Neurological function and HIV risk behaviors of female prison inmates

Risk Factors for Women Being Under the Influence of Alcohol Compared With Other Illicit Substances at the Time of Committing Violent Crimes

PURPOSE

We investigated women under the influence of alcohol compared with other illicit substances at the time of committing a crime to identify predictors of being under the influence of alcohol and female-enacted crime.

METHODS

Analyses of data, obtained from private interviews and examinations of female prison inmates, included regression analyses exploring predictors of being under the influence of alcohol at the time of the crime and predictors of violent crime. In addition, a reanalysis of a previously reported model, predicting conviction of a violent crime, was conducted including a new variable, being under the influence of alcohol at the time of the crime.

RESULTS

Those under the influence of alcohol at the time of their crime had experienced greater nonfamilial childhood sexual abuse and traumatic brain injuries with loss of consciousness predating their crime. They were more likely to have committed a violent, rather than nonviolent, crime compared with those under the influence of other substances, with the latter being not significantly different for those not under the influence of any substance. Being under the influence of alcohol increased the risk of committing a violent crime, adjusting for other predictors of female violence.

CONCLUSION

Women under the influence of alcohol are at a greater risk for committing violent crimes than those under the influence of other substances. Female nonfamilial childhood sexual abuse and traumatic brain injury victims were at a higher risk for being under the influence of alcohol, in comparison with other substances, at the time of committing a violent crime.

Research in the Rehabilitation Unit Presents Challenges to Nurse Researchers

PURPOSE

Gathering data from patients on a rehabilitation unit poses challenges for nurse researchers.

DESIGN

A case study is presented that describes ways the researchers attempted to meet these challenges while conducting their study.

METHODS

The case study presents the approaches that the investigators took to undertake the study and then described the ways in which these approaches could have been improved.

FINDINGS

Their successes and failures are described.

CONCLUSIONS

Suggestions are made for future investigators.

CLINICAL RELEVANCE

Clinical nursing research is required to develop an evidence base for practice in the rehabilitation unit. An analysis of the challenges and possible methods of overcoming these challenges is useful to both future investigators and nurses in practice to insure that studies can be carried out effectively.

Female children with incarcerated adult family members at risk for lifelong neurological decline

A secondary analysis of data from adult female prison inmates in the mid-Atlantic United States defined relationships between having incarcerated adult family members during childhood and neurological outcomes. Of 135 inmates, 99 (60%) had one or more incarcerated adult family members during childhood. Regression analyses revealed that having incarcerated adult family members was related to greater frequency and severity of childhood abuse and higher incidence of neurological deficits in adulthood, especially related to traumatic brain injuries, compared to those without incarcerated adult family members. Along with being role models, adult family members impact the neurological health of children throughout their life-span.

Could spirituality and religion promote stress resilience in survivors of childhood trauma?

Trauma is a precursor to many mental health conditions that greatly impact victims, their loved ones, and society. Studies indicate that neurobiological associations with adverse childhood experiences are mediated by interpersonal relationships and play a role in adult behavior, often leading to cycles of intergenerational trauma. There is a critical need to identify cost effective community resources that optimize stress resilience. Faith-based communities may promote forgiveness rather than retaliation, opportunities for cathartic emotional release, and social support, all of which have been related to neurobiology, behavior, and health outcomes. While spirituality and religion can be related to guilt, neurotic, and psychotic disorders, they also can be powerful sources of hope, meaning, peace, comfort, and forgiveness for the self and others. This article provides an overview of religion and spirituality as they relate to the neurobiology of resilience in victims of childhood trauma.

Obesity, traumatic brain injury, childhood abuse, and suicide attempts in females at risk

PURPOSE

This study tested the hypothesis that obesity is related to history of traumatic brain injury (TBI), severity and frequency of childhood physical (CPA) and sexual abuse (CSA), and suicide attempts, adjusting for related variables in a high risk female population.

DESIGN

This cross-sectional study of 81 females compared obese to non-obese.

METHODS

All variables were verified by private interviews, physical examination, and documented evidence, then statistically analyzed with logistic regression.

FINDINGS

Obesity at the time of interview was related to history of a decreased number of TBIs per person, greater CSA, suicide attempts, and decreased CPA, adjusting for current smoking, depression, currently using selective serotonin reuptake inhibitors, and age.

CONCLUSIONS

Number of TBIs per person and CPA were inversely related to obesity, adjusting for related variables. Greater CSA frequency and severity, and having attempted suicide were significantly related to greater risk of obesity, adjusting for related variables. Though causes of obesity cannot be determined by this design, and findings should be viewed with caution, this study provides new insight into the obesity epidemic that requires further investigation.

CLINICAL RELEVANCE

Rehabilitation nurses are in ideal settings when patient's conditions are less acute, providing opportunities to address complex serious underlying etiologies of obesity. Obesity has not been alleviated by teaching about diet and exercise because obesity may be the result of dietary self-medication of pain from previous experiences. CSA is a very serious problem that could precipitate suicide attempts, obesity, and multifaceted poor health outcomes throughout the life span; subsequently placing individuals at greater risk of requiring rehabilitation services.

HIV Sexual and Drug-Use Risk in Drug-Dependent Pregnant Patients in Comprehensive Drug Treatment

This secondary analysis study investigated HIV sexual and drug-use risk in drug-dependent pregnant patients over the first month postrandomization to reinforcement-based treatment (RBT) (n = 47) or usual care (UC) (n = 42). Analysis of primary outcomes had indicated that RBT participants spent significantly longer time in treatment and recovery housing than UC participants. The present study examined the ability of 9 risk markers-age, race, estimated gestational age at treatment entry, lifetime substance abuse treatment episodes, history of prostitution charges, history of serious depression, current heroin injection status, current housing status, and current partner substance use-to predict changes in HIV risks. Sexual risk declined for participant subgroups with prostitution-charge histories and unstable housing. Drug-use risk declined for heroin injectors and nondepressed participants. A relationship was found between number of lifetime drug treatment episodes and sexual and drug-use risk. The role of risk markers in the response of drug-dependent pregnant women to drug treatment require attention.

Addiction severity index composite scores as predictors for sexual-risk behaviors and drug-use behaviors in drug-using pregnant patients

BACKGROUND

HIV sexual-risk and drug-use behavior predictors have been studied in non-pregnant but not pregnant drug-dependent populations.

OBJECTIVE

Examine the ability of the ASI composite scores to predict HIV sexual- and drug-risk scores as well as the individual items of a modified version of the Risk Assessment Battery in drug-using pregnant women.

METHODS

Pregnant women (N = 76) completing pretreatment ASI and HIV-risk questionnaires.

RESULTS

The Legal composite score was the sole significant predictor of the sexual-risk score, with a 1 SD increase in the Legal composite score resulting in a 24% increase in sexual-risk, p < .001. The Medical, Drug, and Legal composite scores were each significant predictors of the drug-risk score, with a 1 SD increase resulting in a 31% decrease, and 121% and 73% increases, respectively, in drug-risk, all ps < .05.

CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE

Drug-using pregnant women and their fetuses are vulnerable to the consequences of both sexual-risk behaviors and drug-use. The ASI may help screen such patients for HIV sexual-risk and drug-use behaviors as a first step in tailoring treatment to address these issues.

Ethical, regulatory, and investigator considerations in prison research

Although numbers of prison inmates are increasing rapidly, limited research addresses health-related conditions prevalent in prisons. Compelling reasons exist for prison research to address high rates of psychiatric, neurological, and other health-related conditions that may precipitate or result from incarceration, high-risk behaviors, infectious disease transmission, traumatic brain injuries, and other issues related to incarceration. Prison research is critical because inmates are frequently re-incarcerated and released, posing potential risks to themselves and the community. The purpose of this article is to provide a pragmatic overview of ethical, regulatory, and investigator considerations to facilitate critically needed research with vulnerable prison populations.