Dual Trauma Research Articles

East Prussian Sinti and/as German expellees: beyond mémoires croisées

ABSTRACT Romani victims of Nazi persecution and German expellees developed as distinct memory communities after 1945, but the pre-war integration of Sinti and gadje in East Prussia has left traces in their memory texts. Non-Romani texts and photos contain rare evidence for aspects of Sinti life before the genocide, much of it now available (only) on the internet. Conversely, Sinti were among the Germans who were forced to leave East Prussia after 1944, and awareness of dual trauma and nostalgia for the Heimat they shared with other Germans is apparent in their memory texts. The article explores these points of contact between the two memory communities and their implications for more solidary forms of remembering and re-visioning the region’s multiethnic past.

Is it not over yet? – pandemic-induced ongoing burn out continues for students in Azerbaijan.

Abstract In a nagging pandemic, while there will be some regression when the dust from pandemic settles, online, remote and hybrid education seems to stay for good and is expected to maintain a substantial portion of education. Students chronic burnout continues with more questions raised every day than the answers and promises made. It is a known psychological fact that when a younger generation of students encounters life-threatening events, they tend to reflect on death and uncertainty and take stock of their lives with defining what to make of their lives and how to achieve that. We surveyed mental health, social life and its impact on academics of medical and engineering students in Azerbaijan and reported the following data. Out of 274 respondents were 51% female and 48.2% male. 86.5% were from the age group (18–25) and 12.5% from (25–35) years. Majority of the students found themselves juggling with too many balls at the same time, not everyone could keep the focus, skill set and training to succeed. Female students delayed their cultural-ordained marriageable age in pursuit of a well-settled career partner, while male students found themselves looking for an alternative career path. Majority of professional students burn-out by a loss of at least two years of their professional education. This seemed to play out more for medical students as they were not able to find experiential training and hospital residencies. This included medical and engineering students who were ambitious to seek western education but lockdowns and visa regulations held them hostage at their home countries. Azerbaijan students however, were resilient enough to withstand the dual trauma of war with their neighboring country while fighting a global war against COVID-19 pandemic.

Implementation of an evidence-based accelerated pathway: can hospital length of stay for children with blunt solid organ injury be safely decreased?

Recent work has demonstrated that an accelerated pathway for pediatric patients with blunt solid organ injuries is safe; however, this is not well-studied in a dual trauma center. We hypothesized that implementation of an accelerated pathway would decrease length of stay (LOS) and hospitalization cost without increased mortality. Retrospective review of patients < 15years presenting to a dual level 1 trauma center between 2015 and 2020 with traumatic blunt liver and splenic injuries. Patients presenting pre- and post-protocol implementation were compared. The primary outcome was total hospital LOS. Secondary outcomes were number of lab draws, intensive care unit (ICU) LOS, cost of hospitalization, readmissions within 30days, and mortality. 103 patients were evaluated, 67 pre-protocol and 63 post-protocol. LOS was significantly shorter post-protocol (2days vs. 4days, p < 0.001). The ICU LOS was unchanged. There was a decrease in direct hospitalization cost per patient from $6,246 pre-protocol to $4,294 post-protocol (p = 0.001). There was one readmission post-protocol and none pre-protocol. There were no deaths. Implementation of an accelerated pathway for management of blunt solid organ injury at a dual trauma center was associated with decreased LOS and decreased costs with no increased morbidity or mortality.

Computed Tomography for Pediatric Pelvic Fractures in Pediatric Versus Adult Trauma Centers

BackgroundPediatric pelvic fractures are a significant source of morbidity for children in the United States. In the era of specialized care, the relationship between trauma center designation and outcomes remains unknown. We hypothesized that there would be no difference in patient outcomes when treated at adult trauma centers (ATCs), pediatric trauma centers (PTCs), or dual trauma centers (DTCs). Materials and methodsWe used the National Trauma Data Bank to identify pediatric (≤14 y) patients suffering pelvic fractures in 2013-2015. DTCs were defined as centers with level I or II trauma designation for both pediatric and adult care. Primary outcomes included mortality, complications, and computed tomography (CT) utilization. ResultsThere were 4260 patients who met study criteria. Of these, 1290 (22%) were treated at ATCs, 1332 (30%) at PTCs, and 2120 (48%) at DTCs. Pediatric patients treated at ATCs were more likely to suffer a complication or receive a CT scan. On multivariate analysis, patients treated at PTCs and DTCs were significantly less likely to have a recorded complication or receive head, thoracic, or whole-body CT scans compared with ATCs. DTCs, but not PTCs, used fewer abdominal CT scans. Mortality rates were not predicted by center designation. ConclusionsFor pediatric pelvic fractures, centers with pediatric trauma designation (PTCs and DTCs) appear to have better outcomes despite significantly less use of CT scans. Further studies are needed to determine optimal management of pediatric pelvic fractures while minimizing exposure to ionizing radiation. Level of evidenceLevel III Retrospective.

Closing the gap in care of blunt solid organ injury in children.

Cross-sectional data of pediatric blunt solid organ injury demonstrates higher rates of nonoperative management and shorter lengths of stay (LOSs) in pediatric trauma centers (PTCs) versus adult trauma centers (ATCs) or dual trauma centers (DTCs). Recent iterations of guidelines (McVay 2008, J Pediatr Surg 2008;43(6):1072-1076 J Trauma Acute Care Surg 2015;79(4):683-693) have emphasized physiologic parameters rather than injury grade in clinical decision making, improving resource allocation and decreasing LOS. We sought to evaluate how these guidelines have influenced care. The National Trauma Data Bank (2007-2016) was queried for isolated spleen and liver injuries in patients younger than 19 years. Linear regression, odds ratio (OR), and χ test were used to determine significance between operative intervention or LOS among different trauma center types and grade of injury. A total of 55,036 blunt spleen or liver injuries were identified. Although operative rates decreased in ATCs over time (p = 0.037), patients treated at ATCs or DTCs continued to demonstrate higher ORs of operative intervention (OR, 4.43 and 2.88, respectively) compared with PTCs. Mean LOS decreased by 1.52 (p < 0.001), 0.49 (p = 0.26), and 1.31 (p = 0.05) days at ATC, DTC, and PTC to 6.43, 6.68, and 5.16 days. Improvement in LOS for ATCs was distributed across injury Grades I, II, and IV, while there was no correlation among PTCs for injury grade. Despite more than a decade of guidelines in pediatric solid organ injury supporting nonoperative management and accelerated discharge pathways based on physiologic parameters, rates of operative intervention remain much higher in ATCs versus PTCs, and all centers appear to fall short of consensus guidelines for discharge. Care management study, level IV.

“My mind is not like before”: Psychosocial rehabilitation of victims of torture in Athens

Introduction: The dual trauma of being a victim of torture as well as a refugee is related to a myriad of losses, human rights violations and other dimensions of suffering linked to torture experienced pre-migration, as well as different forms of violence experienced during and after migration.&#x0D; Method: To present three case studies to explore culturally-informed perspectives on trauma among victims of torture and track trajectories of psychosocial rehabilitation in relation to environmental factors. The case studies are part of a larger qualitative study of asylum seekers and refugees in a center for victims of torture in Athens, managed by Médecins Sans Frontières and Babel in collaboration with Greek Council for Refugees, which follows beneficiaries, their care providers and community representatives and leaders.&#x0D; Results: Key themes emerging include the substantial psychological impact of current material realities of migrant victims of torture as they adapt to their new environment and engage in rehabilitation. Delayed asylum trials, poor living conditions and unemployment have a substantial impact on posttraumatic symptoms that in turn influence psychosocial rehabilitation. Personal, social, and cultural resources emerged as having a mediating effect.&#x0D; Discussion: The results highlight the significant impact of the political, legal, and sociocultural environment on psychosocial rehabilitation. Practical implications for interventions are to ensure holistic, interdisciplinary, and culturally sensitive care which includes a focus on environmental factors affecting resilience; and with a dynamic focus on the totality of the individual over isolated pathologies.

Remembering French Algeria. Pieds-Noirs, Identity, and Exile

Algeria is the symbol of the collapsing French colonial empire. Its past under French colonial rule therefore is mostly discussed as a story of fighting oppression. The idea of Algeria as a lost French department is still a taboo. In her work Remembering French Algeria. Pieds-Noir, Identity, and Exile, Amy L. Hubbell attacks this blind spot in French History and sheds light on a total different narrative: the one of a lost home to many French citizens who left independent Algeria to ‘the Hexagon’ in 1962, a move which they themselves perceived as ‘exile’. This literary study depicts how French Algeria has been remembered in literature and film since 1962. Hubbell aims to analyse the construction of a collective identity through memory of those so-called Pieds-Noirs, and their oscillation between the feeling of exile and the desire to return to a (forever lost) Algerian past. In contrast to the understanding of ‘Pieds-Noirs’ as French compatriots living in Algeria under French colonial rule, Hubbell defines the repatriation of the Français d’Algérie to the Hexagon after Algerian independence as the key moment for a collective identification. An (originally pejorative) appellation became particularly relevant and almost a sacred affiliation for those coerced to leave their trans-Mediterranean homeland. Suffering from Nostalgérie (‘references to the sun, the heat, the winds, the sea, and the different parts of the largest cities, such as Algiers or Oran’ to describe the repatriates’ nostalgia) constituted the main element for a strong Franco-Algerian double-bind collective identity. The ‘dual trauma of leaving Algeria and being rejected in France’ was then passed on from generation to generation. Hubbell uses the concept of ‘postmemory’ to explain why it is obvious to analyse the memory of French Algeria from its origin in 1962 to the present, when Pieds-Noirs descendants born in the Hexagon still cling to this identity of a ‘paradise lost’ like to a ‘phantom limb’. Interestingly, instead of former ethnic origins, in France, the specific Algerian city they had left became the new origin, the ‘paradisiacal [geographical] point of reference’; unfortunately, Hubbell does not explore this any further.

Reducing primary and secondary traumatic stress symptoms among educators by training them to deliver a resiliency program (ERASE-Stress) following the Christchurch earthquake in New Zealand.

The current investigation evaluated the impact of a universal school-based resiliency intervention (ERASE-Stress) on educators who were working with elementary schoolchildren exposed to the Canterbury earthquake in New Zealand. In the context of major disasters, educators may suffer from "dual trauma"; they can experience symptoms of both primary trauma (as a result of the disaster itself) and secondary trauma (as a result of working with traumatized students). Sixty-three educators were randomly assigned to either the ERASE-Stress intervention or an alternative Managing Emergencies and Traumatic Incidents (METI) program which served as a control group. Efficacy of the program was evaluated at the end of the training as well as at 8 months follow-up. Compared with educators in the control group, those in the ERASE-Stress intervention significantly reduced their posttraumatic distress and secondary traumatization symptoms, improved their perceived level of professional self-efficacy as a helper of earthquake survivors, developed an optimistic outlook regarding their personal future and enhanced their sense of hope, and honed some of their positive coping strategies and reduced the utilization of some maladaptive coping methods. These beneficial consequences of the ERASE-Stress training make it a potentially useful tool for educators working with traumatized students in the context of major disasters. (PsycINFO Database Record

The Shared Traumatic and Professional Posttraumatic Growth Inventory

Purpose: While there are established instruments offering psychometrically sound measurement of primary or secondary trauma, none capture the essence of dual exposure for mental health professionals living and working in traumatological environments. Methods: This study examined the experience of 244 mental health workers who lived and worked in New Orleans during Hurricane Katrina. An instrument, the Shared Trauma and Professional Posttraumatic Growth Inventory (STPPG), a 14-item, Likert-type scale composed of three subscales (Technique-Specific Shared Trauma, Personal Trauma, and Professional Posttraumatic Growth), was developed to understand the nature of dual trauma exposure. Results: The STPPG supports the reciprocal nature of shared trauma and correlates well to existing measures for posttraumatic stress, secondary trauma, shared trauma, and posttraumatic growth. Discussion: The STPPG suggests that personal traumatic experience can impact professional practice, and client traumatic narratives influence one’s personal trauma responses. Implications of STPPG for practice and future research are discussed.

Traumatized relationships: Symptoms of posttraumatic stress disorder, fear of intimacy, and marital adjustment in dual trauma couples.

Traumatized relationships: Symptoms of posttraumatic stress disorder, fear of intimacy, and marital adjustment in dual trauma couples.

Conflict-management behavior in dual trauma couples.

Conflict-management behavior in dual trauma couples.

A Case Study: Factors to Consider When Doing 1:1 Crisis Counseling With Local First Responders With Dual Trauma After Hurricane Katrina

This article focuses on local first responders dealing with dual trauma (the collective experience of having both occupational exposure as first responders/rescuers of their families, friends, and neighbors after Hurricane Katrina as well as personal exposure as citizens of the same [or neighboring] communities, whose lives have been interrupted by Hurricane Katrina). The focus of this article is on 5 revised factors to be used with local first responders with dual trauma. The 5 revised factors (personal factors, predisposing factors, peridisposing factors, postdisposing factors, and protective factors) were used to assess and gather information while doing 1:1 crisis counseling with local first responders with dual trauma.Acasestudyispresentedtoillustratehowthese5revisedfactorswereusedtogather informationandtoassesswhiledoing1:1crisiscounselinginNewOrleanswithonelocalfirst responder with dual trauma. [Brief Treatment and Crisis Intervention 7:91–101 (2007)]

Vicariously Traumatized

SUMMARY This article suggests that male partners of female sexual-abuse survivors may become vicariously traumatized in long term relationships with childhood abuse survivors. Drawing parallels to the symptomology of PTSD and the process of transmission, this article theorizes that highly conflictual home environments may be sufficient to cause distressing psychological and behavioral changes in family members. In these relationships, male partners suffer decrements in self-esteem, power, isolation, and sexual adequacy similar to other sufferers of PTSD. No empirical information is presented, but implications for counseling “dual trauma” couples is included.

. . . and Encouraging Compliance

Patients recently diagnosed as having HIV infection go through a dual trauma: coming to terms with the diagnosis itself and then learning that their lives will be governed by a strict regimen of medications, many with difficult adverse effects.

Women at Risk: Domestic Violence and Women's Health

PART ONE: THEORETICAL PERSPECTIVES Medicine and Patriarchal Violence Imagining Woman Battering Social Knowledge, Social Theory and Patriarchal Benevolence PART TWO: HEALTH CONSEQUENCES Women and Children at Risk A Feminist Perspective on Child Abuse Killing the Beast Within Woman Battering and Female Suicidality Preventing Gendered Homicide PART THREE: CLINICAL INTERVENTIONS Personal Power and Institutional Victimization Treating the Dual Trauma of Woman Battering Clinical Violence Intervention Lessons from Battered Women Discharge Planning with Battered Woman Physicians and Domestic Violence Challenges for Prevention

Dual Trauma Couples

A recent article from the family counseling literature is reviewed, offeringfamily counselors an overview of the "dual trauma couple. " Common themes these couples experience, characteristics they display, and general treatment guidelines from which to construct systemic interventions are discussed.