Sexual assault, as a crime of violence, induces a life crisis which inflicts major psychological and physiological trauma upon the victim. Lack of mutual consent is present in all sexual assaults. Post-traumatic symptoms occur immediately and for a large percentage of victims this trauma is not integrated for many years. Symptoms include the classic triad of post-traumatic stress symptoms of haunting, intrusive recollections, numbing or constriction of feelings and focus and lowered threshold of anxious arousal subsequent to experiencing intense fear, terror and loss of control. Long term effects include anxiety, depression, phobic reactions to situations reminiscent of the sexual assault, sexual dysfunction, impaired social adjustment and diminished capacity to enjoy life. Post-traumatic stress responses, symptomatology, psychodynamics and management of the victim of recent and nonrecent sexual assault are reviewed.
The purpose of this study was to assess the effect of faculty education about sexual harassment on the incidence of sexual harassment experiences among Canadian medical students. The study was designed as a voluntary, anonymous cross-sectional survey at the University of Toronto, Faculty of Medicine. One hundred sixty-eight of 255 fourth-year medical students in February 1991 and 159 of 242 fourth-year medical students in February 1994 participated. The interventions were seminars, workshops, and lectures on sexual harassment for faculty members and students, beginning in the fall of 1991. Our outcome measures were experiences of sexual harassment (noncontact and contact) in 1991 and 1994 for both women and men. The main findings were a decrease in overall sexual harassment from 35.7% (60/168) in 1991 to 22% (35/159) in 1994. Most of this decline was due to a decrease in noncontact sexual harassment from 26.8% (45/168) in 1991 to 13.8% (22/159) in 1994. The number of students who experienced contact sexual harassment remained essentially unchanged, with 15 in 1991 versus 13 in 1994. Significantly more women continued to experience both forms of sexual harassment. Our principal conclusion was that faculty education seems to have led to a decrease in students' experiences of noncontact sexual harassment. However, the stable incidence of contact sexual harassment may indicate a small core of faculty whose behaviors remain unaltered and will require other forms of intervention.
Perinatal loss and grief have been recognized as a special form of loss in the last ten years. Perinatal death includes miscarriage, therapeutic abortion, stillbirth, and infant death shortly after birth. Acknowledgement of the death and support to mourn their loss by significant others promotes resolution of this bereavement. If perinatal bereavement is not resolved, one-quarter to one-third of mothers may go on to develop a clinical depression. A multidisciplinary Perinatal Support Service is in place at Women's College Hospital to provide grief counselling to the mother and her family who have experienced a stillbirth or neonatal loss. The service has a direct link to the community through the Public Health Nurse on the obstetrical service. A review of three years reveals a high rate of referral by the attending physician and obstetrical nurse.
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