Background
: While in recent years epidemiological
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Tobias M. Glück and Ulrich S. Tran contributed equally to this work. They wrote the paper and conducted the statistical analysis, Brigitte ...Lueger-Schuster designed and supervised the project and contributed in writing and revising the paper.
studies on World War (WW) II-related traumatization and prevalence of posttraumatic stress disorder (PTSD) in elderly persons have been conducted for various European countries, for Austria, these numbers are unknown.
Objective
: The focus of this epidemiologic study was to picture the current mental health status and prevalence of PTSD and lifetime traumatic events in Austria's elderly with respect to WWII and subsequent occupation.
Method
: In an interdisciplinary approach of psychologists and historians, 316 elderly Austrians (born before 1946) were interviewed for symptoms of PTSD and lifetime traumatization (Traumatic Life Events Questionnaire, PTSD Checklist-Civilian Version), current mental health (Brief Symptom Inventory), wartime-related trauma, and traumatic experiences with occupational forces. These factors were also compared regarding the zone of occupation (Allied vs. Soviet). Data were collected between March and September 2010.
Results
: 97.5% of the sample reported at least one lifetime trauma. War-related traumata were reported by 92.7% and non-war-related traumata by 82.3%; 40.2% experienced traumatic events with occupational forces. PTSD was present in 1.9% of the sample and up to 13.9% taking subthreshold PTSD into account. Both, the presence of symptoms indicative of PTSD and subthreshold PTSD implied weaker current mental health (regarding General Distress: odds ratios up to 25.51; 95% CI = 9.82 to 66.27). Independent of PTSD diagnosis persons from the Soviet occupied zone showed higher levels of Interpersonal Sensitivity, Global Distress, and Phobic Anxiety. Prevalence of PTSD was independent of gender.
Conclusions
: Our results corroborate findings from other European countries that PTSD is a common disorder in the elderly due to WWII experience and that PTSD and trauma affect mental health even across long periods of time. Postwar distressing conditions also pose a further risk factor for symptomatology and distress in later years.
For the abstract or full text in other languages, please see Supplementary files under Reading Tools online
Wartime rape is an atrocity with long-lasting impacts not only on victims but whole societies. In this brief report, we present data on experience and witness of sexual violence during World War II ...(WWII) and subsequent time of occupation and on indicators of mental health in a sample of elderly Austrians.
Interviews of 298 elderly Austrians from a larger epidemiological study on WWII traumatization were analyzed for the impact of experience and witness of sexual violence during the wartime committed by occupational forces. Interviews comprised a biographical/historical section and psychological measures (BSI, TLEQ, PCL-C). Participants were recruited in all nine provinces of Austria with respect to former zones of occupation (Western Allied/Soviet).
Twelve persons reported direct experience of sexual violence, 33 persons witnessed such atrocities. One third of the victims and 18.2% of the witnesses reported post-traumatic stress disorder (PTSD full/subthreshold). Sexual violence occurred more often in the former Soviet zone. Victims and witnesses displayed higher odds of post-traumatic symptoms and symptoms of depression and phobic fear than non-victims. Furthermore, witnesses displayed higher levels of aggression compared to victims and non-witnesses.
Our results corroborate previous findings that wartime rape has long-lasting effects over decades on current mental health and post-traumatic distress in victims and witnesses. We recommend integration of psychotraumatological knowledge on consequences of sexual violence on mental health into geriatric care and the education of dedicated personnel.
Abstract The aim of this study was to explore the nature and dimensions of institutional child abuse (IA) by the Austrian Catholic Church and to investigate the current mental health of adult ...survivors. Data were collected in two steps. First, documents of 448 adult survivors of IA ( M = 55.1 years, 75.7% men) who had disclosed their abuse history to a victim protection commission were collected. Different types of abuse, perpetrator characteristics, and family related risk factors were investigated. Second, a sample of 185 adult survivors completed the Posttraumatic Stress Disorder Checklist (PCL-C) and the Brief Symptom Inventory (BSI). Participants reported an enormous diversity of acts of violent physical, sexual, and emotional abuse that had occurred in their childhood. The majority of adult survivors (83.3%) experienced emotional abuse. Rates of sexual (68.8%) and physical abuse (68.3%) were almost equally high. The prevalence of PTSD was 48.6% and 84.9% showed clinically relevant symptoms in at least one 1 of 10 symptom dimensions (9 BSI subscales and PTSD). No specific pre-IA influence was found to influence the development of PTSD in later life (e.g. poverty, domestic violence). However, survivors with PTSD reported a significantly higher total number of family related risk factors ( d = 0.33). We conclude that childhood IA includes a wide spectrum of violent acts, and has a massive negative impact on the current mental health of adult survivors. We address the long-term effects of these traumatic experiences in addition to trauma re-activation in adulthood as both bear great challenges for professionals working with survivors.
In recent years, reports of institutional abuse within the Catholic Church have emerged and research on the consequences on mental health is in its beginnings. In this study, we report findings on ...current mental health and resilience in a sample of adult survivors of institutional abuse (N = 185). We compared 3 groups of survivors that differed regarding their current mental health to investigate aspects of resilience, coping, and disclosure. The majority of the sample was male (76.2%), the mean age was 56.28 (SD = 9.46) years, and more than 50.0% of the sample was cohabiting/married. Most of the survivors reported severe mental health problems. Known protective factors (education, social support, age) were not associated with mental health in our sample. Our findings corroborate that institutional abuse has long‐term effects on mental health. We found that fewer emotional reactions during disclosure, task‐oriented coping, and optimism were associated with better mental health. The study was limited by a cross‐sectional design, but we conclude that the kind of institutional abuse reported is especially adverse, and thus typical protective factors for mental health do not apply. Future research should focus on intrapersonal factors and institutional dynamics to improve treatment for persons affected by institutional abuse.
Resumen
Spanish s by the Asociación Chilena de Estrés Traumático (ACET)
En los últimos años, los reportes de abuso institucional en la Iglesia Católica han emergido y la investigación de sus consecuencias en la Salud Mental se encuentra en sus comienzos. En este estudio reportamos hallazgos en la salud mental y resiliencia de una muestra de adultos sobrevivientes de abuso institucional (N = 185). Comparamos 3 grupos de sobrevivientes que diferían en su estado mental actual para investigar aspectos de resiliencia, afrontamiento y denuncia. La mayoría de la muestra fueron hombres (76.2%), con edad promedio de 56.3 años y más de 50.0% de la muestra era conviviente/casado. La mayoría de los sobrevivientes reportaron problemas mentales severos. Los factores protectores conocidos (educación, apoyo social, edad) no se asociaron a la salud mental en esta muestra. Nuestros hallazgos corroboran que el abuso institucional tiene efectos de larga duración en la salud mental. Encontramos que menores reacciones emocionales durante la denuncia, afrontamiento orientado a la tarea y optimismo se asociaron a una mejor salud mental. El estudio estuvo limitado por su diseño seccional cruzado, pero concluimos que la clase de abuso institucional aquí reportado es especialmente adverso, y por tanto, los factores protectores conocidos para salud mental no se aplican. Investigaciones futuras debieran enfocarse en los factores intrapersonales y la dinámica institucional para mejorar los tratamientos para personas afectadas de abuso institucional.
抽象
Traditional and Simplified Chinese s by AsianSTSS
標題：奧地利天主教會機構內童年受虐的成人倖存者精神健康的復原力因素。
撮要：近年不斷出現天主教會機構內虐待的報告，但精神健康結果研究尚在萌芽階段。本文報導一批機構內虐待的成人倖存者現存精神健康和復原力方面的發現(N=185)。現存精神健康情況分為三組，再對照其中復原力、應對和揭露各方面情形。樣本多為男性(76.2%)，平均56.3歲，而>50.0%為同居/已婚者。大多數人有嚴重精神問題。已知保護因素(教育水平，社交支援，年紀)未與精神健康相關。本研究發現證實機構內虐待對精神健康的深遠影響。較佳精神健康與揭露時較少情緒反應、任務導向的應對和樂觀有關係。 本研究受其橫斷面設計所限，但可總結為：機構內虐待特大傷害性，導致已知精神健康保護因素未能有效。未來研究應聚焦：自身因素和機構動態可否改進受機構內虐待人士的治療。
标题：奥地利天主教会机构内童年受虐的成人幸存者精神健康的复原力因素。
撮要：近年不断出现天主教会机构内虐待的报告，但精神健康结果研究尚在萌芽阶段。本文报导一批机构内虐待的成人幸存者现存精神健康和复原力方面的发现(N=185)。现存精神健康情况分为三组，再对照其中复原力、应对和揭露各方面情形。样本多为男性(76.2%)，平均56.3岁，而>50.0%为同居/已婚者。大多数人有严重精神问题。已知保护因素(教育水平，社交支持，年纪)未与精神健康相关。本研究发现证实机构内虐待对精神健康的深远影响。较佳精神健康与揭露时较少情绪反应、任务导向的应对和乐观有关系。 本研究受其横断面设计所限，但可总结为：机构内虐待特大伤害性，导致已知精神健康保护因素未能有效。未来研究应聚焦：自身因素和机构动态可否改进受机构内虐待人士的治疗。
Similar, but less pronounced effects were found for eicosapentaenoic acid and arachidonic acid (20:4n-6). Because the liver is the major source of endogenous HUFA, pseudocholinesterase activity, a ...marker of hepatic metabolizing capacity, was examined and shown to be inversely correlated with increased end-diastolic and end-systolic ventricular wall stress, which emphasizes the hypothesis of a cardio-hepatic syndrome (e.g., influenced by congestion). Because DHA exhibits antiarrhythmogenic actions, the question arises whether reduced atrial DHA levels account for an increased risk of atrial fibrillation.
Abstract Background In several trials, beneficial prognostic effects of highly unsaturated fatty acids (HUFAs) in heart failure were shown. Because other studies showed no incremental benefit in ...nearly preserved cardiac function, the question arises, whether the degree of cardiac dysfunction is involved. It is hypothesized that increased left ventricular (LV) wall stress affects the endogenous hepatic HUFA metabolism, which in turn exhibits adverse cardiac consequences. Methods Cardiac magnetic resonance imaging was performed in 30 patients with suspected cardiomyopathy. The serum fatty acid profile was assessed using gas chromatography/mass spectrometry. Results Docosahexaenoic acid (DHA; P = 0.002) and eicosapentaenoic acid (EPA; by trend) levels were decreased in patients with reduced LV ejection fraction (≤ 50%) or LV dilatation (≥ 90 mL/m2 ). Decreased DHA ( P = 0.003) and EPA ( P = 0.022) levels were associated with a reduced LV ejection fraction. Decreased DHA level was correlated with increased end-diastolic ( P = 0.047) and end-systolic LV wall stress ( P = 0.001). Pseudocholinesterase activity was inversely correlated with end-diastolic ( P = 0.020) and end-systolic LV wall stress ( P = 0.025). Conclusions DHA level was significantly reduced in heart failure. Similar, but less pronounced effects were found for EPA and arachidonic acid by trend. Increased LV wall stress was correlated with a reduced DHA level. Increased LV wall stress exhibits various adverse consequences (eg, increased oxygen consumption, favouring of arrhythmias, and an unfavourable remodelling). The increase of wall stress was paralleled by reduced HUFA level. Increased LV wall stress was correlated with reduced pseudocholinesterase, which is suggestive of hepatic congestion (ie, a cardiohepatic syndrome, involved in the altered fatty acid profile in heart failure) and has major consequences regarding the dose-efficacy of HUFA treatment.
The psychological sequelae of institutionalized abuse and its long-term consequences has not been systematically documented in existing literature in regarding social support once disclosure has been ...made. Reporting abuse is crucial, in particular for adult victims of childhood IA within the Catholic Church. Nevertheless, there is ongoing controversy about the benefits of disclosure. Our study examines the interaction of disclosure and subsequent social support in relation to mental health. We look into the times of disclosure, the behaviour during the disclosure to a commission as adults, different level of perceived social support, and the effect on mental health.
The data were collected in a sample of financially compensated adult survivors who experienced institutionalized abuse during their childhood, using instruments to measure perceived social support, reaction to disclosure, PTSD, and further symptoms.
High levels of perceived social support after early disclosure result in a higher level of mental health and contribute to less emotionally reactive behaviour during disclosure of past institutionalized abuse. Highly perceived levels of social support seem to play a crucial role in mental health, but this inference may be weakened by a possible interference of a lasting competence in looking for social support versus social influences.
Future research should thus disentangle perceived social support into the competence of looking for social support versus socially influenced factors to provide more clarity about the positive association of perceived social support and mental health.
Smart power switches are power switches with integrated control and protection functions for the switching of middle- and high-current loads. In particular in automotive applications, smart power ...switches have to be operated without additional stabilization networks, EMI filters, and heat sinks to keep the weight, required space and costs of the circuit boards as low as possible. Therefore, the generated electromagnetic emissions must be reduced by another measure without significantly increasing the switching losses. This can be achieved by the active control of the first and/or second derivative of the output voltage. This paper presents a digital slew rate control and its extension to an S-shape control strategy, which in addition to the slew rate, also controls the second derivative of the output voltage. Both strategies are based on feedforward gate current profiles, which are iteratively adapted by an iterative learning control strategy to compensate for load variations and temperature dependences. A rapid prototyping test bench is presented, and the performance and robustness of the control strategies are demonstrated by a series of measurement results. An EMC compliance test according to the CSIPR 25 standard shows that the generation of conducted electromagnetic emissions can be reduced in a power efficient way by the proposed approach.
Timely acquisition of 12-lead Electrocardiogram (ECG) in the emergency department (ED) is crucial and recommended by current guidelines.
To evaluate the association of medical history of coronary ...artery disease (hCAD) on door-to-ECG time in the ED.
In this single center, retrospective cohort study, patients admitted to ED for cardiac evaluation were grouped according to hCAD and no hCAD. The primary outcome was door-to-ECG time. A multivariate analysis adjusted for the cofounders sex, age, type of referral and shift was performed to evaluate the association of hCAD with door-to-ECG time.
1101 patients were included in this analysis. 362 patients (33%) had hCAD. Patients with hCAD had shorter door-to-ECG time (20 min. Inter Quartile Range IQR 13-30 vs. 22 min. IQR 14-37; p < 0.001) when compared to patients with no hCAD. In a multivariable regression analysis hCAD was significantly associated with a shorter door-to-ECG time (- 3 min p = 0.007; 95% confidence Interval CI - 5.16 to - 0.84 min).
In this single center registry, hCAD was associated with shorter door-to-ECG time. In patients presenting in ED for cardiac evaluation, timely ECG diagnostic should be facilitated irrespective of hCAD.
The first FDA-approved test to assess risk for acute kidney injury (AKI), TIMP-2•IGFBP7, is clinically available in many parts of the world, including the USA and Europe. We sought to understand how ...the test is currently being used clinically.
We invited a group of experts knowledgeable on the utility of this test for kidney injury to a panel discussion regarding the appropriate use of the test. Specifically, we wanted to identify which patients would be appropriate for testing, how the results are interpreted, and what actions would be taken based on the results of the test. We used a modified Delphi method to prioritize specific populations for testing and actions based on biomarker test results. No attempt was made to evaluate the evidence in support of various actions however.
Our results indicate that clinical experts have developed similar practice patterns for use of the TIMP-2•IGFBP7 test in Europe and North America. Patients undergoing major surgery (both cardiac and non-cardiac), those who were hemodynamically unstable, or those with sepsis appear to be priority patient populations for testing kidney stress. It was agreed that, in patients who tested positive, management of potentially nephrotoxic drugs and fluids would be a priority. Patients who tested negative may be candidates for "fast-track" protocols.
In the experience of our expert panel, biomarker testing has been a priority after major surgery, hemodynamic instability, or sepsis. Our panel members reported that a positive test prompts management of nephrotoxic drugs as well as fluids, while patients with negative results are considered to be excellent candidates for "fast-track" protocols.
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