A Test of Adolescent Internalizing and Externalizing Symptoms as Prospective Predictors of Type of Trauma Exposure and Posttraumatic Stress Disorder

The present study utilized longitudinal data from a high‐risk community sample (N = 377; 166 trauma‐exposed; 202 males; 175 females; 73% non‐Hispanic Caucasian) to test pretrauma measures of adolescent internalizing and externalizing symptoms as unique prospective predictors of type of trauma exposure and PTSD over and above the influence of correlated family adversity (a composite of family conflict, stress, and parental psychopathology). Data were analyzed with logistic and multinomial logistic regressions. Results indicated that females, but not males, with higher levels of internalizing (OR = 2.91) and externalizing (OR = 2.37) symptoms during adolescence were significantly more likely to be exposed to assaultive violence (over and above family adversity). In fact, males with higher levels of internalizing symptoms were significantly less likely to be exposed to assaultive violence (OR = 0.54). Neither internalizing nor externalizing symptoms uniquely predicted exposure to traumatic events that did not involve assaultive violence. Among trauma‐exposed participants, the unique association between internalizing symptoms and later PTSD yielded an odds ratio of 1.79 (p = .07) over and above the influences of family adversity, type of trauma exposure, and gender. Assaultive violence exposure fully mediated the association between females’ externalizing symptoms and future PTSD. Findings may help inform the prevention of both assaultive violence exposure and PTSD.     

Long-Term Outlook after Successful Fibrin Glue Ablation of Cryptoglandular Transsphincteric Fistula-in-Ano

Purpose

Initial success rates for fibrin glue ablation of cryptoglandular transsphincteric fistulas have been disappointing. We examined long-term outcomes after initially successful fibrin glue ablation of cryptoglandular transsphincteric fistulas.

Methods

Retrospective review identified 36 adult patients with cryptoglandular transsphincteric fistula Tisseel VH® fibrin glue ablation that was performed from May 2000 to March 2005. Fibrin glue ablations were performed under supervision of fellowship-trained colorectal surgeons. Follow-up interval was based on time until recurrence of fistula or time of last fistula-free evaluation.

Results

Twenty-four men and 12 women patients had a mean age of 50 (range, 27–85) years. Twenty patients responded to initial fibrin glue ablation treatment. Two additional patients healed with secondary fibrin glue ablation. Sixty-six percent (22/33 patients) of cryptoglandular transsphincteric fistulas were closed at three months. Eleven patients failed fibrin glue ablation at a mean of 33 (range, 6–41) days. Seventeen of 22 short-term success patients (3 months) were available for long-term follow-up. Ninety-four percent (16/17 patients) remained healed at final long-term follow-up. The remaining patient recurred just before the six-month follow-up.

Conclusions

Despite the suboptimal early success rate of fibrin glue ablation for cryptoglandular transsphincteric fistulas, when a fistula does close for at least six months this appears to be a durable closure. A single patient recurred after appearing healed at the three-month check.

     

Stress, social support and problem drinking among women in poverty

AIMS: Previous studies have found that stress contributes to problem drinking, while social support can buffer its effects. However, these studies are confined largely to middle-class and general populations. We extend what is known by examining how the unique stressors and forms of social support experienced by women in poverty impact alcohol problems over a 4-year time-period. DESIGN, SETTING AND PARTICIPANTS: This prospective study used generalized estimating equations (GEE) transition modeling and four annual waves of survey data from 392 American mothers receiving Temporary Assistance for Needy Families (TANF) in a large Northern California county. MEASUREMENTS: We examined the effects of neighborhood disorder, stressful life events and economic hardship on psychological distress and problem drinking over time, and whether social support moderated these relationships for women in poverty. FINDINGS: Neighborhood disorder and stressful life events increased significantly the risk for problem drinking, largely through their effect on psychological distress. We found little evidence, however, that social support buffers poor women from the effects of these stressors. CONCLUSIONS: Women in poverty are exposed to severe, chronic stressors within their communities and immediate social networks which increase vulnerability to psychological distress and problem drinking. The finding that social support does not buffer stress among these women may reflect their high level of exposure to stressors, as well as the hardships and scarce resources within their networks. If the 'private safety net' of the social network fails to provide a strong buffer, more effective environmental interventions that reduce exposure to stressors may be needed to prevent alcohol problems in poor women's lives.     

A Comparison of the Assay Sensitivity of Average and Worst Pain Intensity in Pharmacologic Trials: An ACTTION Systematic Review and Meta-Analysis

Identifying methods to improve assay sensitivity in randomized clinical trials (RCTs) may facilitate the discovery of efficacious pain treatments. RCTs evaluating pain treatments typically use average pain intensity (API) or worst pain intensity (WPI) as the primary efficacy outcome. However, little evidence is available comparing the assay sensitivity of these 2 measures. In this systematic review and meta-analysis, we comprehensively reviewed all low back pain, osteoarthritis pain, fibromyalgia, diabetic peripheral neuropathy pain, and postherpetic neuralgia RCTs that used a parallel group design. Eligibility required: 1) primary RCT report published between 1980 and 2016, 2) comparing 1 or more active, efficacious pharmacologic pain treatment(s) with placebo, and 3) providing data on the standardized effect size (SES) for API as well as WPI for all treatment arms. Twenty-seven active versus placebo comparisons were identified in 23 eligible articles. Using a random-effects meta-analysis, API SES and WPI SES did not differ significantly (difference?=??.021, 95% confidence interval = ?.047 to .004, P?=?.12). The findings indicate that, depending on the objectives of the study, either API or WPI could be used as a primary outcome measure in clinical trials for the chronic pain conditions included in this analysis.