Peritraumatic Dissociation Partially Mediates the Influence of Lifetime Trauma Exposure on Prospective PTSD Symptoms.

Higher lifetime trauma exposure and increased peritraumatic dissociation (PD) are well-known predictors of Post-Traumatic Stress Disorder (PTSD) symptoms following new trauma (prospective PTSD symptoms). The interplay between those factors, however, is not well established. In this study, we aimed to assess whether PD mediates the influence of lifetime trauma exposure on prospective PTSD symptoms. A total of 387 adults visiting five emergency departments who had experienced a traumatic event within 72 hours completed baseline assessments on lifetime trauma exposure count and PD. PTSD symptoms were assessed 1 month later. Structural equation modeling was used to examine the mediation effect of PD in the relationship between lifetime trauma exposure count and 1-month PTSD symptoms. We found that PD mediated the association between lifetime trauma exposure count and 1-month PTSD symptoms, even after accounting for some confounders. However, the mediation was partial, accounting for 17.9% of the lifetime trauma exposure count's total effect. While this finding is significant, it also suggests that additional mechanisms beyond PD play a role in explaining the influence of higher lifetime trauma exposure on prospective PTSD symptoms. These findings provide valuable insights into the complex dynamics of PTSD development and call for further research to explore complementary factors and preventive strategies.

Soft-tissue fossilization illuminates the stepwise evolution of the ray-finned fish brain.

A complex brain is central to the success of backboned animals. However, direct evidence bearing on vertebrate brain evolution comes almost exclusively from extant species, leaving substantial knowledge gaps. Although rare, soft-tissue preservation in fossils can yield unique insights on patterns of neuroanatomical evolution. Paleontological evidence from an exceptionally preserved Pennsylvanian (∼318 Ma) actinopterygian, Coccocephalus, calls into question prior interpretations of ancestral actinopterygian brain conditions. However, the ordering and timing of major evolutionary innovations, such as an everted telencephalon, modified meningeal tissues, and hypothalamic inferior lobes, remain unclear. Here, we report two distinct actinopterygian morphotypes from the latest Carboniferous-earliest Permian (∼299 Ma) of Brazil that show extensive soft-tissue preservation of brains, cranial nerves, eyes, and potential cardiovascular tissues. These fossils corroborate inferences drawn from ✝Coccocephalus, while adding new information about neuroanatomical evolution. Skeletal features indicate that one of these Brazilian morphotypes is more closely related to living actinopterygians than the other, which is also reflected in soft-tissue features. Significantly, the more crownward morphotype shows a key neuroanatomical feature of extant actinopterygians-an everted telencephalon-that is absent in the other morphotype and ✝Coccocephalus. All preserved Paleozoic actinopterygian brains show broad similarities, including an invaginated cerebellum, hypothalamus inferior lobes, and a small forebrain. In each case, preserved brains are substantially smaller than the enclosing cranial chamber. The neuroanatomical similarities shared by this grade of Permo-Carboniferous actinopterygians reflect probable primitive conditions for actinopterygians, providing a revised model for interpreting brain evolution in a major branch of the vertebrate tree of life.

The effect of a single session of psychological first aid in the emergency department on PTSD and depressive symptoms three months post-intervention: results of a randomised controlled trial.

Background: Despite its popularity, evidence of the effectiveness of Psychological First Aid (PFA) is scarce.Objective: To assess whether PFA, compared to psychoeducation (PsyEd), an attention placebo control, reduces PTSD and depressive symptoms three months post-intervention.Methods: In two emergency departments, 166 recent-trauma adult survivors were randomised to a single session of PFA (n = 78) (active listening, breathing retraining, categorisation of needs, assisted referral to social networks, and PsyEd) or stand-alone PsyEd (n = 88). PTSD and depressive symptoms were assessed at baseline (T0), one (T1), and three months post-intervention (T2) with the PTSD Checklist (PCL-C at T0 and PCL-S at T1/T2) and the Beck Depression Inventory-II (BDI-II). Self-reported side effects, post-trauma increased alcohol/substance consumption and interpersonal conflicts, and use of psychotropics, psychotherapy, sick leave, and complementary/alternative medicine were also explored.Results: 86 participants (51.81% of those randomised) dropped out at T2. A significant proportion of participants in the PsyEd group also received PFA components (i.e. contamination). From T0 to T2, we did not find a significant advantage of PFA in reducing PTSD (p = .148) or depressive symptoms (p = .201). However, we found a significant dose-response effect between the number of delivered components, session duration, and PTSD symptom reduction. No significant difference in self-reported adverse effects was found. At T2, a smaller proportion of participants assigned to PFA reported increased consumption of alcohol/substances (OR = 0.09, p = .003), interpersonal conflicts (OR = 0.27, p = .014), and having used psychotropics (OR = 0.23, p = .013) or sick leave (OR = 0.11, p = .047).Conclusions: Three months post-intervention, we did not find evidence that PFA outperforms PsyEd in reducing PTSD or depressive symptoms. Contamination may have affected our results. PFA, nonetheless, appears to be promising in modifying some post-trauma behaviours. Further research is needed.

Psychological First Aid (PFA) is widely recommended early after trauma.We assessed PFA's effectiveness for decreasing PTSD symptoms and other problems 3 months post-trauma.We didn't find definitive evidence of PFA's effectiveness. Still, it seems to be a safe intervention.

Seminarios autogestionados de psiquiatría como modelo de participación estudiantil activa en pregrado. Experiencia 2014-2021 en la Pontificia Universidad Católica de Chile / Self-managed psychiatry seminars as a model of active student participation in undergraduate education

In the last decade, medical students stood out as active agents in their training, which implies their involvement in the design, implementation, evaluation, and curricular co-governance. This article describes a model of active undergraduate student participation from 2014 to 2021 and compares the face-to-face and synchronous online modalities, later brought forward by the SARS-COV-2 pandemic. Annually, a call was made to UC School of Medicine undergraduate students to establish the topics and areas to be addressed during self-managed seminars. Then, medical students located in Chile were invited to attend the activity. Psychiatry was established as a priority topic in six out of eight years. Five seminars were conducted, the last two in synchronous online mode. The number of people enrolled in the online modality increased by 251% compared to the face-to-face modality (face-to-face mean = 133 ± 33 SD; online mean = 336 ± 24SD), with no significant differences in rates of attendance between modalities (Odds ratio (OR) = 1,12; 95% CI= 0,82 - 1,55; p = 0,45). The online modality was associated with a higher proportion of enrollees belonging to an institution outside the Metropolitan Region (OR 12,63; 95% CI = 8,64 - 18,46; p < 0,01). The self-managed psychiatry seminars correspond to a model of active undergraduate student participation, with the synchronous online modality representing an opportunity to massify it throughout the national territory.

Lesión del tronco coronario en paciente con enfermedad renal crónica y terapia dialítica: Reporte de caso y revisión de la literatura / Lesion of the coronary arterial trunk in patients with chronic renal disease undergoing dialysis: Case report and literature review

La enfermedad del tronco se encuentra en el 5 a 7% de pacientes sometidos a angiografía coronaria. El síndrome coronario agudo (SICA) secundario a la complicación de la placa ateromatosa a este nivel, frecuentemente en porción distal, tiene una tasa de mortalidad de 50% en los siguientes tres años. Se presenta el caso de una mujer de 20 años, con enfermedad renal crónica terminal en hemodiálisis, con historia de dolor torácico y disnea recurrente, siendo el último episodio durante la sesión de hemodiálisis, en la cual mostró cambios electrocardiográficos y ecocardiográficos compatibles con SICA, y obstrucción del 95% de arteria epicárdica izquierda principal en porción proximal (enfermedad troncal ostial) en la angiocoronariografía. Se discute sobre las dos posibles opciones terapéuticas, la cirugía de revascularización y el intervencionismo coronario percutáneo, optando por este último, el cual finalmente tuvo éxito en el caso presentado. (AU)

Coronary arterial trunk disease is found in 5-7% of patients undergoing coronary arteriography. Acute coronary syndrome (ACS) resulting from complications of an atheromatous plaque in the distal portion of the arterial trunk has a mortality rate of 50% in the following 3 months. We present the case of a 20-year-old woman with end stage renal disease undergoing dialysis who presented an acute history of chest pain during the procedure, her EKG and heart ultrasound images were compatible with ACS, and 95% obstruction of the main left coronary artery in its distal portion was found in the coronary angiography. The two possible interventions were discussed, surgery and percutaneous procedures opting for the second one with success. (AU)

Propuesta para abordar los problemas de salud mental detectados en el proceso diagnóstico de la Delegación Presidencial para la reconstrucción tras el terremoto del 27 de febrero de 2010 / Proposal to address the mental health problems detected after the February 27, 2010 earthquake

One of the most important topics mentioned by people from places affected by the February 27th, 2010 earthquake to the Presidential Delegation for the Reconstruction, was the urgent need of mental health care. Given the enormous individual and social burden of mental health sequelae after disasters, its treatment becomes a critical issue. In this article, we propose several actions to be implemented in Chile in the context of the process of recovery and reconstruction, including optimization of social communication and media response to disasters; designing and deployment of a national strategy for volunteer service; training of primary care staff in screening and initial management of post-traumatic stress reactions; and training, continuous education and clinical supervision of a critical number of therapists in evidence-based therapies for conditions specifically related to stress.

Post-traumatic symptoms in the staff of a mental health inpatient unit after the suicide of a patient: a case report in Chile / Síntomas postraumáticos en funcionarios de un servicio de hospitalización psiquiátrica luego del suicidio de un paciente: reporte de un caso en Chile

Multiple studies have shown that the suicide of a patient can produce posttraumatic and depressive symptoms among the mental health care providers, who typically have high levels of baseline burnout. OBJECTIVES: To measure posttraumatic, depressive and burnout symptoms in the staff of an inpatient psychiatric unit after the suicide of a patient. METHODS: Two months after the suicide all the employees were invited to answer, anonymously, the Posttraumatic Check-List (PCL), the Beck Depression Inventory (BDI), and the Maslach Burnout Inventory (MBI), for measuring posttraumatic, depressive, and burnout symptoms, respectively. RESULTS: Over 80% of the staff participated. A total of 17.1% had probable PTSD, 19.5% probable major depression, 24.4% and 14.6% high levels of emotional exhaustion and depersonalization, respectively, and 24.4% low levels of professional accomplishment. The group consisting of nurses, paramedic technicians, and nursing assistants ("nursing staff") had PTSD significantly greater than other workers (p < .001). CONCLUSIONS: Suicide in a psychiatric ward can produce posttraumatic and depressive symptoms among the staff, as high as another kind of traumas. The impact may be greater on the nursing staff. It is essential that organizations involved in the provision or teaching of mental health care incorporate this reality into their agenda, to prevent, mitigate and respond better to this phenomenon.

Múltiples estudios han mostrado que el suicidio de un paciente puede producir síntomas postraumáticos y depresivos en el personal de salud mental, quienes además presentan altos niveles de burnout basal. OBJETIVOS: Medir síntomas postraumáticos, depresivos y de burnout en los funcionarios de una unidad de hospitalización psiquiátrica luego del suicidio de un paciente. MÉTODOS: Dos meses después del suicidio, todos los funcionarios fueron invitados a contestar anónimamente el Postraumatic Check-List (PCL), el Inventario de Depresión de Beck (BDI), y el Inventario de Burnout de Maslach (MBI), para medir síntomas postraumáticos, depresivos, y de burnout, respectivamente. RESULTADOS: Más del 80% de los funcionarios contestaron los cuestionarios. Un total de 17,1% tenía probable Trastorno de Estrés Postraumático, 19,5% probable depresión mayor, 24,4% y 14,6% altos niveles de agotamiento emocional y despersonalización, respectivamente, y 24,4% bajos niveles de satisfacción profesional. El grupo compuesto por enfermeras universitarias, técnicos paramédicos, y asistentes de enfermería ("personal de enfermería") tuvo síntomas de Trastorno de Estrés Postraumático significativamente mayores que otros funcionarios (p < .001). CONCLUSIONES: El suicidio en una unidad de hospitalización psiquiátrica puede producir tantos síntomas postraumáticos y depresivos en los funcionarios de salud como otros tipos de traumas. El impacto podría ser mayor en el personal de enfermería. Es indispensable que las organizaciones involucradas en la provisión o enseñanza de salud mental incorporen esta realidad en sus agendas, para prevenir, mitigar y responder mejor a este fenómeno.

Trauma psicológico en la atención primaria: orientaciones de manejo / Management of psychological trauma in primary care

Exposure to traumatic events is frequent in the general population and psychiatric sequelae such as post-traumatic stress disorders are common. The symptoms of psychiatric sequelae after trauma are vague, with multiple psychological and physical symptoms, which can confuse the health care professional. This paper seeks to facilitate the work in primary care, providing practical information about the diagnosis, initial management and referral of patients who have suffered traumatic experiences. Some early interventions and treatments are suggested.

Apoyo psicológico en desastres: Propuesta de un modelo de atención basado en revisiones sistemáticas y metaanálisis / Psychological support for disaster victims: An evidence-based care model

A search for meta analyses and systematic reviews on psychological support to disaster victims was carried out to devise a local support model. Based on 36 meta analyses and systematic reviews, the support should be carried out in five echelon levels: diffusion, social support, general medical care, general psychiatric care and psychiatric care carried out by experts. Only victims with well-established formal psychiatric disorders should receive psychotherapy or psychotropic medication. The rest should only receive psychological first aid. According to the best evidence available, a model for psychological care is proposed.

Ventilación mecánica en paciente con enfermedad pulmonar obstructiva crónica / Mechanical ventilation in patient with chronic obstructive pulmonary disease

La enfermedad pulmonar obstructiva crónica (EPOC) es un problema sanitario y económico mundial. En los pacientes que presentan exacerbación aguda y son hospitalizados, alrededor del 8 por ciento requieren soporte ventilatorio. La ventilación no invasiva es el tratamiento de primera línea en la falla respiratoria, no obstante, la ventilación mecánica invasiva también es requerida. Un buen entendimiento de la fisiopatología de la vía aérea y de la mecánica respiratoria es necesario para un mejor manejo de las exacerbaciones y la falla respiratoria. La hiperinsuflación dinámica a nivel pulmonar derivado de una limitación de los flujos espiratorios es un hecho cardinal. Por ello, es necesario una óptima programación del ventilador mecánico que privilegie el vaciamiento espiratorio de los pulmones, mejorar el intercambio gaseoso y minimizar el trabajo respiratorio del paciente. Esta revisión discute las alteraciones fisiopatológicas y mecánicas respiratorias en el paciente con EPOC exacerbado y las técnicas ventilatorias para optimizar el manejo de la falla respiratoria hipercápnica.

Chronic obstructive pulmonary disease (COPD) is a major global healthcare problem. The patients that present acute exacerbation and are hospitalized, about 8 percent needs support ventilator. The noninvasive ventilation is the treatment of the first line in the respiratory failure, nevertheless, the mechanical invasive ventilation also is needed. A good understanding of the airway pathophysiology and lung mechanics in COPD is necessary for a better manage of the acute exacerbations and respiratory failure. The dynamic hyperinflation derived from an expiratory airflow limitation is a cardinal fact. For management, is necessary an appropriate programming of the mechanical ventilator that favors the reducing the amount of air trapping of the lungs, to improve the gas exchange and to minimize the respiratory work of the patient. This review discusses the alterations pathophysiology and lung mechanics in the patient with acute exacerbation of COPD and ventilatory strategies.

Evacuación aeromédica de pacientes críticos: experiencia institucional, revisión de principios técnicos y recomendaciones / Aeromedical evacuation of critical patients: institutional experience, review of technical principles and recommendations

La Evacuación Aeromédica de Pacientes Críticos (EVACRIT) ha tenido un importante desarrollo en los últimos 15 años. Su propósito es trasladar pacientes de Unidades de Cuidados Intensivos (UCI), que requieren manejo en un centro de mayor complejidad tecnológica y experiencia, luego de una estabilización inicial. Hoy se dispone de medios de monitoreo y soporte vital portátiles de alta confiabilidad. Sin embargo, resulta necesario complementar esta capacidad con una adecuada selección del paciente a trasladar, identificar la mejor oportunidad para realizar el traslado en forma razonablemente segura, prever necesidades, anticipar eventos, y reunir los medios técnicos e insumos, así como los profesionales idóneos para su transporte; incluso puede sugerirse el medio aéreo más adecuado para cada situación. El objetivo de este estudio es presentar y evaluar la experiencia reunida en la Fuerza Aérea de Chile en EVACRIT a partir de 1995, se comentan los fundamentos de esta acción aeromédica y se destacan los principios considerados ejes de esta tarea.

The air medical transport of Critical Care patients has grown considerably in the late 15 years. lt's goal is to transfer patients in critical condition from their original ICU to another one with more complex technology and/or experien¬ce Now days there are quite consistent portable means for monitoring and vital support, so the challenge extends to choosing the most proper moment so as to perform the medical flight with reasonably low risk, gathering the necessary medical equipment and medication, foreseeing the patient's needs and risks. In the same direction a personalized choice of the medical crew must be considered. Even the most adequate aircrafi means may be proposed for each specific situation. This paper shows the experience gathered by the Chilean Air Force's Critical Care Transport teams since 1985, the fundamentals for this are analyzed, the same as the most outstanding principles that rule this kind of medical procedures.