Work-related Trauma Research Articles

A guided single session intervention to reduce intrusive memories of work-related trauma: a randomised controlled trial with healthcare workers in the COVID-19 pandemic

Abstract Background Intrusive memories of psychologically traumatic events bring distress both sub-clinically and clinically. This parallel-group, two-arm randomised controlled trial evaluated the effect of a brief behavioural intervention on reducing intrusive memories in frontline healthcare workers exposed to traumatic events during the COVID-19 pandemic. Methods Participants with at least two intrusive memories of work-related trauma in the week before recruitment were randomised 1:1 to an imagery-competing task intervention (n = 73) or attention-based control task (n = 71). The number of intrusive memories was assessed at baseline and 5 weeks after the guided session (primary endpoint). Results The intervention significantly reduced intrusive memory frequency compared with control [intervention Mdn = 1.0 (IQR = 0–3), control Mdn = 5.0 (IQR = 1–17); p < 0.0001, IRR = 0.30; 95% CI = 0.17–0.53] and led to fewer post-traumatic stress-related symptoms at 1, 3 and 6 month follow-ups (secondary endpoints). Participants and statisticians were blinded to allocation. Adverse events data were acquired throughout the trial, demonstrating safety. There was high adherence and low attrition. Conclusions This brief, single-symptom, repeatable digital intervention for subclinical-to-clinical samples after trauma allows scalability, taking a preventing-to-treating approach after trauma. Trial registration 2020–07-06, ClinicalTrials.gov identifier: NCT04460014.

Flow-Through Procedure in Sequela After Complex Injuries of the Hand With Fingers’ Amputation

PurposeComplex injuries of the hand with finger amputation can result in important functional impairment. If the amputated fingers cannot be replanted, the developed sequelae should be further evaluated. Sometimes, in the presence of a few remaining local vascular resources, the use of the flow-through technique can help in solving the problem. MethodsThis study retrospectively reviews 4 cases who underwent single or multiple fingers reconstruction with toe transfers by using true flow-through or flow-through conduit flaps. A thorough description of the two methods is done, and the quality of the regained functionality of the hand is presented. ResultsAll the patients were males, aged between 21 and 45 (median age 31.75). One of them injured the left dominant hand, and the other three their right dominant hand. The median time between the accident and reconstructive surgery was 14.5 months (range, 3 months-36 months). All the initial lesions were work-related trauma. One patient had severe sequela after forearm compartment syndrome and amputation of the thumb and fifth finger; one patient had a metacarpal hand, one patient had amputation of two fingers (2nd and 4th); and one patient had three fingers amputated (2nd, 3rd, and 4th). In the first patient, a true flow-through flap and a second toe transfer was done, and in the other three patients multiple toe transfers by using the flow-through conduit technique were used. A good functionality of the reconstructed hand was obtained in all the patients. ConclusionsToe transfer remains one of the best methods in the reconstruction of hands with missing fingers. The use of both true flow-through flap and flow-through conduit methods are very useful, especially in cases with few vascular resources.

Understanding Youth Justice Professionals’ Motivations For Their Work

Youth Justice (YJ) professionals experience work-related stress, challenges and trauma in their work (Sibisi & Warria, 2020) yet they continue to enter the field. Research regarding motivations of YJ professionals for their work is limited, but necessary to improve overall quality of care and to ensure the most suitable candidates are hired. Semi-structured interviews aimed to explore YJ workers’ motivations for their work and how they experience and cope with challenges on the job. Thematic analyses indicates that YJ professionals are motivated by the opportunity to contribute to the lives of youth through prevention and intervention, progress and learning, and advocacy and resource provision. Challenges in YJ work are often related to feeling unsupported owing to low salaries, staff shortages, and system constraints. Motivating factors which contribute to their ability to stay in the field despite the challenges include a passion for their work and seeing change in their clients. Healthy coping strategies appear necessary to manage challenges and may contribute to the longevity in the field. Findings provide insight into YJ professionals' motivations, coping, and reasons for remaining in the field. These results can help to inform hiring, training and policy in Ontario YJ work.

Exploring healthcare workers’ experiences of a simple intervention to reduce their intrusive memories of psychological trauma: an interpretative phenomenological analysis

ABSTRACT Background: Many healthcare workers (HCWs) endured psychologically traumatic events at work during the coronavirus disease 2019 (COVID-19) pandemic. For some, these events are re-experienced as unwanted, recurrent, and distressing intrusive memories. Simple psychological support measures are needed to reduce such symptoms of post-traumatic stress in this population. A novel intervention to target intrusive memories, called an imagery-competing task intervention (ICTI), has been developed from the laboratory. The intervention includes a brief memory reminder cue, then a visuospatial task (Tetris® gameplay using mental rotation instructions for approximately 20 min) thought to interfere with the traumatic memory image and reduce its intrusiveness. The intervention has been adapted and evaluated in a randomized controlled trial (RCT) with Swedish HCWs (ClinicalTrials.gov identifier: NCT04460014). Objective: We aimed to explore how HCWs who worked during the COVID-19 pandemic experienced the use of a brief intervention to reduce their intrusive memories of work-related trauma. Method: Interpretative phenomenological analysis was used for in-depth understanding of the lived experiences of HCWs who used the intervention. Seven participants from the RCT were interviewed by an independent researcher without prior knowledge of the intervention. Interviews were conducted via telephone and transcribed verbatim. Results: Four general themes were generated: ‘Triggers and troublesome images’, ‘Five Ws regarding support – what, when, why, by/with who, for whom’, ‘Receiving it, believing it, and doing it’ and ‘The intervention – a different kind of help’; the last two included two subthemes each. The results reflect participants’ similarities and differences in their lived experiences of intrusive memories, support measures, and intervention impressions and effects. Conclusion: HCWs’ experiences of the novel ICTI reflect a promising appraisal of the intervention as a potential help measure for reducing intrusive memories after trauma, and gives us a detailed understanding of HCWs’ needs, with suggestions for its adaption for future implementation. Trial registration: ClinicalTrials.gov identifier: NCT04460014.

Using a Novel Gameplay Intervention to Target Intrusive Memories After Work-Related Trauma: Iterative Qualitative Analysis of Intensive Care Unit Staff Experiences.

Many intensive care unit (ICU) staff experience intrusive memories following work-related traumatic events, which can lead to long-term mental health outcomes and impact work functioning. There is a need for interventions that target intrusive memories in this population; however, factors such as mental health stigma and difficulty in fitting interventions into busy schedules can pose barriers. The Brief Gameplay Intervention For National Health Service Intensive Care Unit Staff Affected By COVID-19 Trauma (GAINS) study tested a brief, digital imagery-competing task intervention (including computer gameplay) with the aim of reducing the recurrence of intrusive memories, which holds promise for overcoming some of these barriers. This substudy aims to explore barriers and facilitators to the uptake and practical use of the intervention by ICU staff, along with its acceptability, and iteratively explore the impact of intervention optimizations to further refine the intervention. The GAINS study is a randomized controlled trial comparing access to a brief digital imagery-competing task intervention for 4 weeks with usual care followed by delayed access to the intervention. The participants were ICU staff who worked during the COVID-19 pandemic and experienced intrusive memories. All participants were sent a questionnaire at 4 weeks to gather data about intervention acceptability. Nested within the randomized controlled trial, a subset of 16 participants was interviewed, and data were analyzed using thematic analysis drawing from a framework approach. Both quantitative and qualitative data indicated high acceptability of the intervention. Intervention use data show that, on average, staff were able to target approximately 73% (3.64/4.88) of their intrusive memories and engaged with the Tetris component for the full 20 minutes per session. Overall, on the acceptability questionnaire, staff found the intervention easy to use, helpful, and highly acceptable. The interviews generated four themes: approach to the intervention, positives of the intervention, negatives of the intervention, and improvements and optimizations. Findings highlighted barriers that ICU staff experienced: stigma, feeling weak for seeking help, not wanting colleagues to know they were struggling, and skepticism. However, they provided suggestions on how barriers could be overcome and discussed the advantages of the intervention when compared with other treatments. Although participants described many positive aspects of the intervention, such as being easy to use, enjoyable, and leading to a reduction in the frequency or intensity of intrusive memories, they also raised practical issues for implementation. The intervention has the potential to overcome stigma and reduce the frequency of intrusive memories after traumatic events among ICU staff. Further refinement is needed to improve the adoption and reach of this intervention. A limitation is that we could not interview the National Health Service staff who were unable or unwilling to take part in the trial.

State Level Policies on First Responder Mental Health in the U.S.: A Scoping Review.

A growing body of evidence demonstrates potential adverse mental health outcomes associated with exposure to occupational trauma among first responders. In response, policymakers nationwide are eager to work on these issues as evidenced by the number of states covering or considering laws for mental health conditions for first responders. Yet, little information exists to facilitate understanding of the impact of mental health-related policies in the United States on this important population. This study aims to identify and synthesize relevant state-level policies and related research on first responder mental health in the United States. Using a scoping review framework, authors searched the empirical and policy literature. State level policies were identified and grouped into two categories: (1) Workers' Compensation-related policies and (2) non-Workers' Compensation (WC) related policies. While benefits levels and other specifics vary greatly by state, 28 states cover certain first responder mental health claims under WC statutes. In addition, at the time of this study, 28 states have policies governing first responder mental health outside of WC. Policies include requiring mental health assessments, provisions for counseling and critical incident management, requiring education and training, providing funding to localities for program development, bolstering peer support initiatives and confidentiality measures, and establishing statewide offices of responder wellness, among others. Authors found a dearth of outcomes research on the impact of state level policies on first responder mental health. Consequently, more research is needed to learn about the direct impact of legislation and establish best practice guidelines for implementing state policy on first responder mental health. By conducting systematic evaluations, researchers can lay the foundation for an evidence-based approach to develop more integrated systems that effectively deliver and finance mental health care for first responders who experience work-related trauma. Such evaluations are crucial for building an understanding of the impact of policies and facilitating improvements in the support provided to first responders in managing mental health challenges arising from their work.

How does it feel? An exploration of neurobiological and clinical correlates of alexithymia in trauma-exposed police-officers with and without PTSD

ABSTRACT Background: Alexithymia, an inability to recognise one’s emotions, has been associated with trauma-exposure and posttraumatic stress disorder (PTSD). Previous research suggests involvement of the oxytocin system, and socio-emotional neural processes. However, the paucity of neurobiological research on alexithymia, particularly in trauma-exposed populations, warrants further investigation. Objective: Explore associations between alexithymia, endogenous oxytocin levels, and socio-emotional brain function and morphometry in a trauma-exposed sample. Method: Dutch trauma-exposed police officers with (n = 38; 18 females) and without PTSD (n = 40; 20 females) were included. Alexithymia was assessed with the Toronto Alexithymia Scale (TAS-20). Endogenous salivary oxytocin was assessed during rest, using radioimmunoassay. Amygdala and insula reactivity to socio-emotional stimuli were assessed with functional MRI, amygdala and insula grey matter volume were derived using Freesurfer. Results: Alexithymia was higher in PTSD patients compared to trauma-exposed controls (F(1,70) = 54.031, p < .001). Within PTSD patients, alexithymia was positively associated with PTSD severity (ρ(36) = 0.497, p = .002). Alexithymia was not associated with childhood trauma exposure (β = 0.076, p = .509), police work-related trauma exposure (β = −0.107, p = .355), oxytocin levels (β = −0.164, p = .161), insula (β = −0.170, p = .158) or amygdala (β = −0.175, p = .135) reactivity, or amygdala volume (β = 0.146, p = .209). Insula volume was positively associated with alexithymia (β = 0.222, p = .016), though not significant after multiple testing corrections. Bayesian analyses supported a lack of associations. Conclusions: No convincing neurobiological correlates of alexithymia were observed with any of the markers included in the current study. Yet, the current study confirmed high levels of alexithymia in PTSD patients, independent of trauma-exposure, substantiating alexithymia’s relevance in the clinical phenotype of PTSD.

Clinical and psychological implications of post-traumatic stress in firefighters: a moderated network study

ABSTRACT Firefighters are frequently exposed to trauma and may experience a unique symptom presentation of post-traumatic stress. Prior research has identified stronger associations between certain post-traumatic stress symptoms (e.g. detachment, intrusions, physiological reactivity) using network analysis. However, little is known about the effects of symptom severity and emergency work-related trauma on symptom networks. The present study probed the network structure of post-traumatic stress symptoms in trauma-exposed firefighters (N = 871) to model the dynamic interactions of psychological symptoms. We developed a network of post-traumatic stress symptoms and a network of post-traumatic stress with clinical covariates and used moderated network modelling to assess the effects of having PTSD and experiencing work-related trauma on the networks. We identified high edge correlations between several nodes (e.g. startle/hypervigilance, internal/external cue avoidance, detachment/lack of interest) and high centrality of detachment, external cue avoidance, and flashbacks. Additionally, having PTSD moderated positive network associations between risk-taking and suicidality and between distorted blame and post-traumatic cognitions. Work-related trauma moderated negative associations between appetite gain and loss and appetite loss and suicidality. Findings suggest that targeting specific symptoms of detachment, external cue avoidance, and flashbacks could allow for the development of effective trauma-informed interventions for these populations.

WHAT ARE THE CAUSES AND TYPES OF FARMER TRAUMA? A LITERATURE REVIEW

Background: The application of technology in agricultural mechanization has not been able to prevent or reduce the threat of occupational health problems in farmers. It is necessary to identify the causative or triggering factors. Purpose: Identify the causes and types of injuries experienced by farmers. Review: The method used in this study was a literature review with an electronic database search through Springer Link, Science Direct, Pub-med, and Google Scholar based on the inclusion criteria respondents that were farmers who had experienced work-related trauma and there were interventions in the form of assessment of trauma events in farmers, using the method of a systematic review or analytical retrospective study or a population-based observational study or cross-sectional study, using Indonesian and English, published in 2018-2022. Result: The results of the literature review showed that the causes of trauma due to agriculture were agricultural machinery, hand tools/ manual agricultural tools, farm animals, wild animals, falls, ergonomic positions, and fatigue. At the same time, the types of trauma in farming accidents were soft tissue injuries, concussions, fractures, avulsions, amputations, and infections to death. Conclusion: Work-induced injuries directly affected farmers' lives, so it is necessary to increase knowledge in recognizing the factors causing injuries and management according to the type of injury experienced.

Frequency of Chronic Pain after Work-Related Trauma: A Preliminary Status Survey during Workers' Compensation Rehabilitation in a Tertiary Clinic

Chronic pain after trauma and surgery is a long-term complication. Its relevance for patients within the workers' compensation rehabilitation process has not been adequately investigated. Initial evaluation of frequency of chronic pain after occupational accidents. In 2017, surgical inpatients (18-65 y) treated in a tertiary hospital were asked about chronic pain arising from an occupational trauma recognized by statutory occupation insurance (interval 2.8±6.9 years), regardless of care received, first at the time of hospitalization and then by telephone interview 6 months later. The focus was on patients with a work-related trauma (A) within the past month or (B) >6 months. frequency of work trauma-related chronic pain (>6 months) at the initial interview (point prevalence), secondary outcomes: frequency of chronicity at 6 months (A) and persistence of chronic pain (B). Tertiary outcomes: ability to work, occupational injury classification, burden based on pain intensity, localization, and medication, functional deficits due to the existence of chronic pain, and comorbidity. Out of 415 patients included in the survey, 85% (160/188) reported accident-related chronic pain (predominantly moderate to highly severe in intensity, localized at joints and bones). 90% (131/145) also reported this pain six months later. 67% (64/96) reported chronic pain for the first time. Patients with chronic pain at follow-up (281/369) were less likely to return to work (p=0.003), required analgesics in 60%, were more often comorbid (p<0.002) and had greater functional deficits (p<0.002). Despite the preliminary nature of the data, chronic pain seems to be common after occupational trauma and negatively affects the recovery of work ability in the long term. Based on the present observational data, a further differentiated re-evaluation of prospective data considering therapeutic measures is strongly recommended.

Comparing post-traumatic stress severity in professional and volunteer Australian firefighters.

While extensive research has highlighted increased risk for post-traumatic stress disorder (PTSD) in firefighters, previous research has yielded mixed results regarding the role of work status (professional versus volunteer) in the development of psychopathological symptoms. To explore the predictive strength of work status on PTSD or post-traumatic stress symptom severity in a large sample of professional (PFFs) and volunteer (VFFs) Australian firefighters exposed to operational work-related trauma. The stratified random sample comprised 1317 PFFs (n = 1148 (87%) males and 13%, n = 169 (13%) females) and 898 VFFs (n = 744 (83%) males and n = 154 (17%) females) who reported having experienced trauma while working or volunteering. Participants completed demographic, health and work-related questions and mental health measures of stress, trauma, PTSD, social support and use of mental health prevention programmes. The results revealed a significant relationship between work status and PTSD, with PFFs reporting higher levels of PTSD symptom severity compared to VFFs. This association persisted after controlling for demographics, health, stress away from work, social support and use of organizational mental health support programmes (debriefing and face-to-face training for mental and physical self-care). This study suggests the importance of work status in PTSD amongst Australian firefighters exposed to operational trauma. Future research is needed to substantiate our findings and examine why PFFs may be more prone to developing PTSD. Implications for the provision of mental health programmes offered by fire organizations to their members are discussed.

Demography, clinical features, and outcome of fungal keratitis presenting in tertiary eye care in Nepal

Background: Fungal keratitis is an important cause of ocular morbidity in developing countries. Aims and Objectives: To study fungal keratitis in detail along with its outcome. Materials and Methods: This is a retrospective study of fungal keratitis that had presented between October 2013 and March 2015. Results: 168 fungal ulcers were enrolled. 145 had fungus isolated in the culture; 23 had fungal elements seen only in potassium hydroxide mount examination. The average age of patients was 46.7 years. 55.3% were male. 75% were farmers. Patients presented at an average of 23.6 days since the onset of symptoms. In 85 cases (50.6%), trauma was the risk factor followed by steroid use (12.5%, n=21) and diabetes mellitus (7.7%, n=13). 72 out of 85 cases of trauma were due to vegetative matter. 94 (55.9%) ulcers had hypopyon. 56 (33.3%) ulcers had infiltrate size of ≥¼ of corneal surface. 12 (7.1%) ulcers were perforated at presentation. Out of 145 fungal isolates, Aspergillus species and Fusarium species were isolated in equal numbers (n=41, 28.3% each), followed by unidentified hyaline fungus (14.4%, n=21). The ulcers were treated with combination of topical natamycin 5% and fluconazole 0.3% with or without oral fluconazole. 111 (66.1%) fungal ulcers improved with medical treatment, 37 (n=22.0%) underwent therapeutic penetrating keratoplasty, 6 (3.6%) were eviscerated and outcome unknown in 14 (8.3%). Smaller-sized ulcers, ulcers without hypopyon and those presenting within 7 days had better prognosis (&gt;80% healing with medical treatment) with statistical significance. Conclusion: Farmers were constantly at risk of fungal keratitis due to work-related trauma. Fungal ulcers presented late with large sized ulcers and with complications, thus making treatment challenging and necessitating surgical intervention. Timely treatment had better prognosis.

Work-related Trauma: Ordinary Work, Extraordinary Stress, and Emotional Labor Climate

Work-related Trauma: Ordinary Work, Extraordinary Stress, and Emotional Labor Climate

Labor and Delivery Clinician Perspectives on Impact of Traumatic Clinical Experiences and Need for Systemic Supports.

Few studies have elucidated the impact of work-related trauma on labor and delivery clinician or considered whether it may be a cause of burnout. This study aims to elicit labor and delivery clinician perspectives on the impact of exposure to traumatic births on their professional quality of life. Labor and delivery clinicians (physicians, midwives, nurse practitioners, and nurses; n = 165) were recruited to complete an online questionnaire on experiences with traumatic births. The questionnaire contained measures from the Maslach Burnout Inventory and the professional quality of life scale version 5. Some participants completed an optional free-text prompt to recommend ways to support clinicians after traumatic births (n = 115). Others opted into a semi-structured phone interview (n = 8). Qualitative data was analyzed using a modified grounded theory approach. Self-reported adequate institutional support for clinicians after a traumatic birth was positively correlated with compassion satisfaction (r = 0.21, p < 0.01) and negatively correlated with secondary traumatic stress (r = -0.27, p < 0.01), and burnout (r = -0.26, p < 0.01). Qualitative themes included lack of system-wide and leadership support, lack of access to mental health resources, and suboptimal workplace culture as contributors toward secondary traumatic stress and burnout. Participants recommended proactive leadership, consistent debriefing protocols, trauma education, and improved access to counseling. Multi-level barriers prevented labor and delivery clinicians from accessing needed mental health support after exposure to traumatic births. Proactive investment in healthcare system supports for clinicians may improve clinician professional quality of life.

ID: 200598 Targeted Muscle Re-Innervation for Management of Terminal Neuroma in Traumatic Upper Limb Amputation

The patient is a 49-year-old male with a left wrist disarticulation in the setting of work-related trauma complicated by thrombosis and osteomyelitis (Figure 1). His case was complicated by severe constant grabbing pain in his distal residual limb, refractory to conservative treatments, functionally limiting his ability to use his prosthesis for more than 30 minutes at a time. His examination revealed significant allodynia with palpation of the left distal forearm with an intact integumentary exam.

Treating intrusive memories after trauma in healthcare workers: a Bayesian adaptive randomised trial developing an imagery-competing task intervention

Intensive care unit (ICU) staff continue to face recurrent work-related traumatic events throughout the COVID-19 pandemic. Intrusive memories (IMs) of such traumatic events comprise sensory image-based memories. Harnessing research on preventing IMs with a novel behavioural intervention on the day of trauma, here we take critical next steps in developing this approach as a treatment for ICU staff who are already experiencing IMs days, weeks, or months post-trauma. To address the urgent need to develop novel mental health interventions, we used Bayesian statistical approaches to optimise a brief imagery-competing task intervention to reduce the number of IMs. We evaluated a digitised version of the intervention for remote, scalable delivery. We conducted a two-arm, parallel-group, randomised, adaptive Bayesian optimisation trial. Eligible participants worked clinically in a UK NHS ICU during the pandemic, experienced at least one work-related traumatic event, and at least three IMs in the week prior to recruitment. Participants were randomised to receive immediate or delayed (after 4 weeks) access to the intervention. Primary outcome was the number of IMs of trauma during week 4, controlling for baseline week. Analyses were conducted on an intention-to-treat basis as a between-group comparison. Prior to final analysis, sequential Bayesian analyses were conducted (n = 20, 23, 29, 37, 41, 45) to inform early stopping of the trial prior to the planned maximum recruitment (n = 150). Final analysis (n = 75) showed strong evidence for a positive treatment effect (Bayes factor, BF = 1.25 × 106): the immediate arm reported fewer IMs (median = 1, IQR = 0–3) than the delayed arm (median = 10, IQR = 6–16.5). With further digital enhancements, the intervention (n = 28) also showed a positive treatment effect (BF = 7.31). Sequential Bayesian analyses provided evidence for reducing IMs of work-related trauma for healthcare workers. This methodology also allowed us to rule out negative effects early, reduced the planned maximum sample size, and allowed evaluation of enhancements. Trial Registration NCT04992390 (www.clinicaltrials.gov).

Biomaterials Used in the Prosthetics of Facial Fractures

The etiology of maxillofacial injuries is represented by car accidents, human aggression, and work-related trauma. Trauma to the maxillofacial area requires a complex treatment that involves functional and aesthetic rehabilitation. To restore the functionality of the damaged areas, a correct surgical technique is necessary along with the use of the ideal prostheses for a better reconstruction. Along with the development and improvement of facial fractures osteosynthesis techniques, an attempt was made to identify the right material to complete these surgical methods. We analyze in this paperwork the benefits of polyetheretherketone-based materials in the prosthetics of different facial fractures in comparison with other materials like titanium.

Validation of the Danish PTSD Checklist for DSM-5 in trauma-exposed chronic pain patients using the Clinician-Administered PTSD Scale for DSM-5

ABSTRACT Background: Validation of post-traumatic stress disorder (PTSD) screening tools across various populations to ensure accurate PTSD estimates is important. Because of the high symptom overlap between PTSD and pain, it is particularly important to validate PTSD screening tools in trauma-exposed chronic pain patients. Objective: The present study is the first seeking to validate the PTSD Checklist for DSM-5 (PCL-5) in a sample of trauma-exposed, treatment-seeking chronic pain patients. Method: The validation and optimal scoring of the PCL-5 were investigated using the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) in chronic pain patients exposed to traffic or work-related traumas (n = 84). Construct validity was investigated using confirmatory factor analyses testing six competing DSM-5 models in a sample of mixed trauma-exposed chronic pain patients (n = 566), and a subsample of chronic pain patients exposed to traffic or work-related trauma only (n = 202). Furthermore, concurrent validity and discriminant validity were investigated using correlation analysis. Results: The results showed moderate (κ = .46) diagnostic consistency between the PCL-5 and the CAPS-5 using the DSM-5 symptom cluster criteria, and the overall accuracy of the scale (area under the curve = .79) was highly acceptable. Furthermore, the Danish PCL-5 showed excellent construct validity both in the full sample and in the subsample of traffic and work-related accidents, with superior fit of the seven-factor hybrid model. Excellent concurrent validity and discriminant validity were also established in the full sample. Conclusion: The PCL-5 appears to have satisfactory psychometric properties in trauma-exposed, treatment-seeking chronic pain patients.

Work-related ocular trauma in the United States: a National Trauma Databank study.

This study aims to investigate trends and risk factors associated with work-related ocular injuries occurring in adults aged 19-64 using the National Trauma Databank (NTDB). In this retrospective, cross-sectional study, the NTDB was used to collect all patients with an ICD-9 code of work-related ocular trauma from 2007 to 2014. Demographic data and risk factors collected included age, gender, race, setting, machinery, and mechanism. Descriptive statistics, univariate, and logistic regression multivariate analyses were conducted. Between 2007 and 2014, 234,983 cases of work-related trauma were identified, of which 11,097 (5.7%) cases involved ocular trauma. The mean age of patients was 40.7years (SD = 12.2), and the majority of patients (93.7%) were male. Most injuries occurred in an industrial facility, and the most common injuries were orbital floor fractures (OFFs), ocular contusions, open wounds to the adnexa, and open globe injuries (OGIs). OFFs most commonly involved a concurrent fracture of another facial or skull bone. Male gender (RR = 1.22; CI 1.09-1.38), accidental falls (RR = 1.50; CI 1.41-1.60), trauma from falling objects (RR = 1.34; CI 1.21-1.48), involvement in an unarmed fight (RR = 1.63; CI 1.39-1.91), assault by a blunt object (RR = 1.59; CI 1.31-1.91), and injury caused by animals (RR = 1.63; CI 1.30-2.02) were risk factors for OFFs. Patients with OFFs were less likely to have a concurrent OGI (RR = 0.27; CI 0.23-0.32). On the other hand, injuries occurring in industrial facilities (RR = 1.29; CI 1.11-1.51) and injuries with a loose foreign body striking the eye or adnexa (RR = 1.54; CI 1.28-1.84) were risk factors for OGI. The most common causes of work-related ocular trauma were accidental falls, motor vehicle accidents, and accidentally being struck in the eye. The mean length of hospital stay was 6.56days (SD = 10.82); 36.7% of patients required ICU admission, and the overall in-hospital mortality rate was 2.8%. The majority of work-related ocular trauma occurred in men, most commonly in industrial locations. Accidental falls were the most common identified cause of trauma. OFF was the most common ocular injury; 80% of OFF cases involved additional facial and skull fractures. Patients with OFFs were less likely to have a concurrent OGI compared with patients without OFFs.

The Relationship Between Trauma and Substance Use Among Healthcare Workers: A Cross-Sectional Analysis.

Trauma exposure is prevalent in the general population, but healthcare workers may be at greater risks for additional work-related trauma. Trauma is a known risk factor for substance use, particularly tobacco and risky alcohol use. Few studies have examined the relationship between trauma and substance use in healthcare workers. Among healthcare workers, the aims of our study were to examine (a) frequency of current tobacco use and risky alcohol use, (b) frequency and types of traumatic experiences, and (c) the associations between trauma experiences and current tobacco and risky alcohol use controlling for demographic factors. This study is a secondary analysis of cross-sectional survey data from healthcare workers (N = 850) in an academic medical center. Demographic and work-related variables, trauma experience, and substance use were examined. Multivariate logistic regression analysis examined associations between trauma exposure and tobacco and risky alcohol use controlling for demographic and work-related variables. Nearly 75% of respondents reported at least one lifetime traumatic experience, and one in 10 reported tobacco and risky alcohol use. When controlling for demographic and work-related variables, a dose-response relationship was observed such that the higher the number of traumatic experiences, there was a greater likelihood of reporting tobacco or risky alcohol use. Because healthcare providers have additional work-related trauma risk above the public, and greater trauma is associated with increased risk for substance use, it is important to screen for trauma and provide appropriate treatment resources to healthcare providers. Future research is needed to better delineate the relationship between specific traumas and risky substance use among healthcare providers.