Exploring the Meanings of Posttraumatic Growth in Spanish Survivors of Clergy-Perpetrated Child Sexual Abuse: A Phenomenological Approach.

A healing and recovery perspective related to child sexual abuse (CSA) has gained attention in the past two decades, a concept that accurately refers to the process is posttraumatic growth (PTG). Scarce empirical research on PTG in clergy-perpetrated CSA survivors shows evidence of the presence of growth after the abusive experience and a tendency to create accounts of trauma as a way to heal. The general aim of the study is to explore the experiences and meanings of PTG as lived by survivors of clergy-perpetrated CSA. Seven clergy-perpetrated CSA survivors were interviewed with semi-structured in-depth interviews conducted in person. Using reflexive thematic analysis, we identified three dominant themes in the participants' stories: (a) the hindering of PTG; (b) the meanings of PTG, and (c) the internal and contextual and facilitators of PTG. The present study brings new insights into the meanings of PTG, the close relationship between damage and growth, and the mechanisms (both internal and contextual) that are involved in healing from clergy-perpetrated CSA in Spanish culture.

The Spanish Posttraumatic Growth Inventory - Short Form in Adult Survivors of Child Sexual Abuse.

BACKGROUND: Child sexual abuse (CSA) survivors can experience psychological changes and growth as a consequence of their victimization experience, known as posttraumatic growth (PTG). The purpose of this study was to evaluate the dimensionality, reliability and validity of the Spanish version of the Posttraumatic Growth Inventory - Short Form (PTGI-SF) (Tedeschi & Calhoun, 1996) in a sample of 104 adult survivors of CSA. METHOD: Different models of PTGI-SF validated in different languages and samples were tested using Confirmatory Factor Analysis. RESULTS: The results showed that the original five-factor model exhibited the best goodness of fit. Internal consistency was adequate for the general scale, and acceptable for the five different factors. Furthermore, positive correlations were found between the PTGI-SF total score and psychosocial and mental health problems, as well as gender differences, with women tending to report more PTG than men. CONCLUSIONS: These results suggest that the Spanish PTGI-SF is a brief, reliable, valid self-report measure for assessing PTG experienced by CSA survivors.

Qué significa la recuperación para las personas usuarias de servicios de salud mental en Catalunya / What recovery means for mental health services users in Catalonia

En este estudio exploramos el significado del concepto de recuperación desde la perspectiva de las personas usuarias de servicios de salud mental en Cataluña. Realizamos cinco grupos focales para recopilar los datos, y utilizamos la teoría fundamentada para el análisis. Identificamos on-ce temas o tópicos en torno a los cuales los participantes organizaron sus argumentos. La ma-nera como las personas entienden la recuperación está vinculada al marco conceptual del que derivan sus ideas: el modelo biomédico o el paradigma de la recuperación. Algunos de estos temas coinciden con el modelo CHIME, propio del marco internacional de las políticas públicas orientadas a la recuperación. Los tópicos o temas que se corresponden con supuestos del mode-lo biomédico generaron perspectivas en conflicto y contraargumentaciones. Participar en espa-cios de apoyo mutuo y activismo de salud mental parece favorecer la incorporación del marco conceptual del paradigma de la recuperación. (AU)

In this study we explored the meaning of the recovery concept from the perspective of users of mental health services in Catalonia. We conducted five focus groups to collect the data, and we used grounded theory for the analysis. We identify eleven themes or topics around which participants organized their arguments. How people understand recovery are linked to the conceptual framework from which their ideas are derived: the biomedical model or the recovery paradigm. Some of these issues coincided with the CHIME model of the international framework of recovery-oriented public policies. The topics or themes which correspond toas-sumptions of the biomedical model generated conflicting perspectives and counterarguments. Participating in spaces for mutual support and mental health activism seems to promote the incorporation of the conceptual framework of the recovery paradigm. (AU)

Características del abuso sexual infantil por representantes de la Iglesia católica en España / Characteristics of Child Sexual Abuse by Representatives of the Catholic Church in Spain / Característiques de l'abús sexual infantil per representants de l'Església catòlica a Espanya

Este es el primer estudio nacional en España en el que se evalúan las características diferenciales de la victimización sexual contra niños, niñas y adolescentes por parte de representantes de la Iglesia católica. Participaron 38 adultos (25 varones y 13 mujeres), a quienes se llegó mediante muestreo no probabilístico de conveniencia y bola de nieve. Se evaluaron las características de la victimización sexual y del victimario, la revelación y notificación y la vivencia de otras formas de victimización por parte de personas no pertenecientes al clero. Los resultados sugieren que las organizaciones religiosas deberían adquirir el compromiso de colaborar en el proceso de superación de las graves experiencias de victimización infantojuvenil acontecidas en su seno por parte de aquellos niños, niñas y adolescentes más vulnerables y victimizados

This is the first national study in Spain in which the differential characteristics of sexual victimization against children and adolescents by representatives of the Catholic Church are evaluated. Thirty-eight adults (25 men and 13 women) reached by non-probabilistic sampling of convenience and snowball participated in the study. The characteristics of the sexual victimization and the perpetrator, the disclosure and notification and the experience of other forms of victimization by people not belonging to the clergy were evaluated. The results suggests that religious organizations should acquire the commitment to collaborate in the process of overcoming the serious experiences of victimization by those most vulnerable and victimized children and adolescents

Aquest és el primer estudi nacional a Espanya en el qual s'avaluen les característiques diferencials de la victimització sexual contra nens, nenes I adolescents per part de representants de l'Església catòlica. Van participar-hi 38 adults (25 homes I 13 dones), als qui es va arribar mitjançant mostreig no probabilístic de conveniència I bola de neu. Es van avaluar les característiques de la victimització sexual I del victimari, la revelació I notificació ila vivència d'altres formes de victimització per part de persones no pertanyents al clergat. Els resultats suggereixen que les organitzacions religioses haurien d'adquirir el compromís de col·laborar en el procés de superació de les greus experiències de victimització infantil I juvenil esdevingudes allà per part d'aquells nens, nenes I adolescents més vulnerables I victimitzats

Reacciones sociales ante la revelación de abuso sexual infantil y malestar psicológico en mujeres víctimas / Social reactions to child sex abuse revelation and psychological distress in female victims

El objetivo de este trabajo es mostrar la relevancia de las reacciones sociales ante la revelación de abuso sexual infantil en el bienestar psicológico de 12 mujeres (M=37 años; DT=10.51), usuarias de un centro español de atención a víctimas. Los resultados muestran relaciones significativas entre las escalas de reacciones sociales relativas a egocentrismo, ayuda e información, distracción, control, tratar diferente y apoyo emocional y la mayoría de síntomas psicopatológicos. Algunas de estas reacciones son confusas, ambivalentes, puesto que son entendidas como bienintencionadas tanto por la persona de apoyo como por la víctima, si bien tienen una importante relación con la presencia de síntomas psicopatológicos. Se subraya la necesidad de continuar con la investigación sobre la influencia de las reacciones sociales en el ajuste psicosocial de las víctimas de experiencias abusivas y de abordar la problemática del abuso sexual infantil desde la prevención y la educación a las familias

The aim of this study is to demonstrate the impact of social reactions to child sexual abuse revelation on the psychological wellbeing of 12 women (M=37 years; SD=10.51), attendees of a Spanish victim support centre. The results demonstrate a significant association between the scales of social reaction relative to egocentrism, help and information, distraction, control, treating differently and emotional support, and most psychopathological symptoms. Some of these reactions are confused and ambivalent since they are perceived as well-intentioned by support workers and victims alike, yet are majorly associated with the presence of psychopathological symptoms. This underlines the need to continue research on the influence of social reactions on the psychosocial adjustment of abuse victims and to address the problem of the sexual abuse of children through prevention and education of the family

Ischemic Gangrene of the Glans following Penile Prosthesis Implantation.

The development of ischemic gangrene of the penis following implantation of prosthesis is unusual, and very few cases are available in the literature. As a result, no established treatment protocol is available. We report our experience within a case of gangrene of the glans following implantation of a three-component prosthesis. We present a 53-year-old male, smoker with diabetes and hypercholesterolemia, who underwent surgery for the insertion of a penile prosthesis with 3 components to correct his erectile dysfunction and severe Peyronie's disease. The procedure was carried out without incidents. During the postoperative period, the patient began to complain from penile and perineal pain. He developed avascular necrosis of the glans. The necrosed area was excised. Four weeks later, he developed fever and perineal pain arriving to the emergency room with the prosthesis extruding through the glans. He had emergency surgery to remove the prosthesis plus surgical lavage and was prescribed broad-spectrum antibiotic therapy. Four weeks later, the penis was completely revascularized and reepithelialized. Ischemic gangrene following penile prosthesis implantation takes place in patients with poor peripheral vascularisation. Diabetes mellitus has been the common denominator to all of the reported cases.

[Hormonal treatment in biochemical recurrence after radical prostatectomy]. / Tratamiento hormonal en la recidiva bioquímica tras prostatectomía radical.

To date, the role of hormonal therapy (HT) after biochemical failure, when to initiate it, the therapeutic scheme and duration remains controversial due to the absence of well designed randomized trials analyzing the overall survival of patients. In clinical practice, the most widely spread treatment in this scenario is hormonal therapy with LH-RH analogues. However, the scientific support for this issue is very weak. We are extrapolating the benefits proven for early vs delayed HT in advanced prostate cancer, to asymptomatic patients presenting just an increase in PSA. These patients usually have a long time disease-history until development of metastasis. It should also be noticed the harmful secondary effects acquired with the time of employment of hormotherapy. Probably patients suffering a Gleason score >8 and PSA doubling time <12 months could obtain a benefit from an early castration treatment, even more if they are young (grade 2c). Except in selected cases of local treatment as radiotherapy, the decision for early or delayed hormonal therapy should be taken carefully with patient consensus. The alternatives for hormonal treatment to preserve sexual function, as intermittent treatment, antiandrogen monotherapy, or antiandrogen plus 5 alpha reductase inhibitors, are very attractive in this scenario. However due to the short time experience with these modalities of treatment should be evaluated with caution.

Tratamiento hormonal en la recidiva bioquimica tras prostatectomía radical / Hormonal treatment in biochemical recurrence after radical prostatectomy

Hasta la fecha el papel de la HT en la recidiva bioquímica, su inicio, esquema y duración permanecen en controversia dada la ausencia de ensayos randomizados que analicen la supervivencia del paciente sometido a esta terapia tras fracaso bioquímico. La hormonoterapia mediante el empleo de análogos LH-RH resulta en este escenario la medida más frecuentemente empleada en la práctica clínica. Sin embargo el sustento científico de la misma es bastante endeble. Implica extrapolar los beneficios de la HT precoz vs diferida, vista en otros estadios de la enfermedad (generalmente avanzada), a un paciente asintomático con exclusivo aumento del PSA, que tendría en muchos casos una larga historia natural hasta el desarrollo de metástasis y con el impuesto añadido de los efectos secundarios bien conocidos actualmente. Probablemente los pacientes con Gleason >8 y TDPSA < 12 meses sí pudieran beneficiarse de un tratamiento hormonal precoz, sobre todo si son jóvenes (grado 2c). En muchos otros casos donde no se contemple un tratamiento local como RT, la decisión de HT precoz o tardía debe ser cuidadosamente valorada y comentada con el paciente. Las alternativas de tratamiento hormonal con preservación de función sexual, como el bloqueo intermitente, monoterapia con antiandrógenos o la suma de un 5- ARI con antiandrógeno, deben ser valoradas con cautela ante la escasez de información a largo plazo aunque éste parece un atractivo escenario para su empleo(AU)

To date, the role of hormonal therapy (HT) after biochemical failure, when to initiate it, the therapeutic scheme and duration remains controversial due to the absence of well designed randomized trials analyzing the overall survival of patients. In clinical practice, the most widely spread treatment in this scenario is hormonal therapy with LH-RH analogues. However, the scientific support for this issue is very weak. We are extrapolating the benefits proven for early vs delayed HT in advanced prostate cancer, to asymptomatic patients presenting just an increase in PSA. These patients usually have a long time disease-history until development of metastasis. It should also be noticed the harmful secondary effects acquired with the time of employment of hormotherapy. Probably patients suffering a Gleason score >8 and PSA doubling time <12 months could obtain a benefit from an early castration treatment, even more if they are young (grade 2c). Except in selected cases of local treatment as radiotherapy, the decision for early or delayed hormonal therapy should be taken carefully with patient consensus. The alternatives for hormonal treatment to preserve sexual function, as intermittent treatment, antiandrogen monotherapy, or antiandrogen plus 5 alpha reductase inhibitors, are very attractive in this scenario. However due to the short time experience with these modalities of treatment should be evaluated with caution(AU)