O trauma hoje é considerado a epidemia do século XXI, representando a principal causa de morte nas primeiras quatro décadas de vida. Na pesquisa atual, foram consideradas para análise as vítimas de traumas decorrentes de acidentes de transporte por considerar a relevância do tema no cenário da saúde nacional e internacional. Os objetivos foram: caracterizar a gravidade das vítimas de acidentes de transporte que foram atendidas em uma unidade de Centro Cirúrgico de um Hospital de referência no atendimento ao trauma no Município de São Paulo; caracterizar a amostra do estudo quanto aos dados sociodemográficos, tipo de colisão e atendimento pré-hospitalar; descrever a gravidade da lesão, segundo a região corpórea pelo score AIS e MAIS; descrever a gravidade global das vítimas, segundo o score ISS; caracterizar as condições clínicas das vítimas nos períodos pré, trans e pós-operatórios, verificar a relação existente entre os dados sociodemográficos, tipo de colisão, atendimento pré-hospitalar, os escores AIS, MAIS, ISS, as características clínicas e a ocorrência de óbito e sequela. Trata-se de uma pesquisa exploratória, descritiva, retrospectiva, de abordagem quantitativa, realizada por meio da análise retrospectiva dos prontuários de todos os pacientes vítimas de acidente de trânsito que foram admitidos no Centro Cirúrgico do ICHC-FMUSP no período de 1 de janeiro a 31 de dezembro de 2008. Concluiu-se estatisticamente que, os pacientes de maior gravidade cirúrgica, eram jovens, vítimas de acidente motociclístico ou pedestres, que chegaram à instituição, utilizando-se de dispositivos para a permeabilidade das vias aéreas (máscara de oxigênio ou cânula de intubação orotraqueal), com sinais vitais instáveis, que apresentavam lesões de abdome e conteúdo pélvico ou de extremidades e cintura pélvica, como fraturas, grandes hemorragias ou lesões abdominais. Eram também os que seriam submetidos em sua maioria, à cirurgia geral e cirurgia ortopédica, procedimentos de grande porte com grande probabilidade de gerarem algum tipo de sequela temporária ou permanente. Em razão dessa gravidade, há necessidade de infusão de volume seja hemoconcentrado, hemoderivado ou solução coloide, objetivando sempre a manutenção da homeostase, primordial para a manutenção da boa condição clínica desses pacientes. A pesquisa indicou que os pacientes que chegaram com maior gravidade à unidade de Centro Cirúrgico, têm maior risco de óbito ou sequela. / Trauma is now considered an epidemic of the century, representing the leading cause of death in the first four decades of life. In the current study, were considered for analysis the victims of injuries from traffic accidents by considering the relevance of the theme in the health service nationally and internationally. The aim of this study was to characterize the severity of traffic accident victims who were treated in Surgical Ward of a referral hospital in trauma care in São Paulo. The study sample was characterized by using demographic data; type of collision and use of pre-hospital service; severity of injury according to the body region using AIS and MAIS score; overall severity of the victims using ISS score; clinical condition of the victims before, during and after surgery; and the relationship between demographic data; type of collision and use of pre-hospital service; the AIS, MAIS and ISS score; the clinical features and occurrence of death and disability. This is an exploratory, descriptive, retrospective, quantitative approach study, carried out by retrospective chart review of all patients victims of traffic accidents who were admitted to the Surgical Ward of ICHC-FMUSP during the period January 1st to December 31th, 2008. It was concluded that statistically patients with more severe surgery were young, victims of motorcycle accidents or pedestrians, who came to the institution, using devices for airway permeability (oxygen mask or orotracheal tube) with unstable vital signs, patients with abdomen and pelvic contents lesions or extremities and pelvis lesions such as fractures, abdominal injuries or major bleeding. They were also to be submitted in most cases to general surgery and orthopedic surgery, major procedures most likely to generate some kind of temporary or permanent disability. Because of this seriousness, volume infusion were needed using blood product or colloid solutions aiming always to maintain homeostasis, essential for maintaining good clinical condition of these patients. The survey indicated that patients who arrived at the Surgical Ward with greater gravity have a higher risk of death or disability.

O trauma hoje é considerado a epidemia do século XXI, representando a principal causa de morte nas primeiras quatro décadas de vida. Na pesquisa atual, foram consideradas para análise as vítimas de traumas decorrentes de acidentes de transporte por considerar a relevância do tema no cenário da saúde nacional e internacional. Os objetivos foram: caracterizar a gravidade das vítimas de acidentes de transporte que foram atendidas em uma unidade de Centro Cirúrgico de um Hospital de referência no atendimento ao trauma no Município de São Paulo; caracterizar a amostra do estudo quanto aos dados sociodemográficos, tipo de colisão e atendimento pré-hospitalar; descrever a gravidade da lesão, segundo a região corpórea pelo score AIS e MAIS; descrever a gravidade global das vítimas, segundo o score ISS; caracterizar as condições clínicas das vítimas nos períodos pré, trans e pós-operatórios, verificar a relação existente entre os dados sociodemográficos, tipo de colisão, atendimento pré-hospitalar, os escores AIS, MAIS, ISS, as características clínicas e a ocorrência de óbito e sequela. Trata-se de uma pesquisa exploratória, descritiva, retrospectiva, de abordagem quantitativa, realizada por meio da análise retrospectiva dos prontuários de todos os pacientes vítimas de acidente de trânsito que foram admitidos no Centro Cirúrgico do ICHC-FMUSP no período de 1 de janeiro a 31 de dezembro de 2008. Concluiu-se estatisticamente que, os pacientes de maior gravidade cirúrgica, eram jovens, vítimas de acidente motociclístico ou pedestres, que chegaram à instituição, utilizando-se de dispositivos para a permeabilidade das vias aéreas (máscara de oxigênio ou cânula de intubação orotraqueal), com sinais vitais instáveis, que apresentavam lesões de abdome e conteúdo pélvico ou de extremidades e cintura pélvica, como fraturas, grandes hemorragias ou lesões abdominais. Eram também os que seriam submetidos em sua maioria, à cirurgia geral e cirurgia ortopédica, procedimentos de grande porte com grande probabilidade de gerarem algum tipo de sequela temporária ou permanente. Em razão dessa gravidade, há necessidade de infusão de volume seja hemoconcentrado, hemoderivado ou solução coloide, objetivando sempre a manutenção da homeostase, primordial para a manutenção da boa condição clínica desses pacientes. A pesquisa indicou que os pacientes que chegaram com maior gravidade à unidade de Centro Cirúrgico, têm maior risco de óbito ou sequela. / Trauma is now considered an epidemic of the century, representing the leading cause of death in the first four decades of life. In the current study, were considered for analysis the victims of injuries from traffic accidents by considering the relevance of the theme in the health service nationally and internationally. The aim of this study was to characterize the severity of traffic accident victims who were treated in Surgical Ward of a referral hospital in trauma care in São Paulo. The study sample was characterized by using demographic data; type of collision and use of pre-hospital service; severity of injury according to the body region using AIS and MAIS score; overall severity of the victims using ISS score; clinical condition of the victims before, during and after surgery; and the relationship between demographic data; type of collision and use of pre-hospital service; the AIS, MAIS and ISS score; the clinical features and occurrence of death and disability. This is an exploratory, descriptive, retrospective, quantitative approach study, carried out by retrospective chart review of all patients victims of traffic accidents who were admitted to the Surgical Ward of ICHC-FMUSP during the period January 1st to December 31th, 2008. It was concluded that statistically patients with more severe surgery were young, victims of motorcycle accidents or pedestrians, who came to the institution, using devices for airway permeability (oxygen mask or orotracheal tube) with unstable vital signs, patients with abdomen and pelvic contents lesions or extremities and pelvis lesions such as fractures, abdominal injuries or major bleeding. They were also to be submitted in most cases to general surgery and orthopedic surgery, major procedures most likely to generate some kind of temporary or permanent disability. Because of this seriousness, volume infusion were needed using blood product or colloid solutions aiming always to maintain homeostasis, essential for maintaining good clinical condition of these patients. The survey indicated that patients who arrived at the Surgical Ward with greater gravity have a higher risk of death or disability.

Therapists who specialize in trauma therapy are indirectly exposed traumatic events presented by clients within the therapeutic relationship. The potential consequences for trauma therapists may be the risk of vicarious trauma. Effective coping and self-care are essential in the practice of trauma work. The research question for this study is: Do coping skills and self-care practices in trauma therapists moderate the disruptive effect of vicarious trauma on the fulfillment of their psychological needs (trust/dependence and control)? The purpose of this research study was to examine quantitatively, the role of trauma therapists' beliefs in the effectiveness of coping skills and time spent devoted to self-care practices as moderators of the disruptive effect of vicarious trauma on their fulfillment of psychological needs of trust/dependence and control. Based on the constructive self-development theory, this study explored 2 psychological needs areas including trust/dependence and control. A sample of therapists with 10 years or more experience in the field and who primarily treated traumatized populations were recruited. A survey design methodology via a customized internet-based system was used to administer the trauma and attachment belief scale and the coping inventory scale. A hierarchical multiple regression analysis was completed to address the research question and hypotheses. The results of regression analysis supported the research question. Contributions to positive social change include increased awareness of the risk of vicarious trauma and potential coping strategies necessary to address this phenomenon. Therapists may then enhance their therapeutic effectiveness and organizational service delivery to traumatized client populations.

This study investigated how therapists working with children and youth victims of interpersonal trauma (e.g. sexual abuse) are impacted by the resilience processes of their clients. Qualitative multiple case study design and thematic analysis were used to explore the research question. Four counselors working in an organization providing services to victims of trauma were interviewed and asked about how the act of bearing witness to the resilience of their clients affected their personal lives and clinical practice. The findings showed that for the participants there was an increased sense of hope and optimism, and an intense sense of being inspired by the strengths of clients as result of working with this population. To reflect about the challenges faced by clients allowed counselors to put their own challenges and strengths into perspective. In addition, they reported positive changes in their personal relationships. Further research is suggested, including further investigation about the relationship between optimism, hope and vicarious resilience processes as well as between the counseling approach adopted and the development of vicarious resilience responses. / Graduate / 0621 / 0622 / 0347 / fabianesilveira@gmail.com

Zugl.: München, Univ., Diss., 2008 u.d.T.: Kühner, Angela: Wessen Trauma?

abstract: This dissertation describes a qualitative research study that was conducted in order to deconstruct the notion of trauma using a resiliency framework in one Pueblo Indian community in New Mexico. Trauma is widely discussed in relation to mental health issues impacting Indigenous peoples worldwide, as demonstrated in my review of the literature and throughout this work. Yet, the result of most research tends towards pointing out deficiencies in Indigenous communities. Rarely, if ever, is trauma explored through a strengths-based and resiliency approach. This study represents the first attempt to do so in and with a Pueblo Indian community. As a Pueblo researcher working with my own community of Kewa, my goal was to go back to the very people consistently being studied, that is, the Indigenous community, and to re-examine what is trauma, including its definitions and with a focus on local culturally-based interventions. This work is broken down into three components that are woven together through the common theme of understanding, deconstructing, and addressing trauma: a journal article, book chapter and policy brief. The journal article is titled: “Walking the Path: A Pueblo Journey through Trauma and Healing.” The journal article begins by reviewing concepts on trauma and resilience documented in a literature. I both review the literature and offer critiques from the perspective of a Pueblo Indian researcher working in the field of health. This segues into my dissertation study. A series of eight qualitative, semi-structured interviews were conducted using an interview guide with open-ended questions. I found that participants reported ample evidence of both trauma and resilience, documenting the need for further research in this area and, most importantly, a values-based intervention. Critical in my research findings is that participants revealed the types of trauma relevent to Pueblo people, which points to our understanding of local issues that may also resonate with the experiences of other Indigenous peoples but that are intended to speak to Pueblo communities. Through my research, I consistently assert that understanding trauma also includes the need to document how Pueblo people have coped and overcome their trauma. These forms of resilience were also documented in the findings. The book chapter is titled, “Using Pueblo Values to Heal from Trauma.” This section of the dissertation details Pueblo values and the implications on trauma. Pueblo values are described in detail based on my research and explicated in relation to theory that I propose. In this book chapter, I argue that these Pueblo values play an integral role in how we cope and heal from trauma. To summarize what participants explained, the idea is proposed that following these values will lead you to “the right path.” Suggestions for an ideal intervention based on participant interviews include the development of a values-based curriculum whose success is contingent on following Pueblo values that teaches values as defined by the Pueblo community. My dissertation concludes with a policy section that focuses on “Finding the Path when you have Fallen Off.” This section talks about “cultural freezing” and the need to integrate positive cultural identity in youth, who are especially vulnerable in Indigenous communities, through the development of a values-based curriculum. The policy section will focus on the implications of trauma concepts defined for Native People that have demonstrated the need to process trauma. In order to process trauma, culturally-relevant frameworks and curricula such as “Transcending the Trauma” or “Gathering of Native Americans” (GONA) have been developed to help guide communities to begin the conversation around trauma. These discussions help to raise awareness around trauma and help people begin their healing journey. However, these developed concepts, frameworks and curricula have only started the journey and now there is a significant need for interventions to sustain recovery from trauma. These interventions also must include levels of individual and community readiness to address trauma and align with the values of the community and individual. It is a step we need to take to decolonize education and unfreeze culture / Dissertation/Thesis / Doctoral Dissertation Justice Studies 2018

Multiple trauma is characterized by a simultaneous injury to multiple body systems, at least one from them directly affects by weakening injured patient or faillure of basic life functions - ventilation, bloodstream and consciousness. Accidents are, despite all prevention measures, one of the important cause of death. Multiple traumas are leading cause of death in the age group up to 45 years in the developed countries. The multiple trauma therapy is continues long and complete process which needs individual approach. The therapy starts at the place of accident and then during the transport and continue in the trauma center. The trauma center is able to provide complete therapy including treatment conditions, which require multidisciplinary coordinated cooperation. The diploma thesis deals with the issue of admission of patient with polytraumate into the traumatic center. The aim of the thesis is to approach the readers the multiple trauma, the possible causes of multiple trauma, which are the treatments of algorithms, how is the role and specification of trauma team during incoming of patient. Practical part of the thesis is about cause study of patient with the multiple trauma which complicated fat embolism. This part describes all processes from incoming patient with multiple trauma, including...

A presente pesquisa trata de analisar a memória dos camponeses do Araguaia sobre um de seus principais Guerrilheiros Osvaldão. A partir da participação da autora da pesquisa em um documentário intitulado Osvaldão foram coletadas entrevistas e através dela identificamos as memórias míticas em torno do personagem supracitado. Essas memórias revelam um homem com qualidades extraordinárias e até sobrenaturais. Nosso objetivo é analisar que elementos propiciaram essa memória mítica e como ela permanece presente entre os moradores do Araguaia. Com as contribuições de Martin Baró, Halbwachs e Selligman Silva compreendemos a relações de trauma e das diferentes estratégias da memória para garantir a própria sobrevivência de quem lembra. A simbolização e a criação do mito surge então como o necessidade para conseguir dar sentido onde não se tem. Essa possibilidade de criação simbólica, de resistência e também o intenso sentimento de solidariedade entre os moradores e Osvaldão funcionam como referências da memória. Em Benjamin, compreendemos que os componentes miraculosos das narrativas funcionam como fatores fixadores e perpetuadores dela. Nas entrevistas percebemos o intenso afeto dos moradores com Osvaldão, o trauma das vivências na guerra e a criação do mito não só como estratégia de sobrevivência dos moradores mas também de Osvaldão / This research is to analyze the memory of the Araguaia peasants on one of its main fighters \"Osvaldão\". From the author\'s participation in the research for the production of the documentary entitled \"Osvaldão\" interviews were collected and, through them, identify the \" mythical \" memories around the aforementioned character. These memories reveal a man with extraordinary and even supernatural qualities. Our goal is to analyze elements that propitiated this memory \"mythical\" and how it remains present among the residents of the Araguaia. With contributions from Martin - Baró, Halbwachs and Selligman - Silva understand the trauma of relationships and different strategies of memory to ensure the survival of those who remember. The symbolization and the creation of the myth then emerge as a need to be able to give direction where no one has. This possibility of symbolic creation, resistance and also the intense feeling of solidarity among residents and Osvaldão function as memory references. In Benjamin, we understand that the miraculous components of the narrative function as fixers and perpetuators of it factors. In the interviews we noticed the intense affection of the residents in relation to Osvaldão, the trauma of the experiences in the war and the creation of the myth not only as a survival strategy of the residents, but also Osvaldão

Nesta pesquisa, foi realizado o levantamento da ocorrência de traumatismos faciais e dentários. A autora utilizou na sua amostra 1.374 laudos de vítimas de traumatismos faciais presentes nos arquivos do Instituto Médico Legal do Município de Taubaté. A maioria das vítimas de traumatismos faciais (61,4%) da amostra é do sexo masculino, na faixa etária dos 20 aos 29 anos de idade e o agente etiológico mais freqüente foi a violência interpessoal. Dos traumatismos faciais, 93,1% das vítimas tiveram lesões de tecido mole, 2,5% apenas lesões de tecido duro e 4,4% apresentaram lesões associadas de tecido mole e duro. No que tange aos tecidos duros, verificou-se que 54,3% das vítimas sofreram somente fraturas ósseas, 31,4% tiveram lesões dentárias e 5,2% traumatismos ósteo-dentários. Os traumatismos dentários ocorreram com maior freqüência no sexo masculino (54,8%) e idade entre 20 a 29 anos e predominou como agente etiológico a violência interpessoal. A maioria das vítimas (61,3%) de traumatismos dentários teve o envolvimento de um único dente. A avaliação do dano, presente nos laudos, classificou a maioria dos traumas dentários como sendo de natureza grave (45,2%). Verificou-se também que, após a vigência da lei de obrigatoriedade do uso do cinto de segurança, houve uma redução de 5,9% nas vítimas de acidentes de trânsito com traumas faciais / This is a study of the occurrences of facial and dental traumas. Its sample was composed by 1.374 awards of facial traumas victims from the files of the Legal Medical Institute of Taubaté. On the sample, the majority of the victims with facial traumas are of the male gender (61,4%), at the age group of 20 to 29 years old, injured as a result of interpersonal violence – main etiological agent. Among facial traumas, 93,1% of the victims had soft tissue injuries, 2,5% had hard tissue injuries and 4,4% had both injuries. Concerning hard tissues, among the victims, 54,3% suffered only bone fractures, 31,4% suffered only dental injuries and 5,2% had both of them. The dental traumas occurred more frequently among the male gender (54,8%), aged between 20 and 29, and predominantly as consequence of interpersonal violence. The majority of the victims (61,3%) with dental traumas damaged only one tooth. According to the loss evaluation, from the awards, most of the dental traumas were of grave nature (45,2%). Another finding from the study was that after security belt became obligatory there has been a decrease of 5,9% of the victims from traffic accidents with facial traumas

Orientador: Gustavo Pereira Fraga / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-21T03:01:48Z (GMT). No. of bitstreams: 1 Pereira_BrunoMonteiroTavares_M.pdf: 4626301 bytes, checksum: 9451595a344efa48b56d290e6bb08e5d (MD5) Previous issue date: 2012 / Resumo: Objetivos: este estudo revisa o estado atual e as implicações do trauma de bexiga nas últimas duas décadas e traz à tona o significado do uso de escores de trauma como uma ferramenta neste cenário, bem como expõe o impacto pouco explorado das lesões associadas ao trauma de bexiga, principalmente lesões do reto, sobre a morbidade e sobrevida. Métodos: gênero, idade, mecanismo / localização dalesão, lesões associadas, pressão arterial sistólica (PAS), Escore de Trauma Revisado (Revised Trauma Score - RTS), Escore de Gravidadade da Lesão (InjurySeverity Score - ISS), Escore de Severidade da Lesão no Trauma (Trauma InjurySeverity Score - TRISS), complicações e tempo de permanência hospitalar, foram analisados em estudo prospectivo de lesões vesicais coletados no período entre 1990 a 2009 em um centro de referência para trauma. Resultados: Entre 2.575 pacientes que foram submetidos à laparotomia após trauma, 111 (4,3%) apresentaram lesões de bexiga grau II ou maior, sendo 83,8% (n = 93) homens, idade média de 31,5 anos (± 11,2). Mecanismo contuso foi responsável por 50,5% (n = 56) - acidentes com veículos automotores (47,3%) e atropelamentos (29,1%). Ferimentos causados por projétil de arma de fogo representaram 87,3% dos casos de mecanismo penetrante. A lesão mais freqüente foi grau IV (51 pacientes, 46%) de acordo com a classificação da Associação Americana para Cirurgia do Trauma (AAST - OIS). A média do ISS foi de 23,8 (± 11,2), TRISS 0,90 (± 0,24), e RTS 7,26 (± 1,48). Gravidade da lesão da bexiga, mecanismo, localização da lesão da bexiga, e nem lesão do reto concomitantemente foram associadas a complicações, maior tempo de permanência hospitalar ou morte. A taxa de mortalidade foi de 10,8%. ISS > 25 (p = 0,0001), PAS <90 mmHg (p = 0,0001), RTS <7,84 (p = 0,0001) e fratura pélvica (p = 0,0011) foram altamente associados com o prognóstico sombrio e morte com razão de risco de 5,46, 2,70, 2,22, e 2,06, respectivamente. Conclusões: Escores de trauma e fratura pélvica demonstraram impacto na sobrevida no trauma de bexiga. A taxa de mortalidade manteve-se estável durante as últimas duas décadas / Abstract: Objectives: this study reviews the current status and implications of bladder trauma in the past two decades and brings out the significance of using trauma scores as a tool in this scenario as well as exposes the unexplored impact of injuries associated with trauma to the bladder, especially lesions of the rectum, on morbidity and survival Methods Gender, age, mechanism/location of damage, associated injuries, systolic blood pressure (SBP), Revised Trauma Score (RTS), Injury Severity Score (ISS), Trauma Injury Severity Score (TRISS), complications, and length of stay (LOS) were analyzed in a prospective collected bladder injuries AAST-OIS grade II database (American Association for the Surgery of Trauma Organ Injury Scaling) from 1990 to 2009 in a trauma reference center. Results Among 2,575 patients experiencing laparotomy for trauma, 111 (4.3 %) presented bladder ruptures grade II, being 83.8 % (n = 93) males, mean age 31.5 years old (±11.2). Blunt mechanism accounted for 50.5 % (n = 56)- motor vehicle crashes 47.3 % (n = 26), pedestrians hit by a car (29.1 %). Gunshot wounds represented 87.3 % of penetrating mechanism. The most frequent injury was grade IV (51 patients, 46 %). The mean ISS was 23.8 (±11.2), TRISS 0.90 (±0.24), and RTS 7.26 (±1.48). Severity (AAST-OIS), mechanism (blunt/penetrating), localization of the bladder injury (intra/extraperitoneal, associated), and neither concomitant rectum lesion were related to complications, LOS, or death. Mortality rate was 10.8 %. ISS > 25 (p = 0.0001), SBP < 90 mmHg (p = 0.0001), RTS < 7.84 (p = 0.0001), and pelvic fracture (p = 0.0011) were highly associated with grim prognosis and death with hazard ratios of 5.46, 2.70, 2.22, and 2.06, respectively. Conclusions Trauma scores and pelvic fractures impact survival in bladder trauma. The mortality rate has remained stable for the last two decades / Mestrado / Fisiopatologia Cirúrgica / Mestre em Ciências da Cirurgia