Temporal Associations Between Moral Injury and Posttraumatic Stress Disorder Symptom Clusters in Military Veterans

War zone veterans who experience posttraumatic stress disorder (PTSD) symptoms might struggle with co‐occurring cognitive, emotional, and behavioral expressions of suffering that align with conceptual definitions of moral injury (MI). However, given that PTSD is a multidimensional condition, disentangling the apparent interplay with MI may inform clinical practice and research. This study incorporated a cross‐lagged design to explore temporal associations between self‐ and other‐directed outcomes related to MI and severity of DSM‐5 PTSD symptom clusters while accounting for depressive symptoms. Drawing on the Expressions of Moral Injury Scale–Military Version in a community sample of 182 previously deployed veterans, MI‐related outcomes were linked with severity of PTSD symptom clusters at two assessments spaced apart by 6 months, rs = .58–.62. Of possible models for conceptualizing the temporal nature of these associations, structural equation modeling analyses revealed a cross‐lagged primary MI model best fit veterans’ responses. Within this model, veterans’ self‐directed MI at Time 1 predicted greater PTSD symptoms at the 6‐month follow‐up. However, an equivalent cross‐lagged path also emerged between Time 1 PTSD Cluster D symptoms and self‐directed MI at Time 2, suggesting the value of a reciprocal MI model for this symptom domain. In contrast, other‐directed outcomes of MI were not linked with PTSD in the presence of other variables. Overall, these findings support the prognostic value of assessing for MI‐related outcomes among veterans who might be struggling with PTSD symptomatology, particularly with respect to self‐directed problems associated with enduring moral distress.     

Association of sedentary time and physical activity with pain,fatigue, and impact of fibromyalgia: the al‐Ándalus study

We examined the association of objectively measured sedentary time (ST) and physical activity (PA) levels with pain, fatigue, and the impact of the disease in women with fibromyalgia. Four hundred and nineteen (mean age ± SD = 51.7 ± 7.6 years old) women with fibromyalgia participated. ST and PA levels (light, moderate, and moderate‐to‐vigorous [MVPA]) were measured with triaxial accelerometry. We assessed experimental pain with algometry and clinical pain, fatigue, and impact of fibromyalgia with a number of questionnaires. The association of ST and light PA with most of the pain‐ and fatigue‐related outcomes and impact of fibromyalgia (all, P ≤ 0.019) was independent of moderate and vigorous PA. Furthermore, the association of vigorous PA with general and physical fatigue was independent of ST and light and moderate PA (all, P < 0.001). In conclusion, lower levels of ST or higher levels of light PA are associated with lower pain, fatigue, and the overall impact of the disease independent of moderate and vigorous PA in women with fibromyalgia. Interestingly, higher vigorous PA is independently associated with lower general and physical fatigue. These results are significant for future ST and PA intervention studies in this population.     

Lesion of the anteroventral third ventricle (AV3V) reduces hypothalamic activation and hypophyseal hormone secretion induced by lipopolysaccharide in rats

This study examined whether electrolytic ablation of the periventricular anteroventral third ventricle (AV3V) region would affect the hypothalamic activation and the increase of hypophysial hormone secretion induced by systemic injection of lipopolysaccharide (LPS) in rats. LPS significantly increased the number of cells showing Fos immunoreactivity in the paraventricular (PVN) and supraoptic (SON) nuclei of the hypothalamus (P<0.05) and also increased plasma levels of vasopressin, oxytocin, adrenocorticotropin and corticosterone (P<0.05). AV3V lesion significantly reduced LPS-induced Fos immunoreactivity (P<0.05) and vasopressin and oxytocin secretion (P<0.05). Elevations in adrenocorticotropin but not in plasma corticosterone after LPS were affected by prior AV3V lesions. These findings demonstrate that LPS-induced Fos expression in the PVN and SON, and hypophysial hormone secretion is dependent on the integrity of the AV3V region.     

Treatment and adequacy of treatment of mental disorders among respondents to the Mexico National Comorbidity Survey

OBJECTIVE: This study described the rate and adequacy of mental health service use among participants in the Mexico National Comorbidity Survey and the correlates of any 12-month treatment and of adequate treatment. METHOD: The authors conducted face-to-face household surveys of a probability sample of individuals ages 18 to 65 years in the noninstitutionalized population living in urban areas of Mexico from 2001 to 2002. The use of mental health services and 12-month DSM-IV disorders was assessed with the World Mental Health version of the World Health Organization Composite International Diagnostic Interview. The rates and correlates of any service use and the adequacy of treatment were identified in logistic regression analyses, taking into account the complex sample design and weighting process. RESULTS: The data reported here were based on 2,362 interviews. Fewer than one in five respondents with any psychiatric disorder during the last 12 months used any service during the prior year. The rates of service use by those with mood disorders were somewhat higher. About one in every two respondents who used services received minimally adequate care. CONCLUSIONS: The authors found large unmet needs for mental health services among those with psychiatric disorders. Those with mental illness and those who deliver or seek to improve mental health care in Mexico face enormous challenges.     

The Mexican migration to the United States and substance use in northern Mexico

Aims   To examine the impact of migration to the United States on substance use and substance use disorders in three urban areas of northern Mexico.
Design   Cross-sectional survey of immigration-related experiences and life-time and past-year alcohol and drug use, in a representative sample of respondents aged 12–65 years.
Setting   Interviews were conducted in the cities of Tijuana, Ciudad Juarez and Monterrey during 2005. Respondents were classified into three groups: (i) 'return migrants', (ii) 'relatives of migrants' and (iii) 'others in the general population'.
Findings   A total of 1630 completed interviews were obtained for a response rate of 70.5%. 'Return migrants' were more likely to have used alcohol, marijuana or cocaine at least once in their life-time and in the last 12 months, more likely to develop a substance use disorder and more likely to have a 12-month substance use disorder compared with 'others in the general population'. Among 'return migrants', longer length of time in the United States and type of work performed as an immigrant were related to higher prevalence of substance use. Among 'relatives of migrants', migration experiences were not associated with increased prevalence of substance use compared with 'others in the general population'.
Conclusion   This study found a link between migration to the United States and the transformation of substance use norms and pathology in Mexico. Future research on pre-migration involvement in substance use and data on the timing of events among return migrants is needed. Public health measures are likely to require cross-border coordination of research and service development.     

Tratamiento laparoscópico de la ureterolitiasis: nuestra experiencia

ObjectiveAnalyze technical details and results of laparoscopic treatment of ureterolithiasis.Materials and methodsBetween January 2005 and August 2008 it was performed laparoscopic ureterolithotomy in 22 patients in our service. Two (9%) by retroperitoneal access and 20 (91%) by transperitoneal access. Mean size of the calculi was 15 mm. with a variation from 8 mm to 23 mm. The calculus were in the upper tract in 18 patients (81,8%) and in mid ureter in 4 patients (18,2), any of the calculus were in lower ureter. Most of calculi were obstructive stones for more than 2 months. Eight patients were submited a previous section of extracorporeal shockwave lithotripsy and 2 by extracorporeal shockwave lithotripsy plus ureterolithotripsy as a calculi treatment attempt. Twelve patients had a laparoscopic ureterolithotomy as a primary indication for treatment.ResultsLaparoscopic ureterolithotomy was successful for 20 patients (90,9%), and the fails occurred in the beginning of our experiment. Mean operative time was 145 minutes with range from 70 to 240 minutes. The indwelling ureteral stent was used in 03 cases; 02 preoperative, and 01 postoperative. The ureteral suture was performed with absorbable 4.0 separated stitches in all patients. The global average of permanence in hospital was 3,3 days and the drain permanence was 7,2 days. The global complication rate was 13,6%. The global rate of stone free was 91%, and there were residual stone in 2 patients.ConclusionsThe laparoscopic treatment of ureterolithiasis besides minimally invasive, it is viable, secure and very effective. It should have taken into consideration as a procedure to extracorporeal shockwave lithotripsy and ureteroscopy. But, in cases where there are obstructive stones for a long time, in selected patients and, in special, in patients with just one kidney, it can be considered as a first line treatment. About the access, if retroperitoneal or transperitoneal; it is not still possible to affirm which would be the best one, the option must take into account the surgeon preference and experience.     

Disubstituted Diaryl Diselenides Inhibit [3H]-Serotonin Uptake in Rats

Diphenyl diselenide (PhSe)₂, the parent compound of disubstituted diaryl diselenides, produces significant antidepressant-like effect when evaluated in the forced swimming test (FST) in rats. The goal of this study was to investigate the effects of diphenyl diselenide (PhSe)₂, m-trifluoromethyl-diphenyl diselenide (F₃CPhSe)₂ and p-methoxy-diphenyl diselenide (CH₃OPhSe)₂ on [³H]-serotonin uptake in rat platelets and synaptosomes. At concentrations higher than 10 μM (PhSe)₂, and (F₃CPhSe)₂ inhibited about 20% [³H]-serotonin uptake in platelets. (CH₃OPhSe)₂ inhibited [³H]-serotonin uptake in platelets at concentrations higher than 1 μM. Similarly, (PhSe)₂, (F₃CPhSe)₂, and (CH₃OPhSe)₂ significantly inhibited [³H]-serotonin uptake (about 50%) in synaptosomes from rat brain at concentrations higher than 1 μM. The maximal inhibitory effects of (PhSe)₂, (F₃CPhSe)₂, and (CH₃OPhSe)₂ on [³H]-serotonin uptake from rat synaptosomes were 65%, 96%, and 80%, respectively. In conclusion, our results demonstrate that disubstituted diaryl diselenides altered monoaminergic system by interacting with monoamine uptake.     

Apoptosis, cell proliferation and modulation of cyclin-dependent kinase inhibitor p21cip1 in vascular remodelling during vein arterialization in the rat

Neo-intima development and atherosclerosis limit long-term vein graft use for revascularization of ischaemic tissues. Using a rat model, which is technically less challenging than smaller rodents, we provide evidence that the temporal morphological, cellular, and key molecular events during vein arterialization resemble the human vein graft adaptation. Right jugular vein was surgically connected to carotid artery and observed up to 90 days. Morphometry demonstrated gradual thickening of the medial layer and important formation of neo-intima with deposition of smooth muscle cells (SMC) in the subendothelial layer from day 7 onwards. Transmission electron microscopy showed that SMCs switch from the contractile to synthetic phenotype on day 3 and new elastic lamellae formation occurs from day 7 onwards. Apoptosis markedly increased on day 1, while α-actin immunostaining for SMC almost disappeared by day 3. On day 7, cell proliferation reached the highest level and cellular density gradually increased until day 90. The relative magnitude of cellular changes was higher in the intima vs . the media layer (100 vs . 2 times respectively). Cyclin-dependent kinase inhibitors (CDKIs) p27^Kip1 and p16^INKA remained unchanged, whereas p21^Cip1 was gradually downregulated, reaching the lowest levels by day 7 until day 90. Taken together, these data indicate for the first time that p21^Cip1 is the main CDKI protein modulated during the arterialization process the rat model of vein arterialization that may be useful to identify and validate new targets and interventions to improve the long-term patency of vein grafts.