Acceptability and Usability of Smileyscope Virtual Reality for Paediatric Pain Management During Burn Procedures: Perspectives of Patients, Carers and Clinicians.

AIM: To explore clinician, child and parent acceptability and usability of the Smileyscope VR device in the context of addressing the unique pain and distress needs of young burn patients. DESIGN: A survey comprising closed and open-ended questions. METHOD: Descriptive statistics analysed participant characteristics, pain and analgesia. Qualitative content was collected from April 2022-August 2022 and analysed to identify barriers and enablers. Categories were then mapped onto the Capabilities, Opportunities and Motivation-Behaviour Wheel (COM-B) framework. RESULTS: Smileyscope was found to be effective for reducing pain and anxiety during dressing changes by both patients (n = 39) and parents (n = 37). Clinicians (n = 35) reported high self-efficacy and willingness to reuse the device. However, concerns arose regarding the device's fit and the need for age-appropriate programmes. CONCLUSION: Smileyscope demonstrated promise in reducing procedural pain and distress. The device is well accepted by all participants implying ease of implementation. Feedback suggests further program development and fitting optimisation is required. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Improved procedural pain has proven to decrease wound healing times, decreasing possible need for further scar management and long-term consequences after sustaining a burn injury. Smileyscope use in rural hospitals presents valuable opportunities for optimising early paediatric burn pain. IMPACT: Increased burn pain can delay wound healing and have long term physical and psychological impact on patients. Smileyscope was well received within this cohort; however, improvements in device design and programmes were suggested. This study shows the potential for use of Smileyscope as a non-pharmacological approach to improving paediatric burn pain and distress. PATIENT OR PUBLIC CONTRIBUTION: While our study included patients, parents and clinicians as research participants, there was no patient or public contribution in the design or conduct of the study, analysis or interpretation of the data.

The association of school bullying victimization and suicidal ideation among school-aged adolescents in Yixing City, China.

BACKGROUND: Research on the associations of type-specific bullying victimization and poly-bullying victimization with suicidal ideation is limited and contradictory. This study aimed to examine these associations among school-aged adolescents. METHODS: A total of 13,258 students from 3 middle schools and 4 high schools in a southern city in China completed a cross-sectional questionnaire in 2019. Multinomial logistic regressions were used to examine associations between type-specific bullying victimization and poly-victimization with suicidal ideation. RESULTS: The latent class analysis identified three subgroups of suicidal ideation: low (70.0 %), moderate (24.0 %), and high (6.0 %). Compared with non-bullying victimization in the past year, the corresponding adjusted odds ratios [aOR] (95 % CI) of moderate and high suicidal ideation for only physical victimization were 1.74 (1.15, 2.63) and 2.51 (1.18, 5.38), respectively, for only relational victimization were 1.26 (0.97, 1.62) and 2.48 (1.65, 3.71), respectively, for only verbal victimization were 1.45 (1.17, 1.78) and 1.42 (0.90, 2.22), respectively, for only property victimization were 1.30 (1.03, 1.65) and 1.31 (0.80, 2.16), respectively, and for sexual victimization were 1.38 (1.03, 1.83) and 2.45 (1.50, 3.99), respectively. Poly-bullying victimization was associated with moderate (aORtwo = 1.45 (1.24, 1.70); aORthree = 1.70 (1.41, 2.05), aORfour = 2.03 (1.61, 2.58), aORfive = 2.48 (1.74, 3.53)) and high suicidal ideation (aORtwo = 2.01 (1.49, 2.70), aORthree = 3.87 (2.86, 5.25), aORfour = 4.55 (3.20,6.46), aORfive = 7.90 (5.06, 12.33)). LIMITATIONS: The research design is cross-sectional, and relevant data was based on self-reports. CONCLUSIONS: Different types of bullying victimization were associated with suicidal ideation and poly-bullying victimization and suicidal ideation association shows a dose-response-relationship.

Age and Sex Differences of Virtual Reality Pain Alleviation Therapeutic During Pediatric Burn Care: A Randomized Clinical Trial.

Virtual reality (VR) effectively alleviates pain for pediatric patients during many medical procedures, such as venipuncture and burn care. In our previously published randomized clinical trial among 90 pediatric burn patients, participants in the active VR group had significantly lower scores for overall pain compared with participants in the standard care control and for worst pain compared with participants in the passive VR and control group. However, whether VR differs by a patient's age or sex remains unresolved. Thus, we reanalyzed our data by comparing the active and passive VR participants to evaluate how age and sex affect VR pain alleviation during dressing care for pediatric burns. In total, 90 patients aged 6-17 years (inclusive) with burn injuries were recruited from an outpatient burn clinic of an American Burn Association-verified pediatric burn center. Before randomization, VR helpfulness and need expectations were assessed on a visual analog scale (0-100). Participants were randomly assigned to active VR, passive VR, or control for one dressing change. Immediately following the dressing change, active and passive VR participants self-reported pain and the time spent thinking about pain and rated the VR features on the degree of realism, pleasure/fun, and perceived engagement level. Path analyses assessed how these VR features were interrelated and how they affected self-reported pain by age and sex. Patients aged 6-9 years reported higher mean expectations of VR helpfulness and need (mean = 73.6 and 94.5, respectively) than 10-12-year-olds (mean = 55.7 and 84.2, respectively) and 13-17-year-olds (mean = 68.6 and 77.4, respectively). The path analysis indicated VR engagement and fun were significantly correlated (p-value < 0.05). VR engagement significantly negatively impacted overall pain scores (coefficient = -0.45, -0.41; p-value < 0.05) and significantly positively impacted time thinking of pain (coefficient = 0.38, 0.32; p-value < 0.05). Younger patients had the highest expectations of VR helpfulness and need. VR game realism, fun, and engagement features were not statistically different between age groups and sexes. VR engagement and thinking of pain during burn dressing significantly positively affected self-reported pain (p-value < 0.05), suggesting an analgesic mechanism beyond distraction alone. Younger patients benefited more from VR than older patients.

Exploring home fall events among infants and toddlers using social media information: an infodemiology study in China.

BACKGROUND: Practical interventions of fall prevention are challenging for infants and toddlers. This study aimed to explore specific details of falls that occurred at home for kids 0-3 years old using key information from social media platforms, which provided abundant data sources for fall events. METHODS: We used internet-based search techniques to collect fall events information from 2013 to 2023. The search was restricted and implemented between 1 and 12 April 2023. Online platforms included Baidu, Weibo, WeChat, TikTok, Toutiao and Little Red Book. A qualitative descriptive approach was used to analyse the fall events and major factors, including the fall event time, child age, environmental factors and behavioural characteristics of children and caregivers. RESULTS: We identified 1005 fall injury cases among infants and toddlers. Fall mechanisms included falls from household furniture (71.2%), falls from height (21.4%) and falls on the same level (7.4%). Environmental risk factors mainly consisted of not using or installing bed rails incorrectly, a gap between beds, unstable furniture, slippery ground and windows without guardrails. Behavioural factors included caregivers leaving a child alone, lapsed attention, turning around to retrieve something, misusing baby products, inadequately holding the child and falling asleep with children. Child behavioural factors included walking or running while holding an object in hand or mouth and underdeveloped walking skills. CONCLUSION: Interventions for preventing falls should be designed specifically for Chinese families, especially considering family function in the context of Chinese culture. Social media reports could provide rich information for researchers.

Trends in pediatric prescription-opioid overdoses in U.S. emergency departments from 2008-2020: An epidemiologic study of pediatric opioid overdose ED visits.

BACKGROUND: Opioid overdose was declared a public health emergency in the United States, but much of the focus has been on adults. Child and adolescent exposure and access to unused prescription-opioid medications is a big concern. More research is needed on the trend of pediatric (age 0-17) prescription-opioid overdose emergency department (ED) visits in the United States, particularly during the COVID-19 pandemic year. METHODS: This retrospective epidemiological study used the 2008-2020 Nationwide Emergency Department Sample to provide a national estimate of ED visits related to prescription-opioid overdose. Inclusion criteria were 0-17-year-old patients treated at the ED due to prescription-opioid overdose. Eligible visits were identified if their medical records included any administrative billing codes for prescription-opioid overdose. National estimates were broken down by age groups, sex, geographic region, primary payer, median household income by zip code, ED disposition, and hospital location/teaching status. Incidence rate per 100,000 U.S. children was calculated for age groups, sex, and geographic region. RESULTS: Overall, the prescription-opioid overdose ED visits for patients from 0-17 years old in the United States decreased by 22% from 2008 to 2019, then increased by 12% in 2020. Most patients were discharged to home following their ED visit; however, there was a 42% increase in patients admitted from 2019 to 2020. The prescription-opioid overdose rate per 100,000 U.S. children was highest in the 0 to 1 and 12 to 17 age groups, with the 12 to 17 group increasing by 27% in 2020. ED visits in the West and Midwest saw prescription-opioid visits increase by 58% and 20%, respectively, from 2019-2020. CONCLUSIONS: Prescription-opioid overdose ED visits among U.S. children and adolescents decreased over the past decade until 2019. However, there was a substantial increase in ED visits from 2019 to 2020, suggesting the potential impact due to the then-emerging COVID-19 pandemic. Findings suggest focusing on young children and adolescents to reduce further prescription-opioid overdoses in the United States.

What Is Medical Extended Reality? A Taxonomy Defining the Current Breadth and Depth of an Evolving Field.

Medical extended reality (MXR) has emerged as a dynamic field at the intersection of health care and immersive technology, encompassing virtual, augmented, and mixed reality applications across a wide range of medical disciplines. Despite its rapid growth and recognition by regulatory bodies, the field lacks a standardized taxonomy to categorize its diverse research and applications. This American Medical Extended Reality Association guideline, authored by the editorial board of the Journal of Medical Extended Reality, introduces a comprehensive taxonomy for MXR, developed through a multidisciplinary and international collaboration of experts. The guideline seeks to standardize terminology, categorize existing work, and provide a structured framework for future research and development in MXR. An international and multidisciplinary panel of experts was convened, selected based on publication track record, contributions to MXR, and other objective measures. Through an iterative process, the panel identified primary and secondary topics in MXR. These topics were refined over several rounds of review, leading to the final taxonomy. The taxonomy comprises 13 primary topics that jointly expand into 180 secondary topics, demonstrating the field's breadth and depth. At the core of the taxonomy are five overarching domains: (1) technological integration and innovation; (2) design, development, and deployment; (3) clinical and therapeutic applications; (4) education, training, and communication; and (5) ethical, regulatory, and socioeconomic considerations. The developed taxonomy offers a framework for categorizing the diverse research and applications within MXR. It may serve as a foundational tool for researchers, clinicians, funders, academic publishers, and regulators, facilitating clearer communication and categorization in this rapidly evolving field. As MXR continues to grow, this taxonomy will be instrumental in guiding its development and ensuring a cohesive understanding of its multifaceted nature.

Distinguishing between translational science and translational research in CTSA pilot studies: A collaborative project across 12 CTSA hubs.

Introduction: The institutions (i.e., hubs) making up the National Institutes of Health (NIH)-funded network of Clinical and Translational Science Awards (CTSAs) share a mission to turn observations into interventions to improve public health. Recently, the focus of the CTSAs has turned increasingly from translational research (TR) to translational science (TS). The current NIH Funding Opportunity Announcement (PAR-21-293) for CTSAs stipulates that pilot studies funded through the CTSAs must be "focused on understanding a scientific or operational principle underlying a step of the translational process with the goal of developing generalizable solutions to accelerate translational research." This new directive places Pilot Program administrators in the position of arbiters with the task of distinguishing between TR and TS projects. The purpose of this study was to explore the utility of a set of TS principles set forth by NCATS for distinguishing between TR and TS. Methods: Twelve CTSA hubs collaborated to generate a list of Translational Science Principles questions. Twenty-nine Pilot Program administrators used these questions to evaluate 26 CTSA-funded pilot studies. Results: Factor analysis yielded three factors: Generalizability/Efficiency, Disruptive Innovation, and Team Science. The Generalizability/Efficiency factor explained the largest amount of variance in the questions and was significantly able to distinguish between projects that were verified as TS or TR (t = 6.92, p < .001) by an expert panel. Conclusions: The seven questions in this factor may be useful for informing deliberations regarding whether a study addresses a question that aligns with NCATS' vision of TS.

Features of virtual reality impact effectiveness of VR pain alleviation therapeutics in pediatric burn patients: A randomized clinical trial.

Key features of virtual reality (VR) that impact the effectiveness of pain reduction remain unknown. We hypothesized that specific features of the VR experience significantly impact VR's effectiveness in reducing pain during pediatric burn dressing care. Our randomized controlled trial included children 6 to 17 years (inclusive) who were treated in the outpatient clinic of an American Burn Association-verified pediatric burn center. Participants were randomly assigned (1:1:1) to active VR (playing the VR), passive VR (immersed in the same VR environment without interactions), or standard-of-care. On a scale from 0 to 100, participants rated overall pain (primary outcome) and features of the VR experience (game realism, fun, and engagement). Path analysis assessed the interrelationships among these VR key features and their impact on self-reported pain scores. From December 2016 to January 2019, a total of 412 patients were screened for eligibility, and 90 were randomly assigned (31 in the active VR group, 30 in the passive VR group, and 29 in the standard-of-care group). The current study only included those in the VR groups. The difference in median scores of VR features was not statistically significant between the active (realism, 77.5 [IQR: 50-100]; fun, 100 [IQR: 81-100]; engagement, 90 [IQR: 70-100]) and passive (realism, 72 [IQR: 29-99]; fun, 93.5 [IQR: 68-100]; engagement, 95 [IQR: 50-100]) VR distraction types. VR engagement had a significant direct (-0.39) and total (-0.44) effect on self-reported pain score (p<0.05). Key VR features significantly impact its effectiveness in pain reduction. The path model suggested an analgesic mechanism beyond distraction. Differences in VR feature scores partly explain active VR's more significant analgesic effect than passive VR. Trial Registration: ClinicalTrials.gov Identifier: NCT04544631.

Worldwide Perinatal Intimate Partner Violence Prevalence and Risk Factors for Post-traumatic Stress Disorder in Women: A Systematic Review and Meta-analysis.

Post-traumatic stress disorder (PTSD) in women who have experienced perinatal intimate partner violence (P-IPV) has gradually attracted the attention of psychologists, mental health, and health care professionals. However, a comprehensive understanding of its prevalence and associated risk factors is still lacking. The aim of this systematic review and meta-analysis was to determine the prevalence and explore influencing factors for PTSD in women who have suffered P-IPV. Our study inclusion criteria were: women who experienced IPV in the year before conception, throughout pregnancy, during delivery, and up to 1 year after giving birth for which a quantitative assessment of PTSD was done using validated diagnostic or screening tools. This study searched nine English databases and four Chinese databases. The final analysis included 16 studies, involving 9,098 female subjects. Meta-analysis was performed on the extracted data using the Stata 16.0 software (Stata Corp. LP, College Station, TX, USA).Fixed or random effect models were selected to pool odds ratio (OR) and 95% confidence interval (CI) of PTSD after heterogeneity test. Meta-analysis showed that the pooled prevalence of PTSD in women who suffered P-IPV was 30.0% (95% confidence interval [95% CI] = [22.0%, 37.0%]). Only nine studies described influencing factors for PTSD based on multivariate logistic regression analysis. The five identified influencing factors were: non-immigrants (OR = 2.56; 95% CI [1.29, 5.08]), non-cohabitation (OR = 2.45; [1.35, 4.42]), trauma history (OR = 1.80; [1.18, 2.76]), education below senior high school (OR = 1.32; [0.64, 2.75]), and age 18 to 29 years (OR = 1.06; [0.94, 1.19]). These findings provided a reference value of PTSD prevalence, risk factors, and potential association with P-IPV among women worldwide. However, the geographical coverage of the reviewed studies is limited and epidemiological investigations from more diverse areas are required in the future.

Impact of opioid law on prescriptions and satisfaction of pediatric burn and orthopedic patients: An epidemiologic study.

OBJECTIVES: The objective of this study was to determine the reduction in prescribed opioid pain dosage units to pediatric patients experiencing acute pain and to assess patient satisfaction with pain control 90-day post discharge following the 2017 Ohio opioid prescribing cap law. METHODS: The retrospective chart review included 960 pediatric (age 0-18 years) burn injury and knee arthroscopy patients treated between August 1, 2015-August 31, 2019. Prospectively, legal guardians completed a survey for a convenience sample of 50 patients. Opioid medications (days and morphine milligram equivalents (MMEs)/kg) prescribed at discharge before and after the Ohio law implementation were collected. Guardians reported experience and satisfaction with their child's opioid prescription at 90-days post discharge. RESULTS: From pre-law to post-law, there was a significant decrease (p<0.001) within the burn and knee cohorts in the median days (1.7 to 1.0 and 5.0 to 3.8, respectively) and median total MMEs prescribed (15.0 to 2.5 and 150.0 to 90.0, respectively). An interrupted time series analysis revealed a statistically significant decrease in MMEs/kg and days prescribed at discharge when the 2017 Ohio opioid prescription law went into effect, with an abrupt level change. Prospectively, more than half of participants were satisfied (72% burn and 68% knee) with their pain control and felt they received the right amount of medication (84% burn and 56% knee). Inpatient opioid use was not changed pre- and post-law. CONCLUSIONS: Discharge opioids prescribed for pediatric burn and knee arthroscopy procedures has decreased from 2015-2019. Caregivers varied greatly in their satisfaction with pain control and the amount of opioid prescribed.

Pilot randomized clinical trial of virtual reality pain management during adult burn dressing changes: Lessons learned.

Opioids are the most frequently used pain medications by US burn centers to control severe procedural pain during wound care. Concerns for long-term opioid use have prompted the exploration of non-pharmaceutical interventions, such as virtual reality (VR), for procedural pain management. The primary objective of this pilot study was to evaluate the feasibility and efficacy of VR pain alleviation treatment in reducing adult burn patients' perceived pain during burn dressing changes. Adult patients aged 18-70 years were recruited from the inpatient unit of a single American Burn Association-verified burn center between May 2019 and February 2020 and randomly assigned to one of three arms. Active VR participants played four VR games; passive VR participants were immersed in the same VR environment without the interaction elements; and a standard of care control group. 71 patients were screened for eligibility and 33 were deemed eligible to approach for informed consent, with 14 agreeing to participate in this study. Of these 14 patients, 4 were randomly assigned to the active VR, 4 to the passive VR, and 6 to the control group. Self-reported overall pain was lowest among participants in the active VR (dressing 1 = 41.3, dressing 2 = 61.0, and dressing 3 = 72.7) and highest among participants in the passive VR (dressing 1 = 58.3, dressing 2 = 74.5, and dressing 3 = 89.0) across all three dressing changes. Self-reported worst pain was lowest among the active VR at the first and last dressing (64.3 and 92.2, respectively), but the control group has the lowest self-reported worst pain at the second dressing (71.3). VR is a useful non-pharmacological tool for pain distraction but designing and implementing clinical research studies face many challenges in real-world medical settings. Lessons from this study have important implications for future VR studies by other researchers. Trial Registration: ClinicalTrials.gov Identifier: NCT04545229.

Data Imputation for Clinical Trial Emulation: A Case Study on Impact of Intracranial Pressure Monitoring for Traumatic Brain Injury.

Randomized clinical trial emulation using real-world data is significant for treatment effect evaluation. Missing values are common in the observational data. Handling missing data improperly would cause biased estimations and invalid conclusions. However, discussions on how to address this issue in causal analysis using observational data are still limited. Multiple imputation by chained equations (MICE) is a popular approach to fill in missing data. In this study, we combined multiple imputation with propensity score weighted model to estimate the average treatment effect (ATE). We compared various multiple imputation (MI) strategies and a complete data analysis on two benchmark datasets. The experiments showed that data imputations had better performances than completely ignoring the missing data, and using different imputation models for different covariates gave a high precision of estimation. Furthermore, we applied the optimal strategy on a medical records data to evaluate the impact of ICP monitoring on inpatient mortality of traumatic brain injury (TBI). The experiment details and code are available at https://github.com/Zhizhen-Zhao/IPTW-TBI.

Data Imputation for Clinical Trial Emulation: A Case Study on Impact of Intracranial Pressure Monitoring for Traumatic Brain Injury.

Randomized clinical trial emulation using real-world data is significant for treatment effect evaluation. Missing values are common in the observational data. Handling missing data improperly would cause biased estimations and invalid conclusions. However, discussions on how to address this issue in causal analysis using observational data are still limited. Multiple imputation by chained equations (MICE) is a popular approach to fill in missing data. In this study, we combined multiple imputation with propensity score weighted model to estimate the average treatment effect (ATE). We compared various multiple imputation (MI) strategies and a complete data analysis on two benchmark datasets. The experiments showed that data imputations had better performances than completely ignoring the missing data, and using different imputation models for different covariates gave a high precision of estimation. Furthermore, we applied the optimal strategy on a medical records data to evaluate the impact of ICP monitoring on inpatient mortality of traumatic brain injury (TBI). The experiment details and code are available at https://github.com/Zhizhen-Zhao/IPTW-TBI .

Association of the Affordable Care Act Medicaid Expansion With Secondary Overtriage among Young Adult Trauma Patients.

BACKGROUND: Previous work has shown that the Affordable Care Act (ACA) Medicaid expansion decreased the uninsured rate and improved some trauma outcomes among young adult trauma patients, but no studies have investigated the impact of ACA Medicaid expansion on secondary overtriage, namely the unnecessary transfer of non-severely injured patients to tertiary trauma centers. METHODS: Statewide hospital inpatient and emergency department discharge data from two Medicaid expansion and one non-expansion state were used to compare changes in insurance coverage and secondary overtriage among trauma patients aged 19-44 y transferred into a level I or II trauma center before (2011-2013) to after (2014-quarter 3, 2015) Medicaid expansion. Difference-in-difference (DD) analyses were used to compare changes overall, by race/ethnicity, and by ZIP code-level median income quartiles. RESULTS: Medicaid expansion was associated with a decrease in the proportion of patients uninsured (DD: -4.3 percentage points; 95% confidence interval (CI): -7.4 to -1.2), an increase in the proportion of patients insured by Medicaid (DD: 8.2; 95% CI: 5.0 to 11.3), but no difference in the proportion of patients who experienced secondary overtriage (DD: -1.5; 95% CI: -4.8 to 1.8). There were no differences by race/ethnicity or community income level in the association of Medicaid expansion with secondary overtriage. CONCLUSIONS: In the first 2 y after ACA Medicaid expansion, insurance coverage increased but secondary overtriage rates were unchanged among young adult trauma patients transferred to level I or II trauma centers.

School Bullying Victimization and Associated Factors Among School-Aged Adolescents in China.

There has been a significant amount of research on correlates of bullying victimization, but most prior studies are descriptive and do not distinguish between different types of bullying. The current study used a case-control study design to explore factors related to different types of bullying victimization, including physical, relational, verbal, sexual, property, and poly-bullying victimization. This study was conducted in a southern city in China, including 3054 cases who self-reported being victims of school bullying and 3054 controls who reported not being involved in any school bullying in the past 12 months. Each victim case was matched with a control on gender, school, and grade level. Univariate logistic analyses and multivariate conditional logistic regression analyses were used to identify factors associated with being a victim of school bullying. Results suggest physical bullying victimization was only associated with a family-level characteristic (parenting style) while the other four types of bullying victimization (relational, verbal, sexual, and property bullying) and poly-bullying victimization were associated with multiple social domain variables at individual, family, and school levels. Findings from this study provide evidence of factors for different types of bullying victimization and have implications for potential measures to prevent bullying. Measures from multiple social domains, including individual, family and school (e.g., developing healthy behaviors, improving social skills, positive parent-child interactions, building trust between teachers and peers, and forming strong friendships), should be considered in order to effectively prevent adolescent victimization from bullying.

Neurobiochemical biomarkers and other risk factors for post-traumatic acute stress disorder.

Trauma is a leading cause of mortality and morbidity around the world and many trauma patients could suffer from a series of cognitive and mental disorders including acute stress disorder (ASD). Yet, little research has been done to investigate the influencing factors and pathogenesis of post-traumatic ASD. Therefore, this study investigated main influencing factors and neurobiochemical biomarkers of ASD in trauma patients with a purpose of early clinical identification and intervention. The patients were followed up by general questionnaire and Acute Stress Disorder scale (ASDS). Using the diagnostic criteria of ASD, the study participants were divided into ASD group and non-ASD group. The generalized estimating equation (GEE) multivariate analysis suggested that life stress, sleep less than 8 h, trauma from road traffic crash, overall pain intensity, injury severity, overall fear after trauma were risk factors for ASD. Neutrophil to lymphocyte ratio (NLR) showed a downward trend in both groups (P < 0.05), and the ASD group was higher than the non-ASD group (P = 0.015). Glu to GABA ratio (GGR) in the ASD group were higher than the non-ASD group (P < 0.001). Both patient demographics and patient's condition could impact the risk of developing ASD after a major injury.

Association of Pre-procedural Anxiety With Procedure-Related Pain During Outpatient Pediatric Burn Care: A Pilot Study.

The relationship between preprocedural anxiety and pain is not clear but has the potential to change the way pediatric patients need to be cared for prior to burn procedures. Using results from our recent randomized clinical trial among outpatient burn patients (n = 90) aged 6-17 years, the objective of this subsequent analysis was to assess whether preprocedural anxiety was associated with self-reported and researcher-observed pain scores. Anxiety before the dressing change was assessed using an abbreviated State-Trait Anxiety Inventory for Children (range 6-21) and reported with 95% confidence intervals (CI). Self-reported pain was reported using a Visual Analog Scale (range 0-100) and observed pain was assessed using the Face, Legs, Activity, Cry, and Consolability-revised scale. Over half of patients (58.9%) reported mild anxiety (score < 12) and about 5% of patients reported severe anxiety (score > 16). Younger children (6-8 years) reported higher anxiety scores than older children (15-17 years), but the difference did not achieve statistical significance (mean = 12.7, 95% CI: 11.5 to 13.9, P = .09). Nonparametric spearman correlation indicated that anxiety score was significantly correlated with observed pain (P = .01) and self-reported overall pain neared statistical significance (P = .06). In the final logistic regression of reporting moderate-to-severe pain (pain score > 30), the association between anxiety scores and self-reported overall moderate-to-severe pain was statistically significant (P = .03) when adjusting for race, healing degree, and pain medication use within 6 hr prior to burn dressing care. This pilot study provides preliminary data showing that anxiety before outpatient pediatric burn dressing changes is significantly associated with self-reported overall moderate-to-severe pain.

U.S. Leading Causes of Death and Years of Potential Life Lost, 1981-2019: Implications for Surgical Research.

INTRODUCTION: Examining burden of diseases could shed light on priorities of public health interventions and research funding. This study examined trends of the U.S. top leading causes of death from 1981 to 2019 using the total number of deaths, age-adjusted death rate, and years of potential life lost (YPLLs). METHODS: Data were from the Web-based Injury Statistics Query and Reporting System. This study gathered total number of deaths, age-adjusted death rates per 100,000 people, and YPLLs under 70 y of age (YPLL-70) from 1981 to 2019 for the top 10 leading causes of death and human immunodeficiency virus/acquired immunodeficiency syndrome (AIDS) for each year. The 39 y from 1981 to 2019 were evenly divided into three study periods: 1981-1993, 1994-2006, and 2007-2019. The percent change of YPLL-70 over three time periods for the top ten leading causes of death and AIDS was calculated. Trends of age-adjusted death rates and YPLL-70 of the top five leading causes of death based on the 2018-2019 death data were also reported by graphing them against time from 1981 to 2019 to highlight major mortality causes. Age-adjusted death rates for the top five leading causes of deaths and the National Institutes of Health (NIH) annual funding level in 2019 were graphed together to illustrate funding discrepancy in injury research and prevention. RESULTS: The total number of deaths caused by malignant neoplasms in 2019 was 244,994, followed by 183,442 deaths of heart diseases, 121,476 deaths of unintentional injuries, and 41,051 suicide deaths. Despite an initial -22.20% drop of YPPL-70 during 1981-1993, unintentional injuries experienced significant increases of 19.38% and 18.59% of YPLL-70 in 1994-2006 and 2007-2019, respectively. The age-adjusted death rate for unintentional injuries was 1182 per 100,000 people in 2019, and the NIH funding in the same year was $897 million. In comparison, the age-adjusted death rate for cancer, heart disease, and human immunodeficiency virus/AIDS was 786, 649, and 30 per 100,000 people while the NIH funding was $2,560, $2,394, and $3037 million, respectively. CONCLUSIONS: Unintentional injuries, suicide, and homicide were consistently among the top leading causes of death and YPLL-70, so they should be prioritized in public health planning, research, and federal funding allocation. Injury and trauma research is severely underfunded by the U.S. premier funding agency.

US racial and sex-based disparities in firearm-related death trends from 1981-2020.

BACKGROUND: Firearms cause the most suicides (60%) and homicides (36%) in the US. The high lethality and availability of firearms make them a particularly dangerous method of attempted violence. The aim of this study was to study US trends in firearm suicide and homicide mortality and years of potential life lost before age 75 (YPLL-75) between 1981 and 2020. METHODS: Data in this cross-sectional study were collected between 1981 and 2020 from the Centers for Disease Control and Prevention (CDC)'s WISQARS database for fatal injury and violence. Data from the US population were considered for all age groups and were divided by racial groups and sex for analysis. RESULTS: Those most heavily impacted by firearm homicide were Black, with homicide age-adjusted death rates almost seven times higher than White people. A spike in firearm homicide deaths occurred between 2019 and 2020, with Black people having the largest increase (39%). White people had the highest rates of firearm suicide, and suicide death rates increased between 2019 and 2020. Increases in homicide and suicide YPLL-75 between 2011 and 2020 had most heavily impacted minority populations. Men had a firearm suicide rate that was seven times higher than women, and a firearm homicide rate that was five times higher than women. CONCLUSION: This study demonstrated that Black and White men were most impacted by firearm deaths, and that firearm homicide and suicide rates increased between 2019 and 2020 for all racial groups except Asian/Pacific Islander. Our results suggest that prevention efforts should focus on specific demographic factors and articulate the urgency to mitigate firearm-related deaths in the US.

Emergency Department Visits for Heat-Related Emergency Conditions in the United States from 2008-2020.

Exposure to high temperatures is detrimental to human health. As climate change is expected to increase the frequency of extreme heat events, and raise ambient temperatures, an investigation into the trend of heat-related emergency department (ED) visits over the past decade is necessary to assess the human health impact of this growing public health crisis. ED visits were examined using the Nationwide Emergency Department Sample. Visits were included if the diagnostic field contained an ICD-9-CM or ICD-10-CM code specific to heat-related emergency conditions. Weighted counts were generated using the study design and weighting variables, to estimate the national burden of heat-related ED visits. A total of 1,078,432 weighted visits were included in this study. The annual incidence rate per 100,000 population increased by an average of 2.85% per year, ranging from 18.21 in 2009, to 32.34 in 2018. The total visit burden was greatest in the South (51.55%), with visits increasing to the greatest degree in the Midwest (8.52%). ED visit volume was greatest in July (29.79%), with visits increasing to the greatest degree in July (15.59%) and March (13.18%). An overall increase in heat-related ED visits for heat-related emergency conditions was found during the past decade across the United States, affecting patients in all regions and during all seasons.