Repeated Bordetella pertussis Infections Are Required to Reprogram Acellular Pertussis Vaccine-Primed Host Responses in the Baboon Model

BACKGROUND

The United States has experienced a resurgence of pertussis following the introduction of acellular pertussis (aP) vaccines. This is likely due to the failure of aP vaccines to induce durable immunity and prevent infection, carriage, and transmission.

METHODS

To evaluate the impact of aP vaccination on the immune response to infection and test the ability of infection to reprogram aP-imprinted immune responses, we challenged unvaccinated and aP-vaccinated baboons with Bordetella pertussis multiple times and accessed the immune responses and outcomes of infections after each exposure.

RESULTS

Multiple infections were required to elicit T-helper 17 responses and protection in aP-vaccinated animals comparable to responses seen in unvaccinated animals after a single challenge. Even after 3 challenges, T-helper 1 responses were not observed in aP-vaccinated animals. Immunoglobulin G responses to vaccine and nonvaccine antigens were not negatively affected in aP-vaccinated animals.

CONCLUSIONS

Our results indicate that it is possible to retrain aP-primed immune responses, but it will likely require an optimal booster and multiple doses. Our results in the baboon model suggest that circulation of B. pertussis in aP-vaccinated populations is concentrated in the younger age bands of the population, providing information that can guide improved modeling of B. pertussis epidemiology in aP-vaccinated populations.

Associations of past-year overall trauma, sexual assault and PTSD with social support for young adult sexual minority women

Background: Young adult sexual minority women (SMW) are at elevated risk for sexual assault (SA), posttraumatic stress disorder (PTSD), and inadequate social support. While SA and PTSD can lead to reductions in social support from close significant others, the impact of SA and PTSD on SMWs' social support has not previously been assessed.Objective: This study examined the associations of past year SA and PTSD with SMW's social support from intimate partners, family, and friends. It was hypothesized that SA and PTSD would be negatively associated with support from partners, family and friends, and that PTSD would moderate the effect of SA on support in early adulthood.Method: Young adult SMW in the United States (N = 235) who were M = 23.93 (SD = 2.15) years old, primarily lesbian or bisexual (n = 186, 79.1%) and White (n = 176, 74.9%) completed measures on past year exposure to SA and non-SA trauma, PTSD, and social support from intimate partners, family and friends.Results: PTSD was associated with less social support from partners, (b  = -0.06, SE = 0.02, p = .010, R2change = .02), family, (b  = -0.06, SE = 0.03, p = .025, R2change = .02), and friends, (b  = -0.07, SE = 0.02, p = .008, R2change = .02). There was a significant interaction between PTSD and SA on social support from partners (b  = -0.01, SE = 0.01, p = .047, R2change = .01). Neither non-SA nor SA trauma was associated with support from family or friends.Conclusions: Results underscore the potential impact of recent SA on intimate partnerships for young adult SMW with more severe PTSD. Future work should explore how addressing PTSD and improving social support quality may help SMW recover from traumatic experiences and ameliorate the effects of SA on intimate partnerships.

Hospital In Home: Evaluating Need and Readiness for Implementation (HENRI) in the Department of Veterans Affairs: protocol for a mixed-methods evaluation and participatory implementation planning study

Background and objectives

The Department of Veterans Affairs (VA) Hospital-In-Home (HIH) program delivers patient-centered, acute-level hospital care at home. Compared to inpatient care, HIH has demonstrated improved patient safety, effectiveness, and patient and caregiver satisfaction. The VA Office of Geriatrics & Extended Care (GEC) has supported the development of 12 HIH program sites nationally, yet adoption in VA remains modest, and questions remain regarding optimal implementation practices to extend reach and adaptability of this innovation. Guided by theoretical and procedural implementation science frameworks, this study aims to systematically gather evidence from the 12 HIH programs and to develop a participatory approach to engage stakeholders, assess readiness, and develop/adapt implementation strategies and evaluation metrics.

Research design and methods

We propose a multi-phase concurrent triangulation design comprising of (1) qualitative interviews with key informants and document review, (2) quantitative evaluation of effectiveness outcomes, and (3) mixed-methods synthesis and adaptation of a Reach Effectiveness Adoption Implementation Maintenance (RE-AIM)-guided conceptual framework.

Results

The prospective phase will involve a participatory process of identifying stakeholders (leadership, HIH staff, veterans, and caregivers), engaging in planning meetings informed by implementation mapping, and developing implementation logic models and blueprints. The process will be assessed using a mixed-methods approach through participant observation and document review.

Discussion and implication

This study will support the continued spread of HIH programs, generate a catalog of HIH implementation evidence, and create implementation tools and infrastructure for future HIH development. The multi-phase nature of informing prospective planning with retrospective analysis is consistent with the Learning Health System framework.

Supplementary Information

The online version contains supplementary material available at 10.1186/s43058-022-00338-7.

Frailty in Young and Middle-Aged Adults: An Integrative Review

BACKGROUND

Frailty is a public health priority resulting in poor health outcomes and early mortality in older adults. Early identification, management, and prevention of frailty may reduce frailty trajectory into later life. However, little is known about frailty in younger adults.

OBJECTIVE

Describe frailty prevalence, definitions, study designs, and components contributing to multidimensional frailty in 18 to 65-year-olds and impart guidance for future research, practice, and policies with potential to positively impact frail individuals.

METHODS

Integrative review approach was selected to explore frailty allowing for inclusion of diverse methodologies and varied persepectives while maintaining rigor and applicability to evidence-based practice initiatives. CINAHL, Embase, PsycInfo, PubMed databases were searched for studies describing frailty in adults age 18 to 65. Articles were excluded if published prior to 2010, not in English, lacked frailty focus, or non-Western culture.

RESULTS

Twelve descriptive correlational studies were included. No intervention or qualitative studies were identified. No standard conceptual definition of frailty was discovered. Studied in participants with health disparities (n=3) and chronic conditions (n=8); HIV was most common (n=4). Frailty prevalence ranged from 3.9% (313 of 8095) to 63% (24 of 38). Many factors associated with frailty were identified among physical (18) and social (14), and fewer among psychological (11) domains.

CONCLUSIONS

Universal frailty definition and multidimensional assessment tool is needed to generate generalizable results in future studies describing frailty in young and middle-aged adults. Early frailty identification by clinicians has potential to facilitate development and implementation of targeted interventions to prevent or mitigate frailty progression, but additional research is needed because risk factors in younger populations may be different than older adults.

Addressing the mental health impact of COVID-19 through population health

The COVID-19 pandemic has and will continue to result in negative mental health outcomes such as depression, anxiety and traumatic stress in people and populations throughout the world. A population mental health perspective informed by clinical psychology, psychiatry and dissemination and implementation science is ideally suited to address the broad, multi-faceted and long-lasting mental health impact of the pandemic. Informed by a systematic review of the burgeoning empirical research on the COVID-19 pandemic and research on prior coronavirus pandemics, we link pandemic risk factors, negative mental health outcomes and appropriate intervention strategies. We describe how social risk factors and pandemic stressors will contribute to negative mental health outcomes, especially among vulnerable populations. We evaluate the scalability of primary, secondary and tertiary interventions according to mental health target, population, modality, intensity and provider type to provide a unified strategy for meeting population mental health needs. Traditional models, in which evidence-based therapies delivered are delivered in-person, by a trained expert, at a specialty care location have proved difficult to scale. The use of non-traditional models, tailoring preventive interventions to populations based on their needs, and ongoing coordinated evaluation of intervention implementation and effectiveness will be critical to refining our efforts to increase reach.

Does it work and does it last? Effects of social and drinking behavior on same- and next-day mood

Both social and drinking behavior have the potential to modify mood. However, if social drinking enhances positive mood and reduces negative mood, as compared to non-drinking social behavior, then interventions to reinforce non-drinking via sober social activity are undermined. Using multilevel modeling analyses, we compared end-of-day mood on drinking days versus non-drinking days, and on days spent with other people as compared to days spent primarily alone. We evaluated the interaction between drinking/non-drinking and social/solitary behavior and assessed whether the effects of social and drinking behavior extended to mood the next day. Participants were 352 college students (53% female; 55% fraternity/sorority membership; mean age 19.7 years) who completed three automated telephone surveys each day during four 14-day intervals over 1 year. Drinking and being social were associated with higher end-of-day positive mood and significantly lower end-of-day negative mood. However, no positive enhancement or negative attenuation effects of alcohol were observed in interaction analyses. Alcohol provided no improvement in mood over-and-above being social at the end of the day or on the following day. However, drinking the previous day significantly reduced next-day positive mood, whereas being social significantly reduced next-day negative mood. These findings provide support for the reinforcing potential of interventions that increase rewarding social activity in the place of alcohol use.

Stressors and Drinking in Sexual Minority Women: The Mediating Role of Emotion Dysregulation

Sexual minority women are at elevated risk for exposure to stressors (both traumatic and discriminatory) and have higher rates of alcohol consumption and problems. The psychological mediation framework (Hatzenbuehler, 2009) suggests that both general (e.g., traumatic events to which minorities and nonminorities may be exposed) and minority-group-specific (e.g., discrimination) stressors contribute to psychopathology through mediators such as emotion dysregulation. Guided by this framework, the present study longitudinally examined the relationship between stressors and problematic drinking outcomes (i.e., binge drinking and alcohol-related problems), as mediated by emotion dysregulation, in sexual minority women (SMW). It addressed two research questions: (1) whether stressors longitudinally predict problematic drinking outcomes in SMW, as mediated by emotion dysregulation, and (2) for which specific forms of stressor (i.e., traumatic events and/or discrimination) this mediational relationship is present. Young adult women (N = 1057) who identified as lesbian or bisexual completed annual measures of daily heterosexism, traumas, and drinking outcomes for four years, and completed a measure of emotion dysregulation during the third year of data collection. We found an indirect relationship between discrimination and problematic drinking outcomes via emotion dysregulation. These findings are consistent with the psychological mediation framework (Hatzenbuehler, 2009) and suggest that SMW group-specific processes such as discrimination may be especially important in conferring risk for problem drinking via emotion dysregulation. Clinicians are advised to assess unique stressors faced by SMW and their potential contribution to problematic drinking outcomes, and to target emotion dysregulation in alcohol treatments.

Participatory System Dynamics Modeling: Increasing Stakeholder Engagement and Precision to Improve Implementation Planning in Systems

Implementation planning typically incorporates stakeholder input. Quality improvement efforts provide data-based feedback regarding progress. Participatory system dynamics modeling (PSD) triangulates stakeholder expertise, data and simulation of implementation plans prior to attempting change. Frontline staff in one VA outpatient mental health system used PSD to examine policy and procedural "mechanisms" they believe underlie local capacity to implement evidence-based psychotherapies (EBPs) for PTSD and depression. We piloted the PSD process, simulating implementation plans to improve EBP reach. Findings indicate PSD is a feasible, useful strategy for building stakeholder consensus, and may save time and effort as compared to trial-and-error EBP implementation planning.

Qualitative Assessment of Vaccination Hesitancy Among Members of the Apostolic Church of Zimbabwe: A Case Study

Vaccine hesitancy or lack of confidence in vaccines is considered a threat to the success of vaccination programs. The rise and spread of measles outbreaks in southern Africa in 2009-2010 were linked to objections among Apostolic Church members, estimated at about 3.5 million in Zimbabwe as of 2014. To inform planning of interventions for a measles-rubella vaccination campaign, we conducted an assessment of the factors contributing to vaccine hesitancy using data from various stakeholders. Among nine districts in three regions of Zimbabwe, we collected data on religious attitudes toward, and perceptions of, vaccines through focus group discussions with health workers serving Apostolic communities and members of the National Expanded Programme on Immunization; semi-structured interviews with religious leaders; and open-ended questions in structured interviews with Apostolic parents/caregivers. Poor knowledge of vaccines, lack of understanding and appreciation of the effectiveness of vaccinations, religious teachings that emphasize prayers over the use of medicine, lack of privacy in a religiously controlled community, and low levels of education were found to be the main factors contributing to vaccine hesitancy among key community members and leaders. Accepting vaccination in public is a risk of sanctions. Poor knowledge of vaccines is a major factor of hesitancy which is reinforced by religious teachings on the power of prayers as alternatives. Because parents/caregivers perceive vaccines as dangerous for their children and believe they can cause death or disease, members of the Apostolic Church have more confidence in alternative methods such as use of holy water and prayers to treat diseases. Under these circumstances, it is important to debunk the myths about the power of holy water on the one hand and disseminate positive information of the efficacy of vaccines on the other hand in order to reduce hesitancy. Education about vaccines and vaccination in conjunction with government intervention, for example, through the use of social distancing policies can provide a framework for reducing hesitancy and increasing demand for vaccination.

Individual, interpersonal, and contextual factors associated with discrepancies between intended and actual spring break drinking

The purpose of the present paper was to examine the extent to which college students underestimate the quantity of alcohol they will consume during Spring Break (SB), and whether individual, interpersonal, and contextual factors may be related to underestimation of SB drinking and drinking consequences. College students participated in web-based surveys prior to and after SB (N=603; 57% women). Overall, results indicated that individual factors (being male, being a member of a fraternity or sorority, previously experiencing more alcohol-related consequences, and intending to drink less during SB), interpersonal factors (reporting friends encourage getting drunk), and contextual factors (going on a SB trip with friends and receiving drinks from others) predicted underestimating peak drinks consumed during SB. Underestimating the peak number of drinks to be consumed on SB was associated with experiencing a greater number of alcohol-related consequences. Targeted interventions designed specifically to focus on underestimation of college student drinking and the impact of SB contextual and interpersonal factors may be an important area of study to reduce negative consequences of alcohol use during SB.

Alcohol and binge eating as mediators between posttraumatic stress disorder symptom severity and body mass index

OBJECTIVE

Sexual-minority women are at elevated risk for obesity, as well as exposure to traumatic events. Rates of obesity are elevated in individuals with posttraumatic stress disorder (PTSD), but little is known about why this relationship exists. Behavioral mechanisms, such as eating patterns and alcohol use, are possible explanations that would be clinically useful to identify.

METHODS

Binge eating and alcohol use were longitudinally investigated as mediators of the relationship between PTSD symptom severity and body mass index (BMI) in a large sample of young-adult, sexual-minority women (N = 425). PTSD symptom severity was assessed at baseline, binge eating and alcohol use were assessed 12 months later, and BMI was assessed 24 months after baseline.

RESULTS

Using a multiple mediator model, higher baseline PTSD symptom severity was found to be significantly associated with higher BMI 2 years later, operating through binge-eating behavior but not through alcohol use. Exploratory moderator analyses found that this effect was higher for those with lower baseline BMI.

CONCLUSIONS

Results suggest that higher PTSD symptoms are longitudinally associated with increased BMI and that binge eating behavior is one factor that explains this relationship.

Adverse Childhood Experiences, Support, and the Perception of Ability to Work in Adults with Disability

OBJECTIVE

To examine the impact of adverse childhood experiences (ACEs) and support on self-reported work inability of adults reporting disability.

PARTICIPANTS

Adults (ages 18-64) who participated in the Behavioral Risk Factor Surveillance System in 2009 or 2010 and who reported having a disability (n = 13,009).

DESIGN AND MAIN OUTCOME MEASURES

The study used a retrospective cohort design with work inability as the main outcome. ACE categories included abuse (sexual, physical, emotional) and family dysfunction (domestic violence, incarceration, mental illness, substance abuse, divorce). Support included functional (perceived emotional/social support) and structural (living with another adult) support. Logistic regression was used to adjust for potential confounders (age, sex and race) and to evaluate whether there was an independent effect of ACEs on work inability after adding other important predictors (support, education, health) to the model.

RESULTS

ACEs were highly prevalent with almost 75% of the sample reporting at least one ACE category and over 25% having a high ACE burden (4 or more categories). ACEs were strongly associated with functional support. Participants experiencing a high ACE burden had a higher adjusted odds ratio (OR) [95% confidence interval] of 1.9 [1.5-2.4] of work inability (reference: zero ACEs). Good functional support (adjusted OR 0.52 [0.42-0.63]) and structural support (adjusted OR 0.48 [0.41-0.56]) were protective against work inability. After adding education and health to the model, ACEs no longer appeared to have an independent effect. Structural support remained highly protective, but functional support only appeared to be protective in those with good physical health.

CONCLUSIONS

ACEs are highly prevalent in working-age US adults with a disability, particularly young adults. ACEs are associated with decreased support, lower educational attainment and worse adult health. Health care providers are encouraged to screen for ACEs. Addressing the effects of ACEs on health and support, in addition to education and retraining, may increase ability to work in those with a disability.

Psychometric analysis and validity of the daily alcohol-related consequences and evaluations measure for young adults

College students experience a variety of effects resulting from alcohol use and evaluate their experiences on a continuum from negative to positive. Using daily reports collected via cell phone, we examined the psychometric properties of alcohol use consequences and evaluations of those consequences. Participants were 349 undergraduate students (mean age 19.7 [SD = 1.26], 53.4% female). Data were analyzed using a multilevel factor analysis framework, incorporating binary items (consequences) and normally distributed items (evaluations). Our model converged on 2 factors-positive and negative-with similar loadings between- and within-persons. Intraclass correlation coefficients for positive consequences and their evaluations ranged from .30 to .40, whereas values for negative consequences were more variable. Intraclass correlation coefficients for negative evaluations were higher, suggesting evaluations were more trait-like compared to experience of consequences which may be context dependent. Generalizability coefficients on the whole were good to excellent, suggesting highly reliable scales at both person-mean and daily-mean levels. However, likely due to binary scale and infrequency, the generalizability coefficients for negative consequences at the daily level was somewhat low. Convergent validity was demonstrated by (a) positive associations between baseline Rutgers Alcohol Problem Index and Alcohol Use Disorders Identification Test scores with latent factors for daily positive and negative consequences, and (b) positive associations between daily drinking and daily consequences and evaluations of consequences. Overall, this measure demonstrated good psychometric properties for use in studies examining daily and lagged relationships between alcohol use and related consequences. (PsycINFO Database Record

Current Suicidal Ideation among Treatment-Engaged Active Duty Soldiers and Marines

We examined suicidal ideation among 399 active duty Soldiers and Marines engaged in mental health treatment. Using a generalized linear model controlling for demographic and military factors, depression, and positive traumatic brain injury screen, we confirmed our hypothesis that self-report measures of current PTSD symptoms uniquely predicted suicidal ideation. The association between PTSD severity and suicidal ideation was moderated by gender with women at higher risk as PTSD severity increased. Female Soldiers and Marines with high levels of PTSD should receive additional monitoring and intervention. Self-report measures may aid with risk assessment and identify symptom-related distress associated with suicide risk.

Expression of Opacity Proteins Interferes with the Transmigration of Neisseria gonorrhoeae across Polarized Epithelial Cells

Neisseria gonorrhoeae (GC) establishes infection at the mucosal surface of the human genital tract, most of which is lined with polarized epithelial cells. GC can cause localized as well as disseminated infections, leading to various complications. GC constantly change their surface structures via phase and antigenic variation, which has been implicated as a means for GC to establish infection at various anatomic locations of male and female genital tracks. However, the exact contribution of each surface molecule to bacterial infectivity remains elusive due to their phase variation. Using a GC derivative that is genetically devoid of all opa genes (MS11∆Opa), this study shows that Opa expression interferes with GC transmigration across polarized human epithelial cells. MS11∆Opa transmigrates across polarized epithelial cells much faster and to a greater extent than MS11Opa+, while adhering at a similar level as MS11Opa+. When MS11Opa+, able to phase vary Opa expression, was inoculated, only those bacteria that turn off Opa expression transmigrate across the polarized epithelial monolayer. Similar to bacteria alone or co-cultured with non-polarized epithelial cells, MS11∆Opa fails to form large microcolonies at the apical surface of polarized epithelial cells. Apical inoculation of MS11Opa+, but not MS11∆Opa, induces the recruitment of the Opa host-cell receptor carcinoembryonic antigen–related cell adhesion molecules (CEACAMs) to the apical junction and the vicinity of bacterial adherent sites. Our results suggest that Opa expression limits gonococcal ability to invade into subepithelial tissues by forming tight interactions with neighboring bacteria and by inducing CEACAM redistribution to cell junctions.

Racial/ethnic differences in identity and mental health outcomes among young sexual minority women

Previous research suggests that sexual minorities are at greater risk for trauma exposure, mental health problems, and substance use. To date, few studies have examined racial/ethnic differences among sexual minorities in relation to health-related behaviors and outcomes. Furthermore, studies of racial/ethnic differences among young adult sexual minority women (SMW) are virtually nonexistent. The current study adds to the previous literature by exploring differences in trauma exposure, sexual identity, mental health, and substance use in a nonprobability national sample of young adult SMW. A total of 967 self- identified lesbian and bisexual women were recruited via the Internet using social networking sites to participate in a larger longitudinal study on young women's health behaviors. The present study included 730 (76%) White, 108 (10%) African American, 91 (9%) Latina, and 38 (4%) Asian women ages 18 to 25 years. Results revealed differences in socioeconomic variables, degree of outness to family, childhood sexual assault, and forcible rape, but not overall lifetime trauma exposure. Among mental health and health-related behavior variables, few differences between groups emerged. Our findings indicate that both researchers and clinicians should turn their attention to processes of resilience among young SMW, particularly young SMW of color.

Preliminary results from a family-based HIV prevention intervention for South African youth

OBJECTIVES

Approximately 5.6 million South Africans are living with human immunodeficiency virus (HIV; UNAIDS, 2010). Prevalence among Black adolescents and young adults is particularly alarming. This pilot study of an HIV preventive intervention targeting South African youth contributes to the growing body of research on culturally competent family-based interventions.

METHOD

A total of 99 parent-child dyads were enrolled in an experimental repeated measures study, using a wait-list control group. Our 6-session intervention targeted general parenting (relationship quality, parental monitoring, and involvement), gender roles, and parent-youth communication about sex (content and quality). Parents and youth were assessed at baseline, postintervention, and 6-month follow-up. Eligibility included being the primary female caregiver of a 10- to 14-year-old child with whom they spent at least 4 nights a week and being able to participate in English or Xhosa.

RESULTS

Effect sizes with this small sample met or exceeded those of other family-based HIV interventions for youth in the United States and South Africa (e.g., Bell et al., 2008; Forehand et al., 2007). Parents' reports at postintervention indicated larger effect sizes for general parenting than youths' reports indicated. Parents' reports showed medium to large effects for all sex communication outcomes at postintervention and the 6-month follow-up. Youth reports demonstrated small to medium effects for most communication variables and these effects lasted through the 6-month follow-up period.

CONCLUSIONS

Intergenerational social networks (e.g., families) hold promise for HIV prevention among South African youth. A full efficacy trial with longer-term follow-up and attention to maintenance of effects is warranted.

Resilience in community: a social ecological development model for young adult sexual minority women

Family support and rejection are associated with health outcomes among sexual minority women (SMW). We examined a social ecological development model among young adult SMW, testing whether identity risk factors or outness to family interacted with family rejection to predict community connectedness and collective self-esteem. Lesbian and bisexual women (N = 843; 57% bisexual) between the ages of 18-25 (M = 21.4; SD = 2.1) completed baseline and 12-month online surveys. The sample identified as White (54.2%), multiple racial backgrounds (16.6%), African American (9.6%) and Asian/Asian American (3.1%); 10.2% endorsed a Hispanic/Latina ethnicity. Rejection ranged from 18 to 41% across family relationships. Longitudinal regression indicated that when outness to family increased, SMW in highly rejecting families demonstrated resilience by finding connections and esteem in sexual minority communities to a greater extent than did non-rejected peers. But, when stigma concerns, concealment motivation, and other identity risk factors increased over the year, high family rejection did not impact community connectedness and SMW reported lower collective self-esteem. Racial minority SMW reported lower community connectedness, but not lower collective self-esteem. Families likely buffer or exacerbate societal risks for ill health. Findings highlight the protective role of LGBTQ communities and normative resilience among SMW and their families.

Sexual assault related distress and drinking: the influence of daily reports of social support and coping control

Introduction. A history of sexual assault (SA) is often associated with increased distress and heavy drinking. One's ability to cope with the distress and seek social support has been associated with drinking more generally. However, SA-related distress, drinking, and the extent to which a woman engages in adaptive coping or seeks social support is known to vary day-to-day. The goal of the present investigation was to examine the moderating influence of perceived coping control and social support on the event-level association between SA-related distress and drinking. Methods. This study included 133 college women with a history of SA who reported recent heavy drinking. Participants provided daily reports of their SA-related distress, perceived coping control, perceived social support, and alcohol consumption every day for 30days. Results. Results of generalized estimating equation models suggest that coping control moderated the association between distress and drinking such that those with less perceived coping control drank more as their SA-related distress increased from their average. Although social support did not moderate between distress and drinking, decreases in perceived social support were associated with more drinking on that day. Conclusions. The results suggest that daily deviations in SA-related distress may influence alcohol consumption more than average levels of distress, especially among women with low coping control. Interventions for women with SA histories should help them build coping skills as well as adequate social support in order to reduce drinking.

Pedagogy of the logic model: teaching undergraduates to work together to change their communities

Undergraduate community psychology courses can empower students to address challenging problems in their local communities. Creating a logic model is an experiential way to learn course concepts by "doing." Throughout the semester, students work with peers to define a problem, develop an intervention, and plan an evaluation focused on an issue of concern to them. This report provides an overview of how to organize a community psychology course around the creation of a logic model in order for students to develop this applied skill. Two undergraduate student authors report on their experience with the logic model assignment, describing the community problem they chose to address, what they learned from the assignment, what they found challenging, and what they are doing now in their communities based on what they learned.

Motherhood, reasons for living, and suicidality among African American women

This report examines the protective role of motherhood against suicidal ideation among low-income African American women with a history of suicide attempts. Findings from previous studies examining the relations between family factors and suicide risks are inconsistent in this population, indicating that family could both exacerbate and reduce risks. Research on the link between motherhood-status specifically and suicide risk is rare, but family and child-related concerns have been identified as unique reasons for living associated with reduced risk of suicide attempt. Self-identified African American women (N = 146), ages 18-64, who attempted suicide within the previous 12 months were recruited from a large urban public hospital. A bootstrapping mediation model was tested using motherhood status from the demographics measure as the predictor, the Reasons for Living (RFL) scales as the mediator, and the Beck Suicidal Ideation Scale as the outcome. The model accounted for 41% of the variance in suicidal ideation and the indirect effect of RFL was statistically significant. These findings provide empirical support for the hypothesis that motherhood is protective against suicidal ideation among African American women with a history of suicide attempts. Future research should seek to determine how incorporating the protective function of motherhood status in clinical interventions with this high-risk population might help to improve treatment effectiveness.

The contributions of prior trauma and peritraumatic dissociation to predicting post-traumatic stress disorder outcome in individuals assessed in the immediate aftermath of a trauma

Objective

This study analyzed predictors of post-traumatic stress disorder (PTSD) in civilian trauma victims to assess how peritraumatic dissociation (PD) relates to PTSD symptom development. We examined PD and PTSD symptoms from a prior trauma simultaneously to better understand the extent to which past and current reactions to a trauma can predict the development of PTSD for a current trauma.

Methods

Participants (N=48) were recruited from the emergency department (ED) of a large, southeastern hospital and assessed immediately after a trauma and again at 4 weeks and 12 weeks post-trauma. We used both self-report and interviewer-based questionnaires to assess PD and PTSD symptoms for prior and current trauma.

Results

A hierarchical linear regression revealed that at 4-week follow up, when controlling for several demographic variables and trauma type, a model including both PD and PTSD symptoms from a prior trauma significantly predicted PTSD outcome (F(47)= 3.70, p=0.00), with PD and prior PTSD symptoms significantly contributing 17% and 9% of variance respectively. At 12 weeks, PTSD symptoms from prior trauma (β=0.094, p=0.538) and PD (β=−0.017, p=0.909) did not account for a significant proportion of the variance in PTSD for the enrolling trauma.

Conclusion

Prior and current reactions to trauma are both important factors in predicting the development of PTSD symptoms to a current trauma. The more immediate measurement of PD during presentation to the ED may explain the strength of its relationship to PTSD symptom development. Furthermore, our findings support the use of PTSD symptoms of a past trauma, as opposed to trauma frequency, as a predictor of PTSD from a subsequent trauma. Methodological limitations and future directions are discussed.

Feasibility of identifying eligible trauma patients for posttraumatic stress disorder intervention

OBJECTIVE

This research report examines the feasibility of identifying eligible trauma patients for a study providing an early therapeutic intervention for the prevention of posttraumatic stress disorder (PTSD), and identifies reasons around participation.

METHODS

This prospective observational study used a convenience sample of acute trauma victims presenting to a university-affiliated Level One trauma center in a large southeastern city. Patients eligible to participate in the early intervention study were adults (18- 65) who experienced a traumatic event within 72 hours of presentation, feared that they might be killed or seriously injured during the event, and were able to return for follow-up appointments. Patients were excluded if they were non-English speaking; experienced a loss of consciousness greater than five minutes; had a history of a serious mental illness or were currently suicidal; or endorsed current substance dependence. Descriptive statistics were conducted to determine differences in ineligible, eligible, and consenting trauma patients who enrolled in the intervention study.

RESULTS

Over a six-month period, n =1961 patients presented for treatment of a traumatic injury during study hours. Results showed that eligible patients were significantly younger than ineligible patients. Survivors of assaults (physical and sexual), younger patients, and women were generally more likely to participate in a study offering a psychological intervention in the immediate aftermath of a traumatic event.

CONCLUSION

Fourteen percent of trauma patients were eligible and entered a study offering an early psychological intervention for the prevention of PTSD. Trauma type, age and gender may play a role in determining preference for receiving psychological services immediately after experiencing a traumatic event.

Azacitidine prolongs overall survival and reduces infections and hospitalizations in patients with WHO-defined acute myeloid leukaemia compared with conventional care regimens: an update

Azacitidine (AZA), as demonstrated in the phase III trial (AZA-001), is the first MDS treatment to significantly prolong overall survival (OS) in higher risk MDS pts ((2007) Blood110 817). Approximately, one-third of the patients (pts) enrolled in AZA-001 were FAB RAEB-T (≥20–30% blasts) and now meet the WHO criteria for acute myeloid leukaemia (AML) ((1999) Blood17 3835). Considering the poor prognosis (median survival <1 year) and the poor response to chemotherapy in these pts, this sub-group analysis evaluated the effects of AZA versus conventional care regimens (CCR) on OS and on response rates in pts with WHO AML.

Incidence of congenital rubella syndrome at a hospital serving a predominantly Hispanic population, El Paso, Texas

OBJECTIVE

The current epidemiology of rubella reveals an increase in the number of cases among adult Hispanics and an increase in the number of congenital rubella syndrome (CRS) cases among infants of Hispanic mothers. Recent rubella outbreaks have occurred primarily among adult Hispanics, many of whom are foreign-born natives of countries where rubella vaccination is not routine or has only recently been implemented. The objective of this study was to estimate the incidence of CRS in a hospital serving a predominantly Hispanic population.

METHODS

Hospital charts of infants <1 year old discharged between January 1, 1994 and December 31, 1996 with International Classification of Diseases, Ninth Revision (ICD-9) discharge codes consistent with CRS were reviewed; we looked for cataracts, deafness, congenital heart defects, dermal erythropoiesis, microcephaly, meningoencephalitis, and other defects associated with CRS. We abstracted data on maternal and infant ethnicity, maternal age, gestational age, infants' birth weight, infants' clinical characteristics, and laboratory evaluation. Cases were categorized according to the Council of State and Territorial Epidemiologists' case classification for CRS.

RESULTS

Of the 182 infants with 1 or more ICD-9 codes consistent with CRS, 6 (3.3%) met either the confirmed or probable case definition for CRS. Two infants met the definition for confirmed CRS. Although laboratory tests for rubella immunoglobulin M antibodies were positive for both of these infants, only 1 of the cases had been reported to the state health department. Four other infants had clinical presentations that met the definition for a probable case. One of these had been tested for rubella immunoglobulin M antibodies, and the test was negative. The other 3 had not been tested. The rate of infants meeting the definition of confirmed and probable CRS was 3.1 per 10 000 hospital births. All confirmed and probable cases were among infants born to Hispanic mothers. Maternal country of origin was Mexico for the 2 confirmed cases and 1 of the probable cases, and unknown for the remaining 3 probable cases.

CONCLUSION

The rate of confirmed and probable CRS among infants in this predominantly Hispanic population is higher than the reported rate in the United States in the vaccine era, which has been reported to range from approximately 0.01-0.08 per 10 000 live births. These findings indicate a need for heightened awareness of CRS among physicians who serve populations at risk for rubella. Physicians should report all confirmed and probable CRS cases to the state health department. The lack of appropriate laboratory testing in 3 infants with probable CRS indicates that physicians should consider a diagnosis of CRS in infants with some signs consistent with CRS, particularly in areas serving high numbers of individuals at risk for rubella.

Congeners of N(alpha)-acetyl-L-cysteine but not aminoguanidine act as neuroprotectants from the lipid peroxidation product 4-hydroxy-2-nonenal

Increased generation of neurotoxic lipid peroxidation products is proposed to contribute to the pathogenesis of Alzheimer's disease (AD). Current antioxidant therapies are directed at limiting propagation of brain lipid peroxidation. Another approach would be to scavenge the reactive aldehyde products of lipid peroxidation. N(alpha)-acetyl-L-cysteine (NAC) and aminoguanidine (AG) react rapidly and irreversibly with 4-hydroxy-2-nonenal (HNE) in vitro, and both have been proposed as potential scavengers of HNE in biological systems. We have compared NAC, AG, and a series of congeners as scavengers of HNE and as neuroprotectants from HNE. Our results showed that while both NAC and AG had comparable chemical reactivity with HNE, only NAC and its congeners were able to block HNE-protein adduct formation in vitro and in neuronal cultures. Moreover, NAC and its congeners, but not AG, effectively protected brain mitochondrial respiration and neuronal microtubule structure from the toxic effects of HNE. We conclude that NAC and its congeners, but not AG, may act as neuroprotectants from HNE.

Unanticipated consequences: a comparison of expected and actual retirement timing among older women

The present study adds to the growing body of literature on women and retirement by means of a comparative analysis of the factors associated with anticipated retirement timing (among pre-retirees) and actual retirement timing (among retirees). Adopting a political economy of aging perspective, we argue that socially-structured patterns of gender inequality related to women's multiple roles across the life course affect patterns of retirement timing. Specifically, we hypothesize that the gendered nature of women's work-retirement decision-making is unanticipated during pre-retirement years. Logistic regression analyses are performed on data drawn from a sample of 275 women aged 45 and older living in the Vancouver area of British Columbia. A central finding is that while actual timing of retirement is affected by family caregiving responsibilities and by health/stress factors, pre-retirees do not perceive these to be important in their own expected retirement timing. Implications for social policy, education, and women's financial and psychological well-being in old age are elaborated.

Functional status outcomes of patients with a coronary artery bypass graft over time

OBJECTIVE

To examine functional status outcomes among patients with a coronary artery bypass graft (CABG) over time (ie, at baseline; 3 months, 6 months, and 12 months after surgery) and the impact of selected patient characteristics (ie, age, sex, comorbidities, and cardiac rehabilitation participation) on functional outcomes.

DESIGN

A prospective, repeated-measures design was used to examine functional status in patients with a CABG over time.

SETTING

A midwestern community hospital and regional cardiac referral center was the setting for enrolling patients with a CABG.

OUTCOME MEASURES

Functional status outcomes were measured by using the Medical Outcomes Study (MOS) Short Form 36 (SF-36) and Modified 7-Day Activity instruments.

METHODS

Baseline data were obtained by patient interview in the hospital setting after CABG surgery. At 3 months, 6 months, and 12 months after surgery, telephone interviews were conducted to administer research instruments.

RESULTS

Baseline scores on 7 of the 8 subscales of the MOS SF-36 were significantly lower than at 3 months, 6 months, or 12 months after surgery. Role-emotional functioning baseline scores were not significantly lower than 3-month scores; however, baseline scores were significantly lower than 6-month and 12-month scores. Three-month subscale scores were also significantly lower than 6-month or 12-month scores except for the subscales measuring social and general health functioning. Functional status as measured by the Modified 7-Day Activity tool did not demonstrate any significant differences between 3-month, 6-month, or 12-month activity levels. There were no significant differences by age group on any of the 8 subscales of the MOS SF-36 instrument. Women and subjects with more than 1 comorbidity had a significantly lower preoperative level of physical functioning. Cardiac rehabilitation participants had lower preoperative scores on role-emotional functioning than subjects who were not in rehabilitation.

CONCLUSION

Findings from this study can assist nurses and other health care workers to gain a perspective of the recovery and rehabilitation trajectory of patients with a CABG. The results of the study provide a basis for determining areas of functional limitations during recovery from CABG surgery. Study results can also be the foundation for evaluating outcomes of patients with a CABG when specific interventions (eg, pain management, psychosocial support, physical strengthening, fatigue management) are implemented during hospitalization, home recovery, and rehabilitation to target optimal psychosocial and physiologic functioning of patients with a CABG.

Sexual and physical abuse among incarcerated youth: implications for sexual behavior, contraceptive use, and teenage pregnancy

OBJECTIVE

In the present study, physical and sexual abuse among incarcerated youth were examined with respect to sexual activity, contraceptive use, and pregnancy.

METHOD

The self-report survey data were collected from 62 females and 334 males who were incarcerated in Nevada youth correctional facilities in the summer of 1994. Of the males, 46.8% (n = 156) reported a history of physical abuse and 9.9% (n = 33) reported sexual abuse. A surprisingly high 73% (n = 46) of the females reported a history of physical abuse and 68.3% (n = 43) reported sexual abuse.

RESULTS

The analyses indicated that females who reported a history of sexual abuse had an earlier mean age of first intercourse than those who reported no sexual abuse. In addition, male and female respondents with a history of physical and/or sexual abuse reported using no method of contraception as compared to youth with no history of abuse.

CONCLUSIONS

Implications of these results for detention-based counseling and prevention programming are discussed.

The relationship and influence of anxiety on postoperative pain in the coronary artery bypass graft patient

The purposes of this study were to investigate the relationship of postoperative anxiety and pain following coronary artery bypass graft (CABG) surgery, and to determine the effects of level of anxiety, demographic, and other factors on the level of postoperative pain. Pain intensity, sensory pain, and affective pain were measured along with anxiety on postoperative day 2 and day 3 by the McGill Pain Questionnaire Subscales (PPI, PRIS, and PRIA) and State Anxiety Inventory Scale, respectively. A direct relationship of anxiety with pain was found over time with the highest relationship on postoperative day 2 (r = 0.235-0.492, P < 0.001). A significant interaction between time and level of anxiety on affective pain was specific to postoperative day 2 (P < 0.01). Significant differences by level of anxiety and time were reported. Factors of age, gender, marital status, number of previous surgeries, and operation time had no effect on the level of postoperative pain.

The efficacy of advanced life support: a review of the literature

INTRODUCTION

Jurisdictions throughout the United States and some other parts of the world have invested substantial time and resources into creating and sustaining a prehospital advanced life support (ALS) system without knowing whether the efficacy of ALS-level care had been validated scientifically. In recent years, it has become fashionable for speakers before large audiences to declare that there is no scientific evidence for the clinical effectiveness of ALS-level care in the out-of-hospital setting. This study was undertaken to evaluate the evidence that pertains to the efficacy of ALS-level care in the current scientific literature.

METHODS

An extensive review of the available literature was accomplished using computerized and manual means to identify all applicable articles from 1966 to October, 1995. Selected articles were read, abstracted, analyzed, and compiled. Each article also was categorized as presenting evidence supporting or refuting the clinical efficacy of ALS-level care, and a list was constructed that pointed to where the preponderance of the evidence lies.

RESULTS

Research in this field differs widely in terms of methodological sophistication. Of the 51 articles reviewed, eight concluded that ALS-level care is not any more effective than is basic life support, seven concluded that it is effective in some applications but not for others, and the remainder demonstrated effectiveness. The strongest support for ALS-level care was in the area of responses to victims of cardiac arrest, whereas somewhat more divergent findings related to trauma or non condition-specific studies.

CONCLUSIONS

While not unanimous, the predominant finding of recent research into the clinical effectiveness of advanced life support demonstrates improved effectiveness over basic life support for patients with certain pathologies. More outcomes-based research is needed.