Caring for victims of sexual abuse.

Recognizing sexual abuse to be universal, in stable as well as disordered societies and directed predominantly but not only against younger women, this article first considers legal definitions of sexual abuse and the forensic evidence health care providers may be expected to gather. It explores the impact on victims of historic definitions of rape, and legal reforms to dispense with proof of sexual penetration. The WHO 2003 guidelines for medico-legal care for victims of sexual violence are noted, which emphasize the need for physical and psychological care of victims. The guidelines show that goals of treating victims and retaining forensic evidence can create a clinical dilemma. Ethical issues concern management of this dilemma, probing whether patients' psychological disturbance may have roots in past sexual abuse, and the conduct of appropriate research. It concludes that much sexual abuse is symptomatic of women's sexual subordination and disregard of their human rights.     

Sexual assault nurse examiner program characteristics, barriers, and lessons learned

Sexual Assault Nurse Examiner (SANE) programs have been developed throughout the United States to better meet the needs of sexual assault survivors. This study builds upon three previously published national surveys of SANE programs, with a random sample of 243 SANE programs surveyed. Results are discussed along with implications for SANE program practice.     

An unusual penetrating stab injury in a child: Case report

Penetrating neck wounds is an otolaryngologic and head and neck emergency.Case report: A 12-year-old female Hausa child admitted through the accident and emergency room with about an hour history of stabbed nail to the right side of the neck while hawking on the street with associated pain at injury site, voice loss and neck swelling She had an emergency neck exploration and removal of the nail with satisfactory post-operative condition.Penetrating neck injury is an ENT emergency that required prompt attention resulting from assault and to draw attention of caregivers to hazards of child labour through street hawking.     

Burn injury as a result of interpersonal violence in the Northern Territory Top End

AimTo describe the demographics, circumstances, burn wound characteristics and current tertiary centre management of interpersonal violence (IPV) burn victims in the Northern Territory Top End. It is anticipated that such knowledge gained will be of benefit to key stakeholders across the spectrum of injury prevention and management in this region.MethodsAll adult admissions to the Royal Darwin Hospital (RDH) during 2010–2015 were identified through the Burns Registry of Australia and New Zealand. Demographic and burn characteristics were compared between those classified as IPV and non-IPV. Case note review provided supplementary data for the IPV subset.ResultsFifty-three patients met IPV criteria, comprising 7.4% of admissions to the RDH Burn Service. IPV burn victims were 2.3 times more likely to be female than those with non-IPV burn (95% CI: 1.2–4.3), and 17 times more likely to be Indigenous (95% CI: 7.9–35). Approximately half (53%) of IPV burns were classified as family or domestic violence; scalding was the most common mechanism in this group. Ten patients (19%) had incomplete burn care through self-discharge, all identified as Indigenous. Twenty percent of patients had no documented inpatient psychosocial support.ConclusionsFemale and Indigenous persons are at increased risk of IPV burn. The challenges of providing care to the IPV burn population extend beyond burn wound closure.     

The seasonal relationship between assault and homicide in England and Wales

Investigating the seasonal asymmetry of violent behaviour has a long history. Despite this, there still remains considerable debate about the nature and aetiology of this phenomenon. Reports on homicide, for example, are mixed: some have found homicide seasonality but most have not. In contrast, all published studies on assault report that this behaviour is seasonal. Moreover, only two studies, both using US data, have examined the seasonal variation of assault and homicide in the same population over the same period of time. One group found assault was seasonal but homicide was not, whilst the other found, overall, that both homicide and assault were seasonal. This first of these findings seems paradoxical, in that there is no seasonal variation in injury related deaths (i.e. homicides), despite the antecedent behaviour (i.e. assaults) having a seasonal pattern of occurrence. We examined the seasonal variation in homicide and assault in UK and found a similar result. Furthermore, our findings are not easily understandable using conventional social models of seasonal behaviour and we suggest biologically mediated seasonal variation in the capacity of equally injured individuals to survive trauma may also play a role, which should be investigated further.     

Providing quality care to the sexual assault survivor: education and training for medical professionals

One in every six women in the United States will be the victim of an attempted or completed rape over the course of their lifetime.³ Health care providers trained in sexual assault examination procedures are not available in all clinical settings. CNMs/CMs have most of the requisite training to provide this service, and they are ideally poised to help women who report sexual abuse. We can assist persons who have been sexually assaulted by becoming educated in sexual assault care, attending specialty training as sexual assault examiners, joining SARTs, and serving as sexual assault response coordinators in our communities. Education about sexual assault care in midwifery programs can facilitate the ability of CNMs/CMs to provide physical assessments and forensic examinations to sexual assault victims.Once training has been obtained, it is essential to stay current about topics such as emergency contraception, STI treatments, and new methods of forensic evidence collection. Sexual assault examiners must have a knowledge of available referral sources and local resources where the person reporting these crimes may receive assistance as needed. Providing medical and forensic care for women who are victims of sexual violence should be considered a core practice within the midwifery scope of practice. CNMs/CMs need to be well prepared to care for sexual assault patients by receiving proper education and training. Specific instruction concerning care for victims of sexual and domestic violence, along with an introduction to serving as an expert witness, should be an integrated into midwifery education programs as part of the core curriculum.     

Treatment of post-traumatic stress disorder with eye movement desensitization and reprocessing: outcome is stable in 35-month follow-up

Post-traumatic stress disorder (PTSD) is an anxiety disorder that may follow major psychological trauma. The disorder is longstanding, even chronic, and there is a need for effective treatment. The most effective short-term treatments are cognitive behavioural therapy and eye movement desensitization and reprocessing (EMDR). Twenty subjects with chronic PTSD following occupational health hazards from “person under train” accidents or assault at work were treated with five sessions of EMDR. They were assessed with psychometric scales and diagnostic interviews before treatment, directly after treatment, at 8 months, and at 35 months after the end of Therapy. The primary outcome variable was full diagnosis of PTSD according to the DSM-IV diagnostic criteria. Results from interview-based and self-evaluation psychometric scales were used as secondary outcome variables. Immediately following treatment, the patients were divided up into two groups, initial remitters (12 of 20) and non-remitters (8 of 20). There were no drop-outs during therapy, but three patients withdrew during follow-up. The initial result was maintained at the 35-month follow-up. The secondary outcome variables also showed a significant immediate change towards normality that was stable during the long-term follow-up. After 3 years of follow-up, 83% of the initial remitters had full working capacity.     

Brain and behavioral evidence for altered social learning mechanisms among women with assault-related posttraumatic stress disorder

Current neurocircuitry models of PTSD focus on the neural mechanisms that mediate hypervigilance for threat and fear inhibition/extinction learning. Less focus has been directed towards explaining social deficits and heightened risk of revictimization observed among individuals with PTSD related to physical or sexual assault. The purpose of the present study was to foster more comprehensive theoretical models of PTSD by testing the hypothesis that assault-related PTSD is associated with behavioral impairments in a social trust and reciprocity task and corresponding alterations in the neural encoding of social learning mechanisms. Adult women with assault-related PTSD (n = 25) and control women (n = 15) completed a multi-trial trust game outside of the MRI scanner. A subset of these participants (15 with PTSD and 14 controls) also completed a social and non-social reinforcement learning task during 3T fMRI. Brain regions that encoded the computationally modeled parameters of value expectation, prediction error, and volatility (i.e., uncertainty) were defined and compared between groups. The PTSD group demonstrated slower learning rates during the trust game and social prediction errors had a lesser impact on subsequent investment decisions. PTSD was also associated with greater encoding of negative expected social outcomes in perigenual anterior cingulate cortex and bilateral middle frontal gyri, and greater encoding of social prediction errors in the left temporoparietal junction. These data suggest mechanisms of PTSD-related deficits in social functioning and heightened risk for re-victimization in assault victims; however, comorbidity in the PTSD group and the lack of a trauma-exposed control group temper conclusions about PTSD specifically.