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Introduction: Emergency departments (ED) provide trauma-informed care to sexual assault (SA) survivors and connect them with comprehensive services. Through surveying SA survivor advocates, we aimed to 1) document updated trends in the quality of care and resources offered to SA survivors and 2) identify potential disparities according to geographic regions in the US, urban vs rural clinic locations, and the availability of sexual assault nurse examiners (SANE).Methods: We conducted a cross-sectional study between June-August 2021, surveying SA advocates who were dispatched from rape crisis centers to support survivors during ED care. Survey questions addressed two major themes in quality of care: staff preparedness to provide trauma-response care; and available resources. Staff preparedness to provide trauma-informed care was assessed through observations of staff behaviors. We used Wilcoxon rank-sum and Kruskal-Wallis tests to analyze differences in responses according to geographic regions and SANE presence.Results: A total of 315 advocates from 99 crisis centers completed the survey. The survey had a participation rate of 88.7% and a completion rate of 87.9%. Advocates who indicated that a higher proportion of their cases were attended by SANEs were more likely to report higher rates of trauma-informed staff behaviors. For example, the recalled rate of staff asking patients for consent at every step of the exam was significantly associated with SANE presence (P < 0.001). With respect to access to resources, 66.7% of advocates reported that hospitals often or always have evidence collection kits available; 30.6% reported that resources such as transportation and housing are often or always available, and 55.3% reported that SANEs are often or always part of the care team. The SANEs were reported to be more frequently available in the Southwest than in other US regions (P < 0.001) and in urban as opposed to rural areas (P < 0.001).Conclusion: Our study indicates that support from sexual assault nurse examiners is highly associated with trauma-informed staff behaviors and comprehensive resources. Urban-rural and regional disparities exist regarding access to SANEs, suggesting that elevating nationwide quality and equity in care of survivors of sexual assault requires increased investments in SANE training and coverage.

Interactions between emergency department (ED) staff and sexual assault (SA) survivors can be a source of retraumatization for survivors, increasing their risk of posttraumatic stress and decreasing utilization of longitudinal medical care. Little is known about nationwide trends in ED staff attitudes and behaviors toward survivors, including the impact of survivor identity. We conducted a survey to determine if survivor identity influenced ED staff behaviors. A nationwide survey of SA patient advocates was conducted between June and August 2021. Advocates are volunteers or staff dispatched from rape crisis centers to support survivors during ED care. Advocates participated in an online survey to determine the frequency of observing six potentially retraumatizing provider attitudes and behaviors. Adaptive questioning was used to explore the impact of survivor identity on each attitude or behavior and which identity groups were more likely to be affected. Three hundred fifteen advocates responded to the survey. Less than 10% indicated that ED staff often or always convey disbelief or blame to survivors. Almost 75% of advocates indicated that they often or always observe ED staff showing empathy to survivors. Disparities were found in provider attitudes. Over 75% of advocates observed that survivors' mental health status or substance use impacted conveyed belief from providers. Patients who were intoxicated when assaulted, had psychiatric disorders, were Black, Hispanic/LatinX, or indigenous, or were not cis-females were more likely to experience disbelief. Patients who were white and/or cis-gender females were more likely to be pressured by ED staff to complete the forensic exam and/or report to the police. Our study documents disparities in ED staff behavior towards SA survivors according to survivor identity. Given that post-assault ED interactions are critical turning points in survivors' future medical processes, disparities in ED care may be linked to larger disparities in healing from trauma. [ABSTRACT FROM AUTHOR]

Emergency departments (EDs) providing care and forensic examinations for sexual assault (SA) survivors are often supported by SA patient advocates. This study explored advocates' perspectives regarding problems and potential solutions in SA patient care through a focus group with 12 advocates. Thematic analysis identified two major themes: provider–patient interactions and ED–hospital systems. Challenging aspects of provider–patient interactions included (a) provider attitudes and (b) disempowering behaviors. Within ED–hospital systems, themes included time constraints, efficiencies, and hospital preparation. Advocates surveyed were optimistic about an increased presence of SA nurse examiners and enhanced protocols and provider training to improve survivors' experiences. [ABSTRACT FROM AUTHOR]

Background: As the proportion of women in family medicine increases, their well-being and job satisfaction become concerns.Objectives: This study aimed to uncover the working conditions and career satisfaction of women family physicians across multiple countries.Methods: A cross-sectional survey of the WONCA Working Party on Women and Family Medicine listserv members to assess working conditions and career satisfaction, with snowballing recruitment. Aspects of physician job satisfaction were measured using the validated Physician Work-Life Survey and calculated as the sum of the scores of each positive item divided by the total number of questions and multiplied by 10. The association between satisfaction and the continent and the country income level was performed using a one-way ANOVA test (P < 0.05).Results: A total of 315 participants across 49 countries responded to the survey with 205 complete responses. Women family physicians reported high overall career satisfaction (8.2 ± 2.3) but were less satisfied with some aspects of their career such as pay (5.3 ± 3.4), personal time (3.5 ± 2.6), and administrative tasks (3.2 ± 3.7). Despite the widespread experience of sexism at work, satisfaction with personal career aspects was universal at the continent and income level, while satisfaction with other career aspects relevant to relationships in work environment and resources varied.Conclusion: Women family physicians around the world are overall satisfied with their careers. However, variation in certain working conditions among countries leaves room for improvement, drawing attention to the need for national review of working environments and pay scales. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 35-year-old healthy woman without a history of high-grade precancerous cervical lesions, immunodeficiency, or exposure to diethylstilbestrol presents to office for her routine health visit. It mentions that USPSTF emphasized that screening alone is not sufficient for the prevention of cervical cancer and that efforts should be made to create equitable access t follow-up of abnormal results and the provision of appropriate treatment.

Rather than extend oral anticoagulation therapy for patients at high risk for recurrence of venous thromboembolism, advise them to take an aspirin a day. [ABSTRACT FROM AUTHOR]

Women ages 30 to 65 years now have a third cervical cancer screening option.