Factors associated with the sexual assault of students: an exploratory study of victims treated at hospital-based sexual assault treatment centers.

Research suggests that students experience high levels of sexual assault, but studies addressing how they differ in their experiences from other sexual assault victims are virtually nonexistent. To address this gap, information was collected from consecutive individuals, aged 16 years or older, presenting to one of 7 hospital-based sexual assault treatment centers in Ontario from 2005 to 2007. Of the 882 victims seen during the study period, 32% were students. Relative to other sexual assault victims, students were more likely to be aged 16 to 18 years and 19 to 24 years versus 25 years and older. They were more likely to be living alone, with family of origin, a partner or spouse, or a nonrelative than on the street or in a shelter or institution. They were also more likely to report having consumed over-the-counter medication in the 72 hours prior to examination. Student victims were less likely than nonstudent victims to report having a disability and having used street drugs. Implications for research, education, and practice are discussed.

Efficacy and safety of sirolimus in lymphangioleiomyomatosis.

BACKGROUND: Lymphangioleiomyomatosis (LAM) is a progressive, cystic lung disease in women; it is associated with inappropriate activation of mammalian target of rapamycin (mTOR) signaling, which regulates cellular growth and lymphangiogenesis. Sirolimus (also called rapamycin) inhibits mTOR and has shown promise in phase 1-2 trials involving patients with LAM. METHODS: We conducted a two-stage trial of sirolimus involving 89 patients with LAM who had moderate lung impairment--a 12-month randomized, double-blind comparison of sirolimus with placebo, followed by a 12-month observation period. The primary end point was the difference between the groups in the rate of change (slope) in forced expiratory volume in 1 second (FEV(1)). RESULTS: During the treatment period, the FEV(1) slope was -12±2 ml per month in the placebo group (43 patients) and 1±2 ml per month in the sirolimus group (46 patients) (P<0.001). The absolute between-group difference in the mean change in FEV(1) during the treatment period was 153 ml, or approximately 11% of the mean FEV(1) at enrollment. As compared with the placebo group, the sirolimus group had improvement from baseline to 12 months in measures of forced vital capacity, functional residual capacity, serum vascular endothelial growth factor D (VEGF-D), and quality of life and functional performance. There was no significant between-group difference in this interval in the change in 6-minute walk distance or diffusing capacity of the lung for carbon monoxide. After discontinuation of sirolimus, the decline in lung function resumed in the sirolimus group and paralleled that in the placebo group. Adverse events were more common with sirolimus, but the frequency of serious adverse events did not differ significantly between the groups. CONCLUSIONS: In patients with LAM, sirolimus stabilized lung function, reduced serum VEGF-D levels, and was associated with a reduction in symptoms and improvement in quality of life. Therapy with sirolimus may be useful in selected patients with LAM. (Funded by the National Institutes of Health and others; MILES ClinicalTrials.gov number, NCT00414648.).

Drug-facilitated sexual assault in Ontario, Canada: toxicological and DNA findings.

The purpose of this study was to determine which persons reporting sexual assault to a hospital-based treatment centre may have been covertly drugged and to provide information about whether a sexual assault may have occurred. Each consecutive adolescent and adult presenting at a sexual assault treatment centre was screened for drug-facilitated sexual assault (DFSA). Urine was collected and tested for central nervous system active drugs. Oral, vaginal, and/or rectal swabs were tested for male DNA. Unexpected drugs were defined as those not reported as having been voluntarily consumed within the previous 72 h. Positive swabs for unexpected DNA were determined by whether the person reported having had consensual intercourse in the previous week. A total of 184 of 882 eligible participants met suspected DFSA criteria. Mean age was 25.8 years (SD=8.5), 96.2% were female and 64.7% White. Urine samples were positive for drugs in 44.9% of cases, alcohol in 12.9%, and both drugs and alcohol in 18.0%. The drugs found on toxicological screening were unexpected in 87 of the 135 (64.4%) cases with a positive drug finding and included cannabinoids (40.2%), cocaine (32.2%), amphetamines (13.8%), MDMA (9.2%), ketamine (2.3%), and GHB (1.1%). Male DNA was unexpected in 30 (46.9%) of 64 cases where it was found. Among those persons presenting to a sexual assault treatment centre with a suspicion of DFSA, the presence of unexpected drugs and male DNA was common, lending support for their contention that they had been intentionally drugged and sexually assaulted. Most unexpected drugs found were not those typically described as 'date rape drugs'.

Factors associated with child witnessing of intimate partner violence in Canada.

Knowing the characteristics associated with child exposure to spousal abuse could aid in early identification of at-risk children. The purpose of our study is to determine possible factors associated with child witnessing of intimate partner violence (IPV) in Canada using data from the 1999 General Social Survey, a representative telephone survey of Canadians aged 15 years and older. Respondents reporting IPV in the five years prior to the survey were asked whether a child had witnessed the incident. Multivariate logistic regression was used to determine the association between child witnessing of IPV and victim, assault, and help-seeking characteristics. Households in which child witnessing of IPV was reported were distinguished by the following factors: female respondent, visible minority, over age 30, separated, divorced, or widowed, low income, and the presence of children aged 0-14 years. Other significant variables associated with child witnessing of IPV were related to the frequency, reporting, and disclosure of violent incidents.

Help-seeking behavior for intimate partner violence among racial minority women in Canada.

INTRODUCTION: Intimate partner violence (IPV) is experienced by women of all ethnoracial backgrounds. Despite the serious adverse impacts of IPV on women's lives, many abused women do not seek help. The main objective of this paper was to determine whether a woman's racial minority status was a significant predictor of help-seeking for IPV after controlling for other factors associated with help-seeking. METHODS: Data from a national Canadian, cross-sectional, telephone survey were used. Help-seeking variables included disclosure of IPV, reporting IPV to police, the use of social services subsequent to IPV, and barriers to social service use. RESULTS: In the bivariate analyses, rates of disclosure and reporting to police were similar for racial minority and white women, however, racial minority women, compared to white women, were significantly less likely to use social services. After adjustment for age, marital status, household income, number of young children at home, immigration status, household language, and severity of IPV, racial minority status was not a significant predictor of help-seeking in the multivariate analysis. DISCUSSION: Our findings suggest that further investigation is necessary to understand what aspects of membership in a racial minority group or sytemic factors may be contributing to inequalities in accessing help for IPV.

Factors associated with suspected drug-facilitated sexual assault.

BACKGROUND: There has been little systematic investigation of widespread reports of drugging and sexual assault. We sought to determine the prevalence of and factors associated with suspected drug-facilitated sexual assault. METHODS: Between June 2005 and March 2007, a total of 977 consecutive sexual assault victims underwent screening for suspected drugging at 7 hospital-based sexual assault treatment centres. We defined victims of drug-facilitated sexual assault as those who presented to a centre within about 72 hours of being assaulted and who provided at least 1 valid reason for suspecting that she or he had been drugged and sexually assaulted. We used logistic regression modelling to compare victims of suspected drug-facilitated sexual assault with other sexual assault victims, controlling for covariates. RESULTS: In total, 882 victims were eligible for inclusion in the study. Of these, 855 (96.9%) were women, and 184 (20.9%) met the criteria for suspected drug-facilitated sexual assault. Compared with other victims, victims of drug-facilitated sexual assault were more likely to have presented to a large urban centre for care (odds ratio [OR] 2.31, 95% confidence interval [CI] 1.47-3.65), to be employed (OR 1.92, 95% CI 1.34-2.76), to have consumed over-the-counter medications (OR 3.97, 95% CI 2.47-6.38) and street drugs (OR 1.71, 95% CI 1.12-2.62) in the 72 hours before being examined and to have used alcohol before the assault (OR 4.00, 95% CI 2.53-6.32). INTERPRETATION: Suspected drug-facilitated sexual assault is a common problem. Sexual assault services should be tailored to meet the needs of those experiencing this type of victimization.

Pregnancy experiences among women with lymphangioleiomyomatosis.

Lymphangioleiomyomatosis (LAM) is a rare lung disease affecting women. Following case reports that pregnancy exacerbates LAM, patients are frequently advised to avoid pregnancy. Our objective was to determine pregnancy and health outcomes in LAM to provide better evidence with which to council patients contemplating pregnancy. We surveyed 328 women with LAM regarding pregnancy outcomes, pulmonary function, subjective and psychological functioning, quality of life, dyspnoea and fatigue. Amongst childless women the main reason not to attempt pregnancy was based on concerns about potential effects of pregnancy on LAM. Almost two thirds of patients had been pregnant, the majority before LAM was diagnosed, in whom pregnancy outcome was generally favourable. Women diagnosed with LAM (n=15) during pregnancy had high rates of pneumothorax (67%), miscarriage (7%) and premature birth (47%). The group diagnosed with LAM before or during pregnancy (n=12) had lower mean FEV(1), FVC and DLCO after pregnancy compared with those diagnosed following pregnancy or never pregnant. There were no differences in subjective or psychological functioning, quality of life, dyspnoea or fatigue scores between groups. In newly diagnosed LAM patients there was a high incidence of premature birth and pneumothorax. These adverse outcomes may be a marker of aggressive LAM.

Gender and psychotropic medication use: the role of intimate partner violence.

OBJECTIVE: Women are known to use more psychotropic medications than men which may be linked to women's greater exposure to intimate partner violence (IPV). METHOD: The use of medications for sleep, depression and anxiety in adults in the 1999 Canadian General Social Survey was assessed. Rates of medication use by adults exposed to IPV (physical, sexual, emotional and financial) were compared to rates of those reporting no IPV. RESULTS: More women (14.9%) than men (9.6%) reported use of psychotropic medications in the preceding month. Rates were significantly higher in both women and men who reported IPV. This link was still present after key sociodemographic and health predictors of medication use were held constant. CONCLUSION: This random population based study provides the first data to support the idea that IPV may explain at least some of the increased psychotropic medication use by women. IPV should be included as a predictor variable in future studies investigating psychotropic medication use which itself can be added to the list of adverse health risks of IPV.

Gender differences in the symptoms of major depressive disorder.

Data from the Canadian Community Health Survey 1.2 were used for a gender analysis of individual symptoms and overall rates of depression in the preceding 12 months. Major depressive disorder was assessed using the Composite International Diagnostic Interview in this national, cross-sectional survey. The female to male ratio of major depressive disorder prevalence was 1.64:1, with n = 1766 having experienced depression (men 668, women 1098). Women reported statistically more depressive symptoms than men (p < 0.001). Depressed women were more likely to report "increased appetite" (15.5% vs. 10.7%), being "often in tears" (82.6% vs. 44.0%), "loss of interest" (86.9% vs. 81.1%), and "thoughts of death" (70.3% vs. 63.4%). No significant gender differences were found for the remaining symptoms. The data are interpreted against women's greater tendency to cry and to restrict food intake when not depressed. The question is raised whether these items preferentially bias assessment of gender differences in depression, particularly in nonclinic samples.

Who is most at risk for intimate partner violence? A Canadian population-based study.

Whole population studies on intimate partner violence (IPV) have given contradictory information about prevalence and risk factors, especially concerning gender. The authors examined the 1999 Canadian General Social Survey data for gender patterns of physical, sexual, emotional, or financial IPV from a current or ex-partner. More women (8.6%) than men (7.0%, p = .001) reported partner physical abuse in general, physical IPV causing physical injury (p < .0001), sexual abuse (1.7% vs. 0.2%, p < .0001), and financial abuse (4.1% vs. 1.6%, p < .0001). There were no gender differences for partner emotional abuse. Significant risk factors after multivariate modeling for physical/sexual IPV were younger age, being divorced/separated or single, having children in the household, and poor self-rated physical health. These findings from a large, randomly generated data set further refine our understanding of the risk profile for IPV in the developed world.

Air travel in women with lymphangioleiomyomatosis.

BACKGROUND AND OBJECTIVE: The safety of air travel in patients with pneumothorax-prone pulmonary diseases, such as lymphangioleiomyomatosis (LAM), has not been studied to any great extent. A questionnaire-based evaluation of air travel in patients with LAM was conducted to determine experiences aboard commercial aircraft. METHODS: A survey was sent to women listed in the US LAM Foundation registry (n = 389) and the UK LAM Action registry (n = 59) to assess air travel, including problems occurring during flight. Women reporting a pneumothorax in flight were followed up to ascertain further details about the incident. RESULTS: 327 (73%) women completed the survey. 308 women answered the travel section, of whom 276 (90%) had "ever" travelled by aeroplane for a total of 454 flights. 95 (35%) women had been advised by their doctor to avoid air travel. Adverse events reported included shortness of breath (14%), pneumothorax (2%, 8/10 confirmed by chest radiograph), nausea or dizziness (8%), chest pain (12%), unusual fatigue (11%), oxygen desaturation (8%), headache (9%), blue hands (2%), haemoptysis (0.4%) and anxiety (22%). 5 of 10 patients with pneumothorax had symptoms that began before the flight: 2 occurred during cruising altitude, 2 soon after landing and 1 not known. The main symptoms were severe chest pain and shortness of breath. DISCUSSION AND CONCLUSION: Adverse effects occurred during air travel in patients with LAM, particularly dyspnoea and chest pain. Hypoxaemia and pneumothorax were reported. The decision to travel should be individualised; patients with unexplained shortness of breath or chest pain before scheduled flights should not board. Patients with borderline oxygen saturations on the ground should be evaluated for supplemental oxygen therapy during flight. Although many women had been advised not to travel by air, most travelled without the occurrence of serious adverse effects.

Help-seeking rates for intimate partner violence (IPV) among Canadian immigrant women.

We examined rates of help seeking for intimate partner violence (IPV) among recent (0-9 years in Canada) and non-recent (10+ years in Canada) immigrant women. Data from a national, cross-sectional, telephone survey were used. Help-seeking variables included disclosure of IPV, reporting IPV to police, use of social services subsequent to IPV, and barriers to social service use. Recent immigrant women, compared with non-recent immigrant women, were significantly more likely to report IPV to police and less likely to use social services. Findings have important implications for prevention and detection of IPV in immigrant communities and in future research.

Adding insult to injury: intimate partner violence among women and men reporting activity limitations.

PURPOSE: Women with activity limitations (ALs) are at risk for Intimate partner violence (IPV). This study examined IPV in men versus women with ALs. METHODS: Data from the Canadian 1999 General Social Survey compared physical, sexual, emotional, and financial IPV from a current/expartner in 5 years for men and women with ALs compared with those without ALs. Logistic regression examined sex differences in IPV among those with ALs, adjusting for sociodemographic factors. RESULTS: Rates of physical (11.9% versus 7.8%; p < 0.0001), sexual (3.5% versus 1.4%; p < 0.0001), emotional (27.1% versus 17.7%; p < 0.0001), and financial (7.5% versus 3.4%; p < 0.0001) IPV were greater in women with compared with without ALs. A similar pattern was seen for men, with greater rates of physical (9.2% versus 6.6%; p = 0.006), emotional (22.6% versus 18.2%; p = 0.002), and financial (2.6% versus 1.4%; p = 0.005) IPV in men with ALs than men without ALs. Risk factors for IPV included younger age, being divorced/separated or single, and having lower income and poorer health. Women with ALs were more likely than men to experience any IPV (29.1% versus 24.9%) and more severe and more incidents of IPV. In multivariable analysis, women were no longer at greater risk for "any IPV" after adjusting for sociodemographic variables (odds ratio = 1.09; 95% confidence interval, 0.88-1.36). CONCLUSION: This is the first study to document IPV rates in men with ALs. Women with ALs were more likely to be divorced/separated, living in poverty, and in poorer health than men with ALs. These factors accounted for sex differences in IPV rates.

The association between length of stay in Canada and intimate partner violence among immigrant women.

OBJECTIVE: We examined the prevalence of intimate partner violence (IPV) among recent (0-9 years) and nonrecent (>/= 10 years) immigrant women in Canada to determine whether differences in IPV were associated with length of stay in Canada. METHODS: We analyzed data from the 1999 General Social Survey, a national cross-sectional telephone survey. We used weighted logistic regression analysis to examine the effect of length of stay in Canada on IPV and controlled for socio-cultural and other factors associated with IPV. RESULTS: The crude prevalence of IPV was similar among recent and nonrecent immigrant women. However, after adjustment, the risk for IPV was significantly lower among recent immigrant women compared with nonrecent immigrant women. Country of origin, age, marital status, and having an activity limitation (physical/mental disability or health problem) also were associated with a higher risk for IPV. CONCLUSIONS: Our findings have important implications for both prevention and detection of IPV among immigrant women.

Intimate partner violence among Canadian women with activity limitations.

OBJECTIVE: To determine the prevalence of intimate partner violence (IPV) in the previous five years among women reporting activity limitations (AL). DESIGN AND SETTING: A community based, representative telephone survey of Canadians aged 15 and over. AL was assessed by the question: "Does a long term physical or mental condition or health problem reduce the amount or the kind of activity that you can do at home, at school, at work or in other activities?" Response categories were: often, sometimes, or never. PARTICIPANTS: 8771 women who had a current/former partner of whom 1483 reported AL. MAIN RESULTS: IPV was reported more often for AL (often or sometimes) compared with no AL women (emotional abuse (27.1, 26.4 v 17.7%, p<0.0001), physical-severe (7.3, 6.7 v 3.6%, p<0.0001), sexual abuse (3.5, 3.6 v 1.4%, p<0.0001)), or any IPV (30.5, 27.8 v 19.6%, p<0.0001). Adjusting for age, marital status, education, income, employment, children in the household, Aboriginal or visible minority status, place of birth, urban or rural residence, region of Canada, time in current residence, and religious attendance, AL women had higher odds of IPV (adjusted odds ratio: AL often=2.12; 95% CI: 1.64, 2.74; AL sometimes: OR=1.64; 95% CI:1.40, 2.29). CONCLUSION: These findings call for increased recognition of violence that occurs in the lives of women with AL. This community based study suggests that abuse among those reporting AL is high. Women with AL represent a high risk group to be targeted in terms of IPV prevention and intervention.

Changing help-seeking rates for intimate partner violence in Canada.

The adverse physical and psychological sequelae of intimate partner violence (IPV) are well documented, as are government initiatives in Canada since the early 1990s to address the problem through public awareness campaigns and service enhancement programs. While these initiatives have been designed to encourage abused women to come forward, there has been little research examining changes over time in help-seeking rates among this group. To fill this void, we compared data from two large Canadian population-based, cross-sectional telephone surveys: the 1993 Violence Against Women Survey (1993-VAWS) and the 1999 General Social Survey (1999-GSS). Among women who reported physical and/or sexual violence by a current or previous partner, we examined differences in rates of disclosure of abuse, help-seeking by type of service, and barriers to service use. Abused women in the 1999-GSS were significantly more likely than those in the 1993-VAWS to have reported disclosing a violent incident(s) to a family member (66.4% v. 43.9%), friend or neighbor (67.4% v. 45.4%), doctor or nurse (31.9% v. 23.0%), and/or minister, priest, or cleric (11.5% v. 7.3%). The 1999-GSS cohort was also more likely to have presented to a shelter or transition house (11.0% v. 7.8%), a crisis center (17.3% v. 4.2%), a counselor or psychologist (39.1% v. 14.7%), a women's center (11.2% v. 3.4%), and/or a community or family center (15.4% v. 4.7%). Among those women who did not seek help, fewer in the 1999-GSS reported that they did not know of any services (6.4% v. 17.0%), or that services were not available (0.8% v. 14.5%). Although we found a demonstrable increase in the numbers of abused women seeking help, overall, rates of service utilization were still low as late as 1999, highlighting the importance of continued government commitment to funding IPV initiatives.

Predictors of women's physical health problems after childbirth.

The objectives of this study were to document the extent and the correlates of common physical health symptoms in women two months after childbirth. Of special interest was determining whether violence and depression histories increase the risk for experiencing these symptoms. Participants were recruited in six Toronto-area hospitals and were interviewed by telephone 8-10 weeks later. Two hundred of the 332 (60.2%) women who were approached completed the study. Most women (96%) reported at least one physical health symptom 2 months postnatally (Mean = 3.4, SD = 2.0). Stepwise logistic regression was conducted for each outcome. Antenatal depression was a significant predictor of excessive fatigue and bad headaches. Sick leave during pregnancy predicted postpartum backaches. Adult emotional abuse and household income were associated with bowel problems. Episiotomy, maternal complications, and planned pregnancy predicted perineal pain. Finally, being Canadian born and having an assisted vaginal delivery increased the risk for hemorrhoids while cesarean section decreased the risk. A high prevalence of physical symptoms was found in women after childbirth. History of depression and violence were implicated in the occurrence of some of these symptoms. Other important predictors included demographic, maternal, and delivery-related factors.

Patients' perceptions versus medical testing of function in women with lymphangioleiomyomatosis (LAM).

Lymphangioleiomyomatosis (LAM), a rare pulmonary disease that occurs primarily in women is characterized by progressive cystic lung lesions causing respiratory failure, which may require lung transplantation. It has been observed that in diseases of the lungs, objective medical tests frequently do not translate to subjective functional status. However, patient's perceptions of functional status directly impact quality of life. In order to evaluate this relationship in LAM, a cross sectional study of 31 lung transplant candidates and 43 lung transplant recipients with LAM was conducted to evaluate functional status. Objective tests (Pulmonary function tests, PFTs, 6 min walk) were obtained in 19 candidates and 23 recipients, and subjective function was assessed in all women using the Functional Performance Inventory. For both groups statistically significant relationships emerged between forced vital capacity with subjective measures of function including total, social and recreational function (P < 0.05). As well diffusing capacity related significantly to total function, ability to maintain household chores, body care, and social function (P < 0.05), where higher scores were associated with better subjective function. Forced expiratory volume in one second was not found to significantly relate to subjective function in these groups, except the physical exercise domain in transplant recipients. However, despite better PFT results in double lung transplant recipients, no differences were found in subjective measures of function between single and double lung recipients. Results suggest that clinicians need to better recognize that certain aspects of spirometry/6 min walk tests do not necessarily correlate well with patient's perceptions of their function. This has implications for the assessment and follow-up of women living with LAM; considering subjective aspects of function may help focus interventions and improve quality of life.

What determines patient satisfaction with cataract care under topical local anesthesia and monitored sedation in a community hospital setting?

The Iowa Satisfaction with Anesthesia Scale (ISAS) is a reliable and valid tool to measure patient satisfaction with monitored anesthesia care. We used the ISAS to discover determinants of patient satisfaction with cataract care under topical local anesthesia and monitored sedation in a small community hospital. The ISAS (scored 1 to 6) was administered to 306 patients immediately after cataract surgery. All patients received topical local anesthesia and IV sedation administered by an anesthesiologist. Patient satisfaction was high: mean ISAS was 5.6 (sd 0.46; range: 3.3-6.0). The incidence of intraoperative and postoperative pain was 13% and 37%; other adverse events were infrequent (<5%). In multivariable logistic regression, significant predictors of satisfaction were postoperative pain (odds ratio [OR]: 4.84; 99% confidence interval [CI]: 2.21, 10.60), surgeon (OR: 0.21; 99% CI: 0.05, 0.91), and preoperative anxiety (OR: 1.17; 99% CI: 1.03, 1.34). ISAS mean scores (OR = 0.28; 99% CI: 0.13, 0.59) and preoperative anxiety (OR = 1.12; 99% CI: 0.99, 1.28) emerged as significant predictors of low rating of quality of experience. Our results indicate that the ISAS can be used to track patient satisfaction with monitored cataract care. Pain during and after cataract surgery is common and is a major reason for lower patient satisfaction with their cataract care.

Violence against Canadian Women.

HEALTH ISSUE: Exposure to violence as children or as adults places a woman at higher risk of poor health outcomes, both physical and psychological. Abused women use more health care services and have poorer social functioning than non-abused women. Knowledge of the prevalence of violence against women, and of which women are at risk, should assist in the planning of services for abuse prevention and treatment of the health consequences of abuse. KEY FINDINGS: The highest rates of any partner violence were in Alberta (25.5%) and British Columbia (23%). The lowest rates were in Ontario (18.8%). Women aged 15-24 had the highest rates in all regions in Canada, compared with older women. Aboriginal women in Manitoba/Saskatchewan and Alberta had higher rates of violence (57.2% and 56.6% respectively) than non-Aboriginal women (20.6%). Lower rates of partner-related violence were reported among women not born in Canada (18.4%) than among Canadian-born women (21.7%). Visible minority women reported lower rates of lifetime sexual assault (5.7%) than non-visible minority women (12.3%). Perceptions of violence may vary by ethnicity. DATA GAPS AND RECOMMENDATIONS: More information is required concerning the prevalence of violence among Aboriginal women, immigrant and refugee women, women with disabilities, lesbian women and pregnant women. Future national population-based surveys need better questions on the health consequences of violence and related resource utilization. Further research is needed to identify the health care system's role in prevention, management and rehabilitation as they relate to violence against women. Future programs and policies must be based on valid, reliable and comprehensive empirical data.