Angola for Life: Rehabilitation and Reform Inside the Louisiana State Penitentiary - Video

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Wounds of the Hand & Forearm Due to Stab Phenomenon Kuluna in Kinshasa, Democratic Republic of Congo: Types of Injuries & Treatment

Democratic Republic of Congo (DRC), a particular form of juvenile delinquency and insecurity intensifies in the city of Kinshasa. This is the phenomenon Kuluna. It is organized gangs equipped with machetes and other weapons. 

The main objective of this study is to know the phenomenon Kuluna and describe the upper limb injuries caused by machetes, while insisting on the specifics of the management of these lesions in our communities. This retrospective descriptive study examines 14 cases of wounds of the hand and forearm due to stab phenomenon Kuluna, in Kinshasa. It covers the period from 1 November 2010 to 1 November 2013. 

Among the 14 patients with lesions in the hand and forearm admitted and treated at the Unit of Plastic Reconstructive and Aesthetic Surgery, Hand Surgery and Burns, University Clinics of Kinshasa to attacks due to the phenomenon Kuluna. We have 11 men and 3 women. The average age was 33, 5 years (extremes of 21 and 56 years). The right upper limb is reached that the left upper limb, respectively 12 patients and 2 patients. The lesions are localized to the wrist in the majority of cases (10 patients) in the palm of hand and in 3 patients in the fingers in 1 patient. The palmar surface is reached (10 cases) and the dorsal (4 cases). Zone 5 of the International Classification of flexor and Zone 8 topographic classification extensors at hand are the predilection sites of lesions respectively the palmar surface (6 out of 10) and the dorsal (2 case 4). The median nerve at the wrist is cut in half the cases. On bone lesions localized to the forearm, we observed a high incidence of fracture of the ulna (62.5%). The treatment begins with the stabilization of bone pieces, gestures revascularization and nerve sutures and suture tendon and finally skin coverage. 

Rehabilitation was mandatory, she supervises the actions of repair and it continues until the recovery of function.

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By:  Kibadi PK, Portaels F, Pichot Y, Kapinga M, Moutet F.

Rev Med Brux. 2015 Nov-Dec;36(6):468-74.

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Risk of Violence in Drug Rehabilitation Centers: Perceptions of People Who Inject Drugs in Tijuana, Mexico

BACKGROUND:

In 2009, Mexico reformed its health law to partially decriminalize drug possession considered for personal use and to increase mandatory referrals to certified drug rehabilitation centers in lieu of incarceration. Concurrently, news media reported violent attacks perpetrated by drug cartels against Mexican drug rehabilitation centers and instances of human rights violations by staff against people who inject drugs (PWID) in treatment. In many cases, these violent situations took place at "Peer Support" (Ayuda Mutua) drug rehabilitation centers that house a large number of drug-dependent PWID. In an effort to understand barriers to treatment uptake, we examined prevalence and correlates of perceived risk of violence at drug rehabilitation centers among PWID in Tijuana, Mexico.

METHODS:

Secondary analysis of baseline data collected between March 2011 and May 2013 of PWID recruited into a prospective cohort study in Tijuana. Interviewer-administered surveys measured perceived risk of violence at drug rehabilitation centers by asking participants to indicate their level of agreement with the statement "going to rehabilitation puts me at risk of violence". Logistic regression was used to examine factors associated with perceived risk of violence.

RESULTS:

Of 733 PWID, 34.5 % perceived risk of violence at drug rehabilitation centers. In multivariate analysis, reporting ever having used crystal methamphetamine and cocaine (separately), having a great or urgent need to get help for drug use, and ever receiving professional help for drug/alcohol use were negatively associated with perceived risk of violence at drug rehabilitation centers, while having been told by law enforcement that drug rehabilitation attendance is mandatory was positively associated with perceived risk of violence. All associations were significant at a 0.05 alpha level.

CONCLUSION:

The perception of violence at drug rehabilitation centers among PWID does not represent the lived experience of those PWID who attended professionalized services, reported a great or urgent need to get help for their drug use and had a history of using crystal and cocaine. Professionalizing service delivery and engaging law enforcement in their new role of decriminalization and service referral for PWID could address the perceptions of violence at drug rehabilitation centers. Similarly, health authorities should expand periodic inspections at drug rehabilitation centers to guarantee quality service provision and minimize PWIDs' concerns about violence.

Demographic characteristics (n=733)

Variable name	Total	Feared violence	Didn't fear violence	p-valuea
	(n=733)	(n=253, 34.5%)	(n=480, 65.5%)
Ageb	37 (31, 44)	36 (30, 42)	37 (31, 45)	0.08
Female (n, %)	279 (38.1%)	102 (40.3%)	177 (36.9%)	0.38
Married (n, %)	332 (45.3%)	113 (44.7%)	219 (45.6%)	0.82
Education
Years of education completedb	8 (6,10)	8 (6,11)	8 (6,10)	0.15
Main source of income
No income (n, %)	25 (3.4%)	8 (3.2%)	17 (3.5%)	0.82
Formal source of income (n, %)	502 (68.5%)	177 (70.0%)	325 (67.7%)
Informal source of income (n, %)	203 (27.7%)	67 (26.5%)	136 (28.3%)
Homeless (where slept most often last 6 mos)
Homeless (n, %)	146 (19.9%)	60 (23.7%)	86 (17.9%)	0.06
Mobility
Lived in Tijuana whole life (n, %)	278 (37.9%)	107 (42.3%)	171 (35.6%)	0.08
Years lived in Tijuana (n= 454) b	21 (10, 34)	20 (10, 34)	21 (10, 33)	0.54
Drug Use History
Age of first time use of illegal drugb	14 (12,16)	14 (12,16)	14 (12,16)	0.30
Age of first injected drugsb	19 (17,24)	20 (17,25)	19 (17,24)	0.58
Ever used heroin	730 (99.6%)	252 (99.6%)	478 (99.6%)	0.99
Ever used cocaine	559 (76.3%)	171 (67.6%)	388 (80.8%)	<0.01
Ever used crystal/methamphetamine	647 (88.3%)	206 (81.4%)	441 (91.9%)	<0.01
Interactions with Law Enforcement
Ever stopped by law enforcement	661 (90.2%)	220 (87.0%)	441 (91.9%)	0.04
Ever been told by law enforcement that you would be required to go to drug treatment	17 (2.3%)	10 (4.0%)	7 (1.5%)	0.04
Drug Rehabilitation History
Great or urgent need to get help for drug use (n, %)	375 (51.2%)	144 (56.9%)	231 (48.1%)	0.02
Ever received professional help for drug usec	417 (56.9%)	124 (49.0%)	293 (61.0%)	0.01
Lifetime # of times received professional help for drug use (n=417) b	1 (0, 3)	0 (0, 3)	1 (0, 4)	0.01
Ever enrolled in drug rehabilitation center (n, %)	375 (51.2%)	109 (43.1%)	266 (55.4%)	0.37
# of times enrolled in drug rehabilitation center(n=375) b	1 (0, 3)	0 (0, 2)	1 (0, 3)	0.01

acomparisons of means made using Student t-test, comparisons of proportions made using chi-squared test, all p-values are two-sided

bMedian, interquartile range

cEver received professional help refers to outpatient counseling services and might include drug rehabilitation services

Full article at:  http://goo.gl/vLPhjh

By:  Harvey-Vera AY1,2, González-Zúñiga P3, Vargas-Ojeda AC4, Medina-Mora ME5, Magis-Rodríguez CL6, Wagner K7, Strathdee SA8, Werb D9.

• 1Division of Global Public Health, University of California, San Diego, School of Medicine, San Diego, California, USA. alvera@ucsd.edu.
• 2Universidad Autónoma de Baja California, Facultad de Medicina y Psicología, Tijuana, Baja California, Mexico. alvera@ucsd.edu.
• 3Division of Global Public Health, University of California, San Diego, School of Medicine, San Diego, California, USA. pgonzalez@ucsd.edu.
• 4Universidad Autónoma de Baja California, Facultad de Medicina y Psicología, Tijuana, Baja California, Mexico. caro_vargas@uabc.edu.mx.
• 5Instituto Nacional de Psiquiatría de México, Ciudad de Mexico, Distrito Federal, Mexico. mmedina@hsph.harvard.edu.
• 6Centro Nacional para la Prevención y Control del VIH/SIDA, Ciudad de Mexico, Distrito Federal, Mexico. carlos.magis@gmail.com.
• 7Division of Global Public Health, University of California, San Diego, School of Medicine, San Diego, California, USA. kdwagner@ucsd.edu.
• 8Division of Global Public Health, University of California, San Diego, School of Medicine, San Diego, California, USA. sstrathdee@ucsd.edu.
• 9Division of Global Public Health, University of California, San Diego, School of Medicine, San Diego, California, USA. dwerb@ucsd.edu. 

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Sexual Functioning & Sexual Well-Being in People with a Limb Amputation: A Cross-Sectional Study in the Netherlands

PURPOSE:

This study aimed to: (a) investigate whether, and if so which, sexual problems are present in people with a limb amputation; (b) analyze how they experience their sexuality; and (c) investigate whether sexuality was discussed with them during their rehabilitation process.

METHOD:

In total, 301 participants completed a survey consisting of a questionnaire on participant characteristics, the Hospital Anxiety and Depression Scale (HADS), the Maudsley Marital Questionnaire (MMQ), the Amputee Body Image Scale (ABIS), the Questionnaire about SexualCounselling, the Questionnaire about Sexuality and the Short Sexual Functioning Scale (SSFS).

RESULTS:

Overall, 20% of the participants experienced one or more sexual dysfunction(s). Participants who had at least one sexual dysfunction were more likely to be male, had an amputation more recently, and had a more negative body image. Moreover, sexuality was only scantly discussed by rehabilitation professionals.

CONCLUSIONS:

Sexual problems and sexual dysfunctions do occur in people with a limb amputation, but these problems are not discussed during the rehabilitation process. Justice for a person's "whole body" can only be served when sexuality is taken seriously in rehabilitation care in order to avoid cutting sexuality out of an amputee's life. Implications for Rehabilitation People with a limb amputation may be confronted with sexual problems and/or sexual dysfunctions. It is therefore important that sexuality is taken seriously as a part of standard rehabilitation care and that professionals bring up the issue of sexuality during the rehabilitation process.

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By:  Verschuren JE1, Geertzen JH1, Enzlin P2,3, Dijkstra PU1,4, Dekker R1.

• 1 Department of Rehabilitation Medicine , Center for Rehabilitation, University of Groningen, University Medical Center Groningen , The Netherlands .
• 2 Department of Neurosciences , Institute for Family and Sexuality Studies , KU Leuven , Belgium .
• 3 Context - Center for Couple, Family and Sex Therapy , Department of Psychiatry , UPC KU Leuven , Belgium , and.
• 4 Department of Oral and Maxillofacial Surgery , University of Groningen, University Medical Center Groningen , The Netherlands.
• Disabil Rehabil. 2016 Feb;38(4):368-73. doi: 10.3109/09638288.2015.1044029. Epub 2015 Jun 1. 

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“I Kicked the Hard Way. I Got Incarcerated.” Withdrawal from Methadone During Incarceration & Subsequent Aversion to Medication Assisted Treatments

Highlights

• This qualitative study examined the barriers to evidence-based opioid agonist treatment in formerly incarcerated individuals with opioid use disorder in the Bronx, NY.
• Inadequate access to methadone maintenance treatment during incarceration was perceived to be a barrier to opioid agonist treatment post-release.
• Subjects who received methadone prior to incarceration reported high levels of withdrawal symptoms during incarceration, which led to subsequent aversion to opioid agonist treatment post-release.
• Policies of American penal facilities may be discouraging individuals with opioid use disorder from seeking opioid agonist treatment upon re-entry.

Incarceration is a common experience for individuals with opioid use disorder, including those receiving medication assisted treatments (MAT), such as buprenorphine or methadone. In the United States, MAT is rarely available during incarceration. 

We were interested in whether challenges with methadone maintenance treatment during incarceration affected subsequent attitudes toward MAT following release. We conducted semi-structured interviews with 21 formerly incarcerated individuals with opioid use disorder in community substance abuse treatment settings. Interviews were audio recorded, transcribed, and analyzed using a grounded theory approach. 

Themes that emerged upon iterative readings of transcripts were discussed by the research team. The three main themes relating to methadone were: 

1. rapid dose reduction during incarceration; 
2. discontinuity of methadone during incarceration; and 
3. post incarceration aversion to methadone. 

Participants who received methadone maintenance treatment prior to incarceration reported severe and prolonged withdrawal symptoms from rapid dose reductions or disruption of their methadone treatment during incarceration. The severe withdrawal during incarceration contributed to a subsequent aversion to methadone and adversely affected future decisions regarding reengagement in MAT. 

Though MAT is the most efficacious treatment for opioid use disorder, current penal policy, which typically requires cessation of MAT during incarceration, may dissuade individuals with opioid use disorder from considering and engaging in MAT after release from incarceration.

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By:   Jeronimo A. Maradiaga, B.A., Shadi Nahvi, M.D., M.S., Chinazo O. Cunningham, M.D., M.S., Jennifer Sanchez, M.P.H., Aaron D. Fox, M.D., M.S.

Affiliations

Albert Einstein College of Medicine, 1300 Morris Park Ave, Bronx, NY, 10461

Correspondence

Corresponding author at: Albert Einstein College of Medicine Montefiore Medical Center, 111 E. 210th Street, Bronx, NY, 10467. Tel.: +1 718 920 3782.

jmaradia@montefiore.org

DOI: http://dx.doi.org/10.1016/j.jsat.2015.11.004

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Gender Differences in the Life Concerns of Persons Seeking Alcohol Detoxification

Highlights

• Mental health, smoking, and finances are the most prevalent life concerns
• Gender affects the life concerns of persons with alcohol use disorders
• Men more concerned than women about money and drug use problems
• Men reported greater concern than women in most domains assessed

Background

This study explored the life concerns of persons seeking alcohol detoxification, a group with multiple life and psychosocial challenges. Gender may be an important contributor to the particular life concerns of persons with alcohol use disorders.

Methods

Using a 32-item, previously-validated life concerns survey that captures ten conceptual domains, we interviewed persons entering inpatient alcohol detoxification asking them to rate their level of concern about health and welfare items.

Results

Participants (n = 189) were 27% female, with a mean age of 43.5 years. Overall, concern about alcohol problems was perceived as the most serious, followed by mental health, cigarette smoking, financial, and relationship problems. Men were significantly more concerned than women about six of the ten domains including money, drug use, transmissible diseases, and physical illness.

Conclusions

Recognition of the daily worries of persons seeking inpatient alcohol detoxification persons could allow providers to better tailor their services to the context of their patients’ lives. Focusing on pressing life concerns such as mental health, financial, relationship problems, and other drug use may influence detoxification services and aftercare treatment choices.

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By:   Michael D. Stein, Megan M. Risi, Jessica N. Flori, Micah T. Conti, Bradley J. Anderson, Genie L. Bailey

Affiliations

General Medicine Research Unit, Butler Hospital, Providence, RI, 02906

Warren Alpert Medical School of Brown University, Providence, RI, 02912

Correspondence

Corresponding author at: Health Services, Policy & Practice, Alpert School of Medicine at Brown University, Butler Hospital, 345 Blackstone Blvd., Providence, RI 02906. Tel.: +401 455 6646; fax: +401 455 6685.

Michael_Stein@brown.edu

DOI: http://dx.doi.org/10.1016/j.jsat.2015.12.005

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Personal Network Structure and Substance use in Women by 12 Months Post Treatment Intake

INTRODUCTION:

Women with substance use disorders enter treatment with limited personal network resources and reduced recovery support. This study examined the impact of personal networks on substance use by 12 months post treatment intake.

METHODS:

Data were collected from 284 women who received substance abuse treatment. At 6month follow up, composition, support availability and structure of personal networks were examined. Substance use was measured by women's report of any use of alcohol or drugs. Hierarchical multivariate logistic regression was conducted to examine the contribution of personal network characteristics on substance use by 12 months post treatment intake.

RESULTS:

Higher numbers of substance using alters (network members) and more densely connected networks at 6 month follow-up were associated with an increased likelihood of substance use by 12 months post treatment intake. A greater number of isolates in women's networks was associated with decreased odds of substance use. Women who did not use substances by 12 months post treatment intake had more non-users among their isolates at 6 months compared to those who used substances. No association was found between support availability and likelihood of substance use.

CONCLUSIONS:

Both network composition and structure could be relevant foci for network interventions e.g. helping women change network composition by reducing substance users as well as increasing network connections. Isolates who are not substance users may be a particular strength to help women cultivate within their network to promote sustained sobriety post treatment.

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By:   Tracy EM1, Min MO2, Park H2, Jun M3, Brown S4, Francis MW2.

• 1Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University (http://msass.case.edu/), 11235 Bellflower Road, Cleveland, Ohio, 44106-7164. Electronic address: ext@case.edu.
• 2Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, 11235 Bellflower Road, Cleveland, Ohio, 44106-7164.
• 3Gyeonggido Family and Women's Research Institute, Gyeonggi-do, Suwon, Republic of Korea.
• 4Wayne State University, School of Social Work, Detroit, Michigan.
• J Subst Abuse Treat. 2015 Nov 25. pii: S0740-5472(15)00285-8. doi: 10.1016/j.jsat.2015.11.002. 
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