Post‐traumatic reactions among rescue personnel before and after exposure to trauma: a brief report

There are only a few studies that check rescue personnel before and after exposure to trauma. Peritraumatic dissociation and post‐traumatic reactions were examined among rescue personnel in a rescue course and 36–48h after exposure to a gas pipe explosion in Tel Aviv. The entire rescue personnel were examined for peritraumatic dissociation and post‐traumatic reactions. Only those with prior measurements of peritraumatic dissociation and post‐traumatic reactions were eligible for analysis. The results showed that the only significant increase among rescue personnel was in peritraumatic dissociation between before in comparison to after exposure to trauma. No significant change was found in avoidance, intrusion, and post‐traumatic symptoms. These results correspond with previous studies that found increased peritraumatic dissociation among rescue personnel as a function of exposure severity. Explanations for these results are discussed. Copyright © 2006 John Wiley & Sons, Ltd.     

The association between peritraumatic dissociation and acute stress reactions among rescue personnel 36–48h after a gas pipe explosion in Tel‐Aviv: a preliminary report

The association between peritraumatic dissociation and acute stress reactions were examined among rescue personnel 36–48h after exposure to a gas pipe explosion resulting in a collapsed building in Tel Aviv. The entire rescue personnel were examined for peritraumatic dissociation and acute stress reactions. The results showed that among men there was a negative association between peritraumatic dissociation and acute stress reactions. Among women, there was a positive association between peritraumatic dissociation and acute stress reactions. These results correspond with previous studies that found an association between peritraumatic dissociation and acute stress reactions. Explanations to these results are discussed. Copyright © 2006 John Wiley & Sons, Ltd.     

Consistency of self‐reports of traumatic events in a population of Dutch peacekeepers: Reason for optimism?

Doubts have been raised concerning the reliability and the validity of self-reports of traumatic events. A correlation between the number of inconsistencies in self-reports and the level of PTSD symptoms has been found. We examine whether these results can be generalized to a population of 137 Dutch peacekeepers who took part in operation UNTAC (United Nations Transitional Authority in Cambodia). The peacekeepers completed a 16-item trauma checklist, 3 and 4 years after their return from UNTAC. The test-retest reliability of the trauma checklist was adequate. Inconsistencies were randomly divided over all respondents and all items and were not correlated with symptoms of PTSD. No increase in the number of reported events over time was found. Earlier findings raising doubts concerning the reliability and validity of self-report measures of exposure were not replicated in this sample of Dutch peacekeepers.     

Trauma in antiquity: 4000 year old post‐traumatic reactions?

‘The lamentation over the destruction of Ur’ and ‘The death of Urnamma’ are probably the earliest documented evidence of post‐traumatic reactions in recorded history. The author of this article suggests extending the time line for the known existence of post‐traumatic reactions back to 2000–2100 BC. The author would like to present a new perception relating to the existence of ancient knowledge regarding psychological trauma. This article is based on cuneiform tablets found in the ruins of the Sumerian city, Ur. The author found that reactions to traumatic events elicit post‐traumatic symptoms have not changed dramatically over the millennia. These data support the thesis that reaction to traumatic events leading to psychological trauma was a known concept in antiquity. Future implications to the study of traumatic reactions are discussed. Copyright © 2004 John Wiley & Sons, Ltd.     

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.     

Post‐traumatic Growth in the Italian Experience of Long‐term Disease‐free Cancer Survivors

Cancer survivors often report post‐traumatic growth. Since culture influences the development of post‐traumatic growth, the aims of this study were to measure the prevalence of post‐traumatic growth in Italian long‐term disease‐free and treatment‐free cancer survivors (≥5 years) and explore the relationship between post‐traumatic growth and sociodemographic and clinical variables. Three hundred sixty long‐term disease‐free and treatment‐free cancer survivors were assessed with Post‐traumatic Growth Inventory (PTGI), Brief COPE and Multidimensional Scale of Perceived Social Support (MSPSS). Mean age was 58.6 years, and mean survival was 11 years (range 5–32). The PTGI average total score was higher in younger survivors, in those without comorbidities, in survivors engaged in physical activity. Positive correlation between PTGI and Brief COPE and between PTGI and MSPSS were found. The variables more associated with post‐traumatic growth were age, comorbidity, physical activity and two coping subscales. The prevalence of post‐traumatic growth in this sample of cancer survivors was lower than previous studies. We discussed some possible explanations, including the consideration that cultural differences may affect the development of post‐traumatic growth in cancer survivors. Having less comorbidities, receiving social support from friends, having the ability to adaptively cope and engaging in physical activity were found to be strongly associated with post‐traumatic growth. Copyright © 2013 John Wiley & Sons, Ltd.     

Post‐traumatic stress disorder's relation with positive and negative emotional avoidance: The moderating role of gender

Post‐traumatic stress disorder (PTSD) is characterized by avoidance of trauma‐related emotions. Research indicates that this avoidance may extend to any emotional experience that elicits distress, including those that are unrelated to the trauma. Literature in this area has been limited in its exclusive focus on negative emotions. Despite evidence of gender differences in PTSD and emotional avoidance separately, no studies to date have examined gender as a moderator of their association. The goal of the current study was to extend research by exploring the moderating role of gender in the relation between PTSD symptom severity and positive and negative emotional avoidance. Participants were 276 trauma‐exposed individuals (65.9% female, 65.6% White, M_age = 19.24) from a university in the north‐eastern United States. Moderation results indicated a main effect for PTSD symptom severity on both positive (b = 0.07, p < .001) and negative (b = 0.04, p = .03) emotional avoidance. The interaction of gender and PTSD symptom severity was significant for positive emotion avoidance (b = 0.97, p = .01). Analysis of simple slopes revealed that PTSD symptom severity was significantly associated with positive emotional avoidance for males (b = 0.13, p < .001) but not females (b = 0.03, p = .08). Results suggest the importance of gender‐sensitive recommendations for assessment and treatment of emotional avoidance in PTSD.     

Efficacy of bacillus Calmette‐Guérin in the treatment of superficial bladder cancer: The impact of previous intravesical treatment

Objective: To clinically evaluate the role of intravesical bacillus Calmette‐Guérin (BCG) in the management of superficial bladder cancer, focusing on dose, age, high grade/stage, and pretreatment episodes with other therapies in long‐term follow‐up patients. Methods: A total of 213 patients with superficial (Ta‐T1) transitional cell carcinoma of the bladder received 6–8 weekly instillations of 40, 60 or 80 mg of Tokyo strain BCG. Further 6–8 monthly applications were given in some cases. Results: Recurrence‐free and progression‐free survival rates were compared with reference to dose, age, previous treatment, grade, stage, and high risk categories. Overall recurrence‐free rates for 3, 5, and 10 years were 70.8%, 67.1%, and 57.6%, with progression‐free survival rates of 94.5%, 93.6%, 90.6%, respectively. In univariate analyses, younger cases demonstrated higher recurrence‐free survival rates, but without statistical significance (P = 0.1229). Recurrence‐free rates were significantly higher for cases without previous intravesical treatment (P = 0.0010). There was no significant BCG dose‐dependence. High grade and high stage patients were confirmed as having higher recurrence and progression rates. Conclusions: Intravesical instillation of BCG is the most effective in the long term when chosen as the initial prophylactic therapy for the prevention of recurrence in superficial bladder cancer.     

Therapeutic opportunities to prevent post‐traumatic arthritis: Lessons from the natural history of arthritis after articular fracture

An estimated 12% of patients seeking surgical intervention for symptomatic arthritis have an etiology of post‐traumatic arthritis (PTA). The onset of PTA is rapid in the setting of articular fracture (AF). The investigation began with development of a murine model of a closed AF that develops PTA. In the process of characterizing this model a technique was developed for assessing quantitative synovial fluid biomarker concentrations. The work began with observations of the natural history of PTA development in the C57BL/6 strain of mice. A species of mice (MRL/MpJ) was found that is protected from PTA after AF. Further work identified key differences between mouse strains that did and did not develop PTA. This knowledge led to an intervention based on anti‐cytokine (interleukin 1 receptor antagonist, (IL‐1Ra) delivery in the C57BL/6 strain of mice that successfully prevented PTA following AF. This success in preventing PTA in the murine model has elucidated several important clinical implications: 1) Pro‐inflammatory cytokines play an important role in the development of PTA after joint injury, 2) Pharmacologic intervention can lessen the severity of PTA after an AF, and 3) The murine AF model of joint injury provides a novel means of studying mechanisms of PTA development. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 33:1266–1277, 2015.     

The effect of childhood sexual assault history on outpatient cognitive processing therapy for military sexual trauma‐related posttraumatic stress disorder: A preliminary investigation

History of childhood sexual assault (CSA) may result in poorer emotion regulation and interpersonal functioning, potentially affecting the tolerability and effectiveness of evidence‐based treatments (EBTs) for posttraumatic stress disorder (PTSD). Survivors of military sexual trauma (MST) have an increased incidence of CSA; however, research examining the role of CSA in EBTs for veterans with MST‐related PTSD is limited. Data from 32 (9 male; 23 female) veterans with MST‐related PTSD were used from a previously conducted randomized clinical trial examining the efficacy of an outpatient PTSD EBT (i.e., cognitive processing therapy [CPT]). Self‐rated PTSD symptom severity was assessed at pretreatment, during treatment, and up to 6 months following treatment completion. Number of CPT sessions attended and treatment completion were also examined. Using a hierarchical linear modelling approach, results indicated both veterans with and without a history of CSA were found to benefit from CPT, and history of CSA did not significantly predict treatment response. Additionally, number of sessions attended and treatment completion did not significantly vary based on history of CSA. These preliminary findings provide support for the tolerability and efficacy of outpatient CPT in veterans with MST‐related PTSD regardless of CSA history.     

Alignment of adherence and risk for HIV acquisition in a demonstration project of pre‐exposure prophylaxis among HIV serodiscordant couples in Kenya and Uganda: a prospective analysis of prevention‐effective adherence

Introduction: Adherence is essential for pre‐exposure prophylaxis (PrEP) to protect against HIV acquisition, but PrEP use need not be life‐long. PrEP is most efficient when its use is aligned with periods of risk – a concept termed prevention‐effective adherence. The objective of this paper is to describe prevention‐effective adherence and predictors of adherence within an open‐label delivery project of integrated PrEP and antiretroviral therapy (ART) among HIV serodiscordant couples in Kenya and Uganda (the Partners Demonstration Project). Methods : We offered PrEP to HIV‐uninfected participants until the partner living with HIV had taken ART for ≥6 months (a strategy known as “PrEP as a bridge to ART”). The level of adherence sufficient to protect against HIV was estimated in two ways: ≥4 and ≥6 doses/week (per electronic monitoring). Risk for HIV acquisition was considered high if the couple reported sex with <100% condom use before six months of ART, low if they reported sex but had 100% condom use and/or six months of ART and very low if no sex was reported. We assessed prevention‐effective adherence by cross‐tabulating PrEP use with HIV risk and used multivariable regression models to assess predictors of ≥4 and ≥6 doses/week. Results : A total of 985 HIV‐uninfected participants initiated PrEP; 67% were male, median age was twenty‐nine years, and 67% reported condomless sex in the month before enrolment. An average of ≥4 doses and ≥6 doses/week were taken in 81% and 67% of participant‐visits, respectively. Adherence sufficient to protect against HIV acquisition was achieved in 75–88% of participant‐visits with high HIV risk. The strongest predictor of achieving sufficient adherence was reporting sex with the study partner who was living with HIV; other statistically significant predictors included no concerns about daily PrEP, pregnancy or pregnancy intention, females aged > 25 years, older male partners and desire for relationship success. Predictors of not achieving sufficient adherence were no longer being a couple, delayed PrEP initiation, >6 months  of follow‐up, ART use > 6 months  by the partner living with HIV and problem alcohol use. Conclusions: Over three‐quarters of participant‐visits by HIV‐uninfected partners in serodiscordant couples achieved prevention‐effective adherence with PrEP. Greater adherence was observed during months with HIV risk and the strongest predictor of achieving sufficient adherence was sexual activity.     

Post‐transplant lymphoproliferative disorders,Epstein‐Barr virus infection,and disease in solid organ transplantation: Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice

These updated guidelines from the American Society of Transplantation Infectious Diseases Community of Practice review the diagnosis, management, and prevention of post‐transplant lymphoproliferative disorders (PTLD) and other Epstein‐Barr virus (EBV) syndromes after solid organ transplantation. PTLD are a heterogeneous spectrum of predominantly B‐cell disorders, often extra‐nodal, with complex distinct pathogeneses and variable clinical presentations determined by pathologic subtype. Recent epidemiologic studies report a decrease in early EBV‐positive (+) PTLD and an increase in late EBV‐negative (?) PTLD. Pre‐transplant EBV‐seronegativity and primary EBV infection, often from donor‐transmitted infection, are an important risk factors for EBV syndromes and early EBV + PTLD. Low‐quality evidence supports preemptive prevention strategies for early EBV + PTLD in EBV‐seronegative recipients that involve EBV DNA measurement in peripheral blood using assays requiring further result harmonization, combined with interventions to lower viral load. Reduction in immunosuppression (RIS) is the best validated intervention. WHO pathology classification of a tissue biopsy remains the gold standard for PTLD diagnosis; optimal staging procedures are uncertain. Treatment of CD20⁺ PTLD with the response‐dependent sequential use of RIS, rituximab, and cytotoxic chemotherapy is recommended. Evidence gaps requiring future research and alternate treatment strategies including immunotherapy are highlighted.     

The impact of sociodemographic characteristics,lifestyle, work exposure and medical history on semen parameters in young Chinese men: A cross‐sectional study

There is an ongoing debate on the declining semen quality, and unfortunately, existing evidence is inconclusive and inconsistence. We evaluated the impact of sociodemographic characteristics, lifestyle, medical history and work exposure on semen quality. Univariate and multivariate analysis was used to investigate the association between different risk factors and semen quality parameters. Total sperm count (p = 0.041), sperm concentration (p = 0.007), normal morphology (p = 0.002), total motility (p = 0.004) and progressive motility (p = 0.009) decreased in men with varicocele. Sperm concentration increased in tea (p = 0.044); progressive and total motility increased in cola (p = 0.018, p = 0.012) consumers. Progressive and total motility decreased in urogenital surgery (p = 0.016, p = 0.014) and infection (p = 0.037, p = 0.022). However, age, coffee and alcohol drinking, physical activities, sleep duration and cell phone use were unrelated to any of semen parameters. Interestingly, semen volume (p < 0.0001), total sperm count (p < 0.0001) and concentration (p < 0.033) increased with longer abstinence period (>5 days); normal morphology (p = 0.013) improved in men with higher body mass index (BMI > 24), curvilinear velocity (p = 0.042) increased with smoking; semen volume (p = 0.050) increased in manual labourers. This study highlights the importance of sociodemographic characteristics, lifestyle, occupational exposure and medical history and provides time trends in semen quality, its clinical importance and direction for further research.     

Comparison of volumetric bone mineral density in the operated and contralateral knee after anterior cruciate ligament and reconstruction: A 1‐year follow‐up study using peripheral quantitative computed tomography

The purpose of this study was to quantify changes in volumetric bone mineral density (vBMD) in the tibial plateau of the operated and contralateral leg measured using peripheral quantitative computed tomography (pQCT) before and 3, 6, and 12 months after anterior cruciate ligament (ACL) reconstruction. The ACL was reconstructed with a hamstring tendon autograft using press‐fit fixation. pQCT measurements of the proximal tibia were obtained in 61 patients after ACL reconstruction, and total, cortical, and trabecular vBMD were calculated. vBMD in the operated leg decreased from baseline to 3 months (?12% [total], ?11% [cortical], and ?12.6% [trabecular]; p < 0.001) and remained below baseline for 12 months after surgery (6 months: ?9.5%, ?9.4%, and ?9.6%, p < 0.001; 12 months: ?8%, ?5%, and ?11%, p < 0.001). vBMD in the contralateral leg was slightly reduced only 6 months after surgery. Including age and sex as covariates into the analysis did not affect the results. ACL reconstruction contributed to loss in bone mineral density within the first year after surgery. The role of factors such as time of weight‐bearing, joint mechanics, post‐traumatic inflammatory reactions, or genetic predisposition in modulating the development of posttraumatic knee osteoarthritis after ACL injury should be further elucidated. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 33:1804–1810, 2015.