Continuous variables were described as means and standard deviations, while categorical variables were analysed using cross-tabs. Prior to analyses, the prerequisites for multinomial logistic regression was evaluated by examining inter-correlations and collinearity statistics, fol- lowing the approach recommended by Belsely, Kuh, and Welsch . There were no indica- tions of multicollinearity. Multinomial logistic regression was used to test the hypothesis that childhoodtrauma would increase the likelihood of experiencing visual hallucinations. The groups of no, mild and psychotic visual hallucinations were entered as the dependent variable, with no visual hallucinations as a reference group. Age, gender, “core schizophrenia”, child- hood social and academic adjustment, childhood interpersonal and non-interpersonal trauma, the continuous score for auditory hallucinations, alcohol abuse, and drug abuse were entered as predictor variables. The same procedure was performed with the groups of no, mild and psy- chotic auditory hallucinations as the dependent variable, with no auditory hallucinations as ref- erence group. All analyses were performed with SPSS, version 22.
Previous studies have analyzed the correlation between TL and childhood adversity in different populations, mainly from the United States and Europe, finding contrasting results. 10-14 To date, no reports have been published about the association between TL, stressful life events and depressive symptomatology in Latin American popula- tions. The aim of the present study was to investigate the possible association between TL and childhoodtrauma in a sample of young Colombians who were assessed for frequency and severity of depressive symptoms.
outcomes because childhoodtrauma has the potential to affect the dynamics of daily life. Day- to-day living accumulates to affect development across the lifespan through various sets of ex- periences, interactions, and events. For example, Charles and colleagues  found that people who were more reactive to daily stressors (i.e., stronger decline in well-being) had an increased risk for mental health disorders over 10 years of time. One might describe these experiences as being comprised of multiple components, which we have captured through use of daily diaries completed by a mid-life sample. The diary data allows us to investigate levels of and variability in daily well-being, reports of both stressors and pleasant events, and emotional reactivity to daily negative and positive events. Well-being has many definitions in the literature, but a com- mon feature to most of those definitions is attention to both the presence of positive affective states and the relative absence of negative emotions [25–27]. Following in this vein we opera- tionalized well-being as according to one’s daily levels of and variability in negative and posi- tive affect, in addition to how negative and positive affect changes in response to daily negative and positive events. Below we set forth the assumptions upon which our investigation is based. First, childhoodtrauma may be associated with reporting lower overall levels of well-being and greater fluctuations from day-to-day (i.e., variability). Childhoodtrauma could alter indi- viduals’ strategies for regulating their desires and emotions that are essential for interpreting and experiencing their daily lives in context [28–29]. Second, childhoodtrauma may lead to poorer health via reporting more daily stressful events and fewer daily positive events. Daily events may be more likely to be appraised and perceived as stressful and high in severity, due to inconsistencies and growing up in an environment where behavior-event relationships were not developed due to a harsh childhood environment, e.g., contingency. Childhoodtrauma could also result in being less engaged in goal-directed behaviors that are associated with daily positive events, resulting in deriving less benefit from these events in daily life. Third, child- hood trauma may prime individuals to be more sensitive to their daily events or context; this is conceptualized as one’s emotional reactivity and assessed via examining changes in well-being on days where daily negative and positive events are reported. In adolescence, childhood mal- treatment is associated with poor self-regulation deficits when encountering social stressors , suggesting that deficits are already present early in life and likely worsen into adulthood. Similarly, previous research in adulthood shows that early life adversity and poor parental relationship quality is associated with stronger increases in negative affect to daily stressors [32–34].
This study presents some limitations, such as the small subsample size, which had a low statistical power. However, our preliminary findings support the main hypothesis, which requires a great deal of clinical and research attention. Another limitation refers to the fact that data on childhoodtrauma were obtained using a self-report instrument, which may be influenced by the memory bias of the participants. Conversely, the CTQ is validated and widely used in different countries and in similar clinical contexts, 21 and the most appropriate
The ChildhoodTrauma Questionnaire. The original CTQ was developed from a 70-item retrospective questionnaire for which participants were required to rate the frequency (0- never true to 5-very often true) of abuse and neglect events that took place when they ‘‘were growing up’’ . In further studies, the length of the scale was reduced to 28 items based on exploratory and confirmatory factor analyses . The therapists’ ratings were used as a stringent test of the validity of retrospective reports of childhood maltreatment, and results revealed very good criterion-related validity. Convergent and discriminant validity was demonstrated using a structured trauma interview . The short version of the CTQ assesses emotional abuse, physical abuse, sexual abuse, emotional neglect, and physical neglect. Emotional abuse refers to verbal assaults on a child’s sense of worth or well being, or any humiliating, demeaning, or threatening behavior directed toward a child by an older person. Physical abuse refers to bodily assaults on a child by an older person that pose a risk of, or result in, injury. Sexual abuse refers to sexual contact or conduct between a child and an older person, including explicit coercion. Emotional neglect refers to the failure of caretakers to provide basic psychological and emotional needs, such as love, encouragement, belonging and support. Physical neglect refers to failure to provide basic physical needs including food, shelter, and safety. Each scale is presented in a 5-point Likert-type scale ranging from 5 to 25. The final scores are classified according to manual’s cut-off scores for the severity of abuse and neglect: ‘‘none to minimal,’’ ‘‘low to moderate,’’ ‘‘moderate to severe,’’ and ‘‘severe to extreme’’. Three additional items compose the Minimization/Denial subscale for detecting socially desirable responses or false-negative trauma reports. The total CTQ score takes into account the severity of multiple forms of abuse and neglect. The internal consistency coefficients of the original version ranged from .61 (physical neglect) to .95 (sexual abuse) .
We tested our conceptual model (see Figure 1) using a structural equation modeling (SEM) approach. This approach allowed us to evaluate how well our hypothesized relationships between a latent exogeneous variable (childhoodtrauma), latent mediators (stress reactivity, resilience, and chronic stress), and a manifest dichot- omous endogeneous variable (FSS) fit our data. We used item parceling to form our latent variables [58-61]. More specifically, we created two parcels for childhoodtrauma, stress reactivity, resilience, and chronic stress, with each parcel being based on four items using an item-to-construct balance approach [58–61]. In case of unidimensional constructs (see the results of the PAA) the parceling approach is recommended as a method to reduce the number of variables and to improve the stability of the parameter estimates [58–61]. As in our study FSS was a dichotomous endogenous variable, we used the modified weighted least squares method (WLSMV) for our analysis . To estimate to what extent the empirical covariance matrix of the involved variables could be reproduced by the model, we conducted a x 2 -Test and referred to several fit indices: Comparative fit index (CFI), Tucker- Lewis index (TLI), and root mean square error of approximation (RMSEA). A CFI $.95, a TLI $.95 as well as an RMSEA #.05 signals a good model fit [63,64]. To test the indirect effects for statistical significance, we used the conventional Sobel test [65,66]. Since the Sobel test does, however, rest on the often implausible assumption that both the sampling distribution and indirect effect is normally distributed, we additionally applied the bias-corrected bootstrapping approach as recommended by MacKinnon et al. . The standard errors of the indirect effects and their 95% confidence intervals were estimated based on 19000 re-samples. In the results section, we report standard errors and p-values based on the Sobel Test (see also Table 1 and 2) and confidence intervals stemming from the bootstrapping approach. All analyses were conducted using MPlus V7.
used to investigate on a retrospective basis child neglect and abuse. CTQ is a self-reporting questionnaire that assesses childhoodtrauma at ive subscales: physical abuse (PA), emotional abuse (EA), sexual abuse (SA), emotional neglect (EN), and physical neglect (PN). Each subscale consists of ive questions rated on a 5-point Likert scale. Different scores are given on each subscale. Data were analyzed using the software SPSS, version 17.0. Mean value, standard deviation, and frequency were calculated, as well as the difference between groups, using t test and chi-square test. To ascertain the predictive power of a maternal history of CSA with regard to having a sexually abused child, a logistic regression model was adopted with the following independent variables: age, years of formal education, and CTQ SA score. All analyses were two-tailed and the signiicance level was set at p < 0.05.
Objective: To investigate whether history of childhoodtrauma is associated with loss of functionality in adult women with i- bromyalgia (FM). A secondary objective was to assess the pre- sence of differences between depressed and non-depressed adult women with FM in a regression model for functionality. Methods: A total of 114 adult women with FM according to the American College of Rheumatology diagnostic criteria answe- red the ChildhoodTrauma Questionnaire and the Fibromyalgia Impact Questionnaire. All subjects were interviewed by trained psychiatrists and evaluated for depression using the Mini Inter- national Neuropsychiatric Interview (MINI) – Brazilian version 5.0.0. Correlation and regression models were used to investi- gate associations between childhoodtrauma and loss of func- tionality among patients with FM. The sample was stratiied by presence and absence of clinical depression.
and without childhood maltreatment. 39 Maltreated indivi- duals experience depressive symptoms at an earlier age and have a more continuous course; have more severe mood, neurovegetative, and so-called endogenous symp- toms of depression; have more comorbidities, particularly substance abuse; and more commonly present with psychotic features, suicide attempts, and deliberate self- harm. 39 As compared with previous studies, our work advances the current understanding of the specificity of such an important risk factor to the phenotypic expression of major depression. Furthermore, by showing that EA could be a specific risk factor for symptoms pertaining to the cognitive dimension of depression, it may help with treatment planning. As an example, in a previous study, childhood maltreatment was associated with better response to cognitive therapy or medication than to interpersonal therapy in adult patients with MDD. 40 In this other landmark study, 681 chronically depressed patients were treated with either pharmacotherapy (nefazodone), psychotherapy (Cognitive Behavioral System of Psy- chotherapy, CBASP), or a combination thereof. 41 Overall, patients responded more favorably to the treatment combination than to either treatment in isolation. How- ever, in the subset of patients with a history of childhoodtrauma, psychotherapy was clearly superior to antide- pressant monotherapy, and the combination provided little added benefit. As there is also evidence that some profiles of depressive symptoms may show differential responses to antidepressant treatments, 42 combining
Most of the articles assessed in this review found a positive association between early life stress and the development of future psychopathology. However, these indings must be evaluated carefully because these studies have limitations. One of the primary limitations concerns the fact that no consensus was found in the literature on the concept of early life stress. Thus, although the most widely used instrument in the articles included in this review was the ChildhoodTrauma Questionnaire, which assesses ive subtypes of trauma (physical, emotional, and sexual abuse and physical and emotional neglect), several other studies evaluated other subtypes of early life stress such as parental loss, family psychiatric disorders, family violence, and economic hardship. The dificulty in collecting these data should also be considered because interviewees in these studies were likely to underestimate the frequency/intensity of the events, so the data may be subject to bias, thus affecting their reliability. However, some patients, such as borderline patients, may confabulate abuse histories or exaggerate certain events. Splitting (i.e., perceiving others as all good or all bad) may make a borderline patient more likely to see the family as malignant or abusive (Herman, Perry, & van der Kolk, 1989; Bandelow et al., 2005).
Family history and traumatic experiences are factors linked to bipolar disorder. It is known that the lifetime risk of bipolar disorder in relatives of a bipolar proband are 5-10% for first degree relatives and 40-70% for monozygotic co-twins. It is also known that patients with early childhoodtrauma present earlier onset of bipolar disorder, increased number of manic episodes, and more suicide attempts. We have recently reported that childhoodtrauma partly mediates the effect of family history on bipolar disorder diagnosis. In light of these findings from the scientific literature, we reviewed the work of British writer Virginia Woolf, who allegedly suffered from bipolar disorder. Her disorder was strongly related to her family background. Moreover, Virginia Woolf was sexually molested by her half siblings for nine years. Her bipolar disorder symptoms presented a pernicious course, associated with hospitalizations, suicidal behavioral, and functional impairment. The concept of neuroprogression has been used to explain the clinical deterioration that takes places in a subgroup of bipolar disorder patients. The examination of Virgina Woolf’s biography and art can provide clinicians with important insights about the course of bipolar disorder.
A amostra foi composta por sujeitos da população geral, com idade a partir de 18 até 50 anos, que espontaneamente responderam aos questionários através de um website de pesquisa (www.temperamento.com.br). Foram incluídos os voluntários que responderam aos instrumentos desde 15 de Janeiro de 2011 a 31 de dezembro de 2014. Os indivíduos completaram questionários padronizados e escalas, que incluíram dados sociodemográficos, comportamento suicida ao longo da vida (Suicide Behavior Questionnaire-17; SDQ-17)(COTTON; DK PETERS; RANGE, 1995; M; LINEHAN, 1989), e histórico de traumas na infância (ChildhoodTrauma Questionnaire; CTQ) (GRASSI-OLIVEIRA; STEIN; PEZZI, 2006). Para garantir a confiabilidade dos dados, questões verificando a atenção foram inseridas nos questionários. Somente aqueles que declararam ser sinceros e sérios ao longo do estudo, e que tiveram acertos nos itens de validade de atenção foram incluídos nas análises. Após verificações de validade (17,7% da amostra inicial foram excluídos) a amostra final foi composta por 71.429 voluntários.
Objetivo: Compreender o fator humano como ameaça à segurança do paciente vítima de trauma no centro cirúrgico, traduzindo para a sala de operação algumas regras importantes já aplicadas no campo da aviação. Métodos: Métodos: Métodos: Métodos: Métodos: A amostra incluiu 50 casos de cirurgia de trauma coletados prospectivamente por observadores em plantões de 12 horas, ,durante seis meses, em um centro de trauma nível I nos Estados Unidos da América. Informações quanto ao tipo de trauma, escore de gravidade e mortalidade foram coletadas, assim como, determinantes de distrações/interrupções e o volume de ruídos na sala de cirurgia durante o ato cirúrgico. Resultados:
Foram atendidos, no período citado acima, 319.354 pacientes sendo que o trauma hepático ocorreu em 154 (5%) deles, dos quais 139 eram do sexo masculino (90,26%) e 15 do sexo feminino (9,74%). A média das idades dos pacientes foi de 26,28 anos, variando de 6 a 70 anos (mediana = 24 anos). O trauma penetrante ocorreu em mais de 2/3 dos casos (112), e o principal mecanismo foi por ferimentos por arma de fogo (FAF) e arma branca (FAB), enquanto que o trauma contuso ocorreu em aproximadamente 1/3 dos pacientes (42) e as colisões en- volvendo veículos automotores (VAM) foram o agente etiológico em mais de 70% dos pacientes (figura 1).
Paciente masculino, branco, com 31 anos de idade, operador de rede elétrica, sofreu queimaduras após ter con- tato com um fio de alta voltagem no abdome. O atendi- mento inicial, realizado no local pelo Serviço de Atendi- mento Pré-hospitalar (SAMU), consistiu basicamente no transporte adequado ao centro de trauma. O paciente foi transportado ao Hospital de Pronto-Socorro Municipal (HPS) e se manteve estável hemodinamicamente (PA = 130 x 90mmHg; FC = 90bpm), sem alterações eletrocardiográfi- cas ou ao exame neurológico (Glasgow 15).
apresentaram alterações nos parâmetros fisiológi- cos aferidos no TS m (escore 12) pode estar relacio- nada a fatores como variabilidade temporal e ao tipo de trauma. Dessa forma, uma única verifica- ção dos parâmetros fisiológicos, durante o atendi- mento pré-hospitalar, poderá ser insuficiente para identificar vítimas com trauma grave que apre- sentam compensação adequada diante do déficit de volume. Além disso, é insuficiente para detec- tar vítimas com trauma torácico, visto que, carac- teristicamente, existe um lapso de tempo até o início da alteração dos parâmetros fisiológicos 32 .
ocorre o conflito entre duas ideias que ganharam adeptos na comunidade científica e que vêm sido estudadas. Por um lado transportar o paciente, directamente, para um Centro de Trauma Nível I, independentemente da distância, com todas as capacidades de tratamento definitivo do paciente ou por outro lado orientar o traumatizado para a instituição de cuidados mais próxima, ainda que com uma capacidade de resposta inferior, mas no entanto capaz de prestar os cuidados necessários durante a “Golden Hour”. Quanto a este ponto, é importante fazer a distinção entre Sistemas de Trauma Urbanos e Rurais, por um lado pela diferença entre as características do Trauma, por outro pelos próprios aspectos geográficos e vias de comunicação existentes na comunidade rural.
Descrevemos um relato de caso de um paciente jovem, que sofreu um trauma testicular durante treinamento em aula de arte marcial, com discussão das principais causas, diagnóstico e tratamen- to. Paciente de 16 anos, com trauma testicular devido a um chute, evoluindo com dor e posterior exame clínico e abordagem cirúrgica. Uma boa anamnese e exame físico, com exames de imagem quando necessários, são as melhores ferramentas para um diagnóstico correto e precoce para o trauma testicular, indicando o melhor tratamento a ser feito.
Improving childhood vaccination coverage and timeliness is a key health policy objective in many developing countries such as Uganda. Of the many factors known to influence uptake of childhood immunizations in under resourced settings, parents’ understanding and per- ception of childhood immunizations has largely been overlooked. The aims of this study were to survey mothers’ knowledge and attitudes towards childhood immunizations and then determine if these variables correlate with the timely vaccination coverage of their chil- dren. From September to December 2013, we conducted a cross-sectional survey of 1,000 parous women in rural Sheema district in southwest Uganda. The survey collected socio- demographic data and knowledge and attitudes towards childhood immunizations. For the women with at least one child between the age of one month and five years who also had a vaccination card available for the child (N = 302), the vaccination status of this child was assessed. 88% of these children received age-appropriate, on-time immunizations. 93.5% of the women were able to state that childhood immunizations protect children from dis- eases. The women not able to point this out were significantly more likely to have an under- vaccinated child (PR 1.354: 95% CI 1.018–1.802). When asked why vaccination rates may be low in their community, the two most common responses were “fearful of side effects” and “ignorance/disinterest/laziness” (44% each). The factors influencing caregivers’ demand for childhood immunizations vary widely between, and also within, developing countries. Research that elucidates local knowledge and attitudes, like this study, allows for decisions and policy pertaining to vaccination programs to be more effective at improving child vaccination rates.