Longitudinal associations between early post-injury serum BDNF levels and the development of post-traumatic stress disorder over two years.

BACKGROUND: This study investigated the longitudinal associations between serum BDNF (sBDNF) levels measured early after injury and the onset of post-traumatic stress disorder (PTSD) across two years. METHODS: Patients with moderate to severe physical injuries were enrolled from a trauma center. At baseline, sBDNF levels were measured and a comprehensive socio-demographic and clinical data were collected. The range of time from physical injuries to blood collection was 1-28 days, with a median (IQR) of 8.0 (6.0) days. PTSD diagnoses were determined at 3, 6, 12, and 24 months post-injury using the CAPS-5. Linear regression analyses assessed the relationship between sBDNF levels and PTSD diagnoses. RESULTS: Out of 923 patients, 112 (12.1 %) developed PTSD during the study. Prevalence rates were 8.8 % at 3 months, 7.6 % at 6 months, 4.8 % at 12 months, and 3.7 % at 24 months. Significantly, lower sBDNF levels were associated with PTSD at 12 and 24 months, after adjusting for covariates and applying Bonferroni corrections, but not at earlier assessments. LIMITATIONS: Focusing on patients with moderate to severe injuries from a single center may limit the findings' generalizability. CONCLUSION: Early post-injury sBDNF levels are predictive biomarkers for PTSD, especially significant at 12 and 24 months post-injury.

Ergonomics and health risk awareness of workers involved in manual material handling at Sabon Gari Market in Zaria, Nigeria.

This study assessed the manual handling of materials in a local market environment and evaluated workers' awareness of ergonomics and health risks. Of 315 workers surveyed, 308 responded. The findings revealed a high prevalence rate of 96.4% for injuries and musculoskeletal discomfort, attributed to a low ergonomics and health risk awareness rate of only 6.8%. Consequently, 75% of workers resorted to self-medication or drug abuse for relief. The study also explored barriers to using engineering equipment, finding that 26.3% of respondents cited cost as a barrier, while 51% believed that the introduction of engineering equipment would lead to job loss. This research is valuable for practitioners and researchers as it highlights the current state of ergonomics and health risk awareness among workers who handle heavy loads. The study also highlights the need for improved ergonomic practices and health risk awareness to reduce injury rates and promote safer work environments.

The global psychological and physical effects of domestic abuse and violence on South Asian women: a qualitative systematic review.

Introduction: The purpose of this review is to systematically extract and analyse global academic literature to determine the physical and psychological effects of domestic abuse and violence on South Asian women. Design: This review employs a qualitative systematic approach and thematic analysis to synthesize the narratives of affected women found in the literature. Given that domestic violence is often concealed and downplayed by various social factors, statistical reports and prevalence data offer only a limited view of the issue due to underreporting. Therefore, qualitative literature is deemed more dependable in this subjective domain as it captures and interprets the experiences and meanings within this under-studied group. Data sources: Embase, PsycINFO, Google Scholar, Web Of Science, MEDLINE, and ASSIA were searched. Review methods: All included studies were critically appraised using the CASP tool for qualitative research. Thematic analysis was conducted to develop six themes. Studies excluded did not address the research question, although intersecting population issues could be valuable topics for further research. Results: The literature indicates severe mental and physical health consequences of domestic violence and abuse, with some traits persisting long-term. The analysis underscores the significant role of resilience, suggesting that individuals can overcome traumatic social experiences without enduring lifelong labels or a deficit model. Conclusion: The findings provide support for future interventions aimed at recognizing signs of abuse and preventing severe psychological and physical consequences, particularly among South Asian women. Further research is needed to understand the impact on children and other family members affected by the victim's abuse, which falls beyond the scope of this review.

High peak drinking levels mediate the relation between impulsive personality and injury risk in emerging adults.

BACKGROUND: Alcohol-induced injury is one of the leading causes of preventable morbidity and mortality. We investigated the relationship between impulsive personality and physical injury (e.g. falls, sports), and whether peak drinking quantity specifically, and/or risky behaviour more generally, mediates the relationship between impulsivity and injury in undergraduates. METHOD: We used data from the winter 2021 UniVenture survey with 1316 first- and second-year undergraduate students aged 18-25 years (79.5% female) from five Canadian Universities. Students completed an online survey regarding their demographics, personality, alcohol use, risky behaviours, and injury experiences. Impulsivity was measured with the substance use risk profile scale, past 30-day peak alcohol use with the quantity-frequency-peak Alcohol Use Index, general risky behaviour with the risky behaviour questionnaire, and past 6-month injury experience with the World Health Organization's (2017) injury measurement questionnaire. RESULTS: Of 1316 total participants, 12.9% (n = 170) reported having sustained a physical injury in the past 6 months. Mean impulsivity, peak drinking quantity, and risky behaviour scores were significantly higher among those who reported vs. did not report injury. Impulsivity and peak drinking quantity, but not general risky behaviour, predicted injury in a multi-level generalized mixed model. Mediation analyses supported impulsivity as both a direct predictor of physical injury and an indirect predictor through increased peak drinking (both p < .05), but not through general risky behaviour. CONCLUSION: Results imply emerging adults with impulsive tendencies should be identified for selective injury prevention programs and suggest targeting their heavy drinking to decrease their risk for physical injury.

Massive transfusion protocol reactivation as a novel marker of physician team under-triage after injury.

BACKGROUND: Large trauma centers have protocols for the assessment of injury and triaging of care with attempts to over-triage to ensure adequate care for all patients. We noted that a significant number of patients undergo a second massive transfusion protocol (MTP) activation in the first 24 h of care and conducted a retrospective cohort study of patients involved over a 3-year period. METHODS: Transfusion service records of MTP activations 2019-2021 were linked to Trauma Registry records and divided into cohorts receiving a single versus a reactivation of the MTP. Time of activation and amounts of blood products issued were linked to demographic, injury severity, and outcome data. Categorical and continuous data were compared between cohorts with chi-squared, Fisher's, and Wilcoxan tests as appropriate, and multivariable regression models were used to seek interactions (p < .05). RESULTS: MTP activation was recorded for 1884 acute trauma patients over our 3-year study period, 142 of whom (7.5%) had reactivation. Factors associated with reactivation included older age (46 vs. 40 years), higher injury severity score (ISS, 27 vs. 22), leg injuries, and presentation during morning shift change (5-7 a.m., 3.3% vs. 7.7%). Patients undergoing MTP reactivation used more RBCs (5 U vs. 2 U) and had more ICU days (3 vs. 2). CONCLUSIONS: Older patients and those presenting during shift change are at risk for failure to recognize their complex injury patterns and under-triage for trauma care. The fidelity and granularity of transfusion service records can provide unique opportunities for quality assessment and improvement in trauma care.

Construction of self-repairing polyethersulfone membrane with high density hydrophilic microregions by two dimensional restricted channels for enhanced dyes/salts selective separation.

Based on the dye/salts separation efficiency and membrane injury caused by serious pollution of dye/salts wastewater, this study constructed a 2D tight ultrafiltration membrane that could both solve the membrane injury problem and improve the dye/salts separation efficiency, the compatibility of good self-healing performance and penetration performance by 2D material magnesium-aluminum Layered double hydroxide (MgAl-LDH). The self-repairing of physical injury was achieved through the swelling effect of AMPS-PAN, this property was proved by permeate flux, the retention performance of salts in dye/salts solution, the comparison of scanning electron microscope (SEM), and the mechanical strength after physical injury. The healing of chemical injury occured through the reaction of CC and polyethersulfone chain breakage, which was confirmed by X-ray photoelectron spectroscopy (XPS), permeate flux, the retention performance of salts in dye/salts solution, and mechanical property. The high separation efficiency of dye/salts was achieved through 2D material MgAl-LDH, which was proved by separation selectivity ɑ. The compatibility of good self-healing performance and penetration performance was obtained by 2D material MgAl-LDH, which was proved by the penetration and self-healing performance. Morever, the membrane illustrated excellent both permeability and dye/sals separation efficiency, just like the permeate flux, the retention performance of sodium sulfate in methyl blue/sodium sulfate solution, the retention performance of Na2SO4 in methyl blue/Na2SO4 solution, the retention rate of methyl blue were 99.1 L/m2h, 12.5%, 7.9%, 97.7%, respectively. The results of pollution index and contact angle also proved that the membrane had anti-pollution performance.

Association Between History of Psychiatric Disorder and Degree of Physical Injury Among Suicide Attempters: Secondary Data Analysis in a Japanese Rural Area.

INTRODUCTION: While there may be differences in the choice of suicide methods between attempters with and those without a history of psychiatric disorders, it is not clear whether these differences predict the actual degree of physical injury. The present study aimed to investigate the association between the history of psychiatric disorder and the degree of physical injury among suicide attempters in a Japanese rural area. METHODS: We conducted a cross-sectional study analyzing secondary data of 806 suicide attempters from April 2012 to March 2022 obtained from a Japanese rural city. The exposure variable was a history of psychiatric disorders. The primary outcome was the degree of physical injury of suicide attempters: moderate and severe. We conducted a multivariate Poisson regression analysis to estimate the prevalence ratios (PRs) and 95% confidence intervals (CIs). RESULTS: Among 806 suicide attempters, a significant negative association between the history of psychiatric disorder and the degree of physical injury was observed (PR = 0.40; 95% CI, 0.28-0.59). Those with and without psychiatric disorders were more likely to choose low- and severe-lethality suicide methods such as drug or psychotropic overdoses and hanging or deep wrist injuries, respectively (P < .001). CONCLUSIONS: The present study highlights the importance of considering suicide attempters, both with and without psychiatric disorders, while formulating targeted suicide prevention strategies.

Clinical Associations of Injuries Caused by Vasovagal Syncope: A Cohort Study From a Tertiary Syncope Unit.

Background Recent research has revealed that vasovagal syncope (VVS) leads to a high incidence of injuries; however, clinical associations of injury are not well-established. We present data from an ongoing VVS cohort and aimed to determine characteristics associated with VVS-related injury. Methods and Results Between 2017 and 2020, consecutive patients ≥18 years of age presenting to a tertiary syncope unit and diagnosed with VVS were included. Clinical characteristics relevant to syncope were obtained for the index episode. The outcome was incidence of injury during VVS, documented by clinical evaluation at the syncope clinic. Among 1115 patients (mean age, 45.9 years; 48% women), 260 injuries (23%) occurred. History of VVS-related injuries (adjusted relative risk [aRR], 1.80 [95% CI, 1.42-2.29]), standing position (aRR, 1.34 [95% CI, 1.06-1.68]), and female sex (aRR, 1.30 [95% CI, 1.06-1.60]) were associated with injury, whereas recurrent VVS (aRR, 0.63 [95% CI, 0.49-0.81]) and syncope in the noon/afternoon (aRR, 0.70 [95% CI, 0.56-0.87]) and evening/night (aRR, 0.43 [95% CI, 0.33-0.57]) compared with morning hours were associated with lower risk. There was a trend for higher rates of injury with overweight/obesity (aRR, 1.23 [95% CI, 0.99-1.54]) and syncope occurring at home (aRR, 1.22 [95% CI, 0.98-1.51]). In a per-syncope analysis considering up to 3 previous episodes (n=2518, 36% traumatic), syncope at home (aRR, 1.33 [95% CI, 1.17-1.51]) and absence of prodromes (aRR, 1.34 [95% CI, 1.09-1.61]) were associated with injury. Conclusions Patient characteristics, VVS presentations, the circumstances, and surroundings can determine the risk of injury. These associations of VVS-related injury identify at-risk individuals and high-risk situations. Future prospective studies are needed to investigate potential strategies for prevention of post-VVS injury in recurrent cases.

Is PTSD a Bodily Injury?

Post-traumatic stress disorder (PTSD) is unique among psychiatric disorders in that the cause, a traumatic event (or events), is known. PTSD is often the subject of legal proceedings, with persons seeking compensation from the agency considered responsible for the trauma. While PTSD is clearly a psychiatric disorder, there is less agreement about whether PTSD can also be categorised as a bodily injury, as defined by the Montreal Convention 1999. This article describes Pel-Air Pty Ltd v Casey, a case involving physical and psychiatric injuries resulting from the forced landing of a plane. It was ruled that PTSD was not a bodily injury under the Convention. While psychiatric expert evidence demonstrated that PTSD causes neurochemical changes, it was ruled that neurochemical changes do not indicate a bodily injury. We describe evidence of neuroanatomical changes and neurochemical changes in PTSD, proposing that the structure of the brain in PTSD support the argument that PTSD is a bodily injury.

Comparison of Ground Release and Drone-Mediated Aerial Release of Aedes aegypti Sterile Males in Southern Mexico: Efficacy and Challenges.

Sterile males of Aedes aegypti were released once a week for 8 weeks to evaluate the dispersal efficiency of ground and aerial drone release methods in a rural village of 26 Ha in southern Mexico. Indoor and outdoor BG-Sentinel traps were placed in 13−16 houses distributed throughout the village. The BG traps were activated 48 h after the release of the sterile males and functioned for a 24 h period following each release. Over the 8-week period of simultaneous ground and aerial releases, an average of 85,117 ± 6457 sterile males/week were released at ground level and 86,724 ± 6474 sterile males/week were released using an aerial drone. The ground release method resulted in higher numbers of captured males (mean = 5.1 ± 1.4, range 1.1−15.7 sterile males/trap) compared with the aerial release method (mean = 2.6 ± 0.8, range 0.5−7.3 sterile males/trap) (p < 0.05). Similarly, the prevalence of traps that captured at least one sterile male was significantly higher for ground release compared to the aerial release method (p < 0.01). The lower numbers of sterile males captured in the aerial release method could be due to mortality or physical injury caused by the chilling process for immobilization, or the compaction of these insects during transport and release. However, aerial releases by a two-person team distributed insects over the entire village in just 20 min, compared to ~90 min of work for a five-person team during the ground release method. Ground release also resulted in higher aggregations of males and some villagers reported feeling discomfort from the presence of large numbers of mosquitoes in and around their houses. We conclude that modifications to the handling and transport of sterile males and the design of containers used to store males are required to avoid injury and to improve the efficiency of aerial releases for area-wide SIT-based population suppression programs targeted at mosquito vectors of human disease.

Child abuse syndrome - a forensic case of fatal impulsive act of violence.

Child abuse syndrome is a medico-social problem widely spread around the world, which includes a complex of clinically manifested forms of violence against children. This syndrome includes different forms of physical violence, sexual violence, neglect, and emotional violence against children. The main problem with this type of violence continues to be the large number of unregistered "hidden" cases. The consequences of violence against children are serious and have a lasting negative effect on the physical and mental health of the victims. Child abuse is often a result of impulsive violent behavior with minimal provocation and may have a fatal outcome.

Educational Case: Burn Injury-Pathophysiology, Classification, and Treatment.

The following fictional case is intended as a learning tool within the Pathology Competencies for Medical Education (PCME), a set of national standards for teaching pathology. These are divided into three basic competencies: Disease Mechanisms and Processes, Organ System Pathology, and Diagnostic Medicine and Therapeutic Pathology. For additional information, and a full list of learning objectives for all three competencies, see http://journals.sagepub.com/doi/10.1177/2374289517715040.1.

Physical health status of music students in a post-secondary institution: A cross-sectional study.

BACKGROUND: Musicians' health is an essential field of healthcare that is specifically tailored to the needs of musicians, which encompasses multiple facets of health. OBJECTIVE: The research seeks to determine the prevalence of physical injuries in music students and musicians, and to identify possible causes. METHODS: A previously unvalidated 42-item survey was distributed to music students, non-music students, and professional musicians. The questions addressed demographics, physical health, mental health, medication use, and interest in musicians' health. The study was conducted from Fall semester 2017 to Winter semester 2019 at McGill University, with analysis completed in August 2019. RESULTS: A total of 585 complete responses were obtained. Music students (35%) had higher prevalence of physical injuries than non-music students (18%), and professional musicians had the highest prevalence (56%). Multiple factors dictate the prevalence of physical injuries among musicians, including gender, age, program of enrollment, and instrument of choice. Of note, daily duration of practice was not one of these factors. CONCLUSIONS: Several factors were identified through this cross-sectional analysis to be associated with musicians' physical injuries. These findings can serve as a foundation through which physicians and post-secondary institutions may implement changes to better enhance the physical health of musicians. It also cast doubts on previous assumptions associated with physical injury of musicians.

Likelihood of injury due to vasovagal syncope: a systematic review and meta-analysis.

AIMS: Vasovagal syncope (VVS) is the most common type of syncope and is usually considered a benign disorder. The potential for injury is worrisome but the likelihood is unknown. We aimed to determine the proportion of patients injured due to VVS. METHODS AND RESULTS: A systematic search of studies published until August 2020 was performed in multiple medical and nursing databases. Included studies had data on the proportion of patients with injury due to VVS prior to study enrolment. Random effects methods were used. Twenty-three studies having 3593 patients met inclusion criteria. Patients were diagnosed clinically with VVS, and 82% had >2 syncopal episodes before enrolment. Tilt test was positive in 60% and 14 studies reported comorbidities (32.6% hypertensive). The weighted mean injury rate was 33.5% [95% confidence interval (CI): 27.3-40.5%]. The likelihood of injury correlated with population age (r = 0.4, P = 0.05), but not with sex, positive tilt test, or hypertension. The injury rates were 25.7% (95% CI: 19.1-32.8%) in studies with younger patients (mean age ≤50 years, n = 1803) and 43.4% (95% CI: 34.9-52.3%) in studies with older patients (P = 0.002). Nine studies reported major injuries; with a weighted mean rate of major injuries of 13.9% (95% CI: 9.5-19.8%). CONCLUSION: Injuries due to syncope are frequent, occurring in 33% of patients with VVS. The risk of major injuries is substantial. Older patients are at higher risk. Clinicians should be aware of the risk of injuries when providing care and advice to patients with VVS.

Physiopathological Role of Neuroactive Steroids in the Peripheral Nervous System.

Peripheral neuropathy (PN) refers to many conditions involving damage to the peripheral nervous system (PNS). Usually, PN causes weakness, numbness and pain and is the result of traumatic injuries, infections, metabolic problems, inherited causes, or exposure to chemicals. Despite the high prevalence of PN, available treatments are still unsatisfactory. Neuroactive steroids (i.e., steroid hormones synthesized by peripheral glands as well as steroids directly synthesized in the nervous system) represent important physiological regulators of PNS functionality. Data obtained so far and here discussed, indeed show that in several experimental models of PN the levels of neuroactive steroids are affected by the pathology and that treatment with these molecules is able to exert protective effects on several PN features, including neuropathic pain. Of note, the observations that neuroactive steroid levels are sexually dimorphic not only in physiological status but also in PN, associated with the finding that PN show sex dimorphic manifestations, may suggest the possibility of a sex specific therapy based on neuroactive steroids.

Serious physical injury and depressive symptoms among adolescents aged 12-15 years from 21 low- and middle-income countries.

BACKGROUND: Little is known about the relationship between physical injury and depression in youths from low- and middle-income countries (LMICs). Therefore, the aim of this study was to analyze the association between serious physical injury and depressive symptoms among adolescents in 21 LMICs. METHODS: Data from the Global School-based Student Health Survey (2003-2008) were analyzed. Serious physical injury and depressive symptoms in the past 12 months were assessed with self-report measures. The association between serious physical injury and depressive symptoms was examined using multivariable logistic regression analysis and meta-analysis. RESULTS: The final sample consisted of 44,333 adolescents aged 12-15 years. After adjustment for sex, age, food insecurity, alcohol consumption, and country, an increasing number of serious physical injuries in the past 12 months was associated with increments in the odds for depressive symptoms in a dose-dependent fashion. Those who had ≥6 serious injuries (vs. no injuries) were 2.79 (95%CI=2.23-3.48) times more likely to have depressive symptoms. The pooled odds ratio (OR) (95%CI) for the association between at least one serious physical injury and depressive symptoms obtained by meta-analysis based on country-wise estimates was 1.83 (1.67-2.01) with a moderate level of between-country heterogeneity (I2=56.0%). LIMITATIONS: This was a cross-sectional study and causality of the association cannot be deduced. CONCLUSIONS: Serious physical injury may be a risk factor for depressive symptoms among adolescents in LMICs. Efforts to prevent physical injury and the provision of adequate health care for those who are injured may improve mental wellbeing among adolescents in this setting.

A Visualization Template for the Graphical Representation of Sport Injury Antecedents and Consequences Models and Data.

A template for visually representing factors affecting and affected by the occurrence of sport injury is presented. The visualization template is designed to facilitate comparison among graphic depictions of models and data pertaining to the antecedents and consequences of sport injury. Innovative aspects and limitations of the visualization template are highlighted, and future applications of the visualization template are discussed.

[Post-traumatic stress disorder and psychogenic pain]. / État de stress post-traumatique et douleurs psychogènes.

Post-traumatic stress disorder is an adjustment disorder combining psychological and physical symptoms. Faced with the pain associated with post-traumatic stress disorder, it is important to know how to differentiate between the pain linked to the physical injury at the time of the traumatic event and the psychogenic pain. Identifying these pains and studying their aetiology, combined with an assessment of the patient's psychological state and life history, enables multi-disciplinary care to be put in place to improve the patient's prognosis and can help to improve recognition of these disorders.

Uncovering a health and wellbeing gap among professional nurses: situated experiences of direct care nurses in two Canadian cities.

Understanding the drivers of nurses' poor health and the implications for quality of care are important in sustaining a healthy workforce, stimulating professional nursing practice, and ensuring healthy lives while promoting the wellbeing of nurses of all ages. Previous scholarship has identified factors influencing nurses' wellbeing, but have neglected to take a comprehensive approach to assessing the multiple dimensions of nurses' wellbeing and their collective, syndemic effects. Neither have these studies explored the context within which these experiences occur, or how these experiences differ for nurses with multiple marginalized identities in spite of an increasingly diverse workforce. Using the six dimensions of wellness framework, we examined the distinct and interrelated dimensions of nurses' wellbeing that were either enhanced or aggravated by professional practice and how it changed by nurses' race and ethnicity using their situated experiences. The study was conducted using a qualitative research design, which drew on phenomenology and in-depth interviews with Registered and Practical Nurses (n = 70) in two Canadian cities. Of the six dimensions of wellbeing identified, direct care practice enhanced nurses' occupational, intellectual, and spiritual wellbeing, but worsened their physical, emotional and social health. A health gap was found along racial lines, as ethnic minority nurses reported more detrimental effects of direct care nursing on their physical, emotional, occupational, and social wellbeing than their white counterparts. Nurses resorted to institutional structures, social and emotional support from supervisors, coworkers and family members, and engaged in spiritual activities to cope with these adverse health effects. These findings highlight the utility of an adaptable framework in identifying the multiple dimensions and gaps in nurses' wellbeing. Furthermore, our findings echo the urgent need for workplace and safety policies that address issues of diversity and make the work environment safe, equitable and promote nurse productivity and quality care.

Developing the Geriatric Injury Documentation Tool (Geri-IDT) to Improve Documentation of Physical Findings in Injured Older Adults.

BACKGROUND: Standardization in tools and documentation of child abuse and intimate partner violence have proven helpful in completely documenting injuries and suspected abuse among these populations. Similar tools do not yet exist for older adults and elder abuse. OBJECTIVE: To (1) use insights from experts to develop a tool to assist clinicians in appropriately and completely documenting physical findings in injured older adults for potential future forensic investigation of abuse or neglect and (2) to assess the feasibility of incorporating this tool into clinical practice. DESIGN: Two-phase, exploratory qualitative study. Phase 1: individual interviews with elder abuse experts from various specialties in medicine and criminal justice. Phase 2: focus groups with anticipated end users of the tool. PARTICIPANTS: Phase 1 telephone-based key informant interviews were conducted with 11 elder abuse experts (2 detectives, 3 prosecutors, 1 forensic pathologist, 2 geriatricians, and 3 emergency medicine physicians). Phase 2 focus groups were conducted among emergency medicine (n = 10) and primary care (n = 8) providers. APPROACH: Key informant interviews were conducted telephonically while the two focus groups were held in-person at an emergency medicine site in New York, NY, and a primary care site in Los Angeles, CA. KEY RESULTS: Experts agreed that medical providers' documentation of geriatric injuries is usually inadequate for investigating alleged elder abuse/neglect. They highlighted elements needed for forensic investigation: initial appearance before treatment is initiated, complete head-to-toe evaluation, documentation of all injuries (even minor ones), and documentation of pertinent negatives. Several noted the value of photographs to supplement written documentation. End users identified practical challenges to utilizing a tool, including the burden of additional or parallel documentation in a busy clinical setting, and how to integrate it into existing electronic medical records. CONCLUSION: A practical tool to improve medical documentation of geriatric injuries for potential forensic use would be valuable. Practical challenges to utilization must be overcome.