Mental Health Problems in Traumatic Spinal Cord Injury Patients - An Umbrella Systematic Review.

The study conducted is the retrospective study and the main objective is to evaluate the benefits and safety of early versus late tracheostomy in traumatic spinal cord injury (SCI) patients requiring mechanical ventilation. Tracheostomy offers many advantages in critical patients who require prolonged mechanical ventilation. Despite the large amount of patients treated, there is still an open debate about advantages of early versus late tracheostomy. Early tracheostomy following the short orotracheal intubation is probably beneficial in appropriately selected patients. It is a retrospective clinical study and we evaluated clinical records of 152 consecutive trauma patients who required mechanical ventilation and who received tracheostomy. The results show that the early placement (before day 7 of mechanical ventilation) offers clear advantages for shortening of mechanical ventilation, reducing ICU stay and lowering rates of severe orotracheal intubation complication, such as tracheal granulomas and concentric tracheal stenosis. On the other hand, we could not demonstrate that early tracheostomy avoids neither risk of ventilator-associated pneumonia nor the mortality rate. In SCI patients, the early tracheostomy was associated with shorter duration of mechanical ventilation, shorter length of ICU stay and decreased laryngotracheal complications. We conclude by suggesting early tracheostomy in traumatic SCI patients who are likely to require prolonged mechanical ventilation.

Prospective open cohort study. Compare the demographic characteristics and rehabilitation outcomes for both non-traumatic SCI (NT-SCI) and traumatic SCI (T-SCI) patients admitted into either specialist spinal cord injury rehabilitation units (SCIRUs) or non-specialist rehabilitation units (NSRUs). Rehabilitation units in Australia. The Australasian Rehabilitation Outcomes Centre maintains a national database on inpatients admitted to most (130/145) public and private rehabilitation units in Australia. Patients were included if they had a diagnosis of spinal cord injury (SCI) and were discharged between 1 January 2006 and 31 December 2006. Patients were excluded if admitted for <7 days, only for assessment, or were a readmission following a previous SCI. There were 668 patients with confirmed SCI admitted (NT-SCI n=361, 54.0%; T-SCI n=307, 46.0%). NT-SCI patients were much less likely to be admitted into a specialist SCIRU (30.5%) compared with T-SCI patients (70.4%). For both NT-SCI and T-SCI patients, those admitted to a specialist SCIRU tended to be younger (P=0.000), have a longer length of stay in rehabilitation (P=0.000), and lower Functional Independence Measure (FIM) motor subscale score on admission (P=0.000) than those admitted to a NSRU. For NT-SCI patients, after adjusting for covariates, those admitted into specialist SCIRU had greater improvement in their FIM motor score during rehabilitation. This finding was not demonstrated in T-SCI patients. There are differences in the characteristics of SCI patients admitted to SCIRU compared with NSRU. NT-SCI patients admitted to SCIRU have greater functional gain.

Despite the critical need for data to support public health policies in Brazil, there is a glaring lack of national epidemiological studies on neurogenic lower urinary tract dysfunction (NLUTD). This study aimed to illuminate the factors associated with the urological management of NLUTD among individuals with traumatic spinal cord injury (TSCI) and non-traumatic spinal cord injury (NTSCI). Employing a quantitative, cross-sectional, and descriptive design, this study analyzed electronic medical records of NLUTD and SCI patients monitored within the SARAH network from 2007 to 2017. Sociodemographic and clinical data were collected, including the ASIA Impairment Scale, and statistical analyses such as the Mann–Whitney and Pearson’s Chi-square tests were conducted. The findings revealed that out of 903 patients, 67% had TSCI and 33% had NTSCI. Clean intermittent catheterization (CIC) was the primary bladder emptying method, utilized by 66.11% of the participants. The average emptying frequency was 4.71 times a day, and urinary incontinence was reported in 58.4% of cases. A significantly higher rate of positive urinary colonization was found among TSCI patients. The study highlighted significant differences in NLUTD management between TSCI and NTSCI patients, with NTSCI patients more frequently achieving voluntary urination and using maneuvers to stimulate urination. These distinctions underscore the need for more individualized approaches and deeper understanding of each type of spinal cord injury, aiming to enhance bladder rehabilitation programs in Brazil.

ABSTRACTBackground: Prior research suggests that both posttraumatic stress disorder (PTSD) and alcohol abuse affect behavioral healthcare utilization among combat-exposed military populations. However, their interactive effect is not well documented, especially after experiencing psychological trauma. Objective: This study examined the role of hazardous alcohol use (i.e. repeated patterns of drinking which lead to harmful consequences) on behavioral healthcare utilization among service members stratified by past-year combat exposure. Method: This study utilized a sample of National Guard service members who participated in an in-depth survey 2–4 months after returning from Operation Enduring Freedom, Operation Iraqi Freedom, or Operation New Dawn deployments (2011–2013) (n = 467). We examine the marginal effect (the change in the probability) of hazardous alcohol use on utilization while controlling for trauma exposure, PTSD and other potential covariates. Results: In the unadjusted logistic model, hazardous alcohol use reduced the probability of behavioral healthcare utilization by 77% among service members who had been exposed to combat within the past year. In the adjusted model, which controlled for socio-demographics (age, gender, and race), health status (PTSD symptoms, depression and physical health), and measures of stigma (perception of services as embarrassing or harmful to one's career or social networks), hazardous alcohol use further reduced the utilization probability by 302%. Conclusion/Importance: Although these findings require replication, they appear to demonstrate that when combat-exposed service members engaged in hazardous alcohol use at postdeployment, they were much less likely to utilize behavioral healthcare to manage their posttraumatic stress symptoms during this period.

Objective Posttraumatic stress disorder (PTSD) and hazardous alcohol use are prevalent among trauma survivors. Despite higher rates of both PTSD and hazardous alcohol use among military combat veterans than civilians, scant research has examined whether military combat experience is associated with drinking alcohol to cope with PTSD symptoms. This study tested the hypothesis that compared to trauma-exposed men without combat experience, men with military combat experience would be more likely to endorse drinking alcohol to cope with their PTSD symptoms. Methods: Interview data from N = 11,474 men who reported at least one lifetime traumatic experience were drawn from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a face-to-face interview study that recruited a nationally representative sample of adults living in the United States between 2004 and 2005. Results: Among men endorsing lifetime trauma exposure, men with military combat experience (n = 1,386) were more likely than men without combat experience (n = 10,088) to report drinking alcohol to cope (7.22 vs. 2.61% in unweighted analyses, 6.46 vs. 2.37% in weighted analyses). Total number of lifetime trauma types, lifetime PTSD severity, and lifetime alcohol abuse/dependence were significantly associated with drinking to cope in bivariate and multivariate analyses. Military combat experience was significantly associated with drinking to cope in multivariate analyses adjusting for lifetime PTSD diagnosis. Military combat experience was not significantly associated with drinking to cope in multivariate analyses adjusting for lifetime PTSD symptom count. Conclusions: Although military combat experience was significantly associated with drinking to cope in bivariate analyses, multivariate analyses yielded mixed findings: combat experience was significantly associated with drinking to cope in models adjusting for PTSD diagnosis, but not in models adjusting for PTSD symptom count. Findings highlight the importance of assessing and targeting PTSD symptom-related alcohol use, even in the absence of alcohol abuse/dependence. Results from this preliminary study could inform future research on drinking to cope with PTSD symptoms among military combat veterans and other trauma survivors.

Objectives: Concurrent substance use disorder (SUD) and posttraumatic stress disorder (PTSD) occur at high rates and are typically associated with poor treatment outcomes in both sexes. However, women have a propensity to cope with increased negative affect via substance use in comparison to men; thus, it is important to elucidate the sex-specific bidirectional relationships between SUD and PTSD to improve our understanding of concurrent SUD/PTSD in men and women. Methods: Using data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC-Wave 3; n = 36,309), the present study evaluated the impact of sex on the relationship between past-year SUDs (new, remitted, ongoing), including alcohol and drug use, and retrospective transitions in new vs. absent and ongoing vs. remitted diagnoses of PTSD. Additionally, the impact of sex was explored in models examining past year PTSD (new, remitted, ongoing) and retrospective transitions in new vs. absent and ongoing vs. remitted diagnosis of SUDs. Diagnostic transitions were based on retrospective reporting. Results: Results indicated that new, remitted, and ongoing SUDs increase the likelihood of new PTSD diagnoses (OR range = 2.53–8.11; p < 0.05). Among individuals with ongoing drug use disorders (DUD), there were greater odds of ongoing PTSD (OR = 2.10, p < 0.01). When examining the relationship reciprocally, new, remitted, and ongoing PTSD increased the likelihood of new SUDs (OR range = 2.50–8.22; p < 0.05), and ongoing PTSD increased the likelihood of ongoing SUD and DUD (OR = 1.40, 1.70, respectively; p < 0.05). Sex-specific analyses revealed that the relationship between PTSD and SUDs varies between sexes, particularly among women. For instance, women with new PTSD had higher odds of SUDs, and women with ongoing PTSD were almost 2.5 times more likely to have an ongoing DUD. Women with a new PTSD diagnosis were more likely to be diagnosed with a new SUD (OR = 3.27) and an ongoing DUD (OR = 3.08). Conclusions: Results indicate a bidirectional relationship between PTSD and SUD that is in many instances larger in women. Thus, illustrating potential sex-specific differences in underlying mechanisms implicated in SUD/PTSD, warranting additional research.

Hurt people who hurt people: Violence amongst individuals with comorbid substance use disorder and post traumatic stress disorder

Tracheostomy and gastrostomy are frequently performed to facilitate prolonged ventilation and nutritional support in spinal cord injury (SCI) patients. The aim of this study was to evaluate the impact of gastrostomy timing relative to tracheostomy on in-hospital outcomes and complications in complete traumatic cervical SCI patients. A multicenter retrospective observational study was performed using data from the Trauma Quality Improvement Program of the American College of Surgeons, between 2010 and 2020. The study included complete traumatic cervical SCI patients who underwent both tracheostomy and gastrostomy. Gastrostomy timing was categorized relative to tracheostomy timing as same-day (within 24 hours of tracheostomy) and delayed (more than 24 hours after tracheostomy). Outcomes of interest included intensive care unit (ICU) and hospital length of stay (LOS), mechanical ventilation duration, incidence of major in-hospital complications, immobility complications, and surgical site infections. Univariate and multivariable models were constructed to assess associations. We conducted a sensitivity analysis using propensity score matching to determine the robustness of our findings. Of 2958 patients included, 2168 underwent same-day tracheostomy and gastrostomy and 790 underwent delayed gastrostomy after tracheostomy. Patients in the same-day group had significantly shorter ICU and hospital LOS and reduced mechanical ventilation duration (adjusted mean difference [MD] -5.83, 95% CI -7.51 to -4.16, P < .001, adjusted MD -8.98, 95% CI -11.33 to -6.63, P < .001, and adjusted MD -5.93, 95% CI -7.80 to -4.07, P < .001, respectively). No evident difference was noted in the occurrence of major hospital adverse events between the groups. The sensitivity analysis recapitulated the primary analysis findings, demonstrating the consistency and robustness of effect estimates. Same-day tracheostomy and gastrostomy in complete traumatic cervical SCI patients was associated with better outcomes than delayed gastrostomy. Specifically, grouping these procedures may shorten ICU and overall hospital LOS, and reduce ventilation duration.

This study aims to quantify the change in time to surgery for treatment of complete traumatic cervical spinal cord injury (SCI) patients in American College of Surgeons accredited trauma centers across North America over the last decade (2010-2020). This multi-center retrospective observational cohort study used data from the Trauma Quality Improvement Program from 2010 to 2020. All surgically treated patients with complete traumatic cervical SCI were included. Primary outcome was time to spine surgery from treating hospital arrival in hours. Both descriptive statistics and a multi-variable Poisson regression model clustering standard of errors by each included trauma center were used to evaluate and quantify the annual change in time to surgical intervention. The study included 6855 complete traumatic cervical SCI patients managed across 484 trauma centers in North America. Median time to spine surgery was 14.6 h. A total of 4618 patients (67.3%) underwent surgical intervention within 24 h from hospital arrival. From 2010 to 2020, median time to surgery decreased by an average 0.6 h (±0.15) per year. A multi-variable adjusted model for time to surgery demonstrated a significant downward annual reduction of 5% in time to surgery between the years 2010 and 2020 (Incidence rate ratio = 0.95; 95% Confidence Interval: 0.93-0.96). This study provides compelling real-world based quantification of the change in time to surgical intervention following traumatic cervical SCI. A significant decreasing annual trend pertaining to surgical timing across trauma centers in North America over the past decade was demonstrated.

This study aimed to compare macrostructural and microstructural neurodegenerative changes remote from a cervical spinal cord injury in traumatic spinal cord injury (tSCI) and degenerative cervical myelopathy (DCM) patients using quantitative magnetic resonance imaging (MRI). Twenty-nine tSCI patients, 20 mild/moderate DCM patients, and 22 healthy controls underwent a high-resolution MRI protocol at the cervical cord (C2/C3). High-resolution T2*-weighted and diffusion-weighted scans provided data to calculate tissue-specific cross-sectional areas of the spinal cord and tract-specific diffusion indices of cord white matter, respectively. Regression analysis determined associations between neurodegeneration and clinical impairment. tSCI patients showed more impairment in upper limb strength and manual dexterity when compared with DCM patients. While macrostructural MRI measures revealed a similar extent of remote cord atrophy at cervical level, microstructural measures (diffusion indices) were able to distinguish more pronounced tract-specific neurodegeneration in tSCI patients when compared with DCM patients. Tract-specific neurodegeneration was associated with upper limb impairment. Despite clinical differences between severely impaired tSCI compared with mildly affected DCM patient, extensive cord atrophy is present remotely from the focal spinal cord injury. Diffusion indices revealed greater tract-specific alterations in tSCI patients. Therefore, diffusion indices are more sensitive than macrostructural MRI measures as these are able to distinguish between traumatic and non-traumatic spinal cord injury. Neuroimaging biomarkers of cervical cord integrity hold potential as predictors of recovery and might be suitable biomarkers for interventional trials both in traumatic and non-traumatic SCI.

Cannabis and alcohol are the most frequently used substances among Black sexual/gender minority people, and co-use of these substances is surging. Little work exists on the association of cannabis/alcohol co-use with HIV prevention and care engagement in this population. The authors examined daily associations of cannabis/alcohol co-use with pre-exposure prophylaxis and antiretroviral medications use, in the context of hazardous alcohol and cannabis use, among Black sexual/gender minority. Daily use of cannabis, alcohol, and pre-exposure prophylaxis/antiretroviral medication was assessed through 14-day ecologic momentary assessment in the Neighborhoods and Networks Part 2 cohort study of Black sexual/gender minority in Chicago (2022-2024). Generalized estimating equations models were used to examine day-level associations between cannabis/alcohol co-use and following-day pre-exposure prophylaxis/antiretroviral medication use. Across 5,729 days for 521 participants with ≥1 ecologic momentary assessment responses, cannabis/alcohol co-use, cannabis-only use, alcohol-only use, and no substance use occurred on 19.8%, 36.5%, 6.3%, and 34.9% days, respectively. Among participants who reported hazardous alcohol use (Alcohol Use Disorders Identification test≥8), on cannabis-only days, participants were more likely to report following-day pre-exposure prophylaxis/antiretroviral medication use (adjusted RR=1.54; 95% CI=1.00, 2.38). Among participants with no hazardous alcohol use, alcohol-only use day was associated with greater following-day pre-exposure prophylaxis/antiretroviral medication use (adjusted RR=1.34; 95% CI=1.02, 1.76). Cannabis/alcohol co-use was not associated with pre-exposure prophylaxis/antiretroviral medication use, regardless of hazardous alcohol or cannabis use status. Heterogeneity exists regarding the associations between cannabis/alcohol co-use and pre-exposure prophylaxis/antiretroviral medication use among Black sexual/gender minority, depending on individuals' hazardous alcohol use status. Future research should collect fine-grained contextual data on cannabis/alcohol co-use to examine the mechanisms through which co-use influences HIV care engagement.

Does a history of violent offending impact treatment response for comorbid PTSD and substance use disorders? A secondary analysis of a randomized controlled trial

Toxic stress in adolescence: A person-centered approach

Substance use disorders (SUDs) are highly prevalent in homeless populations, and rates are typically greater among males. Posttraumatic stress disorder (PTSD) is a common co-occurring condition among individuals with SUDs; however, little attention has been directed to examining this comorbidity in homeless populations. Although some studies indicate considerable sex differences among individuals with PTSD, it has also been suggested that sex differences in PTSD rates diminish in populations with severe SUDs. This cross-sectional study investigated SUD-PTSD comorbidity and its associations with indicators of psychosocial functioning in a sample of 500 homeless individuals from Canada. Sex-related patterns of SUD, PTSD, and their comorbidity were also examined. Males and females had similar SUD prevalence rates, but the rates of PTSD and PTSD-SUD comorbidity were higher in females. PTSD and sex were found to have significant main effects on suicidality, psychological distress, somatic symptoms, and incarceration among individuals with SUD. Sex also moderated the association of PTSD with suicide risk and psychological distress. Our results contradict assumptions that sex differences in PTSD rates attenuate in samples with severe SUDs. Organizations providing SUD treatment for homeless people should address PTSD as an integrated part of their services. SUD and integrated treatment programs may benefit from sex-specific components.

Childhood complex trauma (CCT) prevalence among individuals with comorbid posttraumatic stress disorder (PTSD) and substance use disorder (SUD) is unknown. We conducted a meta-analysis to compare CCT prevalence in samples of PTSD alone, SUD alone and comorbid PTSD+SUD. A systematic review of PTSD, CCT and SUD literature was conducted using online databases. Binary outcome meta-analytic models were fitted comparing CCT prevalence in comorbid PTSD + SUD to PTSD and SUD only. Seven studies were included, and estimates for CCT prevalence were higher, on average, among individuals with comorbid PTSD+SUD (35%-78%) compared to PTSD alone (4%-70%) and SUD alone (2%-65%). A meta-analysis of four studies indicated individuals with comorbid PTSD+SUD were 18% more likely to have experienced CCT compared to individuals with PTSD only (RR = 1.18, 95% CI [1.13, 1.25]) and 24% more likely compared to individuals with SUD only (RR = 1.24, 95% CI [1.20, 1.29]). Further research is needed to establish a more accurate prevalence rate for individuals with comorbid PTSD and SUD. Evidence of greater CCT prevalence will inform research study design and clinical targets during treatment for individuals with comorbid PTSD and SUD.