BACKGROUND & AIMS: BACKGROUND:Early and late dumping are complications of gastric bypass surgery. Early dumping occurs within an hour after eating, when the emptying of food into the small intestine triggers rapid fluid shifts into the intestinal lumen and the release of gastrointestinal hormones, resulting in gastrointestinal and vasomotor symptoms. Late dumping occurs between 1 and 3 hours after carbohydrate ingestion and is caused by an exaggerated insulin release, resulting in hypoglycemia. Almost no data are currently available on the prevalence of early and late dumping or their impact on health-related quality of life (QoL). OBJECTIVES:To study the prevalence of early and late dumping in a large population of patients having undergone a primary Roux-en-Y gastric bypass (RYGB) and its effect on QoL. SETTING:Cross-sectional study at a single bariatric department in the Medical Center Leeuwarden, The Netherlands between 2008 and 2011. METHODS:In 2013, this descriptive cohort study approached by email or post all patients who underwent a primary RYGB in the setting between 2008 and 2011 in one hospital. These patients were asked to fill in standardized questionnaires measuring their QoL (RAND-36), anxiety and depression (HADS), fatigue (MFI-20) and any disease specific indicators of early and late dumping syndrome. RESULTS:The questionnaire was completed and returned by 351 of 613 patients (57.1%) and 121 nonobese volunteers. Participants were mostly female (80%), aged 42 (40-54 years), with an excess weight loss of 76.8% [IQR 61-95] after RYGB surgery 2.3 [ IQR 1.6-3.4] years earlier. Self-reported complaints of moderate to severe intensity suggestive of early and late dumping were present in 18.8% and 11.7% of patients, respectively. Patients with early and late dumping demonstrated significantly lower scores on the RAND-36 and HADS compared with patients without dumping. No differences were seen in the MFI-20 scores between patients with or without early and late dumping. CONCLUSION:In this descriptive cohort, self-reported complaints suggestive of early and late dumping of moderate-to-severe intensity were, respectively, 18.8% and 11.7% in a cohort after primary gastric bypass surgery. These complaints were associated with markedly reduced health-related QoL.

背景与目标：

BACKGROUND & AIMS: BACKGROUND AND AIM:Little is known about the relation between gastroesophageal reflux (GER) episodes and sleep interruptions in infants. The aim of the study was to evaluate the relationship between GER and the incidence of sleep interruptions in infants. METHODS:Study patients included 24 infants (younger than 1 year) referred for multichannel intraluminal impedance and esophageal pH monitoring with simultaneous polysomnography. Exclusion criteria were a previous fundoplication and studies lasting <20 hours. Tests were clinically indicated to investigate suspicion of GER-related apnea (17, 70.8%), stridor (6, 25%), noisy breathing (2, 8.3%), and cyanotic spells (1, 4.2%). Most patients presented with significant comorbidities (19, 79.2%). RESULTS:The number of nonacid GER (NAGER) per hour was greater during sleep time than during daytime and awakening following sleep onset (median 0.27 vs 1.85 and 1.45, P<0.01). A total of 1204 (range 7-86 per infant) arousals in 24 infants was detected, 165 (13.7%) that followed GER episodes, and 43 (3.6%) that preceded GER episodes. Seven patients presented with a positive symptom association probability for arousals; 5 were exclusively because of NAGER. A positive symptom association probability for awakenings was detected in 9 patients; 4 were because of NAGER, 4 were because of AGER, and 1 was because of both NAGER and GER. Patients with awakenings related to GER presented longer mean clearance time of AGER during sleep (165.5 vs 92.8 seconds, P=0.03). CONCLUSIONS:GER was a frequent cause of interrupting sleep among our infant patients, and NAGER proved to be equally important as AGER for causing arousals and awakenings in infants.

背景与目标：

BACKGROUND & AIMS: :A brief 21-item symptom rating scale, the Psychiatric Outpatient Rating Scale (PORS), was developed for use in outpatient clinics. On the basis of its initial use with 86 patients, it was shown to have high internal and interjudge reliability and evidence of concurrent and construct validity. Scores on the PORS correlated significantly with the Global Assessment Scale and with the number of sessions of psychotherapy. For a subsample of 45 patients rated on the PORS at the beginning and termination of psychotherapy, seven symptoms revealed highly significant improvement. The PORS appears to be a potentially useful measure of change in outpatient clinics.

背景与目标： : 开发了一个简短的21项症状评定量表，即精神科门诊评定量表 (PORS)，用于门诊。根据86例患者的首次使用，它被证明具有较高的内部和中间信度以及并发和结构效度的证据。PORS的得分与全球评估量表和心理治疗次数显着相关。对于在心理治疗开始和终止时对PORS进行评分的45名患者的子样本，有7种症状显示出显着改善。PORS似乎是衡量门诊诊所变化的潜在有用指标。

BACKGROUND & AIMS: :Although affective disorders have been known to have sex differences in the associated clinical characteristics and quality of life (QOL), sex differences among patients with panic disorder (PD) have remained relatively unexplored in Korea. We examined the sex differences in different types of stressful life events (SLEs), coping styles, symptom severity, and health-related QOL (HRQOL) in patients with PD. Data from 291 female and 254 male participants diagnosed with PD were analyzed using a structured clinical interview following the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition criteria. Females with PD reported more SLEs including separation issues, physical illness or disability, and pregnancy-related problems than males. They also reported lower levels of confrontation and help-seeking coping strategies and higher levels of agoraphobia in symptom severity than males. The HRQOL of females with PD was significantly lower than male in physical functioning of HRQOL. This study suggests that the patient's sex is relevant to the assessment and treatment of PD.

背景与目标： : 尽管已知情感障碍在相关的临床特征和生活质量 (QOL) 方面存在性别差异，但在韩国，恐慌症 (PD) 患者之间的性别差异仍未得到探索。我们检查了PD患者不同类型的压力生活事件 (sle)，应对方式，症状严重程度和健康相关QOL (HRQOL) 的性别差异。根据《精神障碍诊断和统计手册》第4版标准，使用结构化临床访谈分析了291名被诊断为PD的女性和254名男性参与者的数据。患有PD的女性报告的SLEs比男性更多，包括分离问题，身体疾病或残疾以及与怀孕有关的问题。他们还报告说，与男性相比，对抗和寻求帮助的应对策略水平较低，而广场恐惧症的症状严重程度较高。PD女性的HRQOL在HRQOL的身体功能方面显着低于男性。这项研究表明，患者的性别与PD的评估和治疗有关。

BACKGROUND & AIMS: BACKGROUND:Palliative care is rarely being offered to patients with Parkinson's disease. AIM:To assess symptom prevalence, severity and palliative care needs in advanced stages of Parkinsonism. DESIGN:A cross-sectional survey using a palliative care assessment tool, the Palliative Outcome Scale was administered to patients. SETTING/PARTICIPANTS:Eight-two patients with a diagnosis of idiopathic Parkinson's disease, multiple systems atrophy or progressive supranuclear palsy were included in the study. RESULTS:Their mean age and disease stages 3-5 Hoehn and Yahr were 67 years and 4.1, respectively. Patients reported a mean of 10.7 (standard deviation = 3.9) physical symptoms. Over 80% had pain, fatigue, day time somnolence and problems with mobility. Other symptoms in 50%-80% included constipation, loss of bladder control, swallowing difficulties, drooling, breathlessness and sleep problems. Symptoms rated as causing severe problems were pain, fatigue, constipation and drooling. Assessment of mood revealed 70% of the patients felt anxiety and 60% had felt depressed. Eight-five per cent felt their families were anxious or worried about them. Thirty-eight per cent would have liked more information and 42% had practical problems that still needed to be addressed. There was a positive correlation between number of symptoms and disease severity (r = 0.39, p = 0.01). The total mean Palliative Outcome Scale score was 13.6 (standard deviation = 6.1), suggesting moderate palliative care needs. CONCLUSION:This is the first study to describe the care needs of people with Parkinson's disease using the Palliative Outcome Scale tool. The burden of symptoms and concerns was high in advanced stages of disease. It might be appropriate that people severely affected by these conditions should be considered for referral to specialist palliative care services.

背景与目标：

BACKGROUND & AIMS: OBJECTIVE:This study examined trajectories of posttraumatic stress disorder symptoms in Hurricane Katrina affected youth. METHOD:A total of 426 youth (51% female; 8-16 years old; mean age=11 years; 75% minorities) completed assessments at 4 time points post-disaster. Measures included Hurricane impact variables (initial loss/disruption and perceived life threat); history of family and community violence exposure, parent and peer social support, and post-disaster posttraumatic stress symptoms. RESULTS:Latent class growth analysis demonstrated that there were three distinct trajectories of posttraumatic stress disorder symptoms identified for this sample of youth (resilient, recovering, and chronic, respectively). Youth trajectories were associated with Hurricane-related initial loss/disruption, community violence, and peer social support. CONCLUSIONS:The results suggest that youth exposed to Hurricane Katrina have variable posttraumatic stress disorder symptom trajectories. Significant risk and protective factors were identified. Specifically, youth Hurricane and community violence exposure increased risk for a more problematic posttraumatic stress disorder symptom trajectory, while peer social support served as a protective factor for these youth. Identification of these factors suggests directions for future research as well as potential target areas for screening and intervention with disaster exposed youth. LIMITATIONS:The convenience sample limits the external validity of the findings to other disaster exposed youth, and the self-report data is susceptible to response bias.

背景与目标：

BACKGROUND & AIMS: :This report describes a case of diabetes insipidus associated with acute myelogenous leukemia. An 11-year-old boy presented with fatigue, polydipsia and polyuria. His evaluation revealed a diagnosis of acute myelogenous leukemia FAB-M2, and a water deprivation test confirmed the diagnosis of central diabetes insipidus. His brain magnetic resonance imaging (MRI) showed a thickened, enhancing pituitary stalk with absence of the normal hyperintense signal in the posterior pituitary. He was treated with systemic chemotherapy, intensive intrathecal therapy, and 1,000 cGy to the pituitary. The patient achieved a remission but continued to need desmopressin therapy to control his diabetes insipidus. Diabetes insipidus is a rare complication of acute myelogenous leukemia that can be caused by leukemic infiltration of the pituitary. The diabetes insipidus is irreversible despite intensive systemic and central nervous system chemotherapy and radiation.

背景与目标： : 本报告描述了一例与急性骨髓性白血病相关的尿崩症。一个11岁的男孩出现乏力，多饮和多尿。他的评估显示诊断为急性骨髓性白血病FAB-M2，缺水试验证实了中枢性尿崩症的诊断。他的脑磁共振成像 (MRI) 显示垂体柄增厚，增强，垂体后叶没有正常的高信号。他接受了全身化疗，强化鞘内治疗，并向垂体1,000 cGy。患者获得缓解，但继续需要去莫加压素治疗以控制其尿崩症。尿崩症是急性骨髓性白血病的罕见并发症，可由垂体的白血病浸润引起。尽管进行了大量的全身和中枢神经系统化疗和放疗，但尿崩症是不可逆的。

BACKGROUND & AIMS: :Currently available data indicate a clear and probably causal relationship between long-lasting gastroesophageal reflux disease, the development of long segments with specialized intestinal metaplasia in the distal esophagus and subsequent progression to adenocarcinoma. To a lesser degree, this also appears to be the case for short segments of specialized intestinal metaplasia in the distal esophagus. In contrast, epidemiological data and classic parameters for the diagnosis of gastroesophageal reflux disease do not currently support a causal role of gastroesophageal reflux in the pathogenesis of specialized intestinal metaplasia at the gastric cardia. Despite its high prevalence and malignant potential, many questions about the prevention and management of intestinal metaplasia in the distal esophagus remain unsolved. In patients with chronic gastroesophageal reflux, current modes of medical therapy do not appear to prevent the development of intestinal metaplasia, while effective anti-reflux surgery seems to have a protective effect. Formal studies with adequate follow-up are, however, still lacking. Neither acid-suppression therapy nor anti-reflux surgery, with or without mucosal ablation, can reliably prevent the malignant degeneration of established intestinal metaplasia of the esophagus. Close endoscopic surveillance with extensive biopsies, therefore, remains mandatory in such patients, irrespective of the treatment modality.

背景与目标： : 目前可用的数据表明，长期持续的胃食管反流病，远端食管中长节段的特殊肠上皮化生的发展以及随后发展为腺癌之间存在明确的因果关系。在较小的程度上，远端食道中特异肠化生的短节段似乎也是这种情况。相比之下，用于诊断胃食管反流疾病的流行病学数据和经典参数目前不支持胃食管反流在胃card门特殊肠化生的发病机理中的因果作用。尽管其高患病率和恶性潜能，但有关远端食管肠化生的预防和管理的许多问题仍未解决。在慢性胃食管反流患者中，目前的药物治疗模式似乎无法阻止肠上皮化生的发展，而有效的抗反流手术似乎具有保护作用。然而，仍然缺乏足够随访的正式研究。无论有无粘膜消融，抑酸疗法还是抗反流手术都不能可靠地预防已建立的食管肠化生的恶性变性。因此，对于此类患者，无论治疗方式如何，都必须进行密切的内窥镜检查和广泛的活检。

BACKGROUND & AIMS: Aims:To focus asthma care on those patients most in need whilst providing annual audit data. Methods:An observational questionnaire study. Patients on the asthma register received a postal invitation to the asthma clinic plus a questionnaire which enquired about both symptoms and the process of care. Medical records were searched for data on non-responders. Results:Of the 1241 people sent the invitation and questionnaire 682 (57%) returned it and 99 attended the clinic. Follow-up of responders with high morbidity resulted in a further 32 people attending. The 99 attenders had a higher morbidity than non-attenders on the criteria of a course of oral steroids in the last six months(15% v 29%)and a mean symptom score of 3 or more ( 12% v 31%). Conclusions:Whilst the process did focus care on those in need, and resulted in a manageable number of people attending the asthma clinic, many individuals with high morbidity or risk factors did not attend.

背景与目标：

BACKGROUND & AIMS: The objective of this study was to develop an indigenous measure of common mental disorders (CMD) in the Shona language in Zimbabwe. Ethnographic and qualitative studies elicited idioms of distress of mental disorder leading to the preliminary Shona Symptom Questionnaire (SSQ), and items from the Self-Report Questionnaire (SRQ) were added to it. The 56-item Preliminary Shona Symptom Questionnaire (PSSQ) was administered to 302 randomly selected primary care attenders, of whom 100 were classified as cases on the basis of agreement between care provider assessment and a psychiatric interview. Discriminant analysis identified 14 items that were the strongest predictors of mental disorder. The 14-item SSQ has a high level of internal consistency (Cronbach's alpha = 0.85). The items are a mixture of emic and etic phenomena. The total score correlates strongly with patients' self-assessment of the emotional nature of their illness. Satisfactory specificity and sensitivity occurred at a cut-off point of 7/8. The SSQ is the first indigenous measure of mental disorder developed in sub-Saharan Africa to have included idioms or distress of primary care attenders and involved patients consulting traditional medical practitioners. It promises to be a useful instrument for epidemiological and clinical research. The methodology used is an innovative way of combining etic and emic methods in the evaluation of CMD.

背景与目标： 这项研究的目的是开发一种针对津巴布韦Shona语言的常见精神障碍 (CMD) 的本地测量方法。人种学和定性研究引起了精神障碍困扰的成语，导致了初步的Shona症状问卷 (SSQ)，并在其中添加了自我报告问卷 (SRQ) 中的项目。对302随机选择的初级护理人员进行了56个项目的初步Shona症状问卷 (PSSQ)，其中100人根据护理提供者评估和精神病学访谈之间的协议被归类为病例。判别分析确定了14个项目是精神障碍的最强预测指标。14项SSQ具有高水平的内部一致性 (Cronbach's alpha = 0.85)。这些项目是emic和etic现象的混合物。总分与患者对疾病情感性质的自我评估密切相关。在7/8的临界点出现令人满意的特异性和敏感性。SSQ是撒哈拉以南非洲开发的第一个本地精神障碍措施，其中包括初级保健服务人员的成语或困扰，并涉及患者咨询传统医疗从业人员。它有望成为流行病学和临床研究的有用工具。所使用的方法是在CMD评估中结合etic和emic方法的一种创新方法。

BACKGROUND & AIMS: :Fatigue is a common symptom of patients with chronic kidney disease, but seldom investigated after transplantation. We determined the prevalence, impact and related factors of severe fatigue in kidney transplant recipients (KTRs). Medical records and questionnaires were used to assess kidney function, donor characteristics, fatigue (Checklist Individual Strength), functional impairments (Sickness Impact Profile), work status, body mass index (BMI), pain, depressive symptoms, social support and sleeping problems in 180 participating KTRs. KTRs were compared with sex- and age-matched population-based controls. KTRs were significantly more often severely fatigued (39%) compared to matched controls (22%; P = 0.001). Severely fatigued KTRs had significantly more functional impairments than nonseverely fatigued recipients (effect size ≥ 0.7) P < 0.001, and less often a paid job (27% vs. 48%, P = 0.005). Univariate analysis showed that severely fatigued KTRs received more often a kidney from a deceased donor, had a higher BMI, more pain, discrepancy in social support, depressive symptoms and sleeping problems. In a multivariate analysis (n = 151) the latter two associations remained significant. Severe fatigue is a highly prevalent and disabling symptom in KTRs. Moreover, severe fatigue after kidney transplantation is more strongly related to behavioural and psychosocial factors than specific transplantation-related factors. Findings have implications for fatigue management.

背景与目标： 乏力是慢性肾脏疾病患者的常见症状，但移植后很少进行研究。我们确定了肾移植受者 (KTRs) 严重乏力的患病率，影响和相关因素。使用病历和问卷来评估肾功能，供体特征，乏力 (个人力量清单)，功能障碍 (疾病影响特征)，工作状态，体重指数 (BMI)，疼痛，抑郁症状，社会支持和睡眠问题参加KTRs的180。将KTRs与性别和年龄匹配的基于人群的对照进行比较。与匹配的对照组 (22%; P = 0.001) 相比，ktr明显更经常严重疲劳 (39%)。严重疲劳的KTRs比非严重疲劳的接受者具有明显更多的功能障碍 (效应大小 ≥ 0.7) P <0.001，并且很少有报酬的工作 (27% 对48%，P = 0.005)。单变量分析显示，严重疲劳的KTRs更经常从已故捐赠者那里获得肾脏，BMI更高，疼痛更多，社会支持差异，抑郁症状和睡眠问题。在多变量分析 (n = 151) 中，后两种关联仍然显著。严重乏力是KTRs中非常普遍的致残症状。此外，与特定的移植相关因素相比，肾移植后的严重乏力与行为和社会心理因素的关系更为密切。研究结果对乏力管理有影响。

BACKGROUND & AIMS: Health surveys, studies on physical symptom reporting, and medical registration of physical complaints find consistent sex differences in symptom reporting, with women having the higher rates. By and large, this female excess of physical symptoms is independent from the symptom measure, response format and time frame used, and the population under study. As most studies concern healthy individuals, the sex difference can not simply be attributed to a greater physical morbidity in women. In this paper we propose a number of explanations for this phenomenon, based on a biopsychosocial perspective on symptom perception. We discuss a symptom perception model that brings together factors and processes from the extant literature which are thought to affect symptom reporting, such as somatic information, selection of information through attention and distraction, attribution of somatic sensations, and the personality factors somatisation and negative affectivity. Finally, we discuss the explanations for sex differences in physical symptoms that arise from the model.

背景与目标： 健康调查，身体症状报告研究和身体不适的医疗登记发现，症状报告中的性别差异一致，女性的比率更高。总的来说，这种女性过度的身体症状与症状度量，反应格式和使用的时间范围以及所研究的人群无关。由于大多数研究都涉及健康个体，因此性别差异不能简单地归因于女性的身体发病率更高。在本文中，我们基于症状感知的生物心理社会观点，对这种现象提出了许多解释。我们讨论了一种症状感知模型，该模型将现有文献中的因素和过程汇集在一起，这些因素和过程被认为会影响症状报告，例如躯体信息，通过注意力和分心选择信息，躯体感觉的归因以及人格因素躯体化和负面情感。最后，我们讨论了模型引起的身体症状性别差异的解释。

BACKGROUND & AIMS: BACKGROUND:No studies have evaluated associations between patterns of diet-related practices as determined by latent class analysis (LCA) and gastro-esophageal reflux disease (GERD). We aimed to assess this relationship in a large sample of Iranian adults. METHODS:In a cross-sectional study in 4763 adults, diet-related practices were assessed in four domains, 'meal pattern', 'eating rate', 'intra-meal fluid intake', and 'meal-to-sleep interval', using a pretested questionnaire. LCA was applied to identify classes of diet-related practices. We defined GERD as the presence of heartburn sometimes, often or always. KEY RESULTS:The prevalence of GERD in the study population was 23.5% (n = 1120). We identified two distinct classes of meal patterns: 'regular' and 'irregular', three classes of eating rates: 'moderate', 'moderate-to-slow', and 'moderate-to-fast', two major classes of fluid ingestion with meals: 'moderate' and 'much intra-meal drinking', and two classes regarding the interval between meals and sleeping: 'short' and 'long meal-to-sleep' interval. After adjustment for potential confounders, subjects with 'irregular meal pattern' had higher odds of GERD compared with subjects with 'regular meal pattern' (OR: 1.21; 1.00-1.46). However, when taking into account BMI, the association disappeared. 'Long meal-to-sleep interval' was inversely associated with GERD compared with 'short meal-to-sleep interval' (OR: 0.73; 95% CI: 0.57-0.95). 'Eating rate' and 'intra-meal fluid intake' were not significantly associated with GERD. CONCLUSIONS & INFERENCES:Our data suggest certain associations between dietary patterns and GERD. These findings warrant evaluation in prospective studies to establish the potential value of modifications in dietary behaviors for the management of GERD.

背景与目标：

BACKGROUND & AIMS: BACKGROUND:European studies have shown that itch is a widespread symptom, yet little is known about its frequency in the United States. OBJECTIVE:We sought to describe ambulatory care visits to clinicians in the United States for which itch was coded as a patient symptom. METHODS:This study uses retrospective data from the National Ambulatory Medical Care Survey from 1999 through 2009. RESULTS:Itch was coded as a symptom for an average of 7 million visits per year or approximately 1% of all outpatient visits, which was nearly 40% of the number of visits for the symptom of low back pain. Patients seen in visits for itch were more likely to be black or Asian than other patients (20% vs 14%). They were also more likely than other patients to receive a new medication (68% vs 36%) and were over twice as likely to receive 2 or more new medications (31% vs 14%). LIMITATIONS:Secondary data sets may not optimally capture patient reports and some of the procedures or medications may have been ordered for reasons other than itch. CONCLUSION:Visits to clinicians for itch represent a sizeable proportion of ambulatory care visits in the United States, and research on the epidemiology, treatments, and causes of itch should be a priority.

背景与目标：

BACKGROUND & AIMS: :Exploring how PTSD and alcohol misuse relate to women's use of intimate partner violence (IPV) is vital to develop our understanding of why some women may engage in IPV, which can serve to maximize intervention efforts for women. This study examined the extent to which posttraumatic stress disorder (PTSD) symptom clusters are directly and indirectly related to women's use of IPV through pathways involving alcohol misuse while controlling for severity of women's IPV victimization. The sample was comprised of substance-using, low socioeconomic status community women (N = 143) currently experiencing IPV victimization. The majority of the sample was African American (n = 115, 80.42%). This sample had an average annual household income of $14,368.68 (SD = $12,800.68) and the equivalent of a high school education (11.94 years, SD = 1.32). Path analyses indicated that the strongest statistical relationship emerged between women's use of IPV and women's IPV victimization. PTSD reexperiencing and numbing symptom severity was related to women's use of psychological, minor physical, and severe physical IPV; however, these relationships were indirect through alcohol misuse. Findings lend preliminary support for the application of the self-medication hypothesis to the study of PTSD, alcohol misuse, and IPV among women.

背景与目标： : 探索PTSD和酒精滥用与妇女使用亲密伴侣暴力 (IPV) 之间的关系，对于发展我们对为什么某些妇女可能参与IPV的理解至关重要，这可以最大程度地为妇女提供干预。这项研究调查了创伤后应激障碍 (PTSD) 症状群通过涉及酒精滥用的途径与女性使用IPV直接和间接相关的程度，同时控制了女性IPV受害的严重程度。样本由目前正在遭受IPV受害的物质使用，低社会经济地位的社区妇女 (N = 143) 组成。大多数样本是非裔美国人 (n = 115，80.42%)。该样本的平均家庭年收入为 $14,368.68 (SD = $12,800.68)，相当于高中教育 (11.94年，SD = 1.32)。路径分析表明，妇女使用IPV与妇女IPV受害之间存在最强烈的统计关系。PTSD的再体验和麻木症状的严重程度与女性使用心理，轻微身体和严重身体IPV有关; 但是，这些关系是通过酒精滥用间接的。研究结果为自我用药假说在PTSD，酒精滥用和IPV研究中的应用提供了初步支持。