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PubMed2000

War zone stress, personal and environmental resources, and PTSD symptoms in Gulf War veterans: a longitudinal perspective.

Cross-sectional research has demonstrated a link between personal and environmental resources and development of emotional distress after war zone service. Less is known about the longitudinal relationship between resources and distress. The authors addressed this issue in a study of 348 Gulf War returnees tested at 2 time points. Resources decreased and posttraumatic stress disorder (PTSD) symptoms increased over time. Time 1 avoidance and family cohesion predicted PTSD symptoms at Time 2. Regression analyses revealed a bidirectional relationship over time between resources and PTSD symptoms. Time 1 resources predicted Time 2 psychopathology after accounting for Time 1 emotional distress. PTSD symptoms at Time 1 also predicted changes in coping and family relationships, even after accounting for Time 1 resources. Findings are consistent with the concept of a loss spiral (Hobfoll, 1989), in which resource factors and emotional sequelae to war stress exert reciprocal effects.

Adaptation, Psychological↗
PubMed2000

Cirrhosis mortality among former American prisoners of war of World War II and the Korean conflict: results of a 50-year follow-up.

In our earlier, 30-year follow-up of American prisoners of war (POWs) of World War II and the Korean conflict, we found evidence of increased cirrhosis mortality. Using federal records, we have now extended our follow-up to 50 years (42 years for Korean conflict veterans) and have used proportional hazards analysis to compare the mortality experience of POWs with that of controls. Compared with their controls, World War II POWs had a 32% higher risk of cirrhosis mortality (statistically significant), and mortality risk was higher in the first 30 years of follow-up and also among those aged 51 years and older. Korean POWs had roughly the same risk of cirrhosis mortality as their controls. Neither self-reported data on alcohol consumption nor supplemental morbidity data satisfactorily explained the differences in risk between POWs and controls, although there was evidence that POWs tended to have higher rates of hepatitis, helminthiasis, and nutritional deprivation.

Case-Control Studies↗
PubMed2001

Children war casualties during the 1991-1995 wars in Croatia and Bosnia and Herzegovina.

AIM: To analyze clinical course of war-related injuries in children treated at the Split University Hospital during the wars in Croatia (1991-1995) and Bosnia and Herzegovina (1992-1995). METHODS: Medical records of 94 treated children were analyzed. The severity of wounds was scored according to the Abbreviated Injury Scale (AIS) and Injury Severity Score (ISS) evaluation systems. RESULTS: Most children were wounded during shelling/bombing (n = 28, 10 boys and 18 girls) and by left over explosive devices (n = 26). Children injured by left over explosive devices were predominantly boys (23/26 children), aged 10 to 16 years (19/26 children). Extremities were the most frequently wounded body regions (43% of all wounded regions). The wounds to the head/neck (median AIS = 5.0, range 1-6) and abdomen (median AIS = 4.5, range 3-5) were the most severe. Abdominal wounds required surgical procedures (p < 0.001) and antibiotic treatment (p < 0.05) most frequently, as well as patients with greater AIS and ISS scores (p < 0.05). According to the treatment outcome, more patients wounded to the abdomen and extremities showed improvement than no change or complete recovery (p < .05). Permanent disability remained in 37 (39.4%) children and three (3.3%) children died. CONCLUSION: Boys in upper elementary grades and high school were at greater risk of being wounded by fragments of left over explosive devices than younger boys or girls. The most severe wounds were to the head/neck and the abdomen and inflicted during the shelling or bombing. This should be taken into account in organization of surgical care for the children with war-related injuries.

Adolescent↗
PubMed2002

Health and functioning among four war eras of U.S. veterans: examining the impact of war cohort membership, socioeconomic status, mental health, and disease prevalence.

This analysis examines the self-rated health and functioning of World War II, Vietnam era, Korean Conflict, and Persian Gulf War veterans participating in the Veteran Identity Program Survey 2001. The results indicate that although World War II veterans are more likely to report poor health status and functioning, Vietnam-era veterans report more difficulty with specific activities of daily living and instrumental activities of daily living than any other era of veterans. These relationships remain when controlling for race/ethnicity, socioeconomic status, disease prevalence, and mental health status. These findings suggest that there are characteristics unique to the Vietnam experience that negatively affect this cohort of veterans. We suggest that further analysis examine the specific pathways through which the experience of being a Vietnam veteran affects health. In the meantime, health and social service planning within the Department of Veterans Affairs should explore the services that should be developed and targeted to this cohort of veterans so that they may remain independent in the community.

Activities of Daily Living↗
PubMed2003

[Types of abdominal war injuries in relation to colonic injuries analyzed during 2 war years of treatment at the Clinic for Abdominal Surgery in Sarajevo].

The basic characteristics of war in Sarajevo are occasional shelling, sniper fire, unexpected shelling and a lack of a front line in the classic sense of the word. The extent of the wound is the key factor in deciding how the patient is to be treated. A primary contamination of this kind of wound has all the conditions to turn into a manifest infection. The abdomen wounds, because of their severity and direct threat to life, are among the most dangerous wounds altogether. They make up on average 10% of all war wounds and the mortality of these patients by today's literature is high, about 6%. The aims of this paper are to show which organs in the abdomen are wounded and what is their relationship to the wounding of the colon, and to show what is the relation between multiple and isolated wounding of the abdomen. During the years 1992 and 1993, 1106 patients with war wounds were treated at the clinic for the abdominal surgery. From that number 71 patients were treated with explorative laparotomy. The large intestine was injured in 274 patients while 221 patients had injuries of the small intestine. An injury of the liver was found in 165 cases. The gall bladder was injured in 18 cases. The stomach was injured in 324 patients. The pancreas was damaged in 72 patients. There were 94 cases of injured spleens. The kidneys were wounded in 30 cases. In 40 cases there was bleeding from the retroperitoncum. Treatment of the omentumen was carried out in 753 patients. The number of patients who did not survive is 135 of which 44 had an injury of the large intestine. A retrospective analysis data shows that the number of multiple wounds makes up over 98% of all wounds. Isolated wounds of abdominal organs are found in less than 2% of all cases. The increase mortality in our research can be explained greater energy of the projectiles which amplify the acceleration at asphalt surfaces which product the greater destructions of the tissue and the massiveness of the injuries.

Abdominal Injuries↗
PubMed1991

Risk factors for infection in fracture war wounds (1973 and 1982 wars, Israel)

The development of post-surgical wound infection was compared in two groups of soldiers who sustained fractures or amputations on the battlefield during the first month of the 1982 and 1973 wars. Risk factors for the development of post-surgical wound infection were sought. In the 1982 group, numbering 184, the four variables independently associated with infection were multiple operations during the follow-up period; drains inserted in the first operation; extensive tissue loss; and blood transfusion during the first operation. For the 1973 group, numbering 130, the significant variables were multiple operations; amputations (highly correlated with extensive tissue loss); injury involving other body systems in addition to the fracture; and open drains. The high risk associated with open drains in both wars raises doubt about their usefulness. The main distinction between injuries of the two wars was the high prevalence (72.3%) of multi-system injuries in 1973 versus low prevalence (29.2%) in 1982. Overall infection rates were similar (30.5% and 31.5%), but infections at the site of the fracture were twice as high in 1982. Pseudomonas was the most common single species of bacteria isolated from infected wounds (26% in 1982, 33.6% in 1973). It appeared in the wounds relatively late, 10-14 days after admission.

Adult↗
PubMed1994

[Strongyloides infections in former prisoners of war in South-East Asia in the second World War; additional information from serological diagnosis].

OBJECTIVE: To analyse the efficacy of ELISA serology in patients with Strongyloides infection acquired during World War II and maintained through repeated autoinfection. DESIGN: Descriptive. SETTING: Laboratory of Parasitology, Faculty of Medicine, Leiden, the Netherlands. METHODS: Parasitological and clinical data on 193 ex-prisoners of war (South-east Asia) were presented previously (1990) by Verburg and De Geus. ELISA using L-3 S. ratti antigen was carried out with sera of these patients and the results were compared with those of repeated stool examinations using Baermann's method. RESULTS: All subjects harbouring larvae in repeated stool examinations (26) were positive in serology. In 21 out of 167 patients in whom no larvae could be demonstrated, specific antibodies were detected. Anamnestic information together with data on eosinophilia and IgE levels suggested that the majority of these subjects were actually infected. The serological prevalence of infection with Strongyloides stercoralis was 33% for those imprisoned in Burma and 4% for those who were prisoners of war in the former Netherlands East Indies. CONCLUSION: In the group of subjects studied, in whom Strongyloides infection was apparently maintained through a process of autoinfection for a period of over 40 years, serology appears a sensitive and specific diagnostic tool. Larvae could be detected in no more than 26 out of 47 serologically positive subjects.

Aged↗
PubMed1993

Psychological and war stress symptoms among deployed and non-deployed reservists following the Persian Gulf War.

The present study examined the incidence of war-related psychological distress among Persian Gulf War veterans. A total of 591 Army, Navy, and Marine reservists were administered the Mississippi PTSD Scale, the Beck Depression Inventory, and the SCL-90R. Combat-deployed reservists showed significantly higher levels of psychological symptomatology that non-deployed reservists, generally corresponding to levels of stress exposure. No significant effects were found for race or prior combat exposure, but significant differences were found between combat-deployed male and female reservists. Despite the brevity and the outcome of the Persian Gulf War, significant symptomatology exists among this population.

Adolescent↗
PubMed1996

Lessons relearned--when denial becomes impossible: therapeutic response to combat stress reaction during the Yom Kippur War (1973), the Lebanon War (1982) and the Intifada.

This article presents the attitudes toward CSR during and after the 1973 Yom Kippur War, the 1982 Lebanon War and the Intifada. It analyzes the transition from denial to recognition which evolved following the Yom Kippur War. Several explanations are suggested and discussed, including structural, political and psychoanalytic perspectives.

Combat Disorders↗
PubMed1995

War-related transformation and work of surgery service of the Pozega Medical Center, East-Croatian Hospital unaffected by direct war activities.

The work of the Pozega Medical Center Surgical Unit during the two war years (from July 16, 1991, to October 1, 1993) in Croatia is described. Since the war operations did not affect the town directly, the work was mostly characterized by treatment of wounds inflicted by explosive devices (51.2%) and localized mostly on the extremities (62.9%). Apart from these wounds, there were 0.7% burns, 26.6% gunshot wounds, and 19.6% injuries caused by blunt and hard objects. Of the total of 959 treated wounded persons, only 18 (1.9%) died, illustrating the success of the therapy administered according to the war surgery doctrine criteria.

Adolescent↗
PubMed1997

Federal Nursing Service Award. Rhythms of War: activation experiences during the Persian Gulf War.

Reserve military members and families require family support; however, support needs may increase in war. Stress may stem from entering active duty or change in family situations. This ethnographic study illuminates patterns of activation through deactivation of reserve military members, their families, family support personnel, and commanders during the Persian Gulf War. The sample included 59 individuals. Five themes were uncovered: (1) staying connected, (2) living with war, (3) fluctuating emotions, (4) refocus your sense of life, and (5) challenges of living the day-to-day. This study contributes to understanding family support experience from activation through deactivation. Recommendations are offered.

Anthropology, Cultural↗
PubMed1997

New Zealand military nurses fight for recognition: World War One-World War Two.

This article examines the battle undertaken by New Zealand's military nurses to gain recognition as officers. The fight to win this battle took from just prior to World War One to mid-way through World War Two-twenty seven years. Issues such as male domination of the military and the government, the generally accepted work of women in war and the lack of knowledge concerning nursing's professionalism combined to create a situation whereby practical recognition of the nurses did not take place until visual alterations were made to uniforms in 1941.

Career Mobility↗
PubMedDate not supplied

Maxillofacial war injuries during the war in former Yugoslavia.

War wounds of the maxillofacial region occur in 5-17% of casualties. In the Clinic for Maxillofacial Surgery of the Military Medical Academy, during the war in former Yugoslavia, 482 casualties with dominant wounds in the maxillofacial region were treated. The outcome of the treatment depended on the quality and speed of the first aid and general medical aid, as well as on qualified specialist treatment. Specificity of the management of the war wounds of maxillofacial region includes: minimal debridement of soft tissues, removal of only deperiosted fragments of bony tissues, valid reconstruction of bony and soft tissues defects, correct immobilization, antitetanus prophylaxis, adequate antibiotic therapy, as well as permanent and very meticulous postoperative care.

Humans↗
PubMed1997

On lifting the fog of war in the battle on heart disease: Star Wars technology in pursuit of a seamless integration strategy.

In our efforts to reduce cardiac morbidity and mortality we often use terms such as the "battle" or "war" on heart disease. If we believe efforts to reduce cardiac disease are the moral equivalent of war, then perhaps we should explore ways that military strategic and tactical metaphors can be applied through technology to the cardiac battle. In this article we explore three major areas for technological advancement: adaptation of the strategies of outcomes management and evidence-based medicine, computer simulation and animation efforts to create horizontal and vertical integration of strategic efforts, and use of interactive multimedia in "recruiting an army" through community empowerment. The overall goal is to find ways to lift "the fog of war" in the battle on heart disease, in order to further the integration of our various efforts.

Cardiovascular Diseases↗
PubMed2005

Aviation medicine in the United Kingdom: from the end of World War I to the end of World War II, 1919-1945.

This is the second of three brief papers that summarize the history of Aviation Medicine in the Royal Air Force. British aviation medicine research was rescued from the doldrums of retrenchment after the end of the First World War by the need to support attempts on world records for height and speed. Despite this, the outbreak of the Second World War still found the British inadequately prepared. This part of the account of British aviation medicine research charts its transition from an organization with three full-time workers into a thriving research institute.

Aerospace Medicine↗
PubMed2006

Verbal and physical aggression in World War II former prisoners of war: role of posttraumatic stress disorder and depression.

This study examined the relationship among posttraumatic stress disorder (PTSD), depression, and intimate partner relationship aggression in a community sample of World War II (WWII) male military former prisoners of war (POWs). Sixty percent of these POWs reported verbal aggression in their marriages, and 12% endorsed physical aggression. Both verbal and physical aggression were significantly correlated to the severity of captivity trauma and to PTSD symptoms. Posttraumatic stress disorder symptoms significantly mediated the relationship between severity of trauma and both verbal and physical aggression. Depression was a significant moderator of the relationship between PTSD and both physical and verbal aggression. Theoretical and clinical implications are suggested.

Aggression↗
PubMed1990

War demography: the impact of the 1808-09 war on the civilian population of Aland, Finland.

"A pre-industrial population crisis caused by a war is examined using Finnish historical records. During the War of Finland (1808-09) the Swedish military deployed on the Aland Islands helped spread infectious diseases among the civilian population. The result was a short but intense period of high mortality. This article focuses on the short-term demographic impact of this crisis. Changes in age-specific and sex-specific mortality, fertility, and nuptiality are explored....A projection, assuming that the crisis did not occur, indicates that Aland's population losses were never compensated." (SUMMARY IN FRE)

Age Factors↗
PubMed2005

Risk of selected cardiovascular diseases and posttraumatic stress disorder among former World War II prisoners of war.

PURPOSE: American World War II (WWII) prisoners of war (POWs) suffered both mental and physical deprivation while interned. The long-term health consequences of the internment were studied for an increased risk of cardiovascular diseases and posttraumatic stress disorder (PTSD). METHODS: This study evaluated healthcare utilization data for 10 years (1991-2000) from Veterans Affairs (VA) and non-VA healthcare providers for 19,442 former WWII POWs and 9728 non-POW controls. The risk of diseases was approximated by odds ratios adjusted for race and age. RESULTS: Collectively, former POWs had statistically significant increased risk of PTSD, and those POWs with PTSD also had statistically significant increased risks of cardiovascular diseases including hypertension and chronic ischemic heart disease when compared to both non-POWs and POWs without PTSD. CONCLUSIONS: Among former WWII POWs, risk of cardiovascular disease is related to having PTSD.

Aged↗