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The objective of this study was to assess, via heart rate, the arousal levels of participants in group trauma reexposure therapy for posttraumatic stress disorder, and so to better understand this common mode of treatment, particularly in regards to its presumed curative factor, extinction. Six Vietnam combat-related PTSD inpatients participated twice weekly in group trauma reexposure therapy during which their electrocardiograms were recorded. Heart rate was quantified continuously off-line. Heart rates of participants not directly engaged in imaginal reexposure to their personal combat traumas consistently exhibited mild linear declines from the beginnings to the ends of the approximately 2.5 hour sessions. Participants actively engaged in personal combat trauma reexposure exhibited higher whole-session heart rates. Most also exhibited more specific elevation extending over the later portions of therapy sessions during which intensive reexposure usually occurred. Surprisingly, no patients exhibited focal increases in heart rate concurrent with periods of most intensive traumatic incident review as judged from videotape. Administering imaginal reexposure in a group context does not preclude substantial physiological (sympathetic) arousal, as is preconditional for extinction. Under conditions in which the actively engaged reexposure patient is reliably identified, group trauma reexposure therapy may not provide an opportunity for "vicarious" flooding in nonengaged participants.

This study investigated the relationship between combat exposure and adult antisocial behavior in a sample of 2,490 male Army veterans of the Vietnam War who completed questionnaires about their psychological functioning. After adjustment for history of childhood behavior problems, posttraumatic stress disorder diagnosis, and demographic and military characteristics, it was found that veterans who experienced high and very high levels of combat were twice as likely to report adult antisocial behavior as veterans with no or low levels of combat and were also more likely to meet criteria for antisocial personality disorder. The results indicate that exposure to traumatic events during late adolescence or early adulthood is associated with multiple adult adjustment problems in vocational, interpersonal, and societal functioning. Treatment focusing on the effects of the trauma is likely to be necessary but not sufficient for improving affected veterans' behavior.

One hundred seventeen help-seeking adult survivors of childhood sexual abuse (CSA) were assessed to investigate the relationship between the level of self-reported CSA and posttraumatic stress disorder (PTSD). CSA was measured utilizing the Sexual Abuse Exposure Questionnaire, a new research instrument. Further preliminary psychometric properties of the instrument were reported. CSA was operationalized to include severity, duration, age of onset, number of perpetrators, and use of force. PTSD diagnostic status was assessed utilizing a standardized instrument, the Structured Clinical Interview for DSM-II-R. Eighty-six percent of survivors met full DSM-III-R criteria for a PTSD diagnosis at some point during their lives. Multivariate analysis indicated that CSA severity and duration accounted for significant portions of the variance in PTSD symptoms, providing support for their role as traumagenic variables.

Structural equation modeling was used to examine relationships among prewar factors, dimensions of war-zone stress, and current posttraumatic stress disorder (PTSD) symptomatology using data from 1,632 female and male participants in the National Vietnam Veterans Readjustment Study. For men, previous trauma history (accidents, assaults, and natural disasters) directly predicted PTSD and also interacted with war-zone stressor level to exacerbate PTSD symptoms for high combat-exposed veterans. Male veterans who entered the war at a younger age displayed more symptoms. Family instability, childhood antisocial behavior, and age had indirect effects on PTSD for men. For women, indirect prewar effects emanated from family instability. More attention should be given to critical developmental conditions, especially family instability and earlier trauma exposure, in conceptualizing PTSD in adults.

It is widely accepted that therapeutic intervention is an important and effective component in the treatment of the sexually abused child. The goal of this study was to identify children who are at risk for not receiving mental health services following sexual victimization. Nine-hundred and seventy-two children were followed for 6 months, and intervention by the Department of Children's Services (DCS), law enforcement agencies, and mental health professionals was monitored. Those children who were most likely to enter therapy were Caucasian, between the ages of 7 and 13, had cases in which DCS or law enforcement were involved, were placed outside the home, and experienced abuse of greater frequency. Implications of this study for intervention with child sexual abuse victims are discussed. Recommendations are made for future research.

Objective: The authors examined the relationships among history of previous assault, severity of rape, acute plasma cortisol level after rape, and development of rape-related post-traumatic stress disorder (PTSD)., Method: Blood samples were drawn from 37 adult female rape victims within 51 hours after they had been raped. The subjects were assessed for history of previous assault and for the presence of PTSD 17-157 days (mean = 90 days) after the rape., Results: Women with a history of previous assault had a lower mean acute cortisol level after the rape but a higher probability of subsequently developing PTSD. A significant interaction between history of previous assault and the severity of the index rape was observed: only women who had never been assaulted before had higher cortisol levels following high-severity rapes (those which included injury or multiple types of penetration) than low-severity rapes., Conclusions: The authors conclude that previous traumatization may attenuate the acute cortisol response to trauma.

The present study sought to increase current scientific knowledge about the controversial issue of subjectively reported childhood ritualistic abuse by addressing several key unresolved issues. In particular, the possibility that those reporting ritualistic abuse may be characterized primarily by the severity of their abuse histories or the severity of their present psychological symptoms, rather than the veridicality of the ritualistic events, was explored. Adult female outpatients reporting childhood sexual abuse with ritualistic features were compared with a second group of women who reported childhood sexual abuse without ritualism. Measures included characteristics of childhood sexual and physical abuse, current posttraumatic stress disorder (PTSD) diagnostic status and symptom severity, and severity of current dissociative experiences. Women reporting ritualistic features scored significantly higher on measures of childhood sexual and physical abuse. Neither PTSD diagnostic status nor severity for PTSD nor dissociative experiences were significantly different between the groups. While preliminary in nature, these results suggest that it may be helpful to conceptualize reported childhood ritualistic abuse as indicative of the need to assess carefully for severe abuse and its predictable sequelae within existing traumatic victimization conceptual frameworks.

Severe interpersonal problems are common in veterans with combat-related posttraumatic stress disorder (PTSD) and their families. The authors first detail the rationale and use of behaviorally based family therapy to help reduce avoidance and withdrawal symptoms of PTSD and improve the active coping capacities of both veterans and their loved ones, then present a case example of the model, and finally discuss the clinical application of behavioral family therapy to the unique concerns of veterans with combat-related PTSD.

In the present study, posttraumatic stress disorder (PTSD) prevalence rates were compared among 50 battered women and 37 maritally distressed women who had not experienced battering (N = 87). Participants were administered R. Spitzer and I. B. S. Williams's (1985) Structured Clinical Interview for the DSM-III-R (Diagnostic and Statistical Manual of Mental Disorders [3rd ed., rev.]) to assess PTSD status and previous traumatic experiences in addition to other standardized measures of PTSD and violence exposure. Battered women exhibited significantly higher rates of PTSD than maritally distressed women (58% vs. 18.9%). Although both groups had similar rates of previous trauma experiences, women with a PTSD-positive status (both battered women and maritally distressed women) were significantly more likely to have experienced self-reported childhood sexual abuse and a higher overall number of previous traumas than those with a PTSD-negative status. Battering exposure and childhood sexual abuse predicted 37% of the variance in overall PTSD intensity levels.

Symptom manifestations of posttraumatic stress disorder (PTSD) are explained in light of current research findings. Assessment methods for evaluating PTSD and trauma exposure are presented and implications for treatment are discussed.

Forty-seven help-seeking, adult survivors of childhood sexual abuse (CSA) were assessed to examine the relationship between the level of CSA exposure and the subsequent development of posttraumatic stress disorder. CSA exposure was operationalized to include the overall level of exposure, frequency and duration of the abuse, age of onset, use of force, perceived life threat, and the occurrence of penetration. Participants were administered standardized measures of PTSD, including the Structured Clinical Interview of DSM-III-R (SCID). On the SCID, 69% of the survivors met full DSM-III-R criteria for PTSD. Significant correlations were found between several overall exposure measures and PTSD diagnostic status and the intensity of PTSD symptomatology. Similar relationships were identified with the duration and frequency of the abuse, the age of onset, and the use of force. This study is important in that it utilized standardized measures of PTSD and found a significant incidence of PTSD among adult CSA survivors.

This paper describes a needs analysis and resulting curriculum in Health Care Informatics. It is implemented as a track for the BS degree within the Department of Information Systems at the University of Maryland, Baltimore County. The track in Health Care Informatics is an interdisciplinary specialty within the broader field of Information Systems which is itself an interdisciplinary field. The needs analysis shows current thinking by practitioners and educators in the new field of Health Care Informatics. It also presents a survey of undergraduate students to monitor interest in and knowledge of this field. A curriculum design is presented that addresses these needs.

This study proposed that diagnosable levels of PTSD would be found among battered women and that the level of exposure to violence in the battering relationship would be an important contributing factor to the development of PTSD while other pre-trauma and post-trauma variables such as social support, intercurrent life events, religiosity, and developmental family stressors would also be related to PTSD symptom levels. Fifty-three battered women were given standardized self-report measures to assess these variables. As hypothesized, a significant proportion of battered women in the sample were diagnosed as PTSD positive. Multiple regression analyses revealed that violence exposure severity, recency of the last abusive episode, social support, intercurrent life events, intrinsic religiosity, and developmental family stressors predicted 43% of the variance in PTSD symptomatology.

Objective: The objective of this study was to characterize blood and amniotic fluid contact sustained by obstetric personnel during deliveries., Study Design: Trained observers collected data on 1376 person procedures during 230 deliveries at Grady Memorial Hospital from May to October 1989. Rates of contact were compared by means of the chi 2 test., Results: At least one blood or amniotic fluid contact occurred during 79 (39.1%) of 202 vaginal and 14 (50.0%) of 28 cesarean deliveries; a needle stick occurred in 4 (2.0%) of the vaginal deliveries. Obstetricians and midwives had the highest rates of blood and amniotic fluid contact (18.7% and 28.8% of person procedures, respectively). Half of the contacts sustained by midwives might have been prevented by the use of gowns. Most contacts sustained by obstetricians might have been prevented by face shields, impervious gowns, and impervious shoe covers., Conclusions: Obstetricians and midwives had substantial risk of blood and amniotic fluid contact during delivery; many of their contacts were potentially preventable.

A recently developed statistical method for single-case subject designs based on classical test theory was used to examine the efficacy of imaginal exposure treatment for posttraumatic stress disorder (PTSD) in four Vietnam veterans. The method was sensitive to intraindividual changes across different outcome measures even when relatively few data points were available. Two veterans clearly improved from exposure and maintained their gains at 3- and 15-month follow-ups. One veteran improved marginally, whereas one veteran's symptoms worsened. Changes in heart rate monitored over the first two imaginal exposures indicated that veterans with greater heart-rate habituation responded better to exposure than did veterans with less or no habituation. The results suggest that the statistical method illustrated here has some advantages over other methods (e.g., visual inspection, time-series analysis) for examining clinical interventions in single-case designs.

Operating room personnel are at risk for infection with blood-borne pathogens through blood contact. To describe the nature and frequency of blood contact and its risk factors, trained observers monitored a sample of operations performed by six surgical services at Grady Memorial Hospital, Atlanta, Ga, for 6 months. In 62 (30.1%) of 206 operations, at least one blood contact was observed. Of 1828 operating room person-procedures observed, 96 (5.3%) had 147 blood contacts (133 skin contacts [90%], 10 percutaneous injuries [7%], and four eye splashes [3%]). The mean number of blood contacts per 100 person-procedures was highest for surgeons (18.6). The frequency of percutaneous injury was similar among surgeons and scrub staff (mean, 1.2 per 100 worker-procedures for each group). Risk factors for surgeons' blood contacts were (1) performing a trauma, burn, or orthopedic emergency procedure (odds ratio [OR], 4.1; 95% confidence interval [CI], 2.0 to 8.7); (2) patient blood loss exceeding 250mL (OR, 2.1; 95% CI, 1.2 to 3.7); and (3) being in the operating room longer than 1 hour (OR, 3.3; 95% CI, 1.6 to 7.1). Of 110 blood contacts among surgeons, 81 (74%) were potentially preventable by additional barrier precautions, such as face shields and fluid-resistant gowns. Twenty-one (84%) of 25 blood contacts among surgeons in procedures in which all three risk factors were present were potentially preventable by additional barriers. Of 29 blood contacts among anesthesia and circulating personnel, 20 (69%) would have been prevented by glove use. For surgical procedures in which operating room personnel are at increased risk of blood contact, reevaluation of surgical technique, use of appropriate barrier precautions, and development of puncture-resistant glove materials are indicated.

Although symptoms of Post-Traumatic Stress Disorder are expected to persist for many years, there is often no systematic assessment of Vietnam veterans' combat experiences. A study of 43 help-seeking Vietnam veterans revealed that a reliable assessment of war trauma, the Combat Exposure Scale, could be constructed from dichotomous questions about seven stressful events. Scale scores related significantly to current diagnosis of PTSD and intensity of symptoms. The Guttman scaling technique resulted in an ordering of events that provides clinically relevant information about the nature of trauma in the Vietnam War.

Recent reserach has examined variables related to attendance of aftercare services because of the correlation between aftercare and posthospitalization treatment success. The present study, which examined aftercare attendance for 40 randomyl selected subjects following discharge from an inpatient alcohol treatment program, extends the list of variables found to influence attendance. A multiple-regression analysis of subject demographic variables and variables of a more programmatic nature found that distance variables (e.g., number of miles to an aftercare agency) significantly influenced aftercare attendance. The results are discussed with respect to aftercare program decisions.

This paper presents a review of empirical literature that deals with etiological factors in combat-related post-traumatic stress disorder (PTSD). Variables implicated in PTSD from three time frames, premilitary, military, and postmilitary, are identified, and findings from relevant research are discussed. There is consistency across studies in showing significant correlations between PTSD and combat exposure and post-military psychosocial adjustment. Less consistent are the findings with regard to relationships between premilitary psychosocial factors and PTSD. Recent findings from studies that have explored possible physiological correlates of PTSD also are discussed. Based on current literature, implications for future research on etiological factors in combat-related PTSD are presented.

Assessment data from 118 Vietnam-era veterans seeking psychological services at two Los Angeles Veterans Administration Medical Centers were analyzed to examine the potential relationships between number of preadult and adult antisocial behaviors, as defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-III; American Psychiatric Association, 1980) criteria for antisocial personality disorder, level of combat exposure, and development of combat-related post-traumatic stress disorder (PTSD). Results of hierarchical regression analyses indicated that combat exposure level was related significantly to PTSD symptomatology, whereas number of preadult antisocial behaviors was not. However, both combat exposure level and preadult behaviors, which were not correlated significantly, were related significantly to number of adult antisocial behaviors. There were no significant interaction effects. Results were consistent with a theoretical model of PTSD development that emphasizes the role of trauma vs. premorbid characterological factors. In addition, the significant association between combat exposure and adult antisocial behavior indicates that trauma may play a role in the development and/or maintenance of adult antisocial behaviors observed in some Vietnam veterans.

Developed and evaluated a home-based contracting program to determine its effect on the compliance rates of discharged alcohol patients to a disulfiram (antabuse) regimen. The three comparison groups included (a) no contract/no recording; (b) contract/recording; and (c) contract/recording plus instructions for positive reinforcement. Twenty-five patients who had been treated in a behaviorally oriented inpatient alcohol dependence treatment program and who lived with a significant other (i.e., spouse, sibling, parent) participated in the study. At the end of the 3-month period for which the disulfiram was prescribed, those Ss who were involved in contracting and recording reached criterion more frequently than those who were in the minimal treatment group. Furthermore, 84% of this S sample were abstinent at the 3-month follow-up according to collateral reports. The discussion centers on the use of home-based contracting as an inexpensive alternative to other, more costly disulfiram programs. Additional methods for obtaining measures of reliability on self-report of disulfiram usage also are discussed.

The impact of televised use of alcoholic beverages on children's behavior was evaluated in this study. Children were randomly assigned to one of three experimental conditions: (a) television with drinking depicted, (b) television without drinking, or (c) a no television control condition. Segments of the syndicated television show M.A.S.H. were used as the viewing stimulus. The impact of the various conditions was evaluated in a choice task requiring subjects to choose either martini or regular glasses of either "whiskey" or "water" to serve pictured adults and children. Results indicated that subjects who viewed television drinking were significantly more likely to choose alcoholic beverages for pictured adults but not children. No effect was found for glass preference. Results and implications of these findings and directions for future research are discussed.

Examined possible pre-treatment differences between alcoholic veterans who choose total abstinence and those who choose responsible drinking as their drinking goal. The two groups were compared on a variety of behavioral, cognitive, affective, and demographic characteristics. It was found that those who choose responsible drinking had a significantly shorter history of abusive drinking (6.5 years vs. 11.5 years) and more education (12.5 years vs. 10.8 years). In addition, the responsible drinking group showed a stronger belief that their chance for success was 100%.

A contingency management procedure was instituted with a hospitalized 52-year-old male psychiatric patient to alter behavior associated with an exacerbated diabetic condition. A ten-day baseline indicated consistently elevated urine sugar levels and that the patient frequently violated his prescribed low sugar diet by stealing, trading and hoarding high sugar foods. Beginning in baseline, the patient was instructed to measure his urine sugar levels and post the results on a chart next to his bed. During two of the intervention procedures used in the additive design, the patient could earn coupon booklets from the hospital commissary if his daily average urine sugar levels were less than a set criterion. Two such criteria were employed before the reinforcement contingencies were faded. By the end of the intervention, urine sugar levels were under control and follow-up measures six months post-treatment indicated durable treatment effects.

Social-skills training was used to modify abusive verbal outbursts displayed by two adult psychiatric patients. Five target behaviors--looking, irrelevant comments, hostile comments, inappropriate requests, and appropriate requests were monitored during role-played situations. Social-skills training, consisting of behavior rehearsal with modelling, focused instructions, and feedback, was introduced in a multiple-baseline design across individuals. Training improved all target behaviors. The improved behavior generalized to: (1) novel scenes role-played with the original respondent, (2) training and novel scenes role-played with a different respondent, and (3) interpersonal situations on the hospital ward.

To examine the generality of recent findings on PTSD etiology in help-seeking Vietnam combat veterans, replication was attempted with data from a national study of Vietnam-era men that included combat veterans. Use of a Guttman scaling technique for assessing combat exposure was found to be robust for use with a national nonclinical sample as well. In addition, multiple regression analysis was used to examine predictive relationships between premilitary adjustment, military adjustment, combat exposure, and post-traumatic stress disorder (PTSD). Results obtained from the national sample showed the same patterning as that reported from the smaller clinical sample. Combat exposure was related significantly to PTSD symptomatology, while premilitary adjustment was not. A previously identified discriminant function, composed of psychological symptoms not found in the DSM III criteria for PTSD, also was cross-validated.