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Objectives To explore the association between return to work (RTW) and mental health outcomes in Black men in Philadelphia recovering from serious traumatic injuries. Methods We analyzed data from 498 Black men aged ≥ 18 years living in Philadelphia who were admitted to a Level I trauma center for injury between January 2013 and June 2017. We used multivariable logistic regression to estimate the association between pre-injury occupation, RTW and depression or PTSD 3 months after hospitalization. Results In adjusted analyses, men who had not RTW at follow-up had higher odds of poor mental health outcomes than men who had RTW (OR: 2.7, 95% CI: 1.8, 4.2). Additional significant factors included: younger age, lack of or public health insurance and higher lifetime experiences of racism. Conclusions The mental health recovery trajectory of injured Black men living in Philadelphia is associated with RTW and other factors that can influence financial stability and economic resources. Policy implications Programmatic strategies that seek to optimize recovery after injury in Black men should include consideration of key structural factors such as employment, financial stability, and the impact of racism-related exposures.

Background Black men are disproportionately impacted by injuries in the United States. This disparity is glaring given that injury is one of the top ten causes of death. Injured Black men from disadvantaged neighborhoods experience higher injury mortality, years of life-expectancy loss, and psychological symptoms that persist after initial wounds have been treated. These injured men are typically transported to a hospital where they are medically stabilized and soon after are returned to the community. Black men are less likely to be discharged to comprehensive rehabilitation facilities, magnifying disparities in recovery from injury. While much research has examined individual characteristics that predict poor recovery from injury, fewer studies have focused on social and physical features of the environment and how they may impact the recovery of injury survivors. Purpose The purpose of this study was to describe Black men's perceptions of how characteristics of their environment affect their recovery following serious injury. Methods This was a secondary analysis of an existing data set consisting of semi-structured, qualitative interviews of 43 injured Black men in a northeastern city. The interviews were conducted three months following discharge from a large urban trauma center, and were audiotaped, transcribed verbatim, and de-identified. Thematic analysis consistent with the qualitative paradigm was used to identify themes. Results Four themes were identified in injured men's narratives: challenges to recovery, feeling unsafe, efforts to increase safety, and resources for recovery. Conclusions Our findings emphasize the importance of the role of community resources that can support injured men's recovery within their neighborhoods. Additional resources should be directed to survivors who return to disadvantaged communities after injury in order to minimize adverse emotional experiences that detract from recovery.

Statement of Purpose For the majority of individuals who will survive trauma, healing and restoration is often a long-term process shaped by everyday socio-ecological exposures. The purpose of this analysis was to describe how Black men in Philadelphia perceived the long-term sequalae of their injuries and the influence of environmental and structural factors on recovery. Methods 26 individuals, 12–36 months after injury, were re-recruited from a concluded cohort study which followed over 600 seriously injured Black men from admission to a trauma center in Philadelphia to three months after hospitalization. This sub-sample was generally representative of larger cohort by age, mechanism of injury, insurance status, income, and education. Focus group and individual qualitative interviews elicited perceptions of: long-term symptoms attributed to injury, influences on recovery, outstanding needs for support, and opportunities to extend current health and social resources. Interviews were audio-recorded, transcribed, organized in NVIVO, and analyzed using inductive-deductive thematic analysis. Results Four overarching themes emerged. The first, ‘you used to run’ includes subthemes signifying the persistence of psychological distress, chronic pain, increased substance use, changes in sleep, and social isolation 12–36 months after injury. The second, ‘where it happened,’ describes the impact of neighborhood recovery environments on traumatic stress, gun carrying, outdoor activity, and proximity to social networks. The third, ‘in a hole,’ refers to post-injury changes in workforce participation, financial stability, and barriers to healthcare access. The fourth, ‘should be somebody’s job to help’ included perceived needs for services that address workforce re-entry, psychological stress, healthcare access and peer group interaction. Conclusions The perceptions of Black men in Philadelphia on their long-term recovery illustrates individual, environmental, and structural factors that can be targeted for tertiary prevention. Contributions to Injury and Violence Prevention Science Qualitative evaluation of the effects of trauma can be used to identify pathways through which to diminish outcome disparities and their origins in the socio-ecological context of recovery.

Purpose The burden of injuries is disproportionately concentrated among Black men in the United States. Previous studies suggest that the mental health effects of trauma may vary by the intentionality of the injury (intentional vs. unintentional), yet little is known about this experience among Black men. We explored the emotional responses to traumatic injuries in the context of injury intentionality among Black men in an urban area. Methods We conducted semi-structured, qualitative interviews with 74 Black men who were traumatically injured. The interviews took place three months after discharge from the hospital and they were audiotaped, transcribed, and de-identified. We used systematic thematic analysis to identify themes about post-trauma emotional responses to intentional and unintentional injuries. Results The narratives of intentionally injured men revealed persistent exposure to neighborhood violence and their distrust of others including the people they knew and to whom they felt close. Survivors of unintentional injuries did not express a similar distrust of others. Our findings suggest that survivors of intentional injuries experience loss of social support following their injuries. Conclusions Emotional responses can differ by intentionality of traumatic injury among urban Black men. Intentional injuries may be a marker for chronic exposure to violence and limited social support for recovery. Additional resources should be targeted to survivors of intentional injury who return to disadvantaged communities after medical treatment to decrease risk of re-traumatization and adverse emotional responses.

Background Traumatic injuries are a health event that can begin a trajectory towards chronic health and social challenges. Mobile technology-based prevention and treatment interventions have been used to monitor and transform outcomes across a myriad of health conditions, but their potential in long-term injury recovery is unexplored. The goal of this pilot study was to assess the acceptability and feasibility of mobile health monitoring for long-term outcomes in a population of trauma patients with known barriers to health and social care after injury. Methods We re-recruited 25 individuals, 12-36 months after acute hospitalization, from a recently concluded study of psychological outcomes in seriously injured Black men in Philadelphia, Pennsylvania. This mixed- methods pilot study was conducted in three phases: (I) qualitative interviews and development of a pilot monitoring platform; (II) a 3-month feasibility trial of mobile monitoring of patient-reported outcomes and biometric data using a wrist-worn commercial fitness monitor (n=18); (III) post-implementation qualitative interviews. Results Analysis of data from pre-implementation interviews indicated that the majority of participants used smartphones as a primary means of communicating with their social network and to access the internet. The 90-day pilot trial of mobile monitoring indicated participants' preference text-delivered communication and survey elicitation. Response rates for 12 automated surveys ranged from 84-92%. Twenty-four hours a day adherence to optional biometric monitoring was generally lower than 50% but ranged widely indicating both very low adherence and very high adherence. Four of 25 participants, 2 who had opted for Fitbit monitoring, were lost to follow-up at the end of the 90-day pilot trial. In post-implementation assessments, participants endorsed the acceptability of mobile monitoring highlighting the benefit of its convenience and flexibility over in-person outcome monitoring. Participants also perceived its potential benefit in long-term engagement with health and social services to assist with the challenges they faced when attempting to achieve physical, psychological, social, and financial recovery after hospitalization. These findings were reinforced through qualitative interviews which highlighted, in addition to acceptability, the perceived value of self-monitoring through the use of wearable devices to track health data like physical activity and sleep. Conclusions This study indicates the feasibility and acceptability of mobile health monitoring used to examine long-term injury sequalae. Future research may leverage this novel strategy, refining its application to address current limitations in the reliability and accuracy of commercially available wearable technology, relative costs and benefits of different mobile data collection strategies, integration within current clinical paradigms and generalizability across injured populations and socio-ecological environments.

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Many Black men suffer symptoms of traumatic stress in the aftermath of traumatic injury, and they also often carry social concerns, including experiences of discrimination and stigma, and a lack of financial resources. The objective of the present study was to understand how traumatic symptoms and social factors combine in complex ways toward the outcome of psychological help-seeking. We analyzed qualitative and quantitative data from 32 injured Black men admitted to a Level 1 trauma center. Qualitative interviews explored their attitudes toward seeking professional psychological help. We analyzed quantitative data, collected using validated instruments, on posttraumatic stress and depression symptoms, financial worry, and discrimination/stigma. Fuzzy set qualitative comparative analysis (fsQCA) was conducted by calibrating each condition to fuzzy set membership scores based on our knowledge of the causal conditions and the cases. We then constructed truth tables for QCA analysis using fsQCA software. Three causal pathways for psychological help-seeking were identified: Two pathways showed that severe trauma symptoms in the absence of financial worry were sufficient for seeking help, whereas the third showed that financial worry and discrimination in the absence of trauma symptoms were sufficient for help-seeking. We identified two causal pathways for negated help-seeking, in which low posttraumatic symptom severity and low levels of discrimination or financial worry were sufficient for not seeking psychological help. The QCA analysis revealed multiple pathways for psychological help-seeking among Black men who suffer trauma. These findings highlight the need for further research to understand complex pathways toward psychological help-seeking in this population.

Dear SirIt was interesting to read the analysis from Pugh et al. on resident perceptions about learning following a formative OSCE examination (Pugh et al. 2017). In particular, we found their emph...

OBJECTIVES: Psychological distress is common in survivors of traumatic injury, yet across United States’ trauma systems, it is rare that standard injury care integrates psychological evaluation and professional mental healthcare. The purpose of this study was to explore help-seeking for psychological symptoms in injured Black men living in Philadelphia. DESIGN: A subset of a cohort of 551 injured Black men admitted to a Trauma Center in Philadelphia participated in qualitative interviews that explored their perceptions of psychological symptoms after injury and the factors that guided their decision to seek professional mental health help. Data from 32 participants were analyzed for narrative and thematic content. RESULTS: Three overarching themes emerged: (1) facilitators of help-seeking, (2) barriers to help-seeking, and (3) factors underlying the decision not to consider professional help. Five participants felt that their injury-related psychological distress was severe enough to merit professional help despite any perceived barriers. Seventeen participants identified systemic and interpersonal obstacles to professional help that prevented them from seeking this kind of care. These included: financial constraints, limited access to mental healthcare services, and fear of the judgments of mental healthcare professionals. Ten participants would not consider professional help; these men perceived a lack of need and sufficiency in their existing social support networks. CONCLUSIONS: Research is needed to inform or identify interventions that diminish the impact of barriers to care, and identify from whom, where, and how professional mental health help might be more effectively offered to injured Black men in recovery environments like Philadelphia.

© 2015 The Author(s). Journal compilation © 2015 REABIC. Aquatic Invasions is an Open Access journal which means that all content is freely available without charge to the user or his/her institution. Users are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles in this journal without asking prior permission from the publisher or the author. This is in accordance with the BOAI definition of Open Access.

Purpose To describe the burden of post-injury PTSD and depression and the contribution of injury and acute stress responses to PTSD and depression severity 3 months post-discharge. Methods/Approach 607 seriously injured Black men were enrolled during hospitalisation for injury. 474 have completed follow-up 3 months post-discharge at the time of analysis. Demographics, injury characteristics (mechanism, injury severity), and acute stress responses: Trauma Screening Questionnaire (TSQ), Peri-traumatic Distress Inventory (PDI), Rand Peri-traumatic Dissociation Questionnaire (Rand), were collected in hospital. PTSD (PCL-5) and Depression (QIDSsr16) were collected 3 months post-discharge in the participant’s home, with higher scores reflecting more severe symptoms. Linear regression was used to identify characteristics associated with PTSD and depression symptom severity. Results Mean age 36.8 years (SD15.6). Mean Injury Severity 9.2 (SD7.5). 53% violent and 47% unintentional injury. 137 (28.8%) had PTSD and 169 (35.7%) had depression at 3 months. Significant correlates (p Conclusion Injury characteristics and acute psychological stress responses contribute to PTSD and depression at 3 months after discharge with the acute stress responses accounting for the largest part of variance. Understanding early for psychological responses to injury can help to guide comprehensive care for those at highest risk for post-injury PTSD and depression. Significance/Contribution Limited attention is paid to the psychological effects of the injury. For Black men who sustain serious injury, returning home from the hospital with unrecognised psychological consequences contributes to sub-optimal recovery. PTSD and depression may have behavioural manifestations that contribute to injury recidivism, self-medication for symptoms, or interactions with the criminal justice system.

Dear SirWe were very interested to read the work of Aragao et al. (2018) “Prevalence of depressive symptoms among medical students taught using problem-based learning versus traditional methods”.We...

The authors examined the relationship between body dissatisfaction and self-image across the life span. A sample of 106 women between the ages of 20 and 65 years completed questionnaire measures of body dissatisfaction, body importance, cognitive control over the body, self-concept, and self-esteem. The authors found that body dissatisfaction and body importance did not differ among the groups of women who were younger, middle aged, and older. Although body dissatisfaction was related to self-concept and self-esteem for the entire sample, the strength of that relationship reduced with increasing age and increasing perceptions of cognitive control. The authors concluded that the cognitive strategies of women who were older protect their self-concept and self-esteem from the influence of body dissatisfaction.

We examined the use of functional analysis methodologies to identify the environmental determinants of challenging behaviour for two students with severe disabilities. With one student the functional analysis was conducted in an outpatient clinic which was removed from the school setting. The functional analysis was conducted in the classroom setting with the other student. These assessments produced clear hypotheses regarding the controlling contingencies for challenging behaviour with both students. Individualised support plans were then developed and were successfully implemented by classroom personnel. The results of this study are discussed in terms of using a flexible approach to functional assessment in schools based on the individual characteristics of the student and the classroom context.

Chronic internal inflammation secondary to adiposity is a risk factor for sporadic breast cancer and Post-Menopausal Breast Cancer (PMBC) is largely defined as such. Adiposity is one of the clinical criteria for the diagnosis of Metabolic Syndrome (MetS) and is a risk factor for PMBC. We examined SNPs of eight genes implicated in adiposity, inflammation and cell proliferation in a Prospective-specimen-collection, Retrospective-Blinded-Evaluation (PRoBE) design approach. A total of 180 cases and 732 age-matched controls were identified from the MyCode prospective biobank database and then linked to the Clinical Decision Information System, an enterprise-wide data warehouse, to retrieve clinico-demographic data. Samples were analyzed in a core laboratory where the personnel were masked to their status. Results from multivariate logistic regression yielded one SNP (rs2922126) in the GHSR as protective against PMBC among homozygotes for the minor allele (A/A) (OR = 0.4, 95% CI 0.18-.89, P-value = .02); homozygosity for the minor allele (C/C) of the SNP (rs889312) of the gene MAP3K1 was associated with the risk of PMBC (OR = 2.41, 95% CI 1.25-4.63 P-value = .008). Advanced age was protective against PMBC (OR = 0.98, 95% CI 0.95-0.99, P-value = .02). Family history of breast cancer (OR = 2.22, 95% CI 1.14-4.43. P = .02), HRT (OR = 3.35; 95% CI 2.15-5.21, P

Background Injury is not evenly distributed across race and class. In the U.S., urban Black men are at high risk for injury and poor outcomes from injury. Our purpose was to examine the contribution of adverse childhood experiences (ACEs) to post traumatic stress disorder (PTSD) and depression after recent serious physical injury in Black men. Methods This prospective, cohort follow-up study consecutively enrolled adult Black men hospitalised for serious injury at a Level I Trauma Centre. Men with head injury or currently receiving medical treatment for PTSD or depression, and those in police custody were excluded. ACES (7) were collected by self-report during the intake interview. The outcomes of PTSD (measured by the PCL-C) and depression (measured by the QID-SR 16 ) were collected during in-person interviews in the men’s homes 3 months after hospital discharge. Results 320 (mean age = 36.8 years) were enrolled. Injury was classified as unintentional (50%) or intentional, i.e. the result of interpersonal violence (50%). The mean number of ACEs did not differ between intentional and unintentional injuries (2.64 vs. 2.35, p = 0.187). 81% reported at least 1 ACE, 45% reported 3 or more ACEs and 34% reported > 4 ACEs. Intentional injuries were associated with higher mean PCL-C scores (42.4 vs. 33.7, p Conclusions This sample of urban Black men reported substantial histories of childhood trauma and adversity. Results provide evidence that adverse childhood experiences increase the risk for depression and PTSD after serious injury. (Funded: NIH R01NR013503 to Dr. Richmond)

Certain tumor types have an increased capacity for heme synthesis, which serves as the basis for photodynamic therapy. Heme also serves as the target for the anti-malaria drug artemisinin, which has also been used as an anti-cancer drug. We developed a high-throughput screening assay to identify heme interacting (HI) compounds, which included imidazole, pyridine, carbonitrile, isocyanide, and quinoline core structures that are known to interact with heme or hemin. The cytotoxicity of several of the compounds towards human leukemia cell lines could be modulated by increasing or decreasing heme synthesis. Spectral analysis indicated that distinct molecular interactions occurred with heme, suggesting that HI compounds appear to target heme with exquisite specificity. These studies suggest that heme may serve as a novel therapeutic target for cancer drug discovery.

Background: PMBC most likely arises from combinations of less penetrant SNPs of common genes in combination with other environmental and lifestyle risk factors. Adiposity has the largest population attributable risk (PAR) for PMBC of all other factors at 21.3%. Of all the identified genes associated with human adiposity, the fat mass and obesity-associated gene (FTO) has been reported to have the strongest association and therefore a high PAR in the White population. Results from independent studies suggest that SNPs in the FTO gene are associated with PMBC. Furthermore, SNPs in several genes, i.e. estrogen receptor (ERS1), prostaglandin-endoperoxide synthase 2 (COX-2), ghrelin-obestatin ligand for growth hormone secretagouge receptor (GHRL), growth hormone secretagouge receptor (GHSR), interleukine 6 (IL6), mitogen-activated protein kinase (MAP3K1), are also associated with PMBC. To our knowledge the association between the complex of SNPs in these genes and PMBC has not been evaluated. Methods: Cases with a confirmed diagnosis of primary invasive breast cancer were identified from the MyCode cohort. Controls, matched by date of blood donation and age, were identified from the same cohort. Three controls were matched to each case. Demographic, pathology and clinical data were retrieved and verified by reviewing electronic medical records. The SNP genotyping was performed on a Life Technologies TaqMan OpenArray Genotyping System (Applied BiosystemsLife Technologies, Foster City, CA) and analyzed using the Life Technologies TaqMan Genotyper Software. Logistic regression models were used to analyze the association between PMBC and SNPs. Each SNP was tested individually adjusting for common clinical risk factors (age, first degree breast cancer family history, smoking, alcohol, metabolic syndrome, hormone replacement therapy). Then Multiple-SNP nonepistatic analysis was performed to fit multiple SNPs simultaneously with adjustment for other common clinical factors. Results: Cases (N=159) and controls (N=829) had a mean age of 65 years (± 9) and 64 years (± 9), respectively, at the time of entry into the cohort. A higher proportion of cases (26.5%) were diagnosed with metabolic syndrome, defined by the WHO criteria, compared with controls (4.0%) (p=0.0003). Self-reported family history of breast cancer was almost 4 fold higher among cases than controls (p=0.001). 41 SNPs were tested individually of the association of PMBC, among them 9 SNPs related to inflammatory pathways were tested in multiple SNPs model. One polymorphism in the MAP3K1gene (rs889312) showed increased risk of PMBC among homozygotes for the minor allele C (OR=1.98; 95% CI=1.08-3.63, p=0.03). Homozygotes for the A allele of rs689470 (PTGS2 gene) had a statistically significant increased risk of PMBC (OR= 3.38; 95% CI=1.09-10.51, p=0.03) while homozygotes for the G allele of rs2383529 had a lower risk for PMBC (OR= 0.32; 95% CI=0.11-0.92, p=0.03). In addition, we found a lower risk for PMBC for homozygotes for the C alleles of rs3020314 (ESR1 gene) (OR= 0.51; 95% CI=0.26-0.98; p=0.04). Similarly, the estimated risk of PMBC was lower (OR=0.13; 95% CI=0.03-0.55, p= 0.006) for homozygotes for the A allele of rs7801617 (IL6 gene). Conclusion: Our preliminary findings concur with previous reports suggesting polymorphisms of 2 genes, MAP3K1 and PTGS2 increase the risk of PMBC independent of the well-established risk factors for PMBC. MAP3K1 gene acts in the MAPK-signaling pathway and is responsible for regulation of transcription of estrogen receptor; while, PTGS2 is an inflammatory mediator that is reported to up-regulate aromatase expression and subsequently local synthesis of estrogen in the breast. Further study is to evaluate independence of these SNPs with the known risk factors, as well as to test SNPs interactions effect. Citation Format: Xiaowei(Sherry) Yan, Azadeh Stark, Xin Chu, Ryan Colonie, Jessica Webster, Ling Li, Jill Barnholtz-Sloan, Jeffrey Prichard, Victor Vogel, James F. Evans. Polymorphisms in chronic inflammation mediated pathway genes associated with risk of postmenopausal breast cancer (PMBC). [abstract]. In: Proceedings of the AACR Special Conference on Post-GWAS Horizons in Molecular Epidemiology: Digging Deeper into the Environment; 2012 Nov 11-14; Hollywood, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2012;21(11 Suppl):Abstract nr 65.