Black pregnant individuals are at increased risk for posttraumatic stress disorder (PTSD), symptoms that may be exacerbated by histories of sexual trauma. Disruptions in fear learning are central to the development and maintenance of PTSD. The present study examined longitudinal changes in fear acquisition and extinction over pregnancy, and the moderating role of sexual trauma in fear learning trajectories, in a sample of under-resourced Black pregnant persons. Participants (N = 116) completed an enrollment interview in which the Trauma Exposure Inventory was used to assess lifetime sexual trauma. Fear-potentiated startle was administered in up to three physiological assessments over pregnancy. Linear mixed models showed that percent potentiation to the danger cue during acquisition increased over pregnancy in the general sample (B = 1.85, SE = 0.94, p = 0.049). Conditional models showed that this increase was observed among participants with no (B = 4.49, SE = 1.39, p = 0.001) and mean (B = 2.07, SE = 0.95, p = 0.029) levels of sexual trauma exposure, but not in individuals with high (mean + 1 SD) sexual trauma exposure (B = -0.34, SE = 1.35, p = 0.80). Percent potentiation to the safety cue during acquisition did not change over gestation (B = 0.55, SE = 0.94, p = 0.56), and there were no significant changes in percent potentiation to either the danger (B = 0.23, SE = 0.63, p = 0.716) or safety cue (B = -0.011, SE = 0.63, p = 0.966) during extinction. These findings suggest that pregnancy progression is adaptive by enhancing startle responses to danger cues during fear acquisition, and that high levels of sexual trauma exposure may attenuate typical changes in threat sensitivity that occur during pregnancy.
Exposure to armed conflict is associated with elevated posttraumatic stress symptoms (PTSS). Ethnic minority groups may also face minority-related stressors, such as discrimination and silencing, that compound psychological vulnerability. Conservation of resources theory suggests that loss of valued personal and social resources may help explain PTSS under prolonged adversity. Palestinian Arab grandmothers in Israel remain understudied despite central roles in multigenerational collectivist family systems, which may intensify during collective threat and heighten vulnerability to posttraumatic stress. This study examined associations of grandchild caregiving, war-related trauma, and minority-related stressors with PTSS among Palestinian Arab grandmothers in Israel, and whether resource loss and gain mediated these associations. A cross-sectional study was conducted among 112 Palestinian Arab grandmothers (Mean age = 58.50, SD = 6.60) during a period of continuous war-related traumatic stress. Data were collected using a structured online questionnaire. Mean PTSS was 2.27 (SD = 1.41, range=0-4), indicating a moderate PTSS level. Most participants (93.7%) reported at least one war-related traumatic event, and 34.8% reported at least one minority-related stressor. Weekly grandchild caregiving hours were not associated with PTSS. In regression analyses, minority-related stress remained significantly associated with PTSS (β = .20, p<.05), whereas war-related exposure did not (β = .16, p >.05). Resource loss remained significant in the final model (β=.25, p<.05), which explained 22% of PTSS variance (R2=.22, p <.001). Mediation analysis showed a significant indirect effect of minority-related stress on PTSS through resource loss (ab=.05, 95% CI [0.0012,0.1196]). Interventions targeting minority-related stress and preserving psychosocial resources may benefit Palestinian Arab grandmothers in contexts of ongoing conflict.
Threat-related attentional processes have been highlighted as an important mechanism in the developmental unfolding of childhood anxiety and stress-related disorders. The preschool affective dot probe task is a widely used measure of these attentional processes, however weak psychometric properties have led to inconsistent empirical findings and limited utility in guiding assessment and practice. The current study employs a novel approach to scoring the dot probe task to examine the relationship between dimensions of threat-related attentional processes (e.g., bias, orientation, disengagement), trauma exposure, and child mental health in a sample of 232 preschool children. Young children (ages 4-6) and mothers participated in surveys and an affective dot probe task using emotional faces to measure trauma exposure, mother reports of child anxiety and traumatic stress symptoms, and child-reported traumatic stress. Novel response-based scoring was used to identify vigilance and avoidance indices of threat-related attentional processes. More pronounced avoidance (e.g., avoidant orientation) was related to reduced mental health symptoms and more pronounced vigilance (e.g., vigilance bias) was related to higher mental health symptoms, above and beyond the influence of trauma exposure. Trauma exposure moderated the influence of slow disengagement on child anxiety; for children not exposed to trauma, less pronounced slow disengagement was related to lower anxiety. Response-based scoring offers a nuanced understanding of the mechanisms of threat-related bias and child psychopathology, offering a potential alternative to traditional scoring approaches. Future research should examine the temporally dynamic and context-dependent nature of response-based dimensions of threat-related attentional processes and children's psychopathology.
Childhood trauma can shape emotional development and relationships across the lifespan, yet fathers' subjective experiences remain underexplored. This qualitative study examined how Turkish fathers with childhood trauma histories experience fatherhood and everyday parenting. Using interpretative phenomenological analysis, 17 fathers with elevated Childhood Trauma Questionnaire scores participated in semi-structured online interviews. Six themes emerged: emotional wounds, masculine norms, authority and closeness in parenting, emotional triggering, transformation, and changing fatherhood experiences. Fatherhood often reactivated unresolved childhood experiences, especially during stressful interactions with children. Traditional masculinity norms limited emotional expression and help-seeking. Participants expressed a strong desire to parent differently from their own fathers and prevent harmful intergenerational patterns. For some, fatherhood became a turning point that encouraged self-reflection, emotional growth, and more intentional parenting. The findings suggest that fatherhood may simultaneously reactivate childhood trauma and create opportunities for personal change and healthier parenting practices.
Traumatic brain injury (TBI) remains a major global health burden, disproportionately affecting low- and middle-income countries (LMICs) where access to neurocritical care is limited. Accurate and context-appropriate prognostic models are crucial to guide early clinical decision-making and optimize resource allocation in such settings. This study aims to develop and evaluate machine learning (ML) models for predicting TBI outcomes among adult patients using trauma registry data from Kilimanjaro Christian Medical Centre (KCMC), Tanzania. This retrospective cohort study utilized data from 4596 adult TBI patients recorded in the KCMC trauma registry between 2013 and 2024. The outcome was dichotomized Glasgow Outcome Scale (GOS): poor (1-3) versus good (4-5). Ten supervised ML algorithms, including Random Forest (RF), Decision Tree (DT), Logistic Regression, Support Vector Machine (SVM), and Artificial Neural Networks (ANN), were trained on 70% of the data after applying multiple imputation and synthetic minority Over-sampling Technique (SMOTE) to address missingness and class imbalance. Hyperparameter tuning was performed using 10-fold cross-validation. Model performance was assessed on a 30% test set using area under the ROC curve (AUC), accuracy, sensitivity, specificity, and predictive values. Among the 4596 patients, 26.2% had poor outcomes. The RF and DT models achieved the highest AUCs of 0.83 and 0.82, respectively. RF also showed the highest accuracy (0.78) and strong positive predictive value (PPV = 0.87), while DT had the highest sensitivity for poor outcomes (84.5%). Predictors of poor outcomes included TBI severity, pupil non-reactivity, low oxygen saturation, lack of CT scan, alcohol use, and abnormal vital signs. ML models, particularly RF and DT, demonstrated strong predictive performance for TBI outcomes using routinely collected variables in a resource-limited LMIC setting. Their interpretability and reliance on admission-level data make them potential tools for real-time triage and risk stratification. Future research should focus on external validation and integration into clinical decision-support systems to support scaleup across similar settings.
As trauma-informed care (TIC) becomes more integrated into healthcare systems, consistent and meaningful evaluation remains limited. Educational interventions are central to implementation, yet outcome measures vary widely. This scoping review systematically mapped outcome measures used to evaluate TIC educational interventions in healthcare settings to identify current practices, methodological gaps and opportunities for more coherent and context-sensitive assessment. The review followed PRISMA-ScR guidelines. Five databases (MEDLINE, EMBASE, PsycINFO, CINAHL, ERIC) were searched from database inception to October 2024. Eligible studies described TIC educational interventions for healthcare providers and reported at least one outcome related to knowledge, attitudes, confidence, competence, or behavior. Two reviewers independently screened and extracted data on study design, participants, intervention characteristics and outcome measures. Outcomes were categorized using Moore's Expanded Outcomes Framework, which includes seven hierarchical levels from participation to patient or community health outcomes. Twenty-eight studies met inclusion criteria, most published after 2020 and conducted in the United States. Outcome measurement was dominated by self-reported data, primarily custom pre-post surveys assessing knowledge, confidence or attitudes. Only eight studies used validated tools, most commonly the ARTIC-35 or ARTIC-45. Few assessed behavioral or system-level change, and none directly measured patient outcomes. Educational formats ranged from brief online modules to multi-session interdisciplinary trainings. A small subset explored relational or equity-oriented outcomes such as empathy or cultural humility, often using qualitative methods. This review highlights the field's reliance on short-term, self-reported outcomes and limited use of validated or standardized measures. Developing accessible, equity-informed tools that capture behavioral and system-level change is essential to advance research, guide policy and sustain trauma-informed transformation across healthcare systems.
Open extremity trauma is associated with a high risk of infection, making appropriate antimicrobial use essential. However, existing stewardship tools are often generic and lack a structured, hierarchical evaluation system tailored to this setting. We developed an initial indicator set based on the 5R principles (Right Patient, Right Drug, Right Dose, Right Time, and Right Route). A national panel of 42 experts participated in two rounds of a modified Delphi survey using a 5-point Likert scale to rate indicator importance. The analytic hierarchy process (AHP) was used to assign indicator weights. The finalized system was preliminarily assessed in a retrospective cohort from the Hand and Foot Surgery Department at the Lequn Campus, First Hospital of Jilin University, comparing a pharmacist-led intervention group with a routine-care control group. Response rates were 100% in both Delphi rounds, and the expert authority coefficient was 0.87. Across the two rounds, Kendall's W values ranged from 0.044 to 0.110 for secondary and tertiary indicators, with all P < 0.05, demonstrating statistically significant expert agreement. All indicators met predefined consensus criteria (mean score ≥ 4.0; coefficient of variation ≤ 0.25). The final system comprised 5 primary, 11 secondary, and 22 tertiary indicators; all AHP consistency ratios were < 0.1. In the preliminary applicability assessment, the intervention group achieved higher appropriateness scores (P=0.004) and lower total antimicrobial costs (P<0.001) than the control group. A 5R-guided, Delphi-AHP-derived evaluation system was developed and preliminarily validated. The tool can support standardized assessment and targeted pharmacist-led antimicrobial stewardship in open extremity trauma.
Psychiatric comorbidities are common in people with multiple sclerosis (pwMS). Yet, post-traumatic stress disorder (PTSD) has received little attention to date. Grounded in an emerging literature on the impact of trauma on pwMS, this Topical Review synthesizes current evidence on PTSD in pwMS. Although 5%-16% of pwMS have PTSD, there remains uncertainty about whether the prevalence exceeds that seen in the general population. Nonetheless, PTSD may influence measures of multiple sclerosis (MS)-related disease activity, employment, and participation in healthcare. Preliminary data indicate no sex difference in PTSD in pwMS, in contrast to an elevated risk in females in the general population. Further work is needed to clarify the demographic and disease-related correlates of PTSD, and the effectiveness of potential treatments in pwMS. By summarizing existing knowledge, this review highlights avenues for future research to advance care for people with comorbid PTSD and MS.
Morel-Lavallée lesion (MLL) is a closed degloving injury resulting from the separation of the subcutaneous tissue from the underlying deep fascia due to shearing forces. It most commonly occurs around the pelvis, hip, and thigh. We describe an unusual post-traumatic lesion resembling an MLL but occurring at the periosteal interface of the tibia. A 49-year-old man presented with a localized swelling over the upper anterior aspect of the right leg that developed two months after a blunt injury sustained while kick-starting a motorcycle. Physical examination revealed a firm, mildly tender swelling over the proximal tibia. Ultrasonography demonstrated a well-defined subperiosteal anechoic collection with minimal heterogeneous echogenic contents, consistent with an organized chronic subperiosteal hematoma. Unlike a conventional MLL, the lesion was confined to the plane between the tibial periosteum and the overlying fascial-soft tissue envelope, without intramuscular extension or internal vascularity. Plain radiographs showed no osseous involvement. Ultrasound-guided aspiration confirmed the diagnosis of chronic hematoma. This case highlights a previously undescribed Morel-Lavallée-like periosteal degloving lesion of the tibia resulting in a chronic subperiosteal hematoma. Recognition of this atypical injury pattern and its characteristic ultrasonographic appearance may facilitate the accurate diagnosis of chronic post-traumatic tibial swellings and help avoid unnecessary investigations.
Pilocytic astrocytomas are low‑grade benign pediatric brain tumors that most commonly arise in the cerebellum and typically present with symptoms related to impaired coordination or increased intracranial pressure. We report the case of a three‑year‑old girl with no prior neurologic history who presented to the emergency department (ED) after a fall from a trampoline. Neurologic examination was notable for right‑sided truncal ataxia without additional focal weakness or sensory deficits. Non‑contrast computed tomography (CT) of the head demonstrated a hypodense lesion in the left cerebellum with trace hyperdensity. Magnetic resonance imaging (MRI) revealed a 3.5‑cm left cerebellar mass consistent with a pilocytic astrocytoma. The patient underwent surgical resection with no residual tumor on postoperative imaging and complete resolution of truncal ataxia symptoms on follow‑up.
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To explore facilitators and barriers to the implementation of a novel intervention, the adverse childhood experiences awareness conversation, from the perspectives of home visiting public health nurses and community health workers. A qualitative interpretive study underpinned by Gadamerian philosophical hermeneutics. Semi-structured interviews were conducted with a purposive sample of 13 home visiting public health nurses and three community health workers across three implementation sites from October 2023 to December 2024. Interpretive analysis employed the Capability, Opportunity, Motivation-Behaviour model to map implementation facilitators and barriers. Four themes were identified: (1) initiating adverse childhood experiences conversations, (2) navigating disclosures of adverse childhood experiences, (3) adverse childhood experiences are understood differently across communities and (4) adverse childhood experiences and secondary trauma among home visitors. Relational factors and a strengths-based focus on positive parenting facilitated implementation, whereas lack of consensus as to what constituted an ACE and uncertainty related to process guidelines impeded implementation. Home visiting public health nurses and community health workers addressed the implementation barrier of unresolved personal and secondary trauma through self-care, peer support and debriefing. Discussing adverse childhood experiences during home visits was generally acceptable to the home visitors, yet implementation challenges remain. Providing home visitors with culturally responsive guidance materials and organizational supports to mitigate unresolved personal and secondary trauma can address implementation challenges identified in this study.
Traumatic war events can impair healthcare workers' psychological well-being. We assessed resilience, attendance and perceived sense of danger among Sudanese healthcare workers in active conflict zones. A cross-sectional study (January-March 2025) was conducted in four Omdurman public hospitals involving doctors, nurses, lab technicians and pharmacists. We used a self-administered questionnaire assessing sociodemographics, trauma, resilience (Connor-Davidson Resilience Scale-10), sense of danger (Solomon and Prager) and attendance. Data were analyzed using SPSS v27 (p < 0.05). Among 325 participants, 60% reported property damage, 49% family injury and 41% security escalations. Attendance was higher among males, single workers, those with crisis training and without personal or family injuries. Median resilience score was 24.00 (IQR = 12.00); 41.23% had low resilience, associated with male gender, religiosity, crisis training, full attendance and hospital assignment. Median sense of danger was high (14.0), linked to security escalations and lack of group activities. Resilience and sense of danger showed a weak positive correlation (rho = 0.178, p = 0.001). Healthcare workers in conflict zones exhibited low resilience and high perceived danger, influenced by gender, crisis training and security. Urgent mental health and safety interventions are needed to sustain this critical workforce.
Meningioma-associated acute subdural hematoma (ASDH) is an exceedingly rare clinical entity, and its hemorrhagic mechanisms remain poorly understood. A 65-year-old man presented with progressive headache without a history of trauma. Neurological examination revealed no focal deficits. Computed tomography demonstrated a left convexity acute subdural hematoma, while magnetic resonance imaging revealed a small adjacent extra-axial lesion with mild contrast enhancement. Digital subtraction angiography showed only minimal tumor staining and no evidence of vascular malformation. The patient underwent gross total resection of the tumor and evacuation of the hematoma. Histopathological examination confirmed a meningothelial meningioma with focal disruption of intratumoral venous structures, intratumoral hemorrhage, necrosis, and focal areas of increased proliferative activity. The postoperative course was uneventful, and the patient recovered without neurological deficits. Previously reported cases are discussed to provide clinical context and highlight the diverse presentations and management strategies of this rare condition. Although rare, meningioma should be considered a potential source of non-traumatic ASDH. Because reliable preoperative predictors of hemorrhage have not been established, management should be individualized according to tumor-hematoma continuity, neurological status, surgical feasibility, and patient preferences.
Pediatric pancreatic surgery is challenging due to soft pancreatic texture and small main pancreatic duct (MPD) diameter, both risk factors for postoperative pancreatic fistula (POPF). The modified stent-free Chen's U-suture technique, a continuous transpancreatic U-shaped invagination pancreaticojejunostomy without stenting, has shown low clinically relevant POPF (CR-POPF) rates in adults. This study evaluates its safety and feasibility in children. From July 2018 to November 2025, five children (2 males, 3 females; aged 4.3-10.1 years) underwent pancreatic resection with the modified stent-free Chen's U-suture technique (no MPD stent placement). Diagnoses included pancreatic head solid pseudopapillary neoplasm (SPN, n = 2, one with jaundice), body SPN (n = 1), grade III trauma (n = 1), and complex iatrogenic injury (n = 1). The primary endpoint was POPF rate (ISGPS 2016). All procedures were successful. Median operative time was 5 h (range 3-8); mean pancreaticojejunostomy time 17.8 min (15-21); median blood loss 50 mL (20-100). Two patients had transient mild hyperamylasemia (< 2×upper limit of normal) with imaging showing localized perianastomotic edema/fluid collection without diffuse parenchymal edema or necrosis, managed conservatively. One patient met the criteria for a biochemical leak; no CR-POPF (0%, 95% CI: 0.0%-52.2%) (grade B/C) occurred. No infection, hemorrhage, reoperation, or readmission occurred. Drains were removed on days 5-14 (median, 7 days). At median 25-month follow-up (range 4-92), one child required pancreatic enzyme replacement for fat malabsorption 4 years post-surgery; no new diabetes or other malabsorption occurred. One patient had asymptomatic mild distal MPD dilatation (2.9 mm) at 25 months; another had normal MPD shape (2.3 mm) at 4 months. The modified stent-free Chen's U-suture technique demonstrates promising feasiblility and safety for pediatric pancreatic head, neck, or body tumor resection, grade III trauma, and complex iatrogenic injuries, achieving a 0% CR-POPF rate in this small cohort (95% CI: 0.0%-52.2%) without the need for internal stenting. Transient mild hyperamylasemia with localized perianastomotic inflammatory changes is uncommon and manageable. Long-term pancreatic function is generally preserved, though asymptomatic MPD dilatation may occur.
Necrotizing soft-tissue infections (NSTI) caused by Clostridium spp. are rare. High rates of amputation and mortality are reported, but knowledge on clinical characteristics and outcome is largely based on retrospective cohorts. The role of Clostridium spp. as part of polymicrobial NSTI is also unclear. We identified all clostridial cases from the INFECT cohort, a prospective study including patients with confirmed NSTI admitted to 5 Scandinavian referral hospitals over a 4-year period. Selected parameters were compared to a control group of nonclostridial polymicrobial infections. Additionally, we analyzed polymicrobial infections with clostridial species. Ten cases of clostridial NSTIs were identified, evenly divided between cases caused by Clostridium perfringens and Clostridium septicum. Immunodeficiency (4/10) and penetrating trauma (3/10) were significantly more frequent compared to polymicrobial controls. Clostridial NSTI was also associated with extremity involvement (10/10) and severe pain (7/9). Radiological evidence of gas (4/7) did not distinguish clostridial from polymicrobial infections. Two patients underwent amputation, and 2 others died within 30 days. The cohort also included seven polymicrobial NSTIs with Clostridium spp., with higher rates of both comorbidity (7/7) and 30-day mortality (4/7). Clostridial NSTIs were associated with extremity infection, immunodeficiency, and penetrating trauma. The cases demonstrate a wide spectrum of severity. In polymicrobial NSTIs involving Clostridium spp., the mortality was particularly high, but the pathogenetic role of clostridia in these infections is unclear.
Severe isolated brain injury can trigger systemic oxidative and inflammatory responses extending to distant organs, including the lungs. Supplemental oxygen therapy is routinely used in neurocritical care, but elevated arterial oxygenation may be associated with redox alterations. The primary objective was to characterize temporal dynamics of systemic and pulmonary oxidative stress in patients with severe traumatic brain injury during the first 7 days. Secondary objectives were to assess associations between oxidative stress marker concentrations and arterial oxygenation parameters, clinical severity scores, and 28-day mortality. This was an exploratory study and no causal inferences are drawn. Prospective observational cohort study. First-level trauma centre intensive care unit over 12 months. Forty mechanically ventilated adult patients with isolated severe brain injury were enrolled. No therapeutic intervention was applied. Standard intensive care management was maintained according to institutional protocols. Primary outcomes were concentrations of superoxide dismutases (SOD), catalase (CAT), glutathione peroxidase (GPx), malondialdehyde (MDA), and 8-hydroxy-2'-deoxyguanosine (8-OHdG) measured in serum and bronchoalveolar lavage fluid at three time points during the first 7 days. Secondary outcomes included correlations with arterial oxygen tension (PaO2), inspired oxygen fraction (FiO2), clinical severity scores, and 28-day mortality. Antioxidant enzyme concentrations decreased and oxidative damage marker concentrations increased progressively (p < 0.001 for all). Repeated-measures correlation analysis showed that lower PaO2 values were associated with higher 8-OHdG levels in serum (r = -0.64) and bronchoalveolar lavage fluid (r = -0.55), and with lower SOD and CAT concentrations. The association between PaO2 and MDA was more complex: in mixed-effects models, PaO2 was positively associated with antioxidant enzyme concentrations and serum MDA concentration, suggesting that the relationship between oxygenation and lipid peroxidation is not straightforward. In an exploratory threshold-based analysis, PaO₂ values exceeding 100 mmHg at the earliest time point were associated with higher 28-day mortality (p < 0.05); however, this finding was not supported by a fully adjusted prognostic model and should be interpreted cautiously. Severe isolated brain injury is associated with progressive systemic and pulmonary oxidative stress. The relationship between arterial oxygenation and oxidative stress appears complex and may depend on timing and oxygen exposure levels.
Parents of children admitted to pediatric intensive care units (PICUs) are at increased risk of post-traumatic stress disorder (PTSD), potentially affecting long-term family well-being. This analysis evaluates the feasibility of a pilot randomized controlled trial (RCT) of PICU diaries, including recruitment, retention, and data collection, while providing insights into intervention implementation. Additionally, selected exploratory findings are reported, including parental trauma-related symptoms at six months post-discharge and the potential influence of gender and resilience on suspected PTSD. This pilot RCT was conducted in the PICU of a university hospital. Families were randomized to an ICU diary intervention group (IG) or control group (CG), with stratification by child age. Feasibility outcomes included integration into routine intensive care, family recruitment and retention, and completeness of follow-up. Parents completed questionnaires at admission (T0), PICU discharge (T1), and six months post-discharge (T2). PTSD symptoms were assessed using the German Impact of Event Scale-Revised, while resilience was measured through the Resilience Scale-13. Of 149 eligible families, 104 (69.8%) consented to participate, resulting in a final sample of 150 parents. Dropout until PICU discharge (T1) was 4.7%, while retention from T1 to the 6-month follow-up (T2) was 95.5%. In exploratory analyses, 19 (12.7%) parents screened positive for suspected PTSD after 6 months, providing preliminary estimates for future sample size calculations. Prevalence of suspected PTSD was 14.5% (10/69) in IG and 11.1% (9/81) in CG (OR = 1.36; 95% CI: 0.52-3.56). PTSD rates appeared higher in mothers than fathers (18.5% vs. 5.8%; OR = 3.69; 95% CI: 1.13-13.21). Parents who screened positive were more likely to exhibit lower resilience. This pilot study demonstrates that a RCT of ICU diaries in a PICU setting is feasible, with successful recruitment, high retention, and efficient data collection procedures. The intervention was integrated into routine care without indication of harm. Preliminary findings provide important estimates to inform the design and sample size of a fully powered trial. Future studies should further examine potential subgroup effects, including gender and resilience, as well as the impact of diary interventions at multiple time points following discharge.
Immigrant adolescents are exposed to multiple health risk factors. This study aimed to compare the burden of multimorbidity and psychological distress, along with associated exposure factors, among accompanied and unaccompanied immigrant adolescents seeking care in a hospital-based unit for vulnerable populations. This monocentric observational cohort was undertaken in Marseille, France (2019-2024), and included 384 adolescents aged 10-17 years who had arrived within the previous 5 years. The Cumulative Illness Rating Scale assessed the multimorbidity, and the Protect questionnaire assessed the risk of psychological trauma as a major component of psychological distress. The mean Cumulative Illness Rating Scale was 3.98 (standard deviation: 2.64). Multimorbidity was common, with 35.4% of participants having impairment of ≥ 3 organ systems. The most frequent impairments involved the eye, ear, nose, throat or teeth (48.7%), musculoskeletal and integumentary systems (46.4%), and mental health conditions (25.3%). Multimorbidity was independently associated with chronic medical history before migration (adjusted OR = 1.40, p < .0005) and during migration (adjusted OR = 1.94, p = .005). The risk of psychological trauma was independently associated with unaccompanied immigrant adolescent status (adjusted OR = 4.27, p < .05) and physical morbidity burden (adjusted OR = 1.18, p < .05). Patients had less emergency department visits during and after care in this hospital-based unit. Immigrant adolescents seeking care experience a high burden of multimorbidity and psychological distress. This risk requires particular attention, especially for unaccompanied adolescents, despite the lack of a convenient screening tool. A comprehensive care pathway is needed to reduce health inequalities in this extremely vulnerable population.
Laparoscopic ovariectomy (LOE) is a common procedure for elective sterilization in dogs and is associated with less tissue trauma than open techniques. However, manipulation of the ovarian pedicle may still induce nociceptive stimulation and contribute to perioperative inflammatory responses and changes in antioxidant enzyme activity. Topical administration of local anaesthetic to the ovarian pedicle may improve perioperative analgesia in minimally invasive surgery. To evaluate the effects of topical administration of bupivacaine HCl to the ovarian pedicle on postoperative pain, serum antioxidant enzyme activity and systemic pro-inflammatory cytokines in dogs undergoing LOE. Twenty-four clinically healthy, American Society of Anaesthesiologists (ASA) Class I female dogs were enrolled in a prospective, randomized, controlled trial. The dogs were allocated to receive either a total dose of bupivacaine HCl at 2.2 mg/kg (BPLOVE, n = 12), divided between the two ovarian pedicles, or an equivalent volume of isotonic saline (LOVE, n = 12), applied using the same topical technique. Standardized anaesthesia and surgical protocols were implemented. Postoperative pain was assessed using the University of Melbourne Pain Scale (UMPS) at 0, 2 and 4 h after surgery. Serum samples collected preoperatively, intraoperatively, and at 0, 2 and 4 h postoperatively were analysed for superoxide dismutase (SOD), catalase (CAT), interleukin-1β (IL-1β), interleukin-6 (IL-6) and tumour necrosis factor-α (TNF-α). Data were analysed using repeated-measures ANOVA and non-parametric tests (p < 0.05). All dogs completed the study without experiencing any major complications or requiring intraoperative rescue analgesia. UMPS scores were significantly lower in the BPLOVE group at all postoperative time points (p < 0.05). Significant group and time effects were observed in SOD and CAT activities, with higher antioxidant enzyme activity detected in bupivacaine-treated dogs (p < 0.05). Cytokine outcomes showed no consistent between-group differences; IL-6 was numerically lower in the BPLOVE group across time points, with a significant difference detected only at 4 h postoperatively. Topical administration of bupivacaine HCl to the ovarian pedicle during LOE was associated with improved early postoperative analgesia and higher serum SOD and CAT activities, without consistent short-term changes in systemic pro-inflammatory cytokine concentrations. These findings support the potential value of ovarian pedicle bupivacaine administration as part of multimodal analgesia in canine laparoscopic surgery and indicate changes in antioxidant enzyme activity during the early perioperative period.