As raízes do trauma: uma revisão sobre a história do psicotraumatismo / The roots of trauma: a review of the history of psychotrauma

Resumo A percepção do papel do trauma psicológico na origem de problemas psiquiátricos aumentou e diminuiu ao longo da história da psiquiatria. Com a concepção do transtorno de estresse pós-traumático (TEPT), entretanto, as sociedades ocidentais presenciaram uma profunda expansão do discurso do traumatismo na interpretação de experiências humanas devastadoras, como catástrofes, genocídios, desastres e epidemias. A partir de revisão bibliográfica integrativa, este artigo analisa alguns dos determinantes históricos e epistemológicos que fundamentam o surgimento da memória traumática e o estabelecimento do trauma como campo semântico que orienta respostas clínicas e estratégias políticas no campo das ciências humanas e da saúde.

Abstract Perceptions of the importance of the role of psychological trauma in the origins of psychiatric problems have oscillated throughout the history of psychiatry. However, since the conception of post-traumatic stress disorder (PTSD), western societies have witnessed a marked expansion of the discourse of trauma in the interpretation of devastating human experiences like catastrophes, genocides, disasters, and epidemics. Through an integrative literature review, this article analyzes some of the historical and epistemological determinants behind the emergence of traumatic memory and the establishment of trauma as a semantic field that orients clinical responses and political strategies in the field of the humanities and the health sciences.

Modelo teórico y marcos conceptuales de las lesiones por presión y otras heridas crónicas. Historia y desarrollo / Theoretical model and conceptual frameworks of pressure injuries and other chronic wounds. History and development

El presente artículo hace un repaso histórico por los marcos conceptuales sobre las lesiones por presión y otros tipos de heridas crónicas. En esta revisión se presentan 4 de los modelos más influyentes y representativos de las últimas décadas: a) el modelo conceptual de Braden-Bergstrom, que se desarrolló en 1987 como base teórica para el desarrollo de la escala de Braden y que identifica los factores etiológicos definidos, el aumento de la presión y la disminución de la tolerancia de los tejidos; b) el modelo teórico de las lesiones cutáneas relacionadas con la dependencia, que analiza el principal marco teórico de estas lesiones crónicas, desde su origen en 2011, su difusión en 2014 y las últimas modificaciones realizadas en 2021, en las que ya se incluyen hasta 10 tipos de lesiones distintas; c) el modelo conceptual de la dermatitis asociada a la incontinencia, este modelo hace referencia a la más frecuente de todas las lesiones cutáneas asociadas a la humedad, la dermatitis asociada a la incontinencia, de la que se analizan sus dos grandes factores etiológicos, la sobrehidratación y el aumento del pH, y d) el modelo conceptual de las lesiones por compromiso vital grave, finalmente se analiza el último y más reciente de los modelos, el de las lesiones inevitables y que se dan en las personas cuya situación vital es extremadamente grave, e incluso son el anuncio de una muerte inminente, distinguiendo entre las lesiones por fracaso multiorgánico y las lesiones por vasoconstricción extrema (AU)

This article takes a historical review through the theoretical frameworks of pressure injuries and other chronic wounds. In this review, 4 of the most influential and representative models of the last decades are presented: a) the Braden-Bergstrom conceptual framework, developed in 1987 is presented as the theoretical basis for the development of the Braden scale and the defined etiological factors are identified: increased pressure and decreased tissue tolerance; b) the theoretical model of dependence-related skin lesions, the main theoretical model of these chronic lesions is also analyzed, from its origin in 2011, its dissemination in 2014 and the latest modifications made in 2021 in which up to ten different types of lesions are already included; c) the conceptual model of incontinence-associated dermatitis, this model analyzed refers to the most important of all moisture-associated skin lesions: incontinence-associated dermatitis, analyzing the two major etiological factors: overhydration and increased pH; and d) the conceptual model of severe life-threatening injuries, finally, the last and most recent model is analyzed, that of unavoidable injuries that occurin people whose life situation is extremely serious, and even heralds imminent death, distinguishing between multiorgan dysfunction syndrome skin injuries and skin injuries by extreme vasoconstriction (AU)

Weapon injuries in the crusader mass graves from a 13th century attack on the port city of Sidon (Lebanon).

Archaeological excavations close to St Louis' castle in Sidon, Lebanon have revealed two mass grave deposits containing partially articulated and disarticulated human skeletal remains. A minimum of 25 male individuals have been recovered, with no females or young children. Radiocarbon dating of the human remains, a crusader coin, and the design of Frankish belt buckles strongly indicate they belong to a single event in the mid-13th century CE. The skeletal remains demonstrate a high prevalence of unhealed sharp force, penetrating force and blunt force trauma consistent with medieval weaponry. Higher numbers of wounds on the back of individuals than the front suggests some were attacked from behind, possibly as they fled. The concentration of blade wounds to the back of the neck of others would be compatible with execution by decapitation following their capture. Taphonomic changes indicate the skeletal remains were left exposed for some weeks prior to being collected together and re-deposited in the defensive ditch by a fortified gateway within the town wall. Charring on some bones provides evidence of burning of the bodies. The findings imply the systematic clearance of partially decomposed corpses following an attack on the city, where adult and teenage males died as a result of weapon related trauma. The skeletons date from the second half of the Crusader period, when Christian-held Sidon came under direct assault from both the Mamluk Sultanate (1253 CE) and the Ilkhanate Mongols (1260 CE). It is likely that those in the mass graves died during one of these assaults.

Review article: History of venous trauma.

ABSTRACT: This is a literature review on the history of venous trauma since the 1800s, especially that to the common femoral, femoral and popliteal veins, with focus on the early 1900s, World War I, World War II, Korean War, Vietnam War, and then civilian and military reviews (1960-2020). In the latter two groups, tables were used to summarize the following: incidence of venous repair versus ligation, management of popliteal venous injuries, patency of venous repairs when assessed <30 days from operation, patency of venous repairs when assessed >30 days from operation, clinical assessment (edema or not) after ligation versus repair, incidence of deep venous thrombosis after ligation versus repair, and incidence of pulmonary embolism after ligation versus repair.There is a lack of the following in the literature on the management of venous injuries over the past 80 years: standard definition of magnitude of venous injury in operative reports, accepted indications for venous repair, standard postoperative management, and timing and mode of early and later postoperative assessment.Multiple factors have entered into the decision on venous ligation versus repair after trauma for the past 60 years, but a surgeon's training and local management protocols have the most influence in both civilian and military centers. Ligation of venous injuries, particularly those in the lower extremities, is well tolerated in civilian trauma, although there is the usual lack of short- and long-term follow-up as noted in many of the articles reviewed. LEVEL OF EVIDENCE: Review article, levels IV and V.

A Review of "Prehospital Hypotension as a Valid Indicator of Trauma Team Activation" (2000).

Prehospital hypotension has been utilized for decades as a surrogate marker of injury severity. Several studies have discussed the correlation between injury and hypotension both in the field as well as in the emergency department. Increases have been noted in injury severity score and mortality. Resource utilization is higher in this patient population. This study revisits our original work from 2000 and reviews the current literature regarding hypotension and injury severity. We also examine the role of prehospital hypotension as an indicator of trauma team activation and resource allocation. This review serves as a part of a Literary Festschrift in honor of Dr J David Richardson's role as the Editor-in-Chief of The American Surgeon.

Las heridas de guerra de África (1858-1926) en el ejército español, con especial referencia al conocido como desastre de Annual / The war wounds of Africa (1858-1926) in the spanish army, with special reference to the known as Annual disaster

Los diferentes episodios de guerra acontecidos en el norte de África en los territorios de la región del Rif, actualmente territorio deMarruecos, con la participación del ejército español en la época del Protectorado de España, ocasionó en las partes beligerantes,numerosos muertos y también heridos. Por la características del enemigo, su forma de combatir y las armas empleadas originaronen el lado español, unas lesiones peculiares ocasionadas fundamentalmente por heridas de bala de fusil y en ocasiones de armablanca. No obstante, habría que añadir las heridas por bala de cañón en especial después del episodio de Annual, al disponer elenemigo rifeño de artillería. El ejército español tenía una Sanidad Militar estructurada con atención del herido en el campo debatalla, puestos de socorro, hospitales de evacuación y los de las ciudades, en especial Ceuta y Melilla. Los medios de trasporte delos heridos y enfermos fueron variados e iban desde la simple camilla, pasando por artolas hasta las ambulancias motorizadas. Lasheridas teniendo en cuenta la época en que se originaron, en muchos casos fueron mortales y raro fue el combatiente, sobre todo dela oficialidad que no fueron heridos en una o varias ocasiones. Se analizan en la publicación todos los aspectos relacionados con la atención de estos enfermos. (AU)

The different episodes of war that took place in North Africa in the territories of the Rif region, currently the territory of Morocco,with the participation of the Spanish army at the time of the Protectorate of Spain, caused numerous deaths and injuries to thebelligerent parties. . Due to the characteristics of the enemy, their way of fighting and the weapons used, on the Spanish side, peculiar injuries originated, mainly caused by rifle bullet wounds and sometimes by knives. However, the cannonball wounds should beadded, especially after the Annual episode, as the Riffian enemy had artillery. The Spanish army had a structured Military HealthCare for the wounded on the battlefield, aid stations, evacuation hospitals and those in the cities, especially Ceuta and Melilla.The means of transporting the wounded and sick were varied and ranged from the simple stretcher, through artolas to motorizedambulances. The injuries taking into account the time in which they originated, in many cases were fatal and the combatant wasrare, especially from the officers who were not injured on one or more occasions. All aspects related to the care of these patients are analyzed in the publication. (AU)

Trends in mortality from external causes in the Republic of Seychelles between 1989 and 2018.

Data on injury-related mortality are scarce in the African region. Mortality from external causes in the Seychelles was assessed, where all deaths are medically certified and the population is regularly enumerated. The four fields for underlying causes of death recorded were reviewed in the national vital statistics register. The age-standardised mortality rates were estimated (per 100,000 person-years) from external causes in 1989-1998, 1999-2008, and 2009-2018. Mortality rates per 100,000 person-years from external causes were 4-5 times higher among males than females, and decreased among males over the three 10-year periods (127.5, 101.4, 97.1) but not among females (26.9, 23.1, 26.9). The contribution of external causes to total mortality did not change markedly over time (males 11.6%, females 4.3% in 1989-2018). Apart from external deaths from undetermined causes (males 14.6, females 2.4) and "other unintentional injuries" (males 14.1, females 8.0), the leading external causes of death in 2009-2018 were drowning (25.9), road traffic injuries (18.0) and suicide (10.4) among males; and road traffic injuries (4.6), drowning (3.4) and poisoning (2.6) among females. Mortality from broad categories of external causes did not change consistently over time but rates of road traffic injuries increased among males. External causes contributed approximately 1 in 10 deaths among males and 1 in 20 among females, with no marked change in cause-specific rates over time, except for road traffic injuries. These findings emphasise the need for programs and policies in various sectors to address this large, but mostly avoidable health burden.

Inpatients at the St. John's General Hospital: Morbidity in Late 19th-Century Newfoundland and Labrador.

This research analyzes the role of the St. John's General Hospital in late nineteenth-century Newfoundland and Labrador using extant admission and discharge records from 17 May 1886 to 30 December 1899. Most individuals were discharged from the hospital as "cured" or "convalescent." Trauma, musculoskeletal issues, and respiratory diseases were the most common reasons for admission, with males significantly more likely to seek care for trauma, sexually transmitted infections, and kidney/bladder issues. Female inpatients were significantly more likely to be admitted for tumours/cancers, anemia, digestive issues, and issues concerning the female anatomy. Notable were the short hospital stays for tuberculosis, indicating the General played an important role before the founding of the St. John's Sanatorium. A snapshot of late nineteenth-century morbidity reveals the complex risks facing citizens of St. John's and beyond who sought care at the General, which played a key role in the rapidly modernizing medical ecosystem.

The History of Wound Healing.

Since the dawn of humanity, wounds have afflicted humans, and healers have held responsibility for treating them. This article tracks the evolution of wound care from antiquity to the present, highlighting the roles of surgeons, scientists, culture, and society in the ever-changing management of traumatic and iatrogenic injuries.

Analysis of fatal injuries in Serbian underground coal mines - 50 years review.

The study presented here analyzes mining accidents and fatal injuries in Serbian underground coal mines over a period of 50 years, in order to assess the effectiveness of legislation changes in the overall safety of work environment. Two distinct periods, prior to 2000 and after 2000 were compared. The data from the period after 2000 were further analyzed to provide better understanding of the results. In order to assess the overall state of safety in Serbian mines, the data on fatal injuries were also compared to the international data. It was found that the legislative changes are more easily accepted by the common workers than by the mine management. Consequently, the key recommendation for the safety of coal mine companies in Serbia is the investment in the new technology. Additionally, mine management should be in the focus of the mining inspection with a stronger penal policy regarding mine safety neglect.

[Violence, health and ailment of bodies in the parish of Vila Rica, eighteenth century]. / Violência, saúde e adoecimento dos corpos na comarca de Vila Rica, século XVIII.

Studies into violence in the eighteenth century tend to address questions related to justice and criminality, but not health. The aim of this study is to understand how, in eighteenth century Minas Gerais, Brazil, bodies were affected by violent acts. The investigation records from the parish of Vila Rica held at the historical archive of the Museu da Inconfidência were investigated. The results showed crimes of different kinds associated with a variety of motives, primarily crimes against the body, with the resulting bodily injuries being caused by sharp or pointed objects/instruments. There were more male victims than female, the head being the principal part of the body affected. Criminal and violent acts, very commonplace in this society, interfered in the health and disease processes of the bodies.

Estudos sobre violência no século XVIII abrangem especialmente questões relacionadas à justiça e à criminalidade, mas não à saúde. A pesquisa objetivou compreender como os corpos nas Minas Gerais setecentistas eram afetados por atos violentos. Foram investigados autos de devassas do termo de Vila Rica pertencentes ao acervo do Arquivo Histórico do Museu da Inconfidência. Os resultados mostraram crimes causados por motivos distintos e de tipologias diferentes, predominando os crimes contra o corpo, com consequentes lesões corporais provocadas predominantemente por objetos/instrumentos perfurocortantes. Os homens foram os mais acometidos, sendo a cabeça a principal região atingida. Atos criminosos e violentos, muito comuns nessa sociedade, interferiam na saúde e no adoecimento dos corpos.

Violência, saúde e adoecimento dos corpos na comarca de Vila Rica, século XVIII / Violence, health and ailment of bodies in the parish of Vila Rica, eighteenth century

Resumo Estudos sobre violência no século XVIII abrangem especialmente questões relacionadas à justiça e à criminalidade, mas não à saúde. A pesquisa objetivou compreender como os corpos nas Minas Gerais setecentistas eram afetados por atos violentos. Foram investigados autos de devassas do termo de Vila Rica pertencentes ao acervo do Arquivo Histórico do Museu da Inconfidência. Os resultados mostraram crimes causados por motivos distintos e de tipologias diferentes, predominando os crimes contra o corpo, com consequentes lesões corporais provocadas predominantemente por objetos/instrumentos perfurocortantes. Os homens foram os mais acometidos, sendo a cabeça a principal região atingida. Atos criminosos e violentos, muito comuns nessa sociedade, interferiam na saúde e no adoecimento dos corpos.

Abstract Studies into violence in the eighteenth century tend to address questions related to justice and criminality, but not health. The aim of this study is to understand how, in eighteenth century Minas Gerais, Brazil, bodies were affected by violent acts. The investigation records from the parish of Vila Rica held at the historical archive of the Museu da Inconfidência were investigated. The results showed crimes of different kinds associated with a variety of motives, primarily crimes against the body, with the resulting bodily injuries being caused by sharp or pointed objects/instruments. There were more male victims than female, the head being the principal part of the body affected. Criminal and violent acts, very commonplace in this society, interfered in the health and disease processes of the bodies.

Patterns of trauma across Andean South America: New discoveries and advances in interpretation.

In his review article John W. Verano covered trauma, warfare, trophy taking, and human sacrifice, but his discussion mostly focused on the results of studies of museum or private collections and the recent discovery of the mass human sacrifice from Huaca de la Luna. Due to the renewed interest in the paleopathology of South America, a trend which Verano observed, these types of investigations have grown exponentially in the past twenty years since his initial publication. Here we synthesize the published data on the study and interpretation of traumatic injuries across time and space and we tease out some of the themes that have emerged in the twenty odd years since the seminal paper written by Verano. We searched and analyzed publications from 1997 to 2017 that pertained specifically to Andean South America through the review of library databases and then narrowed our search to trauma-related topics. In our literature review and meta-analysis of published studies on traumatic injuries, we found that nearly one-third of publications related to the field of paleopathology in Andean South America dealt with subjects we classified under trauma (N = 116/378), such as trephination, violence, sacrifice, warfare, etc. Large sample sizes, population-focused research, advances in methods of analysis, and hypothesis driven investigations have led to sophisticated and nuanced interpretations along a wide range of themes so that we understand a great deal more about violence, sacrifice, trephination, warfare and their sociopolitical and environmental contexts in prehistoric and early colonial Andean South America.

What can we learn from the historic road safety performance of high-income countries?

Road traffic deaths in high-income countries (HICs) have been steadily declining for five decades, but are rising or stable in low- and middle-income countries (LMICs). We use time-series cross-sectional methods to assess how age- and sex- specific death rates evolved in 20 HICs during 1955-2015, controlling for income, population density and urbanization. Past work has attributed improvements in safety in HICs to income growth, suggesting that countries intervene when they become richer (Kuznets hypothesis). In contrast, we show that HICs had statistically significant declines in road traffic injuries starting in the late 1960s that persist after controlling for income effects, and inclusion of a lagged dependent variable. These findings are consistent for all age-sex groups but the effects are strongest for the elderly and young children. We argue that the reversal in the traffic injury trend did not occur because HICs reached an income threshold. Instead, the 1960s were a period of paradigmatic change in thinking about road safety. Subsequent, safety improvements occurred because countries at different income levels established regulatory institutions that had a legislative mandate and financial resources to conduct large-scale safety interventions.

Preventing motor vehicle crash injuries and deaths: science vs. folklore lessons from history.

Not long after the beginnings of motorization in the early 1900s, deaths and injuries from motor vehicle crashes became a problem in a number of high-income-countries (HIC)s, especially the United States. With the biggest problem the US led early efforts to address this issue, and for six decades these efforts were based on folklore (ie a body of widely held but false or unsubstantiated beliefs). They were not evaluated, but clearly were unsuccessful as crash deaths and injuries continued to rise. It was not until the 1970s that a broader range of countermeasures began to be adopted and was scientifically evaluated, and as a result, crash deaths and injuries declined. This history has important lessons today for many low-and-middle-income countries that have growing numbers of motor vehicle crash deaths and injuries, many of which are pedestrians and motorcyclists. This is because there continue to be advocates for many of the failed approaches (especially educational) that dominated the early efforts in HICs.

Skeletal evidence for violent trauma from the bronze age Qijia culture (2,300-1,500 BCE), Gansu Province, China.

This research explores how social and environmental factors may have contributed to conflict during the early Bronze Age in Northwest China by analyzing violent trauma on human skeletal remains from a cemetery of the Qijia culture (2300-1500 BCE). The Qijia culture existed during a period of dramatic social, technological, and environmental change, though minimal research has been conducted on how these factors may have contributed to violence within the area of the Qijia and other contemporaneous material cultures. An osteological assessment was conducted on 361 individuals (n = 241 adults, n = 120 non-adults) that were excavated from the Mogou site, Lintan County, Gansu, China. Injuries indicative of violence, including sharp- and blunt-force trauma that was sustained ante- or peri-mortem, were identified, and the patterns of trauma were analysed. Violent injuries were found on 8.58% (n = 31/361) of individuals, primarily adult males. No evidence of trauma was found on infants or children. Cranial trauma was found on 11.8% (n = 23/195) of the adult individuals examined. Of these, 43.5% (n = 10/23) presented with severe peri-mortem craniofacial trauma. The high rate of perimortem injuries and their locations indicate lethal intent. This lethality, in addition to the fact that individuals with trauma were predominantly male, suggest intergroup violence such as raiding, warfare, or feuding. Both social and environmental factors may have contributed to this conflict in the TaoRiver Valley, though future systematic archaeological and paleoenvironmental data will be needed to disentangle the many potential causal factors.