Negative Emotionality Interacts with Trauma Exposure to Prospectively Predict Posttraumatic Stress Disorder Symptoms During Firefighters' First 3 Years of Service.

Firefighters (FFs) protect the public despite significant risks to their health and well-being stemming from frequent trauma exposure and other occupational stressors. A minority of FFs develop posttraumatic stress disorder (PTSD) or related mental health problems, whereas most remain remarkably resilient despite enormous stress. This points toward substantial variability in responses to traumatic stress among FFs. Personality, particularly negative emotionality (NEM), has been shown to predict the development of PTSD in other trauma-exposed populations, yet has not been prospectively studied in relation to PTSD in FFs. The aim of this secondary analysis from a broader study of mental health in FFs was to test whether preemployment NEM predicted PTSD symptom severity over time by influencing how FFs respond to traumatic experiences. In this first prospective study of the development of PTSD symptoms in professional FFs, 322 FFs were recruited from seven urban fire academies across the United States and followed over their first 3 years of fire service. We assessed NEM during the fire academy as well as trauma exposure and both self-reported and clinician-rated PTSD symptoms at 1-, 2-, and 3-year follow-ups. Level of trauma exposure and NEM predicted PTSD symptoms over time, and NEM moderated the effect of trauma exposure on clinician-rated PTSD symptoms across both trauma exposure measures at 1- and 3-year follow-ups, f2 = .03-.10, but not at 2-year follow-up nor for self-reported PTSD symptoms. These findings indicate that NEM, assessed upon entry into a high-risk occupation, is useful in predicting PTSD symptom development.

Deployment risk and resilience inventory-2 (DRRI-2): an updated tool for assessing psychosocial risk and resilience factors among service members and veterans.

The Deployment Risk and Resilience Inventory (DRRI) is a widely used instrument for assessing deployment-related risk and resilience factors among war veterans. A revision of this instrument was recently undertaken to enhance the DRRI's applicability across a variety of deployment-related circumstances and military subgroups. The resulting suite of 17 distinct DRRI-2 scales is the product of a multiyear psychometric endeavor that involved (a) focus groups with Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) veterans to inform an assessment of the content validity of original DRRI measures, (b) examination of item and scale characteristics of revised scales in a national sample of 469 OEF/OIF veterans, and (c) administration of refined scales to a second national sample of 1,046 OEF/OIF veterans to confirm their psychometric quality. Both classical test theory and item response theory analytical strategies were applied to inform major revisions, which included updating the coverage of warfare-related stressors, expanding the assessment of family factors throughout the deployment cycle, and shortening scales. Finalized DRRI-2 scales demonstrated strong internal consistency reliability and criterion-related validity. The DRRI-2 can be applied to examine the role that psychosocial factors play in post deployment health and inform interventions aimed at reducing risk and enhancing resilience among war veterans.

Transcranial Photobiomodulation Treatment: Significant Improvements in Four Ex-Football Players with Possible Chronic Traumatic Encephalopathy.

Background: Chronic traumatic encephalopathy, diagnosed postmortem (hyperphosphorylated tau), is preceded by traumatic encephalopathy syndrome with worsening cognition and behavior/mood disturbances, over years. Transcranial photobiomodulation (tPBM) may promote improvements by increasing ATP in compromised/stressed cells and increasing local blood, lymphatic vessel vasodilation. Objective: Aim 1: Examine cognition, behavior/mood changes Post-tPBM. Aim 2: MRI changes - resting-state functional-connectivity MRI: salience, central executive, default mode networks (SN, CEN, DMN); magnetic resonance spectroscopy, cingulate cortex. Methods: Four ex-players with traumatic encephalopathy syndrome/possible chronic traumatic encephalopathy, playing 11- 16 years, received In-office, red/near-infrared tPBM to scalp, 3x/week for 6 weeks. Two had cavum septum pellucidum. Results: The three younger cases (ages 55, 57, 65) improved 2 SD (p < 0.05) on three to six neuropsychological tests/subtests at 1 week or 1 month Post-tPBM, compared to Pre-Treatment, while the older case (age 74) improved by 1.5 SD on three tests. There was significant improvement at 1 month on post-traumatic stress disorder (PTSD), depression, pain, and sleep. One case discontinued narcotic pain medications and had reduced tinnitus. The possible placebo effect is unknown. At 2 months Post-tPBM, two cases regressed. Then, home tPBM was applied to only cortical nodes, DMN (12 weeks); again, significant improvements were seen. Significant correlations for increased SN functional connectivity (FC) over time, with executive function, attention, PTSD, pain, and sleep; and CEN FC, with verbal learning/memory, depression. Increased n-acetyl-aspartate (NAA) (oxygen consumption, mitochondria) was present in anterior cingulate cortex (ACC), parallel to less pain and PTSD. Conclusion: After tPBM, these ex-football players improved. Significant correlations of increased SN FC and CEN FC with specific cognitive tests and behavior/mood ratings, plus increased NAA in ACC support beneficial effects from tPBM.

Differences in drinking patterns, occupational stress, and exposure to potentially traumatic events among firefighters: predictors of smoking relapse.

BACKGROUND AND OBJECTIVES: Despite the increased awareness regarding the risks of cigarette smoking, this behavior continues to be a serious public health concern. As such, the goal of the current study was to examine risk factors for smoking relapse among individuals employed through fire service. METHODS: In this report, drinking changes, trauma exposure, and occupational stress were compared among firefighters (N = 81) who reported a relapse to cigarette smoking (n = 27), a lifetime former history of smoking (n = 27), or no history of smoking (n = 27). Mechanisms behind tobacco relapse occurring after employment in fire service were explored. RESULTS: Firefighters who relapsed to smoking, when compared to their nonsmoking peers, had higher rates of weekly alcohol consumption throughout their first year of fire service and had greater increases in drinking from preacademy to postacademy. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE: Gaining a better understanding of these behaviors within this understudied and high-risk population may provide valuable information that can be used in designing future relapse prevention strategies as well as smoking cessation interventions.

Unilateral congenital terminal finger absences: a condition that differs from symbrachydactyly.

PURPOSE: To describe a type of nonhereditary unilateral transverse deficiency, which we have named hypodactyly, that is distinct from symbrachydactyly or amniotic disruption sequence. METHODS: We identified 19 patients with unilateral congenital anomalies consisting of absent or short bulbous fingers that lack terminal ectodermal elements. Medical records and radiographs were retrospectively reviewed and contrasted with the typical findings of symbrachydactyly and amniotic disruption sequence. RESULTS: No associated syndromes or potentially causative diagnoses were identified in the hypodactyly patients. The digital absences were of a truncated pattern with thickened, tubular soft tissue coverage. Radiographs revealed a pattern of severity progression that is different from that of symbrachydactyly. Distal phalanges were the bony elements absent most frequently, followed sequentially by the middle phalanx and proximal phalanx. In all cases, metacarpals were present. Unlike symbrachydactyly, the ulnar 2 digits were more involved than the index and long fingers, and the thumb was the least involved digit. CONCLUSIONS: Hypodactyly appears to be a congenital hand anomaly that is clinically and radiographically different from symbrachydactyly or amniotic disruption sequence and is presumed to be caused by a distinct pathomechanism. TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic IV.

Genome-wide association study to identify novel loci associated with therapy-related myeloid leukemia susceptibility.

Therapy-related acute myeloid leukemia (t-AML) is a rare but fatal complication of cytotoxic therapy. Whereas sporadic cancer results from interactions between complex exposures and low-penetrance alleles, t-AML results from an acute exposure to a limited number of potent genotoxins. Consequently, we hypothesized that the effect sizes of variants associated with t-AML would be greater than in sporadic cancer, and, therefore, that these variants could be detected even in a modest-sized cohort. To test this, we undertook an association study in 80 cases and 150 controls using Affymetrix Mapping 10K arrays. Even at nominal significance thresholds, we found a significant excess of associations over chance; for example, although 6 associations were expected at P less than .001, we found 15 (P(enrich) = .002). To replicate our findings, we genotyped the 10 most significantly associated single nucleotide polymorphisms (SNPs) in an independent t-AML cohort (n = 70) and obtained evidence of association with t-AML for 3 SNPs in the subset of patients with loss of chromosomes 5 or 7 or both, acquired abnormalities associated with prior exposure to alkylator chemotherapy. Thus, we conclude that the effect of genetic factors contributing to cancer risk is potentiated and more readily discernable in t-AML compared with sporadic cancer.

A prospective study of firefighters' PTSD and depression symptoms: The first 3 years of service.

Objective: Firefighters are an important sample of convenience to study traumatic exposure and symptom development. This study assessed trauma exposure inside and outside of fire service, diagnosed posttraumatic stress disorder (PTSD) and associated disorders using clinical interviews and self-report measures, then tested the hypothesis that trauma exposure would predict distress in firefighters over the first 3 years in service. Method: In total, 322 professional firefighter recruits were assessed during academy training and through their first 3 years of service. Diagnostic assessments were conducted by psychologists annually, and symptom checklists were completed by telephone every 4 months. Results: Firefighter recruits were exposed to approximately nine potentially traumatic events (PTEs) in the first 3 years of fire service, with 66% of these events occurring in the line of duty. Very few (3%) developed diagnoses of PTSD, major depression, or generalized anxiety disorder. Models of distress supported a trait model of distress. Distress was stable within individuals over time, and although those reporting more distress also reported more trauma exposure, variation in distress over time was not predicted by trauma exposure. Conclusions: Professional firefighters experience frequent exposure to potentially traumatic events during their early careers. This exposure, although large, does not result in a large proportion of mental health diagnoses. Distress was consistent and low, which provides evidence of the resilient nature of those selecting a career in emergency service. Future work is needed to understand the disconnection between the current rigorously collected prospective data and the existing literature regarding the increased risk of PTSD and associated disorders in fire service. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Transcranial Photobiomodulation to Improve Cognition in Gulf War Illness.

Introduction: Approximately 25-30% of veterans deployed to Kuwait, 1990-91, report persistent multi-symptom Gulf War Illness (GWI) likely from neurotoxicant exposures. Photobiomodulation (PBM) in red/near-infrared (NIR) wavelengths is a safe, non-invasive modality shown to help repair hypoxic/stressed cells. Red/NIR wavelengths are absorbed by cytochrome C oxidase in mitochondria, releasing nitric oxide (increasing local vasodilation), and increasing adenosine tri-phosphate production. We investigated whether PBM applied transcranially could improve cognition, and health symptoms in GWI. Materials and Methods: Forty-eight (40 M) participants completed this blinded, randomized, sham-controlled trial using Sham or Real, red/NIR light-emitting diodes (LED) applied transcranially. Fifteen, half-hour transcranial LED (tLED) treatments were twice a week (7.5 weeks, in-office). Goggles worn by participant and assistant maintained blinding for visible red. Pre-/Post- testing was at Entry, 1 week and 1 month post- 15th treatment. Primary outcome measures were neuropsychological (NP) tests; secondary outcomes, Psychosocial Questionnaires, including PTSD. Results: Primary Analyses (all participants), showed improvement for Real vs. Sham, for Digit Span Forwards (p < 0.01); and a trend for Trails 4, Number/Letter Sequencing (p < 0.10). For secondary outcomes, Real group reported more improvement on the SF-36V Plus, Physical Component Score (p < 0.08). Secondary Analyses included only subjects scoring below norm (50%ile) at Entry, on specific NP test/s. Real and Sham improved at 1 week after 15th treatment; however, at 1 month, only those receiving Real improved further: Digit Span Total, Forwards and Backwards; Trails 4, Number/Letter Sequencing; California Verbal Learning Test-II, long delay free recall; Continuous Performance Test-II, False Alarm Rate; and Color-Word Interference, Stroop, Trial 3, Inhibition; Sham group worsened, toward Entry values. Only those with more post-traumatic stress disorder (PTSD) symptomatology at Entry, receiving Real, continued to have additional PTSD reduction at 1 month; Sham regressed. Conclusion: This study was underpowered (n = 48), with large heterogeneity at Entry. This likely contributed to significance or trend to significance, for only two of the NP tests (Digit Span Forwards; Trails 4, Number/Letter Sequencing) and only one general health measure, the SF-36V Plus, Physical Component Score. More subjects receiving Real, self-reported increased concentration, relaxation and sleep. Controlled studies with newer, transcranial LED home treatment devices are warranted; this is expected to increase enrollment. Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT01782378.

The Influence of Exposure to Natural Disasters on Depression and PTSD Symptoms among Firefighters.

Introduction Firefighters represent an important population for understanding the consequences of exposure to potentially traumatic stressors. Hypothesis/Problem The researchers were interested in the effects of pre-employment disaster exposure on firefighter recruits' depression and posttraumatic stress disorder (PTSD) symptoms during the first three years of fire service and hypothesized that: (1) disaster-exposed firefighters would have greater depression and PTSD symptoms than non-exposed overall; and (2) depression and PTSD symptoms would worsen over years in fire service in exposed firefighters, but not in their unexposed counterparts. METHODS: In a baseline interview, 35 male firefighter recruits from seven US cities reported lifetime exposure to natural disaster. These disaster-exposed male firefighter recruits were matched on age, city, and education with non-exposed recruits. RESULTS: A generalized linear mixed model revealed a significant exposure×time interaction (e coef =1.04; P<.001), such that depression symptoms increased with time for those with pre-employment disaster exposure only. This pattern persisted after controlling for social support from colleagues (e coefficient=1.05; P<.001), social support from families (e coefficient=1.04; P=.001), and on-the-job trauma exposure (coefficient=0.06; e coefficient=1.11; P<.001). Posttraumatic stress disorder symptoms did not vary significantly between exposure groups at baseline (P=.61). CONCLUSION: Depression symptoms increased with time for those with pre-employment disaster exposure only, even after controlling for social support. Posttraumatic stress disorder symptoms did not vary between exposure groups. Pennington ML , Carpenter TP , Synett SJ , Torres VA , Teague J , Morissette SB , Knight J , Kamholz BW , Keane TM , Zimering RT , Gulliver SB . The influence of exposure to natural disasters on depression and PTSD symptoms among firefighters. Prehosp Disaster Med. 2018;33(1):102-108.

Late postnatal onset of hearing loss due to GJB2 mutations.

GJB2 mutations account for approximately 50% of recessive non-syndromic deafness, with 35delG being the most prevalent. Homozygous 35delG mutations cause pre-lingual, non-progressive hearing loss that is detected on newborn hearing screening programmes. We present a sibling pair with homozygous 35delG mutations, who passed hearing tests in early infancy and developed progressive sensorineural hearing loss, one requiring a cochlear implant. These cases illustrate that deafness due to such mutations may have a late onset and consequently be missed on neonatal screening programmes and they may present an argument to consider neonatal screening for GJB2 mutations in order to aid early intervention.

Predictors of Cognitive Decline in Older Adult Type 2 Diabetes from the Veterans Affairs Diabetes Trial.

AIMS: Cognitive decline disproportionately affects older adult type 2 diabetes. We tested whether randomized intensive (INT) glucose-lowering reduces the rate(s) of cognitive decline in adults with advanced type 2 diabetes (mean: age, 60 years; diabetes duration, 11 years) from the Veterans Affairs Diabetes Trial. METHODS: A battery of neuropsychological tests [digit span, digit symbol substitution (DSym), and Trails-making Test-Part B (TMT-B)] was administered at baseline in ~1700 participants and repeated at year 5. Thirty-seven risk factors were evaluated as predictors of cognitive decline in multivariable regression analyses. RESULTS: The mean age-adjusted DSym or TMT-B declined significantly in all study participants (P < 0.001). Randomized INT glucose-lowering did not significantly alter the rate of cognitive decline. The final model of risk factors associated with 5-year decline in age-adjusted TMT-B included as significant predictors: longer baseline diabetes duration (beta = -0.028; P = 0.0057), lower baseline diastolic blood pressure (BP; beta = 0.028; P = 0.002), and baseline calcium channel blocker medication use (beta = -0.639; P < 0.001). Higher baseline pulse pressure was significantly associated with decline in age-adjusted TMT-B suggesting a role for both higher systolic and lower diastolic BPs. Baseline thiazide diuretic use (beta = -0.549; P = 0.015) was an additional significant predictor of 5-year decline in age-adjusted digit symbol score. Post-baseline systolic BP-lowering was significantly associated (P < 0.001) with decline in TMT-B performance. There was a significant inverse association between post-baseline plasma triglyceride-lowering (P = 0.045) and decline in digit symbol substitution task performance. CONCLUSION: A 5-year period of randomized INT glucose-lowering did not significantly reduce the rate of cognitive decline in older-aged adults with type 2 diabetes. Systolic and diastolic BPs as well as plasma triglycerides appeared as modifiable risk factors of the rate of cognitive decline in older adult type 2 diabetes.

Transcranial, Red/Near-Infrared Light-Emitting Diode Therapy to Improve Cognition in Chronic Traumatic Brain Injury.

OBJECTIVE: We review the general topic of traumatic brain injury (TBI) and our research utilizing transcranial photobiomodulation (tPBM) to improve cognition in chronic TBI using red/near-infrared (NIR) light-emitting diodes (LEDs) to deliver light to the head. tPBM improves mitochondrial function increasing oxygen consumption, production of adenosine triphosphate (ATP), and improving cellular energy stores. Nitric oxide is released from the cells increasing regional blood flow in the brain. Review of published studies: In our previously published study, 11 chronic TBI patients with closed-head TBI caused by different accidents (motor vehicle accident, sports-related, improvised explosive device blast injury) and exhibiting long-lasting cognitive dysfunction received 18 outpatient treatments (Monday, Wednesday, Friday for 6 weeks) starting at 10 months to 8 years post-TBI. LED therapy is nonthermal, painless, and noninvasive. An LED-based device classified as nonsignificant risk (FDA cleared) was used. Each LED cluster head (5.35 cm diameter, 500 mW, 22.2 mW/cm2) was applied for 9 min 45 sec (13 J/cm2) using 11 locations on the scalp: midline from front-to-back hairline and bilaterally on frontal, parietal, and temporal areas. Testing was performed before and after transcranial LED (tLED; at 1 week, 1 month, and at 2 months after the 18th treatment) and showed significant improvements in executive function and verbal memory. There were also fewer post-traumatic stress disorder (PTSD) symptoms reported. Ongoing studies: Ongoing, current studies involve TBI patients who have been treated with tLED using either 26 J/cm2 per LED location on the head or treated with intranasal only (iLED) using red (633 nm) and NIR (810 nm) diodes placed into the nostrils. The NIR iLED is hypothesized to deliver photons to the hippocampus, and the red 633 nm iLED is believed to increase melatonin. Results have been similar to the previously published tLED study. Actigraphy sleep data showed increased time asleep (on average one additional hour per night) after the 18th tLED or iLED treatment. LED treatments may be performed in the home. Sham-controlled studies with veterans who have cognitive dysfunction from Gulf War Illness, blast TBI, and TBI/PTSD are currently ongoing.

Hypervigilance in college students: Associations with betrayal and dissociation and psychometric properties in a Brief Hypervigilance Scale.

Betrayal trauma theory (Freyd, 1994, 1996) proposes that traumas high in social betrayal are expected to lead to psychological outcomes of dissociation, amnesia, and/or shame because these responses are adaptive to a survivor trying to preserve a necessary relationship in the face of mistreatment. Within the field of trauma studies more generally, there is substantial support for the proposition that traumas that cause intense fear should lead to posttraumatic anxiety and hypervigilance. Despite ample evidence for both theorized causal pathways, very few studies have tested associations between betrayal exposure, hypervigilance, and dissociation. The current study had 2 aims: first, as no self-report measure of hypervigilance had been developed for nonveteran populations, we sought to identify a subset of Hypervigilance Questionnaire (Knight, 1993) items that validly and reliably measure hypervigilance within college undergraduates (n = 489; 62.6% female, 69.9% Caucasian) with and without elevated levels of posttraumatic stress. Second, we tested the associations among trauma history, hypervigilance, and dissociation. Psychometric analyses revealed 5 hypervigilance items we introduce as the Brief Hypervigilance Scale. Partial correlations revealed that each posttraumatic response was not related to a history of low betrayal trauma (i.e. non-interpersonal trauma) controlling for betrayal trauma (i.e. interpersonal trauma), but was related to betrayal trauma controlling for low betrayal trauma. These associations remained significant after controlling for the other posttraumatic response (i.e. hypervigilance or dissociation). Follow-up analyses revealed that hypervigilance was independently associated with adult, but not child high betrayal trauma, and the opposite was true for dissociation. Implications for theory, research, and clinical practice are discussed.

Day-case paediatric mastoid surgery.

OBJECTIVE: Children have traditionally been kept in hospital overnight after mastoid surgery, but evidence from the US in adults suggests that a substantial number of patients may be suitable for discharge on the day of surgery. We sought to ascertain the proportion of our children having mastoid operations between February 1994 and December 2000 who were suitable for same-day discharge. We also evaluated some of the factors that prevented discharge the same day. METHODS: A standard proforma was used to record relevant data in 35 children (mean age 10 years 6 months) undergoing consecutive mastoid operations at Mayday University Hospital, London, UK. Operative findings, duration of anaesthesia and time back on ward were recorded as well as details regarding admission, follow-up findings and complications. A bed was booked preoperatively but there was intent to discharge the patient if feasible. RESULTS: Nine out of twelve patients (75%) operated between 1998 and 2000 were suitable for discharge on the day of surgery. The pre-1998 discharge rate was 20%. Only one of the former group of patients underwent a modified radical mastoidectomy in comparison with ten such procedures pre-1998. There was a significant relationship between extent of surgery and in-patient admission. The outcomes of day-case mastoid surgery, in terms of complications rates and overall success rates, were comparable with surgery performed on an in-patient basis. Using correlation analysis, no relationship could be found between duration of anaesthesia and time of arrival back on the ward and in-patient admission. CONCLUSION: Children can undergo mastoid procedures safely and effectively on a day-case basis but should still have a bed booked pre-operatively as the majority will require admission. The main factor related to admission was the mastoid procedure performed. With improvements in surgical and anaesthetic techniques and other advances, operations such as atticotomy may become standard day-case procedures in paediatric patients.

Significant improvements in cognitive performance post-transcranial, red/near-infrared light-emitting diode treatments in chronic, mild traumatic brain injury: open-protocol study.

This pilot, open-protocol study examined whether scalp application of red and near-infrared (NIR) light-emitting diodes (LED) could improve cognition in patients with chronic, mild traumatic brain injury (mTBI). Application of red/NIR light improves mitochondrial function (especially in hypoxic/compromised cells) promoting increased adenosine triphosphate (ATP) important for cellular metabolism. Nitric oxide is released locally, increasing regional cerebral blood flow. LED therapy is noninvasive, painless, and non-thermal (cleared by the United States Food and Drug Administration [FDA], an insignificant risk device). Eleven chronic, mTBI participants (26-62 years of age, 6 males) with nonpenetrating brain injury and persistent cognitive dysfunction were treated for 18 outpatient sessions (Monday, Wednesday, Friday, for 6 weeks), starting at 10 months to 8 years post- mTBI (motor vehicle accident [MVA] or sports-related; and one participant, improvised explosive device [IED] blast injury). Four had a history of multiple concussions. Each LED cluster head (5.35 cm diameter, 500 mW, 22.2 mW/cm(2)) was applied for 10 min to each of 11 scalp placements (13 J/cm(2)). LEDs were placed on the midline from front-to-back hairline; and bilaterally on frontal, parietal, and temporal areas. Neuropsychological testing was performed pre-LED, and at 1 week, and 1 and 2 months after the 18th treatment. A significant linear trend was observed for the effect of LED treatment over time for the Stroop test for Executive Function, Trial 3 inhibition (p=0.004); Stroop, Trial 4 inhibition switching (p=0.003); California Verbal Learning Test (CVLT)-II, Total Trials 1-5 (p=0.003); and CVLT-II, Long Delay Free Recall (p=0.006). Participants reported improved sleep, and fewer post-traumatic stress disorder (PTSD) symptoms, if present. Participants and family reported better ability to perform social, interpersonal, and occupational functions. These open-protocol data suggest that placebo-controlled studies are warranted.

Predictors of posttraumatic stress disorder and other psychological symptoms in trauma-exposed firefighters.

Firefighters are exposed to a range of potentially traumatic stressors, yet studies examining the impact of this exposure are equivocal. Although some studies suggest increased risk for mental health problems, others suggest unusual resilience. Type of assessment methodology may contribute to the lack of consistent findings. We assessed 142 trauma-exposed, professional firefighters utilizing a standardized clinical interview and self-report measures and found low rates of posttraumatic stress disorder (PTSD) diagnoses (4.2%), and depressive, anxiety, and alcohol-abuse symptoms. Frequency of trauma exposure did not predict psychological symptoms. Perceived social support, occupational stress, coping, as well as the interaction between perceived social support and self-blame were significant predictors of symptoms. Firefighters reporting low-perceived social support and high self-blame demonstrated the highest levels of clinically significant symptoms. These findings may inform education, treatment, and resilience training for emergency personnel.

Examining impelling and disinhibiting factors for intimate partner violence in veterans.

We examined correlates of intimate partner violence (IPV) in a military Veteran sample (N = 129) using Finkel's (2007) framework for understanding the interactions between impelling and disinhibiting risk factors. Correlates investigated included head contact events (HCEs), posttraumatic stress disorder (PTSD) symptoms, and antisocial features. Results indicated that antisocial features were significantly associated with IPV at the bivariate level. PTSD symptoms also were associated with IPV, but this association was marginally significant. Tests of moderation provided support for the expectation that HCEs would potentiate associations between antisocial features and IPV. HCEs also moderated the association between PTSD symptoms and IPV. However, contrary to expectations, the opposite pattern emerged such that PTSD symptoms were associated with a higher rate of IPV for those without a history of HCEs. Study findings have potentially important implications for furthering our understanding of the complex etiology of IPV in this population.

Improved cognitive function after transcranial, light-emitting diode treatments in chronic, traumatic brain injury: two case reports.

OBJECTIVE: Two chronic, traumatic brain injury (TBI) cases, where cognition improved following treatment with red and near-infrared light-emitting diodes (LEDs), applied transcranially to forehead and scalp areas, are presented. BACKGROUND: Significant benefits have been reported following application of transcranial, low-level laser therapy (LLLT) to humans with acute stroke and mice with acute TBI. These are the first case reports documenting improved cognitive function in chronic, TBI patients treated with transcranial LED. METHODS: Treatments were applied bilaterally and to midline sagittal areas using LED cluster heads [2.1″ diameter, 61 diodes (9 × 633 nm, 52 × 870 nm); 12-15 mW per diode; total power: 500 mW; 22.2 mW/cm(2); 13.3 J/cm(2) at scalp (estimated 0.4 J/cm(2) to cortex)]. RESULTS: Seven years after closed-head TBI from a motor vehicle accident, Patient 1 began transcranial LED treatments. Pre-LED, her ability for sustained attention (computer work) lasted 20 min. After eight weekly LED treatments, her sustained attention time increased to 3 h. The patient performs nightly home treatments (5 years); if she stops treating for more than 2 weeks, she regresses. Patient 2 had a history of closed-head trauma (sports/military, and recent fall), and magnetic resonance imaging showed frontoparietal atrophy. Pre-LED, she was on medical disability for 5 months. After 4 months of nightly LED treatments at home, medical disability discontinued; she returned to working full-time as an executive consultant with an international technology consulting firm. Neuropsychological testing after 9 months of transcranial LED indicated significant improvement (+1, +2SD) in executive function (inhibition, inhibition accuracy) and memory, as well as reduction in post-traumatic stress disorder. If she stops treating for more than 1 week, she regresses. At the time of this report, both patients are continuing treatment. CONCLUSIONS: Transcranial LED may improve cognition, reduce costs in TBI treatment, and be applied at home. Controlled studies are warranted.

Disaster mental health workers responding to Ground Zero: one year later.

The current study examined anniversary reactions in mental health disaster relief workers following traumatic exposure at the site of the World Trade Center terrorist attacks. Despite relatively low levels of symptom reporting, workers endorsed an increase in both negative mood symptoms and functional impairment at the one-year anniversary of their traumatic exposure (compared to 6 months postexposure). For those individuals who met at least partial criteria for PTSD immediately following exposure, overall self-reported PTSD symptoms tended to increase from 6 to 12 months. This tendency resulted specifically from an increase in hyperarousal symptoms. Although few endorsed symptoms at clinical levels, our results demonstrate that disaster relief workers may experience an increase in symptomatology at the anniversary of their traumatic exposure.