Preventing posttraumatic psychopathology (e.g., depression or posttraumatic stress disorder [PTSD]) following an acute traumatic event requires attention to modifiable factors that may protect against such psychopathology. In this study, we aimed to identify the relative contributions of resiliency factors across multiple domains to posttraumatic psychopathology and to delineate subcomponents that may be most influential. This study leveraged prospective data from 2,043 trauma-exposed individuals recruited from emergency departments in the Advancing Understanding of RecOvery afteR traumA Study. We first used structural equation modeling to examine higher level regulatory and interpersonal strength domains following acute trauma exposure and their relative associations with symptoms of depression or PTSD at 3 months posttrauma. We then tested which specific factors within these domains were associated with 3-month symptoms. Both regulatory and interpersonal strength domains were linked to fewer symptoms of depression and PTSD 3 months later, though relational strengths were more strongly associated than regulatory strengths when modeled together. Within interpersonal strengths, higher levels of emotional support and supportive networks, but not social engagement, were associated with lower depressive and PTSD symptoms. Within regulatory strengths, trait resilience was associated with lower depressive and PTSD symptoms, and self-efficacy showed mixed associations, whereas mindfulness (measured as nonreactively observing internal experiences) was associated with higher symptoms. Findings suggest enhancing interpersonal resiliency, above and beyond regulatory strengths, may be crucial in the aftermath of acute trauma, with emotional support and supportive networks as especially strong potential buffers against posttraumatic psychopathology. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
Background and Clinical Significance: Acute appendicitis following blunt abdominal trauma is a rare and historically debated clinical entity. We present a century-spanning descriptive review of 106 cases of post-traumatic appendicitis, embedded with an illustrative pediatric case initially managed conservatively. Methods: A comprehensive literature review was conducted following PRISMA guidelines across PubMed/MEDLINE, Web of Science, and Google Scholar, encompassing a 100-year period (1925-2025). Clinical variables, trauma mechanisms, and outcomes were extracted and statistically analyzed by age cohort (Pediatric ≤ 18 vs. Adult > 18) and historical medical era. Results: A total of 106 cases were analyzed. High-energy trauma predominated in adults compared to the pediatric cohort (48.8% vs. 18.5%, p = 0.001). The overall complication rate was exceptionally high (66.0%), with no significant difference between pediatric and adult cohorts (61.5% vs. 73.2%, p = 0.293). An epoch-based analysis revealed a significant drop in perforation rates from the historical era (1925-1980) to the modern era (2001-2025) (51.7% to 27.0%, p = 0.033) due to improved diagnostic timelines. Crucially, purely mechanical injuries such as complete appendiceal auto-amputation remained a constant signature of blunt trauma across the century (11.5% overall rate). Conclusions: Our synthesis of historical cases suggests that post-traumatic appendicitis might be a relevant clinical entity where trauma mechanics appear to play a significant role in injury severity, irrespective of patient age. While conservative management could be feasible and safe in the acute setting of uncomplicated cases, we hypothesize that the initial kinetic impact might cause subtle structural changes or alter local appendiceal dynamics, potentially predisposing the organ to recurrent inflammation, warranting close follow-up or elective surgery.
This study examines representations of transgenerational trauma and healing strategies in Chika Unigwe's The Middle Daughter. The analysis of the novel pays critical attention to the intergenerational transmission of trauma within the mother-middle daughter relationship. Drawing on the tenets of Trauma Theory, the study reveals how silence, emotional repression, and culturally shaped parenting practices contribute to the psychological distress of the protagonist, Nani. Through a close investigation of characterization and events in the narrative, the paper shows how the often-overlooked role of the middle daughter affects emotional visibility and self-perception within the family, yielding to traumatic flashbacks. The analysis further demonstrates that unresolved maternal trauma and cultural expectations influence Nani's romantic and non-romantic relationships, shaping her vulnerability and internalized guilt. Finally, the study discusses Nani's path to healing, through narration, maternal agency, and personal autonomy, arguing that recovery begins with reclaiming one's story and voice. By closely reading the novel alongside the postulations of trauma scholars such as Judith Herman, Cathy Caruth, Marianne Hirsch, C. N. Van der Merwe, and Pumla Gobodo-Madikizela, the research contributes to trauma studies in African literature by highlighting the psychological cost of inherited silence and the therapeutic import of emotional truth-telling.
Risk for disordered eating is high among survivors of military sexual trauma (MST) and combat trauma (CT). However, little research has qualitatively examined factors related to disordered eating among individuals with MST and CT exposure. Semi-structured interviews were conducted with six survivors of MST and/or CT with disordered eating. Interviews inquired about four potential mediators of traumatic stress and disordered eating (i.e. trauma-related self-blame, emotion regulation challenges, body dissatisfaction, and dissociation), and inquired about possible other related factors. Interviews were transcribed and analyzed by means of thematic analysis. Thematic analyses provided contextual illustrations of how trauma-related self-blame, emotion regulation challenges, body dissatisfaction, and dissociation were perceived by MST and/or CT survivors to influence disordered eating. Participants additionally described how they perceived military culture to relate to disordered eating as well as provided suggestions for treatment development to address trauma-related disordered eating. Findings provide important information to consider in developing treatments for co-occurring traumatic stress and disordered eating tailored to the needs of MST and CT survivors.
Populations exposed to prolonged conflict and large-scale traumatic events often experience significant psychological and behavioral consequences. This study examines gender differences in trauma responses following exposure to severe stressors, focusing on adjustment and behavioral dysregulation. Using network analysis, we explored the relationships between trauma exposure, emotional mental health outcomes (e.g., anxiety, depression, and posttraumatic stress disorder [PTSD]), behavioral disturbances (e.g., sleeping, night eating syndrome, and emotional eating), and adjustment difficulties in a sample of 486 participants (47% male, 53% female, mean age = 39.99, and SD = 10.55). Our findings revealed significant gender differences: Women exhibited higher levels of night eating, sleeping problems, stress, emotional eating, adjustment difficulties, and PTSD compared to men who reported higher levels of direct exposure to traumatic events. Network analysis highlighted distinct gender-specific emotional-psychological networks: In women, PTSD and adjustment difficulties played a more central role, whereas in men, direct exposure was more influential. PTSD and anxiety symptoms were rigidly connected in women, suggesting a more systemic relationship between these symptoms. These results underscore the need for network-informed interventions that address the unique structural and behavioral consequences of trauma. By identifying key anchors and stressors within gender-specific networks, this study contributes to a deeper understanding of systemic dysregulation and informs targeted mental health interventions aimed at destabilizing the trauma network. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
Computed tomography [CT] is the frontline imaging modality for the assessment of polytrauma patients because of its speed, diagnostic accuracy and influence on immediate management. Ever since whole-body CT [WB-CT or "pan-scan"] was adopted, there has been ongoing debate about patient selection, optimal protocols and acquisition strategies, radiation safety, and its integration into streamlined trauma workflows. Evidence suggests that WB-CT shortens time-to-diagnosis and improves injury detection compared with region-specific selective CT, although mortality benefits are variable across studies and the radiation dose remains marginally higher. Newer protocol variants, such as the split-bolus single-pass technique, dual-energy CT [DECT], dose-reduced and hybrid timing strategies, monophasic acquisition in select patients aim to optimize diagnostic accuracy while reducing dose and contrast. Structured reporting using trauma-specific templates improve completeness and diagnostic performance, particularly among less experienced radiologists. Emerging tools such as artificial intelligence [AI] triage/flagging systems, photon-counting and spectral CT, and automated structured reporting can potentially improve the trauma workflow efficiency. This article reviews current guidelines, compares WB-CT with selective CT, discusses existing WB-CT protocols, proposes a practical optimized WB-CT protocol termed - 'IMPACT Protocol [Integrated Multiphase Polytrauma Assessment CT]',and offers recommendations for structured reporting and future implementation.
Objective: To examine whether benzodiazepine use within 30 days after mass trauma increases posttraumatic stress disorder (PTSD) risk and whether timing or persistence of use modifies this association. Methods: This retrospective cohort study leveraged 3 advantages: large-scale clinical dataset (∼4 million individuals), unprecedented collective exposure to trauma, and novel methodological approach addressing severity bias. Using data from Clalit Health Services (covering ∼54% of the population), we identified 15,570 benzodiazepine-naïve adults who received a new benzodiazepine prescription within 30 days of index date (October 7, 2023). Medication exposure was defined by prescription redemption (none, early ≤7 days, late 8-30 days) and by persistence based on refill behavior. Incident PTSD diagnoses (ICD-10 F43.1) were identified over 12 months. Cox proportional hazards models estimated hazard ratios (HRs), adjusting for demographic characteristics and psychiatric history. Results: Overall PTSD incidence was 5.0% (773/15,570). Twelve-month risk was 5.2% for nonpurchasers, 4.7% for early purchasers, and 5.0% for late purchasers. Fully adjusted models showed no increased risk with early (HR=0.98, 95% CI=0.80-1.20) or late (HR=1.11, 95% CI=0.94-1.31) purchase. Persistent users had elevated risk (HR=1.60, 95% CI=1.14-2.25 and HR=2.07, 95% CI=1.60-2.68), whereas discontinued users did not. Among Gaza border residents (n=238), both early (HR=0.52, 95% CI=0.31-0.88) and late (HR=0.62, 95% CI=0.38-0.98) purchasers had lower PTSD risk than nonpurchasers. Conclusions: In this naturalistic setting of mass trauma, short-term benzodiazepine use during 30 days postexposure was not associated with increased 12 month PTSD risk. Among highly trauma-exposed individuals, it was linked to reduced risk at 12 months. These findings challenge current caution against early benzodiazepine use in the immediate aftermath of trauma.
Yoga is rapidly gaining popularity as a mind-body intervention with notable benefits on both physical and mental health for survivors of traumatic experiences, such as human trafficking. Among trauma survivors, yoga is associated with significant improvements in psychological symptoms and social functioning. However, little is known about the specific mechanisms through which mind-body practices improve social functioning. In this study, we assessed changes in perceived social support and compassion among female human trafficking survivors (N = 10) in Kampala, Uganda, who participated in a mind-body intervention in a shelter setting. Quantitative survey measures indicate increases, though not statistically significant, in perceived social support and compassion toward others. We also conducted a qualitative analysis of interviews with intervention participants. Qualitative findings highlight the importance of having structured opportunities to interact with fellow survivors and opportunities to discuss prior traumatic experiences that may or may not have been related to human trafficking. Findings from this study have important implications for the utilization of mind-body interventions among trauma survivors. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
A 55-year-old patient presented with persistent back pain after a lifting injury. Later, buttock pain and hypaesthesia of the left knee developed. MRI revealed a lesion at lumbar vertebral body L3, histologically confirmed as a conventional chordoma. Chordomas are rare, locally aggressive tumors of notochordal origin with a high recurrence rate and require specialized treatment. A two-stage en-bloc spondylectomy with dorsal decompression and anterior cage implantation was performed on the patient. Postoperatively, there were motor deficits in hip flexion and knee extension, while distal strength and sensation were preserved. Due to the R1 resection, an additional proton radiation therapy is actually planned. Persistierende Rückenschmerzen nach Hebetrauma – von der Bagatelle bis zum seltenen Fall. Ein 55-jähriger Patient stellte sich nach einem Hebetrauma mit persistierenden Rückenschmerzen vor. Im Verlauf traten neue Gesässschmerzen und eine Hypästhesie am linken Knie auf. In der MRT zeigte sich dann eine Raumforderung im Lendenwirbelkörper 3. Histologisch wurde die Diagnose eines konventionellen Chordoms gestellt. Chordome sind seltene, lokal aggressive Tumoren notochordaler Differenzierung mit hoher Rezidivrate, die eine spezialisierte Therapie mit radikaler lokaler Resektion erfordern. Es erfolgte eine zweizeitige En-bloc-Spondylektomie mit dorsaler Dekompression und anteriorem Cage-Einsatz. Postoperativ bestanden beim Patienten motorische Einschränkungen der Hüftflexion und Knieextension, distal waren Kraft und Sensibilität erhalten. Aufgrund einer R1-Resektion ist aktuell eine ergänzende Protonenbestrahlung geplant. Schlüsselwörter: Rückenschmerzen, Red Flags, Tumor, Chordom.
Adverse and benevolent childhood experiences (ACEs and BCEs, respectively) are uniquely associated with posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD); however, there is no systematic review on the mechanisms of these associations. This systematic review and meta-analysis aimed to synthesize studies considering psychological mediators of the associations between ACEs/BCEs and PTSD/CPTSD. Databases (PsychINFO, PubMed, PTSDpubs, PsycARTICLES, and Web of Science) were searched from inception to August 2025 for peer reviewed studies of adult populations examining psychological mediators of the associations between ACEs or BCEs and PTSD or CPTSD. A total of 63 studies involving 31,540 participants met the inclusion criteria. Mediators were grouped into six categories: cognitive beliefs and appraisals (n = 33), emotion regulation strategies (n = 40), interpersonal relationships (n = 7), spiritual and religious beliefs (n = 2), attachment style (n = 5), and dissociation symptoms (n = 9), with mostly small effect sizes. Subcategory meta-analysis revealed emotion regulation, β = .4, 95% CI [0.001, 0.78], and maladaptive coping strategies, β = .05, 95% CI [0.03, 0.07], significantly mediated the association between ACEs and PTSD. Risk of bias and quality of evidence were assessed. Overall, evidence was insufficient to determine how mediators function across pathways, and a paucity of literature is highlighted, considering BCEs and CPTSD.
Background and Clinical Significance: Acute compartment syndrome is a rare but limb-threatening emergency in pediatric patients. While most cases follow high-energy trauma or displaced fractures, acute compartment syndrome precipitated by initially underestimated forearm injuries is uncommon and may create a significant diagnostic challenge, particularly in young children who exhibit atypical clinical presentations, such as escalating anxiety and analgesic requirements, rather than classic ischemic signs. Case Presentation: We report the case of a 4-year-old girl who developed severe forearm and hand compartment syndrome following a delayed presentation after a fall from a height of 2-2.5 m onto the left upper extremity. Initial evaluation revealed progressive tense swelling, severe pain with passive stretch, diminished distal perfusion, and radiographic evidence of distal radius-ulna buckle fractures associated with a proximal ulna fracture. Emergent surgical decompression via extensive volar and dorsal fasciotomies revealed markedly elevated compartment pressures. Intraoperatively, deep volar muscle ischemia and necrosis were identified, requiring carpal tunnel release, serial debridements, and complex staged wound management. Multidisciplinary care and ongoing rehabilitation were essential for limb salvage and functional recovery. Conclusions: This case underscores the profound unpredictability of pediatric compartment syndrome and demonstrates that even classically stable, benign fractures can initiate a devastating ischemic cascade. A high index of suspicion, regardless of the injury mechanism, along with early recognition and prompt surgical intervention, is absolutely critical for preventing irreversible myoneural damage and optimizing management outcomes in pediatric patients.
Treatment of severely injured patients is challenging, and timely reading of whole-body computed tomography (WBCT) images therefore crucial. Artificial intelligence is increasingly used to prioritize and detect acute injuries in this context. Algorithms focusing on the cervical spine and compression fractures have been deployed successfully. However, tools for whole spine assessment and the entirety of fracture morphologies are lacking. We aimed to investigate the capabilities of an algorithm to detect spine fractures on WBCTs and factors contributing to the difficulties in its development. A version 1.0 (v1) of the algorithm was previously trained with 454 cervical spine fractures using a U-Net via four-fold cross-validation to segment spine fractures and the spine via a multi-task loss. Further training expanded towards whole spine assessment with additional annotated fractures (Cohort 1) of the cervical (n = 50), thoracic (n = 30), and lumbar spine (n = 20), resulting in version 2.0 (v2). Baseline was set to reach the highest sensitivity at a maximum of five false positives per case. Version 1.0 was tested on Cohort 1 and both versions were compared on prospectively collected real-world data (Cohort 2, n = 712 WBCTs). An additional systematic review served to compare the algorithmic performance against the state-of-the-art. Version 1.0 showed promising performance not only for the cervical but also the thoracic and lumbar spine due to generalization (sensitivities ranging between 60% and 87%). Version 2.0 also achieved decent sensitivities for Cohort 2 (sensitivities ranging between 77% and 85%) but generated an abundance of false positives. Various reasons led to false positive results; for Version 2.0, the trabecular structure itself provoked false alerts. Variances in training and test data (image quality, dose, reconstructions), heterogeneity of fractures and anatomies, plus the size of training sets explain some difficulties during algorithm development. Only five other groups described their work on whole-spine fracture detection, encountered similar difficulties, and have also failed to develop a clinically deployable tool. Spine fracture detection on WBCT is feasible, but multiple factors hinder the development of commercially available AI tools. Expansion and the improved design of training cohorts are necessary for further development and simulation of real-life conditions.
Recurrent crises like natural disasters, pandemics, and armed conflicts constitute a persistent traumatic reality for communities worldwide, significantly affecting students, teachers, and parents. While the importance of education in emergencies is well recognized, the research in western contexts has largely focused on acute collective traumas, with less attention to schools facing ongoing war and political conflict traumas. To address this gap, the study explored Israeli teachers' (N = 1,100) and parents' (N = 710) expectations of school psychosocial and material support for students, staff members, and parents; their evaluations of the actual support provided; and discrepancies between the two during the October 7 Israel-Hamas war. t tests were used to compare the school's expected role versus evaluations of provided support regarding students, teachers, and parents and to compare teachers' and parents' perceptions of roles and support provided. Analysis of variance, t tests, and correlations were used to explore associations between participants' background characteristics and their expectations of schools. Both groups emphasized schools' crucial role in providing emotional support and guidance, but notable gaps existed between expectations and actual support, especially regarding counseling (teachers: ta = 28.44, d = 1.07; parents: ta = 33.03, d = 1.08). Parents and teachers also differed in their expectations and perceptions, highlighting the need to include all stakeholder perspectives. The findings indicate the need for increased resources for emotional support, structured guidance, and systemic backing. Enhancing school-family communication and aligning expectations are also vital during crises. The authors stress the importance of preparing for future recurrent emergencies. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
Pediatric testicular rupture is rare, and detailed descriptions of its ultrasonographic (US) findings with operative correlation remain limited. This paper reviews the characteristic ultrasonographic findings of pediatric testicular rupture and correlates them with operative findings and postoperative outcomes. Among 27 male patients who underwent US for suspected testicular trauma over a 23-year period, four cases with surgically confirmed testicular rupture were retrospectively reviewed. Clinical presentation, physical examination findings, timing of presentation and surgery, preoperative US findings, operative findings, and postoperative outcomes were evaluated. The patients ranged in age from 11 to 14 years, with two right-sided and two left-sided injuries. Mechanisms of injury included sports-related trauma (n = 2) and physical assault (n = 2). Presenting symptoms included scrotal swelling, scrotal/lower abdominal pain, and vomiting. Physical examination demonstrated scrotal tenderness in all patients, scrotal swelling in three, and erythema in one. The interval from injury to presentation ranged from 2 to 60 h (median, 34 h), and the interval from injury to surgery ranged from 28 to 130 h (median, 54 h). All patients demonstrated characteristic US findings suggestive of testicular rupture, including discontinuity of the tunica albuginea, poorly defined testicular margins, heterogeneous echotexture of the extruded testicular parenchyma, and decreased blood flow in the extruded area. Associated findings included intratesticular or scrotal hematoma and scrotal wall thickening. Operative findings confirmed rupture of the tunica albuginea in all cases and correlated well with preoperative US findings. During follow-up (mean, 9 months), ipsilateral testicular atrophy developed in three patients, whereas one patient showed preserved testicular volume without abnormal US findings. Pediatric testicular rupture demonstrates characteristic ultrasonographic findings that correlate well with operative findings. Recognition of these findings may facilitate early diagnosis and prompt surgical consultation. Because postoperative testicular atrophy may occur despite testicular preservation, continued ultrasonographic follow-up is important.
Acute anorectal and perineal emergencies encompass a wide spectrum of infectious, inflammatory, traumatic, iatrogenic, and neoplastic conditions that often present with nonspecific symptoms but may rapidly progress to significant morbidity if unrecognized. Imaging plays a central role in diagnosis, assessment of disease extent, detection of complications, and treatment planning because clinical examination frequently underestimates involvement of the complex anorectal and perineal spaces. Computed tomography (CT) is the primary imaging modality in the emergency setting owing to its rapid acquisition and ability to detect abscesses, perforation, hemorrhage, extraluminal gas, and deep pelvic extension, whereas magnetic resonance imaging (MRI) provides superior soft-tissue characterization for evaluation of fistulas, sphincteric involvement, and complex inflammatory disease. This review provides an overview of the pertinent anorectal and perineal anatomy, imaging evaluation strategies, and characteristic multimodality imaging features of common anorectal and perineal emergencies. Particular emphasis is placed on key imaging findings, including rim-enhancing abscesses and fistulous tracts, soft-tissue gas with fascial extension in necrotizing infections, bowel wall thickening and perirectal inflammatory changes in proctocolitis, and the presence of extraluminal air or fluid collections associated with rectal perforation and retained foreign bodies. The review also highlights the value of a compartment-based approach in accurately delineating disease extent and guiding clinical management.
Background and Clinical Significance: Chronic subdural hematomas (cSDHs) present characteristic imaging findings, making the diagnosis straightforward. In rare cases, arachnoid cysts (ACs) may be associated with their formation. There is still no consensus regarding their treatment; Case Presentation: A young adult male presented with occipital headache. Neurological examination was normal. Laboratory investigations were within physiological limits. A CT scan revealed the presence of a Galassi Grade III temporo-parietal AC accompanied by a parietal epidural hematoma (EDH) on the right side. His medical history was significant for treated hypertension. There was no use of anticoagulants, antiplatelets, or history of trauma. Vascular pathology was excluded by MRA/MRV. He was discharged for home care and was readmitted 10 days later after a repeat CT scan. A brief cognitive assessment with the Mini-Mental State Examination (MMSE) revealed mild cognitive impairment. A burr-hole evacuation was performed, and a drainage catheter was left in place for 24 h. Intraoperative findings were consistent with a chronic subdural hematoma. The patient was discharged with complete resolution of symptoms. A follow-up CT scan performed one month postoperatively confirmed the favorable result. Cognitive functions were normal on follow-up; Conclusions: A SDH may mimic the characteristics of an EDH in the presence of an AC. The most common symptom is cephalalgia. Neurocognitive impairment may occur secondary to elevated intracranial pressure. A burr-hole hematoma evacuation may be sufficient. Further treatment should be considered only in the case of complications associated with ACs.
To examine relationships among women's adverse childhood experiences (ACEs), attachment styles, psychological well-being, and Cinderella Syndrome (CS). This descriptive cross-sectional study included 334 women. Data were collected using the Personal Information Form, Early Life Experiences Scale, Three Dimensional Attachment Style Scale, Psychological Well-Being Scale, and Cinderella Syndrome Scale (CSS). Correlation analyses showed positive associations between CSS scores and threatening childhood memories, submissive and threatening experiences, avoidant and anxious-ambivalent attachment styles, age, and number of children, and negative associations with secure attachment and psychological well-being (all p < .001). Multiple regression analyses revealed that threatening childhood memories (B = 0.70 to 1.52, p < .001) and anxious-ambivalent attachment (B = 0.29 to 0.52, p < .001) were consistent positive predictors across CSS subdimensions and total scores. ACEs and insecure attachment patterns significantly contribute to CS tendencies, whereas higher educational level and psychological well-being act as protective factors. Findings emphasize the importance of incorporating psychosocial assessments, trauma-informed care, and attachment-focused interventions in nursing practice to support women's mental health and promote autonomy and resilience.
Asian Americans experience significant health disparities yet remain politically underrepresented. Political participation-a social determinant of health-may be a mechanism for communities to advocate for health resources and policies. This study examines contextual factors influencing political participation in segregated Asian American neighborhoods, with attention to health equity implications. We conducted 11 virtual focus groups with 42 Southeast Asian American residents (Filipino, Vietnamese, Hmong, Cambodian) in three California regions. Using participatory community mapping and qualitative analysis, we explored political participation patterns, contextual promoters and barriers, and connections to community health. Participants identified both structural, spatial, and social factors affecting political participation with implications for health equity. Structural promoters included community health organizations, which explicitly linked civic engagement to health advocacy, and faith-based organizations providing trusted spaces for political education. Barriers included lack of centralized Asian American spaces and language-inaccessible venues. Social factors included generational differences in political engagement, with older immigrants expressing fear of participation rooted in trauma; and cultural pressure to "not rock the boat," limiting health advocacy. Political participation inequities in Asian American communities represent a critical but overlooked determinant of health disparities. Low engagement leads to policy neglect and inadequate health resource allocation. Community health organizations provide promising intervention points. Results inform place-based strategies to promote political participation as a health equity approach, particularly urgent given anti-Asian violence and pandemic impacts on these communities.
Composite indicators of neonatal morbidity specific to Métis populations in Canada are lacking. To estimate the incidence of neonatal morbidity and neonatal death among Métis neonates in Alberta, and to identify maternal and neonatal factors associated with neonatal morbidity. Population-based retrospective cohort study including all singleton live births to Métis mothers in Alberta between April 2006 and March 2016. Hospital discharge data were used to evaluate the Neonatal Adverse Outcome Indicator (NAOI), which comprises a set of newborn medical complications and neonatal death. We estimated overall and annual NAOI incidence proportions and overall neonatal mortality. Multilevel regression models were used to estimate adjusted risk ratios (aRRs) with 95% confidence intervals (CIs) for maternal and neonatal characteristics associated with NAOI. Among 7853 neonates, the overall NAOI incidence proportion was 10.1% (95% CI 9.5, 10.8), ranging annually from 7.7% (95% CI 6.1, 9.7) to 11.9% (95% CI 8.1, 17.2). The most common conditions were respiratory conditions originating in the perinatal period (4.8%, 95% CI 4.3, 5.3) and birth trauma (3.4%, 95% CI 3.0, 3.8). The overall neonatal mortality rate was 2.9 per 1000 live births (95% CI 1.9, 4.4). Increased risk of NAOI was associated with pre-pregnancy disease (aRR 1.27, 95% CI 1.03, 1.51), pregnancy-related disease (aRR 1.92, 95% CI 1.65, 2.18), assisted vaginal delivery (aRR 2.52, 95% CI 2.09, 2.94), caesarean delivery (aRR 1.23, 95% CI 1.04, 1.41), male sex (aRR 1.27, 95% CI 1.09, 1.42), preterm birth (aRR 4.36, 95% CI 3.71, 5.00) and any congenital malformation (aRR 2.71, 95% CI 1.87, 3.56). The incidence of neonatal morbidity among Métis neonates in Alberta highlights the importance of continued surveillance using standardised indicators. Incorporating NAOI into perinatal and obstetric care may inform culturally responsive improvements in care.
Background: Despite stable fixation, aseptic tibial shaft nonunion represents a severe orthopedic complication. Teriparatide and adipose-derived stem-cell augmentation have been proposed as biological supports, but comparative clinical evidence remains limited. This study explored whether adding adjuvant therapies to reamed intramedullary nailing was associated with faster healing than nailing alone. Methods: We retrospectively reviewed 43 adults with aseptic tibial shaft nonunion treated at three level I trauma centers between 2017 and 2020. Patients underwent reamed intramedullary nailing alone (n = 15), nailing plus teriparatide (n = 15), or nailing plus adipose-derived stem-cell augmentation (n = 13). Group allocation was nonrandom and based on contraindications and patient acceptance; results were therefore interpreted as exploratory. Outcomes included time to tricortical radiographic healing, pain, radiographic healing scores over time, complications, ASAMI classification, and SF-12. Results: Baseline demographic and fracture characteristics were comparable across groups. Time to tricortical radiographic healing was shorter in the teriparatide group (87.46 ± 6.34 days) and the adipose-derived stem-cell group (86.41 ± 5.67 days) than in the nailing-alone group (99.71 ± 4.29 days; p = 0.034). Pain, complication rates, ASAMI outcomes, and quality-of-life recovery did not differ significantly among groups at final follow-up. Conclusions: In this exploratory multicenter retrospective cohort, teriparatide and adipose-derived stem-cell augmentation were associated with shorter radiographic healing time after reamed intramedullary nailing for aseptic tibial shaft nonunion, but not with superior long-term functional outcomes. Because no comparator group treated with standard graft-based biological augmentation was included, the findings should be interpreted cautiously. Larger prospective studies or randomized controlled trials comparing these strategies with established graft-based approaches are needed to validate the present data.