History Of Physical Trauma Research Articles

Clinical Application and Fading of Synchronous Reinforcement for Increasing Self-Feeding for a Child with Autism Spectrum Disorder and History of Trauma

In the current case study, we evaluated synchronous reinforcement (SSR) as an intervention to increase self-feeding for a 5-year-old male diagnosed with ASD and a pediatric feeding disorder who also had a history of trauma. Synchronous reinforcement is a schedule of covariation where reinforcement is delivered continuously contingent on responding. Synchronous reinforcement has not been previously reported in the literature in a feeding context. A benefit of reinforcement-based procedures, such as SSR, is that they may align with recommendations for trauma-informed care by preventing or limiting the necessity of physical guidance procedures for those with a history of physical trauma. This is of particular significance given children with disabilities are more likely to experience traumatic events and abuse. We demonstrated that SSR was an effective intervention for increasing self-feeding, as well as methods for fading SSR as a treatment component. We discuss the potential for SSR as a trauma-informed approach, and the importance of caregiver collaboration and programming for generalization.

Predicting alternate light absorption in areas of trauma based on degree of skin pigmentation: Not all wavelengths are equal

Detection and documentation of bruises on survivors of intimate partner violence (IPV) can provide valuable evidence to support investigation and subsequent prosecution of these crimes. Detection of bruises in persons with darker skin tones is often difficult, contributing to disparities in health and criminal justice responses to IPV. The purpose of this secondary data analysis was to determine whether use of an alternate light source (ALS) increased the predictive probability of successfully detecting bruises on diverse skin tones following a history of physical trauma. In this study, data were analyzed from a convenience sample of 157 subjects inclusive of six skin tones (very light, light, intermediate, tan, brown, dark) with induced bruises. Bruises were assessed under white light and an ALS 21 times over four weeks using 10 different ALS wavelength and goggle color combinations. Data analyzed included 31,841 skin observations obtained over 2897 participant assessments. Multilevel modeling was used to account for the correlation among the repeated measurements for each bruise. Across all categories of skin pigmentation, ALS wavelengths 415nm and 450nm viewed through a yellow filter had the most frequent detections of bruises (415nm: n=2777, 11.2%; 450nm: n=2747, 11.1%) and greater predictive probability of a positive finding (415nm: 0.90-0.99; 450nm: 0.85-0.99) than white light (n=2487; 10%; 0.81-0.90). These two ALS wavelengths were the only combinations that provided greater probability of detection than white light on groups with darker skin (brown or dark), whereas additional ALS wavelengths/filters worked equally well on groups with lighter skin. Findings suggest use of an ALS in clinical assessments of patients of color who report IPV may help reduce health and criminal justice-related disparities.

Modifiable lifestyle and environmental factors associated with onset of psoriatic arthritis in patients with psoriasis: A systematic review and meta-analysis of observational studies

Psoriatic arthritis (PsA) is a progressive joint disease associated with psoriasis. To investigate the association of modifiable lifestyle and environmental factors with PsA risk among people with psoriasis. We conducted a systematic search of PubMed, Embase, and Cochrane Library through May 2, 2020, for observational studies reporting lifestyle or environmental factors for PsA onset in patients with psoriasis. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were combined using a random-effects model. We included 16 studies comprising 322,967 individuals. Obesity and being overweight were associated with an increased PsA risk in patients with psoriasis (OR, 1.75 [95% CI, 1.42-2.16] and OR, 1.50 [95% CI, 1.08-2.09], respectively), with an increase of approximately 6% for each kg/m2 rise in body mass index (OR, 1.06; 95% CI, 1.03-1.10). The presence of PsA was associated with a history of physical trauma (OR, 1.33; 95% CI, 1.16-1.54) or fracture (OR, 1.46; 95% CI, 1.22-1.74). No significant associations were observed regarding alcohol consumption (OR, 0.99; 95% CI, 0.88-1.13), smoking (OR, 0.89; 95% CI, 0.75-1.06), female hormonal exposure (OR, 1.45; 95% CI, 0.95-2.20), and psychologically traumatic events. Inherent limitations in the included observational studies. Several lifestyle and environmental factors are associated with PsA onset among patients with psoriasis. These findings indicate that such risk may be modified with lifestyle changes or avoidance of physical trauma in people with psoriasis.

458. Diagnostic Accuracy and Management of Suspected Moderate to Severe Cellulitis Referred to an Infectious Diseases Outpatient Parenteral Antibiotic Clinic: A Prospective Cross-Sectional Study

BackgroundModerate to severe cellulitis is a common reason for presentation to the emergency department and administration of intravenous antibiotics. Misdiagnosis of cellulitis occurs frequently as the disease can masquerade as a wide variety of noninfectious and infectious problems. There are currently no studies evaluating the impact of infectious diseases physicians on the diagnostic accuracy and management of cellulitis referred to an outpatient parenteral antibiotic clinic from the emergency department. The objective of this study was to quantify the prevalence of misdiagnosed moderate to severe cellulitis through an evaluation by an infectious diseases specialist, characterize the alternative diagnoses, and assess variables associated with misdiagnosis.MethodsA prospective cross-sectional study of adults referred from emergency departments with presumed moderate to severe cellulitis to an outpatient parenteral antibiotic clinic staffed by infectious diseases specialists.Results301 consecutive patients with presumed cellulitis were evaluated over a 6-month period. A concurring diagnosis of cellulitis was found in 170 patients (56.5%), for a misdiagnosis rate of 43.5% (131/301). Table 1 summarizes the alternative diagnoses. Infectious conditions other than cellulitis were the most common (63/301; 20.9%), with abscess being present in 23 (7.6%) of patients. Fifty-two of 301 (17.3%) of the diagnoses were noninfectious and 16/301 (5.3%) patients had a dual diagnosis where minor cellulitis was present, but secondary to another, predomintating condition. The presence of stasis dermatitis (OR 6.62, P = 0.013) and a history of physical trauma (OR 1.76, P = 0.046) were associated with a misdiagnosis. 31.9% (107/335) of antibiotic regimens prescribed by emergency physicians were inappropriate or sub-optimal compared with 7.9% (22/280) of those ordered by infectious disease doctors.ConclusionModerate to severe cellulitis was incorrectly diagnosed in nearly half of the patients referred for intravenous antibiotics and resulted in a high rate of unstewardly antimicrobial use. Infectious diseases physicians at an outpatient antibiotic clinic improved the diagnostic accuracy and management of this complicated condition. Disclosures All authors: No reported disclosures.

Sitting height, sitting height/height ratio, arm span and arm span-height difference of healthy adolescents in Surakarta, Indonesia

Background Sitting height, sitting height/height ratio (SHR), arm span, and arm span-height difference (AHD) are indices to diagnose conditions of disproportion. Reference data on sitting height, SHR, arm span, and AHD for Indonesian children are limited.
 Objective To compile reference data on sitting height, SHR, arm span, and AHD in Indonesian adolescents, and to compare these indices for boys and girls at various ages.
 Methods A population-based survey was conducted from August 2016 to November 2017 in three high schools in Surakarta, Central Java, Indonesia. A convenience sampling method was employed to recruit healthy adolescents without history of chronic disease, history of physical trauma, and/or physical disabilities. All subjects underwent anthropometric measurements (height, weight, sitting height, and arm span), and their ethnic origins were noted. The lambda-mu-sigma (LMS) method was used for reference construction.
 Results Of 639 subjects, 42% were male. Body mass index (BMI) values were similar between males and females. Mean height, weight, sitting height, and arm span of males were greater than those of females. The mean male and female SHRs were 51.1 (SD 1.6) % and 51.0 (SD 1.6) %, respectively (P=0.36), while the mean AHDs were 4.2 (SD 4.5) cm and 3.4 (SD 4.1) cm, respectively (P=0.02). The formula to estimate height based on arm span in males was [height = (0.78 x arm span) + 32.14] in cm. The formula in females was [height = (0.66 x arm span) + 50.59] in cm.
 Conclusion There was no significant difference in SHR between male and female adolescents. However, males haVE significantly larger mean AHD than females. We provide references on sitting height, SHR, arm span, and AHD in male and female adolescents.

Gambling in a National U.S. Veteran Population: Prevalence, Socio-demographics, and Psychiatric Comorbidities.

This study aimed to examine associations between gambling level and clinically relevant measures, including psychiatric disorders and suicidality, in a nationally representative sample of U.S. veterans. Data on 3157 U.S. veterans were analyzed from the National Health and Resilience in Veterans Study. Chi square tests and analyses of variance were used to assess associations between gambling level, and demographic, military, and personality characteristics. Multinomial logistic regressions using stepwise selection were used to identify independent correlates of recreational gambling and at-risk/problem gambling (ARPG). A significant proportion of U.S. veterans engage in gambling activities, with 35.1% gambling recreationally and 2.2% screening positive for ARPG. ARPG was associated with greater prevalence of substance use, anxiety, and depressive disorders, as well as with a history of physical trauma or sexual trauma, having sought mental health treatment (particularly from the Veterans Administration), and minority group status. A similar pattern was found associated with recreational gambling, although the magnitudes of association were lower relative to ARPG. Younger age, self-identifying as black, being retired, and trauma burden were associated with increased odds of ARPG, whereas older age, being single, non-white Hispanic, being retired or not having a job, screening positive for alcohol- and drug-use disorders, and trauma burden were associated with increased odds of recreational gambling. More than a third of U.S. veterans gamble recreationally, with a significant minority (2.2%) screening positive for ARPG. Both recreational and ARPG were associated with elevated trauma burden and psychiatric comorbidities. These findings underscore the importance of routine screening and monitoring of gambling severity, and interventions for ARPG in this population.

Association Between Fatigue and Occupational Physical Trauma Among Male Iranian Workers in the Copper Extraction Industry

BACKGROUND: Fatigue may lead to several consequences and principally produces occupational physical trauma among the workforce. Objectives: This study was designed to explore the relationship between work-related physical trauma and fatigue in the copper extraction industry. Materials and Methods: This cross-sectional study was conducted among 453 male workers employed in the copper extraction industry in Kerman, Iran. The validated Persian version of the Piper Chronic Fatigue Scale was used for the data collection. An additional self-administrated questionnaire was prepared to obtain demographic and occupational data, including age, work experience, smoking, and history of physical trauma in the workplace. Results: The results showed that 28.5% of the participants had experienced work-related physical trauma during the past three years. Severe fatigue was most commonly reported on the subscale for life and emotions (14.79%). A higher rate of work-related fatigue was associated with physically strenuous activities and an inappropriate work place. The mean fatigue scores for subjects both with and without physical trauma experiences were 3.75 ± 0.98 and 2.86 ± 0.79, respectively (P = 0.005). Conclusions: General fatigue and its subscales had a significant relationship with workplace physical trauma among miners. Workplace physical trauma can be reduced by managing fatigue with different programs, including decreasing the workload, scheduling rest breaks at the facilities, and possibly providing welfare and entertainment opportunities for the workers. Keywords: Fatigue; Occupational Physical Trauma; Copper Extraction Industry; Iran Language: en

History of Childhood Physical Trauma Has a Negative Impact On Cognitive Functioning in Individuals at Ultra High Risk for Psychosis

In our previous studies we reported that there were more childhood trauma (CT, 1) and cognitive deficits (2) in UHR group. The aim of this study is to measure the relationship between CT and cognitive functioning in UHR group. Sixty-four individuals at UHR for psychosis were applied a neurocgnitive battery assessing attention, processing speed, verbal learning and memory, working memory, interference inhibition and sustained attention. CT was assessed by short version of Childhood Trauma Questionnary (CTQ). We dychotomized the sample by using cut off scores for the existence of emotional, physical, sexual taruma, physical and emotional neglect. Those with history of physical trauma had worse performance on Digit Span-forward, Trail making B (time), Stroop test-difference between colour and word reading times, WCST-completed categories. Physical trauma scores were negatively correlated with WCST-completed categories, and physical neglect scores were negatively correlated with Digit span test-forward. Our findings suggest that history of physical trauma has a negative impact on cognitive functioning in individuals at UHR for psychosis. 1. Sahin S, Yuksel C, Guler J, Karadayi G, Akturan E, Gode E, Ozhan AA, Ucok A. The history of childhood trauma among individuals with ultra high risk for psychosis is as common as among patients with first-episode schizophrenia. Early Interv Psychiatry. 2013; 7:414-20. 2. Ucok A, Direk N, Koyuncu A, Keskin-Ergen Y, Yuksel C, Guler J, Karadayi G, Akturan E, Devrim-Ucok M. Cognitive deficits in clinical and familial high risk groups for psychosis are common as in first episode schizophrenia. Schizophr Res. 2013; 151:265-9

Single-stage Dynamic Reanimation of the Smile in Irreversible Facial Paralysis by Free Functional Muscle Transfer

Unilateral facial paralysis is a common disease that is associated with significant functional, aesthetic and psychological issues. Though idiopathic facial paralysis (Bell’s palsy) is the most common diagnosis, patients can also present with a history of physical trauma, infectious disease, tumor, or iatrogenic facial paralysis. Early repair within one year of injury can be achieved by direct nerve repair, cross-face nerve grafting or regional nerve transfer. It is due to muscle atrophy that in long lasting facial paralysis complex reconstructive methods have to be applied. Instead of one single procedure, different surgical approaches have to be considered to alleviate the various components of the paralysis. The reconstruction of a spontaneous dynamic smile with a symmetric resting tone is a crucial factor to overcome the functional deficits and the social handicap that are associated with facial paralysis. Although numerous surgical techniques have been described, a two-stage approach with an initial cross-facial nerve grafting followed by a free functional muscle transfer is most frequently applied. In selected patients however, a single-stage reconstruction using the motor nerve to the masseter as donor nerve is superior to a two-stage repair. The gracilis muscle is most commonly used for reconstruction, as it presents with a constant anatomy, a simple dissection and minimal donor site morbidity. Here we demonstrate the pre-operative work-up, the post-operative management, and precisely describe the surgical procedure of single-stage microsurgical reconstruction of the smile by free functional gracilis muscle transfer in a step by step protocol. We further illustrate common pitfalls and provide useful tips which should enable the reader to truly comprehend the procedure. We further discuss indications and limitations of the technique and demonstrate representative results.

Idiopathic true brachial artery aneurysm in an 18-month-old girl

An 18-month-old girl was transferred to our university hospital for the management of a 12-mm brachial artery aneurysm found by her mother while the child was being bathed. The patient had had an uneventful vaginal delivery, had met all milestones, and there was no evidence or history of physical trauma. No dysmorphic physical attributes were identified on careful examination. There was also no family history of childhood illnesses, aneurysmal disease, or rheumatic or connective tissue diseases. A whole-body computed tomography angiography demonstrated the partially thrombosed left brachial artery aneurysm with a well-developed profunda brachial artery (A; Cover). There werenootherectatic, aneurysmalor tortuousarteries.Resultsof complete laboratoryassessments, including standard rheumatologic assays were all negative. The lack of long-term data supporting ligation of such an aneurysm vis-a-vis extremity growth and the minimal morbidity of vein bypass in this setting prompted the family to consider brachial artery reconstruction. Preoperativegreat saphenous veinmappingdemonstratedvenousdiametersof15mmin the thighs. The patient was taken to the operating room for brachial artery excision and reconstruction with vascular and microvascular surgical teams. A great saphenous vein segment was isolated from the left thigh while the aneurysm was exposed (B) and controlled with microvascular clips (C). Aneurysmectomy and reconstruction with reversed great saphenous vein sewn end-to-end with 9-0 interrupted nylon suture was performed (D), similar to the description of other reports. An excellent graft Doppler signal and palpable pulses at the wrist were present at the conclusion of the procedure. Final pathology, shown as a cross-sectional image of the brachial aneurysm with elastin stain (E), revealed a true aneurysm with extensive thrombus and florid fibrointimal proliferative ingrowth without evidence of infection or arteritis.

Clinical analysis of deep cutaneous mycoses: a 12‐year experience at a single institution

Deep cutaneous mycoses can cause significant morbidity and mortality, especially in immunocompromised patients. There have been few studies focusing on deep cutaneous mycoses and there are no data from Asian countries. This study aimed to investigate clinical characteristics, underlying predisposing factors, aetiological organisms and outcomes in patients with deep cutaneous mycoses. A retrospective medical record review of patients with deep cutaneous mycoses treated at a tertiary referral centre in Korea from 1999 to 2010. Forty-one cases of deep cutaneous mycosis were identified (median age: 49). Most patients (32/41) had impaired immunological status, and seven of the remaining nine had a history of physical trauma. Neutropenia and long-term use of antibiotics were detected in 13 and 12 patients respectively. Nodular skin lesions were the most common type (17/41) and the morphology of the lesions varied. Fungal organisms were identified by culture and histopathology of skin specimens. Candida (16/41) was the most common organism, followed by Aspergillus, Alternaria, Fusarium (4/41 each). Systemic antifungal treatment was successful in 28 patients, while nine patients died from the fungal infection. Our study may lead to improved insights into deep cutaneous mycoses as their incidence is increasing and they vary in different clinical settings.

Clinical and psychological characteristics of TMD patients with trauma history

The purpose of this study was to investigate clinical and psychological characteristics of temporomandibular disorders (TMD) patients with trauma history. The clinical and psychological characteristics of 34 TMD patients with trauma history were compared with those of 340 TMD patients without trauma history. Craniomandibular index (CMI) was used for clinical characteristics of TMD patients. Symptom severity index (SSI) was used to assess the multiple dimensions of pain. Symptom checklist-90-revision (SCL-90-R) was used for psychological evaluation. Temporomandibular disorders patients with trauma history displayed significantly higher CMI and palpation index. TMD patients with trauma history also exhibited higher values in duration, sensory intensity, affective intensity, tolerability, scope of symptom, and total SSI score. In addition, these patients showed significantly higher values in symptom dimensions of somatization, depression, anxiety, phobic anxiety, and paranoid ideation. Among the symptom dimensions of SCL-90-R, somatization showed the most significant correlations with CMI and SSI. Temporomandibular disorders patients with trauma history displayed more severe subjective, objective, and psychological dysfunction than those without trauma history. Pain of myogenous origin, history of physical trauma, and psychosocial dysfunction were all closely related.

Analysis of factors that modify susceptibility and rate of progression in amyotrophic lateral sclerosis (ALS)

We conducted case-control and prospective longitudinal studies to examine risk factors and predictors of disease progression for ALS. Ninety-five subjects with ALS and 106 healthy control subjects were enrolled. All subjects completed a risk factor questionnaire at enrollment. The ALS subjects were prospectively followed for one year to define factors that influence the rate of disease progression, measured by rate of change in percent predicted forced vital capacity (%FVC) and the ALS functional rating scale (ALSFRS) score. The association of each potential risk factor with ALS was determined using univariate logistic regression. A random slope model was used to determine the association of each risk factor with disease progression. The demographic characteristics of ALS subjects and controls at enrollment did not differ. Significant risk factors for ALS included reported exposure to lead (p = 0.02) and pesticides (p = 0.03). Disease progression was faster in the ALS subjects having bulbar onset and a shorter time period between onset of symptoms and diagnosis. Pertinent variables not associated with either causation or progression of ALS included physical activity, cigarette smoking and a history of physical trauma or other clinical disorders.

A case-control study examining the role of physical trauma in the onset of fibromyalgia syndrome.

To investigate whether physical trauma may precipitate the onset of fibromyalgia syndrome (FMS). A case-control study was carried out to compare fibromyalgia out-patients with controls attending non-rheumatology out-patient clinics. One hundred and thirty-six FMS patients and 152 age- and sex-matched controls completed a postal questionnaire about any physical trauma in the 6 months before the onset of their symptoms. Fifty-three (39%) FMS patients reported significant physical trauma in the 6 months before the onset of their disease, compared with only 36 (24%) of controls (P<0.007). There was no significant difference between FMS patients who had a history of physical trauma and those who did not have physical trauma with regard to age, sex, disease duration, employment status and whether their job at onset was manual. Physical trauma in the preceding 6 months is significantly associated with the onset of FMS.

Differentiating "bad drivers" with and without a DWI.

Risk factors for driving while intoxicated (DWI) are still largely unknown. The aim of this study was to determine the risk factors, other than multiple vehicle-related violations, that identify a group of bad drivers at risk of subsequent DWI violations. A retrospective cohort study was conducted of drivers with multiple vehicle-related violations who completed a questionnaire on driving and personal characteristics (N = 253). Thirty-six variables were found associated with a 1.8- to 6.3-fold increased risk of subsequent DWI in the following categories: driving behavior, drinking behavior, history of physical trauma, alcohol-related expectancies and family history. A screening system could be incorporated in DWI prevention programs to target high-risk groups.