High molar ratios of tumor necrosis factor α (TNF α) soluble receptors I and II to the TNF ligand in human plasma from male veterans with comorbid posttraumatic stress disorder (PTSD) and mild traumatic brain injury (mTBI)

Background and Objectives Posttraumatic stress disorder (PTSD) and traumatic brain injury (TBI) are associated with chronic inflammation, as inferred from increased, but variable, peripheral levels of cytokines. We sought proof of concept for the notion that peripheral cytokine binding proteins and/or soluble receptors can confound measures of cytokines in those with a history of physical and psychological traumatic exposures. Efforts were focused on one of the major cytokines involved in inflammation, tumor necrosis factor-α (TNF- α). Methods We examined blood plasma concentrations of TNF-α, its soluble receptors (TNF-soluble receptors (sR) I and TNFsRII), and C-reactive protein (CRP-1) in a cohort of US Veterans. In a previous study, CRP-1 was shown to be reduced by probiotic anti-inflammatory treatment in this patient cohort. All participants (n = 22) were diagnosed with PTSD and had a history of mild TBI with persistent post-concussive symptoms. Exclusion criteria included medications directly targeting inflammation. Results Molar concentrations of soluble TNFsRI and II exceeded concentrations of the TNF-α ligand. TNFsRI, but not TNFsRII, was significantly associated with CRP-1 (Spearman Rho correlations = 0.518; p=.016 and 0.365; p = .104, respectively). Conclusions TNF soluble receptors may bind to and sequester free TNF-α, suggesting that only measuring ligand concentrations may not provide a fully comprehensive view of inflammation, and potentially lead to inaccurate conclusions. TNFsRI concentration may provide a better estimate of inflammation than TNF-α for those with PTSD and post-acute mTBI with post-concussive symptoms, a hypothesis that invites further testing in larger studies. (AU)

Ansiedad y Depresión en una Muestra de Músicos Militares y Civiles / Anxiety and Depression in a Sample of Military and Civilian Musicians

Diferentes estudios muestran que dos grupos tan diferentes como los militares y los músicos suelen manifestar altos niveles de ansiedad y depresión. Por ello, el objetivo de este estudio es medir estas variables clínicas en músicos militares comparándolo con músicos civiles. La muestra está compuesta por 266 músicos, representada al cincuenta por ciento por músicos militares y civiles provenientes de todo el territorio nacional. Para medir los niveles de ansiedad y depresión se utilizaron el Inventario de Ansiedad de Beck (BAI) y el Inventario de Depresión de Beck (BDI). Los resultados muestran una relación directa entre la ansiedad y la depresión en el total de la muestra y en ambos grupos, encontrando que los músicos militares puntúan más alto que los civiles en ambas variables, y que en el ámbito militar afecta el escalafón, siendo la tropa la que presenta niveles más elevados en ansiedad y especialmente en depresión.(AU)

Different studies show that two groups as different as militaries and musicians usually demonstrate high levels of anxiety and depression. So, the objective of this study is measuring these clinics variables in military musicians comparing with civil musicians. The sample is composed of 266 musicians, represented fifty percent by military and civilian coming from all over the national territory. To measure the levels of anxiety and depression were used the Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI). The results show a direct relationship between anxiety and depression in the sample total and in both groups, finding that military musicians score higher than civilians in both variables, and that in the military sphere it affects the Ladder, being the troop that presents higher levels of anxiety and especially depression.(AU)

Desarrollo y validación de una escala de actitudes hacia la discapacidad en personal militar / Development and validation of an attitudes scale towards disability in military personnel

Antecedentes y objetivo: La concepción actual de la discapacidad, donde las características físicas de una persona son contempladas en su interacción con el entorno, requiere de estudios actitudinales de la población que faciliten la identificación de las barreras que limitan el ejercicio de los derechos en igualdad de oportunidades para las personas con discapacidad en contextos profesionales. El objetivo principal del estudio ha sido el diseño, construcción y validación de un instrumento de evaluación de las actitudes hacia la discapacidad en personal militar.Método:En el estudio han participado 204 militares de diferentes empleos y escalas, donde un 11,76 % fueron mujeres y un 88,24 % hombres. El desarrollo del trabajo estuvo dividido en dos fases. En la primera fase, se construye la escala y se somete a juicio de expertos analizando la concordancia entre los mismos con el fin de valorar la validez de contenido del cuestionario. En la segunda fase, se valoran las cualidades psicométricas de fiabilidad y validez (constructo y concurrente) de la escala.Resultados:Los resultados obtenidos reflejan propiedades psicométricas adecuadas y ajustadas del instrumento. En el análisis de la fiabilidad se observa que, tanto la escala en su conjunto (.87), como las dos subescalas que la conforman (.88 y .89), presentan una adecuada consistencia interna. En los análisis exploratorio y confirmatorio realizados, se obtiene un modelo con una solución de dos factores cuyos datos de bondad de ajuste (NFI = 0.94, GFI = 0.94, CFI = .97, RMSEA = .06 (IC 90 % = .048 - .070), RMR estandarizado = .091) garantizan una adecuada validez de constructo. Asimismo, se observa una adecuada validez concurrente (.76; p< .01).Conclusiones:Se concluye el uso justificado y óptimo del instrumento para la evaluación de las actitudes hacia la discapacidad en personal militar. (AU)

Background and objective: Currently, the conception of disability considers the physical characteristics of the person in their interaction with the environment. This understanding makes it necessary for the development of attitudinal studies of the population that facilitate the identification of barriers that limit the exercise of people with disabilities’ rights in equal opportunities in the professional field. The main objective of the study was the design, construction, and validation of an instrument to assess attitudes towards disability in the Armed Forces.Method:204 soldiers of different positions and scales participated in the study, where 11.76 % were women and 88.24 % were men. The study was divided into two phases. In the first phase, the scale was constructed and evaluated by a group of experts. The concordance between them was also analyzed in order to evaluate the validity of the content of the questionnaire. In a second phase, the psychometric qualities of reliability and validity (construct and concurrent) of the scale were evaluated.Results:The results obtained reflect appropriate psychometric properties adjusted to the instrument. The reliability analysis, shows that both, the scale as a whole (.87), and the two subscales that make it up(.88 and .89), present adequate internal consistency. In the exploratory and confirmatory analyses performed, it is obtained a model with a two-factor solution. Its goodness-of-fit data (NFI = 0.94, GFI = 0.94, CFI = .97, RMSEA = .06 (90 % CI = .048 - .070), standardized RMR = .091) guarantee adequate construct validity. Likewise, an appropriate concurrent validity is observed (.76; p<.01).Conclusions:In conclusion, the use of the instrument for the evaluation of attitudes towards disability in the Armed Forces is justified and optimal. (AU)

Discapacidad militar: revisión de recursos psicosociales en los ejércitos de nuestro entorno / Military disability: review of psychosocial resources in the armies of our environment

El avance legislativo y social respecto a los derechos e igualdad de oportunidades de las personas con discapacidad, no excluye a los contextos militares. Estados Unidos, Francia, Reino Unido o España, han desarrollado instrumentos para garantizar la protección legal, administrativa y económica de los militares con discapacidad, pero los proyectos y programas de recuperación social parecen insuficientes, por lo que este trabajo se centra en el objetivo de revisar los recursos psicosociales disponibles en los ejércitos de nuestro entorno.Los resultados muestran que la mayor parte de los estudios revisados se centran en la recuperación de militares con trastorno de estrés postraumático (TEPT), aunque también se recogen trabajos con lesionados medulares o con daño cerebral. Las temáticas abordadas, con relación al apoyo psicosocial y los recursos disponibles, se enfocan a la empleabilidad, las compensaciones económicas, los tratamientos y los factores que favorecen la integración social. Destacan los estudios sobre: (1) los beneficios aportados por los programas de empleo con apoyo para la salud, la integración social y la autoestima, (2) el uso de perros de servicio, que mejoran la calidad de vida y la producción laboral, y (3) los programas de deporte, que mejoran la autoestima y la calidad de vida, y favorecen el crecimiento postraumático.Como conclusión, se apunta la necesidad de establecer programas de recuperación integral, no solamente sanitaria, sino también psicosocial. Los militares y veteranos con discapacidad deben ser informados y asesorados acerca de los recursos que tienen a su disposición, pero también acompañados en la transición a la vida civil, iniciando proyectos laborales, sociales, deportivos y de ocio, que favorezcan su calidad de vida, su autoestima y su recuperación. (AU)

The legislative and social progress regarding the rights and equal opportunities of people with disabilities does not exclude military contexts. The United States, France, the United Kingdom and Spain have developed instruments to guarantee legal, administrative, and economic protection for military personnel with disabilities, although social recovery projects and programs seem insufficient. Therefore, this bibliographic review focuses on the objective of reviewing the psychosocial resources available in the Armies of our environment.The results show that most of the studies reviewed focus on the recovery of military personnel with post-traumatic stress disorder (PTSD), although there are also studies on spinal cord injury or brain damage. The topics addressed, in relation to psychosocial support and available resources, focus on employability, economic compensation, treatments and factors that favour social integration. Of note are studies on: (1) the benefits brought by supported employment programs, for health, social integration, and self-esteem, (2) the use of service dogs, that improve quality of life and work production, and (3) sports programs, which improve self-esteem and quality of life, and favour post traumatic growth.In conclusion, the need to establish comprehensive recovery programs, not only health, but also psychosocial, is pointed out. Military personnel and veterans with disabilities should be informed and advised about the resources available to them, and accompanied in the transition to civilian life, initiating work, social, sports and leisure projects that favour their quality of life, self-esteem, and recovery. (AU)

Pedro José Martínez Moreno. Practicante de la Armada: algo más que un personaje / Pedro José Martínez Moreno. Practitioner da armada: mais que uma simples personagem / Pedro José Martínez Moreno, a Navy Practitioner: more than just a personage

Los Practicantes de la Armada, desde principios de siglo XX hasta finalizar la guerra civil, en las distintas zonas marítimas de nuestra geografía, fueron protagonistas destacados de la institución colegial. Eran profesionales muy bien formados y con amplias competencias laborales, gran bagaje de vivencias y con un elevado sentido del corporativismo como arma para defender unos derechos que no les eran reconocidos. El objetivo de este estudio consiste en describir la vida de Pedro J. Martínez desde la doble perspectiva de militar y practicante. Para ello, hemos empleado una metodología basada en el proceso heurístico de fuentes primarias de origen archivístico localizadas en el Archivo Central del Cuartel General de la Armada y Archivo del Colegio de Enfermería de Cádiz. También hemos obtenido importante información de la prensa profesional del momento, como es el caso de El Practicante Gaditano y recurrido a la documentación personal con la Catedrática Victoria Fernández Díaz. Toda la documentación obtenida ha sido analizada siguiendo las orientaciones de la disciplina histórica, especialmente la biográfica y de vida. Los resultados obtenidos en esta investigación nos llevan a perfilar a Martínez Moreno como un individuo que, por sus cualidades y conocimientos, destacaba en su actividad profesional y en el ambiente social. Cartagenero de nacimiento y practicante de la Armada, era algo más que un personaje. Desde su tierra natal, donde fue presidente del Colegio Departamental de Cartagena, fundador y propietario de la revista “El Practicante Moderno”, hasta llegar a la capital gaditana donde resultó elegido presidente del Colegio de Practicantes de Cádiz. No pasaba nunca desapercibido y destacaba en todos los ámbitos donde residía. También era un profesional militar muy considerado por sus superiores y así le era oficialmente reconocido. En cumplimiento al Decreto del Gobierno provisional...(AU)

The Navy Surgery Practitioners, from the beginning of the twentieth century until the civil war, the different maritime of our geography, they were prominent protagonist of the collegiate institution. They were very well trained professionals with extensive work skills, great baggage of experiences and with a high sense of corporatism as a weapon to defend rights that were not recognized to them. The objective of this study is describing the life of Pedro J. Martínez Moreno from the dual perspective of military and surgery practitioner. To do this, we have used a methodology based on the heuristic process of primary sources of archival origin located in the Central Archive of the Headquarters of the Navy and file of the College of Nursing of Cádiz. We have also obtained important information from the professional press of the moment, as is the El Practicante Gaditano and resorted to personal documentation with Professor Victoria Fernández Díaz. All the documentation obtained has been analyzed according to the orientation of historical discipline, especially biographical and life. The results obtained in this research lead us to profile Martínez Moreno as an individual who, for his qualities and knowledge, he exceled in...(AU)

Os Praticantes da Marinha, desde o início do século XX até ao fim da guerra civil, nas diferentes áreas marítimas da nossa geografia, foram protagonistas notáveis da instituição colegial. Eram profissionais muito bem treinados, com vastas competências de trabalho, uma grande experiência e um forte sentido de corporativismo como arma para defender direitos que não eram reconhecidos. O objectivo deste estudo é descrever a vida de Pedro J. Martínez a partir da dupla perspectiva de militar e praticante. Para tal, utilizámos uma metodologia baseada no processo heurístico de fontes primárias de origem arquivística localizadas no Arquivo Central do Quartel-General da Marinha e no Arquivo do Colégio de Enfermagem de Cádis. Obtivemos também informações importantes da imprensa profissional da época, como é o caso de El Practicante Gaditano e recorremos à documentação pessoal com a Professora Victoria Fernández Díaz. Toda a documentação obtida foi analisada seguindo as directrizes da disciplina histórica, especialmente a biografia e a história de vida. Os resultados obtidos nesta investigação levam-nos a traçar o perfil de Martínez Moreno como um indivíduo que, devido às suas qualidades e conhecimentos, se destacou na sua actividade profissional e no meio social. Cartaginês de nascimento e estagiário da Marinha, ele era mais do que uma personagem. Desde a sua pátria, onde foi presidente do Colégio Departamental de Cartagena, fundador e proprietário da revista "El Practicante Moderno", até à capital de Cádis, onde foi eleito presidente do Colégio de Praticantes de Cádis. Ele nunca passou despercebido e destacou-se em todas as áreas onde viveu. Era também um profissional militar altamente considerado pelos seus superiores e foi oficialmente reconhecido como tal. Em conformidade com o Decreto do Governo Provisório da República de 23 de Abril de 1931, fez a promessa obrigatória de adesão e lealdade à República...(AU)

¿Es la simulación de trastorno mental en militares un diagnóstico estereotipado? / Is malingering mental disorder a stereotyped diagnosis in the military?

Desde el comienzo de la cultura occidental, la simulación de problemas mentales es descrita como un método empleado para evitar el reclutamiento militar o escapar de la guerra. Durante siglos, la asociación simulación militar ha permanecido unida llegando a crearse, en el siglo XX, un criterio específico en los principales manuales de clasificación psiquiátrica, a pesar de que nunca hubo pruebas objetivas con las que argumentar que los militares fueran más sospechosos que otros profesionales. ¿Se ha estereotipado el diagnóstico de simulación en los militares? Objetivo: Reflexionar sobre si la clasificación actual de simulación de trastorno mental, que incluye el criterio específico de ser militar, se corresponde con datos empíricos. Método: Tras las búsquedas bibliográficas, se analizó la evolución histórica del concepto, la metodología de su detección, las consecuencias que sufren los militares cuando se les etiqueta como simuladores y los estudios de prevalencia. Resultados: Los contextos militares no presentan grandes tasas de simulación en la actualidad. Parece que el estereotipo simulador militar permanece todavía en la perspectiva forense. Conclusión: No hay justificación empírica para incluir un criterio de sospecha de simulación específico para los militares en los manuales de diagnóstico psiquiátrico. Sin embargo, este criterio contribuye a estigmatizar a los militares que presentan problemas psicológicos reales y promueve la disimulación de psicopatología real. Se espera que esta reflexión sirva para ayudar a incluir factores psicosociales en el modelo biológico de la simulación, luchar contra el doble estigma asociado a los problemas mentales en militares, dignificar los problemas de salud invisibles sufridos por los soldados en las guerras y devolver el honor a los que fueron condenados o ejecutados en el pasado por padecer trastornos mentales

From the beginning of Western culture, malingering mental problems has been described as a method used to avoid military recruitment or escape from war. For centuries, the association between malingering and the military has persisted, creating in the 20th century a specific criterion in the main manuals of psychiatric classification, albeit having no objective evidence to support members of the military as more prone to malinger than other professionals. Is the diagnosis of malingering mental disorder stereotyped in the military? Objective: To reflect on whether or not the current classification of malingering mental disorder is based on scientific evidence. Method: After carrying out bibliographical searches the following constructs were analysed: the historical evolution of the concept, the methodology of its detection, the consequences suffered by the military when they were labelled as malingerers. Finally, prevalence studies were examined. Results: Military contexts do not present high rates of malingering nowadays and yet it seems that malingering-military stereotype remains in the forensic perspective. Conclusion: There is no empirical justification to include a specific malingering criterion for military personnel in psychiatric diagnosis manuals. However, this criterion contributes to stigmatizing military personnel who present real psychological problems. In addition, it encourages dissimulation or faking good. Hopefully, the present article will help include psychosocial factors in the biological model of malingering, fight against double stigma associated with mental problems in the military, dignify the invisible wounds of war and restore the honour of those who have been condemned or executed in the past for suffering mental disorders

Brain disease or biopsychosocial model in addiction? Remembering the Vietnam veteran study / ¿Modelo de enfermedad cerebral o biopsicosocial en adicciones? Recordando el Estudio de Veteranos de Vietnam

BACKGROUND: In recent years, we have repeatedly been told that addictions are a brain disease, leaving aside their classic biopsychosocial explanation. OBJECTIVE: To describe both models and discusses the weakness and reductionism of the brain disease model following the consumption of heroin by North American soldiers in the Vietnam war in the 1970s. METHOD: A literature review of the Vietnam Veteran Study in relation to drug consumption. RESULTS: The soldiers greatly increased their consumption of heroin in Vietnam, but almost all of them ceased using it upon returning home. The analysis of the environmental factors related to this self-healing is a critique of the brain disease model of addictions because it cannot explain this or other studies. CONCLUSION: The biopsychosocial model is still the best model to guide the field of addiction due to its utility, coherence, and efficacy in treatment

ANTECEDENTES: en los últimos años se escucha cada vez más la afirmación de que las adicciones son una enfermedad cerebral, dejando a un lado la clásica explicación biopsico-social en adicciones. OBJETIVO: describir ambos modelos y analizar la debilidad y reduccionismo del modelo de enfermedad cerebral siguiendo el Vietnan Veteram Study, sobre el consumo de heroína, en los soldados norteamericanos que participaron en la guerra del Vietnam. MÉTODO: revisión de la literatura del Vietnam Veteran Study en relación al consumo de drogas. RESULTADOS: los soldados incrementaron de modo importante el consumo de heroína en Vietnam, pero casi todos dejaron de consumirla a su vuelta a casa. Analizando los factores ambientales relacionados con esta auto-cura se hace una crítica del modelo de enfermedad cerebral en adicciones ya que el mismo no puede explicar este ni otros estudios. CONCLUSIÓN: el modelo biopsicosocial sigue siendo el mejor modelo para el campo de las adicciones debido a su utilidad, coherencia y eficacia en su tratamiento

Psychiatric comorbidity and PTSD-related health problems in war veterans: Cross-sectional study

Background and objectives: PTSD rarely occurs on its own and opinions on the correlation between PTSD and its comorbidities are still divided. Methods: To identify the comorbidity profile of psychiatric diagnoses in PTSD - affected war veterans and to determine the correlation with mental and health problems. Participants and methods: The experimental group consisted of 154 war veterans with combat-related PTSD. The control group was made of 77 veterans without PTSD. The study applied a general demographic questionnaire, the Harvard Trauma Questionnaire - Bosnia and Herzegovina version and the MINI. Results: A 97.4% of PTSD-diagnosed veterans satisfied criteria for other mental disorders and that 44.8% suffered chronic somatic problems. More frequently they suffered from current depressive episode (41.6%), past depressive episode (36.4%), depressive episode with melancholic features (36.4%), dysthymia (13.6%), panic disorder with agoraphobia (11.0%), generalized anxiety disorder (82.5%) alcohol abuse (34.4%) and suicidal ideation (26.0%). Conclusion: The study showed that chronic PTSD in war veterans was almost always accompanied by multiple psychiatric and often somatic comorbidities

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Effects of the addition of acarbose to insulin and non-insulin regimens in veterans with type 2 diabetes mellitus

Objectives: The primary objective of the study was to assess the mean change in hemoglobin A1c (HbA1c) when acarbose was added to insulin and non-insulin regimens in patients with type 2 diabetes mellitus (T2DM). Secondary objectives were to evaluate the discontinuation rate of acarbose, and to assess the number of patients who were placed on insulin despite the addition of acarbose. Methods: A retrospective chart review was conducted on veterans with T2DM initiated on acarbose between October 1, 2013 and December 31, 2013. To be included, patients must have had a refill history indicating at least 3 months of acarbose use and HbA1c readings within 6 months prior to initiation and after at least 3 months of use. Excluded patients were those with type 1 diabetes mellitus, serum creatinine ≥2 mg/dL at acarbose initiation, or a diagnosis based on ICD-9 codes for an existing gastrointestinal condition or liver cirrhosis. The two-tailed, paired t-test was used for analysis of the primary objective and descriptive statistics were used for all other outcomes. Results: Of the 146 patients screened, 102 patients were included in the study. Exclusions were primarily due to patients not being on acarbose for at least 3 months (n=43). The average HbA1c before and after acarbose initiation was 9.08% (SD=1.74) and 8.43% (SD=1.74) respectively, with an average HbA1c reduction of 0.65% (n=102, p=0.0005). Forty patients (39.2%) discontinued acarbose after at least 3 months of use. Of the 73 patients not on insulin at the time of acarbose initiation, 19 (26%) were started on insulin therapy despite addition of acarbose. Conclusion: Acarbose can be considered in patients who may reach their HbA1c goal with minimal HbA1c reduction. However, adverse effects are a limitation to use. Potential risks and benefits should be assessed and discussed with the patient prior to prescribing acarbose (AU)

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Psychological and behavioral problems in children of war veterans with Post Traumatic Stress Disorder

Background and Objectives: Posttraumatic stress disorder (PTSD) caused by war trauma experiences affects veterans'; ability to meet their parental obligations, which can lead to the appearance of psychological and behavioral problems in their children. We explored, based on the parents'; assessment, whether the children of veterans with PTSD exhibit more psychological and behavioral problems and whether there are differences in relation to the age and sex of the child. Methods: The study group consisted of 91 children from 50 veterans receiving treatment for the war-related PTSD at the Psychiatric Department of the University Clinical Hospital Mostar. The control group consisted of 98 children of 50 war veterans without PTSD who were selected from veteran associations by the snowball method. The following instruments were used in the study: General Demographic Questionnaire, Harvard Trauma Questionnaire-Bosnia and Herzegovina version and the Strengths and Difficulties Questionnaire for children. Results: Children of veterans with PTSD have more pronounced psychological and behavioral problems (U = 2372.5; P < 0.001) compared to the children of veterans without PTSD. Male children of veterans with PTSD have more frequent behavioral problems (χ2 = 7.174; P = 0.025) compared to the female children, and overall, they more frequently exhibit borderline or abnormal psychological difficulties (χ2 = 6.682; P = 0.029). Children exhibiting abnormal levels of hyperactivity are significantly younger than children who exhibit normal or borderline levels of hyperactivity (Kruskal-Wallis = 3.982; P = 0.046). Conclusions: The children of war veterans with PTSD have more psychological and behavioral problems in comparison with the children of veterans without PTSD (AU)

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Comorbidities with Posttraumatic Stress Disorder (PTSD) among combat veterans: 15 years postwar analysis / Comorbilidades con el Trastorno de Estrés Postraumático (TEPT) entre veteranos de guerra: un análisis a los 15 años después de la guerra

The aim of this study was to investigate the differences in the prevalence of somatic diseases among combat veterans and their contemporaries who were not exposed to the traumatic experience at the battlefield, and to determine whether socio-demographic factors, exposure to war-time trauma and/or injury might predict individual somatic diseases. The study included 1,558 subjects living in south Croatia: 501 male combat veterans with Posttraumatic Stress Disorder (PTSD) and the corresponding control group of 825 men who were not exposed to combat experience. Veterans with PTSD, regardless of the length of time spent in war, suffered more often from cardiovascular, dermatological, musculoskeletal, pulmonary and metabolic diseases than corresponding control subjects who were not exposed to combat experience. The predictors of cardiovascular, musculoskeletal and malignant diseases in veterans were age, length of time spent in combat, having been wounded. A longer period in the combat zone was associated with arrhythmias in veterans with PTSD complicated with other psychiatric comorbidities. PTSD as a result of exposure to war trauma increases the possibility of developing somatic diseases (AU)

El propósito de este estudio ha sido comparar la frecuencia de trastornos somáticos en veteranos de guerra y personas no expuestas a la experiencia traumática del campo de batalla, así como determinar si la exposición a factores socio-demográficos en tiempo de guerra pueden predisponer a traumas, alteraciones o trastornos somáticos. El estudio incluye 1,558 sujetos del sur de Croacia: 501 varones veteranos de guerra con síndrome de estrés postraumático (TEPT) y un grupo de control de 825 varones no expuestos a la experiencia de combate. Los veteranos con TEPT, independientemente del tiempo pasado en la guerra, desarrollan más a menudo alteraciones gastrointestinales, cardiovasculares, dermatológicas, locomotoras, pulmonares y metabólicas que los sujetos del grupo control. Los indicadores de alteraciones cardiológicas, locomotoras, entre otros, en veteranos han sido la edad, el tiempo pasado en combate y el daño allí sufrido. Un largo período en la zona de combate ha sido asociado con arritmias y otras complicaciones de tipo psiquiátrico. El TEPT, como resultado de la exposición a experiencias traumáticas del campo de batalla, incrementa la posibilidad de desarrollo de trastornos somáticos (AU)

Medication adherence and glycemic control in patients with psychotic disorders in the Veterans Affairs healthcare system / Cumplimiento de la medicación y control glucémico en pacientes con desordenes psicóticos en el sistema de salud de la Oficina de Veteranos

Objective: To compare antihyperglycemic medication adherence and glycemic control between individuals with schizophrenia and related psychotic disorders and a nonpsychiatric comparison group. Methods: This was a retrospective medical record review. A total of 124 subjects with diabetes (62 patients with schizophrenia or a related psychotic disorder and 62 randomly selected, age-matched patients without a psychiatric illness) receiving their medical and psychiatric care exclusively through the Kansas City Veterans Affairs healthcare system during 2008 were included in the study. Adherence to antihyperglycemic and antipsychotic medication was determined by refill records obtained through the computerized patient record system to calculate the cumulative mean gap ratio. Hemoglobin A1C values were utilized to compare glycemic control between groups and compared to glycemic goals established by diabetes treatment guidelines. Results: Antihyperglycemic medication adherence was poor for both groups as approximately 60% of the psychotic disorder group and 75% of the nonpsychiatric comparison group were without antihyperglycemic medication for greater than 30 days during the 12-month period but adherence did not differ between the groups (p=0.182). Antipsychotic adherent subjects (>=80% adherent) were more likely to be adherent to their antihyperglycemic medication (p=0.0003). There were no significant differences between groups in glycemic control (AU)

Objetivo: Comparar la adherencia a la medicación antihiperglucémica y el control glucémico entre individuos con esquizofrenia y desordenes psicóticos relacionados y un grupo de comparación no psiquiátrico. Métodos: Esto fue una revisión retrospectiva de historiales clínicos. Se incluyeron en el estudio a un total de 124 individuos con diabetes (62 pacientes con esquizofrenia o desordenes psicóticos relacionados y 62 pacientes sin enfermedad psiquiátrica aleatoriamente seleccionados y emparejados por edades) que recibían su medicación y sus cuidados psiquiátricos exclusivamente a través del sistema sanitario de la Oficina de Veteranos de Kansas City durante 2008. La adherencia a la medicación antihiperglicemica y antipsicótica se determinó de los registros de recogida de medicación a través del sistema informático para calcular el porcentaje de discordancia medio acumulativo. Se utilizaron los valores de hemoglobina A1C para comparar el control glucémico entre los grupos y comparar con los objetivos glucémicos establecidos en las guias de tratamiento. esultados: La adherencia a la medicación antihiperglucémica fue pobre en ambos grupos, ya que aproximadamente el 60% del grupo de desordenes psicóticos y el 75% del grupo de comparación no psiquiátrico estuvieron sin medicación antihiperglucémica durante más de 30 días en el periodo de 12 meses pero la adherencia no fue diferente entre los grupos (p=0,182). Los individuos adherentes a los antipsicóticos (>=80% adherentes) eran más adherentes a sus antihiperglucémicos (p=0,0003). No hubo diferencias significativas entre los dos grupos en el control glucémico. Conclusión: La adherencia a la medicación antihiperglucémica y el control glucémico fue menos que óptimo en los dos grupos. No hubo diferencias significativas en la adherencia a la medicación antihiperglucémica y al control glucémico entre pacientes con un desorden psicótico y los que no tenían enfermedad psiquiátrica (AU)

Predisposición genética común en la depresión mayor y el trastorno de estrés postraumático en hombres / Common genetic liability to major depression and posttraumatic stress disorder in men

Fundamento: La depresión mayor (DM) y el trastorno de estrés postraumático (TEPT) se caracterizan por su elevada comorbilidad. No se ha cuantificado el grado hasta el cual una predisposición genética común explica la etiología de su asociación y tiene importantes implicaciones para la investigación y la prevención. Métodos: Este artículo presenta un análisis de los datos de 6.744 miembros del Vietnam Era Twin Registry. La DM y el TEPT se evaluaron mediante el Diagnostic Interview Schedule-III-R en 1991–1992. Se efectuó un modelado bivariante de gemelos para determinar la etiología genética y ambiental de la asociación DM-TEPT. Resultados: El modelo con el mejor ajuste de la asociación DM-TEPT incluyó una correlación genética sustancial (r = 0,77; IC95%, 0,50-1,00) y una correlación modesta ambiental específica individual (r = 0,34; IC del 95%, 0,19–0,48). Una predisposición genética común explicó el 62,5% de la comorbilidad DM-TEPT. Las influencias genéticas comunes a la DM explicaron el 15% de la varianza total en el riesgo de TEPT y el 58% de la varianza genética en el TEPT. Las influencias ambientales específicas individuales comunes a la DM solo explicaron el 11% de la varianza ambiental individual específica en el TEPT. Limitaciones: Los participantes del presente estudio eran veteranos de la guerra de Vietnam y los hallazgos no pueden generalizarse a civiles, mujeres u otras cohortes. Conclusiones: La comorbilidad DM-TEPT se explica en gran parte por influencias genéticas comunes. La superposición genética sustancial entre ambos implica que los genes involucrados en la etiología de la DM son potentes candidatos para el TEPT y al contrario. Las influencias ambientales en ambos explican un menor grado su covariación y parecen ser en su mayor parte específicas de trastorno. Se requiere más investigación para identificar los factores ambientales que influyen en el desarrollo de la DM comparado con el TEPT en el contexto de una predisposición genética común (AU)

Background: Major depression (MD) and posttraumatic stress disorder (PTSD) are highly comorbid. The degree to which a common genetic liability explains the etiology of the MD-PTSD association has not been quantified and has important implications or research and prevention. Methods: This paper presents an analysis of data from 6744 members of the Vietnam Era Twin Registry. MD and PTSD were assessed using the Diagnostic Interview Schedule-III-R in 1991–92. Bivariate twin modeling was conducted to determine the genetic and environmental etiology of the MD-PTSD association. Results: The best-fitting model for the MD-PTSD association included a substantial genetic correlation (r = 77; 95% CI, .50–1.00) and a modest individual-specific environmental correlation (r = .34; 95% CI, .19–48). Common genetic liability explained 62.5% of MD-PTSD comorbidity. Genetic influences common to MD explained 15% of the total variance in risk for PTSD and 58% of the genetic variance in PTSD. Individual-specific environmental influences common to MD explained only 11% of the individualspecific environmental variance in PTSD. Limitations: Our participants were male Vietnam era veterans and our findings may not generalize to civilians, females or other cohorts. Conclusions: MD-PTSD comorbidity is largely explained by common genetic influences. Substantial genetic overlap between MD and PTSD implies that genes implicated in the etiology of MD are strong candidates for PTSD and vice versa. Environmental influences on MD and PTSD explain less of their covariation and appear to be largely disorder-specific. Research is needed to identify environmental factors that influence the development of MD versus PTSD in the context of common genetic liability (AU)

A brief community linkage intervention for veterans with a persistent mental illness and a co-occurring substance abuse disorder

No disponible

Objective: Individuals with co-occurring psychiatric and substance abuse problems often exhibit poor outpatient treatment engagement and re-hospitalization following discharge from acute psychiatric services. Although case management can improve treatment engagement and reduce attrition, these services are often delivered indefinitely, limiting the availability of treatment slots. In an effort to reduce re-hospitalization rates and improve outcomes during the transition from inpatient to outpatient treatment, we developed and evaluated Time-Limited Case Management (TLC), an eight-week integrated mental health and substance abuse augmentation intervention. Method: Sixty-five dually diagnosed veterans admitted to inpatient psychiatric treatment were included in the program evaluation, 32 who received the TLC service in addition to Treatment as Usual (TAU) that began during inpatient treatment and continued after the transition to outpatient services, and a comparison group of 33 who received only TAU without transitional support provided through the TLC augmentation service. Results: The TLC group had fewer days and episodes of hospitalization at two and six month post-study entry. Furthermore, the TLC group exhibited greater improvements on the Global Assessment of Functioning from baseline to the six-month follow-up. Conclusion: TLC appears to be an effective transitional augmentation service with benefits that persist beyond the eight weeks of the program. Future research should include a larger and more rigorously controlled trial to confirm the efficacy and unique contributions of the intervention (AU)

El cumplimiento del contrato psicológico y su relación con la cultura organizacional para nuevos y veteranos: un análisis multigrupo / The fulfilment of the psychological contract and its relation organizational culture for newcomers and veterans: a multigroup analysis

Se presenta un estudio relativo a los cambios en los contratos psicológicos construidos por los miembros recién llegados en el Ejército español. Dos muestras de soldados profesionales (de reciente incorporación N1= 222 y N2= 143) y veteranos (N= 386) completaron cuestionarios. Primeramente, las respuestas fueron comparadas mostrando que los contratos psicológicos de los recién llegados cambian durante la socialización organizacional y que tales cambios se producen en general las normas de los soldados experimentados. Más aún, los resultados del análisis de ecuaciones estructurales sugieren que la cultura organizacional predice el cumplimiento del contrato psicológico. Las implicaciones de las relaciones entre la cultura organizacional y el contrato psicológico se discuten

A study into changes in the psychological contracts held by newcomers into the Spanish Army is reported. Two samples of professional soldiers (newcomers N1= 222 and N2= 143) and veterans (N= 386) completed questionnaire measures. First, responses were compared showing that newcomers’ psychological contracts change during organizational socialization and these changes were generally toward the insider norms of experienced soldiers. Moreover, results of structural equation modelling suggested that organizational culture predicts psychological contract fulfillment. The implications of the relationships between organizational culture and psychological contract are discussed