This study explored the predictors and consequences of sexual assault occurring after the age of 16 years in a nonclinical sample of women. Child sexual abuse occurring before the age of 16 years was the only predictor of later sexual assault among comorbid risk factors. Peer sexual abuse, number of perpetrators, age at time of sexual abuse, and severity of sexual abuse did not increase the risk for later sexual assault. Adult sexual assault victims showed lower levels of mental health functioning than did survivors of child or peer sexual abuse. We discuss a specificity model of revictimization and the differential effects of child, peer, and adult sexual trauma on the developmental trajectory of sexual violence and psychosocial functioning.
Exposure to parental domestic violence in childhood is associated with long-term psychological maladjustment. Although previous studies controlled for childhood physical abuse, it is unclear how the coexisting risk factors of sexual abuse and parental substance use contribute to psychopathology. Questionnaires assessing childhood risk factors and current symptoms were completed by 131 college women. We compared a nonwitness control group with two groups exposed to moderate or to severe marital violence. Witnesses of marital violence experienced more sexual and physical abuse and more parental substance use in childhood than did nonwitnesses and there was more violence in their own dating relationships, even after controlling for other risk factors. Depression, trauma symptoms, antisocial behaviors, and suicidal behaviors were related to childhood experiences of sexual and physical abuse. The need for future research to examine multiple childhood stressors simultaneously is discussed.
The objective of this study was to determine the cost effectiveness of outpatient pulmonary subspecialty consultations via telemedicine. A decision-analytic model was used to compare the cost effectiveness of providing outpatient telemedicine pulmonary consultations with alternative treatment methods. Model options included: (1) telemedicine, (2) routine care (patients travel from a remote site to the hub site to receive care), and (3) on-site care (patients receive care at the remote site). Cost and effectiveness data from the Milwaukee and Iron Mountain Veterans Affairs Medical Centers (VAMC) telepulmonary program were collected for a period of 1 year. The cost-effectiveness analysis was conducted from a societal perspective. Average and incremental cost-effectiveness ratios were calculated together with sensitivity analysis. Telemedicine was found to be more cost effective ($335 per patient/year) compared to routine care ($585 per patient/year) and on-site care ($1,166 per patient/year). Sensitivity analysis revealed that cost effectiveness of telemedicine was sensitive to changes in the values for the number of patients, probability of successful telemedicine consultation, telemedicine equipment cost, utility of telemedicine, and percentage effort assigned to the on-site pulmonary physician. Telemedicine is a cost-effective alternative for the delivery of outpatient pulmonary care for rural populations with limited access to subspecialty services. Cost effectiveness of telemedicine is related to three major factors: cost sharing, i.e., adequate patient volume and sharing of telemedicine infrastructure amongst various clinical users; effectiveness of telemedicine in terms of patient utility and successful clinical consultations; and indirect cost savings accrued by decreasing cost of patients' lost productivity.
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