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This paper provides a critical analysis of the International Nuclear and Radiological Event Scale (INES) and its use, both from an epistemic and an ethical perspective. As very few papers have been dedicated to this subject, our critical analysis is mainly based on the INES 2009 User's Manual and on technical information issued by different nuclear agencies. Our critical analysis leads to suggest several elements, which could contribute to the improvement of the INES scale and thereby to a better communication about nuclear events. First, we show that multiple criteria are used to assign an INES rating, which could lead to an insufficient differentiation between events. In order to avoid this issue, we suggest to clarify the criteria that are used to assess the level of the event. Then, we show that level 7 of the INES scale is ill-defined as it does not allow to properly take differences in severity between disasters into account. In this regard, we recommend to use an open scale instead. Moreover, we highlight the fact that INES is able to take into account neither events with long-term evolution nor events involving multiple initiators. In this respect, we suggest providing additional guidelines and reflecting about the data on which to rely, in order to assess an INES level. Furthermore, we reflect on who should be rating a nuclear event and we recommend that, for severe events, an independent and plural agency should be in charge. Finally, we show why INES appears to be insufficient for a global communication, and we suggest to complement the INES rating with additional information in parallel.

O artigo tem por objetivo rastrear sintomatologia de transtorno de estresse pós-traumático (TEPT) em profissionais que prestaram ajuda humanitária à população haitiana, após o terremoto de 2010. Estudo transversal. A sintomatologia de TEPT foi avaliada pela Escala Impacto do Evento - Revisada (IES-R). Os participantes foram 32 brasileiros (idade m = 37.58 +/- 7.01), 22 estadosunidenses (idade m = 33.67 +/- 8.03) e 12 equatorianos (idade m = 44.80 +/- 15.88) e não apresentaram sintomatologia de TEPT. A relação entre as variáveis experiência prévia em situação de desastre e escore total da IES-R [F(2) = 4.34, p = 0.017] bem como experiência prévia em situação de desastre e subescala intrusão [F(2) = 3.94, p = 0.024] foram significantes nos modelos de regressão linear. Experiência prévia se mostrou preditor significante para escore total da IES-R (p < 0,05). Os resultados demonstraram que vivências atuais podem ser potencializadas pelas memórias de experiências anteriores, aumentando a probabilidade de desenvolvimento de TEPT. Portanto, o cuidado com a saúde mental dos profissionais deve favorecer a precoce identificação do fator de risco experiência prévia, não permitindo que a iniciativa voluntária se sobreponha aos critérios seletivos e aos cuidados específicos. The scope of this article is to screen the symptoms of Post-Traumatic Stress Disorder (PTSD) among the professionals who provided humanitarian aid for the Haitian population after the 2010 earthquake. It involvess a cross-sectional study. The Impact of Event Scale - Revised (IES-R) was used for screening symptoms of PTSD. The participants included 32 Brazilians (mean age = 37.58 +/-7.01), 22 Americans (mean age =33.67 +/-8.03) and 12 Ecuadorians (mean age = 44.80 +/- 15.88). The professionals did not have PTSD symptoms. The relationship between prior experience variables in disaster situations and the total score of the IES-R (F (2) = 4.34, p = 0.017), as well as prior experience in disaster situations and the intrusion subscale (F (2) = 3.94, p = 0.024) were significant in linear regression models. The number of prior experiences was revealed as a significant predictor for the total score of IES (p < 0.05). The results showed that current experiences can be exacerbated by memories of prior experiences, increasing the likelihood of developing PTSD. Therefore the mental health care of the professionals should foster the early identification of prior experience risk factors, thereby not permitting voluntary initiative to transcend selective criteria and specific care.

This study investigated the effect of bereavement (father death due to war in Afghanistan) on autobiographical memory specificity in Afghan adolescents living in Iran. Participants consisted of bereaved (n=70) and non-bereaved (n=33) Afghan adolescents. The measures included Farsi versions of the Autobiographical Memory Test, Mood and Feeling Questionnaire, Revised Children's Manifest Anxiety Scale, and Impact of Event Scale. Results indicated that the bereaved group retrieved a significantly lower proportion of specific memories and a significantly greater proportion of extended and categoric memories than the non-bereaved group. Additionally, depression symptoms and reduced autobiographical memory specificity were significantly correlated. These findings suggest that bereaved adolescents have impaired autobiographical memory specificity.

Self-reported measurements of attentional bias are possibly influenced by social desirability, conscious awareness, or introspection. This study developed a visual dot-probe task to study the relationship between attentional bias and posttraumatic stress disorder among women with breast cancer. Fifty six women with breast cancer were presented with a series of face pairs, which were equally divided into positive-neutral and negative-neutral pairs. One face pair was shown for each trial, which consisted of the neutral and emotional versions of the same face displaying side-toside. Participants’ goal was to detect a small dot displayed on the screen after disappearance of the faces as quickly as possible in 80 trials. Negative/positive attentional bias was the mean latency to detect probes appearing on the side of neutral faces minus that of negative/positive faces. We investigated the relationships between the dot-probe task and the Chinese Impact of Event Scale (CIES-R) and demographic variables. Negative attentional bias as measured by the dot-probe task was positively correlated with the CIES-R total score ( r = 0.30, p< 0.05), the hyperarousal subscale (r = 0.32, p< 0.05), and the intrusions subscale ( r = 0.30, p< 0.05) but not the avoidance subscale ( r = 0.32, p = 0.14). This study has demonstrated that measuring attentional bias with a dot-probe task is possible. The dot-probe task may provide an alternative measurement to self-reported measurements and important information for psychotherapies. Future studies may examine the predictive values of the dot-probe task on treatment outcomes and the risk for developing symptoms of post-traumatic stress disorder.

Background Doctors are at particular risk of occupational needlestick injuries (NSI), and these may result in considerable acute anxiety and fear of disease transmission. Aims To measure the prevalence of post-traumatic stress disorder (PTSD) among trainee doctors who had experienced an NSI. Methods A questionnaire was distributed to trainee doctors starting work in a large university hospital in the UK. The survey gathered demographic information and experience of previous NSI and included questions designed to assess the presence of PTSD via the Impact of Event Scale (IES), a widely used screening tool for PTSD. The six-item version of this tool (IES-6) was used in this study. Results Among the 147 doctors who participated, 80 (54%) had sustained at least one NSI during their training and 77 of these completed the IES-6 survey. Of note, 38% of injuries (30/80) were not reported to the occupational health or emergency departments. Using a cut-off level of 10 in the IES-6, 12% (9/77) of the doctors who suffered NSI during their training showed evidence of PTSD. Since the prevalence of PTSD in the general population is estimated at 3%, the odds ratio of PTSD in doctors who had NSI was 4.28 (95% confidence interval: 2.16-8.47). Conclusions NSI injury is common among doctors in training. As 12% of doctors with experience of NSI had post-traumatic stress reactions, special attention should be paid to psychological impacts of NSIs. We would recommend further prospective studies.

OBJECTIVES Postpartum depressive symptoms (PDS) and acute stress reactions (ASR) after childbirth are frequently documented in mothers, but research is scarce in fathers. In a longitudinal path analysis, the interplay of depressive symptoms in pregnancy and the subjective childbirth experience of mothers and fathers are examined with regard to the development of PDS and ASR postpartum. STUDY DESIGN One hundred eighty nine expectant couples were recruited between August 2006 and September 2009. They completed the Edinburgh Postnatal Depression Scale (EPDS) in the last trimester of pregnancy. In the first week postpartum, they answered the Salmon's Item List (subjective birth experience), and four weeks after birth the EPDS and the Impact of Event Scale - revised (IES-r). The data were evaluated in a longitudinal path analysis. RESULTS Compared with fathers, mothers reported more depressive symptoms (pregnancy: p0.10), but moderately correlated four weeks after birth (r=0.387, p

The study of single streamflow recession events is receiving increasing attention following the presentation of novel theoretical explanations for the emergence of power law forms of the recession relationship, and drivers of its variability. Individually characterizing streamflow recessions often involves describing the similarities and differences between model parameters fitted to each recession time series. Significant methodological sensitivity has been identified in the fitting and parameterization of models that describe populations of many recessions, but the dependence of estimated model parameters on methodological choices has not been evaluated for event-by-event forms of analysis. Here, we use daily streamflow data from 16 catchments in northern California and southern Oregon to investigate how combinations of commonly used streamflow recession definitions and fitting techniques impact parameter estimates of a widely used power law recession model. Results are relevant to watersheds that are relatively steep, forested, and rain-dominated. The highly seasonal mediterranean climate of northern California and southern Oregon ensures study catchments explore a wide range of recession behaviors and wetness states, ideal for a sensitivity analysis. In such catchments, we show the following: (i) methodological decisions, including ones that have received little attention in the literature, can impact parameter value estimates and model goodness of fit; (ii) the central tendencies of event-scale recession parameter probability distributions are largely robust to methodological choices, in the sense that differing methods rank catchments similarly according to the medians of these distributions; (iii) recession parameter distributions are method-dependent, but roughly catchment-independent, such that changing the choices made about a particular method affects a given parameter in similar ways across most catchments; and (iv) the observed correlative relationship between the power-law recession scale parameter and catchment antecedent wetness varies depending on recession definition and fitting choices. Considering study results, we recommend a combination of four key methodological decisions to maximize the quality of fitted recession curves, and to minimize bias in the related populations of fitted recession parameters.

The present work investigates cross-shore shoreline migration as well as its alongshore variability (with deformation) on timescales of days to years using 6 years of time-averaged video images. The variability of the shoreline is estimated through empirical statistical methods with comprehensive reference to three scales of variability. At the meso-to macro-tidal barred Biscarrosse beach, shoreline responds in decreasing order at seasonal (winter/summer cycles, 52%), event (storms, 28%) and inter-annual scales. Whereas seasonal evolution is dominated by wave climate modulation, short-term evolution is influenced by tidal range and surf-zone sandbar characteristics. The influence of tide range and sandbars increases when timescale decreases. This is even more the case for the alongshore deformation of the shoreline which is dominated by short-term evolution. An EOF analysis reveals that the first mode of shoreline change time series is associated with cross-shore migration and explains 58% of the shoreline variability. The rest of the modes are associated to deformation which explain 42% of shoreline variability.

Context. There is a lack of longitudinal studies investigating fatigue from before cancer treatment to long after successful cancer treatment.Objectives. This prospective follow-up study aimed to determine the prevalence and predictors of persistent fatigue in cancer survivors in the first year after completion of cancer treatment.Methods. Sixty patients with various malignancies were assessed before (T1), shortly after curative cancer treatment (T2), and one year after T2 (T3). Fatigue was assessed monthly between T2 and T3. Fatigue severity was measured using the subscale of the Checklist Individual Strength. Questionnaires were used to measure impaired sleep and rest, physical activity, social support, fatigue catastrophizing, and somatic-related attributions regarding fatigue. Linear regression analyses were performed to identify predictors of persistent fatigue.Results. In total, 22% of survivors had severe persistent fatigue over the last six months in the first year after cancer treatment. Fatigue at T1, T2, and negative interactions predicted the severity of persistent fatigue. Analyses without fatigue showed that more negative interactions, impaired sleep and rest, fatigue catastrophizing, and lower self-reported physical activity at T2 were associated with the severity of persistent fatigue.Conclusion. Twenty-two percent of the survivors had severe persistent fatigue in the year after cancer treatment. Fatigue and cognitive behavioral factors predicted persistent fatigue in the year after cancer treatment. Diagnosis or cancer treatment did not predict persistent fatigue. The implication is that cognitive behavioral therapy for postcancer fatigue, aimed at the fatigue-perpetuating factors, could be offered from two months after successful cancer treatment. J Pain Symptom Manage 2013;45:213-222. (C) 2013 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.

The objective of this study is to analyze the prevalence of probable PTSD and depression after earthquake and to find the risk factors. Adolescents having experienced an earthquake were recruited (n = 330) and assessed within 1 month of the trauma. Follow-up surveys were conducted 12 months, 24 months and 36 months later, respectively. Symptoms were assessed by the Children's Revised Impact of Event Scale and the Depression Self-Rating Scale for Children. Results indicate that the prevalence of probable PTSD in different stages was 42.2%, 20.1%, 30.3% and 11.2%. The corresponding rate of depression was 32.3%, 20.7%, 31.0% and 30.3%. The sub-symptoms of PTSD, intrusion and arousal, tended to decrease at the 1st year, followed by a rebound at the 2nd year, then dropping again at the 3rd year. The avoidance showed a consistent diminishing. The PTSD symptoms were significantly associated with gender and the degree of earthquake exposure. However, the gender, family relationship and despair played crucial roles in the development of depressive symptoms. Despite of the tendency of timing abatement, the prevalence of probable PTSD and depression might show rebound at the second year, which remind us a vital threshold for psychological intervention.

The purpose of the research was to investigate the role of personal resources, such as optimism and sense of selfefficacy in both negative (posttraumatic stress disorder (PTSD) symptoms) and positive (posttraumatic growth - PTG) effects of experienced trauma in a group of emergency service representatives.Data of 100 medical rescue workers, mostly men (59%) who have experienced traumatic events in their worksite were analyzed. The age of the participants ranged from 24 to 60 years (mean = 37.43; standard deviation = 8.73). Polish versions of the Impact of Event Scale - Revised and the Posttraumatic Growth Inventory were used to assess the negative and positive effects of experienced events. Optimism was assessed by the Life Orientation Test and sense of self-efficacy by the Generalized Self-Efficacy Scale.The obtained results revealed that optimism is negatively associated with symptoms of PTSD in men, and sense of self-efficacy - positively with the severity of growth after trauma in women.The analyzed personal resources play a diverse role in the emergence of negative and positive effects of experienced traumatic events, depending on the gender of the respondents. Med Pr 2016;67(5):635-644.Celem podjętych badań było ustalenie roli zasobów osobistych, takich jak optymizm i poczucie własnej skuteczności, w występowaniu negatywnych (objawy stresu pourazowego (posttraumatic stress disorder – PTSD)) i pozytywnych (potraumatyczny wzrost (posttraumatic growth – PTG)) skutków doświadczeń traumatycznych wśród przedstawicieli służb ratowniczych.Analizie poddano wyniki 100 ratowników medycznych (59% mężczyzn), którzy doświadczyli zdarzeń traumatycznych w związku z wykonywaną pracą. Wiek badanych wynosił 24–60 lat (średnia = 37,43; odchylenie standardowe = 8,73). Do oceny negatywnych skutków doświadczanych zdarzeń wykorzystano Skalę Wpływu Zdarzeń, a pozytywnych – Inwentarz Potraumatycznego Rozwoju. Optymizm oceniano za pomocą Testu Orientacji Życiowej, a poczucie własnej skuteczności – Uogólnionej Skali Własnej Skuteczności.Stwierdzono, że optymizm jest ujemnie powiązany z objawami zespołu stresu pourazowego w grupie mężczyzn, a poczucie własnej skuteczności – dodatnio z nasileniem wzrostu po traumie w grupie kobiet.Analizowane zasoby osobiste pełnią zróżnicowaną funkcję w pojawianiu się negatywnych i pozytywnych skutków doświadczanych zdarzeń traumatycznych w zależności od płci badanych. Med. Pr. 2016;67(5):635–644.

El estudio es de carácter preliminar y tiene como objetivo describir los niveles de sintomatología de estrés post-traumático y estrés subjetivo en una muestra de 149 estudiantes universitarios de Copiapó, Chile Se utilizó una estrategia asociativa de tipo comparativa transversal y un diseño de grupos naturales. Se aplicó una encuesta sociodemográfica breve y los instrumentos: Escala de Gravedad de Síntomas del Trastorno de Estrés Postraumático (TEPT) y Escala de Impacto al Evento Revisada (EIE-R). Se observó que del total de la muestra el 2% presenta síntomas de estrés postraumático; el 85% presenta síntomas de mediana intensidad de impacto al evento y el 13.4% síntomas severos de estrés subjetivo. Se encontraron diferencias significativas en los puntajes de las escalas en función de la variable grado de impacto emocional, TEPT, F(4, 144) = 17.81, p < .001 y EIE-R F(4, 144) = 17.96; p < .001 y grado de pérdida material, TEPT, F(5, 143) = 3.20, p < .01 y EIE-R, F(5, 43) = 3.26; p < .01. No se encontraron diferencias en las puntuaciones en función del sexo. Los resultados sugieren la existencia de baja prevalencia de estrés postraumático The preliminary study in nature aims to describe the levels of post-traumatic stress symptoms and subjective stress in a sample of 149 college students from Copiapó, Chile. A cross-comparative associate strategy with natural groups was used. A brief sociodemographic survey and two instruments were applied: Severity Scale Symptoms of Post-Traumatic Stress Disorder (PTSD) and Impact Event Scale Revised (EIE-R). Outof the total sample, reslts show that 2% have symptoms of post-traumatic stress; 85% have symptoms of medium impact intensity to the event and 13.4% have severe symptoms of subjective stress. Significant differences were found in the scores of the scales depending on the varying degree of emotional impact: PTSD, F(4, 144) = 17.81, p < .001 and IES-R, F(4, 144) = 17.96; p < .001; and grade of material loss: PTSD, F(5.143) = 3.20, p < .01 and IES-R, F(5.143) = 3.26; p < .01. No differences in scores were found according to gender. These results suggest low prevalence of PTSD

Context: Posttraumatic stress disorder (PTSD) is the most common consequence of traumatic experiences. The North Central Nigeria to which Plateau State belongs has witnessed many ethno‑religious crises. While previous studies suggested a high prevalence of PTSD among students, to the best of our knowledge, no such study has been reported in Nigeria.Aims: The study aimed to determine the prevalence and correlates of PTSD among medical students in a university.Materials and Methods: Cross‑sectional systematic random sampling was used to select 200 medical students. A two staged interview with questionnaire on sociodemographic variables, PTSD Checklist‑Civilian Version, Impact of Event Scale, and Composite International Diagnostic Interview was carried out. Statistical Analysis Used: SPSS Inc. Released 2007. SPSS for Windows, version 16.0. Chicago, SPSS Inc. was used for statistical analysis.Results: Prevalence of PTSD among the students was 23.5%. Previous childhood trauma and personal experiences during the crisis were significantly associated with having PTSD.Conclusions: High prevalence rate of PTSD among medical students in Jos is an indicator of psychological consequences of the recurring crises on the inhabitants. There is a need for follow‑up and counseling/trauma healing for those identified.Keywords: Correlates, Jos, medical students, posttraumatic stress disorder, prevalence

Objectives Diagnostic imaging may be a major source of cancer-related distress, a condition known as “scanxiety”. Scant scholarly work has been performed to evaluate scan-associated distress in cancer. We sought to characterize risk factors for scan-associated distress among patients with Non-Small Cell Lung Cancer (NSCLC), and to evaluate the impact of scan-associated distress on quality of life. Materials and methods We conducted a cross-sectional survey study of patients with recurrent/metastatic NSCLC treated at an academic medical center. Clinical and demographic variables were obtained through chart abstraction and patient self-report. We used a modified version of the Impact of Event Scale 6 (IES-6) to specifically assess distress associated with scans, and quality of life was measured using the Functional Assessment of Cancer Therapy − Lung (FACT-L). Results Among 103 participants (survey response rate 76.3%), median age was 67, 61.2% were women, and 82.5% were white. At the study visit, 72.8% of subjects discussed a recent scan, and 83% reported some scan-associated distress. Scan-associated distress was not associated with whether the patient had a recent scan, progressive disease or time from diagnosis. Scan-associated distress was associated with impaired quality of life (p = 0.004); each unit increase in IES-6 corresponded to an approximately one-unit decrease in FACT-L score. Conclusion Scan-associated distress is a common problem among patients with NSCLC, and is associated with impaired quality of life. Scan-associated distress severity was not associated with time since diagnosis or whether a recent scan was discussed at the study visit, which implies scan-associated distress may be a persistent problem.

International audience; Working with street children and adolescents who lived through the 2010 earthquake in Port-au-Prince, this paper aims to assess the prevalence of symptoms of PTSD, anxiety and depression in relation to peritraumatic distress, and age, and to explore other risk factors and socio-demographic characteristics, four years after the events. Between March and June 2014, with a sample of 128 children and adolescents (120 boys and 8 girls) aged between 7 and 18, of an average age of 13.88 (SD = 2.15), all living on the streets of Port-au-Prince, we used the following scales: the Trauma Exposure (TE), the Life Events Subscale of the CAPS; the Peritraumatic Distress Inventory (PDI); the Children's Revised Impact of Event Scale (CRIES-13) and the Children Depression Inventory (CDI); (BAI). Our study reveals a high prevalence of PTSD, depression and anxiety among street children. It also demonstrates that this prevalence is lower than that of several other groups of children who were also victims of the 2010 earthquake in Port-au-Prince. Children living in the streets for economic reasons presented a lower prevalence of symptoms of PTSD, anxiety and depression than those who were on the streets as a result of psychological or physical abuse within their own families, in adoptive families or in children's homes. This study demonstrates the importance of care provision for these children in terms of helping them develop coping and resilience strategies. It also stresses the importance of providing them with nonviolent living environments and opportunities to facilitate their return to normality.

The aim of this prospective study was to examine the etiology of post-traumatic stress symptoms following childbirth within a transactional framework of stress. Participants were women (N = 1,499) from the Akershus Birth Cohort. These women were followed from pregnancy to 8 weeks postpartum. We modeled predisposing factors (e.g., fear of childbirth) and precipitating factors (subjective and objective birth experiences) as predictors of post-traumatic stress symptoms. Post-traumatic stress symptoms were measured by means of the Impact of Event Scale, objective birth experiences by means of birth journals, and subjective birth experiences by means of three questions. A structural equation model showed that subjective birth experiences had the highest association with post-traumatic stress symptoms. Moreover, they mediated the effect of predisposing factors and objective birth experiences. The results suggest that women's subjective birth experiences are the most important factor in the development of post-traumatic stress symptoms following childbirth.

To establish longitudinal rates of post-traumatic stress in a cohort of child–parent pairs; to determine associations with poorer outcome. This was a prospective longitudinal cohort study set in a 21-bed unit. In total 66 consecutive admissions aged 7–17 years were screened with one parent at 3 and 12 months post-discharge. Measures used were the Children’s Revised Impact of Event Scale (CRIES-8) and the SPAN (short form of Davidson Trauma Scale). In total 29 (44 %) child–parent pairs contained at least one member who scored above cut-off 12 months after discharge, with scores increasing over time for 18 parents and 26 children. At 3 months, 28 (42 %) parents and 20 (32 %) children scored above cut-off; at 12 months the rates were 18 (27 %) parents and 17 (26 %) children. Parents scoring above cut-off at 12 months were more likely to have had a child admitted non-electively (100 % vs. 77 %, p = 0.028); had higher 3-month anxiety scores (11.5 vs. 4.5, p = 0.001) and their children had higher post-traumatic stress scores at 3 months (14 vs. 8, p = 0.017). Children who scored above cut-off at 12 months had higher 3-month post-traumatic stress scores (18 vs. 7, p = 0.001) and higher Paediatric Index of Mortality (PIM) scores on admission (10 vs. 4, p = 0.037). The findings that (a) nearly half of families were still experiencing significant symptoms of post-traumatic stress 12 months after discharge; (b) their distress was predicted more by subjective than by objective factors and (c) many experienced delayed reactions, indicate the need for longer-term monitoring and more support for families in this situation

Objectives PTSD prevalence rates in cardiac and cancer patients greatly vary probably due to diverging samples, designs and assessments. Aim of this study was therefore to compare prevalence rates of PTSD as well as instruments assessing PTSD in different cardiac and cancer patient groups. Methods A total of 274 cardiac and cancer patients were examined with the Post-Traumatic Stress Scale 10 (PTSS-10) and the Impact of Event Scale — revised (IES-R). Presence of PTSD was validated by Structured Clinical Interview for DSM-IV (SCID). Results Diagnostic criteria for the existence of PTSD were met by 29.2% of all patients via PTSS-10, by 7.6% in IES-R and by 4.8% in SCID, indicating substantial discrepancy among assessments. This is further underlined by the moderate correlation between self-reports and poor agreement with the standardised interview. Conclusion A structured interview is the “gold standard” for diagnosing PTSD in cardiac and cancer patients. Questionnaires can be used as screening instruments when they reliably assess trauma-related diagnostic criteria. Further studies are necessary to clarify the specifics of trauma criteria in medical setting.

Nurses can experience secondary traumatic events while caring for patients. However, the severity of this issue is underestimated in Japan. To evaluate the prevalence and factors associated with secondary traumatic stress among general hospital nurses, we carried out a cross-sectional study at a general hospital in August 2006. The rate of experiencing secondary trauma was 90.3% (159 of 176 nurses; 52.1% response rate). The median score of the Impact of Event Scale-Revised was 4.0 (range, 0-56). In multiple regression analyses, variables correlated with the Impact of Event Scale included neuroticism, trauma severity and feelings of self-reproach. It is necessary to develop support systems for nurses at risk for secondary traumatic stress.

This article describes the development and implementation of a stress management model for assisting hospital staff after critical incidents using an adaptation of Mitchell's model (J. Mitchell, 1983). A survey was conducted following the first major incident using M. Horowitz, N. Wilner, and W. Alvarez's (1979) Impact of Event Scale 10 days after and again 6 weeks following the incident to measure its emotional impact on staff. Outcomes included being symptom-free of critical incident stress after a 3-month period. The interventions were intended to help staff at a large metropolitan multispecialty hospital in Queensland in the immediate period following critical incidents. The implications of this program indicated the importance of emotional support at critical times for health professionals.

Many countries are reexamining the risks connected with nuclear power generation after the Fukushima accidents. To provide updated information for the corresponding discussion a simple empirical approach is applied for risk quantification of severe reactor accidents with International Nuclear and Radiological Event Scale (INES) level≥5. The analysis is based on worldwide data of commercial nuclear facilities. An empirical hazard of 21 (95% confidence intervals (CI) 4; 62) severe accidents among the world’s reactors in 100,000 years of operation has been estimated. This result is compatible with the frequency estimate of a probabilistic safety assessment for a typical pressurised power reactor in Germany. It is used in scenario calculations concerning the development in numbers of reactors in the next twenty years. For the base scenario with constant reactor numbers the time to the next accident among the world's 441 reactors, which were connected to the grid in 2010, is estimated to 11 (95% CI 3.7; 52) years. In two other scenarios a moderate increase or decrease in reactor numbers have negligible influence on the results. The time to the next accident can be extended well above the lifetime of reactors by retiring a sizeable number of less secure ones and by safety improvements for the rest.

The present experimental analogue study used computerised attention training to investigate the role of attention bias in the prediction of intrusive memories. After exposure to a trauma film, participants in a training group (n = 22) were presented with a variant of the exogenic cueing task (ECT) in which visual film reminders (i.e., stills from the trauma film) were always presented during invalid and neutral control stimuli always during valid trials. The purpose of this cue-ocation contingency was reinforcing the direction of attention away from film reminders. Control participants (n = 23) performed a similar training without such a contingency. Post-training processing bias was assessed with a single target Rapid Serial Visual Presentation (RSVP) task, in which trauma-film reminders served as task-irrelevant distracters appearing shortly before a neutral target. The frequency of film-related intrusions was recorded in a take-home diary and at a follow-up session three days after film viewing. Participants who underwent attention training reported fewer film-related intrusions and showed less interference by visual film distracters than controls. Implications for research on attention bias after real-life trauma are discussed.

This article reports the follow-up results of our field study (Jarero & Uribe, 2011) that investigated the application of the eye movement desensitization and reprocessing (EMDR) Protocol for Recent Critical Incidents (EMDR-PRECI) in a human massacre situation. A single individual session was provided to 32 forensic personnel of the State Attorney General in the Mexican state of Durango who were working with 258 bodies recovered from clandestine graves. Pre-post results showed significant improvement for both immediate treatment and waitlist/delayed treatment groups on the Impact of Event Scale (IES) and Short PTSD Rating Interview (SPRINT). In this study, we report the follow-up assessment, which was conducted, at 3 and 5 months posttreatment. Follow-up scores showed that the original treatment results were maintained, with a further significant reduction of self-reported symptoms of posttraumatic stress and PTSD between posttreatment and follow-up. During the follow-up period, the employees continued to work with the recovered corpses and were continually exposed to horrific emotional stressors, with ongoing threats to their own safety. This suggests that EMDR-PRECI was an effective early intervention, reducing traumatic stress for a group of traumatized adults continuing to work under extreme stressors in a human massacre situation. It appears that the treatment may have helped to prevent the development of chronic PTSD and to increase psychological and emotional resilience.

The purpose of this study was to validate the Impact of Event Scale-Revised (IES-R) for adolescents who had experienced the floods and mudslides caused by Typhoon Morakot in Taiwan. The internal consistency, construct validity, and criteria validity of the instrument were examined. Principal component analysis followed by an oblique rotation was used to derive a three-factor solution. These factors were labeled intrusion, hyperarousal, and avoidance; all three factors together accounted for 58.1% of the variance. The total Cronbach’s alpha of 0.94 reflected the good internal consistency of the instrument. With reference to diagnosis of posttraumatic stress disorder, the IES-R cutoff point for posttraumatic stress disorder was 19 of 20 with a sensitivity of 85.7% and specificity of 84.1%. In conclusion, the IES-R can be used as a reliable and valid instrument when evaluating psychological distress among adolescents who have experienced a natural disaster, such as flooding and mudslides.

The present study investigated the relationship between trauma exposure and specificity and temporal distribution of autobiographical memories and future-directed thoughts. A group of sexual assault victims were compared with women without previous trauma exposure in relation to specificity of autobiographical memories, as measured by the Autobiographical Memory Task (AMT) and specificity of future-directed thoughts as measured by the Future Cueing Task (FCT). The temporal distribution of future-directed thoughts and autobiographical memories was studied by asking the participants to estimate when each memory reported on the AMT had occurred and when each future event reported on the FCT would occur. The results showed no difference between the trauma group and the controls on specificity of autobiographical memories and future-directed thoughts. In line with a review of Moore and Zoellner (2007), PTSD symptoms as measured by the Impact of Event Scale (IES) correlated negatively with specificity. Furthermore, we observed no difference in temporal distribution of future-directed thoughts or autobiographical memories between trauma exposed participants and controls.

The International Nuclear and Radiological Event Scale, better known as the INES scale, provides criteria allowing the classification of nuclear events according to their severity. The Fukushima Da...

Our study examines gender differences in traumatic exposure and associated posttraumatic stress disorder (PTSD) symptoms reported by a 266 male and female inmates. In our sample, 94.7% of the inmates had experienced at least one traumatic event identified in Trauma History Questionnaire – Modified. Male inmates reported higher rates of witnessing harm to others in childhood (22.4%) and adolescence (43.25) and female inmates, higher rates of interpersonal sexual trauma in childhood (31.2%), adolescence (35.3%), and adulthood (27.7%). Women showed higher rates of PTSD (40.2%) when compared to men (12.5%), as measured by the total PTSD score of the Impact of Event Scale – Revised. The combined trauma types explained 12% and 16% of the total PTSD score in the female and male samples, respectively. In the female model, interpersonal sexual trauma was a significant predictor of PTSD symptoms; whereas in the male model, interpersonal nonsexual trauma was a significant predictor. We discuss these findings as they...

Aims. The aims of this study were to assess the internal reliability (internal consistency), construct validity, sensitivity and ceiling and floor effects of the Brazilian-Portuguese version of the Impact of Event Scale (IES). Design. Methodological research design. Method. The Brazilian-Portuguese version of the IES was applied to a group of 91 burned patients at three times: the first week after the burn injury (time one), between the fourth and the sixth months (time two) and between the ninth and the 12th months (time three). The internal consistency, construct validity (convergent and dimensionality), sensitivity and ceiling and floor effects were tested. Results. Cronbach's alpha coefficients showed high internal consistency for the total scale (0·87) and for the domains intrusive thoughts (0·87) and avoidance responses (0·76). During the hospitalisation (time one), the scale showed low and positive correlations with pain measures immediately before (r = 0·22; p Language: en

One of the reference sections of Maeotian deposits in the south of Russia (the Popov Kamen section) is studied in terms of rock magnetism and paleomagnetism within the framework of the project “Study of Reference Sections of the Taman Downwarp as a Basis for Developing a Detailed Event Scale of the Neogene of the Eastern Paratethys.” The section is located in the southwestern part of the Taman Peninsula, to the south of the Taman Cape. It has been established that the lower-Maeotian deposits carry the magnetization of mainly reversed polarity, whereas the upper-Maeotian deposits are characterized by normal polarity. Two horizons of normally magnetized rocks are recognizable against the background of reversely magnetized lower-Maeotian deposits. A horizon of reversely magnetized rocks is outlined in the upper part of the upper Maeotian. If the paleomagnetic interpretation of the section is true, it can be concluded that the upper part of the upper Maeotian is absent in this section. Comparison with the magnetochronological scale shows that the lower Maeotian probably corresponds to the C3Br, C3Bn, and C3Ar Chrons, and the part of the upper Maeotian studied in this section corresponds to the lower part of the C3An Chron.

The relationship between genetic testing, psychological well-being and surveillance behavior: A questionnaire study in presymptomatic female and male BRCA carriers and non-carriers. Many researchers have investigated the impact of BRCA gene testing on psychological well-being, but results are equivocal. Heterogeneous findings may point to the role of influencing factors. The current questionnaire study investigates the relationship between genetic testing, psychological wellbeing, and surveillance behavior. The role of sex, age, SES, carrier status, time since testing, number of children, and coping is examined. The research sample consists of 119 presymptomatic BRCA gene mutation carriers and non-carriers (Mage=41.71,SD=11.05). Results indicated that genetic testing is related to psychological well-being over time.Women report more distress than men, carriers more than non-carriers. Coping at the moment of the genetic testing also influences psychological well-being over time. The more people used an emotion-oriented and problem-oriented coping style at the moment of testing, the lower their psychological well-being over time. Results furthermore indicated that surveillance behavior is predicted by sex, carrier status, number of children and problem-oriented coping. Carrier status is the only predictor of prophylactic surgery. Results of this study may contribute to the identification of persons at-risk for lower levels of psychological well-being and surveillance behavior.

This study developed and validated a scale that assessed the memory representation of everyday life types of trauma (ELTT). University students (N=275) participated in the survey study. Factor analysis of the data yielded the following three factors: Situationally Accessible Memories, Degree of Verbalization, and Nega-tivity of Verbally Accessible Memories. The internal consistencies of each factor were high. The ELTT scale showed most of the predicted correlation patterns with the Impact of Event Scale and the Posttraumatic Growth Inventory, which supported its validity.

This study addresses the psychometric properties, including the internal consistency and dimensionality, of the Impact of Event Scale-Revised (IES-R) in French-speaking mental health and social professionals in Switzerland faced with a patient suicide. Data were obtained by a self-administered questionnaire from a sample of 297 individuals who had experienced a patient suicide during the previous 5 years. The internal consistency of the IES-R and its subscales was high (α coefficients between 0.82 and 0.91) as were the correlations between the subscores (coefficients between 0.54 and 0.69). The dimensionality of the IES-R was best captured by a three-factor structure accounting for 53.0% of the total variance, with four theoretical intrusion items loading on the hyperarousal factor. The intrusion subscale contributed to more than half of the total score. Variations in the total score were associated with age and profession, while no significant association was found with professional experience, length of time since the patient suicide, or number of patient suicides. The French version of the IES-R is an adequate and reliable instrument for addressing the impact of a patient suicide on mental health and social professionals. Its dimensionality is consistent with the theoretical structure of the original version.

Contains fulltext : 89176.pdf (Publisher’s version ) (Closed access) PURPOSE: This work aims to prospectively study stress response symptoms (SRS) in adolescents during the first year after a parent's cancer diagnosis and factors associated with SRS. Additionally, SRS in these adolescents were compared to SRS in adolescents whose parents were diagnosed 1-5 years (reference group) previously. METHODS: Forty-nine adolescents, 37 ill parents, and 37 spouses completed questionnaires within 4 months after diagnosis (T1) and six (T2) and 12 months (T3) later. RESULTS: Clinically elevated SRS were found in 29% of adolescents at T1, 16% at T2, and 14% at T3. In contrast, in the reference group, we found 29% clinically elevated SRS. Daughters seemed more at risk than sons. Adolescents' age, patient's gender, and intensity and duration of treatment did not significantly affect SRS. Adolescents with more SRS reported having more emotional/behavioral problems. Parents observed fewer problems in those adolescents. Initial SRS affected later SRS and emotional problems. CONCLUSIONS: The findings illustrate that adolescent children of cancer patients may have clinically elevated SRS that are associated with emotional and behavioral problems. The prevalence of such problems may be underestimated by the parents. 01 november 2010

In Galicia (NW Spain) studies on the suspended sediment (SS) transported in river catchments are scarce. Using a dataset comprising three hydrological years (2004/05–2006/07) in the Corbeira catchment (NW Spain), the relationships between rainfall, runoff and SS are analysed at event scale. The catchment was instrumented to measure rainfall, water level and SS in the stream. Several event (rainfall, discharge and SS concentration and load) and pre-event (rainfall and discharge) variables were calculated for all the events analysed. Correlation matrices were developed using these data. Discharge characteristics and rainfall depth showed good correlations with SS concentration and load. Suspended sediment and discharge relationships were also examined. In most of the events, the SS peak preceded peak discharge (clockwise hysteresis), implying that zones near the stream are the main sediment source areas.

Research has demonstrated that the extent to which an individual integrates a traumatic event into their identity ("trauma centrality") positively correlates with posttraumatic stress disorder (PTSD) symptom severity. No research to date has examined trauma centrality in individuals exposed to combat stress. This study investigated trauma centrality using the abridged Centrality of Event Scale (Berntsen & Rubin, 2006) among Operation Enduring Freedom/Operation Iraqi Freedom combat veterans (n = 46). Multiple regression analyses demonstrated that trauma centrality predicted PTSD symptoms. Trauma centrality and PTSD symptoms remained significantly correlated when controlling for depression in subgroups of veterans with or without probable PTSD. This study replicates and extends findings that placing trauma at the center of one's identity is associated with PTSD symptomatology.

Aim The current study examined occurrence and within-family associations of traumatic stress reactions after child burn injury, while in the same model addressing the role of parents’ own symptoms in their reports of child symptoms. Methods One-hundred children (8–18 years old), and their mothers (n = 90) and fathers (n = 74) were assessed within the first month (T1) and three months (T2) after burn. Parents and children rated child traumatic stress reactions on the Children’s Responses to Trauma Inventory (CRTI) and parents rated their own reactions on the Impact of Event Scale (IES). Cross-sectional associations at the two occasions were examined using a structural equation model. Results Occurrence of traumatic stress symptoms in the clinical range was higher in parents (T1: 24–50%; T2: 14–31%) than children (T1: 0–11%; T2: 3–5%, depending on whether children, mothers or fathers reported on symptoms). Traumatic stress symptoms of mothers at T1 and of both parents at T2 were significantly related to child self-reported symptoms. Moreover, mothers who experienced higher stress symptoms themselves gave higher ratings of their child’s symptoms at both time points, while for fathers, this was only found at T2. Conclusions The current study demonstrates the impact of pediatric burn injury on the family level, and shows simultaneous existence of within-family interrelatedness of traumatic stress and an influence of parents’ own symptoms on their perception of child symptoms. Findings highlight the need for trauma symptom screening in all family members and for considering informants’ symptoms to understand the child’s functioning in particular.

False allegations of victimization typically are accompanied by malingered emotional symptomology to corroborate claims. This analog study was designed to compare truthful and fabricated symptom profiles on measures of post-traumatic stress (i.e., Revised Impact of Event Scale, Post-Traumatic Stress Disorder (PTSD) Checklist, Trauma Symptom Inventory) and levels of symptom consistency over time. Participants (undergraduate students) described their mental health symptoms for both traumas at time 1 (N = 291), time 2 (N = 252, 3 month), and time 3 (N = 181, 6 months). Results indicated that fabricated traumas were associated with inflated symptom profiles. Validity scales were not effective at discerning symptom veracity, although reports could be discriminated somewhat by atypical responding and clinical scales. PTSD symptoms in malingerers also were reported more consistently over time. This research offers applicable information for identifying feigned traumatic stress.

Background: Injury, medical treatment, and rehabilitation can have major impacts on patients’ wellbeing. About 25-33% of the patients experience an acute stress disorder (ASD) or a posttraumatic stress disorder (PTSD) after injury. ASD is a relatively new diagnosis. Therefore, knowledge about patients’ experiences, the course of ASD and PTSD, and who is at risk for developing ASD or PTSD is lacking. Objective: The aims of this multi-method study are to explore patients’ experiences with injury (and their care) using a focus group study. Then, in the observational study, different courses of ASD, PTSD, and quality of life will be examined. In addition, this study will examine if these courses could be characterized by socio-demographic, clinical, and psychological variables. Consequently, a risk profile will be developed to determine which patients are at risk for developing ASD or PTSD during the 12 months after injury. Methods: Trauma patients treated in the shock room (in 2015) of the Elisabeth-TweeSteden Hospital will share their experiences with injury in the focus group study. Open, axial, and selective coding will be used to analyze the data. Concerning the observational study, patients treated in the shock room (during 2016 and 2017, Elisabeth-TweeSteden Hospital and Erasmus Medical Centre) will be asked to participate. The inclusion period is 12 months. Participants will complete the Impact of Event Scale-Revised, MINI-plus, the Hospital Anxiety and Depression Scale, and the World Health Organization Quality of Life-BREF after inclusion and at 3, 6, 9, and 12 months after injury. The NEO-Five Factor Inventory and the State-Trait Anxiety Inventory-Trait are completed after inclusion only. Repeated measures of latent class analysis and linear mixed models will be used to examine the research aims. Results: This project was funded in August 2015 by ZonMw. The results of the focus group study are expected in the first trimester of 2018. With regard to the observational study, recruitment is currently underway. Data collection will be completed in November 2018. The first results will be expected in the first trimester of 2019. Conclusions: This is the first multi-method study in trauma patients that examines patients’ experiences (qualitative design) as well as psychological disorders (observational prospective). This study will contribute to necessary information on psychological consequences after injury. Moreover, it provides knowledge about which patients to include in future psychological intervention research. Finally, awareness in clinicians about the psychological consequences can be created, so they are able to act more effectively to provide patient-oriented care. Trial Registration: Netherlands Trial Registry NTR6258; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=6258 (Archived by WebCite at http://www.webcitation.org/6xSCiO1bS) [JMIR Res Protoc 2018;7(3):e88]

Objective: The study aimed at establishing the factor structure of the Impact of Event Scale-Revised (IES-R) in survivors of war. Methods: A total sample of 4.167 participants with post-traumatic stress symptoms following the war in Ex-Yugoslavia were split into three samples: Two independent samples of people who stayed in the area of conflict and one sample of refugees to Western European countries. Alternative models with 3, 4, and 5 factors of posttraumatic symptoms were tested in one sample. The findings were cross-validated in the other two samples. Results: The model of best fit had 5 factors, i.e. intrusion, avoidance, hyperarousal, numbing, and sleep disturbance. Model superiority was cross-validated in two other samples. Conclusions: These findings suggest a 5 factor model of posttraumatic stress symptoms in war survivors with numbing and sleep disturbance as separate factors in addition to intrusion, avoidance and hyperarousal.

Civilian women working in war zones may be vulnerable to posttraumatic stress reactions for decades. Some four decades since the Vietnam war, little is understood of how non-national civilian women have made sense of their experiences both in a war zone and returning to a hostile society and how this has affected their mental well-being over a lifetime. Female entertainers employed by Western allied forces during the Vietnam conflict completed the Posttraumatic Stress Checklist-Military (PCL-M), the Revised Impact of Event Scale (IES-R), and the General Health Questionnaire (GHQ-12) in response to war zone exposure categories of life threat, sexual discrimination and abuse, and personal trauma. The majority of participants were asymptomatic of posttrauma stress according to the PCL-M and IES-R. However, decades later, 9% of participants met diagnostic criteria for PTSD according to the PCL-M, suggesting that civilian women exposed to war zones may be symptomatic for decades.

This study examined the structure of posttraumatic stress disorder (PTSD) as measured by the Impact of Event Scale–Revised (IES-R; Weiss & Marmar, 1997), tested factorial invariance for samples of 235 Israeli emergency room patients and 306 U.S. undergraduate students, and then evaluated factorial invariance over multiple occasions within the emergency room sample. A four-factor structure representing intrusion, avoidance-numbing, hyperarousal, and sleep emerged as the preferred model. Configural invariance over groups was supported for this model. Likewise, configural invariance over occasions was demonstrated, but metric invariance was not fully supported, with variation in the loadings on the intrusion factor over time seemingly the source of misfit. Interpretations and conclusions center on sleep as a separate factor underlying the structure of the IES-R, the distinction between avoidance and numbing as a function of how the IES-R (vs. the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) operationalizes the numbing feature of PTSD and possible shifts in the meaning of intrusion over time.

Limited information is known about insomnia, depression, and distress in men with prostate cancer. This study explored insomnia and its relationship to depression and distress in this population. Participants (N = 51) were recruited from a Veterans Affairs Medical Center outpatient clinic. Questionnaires included the Insomnia Severity Index, Center for Epidemiologic Studies-Depression Scale, and Impact of Event Scale. Findings indicated that many men had insomnia and depression with a moderate level of distress. Half the men with clinically significant insomnia also had clinically significant depression. Significant relationships were found among insomnia, depression, and distress. Implications for research and practice are offered.

The authors assessed medical student attitudes regarding mistreatment and symptoms of posttraumatic stress in those students who reported exposure to mistreatment. Third- and fourth-year medical students (N=71) responded to questions from a vignette in which a student is mistreated and then described any mistreatment they had witnessed or experienced. They also discussed related symptoms of posttraumatic stress subsequent to the mistreatment. The revised Impact of Event Scale was the primary outcome measure. Ninety percent of respondents reported sympathy for the student in the vignette and supported her discussing the incident with peers, the resident, and administration. Seventy-three percent reported witnessing or experiencing mistreatment, suggesting symptoms of posttraumatic stress, with no differences in scores across the intended field of study, age, or gender. In a supportive environment, medical students will discuss their experiences of mistreatment. Symptoms of posttraumatic stress can occur from mistreatment.

This study examined whether familiarity with the physical environment and verbal/pictorial exposure to a tsunami also inducted posttraumatic stress symptoms in adolescents. The Impact of Event Scale (IES) and Pediatric Emotional Distress Scale (PEDS) were administered to 231 subjects (130 directly exposed and 101 indirectly exposed). The directly exposed group scored high on the IES and PEDS. A significant sex difference was observed on all three dimensions of the IES, and fearful and traumatic event-related dimensions of PEDS, with females at a higher risk compared to males. In the indirectly exposed group, no sex difference was observed for the IES (avoidance and total impact score) or the fearful, acting out, or traumatic experience related dimensions of the PEDS. Significant sex differences were observed in this group on the IES intrusion and PEDS withdrawal scores, with males higher on intrusion and females higher on withdrawal.

Purpose To address the widespread concern that false-positive results during breast MRI screening may have adverse psychological effects. Methods Impact of Event Scale measurements in 103 high-risk women enrolled in a longitudinal MRI screening study and comparison of subjects with normal results vs. those with prior recall events. Results Of 189 MRI scans performed, 64 (34%) prompted further evaluation. Subjects with previously abnormal results had significantly higher Avoidance scores at the time of their second MRI. Multivariate analysis showed this was driven by the greater number of BRCA1/2 carriers in that group but was not related to screening recall. Conclusions Practitioners’ concerns about the high false positive rate of breast MRI may not be matched by actual psychological effects in most high-risk women.

Although smaller hippocampi and amygdalae were found in cancer survivors with intrusions, associations between cancer-related posttraumatic stress disorder (PTSD) and these volumes are unknown. The authors performed MRI volumetric analyses of these regions in 15 cancer survivors with PTSD, 15 cancer survivors without PTSD, and 15 healthy comparison subjects. The authors also examined the correlation between PTSD symptom scores of the Impact of Event Scale and these volumes in the PTSD group. These volumes were not significantly different among the groups, but the intrusion score was inversely associated with the hippocampal volume. Results suggest intrusions, not PTSD diagnosis, might be associated with hippocampal volume.

Undesired career termination represents a critical life event for professional athletes. This study examined traumatic stress resulting from (a) a career-ending event and (b) the athlete’s separation from his or her social support network. Data were collected from 40 professional athletes who were members of the German National Ski Team, using standardized (Impact of Event Scale; Posttraumatic Diagnostic Scale) and partially standardized (psychosomatic stress reaction) questionnaires. Correlations between the impact of termination and traumatic stress symptoms were observed over a period of 8 months. Athletes who experienced supportive termination (involving discussion with coaches) endorsed fewer symptoms than those who experienced socially disintegrative termination (lacking support of coaches). Nearly 20% of participants endorsed clinically relevant levels of traumatic stress at 3 and 8 months posttermination.

This study investigates for the first time the relative importance of dissolved organic carbon (DOC) and particulate organic carbon (POC) in the fluvial carbon flux from an actively eroding peatland catchment in the southern Pennines, UK. Event scale variability in DOC and POC was examined and the annual flux of fluvial organic carbon was estimated for the catchment. At the event scale, both DOC and POC were found to increase with discharge, with event based POC export accounting for 95% of flux in only 8% of the time. On an annual cycle, exports of 35.14 t organic carbon (OC) are estimated from the catchment, which represents an areal value of 92.47 g C m−2 a−1. POC was the most significant form of organic carbon export, accounting for 80% of the estimated flux. This suggests that more research is required on both the fate of POC and the rates of POC export in eroding peatland catchments.

This study tests the hypothesis that avoidance and intrusion play different roles in health-related quality of life (QoL) in women who have undergone breast cancer surgery. We assessed QoL (RAND-36), avoidance, intrusion, and total cancer-related distress (Impact of Event Scale) in 83 women at 3, 6, 9, and 12 months after mastectomy. Social functioning and role limitations improved over time; physical functioning, general health, and mental health did not change; vitality initially improved folllowed by a decrease to a below initial level; physical pain initially improved followed by a decrease to an above initial level. Cancer-related distress remained high during follow-up. Individual variation in QoL as assessed across the four measurement times was associated with individual variation in intrusion but not with individual variation in avoidance. Baseline intrusion did not predict the subsequent course of QoL but high initial avoidance was associated with an unfavourable time course in physical functioning, social functioning, and general health. Hence, variation in intrusion over time explains variation in QoL while baseline avoidance predicts the subsequent course of QoL. The findings provide new insight into the relationship between the stress-response system in QoL and women with breast cancer. Copyright (C) 2007 John Wiley & Sons, Ltd.