Pretreatment and outcome correlates of sexual and physical trauma in an epidemiological cohort of first-episode psychosis patients

High prevalence of trauma has been reported in psychosis. While role of trauma as a risk factor for developing psychosis is still debated, its negative impact on outcome has been described. Few studies have explored this issue in first-episode psychosis (FEP) patients. We assessed rate of stressful events, as well as premorbid and outcome correlates of past sexual and/or physical abuse (SPA) in an epidemiological FEP patients cohort.

Attitudes and Social Factors as Predictors of Male Perpetration of Sexual Assault

Previous research has demonstrated a significant association between sexual assault perpetration and hooking up, male peer support for woman abuse, alcohol consumption, and rape myth acceptance (Burt, 1980; Flack, Daubman, Caron, Asadorian, D’Aureli, Gigliotti & Stine, 2007; Schwartz & DeKeseredy, 1997). In the present study, we tested these relationships on the collegiate level by asking male students to indicate levels of male peer support for woman abuse (MPS), acceptance of rape myths (RMA), alcohol consumption, and history of hooking up and sexual assault perpetration during their undergraduate experience. Participants in this study were 200 male Bucknell students (sophomores - seniors) who completed an online survey concerning these issues. The overall prevalence rate for some type of sexual assault perpetration was 10.5%. Specific prevalence rates for non-invasive contact, completed rape, and attempted rape were 5.5%, 2.0%, and 5.0%, respectively. Sexual assault perpetration was positively correlated with MPS and alcohol consumption but not with RMA. Sexual assault was perpetrated most frequently during acquaintance hook ups. These findings demonstrate direct, significant relationships between sexual assault perpetration, alcohol abuse, different types of hooking up, and rape-supportive attitudes, and an association between perpetration and MPS that requires further elaboration.

The role of substance abuse treatment in preventing human immunodeficiency virus transmission among injecting drug users

This exploratory study assesses the utility of substance abuse treatment as a strategy for preventing human immunodeficiency virus (HIV) transmission among injecting drug users (IDUs). Data analyzed in this study were collected in San Antonio, TX, 1989 through 1995 using both qualitative and quantitative methods. Qualitative data included ethnographic interviews with 234 active IDUs; quantitative data included baseline risk assessments and HIV screening plus interviews follow-up interviews administered approximately six months later to 823 IDUs participating in a Federally-funded AIDS community outreach demonstration project.^ Findings that have particularly important implications for substance abuse treatment as an HIV prevention strategy for IDUs are listed below. (1) IDUs who wanted treatment were significantly more likely to be daily heroin users. (2) IDUs who want treatment were significantly more likely to have been to treatment previously. (3) IDUs who wanted treatment at baseline reported significantly higher levels of HIV risk than IDUs who did not want treatment. (4) IDUs who went to treatment between their baseline and follow-up interviews reported significantly higher levels of HIV risk at baseline than IDUs who did not go to treatment. (5) IDUs who went to treatment between their baseline and follow-up interviews reported significantly greater decreases in injection-related HIV risk behaviors. (6) IDUs who went to treatment reported significantly greater decreases in sexual HIV risk behaviors than IDUs who did not go to treatment.^ This study also noted a number of factors that may limit the effectiveness of substance abuse treatment in reducing HIV risk among IDUs. Findings suggest that the impact of methadone maintenance on HIV risk behaviors among opioid dependent IDUs may be limited by the negative manner in which it is perceived by IDUs as well as other elements of society. One consequence of the negative perception of methadone maintenance held by many elements of society may be an unwillingness to provide public funding for an adequate number of methadone maintenance slots. Thus many IDUs who would be willing to enter methadone maintenance are unable to enter it and many IDUs who do enter it are forced to drop out prematurely. ^

The association of childhood trauma and personality disorder with adult chronic depression. A cross-sectional study in depressed outpatients

Objective: Chronic depression has often been associated with childhood trauma. There may, however, be an interaction between personality pathology, childhood trauma, and chronic depression. This interaction has not yet been studied. Method: This retrospective analysis is based on 279 patients contacted for a randomized trial in an outpatient psychotherapy center over a period of 18 months from 2010 to 2012. Current diagnoses of a personality disorder and presence of chronic depression were systematically assessed using the Structured Clinical Interview for DSM-IV. Retrospective reports of childhood trauma were collected using the short form of the Childhood Trauma Questionnaire (CTQ-SF). DSM-IV–defined chronic depression was the primary outcome. The association between chronic depression, childhood trauma, and personality disorders was analyzed using correlations. Variables that had at least a small effect on correlation analysis were entered into a series of logistic regression analyses to determine the predictors of chronic depression and the moderating effect of childhood trauma. Results: The presence of avoidant personality disorder, but no CTQ-SF scale, was associated with the chronicity of depression (odds ratio [OR] = 2.20, P = .015). The emotional abuse subscale of the CTQ-SF did, however, correlate with avoidant personality disorder (OR = 1.15, P = .000). The level of emotional abuse had a moderating effect on the effect of avoidant personality disorder on the presence of chronic depression (OR = 1.08, P = .004). Patients who did not suffer from avoidant personality disorder had a decreased rate of chronic depression if they retrospectively reported more severe levels of emotional abuse (18.9% vs 39.7%, respectively). Conclusions: The presence of avoidant personality pathology may interact with the effect of childhood trauma in the development of chronic depression. This has to be confirmed in a prospective study.

FEMALE SEXUAL MATURATION AND BLOOD PRESSURE (SECONDARY-SEX CHARACTERISTICS, GROWTH, DEVELOPMENT)

This study described the relationship of sexual maturation and blood pressure in a sample (n = 361) of white females, ages seven through 18, attending public schools in a defined area of Central Texas during October through December, 1984. Other correlates of blood pressure were also described for this sample.^ A survey was performed to obtain the data on height, weight, body mass, pulse rate, upper arm circumference and length, and blood pressure. Each subject self-assessed her secondary sex characteristics (breast and pubic hair) according to drawings of the Tanner stages of maturation. The subjects were interviewed to obtain data on personal health habits and menstrual status. Student age, ethnic group and place of residence were abstracted from school records. Parents or guardians of the subjects responded to a questionnaire pertaining to parental and subject health history and parents' occupation and educational attainment.^ In the simple linear regression analysis, sexual maturation and variables of body size were significantly (p < 0.001) and positively associated with systolic and fourth- and fifth-phase diastolic blood pressure. The demographic and socioeconomic variables were not sufficiently variant in this population to have differential effects on the relation between blood pressure and maturation. Stepwise multiple regression was used to assess the contribution of sexual maturation to the variance of blood pressure after accounting for the variables of body size. Sexual maturation (breast stage) along with weight, height and body mass remained in the multiple regression models for fourth- and fifth-phase diastolic blood pressure. Only height and body mass remained in the regression model for systolic blood pressure; sexual maturation did not contribute more to the explanation of the systolic blood pressure variance.^ The association of sexual maturation with blood pressure level was established in this sample of young white females. More research is needed first, to determine if this relationship prevails in other populations of young females, and second, to determine the relationship of sexual maturation sequence and change with the change of blood pressure during childhood and adolescence. ^

BLOOD PRESSURE CHANGES IN RELATION TO DEMOGRAPHIC, ANTHROPOMETRIC, AND SEXUAL MATURATION VARIABLES IN U.S. HEALTH EXAMINATION SURVEY OF CHILDREN AND YOUTHS (UNITED STATES)

The determinants of change in blood pressure during childhood and adolescence were studied in a cohort of U.S. national probability sample of 2146 children examined on two occasions during the Health Examination Survey. Significant negative correlations between the initial level and the subsequent changes in blood pressure were observed. The multiple regression analyses showed that the major determinants of systolic blood pressure (SBP) change were change in weight, baseline SBP, and baseline upper arm girth. Race, time interval between examinations, baseline age, and height change were also significant determinants in SBP change. For the change in diastolic blood pressure (DBP), baseline DBP, baseline weight, and weight change were the major determinants. Baseline SBP, time interval and race were also significant determinants. Sexual maturation variables were also considered in the subgroup analysis for girls. Weight change was the most important predictor of the change in SBP for the group of girls who were still in the pre-menarchal or pre-breast maturation status at the time of the follow-up examination, and who had started to menstruate or to develop breast maturation at sometime between the two examinations. Baseline triceps skinfold thickness or initial SBP were more important variables than weight change for the group of girls who had already experienced menarche or breast maturation at the time of the initial survey. For the total group, pubic hair maturation was found to be a significant predictor of SBP change at the 5% significance level. The importance of weight change and baseline weight for the changes in blood pressure warrants further study. ^

Abusabilidad : Potencialidad de resultar víctima de abuso sexual intrafamiliar

Este estudio se centra en los llamados casos de abusos sexuales intrafamiliares (ASI), donde niños y adolescentes, o aun personas que ya han superado tales etapas vitales, se encuentran condicionadas en su integridad sexual por miembros de su entorno familiar con trato cotidiano, prolongado en el tiempo y con secuelas graves respecto a su estructuración subjetiva y a su vinculación social. En esta producción se intenta conceptualizar dentro de la problemática e abuso sexual, un fenómeno, que si bien no es nuevo, permanece oscurecido por otros que lo anteceden o del que derivan pero sin reconocerlo. Para ello se parte de la experiencia acumulada y del análisis de los textos más importantes sobre el tema. Además de la vinculación con otros profesionales que lo investigan. Esto promovió el deseo de profundizar en un campo, que si bien actualmente es rico en producciones teóricas, se visualiza como abierto, por su complejidad y demanda en aumento, a nuevas propuestas. Por otro lado el abuso sexual, en la actualidad, está reconocido como un hecho que convoca y requiere del compromiso de los profesionales de la salud, para realizar aportes que permitan un abordaje especializado y pertinente de la problemática. Este trabajo quiere brindar un primer punto fundamental para comprender, evaluar y tratar el abuso sexual, propone pensar una inscripción psíquica que funciona como potencialidad, es decir la construcción de atributos particulares que condicionan la concreción de la acción por parte del agresor y concomitantemente, la conversión de un sujeto en víctima de un abuso sexual, en especial cuando es intrafamiliar y prolongado. A tales condicionamientos se los llamará, aquí - Abusabilidad-. El enfoque supone la construcción de una característica particular en un sujeto que favorece que sea abusado, esta característica incluye componentes intrapsíquicos y vinculares, en un entramado complejo. El mismo requiere de una visión transdisciplinaria que permita captar el juego en el que se incluye tanto al abusador como al abusado y a todo el grupo primario al que pertenecen. La participación en este juego es lo que induce al abuso y lo sostiene en el tiempo. De él forma parte todo su grupo familiar y/o de crianza, por acción u omisión, en una característica que se llamará en este trabajo -ceguera y/o parálisis vincular- , y que presenta tanto la víctima directa como sus hermanos, madre u otros familiares. La víctima presenta, simultáneamente, la imposibilidad de defenderse y de pedir ayuda, y es inducida por el abusador y por el contexto en el que se da el abuso, al mantenimiento de un pacto de silencio. En el presente trabajo se intentará revertir el consenso establecido de que todo sujeto es igualmente pasible de resultar victimizado. La reversión surge, por un lado, de obviedades y experiencias (no hay dos sujetos iguales ni contextos idénticos); y, por otro, de lecturas que han orientado la reflexión hacia una dimensión crítica cuestionadora de lo instituido

Abusabilidad : Potencialidad de resultar víctima de abuso sexual intrafamiliar

Este estudio se centra en los llamados casos de abusos sexuales intrafamiliares (ASI), donde niños y adolescentes, o aun personas que ya han superado tales etapas vitales, se encuentran condicionadas en su integridad sexual por miembros de su entorno familiar con trato cotidiano, prolongado en el tiempo y con secuelas graves respecto a su estructuración subjetiva y a su vinculación social. En esta producción se intenta conceptualizar dentro de la problemática e abuso sexual, un fenómeno, que si bien no es nuevo, permanece oscurecido por otros que lo anteceden o del que derivan pero sin reconocerlo. Para ello se parte de la experiencia acumulada y del análisis de los textos más importantes sobre el tema. Además de la vinculación con otros profesionales que lo investigan. Esto promovió el deseo de profundizar en un campo, que si bien actualmente es rico en producciones teóricas, se visualiza como abierto, por su complejidad y demanda en aumento, a nuevas propuestas. Por otro lado el abuso sexual, en la actualidad, está reconocido como un hecho que convoca y requiere del compromiso de los profesionales de la salud, para realizar aportes que permitan un abordaje especializado y pertinente de la problemática. Este trabajo quiere brindar un primer punto fundamental para comprender, evaluar y tratar el abuso sexual, propone pensar una inscripción psíquica que funciona como potencialidad, es decir la construcción de atributos particulares que condicionan la concreción de la acción por parte del agresor y concomitantemente, la conversión de un sujeto en víctima de un abuso sexual, en especial cuando es intrafamiliar y prolongado. A tales condicionamientos se los llamará, aquí - Abusabilidad-. El enfoque supone la construcción de una característica particular en un sujeto que favorece que sea abusado, esta característica incluye componentes intrapsíquicos y vinculares, en un entramado complejo. El mismo requiere de una visión transdisciplinaria que permita captar el juego en el que se incluye tanto al abusador como al abusado y a todo el grupo primario al que pertenecen. La participación en este juego es lo que induce al abuso y lo sostiene en el tiempo. De él forma parte todo su grupo familiar y/o de crianza, por acción u omisión, en una característica que se llamará en este trabajo -ceguera y/o parálisis vincular- , y que presenta tanto la víctima directa como sus hermanos, madre u otros familiares. La víctima presenta, simultáneamente, la imposibilidad de defenderse y de pedir ayuda, y es inducida por el abusador y por el contexto en el que se da el abuso, al mantenimiento de un pacto de silencio. En el presente trabajo se intentará revertir el consenso establecido de que todo sujeto es igualmente pasible de resultar victimizado. La reversión surge, por un lado, de obviedades y experiencias (no hay dos sujetos iguales ni contextos idénticos); y, por otro, de lecturas que han orientado la reflexión hacia una dimensión crítica cuestionadora de lo instituido

Abusabilidad : Potencialidad de resultar víctima de abuso sexual intrafamiliar

Este estudio se centra en los llamados casos de abusos sexuales intrafamiliares (ASI), donde niños y adolescentes, o aun personas que ya han superado tales etapas vitales, se encuentran condicionadas en su integridad sexual por miembros de su entorno familiar con trato cotidiano, prolongado en el tiempo y con secuelas graves respecto a su estructuración subjetiva y a su vinculación social. En esta producción se intenta conceptualizar dentro de la problemática e abuso sexual, un fenómeno, que si bien no es nuevo, permanece oscurecido por otros que lo anteceden o del que derivan pero sin reconocerlo. Para ello se parte de la experiencia acumulada y del análisis de los textos más importantes sobre el tema. Además de la vinculación con otros profesionales que lo investigan. Esto promovió el deseo de profundizar en un campo, que si bien actualmente es rico en producciones teóricas, se visualiza como abierto, por su complejidad y demanda en aumento, a nuevas propuestas. Por otro lado el abuso sexual, en la actualidad, está reconocido como un hecho que convoca y requiere del compromiso de los profesionales de la salud, para realizar aportes que permitan un abordaje especializado y pertinente de la problemática. Este trabajo quiere brindar un primer punto fundamental para comprender, evaluar y tratar el abuso sexual, propone pensar una inscripción psíquica que funciona como potencialidad, es decir la construcción de atributos particulares que condicionan la concreción de la acción por parte del agresor y concomitantemente, la conversión de un sujeto en víctima de un abuso sexual, en especial cuando es intrafamiliar y prolongado. A tales condicionamientos se los llamará, aquí - Abusabilidad-. El enfoque supone la construcción de una característica particular en un sujeto que favorece que sea abusado, esta característica incluye componentes intrapsíquicos y vinculares, en un entramado complejo. El mismo requiere de una visión transdisciplinaria que permita captar el juego en el que se incluye tanto al abusador como al abusado y a todo el grupo primario al que pertenecen. La participación en este juego es lo que induce al abuso y lo sostiene en el tiempo. De él forma parte todo su grupo familiar y/o de crianza, por acción u omisión, en una característica que se llamará en este trabajo -ceguera y/o parálisis vincular- , y que presenta tanto la víctima directa como sus hermanos, madre u otros familiares. La víctima presenta, simultáneamente, la imposibilidad de defenderse y de pedir ayuda, y es inducida por el abusador y por el contexto en el que se da el abuso, al mantenimiento de un pacto de silencio. En el presente trabajo se intentará revertir el consenso establecido de que todo sujeto es igualmente pasible de resultar victimizado. La reversión surge, por un lado, de obviedades y experiencias (no hay dos sujetos iguales ni contextos idénticos); y, por otro, de lecturas que han orientado la reflexión hacia una dimensión crítica cuestionadora de lo instituido

Public and private sources of funding for sexual assault treatment programs /

Mode of access: Internet.

Without women: Masculinities, gay male sexual culture and sexual behaviors in Miami, Florida

Recent studies have reported alarmingly high rates of HIV infection and risky sexual behaviors among gay men in Miami, Florida. Previous research has suggested that the risky sexual behaviors of many gay men reflect the pursuit of intimacy and love, and that barriers to intimate relationships among gay men may stem from traditional masculinity norms. This dissertation examines the meanings which gay men ascribe to their sexual behaviors, as well as the intersections of those meanings with both traditional masculinity constructions and Miami's gay male sexual culture. ^ The study is based upon participant observation, print media content analysis, surveys and ethnographic interviews of a purposive snowball sample of 30 Cuban American, Puerto Rican, African American and Anglo gay men who reside in Miami-Dade County, Florida. Analysis of research questions was accomplished through grounded theory methods and descriptive and non-parametric statistics, including Pearson chi-square, Fisher's Exact and Mann-Whitney U tests. ^ The study shows that culturally-specified masculinity norms vary in the relative importance ascribed to heterosexual prowess, economic providership and competitiveness. These cultural differences appear important not only to the timing of sexual awareness and to the strength of homosexual stereotyping as effeminacy, but also to men's strategies in coming out as gay. The meanings men attributed to their sexual behaviors were, however, constructed in response to both inherited masculinity norms and the hypermasculine structure of Miami's gay male sexual culture. In addition to providing an ethnographic account of this subculture, the study elaborates men's issues relative to casual sex and committed relationships. Unprotected anal intercourse with casual partners during the previous twelve months was associated with growing up without one's father in the home, having been teased for effeminacy during childhood, being defensive about one's masculinity, not trusting men, having been cheated on by boyfriends, and believing that long-term gay male relationships are problematic. ^ It is concluded that the continuing epidemic of HIV infections among local gay men, as well as the hypermasculine form of the gay sexual subculture itself, are nihilistic symptoms embedded in the masculinist gender structure of the larger society. ^

Relational predictors of condom use among adolescents in outpatient substance abuse treatment

Past HIV interventions have been critiqued for their failure to incorporate relational factors linked to condom use. Furthermore, few studies have focused on the relational context of sexual risk behavior among adolescents at elevated risk for HIV/STI exposure in the context of substance use. Therefore, this study evaluated the influence of three key relational factors (rejection sensitivity, intimacy dating goals, intercourse-related anxiety) salient for understanding condom use among adolescents in outpatient substance abuse treatment in South Florida. Structural equation modeling was used to test relational factors as direct and indirect predictors of condom use. Specifically, the current study investigated the influence of rejection sensitivity and intimacy dating goals on percentage of protected intercourse, with intercourse-related anxiety modeled as a mediator of this association. ^ Results obtained from the hypothesized structural model suggest rejection sensitivity and intimacy dating goals are significant predictors of percentage of protected intercourse. As expected, rejection sensitivity was related to lower levels of percentage of protected intercourse via heightened levels of intercourse-related anxiety and was not related directly to percentage of protected intercourse. Intercourse-related anxiety was indicated as a partial mediator between rejection sensitivity and percentage of protected intercourse. In contrast, intimacy dating goals was related to lower levels of percentage of protected intercourse directly. The findings demonstrate the importance of relational factors in condom use among adolescents in outpatient substance abuse treatment. Levels of protected intercourse are likely to increase when relational factors are targeted among adolescents in this high-risk population. Implications for prevention strategies targeting this high-risk subgroup of adolescents are discussed. ^

Um estudo sobre o perfil sexual e reprodutivo das adolescentes de um serviço de referência no município de Natal/RN

Adolescence is seen as a phase of life marked by a series of physical and behavioral changes, which leads to certain risk situations, such as early sexual activity, pregnancy and the occurrence of sexually transmitted diseases. Based on this statement, this research aimed generally: meet the sexual and reproductive adolescents of a reference service in Natal profile. Specifically describe the socioeconomic, sexual and reproductive individual and family characteristics of the population in question, but also verify possible association between pregnancy and age of onset of sexual activity with the socioeconomic aspects. The sectional study conducted in the database from the records of 463 adolescents seeking care in a referral center in Sexual and Reproductive Health in the period March 2011 to June 2012. The data collected were subjected to analysis by Excel 2007 and Statistical Package for Social Sciences (SPSS) 17.0. For data analysis, descriptive statistics, with absolute numbers and percentages was used, and its presentation by means of distribution and frequency tables. Results showed that the parents of these adolescents (65.7% - father; 57.8% - mother), had primary education; family income less than two minimum wages (66.2%); any type of chemical dependency in the family (33.5%) and presence of domestic violence (20.6%). A higher probability of pregnancy was verified when the mother had only primary education (26.3%), persons other than the father or mother contributed to family income (33.3%) and (26%) when there was substance abuse in the family early onset of sexual activity was observed when the mother had primary education (57.3%), persons other than the father or mother contributed to family income (63.1%) and the use of drugs / alcohol as a problem family (67.6%). It was concluded that such vulnerabilities appear as a reflection of the low social status of these young people, aggravated by emotional inheritance that is offered to every individual from birth. These findings may perhaps, support public health surveillance policies for adolescents in several areas

Escola: lugar político da diversidade sexual e de gênero

This work aims to understand how the public school system has become a failing institution with regards to sexual and gender diversity. I start from the principle that the school system performs a social sorting operation, leaving out of its halls almost all people who don‘t fit into the established heteronormative social order. First, I explore the experiences of primary school (Educação do Ensino Fundamental) professionals from the public network (Rede Pública Municipal) of the city of Natal-RN. I consider their narratives a result of daily practices which denounce the rules that govern and produce them in a broader context. Then I aim to establish a dialogue with the students who are victims of name-calling, teasing and abuse for not aligning with the ―normal‖ gender standards. At this stage of the research, I conducted fieldwork at the State Secondary School of Rio Grande do Norte (Escola Estadual de Ensino Médio). This investigation is guided by the following questions: What challenges need to be addressed in order to recognize the students who have been excluded from the school environment on account of sexual and/or gender differences; additionally, how can their classroom attendance and positive learning experience be ensured? To what degree is the school community concerned with building education practices which value and acknowledge sexual and gender diversity? The research goals were: to analyze how the school and its professionals deal with sexual and gender diversity, investigating which pedagogical practices silence, freeze and obstruct the diversity of student identities; examine how the school and its subjects work toward building new pathways for learning, for coexistence, and for facing the challenges of ―new‖ social demands such as homoaffection; observe the spaces that are cracked open by the presence and the voices of students who demand recognition of their existence.

Sexual risk behaviors and HIV risk among Americans aged 50 years or older: a review.

Although HIV-related sexual risk behaviors have been studied extensively in adolescents and young adults, there is limited information about these behaviors among older Americans, which make up a growing segment of the US population and an understudied population. This review of the literature dealing with sexual behaviors that increase the risk of becoming HIV-infected found a low prevalence of condom use among older adults, even when not in a long-term relationship with a single partner. A seminal study by Schick et al published in 2010 reported that the prevalence of condom use at last intercourse was highest among those aged 50-59 years (24.3%; 95% confidence interval, 15.6-35.8) and declined with age, with a 17.1% prevalence among those aged 60-69 years (17.1%; 95% confidence interval, 7.3-34.2). Studies have shown that older Americans may underestimate their risk of becoming HIV-infected. Substance use also increases the risk for sexual risk behaviors, and studies have indicated that the prevalence of substance use among older adults has increased in the past decade. As is the case with younger adults, the prevalence of HIV infections is elevated among ethnic minorities, drug users (eg, injection drug users), and men who have sex with men. When infected, older adults are likely to be diagnosed with HIV-related medical disorders later in the course of illness compared with their younger counterparts. Physicians are less likely to discuss sexual risk behaviors with older adults and to test them for HIV compared with younger adults. Thus, it is important to educate clinicians about sexual risk behaviors in the older age group and to design preventive interventions specifically designed for older adults.