Self-worth as a mediator between attachment and posttraumatic stress in interpersonal trauma

It is well documented that most trauma survivors recover from adversity and only a number of them go on to develop posttraumatic stress disorder (PTSD). In addition, survivors of interpersonal trauma (IPT) appear to be at heightened risk for developing PTSD in comparison to survivors of noninterpersonal trauma (NIPT). Despite a robust association between IPT exposure and attachment disruptions, there is a dearth of research examining the role of attachment-related processes implicated in predicting PTSD. Using a sample of college undergraduates exposed to IPT and NIPT, this study explores the mediating effect of self-worth in the relationship between attachment and PTSD. It is hypothesized that insecure attachment will be related to posttraumatic symptomatology via a reduced sense of self-worth in IPT survivors but not in NIPT survivors. Mediation analyses provide support for this hypothesis, suggesting the importance of considering negative cognitions about the self in therapeutic interventions, particularly those offered to IPT survivors.     

Power and cost containment in a Danish public hospital

The assumption that hospital decision-making is hierarchical in character underpins the policy formulation process in public as well as pluralist national health care systems. This article's analysis of decision-making in a Danish public hospital reinforces the contrary assertion: that effective authority in acute-care hospitals rests in an amorphous power relationship among the hospital's several occupational groups, in which physicians clearly have the upper hand. After a brief introduction to this Danish hospital, the article develops a detailed portrait of its informal power structure and of the different occupational groups' permanent power-maximizing strategies. Subsequently, the article assesses the impact of these strategies upon two recent efforts to contain the hospital's costs: a decision to close an expensive specialty clinic, and an attempt to shrink the hospital's size by transferring less sick elderly patients to a newly created rehabilitation facility. The study's findings suggest that efforts to impose hospital cost containment by exclusively political means are unlikely to succeed.     

Treating low-income and minority women with posttraumatic stress disorder: a pilot study comparing prolonged exposure and treatment as usual conducted by community therapists

Twenty-one female psychiatric outpatients with chronic posttraumatic stress disorder (PTSD) are randomly assigned to prolonged exposure (PE; n = 9) for PTSD or treatment as usual (TAU; n = 12). Participants are predominantly low income and African American with complex trauma and psychiatric histories. Treatment is delivered by community therapists with no prior training in behavior therapy for anxiety disorders. Clients who completed PE show a greater improvement in PTSD symptoms, general anxiety, and depression than clients who completed TAU. These findings provide preliminary evidence suggesting that PE is an effective treatment for core PTSD symptoms, even when delivered by community therapists in a front-line services clinic.     

The devil is in the details: Managed care and the unforeseen costs of utilization review as a cost containment mechanism

This article addresses issues of liability when a single-payor in a national health care system makes a decision based on a utilization review program that injures the patient as a result. In Part I, the history of Managed Care Organizations (MCOs) is discussed to establish an understanding of the current health care landscape. Part II explains MCOs' use of utilization review to contain costs and analyzes the manner in which courts have addressed the issue of MCO liability for patient injuries sustained from denial ofcoverage. Finally, Part III concludes that current case law may limit a patient's access to a remedy for injuries sustained from a utilization review decision in a single-payor national health care system.     

Isolated myocarditis as a cause of sudden death in the first year of life

A series of three cases of isolated myocarditis, presenting as sudden death in infancy, occurred over a period of 3 months. This prompted a review of the autopsy records of the Children's Hospital of Winnipeg. Over a period of 40 years, 24 cases of isolated myocarditis were traced from 3196 autopsies. Most (21 of 24) cases of isolated myocarditis occurred in infants less than 12 months of age. In 16 of the infants there were either no antecedent clinical signs (sudden deaths), or a short clinical history of less than 24 h duration. Heart weights, however, were greater than the 99th percentile of published normals in three infants and above the 95th percentile in a further 16 infants. Areas of hypertrophied fibres were seen even in infants with a short history. These latter findings suggest that a latent phase of myocarditis may exist. The responsible pathogens were identified very rarely, due to a lack of suspicion of the existence of myocarditis, and it is suggested that samples of myocardium should be submitted for virologic examination in all cases of sudden death in the first year of life.     

Access to treatment as a right to life and health

In some countries in Latin America, in the absence of leadership from governments, activists have had to resort to the courts to obtain access to HIV/AIDS treatments for people with HIV/AIDS. In his presentation to the XIII International AIDS Conference (abstract TuOrE458), Edgar Carrasco, of Acción Ciudadana Contra el Sida (ACCSI), discusses the process that was followed in Venezuela. The presentation describes the very limited access people with HIV/AIDS had to antiretroviral therapies and treatments for opportunistic infections under Venezuela's health and social security systems. It provides details of lawsuits that were launched on behalf of several individuals living with HIV/AIDS, and that resulted in the courts ordering the government to provide treatments for these individuals and, eventually, for all people with HIV/AIDS in Venezuela. The presentation concludes that recourse to the courts is a useful tool for activists and that civil actions launched on behalf of people with HIV/AIDS can serve as an example for people with other chronic diseases.     

Bullying and social and emotional loneliness in a sample of adult male prisoners

The present study explored social and emotional loneliness, and victimisation among a sample of adult male prisoners. 241 prisoners took part, completing a behavioural measure of behaviours indicative of bullying (DIPC-R: Direct and Indirect Prisoner behaviour Checklist, Ireland, J.L. 2003. The Direct and Indirect Prisoner behaviour Checklist -- Revised. Psychology Department, University of Central Lancashire). and a measure of social and emotional loneliness (SELSA: Social and Emotional Loneliness Scale for Adults, DiTommaso, E. & Spinner, B. (1993). The development and initial validation of the social and emotional loneliness scale for adults (SELSA). Personality and Individual Differences, 14, 127-134.). Differences between the groups involved in bullying (i.e. pure bullies, pure victims, bully/victims and those not involved) were noted, with victim groups (pure victims and bully/victims) presenting with higher levels of social loneliness than those not-involved. Emotional loneliness was not a distinguishing characteristic for membership to the pure victim or bully/victim group, and instead was found to be associated with the type and amount of victimisation reported: victims who reported multiple types of victimisation presented with higher levels of emotional (family) loneliness than victims reporting just one type of victimisation. Increased victimisation was also associated with increased levels of social and emotional loneliness, most notably with regards to indirect victimisation. The results are discussed with reference to the environment in which the victimisation is taking place, and we outline a potential application of life events and added stress models in understanding social maladjustment (loneliness) among prisoners.     

Victimization, posttraumatic stress disorder symptomatology, and later nonsuicidal self-harm in a birth cohort

This longitudinal population-based study examined pathways to nonsuicidal self-harm (NSSH) in relation to childhood sexual abuse (CSA), assault victimization in early adulthood, posttraumatic stress disorder symptomatology (PTSD), and other mental disorders. At age 21, 476 men and 455 women completed interviews on assault victimization, PTSD, and other mental disorders. At age 26, they completed independent interviews on self-harm and childhood sexual abuse (CSA). Multivariate logistic regression analyses were conducted to determine predictors for NSSH at age 26. For men, anxiety and depressive disorders at age 21 were the only significant predictors of NSSH at age 26. For women, victimization, PTSD, and other anxiety disorders at age 21 all significantly predicted NSSH. CSA predicted later NSSH only indirectly, by increasing the risk of anxiety disorders among men and of assault victimization among women. In conclusion, pathways to nonsuicidal self-harm differed by sex. For women there were direct links with assault victimization and PTSD in early adulthood, whereas for men only internalizing disorders predicted future NSSH.     

Psychopathy,intelligence and emotional responding in a non-forensic sample: an experimental investigation

This study examined the relationships between psychopathy (primary and secondary), intelligence and emotional responding in a sample of 50 university students, using a task measuring autonomic responses to 40 pictorial stimuli (20 neutral and 20 emotionally provoking). Results indicated no significant direct relationship between primary or secondary psychopathy and emotional response, or primary or secondary psychopathy and intelligence. However, a significant moderating effect of intelligence on the association between both psychopathy factors and emotional response was observed, indicating those scoring higher on psychopathy but with lower intelligence portray the expected emotional responses to the affective stimuli (primary: β?=??.56, p?β?=?.80, p?<?.001). These findings indicate abnormal reactivity to emotional stimuli in lower intelligence, higher psychopathic individuals, and suggest differing roles for the two facets of psychopathy in affective responsiveness deviations.     

Variations in vitreous humor chemical values as a result of pre-analytical treatment

Vitreous humor (VH) is used for postmortem diagnosis of metabolic diseases and to clarify the postmortem interval. Because of its viscous nature, this fluid has to be liquefied prior to analysis; however variations in measured concentrations of the analytes are ascribed to different pre-analytical treatment methods with regard to. The aim of this study was to compare different pre-analytical methods. Centrifugation, heat treatment, enzymatic digestion and liquefying by ultrasound were compared using a collection of 120 samples obtained from 2003 to 2007. The determined parameters were: sodium, potassium, chloride, calcium, glucose, creatinine, urea and lactate. Analyses were performed either photometrically or by using ion-selective electrodes. Heat and hyaluronidase treatment generate slightly higher and lower values in the measurement of electrolytes and glucose. However, in the determination of calcium concentration, both methods (heat especially) are associated with extreme low or high values. Only differences between ultrasound and centrifugation treatment show comparatively small variations and are close to instrument accuracy. Therefore, we recommend centrifugation, combined with mixing, as the best and easiest method in which to prepare frozen samples for analysis. Additionally, the measurement of lactate shows that analytical methods, calibrated for serum and urine, cannot be easily applied for VH.     

Obligation to medical treatment as a possibility of medical and social supervision (author's transl)]

In lectures of forensic medicine and in jurisdiction the patient's decision to release his secret records of medical examinations and treatment is considered to be an intangible right. Actually this privilege is only existing for the rich patient who can afford it to resign economic help in daily life and in case of illness, disablement and of incapability of earning his living. The population of our social state is largely subjected to obligations to disclose, tolerate and cooperate. In Civil Right, Social Right and in Labour Law theoretically this cannot be enforced, but it is forced in fact by refusing social and insurance accomplishment. If a young person refuses medical tests, a veto of employment will result. An employee will not get a position in an industrial firm where a medical department had to be established according to the law, or in the public service, if he refuses medical tests. In the attempt to extend the social insurance system to the whole population and to extent medical service in industry to all employees within certain time, there is no longer space for avoiding the social pressure for medical good conduct. Wanting to live a civil life one has to obey those directions. The postulation of lecturers and of High Courts concerning the patients decision on medical examination and treatment has only explanatory value and does not consider medical insurance and labour aspects. Further legal restrictions of this fundamental rights exist in Criminal Law.     

Resilience of a corrupt police network: the first and second jokes in Queensland

Resilient organised crime groups survive and prosper despite law enforcement activity, criminal competition and market forces. Corrupt police networks, like any other crime network, must contain resiliency characteristics if they are to continue operation and avoid being closed down through detection and arrest of their members. This paper examines the resilience of a large corrupt police network, namely The Joke which operated in the Australian state of Queensland for a number of decades. The paper uses social network analysis tools to determine the resilient characteristics of the network. This paper also assumes that these characteristics will be different to those of mainstream organised crime groups because the police network operates within an established policing agency rather than as an independent entity hiding within the broader community.     

Exploring cynicism toward prison administrations as a mediator of the association between quality of treatment and inmate misconduct

This study explores the ability of inmate cynicism to mediate the relationship between perceptions regarding quality of treatment and inmate misconduct in a prison setting. Using a sample of inmates from prisons in South Korea, the generalizability of the process-based model is tested. Also, the indirect effect of quality of treatment on inmate misconduct through cynicism is estimated using a bias-corrected bootstrapped mediation analysis. The findings show that quality of treatment was negatively and significantly associated with inmate misconduct in South Korean prisons. Additionally, results indicate that the quality of treatment and social support are significant predictors of inmate cynicism. Finally, a regression-based path analysis reveals that cynicism mediates the relationship between quality of treatment and inmate misconduct. While quality of treatment was found to predict inmate misconduct significantly, mediation analyses support the hypothesis that inmate cynicism partially mediates this association. The findings suggest that correctional policies should pay more attention to reducing inmates’ cynicism.

     

Forced Marriage as a Harm in Domestic and International Law

This article reports on our analysis of 120 refugee cases from Australia, Canada, and Britain where an actual or threatened forced marriage was part of the claim for protection. We found that forced marriage was rarely considered by refugee decision makers to be a harm in and of itself. This finding contributes to understanding how gender and sexuality are analysed within refugee law, because the harm of forced marriage is experienced differently by lesbians, gay men and heterosexual women. We contrast our findings in the refugee case law with domestic initiatives in Europe aimed at protecting nationals from forced marriages both within Europe and elsewhere. We pay particular attention to British initiatives because they are in many ways the most far-reaching and innovative, and thus the contrast with the response of British refugee law is all the more stark.     

The sexual harassment and exploitation in employment as a manifestation of discrimination in a workplace

＂Sexual harassment＂ is a key-word used for determining the most different behaviours. In the past Polish legal system there were no terms of harassment, sexual harassment or mobbing, but nowadays those terms have legal definitions in Polish law. The sexual harassment at the work according to the Polish Labour Code is defined as not-accepted behaviour about sexual character or referring to the sex of an employee, of which infringing an employee＇s dignity or humiliating her or him is a purpose or an effect of it. The sexual harassment is a form of harassment. The sexual harassment can be classified not only as a violation of labour laws but also as a prohibited act within the meaning of criminal law or civil law delict. The Sexual harassment can be a single behavior or can also occur as a sequence of behavior. This must be the unacceptable behaviour by a particular victim （not by reference to a standard employee, and generally prevailing standards）. The lack of consent must be expressed in some way on the outside by verbal opposition or demonstrated that opposition in other ways, such as pushing back the perpetrator. Behavior of the offender must be deliberate and intentional and the effect as that does not necessarily has to occur because it is enough to just act intentional. The sexual harassment can include physical, verbal or non-verbal elements. A sequence of behaviour （several activities） which accomplish characteristics of sexual harassment and in addition realize the condition of permanence and durability can also fulfill the characteristics of mobbing.