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Women's health > Violence > Flashcards

Violence Flashcards

1
Q

Use of force, coercion, or fraud to obtain some form of labor or commercial sex act
- “Modern day slavery;” Sexual exploitation, labor, organ - Labor thought to be more common, but less reported
- 3rd most profitable form of transnational crime

A

Human Trafficking

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2
Q

human trafficking is esp prevalent where?

A

large, multicultural cities

  • NE - Washington DC, New York
  • MW - Detroit, Chicago, St. Louis
  • SE - Atlanta, Miami, Tampa, Orlando
  • SW - Houston, Dallas, Fort Worth, Las Vegas
  • West - San Diego, San Francisco, LA, Seattle, Denver

HOWEVER…can also be present in smaller communities!

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3
Q

what % of victims of human trafficking are female? are minors?

A
  • 55-70% are female
  • 50% are minors

Any age, race, gender, or nationality, including US citizens

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4
Q

Who Falls Victim to Trafficking?

A

People with little or no “safety net” are especially vulnerable to human trafficking!

  • Economic hardship
  • Violence in the home
  • Unhoused individuals
  • Natural disasters
  • Political instability
  • Undocumented immigrants
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5
Q

Traffickers use a variety of tactics to ensnare victims, including… (3)

A
  1. threats: Violence or threats toward the victim or his/her family members; Controlling individual’s identification documents; Threatening deportation or law enforcement action
  2. manipulation: False promises of love, companionship, a good job, a safe home, etc; Restricted social contact
  3. control: Limited freedom of movement; Garnishing the person’s salary to pay off “debts;” Depriving victim of basic necessities
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6
Q

warning signs of human trafficking

A
  1. Personal Behaviors: Social disconnect; Failure to attend school or work; Sudden or dramatic change in behavior
  2. Abuse/Neglect: Signs of mental or physical abuse; Signs of being denied basic necessities
  3. Living Situation: Living in unsuitable conditions; Lack of personal possessions; Unstable living situation
  4. Suspicious presentation: Accompanied by a controlling individual;“Coached” history
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7
Q

If you suspect Human Trafficking, what do you do?

A
  1. Contact federal law enforcement - 1-866-347-3423 or http://www.ice.gov/tips
  2. Provide patient with reporting information
  3. Take time to build rapport with patient
  4. If immediate, life-threatening situation, may need to contact local law enforcement
  5. Document, document, document
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8
Q

Roughly ?% of domestic violence (DV) victims are female

A

85%

  • “Significant and sustained harm”
  • Consider underreporting and repeat offenses
  • Increasing numbers of male victims
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9
Q

How many men and women are victims of severe IPV in their lifetime?

A

1 in 7 men
1 in 4 women

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10
Q

How many men and women have been stalked?

A

1 in 19 men
1 in 6 women

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11
Q

How many men and women have been victims of rape/attempted rape?

A

1 in 33 men
1 in 6 women

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12
Q

How many men and women have experienced sexual violence victimization (other than rape) in their lifetime?

A

1 in 5 men
1 in 2 women

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13
Q

?% of women and ?% of men who experience sexual violence, stalking or other IPV report sequelae
PTSD, injury, IBS, and other poor mental or physical health

A

27%
12%

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14
Q

threatening, controlling, or harmful behavior imposed on a victim in a domestic or household setting without regards for the victim’s rights, feelings, body or health

A

Domestic Violence (DV)

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15
Q

Average length of victimization before presentation to health care providers or police?

A

4 years

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16
Q

Estimated at least ? of all American women will be physically assaulted by a partner or ex-partner during their lifetime

A

1/5

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17
Q

repeated pattern of harmful, threatening or controlling behavior as above

A

abuse

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18
Q

threats, harm, or controlling inflicted between intimate partners

A

Intimate Partner Violence (IPV)

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19
Q

Risk Factors for DV/IPV

A
  1. race - MC AA & Indigenous
  2. pregnancy - IPV is more frequent, more severe, and higher risk of homicide
  3. age - 16-24 y/o
  4. substance abuse
  5. prior exposure to violence
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20
Q

what is the leading cause of death among pregnant women

A

Homicide

Roughly 4-9% of pregnant women experience some form of IPV

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21
Q

s/s of DV

A
  • Chronic Pelvic Pain
  • Sexual Dysfunction - decreased libido or arousal, dyspareunia, anorgasmia
  • Chronic or recurrent vaginitis
  • Anxiety or tearfulness before or during pelvic or breast examination
  • persistent multiple bodily complaints
  • Psych - depression; PTSD; personality disorders; dissocative identity; substance use; anxiety
22
Q

DV - Persistent multiple bodily complaints may mee the criteria for what disorder?

A

somatoform disorder

23
Q

Domestic violence in ?% of pregnancies
MC than what other conditions in pregnancy? (3)

A

4-9%

MC than preeclampsia, gestational DM, placenta previa

24
Q

DV/IPV leads to what consequences to pregnant women?

s/s of pregnancy

A
  1. Increased physical and psychological stress
  2. Inadequate prenatal care utilization
  3. Poor nutrition and weight gain
  4. Increased maternal behavioral risks - tobacco, alcohol, illicit drug use
25
Q

result of physical trauma to pregnancy

A
  1. placental abruption
  2. preterm labor
  3. preterm premature ROM
  4. maternal and fetal injuries or death
26
Q

As few as ? women experiencing DV are correctly identified by the practitioner to whom they turn for help

A

1 in 20

27
Q

Barriers to Diagnosis DV

A
  • Lack of practitioner knowledge or training
  • Lack of practitioner recognition or awareness of prevalence
  • Time constraints with office visit
  • Fear of offending patient
  • Feeling of powerlessness in area of treatment
  • Many women will not voluntarily disclose abuse
28
Q

The single most important thing a provider can do for a battered woman is?

A

ask about violence

29
Q

screen for DV in who/when?

A

ALL patients for signs

  1. non-pregnant: at routine OB/GYN visits; at family planning visits; at preconception visits
  2. pregnant: throughout pregnancy
    - at first prenatal visit
    - at least once per trimester
    - at postpartum check-up
30
Q

how to approach/screen DV?

A
  1. Give a statement establishing that screening is universal
  2. Direct questioning using behaviorally specific phrasing
  3. Disclosure rates are higher when:
    - face-to-face rather than a questionnaire
    - Behaviorally specific descriptions rather than terms like “abuse”, “domestic violence” or “rape” are used
  4. Ask pts apart from intimate partner, family, friends, or children - Avoid using a friend or relative as interpreter
31
Q

after dx DV, what are the next steps?

A
  1. Acknowledge trauma - Reinforce that the victim is not to blame
  2. Document trauma - Direct quotations of patient explanation; Photographs (with consent)
  3. Maintain confidentiality to avoid retaliation
  4. Assess immediate safety
  5. Assess lethality of violence
  6. Establish a safety plan
32
Q

how to manage/prevent DV

A
  1. If pt is afraid for her safety or the safety of her children, she should be offered shelter
  2. Can get pocket cards with suggested safety/exit plan steps to give to patient or place in restrooms
  3. Provide educational materials: Provide lists of referral resources; Police departments, emergency departments; Battered women shelters and rape crisis centers; Counseling services; Self-help programs; Advocacy agencies
33
Q

tx for DV

A

High rate of psychiatric symptomatology

  • Referral for psychiatric screening and counseling
  • Psychotherapy
  • Psychiatric medication
  • Detoxification and substance abuse treatment
  • Patient advocacy groups
34
Q

any sexual act performed by one person on another without the person’s consent
genital, oral, or anal penetration by a part of the attackers’ body or by an object
force, threat of force, or victim’s inability to give appropriate consent

A

Sexual assault

35
Q

forced coitus or related sexual acts within a marital relationship without the consent of a partner

A

Marital rape

36
Q

sexual assaults committed by someone known to the victim
Make up >75% of adolescent rapes

A

Acquaintance rape

37
Q

rape by a family member, including step family and parental figures

A

incest

38
Q

forced or unwanted sexual activity in the context of a dating relationship
Frequently associated with alcohol
May be associated with drugs

A

date rape

39
Q

sexual intercourse with a female under an age specified by state law (14-18 yrs)
Mandated reporting laws vary by state
In general - greater age differential = greater penalties

A

Statutory rape

40
Q

contact or interaction between a child and an adult when the child is being used for sexual stimulation of that adult or another person
Mandated reporting in all 50 states

A

child sexual abuse

41
Q

Societal Misperceptions about Rape victims

A
  • “Encourage” assault by their attire or actions
  • Put themselves into a situation where it is “expected to happen”
  • Act promiscuously, thereby “setting themselves up”
  • Do not resist the assault enough
  • May be falsifying events and pressing charges for ulterior motives
42
Q

taught that rape is an ____ or _____ extension of normal sex drive

A

impulsive, aggressive

  • Most sexual assault is motivated by a desire for degradation, terrorization, and humiliation of the victim
  • Assault is a demonstration of power, anger, or sadism
43
Q

clinical findings of rape

A
  1. Many do not openly admit to
  2. being sexually assaulted - Complaints of being “mugged;” Concerns over STDs or AIDS
  3. Psych - depression, anxiety, suicidal thoughts or actions
  4. Must obtain a sexual history or assault could go undiagnosed!
  5. 60-70% - no obvious injuries
  6. Vaginal irritation - >50% of victims
  7. Rectal pain and bleeding if anal penetration
  8. Risk for pregnancy and STIs
  9. MC nongenital injuries - bruises, cuts scratches, swelling; unconscious, internal injuries
44
Q

acute phase of rape-trauma syndrome

A

Acute phase - hours to days

  1. Distortion or paralysis of coping mechanism
  2. Presentation ranges from complete loss of emotional control to an unnatural calm and detachment
  3. After first 2 wks - initial reactions of shock, numbness, withdrawal and denial usually abate
  4. Somatic sx
    - disturbed eating or sleeping patterns
    - GI irritability
    - MSK soreness, fatigue, tension headaches, startle reactions
45
Q

delayed phase of rape-trauma syndrome

A

may be months-years after assault

  1. Chronic anxiety, feelings of vulnerability
  2. Loss of control and self-blame
  3. Depression
  4. Sexual dysfunction
  5. Psychologic distress - mistrust of others, phobias, depression
  6. 33-50% report suicidal ideation - Nearly 1 in 5 who do not seek tx will attempt suicide
  7. PTSD is a common long-term sequela - nightmares, flashbacks
  8. Risk of substance abuse
46
Q

how to examine rape victim

A
  1. Physician has medical and legal responsibilities
  2. Consider use of sexual assault assessment kit
  3. Request assistance of personnel trained in collecting samples and information, if they are available - Sexual assault nurse examiners (SANE)
47
Q

obtaining hx of rape victim

A
  1. Obtain informed consent prior to history
  2. H&P in presence of chaperone or victim advocate
  3. Ask patient to describe in her own words what happened and to identify or describe her attacker
  4. LMP, contraceptive use, pre-existing pregnancy and infection, date of last consensual intercourse
  5. Activities between assault and examination - Eating, drinking, bathing, douching, urination, defecation
48
Q

how to perform PE of rape victim

A
  1. Careful PE of the entire body
  2. Document any injuries with photographs and/or drawings in medical record - “consistent with the use of force” rather than “rape” or “assault”
  3. Pelvic - note any injuries to vulva, hymen, vagina, urethra, rectum
  4. Inject 2 mL nml saline into vaginal vault; use non-absorbent swabs to sample fluid for tube and slides - pap, trich/gon/chl
  5. Evidence of coitus in vagina up to 48 hours after attack
  6. Offer baseline serology for hepatitis B, HIV, syphilis
49
Q

rape victim PE - Sperm may persist in cervical mucus up to ?

A

17 days

50
Q

what samples to obtain from rape victim

A
  1. Pubic hair combings
  2. Fingernail scrapings
  3. Skin washings and clothing - Wood’s lamp may be helpful
  4. Collect saliva (within a few hours)
  5. Properly process and label all specimens
    - Must sign off to law enforcement that specimens have not been tampered with
51
Q

tx of sexual assault

A
  1. Treat any physical injuries as appropriate
  2. Emergency contraception can be offered - ulipristal, levonorgestrel, or IUD
    - Serum pregnancy test beforehand
  3. Empiric tx of STIs
    - Ceftriaxone
    - Metronidazole 500 mg - alt: 2 g of metronidazole or tinidazole x 1 dose
    - Doxy
    - HPV vaccination recommended
    - Hep B vax or Ig - depends on pt’s risk
    - ART for HIV prophylaxis - mixed recommendations - Not recommended if >72 hrs post-assault
  4. psych tx - Offer even if individual appears to be in control
    - Do not release from facility until specific follow-up plans are made and agreed upon by patient, physician and counselor

No prophylaxis recommended for HSV or syphilis

52
Q

copmonents of f/u for sexual assault

A
  1. 2 weeks after assault
    - Repeat PE and collection of additional specimens
    - Test for gonorrhea, chlamydia and trichomonas unless prophylactic abx given
    - Discuss counselling again
  2. Additional visits according to needs - Consider appt 12 wks after assault for hep B, syphilis and HIV serology
  3. Assess psychological needs at each visit

Women's health (15 decks)

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