Perceived stigmatization and fear of negative evaluation: Two distinct pathways to body image dissatisfaction and self-esteem in burn survivors.

OBJECTIVE: Scars resulting from burn injury can pose social and psychological problems that may affect body image and self-esteem. This study aimed to investigate whether burn severity, age and female gender are associated with body image dissatisfaction and self-esteem, through an association with perceived stigmatization and fear or negative evaluation. DESIGN & MAIN OUTCOME MEASURES: Burn survivors (N = 224) completed the Fear of Negative Evaluation scale (FNE) and the Perceived Stigmatization Questionnaire (PSQ) at 3 months post-burn, and the Rosenberg Self-Esteem scale (RSE) and the Satisfaction with Appearance scale (SWAP) at 6 months post-burn. Path analysis was used to test the relationships. RESULTS: Body image dissatisfaction and self-esteem were moderately associated. Burn severity was directly and indirectly associated with body image dissatisfaction through perceived stigmatization. Female gender and age were indirectly associated with body image dissatisfaction though fear of negative evaluation. Age was indirectly associated with both perceived stigmatization and fear of negative evaluation. Perceived stigmatization and fear of negative evaluation were associated with self-esteem through body image dissatisfaction, the first indirectly and the latter both directly and indirectly. CONCLUSIONS: Findings highlight that both burn-specific factors and psychological vulnerability should be taken into account to deal with social challenges that may affect body image and self-esteem after burns.

The reimbursement for expensive medicines: stakeholder perspectives on the SMA medicine nusinersen and the Dutch Coverage Lock policy.

BACKGROUND: The reimbursement for expensive medicines poses a growing challenge to healthcare worldwide. In order to increase its control over the costs of medicines, the Dutch government introduced the Coverage Lock (CL) policy in 2015. The CL postpones decisions regarding reimbursement of expensive medicines until detailed advice on i.e., cost-effectiveness has been given. The CL has been in place for six years, has raised many questions and concerns, but currently, no evaluation is known to the authors. A better understanding of the effects of the CL on all stakeholders involved may contribute to reflections on the CL process and help find ways to improve it. An evaluation of Dutch policy will also be relevant for other countries that aim to optimize reimbursement procedures for expensive treatments. To perform this evaluation, we focused on the CL procedure for the medicine nusinersen. Nusinersen is the first treatment for spinal muscular atrophy (SMA). Following EMA approval in May 2017, it was placed in the CL. The analysis of cost-effectiveness and added therapeutic value resulted in an advice for reimbursement limited to children younger than 9.5 years at the start of treatment; this was implemented from August 2018 onwards. METHODS: Qualitative stakeholder perspective analysis of the CL procedure focusing on nusinersen with 15 stakeholders. RESULTS: Stakeholders raised key issues of the CL based on their experience with nusinersen: emotional impact of the CL, duration of the CL procedure, appropriateness of the CL procedure for different types of medicines, transparency of the CL, a wish for patient-centred decision-making and the lack of uniformity of access to expensive treatments. DISCUSSION: Stakeholders supported measures to control healthcare expenses and to ensure reasonable pricing. They considered the delay in access to therapies and lack of procedural transparency to be the main challenges to the CL. Stakeholders also agreed that the interests of patients deserve more attention in the practical implementation of the reimbursement decision. Stakeholders suggested a number of adjustments to improve the CL, such as a faster start with conditional reimbursement programs to ensure access and intensify European collaboration to speed up the assessment of the medicine.

Child Posttraumatic Stress after Parental Cancer: Associations with Individual and Family Factors.

OBJECTIVE: This study aimed to examine the severity of posttraumatic stress disorder (PTSD) symptoms in children of parents with cancer and to identify individual and family factors associated with these symptoms. METHODS: The sample consisted of 175 children (52% girls, aged M = 11.98, SD = 3.20, range = 6-20 years) from 92 families, of which 90 parents with a current or past cancer diagnosis and 71 healthy co-parents also completed questionnaires. Children reported on PTSD symptoms, trauma-related cognitions, emotion regulation difficulties, general family functioning, and family communication. Both parents reported on their own PTSD symptoms. Associations were investigated using multilevel regression. RESULTS: Twenty-seven percentage of the children showed clinically relevant PTSD symptoms. Intraclass correlations indicated that children from the same family showed little overlap in these symptoms. Multilevel analyses showed that child trauma-related cognitions and emotion regulation difficulties were related to higher levels of PTSD symptoms at the individual level. General family functioning was only related to child PTSD symptoms at the family level. Child PTSD severity was unrelated to parental PTSD symptoms and family communication at the family level when taking into account the other factors. CONCLUSIONS: The current study highlights the psychological impact of parental cancer on children. Individual factors contributed more strongly to child PTSD symptoms than family factors. Trauma-related cognitions and emotion regulation difficulties might be targeted through specific psychoeducation for children and parents, family-oriented support and interventions, and evidence-based treatments for child PTSD.

Using Public Deliberation to Set Priorities: The Case of COVID-19 Vaccine Access in New York City.

CONTEXT: The COVID-19 pandemic has resulted in a record number of deaths in the United States and tremendous economic and personal strain. During 2020, in anticipation of a vaccine to slow the spread of disease, local and state governments in the United States developed plans for vaccine prioritization, given a limited initial supply. Recognizing the challenges inherent in prioritization, the New York City (NYC) health department sought guidance from members of the public about the fairest approach to early-stage vaccine distribution. OBJECTIVE: To solicit recommendations from NYC residents on priorities regarding vaccine access for essential worker occupations, considering risk factors and preferred approaches to fairness. IMPLEMENTATION: Five public deliberations were conducted with NYC residents (N = 91). Participants heard presentations on the COVID-19 vaccine, the local distribution of illness and death, and approaches to fairness in the context of deliberating on priorities for 6 essential worker occupations and 4 risk factors. Discussions were transcribed, and transcriptions were coded and analyzed using preidentified and emergent themes. Pre- and post-surveys, focused on factors relevant to prioritization, were administered during each public deliberation. RESULTS: Recommendations for prioritization emphasized risk of severe morbidity and mortality, and work and neighborhood conditions with fewer protections (eg, in-person work, exposure to many people). Participants prioritized elementary schoolteachers, grocery store workers, and bus drivers, underlying health conditions, and neighborhood of residence. Participants focused on equity, recognizing that those at highest risk were largely low-income populations of color and individuals living in low-resourced neighborhoods. CONCLUSIONS: Participants' focus on equity, and acknowledgment of racial and ethnic disparities, revealed a nuanced understanding of the broader determinants of health. Recommendations reinforced the NYC health department's approach to vaccine distribution. PUBLIC HEALTH IMPLICATIONS: Results from these public deliberations confirmed community support for approaches prioritizing health equity, recognizing both societal and personal factors affecting vulnerability to poor health.

Child adjustment to parental cancer: A latent profile analysis.

OBJECTIVE: This study aimed to identify latent classes of adjustment in children confronted with parental cancer, based on profiles of traumatic stress symptoms, health-related quality of life (HRQoL), and satisfaction with life. In addition, correlates of classes were examined. METHOD: Families were recruited through social media, health care providers, and cancer support centers. The sample consisted of 175 children (52% girls, aged M = 11.98, SD = 3.20, range = 6-20 years) from 92 families, including 90 parents with a current or past cancer diagnosis and 71 healthy parents. Children and parents completed self-report questionnaires at home. A latent profile analysis was conducted to identify classes based on child traumatic stress symptoms, HRQoL, and satisfaction with life. RESULTS: Four classes were identified, which were labeled (a) average functioning across domains (64%); (b) high stress, below-average HRQoL and life satisfaction (14%); (c) high stress, below-average HRQoL, and average satisfaction (11%); and (d) high functioning across domains (11%). Child age, parent traumatic stress symptoms, and perceived parental warmth were significantly associated with class membership. Child gender, which parent was diagnosed with cancer, and illness phase were unrelated to class membership. CONCLUSIONS: Meaningful subgroups of children can be distinguished based on positive and negative indicators of adjustment to parental cancer. Whereas the majority of children appear to adjust well, 25% of children display high levels of traumatic stress and impaired HRQoL, in some cases combined with low life satisfaction; these children may need specific attention to improve adjustment in the long term. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

COVID-19 Unmasked Global Collaboration Protocol: longitudinal cohort study examining mental health of young children and caregivers during the pandemic.

BACKGROUND: Early empirical data shows that school-aged children, adolescents and adults are experiencing elevated levels of anxiety and depression during the COVID-19 pandemic. Currently, there is very little research on mental health outcomes for young children. OBJECTIVES: To describe the formation of a global collaboration entitled, 'COVID-19 Unmasked'. The collaborating researchers aim to (1) describe and compare the COVID-19 related experiences within and across countries; (2) examine mental health outcomes for young children (1 to 5 years) and caregivers over a 12-month period during the COVID-19 pandemic; (3) explore the trajectories/time course of psychological outcomes of the children and parents over this period and (4) identify the risk and protective factors for different mental health trajectories. Data will be combined from all participating countries into one large open access cross-cultural dataset to facilitate further international collaborations and joint publications. METHODS: COVID-19 Unmasked is an online prospective longitudinal cohort study. An international steering committee was formed with the aim of starting a global collaboration. Currently, partnerships have been formed with 9 countries (Australia, Cyprus, Greece, the Netherlands, Poland, Spain, Turkey, the UK, and the United States of America). Research partners have started to start data collection with caregivers of young children aged 1-5 years old at baseline, 3-months, 6-months, and 12-months. Caregivers are invited to complete an online survey about COVID-19 related exposure and experiences, child's wellbeing, their own mental health, and parenting. DATA ANALYSIS: Primary study outcomes will be child mental health as assessed by scales from the Patient-Reported Outcomes Measurement Information System - Early Childhood (PROMIS-EC) and caregiver mental health as assessed by the Depression Anxiety Stress Scale (DASS-21). The trajectories/time course of mental health difficulties and the impact of risk and protective factors will be analysed using hierarchical linear models, accounting for nested effects (e.g. country) and repeated measures.

Antecedentes: Los primeros datos empíricos muestran que los niños en edad escolar, los adolescentes y los adultos están experimentando niveles elevados de ansiedad y depresión durante la pandemia de COVID-19. Actualmente, hay muy poca investigación sobre los resultados de salud mental de los niños pequeños. Objetivos: Describir la formación de una colaboración global titulada 'COVID-19 Desenmascarado'. Los investigadores colaboradores tienen como objetivos (1) describir y comparar las experiencias relacionadas con COVID-19 dentro y entre países; (2) examinar los resultados de salud mental de los niños pequeños (de 1 a 5 años) y los cuidadores durante un período de 12 meses durante la pandemia de COVID-19; (3) explorar las trayectorias/temporalidad de los resultados psicológicos de los niños y los padres durante este período e (4) identificar los factores de riesgo y de protección para las diferentes trayectorias de salud mental. Los datos de todos los países participantes se combinarán en un gran conjunto de datos transculturales de acceso abierto para facilitar más colaboraciones internacionales y publicaciones conjuntas. Métodos: COVID-19 Desenmascarado es un estudio de cohorte longitudinal prospectivo en línea. Se formó un comité directivo internacional con el objetivo de iniciar una colaboración global. Actualmente, se han formado asociaciones con 9 países (Australia, Chipre, Grecia, Países Bajos, Polonia, España, Turquía, Reino Unido y Estados Unidos de América). Los socios de investigación han comenzado la recopilación de datos con los cuidadores de niños pequeños de 1 a 5 años al inicio, a los 3 meses, a los 6 meses y a los 12 meses. Se invita a los cuidadores a completar una encuesta en línea sobre la exposición y las experiencias relacionadas con COVID-19, el bienestar del niño, su propia salud mental y parentalidad. Análisis de datos: Los resultados primarios del estudio serán la salud mental infantil según la evaluación de las escalas del Sistema De Información De medición de Resultados Informados Por El Paciente ­ Primera Infancia (PROMIS-EC) y la salud mental del cuidador según la evaluación de la Escala de estrés, ansiedad y depresión (DASS-21). Las trayectorias/temporalidad de las dificultades de salud mental y el impacto de los factores de riesgo y de protección se analizarán utilizando modelos lineales jerárquicos, teniendo en cuenta los efectos anidados (por ejemplo, el país) y las medidas repetidas.

Topical Review: Medical Trauma During Early Childhood.

OBJECTIVE: Early childhood is a high-risk period for exposure to traumatic medical events due to injury/illness. It is also one of the most important and vulnerable periods due to rapid development in neurobiological systems, attachment relationships, cognitive and linguistic capacities, and emotion regulation. The aim of this topical review is to evaluate empirical literature on the psychological impact of medical trauma during early childhood (0-6 years) to inform models of clinical care for assessing, preventing, and treating traumatic stress following injury/illness. METHODS: Topical review of empirical and theoretical literature on pediatric medical traumatic stress (PMTS) during early childhood. RESULTS: There are important developmental factors that influence how infants and young children perceive and respond to medical events. The emerging literature indicates that up to 30% of young children experience PMTS within the first month of an acute illness/injury and between 3% and 10% develop posttraumatic stress disorder. However, significant knowledge gaps remain in our understanding of psychological outcomes for infants and young children, identification of risk-factors and availability of evidence-based interventions for medical trauma following illness. CONCLUSIONS: This topical review on medical trauma during early childhood provides: (a) definitions of key medical trauma terminology, (b) discussion of important developmental considerations, (c) summary of the empirical literature on psychological outcomes, risk factors, and interventions, (d) introduction to a stepped-model-of-care framework to guide clinical practice, and (e) summary of limitations and directions for future research.

Expert Elicitation for Latent Growth Curve Models: The Case of Posttraumatic Stress Symptoms Development in Children With Burn Injuries.

Experts provide an alternative source of information to classical data collection methods such as surveys. They can provide additional insight into problems, supplement existing data, or provide insights when classical data collection is troublesome. In this paper, we explore the (dis)similarities between expert judgments and data collected by traditional data collection methods regarding the development of posttraumatic stress symptoms (PTSSs) in children with burn injuries. By means of an elicitation procedure, the experts' domain expertise is formalized and represented in the form of probability distributions. The method is used to obtain beliefs from 14 experts, including nurses and psychologists. Those beliefs are contrasted with questionnaire data collected on the same issue. The individual and aggregated expert judgments are contrasted with the questionnaire data by means of Kullback-Leibler divergences. The aggregated judgments of the group that mainly includes psychologists resemble the questionnaire data more than almost all of the individual expert judgments.

Latent classes of DSM-5 acute stress disorder symptoms in children after single-incident trauma: findings from an international data archive.

Background: After a potentially traumatic event (PTE), children often show symptoms of acute stress disorder (ASD), which may evolve into posttraumatic stress (PTS) disorder. A growing body of literature has employed latent class analysis (LCA) to disentangle the complex structure underlying PTS symptomatology, distinguishing between homogeneous subgroups based on PTS presentations. So far, little is known about subgroups or classes of ASD reactions in trauma-exposed children. Objective: Our study aimed to identify latent classes of ASD symptoms in children exposed to a single-incident PTE and to identify predictors of class membership (gender, age, cultural background, parental education, trauma type, and trauma history). Method: A sample of 2287 children and adolescents (5-18 years) was derived from the Prospective studies of Acute Child Trauma and Recovery (PACT/R) Data Archive, an international archive including studies from the USA, UK, Australia, and Switzerland. LCA was used to determine distinct subgroups based on ASD symptoms. Predictors of class membership were examined using a three-step approach. Results: Our LCA yielded a three-class solution: low (42%), intermediate (43%) and high (15%) ASD symptom severity that differed in terms of impairment and number of endorsed ASD symptoms. Compared to the low symptoms class, children in the intermediate or high severity class were more likely to be of female gender, be younger of age, have parents who had not completed secondary education, and be exposed to a road traffic accident or interpersonal violence (vs. an unintentional injury). Conclusions: These findings provide new information on children at risk for ASD after single-incident trauma, based on a unique set of international data. Classifying children based on latent symptom profiles helps to identify target groups for prevention and intervention after exposure to a PTE.

Antecedentes: después de un evento potencialmente traumático (EPT), los niños a menudo muestran síntomas de trastorno de estrés agudo (TEA), el cual, puede evolucionar a un trastorno de estrés postraumático (TEPT). Un creciente cuerpo de literatura ha empleado el análisis de clase latente (LCA por sus siglas en ingles) para desenredar la compleja estructura subyacente a la sintomatología de TEPT, distinguiendo entre subgrupos homogéneos basados en presentaciones de TEPT. Hasta ahora, se sabe poco sobre los subgrupos o clases de reacciones TEA en niños expuestos a traumas.Objetivo: Nuestro estudio tuvo como objetivo identificar clases latentes de síntomas de TEA en niños expuestos a un solo incidente de EPT e identificar predictores de pertenencia a la clase (género, edad, antecedentes culturales, educación de los padres, tipo de trauma e historial de trauma).Método: se obtuvo una muestra de 2287 niños y adolescentes (5­18 años) de los estudios Prospectivos del Archivo de Datos de recuperación y Trauma Infantil agudo (PACT/R, en sus siglas en inglés), un archivo internacional que incluye estudios de Estados Unidos, Reino Unido, Australia y Suiza. Se utilizó LCA para determinar distintos subgrupos basados en los síntomas de TEA. Los predictores de pertenencia a la clase se examinaron mediante análisis de regresión logística ponderada.Resultados: Nuestro LCA arrojó una solución de tres clases: gravedad de los síntomas de TEA baja (42%), intermedia (43%) y alta (15%) que difería en términos de deterioro y número de síntomas de TEA atribuidos. En comparación con la clase baja e intermedia, los niños en la clase de gravedad alta tenían más probabilidades de ser de género femenino, de menor edad, tener padres que no habían completado la educación secundaria y estar expuestos a la violencia interpersonal (versus a eventos médicos no interpersonales). Pertenecer a una minoría étnica se asoció con la pertenencia a la clase de "síntomas intermedios" en comparación con la clase de "síntomas bajos".Conclusiones: Estos hallazgos brindan nueva información sobre los niños en riesgo de TEA después de un incidente traumático único, en base a un conjunto único de datos internacionales. La clasificación de los niños según los perfiles de síntomas latentes ayuda a identificar los grupos objetivo para la prevención e intervención después de la exposición a un EPT.

Mothers' emotions after pediatric burn injury: Longitudinal associations with posttraumatic stress and depressive symptoms 18 months postburn.

BACKGROUND: Various emotions are implicated in posttraumatic stress disorder (PTSD). Longitudinal studies examining temporal associations between emotions and posttraumatic stress may reveal who is at risk of chronic psychological problems. This study examined the longitudinal relationships of mothers' trauma-related emotions with posttraumatic stress and depressive symptoms after pediatric burn injury. METHODS: Data from two cohort studies were used (n = 296). Mothers reported the intensity of burn-related emotions within the first month (T1) and 12 months postburn (T2). The Impact of Event Scale (IES) and the Hospital and Anxiety Depression Scale (HADS-D; depression subscale) were administered at T1 and 18 months postburn (T3). RESULTS: Based on two exploratory factor analyses, emotion variables were combined into acute and long-term basic emotions (fear, sadness, horror, anger) and self-conscious emotions (guilt, shame). The path model showed a positive relationship between acute and long-term basic emotions. Higher long-term basic emotions were related to persistence of posttraumatic stress and depressive symptoms. Acute self-conscious emotions showed associations with posttraumatic stress and depressive symptoms at T1 and were longitudinally related to depressive, but not posttraumatic stress, symptoms. LIMITATIONS: The posttraumatic stress measure was not based on DSM-5 PTSD criteria and results require replication using these criteria. CONCLUSIONS: This study suggests that mothers' acute self-conscious and long-term basic emotions in relation to their child's burn injury are involved in the development of posttraumatic stress and depressive symptoms. Clinically, assessing and monitoring parents' early posttraumatic stress, depressive symptoms and burn-related emotions may be useful to identify parents at risk.

The aftermath of burn injury from the child's perspective: A qualitative study.

A burn injury event and subsequent hospitalization are potentially distressing for children. To elucidate the child's experience of pediatric burn injury, children's reflections on the burn event and its aftermath were examined. Semi-structured interviews were conducted with eight children (12-17 years old). Using thematic analysis, interview transcripts were coded and codes were combined into overarching categories. Three categories were identified: vivid memories; the importance of parental support; psychosocial impact and coping. Implications for care are discussed in terms of assessing children's appraisals, paying attention to the parent's role, and preparing families for potential psychological barriers after discharge.

Effectiveness of the Labour Inspection Authority's regulatory tools for work environment and employee health: study protocol for a cluster-randomised controlled trial among Norwegian home-care workers.

INTRODUCTION: There is a need to evaluate whether, and to what degree, labour inspections or other regulatory tools have the desired effects on psychosocial, organisational and mechanical work environment, and employee health. The Norwegian Labour Inspection Authority (NLIA) uses different tools and strategies to enforce compliance with occupational safety and health (OSH) legislation. The aim of the present study is to evaluate the effects of labour inspections and other regulatory tools employed by the NLIA. The home-care service is one of the fastest growing occupations and a prioritised area for the NLIA, hence the present study will investigate regulatory tools in this sector. METHODS AND ANALYSIS: The research project has been designed as a longitudinal, cluster-randomised, controlled trial and will be conducted among Norwegian home-care workers. The objective of the research project is to evaluate the effects of the NLIA's regulatory tools (inspection and guidance) on: (1) compliance with OSH legislation and regulation; (2) psychosocial, organisational and mechanical work environment; (3) employee health in terms of musculoskeletal and mental health complaints; and (4) sickness absence. Public home-care services have been randomised to three intervention groups and one control group. Home-care services in the intervention groups will receive one of three intervention activities from the NLIA: (1) inspection from the Labour Inspection Authority; (2) guidance through an online interactive risk-assessment tool; and (3) guidance on psychosocial, organisational and mechanical work environment through workshops. The interventions will be performed at the organisational level (home-care service), and the effects of the interventions on the working environment and health complaints will be measured at the individual level (home-care employees). ETHICS AND DISSEMINATION: This project has been approved by the Regional Committees for Medical and Health Research Ethics (REC) in Norway (REC South East) (2018/2003/REK sør-øst C), the Norwegian Center for Research Data (566128), and will be conducted in accordance with the World Medical Association Declaration of Helsinki. The results will be reported in international peer-reviewed journals. TRIAL REGISTRATION NUMBER: NCT03855163.

Parents' memories and appraisals after paediatric burn injury: a qualitative study.

Background: It is well established that a paediatric burn injury can lead to parental post-traumatic stress symptoms. The content of parents' memories and appraisals may reveal the traumatic experiences that need attention. Objective: To inform clinical practice, the aim of this study was to qualitatively examine parents' (intrusive) memories and appraisals, and associated emotions, concerning the injury, the hospitalisation, and its consequences. Method: Approximately three to six months after the burn event, semi-structured interviews were conducted with parents of 18 children (0-16 years old) that had been hospitalised for a burn injury. Thematic analysis was carried out to obtain themes. Results: A central element in parents' memories and appraisals was a sense of external or internal threat. Intrusive memories were predominantly related to the accident and first aid (i.e. threat of the injury), whereas parents' memories about the child's suffering were emotional but not experienced as intrusive. Later appraisals of the burn injury and its consequences included negative appraisals of the child's increased vulnerability, responsibility of self or other, the child's prolonged suffering and (risk of) permanent change, as well as appraisals of positive outcome and recovery. Emotions commonly reported in the context of memories and appraisals were fear, sadness, guilt, and relief. Conclusions: This study offers insight into the traumatic nature of paediatric burn injury from the parent's perspective and provides directions for the delivery of trauma-informed (after)care.

Antecedentes: está bien establecido que una lesión por quemadura pediátrica puede provocar síntomas de estrés postraumático en los padres. El contenido de los recuerdos y de su evaluación por parte de los padres, puede revelar las experiencias traumáticas que necesitan atención.Objetivo: Informar la práctica clínica, el objetivo de este estudio fue examinar cualitativamente los recuerdos (intrusivos) de los padres y sus evaluaciones, y las emociones asociadas, en relación con la lesión, la hospitalización y sus consecuencias.Método: Aproximadamente de tres a seis meses después del evento de quemadura, se realizaron entrevistas semiestructuradas con padres de 18 niños (de 0 a 16 años de edad) que habían sido hospitalizados por una lesión por quemadura. Se realizó un análisis temático para obtener los temas.Resultados: Un elemento central en los recuerdos y evaluaciones de los padres era una sensación de amenaza externa o interna. Los recuerdos intrusivos se relacionaban predominantemente con el accidente y los primeros auxilios (i.e. la amenaza de lesión), mientras que los recuerdos de los padres sobre el sufrimiento del niño eran emocionales, pero no experimentado como intrusivo. Las evaluaciones posteriores de la lesión por quemaduras y sus consecuencias incluyeron evaluaciones negativas del aumento en la vulnerabilidad del niño, responsabilidad de sí mismo o de otro, el sufrimiento prolongado del niño y (el riesgo de) cambio permanente, así como una evaluación de resultados positivos y recuperación. Las emociones comúnmente reportadas en el contexto de los recuerdos y las valoraciones fueron el miedo, la tristeza, la culpa y el alivio.Conclusiones: este estudio ofrece información sobre la naturaleza traumática de la lesión por quemadura pediátrica desde la perspectiva de los padres y brinda instrucciones para brindar atención (posterior) a los traumas.

Subacute Combined Spinal Cord Degeneration by Recreational Laughing Gas (N2O) Use.

BACKGROUND: A few young patients were brought in with subacute combined spinal cord degeneration at the Department of Neurology in our hospital. They all have used laughing gas for recreational purposes. CASE: A 30-year-old woman, known with alcohol abuse, was presented to our Department of Neurology for having paresthesia and unstable movements of arms, legs, and trunk for 9 days. She has used 50 laughing gas patterns per day. The diagnosis of laughing gas-induced combined spinal cord degeneration was evident by the low count of vitamin B12 combined with lesions shown on magnetic resonance imaging (MRI). Abstaining from the laughing gas, weekly intramuscular injections of hydroxocobalamin and revalidation, she was fully recovered in 8 weeks. CONCLUSIONS: Recreational use of laughing gas seems to be more used in our society, however, without having any knowledge of the neurological consequences. The right diagnosis and treatment can provide full recovery in these patients. Furthermore, attention for this diagnosis can help increase social awareness.

Emotional Dissonance, Mental Health Complaints, and Sickness Absence Among Health- and Social Workers. The Moderating Role of Self-Efficacy.

Health- and social workers are frequently exposed to emotionally demanding work situations that require emotion regulation. Studies have demonstrated a direct relationship between emotion regulation and health complaints and sickness absence. In order to prevent health complaints and to reduce sickness absence among health- and social workers, there is need for greater attention to mechanisms explaining when and how emotionally demanding work situations are related to employee health and sickness absence. The overarching aim of this study was therefore to examine the moderating role of generalized self-efficacy on the association between emotional dissonance, employee health (mental distress and exhaustion), and registry based sickness absence. The sample consisted of 937 health- and social workers. Data on emotional dissonance, generalized self-efficacy, exhaustion, and mental distress was collected through questionnaires, whereas official registry data were used to assess sickness absence. A two-step hierarchical regression analysis showed that emotional dissonance was significantly associated with exhaustion, mental distress, and sickness absence, after adjusting for sex, age, and occupation. Interaction analyses with simple slope tests found that self-efficacy moderated the association between emotional dissonance and both exhaustion and mental distress, but not the association with sickness absence. This study shows that health- and social workers who frequently experience emotional dissonance report higher levels of exhaustion and mental distress, and have a higher risk of medically certified sickness absence. Further, health- and social workers with lower self-efficacy beliefs are apparently more sensitive to the degree of emotional dissonance and experienced higher levels of exhaustion and mental distress.

Emotional Dissonance and Sickness Absence Among Employees Working With Customers and Clients: A Moderated Mediation Model via Exhaustion and Human Resource Primacy.

Emotional dissonance, i.e., a discrepancy between required and felt emotions, has been established as a predictor of sickness absence in studies, but little is known about mechanisms that can explain this association. In order to prevent and reduce the impact of emotional dissonance on sickness absence, there is a need for greater attention to variables explaining when and how emotional dissonance is related to sickness absence. The overarching aim of this study was to examine whether emotional dissonance has an indirect association with sickness absence through exhaustion. In addition, we examined whether human resource primacy (HRP), which is the employer's degree of concern for human resources, moderates this indirect effect. A sample of 7758 employees, all working with customers and clients, were recruited from 96 Norwegian organizations. Emotional dissonance, exhaustion, and HRP were measured through surveys and then linked to registry data on medically certified sickness absence for the year following the survey assessment. Results showed that exhaustion is a mediator for the relationship between emotional dissonance and sickness absence. Furthermore, higher levels of HRP were found to reduce the positive association between emotional dissonance and exhaustion, and the indirect effect of emotional dissonance on sickness absence through exhaustion is found to be weaker when HRP is high. By testing this moderated mediation model, the current study contributes to the literature on emotion work by clarifying mechanisms that are crucial for the development of targeted interventions that aim to reduce and prevent sickness absence in client-driven work environments.

Mother, father and child traumatic stress reactions after paediatric burn: Within-family co-occurrence and parent-child discrepancies in appraisals of child stress.

AIM: The current study examined occurrence and within-family associations of traumatic stress reactions after child burn injury, while in the same model addressing the role of parents' own symptoms in their reports of child symptoms. METHODS: One-hundred children (8-18 years old), and their mothers (n=90) and fathers (n=74) were assessed within the first month (T1) and three months (T2) after burn. Parents and children rated child traumatic stress reactions on the Children's Responses to Trauma Inventory (CRTI) and parents rated their own reactions on the Impact of Event Scale (IES). Cross-sectional associations at the two occasions were examined using a structural equation model. RESULTS: Occurrence of traumatic stress symptoms in the clinical range was higher in parents (T1: 24-50%; T2: 14-31%) than children (T1: 0-11%; T2: 3-5%, depending on whether children, mothers or fathers reported on symptoms). Traumatic stress symptoms of mothers at T1 and of both parents at T2 were significantly related to child self-reported symptoms. Moreover, mothers who experienced higher stress symptoms themselves gave higher ratings of their child's symptoms at both time points, while for fathers, this was only found at T2. CONCLUSIONS: The current study demonstrates the impact of pediatric burn injury on the family level, and shows simultaneous existence of within-family interrelatedness of traumatic stress and an influence of parents' own symptoms on their perception of child symptoms. Findings highlight the need for trauma symptom screening in all family members and for considering informants' symptoms to understand the child's functioning in particular.