Trajectories of posttraumatic stress disorder following myocardial infarction: a prospective study

BACKGROUND: This study examines the trajectories of posttraumatic stress disorder (PTSD) following myocardial infarction (MI). More specifically, it has 2 aims: (1) to examine whether the trajectory of PTSD is predicted by level of threat and the nature of initial reactions and (2) to examine the associations between the trajectory of PTSD and anxiety, somatization, health-related quality of life, and hospitalization 7 months following MI. METHOD: 116 MI patients were examined twice. At time 1, within a week of the patient's MI, acute stress disorder (ASD) was assessed and medical measures were obtained from patients' hospital records. At time 2, 7 months later, PTSD, anxiety, physical residuals, and health-related quality of life were assessed. Data were gathered in 1999. RESULTS: Six percent of the respondents had both ASD and PTSD, 10% did not have ASD but did have PTSD, and 12% had ASD but not PTSD. The trajectory of PTSD was associated with severity of anxiety, somatic complaints, and health-related quality of life. In addition, while the severity of MI did not predict the trajectory of PTSD, the perceived severity did. Patients without PTSD but with prior ASD did not differ in their initial reactions from those without ASD. CONCLUSION: These findings provide support for the considerable variability in the trajectory of the development of PTSD and suggest that although ASD is associated with subsequent PTSD, the predictive role of initial reactions is limited.     

Secondary contamination of ED personnel from hazardous materials events, 1995-2001

Hazardous materials (hazmat) events pose a health threat not only for those individuals in the immediate vicinity of the release (ie, members of the general public, on-site first responders, employees), but also for ED personnel (ie, physicians and nurses) treating the chemically contaminated victims arriving at the hospital. Secondary contamination injuries to ED personnel result when exposed victims enter the ED without being properly decontaminated. Data from the Agency for Toxic Substances and Disease Registry's Hazardous Substances Emergency Events Surveillance System were used to conduct a retrospective analysis on hazmat events occurring in 16 states from 1995 through 2001 that involved secondary injury to ED personnel. Six events were identified in which 15 ED personnel were secondarily injured while treating contaminated victims. The predominant injuries sustained were respiratory and eye irritation. Proper victim decontamination procedures, good field-to-hospital communication, and appropriate personal protective equipment (PPE) use can help prevent ED personnel injuries and contamination of the ED.     

Use of the prostate-specific antigen test among U.S. men: findings from the 2005 National Health Interview Survey.

BACKGROUND: Although evidence that prostate cancer deaths are reduced by screening for elevated prostate-specific antigen (PSA) concentration coupled with early diagnosis and treatment is insufficient to advocate routine screening for prostate cancer, PSA testing has become more common in the past decade. We examined characteristics that might influence testing and compared test use between men ages 40 to 49 and 50 to 79 years. METHODS: We used data from 7,669 participants with no history of prostate cancer in the 2005 National Health Interview Survey. RESULTS: Among men reporting about PSA testing, an estimated 16% of 40- to 49-year-old men and 49% of 50- to 79-year-old men had a PSA test in the past 2 years. In multivariate analyses, among men ages 40 to 49 years, non-Hispanic Black men were more likely (P < 0.05) to have had a PSA test than non-Hispanic White men. We found no significant difference by race/ethnicity in men ages 50 to 79 years. Higher education, higher poverty threshold, usual source of medical care, family history of prostate cancer, and comorbid conditions were associated with increased PSA test use in both age groups. Additionally, men ages 50 to 79 years born in the United States, who were married, had private or military health insurance, and had been diagnosed with another cancer type were more likely to be tested. CONCLUSIONS: Findings from the multivariate analyses indicated significantly higher PSA test use among younger non-Hispanic Black men than among non-Hispanic White men. These findings may indicate that healthcare providers are getting and conveying the message of increased risk of prostate cancer among African American men.     

Examining factors associated with self-management skills in teenage survivors of cancer

Background

Monitoring long-term health of teenage cancer survivors is dependent on successful transition from pediatric to adult long-term follow-up (LTFU) care. This study identified factors associated with self-management skills (SMSs), an important correlate of successful transition.

Methods

Data were collected from a cross-sectional survey conducted at three Canadian hospitals between July 2011 and January 2012. The sample included 184 childhood cancer survivors aged between 15 and 19 years. Independent factors included demographic- and illness-related factors. The outcome of interest was SMSs, measured using the SMSs scale, with higher scores indicating more SMSs.

Results

More SMSs were associated positively with older age (β?=?1.2, 95 % confidence interval (CI)?=?0.1 to 2.4), being female (β?=?4.6, 95 % CI?=?1.9 to 7.4), and having a non-married parent (β?=?5.2, 95 % CI?=?0.04 to 10.4). There was a negative association between SMSs and having had a central nervous system tumor (CNS) compared to having leukemia (β?=??7.9, 95 % CI?=??13.5 to ?2.2).

Conclusions

Younger, male, and CNS tumor survivors lack SMSs. Future research is needed to explore the extent and nature of associations between SMSs and parents’ marital status.

Implications for cancer survivors

Younger, male, and CNS tumor survivors should be targeted for interventions in order to ensure that adequate SMSs are attained before completion of transition.

     

Indirect Exposure to Captivity Details Is Not Related to Posttraumatic Stress Symptoms Among the Spouses and Offspring of Former Prisoners of War

Indirect exposure to the aversive details of the primary victim's traumatic event(s) has been introduced in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM‐5; American Psychiatric Association, 2013) as a new event criterion (Criterion A4). However, this new criterion has been criticized for its significant emphasis on the exposure to trauma “details” or trauma narrative. This study assessed the associations between reported exposure to details about captivity and posttraumatic stress symptoms (PTSS) among 2 groups of family members of former prisoners of war (ex‐POWs): spouses (n = 115) and adult offspring (n = 78). Results show that in both groups exposure to details regarding captivity was not significantly related to the severity of total PTSS and specifically, high levels of exposure to captivity details were related to lower avoidance symptoms among ex‐POWs' spouses. Among offspring, exposure to paternal behaviors stemming from the fathers' posttraumatic stress disorder was related to PTSS, above and beyond negative life events, quality of relationship with the father, and exposure to captivity details (R² = .34). These results suggest that behavioral displays of the fathers' posttraumatic symptoms, rather than the recounting of trauma‐related details, is related to PTSS among ex‐POWs' offspring.     

Management and risk factors for dyslipidemia with the ketogenic diet

A prospective study was performed of all children started on the ketogenic diet at our institution for intractable epilepsy from January 2003 to March 2007 (n = 137), examining for baseline and follow-up total cholesterol and triglyceride levels. Interventions for dyslipidemia were analyzed for their effectiveness. At baseline, 25% of children had hypercholesterolemia (>200 mg/dL), which increased to 60% for those receiving the ketogenic diet. Children receiving a solely formula-based ketogenic diet were less likely to have hypercholesterolemia than those eating solid food after adjusting for age and initial ketogenic ratio (P < .001). Only a slightly higher likelihood of a 20% decrease in cholesterol occurred for those children in whom a dietary intervention was made compared with observation alone (60% vs 41%; P = .11). Hypercholesterolemia occurs in most children receiving a solid food based ketogenic diet but improved in approximately half, even without interventions.     

Alternative diets to the classical ketogenic diet--can we be more liberal?

The ketogenic diet (KD), a high-fat, adequate protein, low-carbohydrate diet has been used since 1921 for the treatment of severe medically refractory epilepsy. In the past 15 years, the use of the KD has expanded enormously and a huge amount of clinical evidence of its efficacy is available. The classical KD is however restrictive and therefore alternative more liberal varieties of the classical KD have been developed within the last 8 years. The purpose of this report is to summarise the principles and evidence of effectiveness of the alternative ketogenic diets: Medium Chain Triglyceride (MCT)-KD, modified Atkins diet (MAD) and low glycaemic index treatment (LGIT), compared to the classical KD. The clinical evidence to date suggests that the more liberal versions of the classical KD such as MCT KD, MAD and LGIT have an efficacy close to the classical KD; however, no RCT data are available for MAD and LGIT. This evidence suggests that factors such as age, epilepsy type, lifestyle and resources are important factors in deciding which diet we should start a patient on. This report intends to summarise guidelines based on the evidence available.