Risultati per: Riabilitazione dopo un trauma traumatico

Le donne di mezza età a rischio maggiore aterosclerosi carotidea

Objectives
To estimate the level of anhedonia among adolescents and explore the association between anhedonia and childhood trauma (CT).

Design
A stratified random cluster sample of adolescents participated in a survey, which included three questionnaires: Snaith-Pamilton Pleasure Scale, Childhood Trauma Questionnaire and Patient Health Questionnaire-9.

Setting
The study was conducted in 60 classes in 10 primary, middle and high schools in five economically developed cities along the Southeast Coast of China from April to October 2022.

Participants
One thousand seven hundred and forty-five adolescents with ages ranging from 9 to 18 years participated in the study.

Primary and secondary outcomes
The primary outcome was the level of anhedonia, CT and depression among adolescents. The association between anhedonia and CT was determined.

Results
The mean scores of anhedonia, CT and depression were 24.88 (6.18), 36.75 (8.87) and 4.46 (5.36), respectively. Anhedonia scores of boys (24.24±6.12) and girls (25.62±6.16) were different (t=–4.69, p

All’Unità spinale del Cto di Torino, sensorialità da stimolare

Objectives
Using the ‘Four Delay’ framework, our study aimed to identify and explore barriers to accessing quality injury care from the injured patients’, caregivers’ and community leaders’ perspectives.

Design
A qualitative study assessing barriers to trauma care comprising 20 in-depth semistructured interviews and 4 focus group discussions was conducted. The data were analysed thematically.

Setting
This qualitative study was conducted in Rwanda’s rural Burera District, located in the Northern Province, and in Kigali City, the country’s urban capital, to capture both the rural and urban population’s experiences of being injured.

Participants
Purposively selected participants were individuals from urban and rural communities who had accessed injury care in the previous 6 months or cared for the injured people, and community leaders. Fifty-one participants, 13 females and 38 males ranging from 21 to 68 years of age participated in interviews and focus group discussions. Thirty-six (71%) were former trauma patients with a wide range of injuries including fractured long bones (9, 45%), other fractures, head injury, polytrauma (3, 15% each), abdominal trauma (1, 5%), and lacerations (1, 5%), while the rest were caregivers and community leaders.

Results
Multiple barriers were identified cutting across all levels of the ‘Four Delays’ framework, including barriers to seeking, reaching, receiving and remaining in care. Key barriers mentioned by participants in both interviews and focus group discussions were: lack of community health insurance, limited access to ambulances, insufficient number of trauma care specialists and a high volume of trauma patients. The rigid referral process and lack of decentralised rehabilitation services were also identified as significant barriers to accessing quality care for injured patients.

Conclusions
Future interventions to improve access to injury care in Rwanda must be informed by the identified barriers along the spectrum of care, from the point of injury to receipt of care and rehabilitation.

Introduction
Road trauma (RT) is a major public health problem that often results in prolonged absenteeism from work. Limited evidence suggests that recovery after RT is associated with automobile insurance compensation schemes. In May 2021, British Columbia, Canada switched from fault-based to no-fault auto-insurance coverage. This manuscript presents the protocol for a planned evaluation of that natural experiment: We will evaluate the impact of changing automobile insurance schemes on return to work following RT.

Methods and analysis
The evaluation will use a before–after design to analyse auto-insurance claims (1 April 2019 to 30 April 2024) in order to compare recovery of claimants with non-catastrophic injuries who filed claims under the no-fault insurance scheme to that of those who filed claims under the previous system. Claimants will be followed from date of injury until they return to work or have been followed for 6 months (right-censored). We will perform sensitivity analyses to examine the robustness of our findings. First, we will exclude injuries that occurred during the COVID-19 provincial State of Emergency. Second, we will use propensity score methods rather than conventional covariate adjustment to address potential imbalance between characteristics of claimants pre-change and post-change. Finally, as the implementation effect may have a heterogeneous association with time off work, we will use quantile regression with right-censoring at 6 months to model differences in return to work at the 25th, 50th, 75th and 90th percentiles.

Ethics and dissemination
The study uses de-identified data and is approved by the University of British Columbia Clinical Research Ethics Board (H20-03644). This research is funded by the Insurance Corporation of British Columbia (ICBC). Findings will be published in the peer-reviewed literature and summarised in a report prepared for ICBC. We anticipate that our findings will inform policy decisions in other jurisdictions considering switching to no-fault auto-insurance schemes.

To the Editor We have some concerns about the recent study that showed that early administration of 4-factor prothrombin complex concentrate (4F-PCC) had no significant benefit in reduction of 24-hour blood product consumption in patients with severe trauma who were at risk of massive transfusion.

To the Editor The PROCOAG trial showed that 4F-PCC administration did not reduce 24-hour blood product consumption in patients with trauma at risk of massive transfusion, in contrast with previous studies that revealed a benefit of 4F-PCC over fresh frozen plasma. We have concerns about this study.

In Reply We appreciate the Letters to the Editor about the PROCOAG trial. Regarding the comments by Dr Hsu and colleagues about the timing of administration of 4F-PCC, the design of our study stated without ambiguity that early corresponded to administration within the hour of admission to the resuscitation room. The per-protocol population analyzed patients within this time frame.

Annals of Internal Medicine, Ahead of Print.

Annals of Internal Medicine, Volume 176, Issue 9, Page 1163-1171, September 2023.

Objectives
To assess the feasibility, acceptability and the impact of an online parenting programme for forcibly displaced parents of adolescents.

Design
The study was a single-arm feasibility study using pre-intervention post-intervention and follow-up assessments.

Setting
Participants were recruited from municipality-based activities for refugee parents in a small city in the south of Sweden.

Participants
Participants were forcibly displaced parents (n=23; 47.8% maternal figures) of youth (n=23; 8–17 years old; 26.1% female) from Syria, Afghanistan and Somalia participating in an online parenting programme (eConnect).

Intervention
eConnect is an attachment-based and trauma-informed parenting intervention and was delivered over the course of 10 weekly sessions.

Primary and secondary outcome measures
Feasibility was assessed by programme enrolment, attendance, completion and acceptability of the online platform and cultural fit of the programme. Primary outcome measures were programme impact on youth mental health problems. Secondary outcome measures were programme impact on family functioning and parent–child attachment insecurity.

Results
The eConnect programme was highly feasible in terms of overall enrolment (100%), attendance (89.6%) and retention rates (100%). The online platform was acceptable, with mixed feedback primarily related to the access and usage of technology. Cultural fit of the programme was acceptable. Youth mental health problems (2=0.29) and family functioning significantly improved (2=0.18) over the course of the programme. Unexpectedly, parent reports of youth attachment insecurity significantly worsened (2=0.16).

Conclusions
The findings suggest that the online delivery of Connect was a promising way to reduce barriers to service access and improve mental health problems and family functioning among forcibly displaced parents and their children during COVID-19. Future research is needed to explore the acceptability and impact of this programme post-COVID-19, and to develop culturally tailored and psychometrically sound measures for parent and youth reports of attachment.

Introduction
Our previous research has demonstrated significant cognitive effects of earthquake exposure 2–3 years following the Canterbury earthquake sequence of 2011. Such impairment has major implications for a population trying to recover, and to rebuild, a devastated city. This study aims to examine psychological, cognitive and biological factors that may contribute to subjective cognitive difficulties in a large group of individuals exposed to the Canterbury earthquake sequence.

Methods and analysis
Two-hundred earthquake-exposed participants from an existing large cohort study (Christchurch Health and Development Study, CHDS) will be recruited. Inclusion is based on results of online screening of the CHDS cohort, using the Cognitive Failures Questionnaire. Individuals scoring the highest (n=100) and lowest (n=100), representing the highest and lowest levels of subjective cognitive impairment, are selected. Exclusions are: psychotic/bipolar disorders, serious substance/alcohol dependence, chronic medical conditions, pregnancy and previous serious head injury. Participants will undergo a half-day assessment including clinician-rated interviews, self-report measures, objective and subjective cognitive assessments, blood sample collection and physical measurements. The primary analysis will compare cognitive, psychological and biological measures in ‘high’ and ‘low’ subjective cognitive impairment groups. The study will have power (p

Objectives
Foster children are disproportionately exposed to complex trauma, which may lead to multifaceted impairments that manifest in comorbid emotional and behavioural problems. As little is known about the interactions between comorbid disorders over time, the present study aims to explore the co-development of traumatic stress (TS) symptoms and externalising behaviour problems (EBP), as well as the influence of complex trauma operationalised as cumulative child maltreatment (CM).

Setting
As part of a 3-year longitudinal study, children from six foster care facilities in Lower Austria were interviewed at three measurement points.

Participants
Of, in total, 263 participating children, the data of 124 children aged 10–18 years (M=13.5, 28% female) could be analysed.

Primary and secondary outcome measures
Latent growth curve models were used to examine the co-development of TS symptoms (International Trauma Questionnaire) and EBP (Child Behaviour Checklist) over time; gender, age and cumulative CM (Childhood Trauma Questionnaire) acted as time-invariant covariates.

Results
While average TS symptoms decreased over time, EBP remained stable. Findings revealed that the initial severity of EBP was both related to the initial severity of TS symptoms and predictive of their rate of change. Cumulative CM was a significant predictor of initial TS symptoms and EBP even after controlling for age and gender, but not for the rates of change.

Conclusions
Taken together, our results indicate that EBP and TS symptoms are not only cross-sectionally associated but interact with each other over time. Furthermore, an underlying complex trauma could at least partly determine the severity of the two symptom groups. In accordance with a trauma-informed care approach, our study highlights the importance of trauma-specific screening of high-risk children with complex or diffuse symptoms and argues for the benefits of treatments that focus on improving emotion regulation and social skills in addition to addressing trauma.

Al via una sperimentazione all’Irccs Santa Lucia

Operazione eseguita nell’Azienda Dulbecco di Catanzaro