Personality disorders in young adult survivors of pediatric burn injury

The compound losartan cream inhibits scar formation via TGF-β/Smad pathway

The role of angiotensin receptor blocker in wound healing and cutaneous fibrosis has become a hotspot in recent years. We have developed a losartan cream that is comparable to triamcinolone ointment in inhibiting scarring. Considering the effects of chitosan and asiaticoside on wound healing and scarring, we added them to the losartan cream this time and improved the formula, expecting to get a better anti-scarring effect. The effects of creams were investigated on mouse scar model with triamcinolone ointment, onion extract gel, and commercial asiaticoside cream set as positive controls. A preliminary exploration of the mechanism involved in TGF-β/Smad pathway was performed in vivo and in vitro. With all results of anti-scarring, the compound losartan cream (containing chitosan, asiaticoside, and losartan) shows the best effect, followed by the chitosan asiaticoside cream. The treatment of the compound losartan cream inhibited expression of TGF-β1, collagen, and Smads, and decreased phosphorylation of Smad in vivo. These inhibitory effects were also confirmed in vitro. Our findings indicated that the compound losartan cream could inhibit scarring via TGF-β/Smad pathway. This cream might be an effective option for scar treatment.

The psychological impact of paediatric burn injuries: a systematic review

OBJECTIVE

To review and synthesise qualitative literature regarding the psychological outcomes following paediatric burn injuries, and to determine if children and adolescents who experience a burn injury have elevated risk of psychopathology following the injury.

DESIGN

Systematic review of quantitative and qualitative studies.

DATA SOURCES

Informit health, Medline, Embase, and PsycINFO were searched from January 2010 to December 2020.

DATA EXTRACTION AND SYNTHESIS

Two reviewers screened articles, and one reviewer extracted data (with cross-checking from another reviewer) from the included studies and assessed quality using an established tool. Narrative synthesis was used to synthesise the findings from the quantitative studies, and thematic synthesis was used to synthesise the findings of included qualitative studies.

RESULTS

Searches yielded 1240 unique titles, with 130 retained for full-text screening. Forty-five studies from 17 countries were included. The psychological outcomes included in the studies were mental health diagnoses, medication for mental illness, depression, anxiety, stress, fear, post-traumatic stress, post-traumatic growth, emotional issues, self-harm, self-esteem, self-concept, stigmatisation, quality of life, level of disability, resilience, coping, and suicidality.

CONCLUSIONS

Our findings highlight paediatric burn patients as a particularly vulnerable population following a burn injury. Studies suggest elevated anxiety and traumatic stress symptoms, and higher rates of psychopathology in the long-term. Further research is recommended to determine the psychological outcomes in the other mental health domains highlighted in this review, as findings were mixed. Clinical care teams responsible for the aftercare of burn patients should involve psychological support for the children and families to improve outcomes.

Psychosocial Interventions Targeting Recovery in Child and Adolescent Burns: A Systematic Review

Children post-burn injury experience a range of psychosocial sequelae that benefit from early provision of psychosocial support. However, no systematic review exists evaluating the full range of psychological interventions.

OBJECTIVE

To critically evaluate psychosocial interventions for children (<18 years old) with burn injuries in improving psychosocial recovery.

STUDY DESIGN

All-language studies were identified from inception to March 2018 in six electronic databases and appraised according to PRISMA checklist and Cochrane Risk of Bias Tool for quality. Studies were stratified into three groups: distraction (virtual reality, child life therapy, imagery-based therapy, hypnosis), burn camps, and other (social skills, cognitive behavioral therapy, parent group counseling).

RESULTS

Out of a total of 5,456 articles identified, 297 underwent full review resulting in 27 included articles published between 1986 and 2018. Sample sizes ranged from 9 to 266, comprising child and adult participants. A range of interventions and psychosocial outcome measures were found. Several studies (n = 21) reported statistically significant improvements in outcome; the majority were distraction interventions to reduce pain and anxiety. A limited number of studies showing effect was found for cognitive behavioral therapy and parent counseling. Risk of bias was high in studies of burn camps and mixed for all other interventions.

CONCLUSIONS

A range of psychosocial interventions and outcome tools exist in pediatric burns. Distraction interventions prior to and/or during dressing changes or physical therapy were shown to effectively reduce pain and anxiety for a wide range of pediatric ages.

Scarless wound healing: Transitioning from fetal research to regenerative healing

Since the discovery of scarless fetal skin wound healing, research in the field has expanded significantly with the hopes of advancing the finding to adult human patients. There are several differences between fetal and adult skin that have been exploited to facilitate scarless healing in adults including growth factors, cytokines, and extracellular matrix substitutes. However, no one therapy, pathway, or cell subtype is sufficient to support scarless wound healing in adult skin. More recently, products that contain or mimic fetal and adult uninjured dermis were introduced to the wound healing market with promising clinical outcomes. Through our review of the major experimental targets of fetal wound healing, we hope to encourage research in areas that may have a significant clinical impact. Additionally, we will investigate therapies currently in clinical use and evaluate whether they represent a legitimate advance in regenerative medicine or a vulnerary agent. WIREs Dev Biol 2018, 7:e309. doi: 10.1002/wdev.309 This article is categorized under: Adult Stem Cells, Tissue Renewal, and Regeneration > Regeneration Plant Development > Cell Growth and Differentiation Adult Stem Cells, Tissue Renewal, and Regeneration > Environmental Control of Stem Cells.

Women's recovery, negotiation of appearance, and social reintegration following a burn

The gendered nature of postburn coping has received scant research attention in South Africa, a country that has a high rate of burns with significant concentrations among women. In this study, narratives that emerged from in-depth interviews with seven women were examined. The narratives emphasized essential needs of these burn survivors for personal support, the complexities of negotiating intimate relationships, struggles with the humiliation from family and friends, in some instances strained relationships with children, the support found through religious beliefs and institutions, and often frustratingly slow psychological acceptance of scars. These difficulties faced by women survivors of burns have highlighted the need to include religion/spirituality, intimate male partners, and women's children into the psychological recovery process, in an attempt to assist women's journey to psychological and emotional healing after burn.

Cutaneous Scarring: Basic Science, Current Treatments, and Future Directions

Significance: Scarring of the skin from burns, surgery, and injury constitutes a major burden on the healthcare system. Patients affected by major scars, particularly children, suffer from long-term functional and psychological problems. Recent Advances: Scarring in humans is the end result of the wound healing process, which has evolved to rapidly repair injuries. Wound healing and scar formation are well described on the cellular and molecular levels, but truly effective molecular or cell-based antiscarring treatments still do not exist. Recent discoveries have clarified the role of skin stem cells and fibroblasts in the regeneration of injuries and formation of scar. Critical Issues: It will be important to show that new advances in the stem cell and fibroblast biology of scarring can be translated into therapies that prevent and reduce scarring in humans without major side effects. Future Directions: Novel therapies involving the use of purified human cells as well as agents that target specific cells and modulate the immune response to injury are currently undergoing testing. In the basic science realm, researchers continue to refine our understanding of the role that particular cell types play in the development of scar.

Mistrustful and Misunderstood: A Review of Paranoid Personality Disorder

PURPOSE OF REVIEW

Paranoid Personality Disorder (PPD) has historically been neglected by science out of proportion to its prevalence or its association with negative clinical outcomes. This review provides an update on what is known about PPD regarding its prevalence, demographics, comorbidity, biological mechanism, risk factors, and relationship to psychotic disorders.

RECENT FINDINGS

PPD has long been the subject of a rich and prescient theoretical literature which has provided a surprisingly coherent account of the psychological mechanism of non-delusional paranoia. Available data indicate that PPD has a close relationship with childhood trauma and social stress. Descriptive data on a sample of 115 individuals with Paranoid Personality Disorder is examined in comparison with a group of individuals with Borderline Personality Disorder. The descriptive data largely confirm previously identified relationships between Paranoid Personality Disorder and childhood trauma, violence, and race. We identify important similarities to and differences from Borderline Personality Disorder.

SUMMARY

PPD continues to be an important construct in the clinic and the laboratory. Available data lead to a reconsideration of the disorder as more closely related to trauma than to schizophrenia.

Psychometric Properties of a New Instrument for Assessing Irrational Thoughts in Burn Victims (Scale of Irrational Thoughts After Burn Injuries)

The objective of this study was to develop and evaluate a scale for assessing irrational thoughts among burned patients. The present study was mixed (qualitative-methodologic) which was performed in several stages such as investigating similar or related scales, interviewing with patients and psychologists. Content validity was calculated by modified KAPPA basis on relevance and clarity. The reliability of the scale was measured using internal consistency and the test-retest method. To determine the construct validity, exploratory factor analysis approach using maximum likelihood extraction with varimax rotation was conducted. A total of 329 burned patients were recruited from Tehran, Tabriz, and Kermanshah provinces of Iran. Modified kappa scores were 0.80 and 0.91 for relevance and clarity of the items included in scale. The Cronbach alpha for overall scale, subscale 1, and subscale 2 were 0.89, 0.88, and 0.8, respectively. Test-retest reliability was also acceptable (intraclass correlation coefficient = 0.80). The best solution from the maximum likelihood analysis of the 39 items of the scale revealed two factors corresponding to the two subscales with 14 items that subscale 1 (self-acceptance) consisted of 10 statements accounting for 60% of the variance (eigenvalue = 5.04) and subscale 2 (distastefulness and pity) consisted of four statements accounting for 40% of the variance (eigenvalue = 1.53). The scale reflects acceptable levels of validity and reliability in assessing the irrational thoughts among Iranian patients. Moreover, the testing populations of both patients with burned faces and patients with other burned body parts indicates that the scale may also be applicable for patients' burn disfigurements on any part of their bodies.

Impact of personality disorders on health-related quality of life one year after burn injury

PURPOSE

Personality disorders (PDs) are associated with significant distress, disability, and cause great difficulties in life. PDs have been suggested to influence adaptation after major burns, but the potential relationship has not been fully elucidated. This study aimed to describe the prevalence of PDs in 107 patients with major burn injury, and to identify the impact of PDs on perceived patient outcome assessed as health-related quality of life (HRQoL) one year after burn.

METHODS

One burn-specific instrument (Burn Specific Health Scale-Brief (BSHS-B)) and two generic instruments (EuroQol Five Dimensions and Short Form 36 Health Survey) were used, and Psychiatric Axis I and II disorders were assessed one year post burn.

RESULTS

This study identified an above normal prevalence of PDs among individuals afflicted by burn, and participants with PD had a significantly larger lifetime burden of Axis I disorders compared to participants without PD. Participants with PDs scored significantly lower than those without PD in the BSHS-B domain Skin involvement, and the effect of having a PD was related to the subscale Treatment regimens. There was no relationship between the presence of PD and generic HRQoL.

CONCLUSIONS

An implication of these observations is that special rehabilitation efforts including more tailored interventions must be offered to these patients to ensure that the obstacles they perceive to caring for themselves in this respect are eliminated.

IMPLICATIONS FOR REHABILITATION

This study identified an above normal prevalence of PDs among individuals afflicted by burn and these individuals reported poor burn-specific health-related quality of life. The identification of difficulties with compliance and endurance regarding daily skin care may cause negative consequences for optimal rehabilitation and underscore the importance of offering more tailored interventions in rehabilitation. Inflexible behavioral patterns related to the PD diagnosis imply the need for communication strategies by the rehabilitation team, which include flexibility, creativity, and diplomacy. There is a need for further research focusing on identifying the factors that facilitate the individual's own ability to take action and have control.

Management of Traumatic Wounds and a Novel Approach to Delivering Wound Care in Children

Significance: The costs and morbidity of pediatric traumatic wounds are not well known. The literature lacks a comprehensive review of the volume, management, and outcomes of children sustaining soft tissue injury. We briefly review the existing literature for traumatic wounds such as open fractures and burns. Such injuries require dedicated wound care and we propose a novel approach for more efficient and more effective delivery of dedicated pediatric wound care. Recent Advances: New pediatric literature is emerging regarding the long-term effects of wound care pain in traumatic injuries-especially burns. A variety of wound dressings and alternative management techniques exist and are geared toward reducing wound care pain. Our institution utilizes a unique model to provide adequate sedation and pain control through a dedicated pediatric wound care unit. We believe that this model reduces the cost of wound care by decreasing emergency department and operating room visits as well as hospital length of stay. Critical Issues: First, medical costs related to pediatric traumatic wound care are not insignificant. The need for adequate pain control and sedation in children with complex wounds is traditionally managed with operating room intervention. Afterward, added costs can be from a hospital stay for ongoing acute wound management. Second, morbidities of complex traumatic wounds are shown to be related to the acute wound care received. Future Directions: Further guidelines are needed to determine the most effective and efficient care of complex traumatic soft tissue injuries in the pediatric population.

Self-perceptions of young adults who survived severe childhood burn injury

The transition of pediatric burn survivors into adulthood is accompanied by a reformulation of their self-concept. To anticipate the need for and guide development of appropriate psychosocial interventions, this study examines how young adults who were burned as children perceive themselves and how this perception might affect their self-esteem. Eighty-two young adult burn survivors (45 male, 37 female) were assessed using the Tennessee Self-Concept Scale, 2nd edition (TSCS2) to determine how the participants perceive themselves and their interaction with society. To gain insight into the possible effects of these self-concept scores, relationships were analyzed between self-concept, a behavioral assessment (Young Adult Self-Report [YASR]), and a psychiatric symptom assessment (Structured Clinical Interview for DSM-IV Axis I Disorders [SCID I]). This group of burn survivors scored significantly lower in self-concepts, reflected in TSCS2 subscale scores of physical function, appearance, and sexuality, moral conduct, personal values, academics and work, and identity, than did the reference population. Pearson correlation coefficients showed that as moral, personal, family, and social aspects of self-concept decreased, clinical problems endorsed on the YASR subscales increased, including anxiety, somatic, attention, intrusive, and aggressive. Persons with lower self-concept scores on the TSCS2 personal, family, and social scales were more withdrawn on the YASR. Similarly, those with lower TSCS2 scores on the personal and family scales endorsed significantly more thought problems on the YASR. TSCS2 total self-concept, personal, and all of the supplementary scale scores were significantly lower for the group with an affective disorder. Those whose SCID I scores were consistent with a current anxiety disorder had significantly lower scores for the TSCS2 total self-concept and personal. Lower self-concept was associated with endorsement of SCID symptoms. In summary, the significantly lower self-concept scores on the TSCS2 physical scale are consistent with the physical disfigurement and handicaps common with major burn injuries, and a strong indication of this group's perception of the first impression made when interacting with others. The survivors seem to feel worthwhile within the contexts of family and friends. Although the major limitation of this study using the TSCS2 is the lack of a matched reference population to compare the burn survivors, the TSCS2 does help in gaining insight into the self-esteem issues of the burn survivor population.

The year in burns 2012

Approximately 2457 research articles were published with burns in the title, abstract, and/or keyword in 2012. This number continues to rise through the years; this article reviews those selected by the Editor of one of the major journals in the field (Burns) and his colleague that are most likely to have the greatest likelihood of affecting burn care treatment and understanding. As done previously, articles were found and divided into these topic areas: epidemiology of injury and burn prevention, wound and scar characterization, acute care and critical care, inhalation injury, infection, psychological considerations, pain and itching management, rehabilitation, long-term outcomes, and burn reconstruction. Each selected article is mentioned briefly with comment from the authors; readers are referred to the full papers for further details.