BACKGROUND: Evaluating isolated extremity discomfort can be challenging when initial imaging and exams provide limited information. Though subtle patient history hints often underlie occult pathologies, benign symptoms are frequently miscategorized as idiopathic.
METHODS: We present a case of retained glass obscuring as acute calcific periarthritis on imaging. A 48-year-old White male with vague fifth metacarpophalangeal joint pain had unrevealing exams, but radiographs showed periarticular calcification concerning inflammation. Surgical exploration unexpectedly revealed an encapsulated glass fragment eroding bone. Further history uncovered a forgotten glass laceration decade prior. The foreign body was removed, resolving symptoms.
CONCLUSIONS: This case reveals two imperative diagnostic principles for nonspecific extremity pain: (1) advanced imaging lacks specificity to differentiate inflammatory arthropathies from alternate intra-articular processes such as foreign bodies, and (2) obscure patient history questions unearth causal subtleties that direct accurate diagnosis. Though initial scans suggested acute calcific periarthritis, exhaustive revisiting of the patient\'s subtle decade-old glass cut proved pivotal in illuminating the underlying driver of symptoms.
CONCLUSIONS: Our findings underscore the critical limitations of imaging and the vital role that meticulous history-taking plays in clarifying ambiguous chronic limb presentations. They spotlight the imperative of probing even distant trauma when symptoms seem disconnected from causative events. This case reinforces the comprehensive evaluation of all subtle patient clues as key in illuminating elusive extremity pain etiologies.

BACKGROUND: Children admitted to the pediatric intensive care unit (PICU) have post-traumatic stress (PTS) rates up to 64%, and up to 28% of them meet criteria for PTS disorder (PTSD). We aim to examine whether a prior trauma history and increased physiologic parameters due to a heightened sympathetic response are associated with later PTS. Our hypothesis was children with history of prehospitalization trauma, higher heart rates, blood pressures, cortisol, and extrinsic catecholamine administration during PICU admission are more likely to have PTS after discharge.
METHODS: This is a prospective, observational study of children admitted to the PICU at an urban, quaternary, academic children\'s hospital. Children aged 8 to 17 years old without developmental delay, severe psychiatric disorder, or traumatic brain injury were included. Children\'s prehospitalization trauma history was assessed with a semistructured interview. All in-hospital variables were from the electronic medical record. PTS was present if children had 4 of the Diagnostic and Statistical Manual of Mental Disorders IV criteria for PTSD. Student\'s t- and chi-squared tests were used to compare the presence or absence of prior trauma and all of the PICU-associated variables.
RESULTS: Of the 110 children at baseline, 67 had 3-month follow-up. In the latter group, 46% met the criteria for PTS, mean age of 13 years (SD 3), 57% male, a mean PRISM III score of 4.9 (SD 4.3), and intensive care unit length of stay 6.5 days (SD 7.8). There were no statistically significant differences in the demographics of the children with and without PTS. The only variable to show significance was trauma history; children with prehospitalization trauma were more likely to have PTS at 3-month follow-up (P = .02).
CONCLUSIONS: Prehospitalization trauma history was associated with the presence of PTS after admission to the PICU. This study suggests future studies should shift to the potential predictive benefit of screening children for trauma history upon PICU admission.

In a community sample of trauma-exposed postpartum individuals (N = 167; mean age = 30, 90% White; 61.7% completed bachelor\'s degree or higher) longitudinally completed self-report measures on PTSD, depressive, and Obsessive-compulsive disorder (OCD) symptoms (specifically checking, ordering, washing, and obsessing symptoms), preoccupation with intrusive postpartum thoughts/neutralising strategies, and trauma exposure at 4 and 12 weeks postpartum. PTSD symptoms were strongly associated with all OCD symptoms (r = 0.32- 0.49, p < 0.001), preoccupation with postpartum-specific intrusive thoughts (r = 0.32-0.45, p < 0.001), and preoccupation with neutralising strategies (r = 0.21-0.29, p < 0.05) at both time points. PTSD symptoms were also predictive of checking and obsessing symptoms. This study identified PTSD symptoms as a new correlate for preoccupation with postpartum-specific intrusive thoughts and neutralising strategies in the postpartum period in a community sample. These findings add to the evidence suggesting a strong association between PTSD and OCD symptoms across the lifespan, including in non-clinical samples. Future research should examine best practices to assess and treat a variety of postpartum psychopathology symptoms, not just depression.

There is little data on what influences posttraumatic growth for women who experienced non-consensual sexual contact (NCSC) as an undergraduate college student. The purpose of this study is to garner a better understanding of posttraumatic growth among women-identifying survivors of undergraduate NCSC by addressing the following aims: 1) evaluate the mediating role of NCSC-related shame on the relationship between perceived peer rape myth acceptance and posttraumatic growth (n = 174); and 2) evaluate the shared and independent variance contributions of mental health symptoms and trauma history clusters on posttraumatic growth (n = 151).NCSC-related shame did not mediate the relationship between perceived peer rape myth acceptance and posttraumatic growth. Mental health symptoms and trauma history significantly contributed to 35.27% of posttraumatic growth variance, with the trauma history cluster significantly influencing posttraumatic growth scores beyond mental health symptoms. Based on these findings, it is important that clinicians assess for a history of trauma and the impact of that trauma in addition to mental health symptoms when trying to understand posttraumatic growth after campus sexual violence.

Background: Internationally deployed humanitarian aid (HA) workers are routinely confronted with potentially traumatic stressors. However, it remains unknown whether HA deployment and related traumatic stress are associated with long-term changes in hypothalamic-pituitary-adrenal (HPA) axis function. Therefore, we investigated whether cortisol awakening response (CAR) decreased upon deployment and whether this was moderated by previous and recent trauma exposure and parallel changes in symptom severity and perceived social support. Methods: In this prospective study, n = 86 HA workers (68% females) completed questionnaires regarding trauma exposure, posttraumatic stress disorder (PTSD), anxiety and depressive symptoms and perceived social support, as well as salivary cortisol assessments at awakening and 30 minutes post-awakening at before, early and 3-6 months post-deployment. Results: Linear mixed models showed significantly decreased CAR (b(SE) = -.036(.011), p = .002) and awakening cortisol over time (b(SE) = -.007(.003), p = .014). The extent of awakening cortisol change was significantly moderated by interactions between previous and recent trauma exposure. Also, a steeper awakening cortisol decrease was significantly associated with higher mean anxiety and PTSD symptoms across assessments. No significant effects were found for social support. Conclusions: We observed attenuated CAR and awakening cortisol upon HA deployment, with a dose-response effect between trauma exposure before and during the recent deployment on awakening cortisol. Awakening cortisol change was associated with PTSD and anxiety symptom levels across assessments. Our findings support the need for organizational awareness that work-related exposures may have long-lasting biological effects. Further research assessing symptoms and biological measures in parallel is needed to translate current findings into guidelines on the individual level.
Antecedentes: Los trabajadores de la ayuda humanitaria desplegados internacionalmente (HA) se enfrentan rutinariamente a estresores potencialmente traumáticos. Sin embargo, aún se desconoce si el despliegue de la HA y el estrés traumático relacionado están asociados con cambios a largo plazo en la función del eje hipotalámico-pituitaria-suprarrenal (HPA). Por lo tanto, investigamos si la respuesta del cortisol al despertar (CAR, en sus siglas en inglés) disminuyó en el momento del despliegue y si esto fue moderado por una anterior o reciente exposición a un trauma y los cambios paralelos en la gravedad de los síntomas y el apoyo social percibido.Métodos: En este estudio prospectivo, x = 86 trabajadores de la HA (68% mujeres) completaron cuestionarios sobre la exposición al trauma, el trastorno de estrés postraumático (TEPT), la ansiedad y los síntomas depresivos y el apoyo social percibido, así como evaluaciones del cortisol salival al despertar y 30 minutos después del despertar, antes, durante y 3-6 meses después del despliegue.Resultados: Los modelos lineales mixtos mostraron una disminución significativa de la CAR (b(SE) = −.036(.011), p = .002) y del cortisol al despertar, en el transcurso del tiempo (b(SE) = −.007(.003), p = .014). El grado de cambio en el cortisol al despertar fue significativamente moderado por las interacciones entre la exposición anterior y reciente al trauma. Además, una disminución más pronunciada del cortisol al despertar se asoció significativamente con una mayor media de ansiedad y síntomas de TEPT en todas las evaluaciones. No se encontraron efectos significativos en cuanto al apoyo social.Conclusiones: Observamos CAR atenuado y cortisol al despertar en el despliegue de HA, con un efecto dosis-respuesta en el cortisol al despertar, entre la exposición al trauma antes y durante el reciente despliegue. El cambio de cortisol al despertar se asoció con el TEPT y los niveles de síntomas de ansiedad en todas las evaluaciones. Nuestros hallazgos apoyan la necesidad de la conciencia organizacional de que las exposiciones relacionadas con el trabajo pueden tener efectos biológicos duraderos. Se necesitan más investigaciones que evalúen los síntomas y las medidas biológicas en paralelo para traducir los hallazgos actuales en directrices a nivel individual.
背景:国际应征的人道主义援助 (HA) 工作者通常会面临潜在的创伤性压力源。但是, 我们仍不清楚HA应征和相关的创伤应激是否与下丘脑-垂体-肾上腺 (HPA) 轴功能的长期变化有关联。目的:我们旨在研究皮质醇唤醒反应 (CAR) 在部署后是否下降, 以及过去和最近的创伤暴露, 症状严重程度和感知社会支持的平行变化是否对其起到调节作用。方法: 在这项前瞻性研究中, 86名HA工作人员 (68%为女性) 在部署前期, 后期和3-6个月后填写了有关创伤暴露, 创伤后应激障碍 (PTSD), 焦虑和抑郁症状以及感知社会支持的问卷, 并在刚睡醒和30分钟后进行唾液皮质醇测量。结果: 线性混合模型显示, CAR (b(SE) = −.036 (.011), p = .002) 和觉醒皮质醇 (b(SE) = -.007 (.003), p = . 014) 随时间显著降低。过去和最近的创伤暴露的相互作用显著调节了觉醒皮质醇变化的程度。此外, 觉醒皮质醇较快下降与焦虑和PTSD较高的跨时间点平均症状水平显著相关。没有发现对社会支持的明显效应。结论: 我们观察到HA应征后CAR和觉醒皮质醇水平的下降。而且, 在近期部署之前和期间创伤暴露对唤醒皮质醇有剂量反应效应 (dose-response effect) 。觉醒皮质醇变化与跨时间点时的PTSD和焦虑症状水平相关。我们的发现指出, 机构组织有必要认识到与工作有关的暴露可能具有长期持续的生物学影响。但还需要进一步研究对症状和生物学指标进行同时评估, 以期将当前发现转化为个人层面的指导手册。.

Promoting health-related quality of life (HRQOL) is a primary goal of lung cancer treatment. Trauma history and distress can negatively impact HRQOL.
A cross-sectional design examined the associations of trauma history, cancer-specific distress, and HRQOL.
Sixty lung cancer patients completed questionnaires on trauma history including the number and severity of traumatic events experienced. Cancer-specific distress, HRQOL, and depression were also reported.
As hypothesized, trauma history and cancer-specific distress were negatively associated with HRQOL (all r\'s > -.27). Depression emerged as a confound in the association between cancer-specific distress and HRQOL.
Retrospectively-reported trauma was linked with poorer HRQOL in lung cancer patients.
Interventions aimed at improving lung cancer patients\' HRQOL should consider the possible role of trauma history (both frequency and distress).

The present study sought to examine trauma history and hope as predictors of suicide risk in a sample of 561 college students. Furthermore, authors aimed to understand whether the lack of hope agency and hope pathways contributed to further risk for suicide, above and beyond trauma history. Results suggested that trauma history and hope agency were significant and unique predictors of suicide risk among college students. More specifically, hope agency accounted for additional variance in the prediction model of suicide risk, beyond that accounted for by trauma history. Some implications of the present findings for social work practice are discussed.

Experiences of humiliation, unjust hurt caused by another or anger naturally, elicit the desire to seek revenge and fantasies of revenge. The current study examined the associations between a history of traumatic events and feelings of injustice and levels of desire for revenge-seeking and fantasies of revenge. Specifically, it tested whether feelings of injustice mediated the associations between the number of past traumatic events and the desire for revenge or revenge fantasies. Based on recent studies showing that retaliatory violence is gendered, sex differences in levels of feelings of injustice, desire for revenge, and the presence of revenge fantasies were explored, as well whether participants\' sex conditioned the mediation models. The results showed positive associations between feelings of injustice and the desire for revenge and revenge fantasies. The mediation model indicated that feelings of injustice mediated the associations between the number of previous traumatic events and the desire for revenge or revenge fantasies. Men had higher levels of revenge fantasies than women, whereas women tended to perceive revenge as pointless. A sex effect was found for the mediation model, which revealed significant regressed models for women but not for men. The clinical implications are discussed.

Gender, a personal history of trauma and attitudes towards continuous vs recovered memories of abuse significantly impact the believability of Child Sexual Abuse (CSA) disclosures in community samples. Yet, whether these variables influence the believability of CSA disclosure and subsequent clinical decisions made by practicing psychologists is underexplored. A vignette of trauma disclosure from a hypothetical adult client was presented via an online survey to 292 registered psychologists. Participants rated the believability of the disclosure, answered an open-ended item regarding treatment planning, and completed the Brief Betrayal Trauma Survey to measure personal trauma history. Results indicated that female psychologists believed disclosures significantly more than male psychologists and that disclosures comprised of continuous memories were believed more than recently recovered memories. A significant interaction between gender and personal trauma history was also revealed. Female psychologists believed disclosures regardless of their personal trauma history, while male psychologists with a personal history of trauma believed disclosures significantly more than male psychologists without personal trauma history. Reported believability of the disclosure, while unrelated to treatment planning, was associated with a reported intention to validate the client\'s experience. The results support that, similar to community samples, gender and a personal trauma history impact psychologist believability of CSA disclosure. The research further supports that psychologist level of belief then translates into clinical implications.

This study evaluated alcohol consumption as a moderator of the association between adolescent sexual assault and risk of sexual assault in college. It was hypothesized that sexual assault in adolescence would be associated with higher risk of college victimization and that this association would be moderated by alcohol consumption. Predominantly female and European-American university students (N = 201) completed self-report measures of alcohol consumption and sexual assault victimization in adolescence and since enrolling in college at a medium-sized university in the Western United States. Controlling for effects of age and gender, there was a significant interaction between alcohol consumption variables (i.e., typical weekly alcohol consumption and binge drinking) and adolescent sexual assault, such that the greatest risk for sexual assault in college was incurred by the heaviest drinkers with the greatest frequencies of adolescent sexual assault. This study highlights the importance of considering past victimization history in concert with alcohol consumption in efforts to prevent sexual victimization in college.