Indiana University-Purdue University Indianapolis (IUPUI) / While deliberate self-harm (DSH) in adolescents and adults has been established as a reliable predictor of future suicidal behavior and attempts, whether the same is true for younger children has rarely been studied. Two separate articles will address issues regarding intentional self-injury in young children. The first identified describes the demographic profile of young children who engage in NSSI and evaluated whether predictors of adolescent NSSI are also associated with NSSI in children. The second manuscript analyzed NSSI behaviors to see if they can be correctly predicted from knowledge of a child's history of maltreatment to identify which trauma variables are central in prediction of NSSI status. A Chi-square and logistic regression were run on data from 16,271 records of children ages 5-9 years who received services from the IDMHA in 2018. NSSI was significantly (p < .000) associated with trauma history (x2 = 75.54, df = 1), anxiety (x2 = 107.59, df = 1), depression (x2 = 217.011, df = 1), suicide risk (x2= 993, df = 1), and impulsivity (x2 = 122.49, df = 1. Presence of a caregiver mental health problem (x2 =38.29, df = 1), age (x2 = 14.18, df = 4), being male (x2 = 11.59, df = 1), and being Caucasian (x2 = 23.29, df = 6) at p < .05. Regression results indicated the overall model of seven predictors (sexual abuse [OR 1.14], physical abuse [OR 1.26], emotional abuse [OR1.3], neglect [OR .895], medical trauma [OR 1.34], exposure to natural disaster [OR 1.81] and victim of a crime [1.14] was statistically reliable in distinguishing between children who self-injure and those who do not. [-2 Log Likelihood = 6228.78, x2(6) = 105.416, p < .000]. NSSI does occur in preadolescent children and while there is some indication that the risk factors and co-variates are like those of adolescents, there are some differences which need further study. Training clinicians to inquire about self-injury during assessment of younger children is a simple step. The variables of age and sex throughout development as well as identifying protective as well as risk factors with children should be studied.

Research on self-harm and children tends to focus on adolescent children (12 years of age and above). There is limited available information about self-harm in children ages 11 years and younger. This study utilized autoethnography as the methodology to provide a rich description of the professional experiences and practices of an elementary school principal who worked with self-harming primary-aged students. Based on an autoethnographical analysis, this study proposes future research and makes recommendations for school leaders implementing trauma-informed practices, educators working with self-harming students, and districts committed to proactive support.

The purpose of this study is to critically reflect on what is represented to be the problem in harm reduction interventions directed towards drug users. The study is based on five qualitative, semi-structured interviews with professionals in the social services administration of Stockholm. With assistance from Carol Bacchi's theoretical approach "What's the problem represented to be", we critically assess how the problem is constituted in harm reduction interventions. Four themes are addressed. First, our data indicate that the problem is assumed to be that some drug users fail or neglect to comply with the social services' demand for drugabstinence, despite multiple attempts, and are considered to be untreatable. Second, we show that there is an assumption that drug users who receive harm reduction interventions must change and become stabilized, although they are categorized as untreatable. Third, we show how professionals in our study fail to problematize the conditions and checkups people who are subject to harm reduction interventions must follow. Fourth, we illustrate the effects of the problem and show examples of drug users who dare say that they do not aim for abstinence, in an institutional context where abstinence is still the default.

This thesis uses the four principles of biomedical ethics as put forth by Beauchamp and Childress to address the issue of the criminalization of sex work in contemporary national and international settings. Though a controversial subject, the existence of sex work has been a constant for centuries worldwide. However, the criminalization of sex work in contemporary society has been largely predicated on the conflation of sex work and a number of social ills, particularly human trafficking and sexual exploitation. This uncritical and inappropriate conflation of terms has enabled discourse, legislation, and even health care policy that is unethical, ineffective, and explicitly harmful to both sex workers and victims of human trafficking alike.Medical professionals have a unique set of moral obligations to which they must hold themselves in their practice of medicine, both with their individual patients as well as with the society in which they live. This thesis argues that the criminalization of sex work is fundamentally incompatible with contemporary health care ethics, reviewing each of the four fundamental pillars of biomedical ethics as it applies to policies that criminalize sex work. Each chapter will outline the many ways in which criminalization violates each of these fundamental principles, causing immense and largely preventable harm in the form of human rights violations and poor public health outcomes. At the same time, this thesis will introduce the alternative policy of decriminalization, discussing its features and implications for public health, and highlighting the ways in which the decriminalization of sex work results in improved health, safety, and human rights outcomes for both sex workers and victims of sex trafficking, exemplifying a viable, ethical, and evidenced-based alternative to criminalization. Given the gross bioethical and humans rights violations associated with the criminalization of sex work, this thesis concludes that there exists evidence of a substantial ethical imperative on the part of the medical community and its constituent professional societies to formally condemn policies that criminalize any and all aspects of sex work and issue formal recommendations for its urgent decriminalization, as both a public health issue and an issue of human and patients’ rights. / Urban Bioethics

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The present study drew from the publicly available Amerispeak survey (n = 6,515) and examined public stigma towards different substances, the relationship between preferences for abstinence-based recovery and stigma toward each substance, and whether perceived dangerousness of substances moderates the relationship between preferences for abstinence-based recovery and public stigma. The results indicate that the general public has greater stigmatizing attitudes towards methamphetamine use disorder than cocaine use disorder, opioid use disorder, and alcohol use disorder. Furthermore, a preference for abstinence-based recovery was associated with greater stigmatizing attitudes toward all SUDs. The perceived dangerousness of a substance did not moderate the relationship between preference for abstinence-based recovery and stigmatizing attitudes towards SUDs but was related to public stigma in several models. Results have implications for creating stigma interventions for the general public, which can be adapted for abstinence-based settings, like healthcare organizations and treatment centers.

The SARS-CoV-2 pandemic has been a worldwide chronic, stress-inducing natural catastrophe associated with increased emotional challenging. Patients with Post-traumatic stress disorder (PTSD), self-injury behavior, and obesity are predisposed to aggravation of their symptoms at this time, requiring new therapeutic approaches to balance their disrupted neuro-hormonal stress axis. Here we present our observations of an off-label treatment with lamotrigine in an adolescent girl with PTSD, self-injury behavior, and obesity. Lamotrigine was an efficacious pharmaceutical intervention that helped the patient deal with chronic stress and associated anxiety. The results are discussed based on our previous basic research outcomes in animals and humans that focused on the glutamate-cortisol circuits within the limbic brain.

No description available.

The prevalence of self-harm and the relative emotional influences are well understood, but certain cognitive factors such as working memory, rumination, and self-criticism are not fully explored. The aim of the current study is to examine specific aspects of cognition to explore their influence on self-harming behaviors. Participants included 101 undergraduates from a British University. Factors were measured using the Center for Epidemiological Studies Depression Scale, the Depressive Experiences Questionnaire, Ruminative Response Scale, and the Automated Working Memory Assessment. Findings indicated a greater incidence of self-harming behaviors among those who demonstrated higher depressive symptoms, but depression scores were not significantly related to self-harm. Additionally, a binary logistic regression indicated that self-criticism was associated with the presence of self-harming behavior, and a Classification and Regression Trees found that the single strongest predictor of self-harming behavior was a belief that love needs to be continually earned from others. Incorporating treatments that reduce self-criticism, such as improving self-compassion with Compassionate Mind Training, may address underlying mechanisms that trigger self-harm behavior.

BACKGROUND: People experiencing homelessness (PEH) commonly experience “tri-morbidity,” whereby the effects of physical illness, mental illness, and substance use disorder combine to produce complex healthcare needs. Tiny home villages, or communities comprised of dwellings that are 400-square feet or smaller, have emerged in the U.S. as one option to bridge the gap between living on the street and temporary or permanent shelter. However, whether these communities have been successful in connecting PEH to health services has not been well explored. House of Hope Community Development Corporation sought recommendations for health care services organization and delivery at ECHO Village, a temporary tiny home village in Rhode Island, to meet the health care needs of its clients. AIMS: (1) To characterize barriers and opportunities to engage PEH in care from the perspective of health care providers using the CDC’s 6 Guiding Principles to a Trauma Informed Approach; (2) to assess the health care priorities and barriers and facilitators to care from the perspective of PEH using the Behavioral Model for Vulnerable Populations, and (3) to inform recommendations for health services delivery for ECHO Village and for similar homelessness service settings more broadly. METHODS: Literature was reviewed on evidence-based practices for providing health care to PEH, tiny home villages for PEH, and emergency, temporary housing. A matrix was developed to collect and organize descriptive data to select a comparison tiny home village. In Aim 1, 18 in-depth interviews were conducted with health care providers and other key informants in Rhode Island and at Avivo Village, a tiny home village for PEH in Minneapolis, Minnesota, to characterize barriers and opportunities to engage PEH in health care. In Aim 2, 10 in-depth interviews with Avivo Village residents were conducted to identify health care priorities, barriers, and facilitators to care. The 6 Guiding Principles to a Trauma-Informed Approach and the Behavioral Model were used to create initial coding frameworks for provider and resident interviews, respectively. Through an iterative process, codes were refined to aggregate data into patterns of meaning, emerging themes were revealed, and similarities and differences were identified through consensus coding for interpretation purposes. The Behavioral Model was used to assess the role of predisposing, enabling, and needs factors in health services utilization through a structured survey of 93 adults aged ≥18 experiencing homelessness in Rhode Island. Associations between subsistence difficulty and five health utilization outcomes using bivariate tests of survey data were evaluated. Binomial logistic regressions were run to explore the effects of predictor variables on these outcomes. RESULTS: Thematic analysis revealed that the tiny home village setting could facilitate the care of PEH by (1) overcoming many of the common barriers to receiving care for people who had been excluded from traditional shelters and other critical services, (2) affording a sense of safety and security for PEH, and (3) allowing PEH time and space to gain stability to focus on self-identified goals at their own pace. The importance of patient empowerment, peer support, mixed communities in which people in various stages of recovery live together, and non-judgmental providers also emerged as facilitators of care. Quantitative results showed that subsistence difficulty predicted going without needed care for the past 12 months at p <.05. Adjustment for potential confounders did not change our inferences. CONCLUSION: Several promising practices exist for health service organization and delivery in the tiny home village setting that can be replicated, scaled, and sustained regardless of model or service mix. Given the significant barriers to accessing healthcare faced by PEH, the tiny home village setting can serve as an effective engagement point for PEH, particularly for those averse to traditional shelters or care settings. / 2024-07-05T00:00:00Z