Sexual Assault Protocol in Philadelphia

Below is the City of Philadelphia's Sexual Assault Complaint Form for those interested in checking it out.



The actual document is 10 pages long. Stop by our office to look at it!

Here are other resources for you to check out:

Pennsylvania legal statutes on assault
Women Organized Against Rape (WOAR)
Rape, Abused, and Incest National Network (RAINN)
National Sexual Violence Resource Center
Pennsylvania Coalition Against Rape (PCAR)
Department of Justice Rape/Sexual Violence Resources
ACEP's Evaluation of Sexually Assualted/Abused Patient
CDC STD Treatment Guidelines 2010
Preventing Sexual Violence Toolkit for Health Professionals - AAP

Resources from Sex and Gender Health Disparities IM Grand Rounds Jan 5, 2011

Hi,

Thanks for joining me at Grand Rounds. As promised here's the resource listing I mentioned. I've listed the 'what can I use right now?" up front, right after tips to optimize your online blog experience. I included a listing of other resources on health disparities, sex and gender and literacy as well.  Ana Nùñez, MD Associate Professor of Medicine

PART I   Online Information from The Women's Health Education Program and the Philadelphia UJIMA Team

   GENERAL ONLINE SEARCH TIPS:

How To Get The Most Out of Your Search Here – Click on a subject or search for a topic. Optimize your experience by clicking on hyperlinked objects that have articles, tools, resources or useful links.

  Interested in contributing?   Let us know! Don't be intimidated, the skills you need are  being able to create a Word document and to attach hyperlinks. If you are interested in more than that, we can help you. Call or email us!

·      Women’s Health Info Online Resources  (you are here now!) – Target audience: trainees and clinicians. It is available at http://whepducom.blogspot.com

·      Consumer Health Online Info Target audience: patients and lay public. It is available at http://philadelphiaujima.blogspot.com/ (or from left side bar on this page)

·      Philadelphia Ujima website – This is the location of Ujima Collaborative Project and has numerous open access resources, materials and information. It is available at http://www.philadelphiaujima.com/ 

·     Cross Cultural Effectiveness: The Gender Lens – Target audience: faculty; educator and other interested. The site is located here http://culturegenderhealth.blogspot.com

PART II  RIGHT NOW RESOURCES      

• Ask Me Three  http://www.npsf.org/askme3/
• Teach Back Technique in Removing barriers to safer care. Health literacy and patient safety. Help patients understand. Manual for clinicians.  Weiss, B. AMA Foundation
• Motivational Interviewing Miller, W.R. & Rollnick, S. (2002) Motivational Interviewing: preparing people for change (2^nd ed.) New York. Guilford Press.

STAY TUNED!! COMING IN FEBRUARY – New free online videos for motivational interviewing from Ileana Pina, MD at Case Western Reserve as part of the Heart Truth NHBLI Initiative

·      Not mentioned, but other local resources is our School of Public Health – additionally training will impart health services and community engagement tools into your skillset if you are interested in HSR as a way to making your impact on health care.

parities

PART III   SELECTED RESOURCE LISTING  – For Health Disparities; Sex and Gender; and Health Services Research

Scope of Health Disparities in the US.

Singh, GK., Siahpush, M. Widening socioeconomic inequalities in the US life expectancy 1980-2000. Int J Epidemiol.(August 2006) 35(4): 969-979.

Schoen, C., Doty, M.,Collins, S., and Holmgren. Insured But Not Protected: How Many Adults Are Underinsured? A. Health Affairs Web Exclusive, June 14, 2005 W5-289–W5-302

Krisberg, K. Millions of Americans Suffer From Low Health Literacy. Nations Health. American Public Health Association. 2004;34(6) 

Robert Wood Johnson Foundation disparities resources

Blacksher, E. Healthcare disparities: the salience of social class. Camb Q Healthc Ethics. 2008 Spring;17(2):143-53.

Institute of Medicine (2010) Future Directions for National Healthcare Quality and Disparities Resport (Eds. Ulmer, C., Bruno, M., Burke, S.) National Academy Press, Washington DC

Lurie N. Health Disparities — Less Talk, More Action. N Engl J Med 2005; 353:727- 729

Heart Health and Women

Heart Health and Women (2010) Núñez

The Heart Truth Health Professionals Information and Resources

Gender and Ethnic Issues in Heart Health – video and resources here

Sociocultural Determinants of Health and Healthy People 2020

http://www.thecanadianfacts.org/

http://www.healthypeople.gov/hp2020/

Women’s Health Research

INSTITUTE OF MEDICINE (2010) REPORT BRIEF: WOMEN’S HEALTH RESEARCH (Chair Adler, N.) National Academy of Medicine Press Washington, DC.

Women’s Health Report Card by State available at here

WHO Gender and Health : technical paper 1998

Institute of Medicine (2010) Future Directions for the National Healthcare Quality and Disparities Reports. National Academy Press, Washington DC.

Health Services Research

Institute of Medicine (1995).  Health Services Research: Training and Workforce Issues (Eds. Field MJ, Tranquada RE, Feasley JC). National Academy Press, Washington DC.

Lohr KN, Steinwachs D.  Health services research: an evolving definition of the field.  Health Serv Res 2002;37(1):7-9.

UC Berkeley School of Public Health Strategic Plan 2003-2007

Community Participatory Research

            Kemmis S, McTaggart R. 2000. Participatory action research. In: Handbook of Qualitative   

            Research (Denzin NK, Lincoln YS, eds). Thousand Oaks, CA:Sage, 567–605.

Heron J, Reason P. 2001. The practice of cooperative inquiry: research “with” rather than “on” people. In: Handbook of Action Research: Participative Inquiry and Practice (Reason P, Bradbury H, eds). Thousand Oaks, CA:Sage, 179–188.

Gender Informed Health and Analyses

Health Canada. Health Canada’s Gender-based analysis policy. Ottawa:Minister of Public Works, 2000

Integrating Gender Perspectives in the work of WHO, WHO Gender Policy, 2002 

Gender Analysis Toolkit from Gender Evaluation Methodology for Internet and ICTs available here

Wagner Chronic Disease Model

Wagner EH. Chronic disease management: What will it take to improve care for chronic illness? Effective Clinical Practice. 1998;1(1):2-4.]

Health Literacy

Institute of Medicine (2010) Safe Use Initiative and Health Literacy: A Workshop. National Academy Press. Washington, DC.

National Literacy Survey. 1993

National Assessment of Adult Literacy (NAAL) from the IES NAational Center for Education Statistics of the US Dept of Education Institute for Education Sciences 2003 located here

Rothman, RL, Housam, R, Weiss, H, Davis, D, Gregory, R, Gebretsadik, T, Shintani, A, Elasy, TA. Patient understanding of food labels: the role of literacy and numeracy. Am J Prev Med, 31(5), 391-8, 2006.

National Healthcare Reform; City Fresh Food Initiative; the Impact on Women

a little bit more about our speakers.....



Dr. Berkson joined the College of Medicine in 2006 as the program director of the Family Medicine Residency Program and an assistant professor in the Department of Family, Community and Preventive Medicine. He received his M.D. from Pennsylvania State University, then completed his Family Medicine residency at Abington Memorial Hospital and a Sports Medicine fellowship at the University of South Carolina, Palmetto-Richland Memorial Hospital in Columbia, S.C. Dr. Berkson is board certified in Family Medicine and Sports Medicine and is the chief medical officer of Pennsylvania Senior Games and the team physician for Monsignor Bonner High School in Upper Darby. Dr. Berkson received the Degree of Fellow from the American Academy of Family Physicians in 2005. He gives national presentations and, most recently, was awarded the Heroes of York County Award from the American Red Cross for helping save the life of a high-school athlete whose heart stopped.



Aletheia Donahue is a fourth-year medical student at Drexel University College of Medicine specializing in women’s health and health policy. She worked as a consultant on the proposed Fresh Food Tax Credit in the office of Philadelphia City Councilman Bill Green. Aletheia acted as a liaison between small grocers and city government to create policy that incentivizes healthy food sales. Her work included research on food access disparities and diet in Philadelphia and how these problems have been addressed in cities throughout the country.
Prior to starting medical school Aletheia was active in clinical medical research at Massachusetts General Hospital and The University of Pennsylvania’s Abramson Cancer Center. She earned a BA in astronomy and physics from Smith College.



Christine V. Soutendijk, M.D., is the assistant director of the Center for Women's Health, and has been an assistant professor of medicine at Drexel University College of Medicine since 1998. She is a graduate of Indiana University School of Medicine, where she received the John I. Nurnberger Award for Most Accomplished Student of Psychiatry in her graduating class.
Her interest in women's health began in medical school while writing a literature review on the psychosocial impact of breast cancer. She completed her internal medicine residency at Good Samaritan Regional Medical Center/VAMC in Phoenix, Ariz., and has been certified by the American Board of Internal Medicine since 1997. She continues to be interested in the effect of disease on mental health and quality of life, and has special interests in osteoporosis, menopause and metabolic syndrome.

Polycystic Ovarian Syndrome and Infertility

Polycystic ovarian syndrome is a common disorder causing androgen excess, ovulatory dysfunction and polycystic ovaries. PCOS can only be diagnosed if other potential causes of androgen excess are first ruled out (Congenital adrenal hyperplasia, Cushing’s, androgen tumors, etc) Thus, PCOS is a diagnosis of exclusion. In the developed world, PCOS is the most common endocrine disorder causing androgen excess and affects anywhere from 4-12% of all women. It appears to affect all races and nationalities.

In order to diagnose PCOS, the Rotterdam consensus of 2003 states that 2 out of the 3 criteria must be met: 1) elevated circulating androgens 2) oligo or anovulation 3) polycystic ovaries on ultrasound. Some controversy exists regarding the last criteria, since as many as 25% of females with normal androgen levels and regular menses may have polycystic ovaries.

Image from the Florida Department of Health webpage

Most commonly, women with PCOS present with menstrual dysfunction. Other clinical manifestations of PCOS may include signs of virilization such as hirsutism, male pattern balding, oily skin and persistent acne. Women with PCOS appear to have a higher incidence of insulin resistance. Many such women also have metabolic syndrome: obesity and dyslipidemia. Approximately 30-40% of women with PCOS have impaired glucose tolerance and approximately 10% have type 2 diabetes based on 2 hour glucose challenge test results. In the long term, PCOS patients have increased risk of endometrial cancer, Type 2 Diabetes and cardiovascular disease.

Frequently, women with PCOS will present to the gynecologist with complaint of infertility. Although the precise mechanism in which PCOS causes anovulation is unknown, an understanding of the pathophysiology of PCOS will illuminate some aspects of its impact on normal ovulation. Disruptions of the pulsatile GnRH release leads to a relative increase of luteinizing hormones (LH) over follicle stimulating hormones (FSH). This imbalance creates excessive androgen production with decreased conversion of androgens to estradiol. FSH paucity leads to follicular atresia and subsequently anovulation. The LH:FSH ratio is elevated, and over 2 in 60% of women with PCOS. At present, insulin resistance is hypothesized to be another major factor in anovulation.

Most of these women are not infertile, but only sub-fertile. First line treatment and counseling should including weight loss, careful diet and nutrition, and regular exercise. If lifestyle modifications are initiated in earnest and weight loss is achieved, some women with PCOS can see resolution of hyperinsulinemia and ovulation dysfunction. For other patients, lifestyle modifications alone are not enough and may need to be started on medications such as clomiphene citrate and human menopausal gonadotropins and insulin sensitizing agents. For some women, the combination of metformin and clomiphene citrate works well in regulating ovulation and ultimately achieving fertility.

PCOS remains a multi-factorial and complicated disorder. However, many different treatments and therapies are now available to resolve the clinical manifestations of this disease. Primary care physicians and gynecologists should be consulted first if one suspects PCOS. The appropriate referrals can then be made to reproductive endocrinology for more extensive workup.

For more information about PCOS as well as information about latest treatment guidelines and support groups, check out http://www.soulcysters.com/

and  http://www.pcosupport.org/

Common lab tests and treatment found here

Infertility resource center found here

Submitted by Emily Yen, Class of 2011, Women’s Health Pathway Student

References:

Legro, Richard., “Polycystic Ovary Syndrome, Hirsutism and other Androgenic Excess Disorders,” PRECIS: Reproductive Endocrinology, American College of Obstetricians and Gynecologists, 2002

Schorge JO, Schaffer JI, Halvorson LM, Hoffman BL, Bradshaw KD, Cunningham FG, "Chapter 17. Polycystic Ovarian Syndrome and Hyperandrogenism" (Chapter). Williams Gynecology: McGraw Hill Companies, 2008

It’s THAT time again…..

Flu IQ

         

Every fall doctors and nurses talk about getting a flu shot and every year patients have lots of questions about the flu shot. What is it? Do I need it? Who shouldn’t get it? What’s with the nasal vaccine? Should my kids get it? Can it hurt me? So here are some answers!


1. What is in the Flu Vaccine?
The flu vaccine is a medicine that is very similar to the influenza virus itself. When your body sees gets vaccinated your immune system learns how to fight off viruses that are like those in the vaccine. That way when you get exposed to the flu your body already knows how to handle it and you do not get sick.

 2. What about the Swine Flu (H1N1)?
Every year people at the United States Center for Disease Control try to figure out which flu viruses will be the worst and most dangerous. Last year they left one out, the H1N1 swine flu. That is why last year there were 2 different flu shots. This year they included the H1N1 swine flu into the regular seasonal flu vaccine. There are also other strains of flu in this year’s vaccine.

3. What is the Nasal Flu Vaccine (FluMist)?
FluMist is actually a live flu that is changed so that it does not make you sick. It is a nose spray instead of a shot. You must be over age 2 and younger than 49 to get this form of flu vaccine. However, some people should not get this form of vaccine. Kids with asthma, and people with poor immune systems and risk for complications from flu as well as people who have close contact with other people who have poor immune systems.

4. Who should get it? See list here
Odds are you should get a flu vaccine. The Center for Disease control includes more people every year in the group that should get vaccinated. Everyone who is over 6 months old who does not have a medical reason that they can’t get the vaccine should get it. People who are allergic to eggs can’t get the flu vaccine. Kids getting the flu vaccine for the first time need two doses!  Rates of infection are highest among children, but the risks for complications, hospitalizations, and deaths from influenza are higher among persons aged 65 years and older, young children, and persons of any age who have medical conditions that place them at increased risk for complications from influenza.

5. But I got it LAST YEAR!
I know! You have to get it EVERY YEAR. The pesky thing about the flu is it changes every year and so your flu vaccine from last year isn’t protecting you anymore.

6. Should I get it if I am pregnant, breast-feeding or trying to get pregnant?

YES! It is super important to get the flu vaccine when you are pregnant. For reasons that we don’t understand pregnant women are very susceptible to getting very sick and even dying from the flu. It makes many women nervous to get vaccines if they are pregnant but, there is no evidence that the vaccine hurts the baby.  In fact, not getting can result in harm to both mother and fetus!

7. What happens if I don’t get it?

If you do not get vaccinated there is a higher risk of getting flu and of having complications from the flu. The flu can cause serious medical problems and death. These include bacterial pneumonia, ear infections, sinus infections, dehydration, and worsening of chronic medical conditions, such as congestive heart failure, asthma, or diabetes.

8. Are there risks associated with getting the flu vaccine? Here's safety information from the CDC  There are risks to the flu vaccine. There is a rare neurological problem called Guillain-Barré syndrome, which about 1 in 100,000 people will get with the flu vaccine.

9. Who is contraindicated to get this? People with egg allergies; infants under 6 months; individuals who got Guillain Barre (neurologic disease) within six weeks of getting immunized; moderate or severe infection (with/without fever) People in this last category need to resolve their infection before they get immunized.

SO WHERE DO I GET IT?  There are flu shots all over, if you have a doctor, call your doctor to ask abour flu shots. You may also be able to get one at work or school. They have flu shots in grocery stores and pharmacies as well!

So go get your flu shot….And Remember ….

                                                               The FLU ends with U!

For more information on the flu vaccine and immunization try:

http://www.flu.gov/

http://www.cdc.gov/flu/

http://kidshealth.org/parent/growth/medical/immunization_chart.html

Active Lifestyle May Help Counter Obesity Genes

TUESDAY, Aug. 31 (HealthDay News) -- Exercise can reduce a person's genetic predisposition to obesity by 40 percent, finds a new English study.

Researchers looked at 20,430 people in Norwich and focused on genetic variants known to increase the risk of obesity. Most people had inherited 10 to 13 of these variants from their parents, but some had more than 17 while others had fewer than six.

The participants also provided information about their levels of physical activity.
Overall, each additional obesity-related genetic variant was associated with an increase in body mass index (BMI) equivalent to 445 grams (0.98 pounds) for a person 1.70 meters (5 feet, 6 inches) tall. BMI is a measurement that takes into account a person's height and weight.

However, this effect was greater in sedentary people than in active people, the researchers found. For those with a physically active lifestyle the increase was 379 grams (0.84 pounds) per genetic variant. That's 36 percent less than the increase of 592 grams (1.3 pounds) per genetic variant for inactive people.

The researchers also found that each additional obesity susceptibility variant increased the odds of obesity by 1.1-fold. But this risk was 40 percent lower for active people compared to inactive people, the findings revealed.

The study shows that adopting a healthy lifestyle can benefit people at increased genetic risk of obesity, the authors explained.

"Our findings further emphasize the importance of physical activity in the prevention of obesity," “Our research proves that even those who have the highest risk of obesity from their genes can improve their health by taking some form of daily physical activity. People don’t have to run marathons to make a difference either - walking the dog or working in the garden all counts. It goes to show we’re not complete slaves to our genetic make-up and really can make a big difference to our future health by changing our behaviour." Dr. Ruth Loos, of the Medical Research Council's epidemiology unit in Cambridge and colleagues wrote in the August 31st 2010 article published online in PLoS Medicine.

CHECK OUT:

The U.S. National Heart, Lung, and Blood Institute offers a Guide to Physical Activity.

Download  BMI calculator here

Women and overweight obesity data info here and resources here

                  Women lag in time spent in leisure activity (weights, calisthenics) as compared to men,  2008 data

Anti-HIV gel is declared breakthrough for women

By Steve Sternberg, USA TODAY

Researchers say they've achieved the first AIDS prevention breakthrough for women.
More than a decade of failure and frustration ended Monday with a report that a new vaginal gel gives women the power to reduce their risk of contracting HIV and genital herpes without relying on their male partner to use a condom.

The experimental gel is made with Gilead Sciences' antiviral drug tenofovir, which is widely used for treating HIV, the virus that causes AIDS. Applying the 1% tenofovir gel 12 hours before and 12 hours after sex reduced a woman's risk of HIV infection by 39% over the course of 2½ years.
The gel also reduced the risk of genital herpes by 51%, an unexpected bonus because women with herpes are twice as likely to be infected with HIV.
"We now have a product that can potentially alter the epidemic and save millions of lives," says Quarraisha Abdool Karim of the University of KwaZulu-Natal in South Africa, who co-wrote the study with her husband and university colleague, Salim Abdool Karim.
At this level of protection, the researchers say, widespread use of the gel could prevent 1.3 million infections and more than 800,000 deaths in South Africa alone over the next 20 years. The findings were to be released today at the 18th International AIDS Conference in Vienna and in the online edition of Science.
AIDS researchers and advocates who have grown accustomed to failure, or worse — one promising vaginal gel actually was found to boost the risk of infection — hailed the report.

"This is good news," says Yasmin Halima, director of the Global Campaign for Microbicides, an advocacy group that has championed the approach. "Women are vulnerable to HIV across the world. Just having condoms for men is not really a viable option."
In the study, 889 sexually active women ages 18 to 40 were given either the tenofovir gel or a placebo. Thirty-eight of the women in the tenofovir group were infected with HIV, compared with 60 in the placebo group. Of 434 women who did not have herpes at the start of the trial, 29 of those using tenofovir became infected vs. 58 using a placebo.
The gel worked best in the women who used it most consistently. Women who used the gel at least 80% of the time were 54% less likely to become infected, cutting their risk of HIV by more than half.
Anthony Fauci, director of the National Institute for Allergy and Infectious Diseases, says the study marks a "significant conceptual advance" in efforts to give women the tools they need to protect themselves.
"The level of protection isn't as high as we hoped it would be," Fauci says, "but there are a lot of things we can do to change that. The degree of the effect was related to the degree (to which women used the gel.) You may want to use it more often. You may want to put it in a vaginal ring."
Halima noted that the pipeline of microbicides may include drug combinations similar to those now used for HIV treatment. Fauci says his institute is sponsoring a complex trial that compares patients using tenofovir gel daily with those taking oral tenofovir or Truvada, a combination of tenofovir and Emtriva, also made by Gilead Sciences. Results won't be available for at least a year, he says.

Read more here

Bloggers Note - Despite significant challenges in developing an immunization for HIV, this advance may be critical to saving lives for women.  Additionally, this success will stimulate industry and research for additional advances.

HIV terminology
HIV positive - evidence of exposure to HIV
AIDS - evidence of disease from HIV infection
ARVs antiretrovirals;

HAART Highly Active Anti-Retroviral Therapy (HAART) consists of 3 or more highly potent anti-HIV drugs (usually need three to 'contain' the virus and prevent development of resistance)        Click below to enlarge

NRTIs, NNRTIs, PIs and Others