Childbirth and the development of acute trauma symptoms : incidence and contributing factors

Background: Little is known about the relationship between women's birthing experiences and the development of trauma symptoms. This study aimed to determine the incidence of acute trauma symptoms and posttraumatic stress disorder in women as a result of their labor and birth experiences, and to identify factors that contributed to the women's psychological distress. Method: Using a prospective, longitudinal design, women in their last trimester of pregnancy were recruited from four public hospital antenatal clinics. Telephone interviews with 499 participants were conducted at 4 to 6 weeks postpartum to explore the medical and midwifery management of the birth, perceptions of intrapartum care, and the presence of trauma symptoms. Results: One in three women (33%) identified a traumatic birthing event and reported the presence of at least three trauma symptoms. Twenty-eight women (5.6%) met DSM-IV criteria for acute posttraumatic stress disorder. Antenatal variables did not contribute to the development of acute or chronic trauma symptoms. The level of obstetric intervention experienced during childbirth (β= 0.351, p < 0.0001)and the perception of inadequate intrapartum care (β= 0.319, p < 0.0001) during labor were consistently associated with the development of acute trauma symptoms. Conclusions: Posttraumatic stress disorder after childbirth is a poorly recognized phenomenon. Women who experienced both a high level of obstetric intervention and dissatisfaction with their intrapartum care were more likely to develop trauma symptoms than women who received a high level of obstetric intervention or women who perceived their care to be inadequate. These findings should prompt a serious review of intrusive obstetric intervention during labor and delivery, and the care provided to birthing women.

The lived experience of PTSD for children of Australian Vietnam veterans in Australia

There is a growing area of scholarship that attests to the importance of understanding the impact of Post Traumatic Stress Disorder (PTSD) on the military family (Cozza, Chun, & Polo, 2005; Peach, 2005; Riggs, 2009; Siebler, 2003). Recent research highlights the critical role that the family plays in mitigating the effects of this condition for its members (Chase-Lansdale, Wakschlag, & Brooks-Gunn, 1995; Fiese, Foley, & Spagnola, 2006; Hetherington & Blechman, 1996; Pinkerton & Dolan, 2007; Seedat, Niehaus, & Stein, 2001; Serbin & Karp, 2003; Walsh, 2003), society (Jenson & Fraser, 2006; Seedat, Kaminer, Lockhat, & Stein, 2000; Wood & Geismar, 1989) and the next generation (Davidson & Mellor, 2001; Ender, 2006; Weber, 2005; Westerink & Giarratano, 1999). However, little is understood about the way people who grew up in Australlian military families affected by PTSD describe their experiences and what the implications are for their participation in family life. This study addressed the following research questions: (1) ‘How does a child of a Vietnam veteran understand and describe the experience of PTSD in the family?’ and (2) ‘What are the implications of this understanding on their current participation in family life?’ These questions were addressed through a qualitative analysis of focus-group data collected from adults with a Vietnam veteran parent with PTSD. The key rationale for a qualitative approach was to develop an understanding of these questions in a way which was as faithful as possible to the way they talked about their past and present family experiences. A number of experiential themes common to participants were identified through the data analysis. Participants’ experiences linked together to form a central theme of control, which revealed the overarching narrative of ‘It’s all about control and the fear of losing it’, that responds to the first research queston. The second research question led to a deeper analysis of the ‘control experiences’ to identify the ways in which participants responded to and managed these problematic aspects of family life, and the implications for their current sense of participation in family life. These responses can be understood through the overarching narrative of: ‘Soldier on despite the differences’ which assists them to optimise the impact of control and develop strategies required to maintain a semblance of personal normality and a normal family life. This intensive research has led to the development of theoretical propositions about this group’s experiences and responses that can be tested further in subsequent research to assist families and their members who may be experiencing the intergenerational impacts of psychological trauma acquired from military service.

Road trauma perceptions and the potential influence of the media

The United Nations Decade of Action for Road Safety (2011-2020) recognises the urgency of addressing global road trauma. Road crashes and attempts to reduce risky driving, including public education campaigns, receive media attention in many countries. In Australia, road fatalities have declined significantly. However, the extent of awareness about this success and of fatalities overall is unclear. A survey of 833 Australian drivers revealed the majority of participants under-estimated fatalities. Unexpectedly, some under-estimates appear based on recollections of media reports. The findings suggest lack of awareness of the extent of road deaths and that, paradoxically, media reports might contribute to underestimations. This represents a major public health challenge. Engaging community support for road safety, relative to other health/safety messages, may prove difficult if the extent of road trauma is misunderstood. Misperceptions about fatality levels may be a barrier to road users adopting safety precautions or supporting further road safety countermeasures.

Advances and future directions for management of trauma patients with musculoskeletal injuries

Musculoskeletal injuries are the most common reason for operative procedures in severely injured patients and are major determinants of functional outcomes. In this paper, we summarise advances and future directions for management of multiply injured patients with major musculoskeletal trauma. Improved understanding of fracture healing has created new possibilities for management of particularly challenging problems, such as delayed union and non union of fractures and large bone defects. Optimum timing of major orthopaedic interventions is guided by increased knowledge about the immune response after injury. Individual treatment should be guided by trading off the benefits of early definitive skeletal stabilisation, and the potentially life-threatening risks of systemic complications such as fat embolism, acute lung injury, and multiple organ failure. New methods for measurement of fracture healing and function and quality of life outcomes pave the way for landmark trials that will guide the future management of musculoskeletal injuries.

Community development with survivors of torture and trauma : an evaluation framework

Despite an increase in community development initiatives in refugee contexts, there is a lack of evaluation frameworks to assess the effectiveness of interventions in the recovery of refugee communities. In response to this gap, the Forum of Australian Services for Survivors of Torture and Trauma has developed an evaluation framework in consultation with refugee client groups and agencies' staff members. This paper contextualizes the goals, principles and strategies of services implementing community development initiatives with torture and trauma survivors and describes the process of developing the framework within a participatory action approach. Both outcome evaluation and process evaluation are discussed, and examples of the framework are presented. Community development agencies and professionals working with survivors of torture and trauma can play a significant role by fostering community empowerment through evaluation.

Narrative : family trauma or challenge and resilience in the Galapagos Archipelago

The chapter is a "here and now" narration in the first person as witnessed and experienced by the author during field work in the Galapagos Islands in 1976-79. The story begins on the most remote volcanic island of Fernandina where the breeding biology of Flightless cormorants was being studied. A small selection of the many potentially life threatening situations and challenges is described including stories related to the birth of their son.

Study protocol : Screening and treatment of alcohol-related trauma (START): a randomised controlled trial

Background: The incidence of mandibular fractures in the Northern Territory of Australia is very high, especially among Indigenous people. Alcohol intoxication is implicated in the majority of facial injuries, and substance use is therefore an important target for secondary prevention. The current study tests the efficacy of a brief therapy, Motivational Care Planning, in improving wellbeing and substance misuse in youth and adults hospitalised with alcohol-related facial trauma. Methods and design: The study is a randomised controlled trial with 6 months of follow-up, to examine the effectiveness of a brief and culturally adapted intervention in improving outcomes for trauma patients with at-risk drinking admitted to the Royal Darwin Hospital maxillofacial surgery unit. Potential participants are identified using AUDIT-C questionnaire. Eligible participants are randomised to either Motivational Care Planning (MCP) or Treatment as Usual (TAU). The outcome measures will include quantity and frequency of alcohol and other substance use by Timeline Followback. The recruitment target is 154 participants, which with 20% dropout, is hoped to provide 124 people receiving treatment and follow-up. Discussion: This project introduces screening and brief interventions for high-risk drinkers admitted to the hospital with facial trauma. It introduces a practical approach to integrating brief interventions in the hospital setting, and has potential to demonstrate significant benefits for at-risk drinkers with facial trauma.

Orthopaedics and Trauma Queensland Annual Report 2011

Orthopaedics and Trauma Queensland, a Centre for Research and Education in Musculoskeletal Disorders, is an internationally recognised research group that is developing into an international leader in research and education. It provides a stimulus for research, education and clinical application within the international orthopaedic and trauma communities. Orthopaedics and Trauma Queensland develops and promotes the innovative use of engineering and technology, in collaboration with surgeons, to provide new techniques, materials, procedures and medical devices. Its integration with clinical practice and strong links with hospitals ensure that the research will be translated into practical outcomes for patients. The group undertakes clinical practice in orthopaedics and trauma and applies core engineering skills to challenges in medicine. The research is built on a strong foundation of knowledge in biomedical engineering, and incorporates expertise in cell biology, mathematical modelling, human anatomy and physiology and clinical medicine in orthopaedics and trauma. New knowledge is being developed and applied to the full range of orthopaedic diseases and injuries, such as knee and hip replacements, fractures and spinal deformities.

Working with refugee survivors of torture and trauma : an opportunity for vicarious posttraumatic growth

Clinical work with people who have survived trauma carries a risk of vicarious traumatisation for the service provider, but also the potential for vicarious posttraumatic growth. Despite growing interest in this area, the effects of working with survivors of refugee-related trauma have remained relatively unexplored. The aim of the current study was to examine the lived experiences of people working on a daily basis with survivors of torture and trauma who had sought refuge in Australia. Seventeen clinical, administrative, and managerial staff from a not-for-profit organisation participated in a semi-structured interview that was later analysed using interpretive phenomenological analysis. Analysis of the data demonstrated that the entire sample reported symptoms of vicarious trauma (e.g., strong emotional reactions, intrusive images, shattering of existing beliefs) as well as vicarious posttraumatic growth (e.g., forming new relationships, increased self-understanding, greater appreciation of life). Moreover, effortful meaning making processes appeared to facilitate such positive changes. Reduction in the risks associated with this work, enhancement of clinician well-being, and improvement of therapeutic outcomes is a shared responsibility of the organisation and clinician. Without negating the distress of trauma work, clinicians are encouraged to more deeply consider the unique positive outcomes that supporting survivors can provide.

Children, toxic chemicals and Australia's intergenerational obligations

The high volume and widespread use of industrial chemicals, the backlog of internationally untested chemicals, the uptake of synthetic chemicals found in babies’ in utero, cord blood, and in breast milk, and the lack of a unified and comprehensive regulatory framework, all underscore the importance of developing policies that protect the most vulnerable in our society – our children. Australia’s failure to do so raises profound intergenerational ethical issues. This paper tells a story of international policy, and where Australia is falling down. This paper highlights the need for significant policy reforms in the area of chemical regulation in Australia. We argue that we can learn much from countries already taking critical steps to reduce the toxic chemical exposure, and the development of a comprehensive, child-centered chemical regulation framework is central to turning this around.