Use of Medical and Mental Health Care by World War II Survivors in The Netherlands

This study examined the mental and medical health care utilization of World War II (WWII) survivors and the characteristics of survivors seeking professional health care. Forty seven years after the end of WW II, a random sample of 4,057 Dutch WW II survivors answered a four-page questionnaire; 1,461 persons subsequently answered an extensive follow-up questionnaire. Twenty-two percent had sought some form of health care for war-related complaints at some time since WW II. Most consultations were made in the 1940s. More consultations were made to general practioners or to medical specialists as opposed to mental health specialists. Although the level of posttraumatic stress disorder (PTSD) symptoms was most important for discriminating between help-seeking and non-help-seeking respondents, 59% of the highly-exposed respondents with PTSD had not sought professional help in the years 1990–1992. The results show the importance of primary health care in recognizing PTSD symptoms and referring survivors to the appropriate professional helper.     

Posttraumatic Stress Disorder and Service Utilization Among Urban Mental Health Center Clients

Although the urban poor are at high risk for exposure to trauma, community mental health clinics rarefy diagnose clients with PTSD. Failure to diagnose PTSD may undermine the effectiveness of services provided. Our objectives were to (1) assess prevalence of traumatic experiences and PTSD, and (2) examine differences in service utilization between those who had PTSD and those who did not. Interview data were gathered from 181 urban psychiatric outpatients. A substantial number of clients had experienced at least one lifetime trauma (94%), and of those, 42% had PTSD during the past year. Analyses comparing service use between PTSD and nonPTSD clients supported our expectation that clients with PTSD would use more mental health services, and would be less satisfied with services than their nonPTSD counterparts.     

Psychiatric medication use among Manhattan residents following the World Trade Center disaster

To assess medication use in New York after the September 11th attacks, a telephone survey was conducted in October 2001 (N = 1,008). The prevalence of psychiatric medication use 30 days before the disaster was 8.9 and 11.6% 30 days after, a small but significant increase. The most important factor predicting postdisaster use was predisaster use—92% of those who used medications postdisaster used them predisaster. In addition, 3.3% used psychiatric medications 30 days postdisaster, but not 30 days before. Those who had panic attacks, posttraumatic stress disorder (PTSD), and insurance coverage, were the most likely medicated (26.5%). However, among those who used postdisaster medications (n = 129), new users tended to be those with panic attacks (44.1%) and those with panic attacks and PTSD (69.2%).     

Hurricane Sandy Exposure and the Mental Health of World Trade Center Responders

The psychological consequences of a second disaster on populations exposed to an earlier disaster have rarely been studied prospectively. Using a pre‐ and postdesign, we examined the effects of Hurricane Sandy on possible World Trade Center (WTC) related posttraumatic stress disorder (PTSD Checklist score of ≥ 50) and overall depression (major depressive disorder [MDD]; Patient Health Questionnaire depression score of ≥ 10) among 870 WTC responders with a follow‐up monitoring visit at the Long Island WTC Health Program during the 6 months post‐Hurricane Sandy. The Hurricane Sandy exposures evaluated were damage to home (8.3%) and to possessions (7.8%), gasoline shortage (24.1%), prolonged power outage (42.7%), and filing a Federal Emergency Management Agency claim (11.3%). A composite exposure score also was constructed. In unadjusted analyses, Hurricane Sandy exposures were associated with 1.77 to 5.38 increased likelihood of PTSD and 1.58 to 4.13 likelihood of MDD; odds ratios for ≥ 3 exposures were 6.47 for PTSD and 6.45 for MDD. After adjusting for demographic characteristics, WTC exposure, pre‐Hurricane Sandy mental health status, and time between assessments, reporting ≥ 3 Hurricane Sandy exposures was associated with a 3.29 and 3.71 increased likelihood of PTSD and MDD, respectively. These findings underscore the importance of assessing the impact of a subsequent disaster in ongoing responder health surveillance programs.     

The 2001 World Trade Center Disaster: Summary and Evaluation of Experiences

Abstract Objectives:   To collect and analyze data from deaths and injuries, and from evaluation of the responses by medical services and by fire, rescue, and police services 1 year after the terror attack on World Trade Center. Methodology:   Epidemiologic data were collected from all involved agencies and analyzed. The authors personal experience from working at the scene during the event and several other personal testimonies were also included in this analysis. Results:   Totally 2,762 death certificates were issued by the state of New York for victims of the terror attack. 1,361 (49.9%) of these were issued for victims whose remains could not be identified. All but nine of these victims died at the day of the attack. 77% of the victims were male, medium age 39 years. Of the dead were 342 fire fighters and paramedics and 60 police officers. A total of 1,103 patients were treated during the first 48 days in five key hospitals receiving the majority of the injured. 29% of these were rescue workers. 66% of the injured were male, average age 39 years. The most common injuries were respiratory impairment (49%) and ocular affection (26%), many severe. The most common trauma was lacerations (14%) and sprains (14%). Of those administered to hospital, 19% had trauma and 19% burns. Head injuries were registered in 6% and crush injuries in 4%. With regard to response from involved agencies, communication failure was the most common and difficulties in command operations and scene control were also prevalent. Conclusions:   The difficulties encountered were very similar to those commonly seen in major accidents or disasters, although on a great scale. Response plans have to be critically reviewed based on the experiences from this and other events, in order to pre-empt difficulties such as those described here in future responses to major urban accidents and disasters. † John P. Pryor was killed during his work in Iraq on Christmas Day 2008. Received: September 25, 2002; revision accepted: November 27, 2002 First Published in Int J Disaster Medicine 2003;1:56–68; Published Online: June 1, 2009     

Coping,functioning, and adjustment of rescue workers after the Oklahoma City bombing

Studies have not previously considered postdisaster adjustment in the context of psychiatric disorders. After the Oklahoma City bombing, a volunteer sample of 181 firefighters who served as rescue and recovery workers was assessed with a structured diagnostic interview. The firefighters had relatively low rates of posttraumatic stress disorder (PTSD) and described little functional impairment, positive social adjustment, and high job satisfaction. PTSD was associated with reduced job satisfaction and functional impairment, providing diagnostic validity. Turning to social supports, seeking mental health treatment, and taking medication were not widely prevalent coping responses. Postdisaster alcohol use disorders and drinking to cope were significantly associated with indicators of poorer functioning. Surveillance for problem drinking after disaster exposure may identify useful directions for intervention.     

Mental health consequences of the Lockerbie Disaster

This paper examines mental health consequences of the Lockerbie Disaster in 66 adults claiming compensation from the insurers of the airline. Claimants were examined 10 to 14 months after the disaster by clinical interview and questionnaires. The most frequent diagnoses were post-traumatic stress disorder and depression, followed by other anxiety disorders. Many were above caseness levels on questionnaires, and had very high scores on intrusion and avoidance. There were no significant predictors of the presence or severity of diagnosis, but a number of predictors (age, death of friends, exposure to unpleasant sights) of questionnaire scores.     

Mental Health in Offspring of Traumatized Refugees with and without Post‐traumatic Stress Disorder

Intergenerational transmission of psychological trauma and the impact of parental post‐traumatic stress disorder (PTSD) on offspring are controversially discussed. We studied 50 offspring (36 women and 14 men, mean age 42.1 years) of refugees who were severely traumatized as children at the end of World War II. From these, 25 of the refugees currently suffered from chronic PTSD, and 25 had no PTSD. Parental PTSD status did not significantly influence mental health [as per the Symptom Checklist (SCL)‐90‐R] or quality of life (assessed by the 36‐item Short‐form Health Survey) in their children. In the entire sample, frequency of talking with the mother about the flight correlated with phobic anxiety (r = 0.67, p = 0.03). Interestingly, the stated burden of having a parent with a history of flight significantly (p < 0.05) correlated with almost all subscales of the SCL‐90‐R. These results in a non‐clinical sample do not support a specific role of parental PTSD in intergenerational trauma transmission. Our other remarkable, but preliminary, results need to be studied in larger samples using more subtle interaction or schema analyses. Copyright © 2015 John Wiley & Sons, Ltd.     

Crisis support following the herald of free-enterprise disaster: A longitudinal perspective

Crisis support was assessed with survivors of the Herald of Free Enterprise ferry sinking at 3 and 6 years postdisaster. It was found that reported levels of support received from family and friends decreased over the first 3 years after the event but increased over the subsequent 3 years. In addition, higher retrospective ratings of crisis support received in the immediate aftermath of the disaster were found to predict lower levels of posttraumatic symptomatology as assessed by the Impact of Event Scale, the Beck Depression Inventory and the State-Trait Anxiety Inventory at a later period. The results replicate earlier findings following the Jupiter Cruise ship disaster and are thought to have implications for the assessment and treatment of survivors at high risk of disturbance.     

A new development in PTSD and the law: the case of Fairfax County v. Mottram

The decision of the Virginia Supreme Court in Fairfax County Fire & Rescue Department v. Mottram (2002) has important implications for Workers' Compensation claims for posttraumatic stress disorder, particularly those involving emergency services personnel. A firefighter/paramedic who developed chronic, disabling PTSD after responding to a fatal fire was denied benefits because he had previously reported symptoms of the disorder, whereas the statute recognized a single traumatic incident only. The court held that PTSD resulting from multiple traumatic stressors may be considered a compensable occupational disease analogous to dermatitis developed by a flower shop employee with chronic exposure to irritating stimuli. The decision, which constitutes legal recognition of work-related cumulative PTSD in rescue workers, provides benefits for treatment and encourages earlier treatment of traumatic stress in this group.     

Transgenerational Effects of Abusive Violence on the Children of Vietnam Combat Veterans

This study examined the relationship between participation in abusive violence in Vietnam and behavioral disturbances among children aged 6-16 in the next generation. As part of the National Vietnam Veterans Readjustment Study (NVVRS) detailed data were obtained on a national sample of male veterans who were living in households with children aged 6–16 (N = 257). Interviews with spouses/partners were used to evaluate current family relationships and child behavior. Children of veterans who participated in abusive violence showed more behavioral disturbance than children of other Vietnam veterans even after multivariate analysis was used to adjust for other factors such as PTSD symptoms, combat exposure, and postmilitary family relationships. Participation in abusive violence appears to affect parent-child relationships in a way that adversely influences children living at home.     

Psychological consequences of life‐saving cardiac surgery in patients and partners: measurement of emotional stress by the Impact of Event Scale

The objective of this study is to investigate the long‐term psychological aftermaths of the implantation of a ventricular assist device as bridge to successful heart transplantation. Cross‐sectional, retrospective assessment of 30 patients (aged 48.1 ± 11.5 years, m/f = 28/2, 64.8 ± 32.2 months, range 12–134 months after transplantation) and 21 partners (m/f = 1/20) by standardized instruments [Impact of Event Scale (IES‐R), Hospital Anxiety and Depression Scale] and a questionnaire about specific problems regarding the time on the device (Artificial Heart Questionnaire) at Vienna Transplant Center (Austria) were used. Twenty patients suffered from dilatative cardiomyopathy and 10 of ischemic cardiomyopathy. The assist remained implanted for 158 ± 130 days (range 28–711). After transplantation, patients had to stay in Coronary care unit for 8.5 ± 7.3 days (range1–40) and remained in hospital for 29.8 ± 7.9 days (range 21–51) before they were transferred to a rehabilitation unit. None of the patients but 23 per cent of the partners (n = 6) met the criteria for post‐traumatic stress disorder (Maercker cut‐off > 0). Thereby, the IES‐R sum scales differed significantly between the two groups [21.2 ± 15.1 (mean ± standard deviation) for patients versus 38.1 ± 27.8 for partners, respectively, p = 0.001]. Two per cent of the patients and 19 per cent (p = 0.055) of the partners showed mild to moderate depression, and 4 per cent of patients and 23 per cent (p = 0.007) of their partners reported mild to moderate anxiety. None of the results were significantly influenced by the time elapsed since transplantation, the patients' age, diagnoses or indication for heart transplantation. However, the type of assist device had significant effects on hyperarousal (p = 0.040), avoidance (p = 0.030), sum scale (p = 0.050) and IES‐R‐cut‐offs (p = 0.039) of the spouses. Concerning the specific heart support related questions, patients rated all the items lower than did their respective spouses. These values significantly were lower for pain (p = 0.034) and stroke (p = 0.008) in spouses than patients. Despite of patients being much closer to a life threat, it is their partners who experience significantly more psychological distress even in the long run. Our findings highlight the need to support the supporting persons. Copyright © 2008 John Wiley & Sons, Ltd.     

Performance of Children of Adults with PTSD on the Stroop Color-Naming Task: A Preliminary Study

Investigators have used various experimental paradigms to study how individuals with different emotional disorders process emotional information. However, little research has been done on relatives of individuals with emotional disorders, despite developments in the area of emotional contagion. In the current experiment, children of adults with posttraumatic stress disorder (PTSD) (n = 18) and control participants (n = 21), ages 9–17 years, participated in a modified Stroop color-naming task. The results indicated that the children of adults with PTSD showed increased Stroop interference for threat-related relative to neutral words and to the performance of the controls. These findings are discussed with respect to the literature on information processing in PTSD and emotional contagion in families.     

《2020年世界卫生组织运动和久坐行为指南》解读

世界卫生组织(World Health Organization,WHO)于2020年11月发布了《2020年WHO运动和久坐行为指南》.此次指南相较于2010年WHO运动指南纳入了更广泛的医学证据,并对特殊人群进行了针对性的推荐.其主要内容包括对儿童及青少年、成年人、老年人、孕产妇、慢性病群体及残障群体的运动和久坐建...     

Effect of the sexual abstinence period recommended by the World Health Organization on clinical outcomes of fresh embryo transfer cycles with normal ovarian response after intracytoplasmic sperm injection

This study was to investigate whether the sexual abstinence period (SAP) recommended by the World Health Organization (WHO) affects clinical outcomes. We compared the rate of clinical outcomes between 2–7 and ≥8 days of SAP in first fresh embryo transfer after intracytoplasmic sperm injection (ICSI) in groups of young maternal age (YMA: <38 years) and old maternal age (OMA: ≥38 years). We conducted a retrospective study of 449 first ICSI cycles with a normal ovarian response. SAP was identified before collecting the semen samples. Semen analysis was performed based on the guidelines recommended by WHO (2010). Sperm preparation was made using the swim‐up method. Patients’ baseline characteristics in the YMA and OMA groups did not differ. The rates of fertilisation, top‐quality embryos on day 3, biochemical pregnancy, clinical pregnancy, ongoing pregnancy, abortion and implantation per cycle were not significantly different between 2–7 and ≥8 days of SAP in the YMA or OMA group. In conclusion, SAP beyond the recommended period by WHO was not associated with the rates of a lower fertilisation and pregnancy in human in vitro fertilisation (IVF). We think that a new criterion of SAP for clinical application in human IVF needs to be considered by WHO.     

Effect of varicocele on semen characteristics according to the new 2010 World Health Organization criteria: a systematic review and meta-analysis

This study investigated the effects of varicocele on semen parameters in infertile men based on the new 2010 World Health Organization laboratory manual for the examination of human semen. Semen analysis results (volume, sperm count, motility, and morphology) were the primary outcomes. An electronic search to collect the data was conducted using the Medline/PubMed, SJU discover, and Google Scholar databases. We searched articles published from 2010 to August 2015, i.e., after the publication of the 2010 WHO manual. We included only those studies that reported the actual semen parameters of adult infertile men diagnosed with clinical varicocele and contained a control group of either fertile men or normozoospermic men who were not diagnosed with varicocele. Ten studies were included in the meta-analysis, involving 1232 men. Varicocele was associated with reduced sperm count (mean difference: −44.48 × 10⁶ ml⁻¹; 95% CI: −61.45, −27.51 × 10⁶ ml⁻¹; P < 0.001), motility (mean difference: −26.67%; 95% CI: −34.27, −19.08; P < 0.001), and morphology (mean difference: −19.68%; 95% CI: −29.28, −10.07; P < 0.001) but not semen volume (mean difference: −0.23 ml; 95% CI: −0.64, 0.17). Subgroup analyses indicated that the magnitude of effect was influenced by control subtype but not WHO laboratory manual edition used for semen assessment. We conclude that varicocele is a significant risk factor that negatively affects semen quality, but the observed pooled effect size on semen parameters does not seem to be affected by the WHO laboratory manual edition. Given most of the studies published after 2010 still utilized the 1999 manual for semen analysis, further research is required to fully understand the clinical implication of the 2010 WHO laboratory manual on the association between varicocele and semen parameters.     

Evaluating the Impact of Performance Improvement Initiatives on Transplant Center Reporting Compliance and Patient Follow‐Up After Living Kidney Donation

With the changing demographics of the living donor population and increased regulatory oversight, it is important that transplant centers report outcomes accurately. The aim of our retrospective cohort study of 312 living donors who underwent nephrectomy between 2008 and 2013 was to evaluate the impact of living donor program performance improvement initiatives on: (i) transplant center program reporting compliance; (ii) patient compliance with postdonation follow‐up and its associated factors; and (iii) overall financial costs to the transplant center. The effect of the initiatives (donation eras 2008–2010 and 2011–2013) on compliance at key reporting points (6 months, 1 year, 2 years) was analyzed using correlation coefficients, χ² and Fisher's exact tests. Multivariable logistic regression models tested the initiatives' effect on the likelihood of patient follow‐up. The initiatives were associated with significant improvement in form reporting compliance (r ≥ 0.862, p ≤ 0.027; 1 and 2 year Fisher's Exact p ≤ 0.002) and patient follow‐up (χ² p ≤ 0.009) with acceptable transplant center costs. Multivariable analyses demonstrated that donation era was consistently and significantly (p < 0.001) associated with increased likelihood of postdonation patient follow‐up. Institution of performance improvement initiatives with dedicated program resources is financially feasible and leads to more accurate and complete form reporting and improved patient follow‐up after nephrectomy.