Purpose:Alcohol has been associated with 10%—35%trauma admissions and 40%trauma-related deaths globally.In response to the COVID-19 pandemic,the United Kingdom entered a state of"lockdown"on March 23,2020.R...Purpose:Alcohol has been associated with 10%—35%trauma admissions and 40%trauma-related deaths globally.In response to the COVID-19 pandemic,the United Kingdom entered a state of"lockdown"on March 23,2020.Restrictions were most significantly eased on June 1,2020,when shops and schools re-opened.The purpose of this study was to quantify the effect of lockdown on alcohol-related trauma admissions.Methods:All adult patients admitted as"trauma calls"to a London major trauma centre during April 2018 and April 2019(pre-lockdown,n=316),and 1st April—31st May 2020(lockdown,n=191)had electronic patient records analysed retrospectively.Patients’blood alcohol level and records of intoxication were used to identify alcohol-related trauma.Trauma admissions from pre-lockdown and lockdown cohorts were compared using multiple regression analyses.Results:Alcohol-related trauma was present in a significantly higher proportion of adult trauma calls during lockdown(lockdown 60/191(31.4%),vs.pre-lockdown 62/316(19.6%);(odds ratio(OR):0.83,95%CI:0.38—1.28,p<0.001).Lockdown was also associated with increased weekend admissions of trauma(lockdown 125/191 weekend(65.5%)vs.pre-lockdown 179/316(56.7%);OR:0.40,95%CI:0.79 to-0.02,p=0.041).No significant difference existed in the age,gender,or mechanism between pre-lockdown and lockdown cohorts(p>0.05).Conclusions:The United Kingdom lockdown was independently associated with an increased proportion of alcohol-related trauma.Trauma admissions were increased during the weekend when staffing levels are reduced.With the possibility of further global"waves"of COVID-19,the long-term repercussions of dangerous alcohol-related behaviour to public health must be addressed.展开更多
The United Kingdom has a population of 67 million people and is divided into 4 nations:England,Wales,Scotland,and the North of Ireland.Healthcare is provided free to all within each nation via the National Health Serv...The United Kingdom has a population of 67 million people and is divided into 4 nations:England,Wales,Scotland,and the North of Ireland.Healthcare is provided free to all within each nation via the National Health Service(NHS),which is funded by taxes and national insurance payments.Each year,there are approximately 22,000 casesof“major trauma”in the UK across the four nations.Prior to 2010,trauma patients in the UK were managed at any acute hospital with an Emergency Department,irrespective of resource availability or clinical experience and expertise.In the late 2000s,national reports identified significant variation or serious failings in the organization of UK trauma care.These reports,together with political drivers for centralized services,led to the formation of the national major trauma system made up of regional trauma networks.England was the first nation to implement the systemin 2012 and this re-organization of major trauma care was asso ciated with a 19% increase in the odds of survivalfor patients who reached hospital alive.This paper will provide an overview of the positive attributes and challenges within 6 key components of the national trauma system:pre-hospital care,facility-based care,trauma networks,the trauma registries,rehabilitation and governance,financing,and quality assurance.展开更多
目的基于逆境和精神病理维度模型(dimensional model of adversity and psychopathology,DMAP)探索重性抑郁发作患者的威胁型和剥夺型儿童期创伤与功能失调性态度的关联。方法收集970例重性抑郁发作患者资料,根据简版儿童期创伤问卷(chi...目的基于逆境和精神病理维度模型(dimensional model of adversity and psychopathology,DMAP)探索重性抑郁发作患者的威胁型和剥夺型儿童期创伤与功能失调性态度的关联。方法收集970例重性抑郁发作患者资料,根据简版儿童期创伤问卷(childhood trauma questionnaire,CTQ-SF)评分将患者分为无创伤组(426例)、仅威胁组(86例)、仅剥夺组(210例)、混合组(248例),采用功能失调性态度量表(dysfunctional attitudes scale,DAS)评估患者的认知歪曲情况,DAS得分大于所有受试者得分的上四分位数定义为高认知歪曲。采用多因素logistic回归分析探究患者威胁型和剥夺型创伤与功能失调性态度的关联。结果无创伤组、仅威胁组、仅剥夺组、混合组整体高认知歪曲者比例存在统计学差异(19.25%vs.30.23%vs.20.00%vs.35.89%,P<0.001),且各维度高认知歪曲比例均存在统计学差异(P≤0.001)。多因素logistic回归分析显示,威胁型创伤与整体高认知歪曲呈正关联(OR=2.031,P<0.001),且威胁型创伤与DAS中脆弱性(OR=1.709,P<0.001)、吸引与排斥(OR=2.088,P<0.001)、完美化(OR=2.321,P<0.001)、强制性(OR=1.765,P=0.001)、寻求赞许(OR=1.837,P<0.001)、依赖性(OR=1.554,P=0.006)、自主性态度(OR=1.864,P<0.001)等7个维度高认知歪曲呈正关联,剥夺型创伤仅与认知哲学维度高认知歪曲呈正关联(OR=1.495,P=0.015)。结论重性抑郁发作患者的儿童期创伤与功能失调性态度紧密相关,威胁型创伤与整体及除认知哲学外的维度高认知歪曲正相关,而剥夺型创伤仅与认知哲学维度高认知歪曲正相关。展开更多
文摘Purpose:Alcohol has been associated with 10%—35%trauma admissions and 40%trauma-related deaths globally.In response to the COVID-19 pandemic,the United Kingdom entered a state of"lockdown"on March 23,2020.Restrictions were most significantly eased on June 1,2020,when shops and schools re-opened.The purpose of this study was to quantify the effect of lockdown on alcohol-related trauma admissions.Methods:All adult patients admitted as"trauma calls"to a London major trauma centre during April 2018 and April 2019(pre-lockdown,n=316),and 1st April—31st May 2020(lockdown,n=191)had electronic patient records analysed retrospectively.Patients’blood alcohol level and records of intoxication were used to identify alcohol-related trauma.Trauma admissions from pre-lockdown and lockdown cohorts were compared using multiple regression analyses.Results:Alcohol-related trauma was present in a significantly higher proportion of adult trauma calls during lockdown(lockdown 60/191(31.4%),vs.pre-lockdown 62/316(19.6%);(odds ratio(OR):0.83,95%CI:0.38—1.28,p<0.001).Lockdown was also associated with increased weekend admissions of trauma(lockdown 125/191 weekend(65.5%)vs.pre-lockdown 179/316(56.7%);OR:0.40,95%CI:0.79 to-0.02,p=0.041).No significant difference existed in the age,gender,or mechanism between pre-lockdown and lockdown cohorts(p>0.05).Conclusions:The United Kingdom lockdown was independently associated with an increased proportion of alcohol-related trauma.Trauma admissions were increased during the weekend when staffing levels are reduced.With the possibility of further global"waves"of COVID-19,the long-term repercussions of dangerous alcohol-related behaviour to public health must be addressed.
文摘The United Kingdom has a population of 67 million people and is divided into 4 nations:England,Wales,Scotland,and the North of Ireland.Healthcare is provided free to all within each nation via the National Health Service(NHS),which is funded by taxes and national insurance payments.Each year,there are approximately 22,000 casesof“major trauma”in the UK across the four nations.Prior to 2010,trauma patients in the UK were managed at any acute hospital with an Emergency Department,irrespective of resource availability or clinical experience and expertise.In the late 2000s,national reports identified significant variation or serious failings in the organization of UK trauma care.These reports,together with political drivers for centralized services,led to the formation of the national major trauma system made up of regional trauma networks.England was the first nation to implement the systemin 2012 and this re-organization of major trauma care was asso ciated with a 19% increase in the odds of survivalfor patients who reached hospital alive.This paper will provide an overview of the positive attributes and challenges within 6 key components of the national trauma system:pre-hospital care,facility-based care,trauma networks,the trauma registries,rehabilitation and governance,financing,and quality assurance.
文摘目的基于逆境和精神病理维度模型(dimensional model of adversity and psychopathology,DMAP)探索重性抑郁发作患者的威胁型和剥夺型儿童期创伤与功能失调性态度的关联。方法收集970例重性抑郁发作患者资料,根据简版儿童期创伤问卷(childhood trauma questionnaire,CTQ-SF)评分将患者分为无创伤组(426例)、仅威胁组(86例)、仅剥夺组(210例)、混合组(248例),采用功能失调性态度量表(dysfunctional attitudes scale,DAS)评估患者的认知歪曲情况,DAS得分大于所有受试者得分的上四分位数定义为高认知歪曲。采用多因素logistic回归分析探究患者威胁型和剥夺型创伤与功能失调性态度的关联。结果无创伤组、仅威胁组、仅剥夺组、混合组整体高认知歪曲者比例存在统计学差异(19.25%vs.30.23%vs.20.00%vs.35.89%,P<0.001),且各维度高认知歪曲比例均存在统计学差异(P≤0.001)。多因素logistic回归分析显示,威胁型创伤与整体高认知歪曲呈正关联(OR=2.031,P<0.001),且威胁型创伤与DAS中脆弱性(OR=1.709,P<0.001)、吸引与排斥(OR=2.088,P<0.001)、完美化(OR=2.321,P<0.001)、强制性(OR=1.765,P=0.001)、寻求赞许(OR=1.837,P<0.001)、依赖性(OR=1.554,P=0.006)、自主性态度(OR=1.864,P<0.001)等7个维度高认知歪曲呈正关联,剥夺型创伤仅与认知哲学维度高认知歪曲呈正关联(OR=1.495,P=0.015)。结论重性抑郁发作患者的儿童期创伤与功能失调性态度紧密相关,威胁型创伤与整体及除认知哲学外的维度高认知歪曲正相关,而剥夺型创伤仅与认知哲学维度高认知歪曲正相关。
