University Students Who Report Exchanging Sex for Money or Other Compensation: Findings from a Public University Sample.

Whether and how university students exchange sex for financial compensation in the USA is critically understudied. The purpose of this secondary analysis was to determine whether undergraduate and graduate students at a large public university report exchanging sex for financial or other compensation, and identify factors (e.g., demographics, childhood adversity, mental health) associated with exchanging sex. Participants were 600 college students (Mage = 21.3 years [SD = 3.8]); 72% cisgender women; 43.4% racial/ethnic minority) from a large public university in the Northeastern USA who completed cross-sectional, online questionnaires about lifetime trauma, adversity exposure, sexual behaviors, and current mental health and substance use symptoms. A total of 4.5% of participants reported exchanging sex for money, alcohol/drugs, or other forms of compensation. Bivariate analysis revealed that lesbian, gay, bisexual, and trans students (versus cisgender, heterosexual students), students who had more severe childhood trauma, who reported being removed from their family home in childhood, and students who were diagnosed with a mental health disorder before age 18 were more likely to report exchanging sex. In a multivariable model, only emotional neglect and greater alcohol use problems were significantly associated with likelihood of exchanging sex. To our knowledge, this is the first US study to determine whether university students exchange sex for money, alcohol/drugs, or other compensation. Findings suggest that universities could consider addressing exchanging sex in person-centered, supportive sexual health programming, university health services responses, and community spaces that support LGBTQ+ students. Future research is needed to understand students' circumstances in exchanging sex and differentiate compensation type.

A prospective longitudinal study of multidomain resilience among youths with and without maltreatment histories.

The majority of children with maltreatment histories do not go on to develop depression in their adolescent and adult years. These individuals are often identified as being "resilient", but this characterization may conceal difficulties that individuals with maltreatment histories might face in their interpersonal relationships, substance use, physical health, and/or socioeconomic outcomes in their later lives. This study examined how adolescents with maltreatment histories who exhibit low levels of depression function in other domains during their adult years. Longitudinal trajectories of depression (across ages 13-32) in individuals with (n = 3,809) and without (n = 8,249) maltreatment histories were modeled in the National Longitudinal Study of Adolescent to Adult Health. The same "Low," "increasing," and "declining" depression trajectories in both individuals with and without maltreatment histories were identified. Youths with maltreatment histories in the "low" depression trajectory reported lower romantic relationship satisfaction, more exposure to intimate partner and sexual violence, more alcohol abuse/dependency, and poorer general physical health compared to individuals without maltreatment histories in the same "low" depression trajectory in adulthood. Findings add further caution against labeling individuals as "resilient" based on a just single domain of functioning (low depression), as childhood maltreatment has harmful effects on a broad spectrum of functional domains.

A preliminary examination of sexual and physical victimization 6 months after recent rape.

One in four US women will experience a completed or attempted rape in their lifetime, and more than 50% of survivors will experience two or more rapes. Rape and physical violence also co-occur. Multiple experiences of sexual and physical violence are associated with elevated mental and physical health problems. This secondary analysis examined the prevalence and correlates of experiencing sexual or physical violence within 6 months of a sexual assault medical forensic exam (SAMFE). Between May 2009 and December 2013, 233 female rape survivors aged 15 and older were enrolled in a randomized controlled trial during a SAMFE in the emergency department (ED). Demographics, rape characteristics, distress at the ED, and pre-rape history of sexual or physical victimization were assessed. New sexual and physical victimization was assessed 6 months after the SAMFE via telephone interview. Six months after the exam, 21.7% reported a new sexual or physical victimization. Predictors of revictimization during follow-up included sexual or physical victimization prior to the index rape, making less than $10,000 annually, remembering the rape well, life threat during the rape, and higher distress at the ED. In adjusted models, only pre-rape victimization and making less than $10,000 annually were associated with revictimization. Factors assessed at the ED can inform subsequent victimization risk. More research is needed to prevent revictimization among recent rape victims. Policies to provide financial support to recent rape victims and/or targeted prevention for those with pre-rape victimization at the SAMFE could reduce revictimization risk. TRIAL REGISTRATION: NCT01430624.

Latent Profiles of Internal and External Consent During a Recent Sexual Encounter.

Understanding how individuals conceptualize and communicate sexual consent is critical to sexual health and has important implications for the prevention of sexual assault. This study used a data-driven (vs. a theoretical) approach to understand how students' internal feelings of willingness (i.e., internal consent) and behavioral communication of consent (i.e., external consent) cluster together within sexual encounters. Using data from 610 college students (72% female) who reported on their most recent sexual encounter, latent profile analysis revealed five distinct consent profiles. Most students reported willing encounters that involved the use of several external consent cues (68.9%), a small group reported low levels of both internal and external consent (3.8%), and three groups (27.3% altogether) reported encounters with complex patterns of internal and external consent. Demographic and encounter-level differences were observed across profiles. Programming that trains students to attend to their own internal desires in addition to external consent behaviors could improve emotional health and shift social norms about sexual communication.

Maternal prenatal stress phenotypes associate with fetal neurodevelopment and birth outcomes.

Maternal prenatal stress influences offspring neurodevelopment and birth outcomes including the ratio of males to females born; however, there is limited understanding of what types of stress matter, and for whom. Using a data-driven approach with 27 variables from questionnaires, ambulatory diaries, and physical assessments collected early in the singleton pregnancies of 187 women, 3 latent profiles of maternal prenatal stress emerged that were differentially associated with sex at birth, birth outcomes, and fetal neurodevelopment. Most women (66.8%) were in the healthy group (HG); 17.1% were in the psychologically stressed group (PSYG), evidencing clinically meaningful elevations in perceived stress, depression, and anxiety; and 16% were in the physically stressed group (PHSG) with relatively higher ambulatory blood pressure and increased caloric intake. The population normative male:female secondary sex ratio (105:100) was lower in the PSYG (2:3) and PHSG (4:9), and higher in the HG (23:18), consistent with research showing diminished male births in maternal stress contexts. PHSG versus HG infants were born 1.5 wk earlier (P < 0.05) with 22% compared to 5% born preterm. PHSG versus HG fetuses had decreased fetal heart rate-movement coupling (P < 0.05), which may indicate slower central nervous system development, and PSYG versus PHSG fetuses had more birth complications, consistent with previous findings among offspring of women with psychiatric illness. Social support most strongly differentiated the HG, PSYG, and PHSG groups, and higher social support was associated with increased odds of male versus female births. Stress phenotypes in pregnant women are associated with male vulnerability and poor fetal outcomes.

Equity Rx: Boston Medical Center's Work to Accelerate Racial Health Justice.

In November 2021, after more than a year of investigating the racial health disparities across its organization, Boston Medical Center launched the Health Equity Accelerator, a system-wide approach to holistically address the root causes of health inequities among people of different races and ethnicities and speed improvements in health outcomes. This article discusses lessons learned during the institution's process of discovery, shares examples of the work to dismantle a structural narrative that impedes health justice, and outlines interventions that can be applied to other healthcare systems across the United States.

Using a Daily Diary Approach to Examine Substance Use and Negative Sexual Experiences Among College Students.

This article examined substance use and sexual behavior by conducting an analysis of college students' reported behaviors using a daily diary approach. By isolating particular sexual events across a 2-month period, we examined situational predictors of engagement in sex and of negative sexual experiences (coerced sex and/or sex that lacks perceived control) for college men and women. Data come from the daily diary sub-study of the Sexual Health Initiative to Foster Transformation. These data include 60 days of daily responses from 420 undergraduates at one New York City institution. This was a relatively diverse sample comprised of 49% women, 28% identifying as non-heterosexual, 60% non-white, and a roughly equal number of college freshman, sophomores, juniors, and seniors. Analyses examined the effects of alcohol use, binge drinking, marijuana use, and other drug use on sexual experiences. Between-person and within-person substance uses were related to an increased likelihood of having at least one sexual encounter during the study period. After adjusting for each participants' average substance use, both the number of alcoholic drinks consumed (AOR 1.13 (1.05-1.21)) and binge drinking scores (AOR 2.04 (1.10-3.79)) increased the likelihood of negative sex. Interaction analyses showed that compared to men, women were more likely to use alcohol and marijuana prior to sexual encounters. Given that sex and substance use are co-occurring, current prevention approaches should be paired with strategies that attempt to prevent negative sexual experiences, including sexual assault, more directly. These include consent education, bystander training, augmentation of sexual refusal skills, and structural change. Efforts promoting increased sex positivity might also help make all students, and women in particular, less likely to use substances in order to facilitate sex.

A Longitudinal Examination of Posttraumatic Stress Disorder Symptoms and Risky Sexual Behavior: Evaluating Emotion Dysregulation Dimensions as Mediators.

Posttraumatic stress disorder (PTSD) has been linked to a wide array of risky and health-compromising behaviors, including risky sexual behavior (RSB). Cross-sectional studies reveal positive associations between emotion dysregulation and both PTSD and RSB. This study extended that work by exploring whether intermediate levels of emotion dysregulation across multiple dimensions account for the relation between baseline PTSD symptoms and RSB (i.e., number of vaginal sex partners, number of instances of condomless sex, and number of instances of risky/impulsive sex) 16 months later. Participants were 447 trauma-exposed young adult women from the community (60.0% White; M age = 21.80 years) who completed five assessments (separated by 4-month increments) over a 16-month period. Baseline PTSD symptoms were significantly positively associated with all emotion dysregulation dimensions at 8 months and the number of instances of risky/impulsive sex at 16 months. Further, results revealed significant indirect effects of baseline PTSD symptoms on (1) 16-month vaginal sex partners through both the nonacceptance of negative emotions and difficulties controlling impulsive behaviors when distressed at 8-month and (2) 16-month risky/impulsive sex through difficulties engaging in goal-directed behaviors when distressed at 8 months. Results provide support for the mediating roles of nonacceptance of negative emotions and difficulties controlling behaviors when distressed in the relation between PTSD symptoms and later RSB.

Prescription Opioid Misuse After a Recent Sexual Assault: A Randomized Clinical Trial of a Video Intervention.

BACKGROUND AND OBJECTIVES: Prescription opioid (PO) misuse is increasing and is associated with overdose. Individuals who experienced a recent sexual assault are at risk for increased substance use, yet limited interventions target PO misuse after sexual assault. The current study examined the efficacy of video interventions on PO misuse after sexual assault. METHODS: Adolescent girls and women (n = 154) were recruited in the context of a sexual assault medical forensic exam in the emergency department. Effects of a prevention of post-rape stress (PPRS) video and a pleasant imagery and relaxation instruction (PIRI) video were compared with treatment as usual (TAU) during a sexual assault medical forensic exam on PO misuse. Participants reported if they had used POs for non-medical purposes since the sexual assault at 1.5 month follow-up. RESULTS: Results from a logistic regression analysis indicated that participants with a prior sexual assault were less likely to misuse prescription opioids 1.5 months after the assault in the PIRI condition compared with TAU. There were no main effects for video condition and no interactions for the PPRS condition on PO misuse. DISCUSSION AND CONCLUSIONS: Providing the PIRI video, or teaching other types of mindfulness or relaxation exercises, may be warranted as a secondary prevention for individuals during the sexual assault medical forensic exam for those with a prior sexual assault history. SCIENTIFIC SIGNIFICANCE: This research provides an initial examination of the impact of mindfulness skills recently after traumatic event exposure on PO misuse. (Am J Addict 2019;28:376-381).

A Randomized Clinical Trial Examining the Effect of Video-Based Prevention of Alcohol and Marijuana Use Among Recent Sexual Assault Victims.

BACKGROUND: This study examined whether a brief video intervention (Prevention of Post-Rape Stress [PPRS]) delivered in the emergency department to recent sexual assault (SA) victims reduced alcohol and marijuana use at 3 points over the course of a 6-month follow-up compared to treatment as usual (TAU) and an active control condition (Pleasant Imagery and Relaxation Instruction [PIRI]). Prior assault history, minority status, and pre-SA substance use also were examined as moderators of intervention efficacy. METHODS: Women aged 15 and older (N = 154) who participated in a post-SA medical forensic examination were randomly assigned to watch the PPRS video (n = 54) or the PIRI video (n = 48) or receive TAU (n = 52) and completed at least 1 follow-up assessment targeted at 1.5 (T1), 3 (T2), or 6 (T3) months following the examination. RESULTS: Regression analyses revealed that, relative to TAU, PPRS was associated with less frequent alcohol use at 6 months post-SA among women reporting pre-SA binge drinking and minority women. Relative to TAU, PPRS also was associated with fewer days of marijuana use at T1 among those who did not report pre-SA marijuana use and prior SA. Findings for pre-SA marijuana use were maintained at T3; however, findings for prior SA shifted such that PPRS was associated with fewer days of marijuana use at T3 for women with a prior SA. CONCLUSIONS: PPRS may be effective at reducing substance use for some recent SA victims, including those with a prior SA history, a prior substance use history, and minority women.

Relationship violence victimization and binge drinking trajectories among a nationally representative sample of adolescents.

The present study evaluated the impact of relationship violence (RV) victimization on the longitudinal trajectory of binge drinking (BD) among 3614 US adolescents (51.2% male) who participated in an initial telephone interview regarding physical and sexual RV victimization and binge drinking. Two follow-up phone interviews were completed over approximately three years. Multilevel modeling revealed small, but significant, increases in BD over time; older adolescents and those who had ever experienced RV victimization were more likely to report BD at Wave 1 compared to younger adolescents and non-victims. Although new RV victimization reported during the study predicted an increase in the likelihood of BD at that occasion, those who had ever experienced RV victimization were less likely to report BD over time compared to non-victims. Contrary to expectations, no sex differences emerged. Findings indicate that BD may precede RV. Interventions to reduce alcohol-related RV may be especially useful in this population.

Deprescribing proton pump inhibitors: Evidence-based clinical practice guideline.

OBJECTIVE: To develop an evidence-based guideline to help clinicians make decisions about when and how to safely taper or stop proton pump inhibitors (PPIs); to focus on the highest level of evidence available and seek input from primary care professionals in the guideline development, review, and endorsement processes. METHODS: Five health professionals (1 family physician, 3 pharmacists, and 1 gastroenterologist) and 5 nonvoting members comprised the overall team; members disclosed conflicts of interest. The guideline process included the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach, with a detailed evidence review in in-person, telephone, and online meetings. Uniquely, the guideline development process included a systematic review of PPI deprescribing trials and examination of reviews of the harm of continued PPI use. Narrative syntheses of patient preferences and resource-implication literature informed recommendations. The team refined guideline content and recommendation wording through consensus and synthesized clinical considerations to address common front-line clinician questions. The draft guideline was distributed to clinicians and then to health care professional associations for review and revisions made at each stage. A decision-support algorithm was developed in conjunction with the guideline. RECOMMENDATIONS: This guideline recommends deprescribing PPIs (reducing dose, stopping, or using "on-demand" dosing) in adults who have completed a minimum of 4 weeks of PPI treatment for heartburn or mild to moderate gastroesophageal reflux disease or esophagitis, and whose symptoms are resolved. The recommendations do not apply to those who have or have had Barrett esophagus, severe esophagitis grade C or D, or documented history of bleeding gastrointestinal ulcers. CONCLUSION: This guideline provides practical recommendations for making decisions about when and how to reduce the dose of or stop PPIs. Recommendations are meant to assist with, not dictate, decision making in conjunction with patients.

Let's look to innovation, not slashing programs, to make healthcare more effective, affordable.

As the national healthcare debate continues, what if instead of cutting Medicaid eligibility and capping spending, as the legislation approved by the House of Representatives would do, we were discussing innovations that would make the healthcare system more effective and affordable?

Associations Among Child Abuse, Depression, and Interleukin-6 in Pregnant Adolescents: Paradoxical Findings.

OBJECTIVE: Limited data exist on child abuse-related immune variation during pregnancy, despite implications for maternal and infant health and extensive data showing that abuse history and depression are related to increased inflammation in other populations. This study examined associations among child abuse, depression, circulating levels of inflammatory markers, and perinatal health in pregnant adolescents, a group at high risk for childhood abuse and poor birth outcomes. METHODS: Pregnant teenagers (n = 133; 14-19 years; 89.5% Latina) reported on abuse and depression and had two blood draws (24-27 and 34-37 gestational weeks, second and third trimesters, respectively) for interleukin-6 (IL-6) and C-reactive protein; birth outcomes were collected. RESULTS: Abuse and depression interacted to predict higher IL-6 at second trimester (B = 0.006, p = .011) such that severely abused adolescents with high depression had higher IL-6 relative to severely abused adolescents with low depression; depression did not differentiate IL-6 levels for those with low abuse severity. Abuse and IL-6 also interacted to predict gestational age at birth (B = 0.004, p = .040) such that those with low abuse and high IL-6 and those with high abuse and low IL-6 had infants with earlier gestational age at birth. Cortisol at the second trimester mediated the association between IL-6 and gestational age at birth (indirect effect estimate=-0.143, p < .039). CONCLUSIONS: Depression severity distinguished IL-6 levels among more severely abused pregnant Latina adolescents, but it was unrelated to IL-6 among less severely abused adolescents. Cortisol explained the relationship between IL-6 and earlier gestational age at birth. Multiple adversities and inflammation may influence birth outcomes and potentially affect intergenerational health.

Childhood Exposure to Violence and Chronic Physical Conditions in a National Sample of US Adolescents.

OBJECTIVES: Exposure to violence is associated with chronic physical conditions in adults. Although violence exposure is common among youths, it is unknown whether violence is associated with chronic physical conditions in childhood and adolescence. We examined the associations of violence exposure with chronic physical conditions in a population-representative sample of US adolescents and determined whether associations were explained by co-occurring mental disorders. METHODS: Data were drawn from the National Comorbidity Survey Replication-Adolescent Supplement (NCS-A), a national cross-sectional survey of 6,483 adolescents (ages 13-17). Lifetime exposure to violence; Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition mood, anxiety, and substance disorders; and self-reported arthritis, frequent headaches, back or neck problems, other chronic pain, asthma, and allergies were assessed. RESULTS: One in 4 (24.99%) adolescents reported exposure to violence. Violence exposure was associated with elevated odds of back/neck pain, headaches, chronic pain, allergies, and asthma (odds ratio [OR], 1.5-2.1; 95% confidence interval [CI], 1.1-3.5) after adjustment for sociodemographics, socioeconomic status, and lifetime mental disorders. Regarding new onsets, violence exposure was associated with greater hazard for subsequent first-onset only of back/neck pain (hazard ratio, 1.9; 95% CI, 1.2-3.0) and headaches (hazard ratio, 1.4; 95% CI, 1.1-1.8), and these associations were explained by early-onset mental disorders. CONCLUSIONS: Childhood violence exposure is associated with chronic physical conditions that emerge early in the life course, although associations are stronger for prevalent than incident conditions. Violence exposure predicts incident pain conditions only, and these associations are explained by mental disorders that begin after violence exposure. Interventions and policies aimed at preventing violence and detecting and treating early-onset mental disorders have the potential to reduce morbidity, mortality, and health disparities beginning early in development.

Multifaceted intervention to optimize antibiotic use for intra-abdominal infections.

OBJECTIVES: Implementing evidence-based practice guidelines is challenging. We used a multifaceted, continuous educational approach to disseminate an up-to-date internal guideline adapted from published guidelines for management of intra-abdominal infections (IAI). PATIENTS AND METHODS: The intervention consisted of continuing educational sessions, internal guideline pocket cards and posters with collaboration among all key stakeholders starting in December 2010. We emphasized risk stratification and the use of ceftriaxone/metronidazole for treatment of low-risk IAI, and discouraged the use of fluoroquinolones due to the high local resistance rates. We then compared patients with IAI before the intervention (April-November 2010) to those after implementation of the guideline (April-November 2011) in a surgical unit at a tertiary care teaching hospital in Hamilton, Ontario, Canada. Antibiotic use was measured in in-hospital days of antibiotic therapy (DOT) per 1000 patient days (PD). RESULTS: 152 and 145 patients with IAI were included in the pre- and post-intervention periods, respectively. There was a significant reduction in the proportion of patients who received ciprofloxacin therapy from 74% to 34% (OR 0.18, 95% CI 0.11-0.31) and in DOT/1000 PD from 221 to 74 (OR 0.3, 95% CI 0.2-0.3). Also, a reduction in the DOT/1000 PD for piperacillin/tazobactam was seen (from 116 to 67; OR 0.6, 95% CI 0.5-0.7). There was an increase in the use of ceftriaxone from 1.3% to 53% of patients (OR 85, 95% CI 20-515) and from 6 to 92 DOT/1000 PD (OR 17, 95% CI 10-25). This change in practice was sustained over >2 years since the end of the active intervention, as shown in the unit-wide antimicrobial utilization data. CONCLUSIONS: A multifaceted intervention aimed at all key stakeholders resulted in a high adherence to evidence-based treatment guidelines for IAI and has initiated a sustained culture change in prescribing of antibiotics.

Caregiving and 5-HTTLPR Genotype Predict Adolescent Physiological Stress Reactivity: Confirmatory Tests of Gene × Environment Interactions.

A theory-driven confirmatory approach comparing diathesis-stress and differential susceptibility models of Gene × Environment (G × E) interactions was applied to examine whether 5-HTTLPR genotype moderated the effect of early maternal caregiving on autonomic nervous system (ANS) stress reactivity in 113 adolescents aged 13-17 years. Findings supported a differential susceptibility, rather than diathesis-stress, framework. Carriers of one or more 5-HTTLPR short alleles (SS/SL carriers) reporting higher quality caregiving exhibited approach ANS responses to a speech task, whereas those reporting lower quality caregiving exhibited withdrawal ANS responses. Carriers of two 5-HTTLPR long alleles (LL carriers) were unaffected by caregiving. Findings suggest that 5-HTTLPR genotype and early caregiving in interaction are associated with ANS stress reactivity in adolescents in a "for better and for worse" fashion, and they demonstrate the promise of confirmatory methods for testing G × E interactions.

Use of endoanal ultrasound for reducing the risk of complications related to anal sphincter injury after vaginal birth.

BACKGROUND: During childbirth, many women sustain trauma to the perineum, which is the area between the vaginal opening and the anus. These tears can involve the perineal skin, the pelvic floor muscles, the external and internal anal sphincter muscles as well as the rectal mucosa (lining of the bowel). When these tears extend beyond the external anal sphincter they are called 'obstetric anal sphincter injuries' (OASIS). When women sustain an OASIS, they are at increased risk of developing anal incontinence either immediately following birth or later in life. Anal incontinence is associated with significant medical, hygiene and social problems. Endoanal ultrasound (EAUS) can be performed with a bedside scanner by inserting a small probe into the anus and the structures of the anal canal and perineum can be reviewed in real-time. We proposed that by examining the perineum with EAUS after the birth of the baby and before the tear has been repaired, there would be an increase in detection of OASIS. This increased detection could lead to improved primary repair of the external and internal anal sphincter resulting in reduced rates of anal incontinence and improved quality of life for women. EAUS may also have a role after perineal repair in the evaluation of residual injury and may help guide a woman's management in subsequent pregnancies and allow for early referral to specialised units, minimising long-term complications. OBJECTIVES: To evaluate the effectiveness of EAUS in the detection of OASIS following vaginal birth and in reducing the risk of anal sphincter complications related to OASIS. SEARCH METHODS: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 August 2015) and reference list of the one retrieved study. SELECTION CRITERIA: Randomised control trials (RCTs) comparing EAUS versus no ultrasound in women prior to repair of perineal trauma and EAUS performed after perineal repair. RCTs published in abstract form only and trials using a cluster-randomised design were eligible for inclusion, but none were identified.Trials using a cross-over design and quasi-RCTs were not eligible for inclusion. DATA COLLECTION AND ANALYSIS: The two review authors independently assessed the single trial for inclusion and assessed trial quality. Both review authors independently extracted data. Data were checked for accuracy. MAIN RESULTS: We included one trial that randomised 752 primiparous women with clinically detectable second-degree perineal tears to either further assessment with EAUS prior to perineal repair or standard care. We assessed this trial as being at a low risk of bias. The trial reported women's anal incontinence at three and 12 months as well as their pain scores and quality of life assessment. The trial authors reported outcomes at three months for 719 women (364 in the experimental group, 355 in the control group, 4% loss to follow-up), and an outcome at 12 months for 684 women (342 in the experimental group, 342 in the control group, 9% loss to follow-up). Primary outcomeCompared with clinical examination (routine care), the use of EAUS prior to perineal repair was associated with a reduction in the rate of severe anal incontinence (defined as involuntary loss of faeces or flatus that constitutes social and/or hygiene problems, or as defined by authors), at greater than six months postpartum (risk ratio (RR) 0.48, 95% confidence interval (CI) 0.24 to 0.97, 684 women at the 12-month time point). Secondary outcomes Severe anal incontinence at less than six months was reduced with the use of EAUS prior to repair when compared with clinical examination (routine care) (RR 0.38, 95% CI 0.20 to 0.72, 719 women). However, increased perineal pain at three months was associated with the use of EAUS prior to perineal repair when compared with routine care (RR 5.86, 95% CI 1.74 to 19.72, 684 women). There was no clear difference in the number of women who reported any anal incontinence at either less than six months or equal to or greater than six months (outcomes not prespecified in our published protocol). Similarly, there was no clear difference between groups in terms of faecal incontinence, flatal incontinence, faecal urgency, or maternal quality of life. The study did not report any data on the need for secondary repair of external anal sphincter, dyspareunia, women's satisfaction with care or the planned or actual mode of birth in any subsequent pregnancy. We were unable to assess the detection rates of OASIS with EAUS from the included study because women with clinically-detected OASIS were excluded from randomisation. AUTHORS' CONCLUSIONS: There is some evidence to suggest that EAUS prior to perineal repair is associated with reduced risk of severe anal incontinence but an increase in the incidence of perineal pain at three months postpartum. However, these results are based on one small study involving 752 women. The study took place in a large teaching hospital with an average to busy labour ward. The trial participants were similar to those found in most large obstetric units in developed countries, thus increasing applicability of the evidence, but were restricted to primiparous women.More research is needed to further evaluate the effectiveness of EAUS in the detection of OASIS following vaginal birth and in reducing the risk of anal sphincter complications related to OASIS. More high-quality RCTs are needed to fully evaluate the intervention before the routine use of EAUS on the labour ward could be supported. It would be particularly useful if future trials could assess detection rates of OASIS with EAUS versus clinical examination alone as this is the basis of the theory for improved outcomes with this intervention. Cost and the training required to implement EAUS should be considered, along with maternal quality of life and individual symptoms experienced by postnatal women . It would also be useful to follow up women after their subsequent vaginal births to determine if subsequent mode of delivery affects long-term outcomes. Future studies in multiparous women may also be useful.

Dissemination of an Internet-based treatment for chronic insomnia into primary care.

This study evaluated the effectiveness of two strategies (provider-targeted, consumer-targeted) in the dissemination of an insomnia treatment into primary care. Results of the study indicated that more patients from the provider-targeted, than the consumer-targeted, clinic followed up on the referral for insomnia treatment, but that overall there was limited uptake. These results did not seem to be associated with low levels of provider interest, although providers expressed need for more education about the insomnia program. Implications of these results are that future research efforts would benefit from expanding upon the education of providers in terms of treatment offered, perhaps teaching providers how to better motivate their patients for behavior change.

Sexual violence and mental health symptoms among National Guard and Reserve soldiers.

BACKGROUND: Reserve and National Guard (NG) soldiers report disproportionate mental health problems relative to active duty military upon returning from the Iraq and Afghanistan conflicts. However, few studies have examined whether exposure to particular types of traumatic events (e.g., lifetime sexual violence) is associated with this increased burden of psychopathology. OBJECTIVE: The current study examined the prevalence of lifetime sexual violence exposure as well as the adjusted odds and population attributable fraction of psychopathology associated with sexual violence in a large sample of male and female Reserve and NG soldiers. DESIGN: Baseline structured telephone interviews were conducted in 2009. PARTICIPANTS: 1,030 Reserve (23 % female) and 973 NG (15 % female) soldiers. MAIN MEASURES: Four items assessed lifetime and deployment-related sexual violence. Probable lifetime and past-year posttraumatic stress disorder (PTSD) and depression were assessed with the PTSD Checklist and the Patient Health Questionnaire, respectively. KEY RESULTS: Lifetime sexual violence prevalence was 37.4 % and 27.6 % among Reserve and NG women, and 4.3 % and 3.7 % among Reserve and NG men, respectively. Recent deployment-related sexual violence ranged from 1.4 to 2.6 % for women and 0 % for men. Regression analyses indicated that the adjusted odds of probable past-year and lifetime PTSD and depression were 1.2 to 3.5 times greater among those reporting sexual violence relative to non-victims. The proportion of probable lifetime PTSD and depression attributable to sexual violence was 45.2 % and 16.6 %, respectively, in the Reserves, and 10.3 % and 6.2 %, respectively, in the NG. CONCLUSIONS: Lifetime sexual violence prevalence was high among female soldiers, with approximately one-third of Reserve and National Guard women reporting a history. The majority of sexual violence was not related to the most recent deployment; however, sexual violence contributed to a high burden of psychopathology. Findings emphasize a need to screen for lifetime sexual violence and associated mental disorders in military samples.