Characteristics Associated with a History of Physical and Sexual Abuse in a Community Corrections Sample.

Background: Most predictors of future criminal justice involvement are gender neutral. However, recent research has stressed the importance of physical and sexual abuse as a precursor of incarceration for women. Purpose: The aim of the present study was to assess the influence of a history of physical and sexual abuse on mental health, substance use, and criminal justice history for men and women under community corrections supervision. Methods: A sample of 613 (203 women and 410 men) participants completed structured clinical interviews and questionnaires assessing demographics, mental health and abuse history (physical vs. sexual), substance use, and criminal justice involvement. Results: Results of multivariate analyses indicated that for men, physical abuse was linked to White race, a higher number of arrests, history of a person offense, family problems, and suicidality; while sexual abuse was linked to White race, family problems, suicidality, and antisocial personality disorder. For women, physical abuse was only associated with meeting criteria for an anxiety or depressive disorder; while sexual abuse was linked to reporting a history of a substance offense, meeting criteria for an anxiety or depressive disorder, and increased suicidality. Substance use was not associated with any form of abuse in either gender. Conclusions: In general, abuse was associated with worse mental health and more severe criminal justice involvement. Women reported much greater rates of abuse and our results provide some support for the idea that a history of abuse may be an important precursor to criminal justice involvement for individuals under community corrections supervision.

Improving Glycemic Control and Insulin Ordering Efficiency for Hospitalized Patients With Diabetes Through Carbohydrate Counting.

Glycemic control in hospitalized patients is challenging but important for optimal outcomes. Insulin dosing through carbohydrate counting may address patient, provider, and institutional factors that complicate hospital glycemic management. On two surgical units at a tertiary care teaching hospital, we pilot tested postmeal insulin dosing based on carbohydrate counting (plus basal insulin) rather than the current process of ordering scheduled premeal insulin without knowledge of the patient's consumption. Analysis assessed hyperglycemia, hypoglycemia, insulin orders, and nurse and provider satisfaction and confidence. On general surgery, mean glucose level improved from 188 to 137 mg/dl (p < .001). On cardiovascular surgery, mean glucose improved only mildly from 177 to 175 mg/dl (p < .28). No hypoglycemia was reported. Efficiency of mealtime insulin dosing improved through reduced average number of insulin orders per meal from 1.1 to 0.09. Process satisfaction improved for providers (preintervention, 60%; postintervention, 100%), general surgery nurses (preintervention, 72%; postintervention, 100%), and cardiovascular surgery nurses (preintervention, 69%; postintervention, 84%). Confidence in insulin dose accuracy improved for providers (preintervention, 50%; postintervention, 100%), general surgery nurses (preintervention, 59%; postintervention, 100%), and cardiovascular surgery nurses (preintervention, 48%; postintervention, 84%). Carbohydrate counting is effective and efficient and improved staff satisfaction and confidence in hospital mealtime insulin dosing.

Mealtime Insulin Dosing by Carbohydrate Counting in Hospitalized Cardiology Patients: A Retrospective Cohort Study.

BACKGROUND: Carbohydrate counting may improve glycemic control in hospitalized cardiology patients by providing individualized insulin doses tailored to meal consumption. The purpose of this study was to compare glycemic outcomes with mealtime insulin dosed by carbohydrate counting versus fixed dosing in the inpatient setting. MATERIALS AND METHODS: This single-center retrospective cohort study included 225 adult medical cardiology patients who received mealtime, basal, and correction-scale insulin concurrently for at least 72 h and up to 7 days in the interval March 1, 2010-November 7, 2013. Mealtime insulin was dosed by carbohydrate counting or with fixed doses determined prior to meal intake. An inpatient diabetes consult service was responsible for insulin management. Exclusion criteria included receipt of an insulin infusion. The primary end point compared mean daily postprandial glucose values, whereas secondary end points included comparison of preprandial glucose values and mean daily rates of hypoglycemia. RESULTS: Mean postprandial glucose level on Day 7 was 204 and 183 mg/dL in the carbohydrate counting and fixed mealtime dose groups, respectively (unadjusted P=0.04, adjusted P=0.12). There were no statistical differences between groups on Days 2-6. Greater rates of preprandial hypoglycemia were observed in the carbohydrate counting cohort on Day 5 (8.6% vs. 1.5%, P=0.02), Day 6 (1.7% vs. 0%, P=0.01), and Day 7 (7.1% vs. 0%, P=0.008). No differences in postprandial hypoglycemia were seen. CONCLUSIONS: Mealtime insulin dosing by carbohydrate counting was associated with similar glycemic outcomes as fixed mealtime insulin dosing, except for a greater incidence of preprandial hypoglycemia. Additional comparative studies that include hospital outcomes are needed.

Relationship of trauma exposure and substance abuse to self-reported violence among men and women in substance abuse treatment.

Past research showed a relationship between substance abuse and aggression and past trauma and aggression. The nature of the relationships between substance use, trauma, and aggression is inconclusive. The current research hypothesized greater aggression among those with a history of substance abuse and trauma compared with those without such a history and an additive relationship between substance abuse and trauma on aggression. Participants were 615 individuals in a substance abuse treatment program for individuals under criminal justice supervision. Data were collected from face-to-face interviews and self-report measures. Univariate and multivariate analyses assessed the relationships among substance use, trauma, and aggression. Participants with a history of trauma and regular substance use reported the highest rates of homicidal ideation, problem behaviors, and person offenses. Participants in this group also reported greater desire for help managing their stress and tension, dealing with problems in their intimate relationships, developing healthier relationships in general, and learning prosocial approaches to express their feelings. Substance abusing participants who experienced trauma reported more externalizing behaviors and a greater desire for coping- and social-skills training than participants who abused substances but did not report a history of trauma. This suggests that participants in substance abuse treatment programs may have improved outcomes with the addition of components to address these issues.

Effects of trauma and religiosity on self-esteem.

Self-esteem is often lower among persons who have experienced trauma, but religiosity may ameliorate these psychological effects. The purpose of this paper was to examine the relationships among religiosity, self-esteem, and childhood exposure to trauma, utilizing data from the National Comorbidity Survey, a large (N = 8,098) nationally representative population survey in the 48 contiguous states of the USA that assessed religious practices, self-esteem, and exposure to trauma. Exposure to trauma in childhood was assessed through self-report of presence or absence of childhood physical abuse, sexual abuse, or neglect. Religiosity was assessed as the sum of responses to 4 self-report items (religious service attendance, use of religion for comfort and guidance, and importance of religion). Self-esteem was assessed on 9 self-report items adapted from the Rosenberg Self-Esteem Scale. Analysis of variance compared scores for persons who reported exposure to childhood abuse and differed in the value they placed on various religious practices on self-esteem. Persons who reported physical abuse, sexual abuse, or neglect in childhood had significantly lower mean self-esteem than those who did not report these events. There was also a main effect for religiosity in a comparison of persons who reported childhood sexual abuse with those who reported none. The High Religiosity group had higher mean self-esteem than the Medium and Low Religiosity groups. There was a significant interaction as those who reported childhood sexual abuse had lower mean self-esteem than peers who reported none in the Low and Medium Religiosity groups. Mean self-esteem for those who reported childhood sexual abuse was comparable to that of those who reported none in the High Religiosity group.

Quality of parental relationships among persons with a lifetime history of posttraumatic stress disorder.

Several studies of combat veterans have examined the relationship between parental satisfaction and PTSD symptoms. These studies found that numbing is associated with substantial decrements in parent-child relationship quality. The current study extends previous work by assessing the effect of PTSD on parent-child relationships in a nationally representative sample of civilian men and women with PTSD resulting from a broad range of trauma. It was hypothesized that PTSD avoidance/numbing symptoms would be predictive of parent-child relationship quality and parent-child conflict. Moreover, these relationships are predicted to hold after controlling for a broad range of support-related variables and work/finance related variables. As hypothesized, after controlling for number of children and respondent-initiated domestic violence, numbing was predictive of increased parent-child aggression.