Acute Physical Injury Research Articles

The Intersection of Intimate Partner Violence, Strangulation, and Brain Injury Screening: A Pilot Project.

Survivors of intimate partner violence are at a high risk for having a brain injury because of high rates of strangulation and head and face injuries sustained from physical abuse. In addition to acute physical injuries, survivors experience various health complications. Many survivors do not seek medical attention for their injuries, and when they do, their brain injury often goes unrecognized and untreated. Research indicates that screening for brain injury can be an effective intervention to increase the identification of brain injuries and medical referrals for diagnosis and treatment. Unfortunately, brain injury screening is not a standard of care. Shelter-seeking clients were routinely screened for brain injury using a modified HELPS screening tool. A positive screen prompted a medical referral. A modified HELPS screening tool was utilized with permission for the project. Before implementation, 36 individuals entered shelter, 0 were screened for brain injury, and the medical referral rate was 19.4% (n = 7). After implementation, 40 clients entered shelter, 36 were screened for brain injury, 77.8% (n = 28) screened positive, and the medical referral rate was 80.6% (n = 29). Brain injury screening may be an effective evidence-based intervention for shelter-seeking survivors of intimate partner violence to increase medical referrals.

The causes, diagnostics, and treatment of psychogenic blindness – a systematic review

Introduction: Conversion disorders are characterized by the presence of motor or sensory dysfunction, resulting in significant discomfort or disability, the occurrence of which is not justified by any somatic disease. Psychogenic blindness, a specific manifestation of conversion disorders, refers to the loss or impairment of vision that cannot be attributed to any organic abnormalities in the eyes or visual system. The exact mechanisms underlying psychogenic blindness are not fully understood, but it is believed to involve complex interactions between the brain, visual pathways, and psychological processes. This systematic review aims to summarize reported cases of blindness in conversion disorders. Material and methods: A comprehensive search of the MEDLINE and Embase databases identified 13 relevant articles reporting a total of 17 patients with psychogenic blindness. Results: The risk and triggering factors for psychogenic blindness included acute stress (for example acute physical injury), chronic stressful situations (such as chronic health problems, disruptions in family relationships), and multiple factors including coexisting psychiatric conditions (like anxiety or other conversion disorders). The course of blindness varied among patients, with duration ranging from hours to years. Diagnostic methods involved thorough ophthalmic and neurological examinations, brain imaging, and psychiatric evaluations. Conclusions: This review provides valuable insights into managing patients with psychogenic blindness. The findings highlight the need for a multidisciplinary approach involving ophthalmologists, neurologists, and mental health specialists. Further research is required to elucidate the underlying mechanisms and develop effective treatment strategies for individuals with psychogenic blindness. Keywords: psychogenic blindness, conversion disorders, causes

Freedom of Religious Beliefs and Protection of Cultural Heritage: A Comparative Study between Four EU Member States and Recommendations for Training, Education and Awareness Raising

Terrorist attacks and religious hate crimes have escalated in recent years, putting places of worship in greater danger around the world, especially in Europe. Short- and long-term consequences of such attacks, according to the European Commission, include acute physical injuries to people and/or irreparable destruction to highly significant religious artefacts, as well as long-term psychological traumas and increased terror in society. Despite EU and worldwide efforts to defend places of worship, there remains a scarcity of information on the reasons of such assaults and how to prevent them in the future. This paper shares original desk and field research conducted with law enforcement agents, religious leaders, and members of religious communities regarding the social ecosystem analysis of protecting religious heritage in the four partner countries as part of the PROSECUW Project, which is co-funded by the EU (Cyprus, Greece, Germany, and Portugal). Despite the multiplicity of situations, research findings point to a common need for better communication and understanding among members of various religious communities, as well as further training and education for acceptance of diversity, as crucial tools for religious site protection. The paper concludes with key security and protection recommendations for places of worship, including the adoption of novel approaches and instruments to both strengthen security and protect religious heritage.

Calcium homeostasis disruption initiates rapid growth after micro-fragmentation in the scleractinian coral Porites lobata.

Coral reefs are ecosystems under increasing threat from global climate change. Coral restoration is a tool for preserving the biological and ecological function of coral reefs by mitigating coral loss and maintaining the structural integrity and complexity of reefs. To generate the necessary stock for coral restoration, larger coral colonies are usually fragmented to generate smaller specimens for outplanting, taking advantage of the high regenerative ability of corals. In this study, we utilized RNA‐seq technology to understand the physiological responses of Porites lobata colonies to physical fragmentation and outplanting, which have thus far not been characterized. Our results demonstrate that P. lobata fragments undergoing physical injury recover through two distinct phases: rapid wound regeneration of the cut margins, followed by a slower growth phase that cements the colony to the substrate. Our study found rapid physiological responses to acute physical injury and outplanting in the coral host that involved significantly increased energy production, calcium homeostasis disruption, and endoplasmic reticulum (ER) stress leading to increased antioxidant expression and rates of protein turnover. Our results suggest that phosphoinositide‐mediated acute calcium homeostasis disruption stimulates wound recovery processes in response to physical injury. Symbiont gene expression revealed extremely low gene differences in response to fragmentation, growth, and outplanting. These results provide insight into the physiological mechanisms that allow for rapid wound healing and stabilization in response to physical injury in corals.

Long-term Outcomes of Firearm Injury Survivors in the United States: The National Trauma Research Action Plan Scoping Review.

To describe the current literature regarding long-term physical, mental, and social outcomes of firearm injury survivors in the United States. We systematically searched the PubMed/MEDLINE and Embase databases for articles published from 2013 to 2019 that involved survivors of acute physical traumatic injury aged 18 or older and reported health outcomes between 6 months and 10 years postinjury. Out of 747 articles identified, seven reported outcomes on United States-based civilian patients whose mechanism of injury involved firearms. We extended our publication date criteria from 1995 to 2020 and expanded the search strategy to include medical subject headings terms specific for firearm injury outcomes. Ultimately, ten articles met inclusion criteria. When studied, a significant proportion of patients surviving firearm injury screened positive for posttraumatic stress disorder (49%-60%) or were readmitted (13%-26%) within 6 months postinjury. Most studies reported worse long-term outcomes for firearm injury survivors when compared both to similarly injured motor vehicle collision survivors and to the United States general population, including increased chronic pain, new functional limitations, and reduced physical health composite scores. Studies also reported high rates of posttraumatic stress disorder, reduced mental health composite scores, lower employment and return to work rates, poor social functioning, increased alcohol, and substance abuse. Research on the long-term health impact of firearm injury is scant, and heterogeneity in available studies limits the ability to fully characterize the outcomes among these patients. A better understanding of the long-term health impact of firearm injury would support systematic change in policy and patient care to improve outcomes.

In‐Water Bridge Construction Effects on Manatees with Implications for Marine Megafauna Species

ABSTRACTGlobally, increasing coastal development requires construction and maintenance of transportation infrastructure that affects terrestrial and aquatic ecosystems. Construction of bridges as part of transportation networks introduces a series of risks to aquatic species near construction zones. We reviewed relevant literature and obtained exemplary case studies to synthesize potential effects of bridge construction on the West Indian manatee (Trichechus manatus), a nearshore megafauna species vulnerable to human activities. Stages of bridge construction including dredging, pile driving, and installation and assembly of bridge components each involve potential direct and indirect effects on manatees. Direct effects such as vessel interactions, entanglement or ingestion, and entrainment may result in acute physical injury or mortality. Indirect effects from construction such as habitat obstruction or degradation and increased noise from construction activities can alter behavior and intraspecies communication and reduce access to essential resources. Some effects of construction may be immediately difficult to quantify, but cumulative effects through time can result in major habitat and species loss. To prevent large‐scale negative effects of construction on manatees and other aquatic species, use and evaluation of mitigation strategies should be implemented pre‐, during, and post‐construction. As the global human population increasingly occupies coastal zones, effective planning of coastal development, including bridge and other in‐water construction, will be essential to support conservation and recovery efforts for manatees and other species at risk in these areas. © 2021 The Wildlife Society.

Long-term patient-reported outcomes and patient-reported outcome measures after injury: the National Trauma Research Action Plan (NTRAP) scoping review.

The aim of this scoping review is to identify and summarize patient-reported outcome measures (PROMs) that are being used to track long-term patient-reported outcomes (PROs) after injury and can potentially be included in trauma registries. Online databases were used to identify studies published between 2013 and 2019, from which we selected 747 articles that involved survivors of acute physical traumatic injury aged 18 years or older at time of injury and used PROMs to evaluate recovery between 6 months and 10 years postinjury. Data were extracted and summarized using descriptive statistics and a narrative synthesis of the results. Most studies were observational, with relatively small sample sizes, and predominantly on traumatic brain injury or orthopedic patients. The number of PROs assessed per study varied from one to 12, for a total of 2052 PROs extracted, yielding 74 unique constructs (physical health, 25 [34%]; mental health, 27 [37%]; social health, 12 [16%]; cognitive health, 7 [10%]; and quality of life, 3 [4%]). These 74 constructs were assessed using 355 different PROMs. Mental health was the most frequently examined outcome domain followed by physical health. Health-related quality of life, which appeared in more than half of the studies (n = 401), was the most common PRO evaluated, followed by depressive symptoms. Physical health was the domain with the highest number of PROMs used (n = 157), and lower-extremity functionality was the PRO that contributed most PROMs (n = 33). We identified a wide variety of PROMs available to track long-term PROs after injury in five different health domains: physical, mental, social, cognitive, and quality of life. However, efforts to fully understand the health outcomes of trauma patients remain inconsistent and insufficient. Defining PROs that should be prioritized and standardizing the PROMs to measure them will facilitate the incorporation of long-term outcomes in national registries to improve research and quality of care. Systematic Reviews & Meta-analyses, Level IV.

Cannabis-related emergencies in children and teens.

To examine the spectrum of emergency department presentations associated with cannabis use or misuse that are currently seen in the pediatric population. There is a growing concern that pediatric emergency department visits related to cannabis are on the rise, especially given rapidly changing legislation on cannabis and its broad availability in certain areas. These concerns are substantiated in the current literature, as the evidence mounts for an array of emergency department presentations of intentional or accidental cannabis use. The range of presentations documented in the recent literature spans gastrointestinal, psychiatric and cardiorespiratory effects, in addition to traumatic injuries and accidental ingestions by younger children. Complications of chronic cannabis use, such as 'cannabis hyperemesis syndrome', depression, psychosis or cognitive impairment, are now recognized outcomes and even more are likely to emerge. An array of cannabis-related symptoms is possible from acute use or exposure. Common presentations include acute intoxication, hyperemesis, depression and acute physical injuries from impaired psychomotor function. Uncommon presentations include cardiorespiratory effects, and a range of symptoms in young children that include hyperkinesis and coma. Clinical vigilance is needed to suspect and clinically diagnose cannabis exposure in the emergency department.

Eye injury and demographic parameters associated with poor visual outcome

Eye injuries can result in long-term disability, and healthcare providers need better tools to predict outcomes. Few prognostic models for poor visual acuity have been examined using variables usually present in very severe injuries, which creates a gap in prognosis. Therefore, a model associated with severe and less severe injuries is examined. Eye injuries hospitalized in Bosnia and Herzegovina from 2006 through 2014 were included. A total of 258 eye injuries met the inclusion criteria of being an acute mechanical, chemical or physical eye injury. Prognostic variables were grouped by patient characteristics, eye injury characteristics and eye injury diagnosis. Poor final visual acuity was the main outcome measure (vision less than 20/200). Multivariable regression analysis used stepwise selection to identify the strongest set of predictive variables. Lens subluxation (95% CI: 2.09-14.83), vitreous prolapse (95% CI: 2.76-26.87), vitreous hemorrhage (95% CI: 1.71-10.03), posterior segment intraocular foreign body (95% CI: 1.19-39.09), and vitritis (95% CI: 0.97-11.12) were significantly associated with poor final visual acuity. The predictive model identified the combination of age over 36, lens subluxation, vitreous prolapse and hemorrhage, vitritis, and macular hemorrhage as the combination most likely to have poor visual acuity. The final model resulted in a strong fit as measured by AIC, log likelihood, goodness-of-fit, and the c-statistic. This model can be used in clinical practice to evaluate the severity and predict final visual acuity in both severe and less severe eye injuries. The model accounts for characteristics of the injury as well as the patient. Additional studies with larger samples could further verify this model.

The Future of Disaster Medicine is Based on Primary Care Involvement

Introduction:When disasters happen, people experience broad environmental, physical, and psychosocial effects that can last for years. Researchers continue to focus on the acute physical injuries and aspects of patient care without considering the person as a whole. People who experience disasters also experience acute injury, exacerbations of chronic disease, mental and physical health effects, effects on social determinants of health, disruption to usual preventative care, and local community ripple effects. Researchers tend to look at these aspects of care separately, yet an individual can experience them all at once. The focus needs to change to address all the healthcare needs of an individual, rather than the likely needs of groups. Mental and physical care should not be separated, nor the determinants of health. The person, not the population, should be at the center of care. Primary care, poorly integrated into disaster management, can provide that focus with a "business as usual" mindset. This requires comprehensive, holistic coordination of care for people and families in the context of their local community.Aim:To examine how Family Doctors (FDs) actually contribute to disaster response.Methods:Thirty-seven disaster-experienced FDs were interviewed about how they contributed to response and recovery when disasters struck their communities.Results:FDs reported being guided by the usual evidence-based care characteristics of primary practice. The majority provided holistic comprehensive medical care and did not feel they needed many extra clinical training or skills. However, they did wish to understand the systems of disaster management, where they fit in, and their link to the broader disaster response.Discussion:The contribution of FDs to healthcare systems brings strengths of preventative care, early intervention, and ongoing local surveillance by a central, coordinating, and trusted health professional. There is no reason to not include disaster management in primary care.

Sleep and women intimate partner victimization: prevalence, effects and good practices in health care settings.

Intimate Partner Violence is a global health issue with higher prevalence worldwide, mostly in women, higher social and economic costs and devastating physical and mental health consequences for the victims. Sleep disturbances has been associated with other mental health issues, being an important symptom when diagnosing post-traumatic stress disorder, depression or anxiety. It can also constitute an important sign to help health professionals to identify potential victims of intimate partner violence. This review paper main objectives are to address the connection between intimate partner violence and sleep disruption, the role and barriers of health professionals in screening this type of violence when sleep problems are present, and to describe good practices in order to identify these victims and to provide support. It has been found that intimate partner victims commonly experience significant sleep disturbances that include truncated sleep, nightmares and less restful sleep. Health professionals are first-line professionals with a pivot role to screen and identify women victims. However, a set of personal (e.g., lack of knowledge and inadequate perceptions about violence, cultural issues) and organizational barriers (e.g., time constraints, lack of training, absence of institutional protocols) may limit the accurate reading of those symptoms. Accordingly, health professionals must be alert not only to physical health conditions associated with violence (acute physical injuries, chronic physical injuries, obstetric and genital injuries), but also psychological problems, like depression, anxiety, post-traumatic stress disorder, alcohol or drug misuse, sleep disturbances, insomnia and nightmares. In the presence of alert symptoms related to violence, health professionals become able to screen, identify and provide ongoing care for women, promoting a trusting relationship and assuming an attentive non-judgmental listening.

Tendon developmental plasticity and functional regeneration

Tendons enable movement by transferring force from muscle to bone. They are comprised of a highly organized collagen‐rich extracellular matrix. Disruption to the development and maintenance of tendons can lead to birth defects and result in injury in adults. We currently have an incomplete understanding of how tendons interact with their neighboring tissues to regulate the development and morphogenesis of the musculoskeletal system. In addition, once mature mammalian tendon tissue is formed, it has limited regenerative potential after injury. Central to this challenge is to uncover new mechanisms underlying tendon cell regulation during musculoskeletal development and regeneration. To accomplish this, we have turned to the zebrafish system because it is highly regenerative and amenable to genetic manipulations and live imaging. We have previously demonstrated that zebrafish tendons have molecular, developmental, morphological and biomechanical similarities to mammalian tendons, thereby making them an excellent vertebrate model to study tendon biology. However, no study has investigated their capacity to regenerate their tendons. Using the zebrafish, we developed methods to perform genetic tendon cell ablation, lineage tracing, live imaging, and mechanical testing to determine if developing and adult zebrafish can regenerate their tendon tissues. Following tendon cell ablation in developing zebrafish embryos, we observe defects in tendon gene expression and ECM composition. Cartilage and muscle tissue morphology was also disrupted following tendon cell loss. Tendon cells and the collagen organization returned after 1–2 weeks and 1–2 months, respectively. Interestingly, the pattern of the attachment sites was also restored, indicating the presence of regulatory programs that recruit and/or promote tendon cell proliferation and differentiation at the previous attachment sites. We are currently focused on identifying the developmental origins of the regenerating tendon cells and the pathways restoring the attachment site pattern. In addition to embryonic tendon regeneration, we also found that adult zebrafish appear to regenerate their collagen organization and mechanical properties after an acute physical injury. Together, our work demonstrates robust tendon regeneration at embryonic and adult stages in the zebrafish. These studies also provide a system to examine the morphogenetic and molecular events underlying tendon regeneration and musculoskeletal tissue‐tissue interactions, which has significance for regenerative biology approaches to musculoskeletal injuries.Support or Funding InformationNICHD HD06953, NIDCR DE024771, Charles H. Hood Foundation, HSCI Seed GrantThis abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Work-related acute physical injuries, chronic overuse complaints, and the psychosocial work environment in Danish primary care chiropractic practice \u2013 a cross-sectional study

BackgroundLittle is known about the physical and psychosocial work environment of chiropractors and their work-related health complaints, and this has never been described for Danish chiropractors. The aim of this study was, therefore, to describe work-related acute physical injuries, overuse complaints, and psychosocial stress in Danish chiropractic work settings.MethodsWe developed a questionnaire specifically for this study and distributed it electronically in August 2016 using SurveyXact to all 575 members of the Danish Chiropractors’ Association working in primary care clinics. Chiropractors were asked about their work-related acute physical injuries and overuse complaints as well as any psychosocial stress they experienced at work during the previous year. We described our sample and variables using means, medians, ranges, and confidence intervals where appropriate. Statistically significant differences between genders, types of complaints and injuries, and between clinic owners and associates were examined using Chi-square and Fischer’s exact tests, where appropriate, or by examining confidence intervals for non-overlap.Results355 (65.2%) chiropractors answered the survey. Of these, 216 (61%, 95% CI 56–66) had experienced a work-related acute physical injury and/or overuse complaint during the previous year. Work-related overuse complaints were most commonly reported in the low back, wrist, thumb, and shoulder, and were more common among women (63%, 95% CI 56–70) than men (51%, 95% CI 43–59). Chiropractors with more than five years in practice (59%, 95% CI 52–64) reported significantly fewer work-related acute injuries and overuse complaints during the previous year compared with chiropractors with less than five years in practice (83%, 95% CI 73–91). In general, these practicing Danish chiropractors reported having a good psychosocial work environment, and 90% of chiropractors “always” or “often” felt that they were motivated and committed to their work.ConclusionThis sample of Danish practicing chiropractors commonly reported work-related acute physical injuries or overuse complaints. Overuse complaints were most commonly reported in the low back, wrist, thumb, and shoulder and were more common among women than men. Newly educated chiropractors reported more overuse complaints than experienced chiropractors. Collectively, this sample of Danish chiropractors reported that they had a good psychosocial work environment.

Inconsistencies in the Reporting of Perceived Trauma Severity Among Acute Physical Injury Survivors

ABSTRACTThis study aimed to identify and predict inconsistency in perceived trauma severity reports over time among trauma survivors. Hospitalized adult survivors of a traumatic injury completed trauma exposure assessments within 40 days post-injury and 6 weeks later (n = 77). The following trauma severity characteristics were examined: (1) threat of loss of life, (2) threat of loss of a body part, (3) threat of serious injury, and (4) peritraumatic emotionality. Potential predictors of inconsistency were also examined. About half of the reports regarding perceived trauma severity characteristics were inconsistent between the baseline to 6-week assessment. The inconsistent reports were mostly small and equally likely to be either more or less severe over time. Increases in posttraumatic stress disorder (PTSD; especially avoidance) predicted increases in severity of life threat and threat of loss of a body part. Thus, acute reports of perceived trauma severity vary and are influenced by PTSD symptoms.

Mining Electronic Health Records Data: Domestic Violence and Adverse Health Effects.

Intimate partner violence (IPV) often culminates in acute physical injury, sexual assault, and mental health issues. It is crucial to understand the healthcare habits of victims to develop interventions that can drastically improve a victim's quality of life and prevent future abuse. The objective of this study is to mine de-identified and aggregated Electronic Health Record data to identify women's health issues that are potentially associated with IPV. In this study we compared health issues of female domestic abuse victims to female non-domestic abuse victims. The Domestic abuse population contained 5870 patients, while the Non-Domestic Abuse population contained 14,315,140 patients. Explorys provides National Big Data from the entire USA. Statistical analysis identified 2429 terms as significantly more prevalent among victims of domestic abuse, compared to the general population. These terms were classified into broad categories, including acute injury, chronic conditions, substance abuse, mental health, disorders, gynecological and pregnancy related problems.

Dead quiet in the hinterlands: the construction of workplace injuries in western Canadian newspapers, 2009–2014

ABSTRACTMedia reports profoundly misrepresent the nature of workplace injuries and fatalities in Canada. This study uses a new dataset comprising 409 urban and rural newspaper reports in western Canada to confirm the over-representation of fatalities, injuries to men, acute physical injuries, and injuries in blue-collar occupations found in earlier exploratory work. This misleading social construction of injuries may skew public policy and management decision-making about injury prevention. The study also confirms the existence of three key media frames: injuries are “under investigation,” “human tragedies,” and “before the court.” Together, these frames cast workplace injuries as isolated events that happen to “others” for which no one is responsible (except maybe the worker), thereby suggesting that the public need not be concerned about workplace safety. Contrary to expectations, no significant differences were found between the reporting of urban and rural newspapers.

If it bleeds, it leads: the construction of workplace injury in Canadian newspapers, 2009-2014.

Public perceptions of workplace injuries are shaped by media reports, but the accuracy of such reports is unknown. This study identifies differences between workers' compensation claims data and newspaper reports of workplace injuries in Canadian newspapers and media sources. This study applies quantitative content analysis to 245 Canadian English-language newspaper articles from 2009 to 2014. Workers' compensation claims data is drawn from the Association of Workers' Compensation Boards of Canada. Newspapers dramatically overreport fatalities, injuries to men, injuries in the construction and mining/quarrying/oil industries, injuries stemming from contact with objects/equipment and fires/explosions, and acute physical injuries such as burns, fractures, intracranial injuries, and traumatic injuries. Newspaper reporters tend to rely upon government, police/firefighter, and employer accounts, rarely recounting the perspectives of workers. Newspapers overreported fatalities, injuries to men, and injuries in the construction and mining/quarrying/oil industries. This results in a misleading picture of occupational injuries in Canada.

What Caused the UK's Largest Common Dolphin (Delphinus delphis) Mass Stranding Event?

On 9 June 2008, the UK's largest mass stranding event (MSE) of short-beaked common dolphins (Delphinus delphis) occurred in Falmouth Bay, Cornwall. At least 26 dolphins died, and a similar number was refloated/herded back to sea. On necropsy, all dolphins were in good nutritive status with empty stomachs and no evidence of known infectious disease or acute physical injury. Auditory tissues were grossly normal (26/26) but had microscopic haemorrhages (5/5) and mild otitis media (1/5) in the freshest cases. Five lactating adult dolphins, one immature male, and one immature female tested were free of harmful algal toxins and had low chemical pollutant levels. Pathological evidence of mud/seawater inhalation (11/26), local tide cycle, and the relative lack of renal myoglobinuria (26/26) suggested MSE onset on a rising tide between 06∶30 and 08∶21 hrs (9 June). Potential causes excluded or considered highly unlikely included infectious disease, gas/fat embolism, boat strike, by-catch, predator attack, foraging unusually close to shore, chemical or algal toxin exposure, abnormal weather/climatic conditions, and high-intensity acoustic inputs from seismic airgun arrays or natural sources (e.g., earthquakes). International naval exercises did occur in close proximity to the MSE with the most intense part of the exercises (including mid-frequency sonars) occurring four days before the MSE and resuming with helicopter exercises on the morning of the MSE. The MSE may therefore have been a “two-stage process” where a group of normally pelagic dolphins entered Falmouth Bay and, after 3–4 days in/around the Bay, a second acoustic/disturbance event occurred causing them to strand en masse. This spatial and temporal association with the MSE, previous associations between naval activities and cetacean MSEs, and an absence of other identifiable factors known to cause cetacean MSEs, indicates naval activity to be the most probable cause of the Falmouth Bay MSE.

A longitudinal study on cardiac effects of deconditioning and physical reconditioning using the anterior cruciate ligament injury as a model

Studies of cardiovascular deconditioning are primarily carried out after experimental bed rest. No previous study has followed the cardiovascular effects of decreased and resumed physical activity in athletes after acute physical injury and convalescence. Anterior cruciate ligament (ACL) injury causes a significantly decreased activity level over a long period, making it an ideal model for studying effects of deconditioning and reconditioning. Therefore, the aim of this study was to investigate how cardiac dimensions and maximal exercise capacity change after an ACL-injury. Seventeen athletes (5 women) were included. Cardiac magnetic resonance (CMR) was performed within 5days of the injury (CMR1), before endurance training was resumed (CMR2) and 6months after the second scan (CMR3). Maximal exercise testing was performed on the same day as CMR2 and 3. The deconditioning phase between CMR1 and CMR2 was 59±28days. Total heart volume (THV) decreased with -3·1±6·7%, P=0·056. Between CMR2 and 3 (reconditioning), THV increased significantly (2·5±4·6%, P<0·05). Left and right ventricular EDV decreased during deconditioning (-3·0±5·6% and -4·7±6·6%) and increased during reconditioning (1·7±3·9% and 2·6±6·2%) however not statistically significant. Left ventricular mass (LVM) remained unchanged. VO2 peak (mlmin(-1) kg(-1) ) increased significantly during the reconditioning phase (6·1±5·3%, P<0·001). Physiological cardiac adaptation to deconditioning and reconditioning caused by severe knee injury with maintained normal daily living during convalescence was smaller than previously shown in bed rest studies. Total heart volume and VO2 peak were significantly affected by reconditioning whilst LVEDV, RVEDV and LVM remained unchanged over the study period.

Psychological distress after physical injury: A one-year follow-up study of conscious hospitalised patients

BackgroundAcute physical injury may lead to psychological distress. The relationship between peritraumatic responses, injury severity, the personality trait of optimism/pessimism and psychological distress is not fully understood. In addition, the development of post-traumatic stress symptoms may differ in subgroups. MethodsOne hundred and eighty-one patients (18–65years) completed questionnaires 1 (baseline), 3 and 12months after first admission for acute physical injury. All patients were conscious on arrival. Scores on the Casualty Chain Inventory (CCI) for peritraumatic responses, the Impact of Event Scale (IES), the Hospital Anxiety and Depression Scale (HADS), the Life Orientation Test-Revised (LOT-R), trauma-related variables (ISS, Abbreviated Injury Scale [AIS], Glasgow Coma Scale [GCS]), and background variables were assessed. ResultsMean IES scores were 21.5 (95% CI: 19.0–24.0) at baseline and 15.8 (13.5–18.1) at 12months (p<0.001). One subgroup (delayed onset, 12.2%) had an increase of at least 10 points in the IES score and another subgroup (chronic, 13.3%) had high and persistent post-traumatic stress symptoms during the follow-up period. At baseline, 45.3% had an IES score≥20, indicating possible clinical case levels, compared with 33.1% at 12months. Accordingly, 14% had anxiety symptoms and 10.8% had depression symptoms at a case level (HADS≥8) at one-year follow-up. Mutually independent predictors of post-traumatic stress symptoms at 12months were dissociation (OR 1.3, 95% CI: 1.1–1.6) and perception (OR 1.1, 95% CI: 1.0–1.3) measured by the CCI. Being in work before injury (OR 0.1, 95% CI: 0.02–0.4) and higher educational level (OR 0.3, 95% CI: 0.1–0.7) were associated with fewer IES symptoms. Dissociation and having a pessimistic trait predicted anxiety and depression at 12months. Previous psychiatric problems predicted anxiety symptoms, and high educational level predicted less depression symptoms. ConclusionOne-third of conscious physical injured patients had post-traumatic stress symptoms at a possible clinical case level one year after the traumatic event, and one-third of these had delayed onset. Symptoms of peritraumatic dissociation and perception were mutually independent predictors of psychological distress.