A training approach for community maternal health volunteers that builds sustainable capacity

This article examines a training approach for community health volunteers which increased access to maternal health services in rural communities in Zambia. The effectiveness of the training approach was evaluated in an operations research component. Skilled birth attendance rates increased by 63% from baseline over a two-year period in the intervention districts, out-performing increases recorded in control sites at statistically significant levels. As a low-cost, high-impact intervention which shows good sustainability potential, the approach is suitable for national level scale-up and for adaptation for use in other countries in support of maternal and new-born health goals.     

Self-efficacy and substance use outcomes for women in single gender versus mixed-gender group treatment

OBJECTIVE: This study examined baseline self-efficacy as a moderator of outcomes comparing women receiving either the Women's Recovery Group (WRG), a new manualized group treatment for substance use disorders combining single-gender group composition and women-focused content, or Group Drug Counseling (GDC), an empirically supported mixed-gender group treatment. METHODS: To understand the relationship of baseline scores of abstinence self-efficacy measured by the Drug-Taking Confidence Questionnaire (DTCQ) to outcome, we included the interaction of group by phase by continuous DTCQ scores in the outcome analyses. Women were split into groups of high versus low abstinence self-efficacy based on the clinical cutoff score of 80 on DTCQ. RESULTS: We found a significant 3-way interaction effect of treatment condition, time, and baseline DTCQ scores on drinking days and days of any substance use per month. Women in WRG had greater reduction in substance use from baseline to post-treatment than women in GDC, and women in WRG with low self-efficacy had the best outcomes overall. CONCLUSION: The findings suggest that women with low self-efficacy may have enhanced treatment outcomes in a single-gender substance use treatment group.     

A Prospective Examination of Criminal Career Trajectories in Abused and Neglected Males and Females Followed Up into Middle Adulthood

Objectives

To examine the extent to which there are differences in the developmental course of offending among individuals with maltreatment histories, compared to nonmaltreated controls, and whether these patterns vary for males and females.

Methods

This paper uses data from a longitudinal study in which abused and neglected children (N = 908) were matched with non-maltreated children (N = 667) and followed prospectively into adulthood. Group-based trajectory modeling was conducted using official criminal history records collected through mean age 51. Patterns of criminal offending were first considered for the whole sample, with abuse status and sex included as time-stable covariates, and then separately by subgroup (control females, maltreated females, control males and maltreated males).

Results

Analyses revealed that a three-group model provided the best fit (nonoffenders, low-level chronic offenders, mid-level chronic offenders) for the overall sample. Child maltreatment and sex were significant predictors, with offenders more likely to be male and abused/neglected, compared to non-offenders. Separate analyses for the four subgroups revealed some similarities across groups in the characterization of offending trajectories, although trajectories for abused/neglected females differed significantly from trajectories for control females. Additional analyses suggest that desistance from offending may be largely a function of incapacitation due to early death, rather than imprisonment.

Conclusions

These new analyses provide evidence that child maltreatment affects patterns of offending and that there is an impact on females and males, although the impact differs by gender. Future research should build on this work by examining the mechanisms through which child maltreatment leads to differential patterns of offending throughout the life course.

     

Hero or Villain? Cinematic Lawyers and the Delivery of Justice

This essay is concerned with two specific issues that have as their backdrop the heroic central figure, the trial lawyer. First it considers the role of screen lawyers in seeking to maintain public (in this sense the public is the community within the film) support for the due process of law. The issue is the link between the lawyer and the initiation of the formal legal process. Essentially it is the extent to which the lawyer defends the institution of law. The second part of the piece considers when screen lawyers are permitted to go outside the formal process of law to ensure that the right result is achieved. It examines instances of where lawyers have been prepared to go 'beyond law' to achieve justice. Such acts raise a number of questions concerning how such behaviour affects perception of the legitimacy of the law, professional ethics, and the relationship between law and justice     

Bilateral fractures of the coronoid processes: differential diagnosis of intra-oral gunshot trauma and scavenging using a sheep crania model

Approximately half of the skeleton of an adult male (minus the cranium) was found in a forested part of Greater Vancouver, Canada, in August 2000 by the Royal Canadian Mounted Police (RCMP). Authorities ruled the death as suicide. The only compelling signs of perimortem trauma were symmetrically fractured coronoid processes of the mandible, which can be attributed to a gunshot in the mouth. However, the remains had also been scavenged by canids, raising a problem in differential diagnosis. Could canid scavenging produce bilateral fracturing of the mandible indistinguishable from gunshot wounds to the mouth? We found that canid scavengers could not mimic the type of damage to the mandible caused by intra-oral gunshot wounding using a sheep model (n = 20). Bilateral fracturing of the coronoid processes was found to be characteristic of intra-oral gunshot wounding, while canid scavengers typically ignore this region of the mandible.