“I’m not alone, my story matters”: Incarcerated women’s perspectives on the impact and acceptability of group psychotherapy involving imaginal exposure to sexual assault memories

Background Although it is clear that incarcerated women need access to effective therapies for trauma sequelae, some have argued that one of the most effective treatments – exposure therapy – should not be provided in carceral settings due to the presumed lack of safety and stability making such an intervention inappropriate. Group therapy, the typical mode of intervention in prisons, has also been presumed to be unacceptable for exposure-based processing due to assumptions that hearing others’ trauma narratives would be traumatizing and unhelpful to listeners. However, there is a lack of data to support either of the aforementioned assumptions. This study examined the acceptability of an exposure-based group therapy for women survivors of sexual violence who were currently incarcerated (N = 61) by asking women themselves about their experiences completing an exposure-based group therapy protocol (SHARE; SurvivorsHealing fromAbuse:Recovery throughExposure) while incarcerated. We assessed women’s reasons for enrolling in the group, satisfaction with various therapy components (e.g., exposure, skill-building) and the treatment overall, and experiences of both sharing and listening to trauma narratives using a feedback survey that included a mix of multiple-choice and open-ended questions. Treatment dropout was examined as an additional index of acceptability. Results Treatment completion was very high (88.8%). Nearly all women who completed the group reported that they would recommend it to other incarcerated women (96.7%, with the remaining 3.3% reporting “it depends”). Qualitative results revealed overwhelmingly positive feedback about the effect of the group and indicated that sharing and listening to trauma narratives in a group setting serve discrete but dually important functions. Specifically, women almost universally experienced listening to others’ trauma narratives (i.e., exposures) in the SHARE group context as helpful—making them feel less alone and normalizing their experiences. Sharing one’s own story primarily provided an emotional release and/or transformation (i.e., an intrapersonal rather than interpersonal function). Conclusions Our findings challenge common concerns about the appropriateness of 1) prison as a context for trauma-focused treatments, including exposure and 2) sharing trauma narratives in a group setting. Unless empirical evidence demonstrating harm is uncovered, best practices for PTSD and other trauma-related sequelae—those recommended in reputable treatment guidelines and interventions like SHARE that incorporate components shown to be effective (e.g., cognitive challenging, exposure)—should be offered to incarcerated women as part of standard of care.

Impact of dental care on the oral health of in patients with trauma sequelae

This study aims to assess oral health before and after dental care to adult patients restricted to bed with trauma sequelae, admitted to the Instituto Doutor José Frota (IJF) hospital, located in the city of Fortaleza, in the state of Ceará. This is a longitudinal study with adult patients with motor and cognitive disabilities, diagnosis of traumatic brain injury, spinal cord trauma, and exogenous intoxication. We evaluated 39 patients, using the World Health Organization (WHO) dental caries index and Bedside oral exam (BOE) before and after dental care. After two dental consultations, there was a reduction of 46% of decayed teeth, poor oral health decreased by 11% and 29.6% of the BOE index, and good oral health increased by 57%. Although dental care in bed is challenging, it has proved effective, improving the health of the oral mucosa, perioral and dental surfaces and, consequently, reducing the likelihood of changes in oral health.

LIPOSTRUCTURE: EXPERIENCE OF THE DEPARTMENT OF PLASTIC SURGERY OF THE MOHAMMED VI UNIVERSITY TEACHING HOSPITAL OF MARRAKESH

This is a descriptive retrospective study of 42 cases of patients who underwent the lipostructure procedure at the Department of Plastic Surgery of Mohammed VI Teaching Hospital of Marrakesh, over a period of 6 years, from January 2012 to December 2017. It aims to report our experience, and to review the procedure, applications, and outcomes of lipostructure. A total of 61 procedures were performed. The average age of our patients was 28.78 years. A female predominance was noted (86%). The main indications were: burn sequelae (33%), trauma sequelae (17%), infection sequelae (10%) and facial rejuvenation (10%). In terms of local conditions, most of our patients suffered from skin scars (61.9%), atrophy (14.28%), wrinkles (9.52%), facial asymmetries (7.14%), and nasal deformities (7.14%). The samples was mainly harvested from the abdomen (42%), followed by the trochanteric region (saddle bags) in 38% of cases. 67.21% of the samples were harvested from a single donor site. The average volume collected was 74.52 ml. All the samples were centrifuged by the Regenlab system. 52% of the lipostructure procedures were performed on the face, with an average injected volume of 23.25ml. 42.62% of the lipostructures were associated with an injection of PRP, and 6.55% with a facelift.

Need for Age-Appropriate Diagnostic Criteria for PTSD

Studies in patient or community samples suggest that many older adults who experience clinically significant psychopathology do not fit easily into our existing disorder classification systems. This affects older people with traumatic experiences, who in their senescence report multiple mental disturbances and reduced quality of life. Thus, there is a need to develop age-appropriate diagnostic criteria for posttraumatic stress disorder (PTSD). To date, the new ICD-11 has done this only in a very rudimentary way. This article gives a brief historical overview and names the reasons for these diagnostic problems. Subsequently, it proposes six plus one (male-only) features to be dominant and life-stage specific in older adults: posttraumatic nightmares and reenactments, impaired sleep, painful memories of traumatically lost close persons, hypervigilance including elevated startle response, weakness or asthenia, somatoform pain or chronic primary pain, and in males only: reckless or self-destructive behavior. Finally, it outlines future steps to improve the adequate recognition of clinical presentations of trauma sequelae.

Indications and outcome in total elbow arthroplasty: A systematic review

Background Total elbow arthroplasty (TEA) is the established treatment for end-stage rheumatoid arthritis but improved surgical techniques have resulted in expanded indications. The aim of this study is to review the literature to evaluate the evolution of surgical indications for TEA. Methods A systematic review of PubMed and EMBASE databases was conducted. Case series and comparative studies reporting results after three types of primary TEA were eligible for inclusion. Results Forty-nine eligible studies were identified ( n = 1995). The number of TEA cases published annually increased from 6 cases in 1980 to 135 cases in 2008. The commonest indication for TEA throughout the review period was rheumatoid arthritis but its annual proportion reduced from 77% to 50%. The mean Mayo Elbow Performance Score significantly improved for all indications. Three comparative studies reported statistically improved functional outcomes in rheumatoid arthritis over the trauma sequelae group. Complication and revision rates varied; rheumatoid arthritis 5.2–30.9% and 11–13%, acute fracture 0–50% and 10–11%, trauma sequelae 14.2–50% and 0–30%, osteoarthritis 50% and 11%, respectively. Discussion TEA can provide functional improvements in inflammatory arthritis, acute fractures, trauma sequelae and miscellaneous indications. Long-term TEA survivorship appears satisfactory in rheumatoid arthritis and fracture cases; however, further research into alternative surgical indications is still required.

Pattern of Occurrence of Ocular Injuries and their Forensic Aspects

Introduction: All penetrating or non-penetrating intentional ocular trauma causing loss of an organ or part of an organ and which have as a consequence the facial disfigurement or post trauma sequelae formation have forensic implications. Objectives: To study the pattern of ocular injuries its forensic implications and meticulous documentation in ocular medicolegal cases. Methodology: This hospital based cross sectional study was carried out by Forensic medicine personnel in Department of Ophthalmology and Emergency Department of Manipal Teaching Hospital Pokhara, Nepal. A total of 251 cases of ocular injury constituted the sample size. Cases were analyzed according to age, sex, type of trauma, causative agent, and manner of injury and ocular injuries having any medicolegal value. All data was evaluated and relevant information were extracted and entered into a database. Results: Male subjects 174 (69.32%) were more susceptible to ocular injuries and age group 21-30 years 66 (26.3%) were more predisposed to ocular injuries. The commonest cause of ocular trauma was due to fall on blunt objects 42(16.73%). The most common site of injury was cornea 120(47.81%) and corneal abrasion 65(54.16) was the most common ocular finding. Accidental manner of injury was observed in majority of the cases 230 (91.60%). Ocular injuries sustained were all simple in nature 251(100%) as a result no fatality was observed following ocular injury. Conclusion: Proper history taking and methodical documentation of injuries not only assist in diagnosis and management of the patient but also holds an evidentiary value in medico legal cases.