Trauma-informed Approaches to Substance Use Interventions with Indigenous Peoples: A Scoping Review

Indigenous Peoples experience disproportionately higher rates of problematic substance use. These problems are situated in a context of individual and intergenerational trauma from colonization, residential schools, and racist and discriminatory practices, policies, and services. Therefore, substance use interventions need to adopt a trauma-informed approach. We aimed to synthesize and report the current literature exploring the intersection of trauma and substance use interventions for Indigenous Peoples. Fourteen databases were searched using keywords for Indigenous Peoples, trauma, and substance use. Of the 1373 sources identified, 117 met inclusion criteria. Literature on trauma and substance use with Indigenous Peoples has increased in the last 5 years (2012-2016, n = 29; 2017-2021, n = 48), with most literature coming from the United States and Canada and focusing on historical or intergenerational trauma. Few articles focused on intersectional identities such as 2SLGBTQIA+ (n = 4), and none focused on veterans. There were limited sources (n = 25) that reported specific interventions at the intersection of trauma and substance use. These sources advocate for multi-faceted, trauma-informed, and culturally safe interventions for use with Indigenous Peoples. This scoping review illuminates gaps in the literature and highlights a need for research reporting on trauma-informed interventions for substance use with Indigenous Peoples.

Group rehabilitation versus individual rehabilitation following knee and hip replacement: a pilot study with randomized, single-blind, cross-over design

BACKGROUND

In recent years a vast literature has been dedicated to cost effectiveness analysis. In the rehabilitation field, the search for less costly forms of treatment is an area under intense discussion by the rehabilitation scientific community. Group rehabilitation programs for some pathological conditions could permit better allocation of economic resources, but few studies evaluated the efficacy of group physiotherapy as opposed to individual physiotherapy.

AIM

The purpose of this study is to compare the effects of group rehabilitation (GrpR) with individual rehabilitation (IndR) for inpatients that have undergone knee and hip replacement. Design. This is a pilot study with randomized, single-blind, cross-over design.

SETTING

Inpatients Physiotherapy Department of Don Gnocchi Foundation.

METHODS

Clinical disability evaluation (JOASH, IKS, DI) and patient-oriented assessment (SF-36, WOMAC and VAS) were performed on 27 patients undergoing a physical therapy program after knee or hip replacement. Patients having partial weight-bearing postoperatively (about 50% of the total) and a range of motion >50% of the total in the joint replaced were included and then randomized (T0) in two intervention programs: GrpR/IndR - who performed GrpR for 15 days (T1), followed by the IndR for 15 days (T2); and IndR/GrpR - who performed the IndR for 15 days (T1), followed by GrpR for 15 days (T2).

RESULTS

Comparing the changes from baseline T1-T0 and T2-T1 separately in the two groups most outcomes showed no significant difference.

CONCLUSION

This pilot trial suggests that the group rehabilitation program is just as efficient as the individual rehabilitation for inpatients that have undergone knee and hip replacement and are able to weight-bear postoperatively. A potential benefit of group-based therapy is that it is less resource intensive.

Frozen sock use in the prevention of docetaxel-induced nails and skin toxicities: Results of a case-control study

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Background: Nails and skin toxicities (NST) of the hand occur in about 50% of patients (pts) treated with docetaxel (D). No clinical data exists on specific NST of the foot after D treatment. We prospectively investigated the efficacy and safety of an Elasto-Gel (Akromed, France) flexible frozen sock (FS) for the prevention of D-induced NST according to the results of a precedent study on the hand toxicities (JCO 2005). Methods: Cancer pts receiving D at 75 to 100 mg/m2 (one hour infusion q3w) alone or in combination were eligible for this matched case-control study. Each patient wore a FS for a total of 90 minutes (min) on the right foot (15 min before to 15 min after D-infusion). The left foot acted as control was not protected by FS. NST were assessed at each cycle using NCI-CTC version 3 criteria and documented by digital photography. Comfort in socks wearing was assessed using an ad-hoc scale. Wilcoxon matched-pairs ranks test as a non-parametric method was used to determine the magnitude of the difference in terms of nails and skin toxicities between two matched groups. Results: Forty-nine pts were included: median age 64 years, M/F: 37/12, ECOG performance status 0/1/2 (%): 46/39/15, type of cancer (%): prostate: 53; breast: 20; lung: 18; others: 8. Nails toxicities were significantly lower in the FS-protected foot compared with the control foot (P=0.002, Wilcoxon test). Grade (G) of nails toxicities were (FS vs. control %): G0 100 vs. 80, G1–3; 0 vs. 20. Skin toxicity was not significantly different (P=0.18) with a low incidence of disorder (%) G0: 94 vs. 90, G1: 2 vs. 4, G2: 0 vs. 2 (missing data for 2 pts). Median time until nails toxicities occurrence was not significantly different between feet: 97 days with FS vs. 74 days in control foot. Skin toxicity occurred in both sides after a median of 96 days. FS comfort satisfied 74% of patients. Conclusions: Frozen sock significantly reduced nails toxicities of the foot associated with docetaxel treatment.

No significant financial relationships to disclose.

Comparison of laser-assisted uvulopalatopharyngoplasty to electrocautery-assisted uvulopalatopharyngoplasty: a clinical and pathologic correlation in an animal model

OBJECTIVE

To determine if there are any pathologic or technical differences between laser-assisted uvulopalatopharyngoplasty (LAUP) and electrocautery-assisted uvulopalatopharyngoplasty (EAUP).

DESIGN

A prospective randomized in vivo trial in an appropriate animal species.

RESULTS

We found no gross difference in healing between the palates treated with laser and those treated with high-frequency electrocautery. However, there was consistently more thermal damage noted histologically in the hemipalates treated with LAUP. On the other hand, EAUP was faster to perform, more hemostatic, associated with less char formation, and had less histologic evidence of thermal damage.

CONCLUSIONS

These results raise the possibility that the beneficial effects of LAUP over traditional uvulopalatopharyngoplasty (UPPP) may be as a consequence of staging rather than the particular treatment modality used.