Mediators and moderators of the relationship between body image and community integration among burn survivors

IntroductionDue to medical advances, care for patients that experience burns has shifted from saving life to improving quality of life. Reintegrating into the community and maintain body image satisfaction may be difficult after a severe burn. Several studies have analyzed these two variables independently, but none have addressed a potential interrelationship.AimTo investigate the indirect or direct relationship of body image and community integration, potentially mediated or moderated by social stigma, symptoms of depression, symptoms of post-traumatic stress disorder (PTSD), or posttraumatic growth.MethodsData from the Burn Models Systems (BMS) Database between the years 2014 and 2020, patients who were at least 18 years of age and who had completed questionnaires that measured body image satisfaction, attitudes of community integration, perceived social stigma, and symptoms of depression, symptoms of PTSD, and posttraumatic growth were used to analyze potential mediators and moderators of the relationship between body image and community integration using multivariable linear regression models and structural equation modeling.ResultsSocial stigma, symptoms of depression, and symptoms of PTSD were determined to completely mediate the association of body image and community integration. Posttraumatic growth did not mediate this association. Social stigma, symptoms of depression, symptoms of PTSD, and posttraumatic growth did not moderate the relationship between body image and community integration.ConclusionThe finding that symptoms of distress and social stigma account for the relationship between body image satisfaction and community integration support the potential for interventions that ameliorate distress to improve community integration and quality of life in people recovering from burn injuries.     

Social and economic factors associated with the risk of burn injury

Socioeconomic status (SES) factors have been associated with the risk of burn, but the relative significance of these findings across populations and cultures is not known. The purpose of this literature synthesis was to determine: (1) which SES factors have been associated with burn risk; (2) whether these factors are generalizable across studies; and (3) which of these factors are modifiable. A search of studies of SES and burn risk published between January 1992 and September 2006 yielded 34 pertinent studies. SES risk factors were placed into categories pertaining to ethnicity, income, family structure, education, occupation, residence, and general SES. SES factors associated with increased risk included: ethnicity (non-white), low income, large families, single parents, illiteracy, low maternal education, unemployment, job loss, substandard living conditions, not owning a home, not having a telephone, and crowding. The lack of standard definitions for SES, as well as the heterogeneity of study populations and outcome variables, limits the generalizability of these results. However, the results confirm that several SES factors are associated with increased risk of burn and provide a template of factors to be considered when studying burn populations.     

Comparison of the perceived stigmatization measures between the general population and burn survivors in Brazil

ObjectivesTo compare perceived stigmatization, symptoms of depression and self-esteem of adults from Brazilian general population with Brazilian burns survivors and to verify the possible correlations between these populations.MethodThe general population and burn survivors administered the adapted Brazilian versions of the Perceived Stigmatization Questionnaire (BR-PSQ-R), Beck Depression Inventory (BDI) and Rosenberg Self-Esteem Scale (RSES). The Student's t-test for independent samples was employed to identify significant differences between the means of the results from the BR-PSQ-R, BDI and RSES instruments, and the Pearson correlation was used to detect correlations between constructs. The significance level was set at 0.05.ResultsParticipants of this study included: 102 individuals from the general population and 240 burn survivors. The difference between the BR-PSQ-R mean scores of the two groups was not statistically significant (p = 0.077). The mean scores for the BDI (p = 0.001) and RSES (p = 0.001) where found to be lower in the general population, when compared to burn survivors. Moderate correlations were identified between the perceived stigmatization and depression (r = 0.43; p < 0.001) and perceived stigmatization and self-esteem (r = −0.35; p < 0.001).ConclusionsParticipants from the general population and burn survivors exhibit similar levels of perception of stigmatization; the general population presented fewer symptoms of depression and a higher self-esteem when compared to burn survivors.     

Resilience and psychological distress among burn survivors

IntroductionBurn is one of the highly occurring injuries worldwide. In case of an acid attack, survivors are considered an embarrassing element for the family. In other words, survivors’ dignity is judged by the scars on their faces and bodies. Burn survivors experience physical pain of wounds, along with unseen psychological agony. Here, resilience is the most captivating phenomenon that can lead the survivor to normalcy in life after experiencing such traumas. The current study is aimed to explore the role of resilience in the psychological distress of burn survivors.Method160 burn survivors were selected with an age bracket of 18–78 years from indoor hospital settings. To explore resilience, Urdu translated version of the Connor-Davidson Resilience Scale (CD-RISC) by Naz (2011) was used and for symptoms of psychological distress, Urdu version of Depression Anxiety Stress Scale- 21 (DASS-21) by Aslam and Kamal (2017). was also used. The data were analyzed via SPSS 23.ResultsFindings revealed that there is a significant negative relationship between resilience and psychological distress among burn survivors. Moreover, resilience predicted psychological distress. A significant difference was found between types of burn on depression and anxiety. Furthermore, the relationship between resilience to stress and depression is moderated by age of the burn survivor at the time of the incidence. A significant negative relationship between age with psychological distress among burn survivors was observed. The treatment period was associated positively with resilience and negatively with stress among burn survivors. Results also revealed no significant gender difference. However, a significant difference was found between types of burn on depression and anxiety.ConclusionThe findings of current study would be helpful for the medical professionals, mental healthcare providers, and policymakers who can help to develop and implement rehabilitation programs and mental health demands for the said population and can initiate and plan resilience promoting programs that would help promote adaptive coping to deal with trauma.     

艾滋病患者感知歧视影响因素及护理干预研究进展

对艾滋病患者的感知歧视影响因素及相关的干预研究进行综述,其影响因素包括人口学因素、疾病因素、心理因素及社会文化因素等,干预措施包括认知行为治疗、社区干预、工作坊干预及小组培训干预等。建议在借鉴国外干预措施的基础之上,探索实施适合中国国情的艾滋病患者感知歧视干预措施,以改善其心理健康状况,促进艾滋病防治工作的开展。     

Stigma and illness uncertainty among patients with visible burn scars: A cross-sectional study

The purpose of this research was to understand the current status of stigma and illness uncertainty in patients with visible burns and explore the correlation between them. Measures to help patients alleviate shame and uncertainty in illness are also discussed. A cross-sectional study was conducted in a tertiary hospital from November 2020 to March 2021 for patients with burns on exposed parts of the face, neck, or limbs. The scales used in this study include demographic data questionnaires, the Social Impact Scale (SIS), and the Mishel Uncertainty in Illness Scale for Adults (MUIS-A). A two-tailed independent t-test was used to evaluate the differences in the respondents’ sociodemographic characteristics, stigma, and illness uncertainty. The total stigma and illness uncertainty scores of 146 patients were 57.03 ± 6.762 and 68.59 ± 12.901, respectively. Spearman correlation analysis showed that stigma was positively correlated with illness uncertainty (r = 0.398, p < 0.01). Multiple regression analysis showed a relationship between stigma and uncertainty of illness (B = 0.215, p = 0.000), itching (B = 2.555, p = 0.01), residence (B = 2.545, p = 0.029), and age (B = 0.074, p = 0.037). The stigma level of patients with visible burns increased with increasing uncertainty regarding illness. Therefore, reducing the patients’ uncertainty in illness is a way to intervene in stigma.     

Demographic characteristics and prognostic indicators of childhood burn in a developing country

Children constitute a significant proportion of burn victims in most studies from the developing countries. While there has been a progressive improvement in the outcome from childhood burn in many developed nations, the morbidity and mortality remains high in many low and middle income countries. The aim of our study is to evaluate the demographic characteristics and prognostic indicators of childhood burn in a major referral teaching hospital in a developing country. A review of the records of 638 patients with acute burns managed over a 10-year period from January 2001 to December 2010 at the University College Hospital, Ibadan Nigeria was done. The clinical and epidemiological data were retrieved from computerized data base using the ISBI proforma. Information obtained includes Biodata, Etiology, location, TBSA, presence of Inhalation injury and the treatment outcome. Data of patients aged 16 years and below were analyzed using the SPSS version 16. The main outcome measure was the patient's survival. 289 children representing 45.3% of the total number of burn patients were managed over the period. The M:F ratio was 1.1:1. The median age of the cohort was 4.0 years while the median TBSA was 21.0%. Non-intentional causes were responsible for 89.6% cases. Most of the injuries (88.6%) occurred at home. Eighty-three patients had inhalation injury out of which 57 (68.7%) deaths were recorded. The overall mortality rate in the cohort was 39.5% with an LA50 of burn size of 45%. The TBSA was also found to be a determinant of outcome.Majority of childhood burns are from preventable causes with attendant dismal mortality figures. Effective burn prevention strategies and improved quality of care remain pivotal in reducing childhood burn morbidity and mortality in the developing countries.     

Measuring stigma after spinal cord injury: Development and psychometric characteristics of the SCI-QOL Stigma item bank and short form

ObjectiveTo develop a calibrated item bank and computer adaptive test (CAT) to assess the effects of stigma on health-related quality of life in individuals with spinal cord injury (SCI).DesignGrounded-theory based qualitative item development methods, large-scale item calibration field testing, confirmatory factor analysis, and item response theory (IRT)-based psychometric analyses.SettingFive SCI Model System centers and one Department of Veterans Affairs medical center in the United States.ParticipantsAdults with traumatic SCI.ResultsA sample of 611 individuals with traumatic SCI completed 30 items assessing SCI-related stigma. After 7 items were iteratively removed, factor analyses confirmed a unidimensional pool of items. Graded Response Model IRT analyses were used to estimate slopes and thresholds for the final 23 items.ConclusionsThe SCI-QOL Stigma item bank is unique not only in the assessment of SCI-related stigma but also in the inclusion of individuals with SCI in all phases of its development. Use of confirmatory factor analytic and IRT methods provide flexibility and precision of measurement. The item bank may be administered as a CAT or as a 10-item fixed-length short form and can be used for research and clinical applications.     

Development of patient pathways for the surgical management of burn injury

Background: There are many reasons for the development of patient pathways in burn surgery introduced at the Royal Adelaide Hospital in South Australia at the beginning of January 2005. These include education, standardization of technique, scheduling of surgical episodes and rationalization of the use of expensive therapies. Methods: A critical appraisal of both evidence based on published work and personal/peer experience has been used to generate the current pathways. Results: The year 2005 was the busiest in the history of the hospital, both in numerical terms and in the proportion of major burn injuries. These protocols were effective in enabling us to cope with negligible mortality. Conclusion: Although the first draft pathways work in our unit, they will undergo regular audit. It is hoped that they will form a template that can assist other services to create their own pathways.     

烧伤所致代谢紊乱的临床诊断与治疗

烧伤后机体应激导致代谢紊乱，表现为严重高分解代谢，机体损耗和抵抗力下降，严重影响患者预后。临床上主要采用生理营养指标、实验室诊断指标和能量消耗测定3类检测指标对机体代谢状况进行诊断评估，继而通过药物治疗结合非药物治疗手段加以调理支持，促进烧伤修复。目前，仍有多种诊断治疗方法尚未普及或有待完善。     

Eosinophilic recruitment in thermally injured older animals is associated with worse outcomes and higher conversion to full thickness burn

BackgroundPartial burn injury in older patients is associated with higher rates of morbidity, mortality, and conversion to full thickness burn (Finnerty et al., 2009; Pham et al., 2009). Both human and mouse models demonstrate an altered systemic immune response in older subjects, however less is known about the localized response (Jeschke et al., 2016; Farinas et al., 2018; Mohs et al., 2017). We hypothesized that a mouse model could demonstrate differences in the localized inflammatory response of the old.MethodsSix old (66 weeks) and young (8 weeks) mice received partial thickness thermal burns. Localized and systemic expression of nine chemokines (TNFalpha, MCP-1, MIP-2, S100A9, EGF, IL-10, RANTES, G-CSF, and EOTAXIN) were evaluated at day 3 after burn using Luminex analysis. Vimentin immunostaining was used to evaluate injury depth.ResultsVimentin staining demonstrated increased burn depth in old mice (449 ± 38 μm) as compared to young (166 ± 18 μm) (p < 0.05). Both groups exhibited increased localized expression of EOTAXIN after burn (p < 0.05), however expression in old mice (83.6 ± 6.1 pg/ml) was lower than that of young (126.8 ± 18.7 pg/ml) (p < 0.05). Systemically, however, old mice had increased baseline EOTAXIN expression (1332.40 ± 110.78 pg/ml) compared to young (666.12 ± 45.8 pg/ml) (p < 0.005).ConclusionsEOTAXIN is one of the primary chemoattractants for selective eosinophilic recruitment and activation. While eosinophils are important for wound healing, a hyperactive eosinophilic response can result in tissue damage. We hypothesize that the increased baseline serum EOTAXIN in the old may prime their hyperactive response, and may contribute to their worse clinical outcomes. Long-term eosinophil activation requires further study, however our findings indicate a role for EOTAXIN and eosinophils in burn response.     

Incidence and factors associated with sensorineural and conductive hearing loss among survivors of congenital diaphragmatic hernia

Purpose

The reported incidence of sensorineural hearing loss (SNHL) in long-term survivors of congenital diaphragmatic hernia varies widely in the literature. Conductive hearing loss (CHL) is also known to occur in CDH patients, but has been less widely studied. We sought to characterize the incidence and risk factors associated with SNHL and CHL in a large cohort of CDH patients who underwent standardized treatment and follow-up at a single institution.

Methods

We retrospectively reviewed charts of all CDH patients in our pulmonary hypoplasia program from January 2004 through December 2012. Categorical variables were analyzed by Fisher’s exact test and continuous variables by Mann–Whitney t-test (p ≤ 0.05).

Results

A total of 112 patients met study inclusion criteria, with 3 (2.7%) patients diagnosed with SNHL and 38 (34.0%) diagnosed with CHL. SNHL was significantly associated with requirement for ECMO (p = 0.0130), prolonged course of hospitalization (p = 0.0011), duration of mechanical ventilation (p = 0.0046), requirement for tracheostomy (p = 0.0013), and duration of loop diuretic (p = 0.0005) and aminoglycoside therapy (p = 0.0003).

Conclusions

We have identified hearing anomalies in over 30% of long-term CDH survivors. These findings illustrate the need for routine serial audiologic evaluations throughout childhood for all survivors of CDH and stress the importance of targeted interventions to optimize long-term developmental outcomes pertaining to speech and language.     

Risk factors for failure of limb salvage among veterans with foot ulcers

BackgroundThere is limited available information to guide early discussions involving limb salvage for patients with non-traumatic foot ulcers. We hypothesized patient, wound and treatment factors identifiable at initial operative treatment would be associated with failure of attempted limb salvage.MethodsWe retrospectively assessed United States military veterans treated operatively for non-traumatic foot ulcers at a Veteran’s Administration (VA) hospital from 2008 to 2018. Cox proportional hazard analysis assessed for independent associations with eventual above ankle amputation.ResultsLimb salvage failed for 52 of 461 patients (11.0%). Univariable associations included initial wound area ≥1 cm (p < .001), immediate TMA (p < .001), diagnosis of PVD (p < .001) or diabetes (p = .005), nonpalpable pulse (p = .006), CKD (p = .023), creatine ≥ 1.5 (p = .004), and HgA1c ≥ 6.2 (p < .001). Independent associations consisted of initial wound area ≥1 cm (HR 6.0, 95% CI 1.4–25.1, p = .014), immediate TMA (HR 3.5, 95% CI 1.9–6.4, p < .001), and PVD (HR 3.5, 95% CI 1.6–7.5, p = .001). When <2 risk factors were present, 99.1% and 96.8% retained their hindfoot at 5 and 10 years, respectively. However, this decreased to 87.3% and 80.1% with two risk factors and fell to 63.3% and 43.3% with three risk factors.ConclusionFailure of limb salvage was increasingly likely as the number of identified independent risk factors increased. These results may assist in prognostication and shared decision making between patients and providers.Level of evidencePrognostic, Level III.     

面部烧伤后综合康复疗法与单纯中药蒸汽喷雾的疗效比较

目的 探讨面部深Ⅱ度烧伤愈合后单纯中药蒸汽喷雾治疗与综合康复疗法的疗效比较.方法 将80例患者随机分为:中药蒸汽喷雾治疗+压力治疗+物理治疗+康复训练+心理治疗为治疗组(综合康复治疗40例);单纯中药蒸汽喷雾治疗为对照组(40例).3个月后对两组患者分别进行临床疗效评定.结果 治疗3个月后,治疗组大部分患者色素沉着消失,无瘢痕增生,接近正常皮肤.治愈率72.5％,显效率12.5％,有效率7.5％.对照组部分患者面部仍有轻度的瘢痕增生但已不明显,原色素沉着面积缩小、色素变浅但肤色未接近正常皮肤.治愈率42.5％,显效率12.5％,有效率25.0％.两组疗效比较差异有统计学意义(P＜0.05).结论 面部烧伤后综合康复治疗能减少色素沉着、减轻增生瘢痕、提高生活质量等.     

头面部和双手电弧烧伤患者不同治疗阶段心理反应差异的研究

目的:对头面部及双手电弧烧伤住院患者在伤后不同治疗阶段进行心理问卷调查,了解患者焦虑和抑郁的发生状况.方法:对20例成人头面部及双手电弧烧伤住院患者于入院初(伤后24 h内),扩创术前(伤后第5天)、恢复期(伤后2周～1个月)3个不同治疗阶段,采用Zung氏焦虑和抑郁评定量表进行心理问卷调查,统计分析存在焦虑、抑郁状态的存在情况.结果:20例患者在入院初(伤后24 h内)、扩创术前(伤后第5天)及恢复期(伤后2周～1个月)3个治疗阶段均存在焦虑或(和)抑郁倾向;患者在入院初(伤后24 h内)的焦虑和抑郁状况最明显,焦虑和抑郁评分(37.60±7.06和36.90±8.48)均明显高于扩创术前(33.45±6.15±和34.70±8.24)和恢复期(28.75±5.63和29.30±5.69),差异均有显著性(P均＜0.05).结论:头面部及双手电弧烧伤住院患者伤后24 h内焦虑抑郁状态相对于其他诊疗阶段重,建议采取相应的心理护理干预措施.     

Single centre experience of combat-related vascular injury in victims of Syrian conflict: Retrospective evaluation of risk factors associated with amputation

ObjectiveTo elucidate the risk factors associated with amputation in cases with combat-related vascular injury (CRVI).Material and methodsThis retrospective study included 90 cases with CRVI treated between May 2011 and July 2013. The patients were divided into group I (n = 69), in which the limb was salvaged and group II (n = 21), in which the patients received amputation.ResultsThe overall and the secondary amputation rates were 23% and 18%, respectively. There were no amputations with the MESS of nine or less, increasing proportions of amputations at 10 and 11, with a level of 12 leading to 100% amputation rate. The mortality rate was 2%. Among the 52 (58%) cases with the mangled extremity severity score (MESS) ≥ 7, the limb salvage rate was 60%. The patients in group II were more likely to have a combined artery and vein injury (p = 0.042). They were also more likely to be injured as a result of an explosion (p = 0.004). Along with the MESS (p < 0.001), the duration of ischemia (DoI) (p < 0.001) were higher in group II. The rate of bony fracture (p < 0.001) and wound infection (p = 0.011) were higher in group II. For the overall amputation, the odds ratio of the bony fracture (OR: 61.39, p = 0.011), nerve injury (OR: 136.23, p = 0.004), DoI (OR: 2.03, p = 0.003), vascular ligation (OR: 8.65, p = 0.040) and explosive device injury (OR: 10.8, p = 0.041) were significant. Although the DoI (p < 0.001) and the MESS (p = 0.004) were higher in whom a temporary vascular shunt (TVS) was applied, the utilisation of a TVS did not influence the amputation rate (p = 1.0).ConclusionsThe DoI and the variables indicating the extent of tissue disruption were the major determinants of amputation. While statistically non-significant, the benefit of the application of a TVS is non-negligible. MESS is a valid scoring system but should not be the sole foundation for deciding on amputation. Extremities which were doomed to amputation with the MESS >7 seem to benefit from revascularisation with initiation of reperfusion at once. The validity of MESS merits further investigation with regard to the determination of a new cut-off value under ever developing medical management strategies.