIEW We discuss recent evidence around the identification and response to domestic and sexual violence in primary care for perpetrators and victims, in the context of feminist social media movements such as #MeToo. RECENT FINDINGS There is no recent research on identification and response to perpetrators in health settings. There is some limited recent evidence for how health settings can address domestic and sexual violence for female victims and their children. Recent studies of mixed quality focus on advocacy and empowerment, integrated interventions (with alcohol and drug misuse) and couples counselling for domestic violence and cognitive behavioural or processing therapy for sexual violence. Further research on perpetrator interventions in primary care is urgent. Larger sample sizes and a focus on sexual violence are needed to develop the evidence base for female survivors. Clinicians need to ask about violence and provide a first-line response depending on the patient's needs.
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Affiliation(s)
- Kelsey Hegarty
- Department of General Practice, The University of Melbourne, 200 Berkeley Street, Carlton, Victoria, 3058, Australia. .,Centre for Family Violence Prevention, The Royal Women's Hospital, Parkville, Australia.
| | - Laura Tarzia
- Department of General Practice, The University of Melbourne, 200 Berkeley Street, Carlton, Victoria, 3058, Australia.,Centre for Family Violence Prevention, The Royal Women's Hospital, Parkville, Australia
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Kosterina E, Horne SG, Lamb S. The role of gender-based violence, health worries, and ambivalent sexism in the development of women's gynecological symptoms. J Health Psychol 2019; 26:567-579. [PMID: 30696275 DOI: 10.1177/1359105318825292] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This article explored the role of a lifetime history of gender-based violence, ambivalent sexism, and gynecological health worries in the development of reproductive and sexual symptoms among women in Kyrgyzstan. Non-pregnant women who were patients of gynecological clinics (N = 143) participated in the study. A positive relationship between the experience of any type of violence (physical, sexual, and emotional) and number of gynecological symptoms was found. Hostile sexism was found to be a predictor of the number of reported symptoms. The number of gynecological health worries was found to fully mediate the relationship between history of gender-based violence and number of gynecological symptoms.
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18
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Vézina-Gagnon P, Bergeron S, Frappier JY, Daigneault I. Genitourinary Health of Sexually Abused Girls and Boys: A Matched-Cohort Study. J Pediatr 2018; 194:171-176. [PMID: 29273174 DOI: 10.1016/j.jpeds.2017.09.087] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 09/26/2017] [Accepted: 09/29/2017] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To compare genitourinary health problems of children and adolescents with a substantiated report of sexual abuse with those of the general pediatric population. STUDY DESIGN Via a prospective matched-cohort design, administrative databases between January 1996 and March 2013 were used to document genitourinary problems of 882 sexually abused children and those of 882 matched controls. Generalized linear mixed models determined the association between a substantiated sexual abuse and diagnoses for sexually transmitted infections and urinary and genital health problems. RESULTS Adjusted results revealed that up to 12 years after a sexual abuse was substantiated, abused girls had, respectively, 2.1 and 1.4 times more diagnoses for urinary and genital health problems compared with girls from the general population, whereas no difference was found for sexually transmitted infections. Sexually abused boys had an equivalent number of diagnoses as those from the general population for all 3 outcomes. Depending on the genitourinary health problem, abused girls and those from the general population had between 2.5 and 11 times more diagnoses than abused boys or those from the general population. CONCLUSIONS This study showed that substantiated childhood sexual abuse is associated with more urinary and genital health problems among girls but not boys. Early prevention and intervention efforts may mitigate the problems such that they do not persist or worsen over time and into adulthood.
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Affiliation(s)
| | - Sophie Bergeron
- Department of Psychology, University of Montreal, Montreal, Québec, Canada
| | - Jean-Yves Frappier
- Department of Psychology, University of Montreal, Montreal, Québec, Canada
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Gavin AR, Morris J. The Association Between Maternal Early Life Forced Sexual Intercourse and Offspring Birth Weight: The Role of Socioeconomic Status. J Womens Health (Larchmt) 2017; 26:442-449. [PMID: 28129022 DOI: 10.1089/jwh.2016.5789] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND This study utilizes a life-course framework to investigate whether maternal early life forced sexual intercourse operates in conjunction with health behaviors during adolescence, young adulthood, and the prenatal period to influence offspring birth weight. METHODS Using data from the 1994-2009 National Longitudinal Study of Adolescent Health (Add Health), we examined whether early life forced sexual intercourse predicted offspring birth weight through a mediated pathway, including depressive symptoms, substance use, and prenatal cigarette smoking. We stratify our analysis by socioeconomic status (SES) to determine whether the proposed pathways operate similarly, or differently, according to SES. RESULTS Our findings suggest that the pathways through which forced sexual intercourse affects offspring birth weight differ by SES. Among middle-to-high SES women, we found a mediated pathway linking forced sexual intercourse to offspring birth weight with prenatal cigarette smoking predicting lower offspring birth weight. Among low SES women, however, we did not find a mediated pathway linking forced sexual intercourse to birth weight. Findings suggest that prenatal cigarette smoking was not a mechanism of influence in the pathway between maternal early life forced sexual intercourse and offspring birth weight for low SES women. CONCLUSIONS Our findings suggest that forced sexual intercourse may influence infant birth weight in the next generation. Infants born with a low birth weight are at increased risk for a myriad of adverse outcomes across the life-course. Study results suggest the importance of interventions designed to reduce behavioral risks and to support health promoting behaviors among survivors in the short term, in an effort to prevent long-term consequences among later-born offspring.
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Affiliation(s)
- Amelia R Gavin
- 1 School of Social Work, University of Washington , Seattle, Washington
| | - Julia Morris
- 2 Department of Sociology, University of Washington , Seattle, Washington
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Abstract
BACKGROUND Chronic pelvic pain in women represents a difficult diagnostic and therapeutic problem in the gynecological practice which is always a challenge when dealing with affected women. GYNECOLOGICAL CAUSES Possible gynecological causes are endometriosis, adhesions and/or pelvic inflammatory disease (PID), pelvic varicosis and ovarian retention syndrome/ovarian remnant syndrome. Other somatic causes are irritable bowel syndrome, bladder pain syndrome, interstitial cystitis and fibromyalgia. PSYCHOSOCIAL FACTORS Psychosocial causes contributing to chronic pelvic pain are a high comorbidity with psychological factors, such as anxiety disorders and substance abuse or depression but the influence of social factors is less certain. The association with physical and sexual abuse also remains unclear. DIAGNOSTICS AND THERAPY Important diagnostic steps are recording the patient history, a gynecological examination and laparoscopy. Multidisciplinary therapeutic approaches are considered to be very promising. Basic psychosomatic care and psychotherapy should be integrated into the therapeutic concept at an early stage.
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Affiliation(s)
- F Siedentopf
- Klinik für Gynäkologie und Geburtshilfe, Martin-Luther-Krankenhaus, Caspar-Theyß-Str. 27-31, 14193, Berlin, Deutschland,
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21
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Larsen ML, Hilden M, Lidegaard Ø. Sexual assault: a descriptive study of 2500 female victims over a 10-year period. BJOG 2014; 122:577-84. [PMID: 25315463 DOI: 10.1111/1471-0528.13093] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To describe the victims of sexual assault and the circumstances in which the assaults occur. DESIGN Descriptive case study. SETTING Centre for Victims of Sexual Assault (CVSA), Rigshospitalet, Copenhagen, Denmark. POPULATION OR SAMPLE A total of 2541 women attending CVSA from 2001 to 2010. METHODS All women attending CVSA underwent a standardised data collection procedure. Descriptive bivariate analysis and logistic regression analysis were performed. MAIN OUTCOME MEASURES Associations between different assault characteristics and (1) the age of the victim and (2) the relationship between victim and perpetrator. RESULTS Two-thirds of the victims were aged 15-24 years. Seventy-five percent had met the perpetrator before the sexual assault and 70% reported the assault to the police. A physical injury was found in 53, and 27% sustained an anogenital lesion. Alcohol was involved in 60% of the cases. One-third of the victims had experienced a previous sexual assault(s). Women were more likely to report to the police when they were assaulted by a stranger (odds ratio [OR] 1.9, 95% confidence interval [95% CI] 1.3-2.6) and sustained a physical injury (OR 1.7, 95% CI 1.4-2.2) or anogenital lesion (OR 1.5, 95% CI 1.1-2.0). Women aged 45 years or older were more likely to sustain a physical injury (OR 2.0, 95% CI 1.2-3.2) or an anogenital lesion (OR 2.1, 95% CI 1.4-3.2). CONCLUSIONS Our results challenge the typical stereotype of a violent rape attack by a stranger, which is important in creating an environment where women are not reluctant to seek help after a sexual assault. Young age and drinking alcohol were risk factors for sexual assault, and we need to address this when considering preventive strategies.
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Affiliation(s)
- M-L Larsen
- Centre for Victims of Sexual Assault, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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22
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Ipekten Alaman M, Yıldız H. Domestic sexual violence and sexual problems among gynecology outpatients: an example from Turkey. Women Health 2014; 54:439-54. [PMID: 24794853 DOI: 10.1080/03630242.2014.897674] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Domestic violence is a universal problem, and sexual violence in marriage, in particular, is a hidden form of it. This descriptive, cross-sectional study was conducted to determine to the prevalence of domestic sexual violence by husbands, the prevalence of sexual problems, and the relation of these among married women attending a gynecology outpatient clinic. This study was performed in a university hospital in Turkey and data were collected February-April 2009. The study sample consisted of 200 married women, 53% of whom reported having been exposed to at least one type of domestic sexual violence behaviors by their husbands. Among those behaviors, the rate of marital rape was 33%. The frequency of experiencing any sexual problem was 82%. Women expressed that they mostly had orgasmic problems, and their husbands had premature ejaculation problems. The majority of women who reported sexual violence reported experiencing sexual problems; the frequency of sexual problems was higher in the participants who did (94.3%) than in those who did not report (68.1%) sexual violence (p < .001). Bad sexual harmony (Odds ratio [OR] = 13.50, 95% confidence interval [CI] = 3.87-47.01) and experiencing sexual problems (OR = 12.67, 95% CI = 3.78-42.35) were strongly related to sexual violence in marriage. The results also revealed that the prevalence of sexual violence and sexual problems among those married women who attended gynecology clinics was considerable, even though they did not report this to the health care provider as a problem.
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Affiliation(s)
- Mehtap Ipekten Alaman
- a Obstetrics and Gynecology Clinic, Turgut Ozal Medical Center , Inonu University , Malatya , Turkey
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Jonker IE, Sijbrandij M, Wolf JRLM. Toward Needs Profiles of Shelter-Based Abused Women. PSYCHOLOGY OF WOMEN QUARTERLY 2011. [DOI: 10.1177/0361684311413553] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Shelter-based abused women report a variety of needs across different domains (e.g., housing, finances, relationships, health, safety, and empowerment). This diversity of needs underscores the necessity for different types of services. In the current study, the authors constructed profiles of Dutch shelter-based abused women ( N = 218) based on their reported needs. Further, the authors compared their needs profiles with respect to sociodemographic and social–economic characteristics, abuse type, symptoms of depression and posttraumatic stress disorder (PTSD), general life satisfaction, social support, self-efficacy, self-esteem, and the attuning of the shelter services to the needs reported. Latent class analysis (LCA) identified four needs profiles: a High Needs class, a Practical Needs class, an Empowerment Needs class, and a Low Needs class. The classes differed with respect to migration, mental health, well-being variables, and the attuning of care needs. The results of this study underline the necessity for specifically tailored interventions for these four subgroups in women’s shelters.
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Affiliation(s)
- Irene E. Jonker
- Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands
| | - Marit Sijbrandij
- Clinical and Health Psychology, Utrecht University, Utrecht, Netherlands
| | - Judith R. L. M. Wolf
- Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands
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Abstract
Sexual violence is a serious public health problem with devastating health-related consequences. In this article, the authors review the prevalence, characteristics, vulnerability factors for, and impacts of sexual violence victimization for women. Some key factors are reviewed that have been shown to increase vulnerability for victimization, including certain demographic characteristics, previous victimization, and use of drugs or alcohol. The impacts of rape and other sexual violence are described, including physical and sexual health; psychological, social, and societal impacts; as well as impact on risky health behaviors. The authors conclude with a discussion of the public health approach to sexual violence, primary prevention, the relevance of sexual violence research for health care practitioners, and recommendations for health care practice.
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Affiliation(s)
| | - Sharon G. Smith
- Centers for Disease Control and Prevention, Atlanta, Georgia
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26
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Self-rated health and health problems of undocumented immigrant women in the Netherlands: A descriptive study. J Public Health Policy 2009; 30:409-22. [DOI: 10.1057/jphp.2009.32] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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