Assessing the association between probable posttraumatic stress disorder symptoms and quality of life among emergency service workers using path analysis.

BACKGROUND: Emergency service workers have highly stressful occupations; the stressors encountered can contribute to the development of mental disorders such as depression, anxiety, and posttraumatic stress disorder (PTSD). OBJECTIVE: The present study used a conceptual model and survey to identify variables influencing the association between probable PTSD and quality of life (QOL) in emergency service workers. METHOD: PTSD was assessed using the Impact of Event Scale-Revised. QOL was assessed using the Medical Outcomes Study 36-Item Short-Form Health Survey. Path analysis was used to determine whether stress-coping (Brief Coping Orientation to Problems Experienced [Brief COPE] scores), social support (Multidimensional Scale of Perceived Social Support [MSPSS] scores), and resilience (Connor-Davidson Resilience Scale scores) explain the association between probable PTSD and QOL among 220 emergency service workers in Japan. RESULTS: Impact of Event Scale-Revised scores were significantly positively associated with Brief COPE Active coping scores and significantly negatively associated with MSPSS scores. Brief COPE Active coping and MSPSS scores were significantly positively associated with Connor-Davidson Resilience Scale scores, which were in turn significantly positively associated with Medical Outcomes Study 36-Item Short-Form Health Survey scores. CONCLUSION: Active coping in response to stressful situations is important for maintaining good mental health among emergency service workers. Active coping and social support may strengthen resilience, and resilience may improve QOL. Screening for mental health and QOL should include simultaneous assessment of stress-coping, social support, and resilience. Although the findings of this cross-sectional study are important, it could not confirm a causal relationship between PTSD and QOL.

The mediating effect of symptoms of posttraumatic stress disorder and depression on the relationship between personality traits and quality of life in emergency service workers.

BACKGROUND: Emergency service workers are often exposed to fatalities during accidents or disasters. Therefore, they may be more prone to experiencing posttraumatic stress disorder (PTSD) and depression. It has been shown that these comorbid disorders are related to personality traits and quality of life (QOL). METHODS: We hypothesized that mental disorders, such as symptoms of PTSD and depression, mediate the relationship between personality traits, as measured on the 10-Item Personality Inventory (TIPI), and QOL, as measured on the MOS 36-item Short-Form Health Survey (SF-36). RESULTS: Participants were aged 23-61 years. Questionnaires were sent to 373 participants, 220 of whom returned responses. A direct effect was found between two subscales of the TIPI (Extraversion and Emotional stability) and mental component summary scores of the SF-36 (Extraversion: ß = 0.154, p < .001; Emotional stability: ß = 0.179, p < .001), which indicated partial mediation. A significant indirect effect was revealed between two personality traits and mental health summary scores (Extraversion: ß = 0.058, p < .001; Emotional stability: ß = 0.087, p < .001). We also found a direct effect of extraversion scores of the TIPI on role/social component summary scores of the SF-36 (ß = 0.084, p < .05). However, none of the 95% confidential intervals was significant, which indicated full mediation, and the indirect effect was significant (ß = 0.023, p < .01). Sensitivity analysis indicated that a direct effect between extraversion scores of the TIPI and role/social component summary scores of the SF-36 was significant, which indicated partial mediation. CONCLUSIONS: The findings of direct and indirect effects highlight the importance of identifying effective methods for protecting individuals from developing symptoms of PTSD and depression; moreover, they may help improve QOL. The capacity of dealing with incidents among emergency service workers may vary depending on their personality traits. Therefore, the screening of mental health states that includes a personality trait inventory may be valuable.

Assessing Subgroup Differences in Posttraumatic Stress Disorder Among Rescue Workers in Japan With the Impact of Event Scale-Revised.

OBJECTIVE: We examined the impact of demographic confounding factors on responses to the Impact of Event Scale-Revised. METHODS: Participants were rescue workers aged 20 to 65 years who had responded during the Great East Japan Earthquake in 2011. A multiple indicators, multiple causes model was used to examine associations between covariates and latent factors or items in the Impact of Event Scale-Revised. RESULTS: Participants were recruited from April to August 2015. The model fit indices in the confirmatory factor analysis and the multiple indicators, multiple causes model suggested an acceptable model fit. Higher education and the Connor-Davidson Resilience Scale score were significantly associated with a decrease in intrusion, avoidance, and hyperarousal. Counseling was significantly associated with increased avoidance. In the direct path model using modification indices, counseling and early arrival were identified as significant covariates. CONCLUSIONS: This study found that higher education and resilience reduced all 3 factors in the Impact of Event Scale-Revised and improved the symptoms of intrusion, avoidance, and hyperarousal. Counseling and early arrival were also associated with improvement in certain items. However, counseling was also linked to increased avoidance and worsening psychophysiological reactions. Further research is recommended to clarify these relationships. (Disaster Med Public Health Preparedness. 2019;13:309-318).

Onset of rocuronium-induced neuromuscular block evaluated subjectively and accerelomyographically at the masseter muscle.

PURPOSE: The main aim of this study was to compare the onset times of rocuronium evaluated subjectively and by acceleromyography at the masseter muscle (MM). METHODS: Forty female patients were sequentially enrolled in this study. In the first 20 patients, neuromuscular block was evaluated subjectively. After induction of anesthesia with fentanyl and propofol, both the left masseter and ulnar nerves were stimulated in 2-Hz train-of-four (TOF) mode using peripheral nerve stimulators. Contractions of the MM were felt with an anesthesiologist's left hand holding an anesthesia facemask; those of the adductor pollicis (APM) were visually observed. All the patients received a bolus of rocuronium, 0.6 mg/kg. Onset times after rocuronium were defined as the duration until the contractions became impalpable at the MM or invisible at the APM. At the time contraction of the MM had not been felt, intubating conditions were assessed. In the next 20 patients, contractions of the MM and the APM were concurrently quantified using acceleromyography after induction of anesthesia and laryngeal mask insertion. Following 0.6 mg/kg rocuronium, onset of the action was recorded. RESULTS: Onset of the action of rocuronium at the MM evaluated subjectively [mean (SD), 70.3 (17.7) s] was similar to that monitored acceleromyographically [73.3 (27.6) s, P > 0.05], and significantly shorter than that at the APM acceleromyographically [111.0 (34.8) s, P = 0.016]. Intubating conditions of 20 patients were graded either excellent or good. CONCLUSION: Subjective evaluation of contractions of the MM by an anesthesiologist's hand may be reliable to determine faster timing for safe tracheal intubation.

Monitoring masseter muscle evoked responses enables faster tracheal intubation.

PURPOSE: The aim of this study was to investigate whether monitoring neuromuscular block at the masseter muscle (MM) would allow faster tracheal intubation when compared with that at the adductor pollicis muscle (APM). METHODS: Twenty female patients undergoing gynecological surgery were enrolled into this study. Immediately after inducing anesthesia with fentanyl and propofol, both the left masseter and ulnar nerves were stimulated in a 2 Hz train-of-four (TOF) mode using peripheral nerve stimulators. Contractions of the MM were felt with the anesthesiologist's left hand lifting the patient's jaw and holding an anesthesia facemask, while those of the APM were visually observed. Immediately after the contracting responses of the muscles were confirmed, all of the patients received an iv bolus of vecuronium 0.1 mg kg(-1). Onset times after vecuronium were defined as the duration until the contractions became impalpable at the MM or invisible at the APM. When the contraction of the MM could no longer be felt, the conditions for laryngoscopy and tracheal intubation were assessed. RESULTS: Onset time evaluated tactually at the MM (mean +/- SD, 108.4 +/- 27.7 s) was significantly shorter than that evaluated visually at the APM (181.2 +/- 32.1 s, P < 0.0001). The intubating conditions for all patients were graded as either excellent or good. CONCLUSION: Tactual evaluation of muscle paralysis of the MM during induction of anesthesia is clinically useful since it leads to faster tracheal intubation.

[A retrospective study in spinal anesthesia for sumo-wrestlers].

BACKGROUND: Spinal anesthesia for the Sumo-wrestler is thought to be difficult because of following reasons. 1. Sumo-wrestlers are so fatty and weighty that piercing spinal needle into the subarachnoid space is technically difficult. 2. The relationship between volume of local anesthetics and attained spinal anesthesia level is difficult to detect. 3. Upper airway can be easily obstructed during sedation. METHODS: Retrospectively, we compared 30 Sumo-wrestler patients (group S) with normal body weight patients (group N) concerning 17 items. RESULTS: While all patients in group N were approached from L 3 and L 4 interspinal space using 25 gauge spinal needles, 13 patients in group S were approached from another interspinal space, for example L 2 and L 3 or L 4 and L 5 and 40% of patients in group S needed 23 gauge spinal needles. The time intervals from the entrance into the operating room till the end of intrathecal administration of local anesthetics in group S and group N were 34 and 24 minutes, respectively (P < 0.05). The distances from the surface of the skin to subarachnoid space in group S and group N were 80 mm and 49 mm, respectively (P < 0.05). CONCLUSIONS: These results indicate that subarachnoid puncture in Sumo-wrestler patients is difficult and we should understand the specificities of spinal anesthesia for these patients.