PDF(Pubmed)
Abstract：
People seeking asylum are susceptible to head injury (HI) due to exposure to various forms of violence including war, torture, or interpersonal violence. Yet, the extents to which clinicians assess HI, and if so, what the associated characteristics are, are not well known. We analyzed 200 U.S.-based medico-legal affidavits using descriptive, multivariate regression, and thematic analysis. Head injury was documented in 38% of affidavits. Those who experienced physical violence were eight times likelier to experience HI than those who did not experience physical violence. Five themes emerged: (1) HI occurred commonly in the context of interpersonal violence (44%), followed by militarized violence (33%); (2) mechanisms of HI included direct blows to the head and asphyxiation, suggesting potential for both traumatic brain injury and brain injury from oxygen deprivation; (3) HI was often recurrent and concurrent with other physical injuries; (4) co-morbid psychiatric and post-concussive symptoms made it challenging to assess neurological and psychiatric etiologies; and (5) overall, there was a paucity of assessments and documentation of HI and sequelae. Among individuals assessed for asylum claims, HI is common, often recurrent, occurring in the context of interpersonal violence, and concurrent with psychological and other physical trauma. Physical violence is an important risk factor for HI, which should be assessed when physical violence is reported.
摘要：
寻求庇护的人由于遭受包括战争在内的各种形式的暴力而容易遭受头部伤害（HI）。酷刑,或人际暴力。然而，临床医生评估HI的程度，如果是这样,相关的特征是什么，不是众所周知的。我们分析了200份美国的医疗法律宣誓书，使用描述性的，多元回归，和专题分析。38％的宣誓书记录了头部受伤。那些经历过身体暴力的人比那些没有经历过身体暴力的人更有可能经历HI。出现了五个主题：（1）HI通常发生在人际暴力的背景下（44％），其次是军事化暴力（33％）；（2）HI的机制包括直接打击头部和窒息，提示外伤性脑损伤和缺氧导致脑损伤的可能性；（3）HI经常反复发作，并与其他身体损伤同时发生；（4）精神病和脑震荡后症状的共病使评估神经和精神病病因具有挑战性；（5）总体，对HI和后遗症的评估和记录很少。在接受庇护申请评估的个人中，HI是常见的，经常复发，发生在人际暴力的背景下，并伴随着心理和其他身体创伤。身体暴力是HI的重要危险因素，当身体暴力报告时，应该对其进行评估。
