Avoidant coping and treatment outcome in rape-related posttraumatic stress disorder.

OBJECTIVE: This study investigated the impact of avoidant coping on treatment outcome in rape-related posttraumatic stress disorder (PTSD). METHOD: Adult women with rape-related PTSD (N = 62) received 9 sessions of prolonged exposure (PE) or eye movement desensitization and reprocessing (EMDR). The mean age for the sample was 34.7 years, and race or ethnicity was reported as 67.7% Caucasian, 25.8% African American, 3.2% Latina, and 3.2% other. PTSD was assessed with the PTSD Symptom Scale-Self-Report (Foa, Riggs, Dancu, & Rothbaum, 1993), and avoidant coping was assessed using the Coping Strategies Inventory-Disengagement subscale (CSI-D; Tobin, Holroyd, Reynolds, & Wigal, 1989). RESULTS: Pretreatment avoidant coping was negatively associated with posttreatment PTSD symptom severity even when controlling for initial severity of total PTSD symptoms and when removing PTSD avoidance symptoms from the analysis to account for potential overlap between avoidant coping and PTSD avoidance symptoms: ΔR2 = .08, b* = -0.31, 95% CI [-0.17, -0.01], t(60) = -2.27, p = .028. The CSI-D pretreatment mean score of 100 predicted a 96% likelihood of experiencing clinically significant change (CSC) during treatment. A CSI-D pretreatment score of 61 was associated with a 40% likelihood of experiencing CSC. CONCLUSIONS: PE and EMDR appear to be beneficial for women who frequently engage in avoidant coping responses following rape. A small subset of women with initially low levels of avoidant coping are unlikely to experience a therapeutic response from PE or EMDR.

Deficits in emotion regulation mediate the relationship between childhood abuse and later eating disorder symptoms.

The present study examined the relationship of child maltreatment to both emotion dysregulation and subsequent eating pathology. In an effort to extend previous research, the authors examined the unique impact of childhood emotional abuse (CEA) on emotion dysregulation and eating disorder (ED) symptoms while controlling for the effects of sexual and physical abuse. Structural equation modeling was utilized to simultaneously examine the effects of all three abuse types on multiple dependent variables as well as examine whether deficits in emotion regulation mediated the relationship between abuse and eating pathology. Results from a survey of 1,254 female college students revealed significant paths from abuse subtypes to specific eating disorder symptoms, with CEA evidencing the strongest association with ED symptoms. Additionally, emotion dysregulation was positively associated with ED symptoms, and mediated the effects of emotional abuse on symptoms. Findings support previous research on the enduring effects of emotional abuse as well as highlight the importance of the assessment of CEA in the treatment of ED symptoms.

Abuse and parental characteristics, attributions of blame, and psychological adjustment in adult survivors of child sexual abuse.

The purpose of this study was to examine the influence of abuse and parental characteristics on attributional content and determine the relative contribution of different attributions of blame in predicting psychological symptomatology among adult survivors of childhood sexual abuse. One hundred eighty-three female undergraduates with a history of childhood sexual abuse completed self-report questionnaires. Abuse characteristics were significantly related to attributions. Family- and perpetrator-blame accounted for significant variability in psychological symptomatology, beyond the contributions of abuse characteristics, family environment, and self-blame. Implications for research and treatment are discussed.

Attributions of responsibility in a child sexual abuse (CSA) vignette among respondents with CSA histories: the role of abuse similarity to a hypothetical victim.

Previous research suggests that similarity to a victim may influence attributions of responsibility in hypothetical child sexual abuse scenarios. One aspect of similarity receiving mixed support in the literature is respondent child sexual abuse history. Using a sample of 1,345 college women, the present study examined child sexual abuse history, similarity to victim, and attributions of responsibility to a hypothetical victim, family member, and perpetrator in a child sexual abuse vignette. Results revealed no group differences in responsibility ratings among respondents with and without child sexual abuse histories. However, among the 133 respondents with child sexual abuse histories, results indicated that similarity to victim moderated the relationship between vignette characteristics, respondent history, and responsibility attributions. Results suggest that similarity to a victim may influence ratings in a self-preserving manner.

Sexual self-schemas of female child sexual abuse survivors: relationships with risky sexual behavior and sexual assault in adolescence.

Childhood sexual trauma has been demonstrated to increase survivors' risk for engaging in unrestricted sexual behaviors and experiencing adolescent sexual assault. The current study used the sexual self-schema construct to examine cognitive representations of sexuality that might drive these behavioral patterns. In Study 1 (N = 774), we attempted to improve the content validity of the Sexual Self Schema Scale for child sexual abuse (CSA) survivors, introducing a fourth sexual self-schema factor titled the "immoral/irresponsible" factor. In Study 2 (N = 1150), the potential differences in sexual self-views, as assessed by the four sexual self-schema factors, between CSA survivors and non-victims were explored. In addition, Study 2 evaluated how these sexual self-schema differences may contribute to participation in unrestricted sexual behaviors and risk for sexual assault in adolescence. Results indicated that a history of CSA impacted the way women viewed themselves as a sexual person on each of the four factors. CSA survivors were found to view themselves as more open and possessing more immoral/irresponsible cognitions about sexuality as compared to women who did not have a CSA history. In addition, the CSA survivors endorsed less embarrassment and passionate/romantic views of their sexual selves. The interaction of CSA severity and the sexual self-schemas explained variance in adolescent sexual assault experiences above and beyond the severity of CSA history and participation in risky sexual behaviors. The findings suggest that sexual self-views may serve to moderate the relationship between CSA and adolescent sexual assault. Implications of these findings and directions for future research are discussed.

Child sexual abuse, early family risk, and childhood parentification: pathways to current psychosocial adjustment.

In this study, the authors examined the role of parentification (children assuming adult-like roles in the family) as it relates to family risk (parental psychopathology, parental illness, and domestic violence), child sexual abuse (CSA), and psychosocial adjustment in 499 college women. Structural equation modeling was used to test a model of direct, indirect, and mediational pathways through which CSA, family risk, and parentification contributed to later psychosocial maladjustment. Results indicate that CSA and family risk independently and directly predicted higher levels of maladjustment, but only family risk positively predicted parentification in childhood. Parentification was unexpectedly related to less maladjustment. Parentification failed to mediate the relation between early family risk and maladjustment. Findings suggest that family risk factors may contribute to parentification and that parentification is not always related to poorer psychosocial outcomes. Future research should examine the impact of parentification on other aspects of functioning and should assess how individual, familial, and cultural variables (e.g., age, gender, duration, perceived fairness, ethnicity, and family support) moderate the impact of parentification on long-term adjustment.

Sex differences in the experience of unwanted sexual attention and behaviors during childhood.

Girls receive considerable amounts of unwanted sexual attention (UWSA) and behaviors (UWSB). Less is known about boys' unwanted sexual experiences. The primary goal of this study was to obtain a descriptive profile of the types and perpetrators of childhood UWSA/B. Secondary goals were to examine sex differences in emotional reactions to UWSA/B and influence of perpetrator. As many as 100 male and 100 female undergraduates completed the Exposure to Sexual Attention Scale and the Emotional Reaction Checklist. Results indicated that the majority of participants experienced UWSA/B during childhood, with females reporting higher rates of UWSB than males. Sex differences were also observed regarding types of perpetrators and emotional reactions. Findings are discussed as they relate to the sociocultural norms in which children are reared.

Canine visceral leishmaniasis, United States and Canada, 2000-2003.

Visceral leishmaniasis, caused by protozoa of the genus Leishmania donovani complex, is a vectorborne zoonotic infection that infects humans, dogs, and other mammals. In 2000, this infection was implicated as causing high rates of illness and death among foxhounds in a kennel in New York. A serosurvey of >12,000 foxhounds and other canids and 185 persons in 35 states and 4 Canadian provinces was performed to determine geographic extent, prevalence, host range, and modes of transmission within foxhounds, other dogs, and wild canids and to assess possible infections in humans. Foxhounds infected with Leishmania spp. were found in 18 states and 2 Canadian provinces. No evidence of infection was found in humans. The infection in North America appears to be widespread in foxhounds and limited to dog-to-dog mechanisms of transmission; however, if the organism becomes adapted for vector transmission by indigenous phlebotomines, the probability of human exposure will be greatly increased.

Cocaine dependence and PTSD: a pilot study of symptom interplay and treatment preferences.

Cocaine dependence and posttraumatic stress disorder (PTSD) frequently co-occur. Little is known, however, about patients' perceptions of symptom connectedness and preferences for treatment. This pilot study preliminarily investigated perceptions of symptom interplay and preferences regarding concurrent or sequential models of psychotherapy, therapy format, and treatment modalities. Participants were 23 individuals with current cocaine dependence and PTSD. The majority (95.5%) reported a functional relationship between cocaine use and PTSD symptoms (p<0.001). Improvement in PTSD symptoms was typically (63.6%) associated with a decrease in cocaine use (p<0.01). Similarly, a worsening of PTSD symptoms was typically (86.4%) associated with an increase in cocaine use (p<0.001). In contrast, improvement/deterioration in cocaine use was not significantly related to subsequent improvement/deterioration in PTSD symptoms. This finding suggests that changes in PTSD may be an important risk factor to consider among individuals with cocaine dependence and PTSD. Approximately 41% preferred a concurrent model of therapy in which the cocaine use and PTSD are treated simultaneously in therapy. The findings highlight the functional relationship between these two disorders and have direct implications for treatment interventions.

Alcohol dependence and posttraumatic stress disorder: differences in clinical presentation and response to cognitive-behavioral therapy by order of onset.

Alcohol dependence (AD) and posttraumatic stress disorder (PTSD) frequently co-occur. However, little systematic study has examined the importance of their temporal order of onset. In this study, differences in clinical presentation and response to cognitive-behavioral substance-use therapy by order of onset were examined among 94 (51 men and 43 women) individuals with AD and PTSD. The findings revealed that women with primary AD and men with primary PTSD presented as more distressed and/or depressed than their counterparts at treatment entry. A relationship between increased alcohol intake and higher PTSD symptom levels was observed during treatment. In general, the primary PTSD group derived greater overall benefit (e.g., in physical health, alcohol use, social functioning) as compared with the primary AD group. Finally, women with primary AD appeared particularly vulnerable to continued psychiatric distress and depression at the end of treatment. These findings increase awareness of the importance of considering the order of onset and may ultimately lead to treatment improvements for this population.

Perceptions of parenting versus parent-child interactions among incest survivors.

OBJECTIVES: Although women with histories of child sexual abuse (CSA) perceive themselves as less competent mothers and report greater parenting difficulties than nonabused women, few investigators have actually observed the parenting behaviors of CSA survivors. The primary aim of this study was to examine whether incest history was related to maternal perceptions of parenting efficacy and interactional patterns with their children. The secondary aim of this study was to explore the constructs of internal working models of relationships and maternal psychological adjustment as potential mediators of the relation between incest history and parenting. METHODS: A community sample of 17 incest survivors, 18 nonabused women and their 3-6 year-old children participated. Mothers completed self-report measures of parenting efficacy, parental bonding (i.e., internal working models of relationships), and psychological adjustment. In addition, mothers interacted with their children in a problem-solving task. RESULTS: Although incest survivors reported less parenting self-efficacy than did nonabused mothers, their interactional styles with their children were positive overall and comparable to those of nonabused mothers. Specifically, survivors displayed moderate to high levels of support, assistance, and confidence, and their children showed high levels of affection towards their mothers. Incest survivors reported less bonding with their own mothers in childhood and poorer current psychological adjustment. CONCLUSIONS: Findings suggest that incest survivors' perceptions of their parenting abilities may be more negative than their actual parenting behaviors.

Detection of a single nucleotide polymorphism in the human alpha-lactalbumin gene: implications for human milk proteins.

Variability in the protein composition of breast milk has been observed in many women and is believed to be due to natural variation of the human population. Single nucleotide polymorphisms (SNPs) are present throughout the entire human genome, but the impact of this variation on human milk composition and biological activity and infant nutrition and health is unclear. The goals of this study were to characterize a variant of human alpha-lactalbumin observed in milk from a Filipino population by determining the location of the polymorphism in the amino acid and genomic sequences of alpha-lactalbumin. Milk and blood samples were collected from 20 Filipino women, and milk samples were collected from an additional 450 women from nine different countries. alpha-Lactalbumin concentration was measured by high-performance liquid chromatography (HPLC), and milk samples containing the variant form of the protein were identified with both HPLC and mass spectrometry (MS). The molecular weight of the variant form was measured by MS, and the location of the polymorphism was narrowed down by protein reduction, alkylation and trypsin digestion. Genomic DNA was isolated from whole blood, and the polymorphism location and subject genotype were determined by amplifying the entire coding sequence of human alpha-lactalbumin by PCR, followed by DNA sequencing. A variant form of alpha-lactalbumin was observed in HPLC chromatograms, and the difference in molecular weight was determined by MS (wild type=14,070 Da, variant=14,056 Da). Protein reduction and digestion narrowed the polymorphism between the 33rd and 77th amino acid of the protein. The genetic polymorphism was identified as adenine to guanine, which translates to a substitution from isoleucine to valine at amino acid 46. The frequency of variation was higher in milk from China, Japan and Philippines, which suggests that this polymorphism is most prevalent in Asia. There are SNPs in the genome for human milk proteins and their implications for protein bioactivity and infant nutrition need to be considered.

Gender differences in stress reactivity among cocaine-dependent individuals.

RATIONALE: Recent investigations suggest that stress reactivity may play an important role in the relationship between stress and substance use. Important gender differences, such as reasons for using substances, have been well documented, and it is likely that men and women also differ in their stress response. OBJECTIVES: In this study, gender differences in stress reactivity to two laboratory stress manipulations were examined among 18 men and 21 women with current cocaine dependence. METHODS: Participants completed a psychological stress task, the Mental Arithmetic Task (MAT), and a physical stress task, the Cold Pressor Task (CPT). Subjective stress responses (i.e., feelings of stress, anxiety, nervousness, pain, mood), physiological stress responses (i.e., heart rate, skin conductance), and cocaine craving were assessed. RESULTS: In response to both the MAT and the CPT, significant increases in subjective and physiological stress were observed among participants. Women, however, demonstrated greater subjective reactivity, as evidenced by significantly higher ratings of stress, nervousness, and pain as compared to men. Women also immersed their hand in the cold water bath for a significantly shorter period of time as compared to men. CONCLUSIONS: The current findings are among the first to report on gender differences in stress reactivity among cocaine-dependent individuals. The findings suggest that the mechanisms linking stress and substance use may be gender-specific, and that stress reactivity may play a different role for women than for men. Future research and implications for clinical interventions are discussed.

A multinational study of alpha-lactalbumin concentrations in human milk.

Alpha-lactalbumin, a 14-kD protein, plays a central biochemical role in the mammary gland as the regulatory subunit of lactose synthase, and also plays a nutritional role for the rapidly growing neonate as the protein in highest concentration in human milk. The current study was undertaken to better characterize alpha-lactalbumin concentrations in human milk from a variety of countries. Mature human milk (lactation duration > or =1 month) was collected from at least 50 women from nine different countries on five continents. Alpha-lactalbumin concentration was determined by HPLC. The mean +/- SD for 452 samples was 2.44 +/- 0.64 g/L. The mean value of the samples from the United States was significantly higher than that from any other country, and the mean in Mexico was significantly lower than that from every country except China and Canada. Alpha-lactalbumin concentration decreased with increasing duration of lactation and was positively correlated with total nitrogen. On average, alpha-lactalbumin contributed 16% of the total nitrogen content of human milk and consequently an important part of the amino acid content.

Child sexual and physical abuse among college students in Singapore and the United States.

OBJECTIVES: The purpose of this study was to explore differences in rates and characteristics of child sexual and physical abuse experiences among women in Singapore and the US. METHOD: Participants (N=153) completed an anonymous questionnaire which assessed experiences of childhood sexual and physical abuse, abuse characteristics (e.g., victimization age, severity), and behavioral and subjective reactions to such experiences (e.g., labeling of experiences as abuse, psychological symptomatology). Exposure to other forms of traumatic life events was also assessed. RESULTS: In comparison to Singaporean women, US women were more likely to report a history of child sexual abuse, and to report experiencing more severe forms of sexual abuse. Women in Singapore were more likely than women in the US to report a history of child physical abuse, to report experiencing injury as a result of the abuse, and to disclose the abuse. Singaporean women with a history of child sexual abuse reported elevated psychological symptom levels relative to their nonabused peers and to US women with a history of child sexual abuse, even after controlling for exposure to other types of traumatic events. No significant differences in symptomatology with regard to child physical abuse were observed. CONCLUSIONS: Although preliminary in nature, the present findings are among the first to demonstrate differences in psychological adjustment between sexually abused and nonabused Asian women living in Asia. This study also provides some of the first support for cross-national differences in the psychological adjustment of child sexual abuse survivors.

Multinational study of major breast milk carotenoids of healthy mothers.

BACKGROUND: Carotenoids in serum vary between countries and within populations with evidence suggesting a qualitative relationship to diet. Breast milk carotenoids furnish a source of vitamin A and potentially provide immunoprotection and other health benefits for infants. There have been numerous studies of milk carotenoid concentrations in undernourished populations; however, carotenoid concentrations have not previously been compared in populations of well-nourished mothers. AIM OF STUDY: To compare concentrations of five major carotenoid groups: alpha-carotene, beta-carotene, beta-cryptoxanthin, lutein/zeaxanthin, and lycopene in breast milk of healthy women from Australia, Canada, Chile, China, Japan, Mexico, the Philippines, the United Kingdom, and the United States, and to qualitatively compare patterns of dietary intake with milk carotenoid concentrations. METHODS: Breast milk collected from healthy lactating women was analyzed for concentrations of five carotenoids and retinol and quantitated relative to total milk lipid. All determinations were performed in a single research laboratory using standardized methodology. Mothers consumed their usual diets and provided a single 24-h dietary recall. RESULTS: Breast milk carotenoid concentrations varied greatly among countries, with the greatest differences in beta-cryptoxanthin (approximately 9-fold) and the least in alpha-carotene and lycopene (approximately 3-fold). Breast milk retinol concentrations varied approximately 2-fold across countries. The provitamin A carotenoids alpha-carotene, beta-carotene, and beta-cryptoxanthin as a group accounted for > 50 % of the carotenoids measured. Total breast milk carotenoids were highest in Japanese and lowest in Philippine mothers. Breast milk beta-carotene concentrations were highest in Chile and lowest in the Philippines. CONCLUSIONS: Patterns of breast milk carotenoids were unique to each country and qualitative patterns reflected the dietary carotenoid supply.

A randomized, double-blind study of the efficacy of a 10- or 20-day course of sodium stibogluconate for treatment of cutaneous leishmaniasis in United States military personnel.

The recommended treatment for cutaneous leishmaniasis is pentavalent antimony at a dosage of 20 mg/kg/day for 20 days. Some studies conducted in locales in which Leishmania is endemic have suggested that shorter courses of treatment may be as efficacious. We conducted a randomized, double-blind, placebo-controlled study of 10 versus 20 days of sodium stibogluconate (SSG) in United States military personnel who contracted cutaneous leishmaniasis while serving overseas; 19 patients received SSG for 10 days (and placebo for 10 days), and 19 patients received SSG for 20 days. Cure rates were 100% (19 of 19 patients) in the 10-day group and 95% (18 of 19 patients) in the 20-day group. Side effects were more common among patients who received 20 days of therapy. In this group of otherwise healthy young adults, SSG at a dosage of 20 mg/kg/day for 10 days appears to have been therapeutically equivalent and less toxic than the standard 20-day course.