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duminică, 5 august 2012

When Domestic Abusers Most Likely To Attack Revealed By Jailhouse Phone Calls

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Main Category: Women's Health / Gynecology
Also Included In: Psychology / Psychiatry;  Alcohol / Addiction / Illegal Drugs
Article Date: 03 Aug 2012 - 1:00 PDT Current ratings for:
When Domestic Abusers Most Likely To Attack Revealed By Jailhouse Phone Calls
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An analysis of jailhouse phone calls between men charged with felony domestic violence and their victims allowed researchers for the first time to see exactly what triggered episodes of violent abuse.

The findings showed that violence often immediately followed accusations of sexual infidelity made by one or both of the partners. Drug or alcohol use was often involved.

Researchers have long known that sexual jealousy played a general role in abuse, but this is the first time it was shown that it was a specific form of jealousy - infidelity concerns - that tended to initiate the violence, said Julianna Nemeth, lead author of the study and a doctoral student in public health at Ohio State University.

"What we were looking for was the immediate precursor - what was the one thing that happened right before the violence that was the catalyst," Nemeth said.

"I have worked in domestic violence intervention for many years, but still the findings shocked me. We never knew that it was the accusation of infidelity that tended to trigger the violence."

The findings are powerful because they come directly from conversations of the couples involved in domestic violence, said Amy Bonomi, co-author of the study and associate professor of human development and family science at Ohio State.

"What we had before was what the abuser and victim said to police, to courts, to advocates, to health care providers," said Bonomi, who is also an affiliate with the Group Health Research Institute in Seattle.

"But we never before had the couple together discussing just among themselves what happened during the violent episode."

The study appears online in the Journal of Women's Health and will appear in a future print edition.

The study involved 17 heterosexual couples in which the male was in detention in a facility in the state of Washington for felony-level intimate partner violence. The victims had sustained serious injuries during the attacks, including severe head trauma requiring hospitalization, bite wounds, strangulation and lost pregnancy.

The researchers used up to four hours of recorded phone conversations between each couple.

The detention facility in the study routinely records conversations of detainees to increase jail safety. The couples were aware they were being recorded through an automated message at the beginning of each call. Such recordings have been approved by the state Supreme Court, and the researchers gained approval from the county prosecutor's office and detention facility to use the recordings. All the recordings involved cases that had already been resolved.

The researchers listened to the audiotaped recordings and wrote narrative summaries of couples describing acute triggers and chronic stressors for violence. Nemeth then created a table to summarize the themes found in the recordings.

The research team met weekly for two months to discuss the themes and develop a conceptual model to explain what they had found.

Along with the acute trigger for the violence, the researchers found a variety of other chronic stressors in the relationships of these couples that may have contributed to the abuse. One chronic stressor was the same issue that often triggered the violence.

"We found that long-term disputes regarding infidelity pervaded nearly every relationship," Nemeth said. "Even if it didn't trigger the violent event, it was an ongoing stressor in nearly all of the 17 couples we studied."

Drug and alcohol use was also a key both as a trigger to violence and a chronic problem. Alcohol or drugs helped escalate what started out as just a conversation into severe violence, she said.

Many of the couples discussed unmet mental health needs, and ongoing problems with depression and preoccupation with suicide.

Another key to understanding these violent relationships was the extent to which the couples had accepted traditional heterosexual gender roles, which were often justified through religion, Bonomi explained.

"We commonly heard the couples discuss how women are supposed to marry and have children, and how men are supposed to be strong and in control," Bonomi said. "Men tended to use these traditional gender role prescriptions to justify their use of violence."

The violence at times centered on "reproductive coercion" - men who wanted to control when and if their partner became pregnant. For example, one man told his partner he was justified in raping her because she wanted to be a mother anyway.

Five of the 17 couples talked about severe violence during pregnancy and two women discussed a lost pregnancy as a result of violence.

In about half of the couples in which they had clearly internalized traditional gender roles, religion was used as a justification. In one case, the male abuser told his victim that his attack was about "cleansing your soul."

"It was very disturbing the way religion was used to justify the violence and to justify why the relationship should continue," Nemeth said.

These results should prompt several changes in procedures for victim advocates and other mental health providers, Nemeth said.

Advocates for domestic abuse victims often prepare safety plans to determine how much danger a woman may be in and what she can do to protect herself.

"A lot of safety plan tools don't ask specifically about sexual jealousy and infidelity, but it is a question we should be asking," Nemeth said. "If it is an issue that couples are discussing, it is a red flag that the relationship may be volatile."

The results also suggest there should be more coordination between health care providers helping those with drug and alcohol use, mental health issues, and domestic abuse, since all of these issues can be related.

"We need more coordination to help people on all different levels," Nemeth said.

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our women's health / gynecology section for the latest news on this subject. Other authors of the study were Meghan Lee and Jennifer Ludwin, both graduate students at Ohio State.
The study was funded by the Criminal Justice Research Center at Ohio State and the Group Health Foundation of Seattle.
Written by Jeff Grabmeier
Ohio State University Please use one of the following formats to cite this article in your essay, paper or report:

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luni, 12 decembrie 2011

ADHD Drugs Do Not Raise Stroke, Heart Attack Or Sudden Cardiac Death Risk

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Main Category: ADHD
Also Included In: Cardiovascular / Cardiology;  Psychology / Psychiatry
Article Date: 12 Dec 2011 - 11:00 PST

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Young and middle-aged adults who are prescribed ADHD (attention deficit/hyperactivity disorder) drugs do not have a higher chance of developing serious cardiovascular events, such as sudden cardiac death, heart attack or stroke, researchers from Kaiser Permanente Northern California, Oakland, reported in JAMA (Journal of the American Medical Association).

The authors explained that there had been concerns regarding the cardiovascular consequences of taking ADHD medications. This is because they can raise the patient's heart rate and blood pressure.

However, this latest study, involving 150,359 adults with ADHD, found no higher risk of having a cardiovascular event in people taking ADHD medications compared to those who don't. All the adults were young to middle-aged.

The findings of this study are being published ahead of schedule because of their public health importance.

The authors explained:

"Between 2001 and 2010, use of medications labeled for treatment of ADHD increased even more rapidly in adults than in children. According to a 2006 U.S. Food and Drug Administration (FDA) advisory committee briefing on the safety of ADHD medications, more than 1.5 million U.S. adults were taking stimulants in 2005, and adults received approximately 32 percent of all issued prescriptions.

Placebo-controlled studies in children and adults indicate that stimulants and atomoxetine [a medication used to treat ADHD] elevate systolic blood pressure levels by approximately 2 to 5 mm Hg and diastolic blood pressure levels by 1 to 3 mm Hg and also lead to increases in heart rate. Although these effects would be expected to slightly increase risk for myocardial infarction [MI; heart attack], sudden cardiac death (SCD), and stroke, clinical trials have not been large enough to assess risk of these events."

Laurel A. Habel, Ph.D., and team set out to determine whether taking ADHD medications during adulthood might be linked to a higher risk of stroke, heart attack or sudden cardiac death (SCD). They gathered data from four computerized health records at four different sites - the earliest site started in 1986, they all ended in 2005. They also used data from a 2007 survey.

All the study participants were aged from 25 to 64 years, who had been taking various ADHD medications which included amphetamine, atomoxetine, or methylphenidate. They matched each ADHD medication user to two non-users in each study site, by sex, birth date, and calendar year. In total, including users and non-users, the study looked at 443,198 individuals.

They reported a total of 1,357 heart attacks, 296 sudden cardiac deaths, and 575 strokes during follow-up.

After examining the data and analyzing them, they found no statistically significant difference in risk between the users and non-users of ADHD medications for the three serious cardiovascular events.

The researchers wrote:

"We also found little support for an increased risk for any specific medication or with longer duration of current use. Results were similar when users were restricted to new users. Rate ratios did not appear to be influenced by prior cardiovascular disease or by prior non-ADHD psychiatric conditions. They also were similar across age groups.

As expected, event rates were substantially higher in the Medicaid population; however, the rate ratio for current use was similar to that in other sites."

Risk of cardiovascular events were no different for one-off, medium and short term users, during their period of taking their medications and for periods over 12 months after discontinuing. There was a similar or very slightly increased risk in new users compared to non-users.

The authors emphasized that they could not rule out a modest rise in serious cardiovascular events, because of some limitations in the study, which did not have full information on a number of factors which could have influenced the results, as well as other factors associated with ADHD drug usage.

Philip Shaw, M.D., Ph.D., who used to work at the NIMH (National Institute of Mental Health) and is now with the Human Genome Research Institute, said the study's findings have raised a number of clinically important issues:
"First, the findings support the final decision by the FDA in 2006 not to place a black box warning of serious cardiovascular events on ADHD medications for all children and adults but to pursue further research. The findings, however, do not directly inform the current black box warning for psychostimulants, which is confined to patients with structural heart lesions.

The study focused on very rare events, which prevented examination of specific subgroups such as individuals with cardiac disease. Joint care by cardiologists and other physicians remains necessary for these individuals.

In addition, the study provides no evidence to support routine obtaining of electrocardiograms before starting treatment, certainly insofar as this recommendation was driven by concerns about serious cardiovascular events."

Written by Christian Nordqvist
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

Visit our adhd section for the latest news on this subject. "ADHD Medications and Risk of Serious Cardiovascular Events in Young and Middle-aged Adults"
Laurel A. Habel et al
JAMA. Published online December 12, 2011. doi: 10.1001/jama.2011.1830 Please use one of the following formats to cite this article in your essay, paper or report:

MLA

Christian Nordqvist. "ADHD Drugs Do Not Raise Stroke, Heart Attack Or Sudden Cardiac Death Risk." Medical News Today. MediLexicon, Intl., 12 Dec. 2011. Web.
12 Dec. 2011. APA

Please note: If no author information is provided, the source is cited instead.


Please note that we publish your name, but we do not publish your email address. It is only used to let you know when your message is published. We do not use it for any other purpose. Please see our privacy policy for more information.

If you write about specific medications or operations, please do not name health care professionals by name.

All opinions are moderated before being included (to stop spam)

Contact Our News Editors

For any corrections of factual information, or to contact the editors please use our feedback form.

Please send any medical news or health news press releases to:

Note: Any medical information published on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a health care professional. For more information, please read our terms and conditions.



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