Associations among maternal lifetime trauma, psychological symptoms in pregnancy, and infant stress reactivity and regulation.

Maternal trauma has intergenerational implications, including worse birth outcomes, altered brain morphology, and poorer mental health. Research investigating intergenerational effects of maternal trauma on infant stress reactivity and regulation is limited. Maternal mental health during pregnancy may be a contributor: psychopathology is a sequela of trauma exposure and predictor of altered self-regulatory capacity in offspring of affected mothers. We assessed associations among maternal lifetime trauma and infant stress responsivity, mediated by psychological symptoms in pregnancy. Mothers reported lifetime trauma history and anxiety, depressive, and posttraumatic stress symptoms during pregnancy. At infant age 6 months, stress reactivity and regulation were assessed via maternal behavior ratings (Infant Behavior Questionnaire-Revised, IBQ-R) and behavioral (negative mood) and physiological (respiratory sinus arrhythmia, RSA) markers during a laboratory stressor (Still-Face Paradigm). Maternal trauma was directly associated with lower infant physiological regulation and indirectly associated with lower levels of both infant behavioral and physiological regulation via higher maternal anxiety during pregnancy. Maternal trauma was also indirectly associated with higher infant reactivity via higher maternal anxiety during pregnancy. Post hoc analyses indicated differential contributions of maternal prenatal versus postnatal anxiety to infant outcomes. Findings highlight potential contributory mechanisms toward maladaptive child stress response, which has been associated with poor behavioral, cognitive, and academic outcomes.

When epithelialization beats granulation in sacrococcygeal stage IV pressure ulcers/injuries: a report of two cases.

BACKGROUND: Wound healing typically occurs in 4 sequential stages: hemostasis, inflammation, proliferation, and remodeling. During the proliferation stage, the wound undergoes granulation, angiogenesis, and epithelialization. Granulation involves the growth of connective tissue and blood vessels to fill the wound space. Granulation tissue provides a scaffold for subsequent tissue regeneration, supports angiogenesis, and aids in wound contraction. Classically, it also supports epithelialization. The timing and extent of granulation and epithelialization may vary depending on the size and type of wound. In certain cases, especially with superficial wounds or partial-thickness injuries, the intact blood supply from deeper tissue layers may be sufficient to support epithelialization without significant granulation tissue formation. However, this pathway has not been described for full-thickness wounds. CASE REPORTS: The current case report describes wound healing in 2 patients with multiple comorbidities who presented with nonhealing stage IV pressure injuries. After extensive therapy, reepithelialization and wound healing occurred without typical granulation tissue formation. CONCLUSION: The achievement of epithelialization without prior granulation may suggest the existence of an alternative wound healing pathway for full-thickness wounds in which epithelialization occurs independent of robust granulation.

Patient Resiliency and Caregiver Burden After Traumatic Spinal Cord Injury Resulting in Quadriplegia.

Traumatic spinal cord injury (tSCI) resulting in quadriplegia is a life-altering injury for patients and caregivers. We conducted a retrospective review of patients treated for tSCI and quadriplegia at a level 1 trauma center to assess quality of life (QOL), socioeconomic factors, and mortality. Patients and caregivers were surveyed. Of the 65 patients included, 33 contacts were made. Seventeen surveys were completed (12 caregivers and 5 patients). Six unreachable patients were confirmed alive via medical record. Mortality rate among these 39 accessible patients was 23% (n = 9). Medicaid and uninsured patients experienced longer hospital length of stay (P < .0001) and discharged to home or nursing facilities (P < .0001) more often than those with private insurance or Medicare. Patients reported overall "good" QOL (80%) while caregivers reported overall decreased QOL markers. Our results reflect the resilience among this patient population, but also highlight the impact of this life-altering injury on the caregiver.

A Single Hospital-Wide Antibiogram is Insufficient to Account for Differences in Antibiotic Resistance Patterns Across Multiple ICUs.

BACKGROUND: Infection is a common cause of mortality within intensive care units (ICUs). Antibiotic resistance patterns and culture data are used to create antibiograms. Knowledge of antibiograms facilitates guiding empiric therapies and reduces mortality. Most major hospitals utilize data collection to create hospital-wide antibiograms. Previous studies have shown significant differences in susceptibility patterns between hospital wards and ICUs. We hypothesize that institutional or combined ICU antibiograms are inadequate to account for differences in susceptibility for patients in individual ICUs. METHODS: Culture and susceptibility data were reviewed over a 1-year period for 13 bacteria in the following ICUs: Surgical/Trauma, Medical, Neuroscience, Burn, and Emergency department. Antibiotic management decisions are made by individual teams. RESULTS: Nine species had sufficient data for inclusion into an All-ICU antibiogram. E coli and S aureus were the most common isolates. Seven species had significant differences in susceptibility patterns between ICUs. E cloacae showed higher rates of resistance to multiple antibiotics in the STICU than other ICUs. P aeruginosa susceptibility rates in the NSICU and BICU were 88% and 92%, respectively, compared to 60% and 55% in the STICU and MICU. Cephalosporins and Aztreonam had reduced efficacy against E coli in the NSICU, however remain effective in other ICUs. CONCLUSIONS: The results of this study show that different ICUs do have variability in antibiotic susceptibility patterns within a single hospital. While this only represents a single institution, it shows that the use of hospital-wide antibiograms is inadequate for creating empiric antibiotic protocols within individual ICUs.

Delivering Acupuncture Therapy in an Interdisciplinary Global Health Setting in Guatemala: Pilot Study and Lessons Learned.

Objective: Pain, stress, and diabetes mellitus (DM) are common complaints for Guatemalans seeking health care. Because acupuncture therapy (AT) is a low-cost, effective treatment for these concerns, it was offered to Guatemalans during a health care mission as an adjunct to primary care. The purpose of this study was to gather feedback about providing AT in this context and to describe the lessons that were learned. Materials and Methods: A pretest single-arm exploratory study design was used, collecting demographic data and administering a pretest to patients referred for AT. Patients received AT according to presenting symptoms, except patients with DM, who were treated with a previously developed auricular AT protocol. After AT, all patients received adhesive seeds for self-administered auricular acupressure, along with a printed diagram, showing where and how to apply them, and a symptom-tracking form. Results: AT was given to 11 patients (1 had DM; 10 did not). Most were female (9; 82%), older (average 59.27 years; range: 40-81 years), and had little education (average 4 years; range: 0-12 years). Complaints were pain (11; 100%), insomnia (6; 55%), anxiety (4; 36%), depression (7; 64%), and stress (3; 27%). More than 50% had seen health care providers (6; 55%). One person had AT previously and 3 people requested more information about AT before receiving it. Conclusions: Reporting high symptom burdens, most patients were unfamiliar with AT. AT ceased when the licensed acupuncturist contracted COVID. Patients will be followed in 2023 and AT will be given to collect data on feasibility, satisfaction, and possible implementation.