Search Results (486)

Children represent a large proportion of the world’s refugees. The United Nations High Commissioner for Refugees (UNHCR) reported that as of 2020, there were about 27.1 million refugees worldwide, and roughly half of all refugees were under the age of 18 at any given time. The challenges that refugee children face prior to resettlement include interrupted education, repeated moves, exposure to violence, family separation, lengthy stays in camps, and poverty or deprivation. As a result of the experiences gained from an unexpected relocation, being the child of an adult refugee may be traumatic. But it is more damaging when laws enacted in the new host countries fail to take refugee children into account, which in turn could result in socioeconomic harm or gain for these children. In this policy analysis, the researcher intends to look at the socioeconomic outcomes of refugee children while trying to navigate their new home country. In essence, this analysis will use the multiple streams analysis framework to understand how refugee policies in the United States and Nigeria are enacted and their socioeconomic impact on refugee children. Full article

Background: Exposure to potentially traumatic events (PTEs) during childhood and adolescence is relatively common and may result in the development of post-traumatic stress disorder (PTSD). Recent studies have demonstrated the utility of the network approach for examining PTSD symptoms. However, to date, no systematic review has focused exclusively on network-analytic evidence from child and adolescent samples, who require developmental specific evidence to inform clinical practice. Therefore, the present review aimed to summarize network-analytic studies investigating PTSD symptoms among trauma-exposed youth. Methods: Guided by the PRISMA guidelines, a systematic search for network-analytic studies exploring the symptom structure of PTSD-only in children and adolescents was conducted using PubMed and EBSCOHost. The methodological quality of included studies was assessed using the NIH Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Results: Twelve studies (n = 12498; k = 18) were retrieved, with seven rated as of fair quality. Studies examined DSM-IV (n = 10) and DSM-5 (n = 2) PTSD symptoms in children and/or adolescents exposed to PTEs (mostly natural disasters). Although central symptoms varied, heightened physiological reactivity consistently emerged among the most central. The strongest associations were observed between symptoms within the same PTSD cluster, and preliminary evidence suggests that network connectivity may increase with time since exposure. Conclusions: Heightened physiological reactivity to trauma-related cues appears to be a clinically relevant feature of youth exposed to PTEs, warranting consideration in assessment and intervention. Clinical and methodological implications and future directions for pediatric PTSD research are discussed. Full article

Memory consolidation is the process by which newly acquired experiences are stabilized into long-term memory, involving coordinated cellular and network-level activity across brain regions such as the hippocampus and prefrontal cortex. Dysregulation of this process has been implicated in psychiatric disorders including post-traumatic stress disorder (PTSD), which is characterized by the over-consolidation of traumatic memories. LIM kinase 1 (LIMK1), a key regulator of synaptic plasticity, is believed to play an important role in memory consolidation across hippocampal–cortical circuits. In this study, we investigated the function of LIMK1 using Limk1 knockout mice. Behavioral tests such as the novel object location memory task revealed significant memory impairments in knockout animals. In vivo recordings during sleep showed disrupted communication between the hippocampus and prefrontal cortex, suggesting impaired systems-level consolidation. Furthermore, in an underwater trauma exposure model, pharmacological inhibition of LIMK1 with LIMK-i3 alleviated trauma-induced behavioral abnormalities. These findings highlight LIMK1 as a critical mediator of hippocampal–cortical memory consolidation and provide experimental evidence that LIMK1 inhibition can modulate maladaptive memory processes associated with PTSD-like symptoms. Full article

Background/Objectives: Chronic pain is associated with autonomic nervous system (ANS) dysfunction, which can be indexed by heart rate variability (HRV). This cross-sectional study examined associations between ANS dysregulation and phantom limb pain (PLP) intensity in amputees and explored related clinical and psychosocial variables. Methods: Fifty-three adults with chronic PLP (mean age 57.7 ± 15.4; 60% male) were enrolled. Primary exposure was PLP intensity concurrent with HRV time- and frequency-domain metrics. Additional variables included residual limb pain, phantom limb sensations (PLS), telescoping and PLP–PLS index. Results: PLP intensity was not significantly associated with frequency-domain HRV measures. Time-domain parameters RMSSD (root mean square of successive differences) and pNN50 (percentage of successive normal RR intervals >50 ms) were lower in the positive PLP–PLS group. In multivariate models, depression (range of βs:−1.36 to −58.16), pain-medication use (range of βs: −12.3 to −953.4), and body mass index (range of βs: 0.55 to 45.8) were significantly associated with lower SDNN (standard deviation of NN intervals), RMSSD, pNN50, low-frequency (LF), and high-frequency (HF) power. Female sex and pre-amputation pain correlated with higher LF, whereas traumatic etiology correlated with lower LF. Poor sleep quality correlated with elevated HF. No predictors related to the LF/HF ratio. Conclusions: HRV alterations in PLP were associated with depression and pain-medication use rather than pain intensity. Findings support HRV dysfunction as a marker of brain compensatory failure within the autonomic circuit, and maladaptive plasticity, highlighting utility for identifying central dysfunction even when pain severity does not vary. Full article

The COVID-19 pandemic exposed the fragility of global health systems, as physicians faced extremely challenging conditions including excessive workloads, infection risk, and high patient mortality. We conducted a cross-sectional survey that aimed to assess the post-pandemic prevalence of anxiety, depression, and post-traumatic stress disorder (PTSD) in a sample of Greek physicians who worked on the frontline during the SARS-CoV-2 (COVID-19) pandemic. An online survey was conducted between 1 March and 31 July 2023, in which 200 Greek physicians were invited via e-mail to voluntarily answer a confidential online questionnaire, and 58 of them responded. The survey included two clinically validated tools: the Patient Health Questionnaire-4 (PHQ-4) and the Impact of Event Scale—Revised (IES-R). Univariate correlations of 26 exposure variables with anxiety, depression, combined anxiety/depression, and PTSD were performed. In total, 58 eligible physicians (46.6% female) participated in this study. The rates of anxiety, depression, combined anxiety/depression, and PTSD were 27.5% (95% CI: 16.7–40.9), 31.0% (19.5–44.5), 22.4% (12.5–35.3), and 24.1% (13.9–37.2), respectively. Notably none of the physicians working in a laboratory developed any mental health symptoms. The following factors were found to be associated with the development of higher mental health symptoms: age ≤ 30, employment in healthcare ≤ 10 years, working in COVID-19 wards, working in intensive care units or COVID-19 wards, a history of mental health symptoms, a history of physical conditions, shortages of materials and equipment for diagnosing or treating patients, development of a disease other than COVID-19, and the development of a new mental health condition during the pandemic (p < 0.05 for all associations). Our findings highlight the need to better prepare physicians with adequate materials, infrastructure, and psychological support such that, in a potential future health crisis, they will not be at such high risk of mental health problems. Full article

Adverse childhood experiences (ACEs) are established predictors of long-term health risks. While pediatric practices increasingly screen for social drivers of health (SDOH) and other family psycho-social stressors, routine ACEs screening is not recommended due to lack of evidence for long-term benefit and concerns over stigmatization, re-traumatization, and non-standardized follow-up protocols. We piloted routine ACEs screening in Pediatric Primary Care practices that already routinely screen for SDOH, maternal depression and intimate partner violence (IPV). This retrospective chart review (2016–2020) explored the extent to which these family psycho-social screenings could serve as a relative proxy for ACEs identification. Among 1492 participants (738 children aged 0–5 and 690 caregivers mean age 30.3 ± 6.9), ACE and SDOH screening results were significantly associated (p < 0.002), particularly with housing insecurity (p < 0.014). However, 51.7% of individuals who reported a positive ACE screen were not flagged by the SDOH measure (false negatives), indicating relatively poor sensitivity. The negative predictive value for negative SDOH screens and negative ACEs was higher at 86%. These findings suggest that SDOH screening misses over half of true positives, and therefore reliance on SDOH screening alone may underestimate ACE exposure in pediatric primary care. Full article

Background: Displaced individuals endure challenges, including conflict, forced migration, family separation, human rights violations, limited access to essential services, and increased exposure to violence and abuse. These hardships significantly impact their mental health, often leading to heightened trauma-related symptoms. Methods: We used a cross-sectional correlational design in refugee camps, homes, and centers across Jordan and Spain. 200 refugees with confirmed status in the past ten years were recruited. Demographic data were collected via a demographic form, the PTSD-8 Inventory assessed traumatic symptoms, and data analysis included descriptive statistics, independent t-tests, one-way ANOVA, and Chi-square tests. Results: Most participants had a secondary education, were unemployed, and had low incomes. PTSD symptoms were prevalent, with rates of recurrent thoughts (63.5%), re-experiencing events (57.5%), nightmares (50.5%), sudden reactions (56.5%), activity avoidance (53.5%), avoidance of specific thoughts or feelings (56.5%), jumpiness (53.5%), hypervigilance (53.5%), feeling on guard (41.5%), and general avoidance (43.5%) rated from rarely to most of the time. All symptoms were significantly more frequent among refugees in Jordan than in Spain. Conclusions and Recommendations: Intrusive thoughts were more frequent among females, urban residents, and unemployed individuals. Avoidance behaviors were higher in married and unemployed individuals. Hypervigilance was more prevalent among females, married individuals, and those with lower incomes. Regionally, females and married individuals in Jordan exhibited more intrusive thoughts and avoidance. In Spain, intrusive thoughts and hypervigilance were more common among females and the unemployed. The findings highlight the urgent need for targeted mental health interventions, particularly in refugee camps like those in Jordan, where PTSD symptom rates were significantly higher. Programs should prioritize trauma-focused therapies, such as Cognitive Behavioral Therapy, while adopting gender-sensitive approaches to address the heightened vulnerability of women and unemployed individuals. Given the strong link between unemployment and symptom severity, livelihood support and vocational training should be integrated into psychosocial care. Policymakers in host countries like Jordan could benefit from adopting integration strategies similar to Spain’s, which may contribute to lower PTSD prevalence. Additionally, community-based awareness initiatives could improve early symptom recognition and access to care. Future research should explore longitudinal outcomes to assess the long-term impact of displacement and resettlement conditions on mental health. Full article

Vascular surgery has evolved from durable yet invasive open reconstructions to less traumatic endovascular techniques. While endovascular repair reduces perioperative morbidity, it introduces durability challenges and the need for lifelong surveillance. Laparoscopic surgery bridged some gaps but was hindered by steep learning curves and technical limitations. Robotic-assisted surgery represents a “third revolution”, combining the durability of open repair with the recovery and ergonomic benefits of minimally invasive approaches through enhanced 3D visualization, wristed instrumentation, and tremor filtration. This review synthesizes current evidence on robotic applications in vascular surgery, including aortic, visceral, venous, and endovascular interventions. Feasibility of robotic vascular surgery has been demonstrated in over 1500 patients across aortic, visceral, venous, and decompression procedures. Reported outcomes include pooled conversion rates of ~5%, 30-day mortality of 1–3%, and long-term patency rates exceeding 90% in aortoiliac occlusive disease. Similarly favorable outcomes have been observed in AAA repair, visceral artery aneurysm repair, IVC reconstructions, renal vein transpositions, and minimally invasive decompression procedures such as median arcuate ligament and thoracic outlet syndromes. Endovascular robotics enhances catheter navigation precision and reduces operator radiation exposure by 85–95%, with multiple series demonstrating consistent benefit compared to manual techniques. Despite these advantages, adoption is limited by high costs, lack of dedicated vascular instruments, absent haptic feedback on most platforms, and the need for standardized training. Most available evidence is observational and from high-volume centers, highlighting the need for multicenter randomized trials. Future directions include AI-enabled planning and augmented-reality navigation, which are the most feasible near-term technologies since they rely largely on software integration with existing systems. Other advances such as microsurgical robotics, soft-robotic platforms, and telesurgery remain longer-term developments requiring new hardware and regulatory pathways. Overcoming barriers through collaborative innovation, structured training, and robust evidence generation is essential for robotics to become a new standard in vascular care. Full article

Background/Objectives: Adolescents aged 13–18 are exposed to traumatic content even without direct experience, owing to the increasing media coverage of disasters. Such indirect exposure can result in post-traumatic stress symptoms, including intrusion, avoidance, and hyperarousal, as well as associated emotions such as sadness, anger, and guilt. These effects may persist for months, reflecting the vulnerability of adolescents during cognitive and emotional development. This study examined resilience and social support as protective predictors against indirect trauma. Methods: A cross-sectional correlational design was employed, with middle- and high-school students aged 13–18 years in Seoul, South Korea, as participants. Indirect trauma, resilience, and perceived social support were assessed using validated self-report instruments. Correlation analyses were conducted, followed by stepwise regression. Owing to multicollinearity, resilience was retained as the sole predictor in the final model. Results: The average indirect trauma score was 1.20 out of 4, and 59.2% of participants exhibited partial or full post-traumatic stress disorder. The mean resilience and social support scores were 3.47 and 3.82 out of 5, respectively. Resilience was positively correlated with social support (r = 0.60, p = 0.001). The regression analysis indicated that resilience significantly predicted indirect trauma (β = 0.82, p < 0.001), accounting for 66.4% of the variance, whereas social support showed no direct effect. Conclusions: Resilience emerged as a key predictor of indirect trauma, underscoring its importance in mitigating distress. Although social support did not directly predict trauma, its positive correlation with resilience suggests potential indirect effects. These findings highlight the need to strengthen resilience and expand school-based counseling and support systems to help adolescents deal with indirect trauma. Full article

Background/Objectives: In emergency departments (EDs), choosing imaging modalities for adolescents with abdominal pain requires balancing diagnostic accuracy and minimizing radiation exposure. This retrospective study compared imaging modalities in adolescents (16–18 years) presenting with non-traumatic acute abdominal pain between the pediatric ED (PED) and adult ED (AED) in the same institution. Methods: We conducted a retrospective study in patients aged 16–18 years who presented to AED or PED in the same tertiary university-affiliated hospital due to non-traumatic acute abdominal pain between January 2019 and July 2023 (study period = 55 months). The patient freely decided on the emergency department (ED) to be admitted. Results: This study analyzed 950 patients (683 in AED and 267 in PED). Actionable and surgical emergencies were comparable between both EDs (p = 0.617 and 0.245, respectively). PED physicians used fewer CT scans (28.5% vs. 37.9%, p = 0.006) and fewer CT phases (mean, 0.49 vs. 0.76, p < 0.001). Despite more patients undergoing X-rays in PED (77.9% vs. 61.6%, p < 0.001), the number of X-ray images was lower than in AED (mean, 0.9 vs. 1.1, p < 0.001). PED performed more point-of-care US (POCUS) than AED (28.0% vs. 0.1%, p < 0.001). Both EDs had comparable safety outcomes (revisits and missed surgical emergencies). Conclusions: PED physicians utilize POCUS more frequently and employ fewer CT scans, X-ray images, and CT phases than AED physicians in adolescents presenting with non-traumatic acute abdominal pain. Despite lower radiation exposure, the PED achieved safety outcomes comparable to the AED’s, indicating that a PED-style imaging strategy may be safely applied to adolescent abdominal pain evaluation. Full article

The lack of acknowledgment of children as victims of gender-based violence hinders the support they receive. This study aimed to identify the psychological consequences of children’s exposure to gender-based violence and gaps in knowledge. This work used a scoping review approach, based on the PRISMA quality criteria. The search was conducted in the 14 databases included in the Web of Science platform. A total of 13 open-access articles published in English between 2015 and 2025 that focus on gender-based violence psychological consequences in children met the inclusion criteria. The results of the review indicate that gender violence has significant negative psychological, emotional, and social effects on children exposed to it. Thus, symptoms of internalizing, externalizing, and post-traumatic stress disorder may appear. Additionally, there is a high probability of experiencing difficulties in school, interpersonal relationships, and identity development. These effects may have long-term consequences affecting well-being and development later in life. It is crucial to recognize children as direct and significant victims of gender-based violence and promote their protection through psychological, educational, and social support. Full article

Jurors play a critical role in the administration of justice, yet their compulsory exposure to graphic and distressing evidence during criminal trials is often overlooked in discussions of mental health and legal reform. This paper investigates the psychological impact of jury service in trials involving murder, domestic violence, sexual assault, and child abuse, where laypeople are required to view autopsy photographs, listen to emergency calls, and assess disturbing testimonies without any formal training or mandatory psychological support. While vicarious trauma, secondary traumatic stress, and moral injury are recognised in research on law enforcement, social work, and healthcare, there is limited acknowledgement that no professional group consistently receives adequate trauma prevention or recovery support. This gap is particularly concerning for jurors, who are laypeople compelled to participate in the justice process. Drawing on legal case studies, psychiatric research, and international precedent, this paper argues that the justice system imposes an invisible emotional burden on jurors while offering limited, inconsistent, and mostly reactive support. Although applicable to many countries, particular attention is given to Australian jurisdictions, where counselling services are sparse and optional, and where juror confidentiality laws restrict therapeutic disclosures. This research also considers the legal and ethical implications of exposing untrained civilians to traumatic material and explores whether the state could, or should, bear legal liability for post-trial psychological harm. Ultimately, this paper calls for the introduction of clearly defined trauma-informed jury procedures, including pre-trial psychological briefings, structured debriefings, and systemic reform, to acknowledge juror well-being as a necessary component of fair and ethical justice. Full article

Background: Heroin addiction is associated with profound dysregulation of the endogenous opioid and stress response systems, yet current diagnostic frameworks may inadequately capture the traumatising aspects of this condition. This perspective proposes the concept of post-heroin post-traumatic stress spectrum (pH-PTSD/S) as a clinical syndrome emerging from chronic opioid-induced neurobiological and psychosocial dysregulation, even in the absence of Criterion A trauma. Methods: The authors review evidence from neuroendocrinology, behavioural neuroscience, and clinical psychopathology to support a sensitisation-based model of trauma vulnerability in heroin use disorder (HUD). Results: Findings suggest that HUD patients frequently exhibit PTSD-spectrum symptoms, including hyperarousal, avoidance, emotional dysregulation, and altered stress reactivity. Opioid agonist treatment (OAT) may mitigate these symptoms by stabilising HPA axis function and reducing exposure to trauma-related contexts. The pH-PTSD/S construct, measured through a dedicated instrument, identifies patients with subthreshold trauma-related symptoms and greater psychopathological burden. Conclusions: Heroin dependence may constitute a traumatising condition, requiring dimensional diagnostic tools and trauma-informed treatment strategies. Further research is needed to validate the nosological status of pH-PTSD/S, clarify its distinction from protracted withdrawal or complex PTSD, and determine its implications for OAT duration and integrated care pathways. Full article

The azygos lobe (AL), an additional lung lobe most commonly found in the right apical lung region, is a rare anatomical variant present in approximately 1% of the population. It is embryological in origin and may form if the azygos vein fails to migrate medially over the lung. While it is normally clinically silent, it can have surgical and clinical implications. An AL can be the source of infection or disease, such as squamous cell carcinoma, and can also compress the upper lobe and lead to obstruction, infarction, and necrotic tissue. Additionally, it can present as an unforeseen surgical obstacle, specifically during a thoracotomy, and can be mistaken for a thoracic mass on radiographic imaging, potentially leading to unnecessary interventions. In this case report, a 38-year-old male donor with a history of Ogilvie’s syndrome, multiple traumatic brain injuries (TBIs), and chronic respiratory failure presented with an AL during routine donor dissection. The cause of death was listed as prostate cancer, hypertension, atrial fibrillation, and type II diabetes mellitus. The AL, located on the posterior apical surface of the right lung, measured 5 cm in width and 8 cm in length. The left lung showed signs of atrophy and discoloration, possibly the result of pollution exposure or smoking earlier in life. In this article, we describe the incidence, historical classification, embryology, and physiology associated with an AL and its clinical implication for this donor. Full article

In recent years, psychological research has increasingly focused on the impact of media exposure on mental health, identifying young adults as particularly vulnerable due to their high levels of media engagement. To explore these effects, the construct of Media Vicarious Traumatization (MVT) has been introduced as an extension of vicarious traumatization, aimed at capturing the psychological impact of emotionally intense media content. MVT offers a relevant framework for understanding the mental health risks of media exposure, especially in relation to socially significant issues like war, now central in contemporary media discourse. This study aims to culturally adapt and psychometrically validate the Media Vicarious Traumatization Scale (MVTS) within the Italian context, and to investigate the relationship between the war-related MVT construct, generalized anxiety, and future anxiety among young adults. Study I, conducted on a sample of 250 participants (M = 22.40, SD = 2.63), explored the latent structure of the MVTS using Parallel Analysis and Exploratory Factor Analysis (EFA), yielding promising psychometric properties in terms of reliability and factorial stability. An independent sample of 553 participants (M = 22.43, SD = 2.37) was recruited for Study II to confirm the MVTS’s latent structure via Confirmatory Factor Analysis (CFA), which indicated good model fit. This study also evaluated measurement invariance across gender, internal consistency, and convergent, discriminant, and predictive validity, alongside psychometric properties assessed through Item Response Theory (IRT). The results of both studies confirm the stable and robust psychometric properties of the scale. Furthermore, Study II provides novel insights into the predictive role played not only by the war-related MVT but also by the recently introduced construct of Worry about War in exacerbating both generalized anxiety and future anxiety among Italian young adults. Full article