Orientador: Mario Mantovani / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-03T20:12:14Z (GMT). No. of bitstreams: 1 Fraga_GustavoPereira1969-_D.pdf: 5660720 bytes, checksum: b18d767a8ad9e0b60864dcd5c62cff29 (MD5) Previous issue date: 2004 / Resumo: o trauma é um problema de saúde pública de enormes proporções. Constitui-se na principal causa de óbitos na população jovem. Métodos para classificar a gravidade desta doença são usados para a comparação de amostras de pacientes, para mensurar mudanças nas condições dos pacientes e para avaliar os programas de treinamento médico e de tratamento. O Major Trauma Outcome Study (MTOS) é um estudo descritivo e retrospectivo da gravidade das lesões e de evolução dos pacientes, considerado como o maior arquivo contemporâneo de informações descritivas de traumatizados....Observação: O resumo, na integra, podera ser visualizado no texto completo da tese digital / Abstract: Trauma is a public health problem of vast proportions. It is the leading cause of deathin young people. Methods to classify disease severity are used for comparing patient samples, for measuring changes in patients conditions, and for evaluating physicians and treatment programs. The Major Trauma Outcome Study (MTOS) is a retrospective descriptive study of injury severity and outcome, considered the largest database of descriptive contemporary injuries information....Note: The complete abstract is available with the full electronic digital thesis or dissertations / Doutorado / Doutor em Cirurgia

Mexico is widely known as one of the most dangerous countries in the world for journalists, according to advocacy groups and human rights organizations. The phenomenon is especially true in northern Mexico, where journalists have to cover violence committed by drug cartels that seek to hold on to turf in which to conduct operations to sell narcotics to the lucrative U.S. market. This study focuses on the types of trauma that journalists working in an environment marked by violence and threats experience, as well as the resilience they must employ to continue working as a professional there. Twenty-six print journalists in eight cities near the U.S. border have been interviewed to discover the types of trauma and the extent of resilience they have achieved, as well as the way they go about doing so. The study utilizes Shoemaker and Reese’s Hierarchy of Influences model to examine trauma and resilience.

Background: As military women enter roles directly related to combat, they will have greater risk of injury. The present study examined the prevalence of mental health conditions among female service members one year postinjury, and analyzed factors which may place women at risk for mental health concerns and lower quality of life (QOL). Methods: A total of 1,012 U.S. servicewomen who sustained combat-related injury in Iraq and Afghanistan were identified from the Expeditionary Medical Encounter Database (EMED). Injury severity was calculated and QOL scores were collected from a subset of the women. Injury severity, military occupation, branch of service, age, rank, marital status, number of deployments, initial treatment facility, and environment of care were collected as predictor variables. The Military Health System Data Repository was queried for mental health International Classification of Diseases, 9th and 10th Revision codes occurring within one year postinjury. Results: Within the first year postinjury, 404 women (40%) were diagnosed with mental health conditions. The most common were posttraumatic stress disorder (PTSD), (n = 203, 20%), depressive disorders (n = 123, 12.1%), adjustment disorders (n = 92, 9.0%), and anxiety disorders (n = 81, 8.0%). Logistic regression identified that women with minor or moderate injuries had lower odds of mental health diagnoses. Occupation categories of combat support and communications predicted fewer mental health issues. Enlisted women had increased risk of mental health issues. Linear regression showed that officers had higher QOL compared with enlisted women 0.055 (95% CI, 0.005-0.183), p<.05. Women serving in the Air Force had higher QOL postinjury 0.119 (95% CI, .055-.183), p<.000. An independent samples t-test showed that women with mental health diagnoses postinjury (M = 0.46, SD = 0.12) had significantly lower QOL scores (range 0-1) compared to those without mental health diagnoses (M = 0.52, SD = 0.13), t(3.46), p <.05. Conclusions: These findings showed that PTSD, depression, adjustment disorder, and anxiety comprise the most prevalent mental health diagnoses in this population. QOL is significantly lower in injured women with mental health issues after injury. Further research is needed to discover strategies for maintaining optimum health in this population.

Background: It is estimated that adolescent offenders account for 65% of contact child sexual abuse. A range of explanatory theories and models of intervention have been proposed. These are mainly based on cognitive theories with Cognitive Behavioural Therapy (CBT) and psycho-education remaining as the dominant models of treatment intervention. This research explored the issue of harmful sexual behaviour from the psychosocial perspective, drawing on attachment theory and social constructionism. Aim: The research explored attachment strategies among young people with harmful sexual behaviour. It examined young people’s understanding and explanations regarding their sexually abusive behaviour. This included an exploration of how the participants’ accounts and defensive strategies were shaped by wider family and cultural discourses regarding masculinity and sexual activity. In selected cases, the family intergenerational patterns of attachment and emotional regulation were analysed. Furthermore, the research explored the prevalence of harmful sexual behaviour in the study area. This included an exploration of statutory responses and services which were offered to people who engaged in harmful sexual behaviour. Methods: The research employed three interconnected research methods: a) a quantitative audit data of fifty cases which had been reported to the Children’s Services; b) qualitative and descriptive quantitative exploration of eight Transition to Adulthood Attachment Interviews and semi-structured interviews; c) qualitative exploration of the family context and trans-generational patterns of defensive strategies by conducting an Adult Attachment Interview in three cases. The analysis of the attachment and open-ended interviews utilised a combination of the structured ‘discourse analysis’ developed for the Adult Attachment Interview and Critical Discourse Analysis. Findings: The research found that there was no clear and consistent pathway of social care for young people who engaged in harmful sexual behaviour. The analysis of psychological defensive processes found that all of the participants presented with complex insecure attachment strategies alongside intrusions of unresolved traumas or losses. The exploration of intergenerational patterns of attachment strategies identified that all parents showed complex avoidant attachment strategies with intrusion of unresolved trauma and loss. The qualitative study identified a range of discourse themes and strategies in the accounts the young people offered in order to explain their actions and to maintain their sense of self. The dominant discourse themes shared by the young people were: a) life is hard and violence is normal; b) a sense of powerlessness; c) sexual entitlement, d) bravado and denial of vulnerability. Conclusion: Complex insecure attachment strategies with intrusion of trauma and loss play a significant role in the development of harmful sexual behaviour. In addition, the study suggests that the complex relationship between care, comfort and sexual behaviour should be a central focus of clinical interventions with this group of young people and should be investigated further in future research studies.

A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine. / The increase in available ultrasound technology has allowed healthcare professionals to begin learning the skills to use it starting early in their training and careers. The best methods of training to increase proficiency in its use have not been investigated, however. This study compares two different training methods of the Focused Assessment with Sonography in Trauma (FAST). First year medical students were randomized into two groups; one who trained using a conventional live human model and the other who trained using themselves as the model. Both groups were then assessed on a non-self live human model and scored based on time to completion of the FAST and the ability to identify pertinent anatomic landmarks. There was no significant difference in mean scores between both groups. The non-self training group was significantly faster than the self training group. This suggests that the conventional training model remains the best method for increasing proficiency in the FAST exam, although there are significant limitations and further investigations are needed.

Bakgrund: Omhändertagandet av en patient med misstänkt ryggmärgsskada är komplext och ställer höga krav på kompentensen hos ambulanspersonalen. Ambulanspersonalens riktlinjer vid misstanke om en instabil ryggmärgsskada är idag att immobilisera den drabbade i ett neutralt ryggläge. Immobiliseringens betydelse har på senare tid ifrågasatts och istället har forskningen givit indikationer på att det i vissa fall i kan göra mer skada än nytta.  Syfte: Syftet med studien är att undersöka omhändertagandet av patienter med misstänkta ryggmärgsskador utifrån ambulanspersonalens perspektiv. Metod: Metoden var en systematisk litteraturstudie. Sökningar efter vetenskapliga artiklar utfördes i de två databaserna CINAHL och Pubmed. Funna artiklar kvalitetsgranskades och analyserades. Åtta artiklar, varav sex kvantitativa och två kvalitativa svarade på studiens syfte och inkluderades efter en evidensvärdering. Resultat: Två huvudteman med tillhörande subteman framkom efter artikelgranskningen. Ambulanspersonalen arbetar efter rutiner som i vissa fall saknar evidens för vilka samband som finns mellan immobilisering vid misstänkta ryggmärgsskador och vilka framtida positiva och/eller negativa effekter detta har för de drabbade patienterna. Resultatet visade på en viss okunskap angående vilka patienter som ska eller inte ska immobiliseras och även en bristande praktisk förmåga att immobilisera hos ambulanspersonalen som innebär risker. Slutsats: Randomiserade studier behövs som utreder sambandet mellan immobilisering vid misstänkta ryggmärgsskador och vilka framtida positiva och/eller negativa effekter detta har för de drabbade patienterna. Saknaden av relevant forskning kring ryggmärgsskador och immobilisering resulterar i att ambulanspersonalen kommer att fortsätta immobilisera patienter oavsett om detta är den bästa åtgärden eller inte.

During the last three decades, Mexican drug-trafficking organizations have expanded their operations in North America, while drug-related violence has intensified in different regions in Mexico. Since 2006, more than 100,000 people have died as a result of the constant re-organization of Mexican Drug Trafficking Organizations (DTOs), as well as a national security strategy that aims to reduce their power through direct confrontation. Drug-related violence is affecting the lives and livelihoods of Mexican citizens who get caught between the conflicts, and who are not always accounted for in the official data on victims. Drawing on postcolonial theory, affect theory, the growing field of emotional geographies, and critical studies of trauma, this dissertation examines the effects of drug-related violence on secondary witnesses—that is psychologists, social workers, and journalists—based in the northwest Mexican city of Culiacán, the state capital of Sinaloa. This group represents a small sample of ordinary citizens whose daily work brings them into regular contact with some of the outcomes of violence as it relates to the so-called drug wars and its politics—what some have referred to as necropolitics and narcopolitics. Through the analysis of open-ended interviews, findings show that the secondary witnesses of drug-related violence in Culiacán are experiencing symptoms of Secondary Traumatic Stress. At the same time, they are coping with those effects through individual and collective strategies that result from a long-term social and spatial proximity with the phenomenon. In this sense, drug-related violence is a spatial phenomenon that produces traumatic events where affective and emotional effects are collected and stored as traumatic memories. Those memories are critical to understanding the symptoms of job-related stress affecting the secondary witnesses of drug-related violence, as well as the creation and development of coping strategies. The findings of this research are significant for efforts to improve the mental and emotional health of ordinary citizens who inform and offer care and support to the multiple victims of violence in Mexico.

The author was stunned by the way in which justice in Mvenyane village in the district of Matatiele system handled a case of rape which led to murder. The rapist and the murder was caught by community members and brought the police officers but no rape and murder charges were laid against the suspect for that particular case. Family members and relative of deceased including the community members were traumatised by the action surrounding the rape and murder case .The author is trying to find possible pastoral care way when people are going through the turmoil as a result of murder which occurs after rape. The author saw it necessary to journey with the bereaved family and relative in a pastoral care way. The methods used in a study Charles Gerkins method of Shepherding and Nick Pollards method of positive construction. Although some fingers were pointing on the police officers on the way they handled the case, the author find it later that police officers are working under certain restriction under the department of justice. Family members and relatives should make that their case of rape and murder are reported directly to the police officers to be sure that these case are investigated .There should be traumatic and pastoral counsellors who should work to heal the bereaved families and affected community members after murder case in the communities. / Dissertation (MA Theol)--University of Pretoria, 2014. / gm2014 / Practical Theology / unrestricted

The Body of Christ is a traumatised body because it is constituted of traumatised bodies. This thesis explores the nature of that trauma and examines the implications of identifying the trauma of this body. Trauma specialist Bessel Van Der Kolk posits that trauma is written into the somatic, or bodily, memory rather than the semantic memory. This somatic memory is essential to understanding trauma as this memory is repeated in the traumatised body. No theologian has yet explored what the somatic memory of the Christian body might be. This somatic memory not only tells us what the trauma of the Body of Christ is and signposts routes for healing, but also, once we identify the somatic memory, allows us to explore its implications for theology. Beginning with the celebration of the Eucharist as the central place in Christianity where bodies and memory come together, this thesis examines what memory is being remembered and repeated at the altar. The identification of this somatic memory is then used as a hermeneutical lens through which to explore the foundational narratives of the Eucharist and the bodies involved in its celebration. This research reveals that the somatic memory at the heart of Christianity is the memory of the Annunciation-Incarnation event. This event ruptures the foundational eucharistic narratives of priesthood, sacrifice, and presence and demonstrates that Mary must have a central place in Christian theology. It reveals that Christian liturgy holds within it an unclaimed memory and experience of trauma, and an unacknowledged instinct for trauma recovery. The results of this research are significant because they offer a fresh perspective on Christian theology, in particular the Eucharist, and present a call to love the body in all its guises. Furthermore, this traumatic, somatic memory opens up new pathways for considering what it means to ‘be Christian’.

M.A.(Clinical Social Work) / In South Africa, trauma is a vivid reality for many children. Unfortunately due to a lack of resources and knowledge, many children in early childhood who experience trauma symptoms are left untreated. Children in this developmental phase of early childhood, have a limited vocabulary, which adds to the challenge of effectively treating trauma through alternative talk therapies. Neurotherapies like Eye Movement Integration Therapy (EMI), which does not rely on the verbal ability of the child, has therefore gained a lot of interest. The goal of this study was to explore whether EMI can be a useful intervention in treating trauma in early childhood. The objectives included to, i) determine whether or not a change in trauma symptoms was evident from pre- to post-EMI intervention, using the Trauma Symptom Checklist for Young Children (TSCYC); ii) explore the perceptions of parents/caregivers regarding EMI’s effectiveness in the reduction of trauma symptoms; and iii) formulate conclusions and recommendations regarding EMI’s implementation as a trauma intervention with children in early childhood. The researcher followed an exploratory design. The one-group pre-test/post-test design was utilised for conducting the study. The study made use of the Trauma Symptoms Checklist for Young Children (TSCYC), a parent/caregiver report that measures the prevalence and intensity of trauma symptoms like anger, anxiety, dissociation, post-traumatic stress intrusion, post-traumatic stress avoidance, post-traumatic stress arousal, post-traumatic stress total and sexual concerns, in order to determine if a single EMI session could produce a change in trauma symptoms. The group was measured prior to the administration of one EMI session, which according to Beaulieu (2004) is sufficient to result in a measurable change in trauma symptoms. Two weeks later the group’s symptoms were re-measured, using the same instrument. The prescribed EMI protocol was followed. Although the findings from studies of EMI with adults and teenagers appear promising, the usefulness of EMI with young children has not been explored. The results from the study indicated that all of the symptoms as measured by the TSCYC reduced significantly (p<.05) after a single EMI session. It would therefore appear as if EMI might be a useful intervention strategy to treat trauma experienced during early childhood.