War trauma and PTSD in Ukraine's civilian population: comparing urban-dwelling to internally displaced persons.

INTRODUCTION: War in Ukraine started in March 2014 when Russia annexed Crimea and continues today in the Donbass region of Eastern Ukraine. Over 1.5 million people in these regions have been displaced from their homes. We conducted this study 36 months after the conflict began and interviewed civilians residing in Ukraine. PURPOSE: This study examines the prevalence of exposure to war trauma, rates of PTSD by symptom clusters, and whether socio-demographic factors are associated with positive scores for PTSD among civilian urban-dwelling and internally displaced persons in Ukraine during the ongoing conflict in its Donbass region. METHODS: Face-to-face interviews were conducted using a multi-stage random sample of the general population in two large cities (Kharkiv and Lviv) in Ukraine (n = 1247) and a purposive sample of internally displaced persons (n = 300), half living in each city. Exposure to trauma, symptom clusters for Posttraumatic Stress Disorder (PTSD), and overall PTSD were assessed. RESULTS: We found widespread direct exposure to conflict-related traumatic events (65%) among internally displaced people (IDPs) compared to a sizable minority (23%) of urban-dwelling people (UDPs). We found elevated prevalence of PTSD symptoms that were also uniformly spread within several socio-demographic factors. There were, however, significant differences in PTSD between (1) IDPs compared to UDPs and (2) those UDPs with Ukrainian compared to Russian ethnic identity, the former of each pair showing increased likelihoods of positive PTSD scores. CONCLUSIONS: Ukraine's adult civilians, enduring the prolonged engagement in war with Russia and Russian separatists, have elevated rates of PTSD. Moreover, those who have been displaced by the ongoing conflict (IDPs) have significantly higher levels of PTSD compared to UDPs.

Sad Eyes, Crooked Crosses: Religious Struggles, Psychological Distress and the Mediating Role of Psychosocial Resources.

In this paper, we employed data from the 2011 Miami-Dade Health Survey (n = 444) to formally test whether the association between religious struggles and psychological distress is mediated by psychosocial resources. We found that religious struggles were associated with lower levels of social support, self-esteem, the sense of control, and self-control. We also observed that religious struggles were associated with higher levels of non-specific emotional distress, depression, and anxiety, but not somatization. Our mediation analyses revealed significant indirect effects of religious struggles on emotional distress (not somatization) through social support, self-esteem, and the sense of control, but not self-control.

Higher frequency of osteoarthritis in patients with ACL graft rupture than in those with intact ACL grafts 30 years after reconstruction.

PURPOSE: The aim was to assess the results of anterior cruciate ligament (ACL) reconstruction regarding graft failure, knee laxity, and osteoarthritis (OA) from a longterm perspective. It was hypothesized that intact ACL graft reduces the risk for increased OA development. METHODS: The cohort comprised 60 patients with a median follow-up 31 (range 28-33) years after ACL reconstruction. They were evaluated with magnetic resonance imaging, radiography, KT-1000 arthrometer and the pivot shift test. RESULTS: Out of the 60 patients, 30 (50%) showed an intact ACL graft and 30 (50%) a ruptured or absent ACL graft. Patients with ruptured ACL grafts had more medial tibiofemoral compartment OA than those with an intact ACL graft (p = 0.0003). OA was asymmetric in patients with ruptured ACL grafts with more OA in the medial than in the lateral tibiofemoral compartment (p = 0.013) and the patellofemoral compartment (p = 0.002). The distribution of OA between compartments was similar in patients with an intact ACL graft. KT-1000 values of anterior knee laxity were higher in patients with ruptured compared to those with intact ACL grafts (p = 0.012). Side-to-side comparisons of anterior knee laxity showed higher KT-1000 values in patients with ruptured ACL graft (p = 0.0003) and similar results in those with intact graft (p = 0.09). The pivot shift grade was higher in the group with a ruptured ACL graft (p < 0.0001). CONCLUSIONS: Median 31 (range 28-33) years after ACL reconstruction, 50% of the patients showed an intact ACL graft and no side-to-side difference regarding anterior knee laxity. Patients with ruptured ACL grafts had more OA of the medial tibiofemoral compartment than those with intact ACL grafts. LEVEL OF EVIDENCE: Retrospective cohort study, Level III.

Wrist Fractures in Skiers and Snowboarders: Incidence, Severity, and Risk Factors Over 40 Seasons.

PURPOSE: To determine and compare the incidence and severity of wrist fractures in skiers and snowboarders. METHODS: A university-run orthopedic clinic at the base of a major ski resort has maintained an injury database spanning the years 1972 to 2012. Demographic information, equipment type, ability level, trail type and conditions, number of falls, circumstances surrounding the injury, and radiographs were collected on participants sustaining wrist fractures and compared with uninjured control participants asked the same questions, but in reference to their last fall where no injury resulted. A risk factor model for wrist fracture and severity in alpine sports was developed. RESULTS: During the 40-year period, 679 wrist fractures were identified. The incidence of wrist fracture per 1,000 days was 0.447 in snowboarders and 0.024 in skiers. In comparison with a representative sample of uninjured skiers, bivariate analyses revealed that skiers who experienced fractures were less experienced, had a greater number of falls, were on green or double black trails, and were injured owing to jumping or other reason related to technique. A higher risk for fracture was found for beginners, males younger than age 16, women older than age 50, and 4 or fewer days skiing that season. Bivariate analyses found that injured snowboarders were more likely to be female, younger, less experienced and had received less instruction than uninjured snowboarders. Higher risk for wrist fracture among snowboarders was found to be associated with age younger than 18 and less experience. CONCLUSIONS: Wrist fractures occur at an 18 times greater incidence in snowboarders than in skiers. Skiers with wrist fractures were beginners, males younger than 16, women older than 50, or those who had less participation. Snowboarders sustaining wrist fractures were younger than 18 or had less experience. TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic III.

Photothermal Effectiveness of Magnetite Nanoparticles: Dependence upon Particle Size Probed by Experiment and Simulation.

The photothermal effect of nanoparticles has proven efficient for driving diverse physical and chemical processes; however, we know of no study addressing the dependence of efficacy on nanoparticle size. Herein, we report on the photothermal effect of three different sizes (5.5 nm, 10 nm and 15 nm in diameter) of magnetite nanoparticles (MNP) driving the decomposition of poly(propylene carbonate) (PPC). We find that the chemical effectiveness of the photothermal effect is positively correlated with particle volume. Numerical simulations of the photothermal heating of PPC supports this observation, showing that larger particles are able to heat larger volumes of PPC for longer periods of time. The increased heating duration is likely due to increased heat capacity, which is why the volume of the particle functions as a ready guide for the photothermal efficacy.

Religious Involvement and Perceptions of Control: Evidence from the Miami-Dade Health Survey.

This study uses data collected through the 2011 Miami-Dade Health Survey (n = 444) to test whether religious involvement is associated with three distinct control beliefs. Regression results suggest that people who exhibit high levels of religious involvement tend to report higher levels of the sense of control, self-control, and the health locus of control than respondents who exhibit low levels of religious involvement. Although this study suggests that religious involvement can promote perceptions of control over one's own life, this pattern is apparently concentrated at the high end of the distribution for religious involvement, indicating a threshold effect.

Beware the consequences of your imaging.

Advanced imaging, especially magnetic resonance imaging (MRI), has added to our clinical diagnostic capabilities. With this advancement, however, has come the added responsibility of determining clinically significant MRI findings from "incidental findings" of no clinical relevance. It is most important for the clinician to be aware of the occurrence of abnormal findings in asymptomatic populations to place the imaging findings in the context of the history and physical examination to ensure we "treat the patient, not the imaging." Frequently imaged joints are reviewed highlighting these issues.

Structure and torsional properties of oxalyl chloride fluoride in the gas phase: an electron-diffraction investigation.

The structure and torsional properties of oxalyl chloride fluoride in the gas phase have been measured by electron diffraction at temperatures of 22, 81, 158, and 310 °C. The molecule may be regarded as a hybrid of oxalyl chloride and oxalyl fluoride. Since the former exists as a more stable periplanar anti form (ϕ = 180°) in equilibrium with a less stable gauche form (ϕ ≃ 60°) and the latter as an equilibrium between two periplanar forms, anti and syn, the second form of oxalyl chloride fluoride is an interesting question. It was found to be gauche. The system was modeled as two rotational conformers related by a potential of the form 2V = V(1)(1 + cos ϕ) - V(2)(1 - cos 2ϕ) + V(3)(1 + cos 3ϕ). The anti/gauche bond distances and bond angles (r(g)/Angstroms, ∠(α)/degrees) with estimated 2σ uncertainties at 22 °C are = 1.183(2)/1.182(2), Δr(C═O) = 0.003(6)/0.002(6) (assumed from theory), r(C-F) = 1.329(3)/1.335(3), r(C-Cl) = 1.738(2)/1.753(2), ∠(C-C-Cl) = 112.0(3)/111.9(3), ∠(C-C═O3) = 123.0(4)/123.2(4), ∠(O═C-Cl) = 125.0(2)/1.249(2), ∠(O═C-F) = 123.0(3)/125.1(3), and ∠(Cl-C-C-F) = 180.0/59.8. The variation of composition with temperature afforded a determination of the standard enthalpy and entropy of the reaction anti → gauche. The results are ΔH° = 2.5(12) kcal/mol and ΔS° = -6.5(33) cal/(mol·K). The structures and equilibria are discussed.

Exploring the association between posttraumatic growth and PTSD: a national study of Jews and Arabs following the 2006 Israeli-Hezbollah war.

Posttraumatic growth (PTG)-deriving benefits following potentially traumatic events-has become a topic of increasing interest. We examined factors that were related to self-reported PTG, and the relationship between PTG and symptoms of post-traumatic stress (PTS) following the 2006 Israel-Hezbollah. Drawing from a national random sample of Israel, data from 806 terrorism-exposed Israeli adults were analyzed. PTG was associated with being female, lower education, greater recent terrorism exposure, greater loss of psychosocial resources, greater social support, and greater self-efficacy. PTG was a consistent predictor of PTS across hierarchical linear regression models that tested whether demographic, stress, or personal resources moderated the relationship between PTG and PTS. PTG did not relate to PTS differently for people who differed by age, sex, ethnicity, education, religiosity, degree of terrorism exposure, self-efficacy, nonterrorism stressful life events, and loss of psychosocial and economic resources. PTG was not related to well-being for any of these subgroups.

Victimization in early life and mental health in adulthood: an examination of the mediating and moderating influences of psychosocial resources.

Although numerous studies have documented the long-term effects of childhood victimization on mental health in adulthood, few have directly examined potential mediators and moderators of this association. Using data from the Welfare, Children, and Families project (1999)-a probability sample of 2,402 predominantly black and Hispanic low-income women with children living in Boston, Chicago, and San Antonio-we predict psychological distress in adulthood with measures of physical assault and sexual coercion before age 18. Building on previous research, we test the mediating and moderating influences of emotional support, instrumental support, and self-esteem. Although we observe no indirect effects of physical assault, the effect of sexual coercion is partially mediated by instrumental support and self-esteem. We also find that the effects of physical assault and sexual coercion are moderated (buffered) by emotional support and self-esteem.

THE DEFENSIVE NATURE OF BENEFIT FINDING DURING ONGOING TERRORISM: AN EXAMINATION OF A NATIONAL SAMPLE OF ISRAELI JEWS.

A study examining the effects of terrorism on a national sample of 1,136 Jewish adults was conducted in Israel via telephone surveys, during the Second Intifada. The relationship between reports of positive changes occurring subsequent to terrorism exposure (i.e., Benefit finding), posttraumatic stress disorder (PTSD) symptom severity, and negative outgroup attitudes toward Palestinian citizens of Israel (PCI) was examined. Benefit finding was related to greater PTSD symptom severity. Further, Benefit finding was related to greater threat perception of PCI and ethnic exclusionism of PCI. Findings were consistent with hypotheses derived from theories of outgroup bias and support the anxiety buffering role of social affiliation posited by terror management theory. This study suggests that benefit finding may be a defensive coping strategy when expressed under the conditions of ongoing terrorism and external threat.

Alpine Skiing Injuries.

CONTEXT:: Alpine skiing is a popular sport worldwide but has significant risk for injury. The epidemiology of skiing-related injuries has been described, which has led to the identification of risk factors for specific types of injuries. EVIDENCE ACQUISITION:: Pertinent literature from peer-reviewed publications was reviewed. STUDY DESIGN:: Clinical review. LEVEL OF EVIDENCE:: Level 5. RESULTS:: The adoption of international standards for ski-boot-binding systems has changed the profile of skiing-related injuries over time, as has the widespread use of helmets. An understanding of mechanisms of injury, risk factors, and preventative measures may decrease the incidence of skiing-related injuries. CONCLUSION:: Advances in standards for skiing equipment have been effective at decreasing both the frequency and severity of skiing-related injuries, but additional efforts are required to improve the safety of the sport.

The psychological impact of the Israel-Hezbollah War on Jews and Arabs in Israel: the impact of risk and resilience factors.

Although there is abundant evidence that mass traumas are associated with adverse mental health consequences, few studies have used nationally representative samples to examine the impact of war on civilians, and none have examined the impact of the Israel-Hezbollah War, which involved unprecedented levels of civilian trauma exposure from July 12 to August 14, 2006. The aims of this study were to document probable post-traumatic stress disorder (PTSD), determined by the PTSD Symptom Scale and self-reported functional impairment, in Jewish and Arab residents of Israel immediately after the Israel-Hezbollah War and to assess potential risk and resilience factors. A telephone survey was conducted August 15-October 5, 2006, following the cessation of rocket attacks. Stratified random sampling methods yielded a nationally representative population sample of 1200 adult Israeli residents. The rate of probable PTSD was 7.2%. Higher risk of probable PTSD was associated with being a woman, recent trauma exposure, economic loss, and higher psychosocial resource loss. Lower risk of probable PTSD was associated with higher education. The results suggest that economic and psychosocial resource loss, in addition to trauma exposure, have an impact on post-trauma functioning. Thus, interventions that bolster these resources might prove effective in alleviating civilian psychopathology during war.

The emotional needs of care recipients and the psychological well-being of informal caregivers: implications for home care clinicians.

In this exploratory study, 77 informal caregivers of older persons in Ohio completed telephone interviews that included questions regarding their perceived difficulty providing emotional and physical care, perceived quality of care, demographic items including caregivers' health status, and a measure of their psychological well-being. Findings suggest that psychological well-being of informal caregivers is diminished when they experience greater difficulty meeting the care recipients' emotional care needs, are in poorer health, or are older. Suggestions for clinical implications and future research based on these findings are discussed.

Child multi-type maltreatment and associated depression and PTSD symptoms: the role of social support and stress.

OBJECTIVE: This retrospective, cross-sectional study explored the hypothesis that multiple forms of child abuse and neglect (child multi-type maltreatment; CMM) would be associated with women's lower social support and higher stress in adulthood, and that this, in turn, would amplify their vulnerability to symptoms of depression and posttraumatic stress disorder (PTSD). METHOD: Participants were 100 women recruited from an inner-city gynecological treatment center for low-income women. Data were analyzed via structural equation modeling (SEM) with Lisrel 8.0. RESULTS: CMM was directly predictive of decreased social support and increased stress in adulthood. CMM was also directly predictive of PTSD symptoms, but not depression symptoms in adulthood. Social support partially mediated the relationship between CMM and adult PTSD symptoms, and stress fully mediated the relationship between CMM and adult symptoms of depression. CONCLUSIONS: Findings support both direct and mediational effects of social resources on adult depression and PTSD symptoms in women with histories of CMM, suggesting that resources are key factors in psychological adjustment of CMM victims.

Geometric Characteristics of the Knee Are Associated With a Noncontact ACL Injury to the Contralateral Knee After Unilateral ACL Injury in Young Female Athletes.

BACKGROUND: Contralateral anterior cruciate ligament (CACL) injury after recovery from a first-time ACL rupture occurs at a high rate in young females; however, little is known about the risk factors associated with bilateral ACL trauma. HYPOTHESIS: The geometric characteristics of the contralateral knee at the time of the initial ACL injury are associated with risk of suffering a CACL injury in these female athletes. STUDY DESIGN: Case-control study; Level of evidence, 3. METHODS: Sixty-two female athletes who suffered their first noncontact ACL injury while participating in sports at the high school or college level were identified, and geometry of the femoral notch, ACL, tibial spines, tibial subchondral bone, articular cartilage surfaces, and menisci of the contralateral, uninjured, knee was characterized in 3 dimensions. We were unable to contact 7 subjects and followed the remaining 55 until either a CACL injury or an ACL graft injury occurred or, if they were not injured, until the date of last contact (mean, 34 months after their first ACL injury). Cox regression was used to identify risk factors for CACL injury. RESULTS: Ten (18.2%) females suffered a CACL injury. Decreases of 1 SD in femoral intercondylar notch width (measured at its outlet and anterior attachment of the ACL) were associated with increases in the risk of suffering a CACL injury (hazard ratio = 1.88 and 2.05, respectively). Likewise, 1 SD decreases in medial-lateral width of the lateral tibial spine, height of the medial tibial spine, and thickness of the articular cartilage located at the posterior region of the medial tibial compartment were associated with 3.59-, 1.75-, and 2.15-fold increases in the risk of CACL injury, respectively. CONCLUSION: After ACL injury, subsequent injury to the CACL is influenced by geometry of the structures that surround the ACL (the femoral notch and tibial spines). This information can be used to identify individuals at increased risk for CACL trauma, who might benefit from targeted risk-reduction interventions.

Characterization of Prepractice Injury Prevention Exercises of High School Athletic Teams.

BACKGROUND: Static and dynamic exercises are performed before activity to decrease injury risk and increase performance. Although evidence supports using dynamic over static stretching and performing Fédération Internationale de Football Association (FIFA) 11+ as a dynamic prepractice routine, we do not know the frequency at which these exercises are utilized in high school populations. HYPOTHESIS: We hypothesize that there is a wide variety of preparticipation exercises performed by high school athletes, and that few high school teams perform FIFA 11+ as an injury prevention program in its entirety. STUDY DESIGN: Observational study. LEVEL OF EVIDENCE: Level 4. METHODS: High school prepractice routines were observed for 185 teams (football, soccer, basketball, and lacrosse) over 1 season. The percentages of team warm-up routines that included components of FIFA 11+ were calculated, and the chi-square test was used to compare sex, sport, and level of competition. RESULTS: Of a total 644 warm-up observations, 450 (69.9%) included only non-FIFA 11+ exercises, 56 (8.7%) included at least 1 FIFA 11+ exercise, and 38 (5.9%) included only jogging; 69 (10.6%) consisted only of sport-specific activities. The type of warm-up differed significantly between males and females ( P = 0.002), sports ( P < 0.001), and level of competition ( P < 0.001). Static stretching and athletes stretching on their own were observed in 14% and 15% of all observations. No team performed the FIFA 11+ injury prevention routine in its entirety. CONCLUSION: The type of warm-up differed by sex, sport, and level of competition. Static stretching was performed more frequently than anticipated, and an entire FIFA 11+ warm-up was never performed. CLINICAL RELEVANCE: We need to identify the exercises that decrease injury and increase performance and better inform the athletic population about the risks and benefits of static and dynamic warm-up programs.

Relationship between geometry of the extensor mechanism of the knee and risk of anterior cruciate ligament injury.

The complex inter-segmental forces that are developed across an extended knee by body weight and contraction of the quadriceps muscle group transmits an anteriorly directed force on the tibia that strain the anterior cruciate ligament (ACL). We hypothesized that a relationship exists between geometry of the knees extensor mechanism and the risk of sustaining a non-contact ACL injury. Geometry of the extensor mechanism was characterized using MRI scans of the knees of 88 subjects that suffered their first non-contact ACL injury and 88 matched control subjects with normal knees that were on the same team. The orientation of the patellar tendon axis was measured relative to the femoral flexion-extension axis to determine the extensor moment arm (EMA), and relative to tibial long axis to measure coronal patellar tendon angle (CPTA) and sagittal patellar tendon angle (SPTA). Associations between these parameters and ACL injury risk were tested with and without adjustment for flexion and internal rotation position of the tibia relative to the femur during MRI data acquisition. After adjustment for internal rotation position of the tibia relative to the femur there were no associations between EMA, CPTA, and SPTA and risk of suffering an ACL injury. However, increased internal rotation position of the tibia relative to the femur was significantly associated with increased risk of ACL injury in female athletes both in univariate analysis (Odds Ratio = 1.16 per degree of internal rotation of the tibia, p = 0.002), as well as after adjustment for EMA, CPTA, and SPTA.: © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:965-973, 2017.

Exposure to terrorism, stress-related mental health symptoms, and defensive coping among Jews and Arabs in Israel.

The authors conducted a large-scale study of terrorism in Israel via telephone surveys in September 2003 with 905 adult Jewish and Palestinian citizens of Israel (PCIs). Structural equation path modeling indicated that exposure to terrorism was significantly related to greater loss and gain of psychosocial resources and to greater posttraumatic stress disorder (PTSD) and depressive symptoms. Psychosocial resource loss and gain associated with terrorism were, in turn, significantly related to both greater PTSD and depressive symptoms. PCIs had significantly higher levels of PTSD and depressive symptoms than Jews. Further, PTSD symptoms in particular were related to greater authoritarian beliefs and ethnocentrism, suggesting how PTSD may lead to a self-protective style of defensive coping.

The relationship between menstrual cycle phase and anterior cruciate ligament injury: a case-control study of recreational alpine skiers.

BACKGROUND: Female athletes suffer a greater incidence of anterior cruciate ligament tears compared with male athletes when participating in common sports; however, very little is known about the factors that explain this disparity. STUDY DESIGN: Case-control study; Level of evidence, 3. METHODS: Female recreational alpine skiers with an anterior cruciate ligament rupture and age-matched control skiers provided a serum sample and self-reported menstrual history data immediately after injury. Both serum concentrations of progesterone and menstrual history were then used to group subjects into either preovulatory or postovulatory phases of the menstrual cycle. RESULTS: Analysis of serum concentrations of progesterone revealed that alpine skiers in the preovulatory phase of the menstrual cycle were significantly more likely to tear their anterior cruciate ligaments than were skiers in the postovulatory phase (odds ratio, 3.22; 95% confidence interval, 1.09-9.52; P = .027). Analysis of menstrual history data found similar results, but the difference was not statistically significant (odds ratio, 2.38; 95% confidence interval, 0.86-6.54; P = .086). CONCLUSION: The likelihood of sustaining an anterior cruciate ligament injury does not remain constant during the menstrual cycle; instead, the risk of suffering an anterior cruciate ligament disruption is significantly greater during the preovulatory phase of the menstrual cycle compared with the postovulatory phase. CLINICAL RELEVANCE: Phase of menstrual cycle may be one of the risk factors that influence knee ligament injury among female alpine skiers. The findings from this study should be considered in subsequent studies designed to identify persons at risk for anterior cruciate ligament injury and to develop intervention strategies.