Mental health in Sexual Assault Referral Centres: A survey of forensic physicians.

A national survey of Forensic Physicians (FPs) working in Sexual Assault Referral Centres was undertaken. The survey was advertised in the weekly bulletin sent out by the Faculty of Forensic and Legal Medicine. Response was relatively low (n = 45). It is estimated that this figures represents about 12% of the workforce. The aim of the survey was to investigate FPs experience of accessing mental health pathways out of a SARC for complainants of all ages. The results concurred with a previous survey of SARC clinical managers with mental health services proving unresponsive. Informed co-commissioning between NHS England and Clinical Commissioning groups can only improve if aspects of complainant's mental health are routinely assessed within SARCs using structured outcome measures. Structured outcomes should be integrated into NHS England's Sexual Assault Referral Centres Indicators of Performance (SARCIP).

Assessment of the mental health status of a one year cohort attending a two Sexual Assault Referral Centres in England.

A one year audit was undertaken of the mental health (MH) status of adult attendees to the Thames Valley Sexual Assault Centres (SARC). There were 301 relevant referrals over the twelve month period of whom 126 (42%) either fully or partially completed the mental health assessments. 38% (n = 66) of the population did not consent to the research. Participation in the study was felt inappropriate by the case clinician in the rest of the cases. To summarise the findings: 36% were moderately or severely depressed; 30% experienced moderate to severe anxiety; 28% were drinking at hazardous/harmful levels; and 12% had a drug problem that was moderate to severe. Self harm affected 45% of the sample with the greater majority cutting themselves and self-harming before the age of 17. Admission to a psychiatric in-patient unit was not uncommon and 19% had been admitted an average of three times each. The figure of 19% admitted to a psychiatric hospital is 90 times higher than for the general female population. 42% of the total sample were being prescribed medication for their mental health problem. The paper concludes that: there should be agreement nationally on the use of a standardised set of mental health outcome measures which are used in all assessments; there should be a move towards the commissioning of expert psychological support that is offered in a SARC and the pathways for specialist mental health care out of the SARCs. Finally, forensic physicians and general practitioners needs a greater awareness of the mental health sequalae of sexual assault and they then need to make prompt referrals to the appropriate services.

Assessment of critical thinking: a Delphi study.

Nurse educators are responsible for preparing nurses who critically analyze patient information and provide meaningful interventions in today's complex health care system. By using the Delphi research method, this study, utilized the specialized and experiential knowledge of Certified Nurse Educators. This original Delphi research study asked Certified Nurse Educators how to assess the critical-thinking ability of nursing students in the clinical setting. The results showed that nurse educators need time, during the clinical experience, to accurately assess each individual nursing student. This study demonstrated the need for extended student clinical time, and a variety of clinical learning assessment tools.

Female genital injuries resulting from consensual and non-consensual vaginal intercourse.

OBJECTIVES: The purpose of this study was to compare the incidence of genital injury following penile-vaginal penetration with and without consent. DESIGN: This study compared observations of genital injuries from two cohorts. SETTING: Participants were drawn from St. Mary's Sexual Assault Referral Centre and a general practice surgery in Manchester, and a general practice surgery in Buckinghamshire. PARTICIPANTS: Two cohorts were recruited: a retrospective cohort of 500 complainants referred to a specialist Sexual Assault Referral Centre (the Cases) and 68 women recruited at the time of their routine cervical smear test who had recently had sexual intercourse (the Comparison group). MAIN OUTCOME MEASURES: Presence of genital injuries. RESULTS: 22.8% (n=00, 95% CI 19.2-26.7) of adult complainants of penile-vaginal rape by a single assailant sustained an injury to the genitalia that was visible within 48h of the incident. This was approximately three times more than the 5.9% (n=68, 95% CI 1.6-14.4) of women who sustained a genital injury during consensual sex. This was a statistically significant difference (a<0.05, p=0.0007). Factors such as hormonal status, position during intercourse, criminal justice outcome, relationship to assailant, and the locations, sizes and types of injuries were also considered but the only factor associated with injury was the relationship with the complainant, with an increased risk of injury if the assailant was known to the complainant (p=0.019). CONCLUSIONS: Most complainants of rape (n=500, 77%, 95% CI 73-81%) will not sustain any genital injury, although women are three times more likely to sustain a genital injury from an assault than consensual intercourse.

The applicability of measures of socioeconomic position to different ethnic groups within the UK.

BACKGROUND: In this paper we seek to tease out differences in socioeconomic position between ethnic groups. There are 3 main reasons why conventional socioeconomic indicators and asset based measures may not be equally applicable to all ethnic groups:1) Differences in response rate to conventional socioeconomic indicators2) Cultural and social differences in economic priorities/opportunities3) Differences in housing quality, assets and debt within socioeconomic strata METHODS: The sample consisted of White (n = 227), African-Caribbean (n = 213) and Indian and Pakistani (n = 233) adults aged between 18 and 59 years living in Leeds as measured in a stratified population survey. Measures included income, education, employment, car ownership, home ownership, housing quality, household assets, investments, debt, perceived ability to obtain various sums and perceived level of financial support given and received. RESULTS: Response rates to education and income questions were similar for the different ethnic groups. Overall response rates for income were much lower than those for education and biased towards wealthier people. There were differences between ethnic groups in economic priorities/opportunities particularly in relation to car ownership, home ownership, investment and debt. Differences in living conditions, household assets and debt between ethnic groups were dependent on differences in education; however differences in car ownership, home ownership, ability to obtain pound10 000, and loaning money to family/friends and income from employment/self employment persisted after adjustment for education. CONCLUSION: In the UK, education appears to be an effective variable for measuring variation in SEP across ethnic groups but the ability to account for SEP differences may be improved by the addition of car and home ownership, ability to obtain pound10 000, loaning money to family/friends and income from employment/self employment. Further research is required to establish the degree to which results of this study are generalisable.

The impact of different measures of socioeconomic position on the relationship between ethnicity and health.

PURPOSE: In this study we explicitly examine the effect of using asset-based and conventional measures of socioeconomic position (SEP) on ethnic differences in health. METHODS: The survey of white (n = 227), Indian and Pakistani (n = 233), and African Caribbean (n = 213) adults aged 18 to 59 years living in Leeds, United Kingdom aimed to examine the relationship between ethnicity, health, and SEP. SEP variables included perceived ability to get 10,000 pounds if needed, car ownership, level of education, and home ownership. Health variables included self-reported health status, presence of a long-term illness or disability, presence of limitations arising from a long-term illness or disability, one or more limitations in mobility, obesity, and being anxious, worried, or depressed. Logistic regression analysis was used to assess the relationship between ethnicity and SEP and health. Five models were run for each health variable so that the effects of changing the SEP measure could be ascertained. The first model included only ethnicity and the remaining 4 models tested the effects of the perceived ability to get 10,000 pounds, car ownership, level of education, and home ownership separately. RESULTS: The results suggest that the statistical inclusion of asset-based SEP measures, such as car ownership and ability to obtain 10,000 pounds, which reflect an individual's ability to mobilize resources, tend to increase ethnic differences in health, whereas more conventional steady-state indicators, such as education level and home ownership, tended to have little effect or to reduce ethnic differences in health. CONCLUSIONS: Overall, this study suggests that the choice of SEP measure may affect the conclusion of research on ethnicity and health and that choice of SEP measures should in turn be informed by the research problem being examined.

Discrimination and health in an English study.

In this study we examine the relationship between education, racial discrimination and health among white (n=227), African Caribbean (n=213) and Indian and Pakistani (n=233) adults aged between 18 and 59 years living in Leeds, England, as measured in a stratified population survey. Measures of discrimination included any physical attack, verbal abuse and a combined variable, any discrimination due to race, colour, ethnicity or sex. Analyses were conducted examining the relationship between education and discrimination, discrimination and health, and discrimination and health controlling for education. People educated above secondary level were more likely than people educated to secondary level or below to report being physically attacked, verbally abused and exposed to discrimination. People from minority ethnic groups (African Caribbean and Indian Pakistani) were more likely to be verbally abused and exposed to discrimination than the white group. Ethnicity and education interacted for African Caribbeans, such that respondents with post-school qualifications were more likely to report verbal abuse or any discrimination. There was no association between having been exposed to any kind of discrimination and having fair or poor health. Physical attack and any discrimination were associated with anxiety, worry and depression. The results remained unchanged when ethnicity and education were included in the models. Education and ethnicity were associated with differences in exposure to discrimination. In turn, exposure to discrimination was associated with higher levels of anxiety, worry or depression although there was no association between discrimination and health. The results support the contention that racial discrimination may play an important role in modifying the relationship between ethnicity, socioeconomic position and health. The counter-intuitive relationship between education and levels of reported discrimination in non-minority ethnic groups highlights the value of explicitly modeling discrimination to gain a better understanding of the social determinants of health.

Human subtelomeric duplicon structure and organization.

BACKGROUND: Human subtelomeric segmental duplications ('subtelomeric repeats') comprise about 25% of the most distal 500 kb and 80% of the most distal 100 kb in human DNA. A systematic analysis of the duplication substructure of human subtelomeric regions was done in order to develop a detailed understanding of subtelomeric sequence organization and a nucleotide sequence-level characterization of subtelomeric duplicon families. RESULTS: The extent of nucleotide sequence divergence within subtelomeric duplicon families varies considerably, as does the organization of duplicon blocks at subtelomere alleles. Subtelomeric internal (TTAGGG)n-like tracts occur at duplicon boundaries, suggesting their involvement in the generation of the complex sequence organization. Most duplicons have copies at both subtelomere and non-subtelomere locations, but a class of duplicon blocks is identified that are subtelomere-specific. In addition, a group of six subterminal duplicon families are identified that, together with six single-copy telomere-adjacent segments, include all of the (TTAGGG)n-adjacent sequence identified so far in the human genome. CONCLUSION: Identification of a class of duplicon blocks that is subtelomere-specific will facilitate high-resolution analysis of subtelomere repeat copy number variation as well as studies involving somatic subtelomere rearrangements. The significant levels of nucleotide sequence divergence within many duplicon families as well as the differential organization of duplicon blocks on subtelomere alleles may provide opportunities for allele-specific subtelomere marker development; this is especially true for subterminal regions, where divergence and organizational differences are the greatest. These subterminal sequence families comprise the immediate cis-elements for (TTAGGG)n tracts, and are prime candidates for subtelomeric sequences regulating telomere-specific (TTAGGG)n tract length in humans.

Facilities for complainants of sexual assault throughout the United Kingdom.

BACKGROUND: A sexual assault referral centre (SARC) is a model of service established to address the forensic and therapeutic needs arising following sexual assault. As yet, only a minority of urban areas in England are served by one, the rest of the United Kingdom (UK) being served by police victim examination suites. OBJECTIVE: To examine variations in service offered to complainants of sexual assault within the United Kingdom in 2005. METHODS: A purpose designed questionnaire sent to all areas of the United Kingdom. Data were received and analysed from 12 of 13 SARCs and 54 of 58 non SARC services. RESULTS: Very wide disparities in service, most marked between SARC and non SARC services. SARCs see a proportion of complainants from non-police sources. The non SARC services do not usually offer a forensic examination without police involvement, and a significant minority have so few doctors that they cannot provide a 24h rota for examinations. Inadequate numbers of forensic physicians are available for child examinations, and a robust service for 'acute child sexual assault' is virtually absent. Photodocumentation with appropriate safe storage is available in all SARCs, while 45% of non SARCs have no facility for photodocumentation. DNA contamination issues were perceived to be significant in many of non SARC services. Most non SARC services for adults do not provide baseline screening for sexually transmitted infection (STI) or offer prophylaxis against STIs. Follow up is by referral to local clinics which complainants may have to arrange themselves. Funded counselling is rare in the non SARCs with the exception of Yorkshire. CONCLUSION: In the non SARC services, lack of co-operative working with local health services, lack of equipment, and lack of 'in house' medical follow up arrangements is the norm. Many areas rely on the good will of a small number of doctors to provide a service without a rota.

Mapping and initial analysis of human subtelomeric sequence assemblies.

Physical mapping data were combined with public draft and finished sequences to derive subtelomeric sequence assemblies for each of the 41 genetically distinct human telomere regions. Sequence gaps that remain on the reference telomeres are generally small,well-defined,and for the most part,restricted to regions directly adjacent to the terminal (TTAGGG)n tract. Of the 20.66 Mb of subtelomeric DNA analyzed, 3.01 Mb are subtelomeric repeat sequences (Srpt),and an additional 2.11 Mb are segmental duplications. The subtelomeric sequence assemblies are enriched >25-fold in short,internal (TTAGGG)n-like sequences relative to the rest of the genome; a total of 114 (TTAGGG)n-like islands were found,55 within Srpt regions,35 within one-copy regions,11 at one-copy/Srpt or Srpt/segmental duplication boundaries,and 13 at the telomeric ends of assemblies. Transcripts were annotated in each assembly,noting their mapping coordinates relative to their respective telomere and whether they originate in duplicated DNA or single-copy DNA. A total of 697 transcripts were found in 15.53 Mb of one-copy DNA,76 transcripts in 2.11 Mb of segmentally duplicated DNA,and 168 transcripts in 3.01 Mb of Srpt sequence. This overall transcript density is similar (within approximately 10%) to that found genome-wide. Zinc finger-containing genes and olfactory receptor genes are duplicated within and between multiple telomere regions.