Adverse Childhood Experiences and Socioemotional Outcomes of Children Born Very Preterm.

OBJECTIVE: To examine whether adverse childhood experiences (ACEs) confer risk for socioemotional problems in children born very preterm (VPT). STUDY DESIGN: As part of a longitudinal study, 96 infants born VPT at 23-30 weeks of gestation were recruited from a level III neonatal intensive care unit and underwent follow-up at ages 2 and 5 years. Eighty-three full-term (FT) (37-41 weeks gestation) children were recruited from an adjoining obstetric service and the local community. ACEs were assessed with the Child Life Events Scale at age 2 and Preschool Age Psychiatric Assessment at age 5. At age 5, internalizing, externalizing, and attention deficit hyperactivity disorder (ADHD) symptoms were assessed with the Child Behavior Checklist and Conner's Rating Scale-Revised, respectively. Covariates including socioeconomic disadvantage, maternal distress, and parent ADHD symptoms were assessed at the 2- and/or 5-year follow-up. Mediation and moderation analysis, accounting for family clustering, examined associations between birth group, ACEs, and socioemotional outcomes. RESULTS: After covariate adjustment, children born VPT experienced more ACEs (P < .001), particularly medical ACEs (P < .01), and had worse ADHD and internalizing outcomes (P < .05) than full-term children. ACEs mediated the association between birth group and ADHD outcomes (95% CI, 0.11-4.08). There was no evidence of mediation for internalizing outcomes. Higher parent ADHD symptoms (P < .001) and maternal distress (P < .05) were associated with poorer internalizing outcomes. CONCLUSIONS: Screening for childhood ACEs should be embedded in the follow-up care of children born VPT and their families. Strategies to screen for and address parent psychosocial functioning may be important to support children's socioemotional development.

Criteria for neurosurgical treatment of children and adolescents with traumatic brain injury in a Brazilian level 1 trauma center.

OBJECTIVE: Considering Glasgow Coma Scale (GCS) scores and brain CT scans in a group of children and adolescents with traumatic brain injury (TBI), the scope of this study was to identify the criteria established for the indication of emergency neurosurgical treatment in a level 1 trauma center. METHODS: This was a cross-sectional study with consecutive review of medical records of children and adolescents < 17 years with TBI who were hospitalized and underwent neurosurgical treatment between January 2016 and December 2023. Two groups were formed for analysis: patients with GCS scores ≤ 8 versus patients with GCS scores > 8. Based on the GCS score and brain CT scan of each patient, the authors investigated the criteria established for the surgical indications in this group. RESULTS: In the period considered for the study, 376 children and adolescents with TBI were hospitalized and 31% required neurosurgical treatment. The median age was 5 years (interquartile range 1-11 years) and there was a predominance of males (68%). Home accidents predominated in 77% of children < 5 years of age, whereas road accidents predominated among those older than 5 (47%). Diffuse brain lesions on CT scans predominated in patients with GCS scores ≤ 8 when compared to the group with GCS scores > 8 (89% vs 19%; p < 0.0001). Regarding neurosurgical access, decompressive craniectomies (70%) and invasive intracranial pressure monitoring (44%) prevailed among patients with GCS scores ≤ 8, whereas craniotomies for drainage of intracranial hematomas (70%) and surgical correction of depressed skull fracture (21%) prevailed among those with GCS scores > 8. CONCLUSIONS: Based on the GCS scores and CT scans, the authors were able to define the criteria used for neurosurgical indications in a Brazilian level 1 trauma center. They found a high prevalence of decompressive craniectomy in patients with severe TBI in their department due to the irregular supply of disposable catheters necessary for intracranial pressure monitoring.

Adapting Trauma-Informed Kickboxing for the Salvadoran Context: A Practitioner Essay.

This practitioner essay will discuss the evidence base for an Australian trauma-informed kickboxing program, The Fight Back Project. We share key differences and adjustments while delivering this program in the Salvadoran context. We consider practitioner assumptions and limitations when transferring trauma-informed practice principles from the Global North to the Central American setting, and the criticality of gender-responsive adaptations. Drawing from existing research on the benefits of trauma-informed martial arts as a form of physical exercise, we describe the collaborative development and implementation of a trauma-informed kickboxing program alongside a local, community-led organization.

Cervical spine injuries in professional judo: a cross-sectional analysis of prevalence, risk factors, and preventive measures.

INTRODUCTION: Judo, a martial art created by Jigoro Kano in 1882, is a martial art promoting physical and spiritual development. Despite its "gentle way" philosophy, it poses a significant risk for cervical spine injuries, often resulting from throws and ground techniques. METHODS: This cross-sectional study analyzed cervical injuries among professional judo athletes from January to July 2024. Data were collected via an online questionnaire covering demographics, injury details, circumstances, and prevention. The study included athletes from seven countries, with exclusion criteria being pre-existing non-judo-related cervical conditions and incomplete questionnaires. Descriptive and inferential statistical analyses were performed using RStudio 4.4.0. RESULTS: Of the 104 participants, 42 athletes reported cervical injuries, primarily during practice and linked to high-risk techniques like uchi-mata and ippon-seoi-nage. Defensive maneuvers, especially involving the "head dive," were significant risk factors. Injuries ranged from contusions to disc herniations and fractures, with symptoms like pain, numbness, and weakness. Most athletes received physical therapy, though some required surgery. Preventive measures were inconsistently applied, despite advice from coaches and physical therapists. CONCLUSION: Cervical spine injuries in judo are common, especially during defensive maneuvers and specific high-risk techniques. The variability in treatment outcomes underscores the need for better prevention strategies, education, and tailored training. Further research is essential to mitigate injury risks for judo athletes.

COMT Val158Met polymorphism protects the impact of a mother's history of childhood trauma on emotional and behavioural problems in preschool children.

Childhood trauma has a well-established negative impact on mental health outcomes across the lifespan. Cumulative evidence suggests an intergenerational transmission of trauma to descendants. In this way, considering the child's COMT Val158Met (rs4680: G > A) variant, the study aims to investigate the interactive effect of maternal childhood trauma on the emotional/behavioural problems of their offspring in preschoolers age (4-5 and 11 years old) from a population-based dyad of pregnant adolescent women. The behaviour problems of 310 children were assessed using the Child Behaviour Checklist (CBCL) instrument, and maternal trauma was assessed with the Child Trauma Questionnaire (CTQ) between the 20 to 22° gestational weeks. Maternal childhood trauma increases the risk for all emotional/behavioural problems in the offspring, and no direct association between the child's Val158Met genotypes with emotional/behavioural problems. Interestingly, in moderation analysis adjusted by sex, age and skin colour, children of mothers exposed to childhood trauma, carrying the Val/Met genotype, are less likely to develop externalising (p = .020) and total problems (p = .041) when compared to homozygous (Val/Val and Met/Met). Thus, our findings reinforce evidence on the intergenerational impact of maternal trauma on emotional/behavioural problems and demonstrate that this risk is influenced by the genetic background of the individual, varying according to the functional COMT genotype, which confers a protective profile for the development of externalising and total problems.

Examining the association of elevated initial serum lactate with mortality and morbidity in trauma patients: a retrospective study.

BACKGROUND: Elevated initial serum lactate (iSL) levels are frequently employed to assess trauma severity, but their predictive value for mortality and morbidity remains inconsistent. We evaluated the association of iSL with mortality and morbidity at Puerto Rico Trauma Hospital (PRTH). METHODS: This IRB-approved retrospective study included trauma patients ≥ 18 years with iSL measured within the first 48 h of admission to PRTH (July 2014-June 2019). Patients were classified as normal (4.5-19.8 mg/dL) or elevated (≥ 19.9 mg/dL) iSL levels. Group comparisons were conducted using t-tests, Wilcoxon rank-sum tests, Pearson's chi-squared, or Fisher's exact tests. Associations were evaluated with regression and ROC analyses. RESULTS: Among 536 patients, 54.3% had elevated iSL levels. Initially, elevated iSL was associated with in-hospital mortality (OR: 2.18, 95%CI: 1.36-3.51, p < 0.001), traumatic intensive care unit (TICU) admission (OR: 2.06, 95%CI: 1.46-2.92, p < 0.001), and need for mechanical ventilation (MV) (OR: 2.80, 95%CI: 1.97-3.98, p < 0.001). However, adjusted analyses showed no significant associations (Mortality-AOR: 1.72, 95%CI: 0.97-3.04, p = 0.06; TICU-AOR: 1.11, 95%CI: 0.71-1.75, p = 0.65; MV-AOR: 1.49, 95%CI: 0.89-2.49, p = 0.13). Both iSL (AUC: 0.59, 95%CI: 0.54-0.64) and ISS (AUC: 0.59, 95%CI: 0.54-0.64) demonstrated limited ability to predict mortality, with no statistically significant difference between them (p > 0.99). Patients with elevated iSL experienced prolonged hospital and TICU stays and severe injuries. CONCLUSIONS: Elevated iSL levels may not independently predict mortality, TICU admission, or the need for MV in trauma patients. However, their rapid availability supports their use alongside other clinical markers to guide trauma care decision-making and improve trauma outcomes.

Incidence of pressure injury in patients with moderate and severe traumatic brain injury: a systematic review.

BACKGROUND: Patients with moderate and severe traumatic brain injury (TBI) admitted to the intensive care unit (ICU) may develop pressure injury (PI) due to haemodynamic instability caused by the disease, lack of mobility in bed, as well as intense and prolonged compression in prominent bone areas. OBJECTIVE: The objective of this review is to assess the incidence and identify risk factor for the development of PI in patients with moderate and severe TBI admitted to the ICU. METHOD: Searches were conducted in the PubMed, CINAHL, Scopus, Embase, Web of Science, Google Scholar, Trove and Open Grey databases, including all records found up to May 2023. Patients with moderate and severe TBI admitted to the ICU were included in this review. RESULTS: A total of 368 studies on PI and TBI were identified in the databases. Two authors assessed study bias and extracted data, wit. h a third reviewer as arbitrator. Six studies met the inclusion and exclusion criteria in the review. The incidence of PI varied between 6.5% and 20% among the included studies. Only two studies applied the Braden Scale, which identified stage II lesions (52.6% and 51.5%), located in the sacral region (78.9% and 54.6%). The risk factors identified in the studies for the development of PI were mechanical ventilation, TBI severity, vasoactive drugs, age, fever, use of enteral nutrition, haemoglobin levels and time to perform tracheostomy. CONCLUSION: The incidence of PI in moderate and severe patients was similar to that found in ICU patients. There were significant differences across the various studies in the ways in which data were collected and reported. TRIAL REGISTRATION NUMBER: The protocol has been deposited in the PROSPERO repository (CRD42023428817).

Quality of pediatric trauma care: development of an age-adjusted TRISS model and survival benchmarking in a major trauma center.

Background: Pediatric trauma is a major global health concern, accounting for a substantial proportion of deaths and disease burden from age 5 onwards. Effective triage and management are essential in pediatric trauma care, and prediction models such as the Trauma Injury Severity Score (TRISS) play a crucial role in estimating survival probability and guiding quality improvement. However, TRISS does not account for age-specific factors in pediatric populations, limiting its applicability to younger patients. This study aimed to modify TRISS to account for age for children (Peds-TRISS) and to evaluate its performance relative to the original TRISS. We also assessed survival outcomes to explore the model's potential utility across various clinical settings. These efforts align with quality improvement initiatives to reduce preventable mortality and supporting sustainable development goals. Methods: This retrospective cohort study included patients under 18 years of age who were treated at a hospital in Colombia between 2011 and 2019. New coefficients for TRISS covariates were calculated using logistic regression, with age treated as a continuous variable. Model performance was evaluated based on discrimination (C statistic) and calibration, comparing Peds-TRISS with the original TRISS. Internal validation was conducted using bootstrap resampling. Survival outcomes were assessed using the M and Z statistics, which are commonly used for international trauma outcome comparisons. Results: The study included 1,013 pediatric patients with a median age of 12 years (IQR 5-15), of whom 73% were male. The leading causes of injury were traffic accidents (31.1%), falls (28.8%), and assaults (28.7%). The overall mortality rate was 5.7%. The Peds-TRISS model demonstrated good calibration (HL = 9.7, p = 0.3) and discrimination (C statistic = 0.98, 95% CI 0.97-0.99), with no statistically significant difference in the ROC curve comparison with the original TRISS. Internal validation demonstrated strong performance of Peds-TRISS. The M and Z statistics were 0.93 and 0, respectively, indicating no significant differences between expected and observed survival rates. Conclusions: Most fatalities occurred among adolescents and were due to intentional injuries. The Peds-TRISS model showed a partial improvement in performance compared to the original TRISS, with superior results in terms of calibration, although not in discrimination. These findings highlight the potential of model customization for specific populations. Prospective, multicenter studies are recommended to further validate the model's utility across diverse settings.

Treatment of Young Permanent Avulsed Teeth with Multidisciplinary Approach-A Case Report.

Background: Dental trauma very commonly comprises lesions that affect the teeth and their supporting structures. In pediatric ages, the main reasons for dental trauma are falls and accidents at school and while practicing recreative activities and sports. Fortunately, dental avulsions are not common; however, they are key factors in the loss of teeth if the issue is not adequately treated in a quick way, so is very important for parents, teachers, or any person that is present with a child during the accident to have knowledge about dental trauma, specifically regarding avulsed teeth, since the best treatment is reimplantation. Methods: In this case of dentoalveolar trauma, concerning two avulsed teeth, it was very interesting that the tooth that was reimplanted more quickly (40 min) had a worse prognosis than the tooth that was reimplanted 2 h later, since the tooth that was reimplanted more quickly was transported in a personal wallet, which was a highly contaminated area, unlike the tooth that was reimplanted later, which was transported in a solution as an alternative means of transport. Conclusions: So, it is very important that this type of trauma is adequately managed in an interdisciplinary way across multiple dentistry specialties.

Organização do trabalho multiprofissional no atendimento à vítima de politrauma: diagnóstico situacional / Organization of multidisciplinary work aimed at providing care for polytrauma victims: a situational diagnosis / Organización del trabajo multidisciplinario en la atención a víctimas de politraumatismo: diagnóstico situacional

Objetivo: analisar a organização do trabalho multiprofissional no atendimento à vítima de politrauma. Método: estudo qualitativo, exploratório e descritivo realizado na emergência de um hospital referência em politrauma na região sul do Brasil, com 30 profissionais enfermeiros, técnicos de enfermagem e médicos, por meio de entrevistas estruturadas e observação não participante, em maio de 2023. Realizou-se análise interpretativa com agrupamento e organização dos dados em um mapa de associação de ideias. Resultados: emergiram três eixos: Estrutura - estrutura física inadequada, regulação ineficaz e força de trabalho; Processo ­ capacitação e comunicação e; Resultado: ausência de avaliação e liderança no atendimento. Conclusão: foi possível evidenciar dificuldades na estrutura física, insuficiência de profissionais, problemas de comunicação e ausência de educação permanente. Ainda, o estudo revelou iniciativas individuais para superar limitações e colaboração mútua para enfrentar momentos críticos. Destaca-se a organização da equipe multiprofissional como um papel fundamental no atendimento à vítima de politrauma.

Objective: to analyze the organization of multidisciplinary work aimed at providing care for polytrauma victims. Method: qualitative, exploratory and descriptive study carried out in the emergency department of a referral hospital for polytrauma care located in the southern region of Brazil, with 30 professionals including nurses, nursing technicians and doctors through structured interviews and non-participant observation, held in May 2023. An interpretative analysis was carried out and data were grouped and organized into a mind map. Results: three axes emerged: Structure - inadequate physical structure, ineffective regulation and workforce; Process ­ training and communication and; Outcome: lack of evaluation and leadership in care. Conclusion: it was possible to highlight factors such as difficulties in the physical structure, shortage of professionals, communication problems and lack of continuing education. Furthermore, the study revealed individual initiatives to overcome limitations and mutual collaboration to face critical moments. The organization of the multidisciplinary team stands out as a key aspect in the care of polytrauma patients.

Objetivo: analizar la organización del trabajo multidisciplinario en la atención a víctimas de politraumatismo. Método: estudio cualitativo, exploratorio y descriptivo realizado en la sala de emergencia de un hospital de referencia en politraumatismo de la región sur de Brasil, con 30 profesionales enfermeros, técnicos en enfermería y médicos, a través de entrevistas estructuradas y observación no participante, en mayo de 2023. Se realizó un análisis interpretativo con agrupación y organización de datos en un mapa de asociación de ideas. Resultados: surgieron tres ejes: Estructura - estructura física inadecuada, regulación ineficaz y fuerza de trabajo; Proceso ­ capacitación y comunicación y; Resultado: falta de evaluación y liderazgo en la atención. Conclusión: se observaron problemas en la estructura física, déficit de profesionales, problemas de comunicación y falta de educación continua. Además, el estudio reveló iniciativas individuales para superar las limitaciones y colaboración mutua para afrontar momentos críticos. Se destaca que la organización del equipo multidisciplinario es fundamental para la atención de las víctimas de politraumatismo.

Postoperative outcomes after splenectomy: a 20-year single-center experience in Colombia.

BACKGROUND: Splenectomy indications are well documented; however, several infectious complications and potentially life-threatening conditions could arise after splenectomy. We aim to describe a 20-year single-center experience of postoperative outcomes after splenectomy and perform a subgroup analysis according to approach and surgical setting with a 30-day, 90-day, and 1-year follow-up. STUDY DESIGN: A retrospective cohort study was conducted between 2003 and 2023. We included all patients aged 18 years and older who underwent splenectomy. A description of clinical and operative variables with infectious outcomes was performed. Subgroup analyses were performed between open or laparoscopic approach and surgical setting. RESULTS: A total of 134 patients were included. Female patients constituted 52.99% (n = 71) of cases, with a mean age of 51.01 ± 20.79 years. The most frequent surgical indication for splenectomy was trauma in 31.34% (n = 42), and a laparoscopic approach was indicated in 41.79% (n = 56). Overwhelming post-splenectomy syndrome (OPSI) was evidenced in 2.24% (n = 3) of the population. Surgical characteristics such as operative time, intraoperative blood loss, and intensive care requirement and unit length of stay were higher in open and trauma patients. CONCLUSION: Our data describe the demographic, clinical and operative characteristics of patients undergoing splenectomy in Colombia, providing a solid basis for future research. The results obtained on overwhelming postsplenectomy syndrome (OPSI) and postoperative complications are comparable with those reported in the international literature, reinforcing the validity of our findings. Further prospective studies in this population are needed to optimize management strategies and improve clinical outcomes, particularly in higher risk subgroups.

Clinical Experience With a Less Invasive Surgical Transparotid Approach and Trapezoidal Plate for Neck and Base Condylar Fractures: A Retrospective Study.

Study Design: This is a retrospective observational study. Objective: To evaluate the clinical outcomes after an open reduction and internal fixation (ORIF) of condylar neck and base fractures (CNBFs) with a trapezoidal shape plate in patients using a less invasive transparotid approach. Methods: Fifteen patients with condylar fractures were classified according to the Arbeitsgemeinschaft für Osteosynthesefragen Craniomaxillofacial (AOCMF) classification system, treated by ORIF with a trapezoidal plate. All patients were evaluated by clinical examination (pain, occlusion, and mandibular dynamics) and imaging through computed axial tomography. Postoperative evaluations considered a favourable clinical outcome of fragment stability, stable occlusion, absence of pain, and regular mouth opening ranges. In addition, any signs of local infection, malocclusion, facial nerve damage, or failure of the fixation system were recorded. Results: According to the AOCMF classification for condylar fractures, eight fractures affected the condylar base and seven involved the condylar neck. No patients presented pain or joint sounds in the TMJ. All patients obtained a buccal opening greater than or equal to 35 mm. Two patients showed postoperative malocclusion which was corrected by intermaxillary elastics therapy. In addition, two patients had transient paresis during the postoperative period. One of them had paresis of the frontal and buccal branches of the facial nerve while the second patient had paresis of the zygomatic and buccal branches. Conclusions: Using trapezoidal miniplates provides functionally stable fixation for neck and base condylar fractures and allows for a less invasive surgical transparotid approach (2 cm extension). They also reduce the amount of osteosynthesis material and are easier to adapt and fix in the author's opinion.

Frontal Sinus Fractures and Traumatic Brain Injury: Predictors of Mortality in Surgical Management.

Study Design: This is anobservational, retrospective, analytical study. Objective: The aim was todetermine a statistical basis for a future line of research based on the epidemiology of a center located in a developing country, as well as defining indirect mortality predictors. Methods: Clinical files were reviewed based on diagnosis of Traumatic Brain Injury (TBI), according to the International Classification of Diseases 10th Revision (ICD-10). Sociodemographic variables as well as treatment modality of the condition during hospitalization was recorded. The patient sample was divided into two groups. Student's T-test was performed in variables with normal distribution and Chi-square test in independent random variables with standard normal distribution. For correlations, Pearson's correlation coefficient was used, taking the P-value <.05 as statistically significant. Results: A total of 150 participants were included in this study, from which 125 were male (83.3%). The average age was 28.58 ± 16.55 years. The median hospitalization time was 9 days. Forty-five patients (30%) were treated conservatively. Fifteen patients died during hospitalization. The factors considered as predictors of mortality in the general population corresponded to Motor Vehicle Accident, Frontonasal Duct Obstruction, Neuroinfection, Glasgow Coma Scale (GCS) at admission, as well as GCS at discharge. In the patients who underwent surgery, predictors of mortality corresponded to Motor Vehicle Accident, Bilateral Frontal Craniotomy, Surgical Bleeding >475 cc, Neuroinfection, as well as GCS at admission and discharge. Conclusions: The creation of adequate diagnostic and therapeutic algorithms in traumatic brain injury management is needed, especially in developing countries. More specific studies are needed, particularly analytical and multicentric studies, which may allow the development of these algorithms.

Global Trends and Perspectives on Dental Fragment Reattachment (1988-2024): A Bibliometric and Altmetric Review.

Fragment reattachment in traumatic injuries is notable for its excellent esthetic, morphological, and functional results. The aim of this study was to investigate the scientific history and trends in publications on dental fragment reattachment through a bibliometric and altmetric analysis. The search was conducted in October 2024 using Web of Science. Two researchers selected articles and extracted key study characteristics. Collaborative networks were generated using VOSviewer software. Dimensions was consulted to measure altmetric data. The Spearman correlation was used. A total of 129 articles were included. The most cited article received 160 citations. Studies were published between 1988 and 2024. The leading journal was Dental Traumatology (n = 55). Case reports (n = 63) were the most frequent study design. The majority of studies aimed at clinical case follow-up (n = 71), with coronal fractures being most commonly reported (n = 96). Young patients were most affected in the selected studies (n = 49). Tewari N stood out (n = 8). The All India Institute of Medical Sciences was prominent with seven articles. Brazil was the most prevalent country (n = 29), and Asia was the most frequent continent (n = 57). Vosviewer demonstrated collaborations among authors. According to Dimensions, significant mentions were identified on Mendeley, followed by X users. This bibliometric analysis provides a comprehensive description of the technique of fragments reattachment in traumatized teeth, which has been studied for over 36 years. Studies on this technique primarily rely on case reports describing follow-up in young patients. Intervention studies and systematic reviews are recommended. Additionally, more studies in Africa, Oceania, and North America are encouraged.

Risk Factors for Failure of Non-operative Management in Isolated Unilateral Non-displaced Facet Fractures of the Subaxial Cervical Spine: Systematic Review and Meta-Analysis.

STUDY DESIGN: systematic review. OBJECTIVE: To evaluate risk factors associated with failure of non-operative management of isolated unilateral facet fractures of the subaxial cervical spine in neurologically intact patients. METHODS: A systematic review of the PubMed, Embase, LILACS, and Cochrane Library databases was conducted in order to determine risk factors associated with failure of non-operative management in isolated unilateral facet fractures of the subaxial cervical spine without facet and/or vertebral displacement, in neurologically intact patients. Our research was in line with the PRISMA Statement and registered on PROSPERO (CRD42023405699). RESULTS: A total of 1639 studies were identified through a database search on May 5, 2023. In total, 7 studies from the databases were included, along with 1 study found through a manual citation search. The evidence showed high clinical heterogeneity, a serious risk of bias according to the ROBINS-I tool, and a predominance of retrospective cohort studies. In comparison to less complex facet fractures, lateral floating mass fractures were found to have 5.41 times higher odds of failure of non-operative management (OR = 5.41; 95% CI = 1.32, 22.19). We calculated the potential association between lower absolute fracture height and non-operative treatment success [Fracture height (percentage) Mean Difference = -17.51 (-28.22, -6.79 95% CI); Absolute height Mean Difference: -0.46 (-0.60, -0.31 95% CI)]. Other risk factors were not included in the meta-analysis due to lack of data. The level of certainty was rated as "very low". CONCLUSIONS: Lateral floating mass cervical facet fractures and larger fracture fragment size (measured either in absolute terms or as a percentage) are significant risk factors for failure of non-operative treatment.

Item-wise validity study of the Impact of Event Scale - Revised (IES-R): self-reported reactions of hospital personnel exposed to a stressful workplace.

OBJECTIVE: Recent studies have revealed a heterogeneous prevalence and presentation of PTSD across countries. It is crucial to assess the methodological and item-level measurement factors that contribute to variations in mental disorder rates across cultures. This study aimed to investigate the traumatic experiences of hospital workers by employing item analysis of the Impact of Event Scale-Revised (IES-R). METHODS: Data were collected from 1,000 employees of a large hospital during the COVID-19 pandemic and were further subjected to item response theory (IRT) analysis with respect to the discrimination (a) and difficulty (b) parameters of the item pool. RESULTS: Our results demonstrated that the IES-R items had a good discriminative ability (a) and covered a range of distress severity (b) associated with traumatic experiences. The IES-R was found to be a reliable and informative instrument for assessing individuals with moderate to severe trauma-related distress across the spectrum of traumatic symptoms. In particular, items #10 ("jumpy or easily startled") and #6 (" thought about it when didn't mean to"), reflecting the PTSD domains of hyperarousal and intrusion, excelled in discriminating between different levels of traumatic distress. Conversely, items related to avoidance and sleep disturbance showed diminished discriminative ability. CONCLUSIONS: The item analysis of the IES-R may be used to assess trauma symptoms in the context of a traumatic exposure, thereby identifying the most discriminative and informative items of the PTSD measure in our context. Our findings may refine the IES-R and facilitate the development of a more effective scale with optimized item parameters.

Work-related musculoskeletal symptoms among public municipal elementary school teachers in Cuiabá, Brazil.

Introduction: The demands and conditions of work can lead to development of a range of health conditions, including repetitive stress injuries and work-related musculoskeletal disorders. Objectives: To assess the prevalence of musculoskeletal symptoms and the working conditions of primary school teachers working for the public municipal education system in Cuiabá, Mato Grosso, Brazil. Methods: A cross-sectional study was conducted with teachers working for the public municipal education system in the capital of Mato Grosso state. The sample comprised 326 teachers. Data were collected using the Vocal Production Condition - Teacher instrument and the Nordic Musculoskeletal Questionnaire. Results: The mean age of the sample was 43.01 years and teachers were predominantly female (87.12%), were married or in a stable relationship (62.70%), had postgraduate qualifications (73.93%), worked at one school only (58.95%), and stated that the pace of their working routine was sometimes stressful (59.01%), that they always took work home with them (57.45%), and that there was sometimes stress at work (54.92%), and reported presence of musculoskeletal symptoms during the last 12 months (76.74%). Conclusions: The highest prevalence rates of musculoskeletal symptoms were observed among married women, those with postgraduate qualifications, those who worked at one school only, and those who had a stressful working routine. It was therefore concluded that mapping working conditions could provide a foundation for reducing the occurrence of musculoskeletal symptoms and improving the health of this population.

Introdução: As demandas e as condições de trabalho podem levar ao desenvolvimento de diversas complicações de saúde, entre elas as lesões por movimentos repetitivos e os distúrbios osteomusculares relacionados ao trabalho. Objetivos: Avaliar a prevalência de sintomas osteomusculares e as condições de trabalho de professores do ensino fundamental da rede pública municipal de Cuiabá, estado do Mato Grosso, Brasil. Métodos: Estudo transversal, realizado com professores da rede pública municipal da capital de Mato Grosso. A amostra foi composta por 326 professores. Para a coleta de dados, foram utilizados os instrumentos Condição de Produção Vocal do professor e o Nordic Musculoskeletal Questionnaire. Resultados: Os docentes apresentaram idade média de 43,01 anos, com predominância do sexo feminino (87,12%), casados(as) ou em união (62,70%), com nível de escolaridade em pós-graduação (73,93%), que trabalhavam em uma única escola (58,95%), que afirmaram que às vezes o ritmo de trabalho era estressante (59,01%), que sempre levavam trabalho para casa (57,45%), que disseram que às vezes existia estresse em seu trabalho (54,92%) e que referiram presença de sintomas osteomusculares nos últimos 12 meses (76,74%). Conclusões: As maiores prevalências de sintomas osteomusculares foram entre mulheres casadas, com pós-graduação, que trabalhavam em uma única escola e que tinham um ritmo de trabalho estressante. Assim, conclui-se que o mapeamento das condições de trabalho pode servir como subsídio para reduzir a ocorrência de sintomas osteomusculares e melhorar a situação de saúde desta população.

Traumatic Stress in Children and Youth Crossing the U.S. Mexico Border.

PURPOSE OF THE REVIEW: We review the literature and examine the impact of traumatic stress experienced by children and youth crossing the US-Mexico Border and discuss the psychological effects of trauma incurred in this population, observing various traumatic stressors and their implications on both short and long-term mental health outcomes. Additionally, we discuss existing interventions and treatment approaches while also emphasizing the need for greater awareness, new interventions, and further research. RECENT FINDINGS: Over the past several decades, there has been a significant increase in the number of undocumented youth crossing the US-Mexico border into the United States and these individuals experience various traumatic stressors throughout the pre-migration, migration, and post-migration phases. Research on these stressors and their impact on mental health, however, remain limited and access to appropriate mental health care and interventions continues to be inadequate. It is crucial to understand the impact of trauma experienced by youth crossing the US-Mexico border, as it significantly influences their mental health outcomes. Additional research and targeted mental health interventions are necessary to alleviate the disparities in care experienced by these children. Further research is needed to improve awareness and understanding of the problem, develop targeted and effective interventions, and improve overall outcomes.

Scientific evidence in the management of traumatic brain injury in pediatrics: ibero-American academy of pediatric neurology.

Traumatic brain injury (TBI) is a common problem in Latin America and affects many children. Research has advanced, but international publications do not necessarily reflect our reality. For this reason, the Ibero-American Academy of Pediatric Neurology (AINP) formed a committee to review the available evidence, evaluate it, and decide how it could be applied in our region. Articles were searched in different databases and those corresponding to original works were selected, preferably those that received the best qualifications according to the 2011 version of Oxford Levels of Evidence. The main findings are the need to develop a trauma team available throughout the pediatric level III emergency, early monitoring of intracranial pressure, and multimodal monitoring as methods to improve outcomes. We concluded that much remains to be done and more evidence is needed, but more organization is required to provide specialized resources in the emergency care of these patients.

El traumatismo craneano (TC) es un problema frecuente en América Latina y afecta a muchos niños. La investigación ha avanzado pero las publicaciones internacionales no necesariamente toman en cuenta nuestra realidad. En tal virtud la Academia Iberoamericana de Neurologia Pediatrica (AINP) formo un comité para revisar la evidencia disponible, calificarla y decidir cómo se podía aplica en nuestra región. Se buscaron artículos en distintas bases de datos y se seleccionaron aquellos correspondientes a trabajos originales de preferencia los cuales recibieron calificación de acuerdo a los niveles de evidencia de Oxford versión 2011. Los resultados más importantes son la necesidad de desarrollar un equipo de trauma disponible en toda emergencia pediátrica de III nivel, la monitorización temprana de la presión intracraneana y el monitoreo multimodal como métodos para mejorar los pronósticos. Se concluye que falta mucho por hacer, y más evidencia es necesaria pero más organización es necesaria en proveer recursos especializados en la atención de emergencia de estos pacientes.

Severe facial trauma secondary to aircraft propeller injury: The art of facial reconstruction.

The reconstruction of complex facial trauma poses a significant challenge for plastic surgeons, as it requires a multidisciplinary approach to achieve both functional and aesthetic outcomes. Moreover, it represents a substantial burden on public health. In severe facial trauma, initial management to rule out life-threatening conditions through Advanced Trauma Life Support (ATLS) is crucial. Expertise in soft tissue reconstruction and facial fracture management is essential to achieve good results. New reconstruction techniques include free flaps, grafts, expanders, and epidermal grafts. Here, we present the case of a 68-year-old male who suffered facial trauma from an aircraft propeller managed through staged reconstructive surgical techniques. We will describe surgical management, emphasizing the methods and outcomes. The primary objective of this study is to provide insights into the clinical challenges and therapeutic strategies in managing severe facial trauma, underscoring the critical importance of an interdisciplinary approach to achieve successful and functional facial reconstruction.