Katherine E. Miller

H-Y antibody development associates with acute rejection in female patients with male kidney transplants.

Background. Human minor histocompatibility antigens (mHA) and clinically relevant immune responses to them have not been well defined in organ transplantation. We hypothesized that women with male kidney transplants would develop antibodies against H-Y, the mHA encoded on the Y-chromosome, in association with graft rejection. Methods. We tested sera from 118 consecutive transplant recipients with kidney biopsies. Antibodies that specifically recognized the recombinant H-Y antigens RPS4Y1 or DDX3Y were detected by IgG enzyme-linked immunosorbent assay and western blotting. Immunogenic epitopes were further identified using overlapping H-Y antigen peptides for both the H-Y proteins. Results. In the 26 female recipients of male kidneys, H-Y antibody development posttransplant (1) was more frequent (46%) than in other gender combinations (P<0.001), (2) showed strong correlation with acute rejection (P=0.00048), (3) correlated with plasma cell infiltrates in biopsied kidneys (P=0.04), and (4) did not correlate with C4d deposition or donor-specific anti-human leukocyte antigen (HLA) antibodies. Of the two H-Y antigens, RPS4Y1 was more frequently recognized (P=0.005). Conclusion. This first demonstration of a strong association between H-Y antibody development and acute rejection in kidney transplant recipients shows that in solid organ allografts, humoral immune responses against well defined mHA have clear clinical correlates, can be easily monitored, and warrant study for possible effects on long-term graft function.

Meta-Analysis of the Prevalence of Unacknowledged Rape

Many sexual violence survivors do not label their experiences as rape but instead use more benign labels, such as “bad sex” or “miscommunication.” A meta-analysis was conducted to estimate the mean prevalence of unacknowledged rape and to inform our understanding of methodological factors that influence the detection of this phenomenon. Studies were identified using PsycINFO, PubMED, and PILOTS and were required to report the percentage of unacknowledged rape that had occurred since the age of 14 among female survivors. Moderator variables included mean participant age, recruitment source, rape definition, and unacknowledged rape definition. Twenty-eight studies (30 independent samples) containing 5,917 female rape survivors met the inclusion criteria. Based on a random effects model, the overall weighted mean percentage of unacknowledged rape was 60.4% (95% confidence interval [55.0%, 65.6%]). There was a large amount of heterogeneity, Q(29) = 445.11, p < .001, and inconsistency (I2 = 93.5%) among included studies. The prevalence was significantly higher among college student participants compared to noncollege participants. The findings supported that over half of all female rape survivors do not acknowledge that they have been raped. The results suggest that screening tools should use behaviorally descriptive items about sexual contact, rather than using terms such as “rape.”

Venous and arterial thromboembolic disease in women using oral contraceptives

Vascular plasminogen activator was measured by means of a new chromogenic assay in 24 women who had suffered from oral contraceptive-associated thrombotic disease and was compared to that in a control group of 78 premenopausal women. Vascular plasminogen activator levels were significantly reduced in the subjects who had venous thrombosis but not in the five women who had arterial thrombosis (0.04 +/- 0.03 versus 0.38 +/- 0.31, respectively) when compared to the levels in the control group (0.19 +/- 0.20). Since vascular activator levels distribute in a non-Gaussian manner, cases and controls were also stratified into deciles. Seventeen subjects who had suffered from venous thrombosis were stratified in the lowest three deciles, and two subjects, in the fourth and fifth deciles. Subjects who had suffered from arterial thrombosis were in the fourth or higher deciles. The conclusion is that, although there is a correlation between low levels of vascular plasminogen activator and venous thrombosis, no such correlation exists for arterial thrombosis.

Vascular plasminogen activator levels and thromboembolic disease in patients with gynecologic malignancies

Vascular plasminogen activator levels were measured preoperatively in 66 women with gynecologic malignancies. These levels were compared to levels in a matched control group of 84 women and to the incidence of postoperative venous thromboembolic disease in the patient group. Significantly lower levels of plasminogen activator were measured in patients who developed thrombotic complications (p = 0.0014). When results were stratified according to tumor location, patients with ovarian carcinoma had significantly higher activator levels than those found in control subjects (p = 0.0072), and significantly lower levels were associated with endometrial malignancy (p = 0.0140). Measurement of releasable plasminogen activator before operation may be an effective, noninvasive means of identifying patients potentially at risk for venous thromboembolic disease. Postoperative measurement of plasminogen activator may eventually find a role in monitoring tumor therapy and recurrence.

Efficacy of a brief treatment for nightmares and sleep disturbances for veterans.

Nightmares and sleep disturbances are common complaints among military Veterans (Plumb & Zelman, 2009) and may be difficult to eradicate (Forbes, Phelps, & McHugh, 2001). A treatment protocol (Exposure, Relaxation, and Rescription Therapy [ERRT]) targeting nightmares and sleep disturbances, which has been used effectively in civilian populations, was adapted for the military (ERRT-M). A pilot study evaluated the efficacy of ERRT-M in improving sleep quality and quantity and reducing nightmares, symptoms of posttraumatic stress disorder, and depression in a trauma-exposed, Veteran sample (N = 19). At 1 week after treatment, analyses revealed improvements in nightmare frequency and severity, depression, sleep quality, and insomnia severity. Treatment gains were maintained at a 2-month follow-up. Fifty percent of the sample was considered treatment responders (i.e., no nightmares in the previous week). Results of this pilot study suggest that directly targeting sleep and nightmares is successful in alleviating sleep disturbances and related psychopathology in some Veterans.

Sleep and Dreaming in Posttraumatic Stress Disorder

Purpose of ReviewSleep disturbances are core features of posttraumatic stress disorder (PTSD). This review aims to characterize sleep disturbances, summarize the knowledge regarding the relationships between trauma exposure and sleep difficulties, and highlight empirically supported and/or utilized treatments for trauma-related nightmares and insomnia.Recent FindingsTrauma-related nightmares and insomnia, and other sleep disorders, are frequently reported among trauma survivors. The roles of fear of sleep, REM density, and decreased parasympathetic activity are beginning to inform the relationship between trauma exposure and sleep difficulties. Additionally, the potential adaptive role of sleep loss immediately following a traumatic experience is being recognized. Interventions targeting these sleep disturbances show promise in reducing symptoms.SummaryResearch in understanding the role of sleep on the development, course, and treatment of PTSD is expanding. Longitudinal investigations are needed to further elucidate these relationships and identify treatments most effective in ameliorating symptoms.

Comprehensive Support for Family Caregivers: Impact on Veteran Health Care Utilization and Costs

This study aimed to examine the early impact of the Program of Comprehensive Assistance for Family Caregivers (PCAFC) on Veteran health care utilization and costs. A pre-post cohort design including a nonequivalent control group was used to understand how Veterans’ use of Veteran Affairs health care and total health care costs changed in 6-month intervals up to 3 years after PCAFC enrollment. The control group was an inverse probability of treatment weighted sample of Veterans whose caregivers applied for, but were not accepted into, PCAFC. Veterans in PCAFC had similar acute care utilization postenrollment when compared with those in the control group, but significantly greater primary, specialty, and mental health outpatient care use at least 30, and up to 36, months postenrollment. Estimated total health care costs for PCAFC Veterans were

Beyond gender: proximity to interpersonal trauma in examining differences in believing child abuse disclosures

1,500 to

Psychological outcomes after a sexual assault video intervention: a randomized trial

3,400 higher per 6-month interval than for control group Veterans. PCAFC may have increased Veterans’ access to care.

Preliminary validation of a brief measure of the frequency and severity of nightmares: The Trauma-Related Nightmare Survey.

Survivors of child sexual abuse (CSA) often delay disclosing or do not disclose the abuse for fear of not being believed. Studies document that women believe CSA disclosures more often than do men. Little research has examined theoretical underpinnings for gender differences in believing. However, 1 theory suggests that women may be more empathetic to disclosures because interpersonal trauma (IPT) is proximal to their lives. The present study aimed to extend understanding of how proximity to IPT may shape views of others’ experiences of IPT. This study examined whether proximity to IPT (i.e., knowing a close other who had experienced IPT) rather than personal experience would better account for the robust gender differences typically found in believing disclosures. College students (N = 279) completed self-report measures about their personal trauma history and responded to questions regarding knowledge of close others’ trauma histories. Participants read a vignette of an adult female disclosing CSA and rated the disclosure for believability. Results indicate that exposure to IPT increased believing, whereas gender did not. These results suggest that one’s proximity to IPT may be an alternative explanation for influence on believing CSA rather than gender alone.