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Objective: Posttraumatic stress disorder (PTSD) symptoms and alcohol use commonly co-occur and present a prevalent clinical comorbidity. The self-medication/coping model has been applied most consistently to understand the PTSD-alcohol use association. However, there is a relative paucity of self-report measures designed to assess motivations for alcohol use, specifically for coping with PTSD symptoms. The goals of the present study were to develop and validate a measure that assesses the use of alcohol to cope with specific facets of PTSD symptomatology across two independent samples., Method: Two samples were evaluated: a university-based sample ( N = 617; 77.0% women; M age = 22.3; SD = 5.20) composed of racially diverse trauma-exposed students and a nationally representative sample ( N = 510; 52.5% women; M age = 39.5; SD = 10.9) of trauma-exposed adults who endorsed PTSD symptoms and past-year hazardous drinking. Both samples completed identical online questionnaire batteries. A Trauma-Related Alcohol Use Coping (TRAC) measure was developed and validated across both samples., Results: Confirmatory factor analysis was used to support the latent, hierarchical structure of the TRAC measure (total score; coping with intrusion, avoidance, negative alterations in cognitions and mood, and arousal/reactivity symptoms) and supported an 18-item version of the TRAC measure (university-based sample [ N = 617]: RMSEA = 0.047, 90% CI [.04, .05]; SRMR = 0.043; CFI = 0.95; TLI = 0.95; nationally representative sample [ N = 510]: RMSEA = 0.045, 90% CI [.04, .05]; SRMR = 0.021; CFI = 0.98; TLI = 0.97). The TRAC measure demonstrated excellent internal consistency, convergent, and discriminant validity with well-established measures of mental health, known-groups validity, and incremental validity relative to non-PTSD coping-motivated drinking., Conclusions: Overall, the TRAC measure can be used to assess the extent to which alcohol use is related to coping with PTSD symptoms. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Objective: Posttraumatic stress symptoms (PTSS) and anxiety sensitivity (AS) are associated with increased alcohol use and coping-motivated drinking among university students. This study among trauma-exposed Hispanic/Latinx university students sought to examine the indirect effect of PTSS on alcohol use severity through coping-motivated drinking and test the moderating role of AS and AS subfacets., Methods: University students who identified as Hispanic/Latinx ( N  = 830) were recruited from a large, urban, southern university and completed online, self-report questionnaires., Results: A significant interactive effect of PTSS and AS on coping-motivated drinking emerged. PTSS exerted a significant indirect effect on alcohol use severity, through coping-motivated drinking. Simple slope analyses revealed that PTSS was associated with coping-motivated drinking across all levels of AS. Post hoc results revealed unique biological sex differences in probable diagnosis odds ratios., Conclusions: These findings indicate that PTSS and AS are associated with coping-motivated drinking and alcohol use severity in trauma-exposed, Hispanic/Latinx university students.

Firefighters demonstrate heightened rates of posttraumatic stress disorder, depression, anxiety, and alcohol consumption, compared to the general population. This study examined whether firefighters who were satisfied with their romantic relationships experienced lower severities of commonly reported mental health symptoms compared to firefighters who were dissatisfied with their relationships. The sample included 200 firefighters (97% male; M age =41.4, SD =9.3) currently married or living with a romantic partner who completed self-report measures via online survey. An established cut-off score of 13.5 (Couples Satisfaction Index-4) was used to define groups. Firefighters who indicated that they were dissatisfied reported higher levels of all measured outcomes.

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, M age = 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 (Δ R ² = .045, p = .004), NACM symptoms (Δ R ² = .061, p < .001), and arousal/reactivity symptoms (Δ R ² = .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. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Background: Firefighters are at heightened risk of posttraumatic stress disorder (PTSD), underscoring the importance of understanding clinically targetable factors to inform evidence-based intervention development. Hedonic capacity, or the ability to experience pleasure, is a facet of reward functioning. Anhedonia (i.e., low or absent hedonic capacity) is a hallmark symptom of PTSD. Distress tolerance (DT), or the perceived ability to withstand negative emotional states, has also demonstrated associations with PTSD., Objective: The purpose of the present study was to examine the main and interactive effects of self-reported hedonic capacity (Snaith-Hamilton Pleasure Scale) and DT (Distress Tolerance Scale) on PTSD symptom severity among firefighters., Method: A hierarchical linear regression was performed among a sample of 802 trauma-exposed career firefighters, who completed a battery of self-report questionnaires. Covariates included trauma load (i.e., number of trauma types), years in the fire service, and depression symptoms (excluding anhedonia)., Results: Both hedonic capacity ( B = 2.71, SE = .95, p = .005) and DT ( B = -.21, SE = .03, p < .001) were incrementally associated with PTSD symptom severity. The interactive effect of hedonic capacity and DT was associated with heightened PTSD symptom severity ( B = .25, SE = .07, p < .001)., Conclusions: Hedonic capacity and DT were independently and transactionally associated with heightened PTSD symptom severity among trauma-exposed firefighters. These findings provide evidence for the utility in developing interventions that target DT and impaired hedonic capacity among firefighters, particularly those experiencing PTSD symptomatology. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Objective: The present investigation examined the main and interactive effects of coronavirus disease 2019 (COVID-19)-related medical vulnerability (CMV; the number of medical conditions with potential to elevate COVID-19 risk) and first responder status (emergency medical services roles vs non-emergency medical services roles) on mental health symptoms., Methods: A national sample of 189 first responders completed an online survey between June and August 2020. Hierarchal linear regression analyses were conducted and included the following covariates: years served as a first responder, COVID-19 exposure, and trauma load., Results: Unique main and interactive effects emerged for both CMV and first responder status. COVID-19-related medical vulnerability was uniquely associated with anxiety and depression, but not alcohol use. Simple slope analyses revealed divergent results., Conclusions: Findings suggest that first responders with CMV are more likely to experience anxiety and depressive symptoms and that these associations may vary by first responder role., (Copyright © 2023 American College of Occupational and Environmental Medicine.)

Trauma exposure and posttraumatic stress disorder (PTSD) symptoms among firefighters are prevalent and well-documented. Insecure adult attachment style (AAS) and distress tolerance (DT) present two factors with demonstrated relevance to the etiology and maintenance of PTSD. Few studies have examined these constructs in relation to PTSD symptomatology among firefighter populations. The present investigation examined the indirect effect of insecure romantic AAS (i.e., anxious AAS, avoidant AAS) on PTSD symptom severity through DT among firefighters. Exploratory analyses examined this model with each of the PTSD symptom clusters as outcomes. The sample was comprised of 105 firefighters ( M age=40.43, SD =9.15, 95.2% male) recruited from various departments in the southern U.S. An indirect effect was calculated using 10,000 bootstrapped samples. Indirect effects models in the primary analyses were significant when both anxious AAS ( β= .20, SE =.10, CI =.06-.43) and avoidant AAS ( β =.28, SE =.12, CI =.08-.54) were evaluated as predictors. Effects were evident after accounting for gender, relationship status, years of fire service, and trauma load (i.e., number of potentially traumatic event types experienced). Exploratory analyses revealed that anxious and avoidant AAS are both indirectly related to the PTSD intrusion, negative alterations in cognitions and mood, and alterations in arousal and reactivity symptom clusters through DT. Anxious AAS also demonstrated an indirect association with PTSD avoidance symptoms through DT. Attachment styles may influence PTSD symptoms among firefighters through a firefighter's perceived ability to withstand emotional distress. This line of inquiry has potential to inform specialized intervention programs for firefighters. Clinical and empirical implications are discussed., Competing Interests: Disclosure Statement The authors have no conflicts of interest to declare.

The current investigation employed a cross-sectional design to evaluate the associations of COVID-19 stress, sleep disturbance, and substance use among a national sample of 143 adults (57.3% male, M age  = 38.5 years, SD  = 11.28), surveyed at a single time-point using Amazon's MTurk platform. We hypothesized that COVID-19-related stress would be indirectly related to substance use outcomes (i.e. number of substance classes used daily, number of alcoholic drinks per occasion, substance use coping motives; but not substance use enhancement motives) through sleep disturbance severity. As expected, results indicated that the models examining indirect effects were statistically significant for number of substance classes used daily and substance use coping motives. However, there was no evidence that sleep disturbance explained the relation between COVID-19-related stress and number of alcoholic drinks per occasion or substance use enhancement motives. These findings underscore the importance of sleep disturbance in efforts to better understand how COVID-19-related stress is associated with certain types of substance use behavior.

Mindfulness-based interventions have demonstrated efficacy with regard to diverse psychological symptoms across populations. Few studies have evaluated the efficacy of mindfulness-based interventions for firefighters. This pilot randomized clinical trial (RCT) is designed to determine the preliminary efficacy, feasibility, and acceptability of a novel mindfulness-based workshop (entitled "Healthy Action Zone Mindful Attention Training" [HAZMAT]) developed for firefighters (Clinical Trials Identifier: NCT04909216). An anticipated sample size of 100 firefighters from a large fire department in the southern U.S. will be recruited. Firefighters will be randomized to: (1) HAZMAT workshop or (2) waitlist comparison condition. Outcomes will be assessed at baseline and five follow-up time-points: post-workshop, 1-week follow-up, 1-month follow-up, 3-month follow-up, and 6-month follow-up. First, we will evaluate the acceptability of the HAZMAT workshop as defined by firefighters' self-reported satisfaction with the workshop. Feasibility will be defined by the proportion of firefighters who start and complete the full workshop. Second, we will examine the efficacy of the HAZMAT workshop, as compared to waitlist, on psychological symptom reduction , as defined by: self-reported symptom severity of PTSD, depression, anxiety, suicidal ideation, and alcohol use at each follow-up time-point. Third, we will evaluate the impact of the HAZMAT workshop, as compared to waitlist, on putative treatment targets, indexed via self-reported levels of (1) mindful attention and (2) nonjudgmental acceptance each follow-up time-point., (© 2022 The Authors.)

Objectives: Firefighters are regularly exposed to potentially traumatic and injurious events and are at increased risk for developing posttraumatic stress disorder (PTSD) symptoms, pain, and pain-related disability. Mindfulness (i.e., present-oriented awareness and nonjudgmental acceptance of cognitions and bodily sensations) may influence PTSD-pain relations in firefighter populations and inform mutual maintenance models. The current cross-sectional study sought to examine the moderating role of mindfulness on the associations between PTSD symptom severity and pain-related disability and intensity among trauma-exposed firefighters., Methods: Firefighters ( N = 266; M age = 40.48, SD = 9.70; 92.5% male) were recruited from a large, southwestern metropolitan area and voluntarily completed an online, self-report survey advertised throughout the fire department., Results: Accounting for covariates (i.e., age, years in the fire service, trauma load), a significant interactive effect of PTSD symptom severity and mindfulness on pain-related disability (Δ R 2 = 0.05, B = - 0.16, p < .001), but not pain intensity, emerged. Simple slope analyses revealed that PTSD symptom severity was associated with pain-related disability for those with low, but not high mindfulness. Post hoc analyses examining mindfulness facets revealed significant main effects of acting with awareness, non-judging of inner experience, and nonreactivity to inner experience on pain-related disability. Significant interactive effects of observing, describing, and nonreactivity to inner experience with PTSD symptom severity on pain-related disability emerged., Conclusions: Mindfulness moderates PTSD symptom severity and pain-related disability associations in trauma-exposed firefighters. Future work should further examine these associations among first responders, using experimental and/or longitudinal methodologies., Competing Interests: Conflict of Interest The authors declare no competing interests.

Firefighters demonstrate high rates of posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD). Research has yet to compare how these diagnoses and their co-occurrence relate to firefighter mental health. This study evaluated trauma load, PTSD, alcohol use, depression, sleep, suicide risk, anger, and occupational stress across four discrete groups of firefighters ( N  = 660): (1) trauma-exposed only ( n  = 471), (2) probable PTSD-only ( n  = 36), (3) probable AUD-only ( n  = 125), and (4) probable PTSD-AUD ( n  = 28). Firefighters completed an online survey. Firefighters with probable PTSD-AUD demonstrated higher scores on all criterion variables, except trauma load, compared to firefighters with probable AUD-only or trauma-only. Firefighters with probable PTSD-AUD and probable PTSD-only reported similar levels of all indices, except alcohol use severity and suicide risk, which were higher among the probable PTSD-AUD group. Results provide preliminary empirical evidence of the deleterious impact of PTSD-AUD comorbidity among firefighters.

The association between distress tolerance (DT) and posttraumatic stress disorder (PTSD) is well established. This study aimed to provide an account of the magnitude of this effect across available studies. From the 2,212 records yielded by the initial search, 56 studies comprised 12,672 participants ( M age  =   29.96, SD  = 12.05; 44.94% women) were included in the investigation upon a priori criteria. Results demonstrated consistent negative associations between DT and PTSD symptoms, such that lower DT was associated with higher PTSD symptom severity and vice versa; the effect size (ES) was relatively small in magnitude (r  = -0.335, 95% CI [-0.379, -0.289]). Moreover, ESs for the DT-PTSD association were significantly greater for studies which examined self-reported DT compared to those that examined behavioral DT. The number of traumatic event types experienced (trauma load) was the most consistent moderator of the DT and PTSD association. The clinical implications of the role of DT in PTSD are discussed.

Firefighters are exposed to potentially traumatic events throughout their careers, placing them at heightened risk for the development of posttraumatic stress disorder (PTSD). Individuals experiencing PTSD symptoms often experience interpersonal problems and relationship stress, and this may be due to emotion regulation difficulties. The current study examined the association between PTSD symptoms, couple relationship satisfaction, and emotion regulation difficulties among firefighters. Participants were comprised of 188 firefighters ( M age = 41.32, SD = 9.25, 97.3% male) who completed an online questionnaire. Results indicated that PTSD symptom severity was negatively associated with relationship satisfaction and positively associated with emotion regulation difficulties. Additionally, there was a significant negative indirect effect of PTSD symptom severity on relationship satisfaction through heightened emotion regulation difficulties. Negative alterations in cognition and mood were especially relevant to emotion regulation difficulties and relationship satisfaction. Findings highlight the importance of understanding associations between PTSD and interpersonal functioning among firefighters. Emotion regulation difficulties may offer a clinically relevant transdiagnostic factor for targeting PTSD symptoms and relationship functioning among firefighters., Competing Interests: Disclosure of Interest The authors have no conflicts of interest to report.

Background: Anxiety sensitivity (AS), defined as the fear of anxiety-related sensations, is associated with increased risk for suicide and related behavior. However, investigations of AS have centered on primarily non-Hispanic White men and women and with limited attention to clinically relevant underlying factors., Methods: The purpose of this preliminary study was to examine the indirect effect of AS on suicide ideation and elevated suicide risk through mindfulness in a sample of 307 Black adults (79.2% female; M age  = 22.4, SD = 5.6). Participants completed an online questionnaire battery that included measures of AS, mindfulness, suicide ideation, and elevated suicide risk., Results: After controlling for age and gender, results indicated that AS was directly and indirectly associated with suicide ideation and elevated suicide risk via lower levels of mindfulness., Limitations: Limitations include using a cross-sectional methodological design and exclusive reliance on self-report measures., Conclusions: These findings provide preliminary insight into novel risk and protective factors that influence suicide ideation and elevated suicide risk among Black Americans., (Copyright © 2021. Published by Elsevier B.V.)

Objective: Persons in psychiatric inpatient hospitals represent a unique population with high rates of suicidal ideation and behavior as well as childhood maltreatment. Lower levels of perceived distress tolerance (DT) are associated with a history of childhood maltreatment and suicidal ideation and behavior in adulthood. Our study examined the association of childhood maltreatment severity with self-report and behavioral indices of suicide through perceived DT in a sample of adults in an acute-care psychiatric inpatient unit. We hypothesized that lower levels of perceived DT would account for the association between (a) childhood maltreatment severity and suicidal ideation severity and (b) childhood maltreatment severity and prehospitalization suicidality. Method: The sample was composed of 94 trauma-exposed adults (60% men; M age = 33.43; SD = 12.06) admitted to a psychiatric acute-care inpatient hospital in a large metropolitan area in the southern United States. Approximately 55% of the sample were hospitalized due to suicidality, with an average number of 1.28 ( SD = 2.42) prior suicide attempts; 3% of patients exhibited suicidality during their hospitalization. All patients reported experiencing at least one type of childhood maltreatment, with varying degrees of exposure. We conducted indirect effects analyses using PROCESS Macro for SPSS. Results: Childhood maltreatment severity was indirectly associated with both suicidal ideation severity and prehospitalization suicidality through DT. Conclusions: Findings advance our understanding of the association between childhood maltreatment and increased risk for suicidal ideation and behavior in adulthood, specifically among the psychiatric inpatient population. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Alcohol use has been associated with opioid misuse and dependence among adults with chronic pain. Yet, mechanisms underlying the relation between alcohol use problems and opioid misuse and dependence have yet to be fully explored among this population. Distress tolerance, reflecting the perceived ability to withstand negative emotional states, has demonstrated independent associations with alcohol use problems and opioid misuse, but these associations have not been explored among persons with chronic pain. The present study examined the moderating role of distress tolerance in terms of the association between alcohol use problems with opioid misuse and severity of opioid dependence. Participants included 424 adults (74.1% female; M age = 38.3, SD = 11.1) reporting current chronic pain and opioid medication use. Results indicated that alcohol use problems were significantly associated with current opioid misuse ( B = 0.54, p < .001) and severity of opioid dependence ( B = 0.08, p = .002) only for those with lower distress tolerance. These findings suggest that among individuals with chronic pain, the association between alcohol use problems and opioid misuse as well as opioid dependence severity is amplified among those with lower perceived distress tolerance. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Objective: Firefighters represent a distinct group of first responders that are at heightened risk of developing posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD). Assessing the role of transdiagnostic factors that underlie PTSD-AUD associations can inform specialized interventions among this population. This study included urban firefighters ( N  = 657) with probable PTSD-AUD ( n  = 27), probable PTSD-alone ( n  = 35), probable AUD-alone ( n  = 125), and trauma-exposure-only ( n  = 470). Methods: All firefighters completed a self-report, online questionnaire battery. Between group differences in anxiety sensitivity (AS), distress tolerance (DT), mindfulness, and emotional regulation difficulties (ERD) were assessed. It was hypothesized that firefighters with probable PTSD-AUD would endorse elevated AS and ERD, and reduced DT and mindfulness in comparison to all other diagnostic groups. Relationship status was included as a covariate in all comparisons. Results: Firefighters with probable PTSD-AUD endorsed elevated AS and ERD, and reduced DT and mindfulness in comparison to firefighters with trauma-exposure-only and probable AUD-alone. Firefighters with probable PTSD-AUD and probable PTSD-alone did not significantly differ. Conclusions: Given these findings, this line of inquiry has great potential to inform specialized, evidence-based mental health programming among firefighter populations, who represent a unique population susceptible to trauma-exposure, PTSD symptomology, and problematic alcohol use.

Firefighters are an understudied population that reports high rates of alcohol use and hazardous drinking. Pain, which is also commonly experienced by firefighters, may be associated with alcohol use and alcohol use motives, as research among the general population suggests that pain is associated with coping-oriented drinking. Pain-related anxiety, reflecting a tendency to respond to pain with anxiety or fear, may link pain to coping-oriented drinking among firefighters. Therefore, the current study examined the moderating role of pain-related anxiety on the association between pain intensity and alcohol use motives as well as alcohol use severity. The sample was comprised of 189 (M age  = 40.33, SD = 9.97, 89.9% male) firefighters. Results from the current study supported a significant moderation effect of pain-related anxiety on the association between pain intensity and alcohol use coping motives, whereby the association between pain intensity and coping motives was stronger for those with high compared to low pain-related anxiety. No significant moderation effects were documented for social, enhancement, or conformity motives; and no significant moderation effect was found for alcohol use severity. These results highlighted the potential importance of pain intensity and pain-related anxiety in coping-oriented alcohol use among firefighters., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Nicotine enhances the reinforcement of non-drug rewards by increasing nucleus accumbens (NAcc) reactivity to anticipatory cues. This anticipatory effect is selective as no clear evidence has emerged showing that nicotine acutely changes reward receipt reactivity. However, repeated rewarding experiences shift peak brain reactivity from hedonic reward outcome to the motivational anticipatory cue yielding more habitual cue-induced behavior. Given nicotine's influence on NAcc reactivity and connectivity, it is plausible that nicotine acutely induces this shift and alters NAcc functional connectivity during reward processing. To evaluate this currently untested hypothesis, a randomized crossover design was used in which healthy non-smokers were administered placebo and nicotine (2-mg lozenge). Brain activation to monetary reward anticipation and outcome was evaluated with functional magnetic resonance imaging. Relative to placebo, nicotine induced more NAcc reactivity to reward anticipation. Greater NAcc activation during anticipation was significantly associated with lower NAcc activation to outcome. During outcome, nicotine reduced NAcc functional connectivity with cortical regions including the anterior cingulate cortex, orbitofrontal cortex, and insula. These regions showed the same negative relationship between reward anticipation and outcome as noted in the NAcc. The current findings significantly improve our understanding of how nicotine changes corticostriatal circuit function and communication during distinct phases of reward processing and critically show that these alterations happen acutely following a single dose. The implications of this work explain nicotinic modulation of general reward function, which offer insights into the initial drive to smoke and the subsequent difficulty in cessation.

The comorbidity of post-traumatic stress disorder (PTSD) and alcohol use disorders (AUD) is prevalent, complex, and difficult to treat. Cue reactivity paradigms offer a clinically relevant scientific avenue to advance our understanding of PTSD/AUD comorbidity and ultimately inform evidence-based interventions. Cue reactivity paradigms evoke emotional, behavioral, and/or physiological responses by manipulating external (e.g. images, smells, scripts) cues. Through evaluation of how individuals with PTSD/AUD respond to trauma or alcohol cues (e.g. craving, distress, avoidance) in 'real' time, the theoretical framework for understanding functional associations between PTSD and AUD is refined. This brief narrative review of the recent literature (2015-present) will focus upon (1) summarizing the recently published cue reactivity studies relevant to PTSD/AUD, (2) explicating the limitations of the literature, and (3) discussing future empirical directions., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Firefighters represent a unique, vulnerable population at high risk for alcohol use disorder (AUD) and posttraumatic stress disorder (PTSD) symptomatology due to the high rates of occupational exposure to traumatic events. To inform specialized alcohol use interventions for firefighters, it is important to understand relevant malleable cognitive-affective factors related to PTSD and AUD symptoms. Distress tolerance (DT), defined as the perceived ability to withstand negative emotional states, is one promising factor relevant to this domain. The current study examined the moderating role of DT in the association of PTSD symptom severity with alcohol use severity and alcohol use motives. Participants included 652 trauma-exposed firefighters (93.3% male; M age  = 38.7 years, SD = 8.6) who endorsed lifetime (ever) alcohol use. Results indicated that there was a significant interactive effect of PTSD symptom severity and DT on coping-oriented alcohol use motives but not other alcohol-related outcomes. These findings were evident after adjusting for alcohol consumption, romantic relationship status, number of years in the fire service, occupational stress, and trauma load. This is the first study to concurrently examine these variables among firefighters and this line of inquiry has great potential to inform intervention efforts for this vulnerable, understudied population., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Despite the availability of smoking cessation strategies, smoking cue-induced craving remains a relatively untreated relapse risk factor. Utilizing nicotine-free electronic cigarettes (e-cigarettes) to extinguish the motivational influence of smoking cues may be a viable approach to address cue reactivity. In this pilot study, 26 daily tobacco smokers used nicotine-free e-cigarettes while being maintained on daily transdermal sustained-release nicotine replacement therapy (NRT) to mitigate pharmacological withdrawal. Sensitivity to cue-induced craving, measured by the rise in craving after a visual cue exposure task, was assessed at a baseline visit after smoking as usual and again after 2 weeks of nicotine-free e-cigarette and NRT use. Participants' pattern and amount of tobacco cigarette smoking were evaluated on both visits and 1 month posttreatment. Cue-induced craving significantly decreased after the 2-week intervention, yet withdrawal scores increased during this time. One month after study completion, participants continued to report significantly lower overall cigarette craving and conventional tobacco cigarette use. Including the 34.8% that were totally abstinent, 65.2% reported smoking fewer than 10 cigarettes per week (compared to 87.2 per week at baseline for the entire group). A linear regression revealed that greater baseline cue-induced craving predicted better outcomes, whereas more withdrawal at the e-cigarette visit was related to more smoking at 1 month. This proof-of-concept pilot study suggests that the addition of ad libitum nicotine-free e-cigarettes to an existing strategy of transdermal NRT may attenuate cue-induced craving for tobacco smoking. A larger sample that is powered for detecting additional factors and longer-term outcomes is warranted.

Background: Women experience greater difficulty quitting smoking than men, which may be explained by sex differences in brain circuitry underlying cognitive control. Prior work has linked reduced interhemispheric executive control network (ECN) coupling with poor executive function, shorter time to relapse, and greater substance use. Lower structural connectivity between a key ECN hub, the dorsolateral prefrontal cortex (DLPFC), and the dorsal striatum (DS) also contributes to less efficient cognitive control recruitment, and reduced intrahemispheric connectivity between these regions has been associated with smoking relapse. Therefore, sex differences were probed by evaluating interhemispheric ECN and intrahemispheric DLPFC-DS connectivity. To assess the potential sex by nicotine interaction, a pilot sample of non-smokers was evaluated following acute nicotine and placebo administration., Methods: Thirty-five smokers (19 women) completed one resting state functional magnetic resonance imaging scan. Seventeen non-smokers (8 women) were scanned twice using a repeated measures design where they received 2 and 0 mg nicotine., Results: In smokers, women had less interhemispheric ECN and DLPFC-DS coupling than men. In non-smokers, there was a drug x sex interaction where women, relative to men, had weaker ECN coupling following nicotine but not placebo administration., Conclusions: The current work indicates that nicotine-dependent women, versus men, have weaker connectivity in brain networks critically implicated in cognitive control. How these connectivity differences contribute to the behavioral aspects of smoking requires more testing. However, building on the literature, it is likely these deficits in functional connectivity contribute to the lower abstinence rates noted in women relative to men., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Nicotine dependence and major depressive disorder (MDD) are highly comorbid, yet causal links between these prevalent disorders are unclear. One possible mechanism is that nicotine ameliorates MDD-related neurobiological dysfunction in specific networks. For instance, cortico-striatal circuitry is enhanced by nicotine, and such paths are disrupted in individuals with MDD. Specifically, MDD has been associated with reduced connectivity between the nucleus accumbens (NAc) and rostral anterior cingulate cortex (rACC) but enhanced connectivity between the dorsal striatum (DS) and dorsolateral prefrontal cortex (DLPFC). Determining whether nicotine normalizes these circuits in non-smokers with MDD may elucidate mechanisms underlying links between disorders. This was tested by administering placebo and a 2-mg dose of nicotine to unmedicated non-smokers with and without MDD prior to collecting resting-state functional magnetic imaging data using a cross-over design. On placebo, individuals with MDD showed significantly reduced NAc-rACC and a trend for enhanced DS-DLPFC functional connectivity relative to healthy controls. In MDD, acute nicotine administration normalized both pathways to the level of healthy controls, while having no impact on healthy controls. Nicotine's effects on NAc-rACC connectivity was influenced by anhedonia, consistent with the role of this network in reward and nicotine's ability to enhance reward deficiencies in MDD. These results indicate that nicotine normalizes dysfunctional cortico-striatal communication in unmedicated non-smokers with MDD. Nicotine's influence on these circuitries highlights a possible mechanism whereby individuals with MDD are more vulnerable to develop nicotine dependence. Findings suggest that nicotinic agents may have therapeutic effects on disrupted cortico-striatal connectivity.

Background: Poor wound healing and scar formation remain critical problems in daily surgical practice. Generally, most attention is paid to intra- and postoperative interventions to improve wound healing after surgery, while preoperative interventions remain unsatisfactorily explored., Objectives: In this systematic review, the available literature on the beneficial effects of preoperative interventions on wound healing and scar formation have been summarized and compared., Methods: A comprehensive and systematic search has been conducted in MEDLINE, Pubmed, Embase, Web of Science, and Cochrane, supplemented by reference and citation tracking. All preoperative interventions and all clinically relevant outcome parameters have been considered for inclusion, due to the expected limited availability of literature., Results: A total of 13 studies were included, which were all randomized trials. No cohort studies or retrospective studies have been identified. All studies described different preoperative interventions and outcome parameters and could hence not be pooled and compared. Eight studies showed significantly better wound healing after a preoperative intervention. The individual studies have been summarized in this review., Conclusions: This systemic review shows that preoperative interventions can be beneficial in improving wound healing and scar formation. In selected cases, wound healing was found to benefit from a higher preoperative body temperature, topical vitamin E application, and low patient stress levels.

The fluorescence decay kinetics of 1-methylpyrene in small unilamellar l-alpha-dimyristoylphosphatidylcholine vesicles above the phase transition temperature has been studied as a function of concentration and temperature. When the 1-methylpyrene/phospholipid ratio equals 1:2000 no excimer is observed and the fluorescence decay is monoexponential. When this ratio is equal to or higher than 1 200, excimer is observed and the monomer and excimer decays can be adequately described by two exponential terms. The deviation of the monomer decays from monoexponentiality cannot be described by a model where the diffusion-controlled excimer formation is time dependent. The observed decays are compatible with the excimer formation scheme which is valid in an isotropic medium. The activation energy of excimer formation is found to be 29-9 +/-1.4 kJ mol . The (apparent) excimer formation constant and the excimer lifetime at different temperatures have been determined. The diffusion coefficient associated with the excimer formation process varies between 2 x 10(-10) m(2)/s at 70 degrees C to 4 x 10(-11) m(2)/s at 25 degrees C.