Reasons for contacting the consultation service of a Dutch assault centre.

A telephone and e-mail helpline known as the Consultation Service, open to all the public, was launched at a Dutch Centre for Sexual Violence to deal with non-acute sexual violence. The aim of this study was to gain insight into case characteristics, reasons for contacting the Consultation Service and whether these reasons differed for victims, their relatives and professionals. Using a mixed methods design, the study included all consultations handled at the Consultation Service in 2018 and 2019. Descriptive statistics described quantitatively the case characteristics, the themes and differences between victims, relatives and professionals. The themes of the reasons for contact were established from the qualitative analysis, using the method of content analysis. Cases were characterised by complexity. Three themes emerged: case complexity, decision-making on care options and reporting to the police, which differed for victims, relatives and professionals. The differences in reasons for contacting the helpline imply that approaches should be adapted and fitted to different clients. Specialised care is needed to guide clients through cases that are challenging and often complex. There is a widespread lack of knowledge of options in addition to the complex multifaceted aspects to decision making about actions post-assault. Assault centres should implement a Consultation Service in which integrated care is offered not only to the victims, but also to their relatives and professionals.

Trends in victim, incident and care characteristics of a Dutch sexual assault center.

Worldwide, one in three women have experienced sexual violence, causing various physical and mental health problems such as depression, posttraumatic stress disorder and medically unexplained symptoms. Much has changed in the last decade. The use of the Internet, smartphones and apps has increased enormously, sexual violence is discussed more and more openly in the media. These changes have provided a platform for victims of sexual violence which has profoundly influenced the disclosing process and the victims' help-seeking behavior. Nevertheless, the question remains whether the number of victims seeking help from a professional institution has gone up. Therefore, our study aims to investigate if there have been changes in victim, incident and care characteristics among victims of a Dutch Center for Sexual Violence. We used data of victims attending the center between 2013 and 2020, including registered police file registrations instead of victim's reporting statements. Victims were divided into a cohort of early years (2013-2016) and recent years (2017-2020). In 2017-2020, a total of 270 victims attended the center compared to 83 victims in 2013-2016. The percentage of self-referrers increased from 10% to 30% in recent years; the use of psychotropic drugs among victims decreased from 24% to 11%; and more victims were willing to receive psychosocial follow-up care (64% versus 79%). The percentage of male victims remains low at approximately 5% of all victims in both cohorts. Background characteristics such as age and mental disability have hardly changed between 2013 and 2020. The proportion of known perpetrators remains high with approximately 80% in both cohorts, and the proportion of perpetrators who met victims on the Internet remains unchanged with approximately 6% in both cohorts. To improve our understanding of the influence of societal changes on help-seeking behavior, the monitoring of victim, incident and care characteristics remains crucial in the future.

Reporting after sexual violence: The influence of victim, assault and perpetrator characteristics.

Sexual violence is a worldwide public health concern. Care for victims has improved with the development of sexual assault centres, which have served to professionalise and tailor care and to get different services to improve collaboration. Nonetheless, reporting rates remain low, causing perpetrators to walk free without prosecution. We aimed to investigate, firstly, the influence of victim, perpetrator and assault characteristics on the reporting rate, and, secondly, the reasons why victims did not report to the police. Data of a Dutch sexual assault centre was used in this cross-sectional study. All victims who attended the centre between January 2016 and January 2019 were included. Logistic regression analysis was used to assess the relation of certain characteristics with reporting. Forty per cent of the victims reported to the police. Age and injuries were significantly related to reporting. Victims of 26 years or over were less likely to report than victims under 18 years old. Victims with objectified injuries reported to the police more often. Contrary to previous research, no relation between the perpetrator being well-known to the victim and a lower reporting rate was found. Victims mainly refrained from reporting as they experienced conflicting emotions, followed by their feeling discouraged by the police. Other reasons were fear of the perpetrator and defamation, wanting to move on with their life and wanting to spare the perpetrator. Our findings will serve to further optimise care for victims of sexual violence and increase reporting rates.

No Relationship Between the International Prostate Symptom Score and Post-Void Residual Volume in Primary Care.

BACKGROUND: Lower urinary tract symptom (LUTS) is a common condition in older men. In accordance with the Dutch College of General Practitioners Guideline "Micturition symptoms in men", the diagnosis can be made based on a patient's medical history and a physical examination. GPs lack additional tools in primary care to assess the residual urine volume. A residual volume usually requires a referral to a urologist. We hypothesized that the IPSS screening questionnaire score (measuring the severity of symptoms) might be related to patients' residual urine volume. The research objective was to examine the relation between the IPSS score and the residual urine volume. METHODS: In a cross-sectional study, we analysed patients' IPSS and residual urine volume. Men aged over 50 with LUTS who consulted Dutch primary-care physicians were included. The interventions comprised an IPSS screening and a bladder scan. Data regarding the patients' residual volume, total IPSS score, single IPSS score, IPSS storage score, and IPSS voiding score were recorded and analysed. We used odds ratios to describe the relation between the IPSS categories associated with the presence of a normal or abnormal (above 100 cc and above 200 cc) residual urine volume. RESULTS: A total of 126 patients were included in this study. Patients with higher scores on the overall IPSS, separate IPSS, IPSS storage and IPSS voiding showed no higher odds ratios of having an abnormal residual volume, neither above 100 mL or 200 mL. CONCLUSION: We did not find a relation between the IPSS core to an abnormal residual urine volume in men aged over 50 with LUTS consulting primary-care physicians. TRIAL REGISTRATION: This study has been approved by the Central Committee on Research Involving Human Subjects for the Arnhem-Nijmegen Region and is registered with ToetsingOnline under ID number 29822.091.10.

[Recognizing signs of sexual abuse]. / Signalen van seksueel misbruik herkennen.

Sexual abuse is very common. In the Netherlands 42% of women and 13% of men aged over 25 years have experienced unacceptable sexual behaviour. Most victims do not seek professional help nor do they report the abuse to the police, and most of the victims who do seek medical help do not mention the abuse. Doctors often do not recognize the signs of sexual abuse. Most victims of rape have symptoms that may develop into posttraumatic stress disorder (PTSD) if they persist for more than 4 weeks, such as sleep problems or panic attacks. Victims of sexual abuse also more often develop a psychiatric disorder or medically unexplained symptoms (MUS). Doctors should ask about sexual abuse in cases of MUS or unexplained mental problems. The complications of abuse can be treated with eye movement desensitization and reprocessing (EMDR) or cognitive processing therapy (CPT).

Gender differences in quality of care experiences during hospital stay: A contribution to patient-centered healthcare for both men and women.

OBJECTIVES: Studies demonstrate that there are important gender differences in perceptions of medicinal care. Our aim is to investigate whether there are also gender differences in patients'quality of care experiences during their hospital stay. METHODS: In a cross-sectional survey, patients who were admitted to a university hospital were invited to complete a questionnaire. Answers were compared between men and women of different ages, education levels, and health assessments, using the independent t-test. A linear regression model was performed to investigate the relationship between patient characteristics and hospital assessments RESULTS: 4169 questionnaires were sent (41.8% returned). Women rated the hospital significantly (P=0.007) lower than men, especially higher educated women and women between the ages of 18 and 44 years. Behaviors of nurses were perceived to be unsatisfactory by significantly more female patients than male patients (P=0.016). One in six women wanted more privacy compared with one in ten men (P<0.001), and ten percent more women suffered from pain (P<0.001). CONCLUSION: Women, particularly those higher educated and between 45 and 64 years of age, assess hospital care significantly lower than men. IMPLICATIONS FOR PRACTICE: To optimize patients' assessments of hospital care, women require more gender-sensitive nursing care, more privacy, and better pain management than they receive at present.

"Clinical features of women with gout arthritis." A systematic review.

Clinically, gout is generally considered as a preferential male disease. However, it definitely does not occur exclusively in males. Our aim was to assess differences in the clinical features of gout arthritis between female and male patients. Five electronic databases were searched to identify relevant original studies published between 1977 and 2007. The included studies had to focus on adult patients with primary gout arthritis and on sex differences in clinical features. Two reviewers independently assessed eligibility and quality of the studies. Out of 355 articles, 14 were selected. Nine fulfilled the quality and score criteria. We identified the following sex differences in the clinical features of gout in women compared to men: the onset of gout occurs at a higher age, more comorbidity with hypertension or renal insufficiency, more often use of diuretics, less likely to drink alcohol, less often podagra but more often involvement of other joints, less frequent recurrent attacks. We found interesting sex differences regarding the clinical features of patients with gout arthritis. To diagnose gout in women, knowledge of these differences is essential, and more research is needed to understand and explain the differences , especially in the general population.

Sex differences in the use of absorbent (incontinence) pads in independently living elderly people: do men receive less care?

AIM: To examine the use and satisfaction of absorbent (incontinence) pads in independently living men and women aged 60 and above with urinary incontinence (UI). METHODS: The subjects participated in a large-scale study about the prevalence of UI. All the independently living patients in nine family practices aged 60 or above with uncomplicated UI, who were willing to participate in the study were interviewed at home. RESULTS: In total, 56 men and 314 women were interviewed. Fifteen per cent of the men and 87% of the women with UI used pads. All men and nine out of 10 women used different kinds of absorbent pads, and half of the men and women used pads specifically made for UI. Only half of the men and two-third of the women felt satisfied with the pads. The reasons for not being satisfied were: leakage, irritation and discomfort. The use of pads, the use at daytime and the type of pads were correlated to the severity of incontinence. CONCLUSION: Only one out of nine men with UI uses pads in contrast with four out of five women. Only half of them wear pads specifically made for UI. Men are less satisfied about the pads compared with women.

[Prevalence of urinary and faecal incontinence among community-dwelling elderly patients in Nijmegen, The Netherlands, January 1999-July 2001]. / Prevalentie van incontinentie voor urine en ontlasting bij zelfstandig wonende ouderen in Nijmegen, januari 1999-juli 2001.

OBJECTIVE: To evaluate the prevalence of urinary, faecal and double incontinence in community-dwelling elderly patients. DESIGN: Cross-sectional population-based survey. METHOD: By means of a postal questionnaire, data were collected in the period January 1999-July 2001 from patients aged 60 and over from 9 general practices associated with the academic general practitioner registration network of the St Radboud University Medical Centre (the Nijmegen Monitoring Project). Excluded were patients living in a home for the elderly, as well as patients with dementia, patients who were too ill to participate and patients with a catheter. RESULTS: Of the 5278 patients who received a questionnaire, 4650 (88%) returned it. 885 (19%) respondents had involuntary loss of urine twice a month or more, 299 (6%) had involuntary loss of faeces and 153 (3%) had both. The prevalence of urinary, faecal and double incontinence increased with age in both men and women, in men especially in the age group > 80 years. Urinary incontinence was more prevalent in women (29%) than in men (9%). The prevalence of faecal incontinence showed no sex differences (women: 6%; men: 7%), but the loss of slimy faeces occurred twice as often in men as in women (60% versus 29%). Double incontinence was also more or less equally prevalent in men and women (men: 2%; women: 4%), except in the age group 65-74 years (men: 1%; women: 4%). CONCLUSION: Especially urinary, but also faecal incontinence was common in the community-dwelling elderly. The prevalence increased with age. Because of ageing of the population and the increasing life expectancy in the next decennia, the prevalence of incontinence can be expected to increase considerably.

Supine position compared to other positions during the second stage of labor: a meta-analytic review.

The routine use of the supine position during the second stage of labor can be considered to be an intervention in the natural course of labor. This study aimed to establish whether the continuation of this intervention is justified. Nine randomized controlled trials and one cohort study were included. A meta-analysis indicated a higher rate of instrumental deliveries and episiotomies in the supine position. A lower estimated blood loss and lower rate of postpartum hemorrhage were found in the supine position, however it is not clear whether this is a real or only an observed difference. Heterogenous, non-pooled data showed that women experienced more severe pain in the supine position and had a preference for other birthing positions. Many methodological problems were identified in the studies and the appropriateness of a randomized controlled trial to study this subject is called into question. A cohort study is recommended as a more appropriate methodology, supplemented by a qualitative method to study women's experiences. Objective laboratory measurements are advised to examine the difference in blood loss. In conclusion, the results do not justify the continuation of the routine use of the supine position during the second stage of labor.

Treating urinary incontinence in the elderly--conservative therapies that work: a systematic review.

OBJECTIVE: To evaluate the effectiveness of conservative treatment in the community-based elderly (aged > or = 55 years) with stress, urge, and mixed urinary incontinence. DESIGN: Systematic review of before-after studies or randomized controlled trials on the effect of exercise and drug therapy in urinary incontinence. MAIN OUTCOMES MEASURED: Reduction of urinary accidents, patient's perception, cystometric measurement, perineometry, and side effects. SEARCH STRATEGY: MEDLINE (1966-2001), EMBASE (1986-2001), Science Citation Index (1988-2001), The Cochrane Library, and PiCarta were searched. RESULTS Four before-after studies and 4 randomized controlled trials were identified. Drug therapy alone: no study of sufficient quality. Drug therapy compared with behavioral therapy, 3 studies: bladder-sphincter biofeedback reduced urinary accidents in cases of urge or mixed incontinence by 80.7%, significantly better than oxybutynin (68.5%) or placebo (39.4%). Adding drug to behavioral treatment or behavioral to drug treatment also resulted in significant reduction in urodynamic urge incontinence (57.5%-88.5% vs 72.7-84.3%). Pelvic floor exercises alone reduced urinary accidents by 48% (compared with 53% for phenylpropanolamine) in patients with mixed or stress incontinence. Behavioral therapy, 5 studies: bladder-sphincter biofeedback in case of urge or mixed incontinence, bladder training in case of urge incontinence and pelvic floor exercises in case of stress incontinence reduced the urinary accidents with 68% to 94%. CONCLUSION: There are only a few studies of sufficient methodological quality on the effect of conservative treatment of urinary incontinence in the elderly. Behavioral therapy reduced urinary accidents; the effect of drug therapy is unclear. We recommend behavioral therapy as first choice.

Prevalence of urinary, fecal and double incontinence in the elderly living at home.

The aim of this study was to evaluate the prevalence of urinary, fecal and double incontinence in the elderly, through a population-based cross-sectional survey. The study included all patients aged 60 and over of nine general practices in the Nijmegen Monitoring Project. Patients living in a home for the elderly were excluded, as well as patients with dementia, patients who were too ill to participate and patients with a catheter. There were 5278 selected patients who received a postal questionnaire. Of these, 88% returned it. Nineteen percent of the respondents had involuntary loss of urine twice a month or more, 6% loss of feces and 3% both. The prevalence of urinary, fecal and double incontinence increased with age in both men and women, and especially in men in the oldest age group. Urinary incontinence was more prevalent in women than in men. The prevalence of fecal incontinence showed no sex differences, but the type of fecal incontinence did differ between men and women. In men loss of mucus was twice as common as in women. Double incontinence was also equally prevalent in men and women, except in the age group 65-74 years. In conclusion, urinary, fecal and double incontinence are common conditions in the community-dwelling population. The prevalence rates increase with age. Urinary incontinence is more prevalent in women. There were no sex differences in the prevalence of fecal incontinence but the type of fecal incontinence was different in men and women.