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Fiona Elizabeth van Zyl-Bonk, Sibylle Lange, Antoinette Leonarda Maria Lagro-Janssen, Theodora Alberta Maria Teunissen Department of Primary and Community Care, Research Institute for Medical Innovation, Radboud University Medical Center, Nijmegen, the NetherlandsCorrespondence: Theodora Alberta Maria Teunissen, Department of Primary and Community Care, Research Institute for Medical Innovation, Radboud University Medical Center, Geert Grooteplein 21, Postbus 9101, Nijmegen, 6500 HB, the Netherlands, Tel +31 24 3618181, Email doreth.teunissen@radboudumc.nlPurpose: Sexual abuse is a health issue with many consequences. Recognizing and discussing past sexual abuse has proven to be challenging for health care professionals. To improve overall quality of health care for sexual abuse victims, health care professionals need to be properly trained. The aim of this paper is to provide an overview of training methods for health care professionals and to report on their effectiveness.Methods: A scoping review was conducted. A broad search was executed in six databases in December 2022. Study selection was performed by two independent reviewers, followed by quality assessment and data extraction.Results: After screening of titles and abstracts and later full-text assessment for quality appraisal, seven articles were selected, consisting mostly of non-randomized trials, performed among a total of 1299 health care professionals. All studies were assessed to be of moderate to poor quality. The participants attended training courses with a wide variety of durations, settings, formats and methods. The outcomes showed improvements in self-perceived or measured knowledge, skills and confidence to discuss sexual violence. Changes in clinical practice were scarcely investigated. Training courses were most effective when a mix of didactic passive methods, such as lectures and videos, and active participatory strategies, such as discussions and roleplay, were applied. Timely iteration to reinforce retention of gained knowledge and skills also contributed to effectiveness. Participants most enjoyed incorporating opportunities for receiving feedback in small settings and sharing personal experiences.Conclusion: This scoping review summarizes on how to effectively train health care professionals. Flaws and difficulties in measuring the effectiveness of training courses were discussed. Recognition and discussion of past sexual abuse by health care providers can be effectively trained using an alternating mix of multiple active and passive training methods with room for feedback and personal experiences.Keywords: sexual violence, disclosure, recognition, medical education, post-graduate training

Jasmijn Mulder,1 Theodora Alberta Maria Teunissen,1 Veranie Maria Johanna Peters,1 Marie Louise Moors,2 Antoinette Leonarda Maria Lagro-Janssen1 1Department of Primary and Community Care, Gender and Women’s Health, Radboud University Medical Center, Nijmegen, the Netherlands; 2Emergency Department, Radboud University Medical Center, Nijmegen, the NetherlandsCorrespondence: Jasmijn Mulder, Radboudumc, Afdeling Eerstelijnsgeneeskunde, Huispost 121, t.a.v. Jasmijn Mulder, Postbus 9101, Nijmegen, 6500HB, the Netherlands, Email Jasmijn.mulder@radboudumc.nlPurpose: As the response to sexual assault victims proved to be shattered and substandard, sexual assault centers were set up to improve care by providing the victims with medical, psychosocial and legal care. The Dutch Centers for Sexual Assault were launched in 2012. We wished to examine the challenges in interprofessional collaboration experienced in a long-running Dutch Sexual Assault Center.Methods: In this qualitative study, data was collected via semi-structured explorative interviews which were analyzed using thematic analysis in an iterative process. The semi-structured interviews were held with fifteen professionals from medical, psychosocial and legal disciplines. An interview guide was developed based on expert opinion and the Bronstein Index of Interprofessional Collaboration. Qualitative analyses were done using the method of thematic analysis in ATLAS.ti and were reported according to the COREQ criteria. The themes of the experienced challenges in interprofessional collaboration were further clarified using quotations.Results: Participants mentioned three themes that challenged interprofessional collaboration: 1. discrepancies in professional involvement, 2. conflicting goals and 3. a lack of connection. Discrepancies in motivation and affinity to work with victims of sexual violence between professionals proved to be the most pivotal challenge to collaboration, leading to disturbing differences in professional involvement. A low caseload and time restraints complicated gaining expertise, affinity and motivation. Conflicting goals and confidentiality issues arose between the medical and legal disciplines due to their contrasting aims of caring for victims versus facilitating prosecution. Some professionals felt a lack of connection, particularly due to missing face-to-face personal contact, which hindered the sharing of complex or burdensome cases and gaining insight into the other discipline’s competences.Conclusion: Building collective ownership and equal professional involvement are crucial for interprofessional collaboration. Professional involvement should be increased by training courses to clarify conflicting goals and to improve reciprocal personal contact between professionals. Training courses should be facilitated with organizational financial support.Keywords: interprofessional collaboration, sexual assault center, challenges, sexual assault, sexual violence, qualitative methods

HA Lammers, TAM Teunissen, H Bor, IS Smid, ALM Lagro-Janssen Radboudumc, Department of Primary and Community Care/Gender & Women’s Health, Nijmegen, the NetherlandsCorrespondence: HA LammersRadboudumc, Huispost 117, Postbus 9101, Nijmegen 6500 HB, the NetherlandsTel +316 52378946Email Huub.Lammers@radboudumc.nlBackground: 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.Keywords: lower urinary tract symptoms, primary care, international prostate symptom score, post-void residual volume

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. [ABSTRACT FROM AUTHOR]

OBJECTIVE: to establish which factors are associated with birthing positions throughout the second stage of labour and at the time of birth. DESIGN: retrospective cohort study. SETTING: primary care midwifery practices in the Netherlands. PARTICIPANTS: 665 low-risk women who received midwife-led care. MEASUREMENTS AND FINDINGS: a postal questionnaire was sent to women 3-4 years after birth. The number of women who remained in the supine position throughout the second stage varied between midwifery practices, ranging from 31.3% to 95.9% (p<0.001). The majority of women pushed and gave birth in the supine position. For positions used throughout the second stage of labour, a stepwise forward logistic regression analysis was used to examine effects controlled for other factors. Women aged 36 years and highly educated women were less likely to use the supine pushing position alone [odds ratio (OR) 0.54, 95% confidence intervals (CI) 0.31-0.94; OR 0.40, 95% CI 0.21-0.73, respectively]. Women who pushed for longer than 60 minutes and who were referred during the second stage of labour were also less likely to use the supine position alone (OR 0.32, 95% CI 0.16-0.64; OR 0.44, 95% CI 0.23-0.86, respectively). Bivariate analyses were conducted for effects on position at the time of birth. Age 36 years, higher education and homebirth were associated with giving birth in a non-supine position. KEY CONCLUSIONS: the finding that highly educated and older women were more likely to use non-supine birthing positions suggests inequalities in position choice. Although the Dutch maternity care system empowers women to choose their own place of birth, many may not be encouraged to make choices in birthing positions. IMPLICATIONS FOR PRACTICE: education of women, midwives, obstetricians and perhaps the public in general is necessary to make alternatives to the supine position a logical option for all women. Future studies need to establish midwife, clinical and other factors that have an effect on women's choice of birthing positions, and identify strategies that empower women to make their own choices. [ABSTRACT FROM AUTHOR]

Objectives: To shed light on lesbian 'bed death' among lesbian women. To explore the wishes and expectations of lesbian women with respect to healthcare professionals.Methods: Semi-structured interviews with 30 self-identified lesbian women. The interviews were audio recorded. Three researchers classified and analyzed the most important themes.Results: The women indicated few sexual problems except for 'bed death,' a quasi-complete cessation of sexual activity. Twenty-three women experienced 'bed death' during the current relationship or a previous one. The factors felt by the women to contribute to 'bed death' were environmental influences, the existence of a symbiotic relationship, hormonal factors, and reduced sexual initiative. The women indicated that they would like family doctors to adopt a neutral attitude, be knowledgeable about homosexuality, and be able to recognize homosexuality in their patients.Discussion: A careful examination of the potential causes of 'bed death' suggests that the phenomenon is more closely linked to a patient's gender than to her sexual orientation. Lesbian women would also like general practitioners to possess at least some basic knowledge about homosexuality. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of a study to explore the views of midwives on women's positions during the second stage of labour.Background. Many authors recommend encouraging women to use positions that are most comfortable to them. Others advocate encouragement of non-supine positions, because offering 'choice' is not enough to reverse the strong cultural norm of giving birth in the supine position. Midwives' views on women's positions have rarely been explored.Method. Six focus groups were conducted in 2006DS2007 with a purposive sample of 31 midwives. The data were interpreted using Thachuk's models of informed consent and informed choice.Findings. The models were useful in distinguishing between two different approaches of midwives to women's positions during labour. When giving informed consent, midwives implicitly or explicitly ask a woman's consent for what they themselves prefer. When offering informed choice, a woman's preference is the starting point, but midwives will suggest other options if this is in the woman's interest. Obstetric factors and working conditions are reasons to deviate from women's preferences.Conclusions. To give women an informed choice about birthing positions, midwives need to give them information during pregnancy and discuss their position preferences. Women should be prepared for the unpredictability of their feelings in labour and for obstetric factors that may interfere with their choice of position. Equipment for non-supine births should be more midwife-friendly. In addition, midwives and students need to be able to gain experience in assisting births in non-supine positions. [ABSTRACT FROM AUTHOR]

Objective: To gain insight into the needs and expectations of abused women in shelter homes, with regard to family physicians. Methods: Twelve women in two shelter homes were interviewed. The interview focused on women's experiences and expectations of family physicians regarding the abuse situation. Results: Eight women did not disclose intimate partner abuse to their family physicians. The main reasons were shame and fear of retaliation. Six women suffered from extreme controlling behavior by their partners, which made it impossible to seek help. Four women were not aware of the relationship between abuse by a partner and physical symptoms. Women mainly wanted a solution for physical problems and were ambivalent about help to tackle their problems with abuse. The majority of the women found the family physician's attitude of great importance and considered it a task of the family physician to provide assistance. Conclusion: Although the family physician did not play an important role in solving the problems for victims of intimate partner abuse living in shelter homes, an open and empathic attitude was of great importance to these women. Women also expressed the need for assistance by their physician and emphasized that it was important to keep asking about partner abuse, even in case of denial. [ABSTRACT FROM AUTHOR]

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A total of 110 women who had reported urinary incontinence to their general practitioners were randomly assigned to a treatment or control group. Treatment consisted of pelvic floor exercises in the case of stress incontinence and bladder training in the case of urge incontinence. The results were measured after 3 and 12 months by a research assistant on the basis of a constructed severity scale, an incontinence diary, and a comparison by the patients themselves of their previous and current conditions. After 3 months the control group were given the same treatment. After a further 3 and 12 months, they were assessed in exactly the same way as the treatment group. After 3 months about 60% of the patients were either dry or only mildly incontinent; the mean number of wet episodes had gone down from 20 to 7, and 74% of the women felt improved or cured. These results were later corroborated by the control group. After 12 months this successful outcome was improved slightly further. It may be concluded that the majority of women with incontinence can be successfully treated by the general practitioner. The effect of this treatment continues after one year. [ABSTRACT FROM PUBLISHER]

A response by Ank de Jonge, Mariet Th. van Diem and Antoine L. M. Lagro-Janssen to a letter to the editor about their article on the importance of giving women informed choice about birthing position is presented.