A pilot survey of post-deployment health care needs in small community-based primary care clinics

<p>Abstract</p> <p>Background</p> <p>Relatively little is known regarding to what extent community-based primary care physicians are encountering post-deployment health care needs among veterans of the Afghanistan or Iraq conflicts and their family members.</p> <p>Methods</p> <p>This pilot study conducted a cross-sectional survey of 37 primary care physicians working at small urban and suburban clinics belonging to a practice-based research network in the south central region of Texas.</p> <p>Results</p> <p>Approximately 80% of the responding physicians reported caring for patients who have been deployed to the Afghanistan or Iraq war zones, or had a family member deployed. Although these physicians noted a variety of conditions related to physical trauma, mental illnesses and psychosocial disruptions such as marital, family, financial, and legal problems appeared to be even more prevalent among their previously deployed patients and were also noted among family members of deployed veterans.</p> <p>Conclusions</p> <p>Community-based primary care physicians should be aware of common post-deployment health conditions and the resources that are available to meet these needs.</p

Addressing the needs of children with disabilities experiencing disaster or terrorism

Purpose of review: This paper reviews the empirical literature on psychosocial factors relating to children with disabilities in the context of disaster or terrorism. Recent findings: Research indicates individuals with disabilities experience increased exposure to hazards due to existing social disparities and barriers associated with disability status. However, studies on the psychological effects of disaster/terrorism on children with preexisting disabilities are exceedingly few and empirical evidence of the effectiveness of trauma-focused therapies for this population is limited. Secondary adversities, including social stigma and health concerns, also compromise the recovery of these children post-disaster/terrorism. Schools and teachers appear to be particularly important in the recovery of children with disabilities to disaster. Disasters, terrorism, and war all contribute to the incidence of disability, as well as disproportionately affect children with preexisting disabilities. Summary: Disaster preparedness interventions and societal changes are needed to decrease the disproportionate environmental and social vulnerability of children with disabilities to disaster and terrorism

International meta-analysis of PTSD genome-wide association studies identifies sex- and ancestry-specific genetic risk loci

The risk of posttraumatic stress disorder (PTSD) following trauma is heritable, but robust common variants have yet to be identified. In a multi-ethnic cohort including over 30,000 PTSD cases and 170,000 controls we conduct a genome-wide association study of PTSD. We demonstrate SNP-based heritability estimates of 5–20%, varying by sex. Three genome-wide significant loci are identified, 2 in European and 1 in African-ancestry analyses. Analyses stratified by sex implicate 3 additional loci in men. Along with other novel genes and non-coding RNAs, a Parkinson’s disease gene involved in dopamine regulation, PARK2, is associated with PTSD. Finally, we demonstrate that polygenic risk for PTSD is significantly predictive of re-experiencing symptoms in the Million Veteran Program dataset, although specific loci did not replicate. These results demonstrate the role of genetic variation in the biology of risk for PTSD and highlight the necessity of conducting sex-stratified analyses and expanding GWAS beyond European ancestry populations. © 2019, This is a U.S. government work and not under copyright protection in the U.S.; foreign copyright protection may apply

Adverse Childhood Experiences and Use of Cigarettes and Smokeless Tobacco Products

Adverse childhood experiences (ACEs) have been linked to increased use of tobacco products&nbsp;later in life. However, studies to date&nbsp;have ignored smokeless tobacco products. To address this, data from the 2011 Behavioral Risk Factor Surveillance System, which interviewed adults 18&nbsp;years and over (N&nbsp;=&nbsp;102,716) were analyzed. Logistic regression models were fit to estimate odds ratios&nbsp;of ever smoking, current smoking and current smokeless tobacco use in relation to ACEs. Results showed that less than 4&nbsp;% of respondents currently used smokeless tobacco products, while 44.95 and 18.57&nbsp;% reported ever and current smoking, respectively. Physical abuse (OR 1.40; 95&nbsp;% CI 1.14, 1.72), emotional abuse (OR 1.41; 95&nbsp;% CI 1.19, 1.67), sexual abuse (OR 0.70; 95&nbsp;% CI 0.51, 0.95), living with a drug user (OR 1.50; 95&nbsp;% CI 1.17, 1.93), living with someone who was jailed (OR 1.50; 95&nbsp;% CI 1.11, 2.02) and having parents who were separated or divorced (OR 1.31; 95&nbsp;% CI 1.09, 1.57) were associated with smokeless tobacco use in unadjusted models. After accounting for confounders, physical abuse (OR 1.43; 95&nbsp;% CI 1.16, 1.78), emotional abuse (OR 1.32; 95&nbsp;% CI 1.10, 1.57), living with a problem drinker (OR 1.30; 95&nbsp;% CI 1.08, 1.58), living with a drug user (OR 1.31; 95&nbsp;% CI 1.00, 1.72) and living with adults who treated each other violently (OR 1.30; 95&nbsp;% CI 1.05, 1.62) were associated with smokeless tobacco use. Living with someone who was mentally ill (OR 0.70; 95&nbsp;% CI 0.53, 0.92) was associated with smokeless tobacco use after accounting for confounders and all ACEs. Results indicated that some childhood adversities are associated with use of smokeless tobacco products. Special attention is needed to prevent tobacco use&nbsp;of different types among those experiencing ACEs