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Pettke A, Stassen W, Laflamme L, Wallis LA, Hasselberg M. Changes in trauma-related emergency medical services during the COVID-19 lockdown in the Western Cape, South Africa. BMC Emerg Med 2023; 23:72. [PMID: 37370047 DOI: 10.1186/s12873-023-00840-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 06/05/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND To limit virus spread during the COVID pandemic, extensive measures were implemented around the world. In South Africa, these restrictions included alcohol and movement restrictions, factors previously linked to injury burden in the country. Consequently, reports from many countries, including South Africa, have shown a reduction in trauma presentations related to these restrictions. However, only few studies and none from Africa focus on the impact of the pandemic restrictions on the Emergency Medical System (EMS). METHODS We present a retrospective, observational longitudinal study including data from all ambulance transports of physical trauma cases collected during the period 2019-01-01 and 2021-02-28 from the Western Cape Government EMS in the Western Cape Province, South Africa (87,167 cases). Within this timeframe, the 35-days strictest lockdown level period was compared to a 35-days period prior to the lockdown and to the same 35-days period in 2019. Injury characteristics (intent, mechanism, and severity) and time were studied in detail. Ambulance transport volumes as well as ambulance response and on-scene time before and during the pandemic were compared. Significance between indicated periods was determined using Chi-square test. RESULTS During the strictest lockdown period, presentations of trauma cases declined by > 50%. Ambulance transport volumes decreased for all injury mechanisms and proportions changed. The share of assaults and traffic injuries decreased by 6% and 8%, respectively, while accidental injuries increased by 5%. The proportion of self-inflicted injuries increased by 5%. Studies of injury time showed an increased share of injuries during day shift and a reduction of total injury volume during the weekend during the lockdown. Median response- and on-scene time remained stable in the time-periods studied. CONCLUSION This is one of the first reports on the influence of COVID-19 related restrictions on EMS, and the first in South Africa. We report a decline in trauma related ambulance transport volumes in the Western Cape Province as well as changes in injury patterns, largely corresponding to previous findings from hospital settings in South Africa. The unchanged response and on-scene times indicate a well-functioning EMS despite pandemic challenges. More studies are needed, especially disaggregating the different restrictions.
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Affiliation(s)
- Aleksandra Pettke
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
| | - Willem Stassen
- Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa
| | - Lucie Laflamme
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Institute for Social and Health Sciences, University of South Africa, Pretoria, South Africa
| | - Lee Alan Wallis
- Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa
| | - Marie Hasselberg
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
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Langgartner D, Amoroso M, Kempter E, Kustermann M, Scheurer J, Lowry CA, Strauß G, Reber SO. Mycobacterium vaccae protects against glucocorticoid resistance resulting from combined physical and psychosocial trauma in mice. Brain Behav Immun 2023; 109:221-234. [PMID: 36736929 DOI: 10.1016/j.bbi.2023.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 01/09/2023] [Accepted: 01/29/2023] [Indexed: 02/04/2023] Open
Abstract
Stress-related somatic and psychiatric disorders are often associated with a decline in regulatory T cell (Treg) counts and chronic low-grade inflammation. Recent preclinical evidence suggests that the latter is at least partly mediated by stress-induced upregulation of toll-like receptor (TLR)2 in newly generated neutrophils and polymorphonuclear myeloid-derived suppressor cells (PMN-MDSCs), as well as glucocorticoid (GC) resistance in predominantly PMN-MDSCs following stress-induced upregulation of TLR4 expression. Here we show in mice exposed to the chronic subordinate colony housing (CSC) paradigm that repeated intragastric (i.g.) administrations of a heat-killed preparation of Mycobacterium vaccae NCTC 11659, a saprophytic microorganism with immunoregulatory properties, protected against the stress-induced reduction in systemic Tregs, increase in basal and LPS-induced in vitro splenocyte viability, as well as splenic in vitro GC resistance. Our findings further support the hypothesis that i.g. M. vaccae protects against CSC-associated splenic GC resistance via directly affecting the myeloid compartment, thereby preventing the CSC-induced upregulation of TLR4 in newly generated PMN-MDSCs. In contrast, the protective effects of i.g. M. vaccae on the CSC-induced upregulation of TLR2 in neutrophils and the subsequent increase in basal and LPS-induced in vitro splenocyte viability seems to be indirectly mediated via the Treg compartment. These data highlight the potential for use of oral administration of M. vaccae NCTC 11659 to prevent stress-induced exaggeration of inflammation, a risk factor for development of stress-related psychiatric disorders.
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Affiliation(s)
- Dominik Langgartner
- Laboratory for Molecular Psychosomatics, Department of Psychosomatic Medicine and Psychotherapy, Ulm University Medical Center, Ulm, Germany
| | - Mattia Amoroso
- Laboratory for Molecular Psychosomatics, Department of Psychosomatic Medicine and Psychotherapy, Ulm University Medical Center, Ulm, Germany
| | - Elena Kempter
- Laboratory for Molecular Psychosomatics, Department of Psychosomatic Medicine and Psychotherapy, Ulm University Medical Center, Ulm, Germany
| | - Monika Kustermann
- Department of Pediatrics and Adolescent Medicine, University Medical Center Ulm, Ulm, Germany
| | - Jasmin Scheurer
- Department of Pediatrics and Adolescent Medicine, University Medical Center Ulm, Ulm, Germany
| | - Christopher A Lowry
- Department of Integrative Physiology, Department of Psychology and Neuroscience, Center for Neuroscience and Center for Microbial Exploration, University of Colorado Boulder, Boulder, CO 80309, USA; Department of Physical Medicine and Rehabilitation and Center for Neuroscience, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA; Veterans Health Administration, Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), The Rocky Mountain Regional Veterans Affairs Medical Center (RMRVAMC), Aurora, CO 80045, USA; Military and Veteran Microbiome: Consortium for Research and Education (MVM-CoRE), Aurora, CO 80045, USA; VIVO Planetary Health, of the Worldwide Universities Network (WUN), West NY, NJ 07093, USA
| | - Gudrun Strauß
- Department of Pediatrics and Adolescent Medicine, University Medical Center Ulm, Ulm, Germany
| | - Stefan O Reber
- Laboratory for Molecular Psychosomatics, Department of Psychosomatic Medicine and Psychotherapy, Ulm University Medical Center, Ulm, Germany.
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Allen CH, Shold J, Michael Maurer J, Reynolds BL, Anderson NE, Harenski CL, Harenski KA, Calhoun VD, Kiehl KA. Aberrant resting-state functional connectivity associated with childhood trauma among juvenile offenders. Neuroimage Clin 2023; 37:103343. [PMID: 36764058 PMCID: PMC9929859 DOI: 10.1016/j.nicl.2023.103343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/20/2023] [Accepted: 02/03/2023] [Indexed: 02/10/2023]
Abstract
Individuals with history of childhood trauma are characterized by aberrant resting-state limbic and paralimbic functional network connectivity. However, it is unclear whether specific subtypes of trauma (i.e., experienced vs observed or community) showcase differential effects. This study examined whether subtypes of childhood trauma (assessed via the Trauma Checklist [TCL] 2.0) were associated with aberrant intra-network amplitude of fluctuations and connectivity (i.e., functional coherence within a network), and inter-network connectivity across resting-state networks among incarcerated juvenile males (n = 179). Subtypes of trauma were established via principal component analysis of the TCL 2.0 and resting-state networks were identified by applying group independent component analysis to resting-state fMRI scans. We tested the association of subtypes of childhood trauma (i.e., TCL Factor 1 measuring experienced trauma and TCL Factor 2 assessing community trauma), and TCL Total scores to the aforementioned functional connectivity measures. TCL Factor 2 scores were associated with increased high-frequency fluctuations and increased intra-network connectivity in cognitive control, auditory, and sensorimotor networks, occurring primarily in paralimbic regions. TCL Total scores exhibited similar neurobiological patterns to TCL Factor 2 scores (with the addition of aberrant intra-network connectivity in visual networks), and no significant associations were found for TCL Factor 1. Consistent with previous analyses of community samples, our results suggest that childhood trauma among incarcerated juvenile males is associated with aberrant intra-network amplitude of fluctuations and connectivity across multiple networks including predominately paralimbic regions. Our results highlight the importance of accounting for traumatic loss, observed trauma, and community trauma in assessing neurobiological aberrances associated with adverse experiences in childhood, as well as the value of trained-rater trauma assessments compared to self-report.
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Affiliation(s)
- Corey H Allen
- The Mind Research Network, 1101 Yale Blvd NE, Albuquerque, NM 87106-4188, USA.
| | - Jenna Shold
- The Mind Research Network, 1101 Yale Blvd NE, Albuquerque, NM 87106-4188, USA
| | - J Michael Maurer
- The Mind Research Network, 1101 Yale Blvd NE, Albuquerque, NM 87106-4188, USA
| | - Brooke L Reynolds
- The Mind Research Network, 1101 Yale Blvd NE, Albuquerque, NM 87106-4188, USA; School of Graduate Psychology, Pacific University, Hillsboro, OR, USA
| | | | - Carla L Harenski
- The Mind Research Network, 1101 Yale Blvd NE, Albuquerque, NM 87106-4188, USA
| | - Keith A Harenski
- The Mind Research Network, 1101 Yale Blvd NE, Albuquerque, NM 87106-4188, USA
| | - Vince D Calhoun
- Department of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, USA; Tri-Institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS), Georgia State University, Georgia Institute of Technology, Emory University, 55 Park Place NE, 18th Floor, Atlanta, GA 30303, USA; Department of Computer Science, Georgia State University, Atlanta, USA
| | - Kent A Kiehl
- The Mind Research Network, 1101 Yale Blvd NE, Albuquerque, NM 87106-4188, USA; Department of Psychology, University of New Mexico, Albuquerque, NM 87131, USA
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Marle T, Mash R. Trauma patients at the Helderberg District Hospital emergency centre, South Africa: A descriptive study. Afr J Emerg Med 2021; 11:315-320. [PMID: 33996422 PMCID: PMC8100500 DOI: 10.1016/j.afjem.2021.03.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 03/01/2021] [Accepted: 03/28/2021] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Trauma is a substantial component of South Africa's burden of disease. District hospitals provide primary trauma care for a large proportion of this trauma burden, although most studies are in specialised or tertiary settings. The aim was to evaluate the profile of physical trauma patients attending the emergency centre at Helderberg District Hospital, Cape Town. METHODS An observational descriptive study was conducted between 1 January and 30 April 2019. Patients with trauma were identified from a register and systematically sampled to achieve a sample size of 377. Retrospective data from medical records was collected and analysed in the Statistical Package for Social Sciences. RESULTS Of the 14,873 patients attending the emergency centre 24.6% were trauma related and 381 folders were analysed. Of these patients 30.4% were female and 69.6% male with an average age of 27.8 years. Over 60% of patients used an ambulance to get to the hospital. Sundays were the busiest days with 23.9% of all cases. Intentional trauma accounted for 45.4% of cases and accidental injuries 49.1%. The commonest mechanisms were sharp injuries (27.6%), falls (22.0%) and blunt trauma (19.4%). Intentional trauma made up more than half of all trauma in males, was more prevalent than accidental trauma between 20 and 60 years and resulted in a higher proportion of admissions. CONCLUSION There were high levels of intentional trauma, especially involving young males over the weekend, mostly with sharp objects. This trauma burden resulted in high numbers of admissions and transfer to tertiary hospitals. Family physicians and other generalists need to be well trained in trauma resuscitation and stabilisation. District hospital need to be appropriately equipped and supplied to manage trauma. Further research is needed to identify underlying modifiable factors that can be addressed through community-orientated interventions.
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Carlton M, Voisey J, Parker TJ, Punyadeera C, Cuttle L. A review of potential biomarkers for assessing physical and psychological trauma in paediatric burns. Burns Trauma 2021; 9:tkaa049. [PMID: 33654699 PMCID: PMC7901707 DOI: 10.1093/burnst/tkaa049] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 09/09/2020] [Accepted: 01/03/2021] [Indexed: 01/08/2023]
Abstract
Biological markers that evaluate physical healing as well as psychological impact of a burn are essential for effective treatment of paediatric burns. The objective of this review is to summarize the evidence supporting the use of biomarkers in children with burns. An extensive review of the literature was performed using PubMed. A total of 59 biomarkers were identified relating to burn presence, specifically relating to processes involved in inflammation, wound healing, growth and metabolism. In addition, biomarkers involved in the stress response cascade following a burn trauma were also identified. Although many biomarkers have been identified that are potentially associated with burn-related physical and psychological trauma, an understanding of burn biology is still lacking in children. We propose that future research in the field of children’s burns should be conducted using broad screening methods for identifying potential biomarkers, examine the biological interactions of different biomarkers, utilize child-appropriate biological fluids such as urine or saliva, and include a range of different severity burns. Through further research, the biological response to burn injury may be fully realized and clinically relevant diagnostic tests and treatment therapies utilizing these biomarkers could be developed, for the improvement of healing outcomes in paediatric burn patients.
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Affiliation(s)
- Morgan Carlton
- Queensland University of Technology (QUT), Centre for Children's Burn and Trauma Research, Centre for Children's Health Research, South Brisbane, Queensland, Australia
| | - Joanne Voisey
- Queensland University of Technology (QUT), Faculty of Health, School of Biomedical Sciences, Brisbane, Queensland, Australia
| | - Tony J Parker
- Queensland University of Technology (QUT), Faculty of Health, School of Biomedical Sciences, Brisbane, Queensland, Australia
| | - Chamindie Punyadeera
- Queensland University of Technology (QUT), Faculty of Health, School of Biomedical Sciences, Saliva and Liquid Biopsy Translational Laboratory, Brisbane, Queensland, Australia
| | - Leila Cuttle
- Queensland University of Technology (QUT), Centre for Children's Burn and Trauma Research, Centre for Children's Health Research, South Brisbane, Queensland, Australia
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Karabatzakis M, Den Oudsten BL, Gosens T, De Vries J. Psychometric properties of the psychosocial screening instrument for physical trauma patients (PSIT). Health Qual Life Outcomes 2019; 17:172. [PMID: 31718663 PMCID: PMC6852899 DOI: 10.1186/s12955-019-1234-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 10/15/2019] [Indexed: 02/08/2023] Open
Abstract
Background Early detection of psychosocial problems post-injury may prevent them from becoming chronic. Currently, there is no psychosocial screening instrument that can be used in patients surviving a physical trauma or injury. Therefore, we recently developed a psychosocial screening instrument for adult physical trauma patients, the PSIT. The aim of this study was to finalize and psychometrically examine the PSIT. Methods All adult (≥ 18 years) trauma patients admitted to a Dutch level I trauma center from October 2016 through September 2017 without severe cognitive disorders (n = 1448) received the PSIT, Impact of Events Scale-Revised (IES-R), Patient Health Questionnaire-9 (PHQ-9), Rosenberg Self-Esteem Scale (RSES), State-Trait Anxiety Inventory-State (STAI-S), and the World Health Organization Quality of Life-Abbreviated version (WHOQOL-Bref). After 2 weeks, a subgroup of responding participants received the PSIT a second time. The internal structure (principal components analysis, PCA; and confirmatory factor analysis, CFA), internal consistency (Cronbach’s alpha, α), test-retest reliability (Intraclass Correlation Coefficient, ICC), construct validity (Spearman’s rho correlations), diagnostic accuracy (Area Under the Curve, AUC), and potential cut-off values (sensitivity and specificity) were examined. Results A total of 364 (25.1%) patients participated, of whom 128 completed the PSIT again after 19.5 ± 6.8 days. Test-retest reliability was good (ICC = 0.86). Based on PCA, five items were removed because of cross-loadings ≥ 0.3. Three subscales were identified: (1) Negative affect (7 items; α = 0.91; AUC = 0.92); (2) Anxiety and Post-Traumatic Stress Symptoms (4 items; α = 0.77; AUC = 0.88); and (3) Social and self-image (4 items; α = 0.79; AUC = 0.92). CFA supported this structure (comparative fit index = 0.96; root mean square error of approximation = 0.06; standardized rood mean square residual = 0.04). Four of the five a priori formulated hypotheses regarding construct validity were confirmed. The following cut-off values represent maximum sensitivity and specificity: 7 on subscale 1 (89.6% and 83.4%), 3 on subscale 2 (94.4% and 90.3%), and 4 on subscale 3 (85.7% and 90.7%). Conclusion The final PSIT has good psychometric properties in adult trauma patients.
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Affiliation(s)
- Maria Karabatzakis
- Trauma TopCare, ETZ Hospital (Elisabeth-TweeSteden Ziekenhuis), Tilburg, The Netherlands
| | - Brenda Leontine Den Oudsten
- Center of Research on Psychological and Somatic Disorders (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - Taco Gosens
- Trauma TopCare, ETZ Hospital (Elisabeth-TweeSteden Ziekenhuis), Tilburg, The Netherlands.,Department of Orthopaedics and Traumatology, ETZ Hospital (Elisabeth-TweeSteden Ziekenhuis), Tilburg, The Netherlands
| | - Jolanda De Vries
- Trauma TopCare, ETZ Hospital (Elisabeth-TweeSteden Ziekenhuis), Tilburg, The Netherlands. .,Center of Research on Psychological and Somatic Disorders (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands. .,Department of Medical Psychology, ETZ Hospital (Elisabeth-TweeSteden Ziekenhuis), P.O. Box 90151, 5000 LC, Tilburg, The Netherlands.
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Christian MA, Samms-Vaughan M, Lee M, Bressler J, Hessabi M, Grove ML, Shakespeare-Pellington S, Coore Desai C, Reece JA, Loveland KA, Boerwinkle E, Rahbar MH. Maternal Exposures Associated with Autism Spectrum Disorder in Jamaican Children. J Autism Dev Disord 2019; 48:2766-2778. [PMID: 29549549 DOI: 10.1007/s10803-018-3537-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Autism spectrum disorder (ASD) is a complex neurodevelopmental disorder with poorly understood etiology. Many maternal exposures during pregnancy and breastfeeding potentially interfere with neurodevelopment. Using data from two age- and sex-matched case-control studies in Jamaica (n = 298 pairs), results of conditional logistic regression analyses suggest that maternal exposures to fever or infection (matched odds ratio (MOR) = 3.12, 95% CI 1.74-5.60), physical trauma (MOR 2.02, 95% CI 1.01-4.05), and oil-based paints (MOR 1.99, 95% CI 1.14-3.46) may be associated with ASD. Additionally, maternal exposure to oil-based paints may modify the relationship between maternal exposure to pesticides and ASD, which deepens our understanding of the association between pesticides and ASD.
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Affiliation(s)
- MacKinsey A Christian
- Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, USA.,Biostatistics/Epidemiology/Research Design (BERD) core, Center for Clinical and Translational Sciences (CCTS), The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Maureen Samms-Vaughan
- Department of Child and Adolescent Health, The University of the West Indies (UWI), Mona Campus, Kingston, Jamaica
| | - MinJae Lee
- Biostatistics/Epidemiology/Research Design (BERD) core, Center for Clinical and Translational Sciences (CCTS), The University of Texas Health Science Center at Houston, Houston, TX, USA.,Division of Clinical and Translational Sciences, Department of Internal Medicine, The University of Texas McGovern Medical School, Houston, TX, USA
| | - Jan Bressler
- Human Genetics Center, Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Manouchehr Hessabi
- Biostatistics/Epidemiology/Research Design (BERD) core, Center for Clinical and Translational Sciences (CCTS), The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Megan L Grove
- Human Genetics Center, Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | | | - Charlene Coore Desai
- Department of Child and Adolescent Health, The University of the West Indies (UWI), Mona Campus, Kingston, Jamaica
| | - Jody-Ann Reece
- Department of Child and Adolescent Health, The University of the West Indies (UWI), Mona Campus, Kingston, Jamaica
| | - Katherine A Loveland
- Department of Psychiatry and Behavioral Sciences, The University of Texas McGovern Medical School, Houston, TX, USA
| | - Eric Boerwinkle
- Human Genetics Center, Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, USA.,Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX, USA
| | - Mohammad H Rahbar
- Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, USA. .,Biostatistics/Epidemiology/Research Design (BERD) core, Center for Clinical and Translational Sciences (CCTS), The University of Texas Health Science Center at Houston, Houston, TX, USA. .,Division of Clinical and Translational Sciences, Department of Internal Medicine, The University of Texas McGovern Medical School, Houston, TX, USA.
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Løvstad M, Månum G, Wisløff-Aase K, Hafstad GS, Ræder J, Larsen I, Stanghelle JK, Schanke AK. Persons injured in the 2011 terror attacks in Norway - Relationship between post-traumatic stress symptoms, emotional distress, fatigue, sleep, and pain outcomes, and medical and psychosocial factors. Disabil Rehabil 2019; 42:3126-3134. [PMID: 31017034 DOI: 10.1080/09638288.2019.1585489] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Purpose: The main aim was to assess long-term post-traumatic stress symptoms, emotional distress, fatigue, sleep disturbances and pain in individuals hospitalized with physical injuries after two terror attacks in Oslo in 2011, approximately three years after the events. A secondary aim was to explore the relationship between these outcomes and medical and psychosocial factors.Materials and methods: Thirty of 43 potential persons participated. Injury characteristics were collected from medical charts. Level of post-traumatic stress, emotional distress, fatigue, sleep disturbances and pain was assessed and the association with injury severity, resilience, optimism, neuroticism and extroversion, and perceived access to social support was explored.Results: Nine of 30 met criteria for full or partial PTSD, and 14 of 30 displayed clinical levels of emotional distress. Fifteen reported moderate to severe fatigue, and 16 said sleep disturbances affected their daily life. Twelve indicated that pain affected daily activities and work ability, and 15 that pain affected their quality of life. I Resilience, optimism, neuroticism, and perceived social support, were associated with outcomes, but injury severity was not. When controlling for pain, many of the psychosocial variables failed to reach significance.Conclusions: Injury severity was not associated with outcomes. On the other hand, psychosocial factors were, but seemed to be influenced by pain.Implications for rehabilitationPersons who have obtained physical injuries under extreme psychological conditions such as terror, are at high risk of poor long-term outcomes, and will often be in need of comprehensive interdisciplinary rehabilitation services.Psychological outcomes are not associated with severity of physical injury, but premorbid and current psychological variables such as resilience, optimism, personality, and access to social support are highly associated with long-term outcome.Longstanding pain seems to diminish or weaken the role of protective psychological factors and should be addressed in the rehabilitation context.
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Affiliation(s)
- Marianne Løvstad
- Sunnaas Rehabilitation Hospital, Bjørnemyr, Norway.,Department of Psychology, University of Oslo, Oslo, Norway
| | - Grethe Månum
- Sunnaas Rehabilitation Hospital, Bjørnemyr, Norway.,Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Kristin Wisløff-Aase
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Anaesthesiology, Oslo University Hospital, Oslo, Norway
| | | | - Johan Ræder
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Anaesthesiology, Oslo University Hospital, Oslo, Norway
| | - Ingar Larsen
- Sunnaas Rehabilitation Hospital, Bjørnemyr, Norway
| | - Johan Kvalvik Stanghelle
- Sunnaas Rehabilitation Hospital, Bjørnemyr, Norway.,Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Anne-Kristine Schanke
- Sunnaas Rehabilitation Hospital, Bjørnemyr, Norway.,Department of Psychology, University of Oslo, Oslo, Norway
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Skinner HK, Rahtz E, Korszun A. Interviews following physical trauma: A thematic analysis. Int Emerg Nurs 2018; 42:19-24. [PMID: 30262432 DOI: 10.1016/j.ienj.2018.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Revised: 08/22/2018] [Accepted: 08/29/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Mental health problems are common in trauma survivors. In particular, depression, anxiety, acute stress disorder and post-traumatic stress disorder. Yet little is known about how these can be brought to the early attention of medical professionals through patients' accounts of trauma within days of being admitted to emergency care. This study aims to understand how physical trauma patients with early signs of psychological distress, stemming from the trauma, might be supported through their communications with healthcare professionals. METHODS 42 semi-structured interviews with trauma victims attending the Royal London Hospital Trauma Clinic, taken as part of a larger project, were analysed using a qualitative thematic analysis method with a critical realist approach. RESULTS Four key themes were highlighted: Pain and Death, Positivity, Powerlessness, and Remembering and Blame, each with relating subthemes such as Facing Death, Heroism, Waiting Time and Self-blame. DISCUSSION The themes present within the data suggest that there are cues shared by trauma survivors that medical professionals should attend to with regard to the future mental health of their patients. Results may further equip nurses and clinical staff to spot early signs immediately and shortly after trauma.
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10
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Ginty AT, Masters NA, Nelson EB, Kaye KT, Conklin SM. Cardiovascular reactions to psychological stress and abuse history: the role of occurrence, frequency, and type of abuse. Anxiety Stress Coping 2016; 30:155-162. [PMID: 27425575 DOI: 10.1080/10615806.2016.1210791] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND OBJECTIVES Extreme cardiovascular reactions to psychological stress have been associated with traumatic life experiences. Previous studies have focused on the occurrence or frequency of abuse rather than type of abuse. We examined how occurrence, frequency, and the type of abuse history are related to cardiovascular reactivity (CVR) to acute psychological stress. DESIGN The study consisted of between group and continuous analyses to examine the association between occurrence, type, and frequency of abuse with cardiovascular reactions to acute psychological stress. METHODS Data from 64 participants were collected. Heart rate, systolic blood pressure, and diastolic blood pressure were measured at baseline and during a standard mental arithmetic stress task. RESULTS Individuals who experienced abuse showed diminished CVR to acute psychological stress; this was driven specifically by the history of sexual abuse. Frequency of abuse did not relate to stress reactions. CONCLUSIONS These findings accord with previous work suggesting a relationship between traumatic life experience and hypoarousal in physiological reactivity and extend previous findings by suggesting the relationship may be driven by sexual abuse.
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Affiliation(s)
- Annie T Ginty
- a Department of Psychiatry , University of Pittsburgh , Pittsburgh , PA , USA
| | - Nicole A Masters
- b Neuroscience Program , Allegheny College , Meadville , PA , USA
| | - Eliza B Nelson
- c Schools of Medicine & Psychology and Neuroscience , University of St Andrews , St Andrews , UK
| | - Karen T Kaye
- d Department of Psychology , Brandeis University , Waltham , MA , USA
| | - Sarah M Conklin
- b Neuroscience Program , Allegheny College , Meadville , PA , USA.,e Department of Psychology , Allegheny College , Meadville , PA , USA.,f Global Health Studies Program , Allegheny College , Meadville , PA , USA
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Braje SE, Eddy JM, Hall GCN. A Comparison of Two Models of Risky Sexual Behavior During Late Adolescence. Arch Sex Behav 2016; 45:73-83. [PMID: 25925897 DOI: 10.1007/s10508-015-0523-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Revised: 09/18/2014] [Accepted: 12/14/2014] [Indexed: 05/16/2023]
Abstract
Two models of risky sexual behavior (RSB) were compared in a community sample of late adolescents (N = 223). For the traumagenic model, early negative sexual experiences were posited to lead to an association between negative affect with sexual relationships. For the cognitive escape model, depressive affect was posited to lead to engagement in RSB as a way to avoid negative emotions. The current study examined whether depression explained the relationship between sexual trauma and RSB, supporting the cognitive escape model, or whether it was sexual trauma that led specifically to RSB, supporting the traumagenic model. Physical trauma experiences were also examined to disentangle the effects of sexual trauma compared to other emotionally distressing events. The study examined whether the results would be moderated by participant sex. For males, support was found for the cognitive escape model but not the traumagenic model. Among males, physical trauma and depression predicted engagement in RSB but sexual trauma did not. For females, support was found for the traumagenic and cognitive escape model. Among females, depression and sexual trauma both uniquely predicted RSB. There was an additional suppressor effect of socioeconomic status in predicting RSB among females. Results suggest that the association of trauma type with RSB depends on participant sex. Implications of the current study for RSB prevention efforts are discussed.
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Affiliation(s)
- Sopagna Eap Braje
- Clinical Psychology Doctoral Program, California School of Professional Psychology-San Diego, Alliant International University, 10455 Pomerado Road, San Diego, CA, 92116, USA.
| | - J Mark Eddy
- Partners for Our Children, School of Social Work, University of Washington, Seattle, WA, USA
- Oregon Social Learning Center, Eugene, OR, USA
| | - Gordon C N Hall
- Department of Psychology, University of Oregon, Eugene, OR, USA
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Delahanty DL, Marley R, Fenton A, Salvator A, Woofter C, Erck D, Coleman J, Muakkassa F. A comparison between survival from cancer before and after a physical traumatic injury: physical trauma before cancer is associated with decreased survival. J Trauma Manag Outcomes 2015; 9:8. [PMID: 26543499 PMCID: PMC4634146 DOI: 10.1186/s13032-015-0029-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 10/28/2015] [Indexed: 01/30/2023]
Abstract
Background Prior traumatic experiences have been associated with poorer coping strategies, greater distress, and more posttraumatic stress disorder (PTSD) symptoms following a subsequent cancer diagnosis affecting their survival. However, the impact of prior physical traumatic injury on cancer survival has not been examined. Methods The present study matched patients from the same Level 1 Trauma center who appeared in both the trauma and cancer registries. A total of 498 patients met the criteria between 1998 and 2014 who have experienced both a diagnosis of cancer and a physical traumatic injury. The survival between the patients who had physical trauma before cancer (TBC) versus those that had physical trauma after the cancer diagnosis (TAC) were compared. Results The TBC group had a higher percentage of males (48 % vs 33 % p = 0.001) and motor vehicle collisions (18 % vs 7 %, p < 0.001), than the TAC group. TBC patients were also significantly younger than TAC patients at the time of the physical traumatic event (68.7 ± 14.6 vs 76.2 ± 12.0 years, p < 0.001), and longer length of time between the cancer diagnosis and physical traumatic injury (2.9 ± 2.9 vs 1.7 ± 2.6 years, p < 0.001). The overall probability of survival for the entire sample was 68 %. Percent survival for the TBC (n = 251) and TAC (n = 247) groups was 56 and 80 % respectively (p < 0.001). Results were consistent regardless of stage of cancer at diagnosis (hazard ratio (HR (Standard Error)). After adjusting for comorbidities Charlson comorbidity index (CCI) (HR = 1.2 (0.06), p = 0.009)), cancer stage (HR = 2.8 (0.12), p < 0.001)), lung cancer (HR = 1.7 (0.25), p < 0.001) and bladder cancer (HR = 3.5 (0.55), p = 0.02), experiencing a prior physical traumatic injury was associated with an increased HR for mortality of 4.6 (0.93), p < 0.001). Conclusions A physical traumatic episode before cancer diagnosis (TBC) increased the risk of death 4.6 fold compared to the TAC group even after adjusting for CCI, stage of cancer at diagnosis, lung cancer, and bladder cancer. These findings suggest considering a history of physical traumatic injury in cancer patients as a possible risk factor for faster cancer progression and mortality.
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Affiliation(s)
- Douglas L Delahanty
- Kent State University, Kent, Ohio USA ; Northeast Ohio Medical University, Rootstown, Ohio USA
| | | | | | | | | | - Daniel Erck
- West Virginia School of Osteopathic Medicine, Lewisburg, West Virginia USA
| | | | - Farid Muakkassa
- Akron General Medical Center, Akron, Ohio USA ; Trauma and Surgical Intensive Care Unit, Akron General Medical Center, 1 Akron General Avenue, Akron, OH 44307 USA
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