En litteraturbaserad studie som belyser patienters erfarenheter av omhändertagandet i samband med trauma, där patienternas utsatthet framkommer på ett tydligt sätt. En litteraturöversikt med studier utförda i Sverige, England och USA.       Patienterna betonar vikten av sjuksköterskans empatiska förhållningssätt i mötet och vid den fysiska omvårdnaden. Trygghet uppstår när sjuksköterskan är vänlig, visar engagemang och bemöter patienten med respekt. Patienterna beskriver att de känner sig väl omhändertagna när sjuksköterskan vårdar dem ömt, samtidigt som de beskriver känslor av utsatthet och obehag vid fysiska undersökningar. Organisationen på sjukhuset påverkar patienternas erfarenheter av omhändertagandet. Patienterna upplever en tillfredställande vård när traumateamet har en god sammanhållning, skicklighet och kompetens. Vid en god kommunikation mellan sjuksköterskan och patienten upplevs känslor av förtroende och tillit. Patienterna vill få information om vad som händer och det är betydelsefullt att sjuksköterskan aktivt lyssnar på patientens enskilda behov och önskemål. Sjuksköterskan beskrivs som viktig då patienten behöver stöttning i att hantera sin nya situation och att kunna se en hoppfull framtid efter den traumatiska händelsen. Studiens resultat belyser att patienterna är i behov av stöd efter den traumatiska händelsen.       Dagens sjukvård har ekonomiska utmaningar och svårigheter som personalbrist vilket kan emellertid hindra ett optimalt omhändertagande av den sjuka och skadade patienten. En ökad kunskap hos sjuksköterskan och vårdorganisationen om att patienterna är i behov av stöd efter den traumatiska händelsen, kan bidra till en mer individanpassad och tillfredställande vård för patienten. / Background: Trauma is a common cause of death and disability and an event that can lead to a major suffering for the patient. To be exposed to trauma entails both physical and mental stress. Some patients expressed feelings such as guilt and hopelessness and had difficulty seeing the meaning of life after the accident, when the patient´s lifeworld was changed. Aim: The aim of this study was to illuminate patients' experiences of trauma care. Method: A literature review based on a content analysis of nine qualitative and three quantitative studies.  Results: The result revealed that patients needed support after the traumatic event. The findings were three main themes; Professional support from the nurse, Support of a functioning organization, Support of a good communication. Conclusion: The traumatic event turned out to be very emotional for the patients and they needed professional support after the accident. The nurse had a significant role and supportive function in the trauma care of the patient and could help the patient to feel safe in the situation and look hopefully on life again by means of an empathetic approach.

Magister Psychologiae - MPsych / This study investigated the factor analytic structure of the Childhood Trauma Questionnaire(CTQ) in school-going adolescents in the greater Cape Town area. This questionnaire is a retrospective method, assessing childhood exposure to trauma in the form of emotional abuse,physical abuse, sexual abuse, emotional neglect and physical neglect (Bernstein & Fink,1998). The data used originated from a survey where several questionnaires including the Childhood Trauma Questionnaire were used to examine perceived stress and resilience in adolescence. The primary study found that there is extensive published research on trauma exposure in adolescents. However, the investigators found that there is a lack of research on actual perceived stress in the context of certain traumatic experiences. This study examined one of the questionnaires used in the primary study, the CTQ. The question of how the factors cluster in a sample of 631participants between the ages of 11 and 18 was answered by using exploratory factor analysis. Three factor analyses, using principal component analysis and Varimax rotation with Kaiser Normalisation were run. The three factor analyses are (i) the entire sample (adolescents, both trauma exposed and non trauma–exposed) (ii) the sample with moderate/severe childhood trauma and (iii) the sample with mild/no childhood trauma.The results of the current study revealed that for group one, five rotated factors were yielded that accounted for 59.22% of the variance among items, for group two, eight rotated factors was extracted that accounts for 62.47% of the variance among items and for group three, nine rotated factors which accounted for 65.38% of variance among the items was yielded.After conceptual analysis, it was found that only group two held to the five-factor stucture described in the CTQ's manual. This indicates that the severity of trauma exposure does affect the factor structure of the CTQ in this sample of school-going adolescents.

La recherche sur l'association entre l'expérience traumatique et la suicidalité est un domaine en pleine expansion dans la littérature depuis vingt ans. Cette thèse avait originalement pour but d’identifier les conditions suffisantes ou nécessaires de différents types de suicidalité chez les personnes traumatisées. Une procédure d'extraction de règles d'association a été mise en œuvre sur une base de données issue d'une enquête nationale française. Considérant le manque de conditions suffisantes ou nécessaires de suicidalité, deux autres questions liées à la suicidalité ont été envisagées. La première étude porte sur l'ordonnancement empirique des profils de suicidalité et la détection des symptômes qui modèrent les niveaux de risque. En utilisant la tentative de suicide dans le mois passé comme critère prédictif, trois niveaux de risque ont été établis. Tous les niveaux de suicidalité sont systématiquement modérés par le symptôme d'anxiété chronique. La deuxième étude visait à tester la robustesse de l'association entre les niveaux de traumatisme et la fréquence de la tentative de suicide dans le mois passé par l'identification des symptômes modérateurs de l'incidence de tentative de suicide dans chaque niveau de trauma. Sept symptômes concernant l'envie de mourir, l’intention d’automutilation, l’idéation suicidaire, la tentative de suicide au cours de la vie, l'humeur dépressive, la perte d'intérêt, et l'expérience de l'attaque de panique ont démontré un effet «d’éventail». Un examen détaillé de la littérature a révélé la difficulté d'obtenir une vue d'ensemble des types de suicidalité et leurs facteurs de risque dans le contexte «traumatisme-suicidalité». La troisième étude met en avant l’idée d’une plate-forme graphique visant à récapituler les connaissances empiriques obtenues par 26 études portant sur 20 facteurs de risque de six types de suicidalité dans différents échantillons de personnes traumatisées. Les principaux facteurs de risque sont la dépression majeure et le trouble de stress post-traumatique. Cette étude souligne l'importance d'un cadre descriptif commun et de la disponibilité des bases de données recueillies dans les études précédentes. / Research on the association between the experience of trauma and suicidality has been a growing field in the literature since two decades. The current dissertation was originally aimed at identifying sufficient or necessary conditions of suicidality outcomes among individuals exposed to trauma. A procedure of association rule extraction was implemented on a database from of a French national survey. Considering lack of sufficient or necessary conditions of suicidality outcomes, two other suicidality related issues were addressed. The first study focuses on the evidence-based ordering of the suicidality profiles and the detection of symptoms that moderate suicidality levels. Using ‘past month suicide attempt’ as the criterion, three suicidality levels were established. All suicidality levels were systematically moderated by the chronic anxiety symptom. The second study aimed at testing the robustness of the association between the trauma levels and the frequency of past month suicide attempt by identification of the symptoms moderating the incidence of outcome in every trauma level. Seven symptoms regarding desire for death, self-harm intention, suicidal ideation, lifetime suicide attempt, depressed mood, loss of interest, and panic attack exhibited a moderating effect with the fan-shaped pattern. A comprehensive review of the literature revealed the difficulty to obtain an overall picture of the investigated outcomes and their risk factors in the trauma-suicidality background. The third study puts forward a graphical platform aimed at recapitulating the evidence found by 26 studies concerning 20 risk factors of six suicidality outcomes among traumatized individuals. The main risk factors are major depression, and post-traumatic stress disorder. This review highlighted the importance of a common descriptive framework and the availability of the databases collected in previous studies.

Orientador: Eduardo Daruge Junior / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba / Made available in DSpace on 2018-08-27T10:53:09Z (GMT). No. of bitstreams: 1 Simoes_MarciaPereira_M.pdf: 900774 bytes, checksum: 21e06f182c1dee39faba9e25721f37f7 (MD5) Previous issue date: 2015 / Resumo: A violência interpessoal urbana representa um sério desafio para autoridades e gestores públicos. Este estudo investigou o trauma buco-maxilo-facial decorrente de violência interpessoal quanto à epidemiologia e implicações criminais, bem como avaliou a importância da documentação clínica nos exames de corpo de delito. Foi realizado estudo observacional retrospectivo envolvendo 1.048 relatórios odontológicos de corpo de delito gerados nos anos de 2012 e 2013, na cidade do Rio de Janeiro, RJ, Brasil. Violência interpessoal foi causa de trauma buco-maxilo-facial em 405 (38,6%) exames, envolvendo principalmente homens jovens, brancos e solteiros. O agente lesivo mais comum foi o soco. Os tecidos moles foram os mais lesionados, sendo a equimose a lesão prevalente. Os ossos mais fraturados foram maxila e mandíbula. Os dentes anteriores mostraram maior incidência de fraturas coronárias. Quanto à classificação penal, predominou o dano corporal leve, sendo que as lesões somente aos dentes implicaram dano leve, grave e gravíssimo. Houve apresentação de documentação clínica em 132 (32,6%) exames periciais. O trauma buco-maxilo-facial decorrente de violência interpessoal alcançou níveis preocupantes nos dois anos do estudo, representando a documentação clínica importante meio de prova particularmente nos exames de corpo de delito indireto. Sugere-se a realização de estudos epidemiológicos periódicos, que abranjam as demais regiões do Estado do Rio de Janeiro e do país para análise mais completa do fenômeno, bem como a participação do cirurgião-dentista como membro efetivo das equipes forenses / Abstract: The urban interpersonal violence represents a serious challenge for public authorities and managers. This study aimed to investigate the oral maxillofacial trauma caused by interpersonal violence regarding its epidemiologic and criminal implication aspects, as well as to evaluate the importance of clinical documentation in forensic exams. A retrospective observational study has been conducted involving 1,048 forensic dental reports generated in the years 2012 and 2013 in the city of Rio de Janeiro, RJ, Brazil. Interpersonal violence was the cause of oral maxillofacial trauma in 405 (38.6%) exams, involving mainly young, white and unmarried men. The most common harmful agent was the punch. The soft tissues were most injured, being bruise the predominant injury. The more fractured bones were maxilla and mandible. Anterior teeth showed a higher incidence of crown fractures. Regarding criminal classification, light body damage predominated and teeth-only injuries implied light, severe and very severe damage. There was presentation of clinical documentation in 132 (32.6%) forensic exams. It was found that the oral maxillofacial trauma due to interpersonal violence has reached alarming levels in both years of study, being the clinical documentation an important mean of obtaining evidence, particularly in indirect forensic examination. It is suggested to carry out epidemiological studies covering other regions of the State of Rio de Janeiro and the country for more detailed analysis of the phenomenon, as well as the participation of the dentist as an effective forensic team member / Mestrado / Odontologia Legal e Deontologia / Mestra em Biologia Buco-Dental

Foi realizado estudo experimental com ratos Wistar Albinos, com o objetivo de avaliar diferentes modelos de estudo da lesão da medula espinhal. Os controles foram formados pelos grupos Anestesia, Divulsionamento dos tecidos moles pré-vertebrais e Laminectomia. Os grupos para estudo da lesão da medula espinhal foram formados por animais nos quais o segmento vertebral localizado entre T10 e L1 foi submetido à secção total da medula espinhal, secção parcial (hemissecção), secção total precedida da aplicação local de anestésico e compressão vertebral. Os animais foram avaliados 2 e 24 horas após a realização dos procedimentos, por meio da Escala de Avaliação Locomotora, Teste do Campo Aberto, Teste de Retirada da Cauda, Teste da Placa Quente e Teste do Pinçamento da Pata (reflexos segmentares e supra-segmentares) e também por métodos histológicos, utilizando-se as colorações de Níssl, HematoxHina-Eosina e Glees. Foi observado que as escalas de avaliação locomotora utilizadas foram menos sensíveis à detecção de mudanças funcionais nos animais se comparadas com os testes de comportamento sensório-motores. O teste Exploração no Plano Vertical foi o mais sensível para detectar deficiências sensório-motoras nos diferentes grupos experimentais. Por esse método detectamos uma diminuição da capacidade de exploração do plano vertical nos animais 24 horas após os procedimentos. O teste de função reflexa mais sensível à detecção de deficiências sensório-motoras nos animais após trauma raquimedular leve, moderado e grave, foi o Teste da Placa Quente. Portanto, este estudo demonstrou que, além das Escalas de Avaliação Locomotora, o Teste do Campo Aberto e o Teste da Placa Quente são de utilização fácil, simples, barata, reprodutível e quantitativa, com sensibilidade para detectar deficiências funcionais em animais que tenham sofrido trauma raquimedular leve, moderado ou grave. A análise histológica em segmentos da medula espinhal abrangendo o sítio da lesão permitiu a avaliação da lesão e correlação entre a lesão sensitiva e motora. / An experimental study was carried out using Wistar Albine rats, aiming at an evaluation of different models for the study of spinal injury. Controls included the following groups: Anesthesia, Divulsion of the soft prevertebral tissues and Laminectomy. Groups for the study of spinal injury were composed by animals whose vertebral segment between T10 and L1 was submitted to Total Section of the Spinal cord, Partial Section (hemissection), Total Section Preceded of Application of Local Anesthetic and Vertebral Compression. Animals were evaluated, 2 and 24 hours after the experimental procedures, by means of the Locomotor Evaluation Scale, Open Field Test, Tail Flick Test, Hot Plate Test and Paw Nippering Test (segmentary and suprasegmentary reflex), as well as by means of histological methods using Níssl, Hematoxilin-Eosin and Glees Stainning. lt was observed that the Locomotor Evaluation Scales so far used were less sensitive to detection of functional changes in animals when compared with the sensorio-motor behaviour tests. The vertical Plain Exploration Test was the most sensitive for detection of sensorio-motor deficiences in different experimental groups. By means of this method we could detect a decrease in the ability to explore the Vertical Plain in the animals of 24 hours. The more sensitive reflex function test to detect sensorio-motor deficiences of animals, following light, moderate or severe spinal cord injury, was the Hot Plate Test. Therefore, this study showed that, in addition to the locomotor Evaluation scales, the Open Field Test and Hot Plate Test are of easy, simple, cheap, reproducible and quantitative utilization, showing enough sensitivity to detect functional deficiences in animals previously submitted to light, moderate or severe spinal cord injury. Histological analysis of spinal cord segments which enclosed the injured site allowed the evaluation of the injury and the relationship between sensitive and motor lesions.

Chez les Pende du sud-ouest du Congo Kinshasa (RDC), Mbangu, masque porté par les hommes, a la particularité d’être asymétrique, « hémiplégique », surnommé l’« épileptique », victime du sort d’un sorcier. Il présente des similitudes avec d’autres masques asymétriques dans le monde avec lesquels il est mis en perspective dans une approche comparative. Où, quand, comment intervient Mbangu, quel est son rôle ? Il représente, sur un mode visuel, la marginalité et le désordre de la société. Sa sortie sur l’aire de danse est censée réaffirmer l’ordre social dans une ambiance qui mêle dérision, burlesque et compassion. L’hypothèse soutenue est que ce type de masque asymétrique répond à un trauma et exprime douloureusement une « perte de monde » et, corollairement, appelle à la construction d’un ordre social nouveau. Sont ici analysées les conditions historiques, politiques, socio-économiques et culturelles par lesquelles l’expression de la dissymétrie a pu émerger chez les Pende. Par ailleurs, cette société – « société du regard » – a élaboré une morphologie symbolique complexe du visage où le regard est conçu comme un régulateur social auquel le « regard des masques » participe. Le chef qui réunit les caractéristiques du « roi sacré » – et auquel Mbangu renvoie – est la figure emblématique de ce regard par l’action de ses masques et de ceux de la palissade de sa case. Le « regard des masques » semble donc s’instaurer en dispositif politique qui agit en lieu et place de la présence effective du chef. Le masque Mbangu révèle aussi l’importance de la relation scopique dans la représentation de l’altérité et dans la construction de la conscience individuelle et collective pende. / In southwestern Congo Kinshasa (DRC), Mbangu mask of the Pende people, worn by men, has the distinction of being asymmetrical, « hemiplegic », nicknamed the « epileptic », victim of a spell cast by a sorcerer. This mask has some similarities with other asymmetric masks in the world, whith whose is put into perspective in a comparative approach. Where, when and how does Mbangu operate, what is his role ? On a visual mode, it would represent marginality and disorder in society. Its emergence on the dance ground is supposed to reaffirm the social order in a popular uproar that combines burlesque derision and compassion. The hypothesis supported here is that this type of asymmetric mask is the result of a « trauma » and the expression of a « lost world » but, at the same time, it calls for the construction of a new social order. We analyzed the historical, political, socio-economic and cultural conditions in which the expression of the asymmetry could emerge in Pende mascarade. The Pende society – « society of the view » – has developed a complex symbolic morphology of the face where the sight is conceived as a social regulator; and the eyes of masks are part of. The Pende chief who unites the characteristics of the « Sacred King » – which Mbangu refers to – is the emblematic figure of this sight by the action of his masks and those on the fence of his house. The eyes of masks look to be a political apparatus instead of the physical presence of the chief. The Mbangu mask also reveals the importance of the scopic relationship in the representation of otherness and in the construction of individual and collective consciousness of the Pende people.

Trauma has been found to be highly prevalent and associated with many negative health and social outcomes (i.e., heart disease, higher suicide risk, high-risk behaviors) in the general population. Despite these associations, trauma detection is relatively rare in service-providing organizations. Trauma-informed care (TIC) is a proposed solution that encourages trauma detection, understanding the symptoms associated with trauma, and treating trauma while actively avoiding re-traumatization to the service user. Although research about TIC efficacy has been fairly limited, there are some promising potential benefits of the practice to the client, provider, and the population as a whole. For this study, we looked at service providers’ reported familiarity with TIC and implementation of TIC in their organization across seven timepoints. We found familiarity increased more than implementation, and we discuss potential reasons that may cause this discrepancy.

Homelessness is a growing concern in the United States Virgin Islands (USVI) especially since 2 major hurricanes in 2017 devastated the islands. The impact trauma has on reoccurring homelessness in the USVI is unknown. Failure to understand the impact trauma may pose on persons who are homeless could hinder stable housing and perpetuate reoccurring homelessness. The purpose of this cross-sectional study was to examine the predictive relationship between trauma and reoccurring homelessness in persons who are homeless living in the USVI. The theoretical framework for this study was Psychological Trauma Theory. Participants were homeless adult persons (N=73) who were surveyed using the Trauma History Questionnaire and the Residential Timeline Follow-Back. A multiple regression analysis was used to examine the prediction of trauma on reoccurring homelessness, while controlling for demographic variables. The results indicated trauma was not statistically predictive on duration of homelessness and housing stability though when gender and education were controlled, there was significance in predicting service utilization with an adjusted R of (.19) of the variance and a value of (p > .000). Homeless males were more likely to utilize services than females though both homeless males and females with a high school education or higher were less likely to use services. The outcomes of this study have social change implications including counselor educators, counselors, and community stakeholders collaborating to facilitate trauma-informed care and design gender specific programs to increase service utilization among the homeless.

Cette thèse porte sur l’écriture de Scholastique Mukasonga et Atiq Rahimi. Elle interroge principalement leurs écritures respectives à travers Notre-Dame du Nil, Inyenzi ou les cafards et Syngué sabour. Pierre de patience. Bien qu’amas de mots, ces trois œuvres participent d’une écriture du silence du point de vue esthétique et historique. Elle veut démontrer que face à l’horreur et au trauma, l’écriture du silence devient à la fois nécessaire et inévitable car le langage peine désormais à traduire la douleur d’un passé qui ne passe pas. Compte tenu de la difficulté du langage à traduire la souffrance et le trauma de la victime, le silence intervient comme une stratégie langagière qui permet de dépasser le dicible. Aussi, face à Adorno qui estimait que toute poésie après Auschwitz est barbare, la présente analyse démontre que l’écriture subsiste à l’horreur dans la mesure où elle tend, elle-même, vers l’absence et le silence comme le déclarait Blanchot. Pour cela, elle recourt à une esthétique qui allie silence et parole dans une expression qui permet d’atteindre l’indicible. / This thesis deals with the writing of Scholastique Mukasonga and Atiq Rahimi. She mainly questions their respective writings through Our Lady of the Nile, Inyenzi or Cockroaches and Syngué Sabour. Stone of patience. Although full of words, these three worksare part of a writing of silence from an aesthetic and historical point of view. She wants to demonstrate that in the face of horror and trauma, the writing of silence becomes both necessary and inevitable because language is now struggling to translate the pain of a past that does not pass. Given the difficulty of language in translating the suffering and trauma of the victim, silence intervenes as a language strategy that makes it possible to go beyond the sentence. Also,in the face of Adorno, who felt that all poetry after Auschwitz is barbaric, the present analysis demonstrates that writing remains horrifying to the extent that it tends, itself, to absence and silence as declared by Blanchot. . For this, she uses an aesthetic that combines silence and speech in an expression that achieves the unspeakable.

Trauma care across the globe has evolved greatly over the years. However, trauma remains a major contributor to morbidity and mortality as the third leading cause of death in the United States. It also accounts for a considerable portion of healthcare costs. In light of this, and in order to reduce its adverse impacts, appropriate and effective management is necessary. Emergency Medicine, Trauma Surgery, Interventional Radiology and many other specialties contribute to the acute care of patients in the setting of trauma. Other areas of medicine have shown that a clearly outlined multidisciplinary approach to management can lead to better outcomes and shorter hospital stays, specifically where it pertains to rapid response situations. Interventional Radiology has been found to be effective in managing trauma patients presenting with abdominopelvic injury but a clear approach to when they should be involved has yet to be developed. In fact, studies have shown that precise decision making regarding surgical versus non-operative management of trauma patients is essential to providing appropriate care and improving patient outcomes. In order to accomplish this, Interventional Radiology and Trauma Surgery need to have a prompt, active and collaborative dialogue when patients present with such injuries. A description and analysis of the current approach to management of patients with abdominopelvic trauma and subsequent outcomes at a Level 1 Trauma Center will provide valuable insight into how to establish a protocol that could lead to better selection of minimally invasive interventions and in turn improved patient outcomes. / 2022-02-24T00:00:00Z