Injectable tissue prosthesis for instantaneous closed-loop rehabilitation.

To construct tissue-like prosthetic materials, soft electroactive hydrogels are the best candidate owing to their physiological mechanical modulus, low electrical resistance and bidirectional stimulating and recording capability of electrophysiological signals from biological tissues1,2. Nevertheless, until now, bioelectronic devices for such prostheses have been patch type, which cannot be applied onto rough, narrow or deep tissue surfaces3-5. Here we present an injectable tissue prosthesis with instantaneous bidirectional electrical conduction in the neuromuscular system. The soft and injectable prosthesis is composed of a biocompatible hydrogel with unique phenylborate-mediated multiple crosslinking, such as irreversible yet freely rearrangeable biphenyl bonds and reversible coordinate bonds with conductive gold nanoparticles formed in situ by cross-coupling. Closed-loop robot-assisted rehabilitation by injecting this prosthetic material is successfully demonstrated in the early stage of severe muscle injury in rats, and accelerated tissue repair is achieved in the later stage.

Valoración de las lesiones físicas en 702 casos de violencia sexual en la provincia de Alicante (2016-2020) / Analysis of injuries in 702 cases of sexual assault in Alicante (Spain) during the years (2016-2020)

Introducción: el objetivo principal de este trabajo es analizar las características de las víctimas y circunstancias de la violencia sexual asociadas con un mayor riesgo de presentar lesiones físicas, así como determinar la frecuencia y severidad de las mismas. Material y Métodos estudio descriptivo retrospectivo de 702 casos de violencia sexual atendidos en el Instituto de Medicina Legal y Ciencias Forenses de Alicante entre 2016 y 2020. Se ha realizado un estudio comparativo entre las víctimas de violencia sexual con lesiones físicas y sin lesiones, para analizar las variables asociadas que pueden influir en su presentación. Resultados del total de 702 víctimas de violencia sexual, 314 casos (44,8%) presentaban lesiones físicas. Las víctimas con lesiones físicas la mayoría eran mujeres (95,5%), entre 18 y 27 años (31,3%), que referían un consumo voluntario previo de sustancias, fundamentalmente de alcohol (50%). Las lesiones físicas más frecuentes fueron a nivel extragenital (38,6%), seguidas de lesiones a nivel anogenital (15%), de carácter leve en la mayoría de los casos (97,5%). Los días totales de curación fueron menores o iguales a una semana (83,4%). La mayoría se curó sin secuelas (97,1%). Las víctimas que presentaron secuelas (9 casos), las más frecuentes fueron de carácter psíquico (1,6%). Conclusiones la violencia sexual en el grupo de víctimas con lesiones físicas se asocia a factores de vulnerabilidad para la víctima: sexo femenino, edad entre 18 y 27 años y consumo previo de alcohol. Nuestro estudio confirma que las lesiones anogenitales son poco frecuentes en la mayoría de las víctimas de violencia sexual, por lo que su ausencia no puede descartar el haber sufrido violencia sexual. Las lesiones físicas encontradas fueron de carácter leve en la mayoría de los casos. La ausencia de secuelas psíquicas en muchas de las víctimas puede estar condicionado por el escaso seguimiento de las mismas. (AU)

Introduction: The aim of this paper is to analyze the characteristics of the victims and the circumstances of sexual violence related with the risk of physical lesions, as well as to determine the frequency and severity of the injuries. Material and methods Descriptive study of 702 cases of sexual assault attended at the Institute of Legal Medicine and Forensic Sciences of Alicante between the years 2016–2020. A comparative study was carried out between victims with and without injuries, to identify the variables associated to their presentation. Results 314 victims attended showed physical injuries (44,8%). Profile of the victims with injuries were women (95.5%), aged 18 to 27 years (31.3%), and previous alcohol consumption (50%). Injuries physical were mainly extragenital (38.6%), anogenital (15%), or both, and most cases were mild in severity (97.5%). Recovery was less to one week (83.4%) and without aftermath (97.1%). When the victim showed aftermath (9 cases), the most frequent were psychological type (1.6%). Conclusions Physical injuries in sexual violence is related with circumstances of victim vulnerability: women, age between 18 to 27 years, and previous alcohol consumption. Our study shows that anogenital lesions are absent in a significative number of victims of sexual assault, so this absence cannot exclude sexual violence. The lesions found are mild in severity, and the absence of physical aftermath in most of the victims may be conditioned by the scarce follow-up of them. (AU)

Xenoinjertos de piel de tilapia en quemaduras cutáneas. Una revisión exploratoria / Tilapia skin xenografts in skin burns. An exploratory review

Introducción y objetivo: El tratamiento de heridas, y en particular el de las quemaduras es complejo, son lesiones de alto costo e implican amplios periodos de hospitalización, además de incapacidades físicas, laborales y alteraciones emocionales. Existen diferentes tratamientos para su manejo, entre ellos, recientemente, los xenoinjertos de piel de tilapia, del Nilo (Oreochromis niloticus), un pez de agua dulce nativo de África que se encuentra y cultiva comúnmente en diferentes países tropicales y subtropicales. Es un tejido rico en fibras de colágeno tipo I y III, con resistencia a la humedad y estructura similar a la piel humana. Usada como xenoinjerto, posee propiedades antiinflamatorias y antibacterianas que apoyan y mejoran la cicatrización. Evaluamos la eficacia de los injertos de piel de tilapia en comparación con técnicas alternativas para el tratamiento de quemaduras. Material y método: Búsqueda bibliográfica sistemática en las bases de datos PubMed y ScienceDirect, utilizando los términos MeSH, con la ecuación de búsqueda (tilapia skin) AND (burns), incluyendo estudios de casos y controles, reportes de caso y ensayos controlados aleatorios. Resultados: Analizamos 5 trabajos para el estudio final; 4 eran de Brasil (país que actualmente tiene más experiencia en el uso de piel de tilapia en regeneración tisular) y el quinto de Indonesia. Todos en inglés. Conclusiones: De nuestra revisión podemos concluir que, en la actualidad, no existe una técnica estándar para tratar heridas, sin embargo, los injertos de piel de tilapia demostraron una mejor y más rápida cicatrización de heridas, menos cambios de apósitos, menos dolor y costos más bajos, en comparación con las técnicas convencionales.Nivel de evidencia científica 5c Terapéutico.(AU)

Background and objective: Treatment of wounds, and burns in particular, is complex, they are high-cost injuries, imply long periods of hospitalization, additionally physical and work disabilities and emotional disturbances. There are different treatments available for its management, recently including tilapia skin xenografts. Nile tilapia (Oreochromis niloticus) is a fresh water fish, native to Africa and commonly found and farmed in different tropical and subtropical countries. The skin It is a tissue rich in type I and III collagen fibers and has resistance to moisture and skin alterations similar to human skin. Used as a xenograft, it possess anti-inflammatory and antibacterial properties that support and enhance healing. In this study, we evaluate the efficacy of tilapia skin grafts in comparison with alternative techniques for the treatment of burns. Methods: A systematic bibliographic search was carried out using the PubMed and ScienceDirect data bases, MeSH terms were used with the search equation (tilapia skin) AND (burns), including case-control studies, case reports, and randomized controlled trials. Results: Five papers were included for the final study; 4 were from Brazil (the country that currently has the most experience in the use of tilapia skin in tissue regeneration) and 1 from Indonesia, all of them were written in English. Conclusions: There is currently no standard technique for treating wounds, however, fish skin grafts demonstrated faster and improved wound healing, fewer dressing changes, less pain, and lower costs, compared with conventional techniques. Level of evidence 5c Terapeutic.(AU)

Effects of Case Management in Trauma Patients in Taiwan: A Randomized, Longitudinal Study.

BACKGROUND: Case management can improve trauma patient outcomes from the acute to rehabilitation phases. However, a lack of evidence on the effects of case management in trauma patients makes it difficult to translate research findings into clinical practice. OBJECTIVE: To examine the effects of case management on illness perception, coping strategies, and quality of life in trauma patients followed up to 9 months post-hospital discharge. METHODS: A four-wave longitudinal experimental design was used. Patients with traumatic injury hospitalized at a regional hospital in southern Taiwan from 2019 to 2020 were randomly assigned to a case management (experimental) or a usual care (control) group. The intervention was implemented during hospitalization with a phone call follow-up about 2 weeks post-discharge. Illness perception, coping strategies, and health-related quality-of-life perceptions were measured at baseline, 3 months, 6 months, and 9 months after discharge. Generalized estimating equations were used for analysis. RESULTS: Findings showed a significant difference in illness perception at 3 and 6 months and coping strategies used at 6 and 9 months after discharge between the two groups. No significant difference in the quality of life over time between the two groups was found. CONCLUSION: Although case management appears to help patients with traumatic injuries decrease illness perception and better cope with their injury, it did not significantly improve their quality of life 9 months after discharge. It is recommended that health care professionals develop long-term case management strategies for high-risk trauma patients.

Social Determinants of Health in Pediatric Rehabilitation for Children with Traumatic Injury: A Systematic Review.

OBJECTIVE: To examine the current evidence regarding health care disparities in pediatric rehabilitation after hospitalization with traumatic injury. STUDY DESIGN: This systematic review utilized both PubMed and EMBASE, and each was searched with key MESH terms. Studies were included in the systematic review if they (1) addressed social determinants of health including, but not limited to, race, ethnicity, insurance status, and income level; (2) focused on inpatient and outpatient rehabilitation services posthospital stay; (3) were based in the pediatric population; and (4) addressed traumatic injury requiring hospitalization. Only studies from within the US were included. RESULTS: From 10 169 studies identified, 455 abstracts were examined for full-text review, and 24 studies were chosen for data extraction. Synthesis of the 24 studies revealed 3 major themes: (1) access to services; (2) outcomes from rehabilitation; and (3) service provision. Patients with public insurance had decreased availability of service providers and had longer outpatient wait times. Non-Hispanic Black and Hispanic children were more likely to have greater injury severity and decreased functional independence after discharge. Lack of interpreter services was associated with decreased utilization of outpatient services. CONCLUSIONS: This systematic review identified significant effects of health care disparities on the rehabilitation process in pediatric traumatic injury. Social determinants of health must be thoughtfully addressed to identify key areas of improvement for the provision of equitable health care.

Impact of socioeconomic position on the utilization of rehabilitation services among the Chinese older adults disabled by injury.

Aim: This study aimed to explore the utilization of rehabilitation services and associated socioeconomic position (SEP) factors among Chinese older adults disabled by injury. Methods: Data from the second China National Sample Survey on Disability (CSSD) were used in this study. Chi-square test was used to analyze the significant differences between groups, and binary logistic regression model was used to calculate the odds ratios and 95% confidence intervals for socioeconomic factors associated with utilization of rehabilitation services among Chinese older adults disabled by injury. Results: Among the older adults disabled by injury in the CSSD, the gap between demand and utilization of medical treatment, assistive devices and rehabilitation training were around 38, 75, and 64%, respectively. This study revealed two relationship patterns ("high-low-high" and "low-high-low") among SEP, prevalence of injury-caused disability and odds of utilization of rehabilitation services among the Chinese older adults disabled by injury, that is, the older adult with higher SEP have a lower prevalence of injury-caused disability, but a higher odds of utilization of rehabilitation services; conversely, the older adults with lower SEP have a relatively higher prevalence but a lower odds of utilization of rehabilitation services. Conclusion: There is a large gap between the high demand and low utilization of rehabilitation services among the Chinese older adults disabled by injury, especially for those living in the central or western regions or rural areas, without insurance or disability certificate, having the annual household per capita income lower than the national average or lower educational level. Strategies to improve the disability manage system, to strengthen the chain of "information discovery-information transmission-rehabilitation services supply-continuous health monitoring and management" for the older adults disabled by injury are warranted. In view of the poor and illiterate groups among the disabled older adults, to enhance medical aids and popularize the scientific information to compensate for the lack of affordability and awareness of rehabilitation services utilization is essential. In addition, it is necessary to further expand the coverage and improve the payment system of medical insurance for rehabilitation services.

Development and validation of the MAnchester Needs Tool for Injured Children (MANTIC).

OBJECTIVE: To develop a measure of the needs injured children and their families' needs throughout recovery; The MAnchester Needs Tool for Injured Children (MANTIC). DESIGN: Tool development, psychometric testing. SETTING: Five children's major trauma centres in England. PARTICIPANTS: Children aged 2 to 16 years with any type of moderate/severe injury(ies) treated in a major trauma centre within 12 months of injury, plus their parents. METHODS: Stage 1a (Item generation): Interviews with injured children and their parents to generate draft items. Stage 1b (Co-production): Feedback about item clarity, relevance and appropriate response options was provided by parents and the patient and public involvement group. Stage 2 (Psychometric development): Completion of the prototype MANTIC by injured children and their parents with restructuring (as necessary) to establish construct validity. Concurrent validity was assessed by correlation with quality of life (EQ-5D-Y). MANTICs were repeated 2 weeks later to assess test-retest reliability. RESULTS: Stages 1a,b: Interviews (13 injured children, 19 parents) generated 64 items with semantic differential four-point response scale (strongly disagree, disagree, agree, strongly agree). Stage 2: One hundred and forty-four participants completed MANTIC questionnaires (mean age 9.8 years, SD 3.8; 68.1% male). Item responses were strong requiring only minor changes to establish construct validity. Concurrent validity with quality of life was moderate (r = 0.55, P < 0.01) as was test-retest reliability (ICC = 0.46 and 0.59, P < 0.001). Uni-dimensionality was strong (Cronbach's α > 0.7). CONCLUSION: The MANTIC is a feasible, acceptable, valid self-report measure of the needs of injured children and their families, freely available for clinical or research purposes.

Tratamento funcional das fraturas de tornozelo Weber B com carga e mobilização imediatas / Functional treatment of Weber B ankle fractures with weight-bearing and immediate mobilization

Introdução: As fraturas do tornozelo são lesões comuns, apesar de ocorrer em todas as idades, são mais comuns entre homens jovens e mulheres idosas, constituem cerca de 9% de todas as fraturas, com uma incidência de 107 a 187 por 100.000 pessoas por ano. A abordagem de tratamento selecionada ocorrerá de acordo com as condições do paciente e a opção do médico de acordo com cada situação em específico. Objetivo: Avaliar o desfecho do tratamento não cirúrgico e funcional de pacientes com fraturas estáveis e sem desvio do maléolo lateral tipo Weber B, com carga e mobilização articular imediatas. Método: estudo retrospectivo de uma série de pacientes com fratura estável e sem desvio do maléolo lateral tipo Weber B, que foram tratados de forma não cirúrgica com carga e mobilização articular imediatas, de janeiro 2016 a julho 2022. Os pacientes dessa pesquisa foram provenientes do Hospital do Servidor Público Municipal de São Paulo e da Clínica de Ortopedia e Traumatologia Ortocity. Resultados: Os pacientes tinham idade média de 54,7 anos, diagnosticados após eventos traumáticos (quedas, acidentes, etc.) por meio de exames radiográficos, 50% da amostra com comorbidades, especialmente HAS, 73,3% com desvio de 1mm, mais de 50% com consolidação em até 8 semanas, mais de 60% retornaram às atividades normais em até 16 semanas, as complicações ocorreram em aproximadamente 70% da amostra, porém todas leves e sem necessidade de nova abordagem de tratamento posterior. Conclusão: Nesse sentido, pode-se afirmar que a abordagem conservadora associado à mobilização e carga imediatas formam uma alternativa viável de tratamento, com bons resultados de recuperação funcional, semelhantes aos pacientes tratados por abordagens cirúrgicas, conforme a literatura levantada para este estudo. Palavras-chave: Fratura de tornozelo. Abordagem conservadora. Weber B. Resultados funcionais.

Avaliação da funcionalidade e qualidade de vida em idosos com lesões de membros superiores / Evaluation of functionality and quality of life in elderly with upper limb injuries

O envelhecimento é um processo de modificações corporais progressivo, que promove alterações morfofisiológicas e dificulta a realização de tarefas funcionais, podendo ocasionar aumento de lesões e influencia diretamente na qualidade de vida. Objetivo: Avaliar a funcionalidade e qualidade de vida dos idosos em reabilitação de membros superiores. Métodos: Estudo transversal e descritivo envolvendo idosos em reabilitação de membros superiores. Para realização da coleta dos dados foram aplicados três questionários na forma de entrevista, um questionário socioeconômico clínico elaborado pelos autores, o questionário Disabilities of the arm, shoulder and hand (DASH) e o questionário Item Short Form Health Survey (SF-12). Resultados: A amostra foi composta por 30 idosos, com média de idade de 69,53 ± 6.62 anos, predominantemente do sexo feminino (66,7%), ensino superior completo (46,7%), trabalhadores autônomos (46,7%), com renda mensal de 5 ou mais salário-mínimo. (53,3%). Quanto a qualidade de vida do questionário SF-12 obtivemos 40,53% no componente físico (PCS), 52,74% componente mental (MCS). Quanto a funcionalidade do questionário DASH o score de 40,68% classifica como incapacidade leve. Conclusão: Os idosos em reabilitação de membros superiores apresentaram melhor qualidade de vida no componente mental e incapacidade leve nos membros superiores

Aging is a process of progressive body changes, which promotes morphophysiological changes and makes it difficult to perform functional tasks, leading to an increase in injuries and directly influencing the quality of life. Objective: To evaluate the functionality and quality of life of elderly people undergoing rehabilitation of upper limbs. Methods: Cross-sectional and descriptive study involving elderly people undergoing upper limb rehabilitation. To perform the data collection, three questionnaires were applied in the form of an interview. The first was a socioeconomic clinical questionnaire prepared by the authors. Then, the "arm, shoulder, and hand" (DASH) impairments. Last but not least was the Item Short Form Health Survey (SF-12). Results: The sample consisted of 30 elderly people, with a mean age of 69.53 ± 6.62 years, predominantly female (66.7%), complete higher education (46.7%), self-employed (46.7 %), with a monthly income of 5 or more minimum wages. (53.3%). As for the quality of life of the SF-12 questionnaire, we obtained 40.53% in the physical component (PCS) and 52.74% in the mental part (MCS). As for the functionality of the DASH questionnaire, the score of 40.68% classifies it as a mild disability. Conclusion: The elderly undergoing rehabilitation of upper limbs had a better quality of life in the mental component and mild disability in the upper limbs.

Ozonioterapia como opção ao tratamento de lesões cutâneas em humanos: revisão integrativa da literatura / Ozone therapy as an option for the treatment of skin lesions in humans: an integrative literature review / La ozonoterapia como opción para el tratamiento de lesiones cutáneas en humanos: revisión bibliográfica integradora

Este trabalho teve como objetivo realizar uma revisão integrativa sobre a Ozonioterapia como prática complementar no tratamento de lesões em seres humanos. Efetuou-se busca sistematizada nos portais: Biblioteca virtual em saúde (BVS), Biblioteca virtual em saúde de medicinas tradicionais complementares e integrativas (BVS MTCI) e Business source complete (EBSCO) nas seguintes bases de dados: Literatura latino-americana e do caribe em ciências da saúde (LILACS), Base de dados de Enfermagem (BDENF) e Medical literature analysis and retrievel system Online (MEDLINE), com cruzamento dos descritores: ozônio; ferimentos; lesões; cicatrização de feridas. Após os critérios de inclusão serem aplicados, observou-se que dez artigos atingiram todos os critérios previamente definidos. Os estudos apontam que a Ozonioterapia apresenta resultados positivos como opção na terapêutica complementar de lesões. Porém, é um recurso terapêutico com baixa adesão. Faz se necessário maior empenho cientifico sobre a temática. PALAVRAS-CHAVE: Ozônio; Ferimentos; Lesões; Cicatrização de feridas.

Currently, there are several treatments as well as ozone therapy that aim to improve wounds. This work aimed to carry out an integrative review on Ozone Therapy as a complementary practice in the treatment of injuries in humans. A systematic search was conducted on the portals: Virtual Health Library (VHL), Virtual Health Library of Complementary and Integrative Traditional Medicines (VHL MTCI) and Business Source Complete (EBSCO) in the following databases: Latin American and Caribbean Literature in Health Science (LILACS) , Nursing Database (BDENF) and Online Medical Literature Review and Retrieval System (MEDLINE), by crossing descriptors: Ozone, Wounds and Injuries, Healing injuries. After the inclusion criteria were applied, it was observed that ten articles reached all the criteria previously defined. The studies indicate that Ozone therapy presents positive results as a complementary therapy option on wounds. However, it is a therapeutical resource with low adherence. It is necessary a greater scientific commitment on the theme.

Este trabajo tuvo como objetivo realizar una revisión integradora sobre la ozonoterapia como práctica complementaria en el tratamiento de lesiones en humanos. Se realizó una búsqueda sistemática en los siguientes portales: Biblioteca Virtual de Salud (BVS), Biblioteca Virtual de Salud de Medicinas Tradicionales, Complementarias e Integrativas (BVS MTCI) y Business Source Complete (EBSCO) en las siguientes bases de datos: Latin American and Caribbean Health Sciences Literature (LILACS), Nursing Database (BDENF) y Medical Literature Analysis and Retrieval System Online (MEDLINE), utilizando las palabras clave: ozono; heridas; lesiones; curación de heridas. Una vez aplicados los criterios de inclusión, se observó que diez artículos cumplían todos los criterios previamente definidos. Los estudios demostraron que la ozonoterapia tiene resultados positivos como opción terapéutica complementaria para las lesiones. Sin embargo, es un recurso terapéutico con un bajo cumplimiento. Es necesario un mayor esfuerzo científico sobre el tema.

Resistance exercise training and the motor unit.

Resistance exercise training (RET) is a key modality to enhance sports performance, injury prevention and rehabilitation, and improving overall health via increases in muscular strength. Yet, the contribution of neural mechanisms to increases in muscular strength are highly debated. This is particularly true for the involvement of the motor unit, which is the link between neural (activation) and mechanical (muscle fiber twitch forces) mechanisms. A plethora of literature that examines the effects of RET on skeletal muscle speculate the role of motor units, such as increases in firing rates partially explains muscular strength gains. Results, however, are mixed regarding changes in firing rates in studies that utilize single motor unit recordings. The lack of clarity could be related to vast or subtle differences in RET programs, methods to record motor units, muscles tested, types of contractions and intensities used to record motor units, etc. Yet to be discussed, mixed findings could be the result of non-uniform MU behavior that is not typically accounted for in RET research. The purpose of this narration is to discuss the effects of acute resistance exercise training studies on MU behavior and to provide guidance for future research.

Rehabilitation after traumatic injury

This guideline covers complex rehabilitation needs after traumatic injury, including assessment and goal setting, rehabilitation plans and programmes, physical, psychological and cognitive rehabilitation, rehabilitation for specific injuries, coordination of rehabilitation in hospital, at discharge and in the community, and commissioning and organising rehabilitation services. Traumatic injury is any major or minor injury that requires admission to hospital at the time of injury, including musculoskeletal, visceral and nerve injuries, soft tissue damage, spinal injury, limb reconstruction and limb loss. Who is it for?: Healthcare professionals Social care practitioners Commissioners and providers of rehabilitation services Members of the public who have experienced traumatic injury, their families and care

Association between type 2 diabetes and long-term outcomes in middle-aged and older trauma patients.

BACKGROUND: Diabetes is associated with increased hospital complications and mortality following trauma. However, there is limited research on the longer-term recovery of trauma patients with diabetes. The aim of this study was to explore the association between type 2 diabetes (T2D) and in-hospital and 24-month outcomes in major trauma patients. METHODS: In this cohort study using the Victorian State Trauma Registry, middle-aged and older adults (≥45 years) with major trauma were followed up at 24 months postinjury. Logistic regression (univariable and multivariable) analyses were used to determine the association between diabetes status and 24-month patient-reported outcomes. In-hospital outcomes were compared between groups using χ2 tests. RESULTS: Of the 11,490 participants who survived to hospital discharge, 8,493 survived to 24 months postinjury and were followed up at that time point: 953 people (11%) with and 7540 (89%) without T2D. People with T2D had a higher in-hospital death rate (19%) compared with people without T2D (16%; p < 0.001). After adjusting for confounders, people with T2D had poorer outcomes 24 months postinjury than people without T2D, with respect to functional recovery (Glasgow Outcome Scale Extended) (adjusted odds ratio [AOR], 0.58; 95% confidence interval [CI], 0.48-0.69) and return to work/study (AOR, 0.51; 95% CI, 0.37-0.71]). People with T2D experienced higher odds of problems with mobility (AOR, 1.92; 95% CI, 1.60-2.30), self-care (AOR, 1.94; 95% CI, 1.64, 2.29), usual activities (AOR, 1.50; 95% CI, 1.26-1.79), pain and discomfort (AOR, 1.75; 95% CI, 1.49-2.07), anxiety and depression (AOR, 1.45; 95% CI, 1.24, 1.70), and self-reported disability (AOR, 1.51; 95% CI, 1.28-1.79) than people without T2D. CONCLUSION: Major trauma patients with T2D have a poorer prognosis than patients without T2D, both during their hospital admission and 24 months postinjury. Patients with T2D may need additional health care and support following trauma to reach their recovery potential. LEVEL OF EVIDENCE: Prognostic, level III.

Association of the Affordable Care Act Medicaid Expansion with Trauma Outcomes and Access to Rehabilitation among Young Adults: Findings Overall, by Race and Ethnicity, and Community Income Level.

BACKGROUND: Low-income young adults disproportionately experience traumatic injury and poor trauma outcomes. This study aimed to evaluate the effects of the Affordable Care Act's Medicaid expansion, in its first 4 years, on trauma care and outcomes in young adults, overall and by race, ethnicity, and ZIP code-level median income. STUDY DESIGN: Statewide hospital discharge data from 5 states that did and 5 states that did not implement Medicaid expansion were used to perform difference-in-difference (DD) analyses. Changes in insurance coverage and outcomes from before (2011-2013) to after (2014-2017) Medicaid expansion and open enrollment were examined in trauma patients aged 19 to 44 years. RESULTS: Medicaid expansion was associated with a decrease in the percentage of uninsured patients (DD -16.5 percentage points; 95% CI, -17.1 to -15.9 percentage points). This decrease was larger among Black patients but smaller among Hispanic patients than White patients. It was also larger among patients from lower-income ZIP codes (p < 0.05 for all). Medicaid expansion was associated with an increase in discharge to inpatient rehabilitation (DD 0.6 percentage points; 95% CI, 0.2 to 0.9 percentage points). This increase was larger among patients from the lowest-compared with highest-income ZIP codes (p < 0.05). Medicaid expansion was not associated with changes in in-hospital mortality or readmission or return ED visit rates overall, but was associated with decreased in-hospital mortality among Black patients (DD -0.4 percentage points; 95% CI, -0.8 to -0.1 percentage points). CONCLUSIONS: The Affordable Care Act Medicaid expansion, in its first 4 years, increased insurance coverage and access to rehabilitation among young adult trauma patients. It also reduced the socioeconomic disparity in inpatient rehabilitation access and the disparity in in-hospital mortality between Black and White patients.

Species, causes, and outcomes of wildlife rehabilitation in New York State.

Wildlife rehabilitation is a publicly popular practice, though not without controversy. State wildlife agencies frequently debate the ecological impact of rehabilitation. By analyzing case records, we can clarify and quantify the causes for rehabilitation, species involved, and treatment outcomes. This data would aid regulatory agencies and rehabilitators in making informed decisions, as well as gaining insight into causes of species mortality. In New York State, the Department of Environmental Conservation (NYSDEC) has licensed rehabilitators since 1980 and annual reporting is required. In this study, we analyzed 58,185 individual wildlife cases that were attended by New York rehabilitators between 2012 and 2014. These encompassed 30,182 (51.9%) birds, 25,447 (43.7%) mammals, 2,421 (4.2%) reptiles, and 75 (0.1%) amphibians. We identified patterns among taxonomic representation, reasons for presentation to a rehabilitation center, and animal disposition. Major causes of presentation were trauma (n = 22,156; 38.1%) and orphaning (n = 21,679; 37.3%), with habitat loss (n = 3,937; 6.8%), infectious disease (n = 1,824; 3.1%), and poisoning or toxin exposure (n = 806; 1.4%) playing lesser roles. The overall release rate for animals receiving care was 50.2% while 45.3% died or were euthanized during the rehabilitation process. A relatively small number (0.3%) were permanently non-releasable and placed in captivity; 4.1% had unknown outcomes. A comparable evaluation in 1989 revealed that wildlife submissions have increased (annual mean 12,583 vs 19,395), and are accompanied by a significant improvement in release (50.2% in the study period vs 44.4% in 1989) (χ2(1) = 90.43, p < 0.0001). In this manuscript, we aim to describe the rehabilitator community in New York State, and present the causes and outcomes for rehabilitation over a three-year period.

Managing work disability to help patients return to the job.

Improving the timeliness and quality of your guidance on work disability lessens the impact of health problems on patients' lives and livelihoods.

Insult to injury: National analysis of return to work and financial outcomes of trauma patients.

BACKGROUND: While much of trauma care is rightly focused on improving inpatient survival, the ultimate goal of recovery is to help patients return to their daily lives after injury. Although the overwhelming majority of trauma patients in the United States survive to hospital discharge, little is known nationally regarding the postdischarge economic burden of injuries among trauma survivors. METHODS: We used the National Health Interview Survey from 2008 to 2017 to identify working-age trauma patients, aged 18 to 64 years, who sustained injuries requiring hospitalization. We used propensity score matching to identify noninjured respondents. Our primary outcome measure was postinjury return to work among trauma patients. Our secondary outcomes included measures of food insecurity, medical debt, accessibility and affordability of health care, and disability. RESULTS: A nationally weighted sample of 319,580 working-age trauma patients were identified. Of these patients, 51.7% were employed at the time of injury, and 58.9% of them had returned to work at the time of interview, at a median of 47 days postdischarge. Higher rates of returning to work were associated with shorter length of hospital stay, higher education level, and private health insurance. Injury was associated with food insecurity at an adjusted odds ratio (aOR) of 1.8 (95% confidence interval, 1.40-2.37), with difficulty affording health care at aOR of 1.6 (1.00-2.47), with medical debt at aOR of 2.6 (2.11-3.20), and with foregoing care due to cost at aOR of 2.0 (1.52-2.63). Working-age trauma patients had disability at an aOR of 17.6 (12.93-24.05). CONCLUSION: The postdischarge burden of injury among working-age US trauma survivors is profound-patients report significant limitations in employment, financial security, disability, and functional independence. A better understanding of the long-term impact of injury is necessary to design the interventions needed to optimize postinjury recovery so that trauma survivors can lead productive and fulfilling lives after injury. LEVEL OF EVIDENCE: Economic & Value-Based Evaluations, level II; Prognostic, level II.

Preinjury Functional Independence is not Associated with Discharge Location in Older Trauma Patients.

BACKGROUND: The purpose of this study was to evaluate the association between pre-injury Katz Index of Independence in Activities of Daily Living (Katz ADL) functional status and discharge to a facility in non-neurologically injured older trauma patients. METHODS: Data were obtained from 207 patients in the Trauma Medical Home study cohort. Multivariable logistic regression was performed to identify factors associated with non-home discharge. RESULTS: Average patient age was 67.9 (SD 11.1). Patients were predominantly white (89.4%) and female (52.2%) with a median ISS of 11 (IQR 9-14). The most common mechanism of injury was fall (48.3%), followed by motor vehicle crash (41.1%). Nearly all patients (94.7%) reported independence in activities of daily living prior to hospitalization for injury. Discharge disposition varied, 51.7% of patients were discharged home, 37.7% to subacute rehabilitation, 10.1% to acute rehabilitation and 0.5% to long-term acute care. There was no relationship between pre-injury independence and likelihood of discharge home (P = 0.1331). Age (P < 0.0001), BMI (P = 0.0002), Charlson comorbidity score of 3 or greater (P = 0.0187), being single (P = 0.0077), ISS ≥ 16 (P = 0.0075) and being female with self-reported symptoms of anxiety and/or depression over the past two weeks (P = 0.0092) were associated with significantly greater odds of non-home discharge. CONCLUSIONS: Pre-injury Katz ADL is not associated with discharge disposition, though other significantly associated factors were identified. It is imperative that discussions regarding discharge disposition are initiated early during acute hospitalization. Trauma programs could potentially benefit from implementing an inpatient intervention focused on building coping skills for older patients exhibiting symptoms of anxiety or depression.