Trauma Response Research Articles

P1041 Efficacy and Safety of Adalimumab Biosimilar Dose Escalation Treatment in biologic naïve Patients With fistulas Crohn’s Disease: A Prospective, Single-Arm Clinical Practice

Abstract Background The introduction of tumor necrosis factor (TNF) inhibitors, including adalimumab, has dramatically changed the treatment landscape for moderate-to-severe Crohn’s disease (CD). The availability of biosimilars has minimized the economic burden on patients and reduced global health inequalities while ensuring efficacy. However, the efficacy of adalimumab biosimilars for fistula CD is unclear. Methods Sixty patients with fistulas CD from July 2021 to July 2023 were included, and all of them were treated with adalimumab biosimilar treatment for 12 weeks (subcutaneous injection of 160 mg in the 0th week, 80 mg in the 2nd week, and 40 mg from the 4th to the 12th week), and the decision of whether to receive adalimumab conventional therapy (40 mg q2w) or incremental therapy (80 mg q2w) was made based on the patients’ traumatic response at the end of the 12-week period. The decision to follow up with regular (40 mg q2w) or incremental (80 mg q2w) treatment of adalimumab was made based on wound response after 12 weeks, and the dosage was again adjusted according to efficacy after 24 weeks, and the patients were followed up to 52 weeks. The primary outcome of this study was the fistula healing rate at 52 week. Secondary outcomes were fistula response rate, endoscopic response rate and endoscopic remission rate. Results A total of 60 patients with active fistula-type Crohn’s disease were enrolled in the study. Most of the enrolled patients were in the middle-aged and young age group, with a mean age of (26.8±9.5) years, 75.5% males, CDAI score (180.9±97.62), SES-CD score (15.69±7.79), and PDAI score (4.58±2.12). In the conventional treatment group, the fistula response rate was 57.89%, 65.22% and 73.91% at 12, 24 and 52 weeks, respectively; the fistula healing rate was 55.26%, 69.57% and 65.22%, respectively; the endoscopic response rate was 60.53%, 82.61% and 100%, respectively; and the endoscopic relief rate was 36.84%, 73.91% and 86.96%, respectively. In the incremental treatment group, the fistula response rate was 12.5%, 66.67% and 66.67% at 12, 24 and 52 weeks, respectively; the fistula healing rate was 12.5%, 66.67% and 0, respectively; the endoscopic response rate was 50%, 66.67% and 66.67%, respectively; and the endoscopic remission rate was 0, 0 and 16.67%, respectively. All patients had no adverse drug reactions or serious infections during treatment. Conclusion In the real world, adalimumab biosimilar dose escalation treatment may somewhat improve fistula response rates and endoscopic response rates in fistulous CD patients initially treated with biologics, but has a limited effect on fistula healing rates and endoscopic remission rates.

Practice Elements Used in Child Mass Trauma Interventions: A Systematic Review.

The goals of this analysis were to identify practice elements frequently used in child mass trauma interventions and to determine if these elements differed across interventions with respect to type of event addressed. The most frequent elements used were psychoeducation for the child, affect modulation, relaxation, cognitive techniques, exposure, support networking, and narrative. The most frequently used elements were similar for political violence and natural disaster interventions but differed for COVID-19 interventions. Similarities in elements used in political violence and natural disaster interventions reflect the all-hazards approach to mass trauma response. Differences for COVID-19 interventions may address distinctions between the pandemic and these events and underscore the importance of considering an expanded set of elements in future research. The findings suggest that characteristics of the event as well as the population receiving the intervention and the context should guide the selection of interventions and intervention elements.

"That Came Back to Haunt Me": Violence Against Women Survivors' Concerns About Police Use of Body-Worn Cameras.

Despite the substantial contact police have with survivors of violence against women, empirical accounts of survivors' perceptions of police use of body-worn cameras (BWCs) are limited. This study examines survivors' concerns with BWCs. We present qualitative data from semi-structured interviews with 33 survivors of intimate partner abuse and sexual assault. While the majority (79%, n = 26) of the women in this study support police use of BWCs, most (90%, n = 30) still express concerns with the technology. Survivors' concerns fell into three main areas: fear of BWCs capturing trauma responses that could be used against survivors, BWCs decreasing survivor comfort and reporting, and BWCs revictimizing survivors and contributing to survivors' loss of control. The findings reveal concerns that police can work to address to avoid survivor-police relations being deteriorated by police use of BWCs.

Exploring the role of immune biomarkers in idiopathic granulomatous mastitis: A clinical and pathological perspective.

Idiopathic granulomatous mastitis (IGM) is a chronic inflammatory disorder characterised by the formation of non-caseating granulomas in breast tissue, primarily affecting young women of childbearing age. The aetiology of IGM remains unclear, with potential factors including trauma, hormonal influences, and autoimmune responses. Recent studies suggest that immune dysregulation may play a critical role in IGM, highlighting the need for exploration of biomarkers involved in inflammation and immune modulation, particularly LL-37, galectin-3, IL-36, and TLR3. This study included 36 patients diagnosed with IGM and 37 healthy controls. Blood samples were collected from all participants, and serum levels of LL-37, IL-36α, galectin-3, and TLR3 were analyzed using enzyme-linked immunosorbent assay (ELISA). Immunohistochemical evaluations were conducted on breast tissue samples from 16 IGM patients and 10 controls who underwent mammoplasty. Clinical data, including laboratory tests and imaging results, were also collected and analyzed. Statistical analyses were performed using the IBM-SPSS-22.0 software, with significance set at p<0.05. Serum levels of LL-37, IL-36α, galectin-3, and TLR3 were significantly lower in IGM patients compared to healthy controls (p<0.001 for all). Immunohistochemical analysis revealed reduced expression of LL-37 in IGM tissue samples, while galectin-3 levels were comparable between the IGM and control groups (p=0.32). Clinical evaluations indicated significant improvements in inflammatory markers (CRP and ESR) and mass size over the treatment period. The findings of this study suggest that LL-37, IL-36α, galectin-3, and TLR3 are implicated in the pathogenesis of IGM, with their serum levels being significantly diminished in affected patients. The observed reduction in LL-37 may contribute to the decline in IL-36α and TLR3 levels, indicating a potential role of these biomarkers in the inflammatory processes associated with IGM. Further research is warranted to elucidate the mechanisms underlying these alterations and their implications for the diagnosis and treatment of IGM.

Impact of Traffic Patterns on Trauma Response Prenotification [Letter

Impact of Traffic Patterns on Trauma Response Prenotification [Letter

Climate change trauma and collective dissociation: Unraveling the impact on mental health and advocating for collective action

Abstract The climate change crisis is a complex global challenge that has far- reaching implications for public health and well-being. Rising temperatures and more frequent extreme weather events are impacting physical health, mental well-being, and ecological balance. Vulnerable communities are disproportionately affected, especially in terms of food security. Furthermore, climate-related disasters have profound and lasting effects on mental health, leading to trauma responses and dissociation as coping mechanisms. This perspective delves into the concept of collective dissociation, a subconscious defense mechanism that hinders effective action in the face of the overwhelming climate crisis. Understanding and characterizing this phenomenon is essential to promote meaningful climate action. To combat collective dissociation and facilitate effective collective action, several strategies are proposed. Responsible information management for advocacy, local moral support, strategic policy development, and research on climate trauma processing are highlighted as vital approaches. By addressing the mental health implications of climate change, raising awareness, and prioritizing resilience and cooperation, societies can transcend collective dissociation and work together towards a more sustainable future for both the planet and its inhabitants. This call to action underscores the need for comprehensive and guided measures to safeguard planetary and population health in the face of this pressing crisis.

A Scoping Review of Autistic Children’s Neurological, Cognitive, and Psychological Responses to Trauma

Background: Research tells us that autistic children are more likely than their neurotypical peers to experience potentially traumatic events. There is, however, limited literature on how autistic children respond to trauma, and there are few tools available to specifically assess autistic children’s exposure and response to trauma. Consequently, clinicians may lack the knowledge or resources to adequately support these individuals and provide them with appropriate, non-harmful care. Methods: In this scoping review, four databases (CINAHL, MEDLINE, Emcare, and PsycINFO) were searched using keywords that represented the research question: “What are autistic children’s neurological, cognitive, and psychological responses to trauma?” Quantitative and qualitative analyses were conducted on the data, and a frequency analysis was conducted to categorize and describe the results. Results: Thirty-one studies were included in the final analysis. Eleven themes were identified, which included social anxiety, isolation and withdrawal, generalized anxiety, depression, negative emotions and feelings, posttraumatic stress disorder and intrusive thoughts, social behaviors and skills, and behavioral challenges. Conclusions: This scoping review provides important insights into the unique trauma responses of autistic children and highlights the need for additional research and evidence-based guidance to inform clinical best practices and trauma-informed care for this population.

Trauma-informed design: shelter homes for runaway children

ABSTRACT Trauma-informed design (TID) is an inventive architectural methodology that integrates trauma responsiveness into the design of shelters and supportive accommodations for children and youths. This method aims to construct surroundings that endorse the rehabilitation and wellness of trauma survivors. TID strongly stresses principles including independence, protection, empowerment, and reliability. It is founded on the biopsychosocial model and trauma theory. Key design approaches comprise open floor designs, sensory concerns, solitude, adaptability, and a link to the outside atmosphere. However, difficulties comprising illiteracy, economic constraints, and individual variations in trauma responses need to be addressed. The next stages in handling TID are escalating research, advocating for policy, and utilizing technology. TID can alter shelters into spaces where trauma survivor children can find liberation and healing by producing a warm and compassionate environment.

Revealing 'Eha: A Qualitative Project on Historical Trauma Experiences Among Wāhine.

Historical trauma has been established as a determinant of health among all Hawaiians, but limited research exists on how Wāhine (Native Hawaiian women) uniquely experience historical trauma. A phenomenological qualitative study was conducted to primarily understand how historical trauma, trauma response, and the transmission and modes of intergenerational trauma intersect with sexism and patriarchy among contemporary Wāhine, as described in the Historical Trauma Conceptual Model. With partnership and approval of the Waimānalo Pono Research Hui, interviews were conducted with 13 Wāhine from various generations in Hawai'i. The structural, institutional, interpersonal, and internal levels of 'Eha (loosely translated as hurt/suffering/to inflict pain/cause hurt or suffering) were generated as prominent themes from the data. Findings from this project communicate the urgency for change to heal Wāhine with radical aloha and to support them in reimagining a world that is inclusive of their needs.

Trauma and the default mode network: review and exploratory study

While PTSD continues to be researched in great depth, less attention has been given to the continuum of traumatic responses that resides outside this diagnosis. This investigation begins with a literature review examining the spectrum of responses through the lens of the default mode network (DMN). To build upon this literature, a systematic exploratory study was incorporated, examining DMN-related neuropsychological functioning of 27 participants (16 trauma-exposed, and 11 non-trauma-exposed), with a subset (15 participants) completing neuroimaging. This study revealed that in comparison to the control group, the trauma-exposed group had reductions in their capacity for self-referential processing, social cognition, autobiographical recall, prospection, and increased mind-wandering. While correlations were encountered between cognitive findings and brain volume, comparative volumetric findings between trauma-exposed and non-t rauma exposed were insignificant. This suggests that the conservation of DMN structural integrity may play a role in resilience, supporting the existing theory that reduced hippocampal volume may be a pre-existing vulnerability to PTSD rather than a consequence and that reductions in DMN related cognition are functionally mediated.

Hemogram-Based Phenotypes of the Immune Response and Coagulopathy in Blunt Thoracic Trauma.

Background: Blunt thoracic trauma possesses unique physiopathological traits due to the complex interaction of immune and coagulation systems in the lung tissue. Hemogram-based ratios such as neutrophil-to-lymphocyte (NLR), platelet-to-lymphocyte (PLR), neutrophil-to-lymphocyte × platelet (NLPR) ratios have been studied as proxies for immune dysregulation and survival in trauma. We hypothesized that blunt thoracic trauma patients exhibit distinct patterns of coagulation and inflammation abnormalities identifiable by the use of readily available hemogram-derived markers. Methods: The present study represents a retrospective observational analysis that included 86 patients with blunt thoracic trauma from a single high-volume level one trauma center. The primary outcome was mortality prediction in blunt thoracic trauma patients using these derived biomarkers. Secondary outcomes included phenotypes of the immune response and coagulopathy and the prediction of non-fatal adverse events. Results: A U-shaped distribution of mortality was found, with high rates of early deaths in patients with an NLPR value of <3.1 and high rates of late deaths in patients with NLPR > 9.5. A subgroup of blunt thoracic trauma patients expressing moderate inflammation and inflammation-induced hypercoagulation objectified as NLPR between 3.1 and 9.5 may have a survival benefit (p < 0.0001). The NLPR cut-off for predicting early deaths and the need for massive transfusion was 3.1 (sensitivity = 80.00% and specificity = 71.05%). Conclusions: These findings suggest that blunt thoracic trauma patients exhibit distinct phenotypes of the immune response and coagulopathy from the early stages. A controlled, balanced interaction of immune, coagulation, and fibrinolytic systems might effectively achieve tissue repair and increase survival in thoracic trauma patients and should be subject to further research.

Molecular insights into trauma: A framework of epigenetic pathways to resilience through intervention.

Experiences of complex trauma and adversity, especially for children, are ongoing global crises necessitating adaptation. Bioadaptability to adversity and its health consequences emphasizes the dynamism of adaptation to trauma and the potential for research to inform intervention strategies. Epigenetic variability, particularly DNA methylation, associates with chronic adversity while allowing for resilience and adaptability. Epigenetics, including age- and site-specific changes in DNA methylation, gene-environment interactions, pharmacological responses, and biomarker characterization and evaluation, may aid in understanding trauma responses and promoting well-being by facilitating psychological and biological adaptation. Understanding these molecular processes provides a foundation for a biologically adaptive framework to shift public health strategies from restorative to long-term adaptation and resilience. Psychological, cultural, and biological trauma must be addressed in innovative interventions for vulnerable populations, particularly children and adolescents. Understanding molecular changes may provide a biopsychosocial perspective for culturally sensitive, evidence-based interventions that promote resilience and thriving in new settings.

From Complementarity to Mutual Recognition and Thirdness in Child–Parent Psychotherapy

AbstractThis article explores the integration of Jessica Benjamin’s concepts of ‘mutual recognition’ and ‘the third’ into child-parent psychotherapy (CPP), a relationship-based trauma-informed dyadic intervention model rooted in attachment theory. Despite the significance of caregiver-child relationships in trauma response, Benjamin’s work remains underutilized in the CPP literature. This article uses a case illustration to demonstrate how incorporating Benjamin’s concepts enriches CPP interventions that address the relational impact of trauma on young children. Three strategies are outlined to cultivate thirdness within CPP, drawing from clinical material: exploring trauma and complementarity, distinguishing play from reality, and working with the clinician’s subjectivity. The article illustrates how the utilization of Benjamin’s concepts can complement CPP and how emphasizing the intersubjective dynamic between parent and child, enhancing parental subjectivity, and prioritizing the repair of recognition breakdowns can support clinicians in advancing the therapeutic goals of CPP.

Exploring Saudi paramedics’ experiences in managing adult trauma cases: a qualitative study

BackgroundSaudi paramedics face numerous challenges while providing care for adult trauma patients affecting their care but little is known about these specific challenges.MethodsA qualitative study was conducted using a purposive sample of Saudi paramedics from the Saudi Red Crescent Authority (SRCA) across various cities. Data were collected through online semi-structured interviews and analyzed using the framework method.ResultsA total of 20 paramedics were recruited and interviewed. They identified challenges in trauma response, including coordinating care, ensuring the accuracy and accessibility of patient information, and maintaining confidence and readiness. Participants emphasized the need for independent knowledge acquisition through courses, simulations, and peer discussions. They also highlighted the need for more paramedics, strategies to reduce burnout, and the importance of accurately assessing patient conditions. Additionally, they also stressed the importance of raising public awareness to enhance trauma care.ConclusionThis study explored Saudi paramedics' experiences in managing adult trauma patients. standardized handovers, more staff, and greater public awareness are the main key needs to improve daily practice.

Trauma-informed practice for genetic counselors: Insights from a workshop evaluation.

Trauma-informed practice (TIP) is an emerging model of care that acknowledges the widespread impact of trauma and emphasizes both physical and psychological safety for consumer and provider. It is being increasingly integrated into models of healthcare delivery, organizational policies, and practices, and has been shown to improve clinical interactions, increase treatment adherence, and improve healthcare outcomes. However, to date, TIP has not yet been systematically integrated into genetic counseling training and practice. In this study, using the RISE2 Genomics reporting standard, we present the outcomes of developing and evaluating a TIP workshop designed and delivered for genetic counselors in New South Wales, Australia. This workshop was the first of its kind and addressed the unique clinical and psychosocial challenges that genetic counselors face, including the risk of vicarious trauma and the high rates of burnout in the profession. The workshop aimed to enhance genetic counselors' understanding of trauma and its effects, provide practical strategies for communication and engagement with trauma-affected individuals, and offer guidance on incorporating TIP into clinical practice. Genetic counselors who participated in the TIP training expressed strong appreciation for the workshop and reported increased awareness of the ubiquity of trauma and the presentation of traumatic responses, and increased self-perceived knowledge and confidence in providing trauma-informed care. Additionally, participants were interested in ongoing TIP professional development and the integration of TIP into models of genetic counseling and professional practice. As the field of genetic counseling continues to evolve, we suggest that integrating TIP into training, professional development, and practice will not only improve client outcomes but also reduce rates of vicarious trauma and burnout among genetic counselors. This study is the first to consider the educational needs and the incorporation of TIP into genetic counseling practice, and in doing so, it paves the way for future research and policy development that integrates TIP into models of genetic counseling.

The Impact of Affectionate Communication and Emotional Intelligence on Sexual Stress Among College Women

Stress is a pervasive challenge in the lives of college students, with women experiencing higher stress levels than men. This study investigates the unique stress experiences of college women, particularly in the context of sexual stress. Using affection exchange theory (AET; Floyd, 2002) as a theoretical framework, trait affection and emotional intelligence are examined as predictors of sexual stress. Using survey data collected from U.S. college women (N = 337), results indicated that higher levels of both trait affection and emotional intelligence were associated with lower sexual stress. Additionally, emotional intelligence partially mediated the relationship between trait affection and sexual stress. Future research should explore sexual stress in diverse populations and consider additional factors such as previous trauma and hormonal responses to stress. Overall, this research sheds light on an under examined area and underscores the importance of addressing sexual stress in the college population.

Neurosurgery in Australia's Top End: the lifesaving advantages of developing sustainable neurosurgical care in rural and remote regions.

The authors' goal was to perform a retrospective audit of all emergency cranial neurosurgery performed at the Royal Darwin Hospital in the first 5 years of the unit and to compile their data in a similar fashion to an earlier study titled "Emergency Neurosurgery in Darwin: Still the Generalist Surgeons' Responsibility," which was published in 2015. All emergency cranial neurosurgery performed by a neurosurgeon between 2017 and 2021 was identified. Data were extracted from the National Critical Care and Trauma Response Centre database. Statistical analyses were descriptive logistic regression performed using Stata version 15.1 software to examine factors associated with death. A total of 320 patients (42% Indigenous) underwent 427 emergency neurosurgeries. There were 35 emergency neurosurgeries in 2017 and 82 in 2021. The most common procedure performed was insertion of an external ventricular drain, followed by craniotomy and removal of intracranial hematoma. Mortality was 7.5% overall and 8.4% among patients with trauma. Only age proved to be a statistically significant independent risk factor for death (t = -2.95, p < 0.0041; OR 1.06, p = 0.02). Location, sex, injury severity, and presenting Glasgow Coma Scale score were not associated with death. Indigenous and non-Indigenous patients had similar outcomes. The data illustrate the importance of developing small but sustainable neurosurgical units in rural and remote areas. A dedicated neurosurgical unit at the Royal Darwin Hospital has led to an increase in the amount and variety of emergency neurosurgery performed in Darwin. Interstate transfers have reduced. This has tangible lifesaving and economic advantages.

Mindfulness meditation among South African psychologists: a pathway to ‘being’ amid existential suffering in contemporary South Africa

Mindfulness is currently regarded as a life skill as well as part of an approach to life that can generate beneficial intrapersonal and relational outcomes. Given the centrality of intrapersonal and relational outcomes in psychotherapeutic encounters, it seems logical that the practice of mindfulness by psychologists would be relevant to explore, especially in contemporary South African contexts where high levels of trauma, interpersonal distress, and resultant existential and intrapsychic struggles prevail. The study seeks to address an identified gap in existing research concerning the experienced relevance of long-term mindfulness meditative practice for counselling psychology and therapeutic practice generally, particularly in the South African context. Located within an interpretivist paradigm and interpretative phenomenological analysis, this study explored the mindfulness and mindfulness meditation practices of 11 South African counselling psychologists and the ways in which these practices informed their being in both personal and psychotherapeutic settings. Each participant was invited to participate in a semi-structured interview and reflexive journalling task as part of the research process. The findings centralise the being capacities afforded to psychologists through a mindfulness practice and identify how the related elements of non-judgement, nonattachment, and (re)connection enable enhanced relational encounters with clients. The findings contribute to the limited literature related to the value of psychologists’ mindfulness practices in relation to the way in which they manage their own responses to clients, as well as the potential for mindfulness practices to help clients manage presenting trauma responses.

The Impact of Holistic Justice on the Long‐Term Experiences and Wellbeing of Mass Human Rights Violation Survivors: Ethnographic and Interview Evidence From Kosova, Northern Ireland and Albania

ABSTRACTResearch highlights the long‐term collective effects of mass human rights violations (MHRVs) on survivors’ wellbeing. This multi‐method, multi‐context paper combines the social identity approach (SIA), transitional and social justice theories and human rights‐conceptualised wellbeing to propose a human rights understanding of trauma responses and experiences in the context of MHRVs. In Study 1, ethnographic research in four locations in Kosova, 5 years post war indicates that lack of perceived conflict‐related and social justice is experienced as a key contributor to survivors’ individual and collective wellbeing. In Study 2, 61 semi‐structured interviews with MHRVs survivors from post‐war Kosova, post‐conflict Northern Ireland and post‐dictatorship Albania two to three decades post conflict also show that such justice experiences inform wellbeing. These studies illustrate the importance of expanding the SIA to health and trauma theories by taking account of a human rights‐conceptualised wellbeing as well as adopting a holistic analysis of justice perception.

Proceed with Caution! Trigger Warnings in Online Book-related Information Grounds

Online book-related communities serve as information grounds where individuals gather to recommend and discuss reading material of interest to them. The information flow within these groups often evolves to include the sharing and receiving of warnings about content that some readers may find distressing or triggering. Although intended to be helpful, the sharing of trigger warnings could lead to a reader’s decision to avoid content that may elicit trauma responses, resulting in a forfeiture of the potentially therapeutic benefits of such content. Therefore, it is necessary to investigate the role of trigger warnings within online book-related information grounds. This pilot study seeks to explore the upward trend of trigger warning usage by utilizing text analysis to determine the frequency at which GoodReads users include trigger warnings in their book reviews. By shedding light on the prevalence of trigger warnings in platforms like GoodReads, these early findings suggest that while newer titles in the sample contain 20 times more trigger warnings than older titles, the presence of trigger warning in reviews of classics has also been steadily increasing in the last five years. These results serve to initiate broader conversations about the impact of trigger warnings in book-related virtual information grounds, the need for curriculum on trauma informed LIS practices in iSchools, and implications regarding readers’ advisory and collection development in library settings.