Childhood Sexual Abuse and Revictimization In Adolescence and Adulthood

Abstract

Childhood sexual abuse must be seen as a pervasive risk factor in children's lives: No demographic or family characteristics have as yet been identified to rule out the possibility that a child will be or has been sexually abused (Finkelhor, 1993). The adverse consequences of sexual abuse, both immediate and long term, have been documented by a large body of research. After a summary of the main findings from this research, the main objective of the present chapter is to examine the impact of childhood sexual abuse on a particular aspect of psychological functioning: the development of sexual behavior and sexual relationships. In this analysis, special consideration is given to the question of whether individuals who were sexually abused as children are at greater risk of experiencing sexual victimization in later life than individuals without experience of abuse. This question has generated a substantial body of evidence (see Messman & Long, 1996, for a review), and researchers are beginning to understand pathways from the experience of abuse in childhood to revictimization in adolescence and adulthood.     

Small subitizing range in people with Williams syndrome

Recent evidence suggests that the rapid apprehension of small numbers of objects—often called subitizing—engages a system which allows representation of up to 4 objects but is distinct from other aspects of numerical processing. We examined subitizing by studying people with Williams syndrome (WS), a genetic deficit characterized by severe visuospatial impairments, and normally developing children (4–6.5 years old). In Experiment 1, participants first explicitly counted displays of 1 to 8 squares that appeared for 5 s and reported “how many”. They then reported “how many” for the same displays shown for 250 ms, a duration too brief to allow explicit counting, but sufficient for subitizing. All groups were highly accurate up to 8 objects when they explicitly counted. With the brief duration, people with WS showed almost perfect accuracy up to a limit of 3 objects, comparable to 4-year-olds but fewer than either 5- or 6.5-year-old children. In Experiment 2, participants were asked to report “how many” for displays that were presented for an unlimited duration, as rapidly as possible while remaining accurate. Individuals with WS responded as rapidly as 6.5-year-olds, and more rapidly than 4-year-olds. However, their accuracy was as in Experiment 1, comparable to 4-year-olds and lower than older children. These results are consistent with previous findings, indicating that people with WS can simultaneously represent multiple objects, but that they have a smaller capacity than older children, on par with 4-year-olds. This pattern is discussed in the context of normal and abnormal development of visuospatial skills, in particular those linked to the representation of numerosity.     

Substitutes for leadership in anaesthesia teams and their impact on leadership effectiveness

In this study we aim to increase our understanding of leadership in anaesthesia teams by investigating the relationship between substitutes for leadership, leadership behaviour, and team performance in situations with varying levels of routine and standardization. The present study relied on video recordings of 12 anaesthesia teams in a simulated setting with the occurrence of a nonroutine event. Clinical team performance was measured by the speed of adequate team reaction to this event. The leadership behaviours observed were coded either as content oriented (e.g., information transmission) or structuring (e.g., assigning tasks). Results showed that leadership behaviour changed depending upon the level of routine of a situation, the degree of standardization, and, to some extent, on the experience of team members. Leadership tends to be positively related to team performance during nonroutine and low standardized situations but negatively related to team performance in routine and highly standardized situations. Furthermore, leadership is only slightly related to team member experience. This study improves our understanding of influences of substitutes for leadership on successful leadership behaviour in anaesthesia teams. The findings also lead to suggestions for both further research and the enhancement of team leadership in critical care.     

Demands,resources, and work ability: A cross-national examination of health care workers

Understanding work ability, with the goal of promoting it, is important for individuals as well as organizations. It is especially important to study work ability in health care workers, who face many work-related challenges that may threaten work ability. We studied various job demands, job resources, and interactions of demands and resources relating to work ability using the Job Demands–Resources model as a framework. Acute care health care workers from six nations (US, Australia, UK, Brazil, Croatia, and Poland) completed a survey. Role demands related to work ability in the Australia sample only, and supervisor support related to work ability in the Australia sample only. Yet, high levels of supervisor support significantly moderated (buffered) negative relationships between physical demands and work ability in the US sample, along with negative relationships between role demands and work ability in both the Croatia and UK samples. Skill discretion related to work ability in every nation sample, and therefore appears to be particularly important to work ability perceptions. In addition, skill discretion moderated (buffered) a negative relationship between role demands and work ability in the Australia sample. We therefore recommend that interventions to help preserve or improve work ability target this important job resource.     

The Protestant work ethic,religious beliefs,and homonegative attitudes

The purpose of this study was to examine the influence of the Protestant Work Ethic (PWE) on negative attitudes towards gay men and lesbian women (homonegativity). The influence of religious beliefs and the notion of homosexuality as a choice were also examined in combination with PWE in regards to homonegativity. Previous research suggested that those who subscribe to the PWE have more negative attitudes towards societal out-groups (e.g., African–Americans). Thus, it was hypothesized that those with high PWE scores would display more homonegative attitudes. A significant correlation between PWE and homonegativity supported this hypothesis. Multiple regression analyses revealed that PWE interacted with religious beliefs, and religious beliefs interacted marginally with the idea of homosexuality as a choice. Those with high religious beliefs and who strongly believed that homosexuality was a choice were more likely to have negative attitudes towards homosexuals. The implications of these findings are discussed, with particular respect to reducing homonegative attitudes.     

Body talk and body-related co-rumination: Associations with body image,eating attitudes,and psychological adjustment

Talk about physical appearance and body image is common among young women. We investigated how body talk (negative, positive/self-accepting, and co-ruminative) is related to body image, body-related cognitive distortions, disordered eating, psychological adjustment, and friendship quality via hierarchical regression analyses (controlling for social desirability and body mass index). In a sample of young adult women (N = 203), negative body talk was, as predicted, negatively related to body satisfaction and self-esteem and positively related to appearance investment, body-related cognitive distortions, disordered eating, and depression, but not friendship quality. Self-accepting/positive body talk was negatively related to body-related cognitive distortions and positively related to body satisfaction, self-esteem, and friendship quality. Body-related co-rumination demonstrated adjustment trade-offs, being related to body-related cognitive distortions, disordered eating, and higher friendship quality. Results indicated no advantage to negative body talk, both individual and relationship benefits from positive/self-accepting body talk, and mixed outcomes for body-related co-rumination     

Medical tourism in india: perceptions of physicians in tertiary care hospitals

Senior physicians of modern medicine in India play a key role in shaping policies and public opinion and institutional management. This paper explores their perceptions of medical tourism (MT) within India which is a complex process involving international demands and policy shifts from service to commercialisation of health care for trade, gross domestic profit, and foreign exchange. Through interviews of 91 physicians in tertiary care hospitals in three cities of India, this paper explores four areas of concern: their understanding of MT, their views of the hospitals they work in, perceptions of the value and place of MT in their hospital and their views on the implications of MT for medical care in the country. An overwhelming majority (90%) of physicians in the private tertiary sector and 74.3 percent in the public tertiary sector see huge scope for MT in the private tertiary sector in India. The private tertiary sector physicians were concerned about their patients alone and felt that health of the poor was the responsibility of the state. The public tertiary sector physicians’ however, were sensitive to the problems of the common man and felt responsible. Even though the glamour of hi-tech associated with MT dazzled them, only 35.8 percent wanted MT in their hospitals and a total of 56 percent of them said MT cannot be a public sector priority. 10 percent in the private sector expressed reservations towards MT while the rest demanded state subsidies for MT. The disconnect between their concern for the common man and professionals views on MT was due to the lack of appreciation of the continuum between commercialisation, the denial of resources to public hospitals and shift of subsidies to the private sector. The paper highlights the differences and similarities in the perceptions and context of the two sets of physicians, presents evidence, that questions the support for MT and finally analyzes some key implications of MT on Indian health services, ethical issues emerging out of that and the need for understanding the linkages between public and private sectors for a more effective intervention for an equitable medical care policy.     

Promoting social responsibility amongst health care users: medical tourists’ perspectives on an information sheet regarding ethical concerns in medical tourism

Background

Medical tourists, persons that travel across international borders with the intention to access non-emergency medical care, may not be adequately informed of safety and ethical concerns related to the practice of medical tourism. Researchers indicate that the sources of information frequently used by medical tourists during their decision-making process may be biased and/or lack comprehensive information regarding individual safety and treatment outcomes, as well as potential impacts of the medical tourism industry on third parties. This paper explores the feedback from former Canadian medical tourists regarding the use of an information sheet to address this knowledge gap and raise awareness of the safety and ethical concerns related to medical tourism.

Results

According to feedback provided in interviews with former Canadian medical tourists, the majority of participants responded positively to the information sheet and indicated that this document prompted them to engage in further consideration of these issues. Participants indicated some frustration after reading the information sheet regarding a lack of know-how in terms of learning more about the concerns discussed in the document and changing their decision-making. This frustration was due to participants’ desperation for medical care, a topic which participants frequently discussed regarding ethical concerns related to health care provision.

Conclusions

The overall perceptions of former medical tourists indicate that an information sheet may promote further consideration of ethical concerns of medical tourism. However, given that these interviews were performed with former medical tourists, it remains unknown whether such a document might impact upon the decision-making of prospective medical tourists. Furthermore, participants indicated a need for an additional tool such as a website for continued discussion about these concerns. As such, along with dissemination of the information sheet, future research implications should include the development of a website for ongoing discussion that could contribute to a raised awareness of these concerns and potentially increase social responsibility in the medical tourism industry.

     

“Advice to the medical students in my service”: the rediscovery of a golden book by Jean Hamburger,father of nephrology and of medical humanities

Jean Hamburger (1909–1992) is considered the founder of the concept of medical intensive care (réanimation médicale) and the first to propose the name Nephrology for the branch of medicine dealing with kidney diseases. One of the first kidney grafts in the world (with short-term success), in 1953, and the first dialysis session in France, in 1955, were performed under his guidance. His achievements as a writer were at least comparable: Hamburger was awarded several important literary prizes, including prix Femina, prix Balzac and the Cino del Duca prize (1979), awarded, among others, to Jorge Luis Borges and Konrad Lorenz.Here we would like to offer a selected reading of a “golden” book, “Conseils aux étudiants en medicine de mon service” (“Advice to the Medical Students in my Service”), the first book dedicated to patient-physician relationship in Nephrology, written when dialysis and transplantation were becoming clinical options (1963). The themes include: the central role of the patient, who should be known by name, profession, life style, and not by disease; the importance of the setting of the care; the need for truth-telling and for leaving hope; the role of research not only in the progression of science, but also in the daily clinical practice.