Previous Traumas Research Articles

Fear of Childbirth After Major Orthopedic Traumas: A Nationwide Multi-Register Analysis.

The aim of this study was to evaluate the association between previous major traumas and the prevalence of fear of childbirth (FOC) and the subsequent effects of FOC on the intended mode of delivery. In this nationwide retrospective register-based cohort study, data from the Care Register for Health Care were linked with the National Medical Birth Register (MBR) to evaluate the prevalence of FOC after major traumas. A total of 18,573 pregnancies met the inclusion criteria. A multivariable logistic regression model was used to assess the effects of FOC on the intended mode of delivery. Women with major traumas before pregnancy were compared to individuals with wrist fractures. Adjusted odds ratios (aORs) with 95% CIs between the groups were compared. Of those pregnancies that occurred after major traumas, 785 (6.2%) women were diagnosed with FOC after traumatic brain injury (TBI), 111 (6.1%) women after spine fracture, 38 (5.0%) women after pelvic fracture, 22 (3.2%) women after hip or thigh fracture, and 399 (5.2%) women in the control group. Among those women diagnosed with FOC, the adjusted odds for elective CB as an intended mode of delivery were highest among women with previous spine fractures (aOR 2.28, CI 1.45-3.60) when compared to the control group. We found no evidence of differences in maternal FOC in patients with preceding major traumas when compared to the control group. Therefore, it seems highly likely that the major trauma itself is the explanatory factor for the increased rate of elective CB.

The 123s and affective, behavioral, and cognitives of unaccompanied Latinx Minors: A trauma-informed composite case study.

This article explores the stages where trauma is experienced (123s) and its physiopsychological impact (affect, behavior, and cognitions [ABCs]) in unaccompanied Latinx Minors through the analysis of a composite case study. Unaccompanied Latinx Minors represent a unique and growing population in the United States that warrants careful consideration from a trauma-informed and resilience-based framework. A detailed case study was implemented, triangulating caregiver and client therapy records to illustrate the framework of stages of trauma exposure (123s) and physiopsychological impact (ABCs). Latinx children often encounter various potentially traumatic experiences and adverse childhood experiences at the following stages (123s): (1) Preimmigration; (2) During immigration; and (3) Postimmigration. The extended traumas experienced by immigrant youth may easily constitute toxic stress. Moreover, once in the destination country, youth may lack coping resources or encounter stressful circumstances that prolong or exacerbate the impact of previous traumas. This continuous physiological hyperarousal can also result in changes in brain neurobiology, which further compounds the experience of other symptoms (Krupnik, 2021). These potentially complex trauma responses may manifest for these children through ABCs. The cumulative impact of these incidents may have significant effects on minors' A. Affective, B. Behavioral, and C. Cognitive functioning. Relevant clinical implications and policy recommendations for addressing the multifaceted needs of unaccompanied Latinx minors. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Predictive Factors for Total Knee Arthroplasty: An Observational Study.

Introduction Knee osteoarthritis (KOA) is the most common form of osteoarthritis. It is diagnosed based on clinical symptoms, physical examination, and imaging, most frequently by knee X-ray in at least two views. In front of a patient with early KOA, all the predictive factors and risk factors that can be modified, but also that can lead to a rapid evolution of the symptoms and the need for total knee arthroplasty (TKA), must be taken into account and identified. There were a series of prognostic factors associated with KOA, such as age, sex, BMI, degree of physical activity, decrease in bone mineral density, C-reactive protein, malalignment, clinical severity at baseline, and previous traumas. The treatment of KOA is varied and involves pharmacological and non-pharmacological measures and surgical treatment in the final stages of evolution. Materials and methods In the University Emergency Hospital of Bucharest, Bucharest, Romania, patients with KOA presented to the Department of Orthopedics and Traumatology, and those who required surgical treatment, such as TKA, arthroscopy, or non-surgical treatment, were enrolled. We conducted a descriptive and prospective observational study that included 70 patients clinically and imaging diagnosed with KOA. The inclusion criteria consisted of a patient over 45 years old with knee pain and radiological signs of KOA. The exclusion criteria referred to patients with recent traumatic history, signs of active osteoarticular infection, the lack of radiological changes of KOA that imposed the differential diagnosis, patients known to have rheumatological diseases in the Algic phase, and patients in whom it was not possible to collect complete required data. Results Patients who required TKA were older (65.12 ± 8.19 years) than patients who required other therapeutic interventions (52.55 ± 3.63 years), the difference of 12.57 years being statistically significant (t = -8.882, p ≤ 0.001). Women were more than three times more likely to require TKA than men (80.85% vs. 52.17%, OR = 3.87, CI [1.29, 11.56]). Patients with HBP were more than four times more likely to require TKA than patients without HBP (78.57% vs. 42.86%, OR = 4.88, CI [1.42, 16.82]). Patients with elevated ESR were more than 26 times more likely to require TKA than patients with normal ESR (96.67% vs. 52.50%, OR = 26.23, CI [3.25, 211.67]). There are statistically significant differences between the non-TKA group (mean rank = 60.20) and TKA patients' score (mean rank = 25.62) (U = 6.000, Z = -6.606, p ≤ 0.001). Thus, patients who required TKA had a significantly lower KSS score than patients who required other treatments. Conclusion According to the data obtained in the studied group of patients, the characteristics of the patient at high risk of requiring TKA are the following: a female patient over 65 years of age who associates hypertension, high ESR, and fibrinogen values ​​with KSS score and KSS function with low values, recording an average value of 56.70.

Infertility as Trauma: Understanding the Lived Experience of Involuntary Childlessness.

Infertility, to those who are affected by it, is much more than whether one manages (or not) to have a child: it can be a traumatizing experience. Based on a clinical case study that involved one-to-one psychotherapy sessions and semi-structured interviews with six involuntarily childless women living in Norway, this article develops the argument that there is a need to treat infertility as trauma, both conceptually and from the perspective of therapeutic practice. The analysis contributes to our understanding of trauma as a disruptive event that erodes a person's moral agency. It does so by outlining conceptual and therapeutic tools that illuminate what happens in the psyche as a result of the trauma: they help explaining why the moral agency of different individuals is damaged to different extents, and how therapy can repair it. In relation to the issue of involuntary childlessness, the analysis shows where infertility fits within one's traumabiography-a map of the way adverse experiences over the life-course have affected one's psyche and behavior-both as traumatizing in itself and connected to previous traumas. This understanding enables more effective therapeutic support and better care for many individuals whose long-term suffering would otherwise remain unacknowledged and untreated.

Predictors of change in emotional regulation from 6 to 30 months of age in infants born after a threatened preterm labour.

IntroductionEmotional dysregulation are considered early manifestations of neuropsychiatric disorders. Recent research has shown that a threatened preterm labour (TPL) represents an adverse prenatal event that involves temperament disturbances, even in absence of prematurity. Thus, full-term TPL infants at 6 months of age are characterized by lower positive affect, higher negative affect, and worse emotional regulation relative to a full-term non-TPL control group.ObjectivesThe aim of this study is to explore the predictors of change of emotional infant competences.MethodsThis prospective cohort study recruited mothers who suffered from a TPL. Infants’ temperament assessment was performed at 6 and 30 months of age using the Rothbart Behaviour Questionnaires, examining positive affectivity/surgency, negative emotionality, and orienting and emotional regulatory capacity. A regression model was carried out, including gestational age at birth, maternal anxiety trait, maternal history of psychological traumas, prenatal and postnatal maternal depression, anxiety, and cortisol as well as parenting stress as predictors.ResultsIncreased positive affectivity was related with lower paternal stress (p = .044). Maternal history of trauma and parenting stress was associated with increased negative emotionality (p = .037 and p = .045, respectively). Increased emotional regulation disturbance was linked to low gestational age at birth (p < .001), higher postnatal depression (p = .002), higher prenatal anxiety at TPL diagnosis (p = .039) and higher postnatal anxiety (p = .008).ConclusionsTherefore, maternal previous traumas, maternal psychopathology from pregnancy to postpartum as well as parenting stress should be considered in psychological treatment to improve infant’s emotional competences and prevent subsequent neuropsychiatric disorders.Disclosure of InterestNone Declared

Are 6 more accurate than 4? The influence of different modes of delivery on postpartum depression and PTSD

BackgroundEmpirical evidence shows that 4.6–6.3% of all women develop a post-traumatic stress disorder (PTSD) and approximately 10–15% postpartum depression (PPD) following childbirth. This study explores the relationship between delivery mode and the occurrence of PTSD and PPD, specifically examining four distinct caesarean section (CS) modes: primary on maternal request (Grade 4), medically indicated primary (Grade 3), secondary CS from relative indication (Grade 2) and emergency secondary CS (Grade 1), compared to vaginal and assisted vaginal delivery (AVD). The research aims to understand how these six subcategories of delivery modes impact PPD and PTSD levels. Common predictors, including the need for psychological treatment before childbirth, fear of childbirth, planning of pregnancy, induction of labor, birth debriefing, and lack of social support after childbirth, will be analyzed to determine their association with postpartum mental health outcomes.MethodsThe study was planned and carried out by a research team of the psychology department at the Medical School Hamburg, Germany. Within an online-study (cross-sectional design) N = 1223 German speaking women with a baby who did not die before, during or after birth were surveyed once between four weeks and twelve months postpartum via an anonymous online questionnaire on demographic and gynecological data, delivery mode, PTSD (PCL-5) and PPD (EPDS).ResultsFor both psychiatric disorders, ANOVA revealed significant differences between delivery mode and PPD and PTSD. With weak effects for PPD and medium to strong effects for PTSD. Post-hoc tests showed increased levels of PPD for two CS types (Grade 1, Grade 3) compared to vaginal delivery. For PTSD, secondary CS from relative indication (Grade 2), emergency secondary CS (Grade 1) and assisted vaginal delivery (AVD) were associated with elevated levels of PTSD. Regression analysis revealed delivery mode as a significant predictor of EPDS- (medium effect size) and PCL-5-Score (medium to high effect size).LimitationDelivery was considered as the potential traumatic event, and any previous traumas were not documented. Additionally, the categorization of delivery modes relied on subjective reports rather than medical confirmation.ConclusionThe study highlights the influence of delivery mode on the mental health of postpartum mothers: different modes influence postpartum disorders in various ways. However, the definition of delivery mode was only stated subjectively and not medically confirmed. Further research should investigate which aspects of the different delivery modes affect maternal mental health and explore how the perception of childbirth may be influenced by specific delivery experiences.

Factors intervening in the childbirth experience: a mixed-methods study

ObjectiveTo analyze the childbirth experience focusing on the intervening factors and on the delivery method.MethodA sequential and explanatory mixed-methods study guided by the World Health Organization document for positive childbirth experiences. The participants were puerperal women in a maternity teaching hospital from inland São Paulo (Brazil). The first quantitative stage involved descriptive analysis with Poisson regression of 265 answers to the “Termômetro da Iniciativa Hospital Amigo da Mulher e da Criança” (“Women- and Baby-Friendly Hospital Initiative Thermometer”) questionnaire. The second stage, qualitative, thematically analyzed the interviews conducted with 44 puerperal women who took part in the first stage. Data integration was by connection.The results and discussionThe analysis by connection showed that among the factors that restricted the positive experience, C-section was predominant (61.9%), understood as an option due to fear of pain, the treatment modality and previous traumas. Restrictions referring to the presence of a companion (99.6%), not having privacy (83%), disrespectful situations (69.5%), too many touches (56.9%) and the absence of skin-to-skin contact (55%), among others, potentiated fear, loneliness, concern, shame, the perception of disrespect and insecurity with the assistance provided. The promoting factors were as follows: choosing the companion (95.4%) for collaborating in the safety perception, not having infections (83.9%), having continuous team monitoring (82.2%) and pain relief methods (78.9%), which were valued by the women.ConclusionThe intervening factors that promoted positive experiences were related to clinical and protocol-related issues and to service availability. The restrictive factors were associated with excess interventions, deprivation of rights and of choice, absence of privacy and restriction referring to the presence of a companion. Women with a normal postpartum period felt more insecure and disrespected when compared to those subjected to C-sections, whose choices were considered, although they had lower prevalence of skin-to-skin contact. There is an urgent need to apprehend women's experiences and turn them into actions that guarantee their lives in a safe and respectful way.

Platelet-Rich Plasma Injections for the Treatment of Ankle Osteoarthritis

Background: Ankle osteoarthritis is debilitating and usually affects relatively young people, often as a result of previous ankle traumas, frequently occurring in sports. Platelet-rich plasma (PRP) injections for ankle osteoarthritis have shown no evidence of benefit over the course of 26 weeks. Previous studies on PRP for knee osteoarthritis showed that clinically significant improvements with PRP occurred between 6 to 12 months in the absence of initial benefit. No studies have evaluated the effect of PRP from 6 to 12 months in ankle osteoarthritis. Purpose: To assess the efficacy of PRP injections in ankle osteoarthritis over the course of 52 weeks. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: In this 52-week follow-up trial, 100 patients with ankle osteoarthritis were randomized to a PRP group or placebo (saline) group. Patients received 2 intra-articular talocrural injections: at inclusion and after 6 weeks. Patient-reported outcome measures were used to assess pain, function, quality of life, and indirect costs over 52 weeks. Results: Two patients (2%) were lost to follow-up. The adjusted between-group difference for the patient-reported American Orthopaedic Foot & Ankle Society score over 52 weeks was −2 points (95% CI, −5 to 2; P = .31) in favor of the placebo group. No significant between-group differences were observed for any of the secondary outcome measures. Conclusion: For patients with ankle osteoarthritis, PRP injections did not improve ankle symptoms and function over 52 weeks compared with placebo injections. Registration: NTR7261 (Netherlands Trial Register).

Dickensian Divisions: David Copperfield's "Hero[ine] of my own life"

This article explores how Charles Dickens's failed romance with Maria Beadnell–which drove him to burn his early autobiographical attempt–haunts his fictional life-writing novel David Copperfield. Maria's rejection intensified Dickens's previous traumas of the blacking warehouse and his father's imprisonment–subsequently producing a type of Freudian split self that I term the Dickensian hero/protagonist split. David is the novel's protagonist, but Agnes is its hero/ine. These divisions underscore Dickens's overarching preoccupations with legacy, and his notoriously fraught relationship with the life-writing genre. Agnes may not be a figure modern readers can admire; however, her position as hero/ine in David Copperfield's history nonetheless illuminates Dickens's own traumas, manifested in David's insecurities about heroism and narrative legacy.

An Interpretative Phenomenological Analysis of Black Women’s Meaning and Experiences of Sexual Anxiety

ABSTRACT Sexual anxiety can activate the stress response cycle during sex, compromising a woman’s ability to experience sexual pleasure. Black women face additional cultural and contextual factors, such as hypersexualization, partner scarcity, and higher rates of sexual trauma that may increase the magnitude, frequency, and odds of experiencing sexual anxiety. However, limited research has explored this phenomenon among Black women. Thus, we sought to qualitatively explore how N = 25 premenopausal Black women living in the southern United States make meaning of experiences with sexual anxiety. We analyzed the interview data using an interpretive phenomenological approach. Three components of the phenomenon of sexual anxiety were gleaned: 1) causes of sexual anxiety, 2) characteristics of sexual anxiety, and 3) coping strategies. Each component included three to six elements of meaning making. For these Black women, causes of sexual anxiety included fears of sexual pain, partner unfamiliarity, previous traumas, mental health concerns, and intersecting socio-structural factors. Characteristics of sexual anxiety included mental, somatic, and emotional elements. Coping strategies included having a reassuring and supportive sex partner, supporting themselves with affirmations and mindfulness, attending therapy, and using substances. Through reflection about their perceived causes of, experienced characteristics of, and intentional coping with sexual anxiety, meanings were co-constructed through an intersectional frame. Implications for intersectionality-informed interventions and suggestions for mental health professionals and partners are discussed.

Women's Lived Experience of the Interconnectedness of Trauma, Substance Use, and Prison.

The aim of the study was to explore women's experience of Icelandic prisons and of the interconnectedness of trauma, substance use, and prison. Nine incarcerated women, 20-45 years old, participated in this phenomenological study. One or two in-depth interviews were conducted with each participant, in all 16 interviews. The interconnectedness of trauma, substance use, and prison was evident in the participants' accounts. The participants had experienced severe traumas, in childhood and/or in adult life, most of it caused by recurrent experience of violence, bullying, neglect, and beatings and later violent relationships. For the participants, substance use was an unhelpful coping strategy intended to numb severe emotional distress. Most of the participants used substances intravenously that had progressed incredibly fast from initial drug use. They had tried most of the addiction treatments available to them, none of which were trauma based. Participants struggled with complex physical and mental health problems related to substance use and previous traumas but often felt prejudged when they sought healthcare services. They experienced being in prison as depersonalizing and dehumanizing. Most of them were mothers and had lost custody of their children because of substance use causing some of them deep grief. Participants called for more active substance treatment programs in prisons and complained about idleness that they felt increased their addiction. As a conclusion, we call for a trauma-informed care approach in prisons for women to prevent revictimization as well as to assist with mental health issues and substance use.

Confronting Marginality: human and nonhuman resilience in the landscape of disaster

The March 2011 Tōhoku triple disaster reinforced an already liminal space inside Japan. The region of Tōhoku, historically considered at the margins, was once again framed as a marginal space separated from the Japanese ‘centre’. However, the physical area of the disaster acquired new figurative dimensions allowing for an artistic and cultural response to the events of March 2011 and to the national narrative of fast recovery. In the novel In the Zone (2016) by Taguchi Randy, the abandoned and marginal landscape of the exclusion zone assumes the characteristics of a space for survival and renovation. The human and nonhuman characters challenge their social and physical marginality through the continuous movement in the exclusion zone and across several physical and figurative boundaries. Furthermore, in this liminal space, bodily acts—such as laughing, dancing, or singing—become a way to build resilience and recover from previous traumas. This paper concludes that the novel In the Zone constructs the disaster as a positive trope engendering recovery from past traumas and confronting national discourses on the environment, women, and marginal communities.

Association between mistreatment of women during childbirth and symptoms suggestive of postpartum depression

BackgroundPostpartum depression is a common condition in the pregnancy and postpartum cycle. The development of this condition is multifactorial and can be influenced by previous traumas. This study sought to verify whether there is an association between having been exposed to mistreatment during childbirth and presenting symptoms suggestive of postpartum depression.MethodsThis is a cross-sectional study, with the inclusion of 287 women without complications in childbirth, randomly selected from two maternity hospitals of Porto Alegre, southern Brazil, in 2016. Four weeks after delivery, the postpartum women answered a face-to-face interview about socioeconomic aspects, obstetric history, health history, and childbirth experience (practices and interventions applied) and completed the Edinburgh Postnatal Depression Scale (EPDS). From the perception of women regarding the practices performed in the context of childbirth care, a composite variable was created, using item response theory, to measure the level of mistreatment during childbirth. The items that made up this variable were: absence of a companion during delivery, feeling insecure and not welcome, lack of privacy, lack of skin-to-skin contact after delivery, not having understood the information shared with them, and not having felt comfortable to ask questions and make decisions about their care. To define symptoms suggestive of postpartum depression, reflecting on increased probability of this condition, the EPDS score was set at ≥ 8. Poisson Regression with robust variance estimation was used for modeling.ResultsWomen who experienced mistreatment during childbirth had a higher prevalence of symptoms suggestive of postpartum depression (PR 1.55 95% CI 1.07–2.25), as well as those with a history of mental health problems (PR 1.69 95% CI 1.16–2.47), while higher socioeconomic status (A and B) had an inverse association (PR 0.53 95% CI 0.33–0.83).ConclusionsSymptoms suggestive of postpartum depression seem to be more prevalent in women who have suffered mistreatment during childbirth, of low socioeconomic status, and with a history of mental health problems. Thus, qualifying care for women during pregnancy, childbirth and postpartum and reducing social inequalities are challenges to be faced in order to eliminate mistreatment during childbirth and reduce the occurrence of postpartum depression.

Sexual violence experiences among adolescent and young adult males: a review to empower healthcare providers.

Despite 3-17% of adolescent and young adult males (AYAMs) experiencing sexual violence, there is a paucity of information regarding their sexual violence experiences leaving them vulnerable to dangerous and detrimental sequelae. There is underreporting and under-discussion of AYAMs' experiences of sexual violence, with disclosure influenced by societal perceptions of male sexuality, shame, and fear of discrimination. AYAMs experience sexual violence from individuals known to them, with many experiencing physical violence, threats, coercion, and electronic harassment. Intersectionality, previous traumas, inappropriate childhood exposures to sexually explicit situations, select online media consumption, and adverse childhood experiences (ACEs) increase the risk of sexual violence. AYAMs who experience sexual violence are at increased risk of re-victimization, perpetrating sexual violence, experiencing bodily harm, contracting sexually transmitted infections (STIs), and experiencing internalizing and externalizing symptoms, which can lead to significant morbidity and mortality. Research on male-specific protective and resilience factors is scarce and represents an ongoing need. After reviewing AYAMs' experiences of sexual violence, including risk and protective factors, media influences, detrimental sequelae, and resilience factors, we provide a screening framework to empower the healthcare provider (HCP) to champion tailored prevention, screening, intervention, and advocacy efforts to support AYAMs.

Anxiety, past trauma and changes in relationships in Japan during COVID-19

Widely shared traumas have the potential to both improve and impair our relationships with others. During COVID-19 anxiety has been seen as a major individual vulnerability associated with relationship change, as have the wider economic, situational factors facing families and communities. In this national sample of 997 Japanese respondents we assessed perceived relationship changes in couple relations, neighbourhood relations, and wider relations with Japanese nationals, alongside anxiety, exposure to previous mass traumas, household economics, education, and vulnerability to COVID-19. Whilst most respondents reported little change in their relationships during this year there was a small overall improvement in couple relationships and a decline in relations with wider communities. Participant's economic resources were positively associated with an improvement in couple relationships, while anxiety was associated with a decline in relations with both the neighbourhood and the wider society. While neither prior experience of mass trauma, nor education or health vulnerability to COVID-19, were associated with relationship change, having time to talk, and younger age, was positively associated with improvement in couple relations. Findings suggest that anxiety can function to distance relationships during a time of stress, but perceived changes in relationships are little effected by experience of previous trauma. Relationship growth is likely to be greatest in those with better economic conditions. Practitioners need to be mindful of the impact of enhanced anxiety during the pandemic on interpersonal relations, and a potential threat to the relationships of older couples during this time of pandemic threat.

Living through trauma: to bear the unbearable, to speak the unspeakable

ABSTRACT A traumatic situation can be both cataclysmic and disorganising, while putting the whole existence of the individual to the test. Every trauma causes either minor or major rifts in the psyche, thus putting a strain on the patient’s present, past and future. Specifically, when the traumatic experience remains without adequate mentalization, in an instinctive form, it can severely affect the patient, both psychologically and socially. In this paper, we discuss the dual dimension of the traumatic experience. Firstly, since the psyche cannot elaborate the traumatic event or situation psychologically, only minor symbolic or mental representations are available, and the traumatic content cannot find its place in the patient’s psychic history. Since the trauma cannot be worked through psychologically, it usually comprises a massive experience of deadly anxieties, mixed with somatic and sensorial memories. Secondly, the consequences of the trauma have a social dimension. Individuals may feel disconnected and disengaged from their social existence and identity, alone and unprotected, as trauma can lead to them questioning their social identity. The unearthing of the previous psychic traumas explains why the therapy of traumatised patients demands in-depth, individual therapeutic work. Trauma therefore attacks in a dual manner, setting out to test all the aspects of the individual’s functioning. The therapeutic challenges for working with traumatised children and adolescents are considerable, as the clinical vignettes illustrate.

Atypically pulmonary arteriovenous malformations

Pulmonary arteriovenous malformations (PAVM) are abnormal connections between the pulmonary arterial system and the pulmonary veins. PAVMs, which are twice as common in women, are generally seen in 4-6 decades. It is thought that congenital origin, previous thoracic traumas and thoracic surgery, liver cirrhosis, mitral stenosis and infections are among the etiological reasons in PAVM.

Concomitant Congenital Diaphagmatic Hernia (CDH) and bilateral bacterial glomerulonephritis in a pet chinchilla (Chinchilla lanigera)

BackgroundThe domestic chinchilla has been descended from Chinchilla lanigera (long-tailed Chinchilla) or Chinchilla chinchilla (short-tailed Chinchilla). Both species of chinchilla are currently listed as endangered by the IUCN Red List of Threatened Species. Over the past 20 years, they have spread as pets and overall knowledge about their care is improving. The present case report describes a congenital diaphragmatic hernia in a Chinchilla lanigera.Case presentationA 1-year-old, 420 g female chinchilla (Chinchilla lanigera) was presented for clinical examination due to 2 days haematuria episodes and anorexia. A complete haematological analysis was performed, showing a moderate neutrophilia and severe renal involvement. X-rays showed severe intestinal meteorism affecting mostly the cecum, and a soft tissue density mass with translucent areas located in the caudal thorax, making it hard to distinguish the cardiac silhouette. A barium swallow (barium sulfate) was performed and after 20 min, radiograms were performed again, showing part of the stomach dislocated in thorax. Ultrasound was also carried out, confirming the partial stomach herniation into the thoracic cavity and a severe nephropathy. The patient was euthanized according to the owner’s wish and a complete necropsy was performed. The diagnosis was congenital diaphragmatic hernia concomitant to a severe bilateral bacterial glomerulonephritis.Discussion and conclusionsDiaphragmatic hernias can be either congenital or acquired. About CDHs in pet chinchillas, literature is still lacking. In this patient there was no history of previous traumas. No scar tissue or thickening involved margins of the pathological diaphragm window at the necropsy, supporting the hypothesis of a congenital defect. Glomerulonephritis most often results from immune-mediated mechanisms, generally after the deposition of soluble immune complexes within the glomeruli. This mechanism is favoured by a prolonged antigenemia that could occur during specific viral infections, chronic bacterial infections, chronic parasitism, autoimmune diseases and neoplasia. Few cases of nephritis are described in chinchillas (Chinchilla lanigera), mostly related to bacterial sepsis or less commonly involving fungi. The evidence of bacterial aggregates in kidneys at the histopathology, confirmed the infective aetiology. No relationship between the diaphragmatic hernia and glomerulonephritis was found in this report.

Cumulative life stressors and stress response to threatened preterm labour as birth date predictors.

Preterm birth represents one of the main causes of neonatal morbimortality and a risk factor for neurodevelopmental disorders. Appropriate predictive methods for preterm birth outcome, which consequently would facilitate prevention programs, are needed. We aim to predict birth date in women with a threatened preterm labour (TPL) based on stress response to TPL diagnosis, cumulative life stressors, and relevant obstetric variables. A prospective cohort of 157 pregnant women with TPL diagnosis between 24 and 31weeks gestation formed the study sample. To estimate the stress response to TPL, maternal salivary cortisol, α-amylase levels, along with anxiety and depression symptoms were measured. To determine cumulative life stressors, previous traumas, social support, and family functioning were registered. Then, linear regression models were used to examine the effect of potential predictors of birth date. Lower family adaptation, higher Body Mass Index (BMI), higher cortisol levels and TPL diagnosis week were the main predictors of birth date. Gestational week at TPL diagnosis showed a non-linear interaction with cortisol levels: TPL women with middle- and high-cortisol levels before 29weeks of gestation went into imminent labour. A combination of stress response to TPL diagnosis (salivary cortisol) and cumulative life stressors (family adaptation) together with obstetric factors (TPL gestational week and BMI) was the best birth date predictor. Therefore, a psychosocial therapeutic intervention program aimed to increase family adaptation and decrease cortisol levels at TPL diagnosis as well as losing weight, may prevent preterm birth in symptomatic women.

Factors associated with post-traumatic growth in response to the COVID-19 pandemic: Results from a national sample of U.S. military veterans

RationaleThe COVID-19 pandemic has had numerous negative effects globally, contributing to mortality, social restriction, and psychological distress. To date, however, the majority of research on the psychological impact of the COVID-19 pandemic has focused on negative psychological outcomes, such as depression, anxiety, and posttraumatic stress disorder (PTSD). ObjectiveAlthough there is debate about the constructive vs. illusory nature of post-traumatic growth (PTG), it has been found to be prevalent in a broad range of trauma survivors, including individuals affected by the COVID-19 pandemic. The objective of this study was to identify pre- and peri-pandemic factors associated with pandemic-related PTG in a national sample of U.S. veterans. MethodsData were analyzed from the National Health and Resilience in Veterans Study, which surveyed a nationally representative cohort of 3078 U.S. veterans. A broad range of pre-pandemic and 1-year peri-pandemic factors associated with pandemic-related PTG were evaluated. Curve estimation and receiver operating characteristic curve analyses were conducted to characterize the association between pandemic-related PTSD symptoms and PTG. ResultsWorries about the effect of the pandemic on one's physical and mental health, PTG in response to previous traumas (i.e., new possibilities and improved interpersonal relationships), and pandemic-related avoidance symptoms were the strongest correlates of pandemic-related PTG. An inverted-U shaped relationship provided the best fit to the association between pandemic-related PTSD symptoms and endorsement of PTG, with moderate severity of PTSD symptoms optimally efficient in identifying veterans who endorsed PTG. ConclusionsResults of this study suggest that psychosocial interventions that promote more deliberate and organized rumination about the pandemic and enhance PTG in response to prior traumatic events may help facilitate positive psychological changes related to the COVID-19 pandemic in U.S. military veterans. Longitudinal studies on functional correlates of PTG may help inform whether these changes are constructive vs. illusory in nature.