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Adults who experienced the 1992 and 2008 armed conflicts in the Republic of Georgia were exposed to multiple traumatic events and stressors over many years. The aim was to investigate what coping strategies are used by conflict-affected persons in Georgia and their association with mental disorders.
A cross-sectional survey was conducted with 3600 adults, representing internally displaced persons (IDPs) from conflicts in the 1990s (n = 1200) and 2008 (n = 1200) and former IDPs who returned to their homes after the 2008 conflict (n = 1200). Post-traumatic stress disorder, depression, anxiety and coping strategies were measured using the Trauma Screening Questionnaire, Patient Health Questionnaire-9, Generalised Anxiety and adapted version of the Brief Coping Inventory, respectively. Descriptive and multivariate regression analyses were used.
Coping strategies such as use of humour, emotional support, active coping, acceptance and religion were significantly associated with better mental health outcomes. Coping strategies of behavioural and mental disengagement, denial, venting emotions, substance abuse and gambling were significantly associated with poorer mental health outcomes. The reported use of coping strategies varied significantly between men and women for 8 of the 15 strategies addressed.
Many conflict-affected persons in Georgia are still suffering mental health problems years after the conflicts. A number of specific coping strategies appear to be associated with better mental health and should be encouraged and supported where possible.
Post-traumatic stress disorder (PTSD) is typically associated with high-risk population groups, but the risk of PTSD that is associated with trauma experienced in the community, and effect of changes in diagnostic criteria in DSM-5 on prevalence in the general population, is unknown.
Cross-sectional analysis of population-based data from 4558 adults aged 25–83 years resident in Caerphilly county borough, Wales, UK. Exposure to different traumatic events was assessed using categorisation of free-text descriptions of trauma. PTSD caseness was determined using items assessing Diagnostic and Statistical Manual IV (DSM-IV) and DSM-5 A criteria and the Traumatic Screening Questionnaire.
Of the 4558 participants, 1971 (47.0%) reported a traumatic event. The most common DSM-IV A1 qualifying trauma was life-threatening illnesses and injuries (13.6%). The highest risk of PTSD was associated with assaultive violence [34.1%]. The prevalence of PTSD using DSM-IV A criteria was 14.3% (95% confidence interval [CI] = 12.8, 15.9%). Using DSM-5 A criteria reduced the prevalence to 8.0 (95% CI = 6.9, 9.4%), primarily due to exclusion of DSM-IV A1 qualifying events, such as life-threatening illnesses.
Nearly one-half of a general community sample had experienced a traumatic event and of these around one in seven was a DSM-IV case of PTSD. Although the majority of research has concentrated on combat, rape and assaultive violence, life threatening illness is a more common cause of PTSD in the community. Removal of this traumatic event in DSM-5 could reduce the number of cases of PTSD by around 6.0%.
The development of ICD11 and DSM5 was seen as an opportunity to harmonize the two major classification systems for mental disorders. The proposed ICD11 and DSM5 diagnostic criteria for PTSD are markedly different. The implications of this remain to be seen, but have the potential to cause confusion to PTSD sufferers, clinicians, researchers and others impacted on by the condition.
Foreign language (FL) films with subtitles are becoming increasingly popular, and many European countries use subtitling as a cheaper alternative to dubbing. However, the extent to which people process subtitles under different subtitling conditions remains unclear. In this study, participants watched part of a film under standard (FL soundtrack and native language subtitles), reversed (native language soundtrack and FL subtitles), or intralingual (FL soundtrack and FL subtitles) subtitling conditions while their eye movements were recorded. The results revealed that participants read the subtitles irrespective of the subtitling condition. However, participants exhibited more regular reading of the subtitles when the film soundtrack was in an unknown FL. To investigate the incidental acquisition of FL vocabulary, participants also completed an unexpected auditory vocabulary test. Because the results showed no vocabulary acquisition, the need for more sensitive measures of vocabulary acquisition are discussed. Finally, the reading of the subtitles is discussed in relation to the saliency of subtitles and automatic reading behavior.
A new method for surface functionalization of inherently reactive polymers such as polyesters has been developed. It is based on the direct nucleophilic attack on the ester group in the polyethyleneterephtalate backbone by the acid moiety of polyacrylic acid (PAA) catalyzed by titaniumisopropoxide. The PAA grafted surfaces were characterized by X-ray photoelectron spectroscopy to demonstrated the presence of a thin grafted layer rendering the substrates hydrophilic. Subsequent acid group activation using N-ethyl-N'-(3-dimethylaminopropyl) carbodiimide hydrochloride allowed for in-situ collagen immobilization rendering the surfaces cell adhesive. Human smooth muscle and urothelial cells successfully seeded these surfaces, reaching confluence after 7 days.
How best to plan and provide psychosocial care following disasters remains keenly debated.
To develop evidence-informed post-disaster psychosocial management guidelines.
A three-round web-based Delphi process was conducted. One hundred and six experts rated the importance of statements generated from existing evidence using a one to nine scale. Participants reassessed their original scores in the light of others' responses in the subsequent rounds.
A total of 80 (72%) of 111 statements achieved consensus for inclusion. The statement ‘all responses should provide access to pharmacological assessment and management’ did not achieve consensus. The final guidelines recommend that every area has a multi-agency psychosocial care planning group, that responses provide general support, access to social, physical and psychological support and that specific mental health interventions are only provided if indicated by a comprehensive assessment. Trauma-focused cognitive–behavioural therapy (CBT) is recommended for acute stress disorder or acute post-traumatic stress disorder, with other treatments with an evidence base for chronic post-traumatic stress disorder being made available if trauma-focused CBT is not tolerated.
The Delphi process allowed a consensus to be achieved in an area where there are limitations to the current evidence.
Trauma focused cognitive behavioural therapy (TFCBT) is recommended as a first line treatment for post traumatic stress disorder (PTSD). Unfortunately, it is not widely available, often resulting in long waits for sufferers. We attempted to overcome this through a pilot feasibility study of brief training and supervision with a group of mental health professionals (MHPs). The MHPs attended a structured weekly clinical supervision group adhering to a cognitive therapy model of supervision. Eleven PTSD sufferers were treated during the pilot phase. Davidson Trauma Scale scores dropped by a mean of 36.5 points (95% C.I. 12.8, 60.5) over the course of treatment. Group Clinical Supervision for TFCBT appears to have the potential to offer a clinically and cost-effective model of maximizing treatment availability for PTSD sufferers.
With the exception of David Carpenter's chapter, all the papers in this volume were presented at the Third International Conference held under the auspices of the Centre for Late Antique and Medieval Studies at King's College London in the Great Hall of the College in April 1998. The theme was ‘Nobles and Nobility in the Middle Ages’, and the conference was planned to enable comparisons to be made across time, from the fifth to the late fifteenth century, and between very different areas and phases of political development, embracing regions as diverse as England (before and after the Norman Conquest), France, Poland, the Romano-German empire, Norway, and Portugal. One of the highlights of the conference was a performance of courtly music presented in the College Chapel by members of the College Choir, under the direction of Mr David Trendell.
Our grateful thanks are due to the British Academy, the Royal Historical Society, and the Humanties Research Committee of King's College London, all of whom provided financial assistance for various aspects of the Conference; to the Isobel Thornley Bequest, whose generous grant made possible the publication of this volume; to the Music faculty of King's for use of the Viscount St David's Room; to the Dean of King's, who allowed the College Chapel to be used for the concert; and to Janet L. Nelson, who translated the papers presented by Martin Aurell and Régine Le Jan.
In addition, the editor wishes to thank the Musées du Mans and the Radio Times Hutton Picture Library for permission to reproduce the illustrations in Plates 1 and 2.
The concept of nobility in the middle ages is the focus of this volume. Embracing regions as diverse as England (before and after the Norman Conquest), Italy, the Iberian peninsula, France, Norway, Poland, Portugal, and the Romano-German empire, it ranges over the whole medieval period from the fifth to the early sixteenth century. The articles confront many of the central issues about the origins and nature of `nobility', its relationship with the late Roman world, its acquisition and exercise of power, its association with military obligation, and its gradual `pacification' and transformation into a more or less willing instrument of royal government (indeed, the symbiotic relationship between royal, or imperial, and noble power is a recurring theme). Other ideas historically linked to the concept of nobility and discussed here are `nobility' itself; the distinction between nobility of birth and nobility of character; chivalry; violence and its effects; and noblewomen as co-progenitors and transmitters of nobility of blood.
Dr ANNE DUGGAN teaches in the Department of History at King's College London.