A Public Partnership to Support Well-Being: Population Health Implementation of Trauma and Resilience Informed Care Across Child and Family Ecosystems.

Early life adversity and trauma can jeopardize child and family well-being. Mitigating the effects of early adversity and trauma requires a tiered, public health approach that includes trauma-informed mental health promotion, prevention, screening, early intervention, and effective and equitable treatment across community ecosystems and service systems. This article describes the development of a partnership between a public academic (University of California at Los Angeles) and community mental health system (Los Angeles County Department of Mental Health) and provides a roadmap for core principles and actionable steps to implement coherent, comprehensive, and adaptive trauma-informed community systems of support for children.

The effect of backpacks on the lumbar spine in children: a standing magnetic resonance imaging study.

STUDY DESIGN: This study is a repeated measures design to measure the lumbar spine response to typical school backpack loads in healthy children. The lumbar spine in this setting was measured for the first time by an upright magnetic resonance imaging (MRI) scanner. OBJECTIVE: The purpose of this study is to measure the lumbar spine response to typical school backpack loads in healthy children. We hypothesize that backpack loads significantly increase disc compression and lumbar curvature. SUMMARY OF BACKGROUND DATA: Children commonly carry school backpacks of 10% to 22% bodyweight. Despite growing concern among parents about safety, there are no imaging studies which describe the effect of backpack loads on the spine in children. METHODS: Three boys and 5 girls, age 11 +/- 2 years (mean +/- SD) underwent T2 weighted sagittal and coronal MRI scans of the lumbar spine while standing. Scans were repeated with 4, 8, and 12 kg backpack loads, which represented approximately 10%, 20%, and 30% body weight for our sample. Main outcome measures were disc compression, defined as post- minus preloading disc height, and lumbar asymmetry, defined as the coronal Cobb angle between the superior endplates of S1 and L1. RESULTS: Increasing backpack loads significantly compressed lumbar disc heights measured in the midline sagittal plane (P < 0.05, repeated-measures analysis of variance [ANOVA]). Lumbar asymmetry was: 2.23 degrees +/- 1.07 degrees standing, 5.46 degrees +/- 2.50 degrees with 4 kg, 9.18 degrees +/- 2.25 degrees with 8 kg, and 5.68 degrees +/- 1.76 degrees with 12 kg (mean +/- SE). Backpack loads significantly increased lumbar asymmetry (P < 0.03, one-way ANOVA). Four of the 8 subjects had Cobb angles greater than 10 degrees during 8-kg backpack loads. Using a visual-analogue scale to rate their pain (0-no pain, 10-worst pain imaginable), subjects reported significant increases in back pain associated with backpack loads of 4, 8, and 12 kg (P < 0.001, 1-way ANOVA). CONCLUSION: Backpack loads are responsible for a significant amount of back pain in children, which in part, may be due to changes in lumbar disc height or curvature. This is the first upright MRI study to document reduced disc height and greater lumbar asymmetry for common backpack loads in children.

Asymmetric loads and pain associated with backpack carrying by children.

BACKGROUND: Shoulder and back pain in school children is associated with wearing heavy backpacks. Such pain may be attributed to the magnitude of the backpack load and the manner by which children distribute the load over their shoulders and back. The purpose of this study is to quantify the pressures under backpack straps of children while they carried a typical range of loads during varying conditions. METHODS: Ten healthy children (aged, 12-14 years) wore a backpack loaded at 10%, 20%, and 30% body weight (BW). Backpacks were carried under 2 conditions, low on back or high on back. Pressure sensors (0.1 mm thick) measured pressures beneath the shoulder straps. RESULTS: When walking with the backpack straps over both shoulders, contact pressures were significantly greater in the low-back condition than in the high-back condition (P = 0.004). In addition, when children carried the backpack in the low-back condition, mean pressures (+/-SE) over the right shoulder were as follows: 98 +/- 31, 153 +/- 48, and 170 +/- 54 mm Hg at 10%, 20%, and 30% BW, respectively, which were significantly higher (P < 0.001) than those over the left shoulder (46 +/- 14, 92 +/- 29, and 90 +/- 29 mm Hg, respectively). Perceived pain with the backpack over 1 shoulder was significantly greater (P = 0.002) than that for donning with both shoulders in the low-back condition. CONCLUSIONS: Pressures at 10%, 20%, and 30% BW loads on the right or left shoulder, during low-back or high-back conditions, are higher than the pressure thresholds (approximately 30 mm Hg) to occlude skin blood flow. Furthermore, asymmetric and high pressures exerted for extended periods of time may help explain the shoulder and back pain attributed to backpacks.

Human cutaneous vascular responses to whole-body tilting, Gz centrifugation, and LBNP.

We hypothesized that gravitational stimuli elicit cardiovascular responses in the following order with gravitational stress equalized at the level of the feet, from lowest to highest response: short-(SAC) and long-arm centrifugation (LAC), tilt, and lower body negative pressure (LBNP). Up to 15 healthy subjects underwent graded application of the four stimuli. Laser-Doppler flowmetry measured regional skin blood flow. At 0.6 G(z) (60 mmHg LBNP), tilt and LBNP similarly reduced leg skin blood flow to approximately 36% of supine baseline levels. Flow increased back toward baseline levels at 80-100 mmHg LBNP yet remained stable during 0.8-1.0 G(z) tilt. Centrifugation usually produced less leg vasoconstriction than tilt or LBNP. Surprisingly, SAC and LAC did not differ significantly. Thigh responses were less definitive than leg responses. No gravitational vasoconstriction occurred in the neck. All conditions except SAC increased heart rate, according to our hypothesized order. LBNP may be a more effective and practical means of simulating cardiovascular effects of gravity than centrifugation.