Prevalence and characteristics of sexual violence in the Netherlands, the risk of revictimization and pregnancy: results from a national population survey.

Prevalence figures on sexual violence among a representative sample of both men and women were not yet available for the Netherlands. The aim of this study, therefore, was to investigate the prevalence of sexual violence in the Netherlands and to add these figures to the international body of knowledge. Experiences of sexual violence during lifetime, before the age of 16 and in the year before the start of the study were measured. In addition, types of sexual violence were examined, as were the characteristics of the perpetrators. Lastly, revictimization and pregnancy as a result of rape experiences among the victims were investigated. Data were generated from a population survey on sexual health. The sample consisted of more than 6,000 men and women between the age of 15 and 70 years old. Prevalence rates as high as 21% for men and 56% for women were found. Fifty percent of the female victims and 30% of the male victims of child sexual abuse had experienced adult victimization. Of the female rape victims, 7% became pregnant as a consequence of rape. In the Netherlands, as elsewhere, the prevention of sexual violence should be prioritized.

Coping styles as mediator of sexual orientation-related health differences.

The higher prevalence of health problems in homosexual compared to heterosexual populations is usually understood as a consequence of minority stress. We hypothesized that differential rates of health problems also could result from sexual orientation-related differences in coping styles. We explored this using data collected in a general population-based study (N = 9684) via face-to-face interviews. A higher prevalence of both mental and physical health problems, as assessed with individual questions, the GHQ-12, and checklists, was observed in homosexual compared to heterosexual men and women. Coping style was related to sexual orientation in men, but not in women. Compared to heterosexual men, homosexual men more strongly applied emotion-oriented and avoidance coping strategies. Emotion-oriented coping mediated the differences in mental and physical health between heterosexual and homosexual men. Findings suggest the importance of further exploration of the development and use of emotion-oriented and avoidance coping by homosexual men.

Do homosexual persons use health care services more frequently than heterosexual persons: findings from a Dutch population survey.

Use of health care services has been suggested to be lower among homo- or bisexual persons than among heterosexual persons, due to a lack of trust in the health care system. However, population-based studies on differences in health care utilization according to sexual orientation are scarce. The purpose of the current study was to explore differences in health care utilization and confidence in health care between heterosexual, bisexual and homosexual persons. A survey of a random sample of patients of Dutch general practices (n = 9684) gathered data on socio-demographic variables, sexual orientation, health status, confidence in health care and health care utilization. Differences in health care utilization between homo- or bisexual persons and heterosexual persons were analyzed with logistic regression analysis, in which we statistically adjusted for socio-demographics and health status. Reported health was lower among homosexual men and women as compared to heterosexual persons. There were no sexual orientation-related differences in confidence in health care. Controlling for health status, it appeared that gay men more frequently used mental and somatic health care than heterosexual men, and that lesbian or bisexual women more frequently used mental health care than heterosexual women. We found a higher rate of health care use among homosexual and bisexual persons as compared to heterosexual persons, that could only be partly explained by differences in health status. To gain a better understanding of our findings, data on the predisposition to use health services among homosexual and bisexual men and women is needed.

Sexual orientation and mental and physical health status: findings from a Dutch population survey.

OBJECTIVES: We sought to determine whether sexual orientation is related to mental and physical health and health behaviors in the general population. METHODS: Data was derived from a health interview survey that was part of the second Dutch National Survey of General Practice, carried out in 2001 among an all-age random sample of the population. Of the 19685 persons invited to participate, 65% took part in the survey. Sexual orientation was assessed in persons aged 18 years and older and reported by 98.2% of 9684 participants. The respondents' characteristics are comparable with those of the Dutch general population. RESULTS: Gay/lesbian participants reported more acute mental health symptoms than heterosexual people and their general mental health also was poorer. Gay/lesbian people more frequently reported acute physical symptoms and chronic conditions than heterosexual people. Differences in smoking, alcohol use, and drug use were less prominent. CONCLUSIONS: We found that sexual orientation was associated with mental as well as physical health. The causal processes responsible for these differences by sexual orientation need further exploration.

Adolescents' contact with sexuality in mainstream media: a selection-based perspective.

Most work on adolescents' contact with sexuality in mainstream media has been framed in terms of media effects upon the sexual self-concepts, attitudes, and behaviors of youth, even when such causality cannot be inferred. Rarely examined are the sexual characteristics of adolescents that may predict contact with sexual media. Using Steele's (1999) Media Practice Model as a foundation, we reported on these associations for 2,184 Dutch adolescents. This study emphasized sex differences in the characteristics that predict such contact, and the role of youths' critical evaluations of information about sex in the media. Correlation and regression analyses revealed several sex differences in the characteristics related to sexual media contact, with individual characteristics accounting for more variance in females and critical evaluations accounting for more variance in males. This report underscores the need for more comprehensive, longitudinal studies of adolescents' media consumption and its connections to sexual development in youth.

Cognitive impairment in patients with carotid artery occlusion and ipsilateral transient ischemic attacks.

Although transient ischemic attacks (TIAs) by definition do not cause lasting neurological deficits, cognitive impairment has been suggested in patients with carotid artery disease who have suffered from a TIA. The purpose of our study was to assess whether patients with carotid artery disease and TIAs are cognitively impaired, to describe the frequency, nature and severity of this impairment, and to search for associated patient characteristics.Thirty-nine consecutive patients with carotid occlusion and ipsilateral cerebral or retinal TIAs, and 46 healthy controls underwent extensive neuropsychological assessment. Performances were compared group-wise with analysis of variance. In addition, the presence of cognitive impairment in the individual patient was determined. Associations between illness characteristics and cognitive impairment were explored with regression analysis.Fifty-four percent of patients were cognitively impaired. Cognitive deficits were non-specific in nature and mild in severity. Impairment occurred also in patients with isolated retinal symptoms and in those without visible ischemic brain lesions on MRI. Neither the presence of any vascular risk factor, the side of the symptomatic carotid occlusion, the uni- or bilaterality of carotid occlusion, nor the number of cerebral ischemic lesions were predictors of cognitive impairment. We conclude that about half of the patients with carotid artery occlusion and ipsilateral TIAs are cognitively impaired. The presence of cognitive deficits in patients with isolated retinal symptoms and in those without cerebral ischemic lesions on MRI argues against an exclusive role for structural brain damage in the pathogenesis of these deficits.

Cognitive impairment is related to cerebral lactate in patients with carotid artery occlusion and ipsilateral transient ischemic attacks.

BACKGROUND AND PURPOSE: Patients with carotid artery occlusion (CAO) and ipsilateral transient ischemic attack (TIA) can have lasting cognitive impairment, despite the recovery of focal neurological deficits. We sought to assess whether cognitive impairment in these patients is associated with hemodynamic compromise and/or impaired cerebral metabolism. METHODS: In 39 consecutive patients with a TIA associated with an angiographically proven occlusion of the carotid artery, we examined (1) cognitive functioning, (2) cerebrovascular reserve capacity of the middle cerebral artery ipsilateral to the CAO as measured by transcranial Doppler ultrasound, and (3) metabolic ratios as measured by 1H-MR spectroscopy in the centrum semiovale ipsilateral to the symptomatic CAO. Findings were compared with those in healthy control subjects. RESULTS: As a group, patients were cognitively impaired. Mean CO2 reactivity and the mean ratio of N-acetyl aspartate to creatine were decreased. In approximately one third of patients, lactate was present in noninfarcted regions. The presence of lactate proved to be a stronger correlate of cognitive impairment than MRI-detected lesions (beta=0.41 versus beta=0.15). Cognitive impairment did not correlate with CO2 reactivity or the ratio of N-acetyl aspartate to creatine. CONCLUSIONS: This exploratory study in patients with CAO and ipsilateral TIA showed that 1H-MR spectroscopy-detected lactate in noninfarcted regions is a better indicator of cognitive impairment than MRI-detected lesions. Cognitive impairment did not correlate with CO2 reactivity.