Post-combat adaptation: improving social support and reaching constructive growth.

BACKGROUND AND OBJECTIVES: Posttraumatic stress disorder, a commonly researched mental health outcome associated with trauma, does not develop in the majority of survivors. More common trajectories of adaptation include resilience, and posttraumatic growth (PTG). The objectives of the current study were to: (1) describe posttrauma adaptation profiles in a sample of Israeli male military veterans (N = 448); and (2) to explore the protective factors that promote constructive PTG within two profiles of posttrauma adaptation. METHODS: The study used secondary data to estimate latent profile mixture models and a series of logistic regression analyses. RESULTS: Demographic controls, combat related variables, endorsement of coping strategies, and reports of improvement in social support were not significant predictors of constructive growth in the resilient class. However, those in the struggling growth subset of the sample who reported improvement in perceived social support increased the odds of reaching constructive growth. CONCLUSION: These findings highlight the importance of tailored clinical interventions that account for more complex profiles of posttrauma adaptation; and further, provide evidence that adaptation takes place over time. Finally, these findings call for future research to continue to explore the quality of PTG and the contexts in which protective factors promote positive adaptation.

Direct observation of orientation distributions of actin filaments in a solution undergoing shear banding.

Shear banding is frequently observed in complex fluids. However, the configuration of macromolecules in solutions undergoing shear banding has not yet been directly observed. In this study, by using the fact that F-actin solutions exhibit shear banding and actin filaments are visualized by fluorescent labels, we directly observed the intrinsic states of an actin solution undergoing shear banding. By combining the 3D imaging of labeled actin filaments and particle image velocimetry (PIV), we obtained orientation distributions of actin filaments in both high and low shear rate regions, whose quantitative differences are indicated. In addition, by using the orientation distributions and applying stress expression for rod-like polymers, we estimated stress tensors in both high and low shear rate regions. This evaluation indicates that different orientation distributions of filamentous macromolecules can exhibit a common shear stress.

Social determinants of inadequate sleep in US children and adolescents.

BACKGROUND AND OBJECTIVES: Despite recognised disparities in child health outcomes associated with sleep, the majority of research has been based on small, homogeneous samples. Using a nationally-representative sample of US children and adolescents, we examined trends and social determinants of inadequate sleep across age groups. STUDY DESIGN: Comparison of cross-sectional studies. METHODS: Our study used the 2003 (n = 68,418), 2007 (n = 63,442), and 2011/2012 (n = 65,130) waves of the National Survey of Children's Health, a nationally-representative survey of 6-17-year-olds. Parents reported whether the child had inadequate sleep (0-6 days of not getting enough sleep vs 7 days). RESULTS: From 2003 through 2011/12, inadequate sleep increased from 23 to 36% among 6-9-year-olds, 30 to 41% among 10-13-year-olds, and 41 to 49% among 14-17-year-olds. Among 10-17-year-olds, those from households with more than a high school degree were more likely to have inadequate sleep (adjusted ORs 1.2). Although for 10-13-year-olds there was a gradient in inadequate sleep across income (aORs 1.2-1.3), for 14-17-year-olds, only those from the two highest income levels were more likely to have inadequate sleep (aORs 1.3-1.4). Parents' reports that neighbours did not watch out for other's children was associated with an increased risk for inadequate sleep across all ages (aORs 1.1-1.3). CONCLUSIONS: Inadequate sleep occurred as young as age six years and increased with age, became more prevalent, and was socially patterned. In order to prevent inadequate sleep across the life course, surveillance and monitoring are needed across all age groups to identify critical periods for intervention.

Alcohol consumption promotes the intestinal translocation of Streptococcus suis infections.

Streptococcus suis is an emerging zoonotic agent. This study aimed to investigate whether S. suis is likely to translocate across the intestines of human hosts who have liver disease and/or consume alcohol. Both the alcoholism and cirrhosis models exhibited high mRNA expression of TGF and collagen1, but only the cirrhosis model had fibrosis in the liver. After both models were infected with S. suis, significantly different concentrations of S. suis were detected in the blood and brains of the alcoholism model (Blood: 36.4%; Brain: 31.8%) and the cirrhosis model (Blood: 62.5%; Brain: 62.5%) compared to the concentrations in the healthy mice (Blood: 15.4%; Brain: 0%). Trans-epithelial electrical resistance (TER) was used to examine the Caco-2 cells in the in vitro that had an S. suis infection combined with 1% ethanol. Although the ethanol did not influence the Caco-2 cells' barriers, it did rapidly decrease the barriers' TER value and then their E-cadherin compared to the infected Caco-2 cells without the ethanol treatment. Immunofluorescence also indicated that the barriers of the Caco-2 cells treated with ethanol were disrupted and that S. suis translocated from the apical to the basolateral side. This study demonstrated that alcohol consumption helped S. suis to translocate.

The associations between socio-economic status and major depressive disorder among Blacks, Latinos, Asians and non-Hispanic Whites: findings from the Collaborative Psychiatric Epidemiology Studies.

BACKGROUND: This study examined whether there were associations between individual measures of socio-economic status (SES) and the 12-month prevalence of major depressive disorder (MDD) in representative samples of Blacks, Latinos, Asians and Whites in the USA. METHOD: The data used were from the Collaborative Psychiatric Epidemiology Studies (CPES). RESULTS: There was an association between household income and MDD among Whites. However, the association was not statistically significant. Statistically significant associations were present between educational attainment and MDD among Whites. Among both Whites and Latinos, being out of the labor force was significantly associated with MDD. In analyses by nativity, being out of the labor force was significantly associated with MDD among US-born and foreign-born Latinos. CONCLUSIONS: Significant associations between various measures of SES and MDD were consistently observed among White and, in some cases, Latino populations. Future studies should continue to examine sociopsychological factors related to SES that increase the risk of MDD among people from racial-ethnic communities.

Significance of repeated resection for recurrent intrahepatic cholangiocarcinoma.

BACKGROUND/AIMS: Management of patients with recurrent intrahepatic cholangiocarcinoma (ICC) following surgical resection is difficult, and surgical resection is rarely indicated. We retrospectively reviewed patients with recurrent intrahepatic cholangiocarcinoma. METHODOLOGY: Between April 1998 and March 2007, 57 consecutive patients with ICC underwent surgical resection. Mode of recurrence and treatment of recurrent tumors, especially surgical resection for these tumors, in patients with cancer recurrence were evaluated. RESULTS: 37 (65%) patients experienced tumor recurrence. Out of these patients, 24 underwent some type of cancer-directed therapy, including 9 patients (24%) for whom surgical resection was attempted: the latter included 4 hepatic resections, 2 pulmonary resections, 2 tumor resections, and 1 gastric resection. For 6 patients with recurrent tumor in the liver or the lung, microscopic complete resection was achieved, while incomplete resection was resulted in the remaining 3 patients. No postoperative mortality was encountered. Among patients with complete resection, 3 are alive without disease 32, 39 and 77 months after the second operation, one has lived with disease for 13 months, and 2 died of disease after 22 and 26 months. No significant difference in overall survival was observed between patients undergoing primary and second surgical resections, calculated from the primary and the second operations, respectively. CONCLUSIONS: Repeated surgical resection for recurrent ICC can be performed with acceptable morbidity, and affords selected patients a chance for long-term survival.

Alcohol disorders among Asian Americans: associations with unfair treatment, racial/ethnic discrimination, and ethnic identification (the national Latino and Asian Americans study, 2002-2003).

STUDY OBJECTIVE: To examine history of alcohol abuse/dependence disorder in relation to unfair treatment, racial/ethnic discrimination, and ethnic identification among Asian Americans. DESIGN: Weighted multivariate analyses of cross-sectional national survey data predicting lifetime history of alcohol abuse/dependence disorders. SETTING: USA, Asian Americans. PARTICIPANTS: 2007 Asian American adults recruited to the National Latino and Asian American Study (NLAAS; 2002-2003). RESULTS: Controlling for sociodemographic characteristics, Asian Americans who reported experiencing unfair treatment had higher odds of history of alcohol abuse/dependence disorder (OR 5.26, 95% CI 1.90 to 14.56). Participants who reported high levels of ethnic identification had lower odds of history of alcohol abuse/dependence disorders (OR 0.46, 95% CI 0.23 to 0.90). Ethnic identification moderated the influence of racial/ethnic discrimination (p = 0.097). Among participants with low levels of ethnic identification, racial/ethnic discrimination was associated with greater odds of having a history of alcohol disorder compared with those with high levels of ethnic identification. CONCLUSIONS: Social hazards such as unfair treatment and racial/ethnic discrimination should be considered in the development of programmes addressing alcohol disorders among Asian Americans. Interventions that promote ethnic identification in this population may be particularly relevant in mitigating the negative influence of racial/ethnic discrimination on alcohol disorders.

Alleviation of Abeta-induced cognitive impairment by ultrasound-mediated gene transfer of HGF in a mouse model.

A new therapeutic approach to treat Alzheimer's disease (AD) is needed, and the use of growth factors is considered to be a candidate. Hepatocyte growth factor (HGF) is a unique multifunctional growth factor, which has the potential effect to exert neurotrophic action and induce angiogenesis. In this study, we examined the effects of overexpression of human HGF plasmid DNA using ultrasound-mediated gene transfer into the brain in an Abeta-infused cognitive dysfunction mouse model. We demonstrated that HGF gene transfer significantly alleviated Abeta-induced cognitive impairment in mice in behavioral tests. These beneficial effects of HGF might be due to (1) significant recovery of the vessel density in the dentate gyrus of the hippocampus, (2) upregulation of BDNF, (3) a significant decrease in oxidative stress and (4) synaptic enhancement. A pharmacological approach including gene therapy to increase the HGF level in combination with anti-Abeta therapy might be a new therapeutic option for the treatment of AD.

Alkene/diamond liquid/solid interface characterization using internal photoemission spectroscopy.

The photochemical attachment of 10-amino-dec-1-ene molecules protected with a trifluoroacetic acid group (TFAAD) on hydrogen-terminated single-crystalline chemical vapor deposited (CVD) diamond is characterized by total photoyield spectroscopy (TPYS), conductivity, Hall-effect, spectrally resolved photoconductivity (SPC), optical transmission experiments, and, for the first time, by in situ internal photoemission (IPE) spectroscopy applied in the spectral regime from 4 to 6 eV on the alkene/diamond (liquid/solid) heterostructures. These experiments are performed on undoped, (100) oriented, single-crystalline CVD diamond films, which contain no grain boundaries and have negligible bulk and surface defect densities. X-ray photoelectron spectroscopy (XPS) is used to investigate the chemical bonding of alkene molecules to diamond. The spectroscopic set of data shows that the photochemical reaction window of H-terminated diamond is shifted below the optical gap of diamond because of the negative electron affinity. In situ IPE experiments reveal electron emission between 4.5 and 5.2 eV. A model is introduced and discussed in which valence-band electrons are optically excited into empty hydrogen-induced surface states of diamond from where they tunnel into empty pi states of alkene molecules. We theoretically discuss the fastest attachment time to achieve a saturated TFAAD layer of about 2 x 10(14) cm(-)(2) on diamond, which is experimentally detected to be 7 h. In the case of direct optical electron excitations from diamond, the bonding efficiency will be one TFAAD molecule attachment arising from about 1600 emitted electrons.

Evaluation of right ventricular performance long after the atrial switch operation for transposition of the great arteries using the Doppler Tei index.

Right ventricular (RV) dysfunction may occur in patients after the atrial switch operation for d-transposition of the great arteries (d-TGA) and can be an important complication. Noninvasive assessment of RV function using echocardiography is necessary for following up these patients. We evaluated RV function using the Doppler Tei index (RV Tei index). The RV Tei index measures the ratio of total time intervals in isovolumetric contraction and relaxation to the ejection time. The subjects consisted of 33 patients who had undergone the atrial switch operation for d-TGA (the atrial switch group) (mean age, 21 +/- 4 years), 10 patients with pulmonary artery stenosis after the arterial switch operation for d-TGA (the arterial switch group) (mean age, 17 +/- 1 years), and 10 patients with a normally structured heart as a control group (mean age, 26 +/- 7 years). The RV Tei index (0.65 +/- 0.16) was significantly higher in the atrial switch group than in the arterial switch group (0.29 +/- 0.07) and the control group (0.29 +/- 0.01) (p < 0.05). The fractional area change of the RV obtained from the four-chamber view in the atrial switch group showed a significant negative correlation with the RV Tei index (r = -0.58, p < 0.01). The RV Tei index increased with increasing severity of the NYHA functional class. In the moderate/severe tricuspid regurgitation group, it was significantly higher than in patients with none/trivial tricuspid regurgitation. We conclude that the RV Tei index is useful for evaluating RV junction long after the atrial switch operation for d-TGA.

A structural model of acculturation and mental health status among Chinese Americans.

This study examined the role of acculturation and its direct and indirect impact on depressive symptom severity through various correlates, including socioeconomic status (SES), stress, social support, personality negativity, and physical health perception. Using structural equation modeling, the proposed model was tested with 983 employed Chinese Americans from a representative community sample, the majority of whom were immigrants. The results demonstrated that acculturation, correlated with SES, contributed to depressive symptom severity only through indirect pathways. Higher acculturation was found associated with higher stress that in turn contributed to more elevated depressive symptoms. On the other hand, higher acculturation was also found strongly correlated with higher SES, which was associated with lower depressive symptoms directly or indirectly through several mediators. Better support, lower personality negativity, better health perception, and lower stress were found mediating the relationship between higher SES and lower depressive symptom severity. The simultaneous multigroup analysis showed that the final model was comparable for both men and women with very few differences.

Corneal abrasions associated with pepper spray exposure.

Pepper spray containing oleoresin capsicum is used by law enforcement and the public as a form of nonlethal deterrent. Stimulated by the identification of a case of a corneal abrasion associated with pepper spray exposure, a descriptive retrospective review of a physician-maintained log of patients presenting to a jail ward emergency area over a 3-year period was performed. The objective was to give some quantification to the frequency with which an emergency physician could expect to see corneal abrasions associated with pepper spray exposure. Of 100 cases of pepper spray exposure identified, seven patients had sustained corneal abrasions. We conclude that corneal abrasions are not rare events when patients are exposed to pepper spray and that fluorescein staining and slit lamp or Wood's lamp examination should be performed on all exposed patients in whom corneal abrasions cannot be excluded on clinical grounds.

Psychosocial predictors of first-onset depression in Chinese Americans.

BACKGROUND: This study examines the longitudinal and concurrent risk factors associated with first-onset major depression in a community sample of 1747 Chinese Americans in Los Angeles. METHODS: The relative contributions of demographic, health, psychiatric, psychosocial, and cultural variables were assessed in a series of longitudinal and concurrent hierarchical multivariable analyses. RESULTS: Results of the longitudinal analyses indicated that the risk for experiencing a first major depressive episode at 18-months follow-up was higher for those who initially rated their health as poor, reported higher depressive symptoms, and perceived higher levels of social support. After controlling for prior health and psychiatric and psychosocial status at time 1, the results of the concurrent analyses indicated that the risk for experiencing a first major depressive episode at time 2 was higher for those who rated their health as poor, had at least one other psychiatric disorder, were bilingual, experienced high levels of life stress, and perceived themselves as having low and/or decreased social supports. CONCLUSIONS: The results of this study confirm previous evidence that psychosocial vulnerabilities, including higher acculturation, greater stress exposure and reduced social supports, are important predictors of risk for first-onset depressive episodes. Prevention and treatment implications are addressed, and future directions for research are offered.

SF-36 health survey: tests of data quality, scaling assumptions, and reliability in a community sample of Chinese Americans.

BACKGROUND: Chinese Americans are one of the fastest growing ethnic groups in the United States; however, language and cultural obstacles have challenged health workers and policy makers seeking to understand the health status and needs of this population. OBJECTIVES: This study is the first to use a large-scale probability design to evaluate the 36-item Short-Form Health Survey (SF-36) in a Chinese population (n = 1,501). METHODS: Using the International Quality of Life Assessment Project protocols, we examine summated-rating scaling assumptions, item-internal consistency, item-discriminant validity, and reliability. RESULTS: Similar to previous studies, our tests indicated that the SF-36 generally met minimum psychometric criteria with high reliability and satisfactory scaling success rates for most scales. However, the performance of the vitality and mental health scales was less satisfactory with regard to discriminant validity and scaling success rates. Notably, our results indicate that VT3 and VT4 ("feel worn out" and "tired", respectively) formed a separate "fatigue" cluster more highly correlated with the mental health scale. However, MH4 and MH5 ("downhearted and blue" [reverse coded] and "been a happy person") were more highly correlated with the vitality scale, suggesting that it may be more meaningful to reorganize the vitality and mental health items along the dimensions of well-being and distress. CONCLUSIONS: These results are interpreted within a cultural framework; however, additional work is needed to better understand the relationship between vitality and mental health for Chinese Americans.

Coercive and voluntary referrals: how ethnic minority adults get into mental health treatment.

Two hypotheses are typically invoked to examine the referral of adults into mental health care. The first is the clinical behavior hypothesis that suggests the psychiatric problem defines people as dangerous and risky. Accordingly, people with severe mental disorders are more likely to be coercively placed into mental health facilities. The second hypothesis suggests that people with less power are more likely than the powerful to be coercively placed in psychiatric care. We examine the extent to which these hypotheses are supported in a large urban community by investigating referrals into community mental health clinics that serve predominantly poor populations. The data set is unique because it includes four ethnic categories, whites, African Americans, Asian Americans, and Mexican Americans. The findings indicate that the clinical behavior hypothesis is applicable to whites and the stratification hypothesis is consistent with the data for African American, particularly African American men. The referral pattern for Mexican Americans and Asian Americans do not conform to the findings for whites and African Americans. It is likely that other sociocultural factors influence the referrals of these ethnic categories.

Lifetime and twelve-month prevalence rates of major depressive episodes and dysthymia among Chinese Americans in Los Angeles.

OBJECTIVE: The authors' goal was to estimate the lifetime and 12-month rates of major depressive episodes and dysthymia for Chinese Americans who reside in Los Angeles. This effort, the Chinese American Psychiatric Epidemiological Study, is the first large-scale community psychiatric epidemiological study on an Asian American ethnic group that used DSM-III-R criteria for major depressive episodes and dysthymia. METHOD: A multi-stage sampling design was used to select respondents for participation in the survey. The sample included 1,747 adults, 18-65 years of age, who resided in Los Angeles County and who spoke English, Mandarin, or Cantonese. RESULTS: Approximately 6.9% of the respondents had experienced an episode of major depression and 5.2% had had dysthymia in their lifetime. The 12-month rates of depressive episode and dysthymia were 3.4% and 0.9%, respectively. The most consistent correlate of lifetime and 12-month depressive episode and dysthymia was social stress, measured by past traumatic events and recent negative life events. CONCLUSIONS: The Chinese American Psychiatric Epidemiological Study provides a rare opportunity to investigate the heterogeneity within a single Asian American ethnic group, Chinese Americans, and to identify the subgroups among Chinese Americans who may be most at risk for mental health problems.

Health insurance coverage among Chinese Americans in Los Angeles County.

OBJECTIVES: This paper examines the factors associated with health insurance coverage among Chinese Americans in Los Angeles County. METHODS: Data were obtained through interviews conducted in 1993 and 1994 with Chinese Americans (aged 18 through 65 years) residing in Los Angeles County. A multistage probability sample was used to select respondents. RESULTS: The final sample consisted of 1747 respondents, which represented an 82% response rate. Thirty-nine percent of the respondents in the survey were without health insurance at the time of the survey. CONCLUSIONS: Logistic regression analysis showed that marital status, length of residence in the United States, education, employment, and household income were associated with health insurance coverage among Chinese Americans.

Cross-cultural epidemiology.

Two issues led me into the area of cross-cultural psychiatric epidemiology in the 1980s. The National Institute of Mental Health funded the Epidemiological Catchment Area Studies. One of them included a study of a Caucasian and Hispanic populations in Los Angeles. Dr Masaaki Kato, then the Director of the National Institute of Mental Health of Japan, was the consultant for a JAICA-funded project in Lima, Peru. He was interested in fostering psychiatric research there, so I suggested an epidemiological study. This study was done in two phases with Drs Shunichiro Hayashi, Kimpei Minobe and Alberto Perales. Because it is extraordinarily expensive to undertake epidemiological studies in the USA, I met with colleagues regarding psychiatric epidemiological studies in Asia, Dr Chung-kyoon Lee at the Seoul National University in Korea, Dr Eng-Kung Yeh of the National Taiwan University in Taipei,Taiwan, Dr Char-nie Chen of the Chinese University of Hong Kong, and Dr Masaaki Kato in Japan. Studies have been completed in Korea, Taiwan, Hong Kong, but not in Japan. In the meantime, very small pilot studies among Asian groups in Los Angeles were performed. The very recent results of the study of Chinese in Los Angeles, California, with the Composite International Diagnostic Interview are now available to compare the prevalence of selected psychiatric disorders among the Chinese in Los Angeles and the data from the National Co-Morbidity Study.

An epidemiological study of neurasthenia in Chinese-Americans in Los Angeles.

This study examined the prevalence and clinical features of ICD-10-defined neurasthenia (NT) in Chinese-Americans and its relations to other psychiatric disorders. In this community epidemiological survey, the enhanced Composite International Diagnostic Interview [CIDI], with a supplemental NT module, was administered to 1,747 Chinese-Americans, selected with a stratified cluster sampling method. The SCL-90-R was also used for measuring psychiatric morbidity and symptoms. Dimensions of social stress and social support were measured by established instruments. A total of 112 ICD-10 NT subjects (6.4%) were identified. Of these, 63 (56.3%) did not experience any current and lifetime DSM-III-R diagnoses, yielding a 12-month or lifetime prevalence rate of "pure" NT of 3.61%. This rate was much higher than any of the other psychiatric disorders in this sample. Compared with normal subjects, "pure" NT subjects had significantly higher SCL-90-R total and factor scores, experienced more psychosocial stress, and perceived less social support (P < .05 or .01). Compared with subjects with depression and anxiety disorders, "pure" NT cases reported significantly less SCL-90-R psychological symptoms (P < .05 or .01), but had a strikingly similar elevation in the somatization subscale score. These data suggest that NT is a distinctive clinical condition overlapping only partially with the other better recognized diagnostic entities. In view of its high prevalence and the salience of its impact on the health of those afflicted, it is imperative that concerted research efforts be made to further elucidate the temporal stability, natural course, and outcome of such a condition.

Return rates and outcomes from ethnicity-specific mental health programs in Los Angeles.

OBJECTIVES: The present study compared the return rate, length of treatment, and treatment outcome of ethnic minority adults who received services from ethnicity-specific or mainstream programs. METHODS: The sample consisted of 1516 African Americans, 1888 Asian Americans, and 1306 Mexican Americans who used 1 of 36 predominantly White (mainstream) or 18 ethnicity-specific mental health centers in Los Angeles County over a 6-year period. Predictor variables included type of program (ethnicity specific vs mainstream), disorder, ethnic match (whether or not clients had a therapist of the same ethnicity), gender, age, and Medi-Cal eligibility. The criterion variables were return after one session, total number of sessions, and treatment outcome. RESULTS: The study indicated that ethnic clients who attended ethnicity-specific programs had a higher return rate and stayed in the treatment longer than those using mainstream services. The data analyses were less clear cut when treatment outcome was examined. CONCLUSIONS: The findings support the notion that ethnicity-specific programs seem to increase the continued use of mental health services among ethnic minority groups.