Post-trauma Care Research Articles

Predisposing Factors for Traumatic Dental Injury in Primary Teeth and Seeking of Post-trauma Care

The aim of the present study was to investigate predisposing factors for traumatic dental injury (TDI) in the primary dentition and seeking of dental care after the occurrence of TDI. A randomized population-based cross-sectional study was carried out with 814 children aged 3 to 5 years enrolled at public and private preschools in the city of Campina Grande, PB, Brazil. Parents were asked to fill out a questionnaire on demographic data and the child's history of TDI. TDI was evaluated by clinical examinations performed by three previously calibrated dentists (Kappa: 0.85 to 0.90). Bivariate and multivariate Poisson regression models were constructed for TDI and the parent-reported search for dental care (α=0.05). The prevalence of TDI was 34.6%. The most common type of TDI was enamel fracture (55.0%). The central incisors were the most frequently affected teeth (87.5%). Predictors for TDI in the primary dentition were household income >U$312.50 (PR: 1.355; 95% CI: 1.050-1.724) and overjet >2 mm (PR: 1.539; 95% CI: 1.219-1.942). The predictor for seeking dental care following TDI was parent's age >30 years (PR: 1.753; 95% CI: 1.039-2.960). Household income and overjet were associated with TDI. Among children having suffered TDI, parent's age is a crucial determinant for seeking dental care.

Risk Factors of Posttraumatic Stress Disorder After an Earthquake Disaster

This study sought to predict posttraumatic stress disorder (PTSD) from women's reproductive health events after an earthquake experience. Data on antenatal care, pregnancy outcomes, family planning, socioeconomic status, earthquake experiences, and mental health were collected from a random sample of 425 women of reproductive age using the Centers for Disease Control and Prevention Reproductive Health Assessment Toolkit and the Harvard Trauma Questionnaire. Data were analyzed using multivariate regression analysis to predict PTSD symptoms from posttrauma care variables and reproductive health events. Restricted social participation, use of temporary accommodation, pregnancy complications, and use of injectable contraceptives were significant risk factors of PTSD. These factors may be exacerbated by the social context of conservative societies, traditions about health care-seeking behavior, and access to health care. Antecedent reproductive health events influence women's reaction to major trauma including events such as an earthquake.

Using cultural relaxation methods in post-trauma care among refugees in Australia

In the period from May 2007 to May 2009 there were a total of 75 immigrants referred for psychiatric care at the Supporting Survivors of Torture and Trauma, Adelaide. A clinical audit of case notes and qualitative methods using in-depth case studies, participation observation and key informant interviews were used to evaluate the effectiveness of traditional methods. There were 52 males (69%) and 23 females (31%). Average age was 40 years with a range of 19–70 years. The majority had depression (77%), post-traumatic stress disorder (PTSD) (63%), anxiety including panic disorders and somatisation. Eighteen (24%) had both depression and PTSD. In combination with medication, exposure therapy and psychosocial support, the majority of Islamic clients benefitted from Dhikir (88%). Qualitative ethnography suggests that Dhikir was culturally appropriate and effective in these settings. Cultural relaxation methods are useful adjuncts in post-trauma therapy. They are cheap, non-pharmacological, safe and non-toxic with no adverse effects and culturally acceptable.

Intérêt du dosage sérique de la protéine S100B dans la prise en charge du neurotraumatisé

Value of S-100 B protein assay during post-trauma care. S-100B protein is an acid protein specific from glial cells. The first studies suggest that the S-100B could be a tissue marker reflecting brain damages. The aim of this study was to correlate S-100B to the Glasgow Coma Scale during the initial undertaking of the neurotraumatised patient by SMUR. After agreement of CCPPRB of our hospital, 23 consecutive patients neurotraumatised undertaken by the SMUR have been included in this prospective study. The parameters studied were the Glasgow Coma Scale with the three classical items (Gy, Gv, et Gm) after restoration of hemodynamic and respiratory status, before hospitalisation. A first blood sample was taken during getting into condition (Cs1) then, a second one at arrival time in intensive care unit of hospital (Cs2). The assay was performed by an immunoluminometric and chimiluminescente technique (Byk-Sangtec Diagnostica, distributed in France by Nichols Institute Diagnostics). The detection limit is 0,02 μg/L for a normal range below 0, 12 μg/L. The S-100B concentrations at Cs1 and Cs2 have been correlated (Spearman) à G, Gy, Gv, Gm and compared using a Wilcoxon test. The mean age (± SD) of patients included is 35 ± 8 ans. G mean is 10 ± 5. Cs2 value is significantly lower than Cs1. There is no correlation between Cs1, Cs2, G, Gy, Gv, et Gm. The important increase of S-100B (mean, 43 time the normal value at Cs1 suggest that this protein is a brain damages marker. The very fast decreasing kinetic (Cs2 is only 26 time the normal value) lead to predict a very early seric peak post-trauma. Nevertheless, there is no correlation between the initial Glasgow and the seric concentration of S-100B.

Risk factors of adolescent and young adult trauma victims

Repeated injury, or recidivism, because of intentional or unintentional injury is a growing chronic health problem among urban adolescents and young adults in the United States. To describe demographic, social, environmental, psychological, and developmental antecedents and risk-taking behaviors, and to examine their relationships to type of trauma and rate of trauma recidivism in adolescent and young adults in an urban trauma center. One hundred adolescent and young adult trauma victims in an urban trauma center were interviewed, using the Adolescent Risk-Taking Instrument, the Brief Anger/Aggression Questionnaire, and the Trauma Risk Factor Interview Schedule. Bivariate correlation, multiple regression, and discriminant function analysis were used to examine the data. Of the sample, 89% experienced trauma related to interpersonal violence, including firearm injuries, stab wounds, and blunt trauma. Male gender, unemployment, past arrest, lower levels of spirituality, and higher levels of anger/aggression and thrill-seeking accounted for 25% of the variance in the number of risk-taking behaviors. Factors such as male gender, past arrest, unemployment, having been a crime victim in the past, lower autonomy, use of weapons, fighting, and no psychological counseling distinguished subjects with firearm-related injuries from subjects with other injury sources. Use of alcohol on weekdays, past arrest, and higher education levels were associated with trauma recidivism, explaining 14% of the variance. Social/environmental and psychological/developmental variables, as well as risk-taking behaviors, are important correlates of trauma and recidivism. These findings suggest the importance of advocacy for social policies conductive to reducing the risks of violence and trauma and risk-reduction interventions as components of posttrauma care.

SPINAL CORD INJURY: An Overview

Advancements in the management of urologic complications such as the neurogenic bladder have been essential to improving the quality of life and longevity of patients with spinal cord injury. These advances are discussed in greater detail in the subsequent articles in this issue. Despite the many improvements that have been made in post-trauma care, spinal cord injury remains a devastating lesion of the nervous system. Current therapies have not proved to be particularly effective in preventing or reversing damage to the spinal cord. Still, every effort should be made to preserve remaining function and to prevent complications. The care of these patients has been significantly improved with the development of specialized multidisciplinary centers. The emphasis in current treatment focuses on rehabilitation and adaptation to the disability and on prevention of secondary disabilities. Research in basic and clinical neuroscience will result in better, more useful care and treatment for those with spinal cord injury. However, even then, a neurorehabilitation team will be essential to care for these patients. Continuing efforts must be made to ensure that people with spinal cord injury lead full and productive lives.

Developing a Comprehensive Health Services Research Capacity in Physical Disability and Rehabilitation

The lack of an adequate capacity for policy-oriented disability research in the United States has hampered decision making in all aspects of disability policy. This article considers the development of a comprehensive Health Services Research (HSR) capacity in physical disability and rehabilitation, which would examine the organization, provision, and financing of health care services for persons with physical disabilities. Despite the substantial health care needs of such individuals, there have been relatively few HSR studies on the health care issues that affect their lives. This article considers why this is the case, and suggests a strategy for developing a comprehensive HSR/disability capacity. It further presents an agenda for HSR in the areas of trauma care and post-trauma acute care, medical rehabilitation, post-rehabilitation primary care, and long-term support services for persons with physical disabilities.

New Surgical and Medical Approaches in Infectious Disease

A clinical surgeon must run fast merely to keep up with the pack when it comes to the management of infections. This book is one of seven in a series entitled Contemporary Issues in Infectious Disease . This particular volume is specifically directed toward surgeons and surgical specialists. It consists of 18 15- to 20-page monographs, one third of which are summaries of progress in surgical fields, such as the role of oxygen in management of infections, adherence of bacteria to foreign bodies, and current strategies in molecular design of new antibiotics. These well-written, scholarly, short monographs strike a sensitive balance among recent advances in basic science that may be applicable to practicing surgeons. The remaining 11 chapters are summaries of new developments in management of infections in special clinical situations, such as urosepsis, cardiac and biliary surgery, osteomyelitis, burns, and posttrauma care. Two chapters on abdominal abscess, one written by

Cyclosporine and skin allografts for the treatment of thermal injury. II. Development of an experimental massive third-degree burn model demonstrating extensive graft survival.

We have previously reported the successful treatment and apparent development of skin allograft tolerance in a patient sustaining massive burns, utilizing skin allografts and cyclosporine. We now report the experimental correlate via successful achievement of a 75% body surface area (BSA) scald burn cyclosporine-skin allograft model in Lewis (LEW) rats. Cyclosporine (8 mg/kg/day) was given to the experimental animals daily for the first 20 days and then three times a week thereafter. Two experimental groups were studied: one received standard posttrauma care and the second critical posttrauma care. Controls (n = 22) and experimental groups 1 (n = 28) and 2 (n = 4) had average survival times of 13.8 +/- 12.8 days, 44.2 +/- 132.5 days, and 172.0 +/- 19.4 days, respectively. The allografts on the surviving experimental animals appeared normal and healthy and had nearly perfect hair growth. These results indicate that the model follows the clinical burn wound course, and treatment of massive burns with primary excision, skin allografts, and low doses of cyclosporine could provide immediate and complete functional repair of the burn wound.