DNA methylation of Nuclear Factor of Activated T Cells 1 mediates the prospective relation between exposure to different traumatic event types and post-traumatic stress disorder

The mechanisms through which exposure to differing trauma types become biologically embedded to shape the risk for subsequent post-traumatic stress disorder (PTSD) is unclear. DNA methylation (5-mC), particularly in stress-relevant genes, may play a role in this relationship. We conducted path analysis using generalized structural equation modeling to investigate whether blood-derived 5-mC in Nuclear Factor of Activated T Cells 1 (NFATC1) mediated the prospective association between each of five different trauma types (assaultive violence, other injury or shocking experience, learning of trauma to loved one, sudden, unexpected death of a close friend or relative, and other) and lifetime PTSD. All five trauma types were significantly associated with reduced methylation at NFATC1 CpG site, cg17057218. Three of the five trauma types were significantly associated with increased methylation at NFATC1 CpG site, cg22324981. Moreover, methylation at cg17057218 significantly mediated 23-34% of the total effect for three of the five trauma types, while methylation at cg22324981 mediated 36-53% of the total effect for two of the five trauma types. These CpG sites were differentially associated with transcription factor binding sites and chromatin state signatures. NFATC1 5-mC may be a potential mechanism in the relationship between some trauma types and prospective risk for PTSD.

Trends in accident-related admissions to pediatric intensive care units during the first COVID-19 lockdown in Germany

Objective: To compare the number of accident- and injury-related admissions to pediatric intensive care units (PICU) during the first German COVID-19 lockdown with previous years. To investigate if shifts in types of accidents or injuries occurred, especially regarding non-accidental injuries. Design: Retrospective observational multicenter study. Setting: 37 German PICUs. Patients: 1444 children and adolescents < 18 years admitted to German PICUs due to trauma or injuries during the first German lockdown period (16.3.-31.5.2020) and during the same periods of the years 2017-2019. Interventions: None. Measurements and main results: Standardized morbidity ratios (SMR) and 95% confidence intervals (CI) were calculated for the severity of disease, admission reasons, types of accidents, injury patterns, surgeries and procedures, and outcomes. Disease severity did not differ from previous years. We found an increase in ingestions (SMR 1.41 (CI 0.88 - 2.16)) and a decrease in aspirations (0.77 (0.41 - 1.32)) and burns (0.82 (0.59 - 1.12)). The total number of admissions for trauma remained constant, but traffic accidents (0.76 (0.56 - 1.01) and school/kindergarten accidents (0.25 (0.05 - 0.74) decreased. Household (1.32 (1.05 - 1.64)) and leisure accidents (1.32 (1.05 - 1.65)) increased. Injured structures did not change, but less neurosurgeries (0.69 (0.42 - 1.07)) and more visceral surgeries (2.00 (1.14 - 3.24)) were performed. Non-accidental non-suicidal injuries declined (0.85 (0.50 - 1.37)). Suicide attempts increased in adolescent boys (1.57 (0.58 - 3.42)), while there was a decrease in adolescent girls (0.86 (0.53 - 1.31)). Conclusions: Our study showed shifts in trauma types and associated surgeries during the lockdown period that are generally in line with current literature. The decreased number of non-accidental non-suicidal injuries we observed does not suggest a fundamental increase in severe child abuse during the lockdown period. The decrease in suicide attempts among adolescent girls confirms previous findings, while the increase among boys has not been described yet and deserves further investigation.

The impact of poly-traumatization on treatment outcomes in young people with substance use disorders

Background It is believed that clients with psychological trauma experiences have a poor prognosis with regard to treatment participation and outcomes for substance use disorders. However, knowledge on the effect of the number of trauma experiences is scarce. Methods Using data from drug use disorder (DUD) treatment in Denmark, we assessed the impact of having experienced multiple potentially traumatic experiences on DUD treatment efficacy. Baseline and follow-up data from 775 young participants (mean age = 20.2 years, standard deviation = 2.6) recruited at nine treatment centers were included in analyses. Results Analyses showed that participants who were exposed multiple trauma experiences also reported a significantly higher intake of cannabis at treatment entry, and a lower well-being score than participants who reported less types or no types of victimization experiences. During treatment, patients with multiple types of trauma experiences showed a slower rate of reduction of cannabis than patients with few or no trauma experiences. The number of trauma types was not associated with number of sessions attended or the development of well-being in treatment. Conclusion Overall, the results show that although traumatized youth in DUD treatment show up for treatment, helping them to reduce substance use during treatment is uniquely challenging. Trial registration ISRCTN88025085, date of registration: 29.08.2016, retrospectively registered.

Evaluation of the effects of pain scale and analgesic administration on radiological imaging methods and hospitalization in trauma patients admitted to the emergency service

Background: Trauma, one of the major concerns in today’s world, exposes societies to important economic, social and health-related problems. Trauma is known to account for 10% of the world’s deaths. Objective: The aim of the study is to evaluate the demographic characteristics of trauma, which is common in emergency services and causes significant loss of workload and function when appropriate diagnosis and treatment methods are not applied, with radiological imaging methods, pain scale and analgesics. Materials and Methods: This prospective study included 1267 patients over the age of 18, who were admitted to the emergency department due to trauma between 1 January and 31 December 2019. The mean age of patients was 47.01 ± 14.97 year, with a male/female ratio of 1.46. 59.3% of the patients were male and 40.7% were female. Patients’ trauma types, radiology results, mortality, numerical pain scale and analgesic administration were evaluated. Results: Numerical pain scale score of trauma patients in the emergency department was 6.23 ± 2.02. Analysis of radiological imaging methods showed significance with age, numerical pain scale, thoracic and lumbar vertebrae, thoracic and abdominal injuries, types of trauma, consultation, hospitalization, analgesics administration and pain severity. Trauma types were insignificant with age and gender, but a significant relationship was found with all other parameters. Pain intensity was not correlated with gender and tetanus application but was significant with other variables. There was significance in radiological imaging methods and diagnostic types between injury types. Types of diagnosis were found to be correlated with imaging methods, orthopedic consultation, numerical pain scale and injury types. There was a significant correlation with the types of diagnosis, analgesia administration, consultation, and pain classification according to the pain rating scale. There was no correlation between age and gender according to pain intensity. However, there was a strong positive correlation with pain scale scores, consultation, hospitalization, types of trauma, administration of analgesia, and a weak correlation with radiological imaging methods. Conclusion: Early pain scale with radiological imaging and analgesic administration in trauma patients can reduce morbidity rates and shorten hospital stay.

Does Prior Civilian Trauma Moderate the Relationship Between Combat Trauma and Post-deployment Mental Health Symptoms?

In addition to combat trauma, childhood and adult non-military, interpersonal trauma exposures have been linked to a range of psychiatric symptoms (e.g., alcohol use problems, posttraumatic stress disorder [PTSD], depression symptoms) in veterans. However, few studies simultaneously explore the associations between these civilian and combat trauma types and mental health outcomes. Using a sample of combat-exposed veterans who were previously deployed to Iraq and Afghanistan ( N = 302), this study sought to (a) understand the independent associations of civilian interpersonal trauma (i.e., childhood trauma and non-military adult trauma) and combat-related trauma with post-deployment alcohol use, PTSD symptoms, and depressive symptoms, respectively and (b) to examine the interactive effects of trauma type to test whether childhood and non-military adult trauma moderate the association of combat trauma with these outcomes. A path analytic framework was used to allow for the simultaneous prediction of these associations. In the final model non-military adult trauma and combat trauma were found to be significantly associated with PTSD symptoms and depression symptoms, but not average amount of drinks consumed per drinking day. Childhood trauma was not associated with any outcomes (i.e., PTSD symptoms, depression symptoms, average amount of drinks consumed per day). Only combat trauma was significantly associated with average amount of drinks consumed per day. Results underscore the importance of assessing multiple trauma types and considering trauma as a non-specific risk factor, as different trauma types may differentially predict various mental health outcomes other than PTSD. Further, results highlight the noteworthiness of considering co-occurring outcomes within the veteran community. Limitations, future directions, and implications of diversity are discussed.

Evaluation of Dental Luxation Traumas in Turkish Western Mediterranean Population between 1999 and 2017: A Mediterranean Population between 1999 and 2017: A Retrospective Study Retrospective Study

Luxation cases reportedly occur more frequently in men than in women, and the frequency decreases with increasing age. It is important to know the characteristics of luxation injuries to take preventive measures and early treatments. Objective: This study aimed to evaluate luxation trauma cases in the Turkish population in the West Mediterranean region between 1999 and 2017. Methods: An 18-year retrospective analysis of records of patients with luxation traumas was performed. Data regarding age groups, gender, trauma types, etiologic factors, trauma locations, number of affected teeth, trauma types with/without crown fracture, and time elapsed from trauma onset until clinic visit were determined. Acquired data were tabulated as numbers and percentages. Results: A total of 1597 teeth, from 885 patients, exposed to luxation trauma were included. The number of injured teeth per child was 1.8, and single tooth trauma was the most common type. The number of trauma patient was higher in the 0–5 age group, and the number of cases was higher in the primary teeth of the 0–3 age group and in the permanent teeth of the 8–12 age group. The maxillary central incisors were the most commonly affected teeth, and the most common cause was falls. The luxation types most frequently presenting with crown fracture were lateral luxation in the primary teeth (60%) and subluxation in the permanent teeth (33.9%). The proportion of patients with avulsion was the lowest among those visiting the clinic within 2 days of trauma. Conclusion: This study revealed that almost half of the trauma patients have a history of luxation trauma. Educational programs for the community regarding causes and prevention of luxation traumas should be continued.