Drug addictions and sexual violence in childhood and adolescence: analyzing life stories

The sexual abuse suffered in childhood and adolescence, in addition to damage to physical and psychological health of the victim, is considered as an important risk factor for alcohol and drugs addiction, development of psychopathology and psychosocial damage in adulthood. In addition to the pain and humiliation that are submitted by the abuse, children and adolescents also experience shame and guilt which require them to adopt coping strategies to endure those feelings. The use of psychoactive substances is a recognized way of dealing with the pains of living. This work, which is of narrative style, analyses and discusses, through five case reports, chemical dependency as a result of sexual abuse suffered in childhood and/or adolescence. The eight subjects in this study are male and have suffered sexual violence in this age period of life. Their ages range from 23 years to 39 years, and all are admitted to a therapeutic community in a city in the interior of Sao Paulo state, in Brazil, for treatment of chemical dependency, being met by the Department of Psychology. The reasons for the choice of the participants for treatment modality for patients are: difficult to stop using drugs, even unwilling to take it, they have easy access to it; the feeling of losing control over their lives; by successive losses as a result of drug use, and for fear that their lives had a tragic ending. With the exception of two participants, the others do not classify that as a child suffered sexual violence. However, all attribute that facilitated their entry into the world of drugs. Seven participants experienced such violence in childhood (between 7 years and 9 years) and adolescence (age 14). The attackers were people closed to the victims—in the case of two victims, their families, with the exception of one participant who was raped by a stranger. Six participants declared themselves as homosexual. Another participant does not claim to be homosexual, but presents difficulties in terms of sexuality. Two participants are HIV positive. The start of psychoactive substances use occurred during adolescence (12 years to 17 years). The participants see drugs as an anesthetic to the pain of the soul, a way to get pleasure, but they get charged expensively, as it increases the feeling of emptiness, guilt, helplessness, worthlessness and hopelessness. Although participants have sought help to deal with addiction, it is noted that throughout the life course the issue of sexual violence was not treated. It was noted that the patients have a double stigma in society: the issue of drugs addiction and the orientation of sexual desire, because the majority of participants are homosexual. The results reinforce the need for effective action geared to accommodate the victims of sexual violence and effective preventive measures to prevent children and adolescents from being abused.

Violence against children and adolescents: the importance of knowledge of the spectrum of bruise colors in its diagnosis

Introduction: One of the violence types more observed against children is the physical abuse, which produces many types of traumatic injuries. Contusions are common trauma signs and may indicate aggression when frequently present in locations where accidental injuries are rare. Contusions in skin undergo color changes with the passage of time, and such change in color is called “spectrum of bruise colors of Legrand du Saulle”. Thus, it is possible to estimate the age of the lesion based on the evaluation of color. Injuries caused by child abuse often reach regions of head, face and neck, because they are exposed and easily accessible. Therefore, the dentist is responsible with regard to the diagnosis and the actions to be undertaken against the cases of child abuse. Objective: To present and discuss the significance of the spectrum of bruise colors as a considerable visible trace in suspicion of violence against children and adolescents, during dentists’ clinical routine. Literature review: The study of the “spectrum of bruise colors of Legrand du Saulle” refers to the estimation of the age of the injury, in respect to the color change. The application of this study is of great value for identify if a lesion occurred from a single incident or from multiple incidents, especially in cases where it occurs in the same region of the body, indicative of repetitive trauma. Conclusion: The spectrum of bruise colors is very important for health professionals, such as dentists, for the identification or suspicion of cases of abuse against children and adolescents. As great part of the lesions originated of abuse involve the areas of head and neck, it is unacceptable that these professionals are unaware of the basic signs to help in early diagnosis, which is the case of the colors of the lesions. However, concerning the chronology of the spectrum of bruise colors, it is not possible to establish rigorous times.

Gender-based violence and socioeconomic inequalities: Does living in more deprived neighbourhoods increase women's risk of intimate partner violence?

This study investigates the influence of neighbourhood socioeconomic conditions on women's likelihood of experiencing intimate partner violence (IPV) in Sao Paulo, Brazil. Data from 940 women who were interviewed as part of the WHO multi-country study on women's health and domestic violence against women, and census data for Sao Paulo City, were analyzed using multilevel regression techniques. A neighbourhood socioeconomic-level scale was created, and proxies for the socioeconomic positions of the couple were included. Other individual level variables included factors related to partner's behaviour and women's experiences and attitudes. Women's risk of IPV did not vary across neighbourhoods in Sao Paulo nor was it influenced by her individual socioeconomic characteristics. However, women in the middle range of the socioeconomic scale were significantly more likely to report having experienced violence by a partner. Partner behaviours such as excessive alcohol use, controlling behaviour and multiple sexual partnerships were important predictors of IPV. A women's likelihood of IPV also increased if either her mother had experienced IPV or if she used alcohol excessively. These findings suggest that although the characteristics of people living in deprived neighbourhoods may influence the probability that a woman will experience IPV, higher-order contextual dynamics do not seem to affect this risk. While poverty reduction will improve the lives of individuals in many ways, strategies to reduce IPV should prioritize shifting norms that reinforce certain negative male behaviours. (C) 2012 Elsevier Ltd. All rights reserved.

Molecular Characterization and Physical Mapping of Two Classes of 5S rDNA in the Genomes of Gymnotus sylvius and G. inaequilabiatus (Gymnotiformes, Gymnotidae)

The nucleotide sequences of the 5S rRNA multigene family and their distribution across the karyotypes in 2 species of Gymnotiformes, genus Gymnotus (G. sylvius and G. inaequilabiatus) were investigated by means of fluorescence in situ hybridization (FISH). The results showed the existence of 2 distinct classes of 5S rDNA sequences in both species: class I and class II. A high conservative pattern of the codifying region of the 5S rRNA gene was identified, contrasting with significant alterations detected in the nontranscribed spacer (NTS). The presence of TATA-like sequences along the NTS of both species was an expected occurrence, since such sequences have been associated with the regulation of the gene expression. FISH using 5S rDNA class I and class II probes revealed that both gene classes were collocated in the same chromosome pair in the genome of G. sylvius, while in that of G. inaequilabiatus, class II appeared more disperse than class I. Copyright (C) 2012 S. Karger AG, Basel

Construction and validation of an instrument that breaks the silence: the impact of domestic and/or sexual violence on women's health, as shown during climacterium

Objective: The aim of this study was to construct and to validate a measure of the consequences of domestic violence on women's health during climacterium. Methods: A questionnaire was administered at the Outpatient Climacterium Clinic to 124 women aged 40 to 65 years who were the victims of domestic and/or sexual violence (experimental group). They were divided into three groups: (1) those who were victims of violence exclusively during childhood/adolescence, (2) those who were victims of violence exclusively during adulthood, and (3) those who were victims of violence throughout their lives. The instrument included 34 items evaluating the beginning, frequency, and type of violence; the search for health assistance and reporting of the violence; the violence and the number of comorbidities; and violence and the Kupperman Menopausal Index. We also included a control group composed of perimenopausal and postmenopausal women who did not experience any violence (n = 120). Results: The instrument presented a Cronbach alpha = 0.82, good reliability among the examiners (+0.80), and a good possibility of reproducibility. The mean age of menopause was 45.4 years, and the mean age in the control group was 48.1 years. Group 1 showed a mean of 5.1 comorbidities, Group 2 had 4.6, and Group 3 had 4.4. Sexual violence (43.5%) and other types of violence both presented average comorbidities (4.60) but represented a significant impairment in the victim's sexual life. There were significant associations in group 3 and a high Kupperman Menopausal Index score. In the experimental group, 80.6% did not seek health services for the violence they experienced. Conclusions: The questionnaire presented good internal consistency and a validated construction. It can be easily reproduced and is indicated to evaluate the consequences of domestic and/or sexual violence on women's health during climacterium.

Engineering Active Pharmaceutical Ingredients by Spray Drying: Effects on Physical Properties and In Vitro Dissolution

Active pharmaceutical ingredients have very strict quality requirements; minor changes in the physical and chemical properties of pharmaceuticals can adversely affect the dissolution rate and therefore the bioavailability of a given drug. Accordingly, the aim of the present study was to investigate the effect of spray drying on the physical and in vitro dissolution properties of four different active pharmaceutical ingredients, namely carbamazepine, indomethacin, piroxicam, and nifedipine. Each drug was dispersed in a solution of ethanol and water (70:30) and subjected to single-step spray drying using similar operational conditions. A complete characterization of the spray-dried drugs was performed via differential scanning calorimetry (DSC), scanning electron microscopy (SEM), X-ray powder diffraction (XRPD), particle size distribution analysis, solubility analysis, and an in vitro dissolution study. The results from the thermal analysis and X-ray diffraction showed that, except for carbamazepine, no chemical modifications occurred as a result of spray drying. Moreover, the particle size distribution of all the spray-dried drugs significantly decreased. In addition, SEM images showed that most of the particles had an irregular shape. There was no significant improvement in the solubility of the spray-dried drugs compared with the unprocessed compounds; however, in general, the dissolution rates of the spray-dried drugs showed a remarkable improvement over their non-spray-dried counterparts. Therefore, the results from this study demonstrate that a single spray-drying step may lead to changes in the physical properties and dissolution characteristics of drugs and thus improve their therapeutic action.

Synthesis and application of stimuli responsive tunable systems based on physical interactions

Novel single step synthetic procedure for hydrophobically modified alkali soluble latexes (HASE) via a miniemulsion-analogous method is presented. This facile method simplifies the copolymerization of the monomers with basically “opposite” character in terms of their hydrophilic/hydrophobic nature, which represent one of the main challenges in water based systems. Considered systems do not represent classical miniemulsions due to a high content of water soluble monomers. However, the polymerization mechanism was found to be rather similar to miniemulsion polymerization process.rnThe influence of the different factors on the system stability has been investigated. The copolymerization behavior studies typically showed strong composition drifts during copolymerization. It was found that the copolymer composition drift can be suppressed via changing the initial monomer ratio.rnThe neutralization behavior of the obtained HASE systems was investigated via potentiometric titration. The rheological behavior of the obtained systems as a function of the different parameters, such as pH, composition (ultrahydrophobe content) and additive type and content has also been investigated.rnDetailed investigation of the storage and loss moduli, damping factor and the crossover frequencies of the samples showed that at the initial stages of the neutralization the systems show microgel-like behavior.rnThe dependence of the rheological properties on the content and the type of the ultrahydrophobe showed that the tuning of the mechanical properties can be easily achieved via minor (few percent) but significant changes in the content of the latter. Besides, changing the hydrophobicity of the ultrahydrophobe via increasing the carbon chain length represents another simple method for achieving the same results.rnThe influence of amphiphilic additives (especially alcohols) on the rheological behavior of the obtained systems has been studied. An analogy was made between micellation of surfactants and the formation of hydrophobic domains between hydrophobic groups of the polymer side chain.rnDilution induced viscosity reduction was investigated in different systems, without or with different amounts or types of the amphiphilic additive. Possibility of the controlled response to dilution was explored. It was concluded that the sensitivity towards dilution can be reduced, and in extreme cases even the increase of the dynamic modulus can be observed, which is of high importance for the setting behavior of the adhesive material.rnIn the last part of this work, the adhesive behavior of the obtained HASE systems was investigated on different substrates (polypropylene and glass) for the standard labeling paper. Wet tack and setting behavior was studied and the trends for possible applications have been evaluated.rnThe novel synthetic procedure, investigation of rheological properties and the possibility of the tuning via additives, investigated in this work create a firm background for the development of the HASE based adhesives as well as rheology modifiers with vast variety of possible applications due to ease of tuning the mechanical and rheological properties of the systems.

Micro and Macro Causes of Violence

The dominant emotion in violence-threatening situations is confrontational tension/fear (ct/f), which causes most violence to abort, or to be carried out inaccurately and incompetently. For violence to be successful, there must be a pathway around the barrier of ct/f. These pathways include: attacking the weak; audience-oriented staged and controlled fair fights; confrontation-avoiding remote violence; confrontation-avoiding by deception; confrontation-avoiding by absorption in technique. Successfully violent persons, on both sides of the law, are those who have developed these skilled interactional techniques. Since successful violence involves dominating the emotional attention space, only a small proportion of persons can belong to the elite which does most of each type of violence. Macro-violence, including victory and defeat in war, and in struggles of paramilitaries and social movements, is shaped by both material resources and social/emotional resources for maintaining violent organizations and forcing their opponents into organizational breakdown. Social and emotional destruction generally precedes physical destruction.

Domestic Violence

Since the 1960s, there has been growing awareness regarding the issue of domestic violence as a form of violence against women, which has been largely influenced by the work of feminist activist and scholars in North America and Europe (Dobash and Dobash 1992). Other terms have been used to describe the same phenomenon, including domestic abuse, spousal abuse, wife battering, marital violence, intimate partner violence. Though there is no doubt that this problem has existed for much more than five decades, the tendency to label it as ‘private matters’ or ‘marital disagreements’ has obscured the reality of women living with abuse in their home. At a general level, domestic violence can be defined as the means used by a man in order to assert his control and domination over his intimate partner, whether they are married or not (Mullender 1996). It can involve incidents of physical and sexual violence, as well as verbal, psychological and financial abuse. Though some of its manifestations may be associated with particular cultural or religious groups – e.g. forced marriage and honour killing in South-Asian communities – domestic violence affects women from all classes and backgrounds.

Interdisciplinary Cardiovascular and Neurologic Outpatient Rehabilitation in Patients Surviving Transient Ischemic Attack or Stroke With Minor or No Residual Deficits

Objective To evaluate the feasibility and effectiveness of a comprehensive outpatient rehabilitation program combining secondary prevention and neurorehabilitation to improve vascular risk factors, neurologic functions, and health-related quality of life (HRQOL) in patients surviving a transient ischemic attack (TIA) or stroke with minor or no residual deficits. Design Prospective interventional single-center cohort study. Setting University hospital. Participants Consecutive consenting patients having sustained a TIA or stroke with 1 or more vascular risk factors (N=105) were included. Interventions Three-month hospital-based secondary prevention and neurorehabilitation outpatient program with therapeutic and educational sessions twice a week. Patients were evaluated at entry and program end. Main Outcome Measures Impact on vascular risk factors, neurological outcome, and HRQOL. Results A total of 105 patients entered the program and 95 patients completed it. Exercise capacity (P<.000), smoking status (P=.001), systolic (P=.001) and diastolic (P=.008) blood pressure, body mass index (P=.005), low-density lipoprotein cholesterol (P=.03), and triglycerides (P=.001) improved significantly. Furthermore, the 9-Hole-Peg-Test (P<.000), Six-minute Walking Test (P<.000), and One Leg Stand Test (P<.011) values as well as HRQOL improved significantly. The program could be easily integrated into an existing cardiovascular prevention and rehabilitation center and was feasible and highly accepted by patients. Conclusions Comprehensive combined cardiovascular and neurologic outpatient rehabilitation is feasible and effective to improve vascular risk factors, neurologic functions, and HRQOL in patients surviving TIA or stroke with minor or no residual deficits.

An exploratory study about the perception and justification of violence in Mixed Martial Arts and kickboxing athletes

THE INFLUENCE of combat sport practice on behaviour, attitude, personality and other factors was, and still remains, a research topic of great interest as well as conflicting points of view. Findings are as yet inconclusive since a direct or causal effect is difficult to establish and other factors external to the individual, such as the instructor’s coaching style, also need to be taken into consideration. Furthermore, the wide range of disciplines pertaining to the category combat sports differ from each other on a number of characteristics, such as the extent of physical contact or competition rules, and in fact, attempts have been made to distinguish between various sub-types (e.g. Trulson, 1986). A common distinction made is that between the traditional martial arts, which place emphasis on the art’s philosophy, its traditions and hierarchy (e.g. traditional karate, aikido) and the modern (or Western) combat sports (e.g. boxing, Mixed Martial Arts). An ongoing debate exists about the potential positive and/or negative influence of combat sport practice in comparison to other sport disciplines that do not include this element of fighting and direct aggression. On the one hand, combat sports have been presented by some researchers and sport practitioners as a means of promoting positive social and individual behavior, such as in Theeboom, De Knop and Wylleman’s (2008) evaluation of a martial arts Programme for socially disadvantaged youths in Belgium. Results revealed a positive effect of this project; however, it also highlighted the crucial role played by the instructors or leaders of such programmes. In another intervention using martial arts, Trulson (1986) reported a positive effect of a six month traditional martial art (Korean Tae Kwon Do) intervention with male juvenile delinquents including a reduction in aggressiveness and anxiety, thus confirming the positive influence of such an activity. Nevertheless, this effect was not observed in the other group participating in a modern Adaptation of this martial art led by the same instructor, where the philosophical aspect of this discipline was not emphasised. Moreover, an opposite effect was ascertained in this case where an increased tendency towards delinquency was reported. These results support the distinction between the various types of combat sports together with the way this sport is presented and taught by the instructor.

An assessment of self-concept and violence within a delinquent adolescent population

The purpose of this study was to provide further data on the relationship between self-concept and violence focusing on a delinquent adolescent population. Recent research has explored the relationship between self-concept and violence with most of the research being done with adult populations. Within the literature, there are two opposing views on the question of this relationship. The traditional view supports the idea that low self-esteem is a cause of violent behavior while the non-traditional view supports the idea that high self-esteem may be a contributor to violent behavior. ^ Using a sample of 200 delinquent adolescents 100 of whom had committed acts of violence and 100 who had not, a group comparison study was done which addressed the following questions, (1) within a delinquent population of violent and non-violent adolescents, is there a relationship between violence and self-concept? (2) what is that relationship; (3) using the Piers-Harris Children's Self-Concept Scale, can it be determined that attributes such as behavior, anxiety, popularity, happiness, and physical appearance as they relate to self-concept are more predictive than others in determining who within a delinquent population will commit acts of violence. For the purposes of this study, delinquent adolescents were those who had official records of misconduct with either the school or juvenile authorities. Adolescents classified as violent were those who had committed acts such as assault, use of a weapon, use of deadly force, and sexual assault while adolescents classified as non-violent had committed anti-social acts such as, truancy, talking back and rule breaking. ^ The study concluded that there is a relationship between adolescent violence and self-concept. However, there was insufficient statistical evidence that self-concept is a predictor of violence. ^

Is dating violence associated with substance use and sexual risk behaviors among urban, minority, middle school youth

Background. One in 4 adolescents reports some form of dating violence each year. Dating violence among high school adolescents has been linked with several morbidity issues. However, the association between dating violence and sexual risk and/or substance use among young adolescents has rarely been studied.^ Methods. Research hypotheses were tested using a secondary data analysis from a HIV, STI, pregnancy prevention intervention study for urban middle school students.^ Results. At baseline, 21% of youth reported experiencing physical ADV victimization, 48.2% reported non-physical victimization, and 52.6% report any victimization. After adjusting for race/ethnicity, gender, and age ever having sex, alcohol use, and illicit drug use were significantly associated with several forms of ADV.^ Conclusions. Dating violence appears to be associated with early initiation of sexual behavior, as well as alcohol and drug use. Few interventions address ADV among middle school youth. Early interventions that prevent dating violence are needed. ^

Pregnancy intention, intimate partner violence, and the use of prenatal care in Jordan

Previous research has suggested an association between intimate partner violence and pregnancy intention status, and pregnancy intention status and the use of prenatal care services, however much of these studies have been conducted in high income countries (HIC) rather than low and middle income countries (LMIC). The objectives of this study were to examine the relationship between pregnancy intention status and intimate partner violence, and pregnancy intention status and the use of prenatal care among ever-married women in Jordan.^ Data were collected from a nationally representative sample of women interviewed in the 2007 Jordan Demographic and Health Survey. The sample was restricted to ever-married women, 15–49 years of age, who had a live birth within the five years preceding the survey. Multivariate logistic regression analyses was used to determine the relationship between intimate partner violence and pregnancy intention status, and pregnancy intention status and the use of prenatal care services.^ Women who reported a mistimed pregnancy (PORadj 1.96, 95% CI: 1.31–2.95), as well as an unwanted pregnancy (PORadj 1.32, 95% CI: 0.80–2.18) had a higher odds of experiencing lifetime physical and/or sexual abuse compared with women reporting a wanted pregnancy. Women not initiating prenatal care by the end of the first trimester had statistically significant higher odds of reporting both a mistimed (PORadj 2.07, 95% CI: 1.55–2.77) and unwanted pregnancy (PORadj 2.36, 95% CI: 1.68–3.31), compared with women initiating care in the first trimester. Additionally, women not receiving the adequate number of prenatal care visits for their last pregnancy had a higher odds of reporting an unwanted pregnancy (PORadj 2.11, 95% CI: 1.35–3.29) and mistimed pregnancy (POR adj 1.41, 95% CI: 0.96–2.07).^ Reducing intimate partner violence may decrease the prevalence of mistimed or unwanted pregnancies, and reducing both unwanted and mistimed pregnancies may decrease the prevalence of women not receiving timely and adequate prenatal care among women in this population. Further research, particularly in LMIC, is needed regarding the determinants of unintended pregnancy and its association with intimate partner violence as well as with the use of prenatal care services. ^

Program for increasing resident's physical activity at the women's home

Obesity and overweight has reached epidemic proportions in the United States, and the prevalence of overweight and obesity among residents of The Women's Home residents is high. This culminating experience is the result of my practicum at The Women's Home located in Houston, TX. The Women's Home is a rehabilitation center for victims of sexual assault, drug abuse, family violence, or a combination. A needs assessment including focus groups and a literature review was conducted to design a a physical activity intervention for the residents. Results from focus group data showed the resident's average BMI was 32, which is termed clinically obese by American standards. The focus groups determined a strong interest (92%) in engaging in more physical activity to combat their weight problem. As well, they expressed interest in using pedometers as a mechanism to increase physical activity. This planned program, “Every Step Counts”, uses reactivity to pedometers in conjunction with goal setting and increased awareness to increasing steps each day. “Every Step Counts” was developed with support and input from stakeholders, with theoretical constructs and previous evidence based studies. Included in this report are recommendations for implementation, program materials, scope and sequence of program activities, and methods for periodic evaluation.^