'Disgust, disgust beyond description'- shame cues to detect shame in disguise, in interviews with women who were sexually abused during childhood.

Shame is a recurrent theme in the context of sexually abused women. Sexual abuse is taboo and shameful, and so is shame. Shame affects the development of a person and relationships, and is mentally painful. It is often covert. One aim of the present study was to explore whether and how women exposed to sexual abuse during childhood verbally express unacknowledged overt and covert shame, when interviewed about their physical and mental health, relations and circumstances relating to the sexual abuse. Another aim was, if shame was present, to describe the quality of the shame expressed by the women. A mainly qualitative approach with semi-structured interviews was used. Ten women attending self-help groups for women who were sexually abused during childhood were recruited as informants. The interviews were analysed for verbal expressions of shame by identifying code words and phrases, which were first sorted into six shame indicator groups and then categorized into various aspects of shame. The frequency of the code words and phrases was also counted. The findings clearly reveal that the affect of shame is present and negatively influences the lives of the informants in this study. It was possible to sort the code words and phrases most often mentioned into the indicator groups 'alienated', 'inadequate' and 'hurt', in the order of their frequency. It is obvious that shame affects the lives of this study's informants in negative ways. One important clinical implication for professionals in health care and psychiatric services is to acknowledge both sexual abuse and shame in order to make it possible for patients to work through it and thereby help them psychologically to improve their health.

Clustering of bloodstream infections during maggot debridement therapy using contaminated larvae of Protophormia terraenovae.

BACKGROUND: The treatment of human wounds with fly larvae is an ancient procedure recently reintroduced into medical practice under the term of biosurgery. The crucial technical problem of biosurgery is asepsis of the larvae. PATIENTS AND METHODS: Since February 1999, we conducted a prospective observational study on the use of maggot debridement therapy in the management of ulcers refractory to standard treatment. RESULTS: During the first 5 months we observed five bloodstream infections (four with Providencia stuartii and one with Candida albicans) in 24 patients (21%) treated with maggots. The blood isolates could be traced back to contaminated maggots. Accordingly, the disinfecting procedure of the maggots was optimized and the fly species was changed from Protophormia terraenovae to Phaenicia (Lucilia) sericata. With the new procedure, no case of sepsis occurred in 45 patients treated between January 2000 and December 2001 (p < 0.005). CONCLUSION: Despite promising benefits, maggot debridement therapy can be threatened by serious infectious complications. With an appropriate disinfecting procedure, maggots free of pathogens can be obtained. Provided the maggots have been effectively disinfected, their application on chronic ulcers seems to be safe.