Violence-related Trauma Research Articles

Characteristics of blunt and penetrating trauma among victims of physical violence: A retrospective study

BackgroundA significant number of referrals to the emergency departments is due to violence and conflict leading to serious injuries and death. The increasing number of such cases highlights the urgent need for investigating victimization of physical violence.AimThe purpose of this study was to determine the frequency of demographic and clinical characteristics in victims of violence and classify them based on penetrating or blunt trauma.MethodsThe data of the patients who had been the victims of violence in 2020 were extracted from the Trauma Registry System(TRS) of the Guilan Road Trauma Research Center(GTRC). All analyses were performed using SPSS software version 24. The significance level was considered less than 0.05.ResultsThere was a significant difference in the type of violence-related trauma in different age groups (P < 0.001), based on sex (P = 0.002), and marital status (P = 0.012). A significant difference also existed between the trauma type and clinical variables including smoking (P = 0.032), history of alcohol drinking (P = 0.005), and other substance use (P = 0.002), the anatomical location of injury (P < 0.001) and therapeutic interventions (p < 0.001(.ConclusionMost of the clients of the violence suffered from blunt trauma, the severity of which was mild, and they were treated supportively without the need for surgery. Blunt trauma was seen more in women, divorcees, over 40 years and non-smokers. Penetrating trauma was observed more in lower limb injuries and alcohol and amphetamine users. Prevention programs and educational interventions should be programmed for the society long before men alcohol and amphetamine abusers reach their fourth decade of life. Accurately recording the type of physical violence, and the weapon used, and determining the injury severity score in TRS can lead to more reliable results in researching the field of violence issues.

Promising for patients or deeply disturbing? The ethical and legal aspects of deepfake therapy

Deepfakes are hyper-realistic but fabricated videos created with the use of artificial intelligence. In the context of psychotherapy, the first studies on using deepfake technology are emerging, with potential applications...

Antibiotic susceptibility patterns at the Médecins Sans Frontières (MSF) Acute Trauma Hospital in Aden, Yemen: a retrospective study from January 2018 to June 2021.

Antimicrobial resistance (AMR) is an urgent global health concern, especially in countries facing instability or conflicts, with compromised healthcare systems. Médecins Sans Frontières (MSF) established an acute trauma hospital in Aden, Yemen, treating mainly war-wounded civilians, and implemented an antimicrobial stewardship (AMS) programme. This study aimed to describe clinical characteristics and identify antibiotic susceptibility patterns representative of patients treated with antibiotics. Retrospective cross-sectional study using routinely collected data from all patients treated with antibiotics in the MSF-Aden Acute Trauma hospital between January 2018 and June 2021. Routine clinical data from patients' files was entered into an AMS electronic database and microbiological data were entered into WHONET. Both databases were imported and merged in REDCap and analysed using RStudio. Three hundred and sixty-three of 481 (75%) included patients were injured by violence-related trauma. Most were men aged 19-45 years (n = 331; 68.8%). In total, 598 infections were diagnosed and treated. MDR organisms were identified in 362 (60.5%) infections in 311 (65%) patients. Skin and soft-tissue infections (SSTIs) (n = 143; 24%) were the most common, followed by osteomyelitis (n = 125; 21%) and intra-abdominal-infections (IAIs) (n = 116; 19%), and 111 (19%) secondary bloodstream infections were identified. Escherichia coli was the most frequently identified pathogen, causing IAI (n = 87; 28%) and SSTI (n = 43; 16%), while Staphylococcus aureus caused mainly osteomyelitis (n = 84; 19%). Most Gram-negatives were ESBL producers, including E. coli (n = 193; 81.4%), Klebsiella pneumoniae (n = 72; 77.4%) and Enterobacter cloacae (n = 39; 50%) while most S. aureus were methicillin resistant (n = 93; 72.6%). High rates of MDR were found. This information will facilitate a comprehensive review of the empirical antibiotic treatment guidelines.

Injury characteristics from the Poláky-Dolany site : patterns, prevalence and violence-related trauma in a small early medieval Bohemian village

The Poláky-Dolany (Chomutov district) site represents one of a few villages in Bohemia that have been archaeologically studied based on the discovery of an early mediaeval cemetery. According to archaeological evidence, the settlement existed in the 11th century. Nevertheless, in the late 1960s the whole village was demolished due to the construction of the Nechranice Reservoir. Subsequently, the surrounding area was flooded, which significantly hampered research on the site. The archaeological excavation took place during the very dry years of 2015 and 2018, when the water level in the reservoir dropped so much that a large part of the burial site could be explored. Archaeological data indicates that the Dolany inhabitants were farmers benefiting from the nearby river, and they ran a local smithy. This study, conducted on individuals buried in the cemetery of the above-mentioned village based on skeletal trauma seeks to supplement the information about daily life and the dangers that the individuals buried on the Poláky-Dolany site had to face. Signs of trauma were found in 20/119 individuals; the majority of them were accident-related. However, the trauma that was probably associated with violence also occurred.

Prevalence of use and impairment from drugs and alcohol among trauma patients: A national prospective observational study

BackgroundBeing under the influence of psychoactive substances increases the risk of involvement in and dying from a traumatic event. The study is a prospective population-based observational study that aims to determine the prevalence of use and likely impairment from psychoactive substances among patients with suspected severe traumatic injury. MethodThis study was conducted at 35 of 38 Norwegian trauma hospitals from 1 March 2019 to 29 February 2020. All trauma admissions for patients aged ≥ 16 years admitted via trauma team activation during the study period were eligible for inclusion. Blood samples collected on admission were analysed for alcohol, benzodiazepines, benzodiazepine-like hypnotics (Z-drugs), opioids, stimulants, and cannabis (tetrahydrocannabinol). ResultsOf the 4878 trauma admissions included, psychoactive substances were detected in 1714 (35 %) and in 771 (45 %) of these, a combination of two or more psychoactive substances was detected. Regarding the level of impairment, 1373 (28 %) admissions revealed a concentration of one or more psychoactive substances indicating likely impairment, and 1052 (22 %) highly impairment. Alcohol was found in 1009 (21 %) admissions, benzodiazepines and Z-drugs in 613 (13 %), opioids in 467 (10 %), cannabis in 352 (7 %), and stimulants in 371 (8 %). Men aged 27–43 years and patients with violence-related trauma had the highest prevalence of psychoactive substance use with respectively 424 (50 %) and 275 (80 %) testing positive for one or more compounds. ConclusionThe results revealed psychoactive substances in 35 % of trauma admissions, 80 % of which were likely impaired at the time of traumatic injury. A combination of several psychoactive substances was common, and younger males and patients with violence-related injuries were most often impaired. Injury prevention strategies should focus on high-risk groups and involve the prescription of controlled substances. We should consider toxicological screening in trauma admissions and incorporation of toxicological data into trauma registries.

Impact of novel psychosocial programming on readmission and recidivism rates among patients with violence-related trauma.

The Victims of Crime Advocacy and Recovery Program (VOCARP) provides advocacy, mental health resources, and educational materials. This study will report complications, readmissions, and recidivism among crime victims, and who used or did not use victim services. Patients engaged with programming from 3/1/17 until 12/31/18 were included. Control groups were patients injured by violent trauma without VOCARP use (N = 212) and patients injured by unintentional injuries (N = 201). Readmissions, complications, reoperations, and trauma recidivism were reported. 1019 patients (83%) used VOCARP. VOCARP users were less often male (56% vs. 71%), less commonly married (12% vs. 41%), and had fewer gunshot wounds (GSWs, 26% vs. 37%) and sexual assaults (4.1% vs. 8%), all p < 0.05. Of all 1,423 patients, 6.6% had a readmission and 7.4% developed a complication. VOCARP patients had fewer complications (4.5% vs. 13.7%), infections (2% vs. 9%), wound healing problems (1% vs. 3.3%), and deep vein thromboses (0.3% vs. 1.9%), all p < 0.05, but no differences in unplanned operations (4.5%). GSW victims had the most complications, readmissions, and unplanned surgeries. Prior trauma recidivism was frequent among all groups, with crime victim patients having 40% prior violence-related injury (vs 9.0% control, p < 0.0001). Trauma recidivism following VOCARP use occurred in 8.5% (vs 5.7% for non-users, p = 0.16). Crime victims differ from other trauma patients, more often with younger age, single marital status, and unemployment at baseline. Complications were lower for VOCARP patients. GSW patients had the most complications, readmissions, and unplanned secondary procedures, representing a population for future attention.

The Migration Risk Environment: Challenges to Human Security for Venezuelan Migrant and Refugee Women and Girls Pre- and Post-Migration to Colombia

The Venezuelan crisis has unleashed multiple forms of sociopolitical violence against its population and created a context of unmet needs, insecurity, and human rights violations. Outward migration caused by this situation has been linked to health emergencies in neighboring countries. Venezuelan migrant and refugee women and girls (VMRWG) are among the most affected. We conducted a cross-sectional qualitative and Participatory Action Research (PAR) project to characterize the risk environments for VMRWG across migration phases, analyzing pre-departure, transit, border crossing, and resettlement risk factors for health and security through semi-structured interviews ( n = 30) and human cartographies ( n = 16). We found cross border risk and protective factors that inform cross-border health initiatives, migration policies, and human rights efforts for both the migrant and host communities. Findings and Recommendations Migratory trajectories of VMRWG from Venezuela to Colombia represent a risk environment for women and girls, connecting cross-border contexts through armed actors’ control, culturally reinforced gender roles and limited social and economic resources. Long-term sustainable migratory policies that are culturally sensitive and include a gender-approach to health should operationalize how gender roles are intimately connected to HIV risk and mental health disparities through reinforced structural factors. Such policies must address these structural factors. The public health system needs to incorporate and align with programmatic efforts implemented by international platforms (United Nations Population Fund (UNFPA), AID4AIDS, and Médecins Sans Frontières (MSF) also known as Doctors Without Borders) targeting screening for infectious diseases (including HIV and mental health disparities) in border crossings and borderlands. Sustainable policies to bridge gaps between services and populations and to decrease growing HIV cases depends on these strategies. Policies and programs of local governments (city and municipality level) addressing mental health disparities need to be expanded through peer leaders and civil society networks of care to guarantee wellbeing and quality of life after resettlement. International efforts and collaborations should capitalize on the re-opening of the border to establish inter-sectoral collaborations with Venezuelan NGOs and civil society organizations on both sides of the border to address gender-based violence, follow-up of cases, and access to services in sending and receiving communities. In order to broach gaps and tackle access barriers in resettlement communities in Colombia, services must be provided in peripheric territories and neighborhoods where some vulnerable migrants resettle. These services must rely on health sector-community collaborations. Public health sector efforts should be integrated and coordinated with family and child services on a local and national level Instituto Colombiano de Bienestar Familiar (ICBF), gender working groups, shelters, and citywide supported initiatives like the House of Women) to provide and promote access to social resources (education, jobs, and housing) for migrant women. Health promotion strategies are necessary to decrease infectious diseases and violence-related trauma among migrants across borders. These strategies can include outreach through peer leaders, civil society organization campaigns, and HIV mobile testing and counselling. These services should be delivered in a culturally sensitive manner, capitalizing on in-place cross-border networks of support. In Colombia, sustainable efforts in policy and programs have been made to provide Venezuelans with access to health care and social services with the help of inter-sectoral working groups, national laws, and border commissions. However, there is an urgent need to expand the humanitarian response and the health sector coverage to gender-based violence impacting infectious disease risk and mental health trauma in host communities. Connecting pre- and post-migration contexts in South-to-South migration is paramount. Tackling these issues can improve the protection of human rights and resettlement conditions in host communities.

Territorial healing: A spatial spiral weaving transformative reparation

This article introduces the concept of territorial healing as a strategy for holistic intervention with communities affected by violence-related trauma. Violence exerted in places generates affective and territorial ruptures contained in socio-emotional wounds and disruptions in the social and institutional fabric that weakens collective life. Building on post/in-conflict cities studies, peacebuilding studies, and a decolonial approach, we argue that territorial healing agglutinates myriad interventions aimed at a collective restorative reparation of geo-traumas (Pain, 2021) and promotes the construction of collective subjects for decision-making in territorial processes. The article highlights the need to go beyond the local/spatial turn of peacebuilding and reparative planning by providing a more robust understanding of how to frame the political project of reparative justice in urban spaces and across different scales. Territorial healing processes go beyond institutionalized frameworks to involve decentralized and autonomous processes that expand the spatiality of the symbolic, corporeal and emotions of collective urban life. This article suggests that a territorial healing trajectory requires weaving the mapping of body-territory-earth (Cabnal, 2019), collective memory, and spatial imagination as a strategy to manage existing conflicts through therapeutic dialogue and the shaping of reparative infrastructures.

Increasing Trend in Violence-Related Trauma and Suicide Attempts among Pediatric Trauma Patients: A 6-Year Analysis of Trauma Mechanisms and the Effects of the COVID-19 Pandemic.

Background: Trauma is the leading cause of morbidity and mortality in the pediatric population. During the COVID-19 pandemic (COVID-19), different trends for pediatric trauma (PT) were described. This study aims to explore the trend over time of PT in our center, also considering the effects of COVID-19, focusing on trauma mechanisms, violence-related trauma (VRT) and intentionality, especially suicide attempts (SAs). Methods: All PT patients accepted at Niguarda Trauma Center (NTC) in Milan from January 2015 to December 2020 were retrospectively analyzed. We considered demographics and clinical variables and performed descriptive and year comparison analyses. Results: There were 684 cases of PT accepted at NTC: 84 in 2015, 98 in 2016, 125 in 2017, 119 in 2018, 114 in 2019 and 144 in 2020 (p < 0.001), 66.2% male, mean age 9.88 (±5.17). We observed a higher number of traffic-related, fall-related injuries and an increasing trend for VRT and SAs, peaking in 2020. We report an increasing trend over time for head trauma (p = 0.002). The Injury Severity Score did not significantly change. During COVID-19 we recorded a higher number of self-presenting patients with low priority codes. Conclusions: NTC is the adult level I referral trauma center for the Milan urban area with pediatric commitment. During COVID-19, every traumatic emergency was centralized to NCT. In 2020, we observed an increasing trend in SAs and VRT among PT patients. The psychological impact of the COVID-19 restriction could explain this evidence. The long-term effects of COVID-19 on the mental health of the pediatric population should not be underestimated. Focused interventions on psychological support and prevention of SAs and VRT should be implemented, especially during socio-demographic storms such as the last pandemic.

The neglected epidemic of trauma from interpersonal violence against the elderly in South Africa

Geriatric injuries comprise a significant burden in the developed world but much less are known in the developing world setting. This study aims to review our experience of geriatric injuries with a focus on interpersonal violence (IPV) managed at a major trauma centre in South Africa. This was a retrospective study on all patients who were aged > 65 years admitted to our trauma centre from January 2013 to December 2020, based in Pietermaritzburg, South Africa. Over the 8-year study period, 323 cases were included (62% male, mean age 72 years). Mechanism of injury: 80% blunt, 16% penetrating and 4% others. The median injury severity score (ISS) was 9. The median Charlson comorbidity index (CCI) for all 323 cases was 3. Diabetes (n = 53) was the most prevalent comorbidity which was followed by pulmonary disease (n = 23), cerebral vascular accidents (n = 16) and myocardial infarction (n = 15). Fifteen patients were on antiretroviral therapy (5%). Twenty-four per cent required surgical intervention. Eight per cent of cases experienced one or more complications. Twenty-five per cent (80/323) were related to IPV, 61% (49/80) of these were penetrating injuries and the remaining 31 cases were blunt injuries. Of the 49 cases of penetrating injuries, 33 were gunshot wounds (GSWs) and 16 were stab wounds (SWs) (1 GSW and 2 SWs were self-inflicted and were not included in IPV). Those cases that resulted from IPV were significantly more likely to require operative intervention, experience complications and longer lengths of hospital stay. Geriatric patients had poorer outcomes than non-geriatric patients and rural geriatric patients had worse outcomes than urban geriatric patients. Although the burden of geriatric trauma in South Africa appears to be relatively low, it is associated with significant morbidity and mortality. Trauma from interpersonal violence is especially common and is associated with significantly worse outcomes than that of non-interpersonal violence-related trauma. Elderly rural trauma victims have worse outcomes than their urban counterparts.

The effect of the COVID-19 pandemic on community violence in Connecticut

IntroductionNatural disasters may lead to increases in community violence due to broad social disruption, economic hardship, and large-scale morbidity and mortality. The effect of the COVID-19 pandemic on community violence is unknown. MethodsUsing trauma registry data on all violence-related patient presentations in Connecticut from 2018 to 2021, we compared the pattern of violence-related trauma from pre-COVID and COVID pandemic using an interrupted time series linear regression model. ResultsThere was a 55% increase in violence-related trauma in the COVID period compared with the pre-COVID period (IRR: 1.55; 95%CI: 1.34–1.80; p-value<0.001) driven largely by penetrating injuries. This increase disproportionately impacted Black/Latinx communities (IRR: 1.61; 95%CI: 1.36–1.90; p-value<0.001). ConclusionViolence-related trauma increased during the COVID-19 pandemic. Increased community violence is a significant and underappreciated negative health and social consequence of the COVID-19 pandemic, and one that excessively burdens communities already at increased risk from systemic health and social inequities.

Characteristics of Adult Patients for Violence-Related Injuries Presenting to a Level 1 Trauma Center in Midwest United States

Background Hospital violence intervention programs (HVIPs) have recently been initiated in trauma centers across the United States. However, violence-related injuries have unique factors and issues that should be addressed in the health care provided in emergency departments. Purpose This study aimed to characterize the patient population presenting at a level 1 ACS verified trauma center, with a chief complaint of violent trauma, and identify characteristics of patients most at risk for violence-related trauma. Methods The cross-sectional retrospective study examined patients’ electronic health records, at least 18 years, with a diagnosis of blunt or penetrating injury treated by the emergency and trauma team at level 1 ACS verified trauma center in the Midwest. Results Assault injuries accounted for most of the mechanisms that required treatment at the hospital and disposed to home. Nearly 80% of the population had no documentation of the relationship of the assailant. The average age of the patients was 33 years and black males. Eleven patients were treated in the emergency department twice for a trauma-related injury during the six-month data collection. Conclusion Injuries from violence require comprehensive care from various healthcare disciplines, similar to managing acute and chronic illnesses. The American College of Surgeons (ACS) guidelines support the development of an HVIP to identify risk factors and treatment plans for any patient exposed to violence. This research demonstrates that HVIPs should provide standardized screening and follow-up care while in the emergency department or immediately following the hospital to reduce the cyclical events.

Humanitarian surgical service utilization by a host country population: comparing surgery patterns between refugees and Tanzanians using an interrupted time-series analysis

BackgroundWhile current estimates suggest that up to three million additional surgical procedures are needed to meet the needs of forcibly displaced populations, literature on surgical care for refugee or forced migrant populations has often focused on acute phase and war-related trauma or violence with insufficient attention to non-war related pathologies. To our knowledge, no study has compared refugee versus host population utilization of surgical services in a refugee camp-based hospital over such an extended period of twenty years. The aim of this paper is to first describe the patterns of surgical care by comparing refugee and host population utilization of surgical services in Nyarugusu refugee camp between 2000 and 2020, then evaluate the impact of a large influx of refugees in 2015 on refugee and host population utilization.MethodsThe study was based on a retrospective review of surgical logbooks in Nyarugusu refugee camp (Kigoma, Tanzania) between 2000 and 2020. We utilized descriptive statistics and multiple group, interrupted time series methodology to assess baseline utilization of surgical services by a host population (Tanzanians) compared to refugees and trends in utilization before and after a large influx of Burundian refugees in 2015.ResultsA total of 10,489 operations were performed in Nyarugusu refugee camp between 2000 and 2020. Refugees underwent the majority of procedures in this dataset (n = 7,767, 74.0%) versus Tanzanians (n = 2,722, 26.0%). The number of surgeries increased over time for both groups. The top five procedures for both groups included caesarean section, bilateral tubal ligation, herniorrhaphy, exploratory laparotomy and hysterectomy. In our time series model, refugees had 3.21 times the number of surgeries per quarter at baseline when compared to Tanzanians. The large influx of Burundian refugees in 2015 impacted surgical output significantly with a 38% decrease (IRR = 0.62, 95% CI 0.46–0.84) in surgeries in the Tanzanian group and a non-significant 20% increase in the refugee group (IRR = 1.20, 95% CI 0.99–1.46). The IRR for the difference-in-difference (ratio of ratios of post versus pre-intervention slopes between refugees and Tanzanians) was 1.04 (95% CI 1.00–1.07), and this result was significant (p=0.028).ConclusionsSurgical care in conflict and post-conflict settings is not limited to war or violence related trauma but instead includes a large burden of obstetrical and general surgical pathology. Host population utilization of surgical services in Nyarugusu camp accounted for over 25% of all surgeries performed, suggesting some host population benefit of the protracted refugee situation in western Tanzania. Host population utilization of surgical services was apparently different after a large influx of refugees from Burundi in 2015.

Implementation of programming for survivors of violence-related trauma at a level 1 trauma center

BackgroundPrior investigation of violence intervention programs has been limited. This study will describe resources offered by Victims of Crime Advocacy and Recovery Program (VOCARP), their utilization, and effect on recidivism.MethodsVOCARP...

OCULAR INJURY TREND IN COVID-19 ERA- A TERTIARY EYE CARE STUDY IN INDIA

Aim- To study the change in demography and injury pattern of ocular trauma during the lockdown period tothat of a similar period of the previous year. Materials &amp; Methods- This is a retrospective analysis of the data of 362 patients with ocular trauma during the lockdown period from 25 March 2020 to 3 May 2020 and during a similar period of the previous year at a tertiary eye care center in India. Results- There was a decrease of 62.87% of patients of ocular trauma during the lockdown period because of the restricted lifestyle. Although home related and violence-related trauma increased, there was a decrease in trafc and sports-related trauma. Patients with chemical injury by sodium hypochlorite also had a sharp rise. Majority of the patients presented after two days during this period. Conclusion- Guidelines for mass health education and awareness about the risk of ocular trauma, morbidity caused by delayed presentation, and need to adopt safety or preventive strategies should be formulated so that future strategy can be planned to ght with the next pandemic or epidemic.

Patient reported outcomes 6 to 12 months after interpersonal violence: A multicenter cohort study.

Violence continues to be a significant public health burden, but little is known about the long-term outcomes of these patients. Our goal was to determine the impact of violence-related trauma on long-term functional and psychosocial outcomes. We identified trauma patients with moderate to severe injuries (Injury Severity Score, ≥9) treated at one of three level 1 trauma centers. These patients were asked to complete a survey over the phone between 6 and 12 months after injury evaluating both functional and psychosocial outcomes (12-item Short Form Survey, Trauma Quality of Life, posttraumatic stress disorder [PTSD] screen, chronic pain, return to work). Patients were classified as having suffered a violent injury if the mechanism of injury was a stab, gunshot, or assault. Self-inflicted wounds were excluded. Adjusted logistic regression models were built to determine the association between a violent mechanism of injury and long-term outcomes. A total of 1,050 moderate to severely injured patients were successfully followed, of whom 176 (16.8%) were victims of violence. For the victims of violence, mean age was 34.4 years (SD, 12.5 years), 85% were male, and 57.5% were Black; 30.7% reported newly needing help with at least one activity of daily living after the violence-related event. Fifty-nine (49.2%) of 120 patients who were working before their injury had not yet returned to work; 47.1% screened positive for PTSD, and 52.3% reported chronic pain. On multivariate analysis, a violent mechanism was significantly associated with PTSD (odds ratio, 2.57; 95% confidence interval, 1.59-4.17; p < 0.001) but not associated with chronic pain, return to work, or functional outcomes. The physical and mental health burden after violence-related trauma is not insignificant. Further work is needed to identify intervention strategies and social support systems that may be beneficial to reduce this burden. Prognostic and epidemiological, level III.

Changes in Traumatic Memories and Posttraumatic Cognitions Associate with PTSD Symptom Improvement in Treatment of Multiply Traumatized Children and Adolescents

Refinement, targeting, and better dissemination of trauma-focused therapies requires understanding their underlying mechanisms of change. Research on such mechanisms among multiply traumatized children and adolescents is scarce. We examined the role of improvements in problematic qualities of traumatic memories and maladaptive posttraumatic cognitions in PTSD symptom reduction, in a randomized, pragmatic trial of narrative exposure therapy vs. treatment as usual with 40 participants 9–17 years old (48% female, 75% refugee background) repeatedly exposed to war or family violence related trauma. Posttraumatic cognitions, quality of traumatic memories and PTSD symptoms were assessed by self-report before and after treatment. Improvements in both quality of traumatic memories (rMI = .36) and posttraumatic cognitions (rMI = .46) correlated with symptom reduction. However, improvement during treatment was only significant for quality of traumatic memories (FMI(11,333.56) = 4.77), not for posttraumatic cognitions. We detected no difference in effects of narrative exposure therapy and treatment as usual on cognitions or memories. We tentatively suggest problematic, overly sensory and incoherent quality of traumatic memories may be a useful target in the treatment of PTSD symptoms among multiply traumatized children and adolescents. Changing maladaptive posttraumatic cognitions, though important, may be challenging among those with severe, repeated trauma.

Biocultural consequences of the Late Woodland transition at Forbush Creek, North Carolina (AD 800-1200)

After several centuries of cultural continuity, the Late Woodland transition (AD 600-1000) in the Southeastern Woodlands involved a significant intensification of existing lifeways. This study examines the biocultural consequences of the Late Woodland transition at Forbush Creek (AD 800-1200), a Yadkin River Valley site from the Piedmont region of North Carolina. Twelve percent of individuals recovered from the site sustained violence-related trauma, including five individuals with healed blunt force trauma, two individuals with perimortem cranial trauma, and a single projectile point injury. Secondary burial individuals exhibited significantly more trauma (n = 10, 42%) and nutrient deficiencies (n = 12, 50%) than primary burial individuals (n = 1, 4%; and n = 5, 19%, respectively). The Forbush Creek remains provide new evidence of the biological impacts of cultural transitions and suggest that uncertainty, scarcity, and conflict arising from changing lifeways contributed to inequality in the Forbush Creek community. Secondary bundle burial inclusion may represent marginalization and an increased vulnerability to morbidity and mortality risks. The emergence of social inequality in the Late Woodland period likely shaped long-term cultural dynamics that preceded the complex sociopolitical hierarchies of the later Mississippian period.

Traumatic injury in a cranium found at Rakhigarhi cemetery of Harappan civilization as anthropological evidence of interpersonal violence

The Harappan Civilization is notable as one of the earliest complex societies spanning the vast area of northwest India and Pakistan. To uncover patterns of violent injury among the Harappan people, anthropologists have looked for signs of trauma on skeletons. Notwithstanding the pioneering achievements made thus far, there is still more work to do before violence among the Harappan people will be comprehensively understood from the socio-cultural perspective. In this study, we report new evidence of violence-related trauma found among remains unearthed from the Mature Harappan period (2600–1900 BCE) cemetery of Rakhigarhi, located about 150 km northwest of Delhi. Briefly, in the left frontal area of the cranium of an adult female (BR12), we found a depression fracture that might have been caused by a direct blow to the skull with a round-tipped object. Since the traumatic lesion of BR12 had completely healed, the skull fracture is very unlikely to have been the direct cause of death. Our paleopathological report provides significant insight into interpersonal violence that might have occurred among the Harappan people. Proof of whether or not Rakhigarhi society was a hierarchy beset by structural violence differing by class and/or other categories, however, must await future excavations of additional areas of the Rakhigarhi and/or nearby Harappan cemetery.

A Meta-Analysis of Parenting Practices and Child Psychosocial Outcomes in Trauma-Informed Parenting Interventions after Violence Exposure.

Over half of all youth are exposed to violence, which a growing body of literature suggests is associated with a broad range of negative developmental outcomes over the life course. However, best practices for supportingparenting are not widely applied to parents with children exposed to violence-related trauma. This meta-analyses seeks to synthesize the literature base of trauma-informed parenting interventions to better understand their potential impact on parenting and child outcomes. Specifically, 21 trauma-informed parenting interventions were identified that quantitatively assessed intervention effects on parenting and child outcomes. Six meta-analyses were conducted to assess intervention effects on (1) positive parenting practices, (2) negative parenting practices, (3) parenting stress, (4) children's internalizing problems, (5) children's externalizing problems, and (6) trauma symptoms, respectively. Moderate to large effect sizes were found for positive parenting practices (d = 0.62) as well as child internalizing problems, externalizing problems, and trauma symptoms (d = 0.48-0.59). Validity tests indicated robust findings for positive parenting and for all child outcomes. Additional moderator analyses support the importance of informed intervention design, showing differential findings by trauma type as well as by duration of the intervention. These findings indicate the value of evidence-based parenting interventions for violence-related trauma and support models of trauma-informed care that situate treatment in the broader social context, particularly the family. Results are discussed with respect to which parenting practices hold the most promise for supporting children exposed to violence-related trauma.