Trauma, mental health, and everyday functioning among Rohingya refugee people living in short- and long-term resettlements.

PURPOSE: This study investigated if Rohingya refugee people resettled in camps in rural Bangladesh and urban locations in Malaysia had different levels of trauma, mental health and everyday functioning. The study also examined if direct and indirect exposure to traumatic events could predict PTSD, depression, generalized anxiety, and everyday functioning in the two groups separately. An attempt was also made to see if the relations between trauma and mental health were different across the two settings. METHODS: This was a cross-sectional study, for which we conveniently recruited 100 adult Rohingyas, 50 from each country; the majority was males. Rohingyas in Bangladesh fled Myanmar's Rakhine State following a major military crackdown in 2017, whereas Rohingyas in Malaysia fled Rakhine gradually over the last three decades because of recurrent violence and military operations. We assessed trauma (cumulative trauma, direct trauma, and indirect trauma), PTSD, depression, generalized anxiety, and everyday functioning of the participants using traumatic event questionnaire, PTSD-8, PHQ-9, GAD-7, and WHODAS-2.0. RESULTS: The Bangladeshi cohort experienced more types of traumatic events (i.e., cumulative trauma) than did the Malaysian cohort (d = 0.58). Although the two cohorts did not differ in terms of indirect exposure to traumatic incidents (i.e., indirect trauma), the Malaysian cohort had direct exposure to traumatic events (i.e., direct trauma) more frequently than did the Bangladeshi cohort (d = 1.22). The Bangladeshi cohort showed higher PTSD (d = 1.67), depression (d = 0.81), generalized anxiety (d = 1.49), and functional impairment (d = 2.51) than those in Malaysia. Hierarchical linear regression analyses showed that after controlling for demographic variables, both direct and indirect trauma significantly predicted PTSD, depression, and functional impairment among Rohingyas in Bangladesh, with direct trauma being the stronger predictor. However, similar analyses showed that only indirect trauma predicted PTSD among Rohingyas in Malaysia, while all other effects were nonsignificant. The results also showed that the predictive relationship between direct trauma and PTSD was different across the two countries. With the same level of direct trauma, a participant from Malaysia would score 0.256 points lower in PTSD than a participant from Bangladesh. CONCLUSION: The recently experienced direct and indirect trauma have impaired mental health and everyday functioning among the Bangladeshi cohort. However, only indirect trauma was active to cause PTSD in the Malaysian cohort as direct trauma was weakening due to the time elapsed since migration. We discuss the results in the context of the current theories of trauma and mental health and suggest therapeutic interventions for the refugee population.

Autobiographical memory impairment among Rohingya refugee people: roles of direct and indirect trauma exposures and PTSD symptom severity.

Literature indicates that trauma exposure leads to autobiographical memory (AM) impairment, but the differential effects of direct and indirect trauma on memory remain unclear. We investigated AMs of 100 Rohingya refugees (Meanage = 35.79; SDage = 15.36) recruited from camps in Bangladesh and communities in Malaysia. Each participant retrieved ten memories to word cues and rated to what extent those memories were self-defining on a 5-point scale. They also completed the PTSD-8 scale and a trauma checklist reporting the types of traumatic events they experienced. Results showed that participants with frequent exposure to direct and indirect trauma recalled more traumatic memories. Surprisingly, more direct-trauma memories appeared to be specific than indirect trauma and non-trauma memories. As expected, individuals who scored higher on the PTSD-8 scale recalled more non-specific AMs. Rohingyas in Bangladesh who migrated months before data collection, thus retaining recent trauma experiences , retrieved more non-specific memories than those in Malaysia who migrated years ago. The direct trauma memories of the Malaysian cohort were more self-defining than their counterparts. The participant's ability to recall more direct trauma memories with specificity could be attributed to the repeated recall of those memories to the relevant authorities of the host countries to justify their refugee status.

Retrospective analysis of trauma incidence in patients with temporomandibular disorders.

BACKGROUND/AIM: The relationships between direct trauma, whiplash injuries, and temporomandibular disorders (TMD) have not been well established. The aim of this study was to evaluate the percentage of direct and/or whiplash trauma in patients with TMDs. MATERIAL AND METHODS: The clinical records of 237 patients with temporomandibular disorders who had sought treatment at the Orofacial Pain Clinic were reviewed. Clinical data for age and gender of the patients, history of trauma, temporomandibular joint (TMJ) sounds, and TMD diagnosis were extracted from the medical records of all included patients. The presence of TMJ sounds and TMD diagnosis had been determined based on the Research Diagnostic Criteria for TMDs. RESULTS: The mean age of patients with osteoarthritis was significantly higher than that of patients with disk displacement with reduction (P = .001, P Ë‚ .05). There was no statistically significant gender-based difference in diagnosis, clicking, crepitus, and trauma frequency (P > .05). A history of direct and whiplash trauma was observed in 18.6% and 14.8% of patients, respectively. Statistical analysis for the relationship between clicking and crepitus, and trauma showed no significant correlation (P > .05). CONCLUSION: Direct and/or whiplash trauma in patients with temporomandibular disorders were not associated with the diagnostic records and temporomandibular joint sounds.

Alveoler process fracture in mandibular immature permanent incisors region.

The presented case evaluates the treatment of an alveolar fracture associated with mandibular immature lower permanent incisors. An 8-year-old girl was referred to our clinic 3 hours after the trauma. The clinical and radiographic examination of the alveoler bone showed a fracture, along with the mandibular fracture and significant segment mobility and dislocation of several immature mandibular permanent incisors. These were moving together to the lingual side because of the direct trauma associated with falling from the school wall. After the application of the buccal and lingual infiltration of local anaesthesia, the dislodged bone including the lower permanent incisors, were carefully repositioned. The teeth were splinted using semi-rigid arch bars with orthodontic brackets keeping the teeth between primary molars.The splints were removed one month later and no abnormality was observed in the immature permanent incisors. After 24 months follow up, the mandibular permanent incisors were observed to have the apical closure. Treatment of alveolar fractures in growing children with immature teeth may provide beneficial healing pattern with careful semi-rigid splinting and follow up procedures.

Management of Posterior Sternoclavicular Joint Dislocation in a Teenager After a Direct Elbow Strike to His Clavicle: A Case Report.

Posterior dislocation of the sternoclavicular joint is a rare orthopedic injury and may result in complications with high mortality due to the location of the joint, accompanied by neurovascular, tracheal, and esophageal injuries. Therefore, an immediate diagnosis and treatment are necessary to prevent complications. In this case, a 13-year-old male patient received an elbow strike to the left clavicle while playing football. The patient presented to the emergency department with complaints of pain, a gap and deformity in the superior and medial part of his sternum, and numbness in his left upper extremity. For this orthopedic emergency, which is difficult to recognize on direct radiographs, a computed tomography was done, which detected a left sternoclavicular joint posterior dislocation. A closed reduction procedure was performed on the patient under sedation in the operating theatre. A serendipity view with the fluoroscopy showed a successful closed reduction. A shoulder arm sling was applied and the patient was followed regularly. In the fourth week, the shoulder arm sling was removed and exercises were started to increase joint movements. In the sixth week, muscle strengthening exercises were started and in the eighth week, a full range of motion was reached with full muscle strength without any deformity. In this case, possible mortal complications were prevented with early intervention in the posterior dislocation of the sternoclavicular joint. This case report shows that with timely rehabilitation, it is possible to achieve full joint range of motion of the shoulder and full muscle strength without deformity or the need for surgery.

Fratura de patela com ruptura do tendão patelar em um cão: relato de caso / Patella fracture with rupture of the patellar tendon in a dog: case report

Relatou-se a ocorrência de fratura patelar associada à ruptura do tendão patelar em um cão sem raça definida, macho, atendido em um hospital veterinário escola. A técnica utilizada foi a combinação de fixação óssea com fio de Kirschner e aplicação de banda de tensão, recomendada em fraturas transversais da patela. Para reparar a lesão do tendão patelar, realizou-se a sutura tipo Kessler modificada com fio de náilon 0,80mm. No retorno do paciente, 150 dias após o procedimento cirúrgico, havia processo cicatricial ósseo avançado da patela. Concluiu-se que as medidas adotadas para reparação da lesão foram eficazes.

It is reported the occurrence of patellar fracture associated with rupture of the patellar tendon in a mongrel male dog referred to a Teaching Veterinary Hospital. The used technique was the combination of bone fixation with Kirschner wire and application of tension band recommended in most transverse fractures of the patella. To repair the damage to the patellar tendon, the modified Kessler suture with nylon 0.80mm was performed. When the patient returned 150 days after surgery, advanced bone healing process was observed in patella. It was concluded that the measures taken to repair the injury were effective.