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1.
Involuntary sterilization is a violation of human rights and grounds for asylum in the United States. Forensic medical evaluations can be useful in documenting this form of persecution and supporting asylees’ claims for immigration relief. We conducted a retrospective case analysis of the personal and medical affidavits of 14 asylum-seeking women from four Latin America countries who all reported they had been involuntarily sterilized. Sixty-four percent said that “consent” was coerced; the remainder were unaware of having been sterilized at the time of the procedure. In all cases, findings on hysterosalpingogram were consistent with sterilization, revealing that all 14 had undergone a tubal ligation. Eighty-six percent of the women had been sterilized at the time of childbirth. The healthcare providers involved in the 14 cases failed to obtain informed consent, misled patients about sterilization, engaged in discriminatory behavior, and/or breached patient confidentiality regarding their HIV-status. All 14 asylum cases were defensive; of the 7 cases (50%) that have been decided to date, 100% have been granted asylum.  相似文献   
2.
目的探讨完全型雄激素不敏感综合征(CAIS)和46,XY单纯性腺发育不全综合征(Swyer综合征)2种最常见46,XY女性性发育异常疾病(DSD)的临床特征、诊疗方式、鉴别诊断要点。方法选择2002—2020年,于中山大学孙逸仙纪念医院就诊的临床病例资料完整的41例46,XY DSD患者,包括20例CAIS(CAIS组)患者和21例Swyer综合征(Swyer组)患者。对该41例患者的临床表现、实验室检查结果、术中情况及组织病理学检查结果进行回顾性分析。本研究遵循的程序符合2013年新修订的《世界医学协会赫尔辛基宣言》要求。结果①41例46,XY DSD患者在出生及成长过程中的社会性别均为女性,就诊年龄为12~38岁。2组患者年龄比较,差异无统计学意义(P>0.05)。CAIS组患者身高、体重均高于或重于Swyer组,并且差异有统计学意义(P<0.05)。②2组患者血清卵泡刺激素(FSH)、睾酮、雌二醇、17α-羟孕酮(17α-OHP)水平比较,差异均有统计学意义(P<0.05);而2组血清促黄体激素(LH)、催乳素、脱氢表雄酮(DHEA)水平比较,则差异均无统计学意义(P>0.05)。CAIS组患者抗苗勒管激素(AMH)水平均>16 ng/mL,Swyer组均<0.03 ng/mL。③39例接受手术治疗患者中,35例行腹腔镜下性腺切除术,4例行开腹肿瘤细胞减灭术。④CAIS组患者性腺肿瘤发生率为35.0%(7/20),Swyer组为36.8%(7/19)。CAIS组患者性腺有自伞端向腹股沟管迁移趋势,其中4例性腺位于腹股沟管内,Swyer组患者性腺均位于盆腔内。⑤41位患者出院后,均继续以女性性别生活,已婚者性生活无障碍。结论CAIS与Swyer综合征患者临床表现相似,CAIS患者存在苗勒管遗迹,Swyer综合征患者存在子宫发育不良等变异,并且均有不同程度的性腺迁移趋势。AMH水平检测可作为区别CAIS与Swyer综合征患者的特异性指标。  相似文献   
3.
《Journal of emergency nursing》2022,48(2):202-210.e1
IntroductionA sexual assault nurse examiner role exemplifies the high-stress and highly emotional patient interactions that are often associated with burnout. The purpose of this study was to examine the frequency of burnout among sexual assault nurse examiners in North Carolina.MethodsThis cross-sectional study was an anonymous survey of practicing sexual assault nurse examiners within North Carolina using the Maslach Burnout Inventory and additional demographics. Results were analyzed with odds ratios, confidence intervals, Fisher exact, chi-square, and Kruskal Wallis tests as appropriate.ResultsAmong 95 respondents, burnout was more frequent in sexual assault nurse examiners who stopped both emergency and nurse examiner work (55.6%, odds ratio 4.41, 95% confidence interval 1.07-18.06) and in dual function nurses (both emergency and nurse examiner work, 35.7%, odds ratio 2.71, 95% confidence interval 1.04-7.06). Sexual assault nurse examiners who had a high percentage of pediatric cases (above the median of 40%) were more likely to meet burnout thresholds for emotional exhaustion scores > 26 (48.78% vs 25.93%, χ2 = 5.30, P = .02) and more likely to meet burnout thresholds for depersonalization scores > 9 (48.78% vs 24.07%, χ2 = 6.28, P = .01).DiscussionHigher frequency of burnout threshold criteria was found in those people who worked concurrently as a sexual assault nurse examiner and an emergency nurse and in those who had retired from both specialties. We also found that sexual assault nurse examiners with a higher case mix of pediatric cases had higher emotional exhaustion scores and higher depersonalization scores.  相似文献   
4.
《Sexologies》2022,31(3):215-225
Increased life expectancy creates the prospect of prolonged marital intimacy. However, mature couples face many challenges — physiological, cultural, and familial — and they must be able to mobilize their individual and relational resources to maintain good levels of marital and sexual satisfaction. The aim of this study is to highlight various factors that contribute to the conjugal and sexual satisfaction of older couples, and to discuss the stressing of these factors in a crisis context. 534 participants aged between 18 and 74 years old answered several questionnaires measuring their degree of sexual and conjugal satisfaction as well as the areas of strength and fragility in the relational dynamics of their couple. In addition, five couples also accepted a semi-structured interview on their relationship dynamics and their vision of the ageing couple. The results highlight the major impact of several variables contributing to an increase in relational and sexual satisfaction within couples (e.g. health concerns, conflict management, fondness…). Furthermore, a comparison between the scores of the over-51s and the younger ones highlights the areas of strength of older partners. These different factors will be discussed. Finally, we will propone therapeutic advices aimed at supporting the areas of strength of mature couples in order to accompany them towards long-term relational and sexual fulfillment.  相似文献   
5.
BackgroundSexual assault remains a highly prevalent crime worldwide and has the potential to cause a number of short and longer-term health sequelae. Complainants of recent sexual assault may undergo forensic and/or medical examinations for medical treatment or evidence collection, or both. However, the frequency and severity of acute health concerns requiring medical intervention in these patients at the time of examination is not well understood and has implications for their clinical care and safety.Aims & objectivesTo examine the frequency and severity of acute concomitant health concerns at the time of forensic examination following an allegation of recent sexual assault in post-pubertal (age >13 years) individuals, through a review of existing literature. Concomitant health concerns considered in this review include ano-genital and extra-genital injury, and acute substance intoxication.MethodsFour online databases (PubMed, Ovid Medline, CINAHL, Embase) were systematically searched with key terms regarding the topics of sexual assault, forensic examination, injury and intoxication. Articles were assessed for relevance based on inclusion and exclusion criteria.ResultsOf 562 titles, 53 full-text publications met the inclusion criteria. Frequency of ano-genital and extra-genital injury was highly variable across studies, and severity was inconsistently assessed and rarely reported. Medical treatment or transfer to acute care settings was more commonly required for extra-genital injuries. Non-fatal strangulation (NFS) was found to represent an increasingly frequent feature of sexual assault cases. NFS complainants often exhibit signs and symptoms of potentially lethal complications requiring urgent review in acute care settings. Substance use around the time of sexual assault was commonly reported by patients and detected in toxicological screens, and could have significant implications on patient and staff safety at the time of examination.ConclusionThe findings of this review highlight the clinical significance of acute concomitant health concerns following an allegation of recent sexual assault. Ano-genital and extra-genital injury, NFS and both voluntary and involuntary substance use may be more frequent and severe than previously understood. Further investigation into the assessment and management of these acute health needs is required to elucidate their clinical significance and inform evidence-based care for complainants of sexual assault.  相似文献   
6.
目的分析瘀热型慢性前列腺炎(CP)临床症状与心理性因素及性功能的相关性。方法收集2020年6月至2021年6月在南京市江宁中医院泌尿外科门诊诊治的91例瘀热型CP患者的临床资料进行回顾性分析,使用美国国立卫生研究院慢性前列腺炎症状指数评分表(NIH-CPSI)、中医证候量表、7项广泛性焦虑障碍量表(GAD-7)、抑郁症筛查量表(PHQ-9)、疼痛灾难化量表(PCS)、国际勃起功能评分表(IIEF-5)和早泄诊断量表(PEDT)对患者进行评估,对量表评定结果进行Pearson相关性分析和多元线性回归分析。结果(1)症状量表:NIH-CPSI总分与中医量表总分、GAD-7总分呈正相关,中医证候量表总分与CPSI、GAD-7、PHQ-9、PCS、PEDT总分呈正相关(P<0.05);CPSI总分随中医量表总分递增而升高,中医证候量表总分随CPSI疼痛症状、PHQ-9总分递增而升高(P<0.05)。(2)情绪量表:GAD-7总分与CPSI、中医证候量表总分、排尿症状、PHQ总分、PEDT总分呈正相关,PHQ-9总分与中医证候量表总分、疼痛及排尿症状、PCS总分、PEDT总分呈正相关,PCS总分与中医证候量表总分及疼痛症状分值呈正相关(P<0.05);GAD-7总分随PHQ-9总分递增而升高;PHQ-9总分随中医证候量表排尿症状、GAD-7、PCS分值递增而升高;PCS总分随中医证候量表疼痛症状、PHQ-9分值递增而升高(P<0.05)。(3)性功能量表:IIEF-5总分与中医证候量表疼痛分值呈负相关,PEDT总分与中医证候量表总分及疼痛症状、GAD-7、PHQ-9分值呈正相关(P<0.05);IIEF-5总分随中医证候量表疼痛症状分值递减而升高(P<0.05)。结论瘀热型CP患者表现为以疼痛为主,伴随排尿异常、情绪异常、认知障碍和性功能障碍的系列症状,同时使用中医证候量表及CPSI评估能较好的反映其病情的严重程度。  相似文献   
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目的 了解艾滋病病毒感染者/艾滋病患者(HIV/AIDS)确诊后一年内高危性行为变化情况及其影响因素。方法 从国家艾滋病综合防治数据信息管理系统下载2010年1月1日—2019年12月31日的相关资料,描述性行为发生率的变化趋势,采用广义估计方程(GEE)模型分析HIV/AIDS确诊后一年内高危性行为的相关因素。 结果 2 528例HIV/AIDS中,确诊前性行为发生率60.48%而确诊后一年内在57.09%~60.11%之间,女性(趋势χ2 = 5.417,P = 0.020)和未婚者(趋势χ2 = 6.684,P = 0.010)确诊后一年内的性行为发生率呈下降趋势,男性(趋势χ2 = 4.301,P = 0.038)、已婚(趋势χ2 = 4.061,P = 0.044)和ART者(趋势χ2 = 4.783,P = 0.029)的性行为发生率呈上升趋势。高危性行为发生率由61.61%下降至3.98%(趋势χ2 = 1 606.933,P<0.001),多因素结果显示:已婚(OR = 2.374,95%CI:1.478~3.811)和未ART者(OR = 1.837,95%CI:1.431~2.358)更易发生高危性行为。性别和年龄亚组分析显示,已婚和未接受ART治疗与高危性行为的关联方向保持一致。 结论 HIV/AIDS确诊后一年内仍保持性活跃且存在高危性行为,仍具备二代传播、感染其他性传播疾病和不同HIV型别毒株或耐药毒株风险,应提供精准干预,促进HIV/AIDS坚持使用安全套。  相似文献   
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Community health and social care practitioners play an increasingly important role in the health promotion agenda, but lack confidence in having effective health behaviour change (HBC) conversations with members of the public. This study reports the development and evaluation of a training intervention based on health psychology to improve health and social care practitioner self-rated confidence, competence and intention to use five behaviour change techniques (BCTs) in their HBC conversations. A 2-day behavioural science interprofessional skills training course plus online learning module was designed for health and social care staff across North East Scotland, teaching five evidence-based BCTs (e.g. Action Planning), plus person-centred communication skills. Participants rated confidence, competence and future intention to use the BCTs on likert scales (1–10) pre-course and post-course, and provided acceptability data. 177 participants aged 20–64 took part, qualitative and quantitative data suggested that the course had high acceptability. Paired samples t tests (n = 120 with complete data) showed significant improvements in confidence, competence and intention following the course, which remained significant with a conservative analysis (n = 174) assuming no change for missing data. Perceived competence in Action Planning increased most during the course (mean change 3.09). In conclusion, health psychology-based skills training can improve practitioner confidence, competence and intention to use evidence-based BCTs; further evaluation is needed to assess practice change.  相似文献   
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