Sexual abuse in childhood and postoperative depression in women with breast cancer who opt for immediate reconstruction after mastectomy

INTRODUCTION Breast reconstruction is routinely offered to women who undergo mastectomy for breast cancer. However, patient-reported outcomes are mixed. Child abuse has enduring effects on adults’ well-being and body image. As part of a study into damaging effects of abuse on adjustment to breast cancer, we examined: (i) whether women with history of abuse would be more likely than other women to opt for reconstruction; and (ii) whether mood problems in women opting for reconstruction can be explained by greater prevalence of abuse. PATIENTS AND METHODS We recruited 355 women within 2-4 days after surgery for primary breast cancer; 104 had mastectomy alone and 29 opted for reconstruction. Using standardised questionnaires, women self-reported emotional distress and recollections of childhood sexual abuse. Self-report of distress was repeated 12 months later. RESULTS Women who had reconstruction were younger than those who did not. Controlling for this, they reported greater prevalence of abuse and more distress than those having mastectomy alone. They were also more depressed postoperatively, and this effect remained significant after controlling for abuse. CONCLUSIONS One interpretation of these findings is that history of abuse influences women's decisions about responding to the threat of mastectomy, but it is premature to draw inferences for practice until the findings are replicated. If they are replicated, it will be important to recognise increased vulnerability of some patients who choose reconstruction. Studying the characteristics and needs of women who opt for immediate reconstruction and examining the implications for women's adjustment should be a priority for research.

Overgeneral autobiological memory in women: association with childhood abuse and history of depression in a community sample

Objective. Numerous studies have reported elevated levels of overgeneral autobiographical memory among depressed patients and also among those previously exposed to a traumatic event. No previous study has examined their joint association with overgeneral memory in a community sample, nor examined whether the associations are with both juvenile- and adult-onset depression. Methods. The current study examined the relative importance of exposure to childhood abuse and neglect in overgeneral memory of women with and without a history of major depressive disorder (MDD). Autobiographical memory test together with standardized interviews of childhood experiences and MDD were assessed in a risk-stratified community sample of 103 women aged 25–37. Results. Overgenerality in memory was associated with recalled childhood sexual abuse (CSA) but not other adversities. A history of CSA was predictive of overgeneral memory bias even in the absence of MDD. Our analyses indicated no significant association between a history of MDD and overgeneral memory in women who reported no CSA. However, overgeneral memory was increased in women who reported CSA and MDD with a significant difference found in relation to positive cues, the highest scores being seen among those with adult rather than juvenile-onset depression. Conclusions. The findings highlight the significance of CSA in predicting overgeneral memory, differential response in relation to positive and negative cue memories, and point to a specific role in the development of depression for overgeneral memory following CSA.

Graceful remedies: understanding grace in the Catholic Church's treatment of clerical child sexual abuse

This article examines advocacy of Catholic restorative justice for clerical child sexual abuse from the standpoint of feminist criminological critiques of the use of restorative mediation in sexual offence cases. In particular, it questions the Catholic invocation of grace and forgiveness of survivors of abuse in light of critical feminist concerns about the exploitation of emotions in restorative practices, especially in regard to sexual and other gender-based offences. In the context of sexual abuse, the Catholic appeal to grace has the potential for turning into an extraordinary demand made of victims not only to rehabilitate offenders and the church in the eyes of the community, but also to work towards the spiritual absolution of the abuser. This unique feature of Catholic-oriented restorative justice raises important concerns in terms of feminist critiques of the risk of abuses of power within mediation, and is also incompatible with orthodox restorative justice theory, which, although it advocates a ‘spiritual’ response to crime, is concerned foremost with the rights, needs and experiences of victims.

Civilian casualties – do we really care? The failure of the revolution in military affairs of non-lethal weapons in the U.S., Russia and Israel

Causing civilian casualties during military operations has become a much politicised topic in international relations since the Second World War. Since the last decade of the 20th century, different scholars and political analysts have claimed that human life is valued more and more among the general international community. This argument has led many researchers to assume that democratic culture and traditions, modern ethical and moral issues have created a desire for a world without war or, at least, a demand that contemporary armed conflicts, if unavoidable, at least have to be far less lethal forcing the military to seek new technologies that can minimise civilian casualties and collateral damage. Non-Lethal Weapons (NLW) – weapons that are intended to minimise civilian casualties and collateral damage – are based on the technology that, during the 1990s, was expected to revolutionise the conduct of warfare making it significantly less deadly. The rapid rise of interest in NLW, ignited by the American military twenty five years ago, sparked off an entirely new military, as well as an academic, discourse concerning their potential contribution to military success on the 21st century battlefields. It seems, however, that except for this debate, very little has been done within the military forces themselves. This research suggests that the roots of this situation are much deeper than the simple professional misconduct of the military establishment, or the poor political behaviour of political leaders, who had sent them to fight. Following the story of NLW in the U.S., Russia and Israel this research focuses on the political and cultural aspects that have been supposed to force the military organisations of these countries to adopt new technologies and operational and organisational concepts regarding NLW in an attempt to minimise enemy civilian casualties during their military operations. This research finds that while American, Russian and Israeli national characters are, undoubtedly, products of the unique historical experience of each one of these nations, all of three pay very little regard to foreigners’ lives. Moreover, while it is generally argued that the international political pressure is a crucial factor that leads to the significant reduction of harmed civilians and destroyed civilian infrastructure, the findings of this research suggest that the American, Russian and Israeli governments are well prepared and politically equipped to fend off international criticism. As the analyses of the American, Russian and Israeli cases reveal, the political-military leaderships of these countries have very little external or domestic reasons to minimise enemy civilian casualties through fundamental-revolutionary change in their conduct of war. In other words, this research finds that employment of NLW have failed because the political leadership asks the militaries to reduce the enemy civilian casualties to a politically acceptable level, rather than to the technologically possible minimum; as in the socio-cultural-political context of each country, support for the former appears to be significantly higher than for the latter.

Harold Pinter: A Night Out : A Study in the Political ConnotationsAnd the Abuse of Power

Harold Pinter’s A Night Out is a significant but rarely produced piece of drama. Therefore, there is very little criticism to support or contradict my argument. The reason why I chose to do my essay on this particular play is to open doors for academic research and to try and make it an equal to its sister plays. I will raise questions and topics to prove the play is worth the readers’ time and effort and that A Night Out is a sharp piece of political theatre. Although at first glance it is a simple enough story, a straightforward tale of the nasty consequences of motherly love when it is pushed to the limit, on deeper inspection, a more far reaching and complex analysis of the abuse of power can be observed. The play offers a variety of themes, including: interpersonal power struggles, failed attempts at communication, antagonistic relationships, the threat of impending or past violence, the struggle for survival or identity, domination and submission, politics, lies and verbal, physical, psychological and sexual abuse. The prevailing theme in the play is the abuse of power: powerful parties oppressing weaker ones, and the results of the oppressed party looking for a vent in someone even weaker than themselves.

Poverty as an Abuse of Human Rights in Ghana. : A grass roots perspective on poverty and human rights.

The study aimed at getting a grass root opinion on poverty and why Ghana is still poor after 50 years of independence in spite of her richness in natural resources, second largest producer of cocoa in the word and appreciable stable political environment. The opinions of the ordinary people in the Bia district and their observed living conditions was analysed in line with theoretical basis of the study and previous studies to justify the stance that poverty should be considered as an abuse of human rights. It was concluded based on position of informants and previous data available that though many factors have been raised by previous scholars as the cause of poverty, the actions and inactions of both internal and external power-holders is the main source of poverty in Ghana. It was proposed that for poverty to be reduced in a sustainable way there should be strong civil society groups and active citizens through civic education to hold power-holders accountable. Until the actions and inactions of power-holders which have subjected many Ghanaians into intergenerational poverty are seen as human rights abuse, the rights of many Ghanaians would be constantly abused. This will eventually defeat the promotion of human rights culture in Ghana.

Adaptação transcultural para o Português/Brasil do instrumento vulnerability to abuse screening scale (VASS)

Esse trabalho objetivou promover a adaptação transcultural para o Brasil da VASS. Os passos para adaptação transcultural seguirão a proposta de operacionalização alicerçado na apreciação de diferentes tipos de equivalência: a conceitual e de itens, a semântica e a de mensuração. Para alcançar as duas primeiras etapas utilizou-se as técnicas de tradução e retrotradução associada ao procedimento intitulado Painel de Especialistas. Para o pré-teste e verificação de equivalência de mensuração, aplicou-se o questionário com uma população de 30 e 66 idosos, respectivamente. Para as análises dos resultados foi utilizada a estatística descritiva e inferencial, em especial o KR-20, teste T de student, correlação de Pearson e ANOVA univariada, bem como o método kappa de Fleiss para verificação do índice de confiabilidade. Verificou-se que o conceito utilizado para construção do instrumento, bem como seus itens se mostram adequados à investigação do fenômeno. Evidenciou-se boa equivalência semântica entre os itens das retrotraduções e do instrumento original, especialmente quanto aos resultados de T1 R1. Os juízes optaram pelo uso de 11 itens de T1 à versão-síntese. A equivalência operacional mostrou-se satisfatória. Em geral, os resultados apresentados mostraram-se aceitáveis. Quanto à etapa da equivalência de mensuração, verificou-se que a idade dos participantes variou entre 60 a 84 anos, prevalecendo respondentes idosas (n = 38), representando 57,6% da amostra estudada. O valor do KR-20 para o escore geral do instrumento foi de 0,688 (IC95%: 0,670). Os valores encontrados para as quatro dimensões propostas pelos autores do estudo inicial do instrumento foram 0,528, 0,289, 0,552 e 0,303, respectivamente. Apenas os valores de consistência interna das subescalas Vulnerabilidade e Coerção mostraram-se aproximados aos encontrados no estudo original, a saber, 0,550 e 0,390, respectivamente. Verificou-se que com a retirada dos itens nº 04, nº 06 e nº 10, houve aumento do índice de consistência interna da escala total. Já quanto aos valores da consistência interna das subescalas, percebeu-se que apenas com a retirada dos itens nº 09, referente à escala que dimensiona o Desânimo, e nº 12, item da subescala Coerção, é que houve acréscimo nesses valores. Destaca-se que esses são resultados preliminares, uma vez que após a verificação da adequabilidade e de padrões psicométricos iniciais acerca do uso do instrumento para a população idosa, ainda há de se dar continuidade à etapa concernente à verificação de propriedades psicométricas robustas do instrumento, que indiquem, por exemplo, evidências de fidedignidade em situação de teste-reteste, validade de constructo e de critério, se possível e aplicável. A principal limitação do estudo é a falta de um instrumento padrão-ouro para testar a fidedignidade, sensibilidade e especificidade do instrumento em questão. Apesar desta limitação, a adaptação transcultural e a verificação de propriedades psicométricas preliminares do instrumento de uma medida de autorrelato que afere indicativo de violência doméstica contra o idoso tem sua relevância e foi satisfatória

The role of salt abuse on risk for hypercalciuria

Background: Elevated sodium excretion in urine resulting from excessive sodium intake can lead to hypercalciuria and contribute to the formation of urinary stones. The aim of this study was to evaluate salt intake in patients with urinary lithiasis and idiopathic hypercalciuria (IH).Methods: Between August 2007 and June 2008, 105 lithiasic patients were distributed into 2 groups: Group 1 (n = 55): patients with IH (urinary calcium excretion > 250 mg in women and 300 mg in men with normal serum calcium); Group 2 (n = 50): normocalciuric patients (NC). Inclusion criteria were: age over 18 years, normal renal function (creatinine clearance >= 60 ml/min), absent proteinuria and negative urinary culture. Pregnant women, patients with intestinal pathologies, chronic diarrhea or using corticoids were excluded. The protocol of metabolic investigation was based on non-consecutive collection of two 24-hour samples for dosages of: calcium, sodium, uric acid, citrate, oxalate, magnesium and urinary volume. Food intake was evaluated by the three-day dietary record quantitative method, and the Body Mass Index (BMI) was calculated and classified according to the World Health Organization (WHO). Sodium intake was evaluated based on 24-hour urinary sodium excretion.Results: The distribution in both groups as regards mean age (42.11 +/- 10.61 vs. 46.14 +/- 11.52), weight (77.14 +/- 16.03 vs. 75.99 +/- 15.80), height (1.64 +/- 0.10 vs. 1.64 +/- plusorminus 0.08) and BMI (28.78 +/- 5.81 vs. 28.07 +/- 5.27) was homogeneous. Urinary excretion of calcium (433.33 +/- 141.92 vs. 188.93 +/- 53.09), sodium (280.08 +/- 100.94 vs. 200.44.93 +/- 65.81), uric acid (880.63 +/- 281.50 vs. 646.74 +/- 182.76) and magnesium (88.78 +/- 37.53 vs. 64.34 +/- 31.84) was significantly higher in the IH group (p < 0.05). There was no statistical difference in calcium intake between the groups, and there was significantly higher salt intake in patients with IH than in NC.Conclusions: This study showed that salt intake was higher in patients with IH as compared to NC.