Lecture 10: Violence Flashcards
Define human trafficking
Use of force, coercion, or fraud to obtain some form of labor or commercial sex act
3rd most profitable transnational crime
What is the MC demographic of a trafficked human?
Female minor
55-70% female, 50% are minors
What are the 3 methods traffickers primarily use to ensnare victims?
- Threats
- Manipulation
- Control
What are the warning signs of human trafficking? (4)
- Personal behaviors (disconnected, missing school/work)
- Abuse/Neglect
- Living situation (unstable, lack of personal items)
- Suspicious presentation (controlling partner, “coached”)
What should we do if we suspect human trafficking?
- Call the feds: 1-866-347-3423
- Build rapport
- Only call local law if immediately life-threatening
What % of domestic violence victims are female?
85%
Overall, 21% of violent crime experienced by Females is DV/IPV
How common is IPV occurring per minute?
24 people PER MIN
What is the MC form of IPV for males? Females?
- Males: Physical violence
- Females: Multiple forms
How common is sequelae after IPV/DV for both men and women?
- Women: 27%
- Men: 12%
Sequelae: PTSD, injury, IBS, mental health
When does victimization often occur by? (age)
25
What is the average length of victimization before presentation to healthcare providers or police?
4 years
How high is the estimate that an american woman will be physically assaulted by a partner or ex-partner?
1/5
What races are considered RFs for DV/IPV?
- AA
- Indigenous
What is the leading cause of death among pregnant women?
Homicide
When is IPV more frequent, severe, and at a high risk for homicide?
Pregnancy
What age is the highest risk for DV/IPV?
16-24
Prior to age 25
What are the S/S that may increase suspicion for DV/IPV? (6)
- Chronic, vague pelvic pain
- Sexual dysfunction (decreased libido, dyspareunia, anorgasmia)
- Chronic/recurrent vaginitis
- Anxiety/tearfulness prior to pelvic/breast exam
- Persistent multiple bodily complaints
- Psychiatric complaints
Essentially, vague complaints
How common is DV during pregnancy?
4-9%
More common than preeclampsia, gestational DM<, or placenta previa
How accurately do practitioners identify women experiencing DV?
1 in 20
What are the 4 steps in the cycle of abuse?
- Tensions building
- Incident
- Reconciliation
- Calm
What is the single most important thing a provider can do for a battered woman?
Ask about violence
Screen everyone
When should non-pregnant women be screened for DV?
- Routine OB/GYN visits
- Family planning visits
- Preconception visits
When should pregnant women be screened for DV?
- First prenatal visit
- EVERY TRIMESTER
- Postpartum checkup
How should we approach screening for DV/IPV?
- Establish that screening is universal.
- Direct questioning
- Face to face
- Specific descriptions
Actually ask do you get hit, pushed, etc
What are some of the screening tools we can use to assess for DV?
- HITS (Hurt, insult, threaten, screen)
- WAST (woman abuse screening tool) (scoring)
- PVS (Partner violence screen)
When is mandatory reporting indicated generally?
Generally, any injury that seems like it was caused illegally (firearm, stabbing, arson)
State dependent
What are some ways we can help prevent DV?
- Offer shelter
- Pocket cards with suggested safety/exit plans
- Educational materials and resources
When do acquaintance rapes typically occur during?
Adolescence
What is statutory rape?
Sexual intercourse with a female under an age specified by state law
WV is 16 for age of consent.
Where is child sexual abuse mandated to be reported?
All 50 states.
What clinical findings could suggest sexual assault?
- Complaints of being “mugged”
- Concerns over STDs or AIDS
- Psych complaints
- Must obtain a sexual history!!
How common are obvious physical findings in sexual assault?
only 30-40% have obvious injuries.
Most will be minor.
What physical exam sign is MC among sexual assault victims?
Vaginal irritation
More likely than any other sign. > 50% of victims.
What are the MC nongenital injuries seen in sexual assault?
Bruises, cuts, scratches, swelling
What is the acute phase of the rape-trauma syndrome + associated symptoms?
- Distortion/paralysis of coping mechanism
- Complete loss of control to unnatural calm
- Somatic symptoms: disturbed eating/sleep, GI irritability, MSK soreness, fatigue, etc
Wide range; like they’re in shock/petrified
How long does the acute phase of rape-trauma syndrome typically last?
Up to 2 weeks.
What are some of the common sequelae of delayed phase rape-trauma syndrome?
- PTSD (common long-term)
- Psychologic distress (mistrust of others, phobias, depression)
- SI (33-50%)
- Substance abuse
- Depression
How common is a suicidal attempt for patients that were raped that did not seek tx?
1 in 5
If a victim presents to you with evidence of sexual assault, what are your responsibilities?
You are both medically and legally responsible.
Can request assistance from a sexual assault nurse examiner (SANE)
Need hx, kits, full PE
Why are bite marks useful in evidence collection for sexual assault?
They can leave DNA evidence.
What kind of lubricant is preferred for a speculum during a pelvic exam for sexual assault?
Sterile saline
Don’t want to interfere with any DNA collection.
How soon do you f/u regarding sexual assault?
2 weeks
Recheck PE and collect specimens
What tx can we offer for an SA victim?
- Tx any physical injuries as appropriate
- Emergency contraception
- STI tx: Rocephin + Metro + Doxy + HPV vaccinations
- Psych (even if they seem calm at the moment)
When is sexual assault awareness month?
April
