A proposed psychological model for understanding and supporting individuals living with tokophobia

Tokophobia is an overwhelming fear of pregnancy and birth that can lead to severe mental health difficulties in the perinatal period. The condition can be experienced by men as well as women and has implications for physical and mental health wellbeing in pregnancy and the postnatal period. Individuals with tokophobia are likely to have experienced previous traumatic events, which can trigger the condition and are also vulnerable to experiencing traumatic stress. This article proposes an adapted psychologically informed trauma model to help health professionals to understand and support pregnant women (and men) living with this condition. The aim of this is to raise awareness of the condition, as well as offer a guide for professionals to support and validate those living with this condition, as well as help them to feel safe and secure with the professional supporting them. It is hoped that this will lead those with tokophobia to experience a sense of safety, calmness, self-efficacy, connectedness and hope in working with professionals supporting them. This may, in turn, lead to them feeling more empowered and connected to becoming a parent and in planning their birth journey for those that are pregnant and living with this condition.

Dissosiativ identitetsforstyrrelse i utredning av barn og ungdom: Teori og kliniske utfordringer

Background: Clinical practice and recent research indicate that dissociative symptoms and disorders are left unidentified and undiagnosed by health professionals. Based on a clinical case from our work setting, this article describes relevant literature regarding dissociation and dissociative disorders to add to the knowledge of the theoretical and phenomenological features of complex dissociative disorders. Further, we describe differential diagnostic challenges that may arise in clinical practice. Methods: Both systematic and non-systematic literature searches were performed. Findings: Recent research shows the Trauma model to be central to understanding dissociative disorders. Symptoms can be mistaken for cognitive difficulties, oppositional issues or other somatic symptoms. Quantitative measures, systematic observations and clinical evaluations are fundamental for identifying dissociative symptoms and disorders. Implications: There is potential for identifying and evaluating dissociative symptoms at an earlier stage. Interdisciplinary and differential diagnostic evaluations are crucial to provide adequate understanding, assessment, and treatment of these patients. Keywords: Dissociative identity disorder, dissociation, somnambulism, biopsychosocial framework, clinical practice

Salicylate-Induced Changes in Hearing Thresholds in Mongolian Gerbils Are Correlated With Tinnitus Frequency but Not With Tinnitus Strength

Tinnitus is an auditory phantom percept without external sound sources. Despite the high prevalence and tinnitus-associated distress of affected patients, the pathophysiology of tinnitus remains largely unknown, making prevention and treatments difficult to develop. In order to elucidate the pathophysiology of tinnitus, animal models are used where tinnitus is induced either permanently by noise trauma or transiently by the application of salicylate. In a model of trauma-induced tinnitus, we have suggested a central origin of tinnitus-related development of neuronal hyperactivity based on stochastic resonance (SR). SR refers to the physiological phenomenon that weak subthreshold signals for given sensors (or synapses) can still be detected and transmitted if appropriate noise is added to the input of the sensor. The main objective of this study was to characterize the neurophysiological and behavioral effects during salicylate-induced tinnitus and compare these to the conditions within the trauma model. Our data show, in line with the pharmacokinetics, that hearing thresholds generally increase 2 h after salicylate injections. This increase was significantly stronger within the region of best hearing compared to other frequencies. Furthermore, animals showed behavioral signs of tinnitus during that time window and frequency range as assessed by gap prepulse inhibition of the acoustic startle reflex (GPIAS). In contrast to animals with noise trauma-induced tinnitus, salicylate-induced tinnitus animals showed no correlation between hearing thresholds and behavioral signs of tinnitus, indicating that the development of tinnitus after salicylate injection is not based on SR as proposed for the trauma model. In other words, salicylate-induced tinnitus and noise trauma-induced tinnitus are not based on the same neurophysiological mechanism.

HIF-1α as a Target Molecule in the Use of Triazino-Indole Derivative on the Acoustic Trauma Model

The effect of triazino-indole derivative (Trisan) on hypoxia-inducible factor (HIF) expression level in the organ of Corti, when administering it for therapeutic and preventive purposes, was investigated using an acoustic trauma model in experimental animals (female F1 hybrids of CBA and C57BL/6 lines). Cytoflavin was used as a comparator product. Study product Trisan (1% solution) was injected intravenously, intramuscularly and intraperitoneally, in the dose of 5, 7 and 10 mg/kg 2 h after the acoustic trauma for therapeutic purposes and in the dose of 5, 7 and 10 mg/kg for 3 days before the acoustic trauma for preventive purposes. IHC methods were used to investigate the organ of Corti. Trisan was observed to increase HIF expression in hair cells and neurons of the spiral ganglion in case of acoustic trauma. Depending on the dose, the increased HIF-1 expression in hair cells and spiral ganglion occurred both after therapeutic and preventive use of Trisan. Maximum HIF expression in hair cells and ganglion was noted at the therapeutic and preventive drug dose of 10 mg/kg. Following experimental results, we conclude that the otoprotective effect of triazino-indole derivative is realized via its effect on HIF metabolism, which makes it a target molecule for the drug.

Integration of ophthalmology in ocular trauma to improve patient care: A narrative review

Introduction Ocular trauma can cause significant morbidity and is a leading cause of unilateral blindness. In multi-trauma, life- and sight-threatening injuries can co-occur causing increased complexity in the assessment and management of ocular injuries as the competing priorities in the severely injured must be balanced. We conducted a narrative review to determine how ophthalmology may be further integrated into a trauma service and/or the organisation of an ocular trauma service. Methods The literature was reviewed via EMBASE, MEDLINE, CINAHL and Google Scholar utilising comprehensive search strategies and keyword searches. Our review was conducted in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Results The search yielded 437 articles, 30 studies met selection criteria and were included in the review. The included literature comprised guidelines, observational studies and reviews of registry data from Australia, England, the United States, Singapore, Iran and Israel. Conclusion The Australian Trauma Model has clear guidelines for referral of trauma patients to ensure appropriate care of the severely injured. However, there are no clear guidelines for the integration of ophthalmology into trauma. Therefore, early referral to ophthalmology and streamlining of referral pathways of specialist care would improve the care of patients with ocular trauma.

Comparison of dynamic response and maximum principal strain of diagnosed concussion in professional men’s rugby league

Rugby league has been identified as a contact sport with a high incidence of concussion. Research has been conducted to describe incidence and mechanisms of concussion in rugby league, however the risks associated with injury events (shoulder, hip, head to head) are unknown. The purpose of this study was to describe the common injury events leading to concussion in the National Rugby League and compare these events through analysis of dynamic response and brain tissue deformation. Twenty-seven impact videos of concussive injuries were physically reconstructed to obtain linear and rotational accelerations of the head. Dynamic response data were input into the University College Dublin Brain Trauma Model (UCDBTM) to calculate maximum principal strain (MPS). Head-to-head events produced a short duration event with an average peak linear and peak rotational acceleration of 205 g and 15,890 rad/s2, respectively, which were significantly greater than the longer duration hip-to-head (24.7 g and 2650 rad/s2) and shoulder-to-head (24.2 g and 3280 rad/s2) impacts. There were no differences in MPS between events. These results suggest that risk of strain to the brain may be produced by short and long duration acceleration events. Thus, both of these accelerations need to be accounted for in the development of improved head and body protection in rugby. In addition, this data demonstrates that these events cause a risk of concussion requiring efforts to limit or modify how energy is transferred to the head.