<p>Post-traumatic arthritis (PTA) is arthritis that develops following joint injury, including meniscus and ligament tears. Current treatments for PTA range from over-the-counter medication to knee replacement; however, in the presence of obesity, the levels of pro-inflammatory cytokines, such as interleukin-1 (IL-1) and tumor necrosis factor alpha (TNF-α,) are more elevated than in non-obese individuals. The role of fatty acids, obesity, and PTA has been examined, with omega-3 fatty acids showing promise as an anti-inflammatory after injury due to its ability to suppress IL-1 and TNF-α. Due to the difficulty in switching patients’ diets, an alternative solution to increasing omega-3 levels needs to be developed. The Fat-1 enzyme, an omega-3 desaturase that has the ability to convert omega-6 to omega-3 fatty acids, may be a good target for increasing the omega-3 levels in the body. </p><p>In the first study, we examined whether Fat-1 transgenic mice on a high-fat diet would exhibit lower levels of PTA degeneration following the destabilization of the medial meniscus (DMM). Both male and female Fat-1 and wild-type (WT) littermates were put on either a control diet (10% fat) or an omega-6 rich high-fat diet (60% fat) and underwent DMM surgery. Arthritic changes were examined 12 weeks post-surgery. Fat-1 mice on both the control and high-fat diet showed protection from PTA-related degeneration, while WT mice showed severe arthritic changes. These findings suggest that the omega-6/omega-3 ratio plays an important role in reducing PTA following injury, and demonstrates the potential therapeutic benefit of the Fat-1 enzyme in preventing PTA in both normal and obese patients following acute injury.</p><p>Following this, we needed to establish a translatable delivery mechanism for getting the Fat-1 enzyme, which is not present in mammalian cells, into patients. In the second study, we examined whether anti-inflammatory gene delivery of the Fat-1 enzyme would prevent PTA following DMM surgery. In vitro testing of both lentivirus (LV) and adeno-associated virus (AAV) was completed to confirm functionality and conformation of the Fat-1 enzyme after transduction. Male WT mice were placed on an omega-6 rich high-fat diet (60% fat) and underwent DMM surgery; either local or systemic AAV injections of the Fat-1 enzyme or Luciferase, a vector control, were given immediately following surgery. 12 weeks post-surgery, arthritic changes were assessed. The systemic administration of the Fat-1 enzyme showed protection from synovial inflammation and osteophyte formation, while administration of Luciferase did not confer protection. These findings suggest the utility of gene therapy to deliver the Fat-1 enzyme, which has potential as a therapeutic for injured obese patients for the prevention of PTA.</p> / Dissertation

Philosophiae Doctor - PhD / Given the devastating and debilitating impact of spinal cord injuries (SCI) globally and the effects on any population, its impact extends far beyond just the victim to people and institutions surrounding them and supporting them post-injury. Of growing concern is the increased risk that individuals with SCI have been seen to have a three-fold greater risk of developing cardio-vascular disease (CVD) than their able-bodied counterparts. Prevention strategies to curtail the onset of CVD in the SCI population is limited, and often developed for individuals from developed countries. The overall aim of this study was to assess and explore the need to implement CVD prevention programmes in a regional South African population with individuals after sustaining a traumatic spinal cord injury (TSCI). The study employed a mixed methods approach and was conducted in four (4) phases. Permission and ethics clearance were obtained from the Research Ethics Committee at the University of the Western Cape (UWC) and the Western Cape Department of Health. Phase One of the study utilized a questionnaire to collect TSCI incidence data of which 108 of the eligible 132 cases consented to take part in the study. The demographic findings of this study indicated that a person sustaining a TSCI in the Cape Metropolitan area in South Africa is most likely to be a male, young (20 to 29 years of age), from a Black African or Coloured race group and living in the Cape Flats suburbs. The male to female ratio was 6.2:1. The main cause of TSCI was assault at 58.33% (n=63) with males accounting for the majority of cases (88.89%, n=65). According to the AIS classification, ASIA A and D were the most common classification seen in 38.89% (n=42) and 39.81% (n=43) of the cohort respectively. Phase Two utilized a questionnaire and looked at CVD risk factors of the original cohort. A large portion of the cohort was engaged in high-risk behaviours, i.e. smoking and alcohol consumption. A low number of individuals reported a baseline history of hypertension diagnosis prior to their TSCI (5.56%, n=6). Phase Three of the study emplored semi-structured interviews and a focus group discussion to explore the experiences of persons with a TSCI regarding their ability to be physically active once reintegrated back into the community. Despite understanding the associated benefits of physical activity, several barriers to being physically active were reported; factors within their homes, access within their community, and transportation. The present study’s findings illustrated a growing concern among the SCI population for increased risk for developing CVD due to decreased physical activity. Phase Four of the study utilised a scoping review to identify CVD prevention programmes for individuals with a TSCI. Physical activity has been shown to have numerous health benefits of which reducing the risk of CVD is one. Engaging in physical activity, whether it be structured, unstructred or through a sporting activity can play a major role in combating the onset of CVD. Other tools used in reducing the onset of CVD were seen to be self-management strategies of which contrayer views were seen both for and against their use. Conclusion: Better education during the rehabilitation phase might be a key component to individuals with TSCI injury making more informed decisions about prioritising physical activity as they attempt to reintegrate back into their respective communities. The removal of socio-environmental barriers could allow motivated TSCI individuals better access to choosing how to increase their physical activity levels.

Objective: Children and adolescents with a history of traumatic brain injury (TBI) are at increased risk for developing social incompetence and impairment in broad psychosocial functioning. The aim of this study was to examine the relationship between history of TBI, social competence, and broad psychosocial functioning using meta-analytic methods. Methods: Studies relating to social outcome following pediatric TBI were searched for using scientific, academic databases. Sixteen studies (N=2,005) met inclusion criteria, and relevant data relating to social functioning was extracted. Meta-analytic methods were used in order to obtain Hedges's g effect size data for mild, moderate, and severe TBI groups. Meta-regressions were also used to examine the effect of potential moderating variables, including Glasgow Coma Scale (GCS), socioeconomic status (SES), gender, control group (typically developing (TD) or orthopedic injury (OI)), and time/age related variables. Finally, publication bias was calculated using funnel plots and Rosenthal's fail-safe N. Results: A dose-response effect was observed with mild (Hedges's g = -0.387), and moderate (Hedges's g = -0.459) groups demonstrating smaller effects when compared to the severe group (-0.814) on measures of broad psychosocial function. A dose-response effect was also observed on measures of social competence, with mild (Hedges's g = -0.098) and moderate (Hedges's g = -0.450) TBI groups demonstrating smaller effect sizes when compared to the severe TBI group (Hedges's g = -0.832). The GCS was a significant predictor of both broad psychosocial functioning (B = 0.065, p < 0.001) and social competence (B = 0.079, p < 0.001), such that more severe injuries predicted poorer social outcomes. Gender was a significant predictor of effect size (B = 0.018, p = 0.05), such that higher proportions of females was associated with smaller effect sizes. Finally, the type of control group used in these studies was also a significant predictor of effect size (B = 0.369, p = 0.03), such that studies that used TD produced larger effect sizes when compared to studies that used OI. Overall, there was little evidence for publication bias. Conclusions: Children and adolescents with a history of TBI demonstrated significant differences from their peers in social competence and broad psychosocial functioning following TBI. The severity of the injury is important in understanding and predicting social outcomes following pediatric TBI. Implications of these findings are discussed.

The incidence of mild blast traumatic brain injuryhas risen due tothe increased use of improvised explosive devices (IEDs) in militaryconflicts. Mild blast TBI (mbTBI) is especially relevant due to its lack of acutely observable symptoms, and to its association with long-term neurodegenerative and neuropsychiatric disorders. Predominantly, TBI patients often suffer from chronic stress, neuropathic pain and headaches, which greatly compromise the health and quality of life of these individuals. Treatments for neuropathic pain have been empirically found and produce little effect in lessening neuropathic pain, likely due to the lack of targeted therapies. This highlights the need for better understanding of the molecular mechanisms underlying neuropathicpain, TBI and chronic stress that could lead to mechanistic therapeutic targets. Oxidative stress is an important mechanism of the pathophysiology of neuropathic pain, TBI and chronic stress. We hypothesize that acrolein, an endogenously formed neurotoxin, is able to stay active in the body for up to 10 days, is involved in the pathophysiology of neuropathic pain in TBI and chronic stress. This study aims to correlate acrolein elevation in the body with neuropathic pain, deepen the understanding of underlying mechanisms of pain in TBI and chronic stress, and mitigate this pain with acrolein scavenging. The ultimate goal of this research is to provide therapies for TBI and chronic stress patients that can eliminate pain and significantly improve their healthand quality of life

The South African service (SAPS) has a reputation for being resilient despite the amounts of trauma they are exposed to. Research has shown that this occupation is one of the most stressful. However, research surrounding the SAPS suggests that police work is one of society’s most stressful occupations. The way in which individuals respond to such traumatisations is dependent on numerous factors, two being personality and coping. In so far, this study investigated three main areas around police reservists – a unit within the SAPS - in order to understand their responses to trauma: whether personality factors were related to post-traumatic stress symptomatology (PTSS) in the police reservist population; whether coping moderated the relationship between personality factors and PTSS; whether a personality factors predict coping style. A quantitative analysis was conducted among a sample of 36 reservists in the Gauteng area of South Africa. This study found that the relationship between Neuroticism and PTSS is mediated by coping, specifically Emotion-Focused and Dysfunctional Coping styles. A relationship between Conscientiousness and PTSS showed to be prevalent, however this is not due to the mediation affect of coping. Furthermore, Neuroticism and Extraversion showed to predict coping style. Specifically, Neuroticism showed to affect EFC and DC and Extraversion showed to affect EFC. The descriptive statistics showed that this sample of police reservists is suffering from PTSD. Implications of these findings are discussed and directions for future research are explored.

Thesis advisor: Belle Liang / Traumatic brain injury (TBI) survivors often experience isolation from their primary support network following their injury (Marsh, Kersel, Havill, & Sleigh, 1998). Computer-mediated support groups (CMSGs) offer a virtual platform for individuals with complex medical concerns to exchange emotional and informational support (Braithwaite, Waldron, & Finn, 1999). To date, no research has examined the use of CMSGs, such as TBI-related Facebook support groups, for TBI survivors. There is also limited research investigating how emotional and informational support provided and received (i.e., supportive exchanges) relate to well-being and online relational health (Liang et al., 2002). This study examined the relationship between four supportive exchanges and well-being and relational health for TBI survivors using TBI-related Facebook support groups, as well as whether a gender norm—emotional control—and network preference moderated these relationships. Participants included 191 TBI survivors recruited across 14 TBI-related Facebook support groups. Multiple regression analyses tested whether four supportive exchanges directly predicted well-being and relational health after controlling for age and extraversion. Results revealed that supportive exchanges did not predict well-being. However, emotional support provided, emotional support received, and informational support received all predicted higher levels of online relational health. Informational support provided predicted lower levels of online relational health. Additional multiple regression analyses tested whether emotional control and four aspects of network preference moderated the relationship between supportive exchanges and well-being and relational health. Although higher levels of emotional control directly predicted lower levels of relational health, and a preference for weak-tie support networks (e.g., online acquaintances) predicted lower levels of well-being, the moderating effects were generally not significant. The findings underscore the importance of supportive exchanges in developing online relational health for TBI survivors using Facebook support groups. It also suggests that this relationship was not dependent on emotional control and network preference. Future research should investigate other factors affecting supportive online communication for TBI survivors and when they may benefit most from online support. / Thesis (PhD) — Boston College, 2018. / Submitted to: Boston College. Lynch School of Education. / Discipline: Counseling, Developmental and Educational Psychology.

Thesis (M.A.(Industrial Psychology)--University of the Witwatersrand, Arts Faculty, 1996 / At a primary level the current study sought to investigate the post-traumatic stress responses of a sample of black township residents who were victims and witnesses of continuous civil violence [Abbreviated abstract. Open document to view full version]

Violent and traumatic events are a regular occurrence in many South Africans’ lives. The term 'continuous traumatic stress’ was coined by South African anti-apartheid health professionals in the 1980’s to explain the continuous nature of violence and trauma happening within the country. Although the political agenda may have shifted, many South Africans are still living within a context in which violent and traumatic events regularly occur. However, little is known about how health workers respond to continuous trauma within the South African setting. The Community Health Workers - within this study - are part of the South African health model called ‘Primary Health Care Re-engineering’ that is currently being piloted. The research was exploratory in nature and used a mixed methods design. Twenty three Community Health Workers who participated in the study were from two sub-districts within the Ekurhuleni district, Gauteng, Johannesburg. The research included two face to face semi-structured individual interviews. The first included qualitative questions and completion of the quantitative Stressful Life Events Screening Questionnaire (1998) to explore past trauma experiences. Over a seven month period, the participants were asked to document traumatic event exposure and responses through the adapted Life Events Checklist (1995) and personal journaling. At the end of this period, participants were interviewed again to explore their current traumatic experiences. Qualitative data were analysed through thematic content analysis and quantitative data were used to substantiate information from the interviews and checklists. Results show that Community Health Workers – within this study - have a high prevalence of exposure to traumatic events (directly experiencing, witnessing and hearing about). Prominent events included physical and sexual assault, transport accidents, fires and explosions. Media played a powerful role in exposure to events. Traumatic and unexpected losses were key experiences that need to be considered when working with trauma in the South African context. Acknowledgement of experiences (peer and external) is an essential element in developing support structures. These findings – from the context of Ekurhuleni, South Africa - contribute to exploring and understanding the experience of ‘continuous traumatic stress’ for Community Health Workers.

La thèse a pour objectifs d’étudier les liens entre les mécanismes de régulation émotionnelle (RE) et les psychotraumatismes de type I et II. Elle s’intéresse également aux indicateurs physiologiques caractérisant ces processus de RE et leurs éventuelles modifications dans les cas de Stress Post-Traumatique (SPT) ou d’exposition à des événements aversifs (trauma complexe). Pour cela nous avons mené trois études. La première étude s’intéresse à mettre en évidence des prédicteurs du développement d’un SPT complet ou subsyndromique, suite à un accident de la voie publique. Les résultats font apparaître que plus d’un quart des participants présente un subsyndrome traumatique ; pour 7,7% de patients avec un SPT complet. Parmi de nombreuses variables, le meilleur prédicteur est la perception d’une menace vitale. Des liens forts sont également observés entre d’une part, la détresse péritraumatique et les symptômes de reviviscence et d’hyperactivité neurovégétative, et d’autre part entre la dissociation traumatique et l’évitement. La seconde étude s’intéresse à évaluer la variabilité du rythme cardiaque (VRC) comme biomarqueur des difficultés de régulation émotionnelle (DRE) en population non-clinique. Les résultats montrent que le groupe qui a peu de DRE présente une diminution de la VRC durant une phase d’induction émotionnelle puis une augmentation jusqu’à un niveau statistiquement équivalent à sa ligne de base en phase de récupération post-induction. Cette réponse sympathoexcitatrice adaptative est modifiée dans le groupe avec beaucoup de DRE : la VRC n’augmente pas en récupération. Ces données suggèrent que la VRC est un biomarqueur pertinent des DRE. Enfin, la dernière étude cherche à évaluer l’impact d’un trauma complexe (TC) sur plusieurs processus émotionnels. Les DRE et la dissociation somatoforme discriminent le mieux les groupes d’adolescentes présentant un TC des adolescentes contrôles. De plus, les mesures physiologiques montrent que le niveau de VRC au repos est plus faible dans le groupe TC et que le pattern typique de réaction sympathoexcitatrice est absent, à la différence du groupe contrôle. Les analyses de régressions précisent que le manque de conscience émotionnelle prédit le niveau de VRC au repos alors que c’est le niveau de dépression qui prédit le mieux la diminution phasique de VRC. Ajoutée à un taux d’erreur plus important pour évaluer subjectivement les stimuli émotionnels dans le groupe TC, les événements aversifs répétés semblent perturber à la fois des processus liés à l’évaluation des signaux émotionnels et leur intensité, mais aussi les processus psychologiques et physiologiques liés à la régulation des émotions. Ces résultats qui confirment le rôle important des DRE dans les psychotraumatismes seront discutés par rapport à la littérature actuelle pour proposer des pistes thérapeutiques spécifiques. / This thesis aims to explore the links between emotion regulation (ER) mecanisms and type 1 and 2 psychotrauma. We also investigate physiological marker of those ER processes and the potential disturbances caused by Post-Traumatic Stress Disorder (PTSD) and adverse life events (complex trauma). Three studies were carried out. The first study assesses some predictors of the development of a complete or subsyndromic PTSD following a motor vehicule accident. Results reveal that more than one quarter of the sample exhibits subsyndromic PTSD and 7.7% was diagnosed with complete PTSD. Among several variables, the strongest predictor is the perceived life threat. Also, strong correlations are observed between 1) peritraumatic distress and persistent re-experiencing or hyperarousal and 2) dissociation score and avoidance strategy. The second study evaluates Heart Rate Variability (HRV) as a potential biomarker of emotion regulation difficulties (ERD) in a non-clinical population. Results for the low ERD group show that HRV decreases from baseline to elicitation and then increases from elicitation to recovery (no difference between recovery and baseline levels). This adapatative sympato-excitatory pattern is altered in the high ERD group in which HRV do not increase from elicitation to recovery. Those data suggests that HRV could be an unbiased biomarker of ERD. The last study examines the effects of complex trauma (CT) on several emotional processes. ERD and somatoform dissociation best discrimate between CT and control teenagers. Moreover, physiological measures show that HRV level at rest is lower in CT than control and typical sympato-excitatory response is not observed in CT contrary to control group. Regressions analyses further reveal that the lack of emotional awareness predicts HRV level at baseline whereas the level of depression best predicts phasic HRV decrease. Added to greater errors in the subjective assessment of emotional stimuli in the CT group, adverse life events seem to disrupt processes involved in the labelling of emotions and intensity as well as psychological and physiological processes linked to ER. These results which confirm the importance of ERD in psychotrauma are discussed in regard to contemporary literature in order to suggest some specific therapeutic approaches.

A tese discute as implicações e os desdobramentos transferenciais da instituição de um espaço de escuta psicanalítico na sede de uma organização não governamental que abrigava um projeto de Centro da Juventude num bairro da zona sul do município de São Paulo. Depois de abordar a gênese da aposta no desejo de escuta, a autora problematiza o processo de construção desse espaço, dentro do qual surgiu a escuta do caso Maria, marcada pela presença do traumático associado ao silenciamento do sujeito, e paradoxalmente, ao que retorna na compulsão à repetição, no agir atualizado na relação transferencial. A autora examina, também, o que no contexto social pode operar de captura do sujeito e reforçar as posições de sacrifício impostas pelos imperativos superegoicos. A partir da experiência de escuta do traumático no caso Maria, a autora defende o ponto de vista de que a disponibilização de um espaço de escuta psicanalítico, sustentado pela presença do analista, pode suscitar a emergência da fala do sujeito, a elaboração de um pedido de escuta, e propiciar alguma diferenciação das posições que marcam lugares de estagnação / The thesis discuss the transferencial implications and developments of the institution of a psychoanalitic listening space in the headquarters of a non-governmental organization that housed the project of a Youth Center in a neighborhood of the south area of the city of São Paulo. After approaching the genesis of the bet on listening desire, the author problematize the construction process of this space, within wich arose the listening of Maria case, marked by the presence of the traumatic associated with the silencing of the subject, and, paradoxically, with what returns in the repetition compulsion, in the <> updated in the transference relationship. The author examine also, of what in the social context, can operate as a capture of the subject, and reinforce the positions of sacrifice imposed by the super egoic imperatives. Starting from the listening experience of traumatic in the Maria case, the author defends the view that the provision of a psychoanalitic listening space, supported by the presence of the psychoanalyst, may give rise to the emergence of the speech of the subject, to the elaboration of a demand for listening, and propitiate some differentiation in the positions that mark places of stagnation