Search results for: paediatric trauma

Authors: Aaron Akinloye

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this research focuses on the impact of jungle justice on the emotional health challenges experienced by residents in the Lagos metropolitan city in Nigeria. Jungle justice refers to the practice of individuals taking the law into their own hands and administering punishment without proper legal procedures. The aim of this study is to investigate the influence of jungle justice on the emotional challenges faced by residents in Lagos. The specific objectives of the study are to examine the effects of jungle justice on trauma, pressure, fear, and depression among residents. The study adopts a descriptive survey research design and uses a questionnaire as the research instrument. The population of the study consisted of residents in the three senatorial districts that make up Lagos State. A simple random sampling technique was used to select two Local Government Areas (Yaba and Shomolu) from each of the three senatorial districts of Lagos State. Also, a simple random sampling technique was used to select fifty (50) residents from each of the chosen Local Government Areas to make three hundred (300) residents that formed the sample of the study. Accidental sampling technique is employed to select a sample of 300 residents. Data on the variables of interest is collected using a self-developed questionnaire. The research instrument undergoes validation through face, content, and construct validation processes. The reliability coefficient of the instrument is found to be 0.84. The study reveals that jungle justice significantly influences trauma, pressure, fear, and depression among residents in Lagos metropolitan city. The statistical analysis shows significant relationships between jungle justice and these emotional health challenges (df (298) t= 2.33, p< 0.05; df (298) t= 2.16, p< 0.05; df (298) t= 2.20, p< 0.05; df (298) t= 2.14, p< 0.05). This study contributes to the literature by highlighting the negative effects of jungle justice on the emotional well-being of residents. It emphasizes the importance of addressing this issue and implementing measures to prevent such vigilante actions. Data is collected through the administration of the self-developed questionnaire to the selected residents. The collected data is then analyzed using inferential statistics, specifically mean analysis, to examine the relationships between jungle justice and the emotional health challenges experienced by the residents. The main question addressed in this study is how jungle justice affects the emotional health challenges faced by residents in Lagos metropolitan city. Conclusion: The study concludes that jungle justice has a significant influence on trauma, pressure, fear, and depression among residents. To address this issue, recommendations are made, including the implementation of comprehensive awareness campaigns, improvement of law enforcement agencies, development of support systems for victims, and revision of the legal framework to effectively address jungle justice. Overall, this research contributes to the understanding of the consequences of jungle justice and provides recommendations for intervention to protect the emotional well-being of residents in Lagos metropolitan city.

Keywords: jungle justice, emotional health, depression, anger

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Authors: Amar Ghelani

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People with auditory verbal hallucinations (AVH) who seek support from mental health services commonly report feeling unheard and invalidated in their interactions with social workers and psychiatric professionals. Current mental health training and clinical approaches have proven to be inadequate in addressing the complex nature of voice hearing. Childhood trauma is a key factor in the development of AVH and can render people more vulnerable to hearing both supportive and/or disturbing voices. Lived experiences of racism, poverty, and immigration are also associated with development of what is broadly classified as psychosis. Despite evidence affirming the influence of environmental factors on voice hearing, the Western biomedical system typically conceptualizes this experience as a symptom of genetically-based mental illnesses which requires diagnosis and treatment. Overemphasis on psychiatric medications, referrals, and directive approaches to people’s problems has shifted clinical interventions away from assessing and addressing problems directly related to AVH. The Maastricht approach offers voice hearers and mental health workers an alternative and respectful starting point for understanding and coping with voices. The approach was developed by voice hearers in partnership with mental health professionals and entails an innovative method to assess and create meaning from voice hearing and related life stressors. The objectives of the approach are to help people who hear voices: (1) understand the problems and/or people the voices may represent in their history, and (2) cope with distress and find solutions to related problems. The Maastricht approach has also been found to help voice hearers integrate emotional conflicts, reduce avoidance or fear associated with AVH, improve therapeutic relationships, and increase a sense of control over internal experiences. The proposed oral presentation will be guided by a recovery-oriented theoretical framework which suggests healing from psychological wounds occurs through social connections and community support systems. The presentation will start with a brainstorming exercise to identify participants pre-existing knowledge of the subject matter. This will lead into a literature review on the relations between trauma, intersectionality, and AVH. An overview of the Maastricht approach and review of research related to its therapeutic risks and benefits will follow. Participants will learn trauma-informed coping skills and questions which can help voice hearers make meaning from their experiences. The presentation will conclude with a review of resources and learning opportunities where participants can expand their knowledge of the Hearing Voices Movement and Maastricht approach.

Keywords: Maastricht interview, recovery, therapeutic assessment, voice hearing

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Authors: Jiping Cai, Ningzhi Wangyang, Jun Shao

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Traumatic brain injury (TBI) is one of the major causes of morbidity and mortality that leads to structural and functional damage in several parts of the brain, such as cranial nerves, optic nerve tract or other circuitry involved in vision and occipital lobe, depending on its location and severity. As a result, the function associated with vision processing and perception are significantly affected and cause blurred vision, double vision, decreased peripheral vision and blindness. Here two cases complaining of monocular vision loss (actually temporal hemianopia) due to traumatic chiasmal syndrome after frontal head injury were reported, and were compared the findings with individual case reports published in the literature. Reported cases of traumatic chiasmal syndrome appear to share some common features, such as injury to the frontal bone and fracture of the anterior skull base. The degree of bitemporal hemianopia and visual loss acuity have a variable presentation and was not necessarily related to the severity of the craniocerebral trauma. Chiasmal injury may occur even in the absence bony chip impingement. Isolated bitemporal hemianopia is rare and clinical improvement usually may not occur. Mechanisms of damage to the optic chiasm after trauma include direct tearing, contusion haemorrhage and contusion necrosis, and secondary mechanisms such as cell death, inflammation, edema, neurogenesis impairment and axonal damage associated with TBI. Beside visual field test, MRI evaluation of optic pathways seems to the strong objective evidence to demonstrate the impairment of the integrity of visual systems following TBI. Therefore, traumatic chiasmal syndrome should be considered as a differential diagnosis by both neurosurgeons and ophthalmologists in patients presenting with visual impairment, especially bitemporal hemianopia after head injury causing frontal and anterior skull base fracture.

Keywords: bitemporal hemianopia, brain injury, optic chiasma, traumatic chiasmal syndrome.

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Authors: F. Christie, M. Staber

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Malnutrition is a predictor of poor clinical outcome in the elderly. Up to 60% of hip fracture patients are clinically malnourished on admission. This study assessed the perioperative nutritional state of patients admitted with a proximal femoral fracture and examined if adequate nutritional support was achieved. Methods: Prospective, the observational audit of 30 patients, admitted with a proximal femoral fracture, over a one-month period. We recorded: patient demographics; surgical delay; nutritional state on admission; documentation of Malnutrition Universal Screening Tool (MUST) score; dietician input and daily calorie intake through food charts. The nutritional state was re-assessed weekly and at discharge. The outcome was measured by the length of hospital stay and thirty-day mortality. Results: Mean age 87, M:F 1:2 and all patients were ASA three or four. Five patients (17%) had a prolonged ( >24 hours) fasting period. All patients had a MUST score completed on admission, 27% were underweight and 30% were high risk for malnutrition. Twenty-six patients (87%) were appropriately assessed for dietician referral. Thirteen patients had food charts; on average, hospital meals provided 1500kcal daily. No patient achieved > 75% of the provided calories with 69% of patients achieving 50% or less. Only three patients were started on nutritional supplements. Twenty-three patients (77%) lost weight, averaging 6% weight loss during admission. Mean length of stay (LOS) was 23 days and 30-day mortality 9%. Four patients (13%) gained weight, their mean LOS was 17 days and 30-day mortality 0%. Discussion: Malnutrition in the elderly originates in the community. Following major trauma it’s difficult to reverse nutritional deficits in hospitals. It’s therefore concerning that no high-risk patient achieved their recommended calorie intake. Perioperative optimisation needs to include early nutritional intervention, early anaesthetic review and adjusted anaesthetic techniques to support feeding.

Keywords: trauma, nutrition, neck of femur fracture

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Authors: Sara Santos, Cristina Saraiva, Sónia Saraiva

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The objective of this study was to evaluate the welfare of reared broilers using scoring systems at the slaughterhouse. The welfare of broilers from 70 different flocks was assessed in three different slaughterhouses, regarding 373043 animals, although not in equal proportions in each slaughterhouse due to the difference in the amount of flocks slaughtered per day because of different company size. Twenty-one flocks were evaluated in slaughterhouse A (30%), thirty in slaughterhouse B (42,9%) and nineteen in slaughterhouse C (27,1%). The parameters evaluated were feather cleanness, foot pad dermatitis, hock burn, breast burn and causes of carcass condemnation. Feather cleanness was scored into three classes: 0=clean; 1=moderately dirty and 2=dirty feathers. Foot pad dermatitis, hock burn and breast ulcer were graded in three classes: 0=no lesions, 1=moderate lesions and 2=severe lesions. Causes of carcass condemnation were divided into emaciation, ascites, colour alteration and febrile state, arthritis, aerosaculitis, dermatitis, peritonitis, myositis, cellulitis, extensive trauma and technopathies as mechanical trauma, insufficient bleeding and deficient plucking. Broilers evaluated had a body weight ranging between 0,909kg and 2,588kg (median 1,522kg) and age between 25 days and 45 days (median 33 days). Rejection rate of flocks ranged between 0,1% and 10,48% (median 1,4029%) and footpad dermatitis total score between 2 and 197, resulting in 20 flocks presenting moderate lesions and 15 flocks with severe lesions. Moderate hock burn was associated with severe foot pad dermatitis and with breast burn. The associations between these lesions suggest that the development of contact dermatitis is caused by a common cause, the prolonged contact with litter of poor quality. In conclusion, contact dermatitis lesions, mostly foot pad dermatitis, feather hygiene conditions and rejection rate were the main restrictions of good welfare and considered important indicators for the follow-up on the farm conditions.

Keywords: broiler, dermatitis, welfare, slaughterhouse

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Authors: Chi S. Lee

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Marvel superhero movies have obtained its unprecedented popularity around the globe. It is a dominant narrative in current scholarship on superhero studies that the political trauma of America, such as attack of September 11, and the masculinity represented in superhero genre are symbolically connected in a way of remasculinization, a standardized plot that before becoming a superhero, a man has to overcome its trauma in his life. Through this standardized plot, American audience finds their pleasure in the spectatorship of equating this plot of remasculinization with the situation of America, rewriting their traumatic memory and resolving around the economic, social, political, and psychological instability of precarity in their own context. Shifting the context to Hong Kong, where Marvel superhero movies have been reaching its dominant status in the local film market, this analysis finds its limitation in explaining the connection between text and context. This article aims to retain this connection through investigation of the Hong Kong audience’s spectatorship. It is argued that the masculinity represented in Marvel superhero movies no longer fits into the stereotypical image of superhero, but presents itself in crisis. This crisis is resolved by the technological excess of the superpower, namely, technological remasculinization. The technological remasculinization offers a sense of futurity through which it is felt that this remasculinization can be achieved in the foreseeable future instead of remaining imaginary and fictional. In this way, the political crisis of Hong Kong is gendered as masculinity in crisis which is worth being remasculinized in the future. This gendering process is a historical product as the symbolic equation between politics and masculinity has for long been encoded in the colonial history of Hong Kong. In short, Marvel superhero’s masculinity offers a sense of masculine hope for the Hong Kong audiences to overcome the political crisis they confront in reality through a postponed identification with the superhero’s masculinity. After the discussion of the Hong Kong audience’s spectatorship on Marvel superhero movies with the insights casted by spectatorship theory, above idea is generated.

Keywords: political crisis in Hong Kong, Marvel superhero movies, spectatorship, technological remasculinization

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Authors: Tara Hunter, Kristine Concepcion, Wendy Cheng, Brianna Pike, Jane Estoesta, Anne Stuart

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In 2015, Family Planning NSW was contracted by the NSW Ministry of Health to design and deliver Sexual Safety Policy training (SSPT) to mental health professionals across NSW. The training was based on their current guidelines and developed in consultation with an expert reference group. From October 2015 to April 2017 it was delivered to over 2,400 mental health professionals with a view to supporting implementation of consistent prevention and intervention related to sexual safety in the mental health setting. An evaluation was undertaken to determine the knowledge and confidence of participants related to sexual safety before and after the training, and whether any improvements were translated into changes in practice. Participants were invited to complete a survey prior to the training, upon completion and three to six months thereafter. Telephone interviews were conducted among service managers and mental health champions six months post-training. Prior to training, the majority of mental health professionals reported being slightly to moderately confident in identifying a sexual safety incident. When asked on their understanding of sexual safety, gender sensitive practice and trauma informed care, they reported no confidence, slight confidence and moderate confidence. Immediately after the training, 54.5% reported being very confident and 10.9% extremely confident in identifying a sexual safety incident. More than half felt very confident or extremely confident in their understanding of sexual safety principles. The impact survey (six months later) found that the majority of participants (91%) were highly confident in identifying a sexual safety incident. Telephone interviewees reported a change in workplace culture and increased awareness after the training. Mental health professionals experienced increased knowledge and confidence about sexual safety principles following the training and were able to implement positive changes and concrete actions to better address sexual safety issues in their workplace.

Keywords: sexual safety, mental health professionals, trauma informed care, policy training

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Authors: R. Gwynn, P. Panwalkar, K. Veravalli , M. Tofighi, R. Clement, A. Mofidi

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The aim of this study was to access the impact of Covid-19 and lockdown on the incidence, injury pattern, and treatment of tibial plateau fractures in a combined rural and urban population in wales. Methods: Retrospective study was performed to identify tibial plateau fractures in 15-month period of Covid-19 lockdown 15-month period immediately before lockdown. Patient demographics, injury mechanism, injury severity (based on Schatzker classification), and associated injuries, treatment methods, and outcome of fractures in the Covid-19 period was studied. Results: The incidence oftibial plateau fracture was 9 per 100000 during Covid-19, and 8.5 per 100000, and both were similar to previous studies. The average age was 52, and female to male ratio was 1:1 in both control and study group. High energy injury was seen in only 20% of the patients and 35% in the control groups (2=12, p<0025). 14% of the covid-19 population sustained other injuries as opposed 16% in the control group(2=0.09, p>0.95). Lower severity isolated lateral condyle fracturesinjury (Schatzker 1-3) were seen in 40% of fractures this was 60% in the control populations. Higher bicondylar and shaft fractures (Schatzker 5-6) were seen in 60% of the Covid-19 group and 35% in the control groups(2=7.8, p<0.02). Treatment mode was not impacted by Covid-19. The complication rate was low in spite of higher number of complex fractures and the impact of covid-19 pandemic. Conclusion: The associated injuries were similar in spite of a significantly lower mechanism of injury. There were unexpectedly worst tibial plateau fracture based Schatzker classification in the Covid-19 period as compared to the control groups. This was especially relevant for medial condyle and shaft fractures. This was postulated to be caused by reduction in bone density caused by lack of vitamin D and reduction in activity. The treatment mode and outcome was not impacted by the impact of Covid-19 on care for tibial plateau fractures.

Keywords: Covid-19, knee, tibial plateau fracture, trauma

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Authors: Maya Agarwala

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Objectives: Audit the quality of clinical photographs taken for Orthodontic patients at Queen’s hospital, Romford. Design and setting: All Orthodontic photographs are taken in the Medical Photography Department at Queen’s Hospital. Retrospective audit with data collected between January - March 2023. Gold standard: Institute of Medical Illustrators (IMI) standard 12 photographs: 6 extraoral and 6 intraoral. 100% of patients to have the standard 12 photographs meeting a satisfactory diagnostic quality. Materials and methods: 30 patients randomly selected. All photographs analysed against the IMI gold standard. Results: A total of 360 photographs were analysed. 100% of the photographs had the 12 photographic views. Of which, 93.1% met the gold standard. Of the extraoral photos: 99.4% met the gold standard, 0.6% had incorrect head positioning. Of the intraoral photographs: 87.2% met the gold standard. The most common intraoral errors were: the presence of saliva pooling (7.2%), insufficient soft tissue retraction (3.3%), incomplete occlusal surface visibility (2.2%) and mirror fogging (1.1%). Conclusion: The gold standard was not met, however the overall standard of Orthodontic photographs is high. Further training of the Medical Photography team is needed to improve the quality of photographs. Following the training, the audit will be repeated. High-quality clinical photographs are an important part of clinical record keeping.

Keywords: orthodontics, paediatric, photography, audit

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Authors: Jeounghee Kim

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Objective: To describe the incidence of complication, according to the stage of Traumatic Spinal Cord Injury (TSCI) which was treated at Asan Medical Center (AMC), Korea. Hereafter, it should be developed in nursing management protocol of traumatic SCI. Methods. Retrospectively reviewed hospital records about the patients who were admitted AMC Patients with traumatic spinal cord injury until January 2005 and December 2016 were analyzed (n=97). AMC is a single institution of 2,700 beds where patients with trauma and severe trauma can be treated. Patients who were admitted to the emergency room due to spinal cord injury and who underwent intensive care unit, general ward, and rehabilitation ward. To identify long-term complications, we excluded patients who were operated on to other hospitals after surgery. Complications such as respiratory(pneumonia, atelectasis, pulmonary embolism, and others), cardiovascular (hypotension), urinary (autonomic dysreflexia, urinary tract infection (UTI), neurogenic bladder, and others), and skin systems (pressure ulcers) from the time of admission were examined through medical records and images. Results: SCI was graded according to ASIA scale. The initial grade was checked at admission. (grade A 55(56.7%), grade B 14(14.4)%, grade C 11(11.3%), grade D 15(15.5%), and grade E 2(2.1%). The grade was rechecked when the patient was discharged after treatment. (grade A 43(44.3%), grade B 15(15.5%), grade C 12(12.4%), grade D 21(21.6%), and grade E 6(6.2%). The most common complication after SCI was UTI 24cases (mean 36.5day), sore 24cases (40.5day), and Pneumonia which was 23 cases after 10days averagely. The other complications after SCI were neuropathic pain 19 cases, surgical site infection 4 cases. 53.6% of patient who had SCI were educated about intermittent catheterization at discharge from hospital. The mean hospital stay of all SCI patients was 61days. Conclusion: The Complications after traumatic SCI were developed at various stages from acute phase to chronic phase. Nurses need to understand fully the time-course of complication in traumatic SCI to provide evidence-based practice.

Keywords: spinal cord injury, complication, nursing, rehabilitation

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Authors: Remya Radhakrishnan, Hema Perinbanathan, Anukriti Rath, Reshmi Ramachandran, Rohith Thazhathuvetil Sasindrababu, Maria Karizhenskaia

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Childhood adversities have lasting effects on health and well-being. This abstract explores the connection between adverse childhood experiences (ACEs) and health consequences, including substance abuse and obesity. Understanding the impact of childhood trauma and emphasizing the importance of culturally sensitive treatments and focused interventions help to mitigate these effects. Research consistently shows a strong link between ACEs and poor health outcomes. Our team conducted a comprehensive literature review of depression and anxiety in Canadian children and youth, exploring diverse treatment methods, including medical, psychotherapy, and alternative therapies like art and music therapy. We searched Medline, Google Scholar, and St. Lawrence College Library. Only original research papers, published between 2012 and 2023, peer-reviewed, and reporting on childhood adversities on health and its treatment methods in children and youth in Canada were considered. We focused on their significance in treating depression and anxiety. According to the study's findings, the prevalence of adverse childhood experiences (ACEs) is still a significant concern. In Canada, 40% of people report having had multiple ACEs, and 78% report having had at least one ACE, highlighting the persistence of childhood adversity and indicating that the issue is unlikely to fade off in the near future. Likewise, findings revealed that individuals who experienced abuse, neglect, or violence during childhood are likelier to engage in harmful behaviors like polydrug use, suicidal ideation, and victimization and suffer from mental health problems such as depression and post-traumatic stress disorder (PTSD).

Keywords: adverse childhood experiences (ACEs), obesity, post-traumatic stress disorder (PTSD), resilience, substance abuse, trauma-informed care

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Authors: Majse Lind, Carla Sharp, Salome Vanwoerden

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Narrative identity is the dynamic and evolving story individuals create about their personal pasts, presents, and presumed futures. This storied sense of self develops in adolescence and is crucial for fostering a sense of self-unity and purpose in life. A growing body of work has shown that several characteristics of narrative identity are disturbed in adults suffering from borderline personality disorder (BPD). Very little research, however, has explored the stories told by adolescents with BPD features. Investigating narrative identity early in the lifespan and in relation to personality pathology is crucial; BPD is a developmental disorder with early signs appearing already in adolescence. In the current study, we examine narrative identity (focusing on themes of agency and communion) coded from self-defining memories derived from the child attachment interview in 174 inpatient adolescents (M = 15.12, SD = 1.52) at the time of admission. The adolescents’ social cognition was further assessed on the basis of their reactions to movie scenes (i.e., the MASC movie task). They also completed a trauma checklist and self-reported BPD features at three different time points (i.e., at admission, at discharge, and 6 months after admission). Preliminary results show that adolescents who told stories containing themes of agency and communion evinced better social cognition, and lower emotional abuse on the trauma checklist. In addition, adolescents who disclosed stories containing lower levels of agency and communion demonstrated more BPD symptoms at all three time points, even when controlling for the occurrence of traumatic life events. Surprisingly, social cognitive abilities were not significantly associated with BPD features. These preliminary results underscore the importance of narrative identity as an indicator, and potential cause, of incipient personality pathology. Thus, focusing on diminished themes of narrative-based agency and communion in early adolescence could be crucial in preventing the development of personality pathology over time.

Keywords: borderline personality disorder, inpatient adolescents, narrative identity, follow-ups

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Authors: Mumtaz Mooncey, Alexander Jolly, Megan Fisher, Kerry Robinson, Robert Lloyd, Dave Fielding

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Introduction: The integration of the WingFactors in-situ simulation programme has transformed the education landscape at the Whittington Health NHS Trust. To date, there have been a total of 90 simulations - 19 aimed at Paediatric trainees, including 2 Child and Adolescent Mental Health (CAMHS) scenarios. The opportunity for joint debriefs provided by clinical faculty and airline pilots, has created a new exciting avenue to explore human factors within psychiatry. Through the use of real clinical environments and primed actors; the benefits of high fidelity simulation, interdisciplinary and interprofessional learning has been highlighted. The use of in-situ simulation within Psychiatry is a newly emerging concept and its success here has been recognised by unanimously positive feedback from participants and acknowledgement through nomination for the Health Service Journal (HSJ) Award (Best Education Programme 2021). Methodology: The first CAMHS simulation featured a collapsed patient in the toilet with a ligature tied around her neck, accompanied by a distressed parent. This required participants to consider:; emergency physical management of the case, alongside helping to contain the mother and maintaining situational awareness when transferring the patient to an appropriate clinical area. The second simulation was based on a 17- year- old girl attempting to leave the ward after presenting with an overdose, posing potential risk to herself. The safe learning environment enabled participants to explore techniques to engage the young person and understand their concerns, and consider the involvement of other members of the multidisciplinary team. The scenarios were followed by an immediate ‘hot’ debrief, combining technical feedback with Human Factors feedback from uniformed airline pilots and clinicians. The importance of psychological safety was paramount, encouraging open and honest contributions from all participants. Key learning points were summarized into written documents and circulated. Findings: The in-situ simulations demonstrated the need for practical changes both in the Emergency Department and on the Paediatric ward. The presence of airline pilots provided a novel way to debrief on Human Factors. The following key themes were identified: -Team-briefing (‘Golden 5 minutes’) - Taking a few moments to establish experience, initial roles and strategies amongst the team can reduce the need for conversations in front of a distressed patient or anxious relative. -Use of checklists / guidelines - Principles associated with checklist usage (control of pace, rigor, team situational awareness), instead of reliance on accurate memory recall when under pressure. -Read-back - Immediate repetition of safety critical instructions (e.g. drug / dosage) to mitigate the risks associated with miscommunication. -Distraction management - Balancing the risk of losing a team member to manage a distressed relative, versus it impacting on the care of the young person. -Task allocation - The value of the implementation of ‘The 5A’s’ (Availability, Address, Allocate, Ask, Advise), for effective task allocation. Conclusion: 100% of participants have requested more simulation training. Involvement of airline pilots has led to a shift in hospital culture, bringing to the forefront the value of Human Factors focused training and multidisciplinary simulation. This has been of significant value in not only physical health, but also mental health simulation.

Keywords: human factors, in-situ simulation, inter-professional, multidisciplinary

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Authors: Sumanta Meher, Gaurav Shukla

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The torments of the victims of terrorism have not only confined to loss of life and limp but also includes the physiological trauma to the innocent victims. The physical wounds may heal, but the trauma remains in the mind and heart of the victims and their loved ones; however, one should not deny that these terrorist activities affect to a major extent to their livelihood. To protect their human rights and restore the shattered lives of the victims of terrorism all the Nations beyond their differences have to show solidarity and frame a comprehensive restorative policy with an effective implementing mechanism. The General Assembly of United Nations, through its several resolutions, has appealed Nations to show solidarity and also committed to helping the Members State to frame the law and policy to support the victims of terrorism. To achieve the objectives of the resolutions adopted by the United Nations, the Indian legislators in 2008 amended the Code of Criminal Procedure, 1973 and incorporated Section 357A to provide financial assistance to the victims of terrorism. In India, the contemporary developments in the victims’ oriented studies have increased the dimension of the traditional criminal justice systems to protect the rights of the victims. In this regard, the paper has ascertained the Indian legal framework in respect to the restorative justice to the victims of terrorism and also addressed the question as to whether the statutory provisions and enforcement mechanisms are efficient enough to protect the human rights of the victims of terrorism. For that purpose, the paper has analyzed the International instruments and the reports with regard to the compensation to the victims of terrorist attacks, with that, the article also evaluates the initiatives of United Nations to help Members State to frame the law and policies to support the victims of terrorism. The study also made an attempt to critically analyze the legal provisions of compensation and rehabilitation of the victims of terrorist attacks in India and whether they are in alignment with the International standards. While concluding, the paper has made an endeavor for a robust legal framework towards the restorative justice for the victims of terrorism in India.

Keywords: victims of terrorism, restorative justice, human rights, criminal justice system of India

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Authors: Barnali Saha

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Dalit writing is the interventionalist voice of the dispossessed subaltern in the cultural economy of the society. As such, Dalit writing, including Dalit poetry, considers the contradictions that permeate the socio-cultural structure historically allocated and religiously sanctioned in the Indian subcontinent. As an epicenter of all Dalit experiences of trauma and violence, the poetics the Dalit body is deeply rooted in the peripheral space socially assigned to it by anachronistic caste-based litigation. An appraisal of Dalit creative-critical work by writers like Sharan Kumar Limbale, Arjun Dangle, Namdeo Dhasal, Om Prakash Valmiki, Muktibodh and others underscore the conjunction of the physical, psychical and the psychological in their interpretation of Dalit consciousness. They put forward the idea that Dalit poetry is begotten by the trauma of societal oppression and therefore, Dalit language and its revitalization are two elements obdurately linked to Dalit poetics. The present research paper seeks to read the problematization of the Dalit agency through the conduit of the Dalit voice wherein the anatomical category of the mouth is closely related to the question of Dalit identity. Theoretically aligned to Heidegger’s notion of language as the house of being and Bachelard’s assertion of a house as an ideal metaphor of poetic imagination and Dylan Trigg’s view of the coeval existence of space and body, the paper examines a series of selected poems by Dalit poetic voices to examine how their distinct Dalit point of view underscores Dalit speech and directs our attention to the historical abstraction of it. The paper further examines how speech as a category in Dalit writing places the Dalit somatic entity as a site of contestation with the ‘Mouth’ as a loaded symbolic category inspiring rebellion and resistance. And as the quintessential purpose of Dalit literature is the unleashing of Dalit voice from the anti-verbal domain of social decrepitude, Dalit poetry needs to be critically read based on the experience of the mouth and the patois.

Keywords: Dalit, poetry, speech, mouth, subaltern, minority, exploitation, space

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Authors: I. Iroka, L. Mgidlana, J. Willoughby, S. Dhlamini, P. Nxumalo, S. Sefadi, A. Mthembu, E. Gerber, E. Brits

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Introduction: Nephroblastoma is a common paediatric tumor with good survival rates when diagnosed and treated early. Method: This retrospective study aimed to describe the patients with nephroblastoma seen at Universitas Academic Hospital Complex between the years 2000 and 2020. Results: In the study period, there were 207 patients identified. The patient profile had slightly more male than female patients; the median age was under four years of age. The study found a median delay of one month between symptom onset and diagnosis; a common cause was a delay in seeking care. Patients diagnosed and treated more than a month after symptoms started had poorer survival rates. There was a higher rate of Stage IV disease compared to similar studies in South Africa. Good preoperative histology and no relapse had good survival rates.. Patients from Lesotho had longer delays and presented with more severe diseases than the South African cohort. Conclusion: Early identification and treatment lead to better outcomes. Health-seeking behaviour, misdiagnosis, and referral delays might contribute to the long delays. A targeted study for patients from Lesotho is recommended.

Keywords: nephroblastoma, South Africa, Lesotho, developing country

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Authors: Christopher S. Perez, Kendal C. Boyd

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global suicide rates have decreased in recent decades, rates in the United States have increased by 35.2 percent since 1999.American Indians and Alaska Natives (AI/AN) have the highest rates of suicide in the U.S., with approximately 22 suicides per 100,000 people as of 2019. AI/AN have experienced significant historical trauma resulting in disproportionate rates of substance abuse and mental disorders. This literature review aimed to identify the demographic and clinical risk and protective factors for American Indians and Alaska Natives and provide an overview of suicidality in this population. The literature reflected varying definitions of suicidality depending on region, with some AI/AN tribesconceptualizing suicide through a spiritual framework, while others defined suicide in the biomedical sense. Furthermore, AI/AN adults and adolescents experienced higher rates of suicidal ideation when compared to other racial groups. Religious preference, sexual orientation, prior suicidal behavior, psychiatric admission, history of abuse, substance abuse, family history of mental illness, family history of substance abuse, family history of suicidal behaviors, domestic violence, and trauma were discussed as factors related to suicidality. Recommendations included increasing access to and utilization of mental health and medical services, culturally adapting suicide prevention programs to AI/AN communities, increasing support for LGBTQ+ AI/AN, providing opportunities that reinforce ethnic identity, and post-hospitalization follow-up care. The following databases were utilized to obtain peer-reviewed articles for this literature review: Complementary Index, Academic Search Premier, Science Direct, PsycInfo, Social Sciences Citation Index, PsycArticles, PubMed, EbscoHost, and PsycBooks. Articles that examined Native populations outside of the United States did not cite a primary source and/or were published before 1990 were excluded.

Keywords: alaska native, american indian, protective factors, risk factors, suicidality, suicide

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Authors: Glenda Wrenn, Juliet Muzere, Meldra Hall, Allyson Belton, Kisha Holden, Chanita Hughes-Halbert, Martha Kent, Bekh Bradley

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Understanding the help seeking decision making process and experiences of health disparity populations with posttraumatic stress disorder (PTSD) is central to development of trauma-informed, culturally centered, and patient focused services. Yet, little is known about the decision making process among adult Black women who are non-treatment seekers as they are, by definition, not engaged in services. Methods: Audiotaped interviews were conducted with 30 African American adult women with clinically significant PTSD symptoms who were engaged in primary care, but not in treatment for PTSD despite symptom burden. A qualitative interview guide was used to elucidate key themes. Independent coding of themes mapped to theory and identification of emergent themes were conducted using qualitative methods. An existing quantitative dataset was analyzed to contextualize responses and provide a descriptive summary of the sample. Results: Emergent themes revealed that active mental avoidance, the intermittent nature of distress, ambivalence, and self-identified resilience as undermining to help seeking decisions. Participants were stuck within the help-seeking phase of ‘recognition’ of illness and retained a sense of “it is my decision” despite endorsing significant social and environmental negative influencers. Participants distinguished ‘help acceptance’ from ‘help seeking’ with greater willingness to accept help and importance placed on being of help to others. Conclusions: Elucidation of the decision-making process from the perspective of non-treatment seekers has implications for outreach and treatment within models of integrated and specialty systems care. The salience of responses to trauma symptoms and stagnation in the help seeking recognition phase are findings relevant to integrated care service design and community engagement.

Keywords: culture, help-seeking, integrated care, PTSD

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Authors: Jake Hindmarch, Edward Farley, Norman Eizenberg, Mark Midwinter

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There is a need to bring the anatomical knowledge of medical students up to the standards required by surgical specialties. Contention exists amongst anatomists, clinicians, and surgeons about the standard of anatomical knowledge medical students need. The aim of this study was to explore the standards which the Royal Australasian College of Surgeons are applying knowledge of anatomy. Furthermore, to align medical school teaching to what the surgical profession requires from graduates.: The 2018 volume of the ANZ Journal of Surgery was narrowed down to 254 articles by applying the search term “Anatomy”. The main topic was then extracted from each paper. The content of the paper was assessed for ‘novel description’ or ‘application’ of anatomical knowledge’ and classified accordingly. The majority of papers with an anatomical focus was from the general surgery specialty, which focused on surgical techniques, outcomes and management. Vascular surgery had the highest percentage of papers with a novel description and application of anatomy. Cardiothoracic and paediatric surgery had no papers with a novel description of anatomy. Finally, a novel application of anatomy was the main focus of each speciality. Firstly, a high proportion of novel applications and descriptions of anatomy are in general surgery. Secondly, vascular surgery had the largest proportion of novel application and description of anatomy, namely due to the rise of therapeutic imaging and endovascular techniques. Finally, all disciplines demonstrated a trend towards having a higher proportion of novel application of anatomical knowledge

Keywords: anatomical knowledge, anatomy, surgery, novel anatomy

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Authors: Elvis Munyoka

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While the number of African refugees settling in Australia has significantly increased since the mid-1990s, the marginalisation and exclusion of young people from refugee backgrounds in employment remain a critical challenge. Unemployment or underemployment can negatively impact refugees in multiple areas, such as income, housing, life satisfaction, and social status. Higher rates of unemployment among refugees are linked in part to the intersection of pre-migration and daily challenges like trauma, racism, gender identity, and English language competency, all of which generate multiple employability disadvantages. However, the intersection of gender, race, social class, and age in impacting African refugee youth’s access to employment has received less attention. Using a qualitative case study approach, the presentation will explore how gender, race, social class, and age influence African refugee youth graduates’ access to employment in South Australia. The intersectionality theory and capability approach to social justice is used to explore intersecting factors impacting African refugee youth’s access to employment in South Australia. Participants were 16 African refugee graduates aged 18-30 living in South Australia who took part in the study for one year. Based on the trends in the data, the results suggest that long-term unemployment and underemployment, coupled with ongoing racism and marginalisation, have the potential to make refugees more vulnerable to several mental disorders such as depression, hopelessness, and suicidal thoughts. The analysis also reveals that resettlement challenges may limit refugees’ ability to recover from pre-migration trauma. The impact of resettlement challenges on refugee mental health highlights the need for comprehensive policy interventions to address the barriers refugees face in finding employment in resettlement communities. With African refugees constituting such an important part of Australian society, they should have equal access to meaningful employment, as decent work promotes good mental health, successful resettlement, hope, and self-sufficiency.

Keywords: African refugees, employment, mental health, Australia, underemployment

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Authors: Elvis Munyoka

Abstract:

While the number of African refugees settling in Australia has significantly increased since the mid-1990s, the marginalisation and exclusion of young people from refugee backgrounds in employment remain a critical challenge. Unemployment or underemployment can negatively impact refugees in multiple areas, such as income, housing, life satisfaction, and social status. Higher rates of unemployment among refugees are linked in part to the intersection of pre-migration and daily challenges like trauma, racism, gender identity, and English language competency, all of which generate multiple employability disadvantages. However, the intersection of gender, race, social class, and age in impacting African refugee youth’s access to employment has received less attention. Using a qualitative case study approach, the paper will explore how gender, race, social class, and age influence African refugee youth graduates’ access to employment in South Australia. The intersectionality theory and capability approach to social justice is used to explore intersecting factors impacting African refugee youth’s access to employment in South Australia. Participants were 16 African refugee graduates aged 18-30 living in South Australia who took part in the study for one year. Based on the trends in the data, the results suggest that long-term unemployment and underemployment, coupled with ongoing racism and marginalisation, have the potential to make refugees more vulnerable to several mental disorders such as depression, hopelessness, and suicidal thoughts. The analysis also reveals that resettlement challenges may limit refugees’ ability to recover from pre-migration trauma. The impact of resettlement challenges on refugee mental health highlights the need for comprehensive policy interventions to address the barriers refugees face in finding employment in resettlement communities. With African refugees constituting such an important part of Australian society, they should have equal access to meaningful employment, as decent work promotes good mental health, successful resettlement, hope, and self-sufficiency.

Keywords: African refugee youth, mental health, employment, resettlement, racism

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Authors: O. Davies, K. Veravalli, P. Panwalkar, M. Tofighi, P. Butterick, B. Healy, A. Mofidi

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Vancomycin resistant enterococcus infection is a condition that usually impacts ICUs, transplant, dialysis, and cancer units, often as a nosocomial infection. After an outbreak in the acute trauma and orthopaedic unit in Morriston hospital, we aimed to access the conditions that predispose VRE infections in our unit. Thirteen cases of VRE infection and five cases of VRE colonisations were identified in patients who were treated for orthopaedic care between 1/1/2020 and 1/11/2021. Cases were reviewed to identify predisposing factors, specifically looking at age, presenting condition and treatment, presence of infection and antibiotic care, active haemo-oncological condition, long term renal dialysis, previous hospitalisation, VRE predisposition, and clearance (PREVENT) scores, and outcome of care. The presenting condition, treatment, presence of postoperative infection, VRE scores, age was compared between colonised and the infected cohort. VRE type in both colonised and infection group was Enterococcus Faecium in all but one patient. The colonised group had the same age (T=0.6 P>0.05) and sex (2=0.115, p=0.74), presenting condition and treatment which consisted of peri-femoral fixation or arthroplasty in all patients. The infected group had one case of myelodysplasia and four cases of chronic renal failure requiring dialysis. All of the infected patient had sustained an infected complication of their fracture fixation or arthroplasty requiring reoperation and antibiotics. The infected group had an average VRE predisposition score of 8.5 versus the score of 3 in the colonised group (F=36, p<0.001). PREVENT score was 7 in the infected group and 2 in the colonised group(F=153, p<0.001). Six patients(55%) succumbed to their infection, and one VRE infection resulted in limb loss. In the orthopaedic cohort, VRE infection is a nosocomial condition that has peri-femoral predilection and is seen in association with immunosuppression or renal failure. The VRE infection cohort has been treated for infective complication of original surgery weeks prior to VRE infection. Based on our findings, we advise avoidance of infective complications, change of practice in use of antibiotics and use radical surgery and surveillance for VRE infections beyond infective precautions. PREVENT score shows that the infected group are unlikely to clear their VRE in the future but not the colonised group.

Keywords: surgical site infection, enterococcus, orthopaedic surgery, vancomycin resistance

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Authors: Merve Colak, Gizem Donmez Yalcin

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Glutamate has many neurological functions in the central nervous system and is found at high concentrations in the brain. Increased levels of glutamate in the neuronal space are toxic, causing neuron damage and death. This is called glutamate-induced excitotoxicity. Excitotoxicity is among the causes of many neurological diseases such as trauma, cerebral ischemia, epilepsy, Parkinson's Disease, Alzheimer's Disease. Since neuroblastoma cells are known to be excitotoxic, we propose that excitotoxicity can be studied in neuroblastoma cells. Excitotoxicity can be induced using kainic acid in neuroblastoma cells. Measuring the secretion of glutamate, excitotoxicity can be analyzed in neuroblastoma cells.

Keywords: glutamate, excitotoxicity, kainic acid, Sirt4

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Authors: Mohammad Mahbub Alam Talukder, Shahnewaz, Hasanat-E-Rabbi, Mohammed Nazrul Islam

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Road traffic accident is a global problem which is severe in the developing countries like Bangladesh. In consequence, in developing countries road trauma has now been recognized as an increasing public health hazards and economic burning issue. And after road traffic accidents the lack of management and economic costs related with health seeking behavior have a disproportionate impact on lower income groups, thus contributing to the persistence of poverty in conjunction with disability. This cross sectional study, carried out during July 2012 to June 2013, aimed to explore health seeking decision and culture of handling the road traffic accident related victims, as taken from experiences of the poor disabled people of slum dwellers of Dhaka city. The present study has been designed based on qualitative techniques such as in-depth interview and case studies. Additionally, a survey questionnaire was used to collect the demographic characteristics of the study population (n=150) and to select participants purposely for in-depth interview (n=50) and case study (n=30). Content analysis of qualitative data was done through theme coding and matrix analysis of case study was done to use relevant verbatim. Most of the time the health seeking decision totally depended on the surrounded people of the accidental place, their knowledge, awareness and remaining facility and capacity regarding proper management of the victims. However, most of the cases the victims did not get any early treatment and it took 2-12 hours to get even the first aid because of distance, shortage of money, lack of availability of getting the aid, lack of mass awareness etc. Under the reality of discriminated and unaffordable health service provision better treatment could not turn out due to economic inability of the poor victims. To avoid the severe trauma, treatment delay must be reduced by providing first aid within very short time and to do so, mass awareness campaign is necessary for handing the victims. Moreover, necessary measures should be taken to ensure cost free health service provision to treat the chronic disabled condition of the road traffic accident related poor victims.

Keywords: accident, injury, disabled, qualitative, slum

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Authors: Prateek Rastogi, Jenash Acharya

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Histopathology examination has been a boon to forensic experts all around the world since its implication in autopsy cases. Whenever a case of sudden death is encountered, forensic experts clandestinely focus on cardiovascular, respiratory, gastrointestinal or cranio-cerebral causes. After ruling out poisoning or trauma, they are left with the only option available, histopathology examination. Besides preserving thoracic and abdominal organs, brain tissues are very less frequently subjected for the analysis. Based on provisional diagnosis documented on hospital treatment record files, one hemisphere of grossly unremarkable cerebrum was confirmatively diagnosed by histopathology examination to be a case of cerebral toxoplasmosis.

Keywords: cerebral toxoplasmosis, sudden death, health information, histopathology

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Authors: U. K. Tamuli

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Introduction: North East India is graced with natural beauty and hazards. This area is prone to major earthquakes, floods, landslides, accidents, terrorist activities etc. Academy of Trauma (AOT), an NGO of Doctors, conducts training programs, mock drills, field trials amongst the doctors and paramedics in North East India. The present study is to evaluate the efficacy of such training in terms of sensitivity, awareness, and delivery systems of the products. Here the health care delivery system for disaster management is inadequate. Clear guideline of mass casualty management is unavailable. AOT has initiated steps to increase the awareness and handling of mass casualty management to improve the emergency health care delivery system. Method: AOT has conducted training programmes on emergency health management, mass casualty management and hospital preparedness amongst 800 doctors and 1200 paramedics in twenty-two districts of Assam in Northeast India. The training module consists of lectures, hands-on workshop using manikins, mock drills, distribution of manuals, emergency management exercises, periodic exchange of experience and debriefings. AOT evaluates the impact of these trainings by conducting pre and post tests of delegates, trainer’s evaluation, delegate’s satisfaction and confidence level and their suggestions. Results: The module, training, hands-on workshops, mock drills were highly appreciated. There is significant improvement in scores on the post-training tests. The confidence level of the participants has risen to deal with emergency medical situation Conclusion: These kinds of trainings increase the awareness of the medical members to handle mass casualties in different situations. One such training actually sensitises the delegates. Repetition of such training, TOT (Training-of-Trainers) programs, and individual efforts of delegates are extremely important for sustenance and success of health care delivery service during disasters in the developing countries. Further collaboration, assistance, networking, suggestions from established global agencies in this field will be highly appreciated.

Keywords: capacity building, North East India, non-governmental organization, trauma

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Authors: Mandy Wilson, Emma Vieira, Jocelyn Jones, Alice V. Brown, Lindey Andrews, Louise Southalan, Jackie Oakley, Dorothy Bagshaw, Patrick Egan, Laura Dent, Duc Dau, Lucy Spanswick

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Alcohol and drug dependency are pertinent issues for those experiencing homelessness. This includes Aboriginal and Torres Strait Islander people, Australia’s traditional owners, living in Perth, Western Australia (WA). Societal narratives around the drivers behind drug and alcohol dependency in Aboriginal communities, particularly those experiencing homelessness, have been biased and unchanging, with little regard for complexity. This can include the idea that Aboriginal people have ‘chosen’ to use alcohol or other drugs without consideration for intergenerational trauma and the trauma of homelessness that may influence their choices. These narratives have flow-on impacts on policies and services that directly impact Aboriginal people experiencing homelessness. In 2021, we commenced a project which aimed to listen to and elevate the voices of 70-90 Aboriginal people experiencing homelessness in Perth. The project is community-driven, led by an Aboriginal Community Controlled Organisation in partnership with a university research institute. A community-ownership group of Aboriginal Elders endorsed the project’s methods, chosen to ensure their suitability for the Aboriginal community. In this paper, we detail these methods, including semi-structured interviews influenced by an Aboriginal yarning approach – an important style of conversation for Aboriginal people which follows cultural protocols; and photovoice – supporting people to share their stories through photography. Through these engagements, we detail the reasons Aboriginal people in Perth shared for using alcohol or other drugs while experiencing homelessness. These included supporting their survival on the streets, managing their mental health, and coping while on the journey to finding support. We also detail why they sought to discontinue alcohol and other drug use, including wanting to reconnect with family and changing priorities. Finally, we share how Aboriginal people experiencing homelessness have said they are impacted by their family’s alcohol and other drug use, including feeling uncomfortable living with a family who is drug and alcohol-dependent and having to care for grandchildren despite their own homelessness. These findings provide a richer understanding of alcohol and drug use for Aboriginal people experiencing homelessness in Perth, shedding light on potential changes to targeted policy and service approaches.

Keywords: Aboriginal and Torres Strait Islander peoples, alcohol and other drugs, homelessness, community-led research

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Authors: Mauricio Plaza, Willian Aperador

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Hip disarticulation is an amputation through the hip joint capsule, removing the entire lower extremity, with a closure of the remaining musculature over the exposed acetabulum. Tumors of the distal and proximal femur were treated by total femur resection; a hip disarticulation sometimes is a performance for massive trauma with crush injuries to the lower extremity. This article discusses the design a system for rehabilitation of a patient with bilateral hip disarticulations. The prosthetics designed allowed the patient to do natural gait suspended between parallel articulate crutches with the body weight support between the crutches. The care of this patient was a challenge due to bilateral amputations at such a high level and the special needs of a patient mobility.

Keywords: amputation, prosthesis, mobility, hemipelvectomy

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Authors: KongQue

Abstract:

Palestinian novelist Anwar Hamed’s work "The Key" is a science fiction that profoundly metaphors the Palestinian issue. In the novel, Anwar Hamed uses the "key", a popular symbol of Palestinian resistance culture, to symbolize the history of "Nakba" and the Palestinians' right to return, and uses the ghost lingering outside the door of the Israelis as a metaphor Palestinians and the Palestinian issue, for being covered, hidden, and turned a blind eye. Through the literary genre of science fiction, Anwar Hamed continues the literary tradition of Palestinian writers recreating the historical trauma of the Palestinians, explores the causes of the inability to communicate between Palestine and Israel, and attempts to reawaken concern over the plight of Palestinian refugees.

Keywords: palestine, key, science fiction, arabic literature

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Authors: Selin Kara-Bahçekapılı, Bengisu Nehir Aydın

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Objective: In this study, it is aimed to examine the relationship between childhood traumas (overprotection-control, emotional/physical/sexual abuse, emotional/physical neglect), age, emotional regulation difficulties, and the tendency of violence in adults. In the study, the direct and indirect effects of 6 sub-factors of childhood traumas, emotion regulation difficulties, and age on tendency to violence are evaluated on a model that theoretically reveals. Method: The population of this cross-sectional study consists of individuals between the ages of 18-65 living in Turkey. The data from 527 participants were obtained by online surveys and convenience sampling method within the scope of the study. As a result of exclusion criteria and then outlier data analysis, the data of 443 participants were included in the analysis. Data were collected by demographic information form, childhood trauma scale, emotion regulation difficulty scale, and violence tendency scale. Research data were analyzed by SPSS and AMOS using correlation, path analysis, direct and indirect effects. Results: According to the research findings, the variables in the model explained 28.2% of the variance of the mean scores of the individuals' tendency to violence. Emotion regulation difficulties have the most direct effect on the tendency to violence (d=.387; p<.01). The effects of excessive protection and control, emotional neglect, and physical neglect variables on the tendency to violence are not significant. When the significant and indirect effects of the variables on tendency to violence over emotion regulation difficulties are examined, age has a negative effect, emotional neglect has a positive effect, emotional abuse has a positive effect, and overprotection-control has a positive effect. The indirect effects of sexual abuse, physical neglect, and physical abuse on tendency to violence are not significant. Childhood traumas and age variables in the model explained 24.1% of the variance of the mean scores of the individuals’ emotion regulation difficulties. The variable that most affects emotion regulation difficulties is age (d=-.268; p<.001). The direct effects of sexual abuse, physical neglect, and physical abuse on emotion regulation difficulties are not significant. Conclusion: The results of the research emphasize the critical role of difficulty in emotion regulation on the tendency to violence. Difficulty in emotion regulation affects the tendency to violence both directly and by mediating different variables. In addition, it is seen that some sub-factors of childhood traumas have direct and/or indirect effects on the tendency to violence. Emotional abuse and age have both direct and indirect effects on the tendency to violence over emotion regulation difficulties.

Keywords: childhood trauma, emotion regulation difficulties, tendency to violence, path analysis

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