Mental disorders, suicidal ideation, plans and attempts among Canadian police.

BACKGROUND: Recent investigations have demonstrated a significant prevalence of mental health disorders, including post-traumatic stress disorder (PTSD), and suicidal ideation, plans and attempts among Canadian public safety personnel, including police officers. What remains unknown is the relationship between mental disorders and suicide among sworn police officers, and the prevalence of both among civilian police workers. AIMS: To examine the relationship between suicidal ideation, plans and attempts and positive mental health screens for depression, anxiety, panic disorder, alcohol abuse and PTSD among Canadian sworn and civilian police employees. METHODS: Participants completed an online survey that included self-report screening tools for depression, anxiety, panic disorder, alcohol abuse and PTSD. Respondents were also asked if they ever contemplated, planned or attempted suicide. Between-group (Royal Canadian Mounted Police [RCMP], provincial/municipal police and civilians) differences on mental health screening tools were calculated using Kruskal-Wallis analyses. The relationship between mental disorders and suicidal ideation, plans and attempts was evaluated with a series of logistic regressions. RESULTS: There were 4236 civilian and sworn officer participants in the study. RCMP officers reported more suicidal ideation than other police and scored highest on measures of PTSD, depression, anxiety, stress and panic disorder, which were significantly associated with suicidal ideation and plans but not attempts. Relative to provincial and municipal police, civilians reported more suicide attempts and scored higher on measures of anxiety. CONCLUSIONS: The results identify a strong relationship between mental health disorders and increased risk for suicidal ideation, plans and attempts among sworn and civilian Canadian police employees.

Mental health and social support among public safety personnel.

BACKGROUND: Social support may be a protective factor for the mental health of public safety personnel (PSP), who are frequently exposed to potentially psychologically traumatic events and report substantial post-traumatic stress disorder (PTSD) and major depressive disorder (MDD) symptoms. Research examining perceived social support and its association with PTSD and MDD in different PSP categories (e.g. firefighters, paramedics) is limited. AIMS: To examine differences in perceived social support across PSP and determine whether perceived social support is associated with differences in rates of MDD and PTSD. METHODS: We asked Canadian PSP, including correctional workers and officers, public safety communications officials, firefighters, paramedics, municipal and provincial police officers, and Royal Canadian Mounted Police (RCMP) officers, to complete an online anonymous survey that assessed socio-demographic information (e.g. occupation, sex, marital status, service years), social supports and symptoms of mental disorders, including PTSD and MDD. Analyses included ANOVA and logistic regression models. RESULTS: Perceived social support differed by PSP occupation. RCMP officers reported lower social support than all other PSP except paramedics. For most PSP categories, PSP who reported greater social support were less likely to screen positive for PTSD (adjusted odds ratios [AORs]: 0.90-0.93). Across all PSP categories, greater perceived social support was associated with a decreased likelihood of screening positive for MDD (AORs: 0.85-0.91). CONCLUSIONS: Perceived social support differs across some PSP categories and predicts PTSD and MDD diagnostic status. Studies involving diagnostic clinical interviews, longitudinal designs and social support interventions are needed to replicate and extend our results.

The Impact of Acute Stress Physiology on Skilled Motor Performance: Implications for Policing.

Investigations of police performance during acutely stressful situations have primarily focused on higher-order cognitive processes like attention, affect or emotion and decision-making, and the behavioral outcomes of these processes, such as errors in lethal force. However, behavioral outcomes in policing must be understood as a combination of both higher-order processes and the physical execution of motor skills. What is missing from extant police literature is an understanding of how physiological responses to acute stress contribute to observed decrements in skilled motor performance at the neuromuscular level. The purpose of the current paper is to fill this knowledge gap in the following ways: (1) review scientific evidence for the physiological (i.e., autonomic, endocrine, and musculoskeletal) responses to acutely stressful exposures and their influence on skilled motor performance in both human and animal models, (2) review applied evidence on occupationally relevant stress physiology and observed motor decrements in performance among police, and (3) discuss the implications of stress physiology for police training and identify future directions for applied researchers. Evidence is compelling that skill decay is inevitable under high levels of acute stress; however, robust evidence-informed training practices can help mitigate this decay and contribute to officer safety.

Asymptomatic myocardial ischemia.

In the vast majority of patients, angina pectoris is the cornerstone on which the diagnosis and treatment of coronary heart disease are formulated. There is evidence to suggest that transient myocardial ischemia may occur without angina pectoris; such episodes are generally detected during ECG or hemodynamic monitoring. The exact incidence, pathophysiologic nature, and importance of asymptomatic myocardial ischemia is not well known and needs further study.

Merits of stress thallium-201 myocardial perfusion imaging in patients with inconclusive exercise electrocardiograms: correlation with coronary arteriograms.

Stress thallium-201 myocardial perfusion images were obtained in 65 patients with an inconclusive exercise electrocardiogram. All 65 patients underwent coronary angiograpic studies. The exercise electrocardiogram was judged inconclusive in 35 patients (54 percent) because submaximal exercise had been performed and in 30 patients (46 percent) who manifested ST-T segment abnormalities at rest. Exercise thallium-201 myocardial perfusion images were abnormal in 20 patients and normal in 45. Nineteen (95 percent) of the 20 patients with abnormal exercise images had severe disease of one or more major coronary arteries. Thirty-seven (82 percent) of the 45 patients with normal exercise images had no significant coronary artery disease; the remaining 8 patients had coronary artery disease. Therefore, 19 of 27 patients with coronary artery disease had abnormal exercise images (sensitivity 70 percent), and 37 of 38 patients without coronary artery disease had normal exercise images (specificity 97 percent). Thallium-201 imaging predicted the correct diagnosis in 56 patients (86 percent). Thus, exercise myocardial imaging with thallium-201 appears to be a useful diagnostic aid in patients with an inconclusive exercise electrocardiogram.

An outbreak of diphtheria in a hospital for the mentally subnormal.

An account is given of two separate outbreaks of diphtheria amongst mentally subnormal patients and nursing staff. In a total hospital population of about 1000 the number of people involved as carriers or cases was 60 and there were five deaths. The 60 people comprised 56 patients, of whom four were involved in both outbreaks, and four nurses. The organisms isolated were C. diphtheriae mitis but five strains were non-toxigenic. It is postulated that the outbreak began following the conversion of a non-toxigenic organism to a toxigenic one by bacteriophage action. The fatal cases were examples of membranous pharyngo-laryngo-tracheo-bronchial diphtheria with well marked pseudo-casts of the upper air passages.

A review of blood lactate and ventilatory methods of detecting transition thresholds.

As far back as the 1930s exercise physiologists recognised the existence of critical levels of work intensity above which lactate accumulation increased drastically and energy production was affected. Investigation of these transition points (thresholds) both invasively and non-invasively has led to much recent controversy. Respiratory exchange variables such as Ve, Ve/VO2, VCO2, excess CO2 and blood lactate have been monitored for simple, double and exponential breakaway points to elucidate these critical work intensities. A number of studies have produced high correlations between endurance performance and anaerobic threshold calculations, further demonstrating the potential existence of critical work intensities. Much of the controversy surrounding these phenomena has centered on mechanisms and nomenclature. The term 'anaerobic threshold' has been severely criticised because in addition to the tissues being oxygen insufficient, an imbalance in the energy systems may have resulted. The anaerobic condition or lactate accumulation may be due to changes in lactate production and removal. Muscle fibre type and the fibre type recruitment patterns may also be important factors in threshold transitions. Further examination is made in this review of non-invasive measures for determining transition thresholds and protocols for elucidating the critical points.

Postirradiation hyperthermia selectively potentiates the merocyanine 540-sensitized photoinactivation of small cell lung cancer cells.

Lung cancer has long been considered a disease that might benefit from the dose escalation of radio/chemotherapy afforded by a stem cell transplant. However, the clinical experience with high-dose chemotherapy and autologous bone marrow transplantation in lung cancer has been disappointing, with most trials showing little or no improvement in long-term survival. Unfortunately, lung cancer has a tendency to metastasize to the bone marrow, and lung cancer cells are known to circulate in the peripheral blood. Therefore, there is concern that autologous stem cell grafts from lung cancer patients may reinoculate recipients with live tumor cells. Photochemical purging of stem cell grafts with Merocyanine 540 (MC540) is highly effective against a wide range of leukemia and lymphoma cells and is well tolerated by normal hematopoietic stem and progenitor cells. Most solid tumor cells (including lung cancer cells), however, are only moderately sensitive or refractory to MC540-mediated photodynamic therapy (PDT). We report here that postirradiation hyperthermia (< or = 42 degrees C, 3 h) potentiates the MC540-mediated photoinactivation of both wild-type (H69) and cisplatin-resistant mutant (H69/CDDP) small cell lung cancer cells by several orders of magnitude, while only minimally enhancing the depletion of normal human granulocyte/macrophage progenitor cells. Our data suggest that postirradiation hyperthermia provides a simple and effective means of extending the utility of MC540-PDT to the purging of stem cell grafts contaminated with lung cancer and possibly other solid tumor cells.

Inactivation of photosensitizing merocyanine dyes by plasma, serum and serum components.

Merocyanine dyes with an oxygen in the electron donor heterocycle were rapidly degraded by plasma, serum and serum components. Replacement of the oxygen by a sulfur or selenium atom rendered the dyes refractory to degradation. The degradation of labile merocyanine dyes was temperature dependent and oxygen independent. The plasma component that was responsible for the degradation of merocyanine dyes was sensitive to heat and detergent, suggesting an enzymatic process. The identification of the structural requirements for sensitivity/resistance to degradation provides the experimenter with a simple means to manipulate the stability of merocyanines in high serum or plasma environments and may expand the clinical utility of merocyanine photosensitizers beyond their traditional role in the extracorporeal purging of bone marrow grafts.

Potentiation of merocyanine 540-mediated photodynamic therapy by salicylate and related drugs.

Simultaneous exposure to merocyanine 540 (MC540) and light of a suitable wavelength kills leukemia, lymphoma and neuroblastoma cells but is relatively well tolerated by normal pluripotent hematopoietic stem cells. This differential phototoxic effect has been exploited in preclinical models and a phase I clinical trial for the extracorporeal purging of autologous bone marrow grafts. Salicylate is known to potentiate the MC540-mediated photokilling of tumor cells. Assuming that salicylate induces a change in the plasma membrane of tumor cells (but not normal hematopoietic stem cells) that enhances the binding of dye molecules it has been suggested that salicylate may provide a simple and effective means of improving the therapeutic index of MC540-mediated photodynamic therapy. We report here on a direct test of this hypothesis in a murine model of bone marrow transplantation as well as in clonal cultures of normal murine hematopoietic progenitor cells. In both systems, salicylate enhanced the MC540-sensitized photoinactivation of leukemia cells and normal bone marrow cells to a similar extent and thus failed to improve the therapeutic index of MC540 significantly. On the basis of a series of dye-binding studies, we offer an alternative explanation for the potentiating effect of salicylate. Rather than invoking a salicylate-induced change in the plasma membrane of tumor cells, we propose that salicylate displaces dye molecules from serum albumin, thereby enhancing the concentration of free (active) dye available for binding to tumor as well as normal hematopoietic stem cells.

Hypersensitivity of horses in British Columbia to extracts of native and exotic species of Culicoides (Diptera: Ceratopogonidae).

Six horses from British Columbia severely affected by Culicoides hypersensitivity, a seasonal dermatitis caused by the bites of Culicoides spp., were inoculated intradermally with extracts of six species or forms of Culicoides from British Columbia, United States, and Israel. Two native and four exotic species were thought to cause the disease in their own geographical area. The horses developed large welts within 20 min after injection of any of the six extracts, indicating an immediate (type I) reaction. The skin reactions caused by each extract peaked at or after 24 h, indicating an additional delayed (type IV) reaction. These reactions confirm that the reactions to the extracts were allergic in nature. The horses were physically irritated by each extract and developed transverse ridges in the injection area similar to those seen in natural cases of the disease, again indicating an allergic reaction. Previous studies showed that control horses injected with Culicoides extract showed only a small, short-term reaction, with no delayed component, no irritation, and no transverse ridge development, further indicating that the observed reactions were allergic in nature. The affected horses reacted to all extracts of Culicoides, despite the fact that they had not been previously exposed to most of the species, indicating that the allergen(s) was present in all the extracts tested.

Culicoides obsoletus (Diptera: Ceratopogonidae) as a causal agent of Culicoides hypersensitivity (sweet itch) in British Columbia.

Six horses severely affected by a seasonal dermatitis similar in both histopathology and epidemiology to Culicoides hypersensitivity (CH) and six unaffected or normal horses were inoculated intradermally with an extract of Culicoides obsoletus (Meigen), the most common Culicoides in southwestern British Columbia. Affected horses developed large welts within 20 min after injection, representing an immediate (type I) reaction; welts were largest 24 h or more after challenge, indicating in addition a delayed (type IV) reaction. This reaction was discernible for greater than 3 wk in some of the affected horses. Normal horses developed small welts which peaked 2-4 h after challenge. Affected horses were irritated by the injections and developed characteristically ridged skin at the injection sites, similar to that seen in natural lesions, whereas the normal horses showed neither discomfort nor clinical signs. C. obsoletus is one of the most numerous Culicoides species biting horses, feeds on parts of the body where lesions are found, and is, we believe, responsible for dermatitis in the Pacific Northwest. The skin test was repeated 2 yr later in three of the affected horses. In two, the reactions were similar to those in the first test, but in the third horse, the reaction was greatly reduced after the second test. This paralleled a decrease in the severity of its natural clinical signs. Thus, a skin test may be useful in the diagnosis of Culicoides hypersensitivity.

Immunotherapy trial for horses in British Columbia with Culicoides (Diptera:Ceratopogonidae) hypersensitivity.

Immunotherapy was used to treat horses in British Columbia for Culicoides hypersensitivity. This is a severe, chronic, recurrent allergic disease of horses that results in severe irritation, large lesions, hair loss and secondary infection in the ventral midline, mane, and proximal region of the tail. A crude Culicoides extract was injected subcutaneously, in increasing doses, into 10 horses that were affected severely by the disease. Weekly doses reduced the clinical signs in 9 of the 10 horses in the 1st yr. Eight horses were treated with a maintenance dose during a 2nd yr. After the 2nd yr, 3 horses were completely free of clinical signs, 3 showed much less severe clinical signs than in untreated years, and 2 showed moderate reduction in clinical signs. Dosage, frequency of injections, and possible future applications of this technique are discussed.

Effect of molecular structure on the performance of triarylmethane dyes as therapeutic agents for photochemical purging of autologous bone marrow grafts from residual tumor cells.

Extensively conjugated cationic molecules with appropriate structural features naturally accumulate into the mitochondria of living cells, a phenomenon typically more prominent in tumor than in normal cells. Because a variety of tumor cells also retain pertinent cationic structures for longer periods of time compared with normal cells, mitochondrial targeting has been proposed as a selective therapeutic strategy of relevance for both chemotherapy and photochemotherapy of neoplastic diseases. Here we report that the triarylmethane dye crystal violet stains cell mitochondria with efficiency and selectivity, and is a promising candidate for photochemotherapy applications. Crystal violet exhibits pronounced phototoxicity toward L1210 leukemia cells but comparatively small toxic effects toward normal hematopoietic cells (murine granulocyte-macrophage progenitors, CFU-GM). On the basis of a comparative examination of chemical, photochemical, and phototoxic properties of crystal violet and other triarylmethane dyes, we have identified interdependencies between molecular structure, and selective phototoxicity toward tumor cells. These structure-activity relationships represent useful guidelines for the development of novel purging protocols to promote selective elimination of residual tumor cells from autologous bone marrow grafts with minimum toxicity to normal hematopoietic stem cells.

Antineoplastic effects of gallium nitrate on human medulloblastoma in vivo.

Gallium nitrate possesses antineoplastic activity against certain solid tumors and has been demonstrated to be an effective agent in reducing cell proliferation and DNA synthesis in the medulloblastoma Daoy cell line in vitro. In prior studies, gallium inhibited the cellular uptake of 59Fe by brain tumor cells; however, this block in 59Fe uptake was variable and closely paralleled the inhibitory effects of gallium on cell growth. In vivo trials now have been conducted and have yielded some promising results. Nude mice received intradermal injections of medulloblastoma Daoy and then allowed to grow tumors. When the mice had developed at least one tumor between 9 to 10 mm in diameter, a 10-day course of intraperitoneal gallium nitrate injections was initiated. Gallium nitrate treatment reduced overall tumor growth rate and reduced actual tumor size. Nephrotoxicity was severe, but may be preventable by continuous gallium infusion and use of diuretics and hyperhydration.

Modeling dynamic skinfold compression.

Real time compression of skinfolds was measured at three sites (triceps, abdominal medial calf), using a Slim Guide skinfold caliper adapted by the addition of a potentiometer, on eight males and eight females (age range 18-40 years). An average of eight trials for each subject at each site was used in modeling the compression curves. A mechanical model was developed, comprised of two parallel spring and viscous components in series with each other. $ Tt = Tinitial + F \left( { 1 \over k_1 } - \left\lceil { e { -k_1 t \over b_1 } \over k_1 } \right\rceil \right) + F \left( { 1 \over k_2 } - \left\lceil { e { -k_2 t \over b_2 } \over k_2 } \right\rceil \right) $ where: Tt = thickness at time t; Tinitial = intial skinfold thickness; F = force exerted by caliper; k(1) and k(2) = coefficients of elasticity; b(1) and b(2) = coefficients of viscosity. This two-component model was the best fitting model in comparison to one or three component alternatives. The coefficients of the model were different by sex and skinfold site. Coefficients for females showed greater elasticity and less viscosity compared to those for males. Further, there appeared to be a systematic site difference with the triceps having less elasticity and viscosity in both sexes. Am. J. Hum. Biol. 11:531-537, 1999. Copyright 1999 Wiley-Liss, Inc.

Rehabilitation learning needs: patient and family perceptions.

Understanding consumer needs for information provides the foundation for empowering patients and families to assume more responsibility for their own care both in hospital and after discharge. Self administered questionnaires identified adult rehabilitation learning needs from the perspectives of patients and their families both during and following hospitalization. The greatest needs for both groups in both time periods were for information about medical, psychosocial and community integration topics. During the in-patient phase, families identified high needs for information which suggests that they should be targeted for educational activities along with patients. Surveys repeated 6 weeks following discharge indicated that information needs were lower but continued to exist.

Minimum and maximum development rates of some forensically important Calliphoridae (Diptera).

Blow fly development rates are frequently used to estimate elapsed time since death in homicide investigations in the first few weeks after death. However, in order to make more precise estimates of time since death, accurate developmental data must be generated for all carrion species, and at temperatures that are comparable with those found at crime scenes. This paper presents developmental rates determined for five forensically important species in British Columbia, Phormia regina (Meigen), Phaenicia sericata (Meigen), Eucalliphora latifrons (Hough), Lucilia illustris (Meigen), and Calliphora vicina Robineau-Desvoidy, at several temperatures.

Wildlife forensic entomology: determining time of death in two illegally killed black bear cubs.

Forensic entomology is now commonly used to determine time of death in human death investigations. However, it can be equally applicable to wildlife crimes. This paper describes the use of entomology to determine time of death in the illegal killing of two young bear cubs in Manitoba, Canada. Two cubs were found shot, disemboweled, with their gall bladders removed. Natural Resource officers (Conservation Officers) and a Royal Canadian Mounted Police (R.C.M.P.) officer examined the remains, and the R.C.M.P. officer collected insect evidence. The only insects on the remains were adult blow flies coming to lay eggs and the blow fly eggs themselves (Diptera: Calliphoridae). The time of hatch was recorded and the insects were reared to adulthood. Time of hatch, together with species identification, macro and micro climate and lab developmental data were used to determine the time of death. The time was consistent with the time that the defendants were seen at the scene and was used in their conviction. This case illustrates that insect evidence can be equally as valuable in poaching cases as in homicide cases. However, in most cases Conservation Officers are unaware of this science. It is therefore, extremely important for more Conservation Officers to be educated about this field.

The use of insects to determine time of decapitation: a case-study from British Columbia.

A case is presented in which insects were used to determine time of decapitation. A severed human head was located on 28 June in a ditch on Vancouver Island, British Columbia, Canada. The victim had been missing since 17 June. Prepupal Calliphora vomitoria (L.) were found at the cut surface of the neck and no evidence of insect feeding was observed at any of the natural orifices; the eyes were intact. Meteorological and insect developmental data indicated that the insects had been oviposited on or before 20 June. The lack of feeding at the orifices, together with the evidence of feeding and presence of insects at the cut surface of the neck indicated that the eggs had been laid after decapitation. Therefore, decapitation had occurred on or before 20 June. This was consistent with later police evidence.