It has been highlighted that shame may be an important dynamic risk factor for prevention of violence and recidivism in forensic populations. However, past research investigating the relationship between shame and violence, or recidivism has been inconsistent. Different conceptualisations and measurements of shame used in the literature may explain these inconsistencies. Therefore, a systematic review was conducted to explore how shame was conceptualised in forensic populations and these measures were then evaluated. Findings revealed that most studies did not clearly define shame, and when they did, the same theoretical underpinnings were used in different ways. By assessing the validity and reliability of shame measures, it was revealed that different measures focused on different aspects of shame. This could explain the current confusion in the conceptualisation and measurement of shame in forensic populations, and shed light on inconsistent findings between shame and other constructs. Shame in violent female offenders is an unexplored phenomenon and therefore may involve various complex and unexpected factors. A social constructivist grounded theory approach was applied to the narratives of eight violent female offenders, focusing on thoughts, feelings and life experiences in relation to shame and violence. A model was constructed suggesting that childhood victimisation, in the absence of available, compassionate, secure relationships, may lead to difficulties with emotion regulation. The experience of negative emotions, including shame, may lead to self-harm, substance misuse and violence. It was however demonstrated that this vicious cycle could be broken through the development of secure, positive and compassionate relationships. These findings suggest that shame and attachment may be important factors for treatment and service planning, to meet the unique needs of female offenders.

Doctor of Philosophy / School of Family Studies and Human Services / Briana S. Nelson Goff / Several courses in higher education may utilize trauma-related content material as a part of the curriculum. In order to reduce the potential for experiencing secondary traumatic stress in college students, it has been recommended that instructors of such courses be purposeful and cautious with the use of trauma-related materials in the classroom (Cunningham, 2004; Kostouros, 2008). Most recommendations for implementation of these materials are based on theory, and there are few empirical studies that examine actual student reactions to trauma-related content. In the current study, both salivary cortisol and mixed-method survey data were obtained from undergraduate students enrolled in an undergraduate trauma course across three semesters. Results indicated that exposure to higher levels of adverse childhood experiences were significantly related to higher cortisol levels after participating in a course lecture with high levels of trauma content. Generally, students reported favorable views and positive experiences in the course overall. Students with higher levels of lifetime exposure to traumatic events had significantly higher levels of emotional reactions to the course. Qualitative results indicated a range of emotional reactions to the course content, with both positive and negative effects. Implications for teaching practice, policy, and future research are discussed.

Acidentes de trÃnsito sÃo eventos de etiologia multifatorial potencialmente evitÃveis e decorrentes de fatores como aumento da frota de veÃculos, falhas humanas e leis inadequadas ou insuficientes, e responsÃveis por uma parcela importante da morbidade e mortalidade em menores de idade. O trabalho tem como objetivo: calcular a Escala de Trauma PediÃtrico(PTS) e Escala de Trauma Revisado(RTS) e comparar se hà relaÃÃo de gravidade do trauma com a idade do acidentado. Estudo de abordagem quantitativa e documental, do tipo exploratÃrio e descritivo, ocorrido na cidade de Sobral, com 910 ocorrÃncias com motocicletas envolvendo menores de idade, no perÃodo de 2005 a 2013, cuja coleta de dados ocorreu atravÃs de pesquisa nas folhas de ocorrÃncia do SAMU. A analise foi realizada atravÃs do programa SPSS, respeitando os princÃpios Ãticos da ResoluÃÃo 466/12. RESULTADOS: foram 910 os acidentes de motocicleta envolvendo menores de idade entre os anos de 2005 a 2013, sendo 543(59,7%) do sexo masculino;494(54.3%) estavam na idade entre 16 a 18 anos de idade; 377(41.4%) foram vÃtimas de queda de moto. Na faixa etÃria de 0 a 7 anos de idade houve o predomÃnio dos atropelamentos por moto(36,6%) e as quedas de moto(35,9%). O Escore de Trauma PediÃtrico no grupo etÃrio de zero a 07 anos foi menor(01 ponto), quando comparado aos outros grupos etÃrios. NÃo houve diferenÃas no Escore de Trauma Revisado nos grupos etÃrios estudados. Dentre as variÃveis que compÃe o PTS ganha destaque o trauma musculoesquelÃtico(fraturas e lesÃes de pele) como fator de gravidade. CONCLUSÃO: nos acidentes de motocicleta envolvendo menores 07 anos, a gravidade do trauma foi maior quando comparado a outras faixas etÃrias. O PTS à uma boa ferramenta de triagem prÃ-hospitalar a ser aplicada em crianÃas vÃtimas de acidente com motocicleta. / Traffic accidents are multifactorial events potentially avoidable and due to such factors as increasing vehicle fleet, human error and inadequate or insufficient laws, and account for a significant portion of morbidity and mortality in minors. The work aims to: calculate the Pediatric Trauma Scale (PTS) and Trauma Scale Revised (RTS) and compare if there is a relationship of severity of trauma at the age of the injured. Quantitative approach to study and document, exploratory and descriptive, which occurred in the city of Sobral, with 910 occurrences with motorcycles involving minors in the period 2005-2013, whose data were collected through research in the SAMU occurrence of leaves. The analysis was performed using SPSS, respecting the ethical principles of Resolution 466/12. RESULTS: There were 910 motorcycle accidents involving minors between the years 2005-2013, with 543 (59.7%) were male, 494 (54.3%) were aged 16-18 years old; 377 (41.4%) were motorcycle fall victims. In the age group 0-7 years old there was predominance of pedestrian accidents by motorcycle (36.6%) and motorcycle falls (35.9%). Pediatric Trauma Score in the age group of zero to 07 years was lower (01 points), when compared to other age groups. There were no differences in the Revised Trauma Score of the age groups studied. Among the variables that make up the PTS is highlighted musculoskeletal trauma (fractures and skin lesions) as gravity factor. CONCLUSION: in motorcycle accidents involving minors 07 years, trauma severity was higher when compared to other age groups. The PTS is a good pre-hospital screening tool to be applied in children with motorcycle crash victims.

Orientador: Renato Giuseppe Giovanni Terzi / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-04T23:55:32Z (GMT). No. of bitstreams: 1 Ferreira_EvandroLuisAssis_M.pdf: 931139 bytes, checksum: 43023b0149d416b8be47785e6751beb0 (MD5) Previous issue date: 2005 / Resumo: Embora vários modelos experimentais de choque hemorrágico tenham avaliado os efeitos da reposição volêmica, nenhum estudo foi realizado em um modelo baseado em parâmetros hemodinâmicos e metabólicos. Neste modelo experimental quase fatal, foi avaliada a resposta hemodinâmica e metabólica à infusão de dois tipos de solução. Objetivos: Avaliação de dois tipos de solução na ressuscitação do choque hemorrágico em modelo experimental quase fatal e metabolicamente controlado. Material e Métodos: Trinta porcos jovens, com peso médio de 20 a 25Kg, da raça Large-White foram anestesiados, entubados e mantidos sob sedação com Halotano inalatório a 0,5%, em respiração espontânea. Monitorização hemodinâmica com o cateter de Swan-Ganz e metabólica por gasometria (IL-1640) e lactimetria (Accusport®). Três grupos foram estudados. O grupo I (grupo controle, n=10), sem sangramento; grupo II (HES, n=10), submetidos à hemorragia controlada até se atingir uma PAM de 30mmHg e lactato de 10 mM/L, quando foi iniciada a ressuscitação com reposição de volume (7ml/Kg de Amido Hidroxietílico 130/0,4 a 6%, seguida de 33ml/Kg de solução de Ringer Lactato e retransfusão); grupo III (Ringer Lactato), submetidos à hemorragia controlada até se atingir uma PAM de 30mmHg e lactato de 10 mM/L, quando foi iniciada a ressuscitação com reposição de volume (40ml/Kg de solução de Ringer Lactato (RL) e retransfusão). Foram colhidas amostras em quatro tempos distintos: T0: pré-choque, T1: choque, T2: pós-reposição volêmica com HES e RL (grupo II) ou só RL (grupo III); T3: 30 minutos após retransfusão do sangue. Resultados: Todos os parâmetros hemodinâmicos (DC, PAM) e metabólicos avaliados (lactato, diferença de base, delta-PCO2, delta pH e PO2 venosa mista) exibiram melhores resultados com a infusão do colóide. Seis dos animais ressuscitados com RL estavam vivos 24 horas após o choque. Todos os animais ressuscitados com colóide sobreviveram. Conclusão: A reposição volêmica precoce com HES no choque hemorrágico experimental quase fatal resulta em melhor recuperação hemodinâmica e metabólica do que a solução cristalóide / Abstract: Background: Several experimental controlled arterial pressure hemorrhagic shock models have evaluated the effect of the timing, rate and type of volume replacement. However no metabolic end point has been used to target the severity of shock before fluid infusion. In an almost fatal experimental model, we evaluated hemodynamic and metabolic effect of two types of infusion solution. Methods: Thirty young Large-White pigs, average weight of 25Kg, were anesthetized, intubated and sedated with Halotane 0.5%. Breathing spontaneously, hemodynamic and metabolic status was monitored with Swan-Ganz cateter, blood gases and a hand held lactimeter. The animals were randomly assigned to four groups. Group I (sham, n=10), not bled; group II (HES, n=10), submitted the controlled hemorrhage to a MAP of 30mmHg and driven to a blood lactate over 10mM/L, when resuscitation started with 7ml/Kg of Hydroxyethyl Starch 130/0,4 6%, followed by 33ml/Kg of lactated Ringer's solution and retransfusion; group III (LR, n=10), submitted the controlled hemorrhage to a MAP of 30mmHg and driven to a blood lactate over 10mM/L, when resuscitation started with 40ml/Kg of lactated Ringer's solution (7ml/Kg + 33ml/Kg) and retransfusion. Samples were collected at: T0: baseline, T1: shock, T2: after volume replacement with colloid or crystalloid, and T3: 30 minutes after re-transfusion. Results: Hemodynamic and metabolic data improved with all solutions. However, the colloid group exhibited better results than the LR group. Conclusion: Early colloid infusion exhibits better hemodynamic and metabolic parameters, and resulted in prompt recovery of tissue perfusion when compared to infusion with equal volume of crystalloid / Mestrado / Cirurgia / Mestre em Cirurgia

Orientador: Roger William Fernandes Moreira / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba / Made available in DSpace on 2018-08-12T16:38:55Z (GMT). No. of bitstreams: 1 Sawazaki_Renato_D.pdf: 5388533 bytes, checksum: 31653e67d16c0820f63d5a1a7a1c3e50 (MD5) Previous issue date: 2008 / Resumo: Este estudo retrospectivo teve por objetivo avaliar as características epidemiológicas da prevalência, tratamento e taxas de complicação das fraturas dos côndilos mandibulares. Os dados foram coletados dos prontuários do arquivo da Área de Cirurgia Buco-Maxilo-Facial da Faculdade de Odontologia de Piracicaba/Unicamp no período de 1999 a 2007. Foram encontrados 263 pacientes com 317 fraturas de côndilo mandibular. Houve 209 pacientes com fraturas unilaterais e 51 com fraturas bilaterais; com a proporção de 3,05:1 entre homens e mulheres respectivamente; média de idade de 28,4 anos; e predominância da raça branca. A causa mais comum de fratura condilar foram os acidentes de trânsito (57,8%). De forma geral, os dispositivos de proteção induziram uma redução nas fraturas condilares em acidentes de trânsito, contudo o capacete apresentou os piores índices de proteção que o cinto de segurança. As fraturas foram comumente associadas a outros tipos de trauma, sendo relação com a fratura de sínfise e a laceração em mento estatisticamente relevante. O tratamento conservador foi o mais aplicado com 78,55%, principalmente nas fraturas unilaterais, contra 21,45% dos tratamentos cirúrgicos, aplicados em maiores proporções nas fraturas bilaterais. A taxa de complicações foi menor no tratamento conservador com 7,9%, frente aos 33,33% no tratamento cirúrgico, o qual está exposto a mais variáveis como a acesso cirúrgico e a fixação interna rígida. A complicação mais comum foi a má-oclusão tanto no tratamento cirúrgico quanto no conservador. Houve uma relação significativa entre o consumo de substâncias nocivas a saúde (39,16% dos pacientes) e as complicações. Concluiu-s e q u e população afetada tem características urbanas, formada principalmente por adultos jovens do gênero masculino. O tratamento mais empregado é o conservador, o qual possui menores taxas de complicação, mas que não exclui o tratamento cirúrgico. / Abstract: The aim of this study was to evaluate the epidemiological characteristics of prevalence, treatment modalities and complication rates of the condylar fractures of the mandible. Data was collected from patients' records of Oral and Maxillofacial Surgery Area at Piracicaba Dental School - Unicamp from 1999 to 2007. The research results a sample of 263 patients with 317 condylar fractures. There were 209 unilateral fractures and 54 bilateral fractures, with a male:female ratio of 3.05:1,amean age of 28.4 years and white race predominance. Protective devices statistically decreased the prevalence of condylar fractures in car and bicycles accidents; however, seatbelts presents lesser protection in comparison with helmets. Fractures were usually associated with others traumas, with symphysis fracture and soft tissue injury to the chin region the most common ones. The conservative treatment was applied in 78.55%, mainly in unilateral fractures, against 21.45% of the surgical treatment, applied in the majority of the bilateral cases. The complication rate was lesser in the conservative treatment with 7.9%, in comparison with 33.33% of the surgical treatment cases that are more vulnerable to variables like surgical access and rigid internal fixation. The most common complication was malocclusion, both in surgical and non-surgical treatments. There were a significant relation between the use of harmful substances and complications (39.16% of the patients). In conclusion, the population affected had urban characteristics and is composed mainly by male young adults. The most adopted treatment was the conservative, that presented lesser complication rates, but it does not exclude the surgical treatment in some specific cases. / Doutorado / Cirurgia e Traumatologia Buco-Maxilo-Faciais / Doutor em Clínica Odontológica

D.Phil. / The world we live in is characterised by daily trauma, crisis and tragedy. The media, which are everywhere nowadays, expose us to the hurt and suffering of thousands of people, as well as to our own, and too often this creates the impression that only negative events are taking place. One cannot help but wonder whether the human race has not lost control over itself and the environment it has created. Are we victims of external events, or can we still make a difference or a positive contribution to our lives and those of others? This kind of question makes us curious about the human condition, and at the same time makes us aware of the different ways in which people deal with similar situations. Some people cannot function under difficult circumstances, while others cope quite well, and some even flourish! This gives rise to questions such as: What causes people to react so differently under equal circumstances? Why do some people become conquerors and others go to pieces? What can we learn from victors or survivors? Is it possible to teach people to become victors, instead of victims, in testing times? The researcher’s search for answers to these and other questions gave rise to this study. The focus of this study was to determine the possible key factors which led to the researcher’s friend becoming a survivor in the face of a life-threatening disease, breast cancer, and how the researcher herself managed to cope with the trauma of the disintegration of her marriage. More particularly the researcher wanted to explore how the ordeals they had gone through influenced their lives. How did their experience of trauma influence them, and what have they learned from these experiences? Questions which came to the fore at the outset of the study were the following: • How did the two women deal with loss? • Did the trauma influence their sense of purpose and meaning? • What role did their relationships with friends and family play in dealing with the traumatic events? • How did their ordeals affect their careers, and what was their employers’ reaction towards them? • How did trauma affect the various dimensions of their lives? • What advice could they as survivors offer to other people who are going through such traumatic experiences?

Trauma debriefing is a session or meeting that includes the affected individuals and the trained debriefer who facilitates the session. Debriefing is thus, a process whereby the victims of any traumatic events ventilate their experiences in a safe environment with a view to striving towards a normal state of equilibrium. In the milieu of the South African Police Service, the trauma debriefing process is used as a support mechanism to all its members as they are constantly exposed to traumatic events. The ultimate goal of debriefing is to assist the victimised to unblock their feelings. The researcher has to a large extent become motivated to undertake the study as a result of her practical and professional experience in the field of trauma debriefing. Since working as a trauma debriefer for five years in the Police Services, the researcher has been triggered by the fact that trauma debriefing is concentrated on the victims of trauma only, whereas the help providers are never afforded an opportunity to be supported. Much of the researcher’s daily work is to attend to members of the service who have been exposed to traumatic situations. This exposition has made the researcher to be primarily interested in interpersonal relationships that have become more and more of secondary traumatisation and burnout in professionals working with other individuals’ trauma. In her undertaking of the study, the researcher followed a qualitative approach to enhance her to execute the task of collecting data. The basis of the qualitative approach was to assist the researcher to accumulate the experiences of the respondents from their own perspectives. To achieve this objective, the researcher used a semi-structured interview schedule as a tool to encourage nine respondents to offer their reflections about the impact trauma work has on them. In the context of the undertaken study, applied research was pursued with a view to put into perspective the respondents’ experiences from their own account. The researcher had chosen applied research with a view that the findings thereof would contribute in addressing the immediate challenges facing the debriefers in their own work environments. The goal pursued in this exploratory-descriptive study was an exploration of a relatively unknown area. This study was geared towards gaining new insight into what the impact of trauma debriefing was on debriefers. Therefore, the main idea of this study was to explore and describe only. Realising that not much has been written on the impact of trauma debriefing on debriefers, the researcher modified the approach so that emphasis is placed on exploration and description of the debriefers’ experiences. Hence, a combination of exploratory and descriptive research designs was employed. An extensive literature review on the process of trauma debriefing and the impact of trauma debriefing was done. Extracts from the in-depth interviews revealed that the ripple effect of trauma debriefing on debriefers is three fold, namely: · Psychological impact - where it was discovered that trauma workers tend to experience flashbacks, loss of identity which can be attributed to trauma workers identifying themselves with the survivors they debrief, susceptibility to Post Traumatic Stress Disorder (PTSD) as a result of overexposure to secondary trauma and forgetfulness. · Emotional impact - where it was found that elements such as losing touch with oneself, emptiness and hopelessness, typical stress, disconnection from significant others, strong negative feelings and agitation are obvious characteristics of what trauma debriefing can do to trauma workers. · Physical impact - which it has been found, characterises the tiredness, headaches, and post traumatic stress experienced more often by trauma debriefers. On the contrary, some debriefers valued the experiences from their work exposure as energising pleasure and tolerance, and something that gave them a sense of control and fulfilment. The eventual outcomes of the study revealed that trauma has far reaching impact on debriefers, and thus has to be seen as caring cost to organisations such as the South African Police Service. / Dissertation (MSD (EAP))--University of Pretoria, 2005. / Social Work / unrestricted

Counterfactuals generated by people who have experienced traumatic life events were examined to elucidate their significance for the coping process. In Study 1, 93 respondents were interviewed 4-7 years after the loss of their spouse or child in a motor vehicle accident. In Study 2, 124 respondents were interviewed 3 weeks and 18 months following the death of their child to Sudden Infant Death Syndrome. Across these two studies it was found that (a) counterfactuals that undid the traumatic event were commonly reported; (b) the focus of counterfactuals was typically on one's own (in)actions, rather than on the behavior of others; (c) the more freguently respondents were undoing the event, the more distress they reported; and (d) this relation held even after controlling for more general ruminations. In Study 3, 106 respondents were interviewed one week following their spinal cord injury. In this study, self-implicating counterfactuals were shown to predict ascriptions of self-blame, controlling for causal attributions and foreseeability estimates. Taken together, these field data suggest that counterfactuals play an important role in how people cope with traumatic life events. Possible roles that these counterfactual thoughts might play are discussed. / Arts, Faculty of / Psychology, Department of / Graduate

Orientador: Mario Mantovani / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-07-19T11:01:03Z (GMT). No. of bitstreams: 1 CaponeNeto_Antonio_M.pdf: 2280145 bytes, checksum: 74b363196683758f358977eaaafae5f8 (MD5) Previous issue date: 1992 / Resumo: Desenvolveu-se este estudo para avaliar a eficácia e segurança da cateterização da veia femoral no atendimento inicial ao politraumatizado. Estudou-se estudados prospectivamente 67 casos nos quais tentou-se este procedimento. O tempo necessário para executá-lo e as complicações imediatas eram anotadas. Em todos os casos obteve-se o "Trauma Score" e o "Injury Severity Score" para comparação com outros estudos e determinação da gravidade dos casos estudados. Houve sucesso na cateterização em S9 casos (88%) que foram seguidos, em média, por 10 dias. O tempo médio para executar o procedimento foi de 2,2 minutos e a cateterização foi mantida por 2 dias em média. Investigou-se as possíveis complicações venosas através de exames clínicos, de Doppler venoso e ultrassonográfico, realizados de modo seriado. Estudou-se a incidência de infecção através da cultura semi-quantitativa das pontas dos cateteres. Ao final, observou-se que não ocorreram complicações venosas, que houve um caso' de cateterização arterial inadvertida sem outras conseqüências e que três cateteres tiveram cultura positiva. Concluiu-se que a cateterização da veia femoral oferece uma alternativa rápida, segura e adequada de acesso venoso, no atendimento inicial de pacientes politraumatizados / Abstract: This study was undertaken to assess the efficacy and safety of femoral venous catheterization for initial management of multiple trauma patients. During a one-year period there were 67 insertion attempts of a large-bore catheter (8Fr) into the femoral veins. Fifty-nine of them were successful. Ali immediate complication was noted. In order to provide a method for comparing this study with other ones and for determining what kind of patients were studied, the Trauma Score and the Injury Severity Score were obtained in each case. The patients who underwent a femoral vein catheterization were followed up until discharged from the hospital (mean time = 10 days). The femoral cannulation was mantained for two days (mean duration). For monitoring venous complications, besides clinical-exams, Doppler venous and B-mode ultrassonography were made. Microbiological study of the catheters were done by semi-quantitative culture. No venous complications occurred. There were one inadvertent arterial catheterization without further consequences and three positive catheter tip cultures from patients without septic manifestations. It was concluded that the femoral vein catheterization offers a suitable, safe and rapid alternative of venous access In the severely injuried patient / Mestrado / Cirurgia Geral / Mestre em Medicina

Psicólogo / Se presenta el trabajo de (re)construcción de una escena de la Historia de Chile a partir de fragmentos materiales, visuales y discursivos encontrados en una esquina de la ciudad de Santiago y analizados mediante los conceptos y las teorías psicoanalíticas del trauma y de lo irrepresentable, utilizando el método abductivo y bajo un paradigma indiciario, entendiendo que cuando a la historia le está vedado desplazarse por vías simbólicas encontrará la forma de emerger a través de puestas en escena y acontecimientos condenados a repetirse mientras no atraviesen los trabajos de figurabilidad, elaboración y simbolización. Tanto los vacíos de la historia que dejan las crisis sociales como las condiciones de vida y los modos de producción actuales generan fallas en estos procesos ocasionando fracturas y desligazones en los vínculos, traduciéndose en un creciente malestar, de niveles críticos para la salud mental en la capital chilena. El abordaje de estas problemáticas no puede desatender las causas de fondo ni reducirse a la pura medicación y terapéutica individual, haciéndose necesario establecer diálogos interdisciplinarios y proponer innovaciones metodológicas para dar cuenta de las distintas formas en que la insistencia de lo real se presenta en la experiencia de los sujetos y los colectivos. Se trabaja a partir de los modos en que el malestar se inscribe en la esquina de las calles Alameda y Victoria Subercaseaux