9601
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Gillespie CF, Bradley B, Mercer K, Smith AK, Conneely K, Gapen M, Weiss T, Schwartz AC, Cubells JF, Ressler KJ. Trauma exposure and stress-related disorders in inner city primary care patients. Gen Hosp Psychiatry 2009; 31:505-14. [PMID: 19892208 PMCID: PMC2785858 DOI: 10.1016/j.genhosppsych.2009.05.003] [Citation(s) in RCA: 344] [Impact Index Per Article: 22.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2009] [Revised: 05/04/2009] [Accepted: 05/06/2009] [Indexed: 01/03/2023]
Abstract
OBJECTIVE This study was undertaken to increase understanding of environmental risk factors for posttraumatic stress disorder (PTSD) and major depressive disorder (MDD) within an urban, impoverished, population. METHOD This study examined the demographic characteristics, patterns of trauma exposure, prevalence of PTSD and MDD, and predictors of posttraumatic stress and depressive symptomatology using a verbally presented survey and structured clinical interviews administered to low-income, primarily African-American (>93%) women and men seeking care in the primary care and obstetrics-gynecology clinics of an urban public hospital. RESULTS Of the sample, 87.8% (n=1256) reported some form of significant trauma in their lifetime. Accidents were the most common form of trauma exposure followed by interpersonal violence and sexual assault. Childhood level of trauma and adult level of trauma separately, and in combination, predicted level of adult PTSD and depressive symptomatology. The lifetime prevalence of PTSD was 46.2% and the lifetime prevalence of MDD was 36.7%. CONCLUSIONS These data document high levels of childhood and adult trauma exposure, principally interpersonal violence, in a large sample of an inner-city primary care population. Within this group of subjects, PTSD and depression are highly prevalent conditions.
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Affiliation(s)
- Charles F. Gillespie
- Department of Psychiatry and Behavioral Sciences Emory University School of Medicine
| | - Bekh Bradley
- Department of Psychiatry and Behavioral Sciences Emory University School of Medicine,Atlanta VA Medical Center
| | - Kristie Mercer
- Department of Human Genetics Emory University School of Medicine
| | - Alicia K. Smith
- Department of Human Genetics Emory University School of Medicine
| | - Karen Conneely
- Department of Human Genetics Emory University School of Medicine
| | - Mark Gapen
- Department of Psychiatry and Behavioral Sciences Emory University School of Medicine
| | - Tamara Weiss
- Department of Psychiatry and Behavioral Sciences Emory University School of Medicine
| | - Ann C. Schwartz
- Department of Psychiatry and Behavioral Sciences Emory University School of Medicine
| | - Joseph F. Cubells
- Department of Psychiatry and Behavioral Sciences Emory University School of Medicine,Department of Human Genetics Emory University School of Medicine
| | - Kerry J. Ressler
- Department of Psychiatry and Behavioral Sciences Emory University School of Medicine,Howard Hughes Medical Institute,Yerkes National Primate Research Center
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9602
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Jovanovic T, Blanding NQ, Norrholm SD, Duncan E, Bradley B, Ressler KJ. Childhood abuse is associated with increased startle reactivity in adulthood. Depress Anxiety 2009; 26:1018-26. [PMID: 19691032 PMCID: PMC2852033 DOI: 10.1002/da.20599] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Understanding the neurobiological correlates of childhood maltreatment is critical to delineating stress-related psychopathology. The acoustic startle response (ASR) is a subcortical reflex modulated by neural systems implicated in posttraumatic stress disorder (PTSD). The ASR is conserved across species and is increased in rodent models of developmental stress. METHODS We measured ASR to a 40 ms noise probe as well as fear-potentiated startle using electromyographic recordings of the eyeblink in a primarily African American sample (N=60) from a highly traumatized civilian population. We assessed self-reported history of abuse with the Childhood Trauma Questionnaire and current symptoms with the PTSD Symptom Scale and the Beck Depression Inventory. RESULTS We found that subjects reporting a history of high levels of physical or sexual abuse had increased startle on all trial types relative to those with low abuse (P<.01). This effect remained significant after co-varying for the subjects' age and sex, as well as PTSD and depression symptoms. Perceived childhood sexual abuse was the greatest predictor of increased startle response. Notably, emotional abuse in childhood did not affect baseline startle, and all groups demonstrated equivalent levels of fear-potentiated startle. CONCLUSIONS The long-lasting effects of early life trauma result in increased risk for adult psychopathology. These new data demonstrate that a self-report history of child abuse is related to altered baseline startle response that is not accounted for by PTSD or depression symptoms. Increased startle may be a biomarker of stress responsiveness that can be a persevering consequence of early trauma exposure during childhood.
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Affiliation(s)
- Tanja Jovanovic
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia 30303, USA.
| | - Nineequa Q. Blanding
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine
| | - Seth D. Norrholm
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine,Atlanta VA Medical Center
| | - Erica Duncan
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine,Atlanta VA Medical Center
| | - Bekh Bradley
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine,Atlanta VA Medical Center
| | - Kerry J. Ressler
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine,Howard Hughes Medical Institute
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9603
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Koenen KC, Amstadter AB, Ruggiero KJ, Acierno R, Galea S, Kilpatrick DG, Gelernter J. RGS2 and generalized anxiety disorder in an epidemiologic sample of hurricane-exposed adults. Depress Anxiety 2009; 26:309-15. [PMID: 18833580 PMCID: PMC2666784 DOI: 10.1002/da.20528] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Generalized anxiety disorder (GAD) is a common and sometimes disabling condition often associated with stressful life events that involve significant loss or danger. The disorder appears moderately heritable. Polymorphisms in the RGS2 (regulator of G-protein signaling 2) gene were recently associated with anxious behavior in mice and panic disorder and trait anxiety in humans. We examined whether rs4606, a single nucleotide polymorphism (SNP) in the 3' UTR of RGS2, was associated with GAD in an epidemiologic sample of adults exposed to the 2004 Florida Hurricanes. METHODS The sample for the current study is 607 adults from the 2004 Florida Hurricane Study who returned buccal DNA samples via mail. Participants were selected via random digit dial procedures and interviewed via telephone about hurricane exposure, social support, and GAD symptoms. The outcome measure was DSM-IV diagnosis of GAD derived from structured interviews. RESULTS RGS2 SNP rs4606 was significantly associated with GAD in this sample. In logistic regression analyses, each C allele was associated with a 100% (P=.026) increased risk of GAD after controlling for age, sex, ancestry, hurricane exposure, and social support. CONCLUSIONS These findings are consistent with a previously published study showing a higher prevalence of the C allele among panic disorder patients than controls. This study points toward a relevant polymorphism for GAD at the 3' end of the RGS2 gene; and suggests that studying a recently disaster-exposed sample is both feasible and may improve power to find gene-disorder associations.
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Affiliation(s)
- Karestan C Koenen
- Department of Society, Human Development and Health, Harvard School of Public Health, Boston, MA 02115, USA.
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9604
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Abstract
Popliteal artery trauma is a potentially devastating injury to the lower extremity with substantial associated morbidity. Pseudoaneurysm and arteriovenous fistula formation are complications of arterial injury that often present in a delayed fashion. Although these have traditionally been repaired using an open procedure, the growth of minimally invasive techniques has provided new therapeutic options for the treatment of such lesions. The present report discusses the successful treatment of concomitant popliteal pseudoaneurysm and arteriovenous fistula after delayed presentation by placing covered stents endovascularly.
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Affiliation(s)
- Randall W Franz
- Vascular and Vein Center, Grant Medical Center, Columbus, Ohio, USA
| | - Mark A Jump
- Vascular and Vein Center, Grant Medical Center, Columbus, Ohio, USA
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9605
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Timpson S, Ratliff E, Ross M, Williams M, Atkinson J, Bowen A, McCurdy S. A psychosocial comparison of New Orleans and Houston crack smokers in the wake of Hurricane Katrina. Subst Use Misuse 2009; 44:1695-710. [PMID: 19895301 PMCID: PMC2860264 DOI: 10.3109/10826080902962094] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The purpose of this study was to compare psychological distress in a sample of African American crack cocaine users who relocated to Houston from New Orleans after Hurricane Katrina to African American drug users resident in Houston. Fifty-four African Americans from New Orleans were compared to a sample of 162 people in Houston. Data were collected between June 2002 and December 2005. There were no significant differences between the two groups on either depression or anxiety, but the New Orleans sample scored higher on the self-esteem scale and scored slightly lower on the risk-taking scale.
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Affiliation(s)
- Sandra Timpson
- Center for Health Promotion and Prevention, School of Public Health, Houston, Texas 77030, USA.
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9606
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Amstadter AB, Koenen KC, Ruggiero KJ, Acierno R, Galea S, Kilpatrick DG, Gelernter J. Variation in RGS2 is associated with suicidal ideation in an epidemiological study of adults exposed to the 2004 Florida hurricanes. Arch Suicide Res 2009; 13:349-57. [PMID: 19813112 PMCID: PMC2760049 DOI: 10.1080/13811110903266541] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
This study examined whether rs4606, a single nucleotide polymorphism (SNP) in the translated region at the 3' end of RGS2, was related to suicidal ideation in an epidemiologic sample of adults living in areas affected by the 2004 Florida hurricanes. An epidemiologic sample of residents of Florida was recruited via random digit-dial procedures after the 2004 Florida hurricanes; participants were interviewed about suicidal ideation, hurricane exposure, and social support. Participants who returned buccal DNA samples via mail (n = 607) were included here. Rs4606 in RGS2 was associated with increased symptoms of current suicidal ideation (p < 0.01). Each "C" allele was associated with 5.59 times increased risk of having current ideation. No gene-by-environment interactions were found, perhaps due to low power. RGS2 rs4606 is related to risk of current suicidal ideation in stressor-exposed adults.
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Affiliation(s)
- Ananda B Amstadter
- Department of Psychiatry and Behavioral Science, Medical University of South Carolina, Charleston, South Carolina 29425, USA.
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9607
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Abstract
Exposure to stressful events during development has consistently been shown to produce long-lasting alterations in the hypothalamic-pituitary-adrenal (HPA) axis, which may increase vulnerability to disease, including posttraumatic stress disorder and other mood and anxiety disorders. Recently reported genetic association studies indicate that these effects may be mediated, in part, by genexenvironment interactions involving polymorphisms within two key genes, CRHR1 and FKBP5. Data suggest that these genes regulate HPA axis function in conjunction with exposure to child maltreatment or abuse. In addition, a large and growing body of preclinical research suggests that increased activity of the amygdala-HPA axis induced by experimental manipulation of the amygdala mimics several of the physiological and behavioral symptoms of stress-related psychiatric illness in humans. Notably, interactions between the developing amygdala and HPA axis underlie critical periods for emotional learning, which are modulated by developmental support and maternal care. These translational findings lead to an integrated hypothesis: high levels of early life trauma lead to disease through the developmental interaction of genetic variants with neural circuits that regulate emotion, together mediating risk and resilience in adults.
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Affiliation(s)
- Charles F. Gillespie
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine
| | - Justine Phifer
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine
| | - Bekh Bradley
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta Veterans Affairs Hospital
| | - Kerry J. Ressler
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Yerkes National Primate Research Center, Howard Hughes Medical Institute
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9608
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Pérez Benítez CI, Vicente B, Zlotnick C, Kohn R, Johnson J, Valdivia S, Rioseco P. [Not Available]. Salud Ment (Mex) 2009; 32:145-153. [PMID: 21113425 PMCID: PMC2990643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
SUMMARYIn the last decade, our understanding of posttraumatic stress disorder (PTSD) has progressed from studies of war veterans and specific disaster victims to studies that examine the epidemiology of PTSD in the United States (USA) population. Epidemiologic data on PTSD in developing countries is an understudied area with the majority of studies were developed in the USA and other developed countries. Of the few epidemiological surveys undertaken in other countries, most of them have focused its interest on the prevalence rates of PTSD and its risk factors for following specific traumatic events. Besides increasing the international normative and descriptive data base on PTSD, an examination of prevalence rates and risk factors for PTSD in a socio-political and cultural context (that is markedly different to established market economies) can deepen our understanding of the phenomenology and determinants of PTSD. Although many psychiatric diagnoses can be related with previous traumatic experiences, PTSD has been identified as a disorder that requires a previous traumatic exposure for its diagnosis. A growing literature strongly suggests that early exposure to traumatic events disrupts crucial normal stages of childhood development and predisposes children to subsequent psychiatric sequelae. A series of epidemiological studies has demonstrated that childhood sexual abuse is associated with a range of psychiatric disorders in adulthood that includes mood, anxiety, and substance use disorders, even after adjusting for possible confounds, such as family factors and parental psychopathological disorders or other childhood adversities. There is little evidence of diagnostic specificity of childhood sexual abuse, although a consistent finding has been that alcohol and drug disorders are more strongly related to childhood sexual abuse than other psychiatric disorders. Other forms of childhood traumas have been less well studied.This article reviews the findings of an epidemiological study that took place in Chile and examined prevalence rates of PTSD, traumatic events most often associated with PTSD, comorbidity of PTSD with other lifetime psychiatric disorders, gender differences in PTSD as well as trauma exposure in a representative sample of Chileans. This article also reported a comparison of prevalence rates of various psychiatric disorders among persons who reported the first trauma during their childhood, those who reported the first trauma during their adulthood, and those with no trauma history.The study was based on a household-stratified sample of people defined by the health service system to be adults (aged 15 years and older). The study was designed to represent the population of Chile. This analysis is limited to three geographically distinct provinces, chosen as being representative of the distribution of much of the population. The interviews were administered to a representative sample of 2390 persons aged 15 to over 64 years.The measures used were the DSM-III-R PTSD and antisocial personality disorder modules from the Diagnostic Interview Schedule and modules for a range of DSM-III-R diagnoses from the Composite International Diagnostic. Traumatic events were categorized into one of 11 categories: military combat, rape, physical assault, seeing someone hurt or killed, disaster, threat, narrow escape, sudden injury/ accident, news of a sudden death or accident, other event (e.g. kidnapping, torture), or other experience. The translation into Spanish was conducted using the protocol outlined by the World Health Organization. The interviewers were all university students in their senior year studying social sciences.Taylor series linearization method was used to estimate the standard errors due to the sample design and the need for weighting. The analysis was conducted using procedures without replacement for non-respondents. The region, province, comuna, and district selected were used as the defined strata. Logistic regression with the corresponding 95% confidence interval was used to examine associations among PTSD, demographic risk factors, and trauma type. To examine whether the association between PTSD and gender could be explained by other risk factors, multivariate logistic regression analyses were also conducted.The first analysis found that the lifetime prevalence of PTSD was 4.4% (2.5% for men and 6.2% for women). Among the traumatic events, rape was most strongly associated with PTSD diagnosis. Among those exposed to traumas, women were significantly more likely to develop PTSD than men, after controlling for assaultive violence. The second analysis revealed that exposure to a lifetime trauma was associated with a higher probability of psychiatric morbidity in comparison with no trauma exposure.Traumas with childhood onset were significantly related to lifetime panic disorder, independent of number of lifetime traumas and demographic differences.This revealed that women had more probabilities than men of developing PTSD once they are exposed to trauma, independent of previous traumas, experiences of sexual assault, other violent experiences or level of education. Some authors have proposed that women have a higher vulnerability than men to develop PTSD and that there are sex differences in brain morphology, in the social interpretation of trauma, or/and in the peritraumatic dissociative experience. Although many theories have been proposed to explain this gender difference in PTSD, more research is needed to evaluate them empirically.This study highlights the importance of investigating the prevalence of PTSD, the patterns of comorbidity of PTSD, as well as gender differences of PTSD in non-English speaking countries. Although Chile has a different historical and socio-cultural context with respect to other countries in which the epidemiology of PTSD has been examined, in general, this study achieved similar results as those found in other studies.The results showed that PTSD is not an uncommon psychiatric illness, it is associated with a high degree of psychiatric comorbidity, it is more likely to predate other psychiatric disorders. Also, the results showed that men are more likely to be exposed to traumas than women, women are more likely than men to develop PTSD, and that PTSD is associated with relatively high treatment utilization.However, compared to another country in Latin America, such as Mexico, Chile has a lower prevalence of PTSD and trauma exposure, which may due to socio-economic factors, such as less inequity between the wealthy and the poor and less violence, crime, and poverty in Chile than Mexico. These studies also suggest that traumatic events that occur in childhood are related to specific disorders rather than those that occurred later in life.Individuals with childhood interpersonal trauma exposure are more likely to suffer from lifetime panic disorder, agoraphobia or PTSD compared to those who experience interpersonal trauma as an adult. However, research should examine the specificity of these disorders in relation to various types of childhood traumas.Limitations of the current study include the use of lay interviewers who, despite acceptable levels of reliability and validity, may be less accurate than clinicians as interviewers.Also the retrospective recall of lifetime disorders is likely to be less accurate than a more recent time frame. The sample used in this study does not show nation wide perspective, because the Southern portion of the country which includes much of the indigenous population was excluded. This study, like most epidemiological studies, did not use an-depth or validated index of trauma, which may have diluted findings. Since this study was cross-sectional, a direct cause-effect relationship cannot be assumed between trauma exposure and subsequent disorders.
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Affiliation(s)
| | - Benjamin Vicente
- Universidad de Concepción, Departamento de Psiquiatría y Salud Mental, Concepción, Chile
| | - Caron Zlotnick
- The Department of Psychiatry and Human Behavior at Brown Medical School, and Hospital Butler. Rhode Island. USA
| | - Robert Kohn
- The Department of Psychiatry and Human Behavior at Brown Medical School, and Hospital Butler. Rhode Island. USA
| | - Jennifer Johnson
- The Department of Psychiatry and Human Behavior at Brown Medical School. Rhode Island. USA
| | - Sandra Valdivia
- Universidad de Concepción, Departamento de Psiquiatría y Salud Mental, Concepción, Chile
| | - Pedro Rioseco
- Universidad de Concepción, Departamento de Psiquiatría y Salud Mental, Concepción, Chile
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9609
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Mellman TA, Alim T, Brown DD, Gorodetsky E, Buzas B, Lawson WB, Goldman D, Charney DS. Serotonin polymorphisms and post traumatic stress disorder in a trauma exposed African American population. Depress Anxiety 2009; 26:993-7. [PMID: 19842167 PMCID: PMC2963151 DOI: 10.1002/da.20627] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Genetic polymorphisms that influence serotonin (5-hydroxytryptamine, 5HT) neurotransmission are candidates for contributing to susceptibility to posttraumatic stress disorder (PTSD). The objective of our study was to determine if a variable length polymorphism for the promoter regions of the 5HT transporter (5HTTLPR), and/or a substitution polymorphism in the promoter region for the 5HT2A receptor, would be associated with PTSD in a trauma exposed population of adult African-Americans. METHODS Using a case control design, 118 participants recruited from the primary care clinics and the campus of a historically black university who met inclusion criteria including trauma exposure provided blood samples for genomic DNA. PTSD criteria were determined by the Clinician Assessment of PTSD Scale (CAPS) and criteria for other psychiatric disorders by the Structured Clinical Interview for DSM-IV (SCID). 5HTTLPR and 5HT2A-1438A/G were genotyped using established methods. Associations of genotypes with lifetime PTSD, and models testing associations of allele "dose", were analyzed. RESULTS Fifty-five (47%) participants met lifetime criteria for PTSD and 26 (22%) met criteria for (mostly comorbid) major depression. The 5HT2A (lower expressing) G allele was significantly associated with PTSD. We did not find significant associations with 5HTTLPR. CONCLUSIONS Our findings suggest a relationship between genetic variation in the 5HT2A promoter region and PTSD.
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Affiliation(s)
- Thomas A. Mellman
- Howard University College of Medicine, Department of Psychiatry, Washington, District of Columbia,Correspondence to: Thomas A. Mellman, Department of Psychiatry, Howard University Hospital, 2041 Georgia Ave., Washington, DC 20060.
| | - Tanya Alim
- Howard University College of Medicine, Department of Psychiatry, Washington, District of Columbia
| | - Denver D. Brown
- Howard University College of Medicine, Department of Psychiatry, Washington, District of Columbia
| | - Elena Gorodetsky
- Laboratory of Neurogenetics, National Institute of Alcohol Abuse and Alcoholism, National Institute of Health, Bethesda, Maryland
| | - Beata Buzas
- Laboratory of Neurogenetics, National Institute of Alcohol Abuse and Alcoholism, National Institute of Health, Bethesda, Maryland
| | - William B. Lawson
- Howard University College of Medicine, Department of Psychiatry, Washington, District of Columbia
| | - David Goldman
- Laboratory of Neurogenetics, National Institute of Alcohol Abuse and Alcoholism, National Institute of Health, Bethesda, Maryland
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9610
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Hallman JJ, Yoganandan NA, Pintar FA. Characterization of torso side airbag aggressivity - biomed 2009. Biomed Sci Instrum 2009; 45:101-106. [PMID: 19369747 PMCID: PMC2773795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Torso side airbags are typically seat- or door-mounted; i.e., mounted within the seat back or within the door panel lateral to the occupant. Because previous work has shown the propensity of airbags to cause harm in unintended out-of-position occupant orientations, scientific investigation of injury risks continues. Such work involves anthropomorphic test devices and cadaveric specimens which have time and monetary costs associated with their use. These costs necessitate experimental efficiency, achieved by selecting representative airbags from the multitude of options in contemporary automobiles. This study proposes a novel method for characterizing torso side airbag deployment aggressivity for purposes of selection. The test fixture consisted of an array of rigidly positioned three-axis load cells oriented in opposition to a rigid airbag mount at fixed distances of 6 or 8 cm. Six exemplar torso airbag modules were subjected to these two deployment configurations. Force characteristics of maximum resultant force, peak and mean force onset rate, and linear impulse were quantified for comparison. Force characteristics demonstrated ranges between 210% (linear impulse) and 2,500% (mean force onset rate) of minimum value. This test method demonstrated differentiation in the diversity of SAB designs and quantified the airbagenvironment interaction during deployment. These force characteristics may correlate to thoracic injury risk from out-of position torso side airbag deployment.
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Affiliation(s)
- Jason J Hallman
- Medical College of Wisconsin, Marquette University, and VA Medical Center, Milwaukee, WI
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9611
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Abstract
Disasters are unpredictable and frequently lead to chaotic post-disaster situations, creating numerous methodologic challenges for the study of the mental health consequences of disasters. In this commentary, we expand on some of the issues addressed by Kessler and colleagues, largely focusing on the particular challenges of (a) defining, finding, and sampling populations of interest after disasters and (b) designing studies in ways that maximize the potential for valid inference. We discuss these challenges - drawing on specific examples - and suggest potential approaches to each that may be helpful as a guide for future work. We further suggest research directions that may be most helpful in moving the field forward.
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Affiliation(s)
- Sandro Galea
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI 48109-2029, USA.
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9612
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van Winkel R, Stefanis NC, Myin-Germeys I. Psychosocial stress and psychosis. A review of the neurobiological mechanisms and the evidence for gene-stress interaction. Schizophr Bull 2008; 34:1095-105. [PMID: 18718885 PMCID: PMC2632486 DOI: 10.1093/schbul/sbn101] [Citation(s) in RCA: 317] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
This article presents evidence suggesting that psychosocial stress may increase risk for psychosis, especially in the case of cumulative exposure. A heuristically useful framework to study the underlying mechanisms is the concept of "behavioral sensitization" that stipulates that exposure to psychosocial stress--such as life events, childhood trauma, or discriminatory experiences--may progressively increase the behavioral and biological response to subsequent exposures. The neurobiological substrate of sensitization may involve dysregulation of the hypothalamus-pituitary-adrenal axis, contributing to a hypothesized final common pathway of dopamine sensitization in mesolimbic areas and increased stress-induced striatal dopamine release. It is argued that, in order to reconcile genetic and environmental influences on the development of psychosis, gene-environment interactions may be an important mechanism in explaining between-subject differences in risk following (cumulative) exposure to psychosocial stress. To date, most studies suggestive of gene-stress interaction have used proxy measures for genetic vulnerability such as a family history of psychosis; studies investigating interactions between molecular genetic measures and psychosocial stressors are still relatively scarce. Preliminary evidence suggests that polymorphisms within the catechol-O-methyltransferase and brain-derived neurotrophic factor genes may interact with psychosocial stress in the development of psychosis; however, extensive further investigations are required to confirm this.
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Affiliation(s)
- Ruud van Winkel
- Department of Psychiatry and Neuropsychology, EURON, South Limburg Mental Health Research and Teaching Network, Maastricht University Medical Centre, Maastricht, The Netherlands.
| | - Nicholas C. Stefanis
- National and Kapodistrian University of Athens, Eginition Hospital, 74 Vas SofiasAvenue, Athens 11528, Greece,University Mental Health Research Institute, Athens, Greece,Division of Psychological Medicine, Institute of Psychiatry, De Crespigny Park, London SE5 8AF, UK
| | - Inez Myin-Germeys
- Department of Psychiatry and Neuropsychology, EURON, South Limburg Mental Health Research and Teaching Network, Maastricht University Medical Centre, PO Box 616, 6200 MD Maastricht, The Netherlands,School of Psychological Sciences, University of Manchester, Manchester, UK
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9613
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Fortuna LR, Porche MV, Alegria M. Political violence, psychosocial trauma, and the context of mental health services use among immigrant Latinos in the United States. Ethn Health 2008; 13:435-63. [PMID: 18850369 PMCID: PMC2771411 DOI: 10.1080/13557850701837286] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
OBJECTIVES We present the prevalence of exposure to political violence (PV) among Latino immigrants in the US, and perceived need for and correlates of mental health services use among this population. METHODS We use the National Latino and Asian American Study (NLAAS), a nationally representative epidemiological survey of US Latinos, including a probability sample of 1630 immigrant Latinos. Our conceptual framework assumes a strong role of social and cultural factors in understanding the risk for psychopathology and mental health service use. RESULTS Eleven percent of all immigrant Latinos reported PV exposure and 76% described additional lifetime traumas. Among those with a history of PV, an increased likelihood of using mental health services was associated with female gender, English language proficiency, experiencing personal assaults, higher perceived discrimination, and having an anxiety or substance disorder. Latino men and specific subgroups of Latinos were less likely to access mental health services after experiencing PV. Perceived need for mental health services use is the strongest correlate of any lifetime and last-12-months service use. CONCLUSIONS Individuals who come from countries with a history of political violence often have multiple traumatic experiences. This suggests a need for systematic screening for trauma and related psychiatric disorders. Specific outreach interventions focused on perceptions of need could be helpful for subgroups of Latinos including men who are particularly underrepresented in mental health services but who exhibit significant trauma histories.
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Affiliation(s)
- Lisa R Fortuna
- Department of Psychiatry, University of Massachusetts Medical School, USA.
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9614
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van Zelst C. Which environments for G x E? A user perspective on the roles of trauma and structural discrimination in the onset and course of schizophrenia. Schizophr Bull 2008; 34:1106-10. [PMID: 18791078 PMCID: PMC2632506 DOI: 10.1093/schbul/sbn113] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Now that schizophrenia researchers may be moving from unilateral molecular genetic approaches to models including so-called gene-environment interactions, the question rises which environments may be considered for such research and how a user perspective may inform the field. It is argued that trauma and stigma, or perhaps better structural discrimination, represent 2 important environmental factors that deserve more attention. Experiential evidence, collected by users, suggests that trauma in childhood and/or adulthood, before, during, and after the onset of schizophrenia, as well as stigma/structural discrimination, may play important roles in the onset and course of the disorder. A certain reluctance on the part of the professional schizophrenia research community to take these variables as serious as, eg, interesting but inconclusive etiological signals from prenatal hypoxia, prenatal folate deficiency, and prenatal toxoplasmosis is suggested. This article outlines the concepts of trauma and stigma and their negative consequences for the onset and course of schizophrenia. The importance of research into these factors and their possible relevance for gene-environment interactions is discussed. While gene-environment interaction research using these variables is indicated and may possibly prove productive, it is argued that such efforts may not be useful if no subsequent attempt is made to translate the results to the level of interventions, codeveloped by users, eg, in the area of coping with the vicious circle of environmental adversity that users can become exposed to.
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Affiliation(s)
- Catherine van Zelst
- Department of Psychiatry and Neuropsychology, School of Mental Health and Neuroscience, Maastricht University Medical Centre, European Graduate School of Neuroscience, Maastricht, The Netherlands.
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9615
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Abstract
It has become widely accepted that the psychotic disorders are endpoints of atypical developmental trajectories indexed by abnormal emotional and cognitive development early in life. However, the role of environmental factors in determining these trajectories has received relatively little attention. In this article, we argue that (1) the influence of environment on psychosis can best be understood if we focus on specific types of psychotic experiences such as hallucinations and delusions, (2) these symptoms are the products of specific cognitive biases and deficits, and (3) the development of these particular patterns of cognitive functioning is influenced by specific kinds of environmental adversity. This approach is at variance with more conventional approaches because it suggests that each type of experience, rather than being the manifestation of a common underlying illness process, is a product of a specific set of causal variables. Importantly, these variables include environmental determinants, although not to the exclusion of endogenous factors such as neurodevelopmental impairment or genetic vulnerability. We discuss the implications of this approach for neurobiological and genetic research into psychosis, as well as clinical practice.
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Affiliation(s)
- Richard P Bentall
- School of Psychology, University of Bangor, Brigantia Building, Penrallt Road, Bangor, Gwynedd LL57 2AS, UK.
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9616
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Ahmad A, Von Knorring AL, Sundelin-Wahlsten V. Traumatic Experiences and Post-traumatic Stress Symptoms in Kurdish Children in their Native Country and in Exile. Child Adolesc Ment Health 2008; 13:193-197. [PMID: 32847191 DOI: 10.1111/j.1475-3588.2008.00501.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Traumatic experiences and post-traumatic stress symptoms were assessed in Kurdish children in their native country and in exile. METHOD 312 randomly selected school-age children at two sites completed assessments of traumatic experiences and post-traumatic symptoms. RESULTS Although traumatic experiences showed more similarities than differences between the two samples, the PTSD frequencies and post-traumatic stress symptom scores were higher in Kurdistan than in exile. Living in exile showed negative correlation with PTSD frequencies and post-traumatic stress symptom scores. CONCLUSIONS Living in exile seems to have trauma healing effect on children of Kurdistan.
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Affiliation(s)
- Abdulbaghi Ahmad
- Department of Neuroscience, Uppsala University, SE-751 85 Uppsala, Sweden. E-mail:
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9617
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Paquette IM, Burchard KW. Hypoadrenalism following trauma: is sepsis always necessary? Int J Clin Exp Med 2008; 1:327-331. [PMID: 19079677 PMCID: PMC2596327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2008] [Accepted: 10/02/2008] [Indexed: 05/27/2023]
Abstract
PURPOSE OF THE STUDY Trauma patients can exhibit the systemic inflammatory response syndrome (SIRS) without evidence of infection. SIRS from infection has been associated with hypoadrenalism. We hypothesized that hypoadrenalism can accompany SIRS from trauma without infection. To investigate this further, we performed a retrospective study of trauma patients admitted to the ICU at our rural academic level 1 trauma center from October 2003- June 2005, with measurement of blood cortisol in the first 7 days after injury (N=33). We determined the incidence of hypoadrenalism based on serum cortisol levels and performed a univariate analysis to delineate factors associated with hypoadrenalism. Significant Findings: Twelve of 33 (36.6 %) were diagnosed with hypoadrenalism on mean ICU day 2.8. SIRS was documented in 92% of hypoadrenal patients vs. 52% of patients without hypoadrenalism (p=0.021). No patient had evidence of invasive infection. Younger age and higher ISS were also associated with hypoadrenalism. There were no gender differences identified, although most patients in the study were male. There was a trend toward higher etomidate use in the hypoadrenal group, although this was not statistically significant. CONCLUSIONS Trauma patients who demonstrate SIRS early in their ICU course may exhibit hypoadrenalism without infection. Younger age and higher ISS also appear to be associated with this alteration. Further study is needed to determine the true incidence of this condition, and to better delineate which trauma patients are most susceptible.
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Affiliation(s)
- Ian M Paquette
- Department of Surgery, Dartmouth Hitchcock Medical Center Lebanon, NH, USA
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9618
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Abstract
In the mnemonic model of posttraumatic stress disorder (PTSD), the current memory of a negative event, not the event itself, determines symptoms. The model is an alternative to the current event-based etiology of PTSD represented in the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; American Psychiatric Association, 2000). The model accounts for important and reliable findings that are often inconsistent with the current diagnostic view and that have been neglected by theoretical accounts of the disorder, including the following observations. The diagnosis needs objective information about the trauma and peritraumatic emotions but uses retrospective memory reports that can have substantial biases. Negative events and emotions that do not satisfy the current diagnostic criteria for a trauma can be followed by symptoms that would otherwise qualify for PTSD. Predisposing factors that affect the current memory have large effects on symptoms. The inability-to-recall-an-important-aspect-of-the-trauma symptom does not correlate with other symptoms. Loss or enhancement of the trauma memory affects PTSD symptoms in predictable ways. Special mechanisms that apply only to traumatic memories are not needed, increasing parsimony and the knowledge that can be applied to understanding PTSD.
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Affiliation(s)
- David C Rubin
- Department of Psychology and Neuroscience, Duke University
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9619
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Amstadter AB, Vernon LL. A Preliminary Examination of Thought Suppression, Emotion Regulation, and Coping in a Trauma Exposed Sample. J Aggress Maltreat Trauma 2008; 17:279-295. [PMID: 20046535 PMCID: PMC2800361 DOI: 10.1080/10926770802403236] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Attempts to modulate negative emotional and cognitive symptoms of Posttraumatic Stress Disorder (PTSD) may be related to psychopathology. Trauma exposed undergraduates, 31 reporting severe PTSD symptoms (PTSD group) and 34 without PTSD symptoms (no-PTSD group), completed measures of PTSD, depression, anxiety, thought control, emotion regulation, and coping. The PTSD group had greater psychopathology and overall modulation strategy use than the no-PTSD group. Thought suppression, emotion suppression, and avoidant coping strategies were positively related to psychopathology, whereas emotion reappraisal and approach coping strategies were either not related or weakly negatively related. Hierarchical multiple regressions with psychopathologic variables as criteria and modulation strategies as predictors indicated significant models in all cases. Generally, thought suppression was the only significant independent predictor of psychopathology.
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9620
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Scher CD, McCreary DR, Asmundson GJ, Resick PA. The structure of post- traumatic stress disorder symptoms in three female trauma samples: a comparison of interview and self-report measures. J Anxiety Disord 2008; 22:1137-45. [PMID: 18206346 PMCID: PMC2756737 DOI: 10.1016/j.janxdis.2007.11.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2007] [Revised: 11/29/2007] [Accepted: 11/29/2007] [Indexed: 10/22/2022]
Abstract
Empirical research increasingly suggests that post-traumatic stress disorder (PTSD) is comprised of four factors: re-experiencing, avoidance, numbing, and hyperarousal. Nonetheless, there remains some inconsistency in the findings of factor analyses that form the bulk of this empirical literature. One source of such inconsistency may be assessment measure idiosyncrasies. To examine this issue, we conducted confirmatory factor analyses of interview and self-report data across three trauma samples. Analyses of the interview data indicated a good fit for a four-factor model across all samples; analyses of the self-report data indicated an adequate fit in two of three samples. Overall, findings suggest that measure idiosyncrasies may account for some of the inconsistency in previous factor analyses of PTSD symptoms.
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Affiliation(s)
- Christine D. Scher
- Department of Psychology, California State University, Fullerton, PO Box 6846, Fullerton, CA 92834, United States, Corresponding author. Tel.: +1 714 278 8428; fax: +1 714 278 7134. (C.D. Scher)
| | | | | | - Patricia A. Resick
- National Center for PTSD, Boston VA Healthcare System and Boston University, Boston, MA, United States
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9621
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Gill JM, Page GG, Sharps P, Campbell JC. Experiences of traumatic events and associations with PTSD and depression development in urban health care-seeking women. J Urban Health 2008; 85:693-706. [PMID: 18581238 PMCID: PMC2527434 DOI: 10.1007/s11524-008-9290-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2008] [Accepted: 05/14/2008] [Indexed: 10/21/2022]
Abstract
Posttraumatic stress disorder (PTSD) is an anxiety disorder that occurs after a traumatic event and has been linked to psychiatric and physical health declines. Rates of PTSD are far higher in individuals with low incomes and who reside in urban areas compared to the general population. In this study, 250 urban health care-seeking women were interviewed for a diagnosis of PTSD, major depressive disorder, and also the experience of traumatic events. Multivariate logistic regressions were used to determine the associations between traumatic events and PTSD development. Survival analysis was used to determine if PTSD developed from assaultive and nonassaultive events differed in symptom duration. Eighty-six percent of women reported at least one traumatic event, 14.8% of women were diagnosed with current PTSD, and 19.6% with past PTSD. More than half of women with PTSD had comorbid depression. Assaultive traumatic events were most predictive of PTSD development. More than two thirds of the women who developed PTSD developed chronic PTSD. Women who developed PTSD from assaultive events experienced PTSD for at least twice the duration of women who developed PTSD from nonassaultive events. In conclusion, PTSD was very prevalent in urban health care-seeking women. Assaultive violence was most predictive of PTSD development and also nonremittance.
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Affiliation(s)
- Jessica M Gill
- National Institute of Nursing Research, National Institutes of Health, 10 Center Drive, 10/CRC 2-1339, Bethesda, MD 20892-1506, USA.
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9622
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Kiser LJ, Nurse W, Lucksted A, Collins KS. Understanding the Impact of Trauma on Family Life From the Viewpoint of Female Caregivers Living in Urban Poverty. Traumatology (Tallahass Fla) 2008; 14:77-90. [PMID: 21113417 PMCID: PMC2990478 DOI: 10.1177/1534765608320329] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Children and their families living in poor, inner-city neighborhoods are at high risk for experiencing multiple traumas. This article describes findings from a qualitative study designed to explore the impact of chronic traumas on family life through the voices of primarily African American caregivers coping with urban poverty. Structured interviews are conducted with 16 caregivers of children ages 6 to 9 years who had been exposed to multiple traumas and had symptoms of posttraumatic stress disorder. Caregivers explain changing daily routines to accommodate child distress and promoting positive family processes such as increased protectiveness. They also describe various roles that religion/spirituality play in their coping with trauma, including finding comfort in the faith that God controls what happens in their lives. These themes are discussed with regard to theory and practical applications for assisting traumatized families.
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Affiliation(s)
- Laurel J Kiser
- University of Maryland School of Medicine (LJK), University of Maryland Baltimore School of Medicine (WN, AL), University of Maryland School of Social Work (KSC)
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9623
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Eisenman DP, Meredith LS, Rhodes H, Green BL, Kaltman S, Cassells A, Tobin JN. PTSD in Latino patients: illness beliefs, treatment preferences, and implications for care. J Gen Intern Med 2008; 23:1386-92. [PMID: 18587619 PMCID: PMC2518000 DOI: 10.1007/s11606-008-0677-y] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2007] [Revised: 04/16/2008] [Accepted: 05/02/2008] [Indexed: 11/28/2022]
Abstract
BACKGROUND Little is known about how Latinos with post-traumatic stress disorder (PTSD) understand their illness and their preferences for mental health treatment. OBJECTIVE To understand the illness beliefs and treatment preferences of Latino immigrants with PTSD. DESIGN Semi-structured, face-to-face interviews. PARTICIPANTS Sixty foreign-born, Latino adults recruited from five primary care centers in New York and New Jersey and screened for PTSD. APPROACH Content analytic methods identified common themes, their range, and most frequent or typical responses. RESULTS Participants identified their primary feelings as sadness, anxiety, nervousness, and fear. The most common feeling was "sad" (triste). Other words frequently volunteered were "angry" (enojada), "nervous" (nerviosa), and "scared" (miedo). Participants viewed their PTSD as impairing health and functioning. They ascribed their somatic symptoms and their general medical problems to the "stress" from the trauma and its consequences on their lives. The most common reason participants volunteered for their work and school functioning being impaired was their poor concentration, often due to intrusive thoughts. Most expressed their desire to receive mental health treatment, to receive it within their primary care center, and preferred psychotherapy over psychotropic medications. Among participants who did not report wanting treatment, most said it was because the trauma was "in the past." CONCLUSIONS Clinicians may consider enquiring about PTSD in Latino patients who report feeling sad, anxious, nervous, or fearful. Our study suggests topics clinicians may include in the psychoeducation of patients with PTSD.
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9624
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Moore SA, Zoellner LA, Mollenholt N. Are expressive suppression and cognitive reappraisal associated with stress-related symptoms? Behav Res Ther 2008; 46:993-1000. [PMID: 18687419 PMCID: PMC2629793 DOI: 10.1016/j.brat.2008.05.001] [Citation(s) in RCA: 269] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2007] [Revised: 04/10/2008] [Accepted: 05/01/2008] [Indexed: 11/22/2022]
Abstract
Emotion dysregulation is thought to be critical to the development of negative psychological outcomes. Gross (1998b) conceptualized the timing of regulation strategies as key to this relationship, with response-focused strategies, such as expressive suppression, as less effective and more detrimental compared to antecedent-focused ones, such as cognitive reappraisal. In the current study, we examined the relationship between reappraisal and expressive suppression and measures of psychopathology, particularly for stress-related reactions, in both undergraduate and trauma-exposed community samples of women. Generally, expressive suppression was associated with higher, and reappraisal with lower, self-reported stress-related symptoms. In particular, expressive suppression was associated with PTSD, anxiety, and depression symptoms in the trauma-exposed community sample, with rumination partially mediating this association. Finally, based on factor analysis, expressive suppression and cognitive reappraisal appear to be independent constructs. Overall, expressive suppression, much more so than cognitive reappraisal, may play an important role in the experience of stress-related symptoms. Further, given their independence, there are potentially relevant clinical implications, as interventions that shift one of these emotion regulation strategies may not lead to changes in the other.
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Affiliation(s)
- Sally A Moore
- University of Washington, Department of Psychology, Seattle, WA, USA.
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9625
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Newgard CD, Sears GK, Rea TD, Davis DP, Pirrallo RG, Callaway CW, Atkins DL, Stiell IG, Christenson J, Minei JP, Williams CR, Morrison LJ. The Resuscitation Outcomes Consortium Epistry- Trauma: design, development, and implementation of a North American epidemiologic prehospital trauma registry. Resuscitation 2008; 78:170-8. [PMID: 18482792 PMCID: PMC2562032 DOI: 10.1016/j.resuscitation.2008.01.029] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2007] [Accepted: 01/23/2008] [Indexed: 11/23/2022]
Abstract
Injury is a major public health problem generating substantial morbidity, mortality, and economic burden on society. The majority of seriously injured persons are initially evaluated and cared for by prehospital providers, however the effect of emergency medical services (EMS) systems, EMS clinical care, and EMS interventions on trauma patient outcomes is largely unknown. Outcome-based information to guide future EMS care has been hampered by the lack of comprehensive, standardized, multi-center prehospital data resources that include meaningful patient outcomes. In this paper, we describe the background, design, development, implementation, content, and potential uses of the first North American comprehensive epidemiologic prehospital data registry for injured persons. This data registry samples patients from 264 EMS agencies transporting to 287 acute care hospitals in both the United States and Canada.
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Affiliation(s)
- Craig D Newgard
- Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Health & Science University, Portland, OR 97239-3098, United States.
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9626
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Abstract
Ionized hypocalcemia is a common finding in critically ill patients, but the relationship between ionized hypocalcemia and mortality risk in trauma patients has not been well established. The aim of this study was to assess the usefulness of initial ionized calcium (iCa) in predicting mortality in the trauma population, and evaluate its superiority over the three other triage tools: base deficit, systemic inflammatory response syndrome (SIRS) score, and triage-revised trauma score (t-RTS). A pro-and retrospective study was performed on 255 consecutive trauma patients admitted to our Emergency Medical Center from January to December, 2005, who underwent arterial blood gas analysis. Multivariate logistic regression analysis confirmed iCa (<or=0.88 mM/L), low Glasgow coma scale score, and a large transfusion amount to be significant risk factors associated with mortality (p<0.05). The sensitivities of iCa, base deficit, SIRS score, and t-RTS were 82.9%, 76.4%, 67.1%, and 74.5%, and their specificities were 41.0%, 64.1%, 64.1%, and 87.2%, respectively. Receiver operating characteristic curve analysis determined the areas under the curves of these parameters to be 0.607+/-0.062, 0.736+/-0.056, 0.694+/-0.059, and 0.875+/-0.043, respectively (95% confidence interval). Although initial iCa (<or=0.88 mM/L) was confirmed as a significant risk factor associated with mortality, it exhibited a poorer discriminative power for mortality prediction than other predictors, especially t-RTS.
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Affiliation(s)
- Young Cheol Choi
- Department of Surgery, Masan Samsung Hospital, Sungkyunkwan University School of Medicine, Masan, Korea
| | - Seong Youn Hwang
- Department of Emergency Medicine, Masan Samsung Hospital, Sungkyunkwan University School of Medicine, Masan, Korea
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9627
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Ramchand R, Marshall GN, Schell TL, Jaycox LH. Post traumatic distress and physical functioning: a longitudinal study of injured survivors of community violence. J Consult Clin Psychol 2008; 76:668-76. [PMID: 18665694 PMCID: PMC3678762 DOI: 10.1037/0022-006x.76.4.668] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This study examines the cross-lagged relationships between posttraumatic distress symptoms and physical functioning, using a sample of 413 persons who were hospitalized for injuries resulting from community violence. Posttraumatic distress was assessed at 1 week, 3 months, and 12 months postinjury, and posttraumatic physical functioning was assessed at 3 months and 12 months. Structural equation modeling was used to assess the prospective relationship between posttraumatic distress symptoms and physical functioning while controlling for demographic characteristics and objective measures of injury severity. Results indicate that posttraumatic distress and physical functioning are reciprocally related. Individuals with high levels of psychological distress at 1 week posttrauma have worse physical functioning at 3 months. Psychological distress at 3 months was not significantly associated with subsequent change in physical functioning at 12 months. Individuals with poor physical functioning at 3 months had higher than expected levels of psychological distress at 12 months. These findings demonstrate a reciprocal relationship between physical and mental health following traumatic injury. Interventions targeting physical recovery may influence subsequent mental health, and therapies aimed at improving early mental health may also have long-term benefits for physical recovery.
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9628
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Carballo JJ, Harkavy-Friedman J, Burke AK, Sher L, Baca-Garcia E, Sullivan GM, Grunebaum MF, Parsey RV, Mann JJ, Oquendo MA. Family history of suicidal behavior and early traumatic experiences: additive effect on suicidality and course of bipolar illness? J Affect Disord 2008; 109:57-63. [PMID: 18221790 PMCID: PMC3491751 DOI: 10.1016/j.jad.2007.12.225] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2007] [Revised: 12/09/2007] [Accepted: 12/13/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND Bipolar disorder (BD) is associated with a high prevalence of suicide attempt and completion. Family history of suicidal behavior and personal history of childhood abuse are reported risk factors for suicide among BD subjects. METHODS BD individuals with family history of suicidal behavior and personal history of childhood abuse (BD-BOTH), BD individuals with family history of suicidal behavior or personal history of childhood abuse (BD-ONE), and BD individuals with neither of these two risk factors (BD-NONE) were compared with regard to demographic variables and clinical measures. RESULTS Almost 70% of the sample had a history of a previous suicide attempt. There were significantly higher rates of previous suicide attempts in the BD-BOTH and BD-ONE relative to the BD-NONE group. BD-BOTH were significantly younger at the time of their first suicide attempt and had higher number of suicide attempts compared with BD-NONE. BD-BOTH were significantly younger at the time of their first episode of mood disorder and first psychiatric hospitalization and had significantly higher rates of substance use and borderline personality disorders compared to BD-NONE. LIMITATIONS Retrospective study. Use of semi-structured interview for the assessment of risk factors. CONCLUSIONS BD individuals with a familial liability for suicidal behavior and exposed to physical and/or sexual abuse during childhood are at a greater risk to have a more impaired course of bipolar illness and greater suicidality compared to those subjects with either only one or none of these risk factors. Prospective studies are needed to confirm these findings.
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Affiliation(s)
- Juan J Carballo
- Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York, NY.,Department of Psychiatry. Clinica Universitaria de Navarra, Pamplona, Spain
| | - Jill Harkavy-Friedman
- Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York, NY
| | - Ainsley K Burke
- Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York, NY
| | - Leo Sher
- Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York, NY
| | - Enrique Baca-Garcia
- Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York, NY
| | - Gregory M Sullivan
- Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York, NY
| | - Michael F Grunebaum
- Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York, NY
| | - Ramin V Parsey
- Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York, NY
| | - J John Mann
- Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York, NY
| | - Maria A Oquendo
- Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York, NY
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9629
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Hartman M, Watson RS, Linde-Zwirble W, Clermont G, Lave J, Weissfeld L, Kochanek P, Angus D. Pediatric traumatic brain injury is inconsistently regionalized in the United States. Pediatrics 2008; 122:e172-80. [PMID: 18595962 PMCID: PMC2562242 DOI: 10.1542/peds.2007-3399] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Traumatic brain injury is a leading cause of death in children. On the basis of evidence of better outcomes, the American College of Surgery Committee on Trauma recommends that children with severe traumatic brain injury receive care at high-level trauma centers. We assessed rates of adherence to these recommendations and factors associated with adherence. METHODS We studied population and hospital discharge data from 2001 from all of the health care referral regions (n = 68) in 6 US states (Florida, Massachusetts, New Jersey, New York, Texas, and Virginia). We identified children with severe traumatic brain injury by using International Classification of Diseases, Ninth Revision, Clinical Modification, codes and American College of Surgery Committee on Trauma criteria. We defined "high-level centers" as either level I or pediatric trauma centers. We considered an area to be well regionalized if >or=90% of severe traumatic brain injury hospitalizations were in high-level centers. We also explored how use of level II trauma centers affected rates of care at high-level centers. RESULTS Of 2117 admissions for severe pediatric traumatic brain injury, 67.3% were in high-level centers, and 87.3% were in either high-level or level II centers. Among states, 56.4% to 93.6% of severe traumatic brain injury admissions were in high-level centers. Only 2 states, Massachusetts and Virginia, were well regionalized. Across health care referral regions, 0% to 100% of severe traumatic brain injury admissions were in high-level centers, and only 19.1% of health care referral regions were well regionalized. Only a weak relationship existed between the distance to the nearest high-level center and regionalization. The age of statewide trauma systems had no relationship to the extent of regionalization. CONCLUSIONS Despite evidence for improved outcomes of severely injured children admitted to high-level trauma centers, we found that almost one third of the children with severe traumatic brain injury failed to receive care in such centers. Only 2 of 6 states and less than one fifth of 68 health care referral regions were well regionalized. This study highlights problems with current pediatric trauma care that can serve as a basis for additional research and health care policy.
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Affiliation(s)
- Mary Hartman
- Division of Pediatric Critical Care Medicine, Duke Children's Hospital, Durham, North Carolina,Clinical Research, Investigation, and Systems Modeling of Acute Illness Laboratory
| | - Robert Scott Watson
- Clinical Research, Investigation, and Systems Modeling of Acute Illness Laboratory
| | - Walter Linde-Zwirble
- Clinical Research, Investigation, and Systems Modeling of Acute Illness Laboratory,ZD Associates, LLC, Perkasie, Pennsylvania
| | - Gilles Clermont
- Clinical Research, Investigation, and Systems Modeling of Acute Illness Laboratory
| | - Judith Lave
- Clinical Research, Investigation, and Systems Modeling of Acute Illness Laboratory,Department of Health Policy and Management Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Lisa Weissfeld
- Clinical Research, Investigation, and Systems Modeling of Acute Illness Laboratory,Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Patrick Kochanek
- Safar Center for Resuscitation Research, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Derek Angus
- Clinical Research, Investigation, and Systems Modeling of Acute Illness Laboratory
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9630
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Abstract
Peri- and posttraumatic emotional responses have been understudied, and furthermore, have rarely been compared among trauma types. The current study compared college students' retrospective self-reports of peri- and posttraumatic responses of fear, shame, guilt, anger, and sadness among four types of traumatic events: sexual assault, physical assault, transportation accident, and illness/injury. Overall emotional responding was generally high for all trauma types, and for those in the sexual assault group, emotion increased sharply from the peri- to posttraumatic time-point. Generally, fear was higher during the trauma compared to after the trauma, whereas the other emotions tended to remain stable or increase posttrauma. The sexual assault group tended to report higher levels of posttrauma emotion than the other trauma type groups.
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9631
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Wani I. Management of penile fracture. Oman Med J 2008; 23:162-165. [PMID: 22359706 PMCID: PMC3282318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2008] [Accepted: 05/05/2008] [Indexed: 05/31/2023] Open
Abstract
OBJECTIVES To study clinical features and treatment of patients diagnosed with fractured penis. METHODS All patients diagnosed with penis fracture from March 2000-March 2007 were retrospectively studied. No invasive investigation was used for diagnosis. RESULTS Surgical intervention was done in 52 patients while 5 patients were managed conservatively. The constant finding recorded in all cases was that penis fracture occurred in erect penises. Most fractures were observed in the 16-30 years age group (50.88%). Left lateral tear was present in 53.84% cases. One patient had gangrene of penile skin after surgery. CONCLUSION Penis Fracture is not so uncommon as reported. A trauma to erect penis is mandatory for fracture to occur. Surgical intervention is the preferred mode of treatment.
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Affiliation(s)
- Imtiaz Wani
- Address correspondence and reprints request to: Imtiaz Wani, Shodi Gali, Amira Kadal, Department of Surgery, S.M.H.S Hospital Srinagar, Kashmir, India 190009. E-mail:
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9632
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Zoladz PR, Conrad CD, Fleshner M, Diamond DM. Acute episodes of predator exposure in conjunction with chronic social instability as an animal model of post- traumatic stress disorder. Stress 2008; 11:259-81. [PMID: 18574787 PMCID: PMC2535807 DOI: 10.1080/10253890701768613] [Citation(s) in RCA: 110] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
People who are exposed to horrific, life-threatening experiences are at risk for developing post-traumatic stress disorder (PTSD). Some of the symptoms of PTSD include persistent anxiety, exaggerated startle, cognitive impairments and increased sensitivity to yohimbine, an alpha(2)-adrenergic receptor antagonist. We have taken into account the conditions known to induce PTSD, as well as factors responsible for long-term maintenance of the disorder, to develop an animal model of PTSD. Adult male Sprague-Dawley rats were administered a total of 31 days of psychosocial stress, composed of acute and chronic components. The acute component was a 1-h stress session (immobilization during cat exposure), which occurred on Days 1 and 11. The chronic component was that on all 31 days the rats were given unstable housing conditions. We found that psychosocially stressed rats had reduced growth rate, reduced thymus weight, increased adrenal gland weight, increased anxiety, an exaggerated startle response, cognitive impairments, greater cardiovascular and corticosterone reactivity to an acute stressor and heightened responsivity to yohimbine. This work demonstrates the effectiveness of acute inescapable episodes of predator exposure administered in conjunction with daily social instability as an animal model of PTSD.
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Affiliation(s)
- Phillip R. Zoladz
- Department of Psychology, University of South Florida, 4202 E. Fowler Ave., PCD 4118G, Tampa, FL 33620, USA
- Medical Research, VA Hospital, 13000 Bruce B. Downs Blvd., Tampa, FL 33612, USA
| | - Cheryl D. Conrad
- Department of Psychology, Arizona State University, PO Box 871104, Tempe, AZ 85287, USA
| | - Monika Fleshner
- Department of Integrative Physiology and Center for Neuroscience, University of Colorado, Campus Box 354, Carlson 202F, Boulder, CO 80309, USA
| | - David M. Diamond
- Department of Psychology, University of South Florida, 4202 E. Fowler Ave., PCD 4118G, Tampa, FL 33620, USA
- Medical Research, VA Hospital, 13000 Bruce B. Downs Blvd., Tampa, FL 33612, USA
- Department of Molecular Pharmacology and Physiology, University of South Florida, 4202 E. Fowler Ave., PCD 4118G, Tampa, FL 33620, USA
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9633
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Abstract
INTRODUCTION The purpose of this paper is to evaluate the Silver Bullet Wound Closure Device (SBWCD, Boehringer Laboratories, Norristown, PA), a new device for delayed primary closure of fasciotomy wounds. MATERIALS AND METHODS A retrospective review was performed over a period of 36 months of all patients with an upper extremity fasciotomy that could not be closed primarily. Cases that underwent fasciotomy closure with the SBWCD were separated from the patients that had a split thickness skin graft (STSG). RESULTS Seven patients had their wound closed with the SBWCD within 10 days (mean of 7.4 days). The seven patients that underwent STSG had their wound closed in an average of 8.4 days. The average number of days between the day of the fasciotomy incision and the date of the placement of the SBWCD was 1.9 days. STSGs were placed on the fasciotomy wounds on an average of 10.3 days after the date of the fasciotomy incision. We found that the SBWCD allowed for starting to approximate the edges of the fasciotomy wound at an earlier time when compare to STSG (2.1 vs 10.3 days). CONCLUSIONS We feel that the SBWCD as a one-stage procedure provides a consistent and efficacious way to manage upper extremity fasciotomy wounds while minimizing the morbidity associated with STSG. Elimination of a second-stage procedure reduces hospital costs. Our findings may help to inform surgeons about an available alternative when an upper extremity fasciotomy wound is not amenable to primary closure.
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Affiliation(s)
- Carlos Medina
- Department of Surgery, Temple University Hospital, Zone C, Fourth Floor, 3401 N. Broad Street, Philadelphia, PA, 19140, USA.
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9634
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Hamel A, Caillon J, Jacqueline C, Rogez JM, Potel G. Internal device decreases antibiotic's efficacy on experimental osteomyelitis. J Child Orthop 2008; 2:239-43. [PMID: 19308584 PMCID: PMC2656810 DOI: 10.1007/s11832-008-0102-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2008] [Accepted: 04/09/2008] [Indexed: 02/03/2023] Open
Abstract
PURPOSE We have evaluated the effect of internal and external osteosynthesis devices on the efficacy of vancomycin treatment in a rabbit model of methicillin-resistant Staphylococcus aureus (MRSA)-induced post-traumatic osteomyelitis. METHODS Double tibial osteotomies in female New Zealand rabbits were performed, inoculated with a MRSA strain, then fixed with an intramedullary rod. A debridement was performed 4 days later for each rabbit, and a bacterial count in pus was determined (B1). In the first group (G1), the osteosynthesis material was removed and replaced by a new sterile nail. In the second group (G2), the intramedullary rod was removed and then replaced by an external fixator. Immediately after surgery, G1 and G2 rabbits were treated with vancomycin (60 mg/kg twice a day). The animals were sacrificed at the end of a 5-day period, and a bacterial count in pus was performed again (B2). RESULTS The difference of log(10) colony forming units per milliliter (CFU/ml) (B2-B1) was -1.2 +/- 0.5 and -2.9 +/- 1.1, respectively, for G1 and G2. CONCLUSION The efficacy of vancomycin treatment increased after removal of the internal osteosynthesis device.
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Affiliation(s)
- Antoine Hamel
- />Laboratoire de Thérapeutiques Cliniques et Expérimentales des Infections, EA 3826, Faculté de Médecine de Nantes, Université de Nantes, Nantes Atlantique Universités, rue Gaston Veil, Nantes, 44000 France , />Hôpital Mère-Enfant, Service de Chirurgie Pédiatrique, quai Moncousu, Centre Hospitalier Universitaire de Nantes, Nantes, 44093 France
| | - Jocelyne Caillon
- />Laboratoire de Thérapeutiques Cliniques et Expérimentales des Infections, EA 3826, Faculté de Médecine de Nantes, Université de Nantes, Nantes Atlantique Universités, rue Gaston Veil, Nantes, 44000 France
| | - Cédric Jacqueline
- />Laboratoire de Thérapeutiques Cliniques et Expérimentales des Infections, EA 3826, Faculté de Médecine de Nantes, Université de Nantes, Nantes Atlantique Universités, rue Gaston Veil, Nantes, 44000 France
| | - Jean-Michel Rogez
- />Hôpital Mère-Enfant, Service de Chirurgie Pédiatrique, quai Moncousu, Centre Hospitalier Universitaire de Nantes, Nantes, 44093 France
| | - Gilles Potel
- />Laboratoire de Thérapeutiques Cliniques et Expérimentales des Infections, EA 3826, Faculté de Médecine de Nantes, Université de Nantes, Nantes Atlantique Universités, rue Gaston Veil, Nantes, 44000 France
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9635
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Abstract
Renal artery dissection may be caused by iatrogenic injury, trauma, underlying arterial diseases such as fibromuscular disease, atherosclerotic disease, or connective tissue disease. Radiological imaging may be helpful in detecting renal artery pathology, such as renal artery dissection. For patients with acute, isolated renal artery dissection, surgical treatment, endovascular management, or medical treatment have been considered effective measures to preserve renal function. We report a case of renal infarction that came about as a consequence of renal artery dissection.
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Affiliation(s)
- Kyung Pyo Kang
- Department of Internal Medicine, Renal Regeneration Laboratory, Chonbuk National University Medical School, Jeonju, Korea
| | - Sik Lee
- Department of Internal Medicine, Renal Regeneration Laboratory, Chonbuk National University Medical School, Jeonju, Korea
| | - Won Kim
- Department of Internal Medicine, Renal Regeneration Laboratory, Chonbuk National University Medical School, Jeonju, Korea
| | - Gong Yong Jin
- Department of Diagnostic Radiology, Research Institute of Clinical Medicine, Chonbuk National University Medical School, Jeonju, Korea
| | - Ki Ryang Na
- Department of Internal Medicine, Chungnam National University Medical School, Daejeon, Korea
| | - Il Yong Yun
- Department of Internal Medicine, Renal Regeneration Laboratory, Chonbuk National University Medical School, Jeonju, Korea
| | - Sung Kwang Park
- Department of Internal Medicine, Renal Regeneration Laboratory, Chonbuk National University Medical School, Jeonju, Korea
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9636
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Abstract
PURPOSE To investigate injuries among children and adolescents who participate in downhill sports. METHODS We collected trauma registry data (January 1999-May 2006) from a level 1 pediatric trauma center with an average snowfall of 28 in (71 cm)/y. Cases were analyzed for injury mechanism, injury type, organ injured, Injury Severity Score, age, sex, and whether or not an operation was required. RESULTS There were 57 snowboarders and 22 skiers admitted during the study period. Forty-one (72%) of snowboarders and 16 (73%) of skiers required operations; 32 (56%) of snowboarders and 9 (41%) of skiers sustained fractures; and 14 (25%) of snowboarders and 6 (27%) of skiers sustained abdominal injuries. (P = NS for all comparisons). Serious splenic injuries were more common in snowboarders (14% vs 4%), but the difference was not statistically significant. All skiing injuries occurred at recreational facilities (commercial skiing areas), whereas 12% of snowboard injuries occurred at home, other residence, or public parks (P = .08). The most striking finding is the rising number of snowboarding injuries and the relatively stable rate of skiing injuries (see graph). CONCLUSIONS As the popularity of snowboarding rises, snowboarding injuries in children are increasing. Pediatric surgeons should be wary of the "snowboard spleen."
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Affiliation(s)
| | - Jonathan I. Groner
- Corresponding author. Tel.: +1 614 722 3919; fax: +1 614 722 3903. (J.I. Groner)
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9637
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Abstract
The aim of this study was to analyze cognitive dysfunction in PTSD. The testing included 79 Bosnian Army veterans, who participated in Bosnian war from 1992 to 1995. Out of 79 tested war veterans, 45 of developed PTSD while 34 did not. The veterans without PTSD where included in the control group. All the war veterans were of the same education level (secondary education) and between 30 and 50 years of age. Rivermead Behavioral Memory Test - RBMT was applied to all the subjects. The test was originally developed for the purpose of everyday memory problems identification. Clear goal of the 10 RBMT subtests is simulation of everyday life situations. PTSD group achieved significantly lower results than the control group. Results of the total score showed highly significant difference between PTSD and control group. Value of the t-test is t=10,056 with significance level of p<0,001. The same conclusion stands for any RBMT subtest. Numerous psychological studies on PTSD patients show more prominent psychological deficit in war veterans. Our study clearly confirms that finding.
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Affiliation(s)
- Aida Sarac-Hadzihalilović
- Department for Anatomy, Faculty of Medicine, University of Sarajevo, Sarajevo, Bosnia and Herzegovina
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9638
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Abstract
Research indicates that many college students report post-traumatic stress disorder (PTSD) or substance use disorder (SUD), yet there has been scant attention paid to the co-occurrence of these disorders in college students. This review examines the co-occurrence of PTSD and SUD in college students. Recommendations for counseling centers are provided regarding the assessment of this population, an overview of treatment issues, and three areas of clinical importance when working with this population: risk behaviors, interpersonal violence, and social isolation. Future directions for research are also suggested.
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Affiliation(s)
- Brian Borsari
- Assistant Professor, Center for Alcohol and Addiction Studies, Brown University, Box G-S121-5, Providence, RI 02903, and Providence Veterans Affairs Medical Center, 830 Blackstone Boulevard, Providence, RI 02908
| | - Jennifer P. Read
- Assistant Professor, Department of Psychology, 224 Park Hall, The University at Buffalo, State University of New York, Buffalo, NY 14222
| | - James F. Campbell
- Vice President of Clinical Services, Psychological Centers, Inc., 765 Allens Avenue, Providence, RI 02905
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9639
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Houston JE, Murphy J, Adamson G, Stringer M, Shevlin M. Childhood sexual abuse, early cannabis use, and psychosis: testing an interaction model based on the National Comorbidity Survey. Schizophr Bull 2008; 34:580-5. [PMID: 18024467 PMCID: PMC2632429 DOI: 10.1093/schbul/sbm127] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Previous research investigating the etiology of psychosis has identified risk factors such as childhood sexual abuse and cannabis use. This study investigated the multiplicative effect of these variables on clinically assessed diagnoses of psychosis based on a large community sample (the National Comorbidity Survey). Demographic variables (sex, age, urbanicity, ethnicity, education, employment, and living arrangements) and depression were used as predictors in the first block of a binary logistic regression. In the second block, the variables representing early cannabis use, childhood sexual trauma, and the interaction between these variables were entered. There was no significant main effect for early cannabis use or childhood sexual trauma. The interaction was statistically significant (odds ratio [OR] = 6.93, 95% confidence interval [CI] = 1.39-34.63, P = .02). The effect for the sexual trauma variable was statistically significant for those who used cannabis under 16 years (OR = 11.96, 95% CI = 2.10-68.22, P = .01) but not for those who had not used cannabis under 16 years (OR = 1.80, 95% CI = 0.91-3.57, P = .09). Many factors have been shown to be significant in the etiology of psychosis; however, the current research augments previous findings by examining psychosis in terms of an interaction between 2 of these factors.
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Affiliation(s)
| | | | | | | | - Mark Shevlin
- University of Ulster at Magee,To whom correspondence should be addressed; School of Psychology, University of Ulster at Magee College, Londonderry, BT48 7JL, Northern Ireland; tel: +44-28-7137561, fax: +44-28-71375493, e-mail:
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9640
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Mircea B, Florin-Mihail I. Damage control surgery--physiopathological benchmarks. J Med Life 2008; 1:96-100. [PMID: 20108455 PMCID: PMC5654068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
The following article, submitted in two complementary parts deals with an important and also modern concept developed under the name of damage-control surgery. Physiopathologically, the multiple injured patient is characterised by the probable, not just possible, appearance of the "blood's vicious cycle" of hypocoagulability, hypothermia and acidosis with death as a result. The first part of the article addresses the changes that are the reasons and the basis for applying damage-control surgery. Hypothermia is a direct result of trauma and patient's exposure to it but can also emerge throughout transportation, evaluation, emergency and surgical procedures to which the patient undergoes. Surgical procedures are directly a source that decreases the core temperature. While blood losses accompany trauma for certain and affect clot formation, the patient's coagulation system is impaired by these losses and the dysfunction is further enhanced by hypotermia, different mechanisms being involved. The third lethal component is acidosis. While being at first metabolically produced because of tissular injury, it is further enhanced by the other two elements. From a practical point of view, hypothermia and hypocoagulability can be though, more theoretically addressed, acidosis is more difficult to correct. As fav as the emergency specialist is concerned for the moment, the best solution to deal with this deadly triad is to prevent it. Damage-control surgery is just one type of measure in the process of prevention.
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9641
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Abstract
BACKGROUND Disasters are traumatic events that may result in a wide range of mental and physical health consequences. Post-traumatic stress disorder (PTSD) is probably the most commonly studied post-disaster psychiatric disorder. This review aimed to systematically assess the evidence about PTSD following exposure to disasters. MethodA systematic search was performed. Eligible studies for this review included reports based on the DSM criteria of PTSD symptoms. The time-frame for inclusion of reports in this review is from 1980 (when PTSD was first introduced in DSM-III) and February 2007 when the literature search for this examination was terminated. RESULTS We identified 284 reports of PTSD following disasters published in peer-reviewed journals since 1980. We categorized them according to the following classification: (1) human-made disasters (n=90), (2) technological disasters (n=65), and (3) natural disasters (n=116). Since some studies reported on findings from mixed samples (e.g. survivors of flooding and chemical contamination) we grouped these studies together (n=13). CONCLUSIONS The body of research conducted after disasters in the past three decades suggests that the burden of PTSD among persons exposed to disasters is substantial. Post-disaster PTSD is associated with a range of correlates including sociodemographic and background factors, event exposure characteristics, social support factors and personality traits. Relatively few studies have employed longitudinal assessments enabling documentation of the course of PTSD. Methodological limitations and future directions for research in this field are discussed.
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Affiliation(s)
- Y Neria
- Department of Epidemiology, Mailman School of Public Health, Columbia University Medical Center, New York, NY 10032, USA.
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9642
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Ganesh A, Bialasiewicz AA, Al-Zuhaibi SM, Sabt BI, Ganguly SS. Visual rehabilitation by scleral fixation of posterior chamber intraocular lenses in amblyopic aphakic children. Middle East Afr J Ophthalmol 2008; 15:61-5. [PMID: 21346839 PMCID: PMC3038110 DOI: 10.4103/0974-9233.51994] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background/Aims: To report on the outcome of scleral fixated posterior chamber intraocular lens (S-IOL) implantation in aphakic amblyopic children after 1 year. Methods: Amblyopic children with aphakia after traumatic and congenital cataract surgery unsuitable for spectacle or contact lens correction were operated with an anterior vitrectomy and inside-out double thread scleral fixation of an Alcon CZ70BD pcIOL. Refraction and vision was compared after 12 months. Results: From 2001-2006, 23 S-IOLs were implanted in 16 children (19 unilateral, 4 bilateral) aged 2-16 years: 10 eyes with traumatic [Group A], and 13 eyes with congenital cataracts including 3 eyes with ectopia lentis [Group B]. Preoperative UCVA compared to postoperative UCVA improved in 9/10 eyes in group A and 12/13 eyes in group B. Preoperative BCVA compared to postoperative UCVA improved in 9/10 eyes (90 percent) in group A and 4/13 eyes (31 percent) in group B. Mean age at surgery in group A was 6.8 years (1.5-16yrs) and in group B 10.5 years (4-16 years). More than one year elapsed in 2/10 eyes of group A and 8/13 eyes in group B. Postoperative refraction was within 2.0D of target in 17/23 eyes. Complications included temporary IOP rise in 2, vitreous hemorrhage in 1, and iris capture in 3 eyes. Two eyes required revision surgery. Conclusion: S-IOL implantation may be beneficial for aphakic children lacking other means for visual rehabilitation to improve vision. Amblyopia may be improved in most trauma, but only few congenital cataract eyes.
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Affiliation(s)
- Anuradha Ganesh
- Department of Ophthalmology and School of Ophthalmic Technicians, Sultan Qaboos University College of Medicine and Health Sciences, Muscat, Oman
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9643
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Ruchholtz S, Lefering R, Paffrath T, Oestern HJ, Neugebauer E, Nast-Kolb D, Pape HC, Bouillon B. Reduction in mortality of severely injured patients in Germany. Dtsch Arztebl Int 2008; 105:225-31. [PMID: 19629200 DOI: 10.3238/arztebl.2008.0225] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/23/2007] [Accepted: 02/07/2008] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The trauma registry of the German Society of Trauma Surgery is a multicentric prospective record of the treatment of severely injured patients. METHODS The present study examines the effect of a quality management system on key processes and outcomes, in hospitals included in the trauma registry. The study is based on data of 11 013 severely injured patients (injury severity score = 16) who were treated in 105 hospitals between 1993 and 2005. A variety of parameters relating to early diagnosis and treatment were considered. Outcome quality was measured by a comparison between observed and calculated mortality (revised injury severity classification). RESULTS During the 13 year long study period mortality could be significantly reduced from 22.8% to 18.7%. The time to initial radiological and ultrasound diagnosis was reduced, the use of computed tomography increased, the time until emergency operations in hemorrhagic shock was reduced, and damage limiting orthopedic interventions were performed more frequently. DISCUSSION The German Trauma Registry records processes and treatment results in severely injured patients. This information is fed back to participating hospitals. The continuous data feedback is associated with a continuous improvement of process and outcome quality in the treatment of severely injured patients.
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9644
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Koenen KC, Nugent NR, Amstadter AB. Gene-environment interaction in post traumatic stress disorder: review, strategy and new directions for future research. Eur Arch Psychiatry Clin Neurosci 2008; 258:82-96. [PMID: 18297420 PMCID: PMC2736096 DOI: 10.1007/s00406-007-0787-2] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The purpose of this article is to encourage research investigating the role of measured gene-environment interaction (G x E) in the etiology of posttraumatic stress disorder (PTSD). PTSD is uniquely suited to the study of G x E as the diagnosis requires exposure to a potentially-traumatic life event. PTSD is also moderately heritable; however, the role of genetic factors in PTSD etiology has been largely neglected both by trauma researchers and psychiatric geneticists. First, we summarize evidence for genetic influences on PTSD from family, twin, and molecular genetic studies. Second, we discuss the key challenges in G x E studies of PTSD and offer practical strategies for addressing these challenges and for discovering replicable G x E for PTSD. Finally, we propose some promising new directions for PTSD G x E research. We suggest that G x E research in PTSD is essential to understanding vulnerability and resilience following exposure to a traumatic event.
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Affiliation(s)
- Karestan C. Koenen
- Department of Society, Human Development, and Health and Epidemiology, Harvard School of Public Health, 677 Huntington Avenue, Kresge 613, Boston, MA 02115, USA, Tel.: 617/4324622. Fax: 617/4323755 E-Mail: ,Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Nicole R. Nugent
- Department of Psychiatry and Behavioral Science, Medical University of South Carolina, Charleston, SC, USA,Department of Psychology, Kent State University, Kent, OH, USA
| | - Ananda B. Amstadter
- Department of Psychiatry and Behavioral Science, Medical University of South Carolina, Charleston, SC, USA,Department of Psychology, Auburn University, Auburn, AL, USA
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9645
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Abstract
This study examines the relative contributions of cumulative maternal trauma, substance use, depressive and posttraumatic stress diagnoses on parental abuse potential, punitiveness, and psychological and physical aggression in a sample of 176 urban mothers. Participants were categorized into four groups: substance use (n = 41), depressed (n = 40), comorbid (n = 47), and control (n = 48). Participants in the three diagnostic groups reported significantly greater interpersonal trauma exposure than did controls. Hierarchical regressions reveal that cumulative trauma is a significant predictor of all parenting outcomes, even after controlling for demographic and diagnostic variables. Substance use and depression are significantly related to abuse potential, and PTSD is significantly negatively related to physical discipline, with no other significant associations between diagnostic status and parenting outcomes. These findings add to an important growing literature examining the impact of cumulative trauma on parental functioning. Implications for future research and parenting interventions are discussed.
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9646
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Affiliation(s)
- Arthur Becker-Weidman
- Center for Family Development, 5820 Main Street, Suite 406, Williamsville, NY 14221, USA. E-mail:
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9647
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Beck JG, Grant DM, Read JP, Clapp JD, Coffey SF, Miller LM, Palyo SA. The impact of event scale-revised: psychometric properties in a sample of motor vehicle accident survivors. J Anxiety Disord 2008; 22:187-98. [PMID: 17369016 PMCID: PMC2259224 DOI: 10.1016/j.janxdis.2007.02.007] [Citation(s) in RCA: 280] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2006] [Revised: 02/15/2007] [Accepted: 02/21/2007] [Indexed: 12/16/2022]
Abstract
This study examined the factor structure, internal consistency, concurrent validity, and discriminative validity of the Impact of Event Scale-Revised (IES-R, [Weiss, D. S. & Marmar, C. R. (1997). The Impact of Event Scale-Revised. In: J. P. Wilson & T. M. Keane (Eds.). Assessing psychological trauma and PTSD (pp. 399-411). New York: Guilford Press]) in a sample of 182 individuals who had experienced a serious motor vehicle accident. Results supported the three-factor structure of the IES-R, Intrusion, Avoidance, and Hyperarousal, with adequate internal consistency noted for each subscale. Support was obtained for the concurrent and discriminative validity, as well as the absence of social desirability effects. Although some differences were noted between the IES-R Avoidance subscale and diagnostically based measures of this cluster of symptoms, these differences do not necessarily signify measurement problems with the IES-R. The IES-R seems to be a solid measure of post-trauma phenomena that can augment related assessment approaches in clinical and research settings.
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Affiliation(s)
- J Gayle Beck
- Department of Psychology, University at Buffalo-SUNY, 230 Park Hall, Buffalo, NY 14260, USA.
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9648
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Abstract
Post-traumatic stress disorder (PTSD) has only relatively recently been introduced into the diagnostic classification of mental disorders. Building on advances in the treatment of other anxiety disorders, a range of effective psychological treatments for PTSD has been developed. The most effective of these treatments focus on the patient's memory for the traumatic event and its meaning. This paper briefly reviews the currently available evidence for these treatments. It then illustrates the process of developing effective psychological treatments by discussing how a combination of phenomenological, experimental and treatment development studies, and theoretical considerations was used to develop a trauma-focused cognitive-behavioral treatment, cognitive therapy (CT) for PTSD. This treatment program builds on Ehlers & Clark's (2000) model of PTSD, which specifies two core cognitive abnormalities in PTSD. First, people with chronic PTSD show idiosyncratic personal meanings (appraisals) of the trauma and/or its sequelae that lead to a sense of serious current threat. Second, the nature of the trauma memory explains the occurrence of re-experiencing symptoms. It is further proposed that the idiosyncratic appraisals motivate a series of dysfunctional behaviors (such as safety-seeking behaviors) and cognitive strategies (such as thought suppression and rumination) that are intended to reduce the sense of current threat, but maintain the problem by preventing change in the appraisals and trauma memory, and/or lead to increases in symptoms. CT addresses the cognitive abnormalities and maintaining behaviors in an individualized, but focused, way. Four randomized controlled trials and two dissemination studies showed that CT for PTSD is acceptable and effective.
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Affiliation(s)
- Anke Ehlers
- King's College London, Institute of Psychiatry, Department of Psychology, London, UK.
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9649
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Abstract
The management of open fractures continues to provide challenges for the orthopedic surgeon. Despite the improvements in technology and surgical techniques, rates of infection and nonunion are still troublesome. Principles important in the treatment of open fractures are reviewed in this article. Early antibiotic administration is of paramount importance in these cases, and when coupled with early and meticulous irrigation and debridement, the rates of infection can be dramatically decreased. Initial surgical intervention should be conducted as soon as possible, but the classic 6 h rule does not seem to be supported in the literature. All open fractures should be addressed for the risk of contamination from Clostridium tetani. When possible, early closure of open fracture wounds, either by primary means or by flaps, can also decrease the rate of infection, especially from nosocomial organisms. Early skeletal stabilization is necessary, which can be accomplished easily with temporary external fixation. Adhering to these principles can help surgeons provide optimal care to their patients and assist them in an early return to function.
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Affiliation(s)
- William W Cross
- Department of Orthopaedic Surgery, University of Minnesota Medical School, 2450 Riverside Ave., Ste R 200, Minneapolis, MN 55454, USA
| | - Marc F Swiontkowski
- Department of Orthopaedic Surgery, University of Minnesota Medical School, 2450 Riverside Ave., Ste R 200, Minneapolis, MN 55454, USA,Address for correspondence: Dr. Marc F. Swiontkowski, Department of Orthopaedic Surgery, University of Minnesota Medical School, 2450 Riverside Ave., Suite R200, Minneapolis, MN 55454, USA. E-mail:
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9650
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Abstract
Road traffic accidents are increasing at an alarming rate and have become a major public health concern in India. In addition, there is a lack of trauma research output and reliable data from India. There are several issues and challenges that have presented an opportunity for researchers and surgeons in India to develop a collaborative aimed at improving the quality and productivity of orthopaedic trauma research. Establishing a network of surgical researchers across India is a necessary first step towards global leadership in orthopaedic surgery trials.
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Affiliation(s)
- George Mathew
- Division of Orthopaedic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Parag Sancheti
- Sancheti Institute for Orthopaedics and Rehabilitation, Pune, India
| | - Anil Jain
- Professor, University College of Medical Sciences and University of Delhi, Editor, Indian Journal of Orthopaedics
| | - Mohit Bhandari
- Division of Orthopaedic Surgery, McMaster University, Hamilton, Ontario, Canada,Correspondence: Mohit Bhandari, Division of Orthopaedic Surgery, McMaster University 293 Wellington Street North, Suite 110, Hamilton, Ontario, Canada L8L 8E7
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