RESUMEN
Sexual assault is defined as any type of forced or coerced sexual contact or behavior that happens without consent. Victims seeking justice and personal safety must report their assaults to police, however few survivors report their victimization. Sexual and gender minorities, inclusive of the LGBTQI2-S population, are at an increased risk for experiencing sexual assault yet the vast majority of empirical research on sexual victimization has been conducted through a hetero-cisnormative lens. Sexual and gender minorities likely have a unique experience of sexual assault compared to heterosexual, cisgender survivors, especially as it relates to their help-seeking behaviors post-assault. Through the use of Sexual and Gender Script Theory, this review explores barriers that sexual and gender minorities may experience when reporting sexual assault to the police, thereby impeding their access to equitable justice. Opportunities for future policy, practice, and research among sexual and gender minorities are presented.
Asunto(s)
Víctimas de Crimen , Delitos Sexuales , Minorías Sexuales y de Género , Humanos , Policia , Conducta SexualRESUMEN
Rates of sexual victimization among Indigenous women are 3 times higher when compared with non-Indigenous women. The purpose of this secondary data analysis was to explore the experiences and recommendations of Indigenous women who reported sexual assault to the police and were not believed. This qualitative study of the experiences of 11 Indigenous women reflects four themes. The women experienced (a) victimization across the lifespan, (b) violent sexual assault, (c) dismissal by police, and (d) survival and resilience. These women were determined to voice their experience and make recommendations for change in the way police respond to sexual assault.
Asunto(s)
Víctimas de Crimen , Delitos Sexuales , Agresión , Femenino , Humanos , Policia , Conducta SexualRESUMEN
One in four women will experience sexual assault in their lifetime. Although less than 5% of sexual assaults are reported to law enforcement, one in five cases reported to police are deemed baseless (by police) and therefore coded as "unfounded." Police officers are in a unique position to act as gatekeepers for justice in sexual assault cases, given their responsibility to investigate sexual assault reports. However, high rates of unfounded sexual assaults reveal that dismissing sexual violence has become common practice amongst the police. Much of the research on unfounded sexual assault is based on police perceptions of the sexual assault, as indicated in police reports. Women's perspectives about their experiences with police are not represented in research. This qualitative study explored women's experiences when their sexual assault report was disbelieved by the police. Data collection included open-ended and semi-structured interviews with 23 sexual assault survivors. Interviews covered four areas including the sexual assault, the experience with the police, the experience of not being believed, and the impact on their health and well-being. Interviews were audio-recorded, transcribed, and entered into NVIVO for analysis. Data were analyzed using Colaizzi's analytic method, resulting in the identification of four themes, including, (a) vulnerability, (b) drug and alcohol use during the assault, (c) police insensitivity, and (d) police process. The women in this study who experienced a sexual assault and reported the assault to police were hopeful that police would help them and justice would be served. Instead, these women were faced with insensitivity, blaming questions, lack of investigation, and lack of follow-up from the police, all of which contributed to not being believed by the institutions designed to protect them. The findings from this research demonstrate that police officers must gain a deeper understanding of trauma and sensitive communication with survivors of sexual assault.
Asunto(s)
Víctimas de Crimen , Delitos Sexuales , Femenino , Humanos , Aplicación de la Ley/métodos , Policia , SobrevivientesRESUMEN
BACKGROUND: Sexual assault is a prevalent crime against women globally with known negative effects on health. Recent media reports in Canada indicate that many sexual assault reports are not believed by police. Negative reporting experiences of sexual assault have been associated with secondary victimization and trauma among survivors. However, little is known about the impact that being sexually assaulted and not believed by police has on a survivor's health and well-being. The purpose of this study was to explore women's experiences of not being believed by police after sexual assault and their perceived impact on health. METHODS: We conducted open-ended and semi-structured interviews with 23 sexual assault survivors who were sexually assaulted and not believed by police. The interviews explored the self-reported health impacts of not being believed by police and were conducted from April to July, 2019. All interviews were audio-recorded, transcribed, and entered into NVIVO for analysis. Data were analyzed using Colaizzi's analytic method. RESULTS: Analysis revealed three salient themes regarding the health and social impact of not being believed by police on survivors of sexual assault: (1) Broken Expectations which resulted in loss of trust and secondary victimization, (2) Loss of Self, and (3) Cumulative Health and Social Effects. The findings showed that not being believed by police resulted in additional mental and social burdens beyond that of the sexual assault. Many survivors felt further victimized by police at a time when they needed support, leading to the use taking of alcohol and/or drugs as a coping strategy. CONCLUSION: Reporting a sexual assault and not being believed by police has negative health outcomes for survivors. Improving the disclosure experience is needed to mitigate the negative health and social impacts and promote healing. This is important for police, health, and social service providers who receive sexual assault disclosures and may be able to positively influence the reporting experience and overall health effects.
Asunto(s)
Víctimas de Crimen , Delitos Sexuales , Canadá , Femenino , Humanos , Policia , Sobrevivientes , Salud de la MujerRESUMEN
OBJECTIVE: To critically appraise and synthesize existing studies on the relationship between newborn feeding method and neonatal outcomes related to neonatal abstinence syndrome (NAS). DATA SOURCES: A systematic search of the literature on newborn feeding method in newborns with NAS was conducted with the use of the electronic databases PubMed, CINAHL, Nursing and Allied Health, PyschINFO, Evidence Based Medicine, Web of Science, and MEDLINE (Embase). STUDY SELECTION: Studies were eligible for inclusion if the following criteria were met: the authors reported original data on outcomes related to newborn feeding and NAS, the research followed any type of quantitative design that included comparison of breastfed and formula-fed newborns with NAS, and the articles were published in English in peer-reviewed journals from 1990 to February 2018. DATA EXTRACTION: Two authors independently extracted the data from the full-text articles and entered them into a data extraction template developed for the systematic review. The data were synthesized narratively because of the diversity in assessment of newborn feeding methods and outcome measures. DATA SYNTHESIS: We identified eight studies in which newborn feeding method and outcomes related to NAS were evaluated in newborns exposed to opioids. The synthesis indicated that for newborns exposed to methadone, breastfeeding was associated with decreased incidence and duration of pharmacologic treatment, shorter hospital length of stay, and decreased severity of NAS. The association between newborn feeding method and NAS among newborns exposed to buprenorphine was unclear. CONCLUSION: Breastfeeding may be effective to mitigate negative outcomes related to NAS among newborns exposed to methadone in utero. Women who are stable on opioid substitution treatment should be provided with appropriate education and support to breastfeed. However, to effectively promote breastfeeding among these mothers, evidence-based strategies are required, and barriers to breastfeeding need to be addressed.
Asunto(s)
Alimentación con Biberón/estadística & datos numéricos , Lactancia Materna/estadística & datos numéricos , Desarrollo Infantil/fisiología , Síndrome de Abstinencia Neonatal/terapia , Tratamiento de Sustitución de Opiáceos/métodos , Peso Corporal/fisiología , Métodos de Alimentación , Femenino , Estudios de Seguimiento , Humanos , Recién Nacido , Masculino , Síndrome de Abstinencia Neonatal/diagnóstico , EmbarazoRESUMEN
Often referred to as miscarriage, Early Pregnancy Loss (EPL) is the spontaneous death of a fetus experienced within the first 20 weeks of gestation and is the most common complication in pregnancy. Symptoms of an impending EPL are routinely managed in the Emergency Department (ED). EPL can have a substantial impact on women, potentially leading to psychological and emotional health issues and risks to future pregnancies. Despite the high prevalence of EPL, many women suffer in silence due to the common societal belief that EPL are insignificant. Many women experience EPL as an ambiguous loss and are at risk for disenfranchised grief. Compassionate, patient-centred care has been identified by women as an essential and often missing aspect of ED care and can have a profound impact on the overall well-being of women after EPL. Social workers play a critical role in the ED given that they prioritize the psychosocial well-being of patients in a system that is structured to primarily address trauma care. In an effort to reduce the psychological impact and complicated grief reactions of women experiencing EPL, specific recommendations for social work intervention to address the individual needs of women experiencing EPL in the ED are presented. These include acknowledging the loss, providing psychoeducation, honouring the loss, assessing resources, referral and additional information, and building capacity in the ED.
Asunto(s)
Aborto Espontáneo/psicología , Aborto Espontáneo/terapia , Servicio de Urgencia en Hospital/organización & administración , Servicio Social/organización & administración , Femenino , Pesar , Humanos , Derivación y ConsultaRESUMEN
AIM: The purpose of this systematic review was to assess the literature regarding the effectiveness and safety of outpatient pharmacologic weaning for infants with neonatal abstinence syndrome (NAS). BACKGROUND: NAS is a multi-system disorder observed in infants experiencing withdrawal from opioid exposure in utero. Infants requiring pharmacologic treatment to manage withdrawal, traditionally receive treatment as a hospital inpatient resulting in lengthy hospitalization periods. However, there is evidence to suggest that some healthcare institutions are continuing outpatient pharmacologic weaning for select infants in a home environment. As there is no standard of care to guide outpatient weaning, assessment of the safety and effectiveness of this approach is warranted. METHOD: A systematic review of outpatient weaning for infants with NAS was conducted using the electronic databases PubMed, Nursing and Allied Health, CINAHL, Evidence-Based Medicine, Web of Science, Medline, and PsychINFO. Studies were eligible for inclusion in the review if they fulfilled the following criteria: (1) reported original data on outcomes related to the effectiveness or safety of outpatient weaning for infants with NAS, (2) infants were discharged from hospital primarily receiving opioid pharmacologic treatment for NAS, (3) the method included quantitative designs that included an inpatient comparison group, and (4) articles were published in English in a peer-reviewed journal. FINDINGS: The search identified 154 studies, of which 18 provided information related to NAS and outpatient weaning. After reviewing the remaining full-text studies, six studies met all inclusion and exclusion criteria. All studies identified that outpatient weaning for select infants was associated with shorter hospitalization compared with infants weaned in-hospital only and may be potentially effective in reducing associated healthcare costs. However, duration of pharmacologic treatment was longer in the outpatient weaning groups in the majority of the studies. Furthermore, adverse events were rare and compliance to follow-up treatment was high among those who received outpatient weaning.
Asunto(s)
Síndrome de Abstinencia Neonatal , Femenino , Humanos , Incidencia , Recién Nacido , Metadona/uso terapéutico , Morfina/uso terapéutico , Síndrome de Abstinencia Neonatal/diagnóstico , Síndrome de Abstinencia Neonatal/prevención & control , Síndrome de Abstinencia Neonatal/terapia , Tratamiento de Sustitución de Opiáceos , Trastornos Relacionados con Opioides/complicaciones , Embarazo , Complicaciones del EmbarazoRESUMEN
Neonatal Abstinence Syndrome (NAS) is one of the primary negative effects of substance use during pregnancy. The exact statistics regarding NAS and substance use during pregnancy are difficult to determine due to underreporting, especially in the context of pregnancy. Similarly, little is known regarding whether the severity of NAS differs based on substance exposure. The purpose of this study was to evaluate the prevalence of NAS and types of substance use during pregnancy, and determine whether the presentation of NAS symptoms differ based on the type of substance. A retrospective chart review was conducted over a one year period at a tertiary care hospital. One hundred thirty-one mother-infant pairs met the inclusion criteria of documented NAS scores using the Modified Finnegan Scoring Tool and substance use during pregnancy. The results identified a high prevalence of NAS (8.7 %) primarily as a result of exposure to illicit opioids and/or to methadone as the treatment for opioid addiction. In addition, more than half the women on methadone maintenance treatment continued to use additional substances primarily opiates. Infants who were exposed to methadone experienced more severe NAS compared to infants not exposed to methadone including higher peak scores, prolonged NAS treatment, and length of stay. Given the severity of symptoms of the methadone exposed infants and the high rate of opioid use with methadone treatment, evidence-based interventions are required to decrease the negative effects of NAS.
Asunto(s)
Madres/psicología , Síndrome de Abstinencia Neonatal/epidemiología , Efectos Tardíos de la Exposición Prenatal/epidemiología , Adolescente , Adulto , Femenino , Humanos , Recién Nacido , Tiempo de Internación , Metadona/uso terapéutico , Síndrome de Abstinencia Neonatal/diagnóstico , Tratamiento de Sustitución de Opiáceos , Trastornos Relacionados con Opioides/tratamiento farmacológico , Trastornos Relacionados con Opioides/rehabilitación , Embarazo , Complicaciones del Embarazo/tratamiento farmacológico , Complicaciones del Embarazo/rehabilitación , Efectos Tardíos de la Exposición Prenatal/diagnóstico , Prevalencia , Estudios RetrospectivosRESUMEN
Ontario's clinical practice guidelines for neonatal abstinence syndrome (NAS) provide evidence-informed recommendations that address the needs of substance using pregnant women and newborns at risk of NAS. NAS is a complex and multifaceted issue that is escalating along with rapidly rising opioid use in Ontario. Reducing the incidence and impact of NAS requires immediate action in order to improve the care of affected women and infants. This includes optimizing and standardizing treatment strategies, assessing and managing social risk, better monitoring of prescribing practices and facilitating the implementation of better treatment and prevention strategies as they become available. These clinical practice guidelines provide the framework to inform and support the development of a coordinated strategy to address this important issue and to promote safe and effective care.
Asunto(s)
Analgésicos Opioides/efectos adversos , Síndrome de Abstinencia Neonatal/terapia , Trastornos Relacionados con Opioides/complicaciones , Analgésicos Opioides/administración & dosificación , Servicios de Salud del Niño/métodos , Servicios de Salud del Niño/normas , Medicina Basada en la Evidencia , Femenino , Humanos , Incidencia , Recién Nacido , Servicios de Salud Materna/métodos , Servicios de Salud Materna/normas , Síndrome de Abstinencia Neonatal/epidemiología , Síndrome de Abstinencia Neonatal/prevención & control , Ontario , Trastornos Relacionados con Opioides/rehabilitación , Pautas de la Práctica en Medicina/normas , Embarazo , Complicaciones del Embarazo/rehabilitación , RiesgoRESUMEN
PURPOSE: To determine whether neonatal abstinence scores of infants exposed to methadone in utero differed by infant feeding method. DESIGN: A retrospective chart review. SUBJECTS: Twenty-eight term infants that were exposed to methadone in utero and exhibited symptoms of neonatal abstinence syndrome (NAS) prior to hospital discharge were included into the study. The sample was further divided by self-selected infant feeding method including (1) predominately breastfed (n = 8), combination fed (n = 11) or predominately formula fed (n = 9). METHODS: Data were extracted by two independent researchers from both the mother's and infant's chart. This included variables such as NAS scores, NAS treatment, infant feeding method and baseline demographic information. MAIN OUTCOME MEASURES: NAS scores were assessed by Registered Nurses according to hospital protocol using a Modified Finnegan Scoring Tool. PRINCIPAL RESULTS: A non-parametric Kruskal-Wallis one way analysis of variance based on ranks revealed statistically significant differences in the number of NAS scores recorded (P = 0.001), magnitude (P < 0.0001) and area score (P = 0.04) by infant feeding method. In particular, infants who were predominantly breastfed had significantly fewer NAS scores done and lower mean scores suggesting decreased severity and duration of NAS symptoms when compared to infants who were combination fed or predominately formula fed. CONCLUSION: Breastfeeding may offer enhanced benefits for infants who have been exposed to methadone in utero. As such, in the absence of contraindications, mothers in methadone maintenance programs should be encouraged and supported to breastfeed their infants.
Asunto(s)
Lactancia Materna , Fórmulas Infantiles , Metadona/efectos adversos , Síndrome de Abstinencia Neonatal/diagnóstico , Síndrome de Abstinencia Neonatal/terapia , Adolescente , Adulto , Análisis de Varianza , Lactancia Materna/psicología , Femenino , Humanos , Recién Nacido , Masculino , Metadona/uso terapéutico , Ontario , Trastornos Relacionados con Opioides/tratamiento farmacológico , Embarazo , Efectos Tardíos de la Exposición Prenatal/terapia , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Adulto JovenRESUMEN
OBJECTIVE: The main objective of this study was to analyze the consistency in using a standardized newborn toxicology screening protocol to identify infants at risk of developing neonatal abstinence syndrome (NAS). DESIGN: A retrospective cohort comparison design was approved by the institutional review board at the regional hospital and used to gather data from the infants' medical records during the study period. SETTING: The data were collected for a period of 1 year from a regional hospital serving 100,000 patients per annum. PATIENTS/PARTICIPANTS: Data were based on expectant mothers who delivered between March 2006 and March 2007. METHOD: Data of maternal self-reported substance use, and urine toxicology results and meconium results were obtained through retrospective chart review of infants exhibiting signs of NAS as noted by nurses on the Finnegan Scoring Tool. RESULTS: In the absence of accurate prenatal screening, this study lends positively to support the use of toxicology screening protocols at birth to adequately assess and treat infants exposed to illicit substances. Toxicology screening in not intrusive and despite emotional discomfort experienced by mothers of the infants tested, the benefits of attaining accurate information regarding substance exposure is critical for the well-being of the infant. CONCLUSION: The use of a toxicology screening protocol at birth appears beneficial in determining the need for identifying infants with NAS. Early detection of substance exposure in newborns leads to timely assessment for NAS and subsequent treatment to reduce symptoms in newborns.
Asunto(s)
Tamizaje Neonatal , Detección de Abuso de Sustancias , Trastornos Relacionados con Sustancias , Adolescente , Adulto , Canadá/epidemiología , Femenino , Humanos , Drogas Ilícitas/efectos adversos , Recién Nacido , Narcóticos/efectos adversos , Síndrome de Abstinencia Neonatal/diagnóstico , Síndrome de Abstinencia Neonatal/etiología , Síndrome de Abstinencia Neonatal/metabolismo , Síndrome de Abstinencia Neonatal/terapia , Tamizaje Neonatal/métodos , Formulación de Políticas , Embarazo , Complicaciones del Embarazo , Efectos Tardíos de la Exposición Prenatal , Proyectos de Investigación , Estudios Retrospectivos , Detección de Abuso de Sustancias/métodos , Trastornos Relacionados con Sustancias/diagnóstico , Trastornos Relacionados con Sustancias/metabolismoRESUMEN
PURPOSE: This study explored the experiences of NICU nurses in caring for infants with neonatal abstinence syndrome (NAS). DESIGN: A qualitative research approach was used with open-ended questions employing computer-assisted personal interviews. SAMPLE: Fourteen NICU nurses employed in a regional hospital provided responses. RESULTS: The nurses reflected a personal struggle between a desire to employ their technical and critical nursing skills and the need to provide expected maternal care to NAS infants. Other themes included frustration and burnout, challenges to values about parenting, and increased awareness of drug use in the community and at home. DISCUSSION: The results suggest that nurses underrate the skill required to care for infants with NAS. The level of knowledge, patience, and commitment to these newborns should be reframed to increase job satisfaction, and education should be offered to nurses about women struggling with addictions.