Twenty years after the Yom Kippur War: the belated recognition of war-induced psychic trauma.
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Combat Disorders↗
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[Adam Cygielstrejch's two prophetic texts, published in The Medical- psychological annals in 1912, on "mental disorders of war during the Russian-Japanese war in 1904-1905].
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Combat Disorders↗
Uncle Sam's loyal nieces: American medical women, citizenship, and war service in World War I.
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Female↗
[The role of dentists in the development of military stomatology and medical support for the Soviet Army during World War II (on the 50th anniversary of victory in World War II)].
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History, 20th Century↗
Rinderpest: at war with the disease of war.
Rinderpest, the legendary cattle plague, has caused devastating losses for centuries and remains the biggest threat to sustainable livestock production in developing countries. Strenuous efforts are now being made to achieve global eradication of this viral disease, a goal made feasible through the use of attenuated live vaccines developed in the 1950s. Their use almost resulted in eradication in the 1970s but left several foci of disease from where the plague then re-emerged. Recent mass vaccination has resulted in the limitation of disease to parts of Africa, Pakistan, Afghanistan, the Middle East and India. Confirmation of the disease status of the countries has been aided by developments in serological techniques through exploitation of monoclonal antibodies (in Enzyme Linked Immunosorbent Assay-ELISA) and by advances in molecular biology such as in the use of polymerase reaction technologies (PCR). This has extended into the development of new recombinant vaccines. It is anticipated that eradication will be complete by the year 2010. This would be only the second example, after smallpox in man, of the eradication of a viral disease. The picture shows a scene of devastation during the Great Rinderpest Pandemic of 1889-1897 in South Africa. The disease swept through the African continent killing virtually all the cattle and wild ungulates.
Animals↗
Influence of the war in Croatia on the frequency of gynecological cancer in the University Hospital Osijek in the period from 1985 to 2002.
The aim of this study is to estimate the influence of war in Croatia on the frequency of gynecological cancer (cancer of corpus and cervix uteri and ovary) in the Clinical Hospital Osijek, particularly the relation between the pre-war and post-war period. We analyzed 1455 patients with corpus uteri and cervix uteri cancer and ovarian cancer treated in the Clinical Hospital Osijek in the period 1985-2002 (group I). Patients from Osjecko-Baranjska County were analyzed separately--1273 women, (group II) and in the group III there were 182 patients from other counties. The analyzed period was divided into: pre-war 1985-1990, war 1991-1993 and post-war period 1997-2002. In all three groups the number of patients treated for gynecological cancer was significantly larger in the post-war period (group I, N = 611, group II, N = 498, group III, N = 113) than in the pre-war period (group I, N = 457, group II, N = 433, group III, N = 24). The analysis of cancer frequency in relation to the site shows that a total number of patients treated for cervical cancer was larger in the post-war (N = 229) than in the pre-war period (N = 214), but the difference wasn't significant. However, the number of patients from Osjecko-baranjska County treated for cervical cancer was larger in the pre-war (N = 207) than in the post-war period (N = 178) but still, the difference wasn't significant. The number of patients treated for corpus uteri cancer and ovarian cancer was significantly larger for the I group in the post-war (N = 225 and N = 157 respectively) than in the pre-war period (N = 136, and N = 107 respectively). In the group II the number of patients treated for corpus uteri cancer and ovarian cancer was larger in the post-war (N = 196 and N = 124 respectively) than in the pre-war period (N = 130 and N = 96 respectively) but the difference was significant only for corpus uteri cancer. Significantly more women were treated for gynecological cancer in the post-war than in the pre-war period. However, the war had probably an indirect influence on the increased number of patients treated for gynecological cancer mainly because many more women arrived from other counties.
Adult↗
[The prevalence of war-related post-traumatic stress disorder in children from Cundinamarca, Colombia].
OBJECTIVE: Determining the prevalence of post-traumatic stress disorder (PTSD) related to the type of war exposure and associated factors in school-aged children from three Colombian towns. METHODS: Cross-sectional epidemiological study. Representative randomised sample of 493 children aged 5-14. The children were evaluated during 2002 using semi-structured psychiatric interviews and the clinician administered PTSD scale. 167 children were evaluated in La Palma who had been chronically exposed to war, 164 in Arbeláez who had had recent war-exposure and 162 in Sopó who had not been exposed to war. War-related PTSD prevalence was calculated in each municipality. Odds ratio (OR) and chi-square were used for evaluating the association between exposure to war and PTSD and the related risk. Multivariate analysis used the logistic regression model. The affected children required specialised mental health counselling. RESULTS: The prevalence of PTSD resulting from war was 16,8 % in La Palma, 23,2 % in Arbeláez and 1.2% in Sopó. A 19.9 OR (CI 4.7, 119.2), 30,5 Chi-square and p = 0.000 revealed war-related PTSD association and risk for children when comparing the exposed towns to Sopó. The logistic regression showed that geographical closeness to war zone and intense emotional reaction to war increased the probability of war-related PTSD. Vulnerability factors were predominant in war-exposed towns. Poverty, parents' low educational level and child abuse predominated in La Palma. Attention-deficit and psychosomatic disorders were more prevalent in Arbeláez. CONCLUSIONS: War affects children's mental health; the children from the exposed towns had 19 times greater probability of war-related PTSD than those from a non-exposed town. Early therapeutic intervention is a public health priority. The results are useful for countries suffering from war, internal conflict and/or terrorism.
Adolescent↗
[10-year analysis of cerebrovascular accidents at the Neurology Clinic in Sarajevo (before, during and after the war)].
Data was analyzed retrospectively of a ten year period at the Neurology clinic in Sarajevo, with regards to the treatment of patients with acute cerebrovascular accident (CVA or stroke). The whole period has been divided into three segments: a) pre-war period 01.01.1990-05.04.1992, b) the war period 06.04.1992-15.12.1995, and c) post-war period 16.12.1995-31.12.1999. There has been the total of 6,255 patients with a completed stroke, while the patients with transitory ischemic attacks were not involved in the study. General mortality from stroke rose considerably during the war, the rate is somewhat reduced post-war, but not as low as pre-war (35%, 48%, 38% respectively). During the war there was a greater number of patients with intracerebral haemorrhage compared to the atherothrombotic brain infarction group, but the relationship changed after the war in favor of the latter. No difference in sex structure was noticed in the observed three periods. During the war, there was 0 minor increase in the percentage of patients in the 51-60 years age group, but after the war there was a remarkable increase in the 70+ age group. As far as risk factors are concerned, we have traced a marked raise in rates of the hypertension and cardiopathy during the war, with a lower frequency of diabetes. The first two risk factors have kept the same trend post-war, and diabetes returned to the its approximately pre-war level. All changes described here are pointing towards a remarkable influence of war activities on morbidity and mortality of the cerebrovascular accident, where the rates are slowly and incompletely returning to its pre war levels.
Adult↗
The influence of the war on perinatal and maternal mortality in Bosnia and Herzegovina.
OBJECTIVE: To investigate the influence of the war on perinatal and maternal mortality during the war conflict in Bosnia and Herzegovina. METHODS: In a retrospective study we analysed perinatal and maternal mortality in the pre-war period (1988-1991), the war period (1992-1995) and the post-war period (1996-2003). We also analysed the number of deliveries, the perinatal and maternal mortality rates and their causes. RESULTS: During the analysed period we had a range of 3337-6912 deliveries per year, with a decreased number in the war period. During the war period and immediately after the war, the perinatal mortality rate increased to 20.9-26.3% (average 24.28%). After the war the rate decreased to 8.01% in 2003 (p < 0.05). Maternal mortality before the war was 39/100,000 deliveries, during the war it increased to 65/100,000 and after the war it decreased to 12/100,000 deliveries (p < 0.05). The increase in maternal mortality during the war was because of an increased number of uterine ruptures, sepsis and bleeding due to shell injury of pregnant women. CONCLUSIONS: During the war we could expect a decreased number of deliveries, and an increased rate of perinatal and maternal mortality and preterm deliveries due to: inadequate nutrition, stress factors (life in refugee's centers, bombing, deaths of relatives, uncertain future...), and break down of the perinatal care system (lack of medical staff, impossibility of collecting valid health records, particularly perinatal information, and the destruction of medical buildings).
Aortic Dissection↗
Own and parental war experience as a risk factor for mental health problems among adolescents with an immigrant background: results from a cross sectional study in Oslo, Norway.
BACKGROUND: An increasing proportion of immigrants to Western countries in the past decade are from war affected countries. The aim of this study was to estimate the prevalence of war experience among adolescents and their parents and to investigate possible differences in internalizing and externalizing mental health problems between adolescents exposed and unexposed to own and parental war experience. METHOD: The study is based on a cross-sectional population-based survey of all 10th grade pupils in Oslo for two consecutive years. A total of 1,758 adolescents were included, all with both parents born outside of Norway. Internalizing and externalizing mental health problems were measured by Hopkins Symptom Checklist-10 and subscales of the Strengths and Difficulties Questionnaire, respectively. Own and parental war experience is based on adolescent self-report. RESULTS: The proportion of adolescents with own war experience was 14% with the highest prevalence in immigrants from Eastern Europe and Sub-Saharan Africa. The proportion of parental war experience was 33% with Sub-Saharan Africa being highest. Adolescents reporting own war experience had higher scores for both internalizing and externalizing mental health problems compared to immigrants without war experience, but only externalizing problems reached statistically significant differences. For parental war experience there was a statistically significant relationship between parental war experience and internalizing mental health problems. The association remained significant after adjustment for parental educational level and adolescents' own war experience. CONCLUSION: War exposure is highly prevalent among immigrants living in Oslo, Norway, both among adolescents themselves and their parents. Among immigrants to Norway, parental war experience appears to be stronger associated with mental health problems than adolescents own exposure to war experience.
Journal Article↗
Postwar mortality among Australian World War II prisoners of the Japanese.
The impact of detention as a prisoner of war on postwar survival and disease-specific mortality was examined in Australian veterans of World War II. A random sample of 908 ex-prisoners and 797 other veterans of the same theatre of war, all of whom had returned to Australia alive, was traced over the 40 years since the war. The date and cause of death were recorded for those who were found to have died. By means of the subject-years method, the mortality of the prisoners of war was compared with that of the non-prisoners of war while the analysis controlled for the length of follow-up and the subject's age at the close of the war. The prisoners of war showed a higher over-all mortality rate than did the non-prisoners of war. This difference was pronounced in the period from five to 14 years after the war but diminished subsequently. There also was an indication that this effect varied with the subject's age at the end of the war: prisoners of war who were aged 25-29 years at that time had the highest mortality differential from non-prisoners of war, followed by prisoners of war who were aged 30-34 years. However, log-linear modelling, which controlled for age and the follow-up period, did not suggest that these mortality differences could be attributed to particular causes of death.
Adult↗
Healthcare utilization and mortality among veterans of the Gulf War.
The authors conducted an extensive search for published works concerning healthcare utilization and mortality among Gulf War veterans of the Coalition forces who served during the 1990-1991 Gulf War. Reports concerning the health experience of US, UK, Canadian, Saudi and Australian veterans were reviewed. This report summarizes 15 years of observations and research in four categories: Gulf War veteran healthcare registry studies, hospitalization studies, outpatient studies and mortality studies. A total of 149728 (19.8%) of 756373 US, UK, Canadian and Australian Gulf War veterans received health registry evaluations revealing a vast number of symptoms and clinical conditions but no suggestion that a new unique illness was associated with service during the Gulf War. Additionally, no Gulf War exposure was uniquely implicated as a cause for post-war morbidity. Numerous large, controlled studies of US Gulf War veterans' hospitalizations, often involving more than a million veterans, have been conducted. They revealed an increased post-war risk for mental health diagnoses, multi-symptom conditions and musculoskeletal disorders. Again, these data failed to demonstrate that Gulf War veterans suffered from a unique Gulf War-related illness. The sparsely available ambulatory care reports documented that respiratory and gastrointestinal complaints were quite common during deployment. Using perhaps the most reliable data, controlled mortality studies have revealed that Gulf War veterans were at increased risk of injuries, especially those due to vehicular accidents. In general, healthcare utilization data are now exhausted. These findings have now been incorporated into preventive measures in support of current military forces. With a few diagnostic exceptions such as amyotrophic lateral sclerosis, mental disorders and cancer, it now seems time to cease examining Gulf War veteran morbidity and to direct future research efforts to preventing illness among current and future military personnel.
Gulf War↗
Suicide rate after the 1991-1995 War in Southwestern Croatia.
BACKGROUND: The paper analyzed the impact of war, the most pernicious of social evils, taking into consideration intensity of change in rate of suicide in the southwestern region of Croatia during the war and including three distinctly specific intervals, two peacetime-one pre-war (1986-1990) and one post-war (1996-2000) as well as the period of the war itself (1991-1995). METHODS: From 853 cases of suicide committed during the period under review, age and gender of suicide victims, level of alcohol intoxication at suicide, means used in committing suicide, and suicide rate in years under review were analyzed. Quantitative characteristics of suicides were compared with other types of violent deaths, e.g., homicides and accidents. Frequencies of different features are shown graphically. Statistica 4.0 for Windows 98 was used in data processing. RESULTS: Of a total of 2,925 violent deaths in the period under review (1986-2000), 29.16% or 853 suicides (29.1%) were recorded. A total of 513 suicides were committed in the peace-time period--262 prior to the war (1986-1990) and 251 after the war (1996-2000)--while 340 suicides were recorded during the war (1991-1995). Means of committing suicide also changed drastically during the war, when 64 cases of firearm use were recorded compared with 18 cases during the pre-war interval and 36 cases in the post-war interval. CONCLUSIONS: Three parameters, namely, suicide rate, use of firearms, and intoxication, suffered the greatest changes in the war compared with the pre- and post-war period in the region under review.
Adolescent↗
Health of UK servicemen who served in Persian Gulf War.
BACKGROUND: Various symptoms in military personnel in the Persian Gulf War 1990-91 have caused international speculation and concern. We investigated UK servicemen. METHODS: We did a cross-sectional postal survey on a random sample of Gulf War veterans (Gulf War cohort, n=4248) and, stratified for age and rank, servicemen deployed to the Bosnia conflict (Bosnia cohort, n=4250) and those serving during the Gulf War but not deployed there (Era cohort, n=4246). We asked about deployment, exposures, symptoms, and illnesses. We analysed men only. Our outcome measures were physical health, functional capacity (SF-36), the general health questionnaire, the Centers for Disease Control and Prevention (CDC) multisymptom criteria for Gulf War illness, and post-traumatic stress reactions. FINDINGS: There were 8195 (65.1%) valid responses. The Gulf War cohort reported symptoms and disorders significantly more frequently than those in the Bosnia and Era cohorts, which were similar. Perception of physical health and ability were significantly worse in the Gulf War cohort than in the other cohorts, even after adjustment for confounders. Gulf War veterans were more likely than the Bosnia cohort to have substantial fatigue (odds ratio 2.2 [95% CI 1.9-2.6]), symptoms of post-traumatic stress (2.6 [1.9-3.4]), and psychological distress (1.6 [1.4-1.8]), and were nearly twice as likely to reach the CDC case definition (2.5 [2.2-2.8]). In the Gulf War, Bosnia, and Era cohorts, respectively, 61.9%, 36.8%, and 36.4% met the CDC criteria, which fell to 25.3%, 11.8%, and 12.2% for severe symptoms. Potentially harmful exposures were reported most frequently by the Gulf War cohort. All exposures showed associations with all of the outcome measures in the three cohorts. Exposures specific to the Gulf were associated with all outcomes. Vaccination against biological warfare and multiple routine vaccinations were associated with the CDC multisymptom syndrome in the Gulf War cohort. INTERPRETATION: Service in the Gulf War was associated with various health problems over and above those associated with deployment to an unfamiliar hostile environment. Since associations of ill health with adverse events and exposures were found in all cohorts, however, they may not be unique and causally implicated in Gulf-War-related illness. A specific mechanism may link vaccination against biological warfare agents and later ill health, but the risks of illness must be considered against the protection of servicemen.
Adult↗
State of health after deployment in the Persian Gulf. The Danish Gulf War Study.
BACKGROUND: Multiple symptoms have been reported in American Gulf War Veterans including headache, fatigue, impaired short-term memory, sleep disturbances, agitation, respiratory symptoms, muscle and joint pain, diseases of the skin, and intermittent fever. The Danish Gulf War Study was performed to clarify if a corresponding pattern existed among Danes having served in the Persian Gulf during and mainly after the conflict. MATERIAL AND METHODS: A cross-sectional study was performed during the period January 1997 to January 1998 which included 821 subjects who had been deployed in the Persian Gulf within the period August 2 1990 until December 31 1997. Of 686 (83.6%) subjects who participated in the study, 95% had been engaged in peace keeping operations after the war. A group consisting of randomly selected age- and gender matched controls, comprised 231 of 400 potential participants (57.7%). All participants underwent clinical and paraclinical examinations, and had an interview based on a previously completed questionnaire. RESULTS: Unspecific symptoms such as repeated fits of headache, fatigue, memory and concentration difficulties, sleep disturbances, agitation, dyspnea, diseases of the skin, and intermittent fever, were significantly more frequent among Danish Gulf War Veterans, p < 0.05, than among controls; no association was found with respect to muscle and joint pain. The higher symptom prevalence among Gulf War Veterans was observed for conditions which had made their first appearance during or after the Gulf War. The prevalence of symptoms which made their first appearance before August 2 1990 was similar for both groups. CONCLUSION: Except for musculo-skeletal symptoms, this study demonstrated a pattern of symptoms among Danish Gulf War Veterans consistent with the findings among American Gulf War Veterans. Considering that American Gulf War Veterans were predominantly deployed during the armament phase and the brief war phase, and that Danish Gulf War Veterans were predominantly deployed after the war in peace keeping missions, the results indicate the existence of some common risk factors independent of war action.
Adult↗
Perinatal and maternal outcomes in Tuzla Canton during 1992-1995 war in Bosnia and Herzegovina.
AIM: To compare perinatal and maternal outcomes in Tuzla Canton during the 1992-1995 war in Bosnia and Herzegovina with those before (1988-1991) and after (2000-2003) the war. METHODS: We retrospectively collected data on a total of 59,707 liveborn infants and their mothers from the databases of Tuzla University Department for Gynecology and Obstetrics and Tuzla Institute for Public Health. Data on the number of live births, stillbirths, early neonatal deaths, causes of death, gestational age, and birth weights were collected. We also collected data on the number of medically unattended deliveries, examinations during pregnancy, preterm deliveries, and causes of maternal deaths. Perinatal and maternal outcomes were determined for each study period. RESULTS: There were 23,194 live births in the prewar, 18,302 in the war, and 18,211 in the postwar period. Prewar perinatal mortality of 23.3 per 1000 live births increased to 25.8 per 1000 live births during the war (P<0.001), due to a significant increase in early neonatal mortality (10.3 per thousand before vs 15.1 per thousand after the war, P<0.001). After the war, both perinatal mortality (14.4 per thousand) and early neonatal mortality (6.6 per thousand) decreased (P<0.001 for both). The most frequent cause of early neonatal death during the war was prematurity (55.7%), with newborns most often dying within the first 24 hours after birth. During the war, there were more newborns with low birth weight (<2500 g), while term newborns had lower average body weight. Women underwent 2.4 examinations during pregnancy (5.4 before and 6.3 after the war, P<0.001 for both) and 75.9% had delivery attended by a health care professional (99.1% before and 99.8% after the war; P<0.001 for both). Maternal mortality rate of 65 per 100,000 deliveries during the war was significantly higher than that before (39 per 100,000 deliveries) and after (12 per 100,000 deliveries) the war (P<0.001 for both). CONCLUSION: Perinatal and maternal mortality in Tuzla Canton were significantly higher during the war, mainly due to lower adequacy and accessibility of perinatal and maternal health care.
Birth Weight↗
Enhanced cortisol suppression to dexamethasone associated with Gulf War deployment.
OBJECTIVE: To examine whether PTSD or post-deployment health symptoms in veterans of the first Gulf War (Operation Desert Shield/Storm) are associated with enhanced suppression of the pituitary-adrenal axis to low-dose dexamethasone (DEX). METHOD: Plasma cortisol and lymphocyte glucocorticoid receptor (GR) number were measured at 08:00 h on two consecutive days, before and after administration of 0.5mg of DEX at 23:00 h in 42 male Gulf War veterans (14 without psychiatric illness, 16 with PTSD only, and 12 with both PTSD and MDD) and 12 healthy male veterans not deployed to the Gulf War or another war zone. RESULTS: In the absence of group differences in basal cortisol levels or GR number, Gulf War veterans without psychiatric illness and Gulf War veterans with PTSD only had significantly greater cortisol suppression to DEX than non-deployed veterans and Gulf War veterans with both PTSD and MDD. Gulf War deployment was associated with significantly greater cortisol suppression to DEX controlling for weight, smoking status, PTSD, and MDD; PTSD was not associated with response to DEX. Among Gulf War veterans musculoskeletal symptoms were significantly associated with cortisol suppression and those who reported taking anti-nerve gas pills (i.e., pyridostigmine bromide) during the war had significantly greater DEX-induced cortisol suppression than those who did not. CONCLUSIONS: The data demonstrate that alterations in neuroendocrine function are associated with deployment to the Gulf War and post-deployment musculoskeletal symptoms, but not PTSD. Additional studies are needed to examine the relationship of enhanced glucocorticoid responsivity to deployment exposures and chronic unexplained medical symptoms in Gulf War veterans.
Adult↗
Changes in Scottish suicide rates during the Second World War.
BACKGROUND: It is believed that total reported suicide rates tend to decrease during wartime. However, analysis of suicide rates during recent conflicts suggests a more complex picture, with increases in some age groups and changes in method choice. As few age and gender specific analyses of more distant conflicts have been conducted, it is not clear if these findings reflect a change in the epidemiology of suicide in wartime. Therefore, we examined suicide rates in Scotland before, during and after the Second World War to see if similar features were present. METHODS: Data on deaths in Scotland recorded as suicide during the period 1931-1952, and population estimates for each of these years, were obtained from the General Register Office for Scotland. Using computer spreadsheets, suicide rates by gender, age and method were calculated. Forward stepwise logistic regression was used to assess the effect of gender, war and year on suicide rates using SAS V8.2. RESULTS: The all-age suicide rate among both men and women declined during the period studied. However, when this long-term decline is taken into account, the likelihood of suicide during the Second World War was higher than during both the pre-War and post-War periods. Suicide rates among men aged 15-24 years rose during the Second World War, peaking at 148 per million (41 deaths) during 1942 before declining to 39 per million (10 deaths) by 1945, while the rate among men aged 25-34 years reached 199 per million (43 deaths) during 1943 before falling to 66 per million (23 deaths) by 1946. This was accompanied by an increase in male suicides attributable to firearms and explosives during the War years which decreased following its conclusion. CONCLUSION: All age male and female suicide rates decreased in Scotland during World War II. However, once the general background decrease in suicide rates over the whole period is accounted for, the likelihood of suicide among the entire Scottish population during the Second World War was elevated. The overall decrease in suicide rates concealed large increases in younger male age groups during the War years, and an increase in male suicides recorded as due to the use of firearms. We conclude that the effects of war on younger people, reported in recent conflicts in Central Europe, were also seen in Scotland during the Second World War. The results support the findings of studies of recent conflicts which have found a heterogeneous picture with respect to age specific suicide rates during wartime.
Adolescent↗