Post-traumatic stress disorder (PTSD) is prevalent in military personnel and first responders, many of whom do not respond to currently available treatments. This study aimed to assess the efficacy ...and safety of 3,4-methylenedioxymethamphetamine (MDMA)-assisted psychotherapy for treating chronic PTSD in this population.
We did a randomised, double-blind, dose-response, phase 2 trial at an outpatient psychiatric clinic in the USA. We included service personnel who were 18 years or older, with chronic PTSD duration of 6 months or more, and who had a Clinician-Administered PTSD Scale (CAPS-IV) total score of 50 or greater. Using a web-based randomisation system, we randomly assigned participants (1:1:2) to three different dose groups of MDMA plus psychotherapy: 30 mg (active control), 75 mg, or 125 mg. We masked investigators, independent outcome raters, and participants until after the primary endpoint. MDMA was administered orally in two 8-h sessions with concomitant manualised psychotherapy. The primary outcome was mean change in CAPS-IV total score from baseline to 1 month after the second experimental session. Participants in the 30 mg and 75 mg groups subsequently underwent three 100-125 mg MDMA-assisted psychotherapy sessions in an open-label crossover, and all participants were assessed 12 months after the last MDMA session. Safety was monitored through adverse events, spontaneously reported expected reactions, vital signs, and suicidal ideation and behaviour. This study is registered with ClinicalTrials.gov, number NCT01211405.
Between Nov 10, 2010, and Jan 29, 2015, 26 veterans and first responders met eligibility criteria and were randomly assigned to receive 30 mg (n=7), 75 mg (n=7), or 125 mg (n=12) of MDMA plus psychotherapy. At the primary endpoint, the 75 mg and 125 mg groups had significantly greater decreases in PTSD symptom severity (mean change CAPS-IV total scores of -58·3 SD 9·8 and -44·3 28·7; p=0·001) than the 30 mg group (-11·4 12·7). Compared with the 30 mg group, Cohen's d effect sizes were large: 2·8 (95% CI 1·19-4·39) for the 75 mg group and 1·1 (0·04-2·08) for the 125 mg group. In the open-label crossover with full-dose MDMA (100-125 mg), PTSD symptom severity significantly decreased in the group that had previously received 30 mg (p=0·01), whereas no further significant decreases were observed in the group that previously achieved a large response after 75 mg doses in the blinded segment (p=0·81). PTSD symptoms were significantly reduced at the 12-month follow-up compared with baseline after all groups had full-dose MDMA (mean CAPS-IV total score of 38·8 SD 28·1 vs 87·1 16·1; p<0·0001). 85 adverse events were reported by 20 participants. Of these adverse events, four (5%) were serious: three were deemed unrelated and one possibly related to study drug treatment.
Active doses (75 mg and 125 mg) of MDMA with adjunctive psychotherapy in a controlled setting were effective and well tolerated in reducing PTSD symptoms in veterans and first responders.
Multidisciplinary Association for Psychedelic Studies.
The full U.S. Court of Appeals for the Eleventh Circuit issued its long-awaited ruling in Wollschlaeger V. Governor, State of Florida, in validating parts of Florida's Firearm Owner's Privacy Act ...(FOPA) and affirming that the First Amendment applies to the speech between physicians and patients.The majority of U.S adults who live in homes with guns are unaware of the heightened risk posed by bringing guns into a home.In recognizing the central role that the medical profession can play in reducing firearm injuries, the full court's ruling highlights the opportunity that physicians have to reduce firearm violence.
Girls fire and resilience program Bronnie Mackintosh
Australian journal of emergency management,
01/2022, Letnik:
37, Številka:
1
Journal Article
Recenzirano
Girls on Fire is an Australian incorporated association that provides firefighting and resilience programs for girls and young women. It expanded its fire programs format to encompass the need for ...greater community resilience.
Girls fire and resilience program Bronnie Mackintosh
Australian journal of emergency management,
01/2022, Letnik:
37, Številka:
1
Journal Article
Recenzirano
Girls on Fire is an Australian incorporated association that provides firefighting and resilience programs for girls and young women. It expanded its fire programs format to encompass the need for ...greater community resilience.
Purpose
We sought to estimate the pooled current prevalence of posttraumatic stress disorder (PTSD) among rescue workers and to determine the variables implicated in the heterogeneity observed among ...the prevalences of individual studies.
Methods
A systematic review covering studies reporting on the PTSD prevalence in rescue teams was conducted following four sequential steps: (1) research in specialized online databases, (2) review of abstracts and selection of studies, (3) review of reference list, and (4) contact with authors and experts. Prevalence data from all studies were pooled using random effects model. Multivariate meta-regression models were fitted to identify variables related to the prevalences heterogeneity.
Results
A total of 28 studies, reporting on 40 samples with 20,424 rescuers, were selected. The worldwide pooled current prevalence was 10%. Meta-regression modeling in studies carried out in the Asian continent had, on average, higher estimated prevalences than those from Europe, but not higher than the North American estimates. Studies of ambulance personnel also showed higher estimated PTSD prevalence than studies with firefighters and police officers.
Conclusions
Rescue workers in general have a pooled current prevalence of PTSD that is much higher than that of the general population. Ambulance personnel and rescuers from Asia may be more susceptible to PTSD. These results indicate the need for improving pre-employment strategies to select the most resilient individuals for rescue work, to implement continuous preventive measures for personnel, and to promote educational campaigns about PTSD and its therapeutic possibilities.
Wildfire is one of the most significant dangers and the most serious natural catastrophe, endangering forest resources, animal life, and the human economy. Recent years have witnessed a rise in ...wildfire incidents. The two main factors are persistent human interference with the natural environment and global warming. Early detection of fire ignition from initial smoke can help firefighters react to such blazes before they become difficult to handle. Previous deep-learning approaches for wildfire smoke detection have been hampered by small or untrustworthy datasets, making it challenging to extrapolate the performances to real-world scenarios. In this study, we propose an early wildfire smoke detection system using unmanned aerial vehicle (UAV) images based on an improved YOLOv5. First, we curated a 6000-wildfire image dataset using existing UAV images. Second, we optimized the anchor box clustering using the K-mean++ technique to reduce classification errors. Then, we improved the network's backbone using a spatial pyramid pooling fast-plus layer to concentrate small-sized wildfire smoke regions. Third, a bidirectional feature pyramid network was applied to obtain a more accessible and faster multi-scale feature fusion. Finally, network pruning and transfer learning approaches were implemented to refine the network architecture and detection speed, and correctly identify small-scale wildfire smoke areas. The experimental results proved that the proposed method achieved an average precision of 73.6% and outperformed other one- and two-stage object detectors on a custom image dataset.
Background
The purpose of this study was to explore the core and driving symptoms of posttraumatic stress disorder (PTSD) of firefighters before and after rescue. Identifying core symptoms of PTSD ...can help clinicians to understand what may be relevant targets for treatment.
Methods
The study recruited 334 firefighters in a firefighter military school in September 2017 (T1). They were followed up 3 months later (T2), during which time they participated in real rescue activities. The network structure of DSM‐5 PTSD was using regularized partial correlation models and a Bayesian approach computing directed acyclic graphs.
Results
The most central symptom both in T1 and T2 was negative emotional state. Irritable or anger emerged as a key driver of other symptoms in traumatized firefighters.
Conclusions
Negative emotional state and irritable or anger might represent important symptoms within PTSD symptomatology and may offer key targets in PTSD treatment for firefighters.
Posttraumatic stress disorder (PTSD) may develop after exposure to an event in which death, severe physical harm, or violence occurred or was threatened. First responders, including police, fire ...rescue personnel, and emergency dispatchers, have been viewed as populations at high risk for developing PTSD symptoms. Indeed, over 80% of first responders report experiencing traumatic events on the job, and it is estimated that 10–15% have been diagnosed with PTSD. However, to date, limited research has reviewed the impact and services available following these traumatic events across first responders. This review examines research regarding PTSD in police officers, firefighters, and emergency dispatchers with particular attention to the prevalence, comorbid diagnoses, risk and protective factors, and resources available to each group. A discussion of limitations of the available research in this area, and suggestions for directions that future work might take, are offered.
Objective: Firefighters experience heightened rates of posttraumatic stress disorder (PTSD) symptoms compared to the general population. Nascent literature has identified distress overtolerance (DO; ...i.e., the tendency to persist through extremely high levels of distress despite harmful consequences) as a construct of potential relevance to PTSD symptomatology, though empirical research is lacking. The present study examined incremental associations between DO subscales (Capacity for Harm: persevering through distress despite its effect on 1's wellbeing; Fear of Negative Evaluation: persisting through distress due to a fear of being negatively evaluated by others should they quit) and PTSD symptom severity and symptom cluster severity (i.e., intrusion, avoidance, negative alterations in cognitions and mood NACM, arousal and reactivity) among firefighters. Method: Participants included 282 trauma-exposed firefighters (91.8% male, Mage = 40.4, SD = 9.6). Covariates included years in the fire service, trauma load (i.e., number of trauma exposure types), and negative affect. Results: Results indicated that Capacity for Harm was a significant incremental correlate of total PTSD symptom severity (ΔR2 = .045, p = .004), NACM symptoms (ΔR2 = .061, p < .001), and arousal/reactivity symptoms (ΔR2 = .047, p = .005). Fear of Negative Evaluation was not significantly related to any criterion variables. Conclusion: Further work examining DO-PTSD relations is necessary to inform intervention and policy for the fire service.
Clinical Impact Statement
Results indicate that PTSD-specific interventions for firefighters may be improved upon by addressing the role of DO, specifically one's Capacity for Harm.
The fire and emergency services is a particularly large industry - in Australia alone it employs 250,000 personnel - yet there is very little by way of published human factors books addressing this ...sector directly. This book provides an overview of state-of-the-art research that has been conducted within Australia, funded by the Bushfire Cooperative Research Centre. As Karl Weick once commented, emergency events do not 'play by the rules' and these research chapters tell us something about a potential future world of work that is highly dynamic, interdependent and for which improvisation and critical thinking and problem-solving are necessary pre-requisites.
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