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Cutaneous melioidosis in a man who was taken as a prisoner of war by the Japanese during World War II.

Melioidosis, an infection caused by the gram-negative bacillus Burkholderia pseudomallei, is endemic to Southeast Asia and Northern Australia. Human infection is acquired through contact with contaminated water via percutaneous inoculation. Clinical manifestations range from skin and soft tissue infection to pneumonia with sepsis. We report a case of a man who was taken as a prisoner of war by the Japanese during World War II who presented with a nonhealing ulcer on his right hand 62 years after the initial exposure.

Aged↗

Full and partial post-traumatic stress disorder among World War II prisoners of war.

BACKGROUND: The aim of the study is to evaluate the frequency and characteristics of full and partial post-traumatic stress disorder (PTSD) among 66 World War II Nazi prisoners of war, some of whom had been deported to death camps. METHODS: The Structured Clinical Interview for DSM-IV was used to assess the presence of PTSD and major depression. The Dissociative Experiences Scale and the 58-item version of the Hopkins Symptom Checklist were also administered. Partial PTSD was defined as the presence of at least one symptom in each of the clusters defined by DSM-IV. RESULTS: Forty-eight percent of the subjects have a partial PTSD, while 20% reported the full syndrome. When compared to subjects with full PTSD, those with partial PTSD showed a significantly lower frequency of comorbid depression and lower levels of psychological distress, as measured by the Symptom Checklist. No differences were found with regards to dissociative symptoms and help-seeking. CONCLUSIONS: The problem of definition of PTSD partial syndromes deserves more attention in the literature.

Aged↗

Malnutrition and subsequent ischemic heart disease in former prisoners of war of World War II and the Korean conflict.

The harsh treatment of former prisoners of war (POWs) of World War II and the Korean conflict resulted in severe malnutrition. Although rarely linked to specific long-term medical problems, a specific marker of malnutrition, self-reported lower limb edema (presumably due to a vitamin B deficiency) was associated with a three-fold increase in subsequent death attributed to ischemic heart disease (IHD) during the follow-up period from 1967 through 1975. Although there is at present no medical basis for linking edema, which is perhaps a marker for some unmeasured risk factor, to subsequent IHD, this finding may nonetheless have medical implications for the group of former POWs and other populations with severe dietary deficiency. It also suggests there may be a need to reexamine currently held theories on malnutrition and subsequent chronic disease.

Edema↗

Accurate anatomical location of war injuries: analysis of the Lebanon war fatal casualties and the proposition of new principles for the design of military personal armour system.

In this study we present a new approach to the design of the military personal armour system (MPAS). This approach is based on a computerized analysis of the exact anatomical location of 405 penetrating war injuries (290 shrapnel and 115 bullet injuries) in 164 soldiers killed in the Lebanon war. All the penetrating injuries (hits) were plotted on a computerized image of the human body. About 90 per cent of all hits were to the front of the body; 55 per cent of all hits were to the left side. About 45 per cent of all hits were to the torso, which is slightly more than the torso's proportion of total body-surface area (36 per cent). Of all hits to the torso, 64 per cent of the shrapnel hits and 73.3 per cent of the bullet hits were limited to the front mid torso (T4 to T9). The head at the level of the helmet received 9 per cent of all hits, most of which were over the frontal bones (72.4 per cent). The body part with the greatest density of penetrating injuries was the face, with 22.2 per cent of all penetrating wounds, and in particular the mid face, from the level of the lips to the level of the zygomatic bones, was especially vulnerable, sustaining 10 per cent of all the penetrating wounds. These findings suggest several possible modifications in the standard MPAS: an additional protective device over the front mid torso may be incorporated; the face may be protected by a transparent and lightweight face-shield; a horizontal margin added to the standard helmet may protect the upper face from missiles from above; a chin cover may protect the lower face.

Blast Injuries↗

The war on drugs and the war on abortion: some initial thoughts on the connections, intersections and effects.

While many people view the war on abortion and the war on drugs on the part of state and federal governments in the USA as distinct, there are in fact many connections and a great deal of overlap between the two. Their histories, the strategies used to control and punish certain reproductive choices and those to control the use of certain drugs, the limitations that are placed on access to abortion and other reproductive health care and drug treatment, and the populations most harmed by those limitations are remarkably similar. These similarities are particularly apparent where the issues coalesce in the regulation and punishment of pregnant, drug-using women [1]. Efforts to control reproduction and drugs are rooted in forms of bigotry and prejudice that are essentially the same; African-American women are particularly harmed by them [2]. These efforts reflect a common political agenda and draw attention away from real underlying issues, including poverty, race discrimination and lack of a coherent national health care policy. Those who fight against each of them must recognize that they have a common cause and need a comprehensive strategy to address both as fundamental issues of social justice.

Abortion, Induced↗

The Great War, the Russian Civil War, and the invention of big science.

The revolutionary transformation in Russian science toward the Soviet model of research started even before the revolution of 1917. It was triggered by the crisis of World War I, in response to which Russian academics proposed radical changes in the goals and infrastructure of the country's scientific effort. Their drafts envisioned the recognition of science as a profession separate from teaching, the creation of research institutes, and the turn toward practical, applied research linked to the military and industrial needs of the nation. The political revolution and especially the Bolshevik government that shared or appropriated many of the same views on science, helped these reforms materialize during the subsequent Civil War. By 1921, the foundation of a novel system of research and development became established, which in its most essential characteristics was similar to the U. S. later phenomenon known as "big science."

History, 20th Century↗

Anniversary reactions in Gulf War veterans: a naturalistic inquiry 2 years after the Gulf War.

The goal of this study was to assess the occurrence of anniversary reactions in Gulf War veterans 2 years after the conclusion of Operation Desert Storm. Subjects were administered questionnaires and asked to identify specific months of best and worst functioning, and months of least or most symptoms of posttraumatic stress disorder (PTSD). Negatively experienced months were compared to documented dates of exposure to traumatic events during the war. Anniversary reactions occurred with a frequency greater than chance and were seen most in individuals exposed to a greater number, and to more severe types, of traumatic events. This suggests that anniversary reactions are etiologically linked to traumatic events and may be a part of the syndrome of PTSD.

Chi-Square Distribution↗

Posttraumatic stress disorder and war-zone exposure as correlates of perceived health in female Vietnam War veterans.

Previous studies have identified traumatic exposure and posttraumatic stress disorder (PTSD) as predictors of physical health complaints without considering the relationship between exposure and PTSD. This study examined the unique associations of war-zone exposure and PTSD with perceived physical health outcomes in a nontreatment-seeking sample of 109 female veterans of the Vietnam War who responded to a series of psychological, exposure, and health questionnaires. Both PTSD and exposure were associated with reports of negative health outcomes when each variable was not adjusted for the other. The effects associated with exposure decreased when PTSD was controlled for, whereas the effects associated with PTSD remained when exposure was controlled for. Results suggest that effects of traumatic exposure on perceived health are partially mediated by increases in PTSD after exposure, supporting studies on the effects of stress on health.

Adult↗

Posttraumatic stress disorder and current relationship functioning among World War II ex-prisoners of war.

This study examined the association of posttraumatic stress disorder (PTSD) with the quality of intimate relationships among present-day male World War II ex-prisoners of war (POWs). Ex-POWs had considerable marital stability; those with PTSD were no less likely to be in an intimate relationship. Ex-POWs in an intimate relationship who had PTSD (N=125 ) were compared with ex-POWs in a relationship who did not have PTSD (N=206). Marital functioning was within a range expected for persons without traumatic exposure. Yet, over 30% of those with PTSD reported relationship problems compared with only 11% of those without PTSD. Ex-POWs with PTSD reported poorer adjustment and communication with their partners and more difficulties with intimacy. Emotional numbing was significantly associated with relationship difficulties independent of other symptom complexes and severity of PTSD. Implications for clinical practice are discussed.

Aged↗

Maxillofacial war injuries during the Iraq-Iran War: an analysis of 300 cases.

The following study focuses on three hundred maxillofacial war casualties that were admitted to the Basra Republic Hospital during the Iraq-Iran War. These three hundred cases were chosen on the basis of them being only oral and maxillofacial injuries. Of these cases, there was no mortality recorded. This was in part due to the rapid evacuation, immediate resuscitation and proper management of the casualties. An appropriately staffed hospital, efficient surgical techniques and the presence of highly skilled specialists working as a team also made this result possible. This analysis categorizes, evaluates and discusses the treatment of the casualties based on the severity of the injury and outlines several techniques used to treat such patients.

Airway Obstruction↗

Managing 'civilian deaths due to war operations': Yorkshire experiences during world war II.

Air raid precautions prior to and during the Second World War included guidance on the burial of civilians who had been killed by enemy bombardment. The Ministry of Health Circular 1779 was published before the start of the war, on the understanding that 'scheme-making' authorities would need time to prepare for the interment of mass fatalities. As the Blitz got underway, tensions emerged between the state's pragmatic concerns to restrict the cost and resources afforded to burial, and the wish of many local authorities to secure decent burial for their citizens. Key issues on which there was disagreement included the state-proposed use of shrouds instead of coffins, and mass interment. These practices carried overtones of the much-hated pauper funeral and ran counter to the political imperative to present civilian death as 'heroic'. This local study is placed in the wider context of the history of death and burial, and provides an indicator of the strength of attachment to customary funerary ritual during the middle of the twentieth century.

Death↗

Trauma management in a war zone: the Lebanese war experience.

Lessons learned from the Vietnam and Korean conflicts have emphasized the necessity of an organized preparedness for optimal management of casualties. The present report summarizes the experience of a tertiary care center in the present Lebanese war. Between 1975 and 1986, approximately 30,000 war casualties were treated at the American University of Beirut Medical Center (AUBMC). A disaster plan was implemented whenever more than 25 major trauma victims were received within 1 hour. In-field stabilization and emergency room (ER) thoracotomy were not employed. The results are illustrated by an analysis of 1,500 cases of abdominal trauma, (1,314 high-velocity gunshot wounds, 29 stab wounds, 157 blunt injuries). A total of 1,420 patients were operated on within 6 hours of admission and 711 within the first hour. Overall mortality was 130, 8.7%; 9.5% for gunshot wounds, 3.4% for stab wounds, and 2.5% for blunt trauma. One hundred forty-five patients or 9.7% had negative findings at laparotomy. The factors affecting mortality were hypotension on admission (26.5% for a BP less than 90 mm Hg and 2.8% for a BP higher than 90 mm Hg) and the presence of extra-abdominal injuries (14.4% with and 4.4% without). The chief causes of death were hemorrhage (3.7%), sepsis (2.1%), and ARDS (1.2%).

Abdominal Injuries↗

The war on marijuana: the transformation of the war on drugs in the 1990s.

BACKGROUND: As the "war on drugs" enters the latter half of its third decade since being forged into the American lexicon by President Ronald Reagan, the public has grown more skeptical of the current strategy and has proven to be receptive to a broader consideration of alternatives to incarceration. This has been the case most notably with marijuana offenses, where the policy discussion has shifted in some localities to one of decriminalization or de-prioritizing law enforcement resources dedicated to pursuing possession offenses. Despite the increased profile surrounding marijuana policy in recent years, there remains a significant degree of misunderstanding regarding the current strategy, both in terms of how resources are being allocated and to what eventual gain. METHODS: Previous studies have analyzed drug offenses as a general category, but there has yet to be a single study that has focused specifically on marijuana offenders at all stages of the system. This report analyzes multiple sources of data for the period 1990-2002 from each of the critical points in the criminal justice system, from arrest through court processing and into the correctional system, to create an overall portrait of this country's strategy in dealing with marijuana use. RESULTS: The study found that since 1990, the primary focus of the war on drugs has shifted to low-level marijuana offenses. During the study period, 82% of the increase in drug arrests nationally (450,000) was for marijuana offenses, and virtually all of that increase was in possession offenses. Of the nearly 700,000 arrests in 2002, 88% were for possession. Only 1 in 18 of these arrests results in a felony conviction, with the rest either being dismissed or adjudicated as a misdemeanor, meaning that a substantial amount of resources, roughly 4 billion dollars per year for marijuana alone, is being dedicated to minor offenses. CONCLUSION: The results of this study suggest that law enforcement resources are not being effectively allocated to offenses which are most costly to society. The financial and personnel investment in marijuana offenses, at all points in the criminal justice system, diverts funds away from other crime types, thereby representing a questionable policy choice.

Journal Article↗

Defensive and affective-emotional reactions to war: the Abkhazian war as reflected in people's subjective reactions.

Differences in defensive and affective-emotional reactions of 108 male Georgian subjects who had been confronted with the consequences of the Abkhazian war in different ways (nonwounded soldiers, wounded soldiers, and civilian controls) were significant between groups on all defense scales and four of the 12 Gottschalk-Gleser scales. The results are discussed from a perspective with war forming for all three groups an important life event which differentially determined their psychological reactions.

Adaptation, Psychological↗

Chronic strongyloidiasis in World War II Far East ex-prisoners of war.

Fifty-two of 142 (37%) American ex-prisoners of war that worked on the Burma-Thailand Railroad during World War II were found to have previously unrecognized symptomatic Strongyloides stercoralis infections. A characteristic urticarial creeping skin eruption on the abdomen, buttocks and thighs occurred in 92%. Infection was also associated with pruritus ani, abdominal pain, indigestion, heartburn, and diarrhea. Demonstration of larvae in ether-formalin stool concentrates in these chronic low density infections required 5 hours of microscopy per case to detect 90% of positive cases. Therapy with thiabendazole resulted in a clinical cure in 93% and a microscopic cure in 100%; but was associated with frequent side effects. Chronic strongyloidiasis should be considered in veterans of Far East conflicts and in others with intimate soil contact in rural Strongyloides stercoralis-endemic areas who present with recurrent creeping skin eruption, abdominal pain, and eosinophilia.

Aged↗

A confirmatory factor analysis of the Impact of Event Scale using a sample of World War II and Korean War veterans.

This study assessed the factor structure of the Impact of Event Scale (IES), a measure of intrusion and avoidance, using a sample of World War II and Korean War veterans who had experienced combat 40-50 years earlier. A series of 3 confirmatory factor analytic models were specified and estimated using LISREL 8.3. Model 1 specified a 1-factor model. Model 2 specified a correlated 2-factor model. Model 3 specified a 2-factor model with additional cross-factor loadings for Items 2 and 12. Model 3 was found to fit the data. In addition, this model was found to be a better explanation of the data than the other models. Also in addition, the correlations between the Intrusion and Avoidance factors and the 4 subscales of the 28-item General Health Questionnaire were examined to determine the distinctiveness of the two IES factors.

Aged↗

Long-term heart disease and stroke mortality among former American prisoners of war of World War II and the Korean Conflict: results of a 50-year follow-up.

For the first 30 years after repatriation, former American prisoners of war (POWs) of World War II and the Korean Conflict had lower death rates for heart disease and stroke than non-POW veteran controls and the U.S. population, but subsequent morbidity data suggested that this survival advantage may have disappeared. We used U.S. federal records to obtain death data through 1996 and used proportional hazards analysis to compare the mortality experience of POWs and controls. POWs aged 75 years and older showed a significantly higher risk of heart disease deaths than controls (hazard ratio = 1.25; 95% confidence interval, 1.01-1.56), and their stroke mortality was also increased, although not significantly (hazard ratio = 1.13; 95% confidence interval, 0.66-1.91). These results suggest that circulatory disease sequelae of serious, acute malnutrition and the stresses associated with imprisonment may not appear until after many decades.

Aged↗

Increased psychological distress among Danish Gulf War veterans--without evidence for a neurotoxic background. The Danish Gulf War Study.

INTRODUCTION: Compared with controls, up to six years after their return, Danish Gulf War veterans have a significantly higher prevalence of self-reported neuropsychological symptoms, potentially as a result of neurotoxic exposure during deployment. We tested the hypotheses that: 1) GW veterans would perform less well than controls using a computerized neuromotor test battery; and that 2) GW veterans have a psychological profile different from that of controls. MATERIAL AND METHODS: A cross-sectional study of 686 subjects who had been deployed in the Persian Gulf within the period August 2, 1990 until December 31, 1997; the control group comprised 231 subjects matched according to age, gender and profession. All participants underwent clinical and paraclinical examinations, along with a neuromotor test battery (CATSYS Test System) and a psychological health status questionnaire, the SCL-90-R rating scale. RESULTS: No differences were found between GW veterans and controls with respect to lifestyle and cohabitational characteristics. Differences between the two groups with respect to neuromotor function were very small. Within the GW veteran group, stratified according to clustering of neuropsychological symptoms, and stratified according to SCL-90-R score, no trends were found suggesting reduced motor function with increasing symptoms. Of nine dimensions constructed on the basis of the SCL-90-R items, six were significantly associated with being a Gulf War veteran. Statistically, the strongest associations were found for ratings of the obsessive-compulsive dimension and of the depression dimension. No associations were found with respect to phobic anxiety, paranoid ideation, and psychoticism. INTERPRETATION: The increased psychological distress found among Danish GW veterans seemed rather due to a mentally distressing environment than to neurotoxic exposure.

Adult↗