Resilience factors in PTSD

Only a relatively small percentage of the people exposed to traumatic events develop PTSD. While much research has focused on the etiology of the disorder and on risk factors, possible resilience factors in post-traumatic adjustment have been studied considerably less extensively. The field of psychology provides several constructs and theoretical paradigms that may aid in the understanding of resilience. Hardiness, dispositional optimism, locus of control, social support and coping for instance, are all concepts that may readily be applied to the study of buffering or resilience factors in PTSD. To establish how these factors relate to post traumatic stress symptoms multiple regression analyses were performed on test files of 126 Dutch veterans and soldiers. Preliminary results show that neither hardiness nor optimism significantly predicted number and intensity of PTSD symptoms. Levels of social support explained a significant proportion of variance in symptoms as did locus of control. Higher levels of avoidant and emotional coping strategies predicted PTSD symptoms. These results show that coping strategies and resources are important resilience factors. Further analyses, to be performed on a larger data set, will be presented

Velocity-space sensitivity of the time-of-flight neutron spectrometer at JET

The velocity-space sensitivities of fast-ion diagnostics are often described by so-called weight functions. Recently, we formulated weight functions showing the velocity-space sensitivity of the often dominant beam-target part of neutron energy spectra. These weight functions for neutron emission spectrometry (NES) are independent of the particular NES diagnostic. Here we apply these NES weight functions to the time-of-flight spectrometer TOFOR at JET. By taking the instrumental response function of TOFOR into account, we calculate time-of-flight NES weight functions that enable us to directly determine the velocity-space sensitivity of a given part of a measured time-of-flight spectrum from TOFOR

Relationship of edge localized mode burst times with divertor flux loop signal phase in JET

A phase relationship is identified between sequential edge localized modes (ELMs) occurrence times in a set of H-mode tokamak plasmas to the voltage measured in full flux azimuthal loops in the divertor region. We focus on plasmas in the Joint European Torus where a steady H-mode is sustained over several seconds, during which ELMs are observed in the Be II emission at the divertor. The ELMs analysed arise from intrinsic ELMing, in that there is no deliberate intent to control the ELMing process by external means. We use ELM timings derived from the Be II signal to perform direct time domain analysis of the full flux loop VLD2 and VLD3 signals, which provide a high cadence global measurement proportional to the voltage induced by changes in poloidal magnetic flux. Specifically, we examine how the time interval between pairs of successive ELMs is linked to the time-evolving phase of the full flux loop signals. Each ELM produces a clear early pulse in the full flux loop signals, whose peak time is used to condition our analysis. The arrival time of the following ELM, relative to this pulse, is found to fall into one of two categories: (i) prompt ELMs, which are directly paced by the initial response seen in the flux loop signals; and (ii) all other ELMs, which occur after the initial response of the full flux loop signals has decayed in amplitude. The times at which ELMs in category (ii) occur, relative to the first ELM of the pair, are clustered at times when the instantaneous phase of the full flux loop signal is close to its value at the time of the first ELM

SUGAR-DIP trial: Oral medication strategy versus insulin for diabetes in pregnancy, study protocol for a multicentre, open-label, non-inferiority, randomised controlled trial

INTRODUCTION: In women with gestational diabetes mellitus (GDM) requiring pharmacotherapy, insulin was the established first-line treatment. More recently, oral glucose lowering drugs (OGLDs) have gained popularity as a patient-friendly, less expensive and safe alternative. Monotherapy with metformin or glibenclamide (glyburide) is incorporated in several international guidelines. In women who do not reach sufficient glucose control with OGLD monotherapy, usually insulin is added, either with or without continuation of OGLDs. No reliable data from clinical trials, however, are available on the effectiveness of a treatment strategy using all three agents, metformin, glibenclamide and insulin, in a stepwise approach, compared with insulin-only therapy for improving pregnancy outcomes. In this trial, we aim to assess the clinical effectiveness, cost-effectiveness and patient experience of a stepwise combined OGLD treatment protocol, compared with conventional insulin-based therapy for GDM. METHODS: The SUGAR-DIP trial is an open-label, multicentre randomised controlled non-inferiority trial. Participants are women with GDM who do not reach target glycaemic control with modification of diet, between 16 and 34 weeks of gestation. Participants will be randomised to either treatment with OGLDs, starting with metformin and supplemented as needed with glibenclamide, or randomised to treatment with insulin. In women who do not reach target glycaemic control with combined metformin and glibenclamide, glibenclamide will be substituted with insulin, while continuing metformin. The primary outcome will be the incidence of large-for-gestational-age infants (birth weight >90th percentile). Secondary outcome measures are maternal diabetes-related endpoints, obstetric complications, neonatal complications and cost-effectiveness analysis. Outcomes will be analysed according to the intention-to-treat principle. ETHICS AND DISSEMINATION: The study protocol was approved by the Ethics Committee of the Utrecht University Medical Centre. Approval by the boards of management for all participating hospitals will be obtained. Trial results will be submitted for publication in peer-reviewed journals. TRIAL REGISTRATION NUMBER: NTR6134; Pre-results

SUGAR-DIP trial: Oral medication strategy versus insulin for diabetes in pregnancy, study protocol for a multicentre, open-label, non-inferiority, randomised controlled trial

Introduction In women with gestational diabetes mellitus (GDM) requiring pharmacotherapy, insulin was the established first-line treatment. More recently, oral glucose lowering drugs (OGLDs) have gained popularity as a patient-friendly, less expensive and safe alternative. Monotherapy with metformin or glibenclamide (glyburide) is incorporated in several international guidelines. In women who do not reach sufficient glucose control with OGLD monotherapy, usually insulin is added, either with or without continuation of OGLDs. No reliable data from clinical trials, however, are available on the effectiveness of a treatment strategy using all three agents, metformin, glibenclamide and insulin, in a stepwise approach, compared with insulin-only therapy for improving pregnancy outcomes. In this trial, we aim to assess the clinical effectiveness, cost-effectiveness and patient experience of a stepwise combined OGLD treatment protocol, compared with conventional insulin-based therapy for GDM. Methods The SUGAR-DIP trial is an open-label, multicentre randomised controlled non-inferiority trial. Participants are women with GDM who do not reach target glycaemic control with modification of diet, between 16 and 34 weeks of gestation. Participants will be randomised to either treatment with OGLDs, starting with metformin and supplemented as needed with glibenclamide, or randomised to treatment with insulin. In women who do not reach target glycaemic control with combined metformin and glibenclamide, glibenclamide will be substituted with insulin, while continuing metformin. The primary outcome will be the incidence of large-for-gestational-age infants (birth weight >90th percentile). Secondary outcome measures are maternal diabetes-related endpoints, obstetric complications, neonatal complications and cost-effectiveness analysis. Outcomes will be analysed according to the intention-to-treat principle. Ethics and dissemination The study protocol was approved by the Ethics Committee of the Utrecht University Medical Centre. Approval by the boards of management for all participating hospitals will be obtained. Trial results will be submitted for publication in peer-reviewed journals

Personality and Adaptation to Military Trauma

The goal of this dissertation is to increase understanding of individual differences in vulnerability for and resilience to trauma in military personnel. Specifically, the studies in this dissertation examined clinical symptoms and personality profiles of Dutch peacekeepers and sought to elucidate how personality may moderate risk and resilience to posttraumatic stress disorder (PTSD) in soldiers and veterans. Personality affects the development of trauma-related psychopathology at different stages. It may play a role in the development of PTSD by affecting the risk of exposure to trauma and / or by influencing the individual’s potential to effectively deal with stress and trauma. Although the cross-sectional studies in this dissertation foreclose inferences on causality, we demonstrated that healthy soldiers who report more childhood trauma display personality traits that were previously associated with interpersonal problems and mental disorders. Furthermore, the data demonstrated that personality may affect coping resources and behaviour. Hardiness facilitates coping by increasing social support and the use of problem oriented coping behaviour whereas increased neuroticism has opposite effects. Personality may also affect the course of PTSD: personality traits neuroticism and optimism are directly related (in opposite directions) to concurrent symptom severity. Personality vulnerability and resilience factors are closely related. The absence of the former can imply the presence of the latter. However, in some instances it is difficult to disentangle risks from resilience. This dissertation demonstrated that the personality trait of neuroticism is closely (inversely) related to optimism and hardiness, and that both adaptive and maladaptive personality traits can be related to similar underlying biological systems. That is, both harm avoidance and self-directedness are related to hypothalamic-pituitary-adrenal (HPA) axis functioning as measured by the increase in salivary cortisol after awakening. Finally, the need for effective prevention and treatment programs for stress-related disorders in peacekeeping veterans is illustrated by two studies that showed that Dutch veterans with (chronic) PTSD symptoms report diffuse psychiatric symptoms and personality problems, not too dissimilar from what was previously observed in Vietnam veterans, and that their symptoms are difficult to treat. In conclusion, this dissertation demonstrates that personality is an important determinant of post-traumatic morbidity and functioning. Therefore, personality assessment can aid in improving screening programs and may prove useful to optimize military training and treatment programs. However, a number of issues need to be resolved before personality psychology can fulfil its full potential. These include addressing the need for more sophisticated and ‘fine-grained’ assessment procedures on the one hand, and providing more insight into the dynamic relationship between trauma and personality on the other

Prevalence of mental health symptoms in Dutch military personnel returning from deployment to Afghanistan: A 2-year longitudinal analysis

Stress-related psychiatric disorders across the life spa

Course and Predictors of Postdeployment Fatigue: A Prospective Cohort Study in the Dutch Armed Forces

Stress-related psychiatric disorders across the life spa