Children's needs in shelters: mother's perceptions

The needs of children who witness violence directed at their mothers have only recently gained attention. While shelter services to address children's responses are increasingly evident, there is still much we do not understand about their plight, particularly from the perspective of their mothers. This study used focus-group methodology to identify mothers' perceptions of their children's needs while they were in shelters. Five focus group sessions were held with 27 mothers who had experienced violence in their homes and had used shelter services within the previous two-year period. Data were analyzed to identify six dominant categories of need and 12 supporting thematic categories. The dominant categories included: the counselling needs of the children; day-to-day living needs, such as maintaining family integrity and normality; recreational needs; the needs of children with respect to parenting; and finally, aspects of shelter support for mothers, and the impact of the shelter environment on children. The implications of the findings for program development are discussed.

Predicting human oral bioavailability of a compound: development of a novel quantitative structure-bioavailability relationship

PURPOSE

The purpose of this investigation was to develop a quantitative structure-bioavailability relationship (QSBR) model for drug discovery and development.

METHODS

A database of drugs with human oral bioavailability was assembled in electronic form with structure in SMILES format. Using that database, a stepwise regression procedure was used to link oral bioavailability in humans and substructural fragments in drugs. The regression model was compared with Lipinski's Rule of Five.

RESULTS

The human oral bioavailability database contains 591 compounds. A regression model employing 85 descriptors was built to predict the human oral bioavailability of a compound based on its molecular structure. Compared to Lipinski's Rule of Five, the false negative predictions were reduced from 5% to 3% while the false positive predictions decreased from 78% to 53%. A set of substructural descriptors was identified to show which fragments tend to increase/decrease human oral bioavailability.

CONCLUSIONS

A novel quantitative structure-bioavailability relationship (QSBR) was developed. Despite a large degree of experimental error, the model was reasonably predictive and stood up to cross-validation. When compared to Lipinski's Rule of Five, the QSBR model was able to reduce false positive predictions.

The prevalence of a history of child sexual abuse among adults visiting family practitioners in Israel

OBJECTIVE

To determine the prevalence of a history of child sexual abuse (CSA) in a random sample of adult patients presenting for routine health care to family practice clinics in Israel.

METHOD

One thousand and five randomly selected patients aged 18 to 55, attending 48 clinics, participated in this questionnaire study.

RESULTS

Twenty-five percent indicated that they had been sexually abused as children. More women reported CSA (p < .0001 ) than men, as did women originating from Western countries (p = .02) and those with more than 12 years of education (p = .01). There were no significant associations between CSA and the other socio-demographic variables examined. Fondling was the most common and intercourse the least common activity experienced. Forty-five percent of the perpetrators were previously known. The mean age at which the child sexual abuse began varied between 10 and 14. Only 45% of the subjects had ever told anyone about the experience.

CONCLUSIONS

Since no other prevalence study has been reported to date in Israel, these findings suggest that as in other Western countries CSA is a relatively common problem. Family physicians and other health professionals should be aware of this high prevalence and its known potential for initial and long-term deleterious outcomes.

Human population expansion and microsatellite variation

Polymorphisms at di-, tri-, and tetranucleotide microsatellite loci have been analyzed in 14 worldwide populations. A statistical index of population expansion, denoted S(k), is introduced to detect historical changes in population size using the variation at the microsatellites. The index takes the value 0 at equilibrium with constant population size and is positive or negative according to whether the population is expanding or contracting, respectively. The use of S(k) requires estimation of properties of the mutation distribution for which we use both family data of Dib et al. for dinucleotide loci and our population data on tri- and tetranucleotide loci. Statistical estimates of the expansion index, as well as their confidence intervals from bootstrap resampling, are provided. In addition, a dynamical analysis of S(k) is presented under various assumptions on population growth or decline. The studied populations are classified as having high, intermediate, or low values of S(k) and genetic variation, and we use these to interpret the data in terms of possible population dynamics. Observed values of S(k) for samples of di-, tri-, and tetranucleotide data are compatible with population expansion earlier than 60,000 years ago in Africa, Asia, and Europe if the initial population size before the expansion was on the order of 500. Larger initial population sizes force the lower bound for the time since expansion to be much earlier. We find it unlikely that bottlenecks occurred in Central African, East Asian, or European populations, and the estimated expansion times are rather similar for all of these populations. This analysis presented here suggests that modern human populations departed from Africa long before they began to expand in size. Subsequently, the major groups (the African, East Asian, and European groups) started to grow at approximately same time. Populations of South America and Oceania show almost no growth. The Mbuti population from Zaire appears to have experienced a bottleneck during its expansion.

Use of unopposed estrogen in women with uteri: prevalence, clinical implications, and economic consequence

OBJECTIVE

Hormone replacement therapy with estrogen/progestin is the treatment of choice for relieving postmenopausal vasomotor symptoms and preventing urogenital atrophy and osteoporosis in women with intact uteri. However, despite the known increased incidence of endometrial hyperplasia when unopposed estrogen is used in such women, this progestin regimen has not been universally adopted.

DESIGN

This study was conducted in a managed care organization to determine the extent of the use of unopposed estrogen in women with intact uteri. Pharmacy claims data for all women 55 years or older with claims for estrogen only from September 1, 1996, to December 31, 1996, were reviewed. A total of 5,209 records were identified, from which 480 were randomly selected. A survey of the members' physicians was then carried out to determine hysterectomy status and was confirmed by chart audit.

RESULTS

Thirty-three (11%) of the members identified had not undergone hysterectomy. Follow-up physician contact revealed that five women did not have a uterus. Use of estrogen without opposing progestin was documented in a substantial percentage of files reviewed. It is of concern that with the documentation of the risks of endometrial hyperplasia and carcinoma in the intact uterus, unopposed therapy still occurs. In addition to the clinical costs, there are economic consequences to this practice. An economic model of unopposed estrogen use was created. A management cost of $1,504 for 3 years was estimated.

CONCLUSIONS

Further educational efforts are needed to ensure the use of opposed estrogen in the woman with an intact uterus.

Predictors of dropout and burnout in AIDS volunteers: a longitudinal study

Burnout among HIV/AIDS volunteers contributes to the loss of dedicated personnel resulting in strain on the HIV/AIDS care system. Past research has suggested that there were significant stresses and burnout associated with AIDS caregiving. We investigated the predictors of dropout in AIDS volunteers over time, and specifically, which of the variables of the stressors and rewards of being a volunteer (collected at baseline) predicted who would drop out two years later. The volunteers were the subjects of Nesbitt et al. (1996), who were members of an interfaith religious-based organization in Houston, Texas. The subjects were re-contacted by mail after two years, and 76 of the 174 respondents completed a brief questionnaire which gave details of current volunteering activity, reasons for dropout (if they had dropped out) and completed the Texas Revised Inventory of Grief (TRIG). Forty dropped-out from volunteering while 36 continued. Data show the independent variables of total stressor score, the Maslach Burnout Inventory score of Depersonalization intensity and the three subscale scores involving stress: client problems and role ambiguity, emotional overload and organizational factors as being significant in predicting dropout in HIV/AIDS volunteers over time. The best predictors of the dropping-out of HIV/AIDS volunteers can be divided into the stresses (client problems and role ambiguity, emotional overload and organizational factors) and depersonalization intensity. The results showed that volunteers who experienced more client problems and role ambiguity, more emotional overload and more problems with organizational factors are more likely to drop out from the volunteer programme. They also show that the dropout volunteers have a significantly higher level of depersonalization intensity than the continuing volunteers, with the risk of dropout increasing by almost a third in the highest tertile of depersonalization intensity scores compared with those with lower scores. These data indicate that it is the stressors of AIDS volunteering, including the intensity of depersonalization, which lead to dropout, and that rewards do not appear to have a protective effect.

A high-resolution physical map of human chromosome 21p using yeast artificial chromosomes

The short arm of human chromosome 21 (21p) contains many different types of repetitive sequences and is highly homologous to the short arms of other acrocentric chromosomes. Owing to its repetitive nature and the lack of chromosome 21p-specific molecular markers, most physical maps of chromosome 21 exclude this region. We constructed a physical map of chromosome 21p using sequence tagged site (STS) content mapping of yeast artificial chromosomes (YACs). To this end, 39 STSs located on the short arm or near the centromere of chromosome 21 were constructed, including four polymorphic simple tandem repeats (STRs) and two expressed sequence tags (ESTs). Thirty YACs were selected from the St. Louis YAC library, the chromosome 21-enriched ICRF YAC library, and the CEPH YAC and megaYAC libraries. These were assembled in a YAC contig map ranging from the centromere to the rDNA gene cluster at 21p12. The total size of the region covered by YACs is estimated between 2.9 and 5 Mb. The integrity of the YAC contig was confirmed by restriction enzyme fingerprinting and fluorescence in situ hybridization (FISH). One gap with an estimated size of 400 kb remained near the telomeric end of the contig. This YAC contig map of the short arm of human chromosome 21 constitutes a basic framework for further structural and functional studies of chromosome 21p.

Nonequilibrium-molecular-dynamics investigation of the presmectic behavior of the viscosities of a Gay-Berne nematic liquid crystal

Using the method of nonequilibrium molecular dynamics, the behavior of the Miesowicz, Helfrich, and Leslie viscosities as functions of temperature and density are investigated. In particular, attention is focused on the region immediately preceding the nematic-smectic phase transition. The Miesowicz viscosity eta1 for the orientation parallel to the direction of flow and the Helfrich viscosity eta12 are both found to increase rapidly as the phase transition is approached. In most of the cases investigated, a critical exponent nu=1 / 3 is found. Values closer to nu=1 / 4 are also found, but in these cases, the errors are sufficiently large for nu=1 / 3 to be possible. No nonregular behavior of the viscosity coefficients eta2, eta3, gamma1, and gamma2 in the presmectic region was detected.

The association of the combination of sumatriptan and methysergide in myocardial infarction in a premenopausal woman

Acute myocardial infarction occurred in a 43 year-old premenopausal woman with controlled hypertension and no known coronary artery disease following the use of the antimigraine medications sumatriptan succinate injectable form and methysergide maleate. The use of sumatriptan is contraindicated within 24 hours of using ergotamine or ergotamine-type medications such as methysergide. This contraindication is based on the theoretical possibility of prolonged vasospasm with the combined use. Methysergide is primarily a serotonin type 2 (5-HT2) antagonist, although it does act as a partial agonist at 5-HT1 receptors. It is believed that a major component of coronary artery vasospasm is possibly due to 5-HT supersensitivity mediated by 5-HT1Dbeta receptor activation. Drugs that selectively stimulate the 5-HT(D) receptors, such as sumatriptan, are potentially hazardous in people with underlying coronary artery disease, and agents with additional agonistic properties at these receptors may potentiate this effect. Physicians should be warned to inquire about prior 24-hour medication use before prescribing antimigraine medication.

Obstacles to victims' cooperation with the criminal prosecution of their abusers: the role of social support

Over the last 20 years, diminishing tolerance for domestic violence has triggered significant criminal justice reforms designed to facilitate the prosecution of abusers. Prosecutors, for example, have adopted policies requiring that cases go forward even if the victim later has second thoughts. Although increasingly common, these "no drop" policies reflect a profound irony about domestic cases that is well known but little understood: the most formidable problem in prosecuting such cases is often the victim's own unwillingness to bring the abuser to justice. This prospective study explored a range of factors potentially predictive of domestic violence victims' cooperation with the prosecution of their abusers. Although the study focused on interpersonal and institutional social support, it also investigated the influence of violence severity, victim demographic factors, and victim mental health characteristics, including the presence of depressive symptoms, emotional dependence on the abuser, and substance abuse. Findings showed that tangible support, severity of violence in the relationship, and the presence of children in common with the abuser all significantly predicted victims' cooperation with the prosecution of their abusers. Substance abuse significantly predicted victims' noncooperation with prosecution. The research and policy implications of these findings are discussed.

Court-involved battered women's responses to violence: the role of psychological, physical, and sexual abuse

Failure to understand the importance of psychological abuse as a component of domestic violence can result in little appreciation for the complexity of victims' experience and thus a failure to provide the most effective intervention. This study examined the role of psychological abuse, physical violence, injury, and sexual abuse in predicting court-involved women's (1) prior attempts to seek help from the justice system and to leave the battering relationship, (2) use of criminal prosecution and civil protection orders, and (3) traumatic stress reactions. At the univariate level, each abuse variable was significantly associated with at least one strategic response and all traumatic responses to violence. Multivariate analyses revealed that strategic responses were largely predicted by injury and physical assault, whereas traumatic responses were mainly predicted by psychological abuse. Taken together, these findings demonstrate the important role of both physical and psychological abuse in shaping women's responses to domestic violence.

Variation in the arousal pattern after obstructive events in obstructive sleep apnea

The relationship between the severity of obstructive sleep apnea (OSA) (measured by sleep study) and daytime sleepiness is poor. Variation in the degree of arousal accompanying obstructive respiratory events might help explain this poor correlation. Polysomnographic records from patients with OSA were reviewed in order to extract representative examples of apneas and hypopneas (in 10 patients), as well as events both supine and decubitus (in 12 patients). The EEG accompanying each obstructive event was processed with a neural network technique to describe sleep depth on a second-by-second basis. The lengths of any visually evident microarousals were also measured manually. There was considerable interindividual variation in the degree of sleep disturbance using the neural network technique (p < 0.005), but not using the lengths of the visually scored microarousals (p = 0.6). The arousals accompanying apneic events caused greater variability in sleep depth quantified using the neural network technique (p = 0.03), and also lasted longer based on the visual scoring (mean, 12.6; SD, 1.7 s) than the hypopneic events (mean, 9.9; SD, 2.4 s; p = 0.02). There were no significant differences between events occurring supine versus decubitus with either technique (p = 0.7). These differences in arousal magnitude may explain some of the poor correlations between conventional measures of sleep apnea severity and daytime sleepiness.

PCDD/PCDF on land around an industrial site and identification of source

Following the discovery of elevated levels of PCDD/PCDF in dairy products and in flue gases at a nearby industrial site, the levels and spatial distribution of these compounds on surrounding land were determined through soil monitoring. In mass terms, the levels in soil were excessive relative to the UK background but in terms of toxicity they were less significant. There were positive correlations between wind directions and deposition levels. The relative amounts of the prominent congeners/congener groups in the soil were similar to those in the flue gas but different from those in the background. An incinerator of chemical waste was identified as the likely source of the PCDD/PCDF.

Sexual and severe physical violence among high school students. Power beliefs, gender, and relationship

In a sample of 463 high school students, 43% reported being the victim of either sexual violence or severe physical violence by peers in the past year. Perpetrators were more likely to be known rather than unknown to the victim, or to be dating/ex-dating partners, and 70% of those who experienced violence by peers were girls. Findings support a view of high school peer violence that encompasses relationship, gender, effects on the victim, and beliefs about both male role power and personal power.

Altered cell surface expression and signaling of leptin receptors containing the fatty mutation

Leptin and the leptin receptor are key players in the regulation of body weight. In an attempt to dissect the molecular mechanism of the Zucker fatty rat leptin receptor mutation (Gln269 --> Pro) we analyzed the effects of this mutation on leptin receptor signaling and expression in three different expression systems: 1) 32D cells expressing leptin/erythropoietin receptor chimeras, 2) COS-7 cells expressing a leptin receptor short form, and 3) 293 cells expressing soluble receptor forms. To determine if the Gln269 --> Pro mutation is critical for the observed phenotype, we made a similar Gln --> Pro mutation at a vicinal residue two amino acids upstream of the fatty mutation to see if it would have similar effects. Incorporation of either of the Gln --> Pro mutations into wild type receptor forms did not interfere with leptin binding, but it resulted in a signaling-incompetent receptor. In addition, the majority of the mutant receptor protein was localized intracellularly. Our results suggest that the obese phenotype resulting from the Gln269 --> Pro mutation in the leptin receptor of the Zucker fatty rat may be due not only to a reduced cell surface expression of this form of the leptin receptor, but also to a post-leptin binding malfunction of the receptor that interferes with subsequent signal transduction.

The anaemia research nurse in effective multi-disciplinary management of patients on erythropoietin

Following recommendations published by the Renal Association, the standard regarding optimal haemoglobin levels was questioned by members of the Oxford Renal Unit Management Team as perhaps being unrealistic in a unit responsible for nearly 400 patients on dialysis. Subsequent to the appointment of an anaemia research nurse a base-line audit revealed that only 61.3% of the dialysis population had a haemoglobin > 10 g/dl and also identified the reasons why the unit was failing to meet this pre-set target. This paper identifies how the unit addressed these problems which has subsequently led to a change in views about achieving the standard. The establishment of clear management guidelines cannot be over emphasised and all aspects of anaemia in this unit will now be addressed as part of the multi-disciplinary team function rather than being led by medical intervention.

Sexually transmitted diseases are common in women attending Jamaican family planning clinics and appropriate detection tools are lacking

OBJECTIVES

To assess sexually transmitted diseases (STD) among women attending Jamaican family planning clinics and to evaluate decision models as alternatives to STD laboratory diagnosis.

METHODS

Women attending two family planning clinics in Kingston were interviewed and tested for syphilis seroreactivity using toluidine red unheated serum test and Treponema pallidum haemagglutination, for gonorrhoea using culture, for chlamydial infection using enzyme linked immunoassay, and for trichomoniasis using culture. Urine was tested with leucocyte esterase dipstick (LED). The women were treated based upon a clinical algorithm. Computer simulations explored the use of risk inclusive decision models for detection of cervical infection and/or trichomoniasis.

RESULTS

Among 767 women, 206 (26.9%) had at least one STD. The prevalence of gonorrhoea was 2.7%; chlamydial infection 12.2%; gonococcal and/or chlamydial cervical infection 14.1%; trichomoniasis 11.5%; syphilis seroreactivity 5.9%. The clinical algorithm was 3.7% sensitive and 96.7% specific in detecting cervical infection. Detection of cervical infection and/or trichomoniasis was 63.5% sensitive and 60.6% specific using LED and 57.7% sensitive and 46.2% specific using the risk inclusive algorithm employed in Jamaican STD clinics. Either cervical friability or LED (+) or family planning clinic attender less than 25 years old with more than one sexual partner in the past year was 72.5% sensitive and 53.3% specific. The positive predictive values of the STD clinic algorithm, LED, and two developed decision models ranged from 25.0% to 33.4% to detect cervical infection and/or trichomoniasis in these women.

CONCLUSION

STDs were quite prevalent in these mainly asymptomatic family planning clinic attenders. None of the evaluated decision models can be considered a good alternative to case detection using laboratory diagnosis. Appropriate detection tools are needed. In the meantime, available STD control strategies should be maximised, such as promotion of condom use; adequate treatment of symptomatic STD patients and partners; and education of women and men.

Localization of the gene for familial partial lipodystrophy (Dunnigan variety) to chromosome 1q21-22

Obesity is strongly implicated in the pathophysiology of insulin resistance, diabetes mellitus and dyslipidemia. The mechanisms, however, by which obesity causes these complications are not known. The study of single-gene disorders affecting adipose tissue may elucidate some of the mechanisms involved in these processes. Familial partial lipodystrophy, Dunnigan variety, (FPLD, OMIM 308980) is an autosomal-dominant condition characterized by marked loss of subcutaneous adipose tissue affecting the trunk and extremities but with excess fat deposition in the head and neck areas. Affected individuals show an increased preponderance of insulin resistance, diabetes mellitus, dyslipidemia and acanthosis nigricans. The genetic basis of FPLD is unknown. We carried out a genome-wide scan with a set of highly polymorphic short tandem-repeats (STR) in individuals from five well-characterized pedigrees and mapped the FPLD locus to chromosome 1q21-22. The maximum two-point lod score obtained with a highly polymorphic microsatellite at D1S2624 at theta(max)=0 was 5.84. Multipoint-linkage analysis yielded a peak lod score of 8.25 between D1S305 and D1S1600. There was no evidence for genetic heterogeneity (alpha=1) in the pedigrees.

Psychological and socio-medical aspects of HIV/AIDS: a reflection on publications in AIDS care (1989-1995)

It is necessary to consider the content and methods of AIDS social research publications for these represent research advances as well as current issues of concern for practitioners, communities and researchers alike. This article critically examines some of the research that has been conducted to date into social aspects of HIV and AIDS. It quantifies the content and major methodological style of publications in the journal AIDS Care from 1989 to 1995. The most commonly published topic area in AIDS Care, during this period was cultural and demographic issues (15.9%), followed by issues pertinent to the psychological impact of HIV (13.6%), sexual behaviour and condom use (11.3%) and policy and services (9.5%). Research and measurement issues were the least examined content area in AIDS Care 1989-1995 (2.6%). This article discusses possible variables that influence the style and topics that are published in AIDS Care and makes suggestions for authors to consider before embarking on future research projects or publications.

Teenage peer sexual harassment: implications for social work practice in education

Peer sexual harassment is an often overlooked problem for both girls and boys in the educational environment. This article provides a historical framework for defining peer sexual harassment as a sex discrimination issue and a description of peer sexual harassment as a potential mental health issue. The article also reviews the limited empirical research on teenage peer sexual harassment, which has consistently revealed that nearly four of five adolescents are the targets of sexual harassment by their peers. Finally, the authors explore a theoretical context in which to understand sexual harassment and the implications for social work practice in education.