Violence Exposure and Mental Health Consequences Among Urban Youth.

Urban residents are disproportionately affected by violence exposure and mental health consequences as compared to non-urban residents. The present study examined the prevalence of violence exposure and associated mental health consequences among urban and non-urban youth. Urban participants were drawn from Detroit, Michigan, a city that has led the nation for most of the last decade as one of the most violent big cities in the U.S. Participants included 32 Detroit youth and 32 youth recruited from the surrounding non-urban areas, matched on age (M=10.4±2.8 years) and sex (49% male). Youth completed validated measures of violence exposure, anxiety, and depression symptoms. Urban youth reported more violence exposures than their non-urban counterparts, including hearing gunshots (69% vs. 19%, respectively), witnessing a shooting (24% vs. 6%), and witnessing an arrest (58% vs. 27%). Overall, greater violence exposure was associated with more anxiety symptoms, particularly among urban youth. Although violence exposure was not associated with depressive symptoms overall, urban youth reported significantly higher depressive symptoms than non-urban youth. Exposure to specific violence types, particularly hearing gunshots, was associated with higher anxiety and depressive symptoms among urban but not non-urban youth. Being beat up predicted depressive symptoms among non-urban but not urban youth. Household income and community distress did not predict mental health outcomes. Taken together, urban youth have more exposure to violence, particularly firearm violence, and associated mental health problems than their non-urban counterparts. Targeted community-wide initiatives to prevent violence and identify exposed youth are needed to improve mental health in at-risk communities.

Facing ambiguity: Social threat sensitivity mediates the association between peer victimization and adolescent anxiety.

Peer victimization is a developmentally salient stressor that elevates adolescents' risk for anxiety disorders. However, modifiable mechanisms that explain this link and can be targeted via therapeutic interventions remain poorly understood. Drawing from psychobiological models implicating aberrant threat sensitivity in the development and maintenance of psychopathology, the current study investigated sensitivity to peer-related social threats as a mechanism underlying the association between peer victimization and anxiety. A sample of 197 dyads of early adolescents (M age = 12.02; 46% female) and parents/guardians (M age = 41.46; 90% female) completed online surveys assessing peer victimization, sensitivity to potential (i.e., ambiguous) social threats, and anxiety. Controlling for potentially confounding demographic and psychosocial factors, both self- and parent-reported peer victimization were positively associated with adolescent anxiety symptoms. Additionally, there were significant indirect effects from self- and parent-reported peer victimization to anxiety via social threat sensitivity. Supplemental analyses indicated unique effects of covert, but not overt, peer victimization on social threat sensitivity and anxiety. The findings provide initial evidence that peer victimization experiences lower adolescents' threshold for interpreting threats in ambiguous social situations, which contributes to heightened anxiety. These results implicate social threat sensitivity as a potential therapeutic target for interrupting links from peer victimization to psychological distress.

Martial arts-based curriculum reduces stress, emotional, and behavioral problems in elementary schoolchildren during the COVID-19 pandemic: A pilot study.

This exploratory study examined the impact of Heroes Circle, a martial arts-based curriculum on stress, emotional, and behavioral problems in elementary school children. While students completed classroom surveys at baseline, post-curriculum surveys were collected from teachers, students, and parents/guardians two and five months after COVID-19-related school shutdowns. Satisfaction with the curriculum was high among those who received the intervention. Children reported increased mindfulness and decreased stress over the school year. Most children (77%) were still using the program's techniques and reporting benefits five months later, including lower internalizing symptoms and COVID-19-related fears. These patterns were not observed at the control school.

Utilization of Imaging in the Management of Pediatric Dog Bites.

INTRODUCTION: We hypothesized that imaging is overused in the initial workup of dog bite patients. To reduce radiation exposure, we aim to determine which circumstances surrounding dog bites, patient population, and injury patterns would necessitate imaging studies for management. METHODS: A retrospective review was performed on all patients presenting with dog bites to our level I pediatric trauma center between 2013 and 2015. Data collected included: circumstances surrounding the injury, patient demographics, injuries, and imaging studies performed. Our analysis focused on maxillofacial and head CT scans, and plain radiographic studies of the limbs, hands, and feet. Imaging studies were considered positive if there was evidence of bony injury. RESULTS: We identified 615 patients with dog bites, with 114 patients having had at least one imaging study performed (a total of 145 imaging studies to analyze). Only 13 (11%) patients had a positive study. In the CT scan group, 6 (22.2%) of 27 studies were positive. In the plain radiographic group, 7 (5.9%) of 118 studies were positive. CONCLUSIONS: Our review indicates that imaging studies are overused in the initial workup of these patients, and the majority of these studies are negative. This study confirms that it is feasible to institute guidelines for ordering imaging studies in dog bite patients. This will ultimately reduce radiation exposure and the cost of care for these injuries.

A Systematic Review and Meta-Analysis on the Effects of Exercise on the Endocannabinoid System.

Introduction: The endocannabinoid (eCB) system plays a key role in maintaining homeostasis, including the regulation of metabolism and stress responses. Chronic stress may blunt eCB signaling, and disruptions in eCB signaling have been linked to stress-related psychiatric disorders and physical health conditions, including anxiety, depression, post-traumatic stress disorder (PTSD), diabetes, and obesity. Pharmacological and nonpharmacological behavioral interventions (e.g., exercise) that target the eCB system may be promising therapeutic approaches for the prevention and treatment of stress-related diseases. In this study, we perform a systematic review and the first meta-analysis to examine the impact of exercise on circulating eCB concentrations. Materials and Methods: We performed a review of the MEDLINE (PubMed) database for original articles examining the impact of exercise on eCBs in humans and animal models. A total of 262 articles were screened for initial inclusion. Results: Thirty-three articles (reporting on 57 samples) were included in the systematic review and 10 were included in the meta-analysis. The majority of samples that measured anandamide (AEA) showed a significant increase in AEA concentrations following acute exercise (74.4%), whereas effects on 2-arachidonoylglycerol (2-AG) were inconsistent. The meta-analysis, however, revealed a consistent increase in both AEA and 2-AG following acute exercise across modalities (e.g., running, cycling), species (e.g., humans, mice), and in those with and without pre-existing health conditions (e.g., PTSD, depression). There was substantial heterogeneity in the magnitude of the effect across studies, which may relate to exercise intensity, physical fitness, timing of measurement, and/or fasted state. Effects of chronic exercise were inconsistent. Conclusions: Potential interpretations and implications of exercise-induced mobilization of eCBs are discussed, including refilling of energy stores and mediating analgesic and mood elevating effects of exercise. We also offer recommendations for future work and discuss therapeutic implications for exercise in the prevention and treatment of stress-related psychopathology.

Are the kids really alright? Impact of COVID-19 on mental health in a majority Black American sample of schoolchildren.

Children from historically disadvantaged groups (racial minorities, lower socioeconomic status [SES]) may be particularly susceptible to mental health consequences during the COVID-19 pandemic. We examined the impact of the pandemic, including mental health symptoms and COVID-19-related fears and behaviors, in a sample of majority Black American (72%) children (n=64, ages 7-10, 24 female) from an urban area with high infection rates. Children completed a mental health screening form prior to the pandemic (October 2019) and at two time points during the pandemic (May, August 2020). We examined the impact of SES on mental health changes over time, COVID-19 fears and behaviors, and perceived impact of the pandemic. We also tested whether baseline mental health predicted the impact of COVID-19. Children's fears of illness increased over time, and these effects were independent of race and SES. However, lower SES children reported more fears about social distancing during the pandemic as compared to higher SES children. Lower SES children also reported more internalizing symptoms at baseline, which decreased in this group following stay-at-home orders. Results highlight the need to reduce the risk of persistent fear and mitigate the mental health consequences among vulnerable pediatric populations during and after the pandemic.

Pediatric dog bite outcomes: infections and scars.

BACKGROUND: There is little consensus on the management of dog bite victims. Few studies have examined long-term patient outcomes. This study was designed to evaluate two outcomes: infection and unfavorable scar formation. METHODS: A retrospective study of dog bite cases from January 2013 to May 2016 was conducted at our level I pediatric trauma center. Forty-five patients were identified who received definitive repair and had long-term follow-up for reasons other than rabies vaccination. Variables recorded were wound characteristics including presence of tissue loss, location in the hospital of the wound repair procedure, personnel performing the repair, postrepair infection, and a binary assessment of unfavorable scar formation. RESULTS: Unfavorable scarring was not significantly related to either repair location or personnel. Rate of infection was not significantly related to repair location. However, infection rate was significantly related to personnel performing the repair (p=0.002), with 8 of 11 (73%) infections after repair by emergency physicians compared with surgeons. DISCUSSION: The presence of infection was significantly related to bedside repair by emergency physicians. The data are suggestive of differences in wound preparation and repair technique between emergency department and surgical personnel. Standardizing technique could reduce infectious complications and long-term morbidity associated with repairing dog bites and other contaminated wounds. A robust and practical classification system for dog bite wounds would be helpful in stratifying these wounds for research comparison and healthcare triage. LEVEL OF EVIDENCE: The level of evidence for this retrospective study is level III.

Sink bathing burns: A unique opportunity for an injury prevention initiative.

Sink-bathing is common practice among parents. However, this puts infants and young children at unrecognized risk for burn injuries. As the only verified pediatric burn center in a large urban area, we treat burn patients from a large variation in socioeconomic status. This provides us a unique opportunity to examine sink-burn injury patterns, circumstances surrounding these burns, identify areas with high incidence and put in place an injury prevention outreach initiative. This retrospective study included patients treated for sink-bathing burns at our burn center in an 8.5-year period. Analysis of 71 patients revealed infants under one year of age are most commonly afflicted. Additionally, that families of low-socioeconomic means are disproportionately affected. Understanding the different circumstances surrounding sink-bathing burns allows us to be more specific in our community education efforts and efficiently guide our resources.

Circumstances surrounding gun violence with youths in an urban setting.

BACKGROUND: Our pediatric trauma center has noted an increase in the occurrence of gunshot wounds in children. We aimed to understand the circumstances surrounding these injuries in order to provide targeted injury prevention methodologies. METHODS: A retrospective review was performed on patients who presented with a gunshot wound to our Level I Pediatric Trauma Center and two neighboring Adult Trauma Centers between 2013 and 2017. RESULTS: Three hundred twenty-six patients (6 months to 18 years) were treated for gunshot wounds. Patients were African American (86%), Caucasian (9%), and other races (5%). Eight zip-codes were identified as high-risk, accounting for 52% of patients. Most injuries (86%) were from powder firearms. Known circumstances (n = 275) included drive-by shootings (47%), unlocked guns (19%), crime related (13%), altercation between adolescents (7%), cross-fire from adult altercation (6%), home invasion (6%), and suicide attempts (2%). There was a progressive increase of 50% over the last 4 years. The increase in incidence was predominantly from an increase in drive-by shootings; however, the incidence of injuries from unlocked guns has remained relatively constant per year. Mortality was 6%. CONCLUSION: Identifying high-risk zones for drive-by shootings and other crimes is critical for developing system-focused interventions. Zip-code data stratified by age and circumstances, will allow for targeted community outreach on gun safety education, in an effort to reduce the incidence of injuries from unlocked guns. LEVEL OF EVIDENCE: Prognostic and Epidemiologic study, Level III.