Integrated clinical service for sexual assault victims in a genitourinary setting.
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BACKGROUND: Reported sexual assault is increasing, and the diverse immediate and longer term needs of the victim are usually met by exposure to a number of healthcare professionals often in different locations, involving delays and travel, increasing the trauma for the victim. OBJECTIVES: To set up a centre to address the immediate and longer term needs of the sexual assault victim and review issues arising during the development of the service. METHODS: Description of setting up the service in the genitourinary medicine department of Kings College Hospital, south London, and the aspects of care offered. RESULTS: The number of victims referred by police increased from 15 in 1992 to 58 in 1996. In 1996, 55 female and three male victims were seen. 23 different police stations brought victims for examination; mean age of the victim was 27 years (range 14-60), median time between assault and examination was 22 hours (range 3 hours-3 months); 23% had genital injuries, 59% had other physical injury, and 11% needed further hospital care. 71% accepted screening for sexually transmitted infection (STI), 21% had an STI diagnosed, 16% of the women required emergency contraception, 26% received prophylactic antibiotics, and 58% saw a health adviser. 70% had a follow up appointment arranged of which 50% attended. CONCLUSION: The high uptake of STI screening, emergency contraception, health adviser consultation, and follow up supports the concept of a comprehensive integrated system to meet the disparate needs of the victim while still obtaining the necessary forensic evidence. The wide catchment area of service users indicates gaps in services available for the assault victim. Earlier genitourinary involvement after sexual assault is becoming increasingly pertinent in relation to HIV prophylaxis. (+info)
Domestic violence and sexually transmitted diseases: the experience of prenatal care patients.
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OBJECTIVES: The authors analyzed interview responses of patients at a prenatal care clinic to explore whether women who had been victims of sexual and physical abuse were more likely than non-victimized women to have experienced a sexually transmitted disease (STD). METHODS: A consecutive sample of 774 prenatal patients of a large health department in North Carolina were interviewed concerning a variety of health issues, including violence and STDs. Logistic regression analysis was used to model the women's STD status as a function of their experiences of sexual and physical abuse, controlling for several potentially confounding factors. RESULTS: Thirty percent of the women reported having experienced at least one STD, with the most common infections being chlamydia and gonorrhea. Twenty-eight percent of the women reported having been victims of abuse; 16% reported physical abuse only, while 12% reported both physical and sexual abuse. The majority of violence was domestic in nature, perpetrated by the victims' husbands, boyfriends, male friends, and relatives. After controlling for confounding variables, the authors found that women who reported both physical and sexual abuse were significantly more likely to have experienced STDs than non-victims (odds ratio [OR] = 2.25; 95% confidence interval [CI] 1.37, 3.69). The logistic regression analysis also showed a relationship of borderline statistical significance between non-sexual physical abuse and STDs. CONCLUSIONS: Health care providers should routinely screen patients for both abuse and STDs, and they should assist identified women in accessing appropriate health, social, and legal services. (+info)
Training and generalization of sexual abuse prevention skills for women with mental retardation.
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Previous research has shown that behavioral skills training to teach sexual abuse prevention skills to women with mental retardation results in skill acquisition but poor generalization. In this investigation we evaluated procedures for enhancing generalization following training. Five women with mental retardation received 10 behavioral skills training sessions followed by in situ training when the skills did not fully generalize. Behavioral skills training resulted in skill acquisition and in situ training produced generalized responding during naturalistic assessments. (+info)
Family ward: a new therapeutic approach.
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This article describes a new integrated child psychiatric family ward treatment model at the Tampere University Hospital. Theoretically, the treatment is based on an integration of systems and psychoanalytical theories as well as behavioral approach. A centerpiece of the model is a 3-week treatment period for the whole family at the family day ward. The work of the multidisciplinary team on the ward focuses on family relationships, on representational level, and on the interactional behavior of the family. Interaction and relationships are also used as tools, including a reflective working model and sharing concrete interaction with the family. So far, the family ward has offered 165 family treatment periods for 113 different families. Altogether in 63% of the total treatment periods one or both parents have had mental illness and in 15% of the total treatment periods there have been serious custody disputes with accusations of sexual abuse of the child. Helping these multi-problem families is a special challenge for our treatment model and at the moment we are developing new methods for assessment and support of parenthood. (+info)
Frequency and correlates of intimate partner violence by type: physical, sexual, and psychological battering.
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OBJECTIVES: This study estimated the frequency and correlates of intimate partner violence by type (physical, sexual, battering, or emotional abuse) among women seeking primary health care. METHODS: Women aged 18 to 65 years who attended family practice clinics in 1997 and 1998 took part. Participation included a brief in-clinic survey assessing intimate partner violence. Multiple polytomous logistic regression was used to assess correlates of partner violence by type. RESULTS: Of 1401 eligible women surveyed, 772 (55.1%) had experienced some type of intimate partner violence in a current, most recent, or past intimate relationship with a male partner; 20.2% were currently experiencing intimate partner violence. Among those who had experienced partner violence in any relationship, 77.3% experienced physical or sexual violence, and 22.7% experienced nonphysical abuse. Alcohol and/or drug abuse by the male partner was the strongest correlate of violence. CONCLUSIONS: Partner substance abuse and intimate partner violence in the woman's family of origin were strong risk factors for experiencing violence. Efforts to universally screen for partner violence and to effectively intervene to reduce the impact of such violence on women's lives must be a public health priority. (+info)
Lifestyle health risk assessment. Do recently trained family physicians do it better?
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OBJECTIVE: To determine whether recently trained family physicians were more likely to routinely assess lifestyle health risks during general medical evaluations. To document physicians' perceptions of the difficulties of lifestyle risk assessment, of medical training in that area, and of how often they saw patients with lifestyle health risks. DESIGN: Anonymous mailed survey conducted in 1995. SETTING: Family practices in the province of Quebec. PARTICIPANTS: Stratified random sample of 805 active family physicians of 1111 surveyed; 25 were ineligible or could not be located, and 281 did not respond (74.1% response rate). MAIN OUTCOME MEASURES: Proportion of physicians graduating before and after 1989 who reported routinely (with 90% or more of their patients) assessing their adult and adolescent patients during general medical evaluations for substance use, sexual risk behaviours, and history of family violence and sexual abuse. RESULTS: Except for asking about drug use, recently trained family physicians did not report better assessment of lifestyle health risks during general medical examinations than family physicians who graduated more than 10 years ago did. In both groups, routine assessment averaged 82% for tobacco use, 68% for alcohol consumption, and 20% to 40% for sexual risk behaviours. Screening for family violence and sexual abuse was rare, but more frequently reported by older women physicians. Only 20% to 40% of recent graduates rated their medical training adequate for evaluating illicit drug use, family violence, and sexual abuse. CONCLUSION: Recently trained family physicians do not assess most lifestyle risk factors any better than their more experienced colleagues. (+info)
Human immunodeficiency virus type 1 infection after sexual abuse: value of nucleic acid sequence analysis in identifying the offender.
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Nucleic acid sequence analysis of human immunodeficiency virus type 1-specific sequences allowed the identification of the source of infection in a case of sexual abuse of a 10-year-old girl. (+info)
Testosterone levels in healthy men and the relation to behavioural and physical characteristics: facts and constructs.
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This review summarises the correlations between testosterone levels and male physical appearance and behaviour. Methodological shortcomings concerning the measurement of testosterone could limit the value of these findings. In addition, testosterone measured in body fluids represents only one step in the cascade of action from production to biological effect, and could therefore provide only a limited view of the complexity of physiological events. Testosterone levels are influenced by conditions that are partly controlled or initiated by the hormone itself, but also by circumstances beyond hormonal or individual control. Different kinds of behaviour are not only subject to influence by environment, but also androgens can reinforce the particular kind of conduct and the behavioural impact can wield negative or positive feedback on testosterone secretion. Therefore, both generalisation and individualisation of study results will lead to doubtful conclusions and prejudices. Results of such studies must be viewed with caution, and over-simplification as well as over-interpretation should be avoided. (+info)