25-year follow-up of treated and not-treated adolescents after the Spitak earthquake: course and predictors of PTSD and depression.

BACKGROUND: There is a paucity of long-term prospective disaster studies of the psychological sequelae among survivors. METHODS: At 1½ and 25 years after the Spitak earthquake, 142 early adolescents from two cities were assessed: Gumri (moderate-severe exposure) and Spitak (very severe exposure). The Gumri group included treated and not-treated subjects, while the Spitak group included not-treated subjects. Instruments included: DSM-III-R PTSD-Reaction Index (PTSD-RI); DSM-5 PTSD-Checklist (PCL); Depression Self-Rating Scale (DSRS); and Center for Epidemiological Studies-Depression Scale (CES-D). RESULTS: (1) Between 1½ and 25 years, PTSD rates and mean scores decreased significantly in the three groups (over 50%). However, at 25 years 9.1-22.4% met DSM-5 PTSD criteria. (2) At 1½ years, the Spitak group had higher PTSD-RI (p < 0.001) and DSRS scores (p < 0.001) compared to the Gumri-not-treated group. At 25 years, the Spitak group that had experienced fewer post-earthquake adversities (p < 0.03), had a greater decrease in PTSD-RI scores (p < 0.02), and lower CES-D scores (p < 0.01). (3) Before treatment, PTSD-RI and DSRS scores did not differ between the Gumri-treated and not-treated groups. At 25-years, the Gumri-treated group showed a greater decrease in PTSD-RI scores (p < 0.03), and lower mean PTSD-RI (p < 0.02), PCL (p < 0.02), and CES-D (p < 0.01) scores. (4) Predictors of PTSD symptom severity at 25-years included: home destruction, treatment, social support, post-earthquake adversities, and chronic medical illnesses. CONCLUSION: Post-disaster PTSD and depressive symptoms can persist for decades. Trauma-focused treatment, alleviation of post-disaster adversities, improving the social ecology, and monitoring for chronic medical illnesses are essential components of recovery programs.

Social, Occupational, and Cultural Adaptation During a 12-Month Wintering in Antarctica.

BACKGROUND AND METHODS: Life in isolated and confined environments (ICEs) is subject to important constraints which can generate psychosociologically impaired outcomes. This study investigated psychological, social, occupational, and cultural variables which are among the most important determinants in adaptation to a one-year wintering in Antarctica for 13 international subjects. RESULTS: Our findings confirm and give further insight into the role of social (Cohesiveness, Social Support) and occupational (Implementation/Preparedness, Counterproductive Activity, Decision Latitude, and Psychological Job Demands) dimensions of adaptation to ICEs. Relationships between various social and occupational dimensions studies reflected detrimental effects ranging from decrements in cohesiveness (ICE 1, M = 4.44; ICE 7, M = 3.33), social support (ICE 2, M = 4.93; ICE 7, M = 4.28), and work performance (ICE 1, M = 4.33; ICE 6, M = 3.5), which differed across professional status and multicultural factors. DISCUSSION: These psychosocial issues have important implications for pre-mission selection and training, monitoring and support of crews during the mission, and post-mission readaptation. Operational recommendations are suggested to improve adaptation, success, and well-being for long-duration ICE missions, e.g., to Mars and beyond. Nicolas M, Bishop SL, Weiss K, Gaudino M. Social, occupational, and cultural adaptation during a 12-month wintering in Antarctica. Aerosp Med Hum Perform. 2016; 87(9):781-789.

Coping Strategies of Neurology Nurses Experiencing Abuse From Patients and Families.

OBJECTIVE: The objectives of this study were to assess incidence of verbal and physical abuse of neurology nurses, identify their coping strategies, and explore relationships between demographic characteristics, incidence, and coping strategies. BACKGROUND: A 2011 U.S. Department of Justice survey found that average annual rates of nonfatal violent crime against nurses were greater than all occupations and identified nurses as having the highest percentage of workplace violence. METHODS: A descriptive, exploratory research design utilizing an online survey of 112 neurology nurses in the United States was used for this study. RESULTS: Results identified the presence of verbal and physical abuse against neurology nurses, avoidance coping strategies utilized, and gender differences on types of violence and effects of abuse. CONCLUSIONS: Administrative attention must address abuse of neurology nurses by patients and families and develop nursing practice that eliminates the use of avoidance as a way of dealing with this abuse.

Initial Development of C.A.T.E.S.: A Simulation-Based Competency Assessment Instrument for Neonatal Nurse Practitioners.

PURPOSE: Determine content validity of global statements and operational definitions and choose scenarios for Competency, Assessment, Technology, Education, and Simulation (C.A.T.E.S.), instrument in development to evaluate multidimensional competency of neonatal nurse practitioners (NNPs). DESIGN: Real-time Delphi (RTD) method to pursue four specific aims (SAs): (1) identify which cognitive, technical, or behavioral dimension of NNP competency accurately reflects each global statement; (2) map the global statements to the National Association of Neonatal Nurse Practitioners (NANNP) core competency domains; (3) define operational definitions for the novice to expert performance subscales; and (4) determine the essential scenarios to assess NNPs. SAMPLE: Twenty-five NNPs and nurses with competency and simulation experience Main outcome variable: One hundred percent of global statements correct for competency dimension and all but two correct for NANNP domain. One hundred percent novice to expert operational definitions and eight scenarios chosen. RESULTS: Content validity determined for global statements and novice to expert definitions and essential scenarios chosen.

We stop for no storm: coping with an environmental disaster and public health research.

Coping with natural disasters is part of the public nurses' role, and the public health nursing (PHN) researcher is doubly challenged with continuing to conduct community-based research in the midst of the disaster. The PHN may provide service along with attempting to continue the research. The challenges faced by public/community health nurse researchers as a result of hurricane Ike are discussed to provide lessons for other public/community health researchers who may be affected by natural disasters in the future. It is important to consider challenges for recruitment and retention of research subjects after a disaster, impact of natural disasters on ongoing research, and opportunities for research to be found in coping with natural disasters. A community-based study that was in progress at the time of hurricane Ike will be used as an example for coping with a natural disaster. We will present "lessons learned" in the hope of helping researchers consider what can go wrong with research studies in the midst of natural disasters and how to proactively plan for keeping research reliable and valid when natural disasters occur. We will also discuss the opportunities for collaborations between researchers and the community following any disaster.

Evaluation of tele-ultrasound as a tool in remote diagnosis and clinical management at the Amundsen-Scott South Pole Station and the McMurdo Research Station.

UNLABELLED: Abstract Background: A large number of Antarctic stations do not utilize ultrasound for medical care. Regular use of ultrasound imaging at South Pole and McMurdo Stations first began in October 2002. To date, there has been no evaluation of medical events requiring ultrasound examination from this remote environment. Additionally, the importance of tele-ultrasound for clinical management in Antarctica has not yet been assessed. We therefore conducted a retrospective analysis of all ultrasound exams performed at South Pole and McMurdo Stations between October 2002 and October 2003. SUBJECTS AND METHODS: Radiology reports and patient charts were reviewed for pre- and post-ultrasound diagnosis and treatment. RESULTS: Sixty-six ultrasound exams were conducted on 49 patients. Of the exams, 94.0% were interpreted by the store-and-forward method, whereas 6.0% were interpreted in "real-time" format. Abdominal, genitourinary, and gynecology ultrasound exams accounted for 63.6% of exams. Ultrasound examination prevented an intercontinental aeromedical evacuation in 25.8% of cases, and had a significant effect on the diagnosis and management of illness in patients at South Pole and McMurdo research stations. CONCLUSIONS: These findings indicate that diagnostic ultrasound has significant benefits for medical care at Antarctic stations and that tele-ultrasound is a valuable addition to remote medical care for isolated populations with limited access to tertiary-healthcare facilities.

My Disaster Recovery: a pilot randomized controlled trial of an Internet intervention.

This pilot study tested the efficacy of the My Disaster Recovery (MDR) website to decrease negative affect and increase coping self-efficacy. Fifty-six survivors of Hurricane Ike were recruited from a larger study being conducted at the University of Texas Medical Branch at the first anniversary of the storm. Restricted randomization was used to assign participants to the MDR website, an information-only website, or a usual care condition. Group×time interactions indicated that MDR reduced participant worry more than the other conditions. A similar trend was also identified for depression. Both websites were accessed a small to moderate amount and participants reported mixed satisfaction for both websites. Although the effect sizes for worry and depression were in the moderate to large range, small sample size and timing of the intervention qualify the findings. These preliminary findings encourage further evaluation of MDR with a larger, demographically diverse sample and indicate that the MDR website might be helpful in reducing worry and depression.

Changes in family variables among normal and overweight preschoolers.

PURPOSE: The purpose of this study was to examine differences in the weight and height of normal and overweight children in variables relating to the individual, home/family and community across a six month time period. RESEARCH QUESTIONS/HYPOTHESES: What are the ecological factors that influence the body mass index (BMI) of preschool children? SIGNIFICANCE: The rate of overweight preschool children aged 2 to 5 years has more than doubled in the past 30 years. Low socioeconomic and ethnic minority groups have higher rates. Research shows a strong correlation between a child's size (height, weight, and BMI) and the ecological factors present in the family's environment. METHODS: This study is a secondary data analysis from a cross sectional study of 200 Mexican American children ages 2-3 years old receiving WIC services. The sample consisted of 100 children with a BMI > 95% for age and 100 children with a BMI of <85% for age. Variables and measurements included: host/child (BMI percentile, diet, TV watching hours); agent/food (feeding assistance); microsystem/parent (parental BMI, acculturation level, employment, physical activities); microsystem/home (stimulation, TV hours); and microsystem/mother-child relationship (NCAST Teaching Scale).This study is limited to populations with similar characteristics. RESULTS: Both overweight and normal weight children showed decreases in BMI, but maintained their between group differences even while slimming down (p = .000). Overweight children consumed significantly more fruit, bread and other carbohydrates, and total calories, than did normal weight children. Both groups of children increased significantly in their consumption of water, fruit juice and juice drinks, as well as meat and other protein. Maternal BMIs for overweight children were higher than those for the mothers of the normal weight children and increased across time. More overweight children ate in the presence of another person. The interaction patterns between mothers and overweight children were significantly more positive and responsive than were the interaction patterns of mothers and normal weight children. DISCUSSION/CONCLUSION: multiple ecological factors influence the BMI of the preschooler leading to obesity. Nurses can use these findings to teach parents about the importance managing the environmental factors that contribute to childhood obesity and growth.

The effect of acculturation on progesterone/estriol ratios and preterm birth in Hispanics.

OBJECTIVE: To examine the Hispanic acculturation paradox by identifying the effect of acculturation on serum progesterone and estriol levels, the progesterone/estriol ratio, and preterm birth. METHODS: We used an observational, prospective design with 468 self-identified, low-income, pregnant Hispanic women. We used the Language Proficiency Subscale (from the Bidimensional Acculturation Scale for Hispanics) to measure acculturation. We measured progesterone and estriol in maternal serum at 22-24 weeks of pregnancy. We defined preterm birth as birth before 37 weeks of gestation. Statistical analysis was by Wilcox-Mann-Whitney and Kruskal-Wallis tests, analysis of variance, t tests, logistic regression, and structural equation modeling. RESULTS: English proficiency had an adjusted odds ratio of 4.03 (95% confidence interval 1.44-11.25), P<.001, and the lowest quartile of the progesterone/estriol ratio had an adjusted odds ratio of 2.93 (95% confidence interval 1.25-6.89), P<.001, to predict preterm birth. English proficiency was associated with a decrease in progesterone/estriol ratio and an increase in preterm birth. In structural equation modeling, the progesterone/estriol ratio mediated the relationship between acculturation and preterm birth. CONCLUSION: Hispanic woman have four times the risk of a preterm birth if they are more acculturated (ie, proficient in English). These findings demonstrate another possible aspect of obstetric risk, that of acculturation. Further refinement of the risk of acculturation is essential to clarify how we can adjust our clinical care to prevent increasing preterm birth with the increasing Hispanic population. LEVEL OF EVIDENCE: III.

Ventilatory responses to hypoxia and high altitude during sleep in Aconcagua climbers.

BACKGROUND/OBJECTIVE: We examined the changes in ventilation during sleep at high altitude using the LifeShirt monitoring system on 2 climbers who were attempting to summit Mount Aconcagua (6956 m). METHODS: Prior to the summit attempt, we measured cardiovascular and pulmonary function at 401 m (Rochester, MN) and gathered respiratory and cardiovascular data during sleep using the LifeShirt monitoring system with exposure to normobaric normoxia and normobaric hypoxia (simulated 4300 m). We then monitored the ventilatory response during sleep at 3 altitudes (4100 m, 4900 m, and 5900 m). RESULTS: During normoxic sleep, subjects had normal oxygen saturation (O(2sat)), heart rate (HR), respiratory rate (RR), tidal volume (V(T)) and minute ventilation (V(E)), and exhibited no periodic breathing (O(2sat) = 100 +/- 2%, HR = 67 +/- 1 beats/min, RR = 16 +/- 3 breaths/min, V(T) = 516 +/- 49 mL, and V(E) = 9 +/- 1 L/min, mean +/- SD). Sleep during simulated 4300 m caused a reduction in O(2sat), an increase in HR, RR, V(T), and V(E), and induced periodic breathing in both climbers (O(2sat) = 79 +/- 4%, HR = 72 +/- 14 beats/min, RR = 20 +/- 3 breaths/min, V(T) = 701 +/- 180 mL, and V(E) = 14 +/- 3 L/min). All 3 levels of altitude had profound effects on O(2sat), HR, and the ventilatory strategy during sleep (O(2sat) = 79 +/- 2, 70 +/- 8, 60 +/- 2%; HR = 70 +/- 12, 76 +/- 6, 80 +/- 3 beats/min; RR = 17 +/- 6, 18 +/- 4, 20 +/- 6 breaths/min; V(T) = 763 +/- 300, 771 +/- 152, 1145 +/- 123 mL; and V(E) = 13 +/- 1, 14 +/- 0, 22 +/- 4 L/min; for 4100 m, 4900 m, and 5900 m, respectively). There were strong negative correlations between O(2sat) and V(E) and ventilatory drive (V(T)/T(i), where T(i) is the inspiratory time) throughout the study. CONCLUSIONS: Interestingly, the changes in ventilatory response during simulated altitude and at comparable altitude on Aconcagua during the summit attempt were similar, suggesting reductions in FiO(2), rather than in pressure, alter this response.

Evaluating teams in extreme environments: from issues to answers.

The challenge to effectively evaluating teams in extreme environments necessarily involves a wide range of physiological, psychological, and psychosocial factors. The high reliance on technology, the growing frequency of multinational and multicultural teams, and the demand for longer duration missions all further compound the complexity of the problem. The primary goal is the insurance of human health and well-being with expectations that such priorities will naturally lead to improved chances for performance and mission success. This paper provides an overview of some of the most salient immediate challenges for selecting, training, and supporting teams in extreme environments, gives exemplars of research findings concerning these challenges, and discusses the need for future research.

Impact on the family: psychosocial adjustment of siblings of children who survive serious burns.

This study examined the psychosocial adjustment of 79 siblings of children suffering from burn injuries. Nonparametric statistics were used to compare psychosocial adjustment of the study group, as measured by the Child Behavior Checklist with an age-matched and gender-matched reference groups. Analyses found that the study group was better adjusted than the normative group on psychological dimensions; however, the study group fared worse than the normative group on overall competence, particularly social competence. Further analyses found significant differences in sibling adjustment as a function of the severity of the burn injury. The siblings of children with moderate burn injuries did significantly better on psychological adjustment than the normative group, and siblings of children with moderate and severe burn injuries did significantly poorer on social competence. Descriptive analysis of measures developed for the study for parent and sibling reports supported findings of the Child Behavior Checklist quantitative analysis and offered insight into reasons for findings. Results indicate that the burn injury to one child in a family significantly impacts the siblings of that child. The noninjured child may be strengthened in the process of adapting to the changes imposed on the family, but it is also possible that the sibling's growth in one dimension is at the cost of success in another dimension.

Neurovestibular symptoms following space flight.

Neurovestibular symptoms experienced by astronauts in the post-flight period were examined using data from medical debriefs contained in the NASA Longitudinal Study of Astronaut Health database. Ten symptoms were identified (clumsiness, difficulty concentrating, persisting sensation aftereffects, nausea, vomiting, vertigo while walking, vertigo while standing, difficulty walking a straight line, blurred vision, and dry heaves), of which eight were crossed with twelve demographic parameters (mission duration, astronaut gender, age, one-g piloting experience, previous space flight experience, g-suit inflation, g-suit deflation, in-flight space motion sickness, in-flight exercise, post-flight exercise, mission role, fluid loading). Three symptoms were experienced by a majority of subjects, and another two by more than a quarter of the subjects. Intensity of the symptoms was mild, suggesting that they are unlikely to pose a risk to the crew during landing and the post-flight period. Seven of the symptoms and eight of the parameters under study were found to be significantly associated with each other.