Trauma e literalidade: a razão psicodinâmica no espírito da traumatização neurocientífica / Trauma and literality: psychodynamic reason in the spirit of neuroscientific traumatization

Resumo Desde o seu nascimento na medicina cirúrgica do século XVII, a pesquisa do trauma admitiu interpretações múltiplas e associadas ora às lesões visíveis de órgãos e tecidos, ora à influência de agentes psíquicos patogênicos sobre a memória, a consciência e a personalidade. Com o aprofundamento do papel dos sistemas classificatórios desde DSM-III, o fenômeno do trauma será incorporado ao prisma psiquiátrico através do Transtorno de Estresse Pós-Traumático e destinado, finalmente, à circunscrição da pesquisa neurocientífica. A partir de revisão narrativa, este artigo abordará uma das premissas epistemológicas fundamentais para essa transição, que informa como o trauma psicológico ganhou autonomia sobre as descrições anatômicas para ser, cerca de um século depois, por ela reanexado enquanto fenômeno essencialmente corporal e aderido à gramática das neurociências.

Abstract Since its origin in the surgical medicine of the 17th century, trauma research has had multiple interpretations and has been associated either with visible injuries to organs and tissues, or with the influence of pathogenic psychic agents on memory, consciousness and personality. With the intensification of the role of classification systems since DSM-III, the phenomenon of trauma came to be incorporated into the psychiatric realm through Post-Traumatic Stress Disorder and destined finally to the constraints of neuroscientific research. Based on a narrative review, this article will address one of the fundamental epistemological premises for this transition, which informs how psychological trauma gained autonomy over anatomical descriptions to be reclassified, around a century later, as an essentially bodily phenomenon and incorporated into the jargon of neurosciences.

Prévalence et facteurs prédicteurs des troubles post-traumatiques chez les accidentés de la voie publique / Prevalence and predictors of post-traumatic stress disorder in road traffic accidents

Introduction: les troubles post-traumatiques survenant à la suite d'un accident de la route ont un impact tant sanitaire qu'économique. Méthodes: notre étude prospective, vise à déterminer la prévalence de ces troubles, et de dégager leurs facteurs de risque auprès de sujets victimes d'accidents de la route et hospitalisés au service de chirurgie orthopédique et de traumatologie du Centre Hospitalo-Universitaire de Sfax-Tunisie. Résultats: soixante-dix sujets ont été inclus dans notre étude. La prévalence de l'état de stress aigu était de 37,1% et il a été associé au sexe féminin, au niveau scolaire bas, à la présence d'antécédents médicochirurgicaux, à la passivité au cours de l'accident, à la sévérité des lésions, et à la présence d'une symptomatologie anxieuse et dépressive. Le trouble stress post traumatique était constaté chez 40% des sujets et il a été associé au milieu de résidence urbain, à la passivité au cours de l'accident, et à la symptomatologie anxieuse et dépressive. Des scores faibles des stratégies de coping fonctionnelles et des scores élevés des stratégies de coping dysfonctionnelles ont été significativement associés à ces deux troubles. Le niveau scolaire bas, la résidence en milieu urbain, un niveau élevé d'anxiété et de dépression et la stratégie de coping de déni apparaissent comme des facteurs de risque indépendants de l'état de stress aigu et du trouble stress post traumatique. Conclusion: il s'avère ainsi important de déterminer un profil de personnes plus exposées aux troubles post-traumatique afin de permettre un dépistage précoce par les médecins avec lesquels les accidentés pourraient avoir des contacts dans les suites de leurs accidents.

ntroduction: Post-traumatic stress disorder following a road accident has both a health and an economic impact. Methods: we conducted a prospective study to determine the prevalence of this disorder, and to identify risk factors in subjects victims of road accidents and hospitalized in the Department of Orthopedic Surgery and Traumatology of the University Hospital Center of Sfax-Tunisia. Results: a total of sixty-ten subjects were included in this study. The prevalence of acute stress was 37.1% and was associated with female sex, low educational level, previous medical and surgical history, passivity during the accident, severity of injuries and the presence of anxious and depressive symptoms. Post-traumatic stress disorder was observed in 40% of subjects and was associated with urban residential environment, passivity during the accident and anxious and depressive symptoms. Low scores for functional coping strategies and high scores for dysfunctional coping strategies were significantly associated with both disorders. Low educational level, urban residential environment, high levels of anxiety and depression, and denial coping strategy appear to be independent risk factors for acute stress and post-traumatic stress disorder. Conclusion: It is therefore important to determine the profile of people at greater risk of post-traumatic stress disorder, to enable early diagnosis in victims of road accidents.

Experiences of women with physical disabilities in labor and delivery assistance / Experiencias de mujeres con discapacidad física en la asistencia durante el trabajo de parto y parto / Vivências de mulheres com deficiência física na assistência ao trabalho de parto e parto

ABSTRACT Objective: To understand the meaning attributed by women with physical disabilities to the health care received and expected during labor and delivery. Methods: Qualitative study, based on Social Network Theory, conducted through an online workshop in April 2022, with the participation of six women with physical disabilities. Data, collected through the focus group technique, underwent thematic content analysis with the assistance of the IRaMuTeQ tool. Results: Three thematic categories emerged: Challenges experienced during pregnancy; The experience within the maternity ward; and, The importance of social networks. The assistance provided by healthcare professionals sometimes differed between what was expected and what was received by women with physical disabilities during labor and delivery. Final Considerations: Experiences were predominantly negative, resulting from inappropriate professional conduct due to ableist attitudes. Support from members of social networks is crucial for preventing stressors.

RESUMEN Objetivo: Comprender el significado atribuido por mujeres con discapacidad física a la asistencia de salud recibida y esperada durante el trabajo de parto y parto. Métodos: Estudio cualitativo, fundamentado en la Teoría de Redes Sociales, llevado a cabo mediante un taller en línea en abril de 2022, con la participación de seis mujeres con discapacidad física. Los datos, recopilados mediante la técnica de grupo focal, fueron sometidos a análisis de contenido temático con la ayuda de la herramienta IRaMuTeQ. Resultados: Emergieron tres categorías temáticas: Problemas experimentados durante el embarazo; La experiencia dentro de la maternidad; y La importancia de las redes sociales. La asistencia proporcionada por los profesionales de la salud, en ocasiones, difirió entre lo esperado y lo recibido por las mujeres con discapacidad física durante el trabajo de parto y parto. Consideraciones finales: Las experiencias fueron predominantemente negativas, resultado de conductas profesionales inadecuadas debido a actitudes capacitistas. El apoyo de los miembros de las redes sociales es fundamental para la prevención de factores estresores.

RESUMO Objetivo: Compreender o significado atribuído por mulheres com deficiência física à assistência de saúde recebida e esperada durante o trabalho de parto e parto. Métodos: Estudo qualitativo, fundamentado na Teoria de Rede Social, realizado por meio de uma oficina online em abril de 2022, com a participação de seis mulheres com deficiência física. Os dados, coletados por meio da técnica de grupo focal, foram submetidos à análise de conteúdo temático com o auxílio da ferramenta IRaMuTeQ. Resultados: Três categorias temáticas emergiram: Problemas vivenciados na gravidez; A experiência dentro da maternidade; e A importância das redes sociais. A assistência prestada pelos profissionais de saúde, por vezes, diferiu entre o esperado e o recebido pelas mulheres com deficiência física durante o trabalho de parto e parto. Considerações Finais: As vivências foram predominantemente negativas, resultantes de condutas profissionais inadequadas devido a atitudes capacitistas. O apoio dos membros das redes sociais é fundamental para a prevenção de fatores estressores.

Investigaciones biomédicas y psicosociales con enfoque comunitario en Ecuador

Introducción: Varios miembros del Departamento de Investigaciones en Adicciones de la Universidad de Ciencias Médicas de La Habana participaron en el 2020 y 2021 como docentes, asesores y directores de tesis en dos programas de formación académica de estudiantes ecuatorianos: especialización en Medicina Familiar y Comunitaria y maestría en Psicología Clínica (mención en Salud Mental Comunitaria). Objetivo: Describir los resultados del estudio y las investigaciones concluidas en ambos programas de formación académica. Método: Se realizó un estudio descriptivo de corte transversal basado en el análisis de los 69 proyectos de investigación desarrollados. Para la descripción de los resultados se realizó el análisis de contenido del 20 % de las investigaciones. Resultados: El 63,8 % de los estudios fueron investigaciones biomédicas, y el 36,1 % fueron estudios psicosociales. En ambos casos, el contexto social en las comunidades fue de (84,7 %). Entre las investigaciones médicas predominaron las dirigidas al paciente con hipertensión arterial (39,1 %) centradas en la adherencia terapéutica (32,6 %). En los estudios psicológicos predominaron los dirigidos a niños y adolescentes (23,0 %) y a profesionales sanitarios (23,0 %) centradas en las afecciones mentales (19,2 %). Conclusiones: Los proyectos desarrollados concluyeron resultados satisfactorios, se describió con mayor sistematicidad el enfoque comunitario en las investigaciones biomédicas. Se abordaron contenidos relativos a la adherencia terapéutica y las afectaciones a la salud mental. El impacto de la COVID-19 fue valorado como generador de dificultades en niños y adolescentes, profesionales sanitarios y en la población.

Introduction: In 2020 and 2021, the Department of Research on Addiction of Havana University of Medical Sciences participated as teachers, advisors and thesis directors in two academic training programs for Ecuadorian students: specialization in Family and Community Medicine and master's degree in Clinical Psychology with a mention in Community Mental Health. Objective: To describe the results of the study and the research concluded in both academic training programs. Methods: A descriptive cross-sectional study was carried out based on the analysis of the sixty nine research projects established. The content analysis of 20% of the investigations was carried out to describe the results. Results: 63.8% of the studies were biomedical research and 36.1% were psychosocial studies. In both cases, communities was the social context (84.7%). Among the medical investigations, those aimed at the patient with hypertension (39.1%) focused on therapeutic adherence (32.6%) predominated. In the psychological studies, those intended at children and adolescents (23.0%) and health professionals (23.0%) focused on mental disorders (19.2%) prevailed. Conclusions: These projects yielded satisfactory results. The community approach in biomedical research was more systematically described. Contents related to therapeutic adherence and the effects on mental health were addressed. The impact of COVID-19 was assessed as generator of difficulties in children and adolescents, health professionals, and in the population.

The best of two worlds: Combining the DSM-5 and ICD-11 clusters of symptoms for posttraumatic stress disorder in a single screening scale

Objectives: The most recent DSM-5 (2013) and ICD-11 (2018) diagnostic criteria for posttraumatic stress disorder (PTSD) encompass 20 and six symptoms, respectively, organized in different structures. This study aimed to investigate the dimensions of the Posttraumatic Stress Disorder Checklist 5 (PCL-5) according to the DSM-5's broader definition of PTSD and the ICD-11's narrower approach, as well as to explore an alternative restricted model that retains the core symptoms explicitly related to traumatic experiences. Methods: Data were gathered from Brazilian employees (n=1,101) who had directly experienced traumatic life events or had been exposed to them because of their work activities. Confirmatory factor analysis (CFA) and exploratory structural equation modeling (ESEM) were used to evaluate the configural and metric structures of the models. Results: We estimated seven models of the latent structure of PTSD including the four-factor DSM-5 and three-factor ICD-11 PTSD models. Given the lack of evidence of their validity, an alternative 10-symptom model was tested. The final seven-item PTSD model considerably improved estimation of the PTSD construct. This solution showed reliable items with non-redundant content, acceptable fit indices, and satisfactory configural and metric properties. Conclusion: The more parsimonious one-dimensional model comprising the core PTSD symptoms has the potential to improve assessment of PTSD.

Is post-traumatic stress disorder related to the severity of physical trauma?

SUMMARY OBJECTIVE: Trauma can cause physical morbidity and even result in death. Besides, it can lead to serious mental problems as well. The most well-known mental health problem is post-traumatic stress disorder. Through this study, it was primarily aimed to find out whether the severity of physical trauma is effective on post-traumatic stress disorder and other risk factors if any. METHODS: The reports of the patients who were transferred to the Turkish Council of Forensic Medicine Third Speciality Board between January 01, 2019, and December 31, 2020, for post-traumatic invalidity or disability evaluation and whose psychiatric examinations were performed were retrospectively analyzed in the electronic environment. RESULTS: It was found that 34 (26.4%) of the patients had a diagnosis of post-traumatic stress disorder (under treatment for at least 6 months), while 76 (58.9%) of them did not have a psychiatric disease and 19 (14.7%) of them had mental disorders not associated with trauma (i.e., affective disorder, anxiety disorder, etc.). No significant correlation was found between trauma scores and post-traumatic stress disorder (p>0.05). CONCLUSION: Based on the results of our study, post-traumatic stress disorder and the severity of physical trauma are not significantly correlated. Being of female gender, sustaining a non-accidental injury, and witnessing a fatal event stand out as significant risk factors.

Constituição psíquica e linguística de um sujeito com transtorno do espectro do autismo imerso em uma família vulnerável pela imigração no pós-guerra / Psychic and linguistic constitution of a subject with autism spectrum disorder immersed in a family vulnerable by post-war immigration / Constitución psíquica y lingüística de un sujeto con trastorno del espectro autismo inmerso en una familia vulnerable por inmigración de posguerra

Introdução: este artigo apresenta a constituição psíquica e linguística de um jovem autista, proveniente de uma família de imigrantes em situação de pós-guerra, em que entram em questão temas como o luto, a constituição psíquica transgeracional, e a presença de angústias no processo de desenvolvimento da criança em uma situação singular que é a presença do autismo. Objetivo: analisar os efeitos singulares da imigração e multiculturalismo em um caso de autismo e sua evolução terapêutica. Método: estudo de caso longitudinal, que utilizou diário clínico e filmagens de sessões com observações do desenvolvimento de Rafael, desde os dezoito meses até a idade adulta. Como abordagem terapêutica e análise dos resultados, foram utilizados aportes da constituição psíquica da teoria psicanalítica, e sobre o desenvolvimento linguístico em uma perspectiva enunciativa. Resultados: O multiculturalismo acarretava um desafio maior ao processo de aquisição da linguagem por parte da criança com autismo, enquanto o silêncio consequente da dor do luto, presente nos adultos, dificultava a troca verbal e atrasava sua constituição psíquica. O autismo, por sua vez, apresentou-se como transtornos qualitativos na comunicação, necessitando maior investimento por parte de seus cuidadores para que a aquisição da linguagem se desse, pois o paciente precisou ser fisgado para a nossa cultura. Conclusão: Diante de todo esse quadro, o caso clínico demonstra a importância do suporte terapêutico à família e do investimento contínuo na subjetivação, considerando e valorizando os diferentes códigos culturais que compõem o núcleo familiar. (AU)

Introduction: this article presents the psychic and linguistic constitution of an autistic young man, from a post-war immigrant family, in which themes such as mourning, the transgenerational psychic constitution, and the presence of anxieties in the process come into question of the child development in a unique situation that is the presence of autism. Objective: to analyze the unique effects of immigration and multiculturalism in a case of autism and its therapeutic evolution. Method: longitudinal case study, which used a clinical diary and footage of sessions with observations of the development of R. from eighteen months to adulthood. As a therapeutic approach and analysis of results, contributions from the psychic constitution of psychoanalytic theory, and on linguistic development in an enunciative perspective, were used. Results: Multiculturalism posed a greater challenge to the process of language acquisition by the child with autism, while the consequent silence of the pain of grief, present in adults, hindered verbal exchange and delayed their psychic constitution. Autism, in turn, presented itself as qualitative disorders in communication, requiring greater investment on the part of its caregivers for the acquisition of language to take place, as it needed to be hooked for our culture. Conclusion: Given this situation, this clinical case demonstrates the importance of therapeutic support to the family and the continuous investment in subjectivity, considering and valuing the different cultural codes that make up the family nucleus. (AU)

Introducción: este artículo presenta la constitución psíquica y lingüística de un joven autista, proveniente de una familia inmigrante de posguerra, en la que se cuestionan temas como el luto, la constitución psíquica transgeneracional y la presencia de ansiedades en el proceso del desarrollo del niño en una situación única que es la presencia del autismo. Objetivo: analizar los efectos singulares de la inmigración y la multiculturalidad en un caso de autismo y su evolución terapéutica. Método: estudio de caso longitudinal, que utilizó un diario clínico y metraje de sesiones con observaciones del desarrollo de R. desde los dieciocho meses hasta la edad adulta. Como abordaje terapéutico y análisis de resultados se utilizaron aportes desde la constitución psíquica de la teoría psicoanalítica y sobre el desarrollo lingüístico en perspectiva enunciativa. Resultados: El multiculturalismo supuso un mayor desafío al proceso de adquisición del lenguaje por parte del niño con autismo, mientras que el consiguiente silencio del dolor del duelo, presente en los adultos, dificultó el intercambio verbal y retrasó su constitución psíquica. El autismo, a su vez, se presentó como un trastorno cualitativo en la comunicación, requiriendo una mayor inversión por parte de sus cuidadores para que se produjera la adquisición del lenguaje, pues necesitaba engancharse a nuestra cultura. Conclusión: Ante esta situación, este caso clínico demuestra la importancia del apoyo terapéutico a la familia y la continua inversión en la subjetividad, considerando y valorando los diferentes códigos culturales que conforman el núcleo familiar. (AU)

Terapia de extinción y estimulación magnética transcraneal para el tratamiento de trastornos de ansiedad / Extinction therapy and transcranial magnetic stimulation for the treatment of anxiety disorders

Resumen Objetivo: Describir los factores que pueden determinar la reducción de los síntomas en el trastorno de ansiedad generalizada y trastorno por estrés postraumático, mediante estimulación magnética transcraneal en combinación con terapia de extinción. Material y Métodos: Se realizó una búsqueda en bases de datos (Cochrane, EBSCO, Pubmed, Sciencedirect y Wiley), con las palabras clave "transcranial magnetic stimulation", "human", "fear extinction". Los criterios de selección incluyen estudios en humanos, tratamientos con terapia de extinción y EMT, en donde se registre la conductancia de la piel como variable de respuesta. Resultados: Existe poca investigación que cumpla con los criterios de la presente revisión bibliográfica. Se obtuvieron 5 artículos enfocados en el tratamiento de síntomas como el miedo y la recurrencia de recuerdos traumáticos. Los protocolos de estimulación son heterogéneos, la frecuencia de estimulación va de 1 Hz a 30 Hz. La estimulación de alta frecuencia fue la más utilizada. La duración máxima de los efectos reportados fue de 1 mes. Conclusiones: La EMT junto con la terapia de extinción como tratamiento para TEPT y TAG es un campo de estudio que requiere de más investigación. Los resultados sobre su eficacia no son concluyentes, el tamaño de muestra es pequeño y es necesario identificar qué protocolos son eficaces a largo plazo. Los estudios clínicos con pacientes que presenten estos trastornos son relevantes para conocer los efectos de aquellos protocolos que han sido exitosos en pacientes sanos (condicionados al miedo).

Abstract Objective: To describe the factors that can determine the reduction of symptoms in generalized anxiety and posttraumatic stress disorders by transcranial magnetic stimulation in combination with extinction therapy. Material and methods: A bibliographic review was conducted in databases (Cochrane, EBSCO, PubMed, ScienceDirect y Wiley), using the keywords: "transcranial magnetic stimulation", "human" and "fear extinction". A selection of clinical trials that used extinction therapy plus TMS and the skin conductance as variable quantified was made. Results: Five articles focused on the treatment of symptoms, like fear and recurrence of traumatic memories were obtained. There is little research on the topic. Stimulation protocols are heterogeneous between studies (stimulation frequency ranges from 1 to 30 Hz). Most of the studies reviewed reported the use of high-frequency stimulation. The maximum duration of therapeutic effects reported was one month. Conclusions: TMS and extinction therapy as a treatment for PTSD and GAD has a growing research field. Effectiveness results are not conclusive, sample sizes are small, and studies do not focus on which protocols are effective in the long-term. New studies that include patients with diagnosed PTSD and GAD are relevant to assess the protocols that have already been successful in healthy patients (fear-conditioned).

Treating post-traumatic stress disorder in survivors of community and domestic violence using narrative exposure therapy: a case series in two public health centers in Rio de Janeiro/Brazil / Terapia de exposição narrativa para o tratamento do transtorno de estresse pós-traumático com pessoas que passaram por violência doméstica e comunitária: estudo de série de casos em dois centros de saúde no Rio de Janeiro, Brasil

Abstract Prevalence of violence in Brazil is high, which contributes to an increasing number of trauma-related disorders, especially post-traumatic stress disorder (PTSD). This study aims to present a case series of PTSD patients treated with narrative exposure therapy (NET) in two public health centers in Rio de Janeiro (Brazil). Health professionals were trained in a two-week workshop to deliver NET. Exposure to violence and other potentially traumatic events, as well as PTSD were assessed by interviewers before treatment and six months later in follow-up interviews conducted by blind assessors. Multiple traumatic events, including different types of childhood and sexual abuse, intimate partner violence and community violence were reported. Five patients were exposed to community violence, and one to domestic violence, during or after NET treatment. Treatment delivery was integrated into the routine of health centers. Eight patients completed NET and presented a substantial reduction in PTSD severity at six-month follow-up. NET is a feasible and effective treatment for PTSD patients exposed to ongoing violence, and can be integrated into established public health services.

Resumo A prevalência de exposição à violência é alta no Brasil, contribuindo para o aumento do número de transtornos relacionados a traumas, especialmente o transtorno de estresse pós-traumático (TEPT). Este estudo tem por objetivo apresentar uma série de casos de pacientes com TEPT que passaram pela terapia de exposição narrativa (NET) em dois centros de saúde do Rio de Janeiro. Os profissionais de saúde receberam duas semanas de treinamento NET. A exposição à violência e a outros eventos potencialmente traumáticos, bem como o TEPT, foram avaliados por entrevistadores antes do tratamento e seis meses depois em entrevistas de acompanhamento conduzidas por avaliadores sob condição cega. O tratamento foi integrado à rotina dos serviços. Oito pacientes completaram a NET e apresentaram redução substancial na severidade do TEPT. Todos reportaram exposição a eventos traumáticos múltiplos, incluindo diferentes tipos de abuso infantil, sexual, violência por parceiro íntimo e comunitária. Cinco pacientes foram expostos à violência comunitária e um à violência doméstica durante ou após o tratamento. Esta série de casos mostra que a NET é um tratamento eficaz para pacientes com TEPT expostos a violências contínuas e pode ser integrado nos serviços públicos de saúde.

Validation Spanish of the Post-Traumatic Stress Disorder Scale in the Postpartum - City BITS / Validación al castellano de la Escala de Trastorno de Estrés Postraumático en el Postparto - City BITS

Background: Postpartum post-traumatic stress disorder (PTSD) has a prevalence of 3-4% in women, rising to 15-19% in the presence of risks during pregnancy or childbirth, and reaching 39% in the case of neonatal death. Perinatal complications can trigger a real or perceived threat to maternal or neonatal life, which can evoke intense emotional reactions equivalent to a traumatic stressor according to PTSD criteria. Four symptom clusters have been identified: re-experiencing, avoidance, negative cognitions and mood, and hyperarousal symptoms. Despite its high comorbidity with depression and anxiety, postpartum PTSD remains underdiagnosed in maternal settings. The Postpartum Posttraumatic Stress Disorder Scale, originally developed in England, is in the process of translation and global validation. Objective: To validate the Spanish adaptation of the City Birth Trauma Scale. Methods: Quantitative, nonexperimental, cross-sectional, descriptive-correlational study in a sample of 677 Argentine women with children under 12 months of age. Results: Exploratory factor analysis revealed two dimensions that explained 49.56% of the total variance. Confirmatory factor analysis supported the two-factor structure. The scale showed high internal consistency (total α = .903), with α = .872 for 'birth-related symptoms' and α = .886 for 'general symptoms'. Construct validity of the City BiTS was demonstrated by moderate associations with the DASS-21 subscales and a negative correlation with the BIEPS-A. Conclusions: The Spanish adaptation of the City Birth Trauma Scale is confirmed as a reliable and valid instrument, consistent with original research findings and subsequent validations, articulating postpartum PTSD in two symptom categories: birth-related and general.

Introducci�n: El Trastorno de Estr�s Postraum�tico (TEPT) posparto tiene una prevalencia del 3�4% en mujeres, incrementando al 15-19% en presencia de riesgos durante la gestaci�n o parto, y alcanzando un 39% en caso de fallecimiento neonatal. Las complicaciones perinatales pueden desencadenar una amenaza real o interpretada sobre la vida materna o neonatal, lo cual puede suscitar intensas respuestas emocionales equivalentes a un estresor traum�tico seg�n los criterios de TEPT. Se identifican cuatro grupos sintom�ticos: reexperimentaci�n, evitaci�n, cogniciones y estado de �nimo negativos y s�ntomas de hiperactivaci�n. A pesar de su alta comorbilidad con depresi�n y ansiedad, el TEPT posparto permanece subdiagnosticado en contextos maternales. La Escala de Trastorno de Estr�s Postraum�tico en el Postparto, originalmente dise�ada en ingl�s en Inglaterra, est� en proceso de traducci�n y validaci�n global. Objetivo: Validar la adaptaci�n al castellano de The City Birth Trauma Scale. M�todo: Estudio cuantitativo, no experimental, transversal y descriptivo-correlacional en una muestra de 677 mujeres argentinas con hijos menores de 12 meses. Resultados: El an�lisis factorial exploratorio revel� dos dimensiones que explican el 49.56% de la varianza total. El an�lisis factorial confirmatorio respald� esta estructura bifactorial. La escala demostr� una alta consistencia interna (α total = 0.903), siendo α = 0.872 para "S�ntomas relacionados con el parto" y α = 0.886 para "S�ntomas generales". La validez de constructo de City BiTS se evidenci� a trav�s de asociaciones moderadas con las subescalas de DASS-21 y una correlaci�n negativa con BIEPS-A. Conclusi�n: La adaptaci�n al castellano de The City Birth Trauma Scale se confirma como un instrumento confiable y v�lido, alineado con hallazgos de la investigaci�n original y validaciones subsiguientes, articulando el TEPT posparto en dos categor�as sintom�ticas: las relacionadas al parto y las generales.

Effect of obesity induced by high-fat diet and adipose exosomes on knee post-traumatic osteoarthritis caused by destabilization of medial meniscus surgery in young mice / 药学学报

Obesity is an important risk factor related to osteoarthritis, but it′s role in post-traumatic osteoarthritis on young people need to further study. The internal mechanism except the mechanical loading may be associated with adipose exosomes. To examine the effect of obesity induced by high fat diet and adipose exosomes on knee post-traumatic osteoarthritis caused by destabilization of medial meniscus (DMM) surgery in young mice, 20 6-week-old C57BL/6J mice were randomly assigned to the control diet group (CD, n = 5), the DMM group (n = 5), the high fat diet group (HFD, n = 5) and the HFD plus DMM group (HFD+DMM, n = 5). The CD and DMM group were fed with a control diet, and the HFD and HFD+DMM group were fed with a high fat diet. We did the DMM surgery and the sham surgery on the mice when it was 10 weeks old. Extract obese and normal adipose exosomes, identify exosomes in vitro, and proceed fluorescence imaging in vivo using DiR staining. DMM+HFD-Exo group and DMM+CD-Exo group were injected the exosomes from the tail vain once a week (100 μL per shot with a concentration of 1 μg·μL-1). Second, 15 6-week-old C57BL/6J mice were randomly assigned to the DMM group (n = 5), the DMM plus obese adipose exosomes group (DMM+HFD-Exo, n = 5), and the DMM plus control diet adipose exosomes group (DMM+CD-Exo, n = 5). Animal welfare and experimental process are in accordance with the regulations of the Experimental Animal Ethics Committee of Nanjing University (IACUC-D2204005). All mice were sacrificed at the age of 18 weeks, the knee joints of the mice were harvested and fixed. We used micro CT to examine the samples and measured the bone volume/tissue volume, trabecular thickness, trabecular number and trabecular separation. Then the samples were decalcified and embedded in paraffin, and 4 μm thickness sections were stained with H&E and safranin O/fast green to observe the histological changes of the knee joint. The results showed compared with the control diet group, high fat diet induced obesity can aggravate the pathological changes of the post-traumatic osteoarthritis caused by DMM surgery, which shows in having a higher Mankin score. The surface of knee articular cartilage in the HFD+DMM group was rough, and the subchondral bone has an increase in bone sclerosis. Compared with the DMM group, obese adipose exosomes can exacerbate the pathological changes of the knee articular cartilage, while not influencing the subchondral bone. In conclusion, high fat diet induced obesity can aggravate the post-traumatic osteoarthritis caused by DMM surgery in young mice. The obese adipose exosomes mainly affect the surface of the knee articular cartilage.

Positive psychological capital and its influencing factors among parents of children with leukemia / 四川精神卫生

BackgroundPsychological capital has a significant impact on individual post-traumatic growth and well-being. However， there is limited research on the psychological capital and its related factors among parents of children with leukemia. ObjectiveTo explore the psychological capital status of parents of children with leukemia and analyze its influencing factors， in order to provide references for formulating intervention strategies to improve the psychological capital among these parents. MethodsFrom March 2021 to April 2022， 143 parents of children diagnosed with leukemia from the Department of Pediatrics at the First Affiliated Hospital of Xinjiang Medical University was selected. The general demographic information questionnaire， Positive Psychological Capital Questionnaire （PPQ）， Chinese-Posttraumatic Growth Inventory （C-PTGI） and Index of Well-being Scale （IWB） were used to investigate the participants. Multiple linear regression analysis was used to analyze the influencing factors of psychological capital. ResultsThe PPQ total score for parents of children with leukemia was （113.48±15.80）. The PPQ total score showed positive correlations with the scores of C-PTGI and IWB （r=0.727， 0.598， P<0.01）. The course of children's illness （β=0.136， P=0.017）， parental education level （β=0.139， P=0.012） and C-PTGI score （β=0.622， P<0.01） were influencing factors of psychological capital among these parents， collectively explaining 57.6% of the total variability. ConclusionThe level of positive psychological capital among parents of children with leukemia warrants improvement. Factors including course of the children's illness， parental education level and post-traumatic growth significantly impacted their psychological capital.［Funded by Innovation and Entrepreneurship Project for Graduate Students of Xinjiang Medical University （number， CXCY2022047）］

Head and Neck Cancer Survivors’ Perceptions of Cancer Treatment and Posttraumatic Growth

@#Introduction: Cancer patients’ perception on the treatment they received is vital to determine their adherence to cancer treatment, but important data on how this variable affects posttraumatic growth (PTG) experience by cancer patients is lacking. This cross-sectional study aimed to evaluate the degree of PTG among a cohort of head and neck cancer (HNC) survivors who were within first year of diagnosis and determined the association between perception of cancer treatment received (expectation and satisfaction with cancer treatment received and the feeling about the adverse effects) and PTG controlling for socio-demographic and clinical characteristics. Methods: HNC survivors were recruited from two oncology referral centres, and they were administered socio-demographic and clinical characteristics questionnaire, the Malay version of the Cancer Therapy Satisfaction Questionnaire (CTSQ) (to assess the satisfaction, expectation and feeling about the adverse effects of cancer treatment received) and the Malay version of the Posttraumatic Growth Inventory-Short Form (PTGi-SF) (to measure the degree of PTG). Results: A total of 200 HNC survivors participated in the study. The mean total PTGI-SF score was 39.5 (standard deviation [SD] = 9.3). Greater degree of positive expectation of cancer treatment and satisfaction with cancer treatment received significantly contributed to higher level of PTG, whereas feeling about side effects of treatment was not associated with PTG, after controlling for socio-demographic and clinical characteristics. Conclusion: Incorporating psychosocial interventions (such as education on cancer treatment and counselling) into the treatment regimen may facilitate development of PTG and hence, safeguard the mental well-being of HNC patients.

Short- and mid-term effectiveness of unicompartmental knee arthroplasty for post-traumatic arthritis of knee / 中国修复重建外科杂志

OBJECTIVE@#To investigate the short- and mid-term effectiveness of unicompartmental knee arthroplasty (UKA) for post-traumatic arthritis (PTA) of knee.@*METHODS@#The clinical data of 30 patients with PTA of unilateral knee between March 2014 and September 2021 was retrospectively analyzed. There were 14 males and 16 females with an average of 64.5 years (range, 33-81 years). The average body mass index was 26.7 kg/m 2 (range, 19.8-35.6 kg/m 2). The types of injuries that caused PTA included intra-articular fracture in 16 cases, extra-articular fracture in 8 cases, and soft tissue injury in 6 cases. The initial injuries were treated by conservative therapy in 12 cases and by surgical therapy in 18 cases. Ten cases were medial compartment osteoarthritis and 20 cases were lateral compartment osteoarthritis. According to Kellgren-Lawrence staging, there were 19 cases of grade Ⅲ and 11 cases of grade Ⅳ. The operative time, the length of hospital stay, complications, and subjective satisfaction were recorded. The Oxford Knee Function Score (OKS), Hospital for Special Surgery (HSS) score, and knee range of motion (ROM) were used to evaluate knee function. Weight-bearing X-ray films were taken to measure the femoro-tibial angle (FTA) and to assess alignment correction of the lower limb.@*RESULTS@#The operative time ranged from 50 to 95 minutes (mean, 63.7 minutes), the length of hospital stay ranged from 3 to 8 days (mean, 6.9 days). Superficial infection occurred in 2 patients, while the remaining incisions healed by first intention. There was no deep vein thrombosis or neurovascular injury. All patients were followed up 17-109 months (median, 70 months). At last follow-up, OKS score, HSS score, and ROM in 30 cases significantly improved when compared with those before operation (P<0.05). Lower limb alignment was significantly corrected and there was significant difference in FTA of the varus and valgus knees between pre- and post-operation ( P<0.05). The patient satisfaction rate was 86.7% (26/30). Two cases developed contralateral osteoarthritis progression during follow-up. No bearing dislocation, prosthesis loosening or sinking occurred and none required further revision.@*CONCLUSION@#For patients with PTA of knee, UKA can obtain definite short- and mid-term effectiveness with high patient satisfaction.

Mechanism of action of oxidative stress in severe traumatic brain injury and its complications: recent progress / 中华创伤杂志

Severe traumatic brain injury (sTBI) is characterized by critical condition, high lethality and poor prognosis. Its development and progression will lead to the damage and death of a large number of nerve cells, eventually causing a series of serious complications. The current treatments of sTBI and its complications are not optimistic due to problems such as unclear mechanism of action, challenges in treatment, and lack of effective prevention strategies. In recent years, more research evidences have shown that oxidative stress plays an important role in the development and progression of sTBI and its related complications. Therefore, it is of great significance to clarify the relationship of oxidative stress with sTBI and its complications and to understand the way of oxidative stress participating in the development and progression of sTBI. However, relevant researches are scattered and there lacks comprehensive and systematic summaries of oxidative stress participating in sTBI and its related complications. To this end, the authors reviewed the progress of the mechanism by which oxidative stress involves in sTBI and its complications, hoping to provide references for the research, treatment and prevention of sTBI.

Issues concerning total knee arthrophlalsty in the treatment of post-traumatic osteoarthritis / 中华创伤杂志

Post-traumatic osteoarthritis (PTOA) refers to the degeneration and destruction of cartilage after trauma to joints and surrounding tissues, along with the damage of subchondral bone, synovium, capsule, muscles and ligaments, finally resulting in osteoarthritis and dysfunction. PTOA of the knee mainly manifests as pain, stiffness and impairment of motion capacity. Management of PTOA includes physical therapy, medication and surgical intervention. Despite the pain was temporarily relieved, the long-term prognosis is still not satisfactory after medication and physical therapy. Surgical intervention is strongly recommended for the moderate and advanced stages of PTOA, which includes arthroscopic debridement, repair of cartilage, osteotomy and arthrodesis. For terminal PTOA, total knee arthroplasty (TKA) is necessary. However, TKA in the treatment of PTOA is challenging, especially for patients with surgical history, poor soft tissue conditions, abnormal alignment, multiple complications, as well as individual variation. Up to now, there is still a lack of standards and consensus for TKA in the treatment of PTOA. Accordingly, the author discusses the issues related to TKA in the treatment of PTOA, aiming to provide a reference for the treatment of PTOA of the knee.

Research progress in multi-omics biomarkers involved in post-traumatic stress disorder / 中华创伤杂志

Post-traumatic stress disorder (PTSD) is a psychiatric illness induced by exposure to severe stress-induced traumatic events. Repeated traumatic re-experience, avoidance, negative cognition and emotional changes seriously reduce the quality of life of PTSD patients. Currently, it is urgent to further clarify the etiology and molecular mechanism of PTSD in order to guide the diagnosis and treatment of PTSD. Considering the underlying pathophysiology is not entirely known, to identify the pertinent biomarkers of PTSD is critical in researching its incidence and progression. In contrast with the single-omics researches, multi-omics studies may methodically expand on biomolecular interactions from a range of angles, creating a new potential to comprehend the development of complicated human illnesses. Therefore, the authors review the research progress in PTSD biomarkers from aspects of genomics, transcriptomics and proteomics, hoping to provide a reference for future research and treatment of PTSD.

Effect of early intervention with electroacupuncture on behavior and gut microbiota in mice with post-traumatic stress disorder / 中华行为医学与脑科学杂志

Objective:To investigate the effect of early intervention with electroacupuncture (EA) on the gut microbiota in a mouse model of post-traumatic stress disorder(PTSD).Methods:Totally 32 C57BL/6 mice were randomly assigned to the following 4 groups ( n=8 for each group): Control group, EA group, PTSD group and PTSD+ EA group.After 7 days acclimation, mice in the PTSD group and PTSD+ EA group were subjected to modified single prolonged stress (mSPS). Mice in the EA group and PTSD+ EA group received EA (2/15 Hz, 1 mA, dilatational wave, 30 min/d) on "Baihui" for 7 days. Mice in the Control group and PTSD group received false stimulation (stimulated the same acupiont without electricity) for 7 days. Seven days after the last stimulation, elevated plus maze test and fear conditioning test were conducted to observe the effect of EA on PTSD-like behavior of mice. At the same time, feces of the mice were collected for gut microbiota detection by 16S rRNA sequencing.SPSS 19.0 was used for statistical analysis.One-way ANOVA was used for multiple group comparison and Bonferrani test was done for further pairwise comparision. Results:(1) There were statistically differences in the open arm activity time of the elevated plus maze test and the immobility time in contextual and cued fear conditioning test among the four groups ( F=6.93, 5.26, 14.51, all P<0.01). In the elevated plus maze test, mice in PTSD group ((60.17±15.52) s) showed significant less time in the open arms than mice in Control group((96.37±14.62) s) and PTSD+ EA group ((86.89±15.02) s) (both P<0.05). In the fear conditioning test, mice in PTSD group ((121.99±29.67) s, (130.82±29.11) s) showed significant increased immobility time both in contextual and cued fear conditioning tests than mice in Control group((74.50±26.65) s, (39.50±23.52) s) and PTSD+ EA group ((76.77±22.60) s, (102.17±3.39) s)(both P<0.05). (2) There were no significant differences among the four groups in the alpha diversity of gut microbiota ( F=0.79-2.45, all P>0.05). (3)Correlation analysis showed that 13 gut microbiotas were negatively correlated with the immobility time in contextual fear conditioning test, 2 gut microbiotas were positively correlated with it; 7 gut microbiotas were negatively correlated with the immobility time in cued fear conditioning test, 1 gut microbiota was positively correlated with it; 3 gut microbiotas were positively correlated with time spent in open arms of elevated plus maze test. Conclusion:Early intervention with EA can improve anxiety-fear like behaviors and gut microflora disorder in PTSD model mice.

Relationship between kinesiophobia and somnipathy among inpatients with lumbar degenerative disease after surgery and its impact pathway / 中国实用护理杂志

Objective:To explore the relationship between kinesiophobia and somnipathy among inpatients with lumbar degenerative disease after surgery, and analyze the mediating effects of post-traumatic stress disorder and family care.Methods:A cross-sectional survey method was adopted, from July 2020 to July 2022, a total of 130 lumbar degenerative disease patients from Wuhan Dongxihu District People′s Hospital were enrolled as research object by convenience sampling method. General information questionnaire, Tampa Scale for Kinesiophobia, Pittsburgh Sleep Quality Index, Posttraumatic Stress Checklist-civilian version and Family APGAR index were used for investigation. A structural equation model was established to evaluate the mediating effect of post-traumatic stress disorder, family care on kinesiophobia and somnipathy.Results:The scores of kinesiophobia, somnipathy, post-traumatic stress disorder and family care were (39.95 ± 3.90), (7.63 ± 0.46), (25.99 ± 4.99), (5.67 ± 1.76) points, respectively. There were significant differences in the scores of somnipathy in terms of age, monthly income, course of disease and pain degree ( F values were 3.21 to 10.12, all P<0.05). The dimensions and total scores of somnipathy were positively correlated with kinesiophobia ( r values were 0.347 to 0.800, all P<0.05) and post-traumatic stress disorder ( r values were 0.385 to 0.825, all P<0.05), negatively correlated with the scores of family care ( r values were - 0.653 to - 0.282, all P<0.05); the scores of family care was negatively correlated with kinesiophobia and post-traumatic stress disorder ( r = - 0.695, - 0.637, both P<0.05); the scores of kinesiophobia was positively correlated with post-traumatic stress disorder ( r = 0.773, P<0.05). The indirect effect of kinesiophobia on somnipathy was identified, and the total indirect effect value was 0.44; the indirect effect value of family care and post-traumatic stress disorder was 0.09, which accounted for 12.0% of the total effect. Conclusions:Post-traumatic stress disorder and family care play a multiple mediating role on the relationship between kinesiophobia and somnipathy in patients with lumbar degenerative disease after surgery.