Self-Reported Posttraumatic Stress and Borderline Personality Behaviors in Relation to Reports of Traumatic Events, Attachment, Parental Behavior, and Social Support

Borderline personality disorder (BPD) and posttraumatic stress disorder (PTSD) are conceptualized as different constructs in the DSM-IV, but research increasingly reveals an association among the symptoms of these disorders. Two relational models were examined: a Shared Risk Factor Model and a Continuum Model. In a sample of 603 college students, principle axis factoring of the Borderline Symptom List and PTSD Checklist showed minimal overlap in symptom presentation, partially supporting a Shared Risk Factor Model. Further support was established as regression analyses showed shared risk factors for reporting a greater number of BPD and PTSD behaviors, including experiencing at least one interpersonal traumatic event, a greater number of incidents of interpersonal trauma, and interpersonal trauma across more age periods (0--4, 5--8, etc.). Mediation analyses suggest only parental behavior mediated the relation between trauma characteristics and PTSD. However, there were multiple mediators of BPD and trauma characteristics, including parental rejection, attachment, and social support by the primary support

Relation of Interpersonal Conflict Behaviors to Emotion Dysregulation and PTSD in Adolescents with a History of Betrayal Trauma

Posttraumatic stress disorder (PTSD) is a disorder that develops in response to exposure to a traumatic stressor. Although this is the most well known diagnosis for individuals who have difficulties after a traumatic event, research documents numerous difficulties and psychopathology that can result from traumatic events, many of which do not fit the DSM-IV criteria of PTSD. Specifically, severe, chronic, interpersonal trauma tends to have a different pattern of effects on individuals than does acute, non-interpersonal trauma. This is particularly true for children (e.g., van der Kolk, Roth, Pelcovitz, Sunday, & Spinazzola, 2005). Because of this, the construct of Developmental Trauma Disorder (DTD) was introduced, although it is not currently recognized in the DSM 5. Emotion regulation skills and interpersonal dysfunction are two core components of this disorder. Trauma perpetrator (i.e., betrayal trauma) has also been found to be an important trauma characteristic when determining the clinical trajectory following traumatic experiences. The current study examined whether adolescents who have experienced betrayal trauma exhibit more negative communication behavior during a stressful interpersonal task, and report more emotion regulation deficits, than adolescents with non-betrayal trauma histories. The study also examined whether emotion regulation mediates the relation between betrayal trauma and negative communication. Finally, analyses were conducted to determine if PTSD or betrayal trauma best predicts negative communication behavior. Adolescents with a history of betrayal trauma reported more emotion regulation difficulties, and exhibited significantly more aggressive, negative non-aggressive, and fewer positive behaviors when engaged in a stressful interpersonal task with their mothers. Although PTSD symptom severity was related to experiencing a betrayal trauma, neither PTSD severity nor PTSD diagnosis predicted interpersonal difficulties as well as betrayal trauma history or emotion regulation difficulties. Finally, emotion regulation difficulties were found to mediate the relation between betrayal trauma and negative communication behavior. These results lend support for adding DTD to the next version of the DSM, illustrating that clinically significant problems related to trauma may not look PTSD-like.

Use of medical, surgical and complementary treatments among women with fibroids

OBJECTIVE: To examine the use of medical management, uterus-preserving surgery (UPS), and complementary treatments among women with uterine fibroids. STUDY DESIGN: Prospective cohort study of 933 premenopausal women ages 31-54 years with symptomatic fibroids who participated in the Study of Pelvic Problems, Hysterectomy, and Intervention Alternatives (SOPHIA) for an average of 4.3 years (SD 2.5 years). Incident use of fibroid treatments was determined through annual interviews. Linear regression models were used to compare changes in fibroid-related symptoms among women who underwent UPS versus those who did not undergo surgery. RESULTS: Participants were racially and ethnically diverse, with a mean age of 43 years. During study follow-up, 531 participants (57%) did not undergo UPS or hysterectomy, 250 (27%) had at least one UPS, and 152 (16%) underwent hysterectomy. Complementary and alternative treatments were commonly used, including exercise (45%), diet (34%), herbs (37%), and acupuncture (16%): participants reported significant symptom improvement and few side effects with these interventions. In multivariable linear regression models, women who did not undergo surgery during the study reported improvement in dyspareunia (p<.001), pelvic pain (p<.001), and menstrual cramps (p<.001). However, women who underwent UPS reported greater overall resolution of "pelvic problems" compared with women who did not have surgical treatment (difference in change score 1.18 on a four-point Likert scale, p<.001). CONCLUSION: UPS are effective treatments for women with fibroids, but many women use hormonal or complementary treatments and report significant symptom improvement without surgical intervention

Laparoscopic Radiofrequency Ablation of Uterine Leiomyomas: Clinical Outcomes during Early Adoption into Surgical Practice.

STUDY OBJECTIVE:To assess surgical outcomes, clinical effectiveness, and gynecologist experience of introducing laparoscopic radiofrequency ablation (RFA) of leiomyomas into surgical practice. DESIGN:Uncontrolled clinical trial. SETTING:Five academic medical centers across California. PATIENTS:Premenopausal women with symptomatic uterine leiomyomas, uterus size ≤16 weeks size, and all leiomyomas ≤10 cm with no more than 6 total leiomyomas. INTERVENTIONS:Laparoscopic RFA of leiomyomas. MEASUREMENTS AND MAIN RESULTS:We assessed intraoperative complications, blood loss, operative time, and adverse events. Gynecologists reported the operative difficulty and need for further training after each case. Participants reported leiomyoma symptoms preoperatively and at 6 and 12 weeks after surgery. We analyzed all outcome data from the first case performed by gynecologists with no previous RFA experience. Patient demand for RFA was high, but poor insurance authorization prevented 74% of eligible women from trial participation; 26 women underwent surgery and were enrolled. The mean age of the participants was 41.5 ± 4.9 years. The mean operating time was 153 ± 51 minutes, and mean estimated blood loss was 24 ± 40 cc. There were no intraoperative complications and no major adverse events. Menstrual bleeding, sexual function, and quality of life symptoms improved significantly from baseline to 12 weeks, with a 25 ± 18-point, or 47%, decrease in the Leiomyoma Symptom Severity Score. After the first procedure, the mean difficulty score was 6 (95% confidence interval [CI], 4-7.5) on a 10-point scale, and 89% of surgeons felt "very or somewhat" confident in performing laparoscopic RFA. The difficulty score decreased to 4.25 (95% CI, 1.2-6) after the fourth procedure, with all gynecologists reporting surgical confidence. CONCLUSION:Laparoscopic RFA of leiomyomas can be introduced into surgical practice with good clinical outcomes for patients. Gynecologists with no previous experience are able to gain confidence and skill with the procedure in fewer than 5 cases

Differential Use of Diagnostic Ultrasound in U.S. Emergency Departments by Time of Day

Background: Survey data over the last several decades suggests that emergency department (ED) access to diagnostic ultrasound performed by the radiology department is unreliable, particularly outside of regular business hours.Objective: To evaluate the association between the time of day of patient presentation and the use of diagnostic ultrasound services in United States (U.S.) EDs.Methods: This was a cross-sectional study of ED patient visits using the National Hospital Ambulatory Medical Care Survey for the years 2003 to 2005. Our main outcome measure was the use of diagnostic ultrasound during the ED patient visit as abstracted from the medical record. We performed multivariate analyses to identify any association between ultrasound use and time of presentation for all patients, as well as for two subgroups who are more likely to need ultrasound as part of their routine workup: patients at risk of deep venous thrombosis, and patients at risk for ectopic pregnancy.Results: During the three-year period, we analyzed 110,447 patient encounters, representing 39 million national visits. Of all ED visits, 2.6% received diagnostic ultrasound. Presenting to the ED “off hours” (defined as Monday through Friday 7pm to 7am and weekends) was associated with a lower rate of ultrasound use independent of potential confounders (odds ratio [OR] 0.73, 95% confidence interval [CI]: 0.65 - 0.82). Patients at increased risk of deep venous thrombosis who presented to the ED during “off hours” were also less likely to undergo diagnostic ultrasound (OR 0.34, 95% CI: 0.15 - 0.79). Similarly, patients at increased risk of ectopic pregnancy received fewer diagnostic ultrasounds during “off hours” (OR 0.56, 95% CI 0.35 - 0.91).Conclusion: In U.S. EDs, ultrasound use was lower during “off hours,” even among patient populations where its use would be strongly indicated. [West J Emerg Med. 2011;12(1):90-95.

Integrated Climate-Change Assessment Scenarios and Carbon Dioxide Removal

To halt climate change this century, we must reduce carbon dioxide (CO2) emissions from human activities to net zero. Any emission sources, such as in the energy or land-use sectors, must be balanced by natural or technological carbon sinks that facilitate CO2 removal (CDR) from the atmosphere. Projections of demand for large-scale CDR are based on an integrated scenario framework for emission scenarios composed of emission profiles as well as alternative socio-economic development trends and social values consistent with them. The framework, however, was developed years before systematic reviews of CDR entered the literature. This primer provides an overview of the purposes of scenarios in climate-change research and how they are used. It also introduces the integrated scenario framework and why it came about. CDR studies using the scenario framework, as well as its limitations, are discussed. Possible future developments for the scenario framework are highlighted, especially in relation to CDR

Bone mineral density in patients with hepatic glycogen storage diseases

The association between bone mineral density (BMD) and hepatic glycogen storage diseases (GSDs) is still unclear. To evaluate the BMD of patients with GSD I, IIIa and IXα, a cross-sectional study was performed, including 23 patients (GSD Ia = 13, Ib = 5, IIIa = 2 and IXα = 3; median age = 11.9 years; IQ = 10.9–20.1) who underwent a dual-energy X-ray absorptiometry (DXA). Osteocalcin (OC, n = 18), procollagen type 1 N-terminal propeptide (P1NP, n = 19), collagen type 1 C-terminal telopeptide (CTX, n = 18) and 25-OH Vitamin D (n = 23) were also measured. The participants completed a 3-day food diary (n = 20). Low BMD was defined as a Z-score ≤ −2.0. All participants were receiving uncooked cornstarch (median dosage = 6.3 g/kg/day) at inclusion, and 11 (47.8%) presented good metabolic control. Three (13%) patients (GSD Ia = 1, with poor metabolic control; IIIa = 2, both with high CPK levels) had a BMD ≤ −2.0. CTX, OC and P1NP correlated negatively with body weight and age. 25-OH Vitamin D concentration was decreased in seven (30.4%) patients. Our data suggest that patients with hepatic GSDs may have low BMD, especially in the presence of muscular involvement and poor metabolic control. Systematic nutritional monitoring of these patients is essential

Aerobic exercise improves sleep in U. S. active duty service members following brief treatment for posttraumatic stress disorder symptoms

IntroductionPhysical exercise is a lifestyle intervention that can positively impact aspects of physical and psychological health. There is a growing body of evidence suggesting that physical exercise, sleep, and PTSD are interrelated. This study investigated possible relationships. Three research questions were posed: (1) Did randomization to an aerobic exercise intervention reduce insomnia more than being randomized to an intervention without exercise, (2) Did change in sleep predict change in PTSD symptoms, and (3) Did change in sleep impact the relationship between exercise and PTSD symptom reductions?MethodsData were collected from 69 treatment-seeking active duty service members with PTSD symptoms randomized into one of four conditions; two conditions included aerobic exercise, and two conditions did not include exercise. Participants in the exercise groups exercised five times per week keeping their heart rate &gt; 60% of their heart rate reserve for 20–25 min.ResultsAt baseline, 58% of participants reported moderate or severe insomnia. PTSD symptom severity decreased following treatment for all groups (p &lt; 0.001). Participants randomized to exercise reported greater reductions in insomnia compared to those in the no exercise group (p = 0.47). However, change in insomnia did not predict change in PTSD symptoms nor did it significantly impact the relationship between exercise and PTSD symptom reductions.DiscussionAdding exercise to evidence-based treatments for PTSD could reduce sleep disturbance, a characteristic of PTSD not directly addressed with behavioral therapies. A better understanding of exercise as a lifestyle intervention that can reduce PTSD symptoms and insomnia is warranted