Liberals are Believers: Young People Assign Trust to Social Media for COVID-19 Information.

The COVID-19 pandemic has challenged existing health communication strategies as more people turn to social media as a primary health information source. Although many studies have explored how young people use social media, this study examined how sociodemographic factors and political ideology are associated with use and trust in social media as a source for COVID-19 information among young adults, and how use and trust in social media as a COVID-19 information source are associated with their beliefs about COVID-19. In Spring 2021, an online survey was conducted among 2,105 18-29-year-old students at an urban university in California. Our findings show that younger, female, non-binary, Asian, and Black/African American students are most likely to obtain and trust COVID-19 information on social media. Results also suggest that liberal students are more likely to turn to social media as a source for COVID-19 information compared to conservatives. However, conservative students who use social media as a source for information were more likely to believe false health information about prevention measures and the vaccine and to have lower perceived effectiveness of COVID-19 prevention behaviors and vaccination compared to liberals.

High engagement in nonpharmaceutical interventions and their associations with reduced COVID-19 among US college students.

BACKGROUND: Nonpharmaceutical interventions, including face mask-wearing, physical distancing, and avoidance of crowds and poorly ventilated spaces, have been widely recommended to limit the spread of SARS-CoV-2. To date, there is little data available on engagement in nonpharmaceutical interventions and COVID-19 in college students. Using a large sample of college students, we estimate the prevalence of engagement in mask-wearing, physical distancing, and avoidance of crowds/poorly ventilated spaces and their associations with COVID-19. METHODS: A cross-sectional study was conducted (February-March 2021) using a college-wide online survey among students (n = 2,132) in California. Multiple modified poisson regression models assessed associations between mask-wearing indoors, physical distancing (both indoors or public settings/outdoors), avoidance of crowds/poorly ventilated spaces and COVID-19, controlling for potential confounders. RESULTS: Fourteen percent (14.4%) reported a previous COVID-19 illness. Most students reported wearing masks consistently indoors (58%), and 78% avoided crowds/poorly ventilated spaces. About half (50%) reported consistent physical distancing in public settings/outdoor and 45% indoors. Wearing a mask indoors was associated with 26% lower risk of COVID-19 disease (RR = 0.74; 95% CI: 0.60,0.92). Physical distancing indoors and in public settings/outdoors was associated with a 30% (RR = 0.70; 95% CI: 0.56,0.88) and 28% (RR = 0.72; 95% CI: 0.58,0.90) decrease risk of COVID-19, respectively. No association was observed with avoidance of crowds/poorly ventilated spaces. The risk of COVID-19 declined as the number of preventive behaviors a student engaged in increased. Compared to those who did not engage in any preventive behaviors (consistently), students who consistently engaged in one behavior had a 25% lower risk (RR = 0.75; 95% CI: 0.53,1.06), those who engaged in two behaviors had 26% lower risk (RR = 0.74; 95% CI: 0.53,1.03), those who engaged in three behaviors had 51% lower risk (RR = 0.49; 95% CI: 0.33,0.74), and those who consistently engaged in all four behaviors had 45% lower risk of COVID-19 (RR = 0.55; 95% CI: 0.40,0.78). CONCLUSIONS: Wearing face masks and physical distancing were both associated with a lower risk of COVID-19. Students who engaged in more nonpharmaceutical interventions were less likely to report COVID-19. Our findings support guidelines promoting mask-wearing and physical distancing to limit the spread of COVID-19 on campuses and the surrounding communities.

Higher baseline emotion dysregulation predicts treatment dropout in outpatients with borderline personality disorder.

Treatment dropout is high among outpatients with borderline personality disorder (BPD) and is associated with myriad negative therapeutic and psychosocial outcomes. Identifying predictors of treatment dropout can inform treatment provision for this population. The present study investigated whether symptom profiles of static and dynamic factors could predict treatment dropout. Treatment-seeking outpatients with BPD (N = 102) completed pre-treatment measures of BPD symptom severity, emotion dysregulation, impulsivity, motivation, self-harm, and attachment style to determine their collective impact on dropout prior to 6 months of treatment. Discriminant function analysis was used to classify group membership (treatment dropout vs. nondropout) but did not produce a statistically significant function. Groups were distinguished by baseline levels of emotion dysregulation with higher dysregulation predicting premature treatment dropout. Clinicians working with outpatients with BPD might benefit from optimizing emotion regulation and distress tolerance strategies earlier in treatment to reduce premature dropout. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Clinical Stakes of Sexual Abuse in Adolescent Psychiatry.

BACKGROUND: The extent and nature of sexual abuse (SA) and its consequences in psychiatry are still poorly described in adolescence. OBJECTIVE: This article describes the frequency of SA reported in an adolescent population hospitalized in psychiatry, and assesses its links with the severity of mental disorders and the medical issues of these adolescents. METHODS: The study includes 100 patients for whom SA has been mentioned, among all patients aged 13 to 17 years old hospitalized for about 4 years. The characteristics of sexual abuse were correlated with the medical severity of the patients, as well as the number, the duration of their hospitalization(s), and the time until disclosure. RESULTS: The results show the central place of SA in adolescent psychiatry, with a prevalence of 28.5% and a cumulative hospital stay which is five times longer than average. Correlations have been observed between the number of suicide attempts and the number of abuses reported. The medical severity of patients is significantly increased when the named aggressor is an adult. The number of hospitalizations is positively correlated with the number of reported abuses, as well as with the intrafamilial and adult status of the perpetrator. Finally, an early age of onset, repeated abuse, and the intrafamilial nature of the abuse are associated with a longer time to disclosure. CONCLUSIONS: The severity of adolescent psychiatric situation is statistically in favor of a history of SA, which should therefore be actively explored during care.

COVID-19 vaccine coverage among college students following vaccine mandates.

OBJECTIVE: Colleges are potential hotspots for transmission of SARS-CoV-2 due to lower immunization rates and possible close contacts among young adults. Some universities have implemented policies mandating COVID-19 vaccination; however, their effects remain uncertain. We estimated COVID-19 vaccination rates with and without university-mandated vaccination policies. PARTICIPANTS: A university-wide survey was conducted among 2,011 students. METHODS: Students completed an online questionnaire on sociodemographics, COVID-19 vaccine status, and vaccine intention. RESULTS: Without university vaccine mandates, 76% of students would receive a COVID-19 vaccination, and with vaccine mandates, more than 82% of students would receive vaccination. Despite this improvement, we observed fewer changes in vaccine coverage for certain subgroups of students, indicating these policies could exacerbate ongoing disparities in COVID-19 vaccination rates. CONCLUSIONS: COVID-19 vaccine mandates on campuses are likely to increase vaccination rates modestly. However, interventions will likely be required to supplement vaccine mandates.

Relations Between Anxiety Sensitivity and Attachment in Outpatients With Borderline Personality Disorder.

Borderline personality disorder (BPD) is characterized by dysregulated emotion, interpersonal relationships, and impulsivity, and is putatively linked to a known transdiagnostic risk factor, anxiety sensitivity (AS). AS is a dispositional fear of the physical, cognitive, and/or social consequences of arousal-related somatic sensations. Gratz et al. (2008) demonstrated significantly higher AS in outpatients with BPD and a predictive value of AS over and above emotion dysregulation and impulsivity. The present study sought to extend these findings with a larger sample of outpatients with BPD by investigating predictive value of AS dimensions; relations between AS and attachment style; and impact of BPD treatment on AS. Participants completed measures at three time points: pretreatment and 6 and 12 months posttreatment. AS social was the best predictor; attachment anxiety correlated positively with AS global and AS physical. AS levels significantly decreased from pretreatment to 6 months posttreatment. Clinical implications discussed include targeting AS in BPD treatment.

High Fear of Discriminatory Violence among Racial, Gender, and Sexual Minority College Students and Its Association with Anxiety and Depression.

Minority students experience more discrimination on college campuses, yet little is known about fear of discrimination. This paper (a) establishes a new measure, fear of discriminatory violence, (b) assesses sociodemographic correlates of fear of discriminatory violence, and (c) estimates the effect of fear of discriminatory violence on anxiety and depression. A cross-sectional study using online surveys was undertaken among college students. A zero-inflated negative binomial model estimated the association between sociodemographics and fear of discriminatory violence. Multiple logistic regression models estimated the association between fear of discriminatory violence and anxiety/depression. Fear of discriminatory violence was higher among Black (ME: 11.9, p < 0.0001), Hispanic (ME: 5.9, p < 0.0001), Middle Eastern (ME: 5.4, p = 0.03), Asian (ME: 4.9, p < 0.0001), and multiracial (ME: 2.9, p < 0.0001) students compared with White students; transgender/gender non-conforming (ME: 7.2, p = 0.01) and female (ME: 3.4, p < 0.0001) students compared with male students; and gay (ME: 10.7, p < 0.0001), lesbian (ME: 9.0, p = 0.01), and bisexual students (ME: 3.4, p = 0.001) as well as those with a sexual orientation not included (ME: 5.5, p = 0.001), compared with heterosexual students. Increasing fear of discriminatory violence was associated with increased odds of anxiety (AOR: 1.04; 95% CI: 1.02, 1.06) and depression (AOR: 1.03; 95% CI: 1.02, 1.05). This understudied public health issue should be addressed to prevent fear of discriminatory violence and the resulting mental health consequences among college populations.

Associations between having been threatened or injured with a weapon and substance use and mental health among high school students in the United States.

Being threatened or injured with a weapon is a serious form of physical bullying. Little is known about the effects of being threatened or injured with a weapon on substance use and mental health among adolescents. A secondary analysis of 2017 Youth Risk Behavior Survey data assessed the associations between having been threatened or injured with a weapon and substance use (binge drinking, marijuana, tobacco use, prescription medication misuse) and mental health (feeling sad or hopeless, considering suicide). Multiple logistic regression models with complex survey weights were used, controlling for potential confounders. Approximately 6.0% of students reported having been threatened/injured with a weapon. After adjusting for covariates, having been threatened/injured with a weapon was associated with binge drinking (AOR = 2.5; 95% CI: 1.9-3.4), marijuana (AOR = 2.1; 95% CI: 1.6-2.7), tobacco use (AOR = 2.6; 95% CI: 2.0-3.5), and misuse of prescription medication (AOR = 2.2; 95% CI: 1.6-3.0) compared with students who have not been threatened/injured. Having been threatened/injured with a weapon was associated with 1.6 times the odds (95% CI: 1.2-2.2) of feeling sad/hopeless and 1.7 times the odds (95% CI: 1.3-2.3) of considering suicide. Having been threatened or injured with a weapon is an important public health issue associated with negative mental health and substance use.

Impact of Prior Antiplatelet Therapy on Outcomes After Endovascular Therapy for Acute Stroke: Endovascular Treatment in Ischemic Stroke Registry Results.

BACKGROUND AND PURPOSE: The influence of prior antiplatelet therapy (APT) uses on the outcomes of patients with acute ischemic stroke treated with endovascular therapy is unclear. We compared procedural and clinical outcomes of endovascular therapy in patients on APT or not before stroke onset. METHODS: We analyzed 2 groups from the ongoing prospective multicenter Endovascular Treatment in Ischemic Stroke registry in France: patients on prior APT (APT+) and patients without prior APT (APT-) treated by endovascular therapy, with and without intravenous thrombolysis. Multilevel mixed-effects logistic models including center as random effect were used to compare angiographic (rates of reperfusion at the end of procedure, procedural complications) and clinical (favorable and excellent outcome, 90-day all-cause mortality, and hemorrhagic complications) outcomes according to APT subgroups. Comparisons were adjusted for prespecified confounders (age, admission National Institutes of Health Stroke Scale score, Alberta Stroke Program Early CT Score, intravenous thrombolysis, and time from onset to puncture), as well as for meaningful baseline between-group differences. RESULTS: A total of 2939 patients were analyzed, of whom 877 (29.8%) were on prior APT. Patients with prior APT were older, had more frequent vascular risk factors, cardioembolic stroke mechanism, and prestroke disability. Rates of complete reperfusion (37.9% in the APT- group versus 42.7 % in the APT+ group; aOR, 1.09 [95% CI, 0.88-1.34]; P=0.41) and periprocedural complication (16.9% versus 13.3%; aOR, 0.90 [95% CI, 0.7-1.2]; P=0.66) did not differ between the two groups. Symptomatic intracerebral hemorrhage (aOR, 0.93 [95% CI, 0.63-1.37]; P=0.73), 3 months favorable clinical outcome (modified Rankin Scale score of 0-2; aOR, 0.98 [95% CI, 0.77-1.25]; P=0.89), and mortality (aOR, 0.95 [95% CI, 0.72-1.26]; P=0.76) at 90 days did not differ between the groups. CONCLUSIONS: Prior APT does not influence angiographic and functional outcomes following endovascular therapy and should not be taken into account for acute revascularization strategies.

Antiplatelet therapy increases symptomatic ICH risk after thrombolysis and thrombectomy.

BACKGROUND AND PURPOSE: The influence of chronic treatment by antiplatelet drug (APD) at stroke onset on the outcomes of patients with acute ischemic stroke (AIS) treated with combined intravenous thrombolysis (IVT) and endovascular therapy (EVT) is unclear. We investigated whether prior APD use influences the risk of symptomatic intracranial hemorrhage (sICH) and functional outcome in AIS patients treated with combined reperfusion therapy. METHODS: A single-center retrospective analysis of AIS patients with proximal intracranial occlusion who underwent IVT and EVT between January 2015 and May 2017. The main outcomes were the incidence of sICH using the Heidelberg Bleeding Classification and patients' functional status at 90 days, as defined by the modified Rankin scale (mRS). Outcomes were evaluated according to daily exposure to APD, and associations were assessed using multivariate logistic regression analysis. RESULTS: This study included 204 patients: 71 (34.8%) were taking APD before AIS. Patients with chronic treatment by APD at stroke onset had a higher rate of sICH (26.7% vs. 3.7%; p< .001) and worse functional outcome (mRS >2) at 90 days (69% vs. 36.8%; p < .001). Prior APD use was associated with an increased likelihood of sICH (OR 9.8; 95%CI [3.6-31.3], p < .05) and of functional dependence at 90 days (OR 5.72; 95%CI [2.09-1.72], p < .001), independent of confounders on multivariate analysis. CONCLUSIONS: Chronic treatment by APD at stroke onset in AIS patients with proximal intracranial occlusion treated using IVT and EVT increases the risk of sICH and worsens the functional prognosis. Further investigation to refine acute revascularization strategies in this population might be required.

Factors associated with phosphatidylethanol (PEth) sensitivity for detecting unhealthy alcohol use: An individual patient data meta-analysis.

BACKGROUND: Objective measurement of alcohol consumption is important for clinical care and research. Adjusting for self-reported alcohol use, we conducted an individual participant data (IPD) meta-analysis to examine factors associated with the sensitivity of phosphatidylethanol (PEth), an alcohol metabolite, among persons self-reporting unhealthy alcohol consumption. METHODS: We identified 21 eligible studies and obtained 4073 observations from 3085 participants with Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) positive scores (≥3 for women and ≥4 for men) and PEth measurements. We conducted 1-step IPD meta-analysis using mixed effects models with random intercepts for study site. We examined the associations between demographic (sex, race/ethnicity, and age) and biologic (body mass index-BMI, hemoglobin, HIV status, liver fibrosis, and venous versus finger-prick blood collection) variables with PEth sensitivity (PEth≥8 ng/ml), adjusting for the level of self-reported alcohol use using the AUDIT-C score. RESULTS: One third (31%) of participants were women, 32% were African, 28% African American, 28% White, and 12% other race/ethnicity. PEth sensitivity (i.e., ≥8 ng/ml) was 81.8%. After adjusting for AUDIT-C, we found no associations of sex, age, race/ethnicity, or method of blood collection with PEth sensitivity. In models that additionally included biologic variables, those with higher hemoglobin and indeterminate and advanced liver fibrosis had significantly higher odds of PEth sensitivity; those with higher BMI and those living with HIV had significantly lower odds of PEth sensitivity. African Americans and Africans had higher odds of PEth sensitivity than whites in models that included biologic variables. CONCLUSIONS: Among people reporting unhealthy alcohol use, several biological factors (hemoglobin, BMI, liver fibrosis, and HIV status) were associated with PEth sensitivity. Race/ethnicity was associated with PEth sensitivity in some models but age, sex, and method of blood collection were not. Clinicians should be aware of these factors, and researchers should consider adjusting analyses for these characteristics where possible.

Joint effects of alcohol and stimulant use disorders on self-reported sexually transmitted infections in a prospective study of Cambodian female entertainment and sex workers.

Female entertainment and sex workers (FESW) have high rates of alcohol and amphetamine-type stimulant (ATS) use, increasing risk for HIV/sexually transmitted infections (STI), and other negative outcomes. A prospective cohort of 1,198 FESW in a HIV/ATS use prevention intervention in Cambodia was assessed for alcohol and stimulant use disorders (AUD and SUD) using the Alcohol and Substance Use Involvement (ASSIST) scale. STI history was measured by self-report at baseline and at quarterly follow-up visits. Participants were asked if they had been diagnosed with an STI by a medical provider in the past 3 months. Marginal structural models were used to estimate joint effects of AUD and SUD on recent STI. At baseline, one-in-four screened AUD positive and 7% screened positive for SUD. At 18-months, 26% reported ≥1 recent STI. Accounting for time-varying and other known confounders, the adjusted odds ratio (AOR) for recent STI associated with AUD alone and SUD alone were 2.8 (95% CI:1.5-5.1) and 3.5 (95% CI:1.1-11.3), respectively. The AOR for joint effects of AUD and SUD was 5.7 (95% CI:2.2-15.2). AUD and SUD are independently and jointly associated with greater odds of STI among Cambodian FESW. Further research is critical for understanding how AUD and SUD potentiate biological and behavioural pathways that influence STI acquisition and to inform HIV risk-reduction interventions in FESW.

Syndemic Psychosocial Health Conditions Associated with Recent Client-Perpetrated Violence Against Female Entertainment and Sex Workers in Cambodia.

Female entertainment and sex workers (FESW) are vulnerable to violence, which impedes safer sex behaviors and increases risk of HIV. FESW are also disproportionately affected by co-occurring psychosocial health conditions, including substance use, depression, and economic insecurity, which increased risk of exposure to violence. We used a syndemic framework to examine the effects of co-occurring psychosocial conditions on the risk of client-perpetrated physical and sexual violence against FESW. Data were collected among 1198 Cambodian FESW on recent client-perpetrated physical and sexual violence, and psychosocial conditions (psychological distress, alcohol consumption, amphetamine-type stimulant (ATS) use, debts, housing, and food insecurity). Bivariate and multivariate logistic regressions were conducted. Prevalence of physical and sexual violence from clients was 4.8% and 6.9%, respectively. Client-perpetrated physical violence was associated with housing insecurity, ATS use, and psychological distress. All psychosocial conditions, except ATS, were associated with exposure to sexual violence. In multivariable models, odds of client-perpetrated physical violence were twice higher among women with ≥ 4 compared to ≤ 3 psychosocial conditions. Risk of sexual violence increased with the number of psychosocial conditions. Compared to those with ≤ 1 condition, FESW with two psychosocial conditions had twice the odds (AOR = 2.08; 95% CI 1.00-4.31) and women with 5-6 psychosocial conditions had eightfold higher odds (AOR = 8.10; 95% CI 3.4-19.31) of sexual violence from clients. Our findings support a syndemic model of co-occurring psychosocial conditions among FESW that are associated with increased risk of violence. Violence prevention interventions targeting FESW should adopt comprehensive approaches that address co-occurring psychosocial conditions.

Effect of fear of victimization on hazardous alcohol drinking, tobacco, and marijuana use among university students: A tale of two sexes.

BACKGROUND: Fear of victimization has been associated with poorer physical and mental health, yet is understudied in public health. Few studies have examined sex differences in the effects of fear of victimization on substance use. We examined associations between fear of victimization and hazardous alcohol drinking, tobacco, and marijuana use among female and male university students. METHODS: A cross-sectional study was conducted among university students in an urban location (n = 1415). Socio-demographics, substance use, and fear related to various crimes were measured using online surveys. All fear types were summed into a total fear score and categorized into quartiles: no/little fear, moderate fear, high fear, and very high fear. Chi-square tests and multiple logistic regression models were used to examine associations between fear of victimization, hazardous alcohol drinking, tobacco and marijuana use, by sex. RESULTS: Females were more likely to report high and very high fear of victimization (26.6% and 33.1%) than male students (19.8% and 16.3%; p < 0.001). In multiple logistic regression models, associations differed by sex: moderate, high, and very high fear were all independently associated with hazardous drinking among females but not males. Female students with very high fear of victimization were more likely to report tobacco use. High and very high fear was also independently associated with marijuana use among female only. CONCLUSIONS: Higher fear of victimization was associated with substance use among females but not male students. Public health and health care professionals should acknowledge fear of victimization as a potential risk factor for substance use, particularly among women.

Longitudinal Evaluation of Pressure Applied by Custom Fabricated Garments Worn by Adult Burn Survivors.

Custom fabricated pressure garments (PGs) are commonly used to prevent or treat hypertrophic scars (HSc) after burn injury. However, there is minimal scientific evidence quantifying pressure after standard measurement and fitting techniques. Adult burn survivors whose HSc was treated with PGs were recruited. Trained fitters, blinded to study locations and results, took the garment measures. Once the PGs arrived and were fitted, baseline pressure measures at HSc and normal skin (NS) sites were determined using the Pliance X® System. Pressure readings were repeated at 1, 2, and 3 months. The mean baseline pressure was 15.3 (SD 10.4) at HSc and 13.4 (SD 11.9) at NS sites. There was a significant reduction during the first month at both sites (P = .0002 HSc; P = .0002 NS). A multivariable linear regression mixed model, adjusting for garment type, baseline pressure, and repeated measures, revealed further reduction at HSc sites between 1 and 2 months (P = .03). By 3 months, the mean pressure reduced to 9.9 (SD 6.7) and 9.15 (SD 7.2) mm Hg at HSc and NS sites, respectively. At each time point, the pressure was higher at HSc compared with NS but was significantly different only at 1 month (P = .01). PGs were worn ≥12 hr/d 7 d/wk. PGs that apply 15 to 25 mm Hg pressure significantly improve HSc; however, immediately after fitting newly fabricated PGs, the average pressure was at the bottom of the recommended range and by 1 month was significantly below. Clinicians are likely underestimating the dosage required and the significant pressure loss within the first 2 months.

A qualitative study of the perceived effects of alcohol on depressive symptoms among undergraduates who drink to cope with depression.

INTRODUCTION AND AIMS: Heavy drinking is prevalent among undergraduate students and is linked with drinking to cope with depression motives for drinking. Drinking to cope with depression remains poorly understood given that alcohol has been shown to have adverse effects on mood when consumed at high doses. Using semi-structured qualitative interviews, the present study examined the perceived effects of alcohol on depressive symptoms as reported by undergraduate students who endorse high levels of drinking to cope with depression. DESIGN AND METHODS: Sixteen undergraduate coping-with-depression-motivated (CWDM) drinkers (nine women, seven men), identified using the Modified Drinking Motives Questionnaire-Revised [1], reported on their experiences of drinking to cope with depression. Thematic analysis was conducted to identify themes and subthemes in the data. RESULTS: Undergraduate students reported several effects of alcohol on affective, cognitive and behavioural depressive symptoms. While most of the perceived alcohol effects they described involved relief from depressive symptoms, some perceived effects involved worsening depressive symptoms. DISCUSSION AND CONCLUSIONS: The study generated several hypotheses to explain drinking to cope with depression, some of which might be testable in future experimental work. Overall, findings suggest the mood-altering effects of alcohol do not fully explain why depression and alcohol use are frequently co-morbid. Indeed, effects of alcohol on cognitive and behavioural depressive symptoms might be particularly reinforcing for CWDM drinkers. Interventions that target co-morbid depression and alcohol use might be improved by teaching CWDM drinkers skills to reduce depressive cognitions and to improve interpersonal interactions outside of drinking contexts.

Anxiety Sensitivity Mediates Relations Between Attachment and Aggression Differently by Gender.

The present study examined relations among attachment, aggression, and anxiety sensitivity (AS) in a sample of male and female undergraduates. Given that some individuals may use aggression to modulate negative emotional states, it was predicted that AS dimensions would mediate relations between attachment anxiety (vs. attachment avoidance) and certain forms of aggression, particularly impulsive aggression. Moreover, it was hypothesized that the relations among attachment, aggression, and AS would be moderated by gender. Participants (N = 1,042) completed measures of attachment (Experiences in Close Relationships-Revised [ECR-R]), aggression (Aggression Questionnaire [AQ]; Impulsive/Premeditated Aggression Scales [IPAS]), and AS (AS Index-3 [ASI-3]). Results indicated that AS mediated relations between attachment dimensions (both anxiety and avoidance) and most forms of aggression, with each of the AS dimensions playing a unique role differentially by gender. Cognitive concerns emerged as a significant mediator, particularly for men; physical and social concerns played more of a mediating role for women. Interestingly, none of the AS dimensions played a significant mediating role between attachment (either anxiety or avoidance) and physical aggression for men. Results are discussed in terms of their clinical implications and directions for future research.

Perceived Value of a Knowledge Translation Intervention Designed to Facilitate Burn Survivors' Work Reintegration.

Returning to work can be challenging for burn survivors. Approximately 28% never return to any form of employment, resulting in lower health-related quality of life. Open communication has been identified as a facilitator for return to work (RTW). To ease the RTW process and promote communication with coworkers and employers a knowledge translation (KT) intervention was developed for burn survivors. Following its implementation, the impact on the RTW process was evaluated. This study was a cross-sectional, mixed methods study where burn survivors included in the KT intervention were compared with a control group. Control group participants were selectively invited so that the two groups' mean age, sex, and percent total body surface area burned were similar. Semistructured interviews gathered information about their RTW process and outcomes. Qualitative data were analyzed through thematic analysis and quantitative data were summarized and compared using Mann-Whitney tests. Overall, both groups were satisfied with their RTW process. Participants from the control group identified more barriers related to support received, particularly at work, and reported more psychological symptoms such as posttraumatic stress disorder, self-consciousness, and discomfort with questions. Many participants from the KT group indicated the KT intervention gave them tools and information to provide others with a better understanding of their lived experience. It is possible that the KT intervention facilitated more open communication by empowering burn survivors to explain their situation on their own, thus reducing the prevalence of social and psychological barriers by allowing them to self-advocate for more support.

Randomized controlled trial of the immediate and long-term effect of massage on adult postburn scar.

BACKGROUND: One objective of massage therapy applied to hypertrophic scar (HSc), is to improve the structural properties so skin possesses the strength and elasticity required for normal mobility. However, research supporting this effect is lacking. The objective of this study was to characterize the changes in scar elasticity, erythema, melanin, and thickness immediately after a massage therapy session and after a 12-week course of treatment compared to intra-individual matched control scars. METHODS: We conducted a prospective, randomized, single-blinded, pragmatic, controlled, clinical trial evaluating the impact of a 12-week course of massage therapy. Seventy burn survivors consented to participate and 60 completed the study. Two homogeneous, intra-individual scars were randomized to usual care control or massage therapy plus usual care. Massage, occupational or physical therapists provided massage treatment 3x/week for 12 weeks. Scar site characteristics were evaluated weekly immediately before and after massage treatment including elasticity (Cutometer), erythema and melanin (Mexameter), and thickness (high-frequency ultrasound). Analysis of covariance (ANCOVAs) were performed to test for immediate and long-term treatment effects. A mixed-model approach was used to account for the intra-individual scars. RESULTS: Scar evaluation immediately before and after massage therapy at each time point revealed changes for all scar characteristics, but the group differences were predominantly present during the early weeks of treatment. The within group long-term analysis revealed a significant increase in elasticity, and a reduction in thickness, during the 12-week treatment period for both the control scar (CS) and massage scar (MS). The increase in elasticity reached significance at week 8 for the MS and week 10 for the CS and the reduction in thickness at week 5 for the CS and week 7 for the MS. There was no significant within group long-term differences for either erythema or melanin. There were group differences in erythema at week 8 and 11 where the CS was less erythematous than the MS. CONCLUSIONS: The immediate impact of forces applied during massage therapy may lead patients and therapists to believe that there are long-term changes in elasticity, erythema, and pigmentation, however, once baseline measures, the control scar, and time were incorporated in the analysis there was no evidence of long-term benefit. Massage therapy applied with the objective of increasing scar elasticity or reducing erythema or thickness over the long-term should be reconsidered.

Development and clinimetric evaluation of the mouth impairment and disability assessment (MIDA).

INTRODUCTION: Burns of the face and mouth region have a profound impact on function. Currently the outcome measure that is most commonly used in the burn care literature is horizontal and vertical opening. Impairment-based outcomes such as this do not capture the functional implications of these injuries in spite of the devastating impact they can have on burn survivor's lives. PURPOSE OF THE STUDY: To generate an assessment that evaluates the impairments, activity limitations, and participation restrictions associated with mouth injuries and prospectively collect data to examine the clinimetric properties. METHODS: A multistep assessment development process was undertaken including a comprehensive literature search and review, burn care expert and burn survivor interviews, generation of a preliminary version and field-testing, modifications based on field testing and updated literature review, and further field testing with data collection of 23 burn survivors. Clinimetric properties were examined by evaluating: whether there was a ceiling or floor effect, the internal consistency, construct validity, and responsiveness. RESULTS: The mouth impairment and disability assessment (MIDA) has a 28 item self-report portion, divided into four subscales, completed by the patient and an impairment-based section completed by the burn therapist. Two items demonstrated a ceiling effect, one was removed the other retained. There was strong and statistically significant (p<0.0001) correlation of the symptoms subscale as well as vertical opening with the functional activities subscale of the MIDA. The functional activities subscale demonstrated good internal consistency and the symptoms subscale was adequate. Re-evaluation approximately seven and a half months after the baseline evaluation demonstrated a statistically significant change with time and treatment. CONCLUSIONS: The MIDA now offers clinicians the ability to assess mouth impairment and disability of burn survivors who have sustained burn injuries to their face and mouth region.