Prevalence and risk factors of depression in U.S. adults post mass shootings: evidence from population-based surveys of multiple communities.

OBJECTIVES: Mass violence incidents (MVIs) involving firearms, commonly referred to as "mass shootings" have become increasingly frequent in the United States. These shootings often result in immediate casualties and have far-reaching psychological impacts on survivors, witnesses, and the broader community. This study aimed to assess the prevalence and risk factors of depression within affected communities. STUDY DESIGN: Population-based cross-sectional study. METHODS: Data were collected from six communities affected by MVIs involving firearms that occurred between 2015 and 2020. Participants were randomly selected through address-based sampling, and depression was assessed using Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) diagnostic-level major depressive episode (MDE). RESULTS: Overall, the MDE prevalence was 17·2% since the MVI, 15·4% in the past year, and 8·2% in the past month. Significant risk factors for MDE since MVIs include high exposure to the incident (adjusted relative risk [aRR] = 1·32, 95% confidence interval [CI]: 19-1·60), being aged 18-29 years (aRR = 2·52, 95% CI: 1·61-3·95), being a woman (aRR = 1·58, 95% CI: 1·27-1·96), having low social support (aRR = 1·80, 95% CI: 1·46-2·22), and experiencing past sexual or physical trauma (aRR = 2·20, 1·52-3·19). CONCLUSION: Our study reveals a high burden of depression within communities affected by MVIs involving firearm use. Persons with high exposure to the MVIs and certain demographic groups had greater risks for MDE. These findings highlight the long-term mental health burden in communities affected by MVIs and underscore the necessity of providing mental health services in its aftermath.

Examining Stressors and Available Parenting Resources for Opioid-Using Mothers: Qualitative Findings from an Inpatient Substance Use Treatment Program.

Given the alarming opioid epidemic, high prevalence of parents involved in substance use treatment programs for opioid use disorder, and critical role that parenting stress plays on opioid use and relapse, the current study examines stressors experienced by mothers enrolled in substance use treatment. Specifically, interviews were conducted with mothers with opioid use disorder (OUD) enrolled in an inpatient substance use treatment program, to identify common themes and develop recommendations related to interventions targeting common stressors among this population. A significant number of parent-related, substance use-related, and other stressors were present prior to and during substance use treatment; with more stressors reported during treatment than prior to treatment. Mothers with OUD reported that they would be interested in receiving parenting services, but that relevant parenting resources were not offered during substance use treatment.

Adverse childhood experiences among early care and education teachers: Prevalence and associations with observed quality of classroom social and emotional climate.

This study examines the prevalence of self-reported adverse childhood experiences (ACEs) among a sample of 349 early care and education teachers. Seventy-three percent of the sample reported experiencing at least one ACE and 22% reported experiencing 4 or more ACEs. Live observational assessments of the quality of the social and emotional climate in teacher's classrooms were conducted for a subsample of 58 teachers. Within this subsample, reporting a higher number of ACEs was associated with facilitating a lower quality social and emotional classroom climate. Individual ACEs were also examined. Teachers who reported experiencing incarceration of a family member, physical abuse, or emotional abuse were observed to facilitate a lower quality social and emotional classroom climate. This study provides preliminary insight into the prevalence of ACEs among members of the early care and education workforce. Further, it extends previous work examining the multi-generational impacts of ACEs within families by showing that ACEs may influence the care that is provided to children in childcare settings.

A subset of Cowdria ruminantium genes important for immune recognition and protection.

Cowdria ruminantium causes the tick-borne rickettsial disease of heartwater, which is devastating to livestock production in sub-Saharan Africa. Current diagnosis and control methods are inadequate. We have identified and sequenced a subset of genes encoding recombinant antigens recognized by antibody and peripheral blood mononuclear cells from immune ruminants. The identified genes include many with significant similarity to those of Rickettsia prowazekii, genes predicted to encode different outer membrane proteins and lipoproteins and a gene containing an unusual tandem repeat structure. Evidence is presented for immune protection by recombinant antigens in a mouse model of C. ruminantium infection. These data identify new recombinant antigens for evaluation in vaccines and diagnostic tests to control heartwater.

Enhancement of murine thyroid allograft survival after 16 to 20 hours' organ culture.

Fully allogeneic thyroid organs cultured 16-20 hr in Hanks' balanced salt solution (HBSS) were transplanted to mice under the kidney capsule. Organ cultures maintained in 5% CO2 and air or in 100% nitrogen atmosphere in HBSS survived beyond the normal period required for graft rejection, in contrast to those maintained in room air or thyroids cultured in Eagle's minimum essential medium. Rejection of HBSS-cultured allogeneic thyroids can be induced by the injection of donor peritoneal exudate cells into the recipient 2 days after transplant. Lymphoid stimulator cells cultured overnight in HBSS, but not in (Eagle's) minimum essential medium in 5% CO2 and air, failed to induce alloreactive cytotoxic T cells in mixed lymphocyte cultures in vitro. The data suggest that short-term organ culture in a chemically simpler and nutritionally deficient medium in a low-oxygen environment enhances allograft survival. This is in contrast to the presently held theory, in which high-oxygen concentration is believed responsible for enhancement of allograft survival. This procedure should prove helpful in further determination of the factors involved in homograft rejection.

Investigation of the potential use of immunosuppressive agent gliotoxin in organ transplantation.

Gliotoxin is an immunosuppressive secondary metabolite produced by several pathogenic fungi. It has previously been shown to prevent graft-versus-host disease in transplantation of allogeneic mouse bone marrow and to reduce the immunogenicity of human fetal pancreas. We here report on the effect of gliotoxin on the prevention of rejection of allografts in two distinct models. Bathing mouse thyroid tissue in gliotoxin solution for 16 hr prolonged graft survival following transplantation into allogeneic recipients. In contrast the perfusion of rat kidneys with gliotoxin followed by 1 hr of incubation before orthotopic transplantation had little success with preventing allograft rejection. This disparity is most likely due to the incubation in the renal model not allowing sufficient time for the elimination of antigen presenting cells in the donor organ. However, the success with the thyroid grafts demonstrates the potential of gliotoxin as an immunomodulating agent in organ transplantation and warrants further investigation in other systems.

Prevention of graft-versus-host disease by treatment of bone marrow with gliotoxin in fully allogeneic chimeras and their cytotoxic T cell repertoire.

Gliotoxin, a secondary fungal metabolite, at nanomolar concentrations, irreversibly inhibits murine T cell proliferation to mitogen. Treatment of allogeneic spleen cells with gliotoxin allows their transfer into sublethally irradiated recipients without inducing a GVH reaction. Gliotoxin treatment of bone marrow allows the establishment of fully allogenic bone marrow chimeras free of GVH disease. The cytotoxic T cell repertoire against influenza virus in these animals is restricted to both host- and donor-type MHC. However, their immune competence is severely compromised by their lack of host MHC-type stimulator cells.

T helper-suppressor cell imbalance in pyoderma gangrenosum, with relapsing polychondritis and corneal keratolysis.

We found decreased T helper/inducer and increased T suppressor/cytotoxic cells in a 45-year-old woman with pyoderma gangrenosum. Serum immunoglobulin levels were normal, suggesting that these T suppressor cells did not function primarily to regulate antibody synthesis. The patient had diminished cutaneous delayed hypersensitivity responses, reacting to only one of six antigens tested, but responded in vitro to three of three antigens. Because of their various regulatory functions, excess T suppressor cells, or a lack of T helper cells, could be a common factor underlying many of the humoral and cell-mediated immune derangements, as well as the neutrophil abnormalities, that have been found in pyoderma gangrenosum. Our patient also had relapsing polychondritis and corneal keratolysis, consistent with the systemic nature of the disorder. The T-cell imbalance persisted even as the ulcer improved. Since monoclonal antibodies against T cell subpopulations are readily available, measuring these cell types as part of the immunological workup of patients with pyoderma gangrenosum might yield valuable clues concerning the pathogenesis of this disorder.

Negative immunoperoxidase staining for lysozyme in nodular subepidermal fibrosis.

Nodular subepidermal fibrosis (NSF) is a clinical entity, the histogenetic origins of which remain unclear. More than 200 such lesions were examined with light microscopy and subdivided into four types based on their relative degree of cellularity. Five examples of each subtype were stained for lysozyme with the peroxidase-antiperoxidase technique. None of the 20 lesions contained cells with lysozyme. We conclude that the basic cell type in NSF is not lysozyme-containing macrophage; it is a different cell, perhaps one of mesenchymal origin.

Treatment of actinic prurigo with intermittent short-course topical 0.05% clobetasol 17-propionate. A preliminary report.

Actinic prurigo is a chronic familial photodermatosis that occurs mostly in Amerindians. Eight patients with actinic prurigo were given intermittent 3- to 14-day courses of topical 0.05% clobetasol 17-propionate cream or ointment in 1988 and 1989. Seven out of eight patients cleared or markedly improved. All of the patients had been resistant previously to milder topical corticosteroids. There have been no side effects. This therapy offers an effective alternative to systemic corticosteroids, oral psoralen with long-wave UV radiation in the A range, or thalidomide.

Electrocardiographic values from clinically normal, anesthetized ferrets (Mustela putorius furo).

Electrocardiograms were recorded from 25 clinically normal male ferrets anesthetized with ketamine and xylazine and from 7 ferrets anesthetized with ketamine alone. Ferrets anesthetized with ketamine alone had excessive salivation, open eyes, muscle tremors, muscle twitching, paddling motions, attempts to stand, and an unstable ECG baseline. Because ketamine/xylazine combination resulted in induction and good muscle relaxation, the ECG had little interference resulting from muscular movement.

Serum concentrations of gentamicin in cats.

Twenty-one adult cats, allotted into 2 groups, were given gentamicin sulfate at dosages of either 5.0 mg/kg of body weight or 2.5 mg/kg as a single IM injection. During a 24-hour period, serum concentrations of gentamicin were measured serially, using a fluorescence immunoassay. The mean peak serum concentration of gentamicin in cats given 5.0 mg/kg was 23.1 micrograms/ml at postinjection hour (PIH) 0.5; thereafter, the mean serum concentration steadily decreased to 2.0 micrograms/ml at PIH 24. The mean peak serum concentration for cats administered 2.5 mg/kg was 9.1 micrograms/ml at PIH 0.5; thereafter, the mean serum concentration steadily decreased to 1.3 micrograms/ml at PIH 12. Serum therapeutic concentrations, without exceeding toxic concentrations, were attained at the 2.5 mg/kg dosage.

Dirofilariasis in a ferret.

An adult male ferret was found to be lethargic and dyspneic. Necropsy revealed 21 worms in the heart, vena cava, and pulmonary artery. The worms were identified as Dirofilaria immitis. Histologic examination of lung tissue revealed numerous microfilariae.

Vulvar manifestations of sexually transmitted diseases.

On the vulva, the appearance of sexually transmitted diseases (STD) is modified for several reasons. Recognition of the special characteristics of vulvar epithelium facilitates diagnosis of both sexually transmitted diseases and vulvar dermatoses that may be mistaken for STDs. The first section will review examination techniques and anatomic considerations. The second section will describe distinctive manifestations of vulvar herpes, human papillomavirus (HPV), molluscum contagiosum, scabies, and syphilis. The final section will provide differential diagnoses for primary and secondary vulvar lesions including erythema, papules, plaques, pustules, bullae, erosions, and ulcers.