Auxetic structures used in kinesiology tapes can improve form-fitting and personalization.

Each year 65% of young athletes and 25% of physically active adults suffer from at least one musculoskeletal injury that prevents them from continuing with physical activity, negatively influencing their physical and mental well-being. The treatment of musculoskeletal injuries with the adhesive elastic kinesiology tape (KT) decreases the recovery time. Patients can thus recommence physical exercise earlier. Here, a novel KT based on auxetic structures is proposed to simplify the application procedure and allow personalization. This novel KT exploits the form-fitting property of auxetics as well as their ability to simultaneously expand in two perpendicular directions when stretched. The auxetic contribution is tuned by optimizing the structure design using analytical equations and experimental measurements. A reentrant honeycomb topology is selected to demonstrate the validity of the proposed approach. Prototypes of auxetic KT to treat general elbow pains and muscle tenseness in the forearm are developed.

Building Nurses' Resilience to Trauma Through Contemplative Practices.

Nurses can benefit from strategies that build resilience to counterbalance trauma exposures. Adverse childhood experiences (ACEs) and adverse community environments are common; nurses frequently encounter trauma victims and hear trauma narratives in most care settings. Having skills to manage the triggers present in health-care environments is essential. Contemplative practices can help to meet these needs. Breathing exercises can be used as needed throughout the work day; gratitude practices are simple but powerful; and visual journaling can help nurses process experiences. These practices are easy to implement and can profoundly affect health outcomes for nurses.

Pre-trauma Growth under Terror Threat: Suggestive Communication Method in Anticipatory Trauma.

Counterterror measures put communities in a state of alertness for several years. Jewish schools in Europe respond with higher security measures, going through transformations in their daily routines and environments, marked by security rituals. Anticipating the trauma creates extreme situations that polarizes the sense of agency and alters the state of consciousness, having a collective impact. Analyzing the anticipatory trauma within the framework of the altered state of consciousness opens the possibility for intervening with suggestive communication methods that aim to increase the sense of agency. The positive effect of teachers learning the suggestive communication methods on the sense of agency was measured with the Sense of Agency Scale. The altered state of consciousness in anticipatory trauma opens the mind for the sense of agency changing in a signature pattern, in a way that is typical for a group, allowing cultural reproduction.

Differences in the association of spirituality, forgiveness, PTSD and stress among social workers and social work students treating trauma survivors.

Providing professional assistance to trauma victims may cause significant emotional distress to those who provide the assistance. Dealing with such stress requires attention to significant personal resources. This study examined the relationship between tendency to forgive and spirituality with PTSD symptoms and stress among social workers and social work students (N = 157) who are at the front line dealing with trauma survivors. The study results demonstrated that social work students had higher levels of stress while no significant differences were found regarding spiritually, PTSD, and forgiveness. Examining the subscales revealed that social work students had higher negative PTSD alteration symptoms than trained social workers while trained social workers had higher levels of forgiveness to self. Additionally, structural equation models showed that among social workers, forgiveness to self and spirituality were associated simultaneously with lower PTSD symptoms and stress. However, among social work students, the tendency to forgive the self was associated with lower PTSD symptoms only. The findings illuminate spirituality and forgiveness as key factors that can help cope with the emotional toll of those who assist trauma survivors, while focusing on differences for trained professionals and training professionals. Theoretical and clinical implications are discussed.

The Center for Trauma Survivorship: Addressing the great unmet need for posttrauma center care.

BACKGROUND: Returning patients to preinjury status is the goal of a trauma system. Trauma centers (TCs) provide inpatient care, but postdischarge treatment is fragmented with clinic follow-up rates of <30%. Posttraumatic stress disorder (PTSD) and depression are common, but few patients ever obtain necessary behavioral health services. We postulated that a multidisciplinary Center for Trauma Survivorship (CTS) providing comprehensive care would meet patient's needs, improve postdischarge compliance, deliver behavioral health, and decrease unplanned emergency department (ED) visits and readmissions. METHODS: Focus groups of trauma survivors were conducted to identify issues following TC discharge. Center for Trauma Survivorship eligible patients are aged 18 to 80 years and have intensive care unit stay of >2 days or have a New Injury Severity Score of ≥16. Center for Trauma Survivorship visits were scheduled by a dedicated navigator and included physical and behavioral health care. Patients were screened for PTSD and depression. Patients screening positive were referred for behavioral health services. Patients were provided 24/7 access to the CTS team. Outcomes include compliance with appointments, mental health visits, unplanned ED visits, and readmissions in the year following discharge from the TC. RESULTS: Patients universally felt abandoned by the TC after discharge. Over 1 year, 107 patients had 386 CTS visits. Average time for each appointment was >1 hour. Center for Trauma Survivorship "no show" rate was 17%. Eighty-six percent screening positive for PTSD/depression successfully received behavioral health services. Postdischarge ED and hospital admissions were most often for infections or unrelated conditions. Emergency department utilization was significantly lower than a similarly injured group of patients 1 year before the inception of the CTS. CONCLUSION: A CTS fills the vast gaps in care following TC discharge leading to improved compliance with appointments and delivery of physical and behavioral health services. Center for Trauma Survivorship also appears to decrease ED visits in the year following discharge. To achieve optimal long-term recovery from injury, trauma care must continue long after patients leave the TC. LEVEL OF EVIDENCE: Therapeutic, Level III.

What can trauma patients' experiences and perspectives tell us about the perceived quality of trauma care? a qualitative study set within the UK National Health Service.

The global drive for improvements in the efficiency and quality of healthcare has led to the development of frameworks to assist in defining and measuring 'good quality care'. However, such frameworks lack a systematic or meaningful definition of what 'good quality care' means from the patients' perspective. The present research provides an in-depth analysis of patients' experiences in a hospital setting from a quality of care perspective. Forty-five adults (aged 16-70) hospitalised in one of four UK NHS trusts following an unintentional injury were interviewed about their experiences of care. The findings show variability in perceived quality of care within the same hospital episode which cannot be meaningfully captured by existing frameworks. The context of trauma care (e.g. distressing nature of injury, patient vulnerability, expectations of hospitalisation and participants' interaction with different service providers) defined the care experience and the value of being 'cared for'. Participants identified some aspects of good and care which related to holistic, person-centred and personalised care beyond the medical needs. Participants discussed the value of being understood, staff thinking of their needs beyond hospitalisation, staff trying 'their best' despite constrains of current care, having their emotional needs recognised and addressed and staff competence. Patients reported also poor quality of care and 'not being cared for' by specific staff groups which they expected to fulfil this role, rushed and unsympathetic care, lack of recognition for emotional impact of injury mapped onto existing quality frameworks e.g. safety, equity, accessibility and patient-centeredness as well as quality of interaction with providers, empathetic care which extended beyond medical needs, coordination of care, and the positivity of care delivery as important dimensions of quality care with implications for their recovery. The findings have implications for quality frameworks and theoretical definitions of quality of care; they demonstrate the importance of patient experience in addition to clinical effectiveness and safety as an essential dimension of quality care. In terms of practice, the findings support the need to incorporate knowledge and training of injured adults' psychological needs, and the value of interaction with professionals as a patient defined dimension of the quality of care.

Trauma- and Stress-Induced Craving for Alcohol in Individuals Without PTSD.

AIMS: The main objective of the study was to compare the differences in craving following trauma and stress scripts in individuals with alcohol dependence (AD) who have experienced trauma but did not meet criteria for post-traumatic stress disorder (PTSD). METHODS: Twenty-eight men and women who participated in a treatment trial were included in this study before starting treatment. All had to meet criteria for AD and had experienced trauma at some point of their lives but were never diagnosed with PTSD. All participants had one laboratory session and were exposed to stress, trauma and neutral scripts randomly assigned. Main measures of craving, anxiety and mood were administered before, during and after each script. RESULTS: Stress and trauma scripts induced significantly more craving and anxiety than the neutral scripts. Interestingly, stress scripts produced stronger craving and anxiety than the trauma scripts but only with some measures. Stress and trauma scripts produced significantly more fear, anger and sadness and significantly lower ratings of joy and relaxation than the neutral script. Again, there were no differences between stress and trauma scripts for any of the emotional subscales. CONCLUSIONS: Trauma scripts did not result in stronger craving than stress scripts. These findings suggest that trauma in the absence of PTSD diagnosis does not lead to stronger craving for alcohol.

Two-generational trauma-informed assessment improves documentation and service referral frequency in a child protection program.

BACKGROUND: Two-generational trauma-informed assessment (TIA) helps providers conduct holistic family well-being assessment (FWbA). This tool makes it possible to use families' trauma history in the case-finding process. OBJECTIVE: This study compares the documentation and frequency of adverse childhood experiences (ACEs) and service referral rates for index children and their caretakers in two groups of families evaluated in a child abuse clinic (CAC). PARTICIPANTS AND SETTING: The sample consisted of 364 children stratified into two groups: Group 1 - children seen in the CAC after implementation of FWbA in years 2014, 2015, 2016 and Group 2 - children seen in the CAC prior to implementation of FWbA in years 2011, 2012, 2013. METHODS: Researchers utilized retrospective chart review method and analyzed data regarding ACEs and service referrals for patients and their caregivers. RESULTS: Documentation of ACEs was higher in Group 1 for children (77.7 % vs 26.6 %,p <  0.0001) and caretakers (60.7 % vs 7.3 % p <  0.0001). Caretakers in Group 1 had a higher rate of four or more ACEs (47.0 % vs 5.1 % p <  0.001) while the increase for children was not statistically significant (61.4 % vs 51.1 %, p =  0.110). Both children and caretakers were referred to more services in Group 1 (2.7 + 1.5 vs 1.5 + 1.3, and 3.0 + 1.9 vs 1.2 + 1.2, respectively, p <  0.0001). CONCLUSIONS: In families evaluated for child abuse and neglect, conducting TIA in addition to conventional psychosocial evaluation increased documentation regarding trauma history, which led to increased referral rates.

Fostering Holistic Hand Therapy: Emergent Themes of Client Experiences of Mind-Body Interventions.

Mind-body interventions are a viable holistic approach to rehabilitation; however, evidence for mind-body approaches in hand therapy is lacking. This study explored the experiences of clients with musculoskeletal disorders undergoing two mind-body interventions within hand therapy. Qualitative data were obtained from clients who received mindfulness meditation and sonographic biofeedback as part of hand therapy. Semi-structured interviews conducted after four therapy sessions elicited participants' experiences and acceptability. Emergent themes were identified through an iterative, qualitative descriptive process. The following three themes emerged as results: insight on the body, relaxation and relief, and I am in control. A fourth theme was identified in the acceptability data, that is, mindfulness as a meaningful activity. At least one of the interventions was acceptable to each participant. Positive participant experiences support further consideration of mind-body interventions as a useful holistic approach in hand therapy to support wellness, quality of care, and participation in recovery.

Advanced mobile prehospital nursing care for elderly people post-trauma: integrative review.

OBJECTIVE: to identify scientific evidences available on the literature on nursing interventions on advanced mobile prehospital care for elderly people post-trauma. METHOD: an integrative review of literature on the databases PubMed, CINAHL, and LILACS, from 2012 to 2017. RESULTS: a sample composed by 26 studies, grouped into six thematic categories: circulation with hemorrhage control (n=11); dysfunction, neurological state (n=7); airway with protection of the cervical spine (n=3); secondary evaluation (n=3); ventilation and breathing (n=1), and environment exposition/control (n=1). CONCLUSION: Despite having identified nursing interventions, there was no description of specific nursing interventions related to advanced mobile prehospital care for elderly people post-trauma.

The effect of mindfulness training on extinction retention.

Anxiety and trauma related disorders are highly prevalent, causing suffering and high costs for society. Current treatment strategies, although effective, only show moderate effect-sizes when compared to adequate control groups demonstrating a need to develop new forms of treatment or optimize existing ones. In order to achieve this, an increased understanding of what mechanisms are involved is needed. An emerging literature indicates that mindfulness training (MFT) can be used to treat fear and anxiety related disorders, but the treatment mechanisms are unclear. One hypothesis, largely based on findings from neuroimaging studies, states that MFT may improve extinction retention, but this has not been demonstrated empirically. To investigate this question healthy subjects either completed a 4-week MFT- intervention delivered through a smart-phone app (n = 14) or were assigned to a waitlist (n = 15). Subsequently, subjects participated in a two-day experimental protocol using pavlovian aversive conditioning, evaluating acquisition and extinction of threat-related responses on day 1, and extinction retention on day 2. Results showed that the MFT group displayed reduced spontaneous recovery of threat related arousal responses, as compared to the waitlist control group, on day 2. MFT did not however, have an effect on either the acquisition or extinction of conditioned responses day 1. This clarifies the positive effect of MFT on emotional functioning and could have implications for the treatment of anxiety and trauma related disorders.

Reduced electrophysiological habituation to novelty after trauma reflects heightened salience network detection.

BACKGROUND: Event-Related Potential (ERP) studies of PTSD have reported enhanced P3 amplitudes in response to trauma-related stimuli that are less likely to habituate over time. METHODS: In the present study, we compared ERPs to the first and last half of an auditory novelty oddball task using neutral (trauma-unrelated) stimuli. Participants were 59 young students who were: trauma-exposed with "Probable PTSD", trauma-exposed without PTSD, or non-traumatized controls. RESULTS: Reduced P3 amplitudes were observed for the last half of the trials for the entire sample, but this habituation was less profound for both trauma-exposed groups, demonstrating reduced habituation over time. Arousal symptom severity and trauma history negatively correlated with P3 amplitude habituation across the entire sample. Reduced N1 amplitudes for the last half of the trials were found in both trauma-exposed groups, but not among controls. CONCLUSIONS: Our findings suggest that trauma-exposed individuals exhibit information processing alterations in response to neutral environmental stimuli that may be related to a general pattern of heightened activity of the Salience Network. Implications for the neurobiological model of PTSD and PTSD psychotherapy are discussed.

Holistic management of malignant wounds in palliative patients.

Malignant wounds are a complication of cancer, and usually occur in those individuals with advanced disease. When healing ceases to be the goal, treatment is centred around symptom control and improving quality of life. Caring for individuals with malignant wounds presents challenges for patients, their families and nurses alike. This article discusses the holistic management of malignant wounds, with an emphasis on the control of both physical and psychosocial symptoms of wound management, as well as the impact that this may have on all those involved. Common physical symptoms of malignant wounds include malodour, bleeding, pain, exudate and pruritis. Psychosocial symptoms may result in social isolation and depression. All these symptoms have a huge impact, not only on patients and their families, but also on healthcare professionals both during and after care. Managing these symptoms requires a multidisciplinary approach to facilitate the best possible outcomes for patients and their caregivers.

Preliminary Report on a Spiritually-Based PTSD Intervention for Military Veterans.

Military veterans can experience spiritual/religious struggles such as weakening of beliefs, loss of meaning, increased guilt, difficulty forgiving, and moral challenges as a result of military trauma. While mainstream treatments (e.g., exposure therapy) have been shown to be effective for many, they often fail to address these issues adequately. This paper describes an 8-session spiritually-based group intervention designed to treat trauma-related spiritual wounds among military veterans. A program evaluation conducted with 24 veterans revealed significant reductions in PTSD symptoms, spiritual injury, and negative religious coping from pretest to posttest. The findings support the need for additional PTSD treatment approaches.

Mental health issues among indigenous communities and the role of traditional medicine.

INTRODUCTION: Mental health in indigenous communities is a relevant issue for the World Health Organization (WHO). These communities are supposed to live in a pure, clean and intact environment. Their real condition is far different from the imaginary; they are vulnerable populations living in difficult areas, exposed to pollution, located far from the health services, exposed to several market operations conducted to extract natural resources, facing criminal groups or illegal exploitation of land resources. These factors may have an impact on mental health of indigenous population. METHODS: We reviewed all papers available on PubMed, EMBASE and The Cochrane Library until December 2018. We focused on those factors affecting the changes from a traditional to a post-modern society and reviewed data available on stress-related issues, mental distress affecting indigenous/aboriginal communities and the role of Traditional Medicine (TM). We reviewed articles from different countries hosting indigenous communities. RESULTS: The incidence of mental distress and related phenomena (e.g. collective suicide, alcoholism and violence) among indigenous populations is affected by political and socio-economic variables. The mental health of these populations is poorly studied and described even if mental illness indicators are somewhat alarming. TM still seems to have a role in supporting affected people and may reduce deficiencies due to poor access to medical insurance/coverage, psychiatry and psychotherapy. It would be helpful to combine TM and modern medicine in a healthcare model to face indigenous populations' health needs. CONCLUSION: This review confirms the impact of societal changes, environmental threats and exploitation of natural resources on the mental health of indigenous populations. Global Mental Health needs to deal with the health needs of indigenous populations as well as psychiatry needs to develop new categories to describe psychopathology related to social variance as recently proposed by the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5).

Expressive writing to improve resilience to trauma: A clinical feasibility trial.

BACKGROUND AND PURPOSE: Trauma is highly prevalent, with estimates that up to 90% of the U.S. population have been exposed to a traumatic event. The adverse health consequences of trauma exposure are diverse and often long-lasting. While expressive writing has been shown to improve emotional and physical health in numerous populations, the feasibility and potential effectiveness of a novel expressive writing program provided in a clinical setting to improve resilience is unknown. Our objective was to determine the feasibility and potential effectiveness of a 6-week expressive writing course provided in a clinical setting to improve resilience in individuals with a history of trauma. MATERIALS AND METHODS: This prospective, observational trial of a 6-week expressive writing intervention (Transform Your Life: Write to Heal) was conducted in an academic outpatient integrative clinic. Eligible participants were a self-referred sample of 39 English-speaking adults who identified as having had a trauma, or significant emotional/physical upheaval, within the past year. Main outcome measures included: Feasibility: Enrollment, Retention in Program and Trial, Adherence. Acceptability: Adverse Events; Participant Ratings. Primary Psychological Outcome: Connor-Davidson Resilience Scale (CD-RISC). Secondary Psychological Outcomes: Perceived Stress Scale - 10 item (PSS-10); Center for Epidemiologic Studies Depression Scale (CES-D); Rumination Response Scale (RRS). RESULTS: All measures of feasibility including those related to enrollment, retention, and adherence support feasibility. All measures of acceptability including adverse events and participant ratings support the intervention as being safe, well-received and personally valuable. Resilience scores increased from baseline (64.3 ±â€¯14.40) to post-intervention (74.2 ±â€¯13.15), t(37) = 4.61, p < 0.0005; Cohen's d = 0.75. In addition, across the same period, Perceived Stress scores decreased close to a standard deviation (20.5 ±â€¯7.43 to 14.3 ±â€¯6.64), t(37) = -4.71, p < 0.0005, Cohen's d = 0.76; depression symptoms decreased (from 19.0 ±â€¯13.48 to 12.7 ±â€¯11.68), t(37) = -3.21, p = 0.003, Cohen's d = 0.52; and rumination scores decreased from 48.5 ±â€¯12.56 to 39.8 ±â€¯10.07), t(37) = -5.03, p < 0.0005, Cohen's d = 0.82. Effect sizes ranged from medium to large. CONCLUSION: The Transform Your Life: Write to Heal program is feasible to offer in a clinical setting, was well-received by participants, and demonstrated preliminary findings of effectiveness. Our study suggests that this novel 6-week writing intervention including expressive, transactional, poetic, affirmative, legacy, and mindful writing prompts increases resilience, and decreases depressive symptoms, perceived stress, and rumination in an outpatient sample of those reporting trauma in the past year. The program appears suitable to be evaluated in a larger randomized controlled trial.

Barriers and facilitators to implementing playlists as a novel personalised music intervention in public healthcare settings in New South Wales, Australia.

Listening to personalised music is a simple and low-cost intervention with expected therapeutic benefits, including reduced agitation, stress responses and anxiety. While there is growing evidence for the use of personalised music as a therapeutic intervention, there has been little investigation into processes and strategies that would support the implementation of playlists. The aim of this study was to identify the perceived barriers and facilitators to implementing personalised playlists on a large scale in public healthcare settings. A mixed-methods approach was used to evaluate the feasibility of the intervention in 21 different acute, sub-acute and primary healthcare settings in New South Wales (NSW), Australia, between June 2016 and June 2017. Data collection included 153 survey responses (staff n=35, patients n=49 and family members n=69), six focus groups (staff n=21) and an analysis of 37 documents. Data sources were systematically categorised using a Policy Analysis Framework. Facilitators included the use of implementation leads and volunteers, a high level of staff engagement and the integration of music selection and playlist development into routine clinical practice. Barriers included ongoing and unexpected funding, time to prepare playlists and staff turnover. The results from this study support the feasibility and acceptability of implementing playlists in different healthcare settings.

Parent experiences and psychosocial support needs 6 months following paediatric critical injury: A qualitative study.

INTRODUCTION: Parents of critically injured children can experience high levels of psychological distress post-injury, however little is known about their experiences and needs following injury. This study aimed to explore parent experiences and psychosocial support needs in the six months following child critical injury. METHODS: An interpretive qualitative design was used. Semi-structured interviews were conducted with 30 parents of 23 critically injured children. Interviews explored parent experiences and psychosocial support needs. Qualitative data were managed using NVIVO 10 and analysed thematically. RESULTS: Four themes were identified: integrating back into home life; adjusting mentally and emotionally to injury; coping with injury as a family; and navigating resources to meet family needs. Parents and families experienced substantial ongoing emotional impacts at 6 months following child injury. Parents were unprepared for the negative changes in their child's psychological wellbeing and behaviour post injury, and parents' mental health was negatively impacted, with mothers more likely to seek emotional support than fathers. Parents reported receiving no psychosocial follow-up from the hospital and limited information about community services and accessing local community resources on returning home. CONCLUSIONS: There is a need to include all family members in discharge planning, and to use a family-centred continuity-of-care approach from the time of child injury through to post-discharge recovery. To strengthen parent and family wellbeing, a biopsychosocial holistic approach is recommended, including cognitive-behavioural and other psychological strategies to help reduce distress for parents and all family members and strengthen their coping capacity. A dedicated family support coordinator role to facilitate care over the child recovery trajectory, and development of accessible online and e-psychosocial support resources for parents and families are recommended.

Application of a RE-AIM Evaluation Framework to Test Integration of a Mindfulness Based Parenting Intervention into a Drug Treatment Program.

Background The RE-AIM framework was applied to the Mindfulness Based Parenting (MBP) intervention to evaluate the feasibility and effectiveness of this innovative trauma informed model in a drug treatment program. The MBP intervention is aimed at mitigating the stress experienced by women in treatment for substance use disorders, and thereby improving parenting and dyadic attachment between mother and child. Methods This was a single arm pre-test post-test design using repeated measure data collected between 2013 and 2016. The design also includes comprehensive process and impact evaluation data. Participants were 120 parenting women enrolled in an opioid treatment program between 2013 and 2016 in Philadelphia, PA. The MBP intervention included weekly 2-h MBP group sessions over 12 weeks, including three dyadic sessions with their child. The main outcomes of this study include the five facets of RE-AIM: Reach, Effectiveness, Adoption, Implementation, and Maintenance. Results The MBP intervention was associated with improvements in parenting across participants. Data showed implementation and sustainability are contingent upon a strong multidisciplinary team and clinical staff support and "buy-in". Iterative adaptations of interventions used in the general population may be necessary when working with a traumatized population burdened by low literacy levels, trauma history and co-occurring disorders. Conclusions MBP is a feasible and effective intervention for improving parenting and dyadic attachment between women with opioid use disorder and their children, and may be useful for other programs that serve parenting women with substance use disorders.

Mindfulness moderates the relation between trauma and anxiety symptoms in college students.

OBJECTIVE: To explore the relations between trauma exposure and anxiety and depression among college students, and to determine whether trait mindfulness may moderate these relations. PARTICIPANTS: Self-report survey data from 2,336 college sophomores were drawn from a larger university-wide study ("Spit for Science"). METHODS: We constructed multiple linear regression models using past-year trauma exposure, trait mindfulness, and their multiplicative interaction to predict current anxiety and depressive symptom severity, while controlling for covariates. RESULTS: Mindfulness was associated with lower levels of depression and anxiety symptom severity. Trauma was a significant predictor of anxiety, but not depression, and high levels of mindfulness attenuated the association between trauma exposure and higher anxiety symptom severity. CONCLUSIONS: These results have implications for the treatment and prevention of anxiety among trauma-exposed college students and provide a basis for further research into the mechanisms through which mindfulness may facilitate positive mental health.