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PubMed2002

Landmine injuries and rehabilitation for landmine survivors.

There is a tremendous international need for the development of rehabilitation educational programs, especially in low-income countries. These programs are most urgently needed in those countries where there is active conflict, where there has been recent civil war, and where significant casualties have been created because of landmines and weapons-fire. Most of these countries are developing nations where rehabilitation is a lower priority than the provision of basic health needs. These countries generally have few financial, personnel, and system resources to provide much rehabilitation for their disabled citizens. Also, they generally have few, if any, physicians trained in the principles and practice of rehabilitation medicine. These countries can benefit from the use of psychiatric consultants to help assess their rehabilitation needs in designing relevant educational curricula for health professionals and in developing rehabilitation teams. These teams can then develop systems of care for the most common disabling conditions in that area of the world. Western technology, however, cannot be imposed on these countries. Any rehabilitation systems of care must be established within the context of the particular culture and governmental health system organization, if it is to be useful and succeed in a particular nation.

Amputees↗
PubMed1999

Learning from cholera: medical and social responses to the first great Paris epidemic in 1832.

This essay explores responses to the Paris cholera epidemic of 1832 to show how medical ideas shaped popular conceptions of the social world, while at the same time this world influenced how scientists posed their basic hypotheses. It demonstrates how responses to the epidemic were shaped by two major realities: the population of Paris was exploding and France had recently experienced a second major revolution.

Cholera↗
PubMed1982

Psychotropic drug use in Northern Ireland 1966-80: prescribing trends, inter- and intra-regional comparisons and relationship to demographic and socioeconomic variables.

A study of psychotropic drug prescribing, derived from the computerized pricing data in Northern Ireland from 1966, showed that the use of these drugs reached a peak in 1975, when about 12.5% of the adult population were estimated to have been receiving them, and declined in the following 5 years. Benzodioazepines accounted for three-quarters of all psychotropic drugs prescribed in 1980. Benzodiazepine tranquillizer prescribing was consistently 20-30% higher than in the rest of the United Kingdom, in contrast to hypnotic and antidepressant prescribing which has been consistently lower. The rate of increase in benzodiazepine tranquillizer prescribing was greater than in other European countries, but the level remains lower than in Iceland and Denmark. The influence of a number of demographic and socioeconomic variables was studied in an intra-regional analysis of the 1978 data for the 17 health districts in the province, using multivariate and multiple regression statistics. The prescribing of benzodiazepine hypnotics was almost entirely accounted for by the proportion of elderly (over 65 years) and women aged 45-59 years: neuroleptic prescribing was largely a function of factors associated with rural areas (overcrowding and unemployment) and the proportion of elderly; but neither tranquillizer, antidepressant, barbiturate hypnotic nor psychostimulant prescribing were satisfactorily explained by these variables.

Anti-Anxiety Agents↗
PubMedDate not supplied

Complex emergencies in Indonesia.

Recently, Indonesia has experienced six major provincial, civil, armed conflicts. Underlying causes include the transmigration policy, sectarian disputes, the Asian economic crisis, fall of authoritarian rule, and a backlash against civil and military abuses. The public health impact involves the displacement nationwide of > 1.2 million persons. Violence in the Malukus, Timor, and Kalimantan has sparked the greatest population movements such that five provinces in Indonesia each now harbor > 100,000 internally displaced persons. With a background of government instability, hyperinflation, macroeconomic collapse, and elusive political solutions, these civil armed conflicts are ripe for persistence as complex emergencies. Indonesia has made substantial progress in domestic disaster management with the establishment of central administrative authority, strategic planning, and training programs. Nevertheless, the Indonesian experience reveals recurrent issues in international humanitarian health assistance. Clinical care remains complicated by absences of treatment protocols, inappropriate drug use, high procedural complication rates, and variable referral practices. Epidemiological surveillance remains complicated by unsettled clinical case definitions, non-standardized case management of diseases with epidemic potential, variable outbreak management protocols, and inadequate epidemiological analytic capacity. International donor support has been semi-selective, insufficient, and late. The militia murders of three UN staff in West Timor prompted the withdrawal of UN international staff from West Timor for nearly a year to date. Re-establishing rules of engagement for humanitarian health workers must address security, public health, and clinical threats.

Civil Disorders↗
PubMed1997

The violence of despair: consultation to a HeadStart program following the Los Angeles uprising of 1992.

This paper describes an acute trauma consultation to one Los Angeles HeadStart program following the severe civil disturbance in the spring of 1992. By self-report, 7% (3/42) of the teachers had severe post-traumatic stress symptoms, and 29% (21/42) had moderate symptoms one month after the event. Teachers, comparing behavior following the disturbance to behavior two weeks before, reported statistically significant increases in the students' aggression and noise level, and decreases in "getting along" with peers and academic progress. Difficulties encountered in this type of community psychiatric consultation are discussed.

Aggression↗
PubMed1998

Sri Lanka. Political violence and ethnic conflict.

In recent years, Sri Lanka has experienced 2 violent rebellions in which youths have played a prominent role, 1 in the majority Sinhala community and 1 in the minority Tamil community. The former was crushed, but the latter remains ongoing, with the Liberation Tigers of Tamil Eelam, who claim to represent the Tamil minority, battling the Sinhala-dominated government. Prospects for peace in the short- and medium term appear poor. These events have generated an impressive body of interdisciplinary interpretation, but several important topics have received relatively little attention. Most ongoing research is being carried out by anthropologists, historians, and political scientists, but psychological insights would offer important complementary perspectives.

Civil Disorders↗
PubMed1978

Ambient temperature and the occurrence of collective violence: the "long, hot summer" revisited.

Archival data pertaining to 102 instances of serious collective violence were examined in order to study the relationship between ambient temperature and the occurrence of such events. Results indicated that the frequency of collective violence and ambient temperature were curvilinearly related. Specifically, ambient temperature was directly associated with the frequency of collective violence through the mid-80s (degrees Fahrenheit). Beyond this point, however, further increments in temperature were associated with a decreasing incidence of such events. Additional findings indicated that ambient temperature increased significantly during the 7 days preceding the outbreak of collective violence, remained stable during its occurrence, but then decreased significantly in the 3 days following its termination. Possible implications of these findings, as well as their relationship to the results of previous laboratory studies, are discussed.

Civil Disorders↗
PubMed1995

Iranian refugee children in Sweden: effects of organized violence and forced migration on preschool children.

Using play techniques, individual assessments were made of 50 preschool children from 47 Iranian refugee families living in Sweden, while their parents were interviewed about the children's exposure to violence and separation. Reenacting play involving war and persecution was performed by 19 of the children, most of them eyewitnesses to violence. The study demonstrated ways of obtaining information directly from young children to supplement parental reports.

Anxiety, Separation↗