Consecuencias psicológicas de las amputaciones por accidente laboral / Psychological consequences of amputations in work accidents

Fundamentos: Las amputaciones en accidente laboral son un fenómeno con gran incidencia y características peculiares. Los escasos estudios que abordan los efectos de la amputación se refieren a grandes extremidades y muestran que, más allá de las secuelas físicas, existen consecuencias importantes a nivel psicológico. El objetivo de este artículo fue mostrar el conocimiento actualizado sobre las principales consecuencias psicopatológicas de las amputaciones por accidente laboral y de las variables que pueden modularlas. Métodos: Se llevó a cabo una revisión bibliográfica de carácter no sistemático, con búsquedas variadas ad hoc para las distintas variables estudiadas. Resultados: Los estudios se han centrado principalmente en la sintomatología ansiosa y depresiva, el trastorno de estrés postraumático y el dolor del miembro fantasma. También se han identificado variables moduladoras que mejoran el pronóstico: adaptación a la vida cotidiana, ejercicio físico, estrategias de afrontamiento, resiliencia y calidad de vida. Conclusiones: Las distintas áreas psicológicas afectadas revisadas deben considerarse al acompañar a las personas con amputación por accidente laboral. Asimismo, potenciar las variables moduladoras cuya presencia mejora el pronóstico es un campo interesante para la intervención profesional.(AU)

Background: Amputations in work accidents are a phenomenon with a high incidence and peculiar characteristics. The few studies about the effects of amputation are referred to large limbs, and show that, beyond the physical consequences, there are important psychological consequences. The goal of this paper was to show the updated knowledge on the main psychopathological consequences of amputations in work accidents, as well as the variables that can modulate them. Methods: A non-systematic bibliographic review was carried out, with varied ad hoc searches for the different variables studied. Results: Studies have focused mainly on anxiety and depressive symptoms, post-traumatic stress disorder, and phantom limb pain. Modulating variables whose presence improves the prognosis of these persons have been identified, such as adaptation to daily life, physical exercise, coping strategies, resilience and quality of life. Conclusions: The different psychological areas reviewed should be considered when attending people who have suffered an amputation in a work accident. Likewise, enhancing the modulating variables whose presence improves the prognosis is an interes-ting field for professional intervention.(AU)

Risk of injuries before and after a diagnosis of cirrhosis: A population-based cohort study.

BACKGROUND: Cirrhosis is often asymptomatic prior to decompensation. Still, cognitive impairment and sarcopenia may be present before decompensation, possibly increasing the risk of injuries. We estimated the risk of injuries during the period shortly before and after cirrhosis diagnosis. METHODS: All patients (N=59,329) with a diagnosis of cirrhosis from 1997 to 2019 were identified from the Swedish National Patient Register. We used a self-controlled case series design to compare the incidence rates (IR) of injuries during a "diagnostic period" (within 3 months before or after the cirrhosis diagnosis date) to a self-controlled "prediagnostic period" (the same 6 calendar months 3 years before diagnosis), using conditional Poisson regression. Injuries were ascertained from the National Patient Register. RESULTS: We identified 23,733 (40.0%) patients with compensated and 35,595 (60.0%) with decompensated cirrhosis. There were 975 injuries (IR 2.8/1000 person-months) during the prediagnostic period, and 3610 injuries (IR 11.6/1000 person-months) identified during the diagnostic period. The IR ratio was 8.1 (95% CI 7.5-8.7) comparing the diagnostic period with the prediagnostic period. For patients with compensated cirrhosis, the risk increment of injuries was highest just before the diagnosis of cirrhosis, whereas the risk increase was highest shortly after the diagnosis for those with decompensation. CONCLUSIONS: The incidence of injuries increases shortly before and after the diagnosis of cirrhosis. These findings indicate that cirrhosis is frequently diagnosed in conjunction with an injury, and highlight the need for injury prevention after cirrhosis diagnosis, especially in patients with decompensation.

Conventional Resilience and the Impact of Catastrophic Injury Exposure on Special Operations Surgical Teams.

This article presents a justification for using an ethnographic approach to research resilience. Our hypothesis is that the conventional resilience construct is ineffective in achieving its stated goal of mitigating diagnosable stress pathologies because it is grounded in a set of assumptions that overlook human experience when examining human performance in combat. To achieve this goal, we (1) describe the evolution of the strategic framework within which the conventional resilience construct is defined; (2) highlight certain limiting assumptions entailed in this framework; (3) explain how bottom-up ethnographic research relates the medic's practical performance to military requirements and mission capabilities; and (4) articulate the unique elements of our study that widen the aperture of the conventional resilience construct. We conclude by gesturing to initial research findings.

Examining the unique and additive effect of trauma and racial microaggressions on substance use risk among Black young adults.

OBJECTIVE: Exposure to traumatic events is linked to adverse health outcomes, including substance use. Contemporary models have conceptualized racism, including racial microaggressions, as a form of trauma. However, few studies have been conducted examining the unique and additive effect of racial microaggressions within models that include exposure to traditional forms of trauma on substance use outcomes, as well as whether effects vary by gender. METHOD: Three hundred and ninety-nine Black young adults between 18 and 29 (61% female, mean age 20.7) completed measures on problem alcohol and cannabis use, and experiences of trauma and racial microaggressions. RESULTS: Controlling for age, gender, income, race (i.e., monoracial vs. multiracial), and recruitment source, regression analyses showed that racial microaggressions predicted problem substance use above the effect of trauma exposure. Moreover, exoticization/assumptions of similarity and workplace/school microaggressions primarily accounted for the effect of racial microaggressions on substance use risk. One gender effect was found, with trauma exposure associated with lower cannabis use for Black males and a nonsignificant effect found for Black females. CONCLUSIONS: Racial microaggressions provide unique and additive understanding in risk for substance use outcomes among Black young adults above effects observed from exposure to traditional forms of trauma. This finding highlights the significance of racial microaggression on health outcomes for Black young adults and can inform future research in the area of trauma exposure and substance use risk among this population of young people. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Psychometric evaluation of the Wound-QoL questionnaire to assess health-related quality of life in Chinese people with chronic wounds.

Chronic wounds are very common wound types in clinics which have a prolonged and painful healing process. Chronic wounds affect health-related quality of life (HRQoL) on patients. However, there is no specific instrument to measure the HRQoL in Chinese patients with chronic wounds. Wound-QoL is a questionnaire targeted the experience of health-related life to patients with chronic wounds. The study aims to translate and cross-culturally adapt the Wound-QoL into Chinese and to evaluate its psychometric properties (validity, reliability, floor, and ceiling effect) in a convenience sample of 203 Chinese outpatients with chronic wounds. Reliability was good, with internal consistency of 0.798-0.960 and test-retest reliability of 0.720-0.838. Criterion-related validity was assessed by the correlation coefficient between Wound-QoL and generic European QoL instrument- EQ-5D-5L, which was found statistically significant (P<.001). No signs of floor or ceiling effect could be detected. Further, confirmatory factor analysis (CFA) was used to verify the reliability and validity of the instrument in this study. In conclusion, the Chinese Wound-QoL is a valid and reliable tool for measuring HRQoL in populations with chronic wounds.

Traumas e emoções sociais em tempos de crise

No dia 9 de julho de 2021, as professoras Ana Teresa A. Venancio e Cristiana Facchinetti mediaram a Terceira Mesa do Ciclo de Debates História em Tempos Pandêmicos, organizada pelo Departamento de Pesquisa da Casa de Oswaldo Cruz/Fiocruz A partir do tema Traumas e emoções sociais em tempos de crise, a mesa contou com a participação dos pesquisadores Maria Cláudia Coelho (UERJ), Durval Muniz de Albuquerque Junior (UFRN) e Francisco Carlos Teixeira Silva (UFRJ/UFJF).

Auxetic structures used in kinesiology tapes can improve form-fitting and personalization.

Each year 65% of young athletes and 25% of physically active adults suffer from at least one musculoskeletal injury that prevents them from continuing with physical activity, negatively influencing their physical and mental well-being. The treatment of musculoskeletal injuries with the adhesive elastic kinesiology tape (KT) decreases the recovery time. Patients can thus recommence physical exercise earlier. Here, a novel KT based on auxetic structures is proposed to simplify the application procedure and allow personalization. This novel KT exploits the form-fitting property of auxetics as well as their ability to simultaneously expand in two perpendicular directions when stretched. The auxetic contribution is tuned by optimizing the structure design using analytical equations and experimental measurements. A reentrant honeycomb topology is selected to demonstrate the validity of the proposed approach. Prototypes of auxetic KT to treat general elbow pains and muscle tenseness in the forearm are developed.

Direcionalidade da violência em casais heterossexuais / Directionality of violence in heterosexual couples / Direccionalidad de la violencia en parejas heterosexuales

Ainda existem controvérsias entre pesquisas que analisam a violência cometida por homens e mulheres. O objetivo foi avaliar a direcionalidade da violência conjugal em diferentes manifestações (física, psicológica, coerção sexual e lesão corporal). Trata-se de uma pesquisa quantitativa, exploratória e descritiva, da qual participaram 304 casais heterossexuais. Aplicou-se um questionário sociodemográfico e a escala Revised Conflict Tactics Scales (CTS2), sendo realizadas análises descritivas dos dados pelo programa estatístico SPSS 22.0. Os resultados indicaram que mais de 70% da violência psicológica ocorre de forma bidirecional e, quando se expressa de forma unidirecional, é mais cometida por mulheres. A violência física e a coerção sexual, quando unidirecionais, foram mais cometidas pelos homens. Já a lesão corporal não apresentou diferença significativa. Os casais mais velhos apresentaram mais violência unidirecional, enquanto os mais jovens praticaram mais violência bidirecional. Esses dados podem auxiliar no desenvolvimento de políticas públicas nas situações de violência conjugal. (AU)

There are still controversies between researches analyzing violence committed by men and women. The objective was to evaluate the directionality of conjugal violence in different manifestations (physical, psychological, sexual coercion and bodily injury). This is a quantitative, exploratory and descriptive, cross-sectional study, in which 304 heterosexual couples, aged between 18 and 82 years participated. It was applied a sociodemographic questionnaire and the Revised Conflict Tactics Scales (CTS2) and descriptive analyses of the data were performed using the SPSS 22.0 statistical program. The results indicated that more than 70% of psychological violence occurs in a bidirectional way and, when expressed in a unidirectional way, it is more committed by women. Physical violence and sexual coercion, when unidirectional, were more committed by men. As for bodily injuries, men and women scored equally. Older couples experienced more unidirectional violence, while younger couples had more bidirectional violence. These data can assist in the development of public policies in situations of conjugal violence. (AU)

Todavía existen controversias entre las investigaciones que analizan la violencia cometida por hombres y mujeres. El objetivo fue evaluar la direccionalidad de la violencia conyugal en diferentes manifestaciones (física, psicológica, coacción sexual y lesión corporal). Se trata de una investigación cuantitativa, exploratoria y descriptiva, en la que participaron 304 parejas heterosexuales. Se aplicó un cuestionario sociodemográfico y la escala Revised Conflict Tactics Scales (CTS2) realizando análisis descriptivos de los datos mediante el programa estadístico SPSS 22.0. Los resultados indicaron que más del 70% de la violencia psicológica ocurre de forma bidireccional y, cuando se expresa de forma unidireccional, es más cometida por mujeres. La violencia física y la coacción sexual, cuando eran unidireccionales, eran más cometidas por hombres. Por otro lado, las lesiones corporales no mostraron diferencias significativas. Las parejas mayores experimentaron más violencia unidireccional, mientras que las parejas más jóvenes practicaron más violencia bidireccional. Estos datos pueden ayudar en el desarrollo de políticas públicas en situaciones de violencia conyugal. (AU)

Peer Support for Public Safety Personnel in Canada: Towards a Typology.

Public safety personnel (PSP) are frequently exposed to potentially psychologically traumatic events (PPTEs) which can impact mental health. To help mitigate the negative effects of PPTEs, PSP commonly rely on peer support. Peer support generally refers to a wide variety of mental health resources that offer social or emotional assistance to a peer, and in some cases professional assistance. Despite the use of and demand for peer support, there is relatively little empirical evidence regarding effectiveness. The evidence gaps regarding peer support effectiveness may be due, in part, to inadequate guidelines and standards of practice that are publicly supported by a consensus among peer support providers. The current study was designed to explore the current conceptualization and implementation of peer support among Canadian PSP using a document analysis. The results indicate that peer support can be conceptualized via three models (i.e., peer-enabled, peer-led, peer-partnership) and implemented via two delivery methods (i.e., program, service). The research team proposed a novel diagram towards a typology of peer support to highlight the diversity in peer support conceptualization and implementation and provide a foundation for the development of mutually agreed-upon language and a shared framework. Overall, the current study can help inform peer support resources within and beyond PSP communities.

Qualitative analysis of hotspots and intrusive memories after viewing an aversive film highlights their sensory and spatial features.

Intrusive memories of trauma are recurrent distressing sensory-perceptual impressions of the traumatic event that enter consciousness spontaneously and unwanted. They often contain the worst moment/s ('hotspots') of the trauma memory and have primarily been studied in clinical populations after real trauma. Intrusive memories can also be studied using analogue trauma as an 'experimental psychology model'. Little is known about the features of analogue trauma hotspots. Here we report an ancillary analysis of data from a randomized controlled trial. Seventy non-clinical participants viewed a trauma film containing COVID-19 related footage. Features of hotspots/intrusive memories of the film were explored using linguistic analysis and qualitative content coding. Participants reported on average five hotspots (M = 9.5 words/hotspot). Akin to hotspots soon after real trauma, analogue hotspots/intrusions primarily contained words related to space. Most contained sensory features, yet few cognitions and emotions. Results indicate that features of analogue trauma hotspots mirror those of hotspots soon after real trauma, speaking to the clinical validity of this 'experimental psychology model'.ClinicalTrials.gov ID: NCT04608097, registered on 29/10/2020.

Sex-differential PTSD symptom trajectories across one year following suspected serious injury.

Background: Recent years have shown an increased application of prospective trajectory-oriented approaches to posttraumatic stress disorder (PTSD). Although women are generally considered at increased PTSD risk, sex and gender differences in PTSD symptom trajectories have not yet been extensively studied. Objective: To perform an in-depth investigation of differences in PTSD symptom trajectories across one-year post-trauma between men and women, by interpreting the general trends of trajectories observed in sex-disaggregated samples, and comparing within-trajectory symptom course and prevalence rates. Method: We included N = 554 participants (62.5% men, 37.5% women) from a multi-centre prospective cohort of emergency department patients with suspected severe injury. PTSD symptom severity was assessed at 1, 3, 6, and 12 months post-trauma, using the Clinician-Administered PTSD Scale for DSM-IV. Latent growth mixture modelling on longitudinal PTSD symptoms was performed within the sex-disaggregated whole samples. Bayesian modelling with informative priors was applied for reliable model estimation, considering the imbalanced prevalence of the expected latent trajectories. Results: In terms of general trends, the same trajectories were observed for men and women, i.e. resilient, recovery, chronic symptoms and delayed onset. Within-trajectory symptom courses were largely comparable, but resilient women had higher symptoms than resilient men. Sex differences in prevalence rates were observed for the recovery (higher in women) and delayed onset (higher in men) trajectories. Model fit for the sex-disaggregated samples was better than for the whole sample, indicating preferred application of sex-disaggregation. Analyses within the whole sample led to biased estimates of overall and sex-specific trajectory prevalence rates. Conclusions: Sex-disaggregated trajectory analyses revealed limited sex differences in PTSD symptom trajectories within one-year post-trauma in terms of general trends, courses and prevalence rates. The observed biased trajectory prevalence rates in the whole sample emphasize the necessity to apply appropriate statistical techniques when conducting sex-sensitive research.

Antecedentes: Los últimos años han demostrado una mayor aplicación de enfoques prospectivos orientados a la trayectoria para el trastorno de estrés postraumático (TEPT). Aunque generalmente se considera que las mujeres tienen un mayor riesgo de TEPT, las diferencias de sexo y género en las trayectorias de los síntomas del TEPT aún no se han estudiado ampliamente.Objetivo: Realizar una investigación en profundidad de las diferencias en las trayectorias de los síntomas del TEPT a lo largo de un año después de un trauma entre hombres y mujeres, interpretando las tendencias generales de las trayectorias observadas en muestras desagregadas por sexo, así como comparar el curso y la evolución de los síntomas dentro de la trayectoria y las tasas de prevalencia.Método: Incluimos N = 554 participantes (62.5% hombres, 37.5% mujeres) de una cohorte prospectiva multicéntrica de pacientes del servicio de urgencias con sospecha de lesión grave. La gravedad de los síntomas del TEPT se evaluó 1, 3, 6 y 12 meses después del trauma, utilizando la Escala de TEPT administrada por un médico para el DSM-IV. Se realizó un modelo de mezcla de crecimiento latente sobre los síntomas longitudinales de TEPT en las muestras desagregadas por sexo y en la muestra completa. Se aplicó un modelo bayesiano con antecedentes informativos para una estimación confiable del modelo, considerando la prevalencia desequilibrada de las trayectorias latentes esperadas.Resultados: En términos de tendencias generales, se observaron las mismas trayectorias para hombres y mujeres, es decir, resiliente, recuperación, síntomas crónicos y aparición tardía. Los cursos de síntomas dentro de la trayectoria fueron en gran medida comparables, pero las mujeres resilientes tenían más síntomas másque los hombres resilientes. Se observaron diferencias por sexo en las tasas de prevalencia para las trayectorias de recuperación (mayor en mujeres) y de inicio tardío (mayor en hombres). El ajuste del modelo para las muestras desagregadas por sexo fue mejor que para la muestra completa, lo que indica la aplicación preferida de la desagregación por sexo. Los análisis de la muestra completa llevaron a estimaciones sesgadas de las tasas de prevalencia de trayectorias generales y específicas por sexo.Conclusiones: Los análisis de trayectoria desagregados por sexo revelaron diferencias limitadas entre los sexos en las trayectorias de los síntomas del TEPT durante el año posterior al trauma en términos de tendencias generales, cursos y tasas de prevalencia. Las tasas de prevalencia de trayectoria sesgada observadas en el conjunto de la muestra enfatizan la necesidad de aplicar técnicas estadísticas apropiadas al realizar investigaciones que tengan en cuenta el sexo.

Mediating Effects of Coping Strategies on Quality of Life Following Extremity Injury.

BACKGROUND: Few researches have explored the self-regulation process in patients with extremity injuries. Knowledge about the role of coping in the postinjury self-regulation process remains scarce. OBJECTIVES: We examined the relationships between illness representations, coping, and quality of life (QoL) based on the self-regulation framework, assuming adaptive and maladaptive coping strategies play mediating roles between illness representation and QoL in patients with extremity injuries. METHODS: A cross-sectional survey with a correlational model testing design was used. A sample of 192 patients with extremity injury was recruited before hospital discharge at trauma centers in Indonesia. Validated questionnaires were used to assess patients' illness representations, coping, and QoL. Hierarchical regressions were carried out, and multiple mediation analyses were used to identify the mediating role of coping. RESULTS: Patients with extremity injuries who harbored negative illness representations were less focused on using adaptive coping strategies, were more focused on using maladaptive coping strategies, and tended to experience reduced QoL. The mediating effects of coping, which manifested as parallel mediations of adaptive and maladaptive coping strategies, could significantly explain the QoL variance. DISCUSSION: In postinjury self-regulation, coping has a parallel mediating role that can facilitate the effect of illness representations and directly influence postinjury QoL. Enhancing adaptive coping strategies, reducing maladaptive coping techniques, and reframing negative illness representations during the early recovery phase could improve postinjury QoL. Early screening and preventive efforts using psychologically driven interventions may help redirect patients' focus toward adaptive coping strategies and reframe their illness representations before they transition back into the community.

A cluster analytic approach to examining the role of cortisol in the development of post-traumatic stress and dysphoria in adult traumatic injury survivors.

Identification of specific risk factors for posttraumatic stress disorder (PTSD) versus depression after trauma has been challenging, in part due to the high comorbidity of these disorders. As exposure to trauma triggers activation of the hypothalamic-pituitary-adrenal (HPA)-axis, examining atypical stress responses via HPA-axis hormones, namely cortisol, may help in the delineation of these disorders. Indeed, extant research demonstrates that, following stress, individuals with chronic PTSD exhibit hypocortisolism (e.g., lower cortisol response than controls), while those with chronic depression exhibit hypercortisolism (e.g., higher response than controls). Less is known about the role of cortisol and these seemingly disparate profiles immediately following traumatic injury as well as whether cortisol can be used as a predictor of future development of PTSD versus depression symptoms. In this study cortisol was measured blood from 172 traumatic injury survivors during hospitalization (on average 2.5 days post-injury). PTSD and depression severity were assessed from Clinician Assessed PTSD Scale (CAPS-5) six-eight months later using a two-factor dimensional approach that measures trauma-specific symptoms of PTSD versus dysphoria (akin to depression). Cluster analysis was used to group individuals based on post-injury cortisol, PTSD, and dysphoria. Results demonstrated that trauma survivors who only developed symptoms of dysphoria at six months (with minimal symptoms of PTSD) were differentiated by high post-injury cortisol compared to other groups. By contrast, individuals who developed symptoms of both PTSD and dysphoria were differentiated by low post-injury cortisol and most severe symptoms of PTSD. Findings provide support for the presence of subgroups of trauma survivors defined, in part, by post-trauma cortisol.

How Is the Probability of Reporting Various Levels of Pain 12 Months After Noncatastrophic Injuries Associated with the Level of Peritraumatic Distress?

BACKGROUND: Psychological factors have been shown to be consistent predictors of chronic pain in people with musculoskeletal injuries. However, few prognostic studies have considered multiple risk factors including peritraumatic distress. In addition, previous research has not considered that the associations between peritraumatic distress and pain levels can vary across pain outcomes. QUESTION/PURPOSE: To determine whether an easily measurable level of baseline distress is associated with pain levels 1 year after noncatastrophic traumatic injuries when the outcome to be assessed is not normally distributed. METHODS: This was a prospective cohort study. The data were captured from two cohorts in London, Ontario, Canada, and Chicago, IL, USA. Participants were adults with acute noncatastrophic (that is, not treated with surgery or hospitalization) musculoskeletal injuries of any etiology with various injury locations (60% [145 of 241] spinal and 40% [96 of 241] peripheral) that presented to local urgent care centers. Other inclusion criteria included English/French speakers and having no other disorder that would affect their pain levels. In total, between the years 2015 and 2018, 241 participants were recruited based on the inclusion criteria. Ninety-three percent (225 of 241) of participants provided baseline data, and of these, 48% (109 of 225) were lost to follow-up in 1 year. Based on a complete case approach, this study included 116 participants who ranged in age from 18 to 66 years and 69% (80) of whom were women. The Traumatic Injuries Distress Scale (TIDS) was used to evaluate distress at baseline (within 4 weeks of injury). The TIDS is a validated, reliable 12-item risk prognosis screening tool that takes less than 3 minutes to complete with questions regarding uncontrolled pain, negative affect, and intrusion/hyperarousal. The minimum and maximum possible scores are 0 and 24, with higher scores indicating higher levels of distress. The Numeric Pain Rating Scale (NPRS) was used to assess the pain level at baseline and again 12 months postinjury. To complete the NPRS, participants rate the severity of their pain on a scale of 0 to 10, with 0 indicating no pain and 10 indicating the worst pain imaginable. NPRS scores of 1 to 3 indicate mild pain, 4 to 6 indicate moderate pain and 7 or higher indicate severe pain. As a preliminary analysis, to assess whether the participants as a group experienced recovery, a paired samples t-test was used to compare NPRS scores at baseline and 12 months. In all, 52% (60 of 116) of participants reported no pain (NPRS = 0), and mean pain intensity scores improved from 4.8 ± 2.1 at baseline to 1.6 ± 1.6 at 12-month follow-up (p < 0.001). Quantile regression was used to describe the association between baseline distress and pain levels 1 year after the injury. This technique was used because it reveals the relationships at different quantiles of the pain outcome distribution. RESULTS: The results indicate some people (52% [60 of 116]) recovered regardless of their baseline level of distress (30th quantile of the NPRS: ß = 0). However, in those with persisting pain, higher levels of baseline distress are associated with greater levels of pain 12 months after the injury (50th quantile of the NPRS: ß = 0.11; p = 0.01; 70th quantile of the NPRS: ß = 0.27; p < 0.001; 90th quantile of the NPRS: ß = 0.31; p = 0.01). According to this model, with a baseline TIDS score of 5, there is 10% probability that patients will report moderate or greater levels of pain (4 or higher of 10) 12 months later. This probability then increases as the TIDS score increases. For instance, at a score of 13 on the TIDS, the probability of a patient reporting moderate or higher levels of pain increases to 30%, and the probability of reporting severe pain (higher than 6 of 10) is 10%. CONCLUSION: Clinicians and surgeons in orthopaedic settings can screen for the presence of peritraumatic distress using the TIDS, which is an easily administered tool that does not require extensive knowledge of psychology, and by using it they can identify those with higher levels of distress who are more likely to have persistent, long-term pain. A score of 4 or less indicates a low risk of persistent pain, a score between 5 and 12 (endpoints included) indicates moderate risk, and a score of 13 or higher indicates high risk. Future studies should investigate whether certain immediate interventions for peritraumatic distress in the aftermath of trauma can decrease the likelihood that a patient will develop chronic pain after injury. As an analysis technique, quantile regression is useful to assess complex associations in many orthopaedic settings in which a certain outcome is expected to occur in most patients leading to non-normally distributed data. LEVEL OF EVIDENCE: Level II, therapeutic study.

"Did You Think You Would Die?": Fear of Death and Its Relationship to the Development of Posttraumatic Stress Disorder After Traumatic Injury.

INTRODUCTION: Patient-specific factors may influence posttraumatic stress disorder (PTSD) development and warrant further examination. This study investigates potential association between patient-reported fear of death at the time of injury and development of PTSD. METHODS: Over 35 months, 250 patients were screened for PTSD at their first posthospitalization clinic visit and were asked "Did you think you were going to die from this injury?" (yes or no). PTSD screening was conducted using the PTSD checklist for DSM-5 questionnaire. A score ≥33 was considered positive for PTSD, and patients were offered ancillary psychiatric services. Retrospectively, medical records were reviewed for baseline demographics and injury information. RESULTS: Forty-three patients (17%) indicated a fear of death. The mean age was 46 years, with patients who feared death being younger (36 versus 48, P < 0.001), and 62% were male. The most common mechanisms of injury were motor vehicle or motorcycle collisions (30%) and ground-level falls (21%). Gunshot wounds were more common among patients who feared death from trauma (44% versus 7%, P < 0.001). PTSD questionnaires were completed a median of 26 days after injury, with an average score of 12.6. PTSD scores were higher for patients with fear of death (32.7 versus 8.5), and these patients required more acute interventions (47% versus 7%), both P < 0.001. After multivariable logistic regression, patients who thought that they would die from their trauma had >13 times higher odds of developing PTSD (odds ratios: 13.42, P < 0.0001). Apart from positive psychiatric history (OR: 5.46, P = 0.001), no factors (ie, age, sex, mechanism, or any injury or treatment characteristic) were predictive of positive PTSD scores on regression. DICUSSION: Patients who reported fear of death at the time of injury were 13 times more likely to develop PTSD. Simply asking patients whether they thought that they would die at the time of injury may prospectively identify PTSD risk. LEVEL OF EVIDENCE: Prognostic Level II.

Important Issues to Severe Trauma Survivors: A Qualitative Study.

OBJECTIVE: Identify issues that are important to severe trauma survivors up to 3 years after the trauma. BACKGROUND: Severe trauma is the first cause of disability-adjusted life years worldwide, yet most attention has focused on acute care and the impact on long-term health is poorly evaluated. METHOD: We conducted a large-scale qualitative study based on semi-structured phone interviews. Qualitative research methods involve the systematic collection, organization, and interpretation of conversations or textual data with patients to explore the meaning of a phenomenon experienced by individuals themselves. We randomly selected severe trauma survivors (abbreviated injury score ≥3 in at least 1 body region) who were receiving care in 6 urban academic level-I trauma centers in France between March 2015 and March 2018. We conducted double independent thematic analysis. Issues reported by patients were grouped into overarching domains by a panel of 5 experts in trauma care. Point of data saturation was estimated with a mathematical model. RESULTS: We included 340 participants from 3 months to 3 years after the trauma [median age: 41 years (Q1-Q3 24-54), median injury severity score: 17 (Q1-Q3 11-22)]. We identified 97 common issues that we grouped into 5 overarching domains: body and neurological issues (29 issues elicited by 277 participants), biographical disruption (23 issues, 210 participants), psychological and personality issues (21 issues, 147 participants), burden of treatment (14 issues, 145 participants), and altered relationships (10 issues, 87 participants). Time elapsed because the trauma, injury location, or in-hospital trauma severity did not affect the distribution of these domains across participants' answers. CONCLUSIONS: This qualitative study explored trauma survivors' experiences of the long-term effect of their injury and allowed for identifying a set of issues that they consider important, including dimensions that seem overlooked in trauma research. Our findings confirm that trauma is a chronic medical condition that demands new approaches to post-discharge and long-term care.

Network analysis of trauma in patients with early-stage psychosis.

Childhood trauma (ChT) is a risk factor for psychosis. Negative lifestyle factors such as rumination, negative schemas, and poor diet and exercise are common in psychosis. The present study aimed to perform a network analysis of interactions between ChT and negative lifestyle in patients and controls. We used data of patients with early-stage psychosis (n = 500) and healthy controls (n = 202). Networks were constructed using 12 nodes from five scales: the Brief Core Schema Scale (BCSS), Brooding Scale (BS), Dietary Habits Questionnaire, Physical Activity Rating, and Early Trauma Inventory Self Report-Short Form (ETI). Graph metrics were calculated. The nodes with the highest predictability and expected influence in both patients and controls were cognitive and emotional components of the BS and emotional abuse of the ETI. The emotional abuse was a mediator in the shortest pathway connecting the ETI and negative lifestyle for both groups. The negative others and negative self of the BCSS mediated emotional abuse to other BCSS or BS for patients and controls, respectively. Our findings suggest that rumination and emotional abuse were central symptoms in both groups and that negative others and negative self played important mediating roles for patients and controls, respectively.Trial Registration: ClinicalTrials.gov identifier: CUH201411002.

Metabolic reprogramming mediates hippocampal microglial M1 polarization in response to surgical trauma causing perioperative neurocognitive disorders.

BACKGROUND: Microglial polarization toward pro-inflammatory M1 phenotype are major contributors to the development of perioperative neurocognitive disorders (PNDs). Metabolic reprogramming plays an important role in regulating microglial polarization. We therefore hypothesized that surgical trauma can activate microglial M1 polarization by metabolic reprogramming to induce hippocampal neuroinflammation and subsequent postoperative cognitive impairment. METHODS: We used aged mice to establish a model of PNDs, and investigated whether surgical trauma induced metabolic reprograming in hippocampus using PET/CT and GC/TOF-MS based metabolomic analysis. We then determined the effect of the glycolytic inhibitor 2-deoxy-D-glucose (2-DG) on hippocampal microglial M1 polarization, neuroinflammation, and cognitive function at 3 d after surgery. RESULTS: We found that surgery group had less context-related freezing time than either control or anesthesia group (P < 0.05) without significant difference in tone-related freezing time (P > 0.05). The level of Iba-1 fluorescence intensity in hippocampus were significantly increased in surgery group than that in control group (P < 0.05) accompanied by activated morphological changes of microglia and increased expression of iNOS/CD86 (M1 marker) in enriched microglia from hippocampus (P < 0.05). PET/CT and metabolomics analysis indicated that surgical trauma provoked the metabolic reprogramming from oxidative phosphorylation to glycolysis in hippocampus. Inhibition of glycolysis by 2-DG significantly alleviated the surgical trauma induced increase of M1 (CD86+CD206-) phenotype in enriched microglia from hippocampus and up-regulation of pro-inflammatory mediators (IL-1ß and IL-6) expression in hippocampus. Furthermore, glycolytic inhibition by 2-DG ameliorated the hippocampus dependent cognitive deficit caused by surgical trauma. CONCLUSIONS: Metabolic reprogramming is crucial for regulating hippocampal microglial M1 polarization and neuroinflammation in PNDs. Manipulating microglial metabolism might provide a valuable therapeutic strategy for treating PNDs.

Analysis of Factors Influencing Anxiety and Depression among Hospitalized Patients with Chronic Wounds.

OBJECTIVE: To investigate the prevalence of anxiety and depression among hospitalized patients with a chronic wound and explore the influence of demographic factors, disease characteristics, social support, and coping styles on their mental status. METHODS: Investigators recruited 216 patients with a chronic wound. The Self-rating Anxiety Scale and Self-rating Depression Scale were used to measure anxiety and depression. Patients' coping style and their social support were assessed through face-to-face interviews. RESULTS: Overall, 36.6% of participants presented with symptoms of anxiety, and 37% showed depressive symptoms. Participants who typically had less than 5 hours of sleep; experienced more severe pain; or had an odorous wound, negative coping style, or lower level of social support had a higher prevalence of anxiety and depression (P < .05). Men with higher monthly incomes who lived in the city were more likely to develop anxiety than women with lower monthly incomes who lived outside the city (P < .05). Participants with fewer years of education and without spouses were more likely to experience depression than married participants with more education (P < .05). CONCLUSIONS: The prevalence of anxiety and depression among hospitalized patients with a chronic wound is high. Support from loved ones including a spouse and a positive coping style are key protective factors for mental health and well-being.