Exploring the roles of compassion and post-traumatic stress disorder on global distress after sexual trauma

OBJECTIVES

Recovery from sexual trauma can be complex and multi-faceted. Most current psychological treatment protocols for trauma use a cognitive model of post-traumatic stress disorder (PTSD). However, sexual trauma may include specific complexities beyond that of a cognitive model of PTSD, such as relational factors. The distress experienced after sexual abuse may involve variables not exclusive to a PTSD model. Compassion focused therapy (CFT) is an approach that incorporates evolutionary, relational and social perspectives. This study explored the relationships between variables associated with CFT, PTSD and distress in survivors of sexual abuse to determine the role of CFT-related variables.

METHODS

155 adults who had experienced sexual abuse or any unwanted sexual experience at any point in their lives completed online questionnaires pertaining to various CFT variables (self-compassion, receiving compassion from others, having a fear of compassion from others, having a fear of compassion from the self, shame and self-criticism) and questionnaires measuring global distress as the outcome of sexual abuse and PTSD symptoms.

RESULTS

An exploratory model involving CFT-related variables explained significantly more of the variance (4.4%) in global distress than PTSD symptomology alone. Self-criticism was found to be the variable with significant contribution.

CONCLUSIONS

That CFT treatments, targeting self-criticism, should be developed alongside the standard cognitive model of PTSD based treatments for survivors of sexual abuse was supported. Future research may explore experimental designs utilizing CFT in this population, as well as further investigations on the roles of these specific CFT variables.

An interpretative phenomenological analysis of service users' experiences in a psychosocial addictions intervention

OBJECTIVES

The aim of this study was to explore the subjective experiences of participants who: (1) received a psychosocial intervention as part of an addiction recovery research trial, and (2) responded to treatment through drug reduction, with the intention of eliciting qualitative change processes of recovery.

DESIGN

Data were collected using semi-structured interviews designed to capture detailed descriptions of participants' experiences of recovery within the intervention.

METHODS

Eleven participants who had achieved drug abstinence or significant drug reduction by successfully completing the psychosocial intervention took part in the study. The data were analysed using interpretative phenomenological analysis (IPA).

RESULTS

Five superordinate themes were identified relating to (1) An active, individualised and skills-based intervention that validates a new way of being; (2) Staff that foster good working relationships based on trust and safety within services that do not stigmatise; (3) To be understood individually, historically and psychologically, and with regard to the pernicious relationship with drugs; (4) Motivation is personal, intrinsic, requires vigilance and is driven forward by periods of success through abstinence; and (5) Interpersonal connectedness is essential to recovery; family is a key reason to abstain and friendships can either facilitate or hinder success.

CONCLUSIONS

These findings suggest that the success of the psychosocial intervention may be due to a combination of modality specific factors and also broader holistic aspects that were provided through intervention. Future research is required to generalise these findings to wider addiction populations.

PRACTITIONER POINTS

Review of the evidence base suggests the need to move beyond testing addiction interventions and instead understand change processes through psychosocial intervention. Narratives of lived experience of those undergoing psychosocial intervention inform us that specific features relating to intervention, working relationship, motivation, identity and interpersonal factors instigate recovery. Practitioners should consider a multi-faceted approach in designing and applying psychosocial intervention for addiction.

Perimenopausal bleeding: Patterns, pathology, response to progestins and clinical outcome

This prospective observational study was done on 400 perimenopausal patients who presented with abnormal uterine bleeding with selective endometrial lesions diagnosed on histopathology. Patients were followed to determine their response to progestin therapy and their final clinical outcome. The commonest bleeding pattern was menorrhagia (67.5%), the commonest pathology was simple endometrial hyperplasia without atypia (31%). 142 cases with non- atypical endometrial hyperplasia received progestin therapy with follow up, 100 cases (70.4%) experienced lesion regression, 38 cases (26.7%) experienced persistence and four cases (2.9%) experienced progression to atypia. Low dose progestin therapy (< 20 mg/day) was more effective when used for 4-5 months. Hysterectomy was done for 44 cases, due to atypical endometrial hyperplasia, persistence and progression of non atypical hyperplasia. Perimenopausal bleeding is mostly dysfunctional in origin but organic lesions remained a major concern which requires endometrial sampling with proper interpretation to achieve better clinical outcome.

RETRACTED: Nicorandil vs nifedipine for the treatment of preterm labour: a randomized clinical trial

This article has been retracted: please see Elsevier Policy on Article Withdrawal (http://www.elsevier.com/locate/withdrawalpolicy). This article has been retracted at the request of the Editor-in-Chief. The editors were alerted to the following concerning features of this trial: The submission date is impossible. Patients were recruited at 24 to 34 weeks (mean 31 w). 18% of participants delivered after 37 weeks. Average recruitment 26 per month. Recruitment ended September 2014 but the paper was received by journal on 23 October 2014. The second author, Sayyed T, is co-author of related retracted papers in BJOG. In view of these concerns we wrote to Dr Rezk who had no satisfactory explanation and declined to share the data. We have therefore decided to retract.

Prevalence and risk factors of iron-deficiency anaemia among pregnant women in rural districts of Menoufia governorate, Egypt

This cross-sectional community-based study with analytic component was conducted among Egyptian pregnant women in rural districts during January to December 2013. A total of 2470 pregnant women were enrolled for laboratory tests for iron- deficiency anaemia (IDA). The prevalence of IDA was 51.3% (1267 of 2470); IDA affects about one in every two pregnant women in rural districts in Egypt. Women who are older than 30 years (Odds ratio [OR], 0.73) had more than three children (OR, 0.73), with body mass index less than 20 (OR, 1.57), shorter birth spacing less than 2 years (OR, 0.68), lack of antenatal care visits (OR, 1.25), low intake of foods of animal origin (OR, 1.57), vegetables and fruits (OR, 1.29) and having intestinal parasites (OR, 0.74) were positively associated with anaemia [at confidence interval 95%]. In addition to nutritional deficiency, multiparity and increasing maternal age are the main causes of IDA.

The safety and acceptability of intravenous fentanyl versus intramuscular pethidine for pain relief during labour

OBJECTIVES

This trial aimed to ascertain the relative efficacy, adverse effects, and acceptability of fentanyl versus pethidine for pain relief during labour.

MATERIALS AND METHODS

Parturients (n=80) in the active phase who requested analgesia were randomly assigned to receive either intravenous fentanyl (n=40) or intramuscular pethidine (n=40). Pain scores hourly, maternal and fetal adverse effects, neonatal outcome, and maternal acceptability were assessed.

RESULTS

Pain scores decreased in both groups, the decrease varying from mild to moderate, average pain scores remaining above 3.5 in both groups. Pain scores returned towards baseline over time; three hours after the initiation of treatment in the fentanyl group. Pethidine was associated with more maternal nausea and vomiting (p < 0.05) while fentanyl was associated with more neonates with low Apgar scores at one minute and more need for neonatal resuscitation and naloxone administration when compared to pethidine (p < 0.05). Both drugs were acceptable for pain relief during labour.

CONCLUSION

Fentanyl is comparable to pethidine for pain relief during labour regarding efficacy and acceptability, but with more neonates with low Apgar scores at one minute and higher need for neonatal resuscitation and naloxone administration. Further larger trials are needed to confirm its safety.

Case of the month: The skin wrinkle test: a simple nerve injury test for paediatric and uncooperative patients

Assessment of the distal neurological status after injuries to the hand and fingers is one of the most frequent parts of standard trauma practice. Two-point discrimination as clinical examination is often sufficient to identify such lesions, but difficulties occur in the comatose, young or otherwise uncooperative patient. This article describes a simple pain-free alternative method of assessing digital nerve integrity by submerging the finger tip in water and observing if wrinkles develop on the skin.

Improved diagnostic methods in the follow-up of medullary thyroid carcinoma by highly specific calcitonin measurements

Calcitonin (CT) is an important tumor marker for medullary thyroid carcinoma (MTC). Recent CT assays chiefly recognize the monomeric form of CT (mCT). It was the objective of this study to examine the consequences of the higher specificity of the assay for interpretation of the postoperative CT values in MTC patients. The postoperative mCT concentration was measured in 214 patients with differentiated thyroid carcinoma (MTC excepted; non-MTC patients) to determine a reference range of mCT in totally thyroidectomized patients. Monomeric CT was also determined with a two-site chemiluminescence immunoassay (Nichols) in 94 healthy subjects and in 68 MTC patients. The mCT concentrations were below the detection limit in all examined completely thyroidectomized non-MTC patients. Basal and stimulated mCT values were also below the detection limit in 32 of the 68 MTC patients. The biochemical and imaging diagnosis of the latter patients did not give any indication of tumor recurrence. We conclude that completely thyroidectomized patients with non-MTC do not show any measurable mCT concentrations. In comparison with an unspecific CT-RIA, the more specific mCT determination by immunoluminometric assay permits a more precise differentiation between postoperative normal and pathological values and an earlier diagnosis of recurrent MTC.