The REBOOT First Responders Program: Insights of U.S. Graduates.

The REBOOT First Responders program offers spiritual care for occupational stress. Although prior work suggests benefits to the program, no research has considered attendees' experiences in an open-ended way. The aim of this study was to document first responders' thoughts about the effectiveness, evaluation, and effects of the course in their own words. Interviews with 36 graduates living in the U.S. indicated favorable perceptions of the course. Reasons for success included the program's tangible benefits, community atmosphere, and faith-based approach (RQ1). Strengths involved helping first responders realize they are not alone and educating them about trauma; recommended upgrades involved customizing to specific occupations and offering ongoing support (RQ2). Effects included more self-acceptance, enhanced spirituality, better relationships, a more constructive view of trauma, and greater optimism about the future (RQ3). These results have implications for improving spiritual care for first responders.

Eye movement desensitization and reprocessing for the treatment and early intervention of trauma among first responders: A systematic review.

First responders are exposed to repetitive work-related trauma and, thus, are at risk of developing posttraumatic stress disorder (PTSD). Eye-movement desensitization and reprocessing (EMDR) is a psychotherapy intervention designed to treat symptoms of posttraumatic stress. We conducted a systematic review to examine the viability of EMDR among first responders. The primary aim of this review was to identify studies that have trialed EMDR among first responders and evaluate its effectiveness in reducing trauma-related symptoms; a secondary aim was to identify whether EMDR has been used as an early intervention for this cohort and determine its effectiveness as such. Four databases were searched. Studies were included if they evaluated the extent to which EMDR was effective in alleviating symptoms stemming from work-related trauma exposure among first responders. The findings from each study were reported descriptively, and eight studies that evaluated the efficacy of EMDR in this population were included. There was substantial variation in how EMDR was implemented, particularly in the type, duration, frequency, and timing. The findings suggest that EMDR can alleviate symptoms of work-related trauma exposure among first responders; however, findings regarding early intervention were inconclusive, and a methodological quality assessment revealed that all studies were classified as being of either weak or medium quality. Although this review provides preliminary insights into the effectiveness of EMDR for first responders, the conclusions that can be drawn from the literature are limited, and the findings highlight several gaps in the literature.

The association of distress tolerance and mindful awareness with mental health in first responders.

Mindful awareness (MA) and distress tolerance are emerging as robust predictors of mental health in populations with high levels of stress and trauma exposure, such as first responders. The combination of both protective factors may have potentiating benefits for mental health. First responders might especially benefit from high levels of MA if they are able to tolerate distressing present-moment experiences as needed. In this study, cross-sectional data were used to test whether distress intolerance (DI) moderated the relationship between MA and mental health. First responders (N = 176) completed an online assessment battery including measures of MA (Mindful Attention Awareness Scale), DI (Distress Intolerance Index), and mental health outcomes (i.e., Depression, Anxiety, and Stress Scale; Posttraumatic Stress Disorder [PTSD] Checklist for Diagnostic and Statistical Manual of Mental Disorders, 5th edition [DSM-5]; Secondary Traumatic Stress Scale; abbreviated Maslach Burnout Inventory; compassion satisfaction subscale of the Professional Quality of Life Scale; Satisfaction with Life Scale; and Brief Resilience Scale). Multiple regression models demonstrated that among first responders with higher DI, MA had a stronger association with lower anxiety and depression symptoms. Interactions between MA and DI were not significant for other outcome measures. However, higher MA and lower DI each independently predicted lower stress (lower posttraumatic stress, secondary traumatic stress, and general stress); higher MA independently predicted better occupational health (lower burnout and higher compassion satisfaction); and lower DI independently predicted positive mental health (greater resilience and life satisfaction). Results highlight the independent associations of high MA and low DI with first responders' mental health and underscore the importance of studying of interventions that promote both of these protective factors in first responders. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Fetal alcohol spectrum disorders (FASD) and youth firesetting: A call on criminal justice, emergency responder, and fire prevention specialists to become informed.

Central nervous system damage resulting from prenatal exposure to alcohol, often referred to as fetal alcohol spectrum disorders (FASD), commonly manifests as lacking cognitive functioning, problem solving, impulsivity, memory, executive functioning, and social skill deficits. For individuals with FASD, these brain-based deficits translate into impulsive behaviors and poorly thought-out decision-making, coupled with an inability to anticipate and recognize the sometimes very severe consequences of their behaviors. Not unexpectedly, individuals with FASD frequently find themselves disproportionately involved in the criminal justice system and mental health services. For some individuals with FASD, these behaviors can also include firesetting. First responders, like other health and legal professionals, are often unable to recognize the behavioral indicators of FASD, primarily due to a lack of training. As a result, firesetting behaviors are often attributed to deliberate, willful acts of delinquency, a desire to damage property, thrill seeking, or as attempts for personal gain, rather than being viewed as maladaptive attempts to solve problems by individuals who lack the tools to do this in more appropriate ways. These same skill deficits also present when individuals with FASD are interviewed about their involvement in such behaviors, sometimes resulting in confabulation, suggestibility, and false confessions. Further education and training in FASD are vital for first responders if they are to better support individuals with FASD and minimize their chances of becoming involved in firesetting behaviors. Furthermore, this training and education will help ensure that first responders can intervene in more appropriately when crisis situations do occur. This article will outline key behavioral symptoms of FASD as well as provide first responders with suggestions as to how to best support individuals when FASD is suspected. The brief quote that follows highlights some of the key challenges facing individuals with FASD and how poor decision-making and impulsiveness can result in severe consequences for the individual and those around them.

EMS at 3600 Meters: Exploring Barriers to Emergency Care and Transport in Rural Andean Perú.

BACKGROUND: Given the demonstrated success of programs that bolster informal Emergency Medical Service (EMS) systems in other low- and middle-income counties (LMICs), this study aimed to explore formal and informal systems, practices, customs, and structures for emergency response and medical transport in Colca Valley, Perú while identifying possible opportunities for future intervention. METHODS: Twenty-two interviews with first responders and community members were conducted in three mountain villages throughout rural Andean Colca Valley of Perú. Subjects were recruited based on profession and experience with medical emergencies in the area. Transcripts were entered into Dedoose, coded, and analyzed to identify themes. RESULTS: Providers and community members shared similar perceptions on the most common barriers to emergency care and transport. Challenges experienced equally by both groups were identified as "structural problems," such as lack of infrastructure, lack of structured care delivery, and unclear protocols.Incongruities of responses between groups emerged with regard to certain barriers to care. Providers perceived baseline health education and use of home remedies as significant barriers to seeking care, which was not proportionally corroborated by community members. In contrast, 86% of community members cited lack of trust in health providers as a major barrier.Community members often noted witnessing a high frequency of emergency events, their personal experiences of helping, and the formal utilization of lay providers. When specifically questioned on their willingness to engage in first aid training, all participants were in agreement. CONCLUSION: While structural changes such as increased infrastructure would likely be the most durable improvement, future interventions focused on both empowering community members and improving the relationship between the health center and the community would be beneficial in this community. Additionally, these interview data suggest that a layperson first aid training program would be feasible and well-received.

Osteopathic Manipulative Treatment as an Intervention to Reduce Stress, Anxiety, and Depression in First Responders: A Pilot Study.

In this pilot study, we examined the efficacy of Osteopathic Manipulative Treatment (OMT) for improving symptoms of stress, anxiety, and depression (SAD) to determine a correlation between overall improvement in health and quality of life for first responders. Participants received weekly OMT or sham OMT targeting autonomic imbalance. Indicators of SAD were examined pre- and post-study. Overall, this pilot study suggests improvement in both the social-psychological (mental) self-assessments, and alterations in SAD-associated biomarkers from OMT.

Non-pharmacological therapies for the treatment of post-traumatic stress disorder among emergency responders: a scoping review.

OBJECTIVE: Identify non-pharmacological therapies for the treatment of post-traumatic stress disorder in emergency responders. METHOD: Scope review according to the guidelines of the Joanna Briggs Institute and the PRISMA-ScR protocol. A search was conducted in nine databases, portals of theses and dissertations, and using an electronic search engine. RESULTS: In total, 23 studies were selected and analyzed, and then categorized into six thematic fields - therapy with omega 3 food supplement, art therapy, physical exercise therapy, mindfulness-based therapy, therapy with elements of nature, and psychotherapy - which were considered non-pharmacological treatments for this psychopathology among emergency responders, as well as the use of psychotherapy via telehealth as an option for treatment. CONCLUSION: More evidence supporting diet therapy is required, while the other therapeutic options presented positive results, finding support in national and international recommendations of treatment and clinical practice.

Supporting the Mental Health and Well-Being of First Responders from Career to Retirement: A Scoping Review.

INTRODUCTION: First responders are at greater risk of mental ill health and compromised well-being compared to the general population. It is important to identify strategies that will be effective in supporting mental health, both during and after the first responder's career. METHODS: A scoping review was conducted using the PubMed database (1966 to October 1, 2020) and the Google Scholar database (October 1, 2020) using relevant search terms, truncation symbols, and Boolean combination functions. The reference lists of all relevant publications were also reviewed to identify further publications. RESULTS: A total of 172 publications were retrieved by the combined search strategies. Of these, 56 met the inclusion criteria and informed the results of this overview paper. These publications identified that strategies supporting first responder mental health and well-being need to break down stigma and build resilience. Normalizing conversations around mental health is integral for increasing help-seeking behaviors, both during a first responder's career and in retirement. Organizations should consider the implementation of both pre-retirement and post-retirement support strategies to improve mental health and well-being. CONCLUSION: Strategies for supporting mental health and well-being need to be implemented early in the first responder career and reinforced throughout and into retirement. They should utilize holistic approaches which encourage "reaching in" rather than placing an onus on first responders to "reach out" when they are in crisis.

Mindfulness, Posttraumatic Stress Symptoms, and Posttraumatic Growth in Aid Workers: The Role of Self-Acceptance and Rumination.

ABSTRACT: Objective: The risk for aid workers to develop posttraumatic mental problems highlights the importance of reducing the harm of posttraumatic stress symptoms (PTSS) and promoting the benefits of posttraumatic growth (PTG). This study examined the negative relationship between mindfulness and PTSS, and the positive relationship between mindfulness and PTG, and further explored the mediating roles of self-acceptance, intrusive rumination, and deliberate rumination. Methods: Aid workers from the Red Cross Organization (N = 298) were recruited in the study. They completed a series of questionnaires assessing mindfulness, self-acceptance, rumination, posttraumatic stress disorder (PTSD), and PTG. Results: Results showed that mindfulness was significantly and negatively associated with PTSD through positively predicting self-acceptance and negatively predicting intrusive rumination. Mindfulness was significantly and positively associated with PTG, although the mediating effect did not exist because the path between self-acceptance and deliberate rumination was impassable. Conclusion: The mechanisms between mindfulness, PTSD, and PTG were further explored. Limitations and implications for trauma intervention and future research were discussed.

Non-pharmacological therapies for the treatment of post-traumatic stress disorder among emergency responders: a scoping review / Terapias no farmacológicas de tratamiento del trastorno de estrés postraumático en emergencistas: revisión de alcance / Terapias não farmacológicas no tratamento de transtorno do estresse pós-traumático em emergencistas: revisão de escopo

ABSTRACT Objective: Identify non-pharmacological therapies for the treatment of post-traumatic stress disorder in emergency responders. Method: Scope review according to the guidelines of the Joanna Briggs Institute and the PRISMA-ScR protocol. A search was conducted in nine databases, portals of theses and dissertations, and using an electronic search engine. Results: In total, 23 studies were selected and analyzed, and then categorized into six thematic fields - therapy with omega 3 food supplement, art therapy, physical exercise therapy, mindfulness-based therapy, therapy with elements of nature, and psychotherapy - which were considered non-pharmacological treatments for this psychopathology among emergency responders, as well as the use of psychotherapy via telehealth as an option for treatment. Conclusion: More evidence supporting diet therapy is required, while the other therapeutic options presented positive results, finding support in national and international recommendations of treatment and clinical practice.

RESUMEN Objetivo: Identificar las terapias no farmacológicas utilizadas para tratamiento del trastorno de estrés postraumático en profesionales emergencistas. Método: Revisión de alcance conforme indicaciones del Instituto Joanna Briggs y del protocolo PRISMA-ScR. Búsqueda realizada en nueve bases de datos, portales de tesis y disertaciones, y mediante buscador electrónico. Resultados: Fueron seleccionados y caracterizados 23 estudios, categorizados en seis ejes temáticos, a saber: terapia con suplemento alimentario de omega 3; arteterapia, terapia con ejercicios físicos, terapia con técnica de mindfulness, terapia con elementos de la naturaleza y psicoterapia, todos ellos destacados como tratamientos no farmacológicos para esta patología en profesionales emergencistas, así como el recurso de la psicoterapia vía telesalud como alternativa de tratamiento. Conclusión: Se necesita mayor cantidad de evidencias respaldando la terapia alimentaria, mientras que las demás alternativas terapéuticas encontradas demostraron resultados positivos, hallando respaldo en recomendaciones nacionales e internacionales de tratamiento y práctica clínica.

RESUMO Objetivo: Identificar as terapias não farmacológicas utilizadas no tratamento do transtorno de estresse pós-traumático em profissionais emergencistas. Método: Revisão de escopo conforme orientações do Instituto Joanna Briggs e do protocolo PRISMA-ScR. A busca foi realizada em nove bases de dados, portais de teses e dissertações e por meio de buscador eletrônico. Resultados: Foram selecionados e caracterizados 23 estudos, que foram categorizados em seis eixos temáticos, sendo eles: terapia com suplementação alimentar com ômega 3, arteterapia, terapia com exercícios físicos, terapia envolvendo a técnica mindfulness, terapia com elementos da natureza e psicoterapia, que foram apontados como tratamentos não farmacológicos para esta psicopatologia em profissionais emergencistas e, ainda, o recurso da psicoterapia via telessaúde como uma alternativa no tratamento. Conclusão: É necessário maior número de evidências que suportem a terapia dietética, enquanto as demais alternativas terapêuticas encontradas apresentaram resultados positivos, encontrando suporte nas recomendações nacionais e internacionais de tratamento e prática clínica.

Creating a hazard-based training and assessment tool for emergency response drivers.

Emergency response drivers (ERDs) are often required to engage in high-risk driving manoeuvres on their way to a reported incident. Such risk requires that these drivers receive a high-level of training and continued development. The aim of this paper was to investigate an innovative format for a new potential tool that could support the training and assessment of these drivers: a single-clip Holistic Hazard Test, containing multiple hazards in a single route. In study one, we created a proof-of-concept 15-minute clip containing hazards, multiple-choice questions and probes to collect self-reported safety ratings. ERDs were more accurate on the multiple-choice questions (MCQs) than a control group, though response time scores to hazards did not reach the threshold for significance. In study two, we refined the development process and created a series of new holistic hazard tests across four counties of the East Midlands, UK. Each test contained many hazards and MCQs that assessed situation awareness and decision-making, based on the results of study 1. Participants were recruited across the four counties and were presented with both the test that was specific to their county and one of the unfamiliar-location tests, in order to assess the generalisability of the tests across different locales. The results showed no differences regarding location familiarity, suggesting that tests filmed in one area of the country can be viewed by drivers elsewhere without detriment to performance. ERDs once again responded to MCQs more accurately, and also scored more hazard points on the basis of faster responses to hazards compared to control participants. These results suggest such tests can successfully tap into ERD-specific skills with regard to spotting, predicting and responding to hazards on the road. We recommend refinement of this tool for assessment of emergency response drivers, and further development to extend the materials to create a training tool.

GPs who volunteer to be first responders for out-of-hospital cardiac arrest: A qualitative study.

Background: Out-of-hospital cardiac arrest (OHCA) is a major cause of premature mortality. Survival is possible when timely cardiopulmonary resuscitation and defibrillation are available in the community. GPs are well placed to provide early OHCA care and significantly increased rates of survival are achieved when GPs participate in resuscitation. A novel project alerts volunteer GP first responders to nearby OHCAs in Ireland.Objectives: To explore the reasons why GPs volunteer to be OHCA first responders and their experience of participation.Methods: A qualitative study involving in-depth, semi-structured interviews followed by thematic analysis was undertaken in 2017/18. Fourteen GPs from differing geographical areas in Ireland, who volunteered as OHCA first-responders were recruited to participate by purposive methods.Results: GP participation in OHCA voluntary first response was understood as a function of GPs relationship to the community, their ability to manage competing demands in their personal and professional lives and also specific participatory gains. GPs expressed both altruistic motivations and a sense of obligation. GPs described a complex, multifaceted role in providing OHCA first response; they derived an inherent sense of satisfaction in delivering potentially life-saving interventions but also in the provision of holistic, compassionate end-of-life care for patients and their families. Participation was not without psychosocial risk for GPs.Conclusion: GPs volunteer to provide early OHCA emergency care because of their relationship to the community. Care provided is complex and includes both resuscitation and end-of-life care.

HIRUDOTHERAPY IN PRESBYACUZIS PRAECOX IN CLEAN-UP WORKERS AFTER THE CHORNOBYL ACCIDENT DURING THE POST-CATASTROPHE YEARS. / GIRUDOTERAPIIa PRY PRESBYACUZIS PRAECOX V UChASNYKIV LIKVIDATsIÏ NASLIDKIV AVARIÏ NA ChORNOBYL'S'KIY̆ ATOMNIY̆ ELEKTROSTANTsIÏ U PISLIaAVARIY̆NYKh ROKAKh.

OBJECTIVE: to study the hirudotherapy efficacy in presbyacuzis praecox in clean-up workers (CUWs) of the Chornobyl disaster (ChD) during the post-accident years. MATERIALS AND METHODS: From archive data of previously examined 8,136 males' CUWs we selected among them 129 persons with the determined presbyacuzis praecox during the post-accident years. According to the physical dosime- try data the individual radiation of received by CUWs during the work on a rotational scheme in the Chornobyl exclu- sion zone from the end of 1986 to 1992-1994 amounted to 0.21-0.50 Gy. The examinations were carried out using a modern standard set of audiometric, vestibulometric and electrophysiological methods. Two forms of sensory and neural hearing loss in the elderly were distinguished, namely the presbyacuzis and presbyacuzis praecox. Prior to work in the exclusion zone, patients' auditory and vestibular functions were within normal range. Among 129 patients, 68 ones with presbyacuzis praecox were included in two main age groups (aged 40-49 and 50-59 yrs) and were treated using hirudotherapy, taking into consideration their coagulation hemostasis. Other 61 patients of analogical age groups were treated by allopathotherapy. For the analysis of results obtained, techniques of variational statistics were used. RESULTS: Direct correlation (r = 0.71) between inhibitory processes in central areas of the auditory analyzer in pres- byacuzis praecox in CUWs was established by electrophysiology and by speech audiometry data obtained before the treatment. Hyperacusis signs were detected in CUWs of two main and two control groups. Following the use of two treatment schemas, a significant improving of auditory functions was found (p < 0.05) according to tone and speech audiometries. The positive hirudotherapy effect concerning hearing functions was registered in 88% cases (in 59 CUWs among 68 ones); if allopathotherapy had been used, such effect was found in 65% cases (in 45 control patients among 61 ones of control group). The duration of allopathotherapy effect reached 6-9 months comparing to 12-18 months of hiruditherapy one, being twice longer. Improving the patients' coagulation hemostasis, hirudotherapy activated cardiovascular activity favoring the increase of social adequacy in CUWs with presbyacuzis praecox. CONCLUSIONS: It has been shown that hirudotherapy as a kind of naturopathy has significant advantages over alopa- totherapy by the absence of side effects, 23.0% higher and twice as long as improvement of auditory functions. Hirudotherapy, as an effective therapeutic and recreational measures, should be more widely implemented in clini- cal practice in order to minimize the development and progression of diseases in the special population of people who have been exposed to ionizing radiation due to the Chornobyl catastrophe to continue their vitality.

Resilience@Work Mindfulness Program: Results From a Cluster Randomized Controlled Trial With First Responders.

BACKGROUND: A growing body of research suggests that resilience training can play a pivotal role in creating mentally healthy workplaces, particularly with regard to protecting the long-term well-being of workers. Emerging research describes positive outcomes from various types of resilience training programs (RTPs) among different occupational groups. One specific group of workers that may benefit from this form of proactive resilience training is first responders. Given the nature of their work, first responders are frequently exposed to stressful circumstances and potentially traumatic events, which may impact their overall resilience and well-being over time. OBJECTIVE: This study aimed to examine whether a mindfulness-based RTP (the Resilience@Work [RAW] Mindfulness Program) delivered via the internet can effectively enhance resilience among a group of high-risk workers. METHODS: We conducted a cluster randomized controlled trial (RCT) comprising 24 Primary Fire and Rescue and Hazmat stations within New South Wales. Overall, 12 stations were assigned to the 6-session RAW Mindfulness Program and 12 stations were assigned to the control condition. A total of 143 active full-time firefighters enrolled in the study. Questionnaires were administered at baseline, immediately post training, and at 6-month follow-up. Measurements examined change in both adaptive and bounce-back resilience as well as several secondary outcomes examining resilience resources and acceptance and mindfulness skills. RESULTS: Mixed-model repeated measures analysis found that the overall test of group-by-time interaction was significant (P=.008), with the intervention group increasing in adaptive resilience over time. However, no significant differences were found between the intervention group and the control group in terms of change in bounce-back resilience (P=.09). At 6-month follow-up, the group receiving the RAW intervention had an average increase in their resilience score of 1.3, equating to a moderate-to-large effect size compared with the control group of 0.73 (95% CI 0.38-1.06). Per-protocol analysis found that compared with the control group, the greatest improvements in adaptive resilience were observed among those who completed most of the RAW program, that is, 5 to 6 sessions (P=.002). CONCLUSIONS: The results of this RCT suggest that mindfulness-based resilience training delivered in an internet format can create improvements in adaptive resilience and related resources among high-risk workers, such as first responders. Despite a number of limitations, the results of this study suggest that the RAW Mindfulness Program is an effective, scalable, and practical means of delivering online resilience training in high-risk workplace settings. To the best of our knowledge, this is the first time a mindfulness-based RTP delivered entirely via the internet has been tested in the workplace. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12615000574549; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=368296 (Archived by WebCite at http://www.webcitation.org/75w4xtrpw).

Mindfulness-Based Psychotherapy Approaches for First Responders: From Research to Clinical Practice.

First responders are psychosocially burdened with work-related stressors that occur frequently during required duties. Related mental health difficulties, such as direct and vicarious trauma, depression, and interpersonal problems often affect first responders' ability to perform effectively, and their personal lives may be disrupted. Mindfulness-based interventions have been shown to directly promote first responders' mental and physical health while providing increased resilience when facing work-related stressors. This article summarizes mindfulness-based benefits and empirical research related to first responders, using law enforcement officers as one specific example. Two specific mindfulness-based psychotherapies are introduced, as are generalizable mindfulness techniques useful for first responders. Psychotherapists can use these empirically supported treatment approaches to help first responders understand and incorporate awareness-based, nonjudgmental, and present-centered mindfulness techniques during critical incidents and while off duty as resilience-building mechanisms.

Health system and law enforcement synergies for injury surveillance, control and prevention: a scoping review.

BACKGROUND: Healthcare providers and law enforcement (LE) officers are among the most common first responders to injuring events. Despite frequent interface between the health system (HS) and LE sectors, the published evidence that supports their collaboration in injury surveillance, control and prevention has not been comprehensively reviewed. METHODS: We conducted a scoping review of literature published from 1990 to 2016 that focused on local and regional HS and LE collaborations in injury surveillance, control and prevention. Our aim was to describe what is known and what remains unexplored about these cross-sector efforts. RESULTS: 128 articles were included in the final review. These were categorised by their focus on either surveillance activities or partnerships in injury control and prevention programmes. The majority of surveillance articles focused on road traffic injuries. Conversely, articles describing partnerships and programme evaluations primarily targeted the prevention of interpersonal violence. DISCUSSION: This review yielded two major findings: overall, the combination of HS and LE injury data added value to surveillance systems, especially as HS data augmented LE data; and HS and LE partnerships have been developed to improve injury control and prevention. However, there are few studies that have evaluated the impact and sustainability of these partnerships. CONCLUSIONS: The current evidence to support HS and LE collaboration in injury surveillance and control and prevention programmes is heterogeneous. Notable gaps suggest ample opportunity for further research and programme evaluation across all types of injury.

The Deepwater Horizon Oil Spill Coast Guard Cohort study.

OBJECTIVES: Long-term studies of oil spill responders are urgently needed as oil spills continue to occur. To this end, we established the prospective Deepwater Horizon (DWH) Oil Spill Coast Guard Cohort study. METHODS: DWH oil spill responders (n=8696) and non-responders (n=44 823) who were members of the US Coast Guard (20 April-17 December 2010) were included. This cohort uses both prospective, objective health data from military medical encounters and cross-sectional survey data. Here, we describe the cohort, present adjusted prevalence ratios (PRs) estimating cross-sectional associations between crude oil exposure (none, low/medium, high) and acute physical symptoms, and present adjusted relative risks (RRs) based on longitudinal medical encounter data (2010-2012) for responders/non-responders and responders exposed/not exposed to crude oil. RESULTS: Responders and non-responders in this large cohort (n=53 519) have similar characteristics. Crude oil exposure was reported by >50% of responders. We found statistically significant associations for crude oil exposure with coughing (PRhigh=1.78), shortness of breath (PRhigh=2.30), wheezing (PRhigh=2.32), headaches (PRhigh=1.46), light-headedness/dizziness (PRhigh=1.96), skin rash/itching (PRhigh=1.87), diarrhoea (PRhigh=1.76), stomach pain (PRhigh=1.67), nausea/vomiting (PRhigh=1.48) and painful/burning urination (PRhigh=2.89) during deployment. Longitudinal analyses revealed that responders had elevated RRs for dermal conditions (RR=1.09), as did oil-exposed responders for chronic respiratory conditions (RR=1.32), asthma (RR=1.83) and dermal conditions (RR=1.21). CONCLUSIONS: We found positive associations between crude oil exposure and various acute physical symptoms among responders, as well as longer term health effects. This cohort is well positioned to evaluate both short-term and long-term effects of oil spill exposures using both self-reported and clinical health data.

Comparative characteristics of hepatoprotectors used for the treatment of non alcoholic steatohepatitis associated with herpesvirus infection in sufferers of the Chornobyl accident. / PORIVNIaL'NA KhARAKTERYSTYKA GEPATOPROTEKTORIV, ZASTOSOVANYKh DLIa LIKUVANNIa NEALKOGOL'NOGO STEATOGEPATYTU, ASOTsIY̆OVANOGO Z GERPESVIRUSNOIu INFEKTsIIeIu, U POSTRAZhDALYKh VNASLIDOK AVARIÏ NA ChAES.

Objective of the study was to determine the effectiveness of various groups of hepatoprotectors in the treatment of patients with nonalcoholic steatohepatitis (NASH) sufferers of the accident at the Chornobyl NPP following the assessment of metabolic changes and control of persistent infections. MATERIALS AND METHODS: The study included 104 males with NASH, who were sufferers of the Chornobyl disaster and underwent examination and treatment in the conditions of the clinics of the National Research Center for Radiation Medicine of the National Academy of Medical Sciences of Ukraine. Analysis of the course of the functional state of the liver before and after treatment with hepatoprotectors was carried out using laboratory methods of investiga tion. RESULTS: Hepatoprotectors of different groups used for the treatment of patients affected by the Chornobyl accident with NASH, differed in their effect on various chains in the pathogenesis of disease. Ursodeoxycholic acid (UDCA) drugs and preparations of holy thistle normalized the functional state of the liver and disorders of fat metabolism. Treatment with essential phospholipids eliminated cytolytic syndrome with a significant decrease in alanine amino transferase (p < 0.05), but increased alkaline phosphatase (p < 0.001), beta lipoproteins (p < 0.05), triglycerides (p < 0.05), the total cholesterol level remained elevated to (7.0 ± 0.8) mmol/L. Amino acid (AA) preparations normal ized the level of aminotransferases, eliminated the symptoms of cholestasis with a significant decrease in bilirubin (p < 0.001) and alkaline phosphatase (p < 0.001), positively influenced on fat and carbohydrate metabolism decreasing levels of beta lipoproteins (p < 0.05), triglycerides and glucose. Treatment with hepatoprotectors posi tively influenced on the state of antioxidant protection (AOP) - decreased before treatment in 56.5 % of patients, after treatment it reduced to 28.6 % (p < 0.05), the number of patients with elevated lipid peroxidation indices decreased from 39.1 % to 21.4 %. Titres of antibodies to persistent herpes virus infections, elevated before treat ment, under the influence of hepatoprotectors did not decrease to reference values. CONCLUSION: The most effective were drugs on the basis of AA, when applied they normalized the functional state of the, fat and carbohydrate metabolism, decreased lipoperoxidation and improved AOP state. Effect of drugs AA and UDCA on the level of antibodies to herpesvirus infection requires further study.

Decompressing rescue personnel during Australian submarine rescue operations.

INTRODUCTION: Personnel rescuing survivors from a pressurized, distressed Royal Australian Navy (RAN) submarine may themselves accumulate a decompression obligation, which may exceed the bottom time limits of the Defense and Civil Institute of Environmental Medicine (DCIEM) Air and In-Water Oxygen Decompression tables (DCIEM Table 1 and 2) presently used by the RAN. This study compared DCIEM Table 2 with alternative decompression tables with longer bottom times: United States Navy XVALSS_DISSUB 7, VVAL-18M and Royal Navy 14 Modified tables. METHODS: Estimated probability of decompression sickness (PDCS), the units pulmonary oxygen toxicity dose (UPTD), the volume of oxygen required and the total decompression time were calculated for hypothetical single and repetitive exposures to 253 kPa air pressure for various bottom times and prescribed decompression schedules. RESULTS: Compared to DCIEM Table 2, XVALSS_DISSUB 7 single and repetitive schedules had lower estimated PDCS, which came at the cost of longer oxygen decompressions. For single exposures, DCIEM schedules had PDCS estimates ranging from 1.8% to 6.4% with 0 to 101 UPTD and XVALSS_DISSUB 7 schedules had PDCS of less than 3.1%, with 36 to 350 UPTD. CONCLUSIONS: The XVALSS_DISSUB 7 table was specifically designed for submarine rescue and, unlike DCIEM Table 2, has schedules for the estimated maximum required bottom times at 253 kPa. Adopting these tables may negate the requirement for saturation decompression of rescue personnel exceeding DCIEM limits.

Patient aggression towards different professional groups of healthcare workers.

INTRODUCTION: Patient aggression affects healthcare quality and, in extreme situations, may even lead to medical malpractice. Little is known, however, about the specific distribution of health care professionals' exposure to patient aggression in various countries. OBJECTIVE: The aim of this study was to assess the exposure of various professional groups of healthcare personnel to patient aggression, and to identify potential determinants (medical profession, age, gender, professional experience and employment at outpatient/inpatient healthcare units) of this exposure. METHODS: The study was performed between January 2008 - December 2009 in northeastern Poland, and included 1,624 healthcare workers (493 nurses, 504 midwives, 501 physicians and 126 medical rescue workers). Exposure to eight forms of patient aggression was assessed using the MDM Mobbing Questionnaire. RESULTS: Using a raised voice was the most frequently observed form of aggression in all groups, whereas the least frequent form of aggression encountered was the use of direct physical violence. In inpatient healthcare units, the intensity of patient aggression was encountered most by nurses and medical rescue workers, followed by physicians and midwives. In outpatient healthcare units, medical rescue workers experienced significantly higher levels of aggression when compared to other professional groups. Significant differences in mean aggression intensity experienced in inpatient and outpatient healthcare units were observed only in nurses and physicians. Furthermore, no significant effects of gender were observed on the intensity of patient aggression. CONCLUSION: Nurses are most exposed to different forms of patient aggression, with verbal attacks being most prevalent. Nurses employed at inpatient healthcare units experienced aggression more frequently than those working in outpatient healthcare units.