Management of acute adult sexual assault

An estimated 13% of women and 3% of men worldwide report sexual assault in their lifetime. Although managing sexual assault may appear daunting, some victims want medical care only. After disclosure, discuss forensic assessment. If a complaint to the police is possible, give the first dose of emergency contraception if required, and refer for forensic assessment. If medical care only is desired, determine the timing and type of assault and current contraception, manage general and genital injuries and perform relevant tests. After unprotected vaginal rape, offer emergency contraception, chlamydia prophylaxis and vaccination against hepatitis B virus. Counselling is important for all victims of sexual assault, as psychosocial consequences are more common than physical injuries. Management by a sympathetic, non-judgmental health practitioner helps the victim to regain control.     

Violence against women in North Carolina

Research shows that partner violence and sexual assault against women are significant statewide problems in North Carolina. This commentary provides an overview of the research on evidence-based interventions designed to prevent such violence, highlights current prevention efforts in North Carolina, and offers future directions.     

North Carolina's preparedness to respond to on-farm emergencies

North Carolina farm families, emergency services, and fire departments do not always have sufficient training to respond to on-farm emergencies. The main barrier to preparedness is lack of awareness of these needs. We recommend improved emergency response through collaborative education using AgriSafe of North Carolina and Certified Safe Farm North Carolina, two programs geared toward safety training.     

51例性侵害案件中受害人性防卫能力鉴定分析

目的:探讨精神障碍患者受性侵害的特征及性防卫能力在司法鉴定中的评定。方法:采用自制调查表对51例女性受性侵害案司法鉴定资料进行统计分析。结果:鉴定诊断以精神发育迟滞为主,对性防卫能力丧失、性防卫能力削弱及性防卫能力存在三组中受害人案发后是否主动报案、是否获利、赔偿态度及平时的社会适应能力状况进行比较,存在显著差异(P<0.05)。结论:年轻的女性精神发育迟滞患者更容易被性侵害,在进行性自我防卫能力评定时应掌握客观证据,从犯罪嫌疑人的犯罪特征、受害人的社会适应情况及对性行为的性质、后果的理解能力等多方面综合考察评定。     

Male victims of sexual assault.

OBJECTIVE--To compare the demographics, physical findings, and assault characteristics of incarcerated, sexually assaulted men with those of nonincarcerated, sexually assaulted men. DESIGN--Case series of 99 adult male victims of sexual assault evaluated over a 3-year period. SETTING--Memphis Sexual Assault Resource Center, a nonhospital-based clinic that serves as the primary resource for sexually assaulted victims in the Memphis and Shelby County, Tennessee, area. PARTICIPANTS--All adult male victims of sexual assault evaluated at the Memphis Sexual Assault Resource Center during the study period were included in the study. Ninety-nine victims were studied, including 80 incarcerated men and 19 men from the community. RESULTS--The victims of sexual assault in the community group were older than the victims in the incarcerated group. Apart from the age difference and weapon use, there were no statistically significant differences between the incarcerated and nonincarcerated victims. CONCLUSIONS--The similarities between the two groups suggest that sexual assault of men may not be unique to prisons, and all men are potential victims. Further studies are required to better understand these crimes and to develop education and prevention programs.     

Effect of community-based interventions on high-risk drinking and alcohol-related injuries

CONTEXT: High-risk alcohol consumption patterns, such as binge drinking and drinking before driving, and underage drinking may be linked to traffic crashes and violent assaults in community settings. OBJECTIVES: To determine the effect of community-based environmental interventions in reducing the rate of high-risk drinking and alcohol-related motor vehicle injuries and assaults. DESIGN AND SETTING: A longitudinal multiple time series of 3 matched intervention communities (northern California, southern California, and South Carolina) conducted from April 1992 to December 1996. Outcomes were assessed by 120 general population telephone surveys per month of randomly selected individuals in the intervention and comparison sites, traffic data on motor vehicle crashes, and emergency department surveys in 1 intervention-comparison pair and 1 additional intervention site. INTERVENTIONS: Mobilize the community; encourage responsible beverage service; reduce underage drinking by limiting access to alcohol; increase local enforcement of drinking and driving laws; and limit access to alcohol by using zoning. MAIN OUTCOME MEASURES: Self-reported alcohol consumption and driving after drinking; rates of alcohol-related crashes and assault injuries observed in emergency departments and admitted to hospitals. RESULTS: Population surveys revealed that the self-reported amount of alcohol consumed per drinking occasion declined 6% from 1.37 to 1. 29 drinks. Self-reported rate of "having had too much to drink" declined 49% from 0.43 to 0.22 times per 6-month period. Self-reported driving when "over the legal limit" was 51% lower (0. 77 vs 0.38 times) per 6-month period in the intervention communities relative to the comparison communities. Traffic data revealed that, in the intervention vs comparison communities, nighttime injury crashes declined by 10% and crashes in which the driver had been drinking declined by 6%. Assault injuries observed in emergency departments declined by 43% in the intervention communities vs the comparison communities, and all hospitalized assault injuries declined by 2%. CONCLUSION: A coordinated, comprehensive, community-based intervention can reduce high-risk alcohol consumption and alcohol-related injuries resulting from motor vehicle crashes and assaults. JAMA. 2000;284:2341-2347.     

急诊科护士职业性损伤危险因素分析与防护措施

目的:探讨急诊科护士职业损伤的原因及防护对策。方法:分析笔者所在医院急诊科存在的职业危险因素,并采取预防措施。结果:通过采取针对性的防护措施,该院急诊科护士未发生重大职业危害事件。结论:急诊科护士职业损伤客观存在,但是只要防护措施得当,就能避免职业危害事件的发生,确保护理人员安全。     

Emergency department post-coital contraception in Northern Ireland

Background The granting of a licence to Levonelle as an emergency hormonal contraceptive in the Republic of Ireland may require accident and emergency (A&E) departments to formally provide such a service. This article outlines the experiences of a Northern Ireland A&E unit. Aims To examine the pattern of attendance of patients requesting emergency contraception at an A&E department and to assess if adequate standards of care are achieved. Method Retrospective case note review of 100 patients attending the A&E department requesting emergency contraception. Results Sixty-one per cent of requests for emergency contraception were outside normal pharmacy opening hours. Seventy-seven per cent of these patients were less than 26 years old. Most (63%) attended within 24 hours of unprotected sexual intercourse. Forty-three per cent of the patients studied had used no contraception prior to this request. Recording of menstrual details and sexual behaviour as part of the consultation was variable. Conclusions A&E departments receive requests for emergency hormonal contraception particularly from younger women (<25 years). A&E staff must have appropriate training and support to manage these consultations effectively.     

A sexual assault referral service based on a hospital in a small Australian town

A sexual assault referral service was established in a hospital in a small Tasmanian town in late 1976. The objectives and resources of the service, and different forms of patient management, are discussed. A study has been made of 100 consecutive patients who presented to the service, and their experiences of the short- and long-term consequences of sexual assault are detailed. The special needs of the victims, and of the doctors who are involved in such a service, are defined and a recommendation is made for the establishment of similar services in small towns and country areas in other parts of Australia.     

Sexual assault tracking study: who gets lost to follow-up?

OBJECTIVES: To determine whether loss to follow-up can be predicted in patients who present to an emergency sexual assault assessment service and to generate hypotheses regarding the prediction of loss to follow-up on the basis of patient characteristics, assault characteristics and the services provided. DESIGN: Prospective, exploratory study. SETTING: Emergency department functioning as a regional sexual assault centre in a tertiary care hospital. PATIENTS: All 294 women over the age of 16 years who presented to the emergency department with a complaint of sexual assault and consented to be followed up. INTERVENTIONS: Telephone interviews at 24 to 48 hours and 1 month after presentation; face-to-face interviews after 1 week, 3 months and 6 months. MAIN OUTCOME MEASURES: Follow-up status (tracked versus lost to follow-up), State-Trait Anxiety Inventory (STAI-Y), Beck Depression Scale (Beck) and Rape Trauma Symptom Rating Scale (RTSRS). RESULTS: At 24 to 48 hours 136 (46%) of the patients could not be reached. Only 61 (21%) were still tracked at 6 months. Loss to follow-up at 1 month accurately predicted loss to follow-up at 6 months in 209 (98%) of 214 patients. For tracked patients the STAI-Y and Beck scores improved over 6 months. These scores at 1 week did not predict follow-up status at 6 months, but the numbers were small. Subjects with a higher RTSRS score at 24 to 48 hours were most likely to remain tracked throughout the 6 months. CONCLUSIONS: Decisions regarding how vigorously to track patients with a complaint of sexual assault can tentatively be based on the characteristics of the victim and of the assault. We hypothesize that the characteristics predicting loss to follow-up include denial and avoidance behaviour, lack of a telephone number or forwarding address, history of a psychiatric condition, a disability (e.g., deafness), characterization as a "street person," a high degree of violence or injury in the assault, and threat by the assailant. Although a predictive model requires further data, crisis intervention services in an emergency department are essential, given the large number of patients lost to follow-up.     

Collaborative accountability for care transitions: the community care of North Carolina transitions program

Community Care of North Carolina initiated efforts to improve care transitions for North Carolina Medicaid recipients in 2008. The transitions program is now statewide, serving more than 4,000 patients every month, virtually every North Carolina hospital, and more than 1,400 primary care practices. This commentary describes program components, early outcomes, and future challenges.     

Offering HIV prophylaxis to people who have been sexually assaulted: 16 months'' experience in a sexual assault service

The sexual assault service, operated by the Children's & Women's Health Centre of British Columbia in partnership with the Vancouver General Hospital Emergency Department, started offering HIV prophylaxis in November 1996 to patients presenting to the emergency department after a sexual assault. In the first 16 months of the program a total of 258 people were seen by the service, of whom 71 accepted the offer of HIV prophylaxis. Only 29 continued with the drug treatment after receiving the initial 5-day starter pack, and only 8 completed the full 4-week treatment regmen and returned for their final follow-up visit. Patients at highest risk for HIV infection (those who had penetration by an assailant known to be HIV positive or at high risk for HIV infection [men who have sex with men, injection drug users]) were more likely to accept prophylaxis and more likely to complete the treatment than those at lower risk. Compliance and follow-up were the main problems with implementing this service. Service providers found it difficult to give the information about HIV prophylaxis to traumatized patients. After this program evaluation, the service changed its policy to offer HIV prophylaxis only to people at high risk of HIV infection. This targeting of services is expected to make the service providers' jobs easier and to make the program more cost-effective while still protecting sexual assault victims against HIV infection.     

Sexual assault evidence collection

The evidentiary exam following sexual assault provides crucial evidence that can be used by the prosecuting attorney to obtain a conviction in sexual assault cases. Evidence is collected for three purposes: to corroborate the use of force; to corroborate that recent sexual contact occurred; and to identify the perpetrator. Relatively few assailants (4%) go to jail for rape. To a great extent this is because of a lack of corroborating evidence and misinterpretation of this lack of evidence by police, courts, and jurors. This paper presents the results of a study to determine the likelihood of obtaining corroborating evidence of recent coitus along with an explanation of what negative results mean. Based on the results, recommendations are presented for sexual assault evidence collection in emergency departments.     

建立区域性社区急救医疗模式的实证研究

目的研究建立区域性社区急救医疗模式的方法和作用。方法通过建设社区急救网点、完善院前急救科室和院内急救科室及其衔接程序,进一步完善医疗急救模式,抽样调查680例急诊患者和60名护师（社区护师30名,急诊科护师30名）,对建设区域性社区急救医疗模式前后本社区院前患者活的院前急救率和发病到获得治疗时间、急诊救治成功率进行比较;比较建立区域性社区急救医疗模式60名护师的急救核型能力评价结果。结果观察组院前急救率为100.00%,发病到获得救治时间为（4.5±1.4）min,急救成功率为85.00%,对照组分别为90.29%、（18.7±14.6）min、72.06%,观察组明显优于对照组,差异有统计学意义（P=0）。建立区域性社区急救医疗模式前社区医师急救能力评价评分为（78.84±12.19）分,建立后为（84.56±9.47）分;建立前急诊医师急救能力评价评分为（88.47±8.22）分,建立后为（95.44±3.69）分;组内比较差异有统计学意义（P=0）。结论建立区域性社区急救医疗模式有助于缩短急诊患者就诊时间,提高院前急救效率和急救成功率,值得研究推广。     

Linking primary care with adult care homes

This commentary describes a pilot program wherein a community health center is partnering with Community Care of North Carolina to create a system of integrated care management and "treatment-in-place" visits for aged residents and disabled residents of adult care homes, with the goal of improving the quality of care and reducing unnecessary visits to emergency departments.     

成都市三甲医院急诊科护理人员工作满意度调查

目的调查成都市三甲医院急诊科不同人口学特征护理人员工作满意度现状,为护理管理者制定相关管理措施提供依据。方法采用随机整群抽样法,进行横断面调查。对纳入研究的10家医院急诊科全体护理人员的调查数据进行统计分析。结果急诊护理人员总体满意度比较高。不同人口特征的护理人员在工作满意度不同维度上存在差异。结论提高急诊护理人员工作满意度应该关注不同人口学特征的影响。维持并促进急诊护理人员不同维度工作满意度仍应是护理管理者关心的重要问题。     

Parivar Seva's experience with emergency contraceptive pills

Parivar Seva, an NGO working in the area of reproductive health carried out an operation research project as a feasibility study on emergency contraception recently. The study was conducted among 1120 clients coming after unprotected sexual intercourse or improper use of any contraceptive method by using emergency contraception pills coming within 3 days and IUCD coming between 3 and 5 days of unprotected sexual intercourse. It was found that failure of emergency contraception was as low as 0.6%. The success rate in term of preventing pregnancy was 99.4% both with combined oral contraception pills and laevonorgesterol. There lies the scope for introducing emergency contraception in India wide and it can occupy a unique position in a range of contraceptive choices currently available to Indian women, as it can prevent unwanted pregnancies. A coalition of 30 like minded organisations including the Parivar Seva had formed a subcommittee on emergency contraception to evolve strategies to address promotion of emergency contraception.     

米非司酮合并氨甲蝶呤用于紧急避孕初步观察

目的 对小剂量米非司酮（２５ｍｇ）合并小剂量氨甲蝶呤（５ｍｇ）用于紧急避孕进行初步的临床观察。方法 １７名受试者在无防护性交或避孕失败后采用本方案紧急避孕。结果 无论是性交后７２ｈ之内还是性交后超过７２ｈ服药,无一例妊娠,且无明显副反应发生,使小剂量米非司酮紧急避孕的效果得到了提高并且拓宽了其使用时限。结论 该法有可能成为一种安全高效,不受性交时间、次数制约的新型紧急避孕方法。     

Requests for emergency contraception at an accident and emergency department--assessing the impact of a change in legislation

The aim of this study was to examine the pattern of attendance of patients requesting Emergency Hormonal Contraception (EHC) at an accident and emergency department before and after a government driven change in legislation, which allowed EHC to be sold over-the-counter by trained pharmacists, to women aged 16 years and above. We employed retrospective comparative study using computer records of all accident and emergency attendances coded as requests for emergency contraception for the years 2000 and 2001. The number of patients requesting emergency contraception at the A&E department decreased after over-the-counter sales were introduced, from 196 in the year 2000 to 164 in 2001 (p = 0.037). Despite this, the number of teenagers requesting emergency contraception at the A&E department increased in 2001--from 63 in 2000 to 74 in 2001 (p = 0.0115). Most requests are received outside local pharmacy opening hours--63.77% in 2000 and 62.2% in 2001. This study raises concerns that the government initiative allowing emergency hormonal contraception to be sold in pharmacies is having little impact on teenagers most in need of this service. A&E departments can expect to continue to receive a significant number of requests for emergency contraception. Further measures will be required to reduce the U.K.'s high rate of unplanned pregnancies.