O trauma ortopédico representa hoje um importante problema de saúde pública. A compreensão de fatores associados ao perfil epidemiológico desses tipos de lesões pode contribuir para políticas públicas de prevenção. Dessa forma, pretendeu-se determinar o perfil epidemiológico das vítimas de trauma ortopédico na microrregião de Caratinga-MG, atendidos no Hospital Nossa Senhora Auxiliadora (HNSA), no período de janeiro a setembro de 2009. Para a obtenção de nossos dados considerou-se o perfil sociodemográfico (gênero, faixa etária, origem residencial, modo de acesso ao serviço de saúde, profissão e grau de instrução), a distribuição mensal de atendimentos e o perfil clínico (etiologia do trauma, tipo de lesão, diagnósticos mais frequentes e forma de tratamento). Foram também estabelecidas as associações entre o tipo de lesão e o perfil sociodemográfico e o tipo de lesão e sua etiologia. Os dados foram apresentados em gráficos de percentuais e as associações em tabelas, cuja significância foi considerada para Plt;0,05, através do teste do Qui Quadrado. Nossos resultados foram caracterizados por uma população de indivíduos do gênero masculino, com faixa etária entre 10 e 19 anos e idade média de 30,44 anos, oriunda principalmente da área urbana de Caratinga, atendida pelo SUS, formada predominantemente por estudantes e trabalhadores rurais e com ensino fundamental incompleto. Houve maior frequência de atendimentos no mês de julho, tendo a queda como a principal etiologia do trauma, o predomínio das fraturas como tipo de lesão e sendo a entorse de tornozelo e a fratura de rádio distal os diagnósticos mais frequentes, quando considerados de forma isolada. Constatou-se também uma maior frequência de tratamento não cirúrgico. Quanto às associações, foi significativa entre fratura e faixa etária, com predomínio em indivíduos de 0 a 19 anos e de 60 ou mais; entre fratura e profissão, com percentuais mais elevados para indivíduos sem profissão (crianças sem idade escolar) e aposentados; entre entorse e grau de instrução, sendo mais frequente no ensino médio e entre tipo de lesão e sua etiologia, com a queda sendo a causa principal para fratura, a prática de esporte a causa principal para entorse e o acidente de motocicleta a causa principal para contusão.

The thinking that resulted in this thesis has its roots in the first televised images that marked my childhood. The destruction of Beirut under the Israeli fire was the news item during my first school holidays. I was seven years old and I remember seeing Menachem Begin's impassionate speeches, thinking that they made sense. Knowing that Hitler was the ultimate evil, and hearing that Arafat was like Hitler, how could it be wrong to destroy him? But when I looked among the images of people in Beirut to find the Nazis, all I could see were people who looked poor, quiet or scared. Nothing like the tall and erect Nazis, shouting out orders in their uniforms and shiny boots. I was confused. And this confusion bred a lifelong interest in what was really going on in Israel. How could a people that had suffered so much cause so much suffering? Why were they telling the world that they were fighting the Nazis? And why did the world believe them?

Trauma-induced secondary cardiac injury (TISCI) represents an under recognised complication of severe injury with haemorrhage. A limited number of clinical studies have supported the development of adverse cardiac events, such as arrhythmia, in association with biomarker proven TISCI. Pre-clinical studies using small animal models have provided insights into potential mechanisms and key effector molecules involved in the development of TISCI, but there remains a general lack of understanding regarding the in vivo functional implications of this indirect cardiac injury resulting from trauma-haemorrhage. This project aimed to investigate the implications of cardiac injury on myocardial systolic function. A robust, translatable model of TISCI was developed, which reflected the cardiac biomarker profile identified in clinical studies and, for the first time, demonstrated a significant, dose-dependent rise in Heart-type Fatty Acid Binding Protein (H-FABP) in response to trauma-haemorrhage. Non-invasive echocardiography was used to determine the acute myocardial response to injury and haemorrhage and also to assess the response of the left ventricle to resuscitation after an antecedent 60-minute period of trauma-haemorrhage. The functional studies presented here have enabled real time visualisation of the impact of trauma-haemorrhage upon systolic left ventricular function over 1 to 6 hours, both with and without resuscitation. Having established the trends in in vivo systolic function over time, further studies were then conducted to test the combination of adenosine, lidocaine and magnesium (ALM) as a cardiovascular rescue agent in TISCI. ALM, as an adjunct to fluid resuscitation, has shown great promise as a therapeutic agent which improves haemodynamic outcomes, reduces the volume of resuscitation fluid required and favours survival in the murine model of TISCI.

Over the course of several decades, the foster youth population continues to grow due to various forms of abuse that have occurred in the biological home. Many foster children experience multiple placements which ultimately cause a significant amount of trauma due to placement instability. The study examined trauma of instability among foster youth and discussed interventions that could be implemented when working with resource families and foster youth within the field of social work. A post-positivism paradigm was used to focus on understanding the trauma of placement instability. A total of six face-to-face interviews of master’s level social workers were conducted to obtain qualitative data. The interviews consisted of a variety of both descriptive, structural, and contrast questions to explore trauma and common behaviors of foster youth who experienced instability. All data obtained from the interviews were recorded, transcribed, and analyzed through open coding, axial coding, and selective coding by traditional means. Content analysis was used to identify four themes: Impact of Multiple Placements, Useful Interventions, Benefits of Stability, and Family Characteristics. The following research study contributes to social work practice by providing useful interventions such as: teaching, modeling, self-regulation and self-awareness techniques for youth and foster families to address instability. This also includes training families to be trauma-informed caretakers and pre-screening foster families to identify the best match for children to reduce instability.

acase@tulane.edu / Although the theoretical basis supporting the use of trauma-informed approaches in schools is promising, evidence for mechanisms of facilitating their acceptability among teachers is limited. Findings from implementation science indicate that foundational professional development training during pre-implementation activities can generate teacher support for a new approach, which is essential to successful formal implementation. Theoretical models point toward enhanced teacher knowledge of the approach as a predictor of such support. The current study examined whether foundational professional development training increased teacher knowledge of a new school-wide initiative, trauma-informed approaches, and evaluated that knowledge growth as a predictor of teacher perceptions of acceptability for trauma-informed approaches. Feasibility and system fit, two domains of perceived social validity of trauma-informed approaches, were assessed as potential moderators of the association between knowledge growth and acceptability. Although the training significantly increased teachers’ knowledge of trauma-informed approaches, knowledge growth did not predict acceptability ratings. Feasibility and knowledge growth did not interact to predict acceptability ratings. However, individuals providing higher ratings of system fit demonstrated a positive relationship between knowledge growth and acceptability. When system fit ratings were lower, knowledge growth predicted lower acceptability ratings. Findings provide partial support for foundational professional development training as a pre-implementation tool and identify factors that influence pre-implementation acceptability of trauma-informed approaches among teachers. / 1 / Elizabeth McIntyre

Bei einem SHT handelt es sich um eine mechanische Schädigung des Hirngewebes, verursacht durch eine Gewalteinwirkung auf den Kopf. Diese initiale Schädigung des Hirngewebes weitet sich nachfolgend aus. Wirksame Therapien, um diese sekundären Pathomechanismen zu inhibieren, gibt es nicht. Sofern das SHT überlebt wird, ist es eine der häufigsten Ursachen für bleibende Behinderungen. Wichtige Pathomechanismen, welche zur Ausweitung der Hirnschädigung beitragen, sind das posttraumatische Hirnödem und Entzündungsreaktionen. Beides wird durch die Aktivierung des so-genannten Kallikrein-Kinin-Systems begünstigt. In der vorliegenden Arbeit wurde dieses System 1 Stunde nach experimentellem SHT durch die Applikation des C1-Inhibitors gehemmt und am nachfolgenden Tag die Auswirkungen bewertet. Die Ergebnisse zeigen, dass diese Behandlung nach der Hirnverletzung zu einer Reduktion des Hirnödems und der Entzündungsreaktion führt. Die Bildung von Thromben in den Hirngefäßen ist geringer als in Kontrolltieren, vermutlich da der C1-Inhibitor auch die intrinsische Gerinnungs-kaskade hemmt. Insgesamt führt die Behandlung zu kleineren Hirnläsionen als in entsprechenden Kontrolltieren. Hiermit stellt der C1-Inhibitor ein potenzieller Therapieansatz bei SHT dar. Jedoch bleibt es offen, inwiefern sich diese Ergebnisse auf das menschliche SHT übertragen lassen. / Traumatic brain injury is a mechanical disruption of brain tissue caused by a violent effect on the head. This initial damage to the brain tissue subsequently expands. There are no effective therapies to inhibit these secondary pathomechanisms. The brain injury is one of the major causes of death and disability. Posttraumatic cerebral edema and inflammatory reactions are important pathomechanisms that contribute to the expansion of brain damage. Both are enhanced by the activation of the kallikrein-kinin system. In the present study, this system was inhibited 1 hour after experimental brain injury by the application of the C1 inhibitor and the effects were evaluated on the following day. The results show that this treatment leads to a reduction of brain edema and inflammatory response after brain injury. The formation of microthrombi in the brain vessels is less than in control animals, presumably because the C1 inhibitor also inhibits the intrinsic coagulation cascade. Overall, the treatment leads to smaller brain lesions than in control animals. The C1 inhibitor thus represents a potential therapeutic target for traumatic brain injury. However, it remains unclear how these results can be transferred to human brain injury.

Traumatic brain injury (TBI) is a devastating public health problem for patients and their families. The neurodegeneration that follows TBI is complex, but can be broadly subdivided into primary and secondary damage. Though primary damage is irreversible and therefore unsalvageable, extensive literature aimed at understanding the tissue, cellular, inflammatory and subcellular processes following the injury have proven unequivocally that secondary pathophysiological events are delayed and progressive in nature. Understanding these secondary events at the cellular levels is critical in the eventual establishment of targeted therapeutics aimed at limiting progressive injury after an initial trauma. One such secondary event is referred to in the literature as excitotoxicity; a sustained and de-regulated activation of glutamate receptors that leads to rapid cytotoxic edema and calcium overload. Our understanding of excitotoxicity has evolved to include not only a role for elevated extracellular glutamate in mediating neuronal damage, but also post-synaptic receptor modifications that render glutamate profoundly more toxic to injured neurons than healthy tissue. In this thesis, we explored the hypothesis that glutamate excitotoxicity can be perpetuated by trauma-induced post-synaptic modification of the AMPA receptor. Specifically, we used a cortical culture model of TBI as well as the fluid percussion injury device to test the hypothesis that TBI confers a reduction of surface GluR2 protein, an AMPA receptor subunit that limits neuronal calcium permeability. We conjectured that this decrease in the expression of surface GluR2 would increase the expression of calcium-permeable AMPA receptors, thereby rendering neurons vulnerable to secondary excitotoxic injury. We further investigated the subcellular mechanisms responsible for the internalization of surface GluR2, and the phenotypic consequences of GluR2 endocytosis in both models. Our data revealed that both models of TBI resulted in a regulated signaling cascade leading to the phosphorylation and internalization of GluR2. By exogenously interrupting the trafficking of GluR2 protein with an inhibitory peptide, we further observed that GluR2 internalization was mediated by a protein interaction involving protein interacting with C kinase 1 (PICK1) and protein kinase C alpha (PKCα), two PDZ domain-containing proteins that mediate GluR2 trafficking during constitutive synaptic plasticity. We observed that GluR2 endocytosis was NMDA receptor dependent, and resulted in increased neuronal calcium permeability, augmented AMPA receptor-mediated electrophysiological activity and increased susceptibility to delayed cell death. Finally, we demonstrated that the interruption of GluR2 trafficking is cytoprotective, suggesting that sustaining surface GluR2 protein protects neurons against secondary injury. Overall, our findings suggest that experimental TBI promotes the expression of injurious GluR2-lacking AMPA receptors, thereby enhancing cellular vulnerability to secondary excitotoxicity.

The purpose of this study was to investigate the influence of childhood sexual, physical and emotional abuse and childhood emotional and physical neglect on eating disorder symptoms and general psychopathology. This study utilized a cross-sectional research design incorporating a combination of self-report measures and clinical interviews. Seventy participants were recruited from two eating disorder treatment centres. A series of univariate tests revealed no significant differences between individuals who reported a mild level of trauma and those who reported a severe level of trauma on all clinical measures. Logistic regression analyses revealed associations between impulsivity and childhood physical abuse and between psychiatric comorbidity and childhood physical neglect. Few associations were found and the observed effect sizes were generally small suggesting that the null findings were not due to inadequate power. It may be that the study sample differed from those used in previous investigations in which significant associations have been documented.

The purpose of this study was to investigate the influence of childhood sexual, physical and emotional abuse and childhood emotional and physical neglect on eating disorder symptoms and general psychopathology. This study utilized a cross-sectional research design incorporating a combination of self-report measures and clinical interviews. Seventy participants were recruited from two eating disorder treatment centres. A series of univariate tests revealed no significant differences between individuals who reported a mild level of trauma and those who reported a severe level of trauma on all clinical measures. Logistic regression analyses revealed associations between impulsivity and childhood physical abuse and between psychiatric comorbidity and childhood physical neglect. Few associations were found and the observed effect sizes were generally small suggesting that the null findings were not due to inadequate power. It may be that the study sample differed from those used in previous investigations in which significant associations have been documented.

Female survivors of multiple forms of trauma are increasingly found to be a significant portion of the university population (Briere, Kaltman, & Green 2008). While there is a strong literature base for understanding the effects of individual trauma on psychological functioning (e.g., Briere, 1992; Kaltman, Krumnick, Stockton, Hooper, & Green, 2005), little is known about specific symptom constellations for those who have experienced multiple traumas (Rich, Gingerich, & Roseìn, 1997). Using a clinical population of 500 female university students, this study explored the rates of multiple interpersonal traumatic experiences, the connection between multiple traumas and symptom severity, and the association of specific constellations of multiple types of traumas with specific constellations of trauma symptoms. The Trauma Symptom Inventory-Alternate (Briere, 1995) and self-report measures of demographic data and abuse histories were used to collect data, which was analyzed with frequencies, Multivariate Analysis of Variance, and a Canonical Correlation to explore the interrelationships of abuse and trauma symptoms. Multiple abuse was common, with 81% of participants experiencing two or more types of abuse. Multiple trauma generally predicted more severe trauma-related symptoms than those with no trauma or single traumas. A Canonical Correlation revealed a moderately significant relationship between participants with aggressive types of abuse (e.g., childhood physical, adult physical, and adult sexual abuse) with higher symptoms of intrusive experiences, defensive-avoidance, and dissociation. These findings suggest a differential model of trauma effects, particularly for trauma types characterized by aggression. Implications for future research and clinical practice are addressed.