Violent Trauma Research Articles

The management of penetrating neck injury at a level 1 trauma centre: three year's experience

Introduction: King's College Hospital serves an inner-city area with a high incidence of violent penetrating trauma. The OMFS team is involved in the management of penetrating injuries sustained to neck, and there is a standard operating procedure (SOP) in place for such cases.

Interplay between traumatic brain injury and intimate partner violence: data driven analysis utilizing electronic health records

BackgroundIt is estimated that a majority of intimate partner violence (IPV) victims suffer from blunt force to the head, neck and the face area. Injuries to head and neck are among the major causes for traumatic brain injury (TBI).MethodsIn this interdisciplinary study, we aimed to characterize the key associations between IPV and TBI by mining de-identified electronic health records data with more than 12 M records between 1999 to 2017 from the IBM Explorys platform. For this purpose, we formulated a data-driven analytical framework to identify significant health correlates among IPV, TBI and six control cohorts. Using this framework, we assessed the co-morbidity, shared prevalence, and synergy between pairs of conditions.ResultsOur findings suggested that health effects attributed to malnutrition, acquired thrombocytopenia, post-traumatic wound infection, local infection of wound, poisoning by cardiovascular drug, alcoholic cirrhosis, alcoholic fatty liver, and drug-induced cirrhosis were highly significant at the joint presence of IPV and TBI.ConclusionTo develop a better understanding of how IPV is related to negative health effects, it is potentially useful to determine the interactions and relationships between symptom categories. Our results can potentially improve the accuracy and confidence of existing clinical screening techniques on determining IPV-induced TBI diagnoses.

Narrar ´e encadear tempos e espaços perdidos: violência de gênero e trauma em "Um amor incômodo" de Elena Ferrante

No presente artigo, pretendemos evidenciar como o romance Um amor incômodo, de Elena Ferrante, é atravessado por um abuso sexual que resvala na relação entre uma filha e sua mãe. Na medida em que se articula à violência de gênero, esse acontecimento apresenta-se como um ponto cego da cultura, configurando-se como traumático. Ao final do livro, após reconstituir a história de sua mãe, é possível para a narradora, Delia, lembrar do abuso que sofreu quando criança e significar pontos de sua trajetória que se apresentam como um mal-estar. O incômodo do título, que diz respeito à relação mãe e filha, atravessa a trama ressoando o incômodo da violência que é desvelada no final do romance. Como aporte teórico, tomamos as considerações da crítica literária Shoshana Felman acerca de literatura, testemunho e traumas culturais. Com o intuito de relacionar o trauma com a violência de gênero, retomamos a perspectiva de Sigmund Freud sobre o tema, assim como a discussões mais atuais, através de Cathy Caruth e Gayle Rubin. Assim, propomos que o romance de Elena Ferrante permite um esgarçamento das possibilidades narrativas do trauma do abuso sexual e da violência de gênero, enquanto pontos cegos da cultura.

When Anne Frank Met Astro Boy

This article examines the evolution and impact of Anne Frank’s The Diary of a Young Girl on postwar manga (print comics) and Japanese visual culture. The author argues that Anne’s enduring legacy in Japan, dating back to 1952, owes much to the ways in which the content of her Diary capitalizes on certain hallmarks of shōjo (girls’) manga culture, such as affective storytelling and character interiority. Moreover, as shown through a primary analysis of two emonogatari (illustrated story) versions of the Diary from 1964 and two manga versions from 1967, among others referenced, Anne Frank’s life and legacy inspires a hybridized narrative and visual style in manga that blends the emotionality and interiority of shōjo with the more graphic depictions of violence common to shōnen manga for young boys. In so doing, it encourages a reevaluation of the shōjo mode and its ability to bear witness to the physical violence and psychological trauma of the Holocaust.

Freedom Made Manifest: Rahner's Fundamental Option and Theological Aesthetics, Peter JosephFritz, The Catholic University of America Press, 2019 (ISBN 978‐0‐8132‐3119‐8), xx + 278 pp., hb $65

Freedom Made Manifest: Rahner's Fundamental Option and Theological Aesthetics, Peter JosephFritz, The Catholic University of America Press, 2019 (ISBN 978‐0‐8132‐3119‐8), xx + 278 pp., hb $65

Conceptualizing the Effects of Continuous Traumatic Violence on HIV Continuum of Care Outcomes for Young Black Men Who Have Sex with Men in the United States.

The United States (US) is on track to achieve the 90-90-90 targets set forth by UNAIDS and the National HIV/AIDS strategy, yet significant racial disparities in HIV care outcomes remain, particularly for young Black men who have sex with men (YBMSM). Research has demonstrated that various types of violence are key aspects of syndemics that contribute to disparities in HIV risk. However, little research has looked collectively at cumulative violent experiences and how those might affect HIV treatment and care outcomes. Drawing on extant literature and theoretical underpinnings of syndemics, we provide a conceptual model that highlights how continuous traumatic violence experienced by YBMSM may affect HIV outcomes and contribute to racial disparities in HIV outcomes. The findings of this focused review suggest a need for research on how continuous exposure to various types of violence influence HIV prevention and treatment outcomes for young Black MSM.

Aspects épidémiologiques, cliniques et évolutifs des traumatisés graves admis en réanimation polyvalente du Centre Hospitalier Universitaire de Brazzaville, République du Congo

Contexte : Le traumatisé grave (TG) est un patient ayant subi un traumatisme violent quelles que soient les lésions apparentes. Aucune donnée épidémiologique n’a été retrouvée au Congo-Brazzaville. L’objectif était de décrire les aspects épidémiologiques, cliniques et évolutifs des TG au CHU de Brazzaville (CHU-B).
 Matériels et méthodes : L’étude était rétrospective en 30 mois sur 82 TG en réanimation. Les variables épidémiologiques, cliniques et évolutives étaient analysées sur Excel 2016.
 Résultats : L’âge moyen était de 37,2 ± 16,4 ans (sex-ratio : 4,1). Les patients étaient transférés des urgences dans 48,8 %. Les accidents de la voie publique (82,9 %) constituaient la circonstance traumatique la plus fréquente. Le Glasgow moyen était de 10,1 ± 4,1. La détresse respiratoire et l’état de choc étaient respectivement observés dans 35,4 % et 17,1 %. La tête (76,8 %) et le thorax (41,5 %) étaient les régions les plus touchées. Les complications étaient retrouvées dans 34,1 %. Le taux de mortalité était de 42,7 %. La détresse neurologique (62,9 %) était la principale cause de décès. La durée médiane d’hospitalisation était de 5 jours.
 Conclusion : Le TG occupe 5,7 % des admissions en réanimation. Il touche une population juvénile masculine victime d’AVP. La tête et le thorax étaient les plus touchés. La mortalité est très élevée.

Valley of the Guns: The Pleasant Valley War and the Trauma of Violence

Valley of the Guns: The Pleasant Valley War and the Trauma of Violence

Indigenous suicide in Brazil, the self-killing of a vulnerable population

Abstract Introduction One of the Sustainable Development Goals is to promote mental health. It is then mandatory to know the death profile of this population and to develop public policies to reduce it. Methods Epidemiological descriptive study regarding the proportion of indigenous deaths according to the variables: age group, year of occurrence, gender, region, municipality and ICD-10 category, in the period 2008 to 2017 in Brazil, using data from the national database DATASUS. Results From 2008 to 2017, there were 5,489 indigenous deaths due to external causes in Brazil, with 1,107 (20.1%) due to self-caused lesions. The annual average was 110.7 cases per year: 100 in 2008, 95 in 2009, 93 in 2010, 97 in 2011, 90 in 2012, 113 in 2013, 117 in 2014, 132 in 2015, 120 in 2016, and 150 in 2017. Regarding causes, strangling/hanging/suffocation were 979 (88.4%), self-intoxication was 31 (2.8%) with other chemicals and 21 (1.8%) with pesticides. Regarding age group, 365 (32.9%) were between 15 to 19 years old, 325 (29.3%) between 20 to 29, 150 (13.5%) between 30 to 39, 131 (11.8%) between 10 to 14, and 136 (12.2%) in other age groups. Regarding gender, 807 (72.9%) were male, 299 (27.0%) were female, and 1 (0.09%) was ignored. Regarding region, the Northern Region had 575 (51.9%) cases and the Central-Western Region had 403 (36.4%) cases. The municipality of São Gabriel da Cachoeira was the one with the highest amount of cases: 132 (12.7%). Conclusions The 50% increase in the amount of deaths by suicide among indigenous people in the analyzed period reveals the infficacy of established public policies in Brazil. The number of deaths among the youth reveals the community trauma of exploration, violence and dignity loss. The Nothern and Central-Western regions had conflicts due to land demarcation and prospecting, which explain the high rates. The reduction of such tragedy demands capacitation of all the public spheres. Key messages Evaluate the aspects that promote it and to propose effective interventions in environments of difficult access and in a historically vulnerable population. Discuss some relevant characteristics among natives who are vulnerable to practicing self-made injuries, in order to make it possible to create new ways to protect this population.

Facial Injuries and the Gender Issue: Expressions of Violence in a Metropolitan Region of Northeastern Brazil.

The aims of this investigation were to describe the profile of men and women victims of violence and identify factors associated with the severity of facial trauma. A retrospective study was carried out from 762 records of victims attended at the Institute of Legal Medicine and Dentistry located in a metropolitan region of Northeastern Brazil. The dependent variable was type of facial trauma suffered by victims. Independent variables were the sociodemographic characteristics of victims, characteristics of aggressors and circumstances of violence. Descriptive, bivariate (c2 test) and multivariate statistics were made through logistic regression. Level of significance was set at p < 0.05. The mean age of victims was 29.78 years (SD=13.33). Based on the final regression model, male subjects [odds ratio (OR)=2.22, 95% CI=1.08-4.57, p=0.030], assaulted by other male subjects (OR=4.88; 95% CI=1.12-21.26; p=0.035) through instrument (OR=6.67; 95% CI=2.85-15.60; p<0,001) or mixed aggressions (OR=4.34; 95% CI=1.44-13.02; p=0.009) were more likely to exhibit facial bone fractures or dentoalveolar fractures. The findings highlight that men and women present important victimization differentials in relation to interpersonal violence and facial trauma. Victim's gender, aggressor's gender and mechanism of aggression may exert influence on facial trauma patterns.

The intergenerational impact of war on mental health and psychosocial wellbeing: lessons from the longitudinal study of war-affected youth in Sierra Leone

BackgroundGlobally, one in four children lives in a country affected by armed conflict or disaster often accompanied by exposure to a range of adversities including violent trauma and loss. Children involved with armed groups (often referred to as “child soldiers”) typically exhibit high levels of mental health needs linked to their experiences. The Longitudinal Study of War-Affected Youth (LSWAY) in Sierra Leone is a seventeen-year prospective longitudinal study of the long-term effects of children’s experiences in the country’s eleven-year (1991–2002) civil war on their adult mental health and functioning in addition to exploring the potential mechanisms by which intergenerational transmission of emotional and behavioral disruptions due to war trauma may operate. LSWAY illuminates how war-related and post-conflict experiences shape long-term adult functioning, family dynamics, and developmental outcomes in offspring.DiscussionThe LSWAY study utilizes mixed methodologies that incorporate qualitative and quantitative data to unpack risk and protective factors involved in social reintegration, psychosocial adjustment, parenting, and interpersonal relationships. To date, study findings demonstrate striking levels of persistent mental health problems among former child soldiers as adults with consequences for their families, but also risk and protective patterns that involve family- and community-level factors. This case study examines the course of LSWAY from inception through implementation and dissemination, including building on the study results to design and evaluate several intervention models.ConclusionThe case study offers a unique perspective on challenges and field realities of health research in a fragile, post-conflict setting common in the context of humanitarian emergencies. LSWAY findings along with lessons learned from the field can inform future research as well as intervention research and implementation science to address the mental health and development of war-affected young people. With four waves of data collection and a planned fifth wave, LSWAY also provides rare insights into the intergenerational effects of humanitarian crises on children, youth, and families across generations.

Geospatial relationship of trauma and violent crime: An analysis of violent crime and trauma center utilization

Introduction Descriptive epidemiologic and geographic analysis utilizing geographic information science (GIS) has been used to determine the utilization of trauma systems and to spatially describe patterns of trauma and crime. We examined the relationship between spatial components of criminality and injuries in order to evaluate the optimal trauma center location and determine a correlation between reported violent crime and trauma center utilization. Methods All adult trauma and violent crime (VC) encounters in a defined area over a single year were included. Geospatial statistics pattern analysis tools of Median Center (MC) and the Average Nearest Neighbor analysis (ANNa) were used to determine if mapped points occurred in complete spatial randomness or were clustered in a significant pattern. Results ANNa of VC resulted in a z-score of –20.54 and a p-value of &lt;0.001, indicating a &lt;1% likelihood that violent crimes were distributed randomly. Further ANNa yielded a zscore of –5.67 and p-value of &lt;0.001 for injuries. Our trauma center is 1.45 miles from the MC of VC and 2.28 miles from the MC for injuries. Spatial autocorrelation failed to demonstrate a direct relationship between criminality and trauma center utilization with a z-score of 0.030 and p-value of 0.98. Conclusion While not statistically significant, the spatial trends of violent crime and trauma center utilization demonstrated a clear pattern. GIS is a powerful tool for the trauma director, and examination of the local regional patterns of trauma should be undertaken by health systems to assist with optimizing outreach, expansion, and response times.

Using Photovoice to Understand Survivors' Healthcare Experiences and Strategies

The unique, individual nature of traumatic experiences and trauma symptoms and the limited healthcare resources typically allocated for individual patients pose barriers to implementing trauma-informed care. Developing knowledge on how survivors of violence engage in healthcare and self-advocate can lead to more empowering and efficient implementation of trauma-informed care. However, survivor perspectives on trauma-informed care are underrepresented in current literature and survivors' strategies for navigating healthcare are understudied. The aims of this participatory Photovoice study were to describe the healthcare experiences of female survivors of violence and their strategies for dealing with difficult healthcare experiences, healthcare providers, and the healthcare system. A sample of community-based women participated in an iterative series of five Photovoice meetings. Participants discussed multifaceted vulnerability in healthcare settings with regard to past traumatic violence, triggering or retraumatizing health care experiences, medical knowledge, and provider-patient relationships. They agreed that providers believing their symptoms, health concerns, and trauma disclosures was essential for positive provider-patient relationships and healthcare experiences. Findings on the importance of perceived belief with regard to trauma disclosure and health concerns and survivors' healthcare strategies are unique contributions to the literature. Providers should be accountable for integrating survivors’ self-knowledge in collaborative healthcare decision-making, for making medical records and information easily accessible, and for expressing belief in trauma disclosures and health concerns. Future research should continue using participatory methods to assess evolving trauma-informed practices and patient engagement among survivors and to hasten progress toward trauma-informed care that effectively meets the needs of survivors.

Traumatic stress in emergency nurses: Does your work environment feel like a war zone?

IntroductionEmergency nurses are exposed to both primary and secondary trauma with attendant sequelae in both work and personal spheres. The purpose of the study was to investigate the prevalence of traumatic stress, measured by the secondary traumatic stress scale (STSS) in a sample of emergency nurses and describe the impact of traumatic stress on nursing practice and workplace environment. MethodsMixed methods approach using survey instrument data from the Secondary Traumatic Stress Scale (STSS) (N = 125) and focus group data (N = 53). ResultsThe average total score on the STSS was 51.83 for nurses who attended one of the focus groups 48.42 for nurses who did not attend (clinical cutoff for STS = 39). Focus group data aligned with elements of the STSS; thematic categories of cumulative trauma, mental health sequelae, bullying and organizational violence, coping mechanisms, relationship damage, and solutions were described. Although we measured only STS, participants often used the terms “PTSD” and “STS” interchangeably. ConclusionsThe nurses in this study demonstrated high levels of STS and described in detail how chronic, cumulative trauma affected relational nursing care and social connections. Participants discussed high levels of suicidality in the profession, and the compounding trauma of relational and organizational violence. The pervasiveness of traumatic stress and the extent to which it affects all areas of nurses’ lives is a cause for great concern.

Quelles échelles utiliser pour mesurer la résilience en psychiatrie adulte ?

This communication based on a literature review, summarizes the most appropriate evaluation scales which measure resilience in adult psychiatry, and lists the principal clinical dimensions studied in the articles on the topic. The objective of this communication is to provide psychiatric institutions which receive adult patients with a list of resilience evaluation scales we consider to be the most pertinent to measure resilience in that sector. MethodThe review was done using Pubmed on articles written between 2016 and 2019, using the terms “resilience scales in psychiatry” and “resilience scales in psychology”. Two hundred and seventy-eight articles were found. Fifty articles concerning mental health in adult psychiatry more precisely were kept, and we looked at which resilience evaluation scales were most used in those researches, and which associated clinical dimensions were studied. We started by defining resilience, as defined originally in physics, and how it was then derived in psychology, notably introduced in France by Boris Cyrulnik. We then looked at how resilience is measured in adult psychiatry. Some researchers such as Wagnild used instruments specifically designed to measure resilience. Ionescu & Jourdan-Ionescu did an inventory of the instruments, and Windle, Bennett & Noyes a review. ResultAfter briefly defining what resilience is, particularly in the psychological field, we succinctly summarized the 6 scales we consider to be the most adapted for researches on resilience in adult psychiatry and listed the main clinical dimensions that have been researched in the articles we kept. These six scales, are widely used, validated and adapted to clinical psychiatry. This communication is therefore a mini guide of the most adapted resilience evaluation scales for potential future researches in adult psychiatry. The Wagnild & Young Resilience scale was validated among women aged 53 to 95 and it has a French version widely used to measure resilience among the general and clinical population. The Fryborg et al. RSA also measures adult resilience and is useful to measure protective factors against psychological disorders. The Ponce-Garcia, Madwell & Kennison SPF apprehends a complete measure of resilience and is a reliable scale among survivors of violent trauma. The Roussow & Roussow Predictive 6-Factor Resilience Scale was based on a neurobiological basis of resilience and has also a good consistence with health hygiene scores. It is considered an efficient measure to use in improving resilience. Finally, The Resilience Questionnaire for Bipolar Disorder from Echezarraga, Las Hayas, González-Pinto & Jones specifically measures resilience among a bipolar disorders population. The main clinical dimensions which figured in researches on resilience were varied and numerous. Many refer to post-traumatic stress disorder (PTSD), especially among American veterans. Besides PTSD, dimensions linked to stress, depression and psychiatric disorders were also researched. Scales are the same as those used in general population. However, some are validated for a clinical population. These scales can measure the link between resilience and various clinical dimensions and disorders. This opens the door for researches in adult psychiatry using one or more of the scales described in this article.

A História e seus silêncios: Honrarás a tu padre y a tu madre, de Cristina Fallarás

O romance Honrarás a tu padre y a tu madre, da escritora espanhola Cristina Fallarás, trata das consequências da Guerra Civil e da repressão franquista na sociedade espanhola da atualidade. Por meio da recuperação de memórias e acontecimentos do passado familiar que haviam sido silenciados, a narradora – que não por acaso possui o mesmo nome da autora – questiona sua própria história pessoal e a História de seu país. O propósito deste trabalho é evidenciar o processo de ressignificação identitária levado a cabo pela personagem, a partir das contribuições de Michael Pollak, sobre memória e identidade, e de Clara Valverde Gefaell, sobre transmissão geracional do trauma da violência política do século XX na Espanha.

Endovascular repair of traumatic aortic isthmic rupture: Early and mid-term results.

Conventional open repair of a traumatic aortic isthmic rupture is associated with a significantly high mortality and morbidity rates. Thoracic endovascular aortic repair (TEVAR) is currently often performed because it is a less invasive treatment than surgery. The aim of this study was to evaluate short and mid-term results of TEVAR in traumatic aortic isthmic rupture. This is a retrospective study conducted between 2010 and 2018 including patients who underwent TEVAR for traumatic aortic isthmic rupture. Thirty-six consecutive patients were included. All patients had sustained a violent blunt chest trauma after a sudden deceleration with associated injuries. The injury severity score (ISS) was 40 (14-66). All patients were hemodynamically stable at admission. We deployed thoracic aorta stent grafts with a mean diameter of 26mm (18-36). The procedural success rate was 100%. We reported one intra-operative complication which was a distal migration of the graft, managed by an implantation of an aortic extension graft. On the first postoperative day, one patient presented an acute lower limb ischemia, probably due to the surgical femoral access, treated with an embolectomy with a Fogarty catheter with satisfactory results. The mean follow-up was 40.41 months (6.5-96). The mortality and paraplegia rates were 0% at one month and during the follow-up period. We reported a case of kinking of the graft that occurred at 6 months. No cases of endoleak neither re-intervention were reported. TEVAR is a safe and a reliable method for the treatment of sub-acute traumatic thoracic aortic injuries.

The cost of gunshot abdominal vascular injuries. Its impact on patient, family and hospital.

Violent trauma with penetrating injuries is a relevant public health issue. Penetrating abdominal wounds cause 90-95% of vascular injuries, which not only have high associated morbidity and lethality, but also involve high attention costs. Cost analysis in hospitals has become a topic of great interest, as it justifies changes in hospital organization and management. Determine the cost of gunshot abdominal vascular injuries for the patient, his family and the hospital. We drove an observational, descriptive, prospective and longitudinal study of patients with of gunshot abdominal vascular injuries admitted in the Mexican Red Cross Trauma Center in the Federal District from January 1st to October 31st, 2018. 8149 patients were admitted in the emergency department, 149 with a diagnosis of gunshot injury, of which 6 (0.07%) had abdominal vascular injury. The total cost of medical care these patients was on average $174,770.79 (median $132,999.50) per capita, amount that surpasses their annual income and implies an institutional absorption of expenditure up to 95.5%. Institutional investment on the attention of high-impact pathologies and the development of strategies that facilitate access to health services are a real and priority necessity.

Who has to tell their trauma story and how hard will it be? Influence of cultural stigma and narrative redemption on the storying of sexual violence.

Although survivors of sexual violence have shared their stories with the public on social media and mass media platforms in growing numbers, less is known about how general audiences perceive such trauma stories. These perceptions can have profound consequences for survivor mental health. In the present experimental, vignette-based studies, we anticipated that cultural stigma surrounding sexual violence and cultural preference for positive (redemptive) endings to adversity in the United States (U.S.) would shape perceptions. Four samples of U.S. adults (N = 1872) rated first-person narratives of 6 more stigmatizing (i.e., sexual violence) or less stigmatizing (e.g., natural disaster) traumatic events. Confirming pre-registered hypotheses, sexual violence trauma (versus other types of trauma) stories were perceived as more difficult to tell, and their storytellers less likeable, even when they had redemptive endings. Disconfirming other pre-registered hypotheses, redemptive (versus negative) story endings did not boost the perceived likelihood or obligation to share a sexual violence trauma story. Rather, redemptive (versus negative) story endings only boosted the perceived likelihood, obligation, and ease of telling other, less stigmatizing types of trauma stories. Findings suggest that sexual violence survivors do not benefit, to the same degree as other survivors, from telling their stories with the culturally valued narrative template of redemption. Clinical and societal implications of the less receptive climate for sexual violence stories are discussed.

Background and psychological impact of organised and ritual child sexual abuse: Reports to the Independent Inquiry into Child Sexual Abuse in Germany

Organised child sexual abuse is characterised by commercial exploitation of children and adolescents by networking perpetrator groups. Ritual abuse is further characterised by ideological frameworks (e.g., cults). Forty-one confidential hearings and written reports, gathered by the German Independent Inquiry into Child Sexual Abuse from individuals as well as contemporary witnesses subjected to organised and ritual abuse (ORA) were analysed by means of a quantitative content analysis. Right-wing extremist, Satanist and religious ideologies were most frequently described. The perpetrators were, next to unknown offenders, mostly described as fathers, and in half of the reports, besides also mothers of the victims. Dissociative identity disorders resulting from such traumatic violence present a challenge to psychosocial and psychiatric professionals. It is necessary to educate professionals in psychosocial care settings about ORA and the psychological consequences of extreme violence.