Traumatic Events Research Articles

Extracorporeal pediatric renal replacement therapy: diversifying application beyond kidney failure.

The utilization of extracorporeal renal replacement therapy (RRT), including continuous renal replacement therapy (CRRT) and hemodialysis (HD), beyond the treatment of volume overload and acute kidney injury (AKI) has witnessed a significant shift, demonstrating the potential to improve patient outcomes for a range of diseases. This comprehensive review explores the non-kidney applications for RRT platforms in critically ill children, focusing on diverse clinical scenarios such as sepsis, inborn errors of metabolism, liver failure, drug overdose, tumor lysis syndrome, and rhabdomyolysis. In the context of sepsis and septic shock, RRT not only facilitates fluid, electrolyte, and acid/base homeostasis, but may offer benefits in cytokine regulation, endotoxin clearance, and immunomodulation which may improve multi-organ dysfunction as well as hemodynamic challenges posed by this life-threatening condition. RRT modalities also have an important role in caring for children with inborn errors of metabolism, liver failure, and tumor lysis syndrome as they can control metabolic derangements with the efficient clearance of endogenous toxins in affected children. In cases of drug overdose, RRT is a crucial tool for rapid extracorporeal clearance of exogenous toxins, mitigating potential organ damage. The intricate interplay between liver failure and kidney function is examined, elucidating the role of RRT and plasma exchange in maintaining fluid and electrolyte balance when hepatic dysfunction complicates the clinical picture. Furthermore, RRT and HD are explored in the context of rhabdomyolysis, highlighting their utility in addressing AKI secondary to traumatic events and crush syndrome.

Effects of acceptance and commitment therapy on trauma-related symptoms: A systematic review and meta-analysis.

Acceptance and commitment therapy (ACT) is a third-wave cognitive behavioral therapy that has shown promise as an effective treatment for reducing trauma-related symptoms. Although there have been systematic reviews on the clinical effectiveness of ACT for posttraumatic stress disorder, there are no known meta-analyses published on the impact of ACT in adult populations with trauma-related symptoms. Hence, the purpose of this meta-analysis and systematic review was to update the literature and assess the effectiveness of ACT interventions for decreasing trauma-related distress in adults who have developed trauma symptoms following exposure to one or more traumatic events. A systematic review of the literature was completed, and between-groups random effects meta-analysis was conducted assessing trauma symptom reduction at the initial posttest. Subgroup analyses were also performed to assess differences between groups based on research design, type of trauma, and comparator group. A meta-analysis of 11 studies revealed a moderate and statistically significant overall effect of ACT on symptom reduction at immediate posttest (Hedges' g = -.423, 95% CI [-.605, -.240]; I² = 25.75%), indicating that on average, those who received ACT interventions reported fewer trauma symptoms postintervention than those in various comparison groups. Ultimately, this research provides additional evidence supporting the effectiveness of ACT interventions for clients reporting trauma-related concerns. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

HUBUNGAN STRES DENGAN KEJADIAN HIPERTENSI PADA PEKERJA MITIGASI PEMADAM KEBAKARAN DI KOTA BATAM

Background: Hypertension is a condition where the blood vessels experience a continuous increase, while diastolic blood pressure is the blood pressure when the heart relaxes. This hypertension can be influenced by several factors, especially stress. Stress is a state or condition that arises due to the inability of a person experiencing stress to deal with stressors including circumstances and biological, psychological and social resources. One job that can be at risk of hypertension due to work stress is firefighting, because this job involves repeated exposure to traumatic events that can cause psychological problems. Method: This research uses quantitative methods through a cross sectional approach. This research was conducted at Batam University in December-January 2023/2024. The sampling technique used Isaac Michael's formula with a sample size of 43 out of 110 workers Result: The results of the analysis test using the Spearman Rank test showed a p result of 0.002 (<0.05), indicating that there was a significant relationship between stress levels and the incidence of hypertension. with a Spearman Rank correlation coefficient value of 0.432. Conclusion: Based on the research results, it was found that there was a relationship between stress and the incidence of hypertension in firefighting mitigation workers in Batam City in 2023.

Afektinės būsenos savižudybės procese: patirtys ir formavimosi prielaidos

The emergence of affective states during the process of suicide is regarded as a serious indicator of suicide risk. This study aims to describe the experience of affective states characteristic of the suicide process and to raise assumptions about how these affective states develop over a person’s lifetime. A qualitative approach was employed in this study, with the objective of retrospectively exploring individuals’ life experiences through in-depth semistructured interviews. The research sample comprises 12 participants (4 men, 1 person with a nonbinary gender identity, and 7 women) who had attempted suicide no more than one year prior to the study and were receiving treatment at the Vilnius City Mental Health Centre at the time of data collection. Data were analysed using phenomenological interpretive analysis to identify recurring experiential patterns. The analysis revealed nine main experiential themes: some life difficulties experienced during the suicide process were not perceived as related to suicidality; repeated traumatic events provided a foundation for the formation of deep feelings of deficiency; a compensatory mechanism emerged to fill these feelings of deficiency; exhaustion developed from the effort to maintain this compensatory mechanism; the main trigger directly challenged the compensatory mechanism; an affective state followed the experience of the primary trigger; during the affective state, dissociation may help isolate psychological pain; suicidal thoughts during the affective state are experienced as arising automatically; and suicide is perceived as a means to end suffering. The findings of the study indicate that individuals’ narratives reveal a pattern of the formation of affective states characteristic of the suicide process. Through reflection, individuals are able to intuitively distinguish significant, distressing life events from those irrelevant to the suicide process and reconsider their experiences. This ability is a valuable resource for both intervention and postvention efforts.

8663 Sex differences in delayed fear incubation in mice

Abstract Disclosure: M. Littlepage-Saunders: None. M. Rusnak: None. M. Tsuda: None. T. Wu: None. Post-traumatic stress disorder (PTSD) has a lifetime prevalence of 1 in 13 people. It is not fully understood why some are more vulnerable to developing PTSD whereas others are more resilient. Among those who develop PTSD, about a quarter have delayed-onset PTSD where onset of symptoms occur at 6 months or later after experiencing a traumatic event. While there is recognition of this type of PTSD, the underlying mechanism is poorly understood. The development of PTSD is more prevalent in women than men. However, previous preclinical and clinical studies have focused mainly on males. Thus, there lacks an understanding of this sex difference. To enhance our understanding of the causal mechanisms, we designed a study with mice to compare the effect of sex on delayed fear incubation. We expected the female mice to show increased fear responses that would suggest more chronic delayed fear incubation than the male mice. To test this, we evaluated distance travelled, freezing, and latency until the first freezing episode in adult male and female C57Bl/6J mice (7-8 weeks of age; n=8/group) using a delayed fear incubation behavioral assay. Animals were placed in a fear conditioning chamber for a 198 s acclimation period and then administered a single 2 s scrambled footshock of 1.5 mA via the metal grid floor. After an additional 60 s, animals were returned to their home cage. At specific time after shock application, animals underwent a fear recall test where the animals were placed back in the shock chamber for a total of 180 s without any additional footshocks and then returned to their home cage. The study was based on a 2X2 factorial design comprising of sex (male vs female) and recall time (1 day and 14 days post shock). The data showed an increasing freezing trend (p=0.08) at d 14 compared to their recall d 1 counterparts. There was no effect of time or sex on distance travelled or latency until the first freezing episode. Interestingly, female mice showed less freezing when compared to the male mice. Ongoing experiments will look more into circuitry-level changes by comparing neuronal activation through cFos expression in different brain regions that are a part of the limbic system and/or have been associated with fear: the amygdala, hippocampus, prefrontal cortex, and paraventricular nucleus. Presentation: 6/2/2024

Mechanisms of psilocybin on the treatment of posttraumatic stress disorder.

Posttraumatic stress disorder (PTSD) is a condition that can develop after a traumatic event, causing distressing symptoms, including intrusive re-experiencing symptoms, alterations in mood and cognition, and changes in arousal and reactivity. Few treatment options exist for patients who find conventional psychotherapy and pharmacotherapy to be inaccessible, ineffective, or intolerable. We explore psilocybin as a potential treatment option for PTSD by examining the neurobiology of PTSD as well as psilocybin's mechanism of action. Based on both pharmacodynamic and psychoanalytic principles, psilocybin may be an underexplored treatment option for patients with PTSD, though further research is required.

The impact of trauma core dimensions on anxiety and depression: a latent regression model through the Post-Traumatic Symptom Questionnaire (PTSQ)

Adverse life events (e.g., severe accidents, violence/abuse, organic disorders) can elicit traumatic responses characterized by intrusive thoughts, hyperarousal, and avoidance—highlighting the need for sound assessment tools. Also, these traumatic components could heighten anxiety and depression symptoms. This study aims included to: (1) assessing the psychometric properties of the Post-Traumatic Symptom Questionnaire (PTSQ) and delineating clinical cut-offs; (2) investigating how distinct trauma components contribute to anxiety and depression symptoms. Involving 761 participants who experienced a traumatic event, Part I tested the PTSQ psychometric properties, defining clinical cut-offs. Part II tested the impact of traumatic components on anxiety and depression symptoms, using a multiple multivariate latent regression model. PTSQ exhibited exemplary fit indices and robust psychometric properties. Clinically relevant cut-offs were identified. The differential contributions of intrusion, avoidance, and hyperarousal to anxiety and depression symptoms were evaluated, elucidating the strength and nature of these relationships. This study reaffirms the PTSQ as a psychometrically sound and reliable instrument. It underscores the effects of intrusion, avoidance, and hyperarousal on anxiety and depression symptoms in individuals with traumatic experiences. These insights advocate for evidence-based interventions aimed at alleviating the psychological suffering associated with trauma components, fostering adaptation and supporting psychological health.

Moral Injury for LGBTQ+ Individuals and their Communities

Abstract Introduction Moral injury describes the severe distress and associated impairments that result from experiencing specific traumatic events. These are events that violate the values or core beliefs of the injured person, and are often directed from a person in a position of power. Research on moral injury is not new, but has typically had a limited focus (e.g., on moral injury sustained during war) and has only recently begun to focus on the context and severity of moral injuries for individuals from minoritized communities. Contents of Paper This paper: (a) puts forward a case that members of the LGBTQ+ communities are at-risk individuals for moral injury, and in particular religious or spiritual injuries; (b) presents the findings of a scoping review (using a systematic search) that evaluates the extant evidence on LGTBQ + moral injury, and; (c) details a series of considerations for practitioners who are supporting LGBTQ+ survivors of moral injury. Conclusion We close this paper with an urgent call for more on the scope and nature of moral injury for LGBTQ+ individuals and their communities, in order to help better inform interventions and other forms of support for survivors.

Six of one, half a dozen of the other? Examining measurement properties of different potentially traumatic event polyvictimization operationalizations using a multiverse analysis framework.

Numerous differences exist between and within research projects related to assessment and operationalization of potentially traumatic events (PTEs) for youth, especially when measuring polyvictimization. However, few studies have systematically examined how polyvictimization measurement differences influence PTE's relation to functioning. This study sought to address these knowledge gaps by conducting a secondary data multiverse replication (SDMR) to systematically (re)evaluate PTE polyvictimization measurement approaches. Participants included 3297 adolescents (Mage = 14.63; 50.59% female; 65.15% white) from the National Survey of Adolescents-Replication study who completed a structured interview on PTE exposure and emotional and behavioral health (i.e., posttraumatic stress and major depressive disorder, drug and alcohol use, and delinquency). Results indicated that PTE operationalizations using a count variable tended to demonstrate better model performance and prediction of youth at-risk of emotional and behavioral health challenges, compared to models using a binary (yes/no) PTE operationalization. Differences in model performance and prediction were less distinct between models examining multiple forms of a single type of PTE (e.g., maltreatment, community violence), compared to models examining multiple PTE types. These findings emphasize the importance of using multidimensional approaches to PTE operationalization and the need for more multiverse analyses to improve PTE evidence-based assessment.

High rates of probable PTSD among Ukrainian war refugees: the role of intolerance of uncertainty, loss of control and subsequent discrimination

ABSTRACT Background: Intolerance of uncertainty is a well-known predictor of post-traumatic stress symptoms following a traumatic event. At the same time, it is relatively unknown whether intolerance of uncertainty amplifies the effects of other adverse life events on PTSD symptoms among traumatized individuals. Objective: This article addresses this problem in a study of Ukrainian war refugees’ experiences with post-migration discrimination and powerlessness (loss of control). Method: 4972 forced immigrants from Ukraine took part in the study (90.2% women, Mage = 40.4, SD = 12.5) completing the PTSD-8 scale, measures of post-migration discrimination and loss of control experiences, and intolerance of uncertainty. Results: Almost half of respondents (47.5%) have probable PTSD. Regression analysis confirmed that war-related experiences, as well as intolerance of uncertainty, post-migration loss of control and experiences of discrimination were significant predictors of self-reported PTSD symptoms. Also, intolerance of uncertainty weakly moderated the effects of experienced discrimination and control deprivation on self-reported PTSD symptoms, so that the effects of adverse post-migration experiences were more pronounced among individuals high in intolerance of uncertainty. Conclusions: Understanding the effect of post-migration experiences on war refugees’ mental health is crucial for developing improved acculturation policies and fostering a supportive environment for forced migrants.

A parallel investigation of trauma exposure, maladaptive appraisals and posttraumatic stress reactions in two groups of trauma-exposed adolescents

ABSTRACT Background: Maladaptive appraisals, such as thoughts about experiencing a permanent and disturbing change and about being a fragile person in a scary world, are associated with posttraumatic stress reactions (PTSR) for trauma-exposed children and adolescents. Less is known about what puts young people at risk for developing such appraisals, and the differential relationship between the types of appraisals and PTSR. Objective: The primary aim was to examine the role of age, gender and exposure to potentially traumatizing events (PTEs) for the levels of maladaptive appraisals. The secondary aim was to investigate the association between the levels of maladaptive appraisals (appraisals of a permanent change and appraisals about a scary world) and PTSR. Methods: We investigated these aims in two samples: survivors after the terror attack at Utøya island in Norway in 2011 (N = 165, mean age 17.65, SD = 1.19) and adolescents referred to treatment after mainly interpersonal trauma (N = 152, mean age 15.08, SD = 2.18). The aims were investigated using linear regression and partial correlation. Results: In the terror-exposed sample, female gender was significantly associated with higher levels of scary-world appraisals, witnessing or learning that someone close were exposed to physical violence was significantly associated with more permanent-change appraisals, and a higher number of PTEs was significantly associated with higher levels of both types of appraisals. For the clinical sample, we found no significant associations between exposure to PTEs, gender, age, and the level of maladaptive appraisals. Both types of maladaptive appraisals were highly associated with PTSR in both samples, and there was no significant difference in the strength of the associations between the types of appraisals and PTSR. Conclusions: The results have implications for identifying adolescents at risk for developing harmful maladaptive appraisals. Both scary-world appraisals and permanent-change appraisals were strongly associated with PTSR in both groups of trauma-exposed adolescents.

Traumatised youth harbour feelings of revenge: investigating the association between PTSD symptomatology, vengeance, and willingness to forgive among the Congolese adolescent refugees in Uganda

ABSTRACT Background: Prolonged conflicts in the Democratic Republic of Congo (DRC) have caused widespread psychological trauma among civilians leading to maladaptive coping strategies across generations. Despite this occurrence, empirical studies on the prevalence of trauma and its impact on attitudes towards revenge and forgiveness, particularly among the youth, are scarce. This study aims to clarify the relationship between Post Traumatic Stress Disorder (PTSD) symptom severity and the desires for forgiveness and revenge among Congolese adolescents residing in Uganda. Methods: We analysed data from 269 adolescent refugees from the DRC living in the Nakivale refugee settlement in Southwestern Uganda. The assessment included exposure to war-related traumatic events and the MINI-KID for DSM-V PTSD symptom severity. The Heartland Forgiveness and Vengeance Scales measured willingness to forgive and feelings of vengeance. Results: Exposure to war-related traumatic events was notably high in our sample, with severe deprivation of food (260 [97%]), exposure to armed combat (249 [93%]), witnessing bombing, burning, or destruction of houses (245 [91%]), disappearance of family members (239 [89%]), and seeing dead bodies (236 [88%]). PTSD symptom severity was negatively associated with willingness to forgive (b = −0.48; 95% CI −0.71–−0.25; p < .001) and positively associated with vengeance (b = 0.18; 95% CI 0.04–0.32; p = .011). Conclusion: PTSD symptom severity reduces the willingness to forgive and increases the desire for vengeance among adolescent refugees. Mental health clinicians and policymakers should consider addressing maladaptive coping behaviours related to feelings of revenge and unwillingness to forgive in their support strategies for refugees.

Trauma Exposure Checklist: Preliminary Results Show Promising Psychometric Properties to Assess Subjective Perceptions of Exposure to Potentially Traumatic Events

Most individuals in the general population will be exposed to potentially traumatic situations at some point in their lifespan. There is a strong body of research focusing on the clinical implications of exposure to potentially traumatic situations, but less attention has been given to psychological adjustment following these events. Very few available instruments assess trauma exposure while considering subjective perceptions of both positive and negative features. In this study, 304 adults from the general population, mostly women of middle and high socioeconomic status (mean age = 43), filled in a questionnaire with sociodemographic questions and an adapted version of the Trauma Exposure Checklist, which was originally developed in the context of the COVID-19 pandemic. Results indicate that most participants have experienced a potentially traumatic event, most prevalently related to violence and/or criminality and to the severe illnesses and deaths of close relatives. Principal components and reliability analyses lent support to a three-factor structure that considers perceptions of internal and external losses and a positive factor that addresses resources and social support. This study is a first step towards advancing our knowledge on the impact of developmental and sociodemographic factors on subjective experiences of psychological crises and, consequently, psychological adjustment throughout the lifespan.

The prevalence of lifetime trauma and association with physical and psychosocial health among adults at the end of life.

National guidelines recognize lifetime trauma as relevant to clinical care for adults nearing the end of life. We determined the prevalence of early life and cumulative trauma among persons at the end of life by gender and birth cohort, and the association of lifetime trauma with end-of-life physical, mental, and social well-being. We used nationally representative Health and Retirement Study data (2006-2020), including adults age > 50 who died while enrolled (N = 6495). Early life and cumulative traumatic events were measured using an 11-item traumatic events scale (cumulative trauma: 0-5+ events over the lifespan). We included six birth cohorts (born <1924; children of depression [1924-1930]; HRS cohort [1931-1941]; war babies [1942-1947]; early baby-boomers [1948-1953]; mid-baby boomers [1954-1959]). End-of-life outcomes included validated measures of physical (pain, fatigue, dyspnea), mental (depression, life satisfaction), and social (loneliness, social isolation) needs. We report the prevalence of lifetime trauma by gender and birth cohort and the adjusted probability of each end-of-life outcome by trauma using multivariable logistic regression. The mean age at death was 78 years (SD = 11.1) and 52% were female. Lifetime trauma was common (0 events: 19%; 1-2: 47%; 3-4: 25%; 5+: 9%), with variation in individual events (e.g., death of a child, weapons in combat) by gender and birth cohort. After adjustment, increasing cumulative trauma was significantly associated (p-value<0.001) with higher reports of end-of-life moderate-to-severe pain (0 events: 46%; 1-2 events: 50%; 3-4 events: 57%; 5+ events: 60%), fatigue (58%; 60%; 66%; 69%), dyspnea (46%; 51%; 56%; 58%), depression (24%; 33%; 37%; 40%), loneliness (12%; 17%; 19%; 22%), and lower life satisfaction (73%; 63%; 58%; 54%). Older adults in the last years of life report a high prevalence of lifetime traumatic events which are associated with worse end-of-life physical and psychosocial health. A trauma-informed approach to end-of-life care and management of physical and psychosocial needs may improve a patient's quality of life.

336 - Association of Psychological Symptoms and Traumatic Events with Obstructed Defecation and Fecal Incontinence Symptoms

336 - Association of Psychological Symptoms and Traumatic Events with Obstructed Defecation and Fecal Incontinence Symptoms

Navigating treatment trajectories for families with young children after domestic violence: A Delphi-study exploring the priorities in terms of trauma-therapy and attachment-based intervention

BackgroundIn families with young children who have experienced domestic violence, both parents and children are at risk to develop post-traumatic stress disorder (PTSD) symptoms, and there is a risk for disrupted parent-child interactions. ObjectiveTo identify the factors on which expert-clinicians agree that they should be considered when deciding on the order of trauma therapy for the parent, trauma therapy for the child, and attachment-based intervention. Participantsand settings: Participants were 16 experienced clinicians, trained in attachment-based intervention for parents and their young children, trauma therapy for adults, and trauma therapy for young children. MethodsA classic three-round Delphi approach was used. Anonymous online surveys were filled out by the participants. Consensus was defined as agreement among 70% of the participants. ResultsAfter the third survey round, there were eleven factors for which there was consensus. These included the preference of the parent for one of the three individual therapies, impaired parental mentalizing capacity, insensitive/disrupted parenting, a problematic attachment history between parent and child, a high level of child PTSD symptoms, a high level of parental PTSD symptoms, severe risks for the development of the child, a very young age of the child, and exposure of the child to one or more traumatic events. ConclusionsAgreement was found on which factors to consider in planning the order of treatments for families who have experienced domestic violence. These factors can provide a starting point from where clinicians can design a treatment plan with a specific family.

Secondary traumatization in refugee care—EMDR intervention for interpreters (STEIN): a study protocol for a quasi-randomized controlled trial

BackgroundBy the end of 2022, more than 100 million people worldwide fled their homes. Before, during and after their flight, refugees have high risk of experiencing traumatic events. Accordingly, around every third refugee is affected by posttraumatic stress disorder. For adequate mental health care, the service of interpreters is often urgently needed to overcome existing language barriers. However, repeated exposure with details of traumatic narratives, as experienced by interpreters, can be burdensome and can lead to trauma sequela symptoms in terms of secondary traumatic stress. Only few studies have examined the treatment of secondary traumatic stress to date. Based on the recommendations for the treatment of posttraumatic stress disorder with confrontational methods, this study was designed to evaluate the effectiveness of an eye movement desensitization and reprocessing (EMDR) intervention in a sample of interpreters working in refugee care suffering from secondary traumatic stress symptoms.MethodsTo evaluate the effectiveness of an EMDR intervention for the treatment of secondary traumatic stress symptoms, a quasi-randomized controlled trial using a waiting group design will be performed. Participants will be treated with a maximum of 6 sessions based on EMDR standard protocol. Primary outcome is the symptom load of secondary traumatic stress, assessed with the Questionnaire for Secondary Traumatization, while secondary outcomes comprise further symptom complexes such as PTSD due to self-experienced traumatic events, depression, anxiety, and somatization as well as quality of life, quality of professional life, and psychological wellbeing that will be assessed with the PDS, PHQ-9, GAD-7, SSD-12, SF-12, PROQOL-5, and WHO-5, respectively.DiscussionOur primary interest is to determine the efficacy of an EMDR intervention in interpreters affected by secondary traumatic stress, especially how many sessions are needed for significant symptom reduction. Change of associated symptom complexes and quality of life will be investigated. Reprocessing one’s own stressful experiences may also contribute to this, which is not the focus of the treatment but relevant to the EMDR protocol. This study aims to assess if EMDR could be an acceptable, effective, and time-efficient method for reducing work-related secondary traumatization.Trial registrationGerman Clinical Trials Register, DRKS00032092, registered 16 June 2023.

Protocol for osteoporosis screening in CPTS

Osteoporosis is a chronic disease that affects bone density and quality, making the skeleton more fragile and susceptible to fracture in the event of minor trauma, or even spontaneously in the most severe cases. It seriously affects patients' quality of life and generates considerable costs for healthcare systems. Given this situation, early detection and management of this disease is crucial. With this in mind, the Communauté Professionnelle Territoriale de Santé (CPTS) in southern Toulouse has developed a care pathway based on a cooperation protocol designed to facilitate screening for the disease.

Clinical and Humanistic Burden of Non-inhibitor HaemophiliaA in Five European Countries: Insights from the CHESSII Study.

HaemophiliaA (HA) is a congenital bleeding disorder caused by a deficiency/absence of factorVIII (FVIII) and characterised by frequent, acute and prolonged spontaneous or traumatic bleeding events, often leading to haemophilic arthropathy and progressive joint deterioration. HA severity is characterized by endogenous FVIII activity: mild (> 5-40%), moderate (1-5%), or severe (< 1%). HA poses a substantial clinical and socioeconomic burden on people with HA (PWHA), their caregivers, and society. This analysis evaluates clinical and patient-centric outcomes of a cohort of individuals with non-inhibitor HA sampled from France, Germany, Italy, Spain, and the UK in the 'Cost of Haemophilia in Europe: A Socioeconomic Survey II' (CHESSII) study. CHESSII was a cross-sectional burden-of-illness study collecting clinical and socioeconomic data on adult (≥ 18years) individuals with haemophiliaA or B of any severity with or without inhibitors from eight European countries. Descriptive analyses were conducted examining physician-reported demographics, clinical and health resource utilisation information. PWHA-reported health-related quality of life (HRQoL) using the EQ-5D-5L and Work Productivity and Activity Impairment (WPAI) were also examined. Outcomes were stratified by HA severity and reported at country level. Demographics and clinical characteristics of the cohort (N = 880) were generally consistent across countries. Individuals with severe HA experienced more frequent bleeding events and joint disease despite broad use of factor replacement therapy long-term prophylaxis. A minority of those with mild or moderate HA also experienced such challenges. HRQoL and workforce participation diminished, and chronic pain increased, with increasing HA severity. This analysis provides up-to-date insights on the impact of HA across five European countries. Increasing HA severity was generally associated with worse clinical outcomes, HRQoL and workforce participation. These findings suggest a place for continued evidence-based tailored treatment and clinical management approaches in addressing the residual burden of HA.

Tools for Success in Experiential Education for Pharm.D. Students with Trauma and Adverse Childhood Events (ACES).

In the past five years, new priorities for student wellness, burnout prevention, and improved mental health have become top priorities for experiential learning. Individual students ' academic resilience is a critical aspect of these student factors. Self-regulatory skills like emotion regulation and executive functioning are vital underlying resilience processes. Preceptors, faculty, and administration should assess threats to academic resilience, such as adverse childhood experiences (ACES) and trauma, to ensure students' optimal outcomes in experiential learning. This article uses the recognizing, responding, and preventing re-traumatization principles from the Substance Abuse and Mental Health Services Administration (SAMHSA) concept of a trauma-informed approach to provide tools for success for pharmacy students living with trauma and adverse childhood experiences (ACES). Preceptor tools for students living with trauma and ACES are designed to proactively recognize trauma responses, whether they occur in isolated incidences or of a chronic nature. Screening and assessment can identify students preemptively who may need extra support, resources, and tools for academic resilience. Responding to a student's disclosure with a disclosure plan will lay the groundwork for a safe and productive encounter. During the encounter, prevent re-traumatization by being up to date on sensitive and appropriate language while providing daily logistical tools for success in an experiential practice rotation. Little is known about the specific effects of ACES on self-regulation, resilience, and executive function in Doctor of Pharmacy students. However, preceptors can provide tools to develop students' academic resilience and improve their educational outcomes in experiential learning.