Effects of trauma-focused psychotherapy upon war refugees.

PubMed

Kruse, Johannes; Joksimovic, Ljiljana; Cavka, Majda; Wöller, Wolfgang; Schmitz, Norbert

2009-12-01

The aim of this study is to evaluate the effects of a trauma-focused psychotherapy upon war refugees from Bosnia. Seventy refugees who met the criteria for posttraumatic stress disorder (PTSD) and somatoform disorders were included. The first 35 refugees were offered psychotherapy and the following 35 refugees received usual care. Outcome variables were changes in self-reported PTSD symptoms, psychological symptoms, and health status. At 12-month follow-up, participants in the intervention group reported significantly lower scores on the PTSD scale and the measure of psychological symptoms than the comparison group participants. Our results suggest that psychotherapy reduces symptoms of PTSD and somatoform disorders among war refugees even in the presence of insecure residence status.

Becoming a Guidance Counsellor in Ontario: Formative Influences from Counsellors' Perspective

ERIC Educational Resources Information Center

Nadon, Daniel; Samson, André; Gazzola, Nicola; Thériault, Anne

2016-01-01

Contrary to guidance counsellors elsewhere in North America who hold a master's degree, career and guidance counselling services in secondary schools in Ontario are delivered by teachers who have completed additional undergraduate studies. Guidance counsellors are pivotal components of the school as they complete tasks that promote students'…

Israeli School and Community Response to War Trauma: A Review of Selected Literature

ERIC Educational Resources Information Center

Abel, Rachel M.; Friedman, Howard A.

2009-01-01

This article presents a review of literature focusing on mental health clinicians who have responded to war trauma in their work with children in Israeli schools. The review provides a brief introduction to the country's war history and inception of school psychological and counselling services. Within this framework, results of empirical…

Reading, Trauma and Literary Caregiving 1914-1918: Helen Mary Gaskell and the War Library.

PubMed

Haslam, Sara

2018-03-28

This article is about the relationship between reading, trauma and responsive literary caregiving in Britain during the First World War. Its analysis of two little-known documents describing the history of the War Library, begun by Helen Mary Gaskell in 1914, exposes a gap in the scholarship of war-time reading; generates a new narrative of "how," "when," and "why" books went to war; and foregrounds gender in its analysis of the historiography. The Library of Congress's T. W. Koch discovered Gaskell's ground-breaking work in 1917 and reported its successes to the American Library Association. The British Times also covered Gaskell's library, yet researchers working on reading during the war have routinely neglected her distinct model and method, skewing the research base on war-time reading and its association with trauma and caregiving. In the article's second half, a literary case study of a popular war novel demonstrates the extent of the "bitter cry for books." The success of Gaskell's intervention is examined alongside H. G. Wells's representation of textual healing. Reading is shown to offer sick, traumatized and recovering combatants emotional and psychological caregiving in ways that she could not always have predicted and that are not visible in the literary/historical record.

Untreated arteriovenous fistula after World War II trauma.

PubMed

Schneider, M; Creutzig, A; Alexander, K

1996-01-01

A 76-year-old-patient with severe congestive heart failure due to femoral arteriovenous fistula (AVF) after World War II trauma is presented. He was admitted to our clinic because of increasing dyspnea and vertigo during the last years. Moreover he suffered from chronic venous insufficiency on the lower limb distal of the fistula. History revealed a bullet trauma sustained 50 years ago in 1945 while riding on a train that was taken under fire. In 1973 diagnosis of traumatic AVF was first established by arteriography but the patient did not undergo surgical repair. Actual diagnostic procedure included colour Doppler imaging, chest x-ray, and echocardiography. The patient refused invasive treatment, but drug therapy of congestive heart failure was accepted.

Long-term effects of conflict-related sexual violence compared with non-sexual war trauma in female World War II survivors: a matched pairs study.

PubMed

Kuwert, Philipp; Glaesmer, Heide; Eichhorn, Svenja; Grundke, Elena; Pietrzak, Robert H; Freyberger, Harald J; Klauer, Thomas

2014-08-01

The aim of the study was to compare the long-term effects of conflict-related sexual violence experienced at the end of World War II (WWII) with non-sexual WWII trauma (e.g., being exposed to shell shock or physical violence). A total of 27 elderly wartime rape survivors were compared to age- and gender-matched control subjects who were drawn from a larger sample of subjects over 70 years of age who had experienced WWII-related trauma. A modified version of the Posttraumatic Diagnostic Scale was used to assess trauma characteristics and posttraumatic stress disorder (PTSD) symptoms and the Brief Symptom Inventory-18 was used to assess current psychopathology. Additionally, measures of posttraumatic growth (Posttraumatic Growth Inventory) and social acknowledgement as a trauma survivor (Social Acknowledgement Questionnaire) were used to assess two mediating variables in post-trauma conditions of rape victims. Women exposed to conflict-related sexual violence reported greater severity of PTSD-related avoidance and hyperarousal symptoms, as well as anxiety, compared with female long-term survivors of non-sexual WWII trauma. The vast majority (80.9 %) of these women also reported severe sexual problems during their lifetimes relative to 19.0 % of women who experienced non-sexual war trauma. Women exposed to conflict-related sexual violence also reported greater posttraumatic growth, but less social acknowledgement as trauma survivors, compared to survivors of non-sexual war trauma. The results were consistent with emerging neurobiological research, which suggests that different traumas may be differentially associated with long-term posttraumatic sequelae in sexual assault survivors than in other survivor groups and highlights the need to treat (or better prevent) deleterious effects of conflict-related sexual violence in current worldwide crisis zones.

Family systems approach to attachment relations, war trauma, and mental health among Palestinian children and parents

PubMed Central

Punamäki, Raija-Leena; Qouta, Samir R.; Peltonen, Kirsi

2017-01-01

ABSTRACT Background: Trauma affects the family unit as a whole; however, most existing research uses individual or, at most, dyadic approaches to analyse families with histories of trauma. Objective: This study aims to identify potentially distinct family types according to attachment, parenting, and sibling relations, to analyse how these family types differ with respect to war trauma, and to explore how children’s mental health and cognitive processing differ across these family types. Method: Participants included Palestinian mothers and fathers (N = 325) and their children (one per family; 49.4% girls; 10–13 years old; mean ± SD age = 11.35 ± 0.57 years) after the Gaza War of 2008–2009. Both parents reported their exposure to war trauma, secure attachment availability, and parenting practices, as well as the target child’s internalizing and externalizing symptoms [Strengths and Difficulties Questionnaire (SDQ)]. Children reported their symptoms of post-traumatic stress disorder (on the Children’s Revised Impact Event Scale), depression (Birleson), and SDQ, as well as their post-traumatic cognitions (Children’s Post Traumatic Cognitions Inventory). Results: A cluster analysis identified four family types. The largest type reflected secure attachment and optimal relationships (security and positive family relationships, 36.2%, n = 102), and the smallest exhibited insecurity and problematic relationships (insecurity and negative family relationships, 15.6%; n = 44). Further, families with discrepant experiences (23.0%; n = 65) and moderate security and neutral relationships (25.2%; n = 71) emerged. The insecurity and negative relationships family type showed higher levels of war trauma; internalizing, externalizing, and depressive symptoms among children; and dysfunctional post-traumatic cognitions than other family types. Conclusion: The family systems approach to mental health is warranted in war conditions, and therapeutic

Family systems approach to attachment relations, war trauma, and mental health among Palestinian children and parents.

PubMed

Punamäki, Raija-Leena; Qouta, Samir R; Peltonen, Kirsi

2017-01-01

Background : Trauma affects the family unit as a whole; however, most existing research uses individual or, at most, dyadic approaches to analyse families with histories of trauma. Objective : This study aims to identify potentially distinct family types according to attachment, parenting, and sibling relations, to analyse how these family types differ with respect to war trauma, and to explore how children's mental health and cognitive processing differ across these family types. Method: Participants included Palestinian mothers and fathers ( N  = 325) and their children (one per family; 49.4% girls; 10-13 years old; mean ±  SD age = 11.35 ± 0.57 years) after the Gaza War of 2008-2009. Both parents reported their exposure to war trauma, secure attachment availability, and parenting practices, as well as the target child's internalizing and externalizing symptoms [Strengths and Difficulties Questionnaire (SDQ)]. Children reported their symptoms of post-traumatic stress disorder (on the Children's Revised Impact Event Scale), depression (Birleson), and SDQ, as well as their post-traumatic cognitions (Children's Post Traumatic Cognitions Inventory). Results: A cluster analysis identified four family types. The largest type reflected secure attachment and optimal relationships (security and positive family relationships, 36.2%, n  = 102), and the smallest exhibited insecurity and problematic relationships (insecurity and negative family relationships, 15.6%; n  = 44). Further, families with discrepant experiences (23.0%; n  = 65) and moderate security and neutral relationships (25.2%; n  = 71) emerged. The insecurity and negative relationships family type showed higher levels of war trauma; internalizing, externalizing, and depressive symptoms among children; and dysfunctional post-traumatic cognitions than other family types. Conclusion: The family systems approach to mental health is warranted in war conditions, and therapeutic interventions for

Recalling war trauma of the Pacific War and the Japanese occupation in the oral history of Malaysia and Singapore.

PubMed

Blackburn, Kevin

2009-01-01

The Pacific War and the Japanese Occupation were traumatic periods in the lives of people now over seventy years old in Malaysia and Singapore. This study traces why individuals interviewed for oral history of the Pacific War and the Japanese Occupation have often been able to tell stories of trauma without being overwhelmed by their reminiscences. It emphasizes that memories of traumatic experiences of the Pacific War and the Japanese Occupation in Malaysia and Singapore are mediated and eased by supportive social networks that are part of the interview subject's community. The individual's personal memories of traumatic war experiences are positioned in the context of the collective memory of the group and, thus, are made easier to recall. However, for individuals whose personal memories are at variance with the collective memory of the group they belong to, recalling traumatic experiences is more difficult and alienating as they do not have the support in their community. The act of recalling traumatic memories in the context of the collective memory of a group is particularly relevant in Malaysia and Singapore. These countries have a long history of being plural societies, where although the major ethnic groups -- the Malays, Chinese, and Indians -- have lived side by side peacefully, they have lived in culturally and socially separate worlds, not interacting much with the other groups. The self -- identity of many older people who lived through the Pacific War and the Japanese Occupation is inextricably bound up with their ethnicity. Oral history on war trauma strongly reflects these identities.

Differences in prevalence rates of PTSD in various European countries explained by war exposure, other trauma and cultural value orientation

PubMed Central

2014-01-01

Background Guided by previous explorations of historical and cultural influences on the occurrence of PTSD, the aim of the present study was to investigate the contributions of war victimisation (in particular, World War II) and other civil trauma on the prevalence of PTSD, as mediated by cultural value orientation. Secondary data analysis was performed for 12 European countries using data, including PTSD prevalence and number of war victims, crime victims, and natural disaster victims, from different sources. Ten single value orientations, as well as value aggregates for traditional and modern factors, were investigated. Results Whilst differences in PTSD prevalence were strongly associated with war victim rates, associations, albeit weaker, were also found between crime victims and PTSD. When cultural value orientations, such as stimulation and conformity as representatives of modern and traditional values, were included in the multivariate predictions of PTSD prevalence, an average of approximately 80% of PTSD variance could be explained by the model, independent of the type of trauma exposure. Conclusion The results suggest that the aftermath of war contributes to current PTSD prevalence, which may be explained by the high proportion of the older population who directly or indirectly experienced traumatic war experiences. Additional findings for other types of civil trauma point towards an interaction between value orientation and country-specific trauma rates. Particularly, being personally oriented towards stimulation appears to interact with differences in trauma prevalence. Thus, cultural value orientation might be viewed not only as an individual intrinsic process but also as a compensatory strategy after trauma exposure. PMID:24972489

Factorial Composition of Counsellor Effectiveness Scale

ERIC Educational Resources Information Center

Oluseyi, Adeyemo Emily; Oreoluwa, Shaba Veronica

2014-01-01

The study developed a set of items that could measure counsellor effectiveness. It reduced the initial set of variables related to counsellor effectiveness to such number of variables that are generally perceived as indicative of counsellor effectiveness and determined the factorial composition of the scale. in order to identify the major factors…

Portrayals of suffering: perceptions of trauma in the writings of First World War nurses and volunteers.

PubMed

Hallett, Christine E

2010-01-01

The trauma-writings of World War I nurses have been identified as an important and influential corpus of early 20th-century works. Not only did the rediscovery of these writings in the later 20th century serve to recognize the importance of women's writings as part of the historical record, and identify certain female writers as some of the most important thinkers of the modernist movement; they also demonstrated the importance of the nursing perspective as one element of wartime experience. This paper considers a number of influential works written by both nurses and members of the Voluntary Aid Detachments (VAD) who assisted with nursing work during the war. The paper identifies how nurses and VADs presented their experiences of war trauma. It also considers how some writers strove to attach meaning to (or in some, cases expressed their sense of the meaninglessness of) the suffering caused by the war. The paper considers further how some nurses themselves experienced trauma as a result of their exposure to wartime work, and how some writers developed what are referred to as "philosophies of suffering," in which they struggled to understand suffering as an element of human experience.

Trauma exposure and the mediating role of posttraumatic stress on somatic symptoms in civilian war victims.

PubMed

Morina, Naser; Schnyder, Ulrich; Klaghofer, Richard; Müller, Julia; Martin-Soelch, Chantal

2018-04-10

It has been well documented that the exposure to war has a negative effect on the psychological health of civilian. However, little is known on the impact of war exposure on the physical health of the civilian population. In addition, the link between trauma exposure and somatic symptoms remain poorly understood. This cross-sectional study examined levels of somatic symptoms in the aftermath of war, and the mediating role of posttraumatic stress symptoms in the relationship between trauma exposure and somatic symptoms. Civilian war survivors (N = 142) from Kosovo were assessed for potentially traumatic events, posttraumatic stress symptoms, and somatic symptoms. Data were analyzed using mediation analyses. Posttraumatic stress disorder (PTSD) symptoms were categorized based on King's four factor model (Psychol Assessment. 10: 90-96, 1998). Participants reported on average more than 5 types of traumatic exposure. The cut-off indicative for PTSD was exceeded by 26.1% of participants. Symptom levels of PTSD were associated with somatic symptoms. The relationship between trauma exposure and somatic symptoms was partly mediated by the active avoidance and hyperarousal symptom clusters of PTSD. Active avoidance and hyperarousal symptoms seem to play a key role in traumatized people suffering from somatic symptoms.

Psychiatric and cognitive effects of war in former yugoslavia: association of lack of redress for trauma and posttraumatic stress reactions.

PubMed

Başoglu, Metin; Livanou, Maria; Crnobarić, Cvetana; Francisković, Tanja; Suljić, Enra; Durić, Dijana; Vranesić, Melin

2005-08-03

Although impunity for those responsible for trauma is widely thought to be associated with psychological problems in survivors of political violence, no study has yet investigated this issue. To examine the mental health and cognitive effects of war trauma and how appraisal of redress for trauma and beliefs about justice, safety, other people, war cause, and religion relate to posttraumatic stress responses in war survivors. A cross-sectional survey conducted between March 2000 and July 2002 with a population-based sample of 1358 war survivors who had experienced at least 1 war-related stressor (combat, torture, internal displacement, refugee experience, siege, and/or aerial bombardment) from 4 sites in former Yugoslavia, accessed through linkage sampling. Control groups at 2 study sites were matched with survivors on sex, age, and education. Semi-structured Interview for Survivors of War, Redress for Trauma Survivors Questionnaire, Emotions and Beliefs After War questionnaire, Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). The mean (SD) age was 39 (12) years, 806 (59%) were men, and 339 (25%) had high school or higher level of education. Participants reported experiencing a mean of 12.6 war-related events, with 292 (22%) and 451 (33%) having current and lifetime posttraumatic stress disorder (PTSD), respectively, and 129 (10%) with current major depression. A total of 1074 (79%) of the survivors reported a sense of injustice in relation to perceived lack of redress for trauma. Perceived impunity for those held responsible for trauma was only one of the factors associated with sense of injustice. Relative to controls, survivors had stronger emotional responses to impunity, greater fear and loss of control over life, less belief in benevolence of people, greater loss of meaning in war cause, stronger faith in God, and higher rates of PTSD and depression. Fear and loss of control over life were

Complex sequelae of psychological trauma among Kosovar civilian war victims.

PubMed

Morina, Nexhmedin; Ford, Julian D

2008-09-01

The impact of war trauma on civilians may include, but also extend beyond, post-traumatic stress disorder (PTSD) to include complex sequelae such as those described by the syndrome of Disorders of Extreme Stress Not Otherwise Specified (DESNOS). In the present study, 102 civilian war victims were interviewed in Kosovo, assessing traumatic life events, PTSD, DESNOS, and depression. Full DESNOS rarely occurred (2% prevalence), however, clinically significant DESNOS symptoms of somatization, altered relationships, and altered systems of meaning were reported by between 24-42% of respondents. Although DESNOS symptoms were correlated with PTSD symptoms, DESNOS symptoms were associated with poorer overall psychological functioning, self-evaluations, satisfaction with life, and social support independent of the effects of PTSD. The findings suggest that DESNOS warrants attention in addition to PTSD in the assessment and treatment of civilians who have been exposed to war and genocide.

Psychological Counseling Processes of Prospective Psychological Counsellors: An Investigation of Client-Counsellor Interactions

ERIC Educational Resources Information Center

Sanberk, Ismail; Akbas, Turan

2015-01-01

The general purpose of this study is to investigate the client-counsellor interaction in the psychological counseling process at the verbal behavior level. The study also aims to analyze the relationship between the behaviors observed in the process with both clients and counsellors' evaluations of sessions and whether changes were observed in…

Ethics in Counsellor Education: A Sample Orientation Manual

ERIC Educational Resources Information Center

Braun, Ruth Bergen

2009-01-01

This project draws attention to ethics in counsellor education, showing that ethics is critical to the formation of new counsellors, not simply an add-on component in counsellor training. This project demonstrates that beginning counsellors, before they commence employment, must have a strong ethical foundation. It examines both formal counsellor…

[War trauma and PTSD among German war survivors. A comparison of former soldiers and women of World War II].

PubMed

Nandi, C; Weierstall, R; Huth, S; Knecht, J; Elbert, T

2014-03-01

Stressful war experiences can cause posttraumatic stress disorder (PTSD) in survivors. To what extent were the soldiers and young women of World War II affected by PTSD symptoms over the course of their lives? Do these men and women differ in the traumatic experiences and PTSD symptom severity? To investigate these questions 52 male and 20 female Germans aged 81-95 years were recruited through newspaper advertisements and notices and interviewed regarding war experiences and PTSD symptoms. Of the men 2% and 7% met the criteria for current and lifetime PTSD diagnoses, respectively, as compared to 10% and 30% of the women, respectively. Using multiple linear regression a dose-response relationship between the number of trauma types experienced and PTSD symptom severity could be demonstrated. The slope of the regression curve was steeper for women than for men. When controlling for the number of different traumatic experiences women reported a significantly higher severity of PTSD symptoms than men. It is presumed that this difference in severity of symptoms can be attributed to qualitative differences in the type of traumatic stress factors during the war. The present study provides evidence that even today people continue to be affected by PTSD symptoms due to events which occurred during World War II; therefore, during patient contact with this age group the war experiences specific to each individual need to be considered as potential moderators of symptoms.

Religious Moral Beliefs Inversely Related to Trauma Experiences Severity and Presented Posttraumatic Stress Disorder Among Bosnia and Herzegovina War Veterans.

PubMed

Hasanović, Mevludin; Pajević, Izet

2015-08-01

The aim of this study was to determine the correlation of the level of religious moral beliefs (RMB) with trauma experiences and posttraumatic stress disorder (PTSD) severity in war veterans of Bosnia and Herzegovina. The sample consists of 120 Bosnian war veterans divided into two equal groups-one with and one without PTSD. We used the Harvard Trauma Questionnaire and the RMB belief scale. We then correlated the severity of trauma experiences and PTSD symptoms with veterans' scores on the RMB scale. The score on the RMB scale was negatively correlated to severity of trauma experiences and PTSD symptoms (Pearson's r = -0.509, P = 0.004; Pearson's r = -0.325, P < 0.001, respectively). The RMB may have protective role in the mental health stability of severely traumatized war veterans.

Leveraging Trauma Lessons from War to Win in a Complex Global Environment.

PubMed

Remick, Kyle N

2016-01-01

The US military has made great strides in combat casualty care since 2001. As the Army concludes combat operations in Iraq and Afghanistan, it faces new operational challenges in trauma care. The military medical community must stay ahead of the curve through sustaining current investments in combat casualty care research. This article describes lessons learned at war from a Joint Trauma System perspective in order to place in context how we should proceed in order to provide optimal care for our Warfighters in the future.

Counsellors' Attitudes towards Disability Equality Training (DET)

ERIC Educational Resources Information Center

Parkinson, Gill

2006-01-01

This paper explores the attitudes and conceptions held by trainee and practising counsellors towards people with disabilities. Awareness of counsellors' own views of disability and impairment can complicate the counsellor-client relationship when the latter is seen primarily from a deficiency model perspective or self-defined model of disability,…

Counsellors Respond to the DSM-IV-TR

ERIC Educational Resources Information Center

Strong, Tom; Gaete, Joaquin; Sametband, Ines N.; French, Jared; Eeson, Jen

2012-01-01

The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) is an administrative fact for many counsellors. This psychiatric approach to formulating client concerns runs counter to those used by counsellors of many approaches (e.g., systemic, feminist). Using an online survey of counsellors (N = 116), invited contributions to a website…

Predicting adolescent posttraumatic stress in the aftermath of war: differential effects of coping strategies across trauma reminder, loss reminder, and family conflict domains.

PubMed

Howell, Kathryn H; Kaplow, Julie B; Layne, Christopher M; Benson, Molly A; Compas, Bruce E; Katalinski, Ranka; Pasalic, Hafiza; Bosankic, Nina; Pynoos, Robert

2015-01-01

The vast majority of youth who lived through the Bosnian war were exposed to multiple traumatic events, including interpersonal violence, community destruction, and the loss of a loved one. This study examined factors that predict post-war psychological adjustment, specifically posttraumatic stress, in Bosnian adolescents. Regression analyses evaluated theorized differential relations between three types of post-war stressors - exposure to trauma reminders, loss reminders, and intrafamilial conflict - specific coping strategies, and posttraumatic stress symptom dimensions. We examined 555 Bosnian adolescents, aged 15-19 years, to predict their long-term posttraumatic stress reactions in the aftermath of war. Findings indicated that post-war exposure to trauma reminders, loss reminders, and family conflict, as well as engagement and disengagement coping strategies, predicted posttraumatic stress symptoms. Secondary control engagement coping responses to all three types of post-war stressors were inversely associated with posttraumatic stress symptoms, whereas primary control engagement coping responses to family conflict were inversely associated with hyperarousal symptoms. Disengagement responses to trauma reminders and family conflict were positively associated with re-experiencing symptoms. These findings shed light on ways in which trauma reminders, loss reminders, and family conflict may intersect with coping responses to influence adolescent postwar adjustment.

The role of war trauma survivors in managing their own mental conditions, Syria civil war as an example.

PubMed

Almoshmosh, Nadim

2016-01-01

War trauma leads to a wide range of psychological consequences and disorders that can be quite disabling to individuals and their families. At times of war, existing resources become strained to cope with all demands of trauma sufferers. The survivors' role of managing their own mental conditions becomes highly important and relevant as a way of reducing the resulted suffering. Unfortunately, this role is often ignored or trivialized by all concerned. The self-efficacy and resilience of people are the factors not to be underestimated and should be built upon. Reaching solutions are generally more satisfying and long-lasting when the affected person has taken a positive active part in finding them. Encouraging the use of own resources and experiences and using own problem-solving skills can be all that is needed for survivors to feel enabled. Engaging survivors and focusing on promoting recovery and social inclusion along with the use of self-help skills make them feel more positive about their own conditions. Being more involved, taking even small steps reduces the development of learned helplessness and reduces the psychiatric morbidities.

Moral injury: a mechanism for war-related psychological trauma in military family members.

PubMed

Nash, William P; Litz, Brett T

2013-12-01

Recent research has provided compelling evidence of mental health problems in military spouses and children, including post-traumatic stress disorder (PTSD), related to the war-zone deployments, combat exposures, and post-deployment mental health symptoms experienced by military service members in the family. One obstacle to further research and federal programs targeting the psychological health of military family members has been the lack of a clear, compelling, and testable model to explain how war-zone events can result in psychological trauma in military spouses and children. In this article, we propose a possible mechanism for deployment-related psychological trauma in military spouses and children based on the concept of moral injury, a model that has been developed to better understand how service members and veterans may develop PTSD and other serious mental and behavioral problems in the wake of war-zone events that inflict damage to moral belief systems rather by threatening personal life and safety. After describing means of adapting the moral injury model to family systems, we discuss the clinical implications of moral injury, and describe a model for its psychological treatment.

Trauma and autobiographical memory: contents and determinants of earliest memories among war-affected Palestinian children.

PubMed

Peltonen, Kirsi; Kangaslampi, Samuli; Qouta, Samir; Punamäki, Raija-Leena

2017-11-01

The contents of earliest memories (EM), as part of autobiographical memory, continue to fascinate scientists and therapists. However, research is scarce on the determinants of EM, especially among children. This study aims, first, to identify contents of EM of children living in war conditions, and, second, to analyse child gender, traumatic events and mental health as determinants of the contents of EM. The participants were 240 Palestinian schoolchildren from the Gaza Strip (10-12 years, M = 11.35, SD = 0.57; 49.4% girls). They responded to an open-ended EM question, and reported their trauma exposures (war trauma, losses and current traumatic events), posttraumatic stress, depressive symptoms and psychosocial well-being, indicating mental health. The EM coding involved nature, social orientation, emotional tone and specificity. Results showed, first, that 43% reported playing or visiting a nice place as EM, and about a third (30%) traumatic events or accidents (30%) or miscellaneous events (27%). The individual and social orientation were almost equally common, the emotional tone mainly neutral (45.5%), and 60% remembered a specific event. Second, boys remembered more EM involving traumatic events or accidents, and girls more social events. Third, war trauma was associated with less positive emotional tone and with more specific memories.

Trauma-Induced Weight Loss and Cognitive Deficits among Former Prisoners of War.

ERIC Educational Resources Information Center

Sutker, Patricia B.; And Others

1990-01-01

Compared former prisoners of war (POWs) reporting confinement weight losses greater than 35 percent (N=60), less than 35 percent (N=113), and non-POW combat veterans (N=50) on Wechsler Adult Intelligence Scale-Revised and Wechsler Memory Scale Logical Memory indices. Findings suggest that severe POW confinement stress reflected by trauma-induced…

Trajectories of posttraumatic stress symptoms (PTSS) after major war among Palestinian children: Trauma, family- and child-related predictors.

PubMed

Punamäki, Raija-Leena; Palosaari, Esa; Diab, Marwan; Peltonen, Kirsi; Qouta, Samir R

2015-02-01

Research shows great individual variation in changes in posttraumatic stress symptoms (PTSSs) after major traumas of terrorist attacks, military combat, and natural disasters. Earlier studies have identified specific mental health trajectories both in children and adults. This study aimed, first, to identify potential PTSS-related trajectories by using latent class growth analyses among children in a three-wave assessment after the 2008/2009 War on Gaza, Palestine. Second, it analyzed how family- and child related factors (e.g., attachment relations, posttraumatic cognitions (PTCs), guilt, and emotion regulation) associate with the trajectory class membership. The sample consisted of 240 Palestinian children (49.4% girls and 50.6% boys) of 10-13 years of age (M=11.29, SD=0.68), who completed PTSS (CRIES) assessments at 3 (T1), 5 (T2), and 11 (T3) months after the war. Children reported their personal exposure to war trauma, attachment style, cognitive trauma processing, and emotion regulation, and their parents reported family war trauma exposure and attachment style. Results revealed a three-trajectory solution, a majority of children belonging to the Recovery trajectory (n=183), and a minority belonged either to Resistant trajectory (n=29) or to Increasing symptoms trajectory (n=28). Low levels of negative posttraumatic cognitive appraisals, feelings of guilt and emotion regulation were characteristic of children in the Resistant trajectory as compared to Increasing symptoms trajectory. Father׳s attachment security was further associated with the Resistant trajectory membership. Children׳s attachment avoidance and high parental trauma were typical to children in Recovery trajectory (as compared to the Increasing symptoms trajectory). Copyright © 2014 Elsevier B.V. All rights reserved.

Drawing trauma: the therapeutic potential of witnessing the child's visual testimony of war.

PubMed

Farley, Lisa; Mishra Tarc, Aparna

2014-10-01

Countertransference plays an often neglected role in witnessing children's testimony of war and trauma. A dual notion of countertransference, based on the work of Winnicott and Klein, is offered that involves both internal conflict related to early life experience and socially mediated notions of childhood, war, and trauma circulating in a given time and place. A drawing by a thirteen-year-old boy living in the refugee camps in Darfur is used to show how countertransference affects our interpretation of the image, even while its symbolization in language establishes the conditions for a potentially therapeutic response. It is argued that a psychoanalytic reading can supplement the "legal-conscious terminology" in which the Darfur archive has been predominantly framed (Felman 2002, p. 5). This expanded view of witnessing involves reading the child's testimony both for the history of violence it conveys and for the social and emotional histories it calls up in the witness as the ground and possibility of justice. © 2014 by the American Psychoanalytic Association.

Shell shock, trauma, and the First World War: the making of a diagnosis and its histories.

PubMed

Loughran, Tracey

2012-01-01

During the First World War, thousands of soldiers were treated for "shell shock," a condition which encompassed a range of physical and psychological symptoms. Shell shock has most often been located within a "genealogy of trauma," and identified as an important marker in the gradual recognition of the psychological afflictions caused by combat. In recent years, shell shock has increasingly been viewed as a powerful emblem of the suffering of war. This article, which focuses on Britain, extends scholarly analyses which question characterizations of shell shock as an early form of post-traumatic stress disorder. It also considers some of the methodological problems raised by recasting shell shock as a wartime medical construction rather than an essentially timeless manifestation of trauma. It argues that shell shock must be analyzed as a diagnosis shaped by a specific set of contemporary concerns, knowledges, and practices. Such an analysis challenges accepted understandings of what shell shock "meant" in the First World War, and also offers new perspectives on the role of shell shock in shaping the emergence of psychology and psychiatry in the early part of the twentieth century. The article also considers what relation, if any, might exist between intellectual and other histories, literary approaches, and perceptions of trauma as timeless and unchanging.

Lydgate's Danse Macabre and the Trauma of the Hundred Years War.

PubMed

Perry, R D

2015-01-01

This essay argues that the foundational traumatic lacuna behind John Lydgate's Danse Macabre is the social agon between those who wage the Hundred Years War and those who fight in it. Drawing from the insights of trauma theory to discuss the poem's form, the essay uncovers Lydgate's persistent concern with the damage caused by the war and the concomitant political unrest it causes. It argues further that Lydgate theorized this agon using the emergent genre of tragedy, which is beginning to be practiced anew in late-medieval England. Tragic discourse is riven by concerns about the efficacy of human action and the radical contingency of fortune, creating a crisis of agency that can be used as a form of political critique. Ultimately, Lydgate blends the genre of tragedy with the mirror for princes and estates satire genres to argue that, while everyone must eventually dance with death, during war some estates lead the dance.

Guidance Counsellor Strategies for Handling Bullying

ERIC Educational Resources Information Center

Power-Elliott, Michleen; Harris, Gregory E.

2012-01-01

The purpose of this exploratory-descriptive study was to examine how guidance counsellors in the province of Newfoundland and Labrador would handle a specific verbal-relational bullying incident. Also of interest was guidance counsellor involvement and training in bullying programmes and Positive Behaviour Supports. Data for this study was…

Counsellors becoming Counsellor Educators: A New Zealand Example

ERIC Educational Resources Information Center

Crocket, Kathie; Kotze, Elmarie

2012-01-01

The international literature on adjunct faculty in higher education, including professional education, does not yet cover counsellor education in particular, although many programmes rely on the teaching services of experienced practitioners in adjunct faculty positions. This article reports on a small, exploratory study conducted with adjunct…

Beyond Individual War Trauma: Domestic Violence against Children in Afghanistan and Sri Lanka

ERIC Educational Resources Information Center

Catani, Claudia; Schauer, Elisabeth; Neuner, Frank

2008-01-01

To date, research on the psychosocial consequences of mass trauma resulting from war and organized violence on children has primarily focused on the individual as the unit of treatment and analysis with particular focus on mental disorders caused by traumatic stress. This body of research has stimulated the development of promising…

A longitudinal study of posttraumatic stress disorder, depression, and generalized anxiety disorder in Israeli civilians exposed to war trauma.

PubMed

Neria, Yuval; Besser, Avi; Kiper, Dasha; Westphal, Maren

2010-06-01

This 3-wave longitudinal study examined the mental health consequences of the Israel-Gaza 2008-2009 war among young Israeli civilians. Data on posttraumatic stress disorder (PTSD), major depressive disorder (MDD), and generalized anxiety disorder (GAD), and their predictors were collected during the war, and 2 and 4 months after cease fire. Results showed a sharp decline in symptom levels of PTSD, MDD, and GAD over time. Perceived social support during the war moderated the effects of immediate emotional response on subsequent levels of PTSD, MDD, and GAD. These findings underscore the importance of social support and immediate emotional response to trauma in predicting trauma-related psychopathology, and highlight the potential need for providing early care to exposed individuals exhibiting immediate and severe emotional responses.

Can functional emotion regulation protect children's mental health from war trauma? A Palestinian study.

PubMed

Diab, Marwan; Peltonen, Kirsi; Qouta, Samir R; Palosaari, Esa; Punamäki, Raija-Leena

2017-04-19

Effective emotion regulation (ER) is expected to protect mental health in traumatic stress. We first analysed the protective (moderator) function of different ER strategies and the associations between ER and mental health. Second, we tested gender differences in the protective function of ER and the associations between ER strategies and mental health. Participants were 482 Palestinian children (girls 49.4%; 10-13 years, M = 11.29, SD = .68) whose ER was assessed by the Emotion Regulation Questionnaire and mental health by post-traumatic stress (Children's Impact Event Scale), depressive, and psychological distress (Strengths and Difficulties Questionnaire) symptoms, and by psychosocial well-being (Mental Health Continuum-Short Form). War trauma involved 42 events. Results showed, first, that none of the ER strategies could protect a child's mental health from negative impact of war trauma, but self-focused ER was associated with low depressive symptoms, and other-facilitated ER with high psychological well-being. However, controlling of emotions formed a comprehensive risk for children's mental health. Second, gender differences were found in the protective role of ER, as self-focused and distractive ER formed a vulnerability among boys. The results are discussed in the context of emotional and regulative demands of war and life-threat. © 2017 International Union of Psychological Science.

A Counsellor's Guide to Conducting Psychobiographical Research

ERIC Educational Resources Information Center

Ponterotto, Joseph G.

2017-01-01

By nature of their interests and professional training, counsellors are ideally equipped to conduct psychobiographical research. This article positions the counselling field in the broad specialty area of psychobiography, highlights the preparedness of counsellors to conduct psychobiographical research, and emphasizes the benefits of this research…

Ethical Considerations of Social Networking for Counsellors

ERIC Educational Resources Information Center

Bratt, William Edgar Vernon

2010-01-01

The use of online social networking websites has increased among Canadians in recent years. There are many professional and ethical implications for counsellors who use these sites (Boyd, 2007). Although they offer advantages to counsellors, their use can also raise issues around ethical conduct. Because the counselling literature has not yet…

The Challenge of Prejudice: Counsellors' Talk about Challenging Clients' Prejudices

ERIC Educational Resources Information Center

Spong, Sheila J.

2012-01-01

This paper considers the implications for training and practice of counsellors' responses to the notion of challenging clients' prejudices. It explores tensions in counselling discourse between social responsibility, responsibility to the client and responsibility for one's self as counsellor. Three focus groups of counsellors were asked whether a…

Constructing Bridges of Support: School Counsellors' Experiences of Student Suicide

ERIC Educational Resources Information Center

Christianson, Carley L.; Everall, Robin D.

2008-01-01

School counsellors are professionals with specialized training in personal counselling who work in school settings. They are usually the front-line school personnel required to deal with youth suicide. Despite the important roles of school counsellors, there is little research that explores the experiences of school counsellors who have lost…

The influence of combat and interpersonal trauma on PTSD, depression, and alcohol misuse in U.S. Gulf War and OEF/OIF women veterans.

PubMed

Hassija, Christina M; Jakupcak, Matthew; Maguen, Shira; Shipherd, Jillian C

2012-04-01

The present study evaluated the impact of combat and interpersonal trauma exposure in a sample of 115 U.S. women veterans from Gulf War I and the Iraq and Afghanistan wars on 3 postdeployment trauma-related mental health outcomes: posttraumatic stress disorder symptoms (PSS), depressive symptom severity (DSS), and alcohol misuse. Patients presenting for healthcare services at a Veterans Affairs postdeployment health specialty clinic completed screening questionnaires that assessed combat exposure, lifetime interpersonal trauma history of childhood neglect, physical, or sexual abuse, and adult sexual and physical assault. In a regression model, combat exposure was the only significant independent variable associated with PSS, DSS, and alcohol misuse (β = .42, .27 and B = 1.58, respectively) even after adding lifetime interpersonal assault exposure to the model. Results highlight the negative effects of combat exposure on treatment-seeking women veterans' postdeployment mental health. Incorporating combat exposure into routine screening procedures for Gulf War and Iraq and Afghanistan war women veterans can aid in mental health treatment planning. Copyright © 2012 International Society for Traumatic Stress Studies.

Modern Initial Management of Severe Limbs Trauma in War Surgery: Orthopaedic Damage Control

DTIC Science & Technology

2010-04-01

avoid fat embolism , allow an optimal nursing and medical evacuation without any secondary functional consequences [3]. 2.2.1 Indications: The...decrease the risk of fat embolism . Modern Initial Management of Severe Limbs Trauma in War Surgery: “Orthopaedic Damage Control” RTO-MP-HFM-182 17...injuries. Orthopaedic Imperious: Multiple open shaft fractures with blood loss, complex epiphysal fractures requiring a long difficult surgical bloody

Ready for School? Trauma Exposure and Mental Health in a Group of War-Affected Ugandan Adolescents Re-Attending School

ERIC Educational Resources Information Center

Schultz, Jon-Hakon; Sorensen, Peer Moller; Waaktaar, Trine

2012-01-01

The objective of this study was to assess trauma-related symptoms and mental health among war-exposed Ugandan adolescents (n = 81) as a basis for planning their re-attendance at school. Self-reports of exposure to traumatic events, trauma-related symptoms, and indicators of mental health were collected. While about half of the youths (51.9%)…

The role of counsellors in general practice. A qualitative study.

PubMed Central

Sibbald, B.; Addington-Hall, J.; Brenneman, D.; Obe, P. F.

1996-01-01

Counselling services in general practice are now widespread but little is known about their nature or role. We therefore carried out in-depth telephone interviews with a representative sample of 72 general practitioners and 60 of their counsellors who had participated in a previous national survey of counselling services in England and Wales. Our aim was to gain greater insight into the functioning of these services in order to determine the most appropriate focus for future research and development. Interviews were semi-structured and focused on service initiation and duration; counsellors' background and training; working arrangements including sources of funding; types of clients; communication between general practitioners and counsellors; perceived advantages and disadvantages to general practitioners, counsellors, and clients; goals, barriers, and proposed changes. Approximately two thirds of counsellors were employed by district health authorities and attached to practices. One third were employed by the practice with the financial assistance of family health services authorities. Practice-employed counsellors appeared a relatively new service innovation whose growth was facilitated by the general practitioner contract of 1991. Practice-employed counsellors were preferred to practice-attached staff in that general practitioners had greater control over the selection of counsellors and their working arrangements. Problems with interprofessional communication were noted in relation to counsellors' wishes to maintain patient confidentiality by not exchanging information about patients with general practitioners. Counsellors received referrals principally from general practitioners and occasionally from other primary health care staff. Self-referral by patients was rare. The problems for which patients were most commonly referred were: stress/anxiety, relationship problems, depression, and bereavement. The principal therapeutic styles were Rogerian counselling

Head and neck trauma in Iraq and Afghanistan: different war, different surgery, lessons learned.

PubMed

Brennan, Joseph

2013-10-01

The objectives are to compare and contrast the head and neck trauma experience in Iraq and Afghanistan and to identify trauma lessons learned that are applicable to civilian practice. A retrospective review of one head and neck surgeon's operative experience in Iraq and Afghanistan was performed using operative logs and medical records. The surgeon's daily operative log book with patient demographic data and operative reports was reviewed. Also, patient medical records were examined to identify the preoperative and postoperative course of care. The head and neck trauma experiences in Iraq and Afghanistan were very different, with a higher percentage of emergent cases performed in Iraq. In Iraq, only 10% of patients were pretreated at a facility with surgical capabilities. In Afghanistan, 93% of patients were pretreated at such facilities. Emergent neck exploration for penetrating neck trauma and emergent airway surgery were more common in Iraq, which most likely accounted for the increased perioperative mortality also seen in Iraq (5.3% in Iraq vs. 1.3% in Afghanistan). Valuable lessons regarding soft tissue trauma repair, midface fracture repair, and mandible fracture repair were learned. The head and neck trauma experiences in Iraq and Afghanistan were very different, and the future training for mass casualty trauma events should reflect these differences. Furthermore, valuable head and neck trauma lessons learned in both war zones are applicable to the civilian practice of trauma. Level 4. Copyright © 2013 The American Laryngological, Rhinological and Otological Society, Inc.

Results of a Nationwide Capacity Survey of Hospitals Providing Trauma Care in War-Affected Syria.

PubMed

Mowafi, Hani; Hariri, Mahmoud; Alnahhas, Houssam; Ludwig, Elizabeth; Allodami, Tammam; Mahameed, Bahaa; Koly, Jamal Kaby; Aldbis, Ahmed; Saqqur, Maher; Zhang, Baobao; Al-Kassem, Anas

2016-09-01

The Syrian civil war has resulted in large-scale devastation of Syria's health infrastructure along with widespread injuries and death from trauma. The capacity of Syrian trauma hospitals is not well characterized. Data are needed to allocate resources for trauma care to the population remaining in Syria. To identify the number of trauma hospitals operating in Syria and to delineate their capacities. From February 1 to March 31, 2015, a nationwide survey of 94 trauma hospitals was conducted inside Syria, representing a coverage rate of 69% to 93% of reported hospitals in nongovernment controlled areas. Identification and geocoding of trauma and essential surgical services in Syria. Although 86 hospitals (91%) reported capacity to perform emergency surgery, 1 in 6 hospitals (16%) reported having no inpatient ward for patients after surgery. Sixty-three hospitals (70%) could transfuse whole blood but only 7 (7.4%) could separate and bank blood products. Seventy-one hospitals (76%) had any pharmacy services. Only 10 (11%) could provide renal replacement therapy, and only 18 (20%) provided any form of rehabilitative services. Syrian hospitals are isolated, with 24 (26%) relying on smuggling routes to refer patients to other hospitals and 47 hospitals (50%) reporting domestic supply lines that were never open or open less than daily. There were 538 surgeons, 378 physicians, and 1444 nurses identified in this survey, yielding a nurse to physician ratio of 1.8:1. Only 74 hospitals (79%) reported any salary support for staff, and 84 (89%) reported material support. There is an unmet need for biomedical engineering support in Syrian trauma hospitals, with 12 fixed x-ray machines (23%), 11 portable x-ray machines (13%), 13 computed tomographic scanners (22%), 21 adult (21%) and 5 pediatric (19%) ventilators, 14 anesthesia machines (10%), and 116 oxygen cylinders (15%) not functional. No functioning computed tomographic scanners remain in Aleppo, and 95 oxygen cylinders (42

Lydgate's Danse Macabre and the Trauma of the Hundred Years War.

PubMed

Perry, R D

2015-01-01

This essay argues that the foundational traumatic lacuna behind John Lydgate's Danse Macabre is the social agon between those who wage the Hundred Years War and those who fight in it. Drawing from the insights of trauma theory to discuss the poem's form, the essay uncovers Lydgate's persistent concern with the damage caused by the war and the concomitant political unrest it causes. It argues further that Lydgate theorized this agon using the emergent genre of tragedy, which is beginning to be practiced anew in late-medieval England. Tragic discourse is riven by concerns about the efficacy of human action and the radical contingency of fortune, creating a crisis of agency that can be used as a form of political critique. Ultimately, Lydgate blends the genre of tragedy with the mirror for princes and estates satire genres to argue that, while everyone must eventually dance with death, during war some estates lead the dance.

Genetic Counsellors and Private Practice: Professional Turbulence and Common Values.

PubMed

Collis, Sarah; Gaff, Clara; Wake, Samantha; McEwen, Alison

2017-12-27

Genetic counsellors face tensions between past and future identities: between established values and goals, and a broadening scope of settings and activities. This study examines the advent of genetic counsellors in private practice in Australia and New Zealand from the perspectives of the small numbers working in this sector and those who have only worked in public practice. Semi-structured interviews were conducted with 16 genetic counsellors who had experience in private practice, and 14 genetic counsellors without private sector experience. Results demonstrated that circumstantial and personal factors can mitigate the challenges experienced and the amount of support desired by those who had established a private practice, and those who were employed by private companies. Notably, most participants with private sector experience perceived themselves to be viewed negatively by other genetic counsellors. Most participants without private sector experience expressed concern that the challenges they believed genetic counsellors face in private practice may impact service quality, but wished to address such concerns by providing appropriate support. Together, our results reinforce that participants in private and public sectors are strong advocates for peer support, multidisciplinary team work, and professional development. These core values, and seeking understanding of different circumstances and support needs, will enable genetic counsellors in different sectors to move forward together. Our results suggest supports that may be acted upon by members of the profession, professional groups, and training programs, in Australia, New Zealand, and overseas.

The emotional wellbeing of lay HIV counselling and testing counsellors.

PubMed

Visser, Maretha; Mabota, Princess

2015-01-01

The HIV testing, treatment and care programme of the South African public healthcare system depends on HIV counselling and testing (HCT) that is primarily delivered by lay counsellors. Lay counsellors are expected to educate clients about HIV/AIDS, advocate behaviour change, convey test results and support those infected and affected to cope with the emotional and social challenges associated with HIV/AIDS. This research focuses on the emotional wellbeing of lay HCT counsellors because this influences the quality of services they provide. A mixed methods approach was used. The emotional wellbeing, level of burnout, depression and coping style of 50 lay HCT counsellors working at the City of Tshwane clinics were assessed. Additionally, five focus group discussions were conducted. The results showed that HCT counsellors reported average emotional wellbeing, high levels of emotional exhaustion and depression. They had a sense of personal accomplishment and positive coping skills. The results revealed that they may have difficulty dealing with clients' emotional distress without adequate training and supervision. This creates a dilemma for service delivery. In the light of the important role they play in service delivery, the role of the lay HCT counsellor needs to be reconsidered. HCT should develop as a profession with specific training and supervision to develop their emotional competencies to conduct effective counselling sessions.

Supervision Effects on Self-Effcacy, Competency, and Job Involvement of School Counsellors

ERIC Educational Resources Information Center

Tan, Soo Yin; Chou, Chih Chin

2018-01-01

This research examined the effects of structured group supervision (SGS) on counsellors' self-efficacy, counselling competency, and job involvement in Singapore. Twenty-one counsellors participated in six, 3- hour SGS sessions over 12 weeks with one qualified counselling supervisor. The counsellors had at least six months' experience working as…

Psychometric properties of the Portuguese version of the Acceptance and Action Questionnaire-Trauma Specific (AAQ-TS): A study with Portuguese Colonial War Veterans.

PubMed

Pinto-Gouveia, José; Carvalho, Teresa; Cunha, Marina; Duarte, Joana; Walser, Robyn D

2015-10-01

The Acceptance and Action Questionnaire-Trauma Specific (AAQ-TS) is a self-report measure designed to assess-trauma-related psychological (in)flexibility, as conceptualized in Acceptance and Commitment Therapy. However, there are no studies to date regarding its psychometric properties. This study explores such properties in the Portuguese version of the AAQ-TS, in Portuguese Colonial War Veterans. A Principal Components Analysis (PCA) was conducted in a sample from the general population of war Veterans (N=371). Confirmatory Factor Analysis (CFA) as well as reliability and convergent validity studies were performed in a different sample from the same population (N=312). For the discriminant validity a clinical sample with a war-related PTSD (N=42) and a non-clinical sample without PTSD (N=44) were used. The CFA suggested a re-specified 15-item model with good global adjustment and factorial validity. The AAQ-TS showed internal consistency, a good temporal reliability, convergent validity with psychopathological symptoms (related to PTSD, anxiety, depression and stress) and peritraumatic dissociation (altered awareness and depersonalization/derealization). The questionnaire also discriminates between war Veterans with and without a PTSD diagnosis. The major limitation relates to the samples' characteristics and sampling methods, which can limit the generalization of results. The Portuguese version of the AAQ-TS is a reliable and valid measure to assess experiential avoidance related to trauma in Portuguese Colonial War Veterans. Copyright © 2015 Elsevier B.V. All rights reserved.

Women and War, Children and War: Stretching the Bonds of Caregiving.

ERIC Educational Resources Information Center

McNamee, Abigail S.

Many things stretch the bonds between caregiver and child, such as war, stress, and trauma. This paper reviews the literature on children who are in direct contact with war or indirect contact with war through television or others' conversations. It also describes the effects of war on children and their families, and children's psychological…

A Narrative Study of Counsellors' Understandings of Inuit Spirituality

ERIC Educational Resources Information Center

Wihak, Christine; Merali, Noorfarah

2005-01-01

Eight non-Indigenous counsellors who temporarily lived in Nunavut to serve Inuit clients were interviewed regarding what they learned about Inuit spirituality during their cultural immersion experience. They were also asked about how they applied their understandings of the Inuit spiritual worldview in their professional practice. Counsellors'…

Life satisfaction and trauma in clinical and non-clinical children living in a war-torn environment: A discriminant analysis.

PubMed

Veronese, Guido; Pepe, Alessandro

2017-07-01

The aim of this work was to discriminate between healthy children and children at risk of developing mental impairments by evaluating the impact on contextual and individual factors of a context characterized by war. We tested the hypothesis that a linear discriminant function composed of trauma, life satisfaction, and affect balance has the power to classify the children as community or clinical referred. Membership of the clinical-referred group was associated with poorer life satisfaction and higher levels of trauma. Community-referred profiles were associated with lesser trauma. Perceived life satisfaction regarding family and school was the main contributor to the discriminant function.

Post-War Trauma and Reconciliation in Bosnia-Herzegovina: Observations, Experiences, and Implications for Marriage and Family Therapy.

ERIC Educational Resources Information Center

Nelson, Briana S.

2003-01-01

The 1992-1995 war in Bosnia-Herzegovina caused mush devastation in that region of the world. This article describes the themes and issues that emerged from information gained from interviews with Bosnian professionals through a project entitled "Trauma and Reconciliation in Bosnia-Herzegovina." Recommendations and implications for family…

A Randomized Controlled Trial of Trauma-Focused Cognitive Behavioral Therapy for Sexually Exploited, War-Affected Congolese Girls

ERIC Educational Resources Information Center

O'Callaghan, Paul; McMullen, John; Shannon, Ciaran; Rafferty, Harry; Black, Alastair

2013-01-01

Objective: To assess the efficacy of trauma-focused cognitive behavioral therapy (TF-CBT) delivered by nonclinical facilitators in reducing posttraumatic stress, depression, and anxiety and conduct problems and increasing prosocial behavior in a group of war-affected, sexually exploited girls in a single-blind, parallel-design, randomized,…

The Importance of PRI Therapy for the Pastoral Counsellor

PubMed Central

2009-01-01

It is not always easy for pastoral counsellors to help people change. Often people have become stuck in their ways. Recent developments in the field of brain research help explain why change is difficult. This article discusses Past Reality Integration Therapy (PRI), a psychotherapeutic method that integrates recent findings of brain research and offers an important addition to the work of (pastoral) counsellors and psychotherapists. The use of this approach with Dutch students in their pastoral training is presented. Furthermore the importance of this new method for counsellors themselves, their clients and their work is discussed and some overall conclusions about the method and its practical application are presented. PMID:20835380

Facial trauma in the Trojan War.

PubMed

Ralli, Ioanna; Stathopoulos, Panagiotis; Mourouzis, Konstantinos; Piagkou, Mara; Rallis, George

2015-06-01

The Iliad and Odyssey of Homer represent the cornerstones of classical Greek literature and subsequently the foundations of literature of the Western civilization. The Iliad, particularly, is the most famous and influential epic poem ever conceived and is considered to be the most prominent and representative work of the ancient Greek epic poetry. We present the injuries that involve the face, mentioned so vividly in the Iliad, and discuss the aetiology of their extraordinary mortality rate. We recorded the references of the injuries, the attacker and defender involved, the weapons that were used, the site and the result of the injury. The face was involved in 21 trauma cases. The frontal area was traumatized in 7 cases; the oral cavity in 6; the auricular area in 4; the orbits and the retromandibular area in 3; the mandible and the nose in 2; and the maxilla, the submental and the buccal area in 1, respectively. The mortality rate concerning the facial injuries reaches 100%. Homer's literate dexterity, charisma and his unique aptitude in the narration of the events of the Trojan War have established him as the greatest epic poet. We consider the study of these vibrantly described events to be recreational and entertaining for everyone but especially for a surgeon.

Impact of War Trauma and Posttraumatic Stress Disorder on Psychopathology in Croatian and German Patients with Severe Mental Illness

PubMed Central

Jovanović, Nikolina; Kuwert, Philipp; Sarajlić Vuković, Iris; Poredoš Lavor, Daša; Medved, Vesna; Kovač, Marina; Spitzer, Carsten; Dudeck, Manuela; Vogel, Matthias; Freyberger, Harald J.; Grabe, Hans J.

2010-01-01

Aim To explore posttraumatic stress symptoms and current psychopathology in a binational sample of Croatian and German participants with severe mental illness. Methods We studied 178 inpatients from the Greifswald University (German patients, n = 89) and University Hospital Zagreb and Ivan Barbot Neuropsychiatric Hospital (Croatian patients, n = 89) with either major depression (n = 150), schizophrenia (n = 26), or bipolar disorder (n = 2). Measurements included the Posttraumatic Diagnostic Scale and the Symptom Check List 90-R. Participants were matched according to age, sex, and diagnosis. Results Croatians reported significantly more war traumatic events (64/82 vs 5/74, χ21 = 77.142, P < 0.001) and significantly more Croatians met the criteria for posttraumatic stress disorder (55/89 vs 27/89, χ21 = 17.73, P < 0.001). They also suffered from a higher level of psychopathological distress as they scored significantly higher at all Symptom Check List-90 revised version subscales (P < 0.001). The regression models demonstrated that predictors of general psychopathological distress were war trauma (P < 0.001), posttraumatic stress disorder (P < 0.001), and diagnosis (P = 0.01). Conclusion This is the first study comparing the impact of war trauma on psychopathology of participants with severe mental illness between two nations. Our results clearly indicate the importance of trauma assessment in patients with severe mental illness, particularly in post-conflict settings. PMID:20401955

Relationship of Religiousness and Religious Coping with Quality of Life among War Trauma Survivors.

PubMed

Fadilpašić, Senadin; Maleč, Daniel; Džubur-Kulenović, Alma

2017-09-01

Long-term posttraumatic outcomes such as quality of life are dependent on a series of factors from the very exposure to traumatic events and stress appraisals, personality traits, posttraumatic growth, symptoms of Posttraumatic stress disorder (PTSD) and different coping strategies to religiousness and religious coping styles. Except of exposure to traumatic events and related stress, all other variables may have indirect mediating effects on long-term posttraumatic outcomes. The main aim of this cross-sectional study is to explore relative independent contribution of these variables in the explanation of quality of life among war trauma survivors, with a special emphasis on the variables of religiousness and religious coping. The research was conducted on 353 subjects who experienced war related traumatic events during the war in Bosnia and Herzegovina (B&H). The data was collected through several self-report measuring instruments: Manchester Short Assessment of Quality of Life, Stressors Check List (SCL); Religiousness Scale, Social Support Resources Scale; Religious Problem-Solving Scale, Brief RCOPE, Posttraumatic Growth Inventory and Mississippi Scale for PTSD. According to the results of the study, experience of loss and frequent exposure to war trauma and high levels on the primary stress appraisals, self-directing coping style and PTSD-symptoms were associated with lower perceived quality of life among the subjects. High levels of extrinsic religious orientation, effect of religiousness on social behavior, positive religious coping and posttraumatic growth were associated with higher perceived quality of life among subjects. These variables showed significant independent contribution to the prediction of the values on quality of life. Results of the study have a scientific significance in understanding the importance and mediating role of religiousness and religious coping for quality of life perception as one of long-term posttraumatic outcomes. Effects of

Shared trauma reality in war: Mental health therapists' experience.

PubMed

Freedman, Sara A; Tuval Mashiach, Rivka

2018-01-01

Shared traumatic reality occurs when therapists are doubly exposed to a traumatic event, both through their clients' experience, along with their own direct exposure. Studies have shown that a shared traumatic reality can lead to both positive and negative outcomes for therapists. Most studies have examined these reactions sometime after the end of the traumatic event, and less is known about reactions that occur during a traumatic event. In addition, most studies have assumed, rather than examined, indirect exposure. In this study, we extend this literature by examining direct and indirect exposure of therapists during a war situation, and their psychological reactions. Over a period of two months in 2014, 70% of the Israeli population was exposed to rocket fire. Geographical areas differed in terms of amount of exposure, and its potential danger. 151 therapists living throughout Israel were assessed via an Internet based survey in the middle of the war, and were assessed for the effects on their professional and personal lives, degree of burnout, ways of coping and symptoms levels of PTSD and psychological distress. These indicate that significant differences in direct exposure occurred depending on place of residence. PTSD levels were related to higher direct exposure, as well as prior trauma exposure, but not to indirect exposure. Indirect exposure, as measured by increased workload, was related to increased distress and emotional exhaustion. These data shed light on the effects of direct and indirect exposure to a shared traumatic experience of war amongst therapists. The data support previous studies showing a greater effect of direct exposure on PTSD. Since indirect exposure appears to negatively impact burnout and psychological distress, rather than PTSD, this study shows that symptoms other than PTSD should be the result of in a shared traumatic reality.

Shared trauma reality in war: Mental health therapists’ experience

PubMed Central

Tuval Mashiach, Rivka

2018-01-01

Introduction Shared traumatic reality occurs when therapists are doubly exposed to a traumatic event, both through their clients’ experience, along with their own direct exposure. Studies have shown that a shared traumatic reality can lead to both positive and negative outcomes for therapists. Most studies have examined these reactions sometime after the end of the traumatic event, and less is known about reactions that occur during a traumatic event. In addition, most studies have assumed, rather than examined, indirect exposure. In this study, we extend this literature by examining direct and indirect exposure of therapists during a war situation, and their psychological reactions. Method Over a period of two months in 2014, 70% of the Israeli population was exposed to rocket fire. Geographical areas differed in terms of amount of exposure, and its potential danger. 151 therapists living throughout Israel were assessed via an Internet based survey in the middle of the war, and were assessed for the effects on their professional and personal lives, degree of burnout, ways of coping and symptoms levels of PTSD and psychological distress. Results These indicate that significant differences in direct exposure occurred depending on place of residence. PTSD levels were related to higher direct exposure, as well as prior trauma exposure, but not to indirect exposure. Indirect exposure, as measured by increased workload, was related to increased distress and emotional exhaustion. Discussion These data shed light on the effects of direct and indirect exposure to a shared traumatic experience of war amongst therapists. The data support previous studies showing a greater effect of direct exposure on PTSD. Since indirect exposure appears to negatively impact burnout and psychological distress, rather than PTSD, this study shows that symptoms other than PTSD should be the result of in a shared traumatic reality. PMID:29408879

Physical and mental health costs of traumatic war experiences among Civil War veterans.

PubMed

Pizarro, Judith; Silver, Roxane Cohen; Prause, JoAnn

2006-02-01

Hundreds of thousands of soldiers face exposure to combat during wars across the globe. The health effects of traumatic war experiences have not been adequately assessed across the lifetime of these veterans. To identify the role of traumatic war experiences in predicting postwar nervous and physical disease and mortality using archival data from military and medical records of veterans from the Civil War. An archival examination of military and medical records of Civil War veterans was conducted. Degree of trauma experienced (prisoner-of-war experience, percentage of company killed, being wounded, and early age at enlistment), signs of lifetime physician-diagnosed disease, and age at death were recorded. The US Pension Board surgeons conducted standardized medical examinations of Civil War veterans over their postwar lifetimes. Military records of 17,700 Civil War veterans were matched to postwar medical records. Signs of physician-diagnosed disease, including cardiac, gastrointestinal, and nervous disease; number of unique ailments within each disease; and mortality. Military trauma was related to signs of disease and mortality. A greater percentage of company killed was associated with signs of postwar cardiac and gastrointestinal disease (incidence risk ratio [IRR], 1.34; P < .02), comorbid nervous and physical disease (IRR, 1.51; P < .005), and more unique ailments within each disease (IRR, 1.14; P < .005). Younger soldiers (<18 years), compared with older enlistees (>30 years), showed a higher mortality risk (hazard ratio, 1.52), signs of comorbid nervous and physical disease (IRR, 1.93), and more unique ailments within each disease (IRR, 1.32) (P < .005 for all), controlling for time lived and other covariates. Greater exposure to death of military comrades and younger exposure to war trauma were associated with increased signs of physician-diagnosed cardiac, gastrointestinal, and nervous disease and more unique disease ailments across the life of Civil War

War trauma and maternal-fetal attachment predicting maternal mental health, infant development, and dyadic interaction in Palestinian families.

PubMed

Punamäki, Raija-Leena; Isosävi, Sanna; Qouta, Samir R; Kuittinen, Saija; Diab, Safwat Y

2017-10-01

Optimal maternal-fetal attachment (MFA) is believed to be beneficial for infant well-being and dyadic interaction, but research is scarce in general and among risk populations. Our study involved dyads living in war conditions and examined how traumatic war trauma associates with MFA and which factors mediate that association. It also modeled the role of MFA in predicting newborn health, infant development, mother-infant interaction, and maternal postpartum mental health. Palestinian women from the Gaza Strip (N = 511) participated during their second trimester (T1), and when their infants were 4 (T2) and 12 (T3) months. Mothers reported MFA (interaction with, attributions to, and fantasies about the fetus), social support, and prenatal mental health (post-traumatic stress disorder, depression, and anxiety) at T1, newborn health at T2, and the postpartum mental health, infant's sensorimotor and language development, and mother-infant interaction (emotional availability) at T3. Results revealed, first, that war trauma was not directly associated with MFA but that it was mediated through a low level of social support and high level of maternal prenatal mental health problems. Second, intensive MFA predicted optimal mother-reported infant's sensorimotor and language development and mother-infant emotional availability but not newborn health or maternal postpartum mental health.

Turkish School Counsellors and Counselling Students' Knowledge of Adolescent Suicide

ERIC Educational Resources Information Center

Siyez, Digdem Müge; Bas, Asli Uz

2009-01-01

The aim of the study was to investigate the knowledge of Turkish high school counsellors and counselling students about adolescence suicide. The sample consisted of 71 school counsellors and 82 third and fourth year psychology counselling students who completed the Adolescent Suicide Behavior Questionnaire. The results showed that although…

[Etiology and prognosis of the eye traumas by war weapons in the Senegalese army].

PubMed

Seck, S M; Diakhaté, M; Ndiaye Sow, M N; Dieng, M; Agboton, G; Guèye, N N

2017-02-01

The aim of this work is to identify the main weapons causing eye injuries during the campaigns of the Senegalese army in the south of the country, as well as the prognosis of these traumas. This study is retrospective and concerns soldiers wounded by the weapons of war during the exercise of their mission within the Senegalese armed forces of 1991 in 2005. They are mainly soldiers affected in the south of the country during a war, clashes with the rebels or in Guinea-Bissau during operation Gabou in 1998. And they were evacuated to the ophthalmology department of the Principal Hospital in Dakar, which is a level 3. Thirty-seven military all male, with an average age of 30.5 years. Forty-six eyes including 9 bilateral cases. The trauma agent is a burst of RPG7 shells in 62% of cases, mine explosion in 13.5%, offensive grenade 10.8%, assault rifle 5.7% and flame lance-roquette anti-char (LRAC) accounts for 8%. We noted a phthisis of the globe for 14 eyes (30.43%) and for 15 eyes (32.60%) a functional loss of the affected globe. Inability to fight was decided by 29 wounded soldiers (78.37% of the cases), sedentary employment in 27 cases (72.97%) and 10 cases (27.03%) of reformed soldiers. In the conflict in southern Senegal, the RPG7 shell burst causes 62% of eye injuries. This RPG7 shell called "rebel weapon" is frequently used in conflicts in Africa. The prognosis of trauma with these types of weapons is severe. The combat goggles systematically integrated in the equipment of the Senegalese combatant, would be an invaluable contribution on the prevention of the traumatisms of the eye. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

Towards Automated e-Counselling System Based on Counsellors Emotion Perception

ERIC Educational Resources Information Center

Kolog, Emmanuel Awuni; Montero, Calkin Suero

2018-01-01

Emotions are a core semantic component of human communication. Since counsellors are humans we assume that their own state of emotions could affect their intuitional effort when taking decisions concerning their clients. Therefore, the accuracy of detected emotions by counsellors could be doubtful. And this highlights the need for complementing…

Trauma healing in refugee camps in Guinea: a psychosocial program for Liberian and Sierra Leonean survivors of torture and war.

PubMed

Stepakoff, Shanee; Hubbard, Jon; Katoh, Maki; Falk, Erika; Mikulu, Jean-Baptiste; Nkhoma, Potiphar; Omagwa, Yuvenalis

2006-11-01

From 1999 to 2005, the Minneapolis-based Center for Victims of Torture (CVT) served Liberian and Sierra Leonean survivors of torture and war living in the refugee camps of Guinea. A psychosocial program was developed with 3 main goals: (a) to provide mental health care, (b) to train local refugee counselors, and (c) to raise community awareness about war trauma and mental health. Utilizing paraprofessional counselors under the close, on-site supervision of expatriate clinicians, the treatment model blended elements of Western and indigenous healing. The core component consisted of relationship-based supportive group counseling. Clinical interventions were guided by a 3-stage model of trauma recovery (safety, mourning, reconnection), which was adapted to the realities of the refugee camp setting. Over 4,000 clients were provided with counseling, and an additional 15,000 were provided with other supportive services. Results from follow-up assessments indicated significant reductions in trauma symptoms and increases in measures of daily functioning and social support during and after participation in groups. The treatment model developed in Guinea served as the basis for CVT's ongoing work with survivors in Sierra Leone and Liberia. ((c) 2006 APA, all rights reserved).

Life outside the 50-Minute Hour: The Personal Lives of Counsellors

ERIC Educational Resources Information Center

Kennedy, Barbara Sampaio Alhanati; Black, Timothy G.

2010-01-01

This study investigates the effects that becoming and being a professional counsellor, including training and professional practice, can have on one's personal life. Semi-structured interviews were conducted with six professional counsellors, asking how their training and professional practice has affected their personal lives. Qualitative…

Abdominal Trauma Revisited.

PubMed

Feliciano, David V

2017-11-01

Although abdominal trauma has been described since antiquity, formal laparotomies for trauma were not performed until the 1800s. Even with the introduction of general anesthesia in the United States during the years 1842 to 1846, laparotomies for abdominal trauma were not performed during the Civil War. The first laparotomy for an abdominal gunshot wound in the United States was finally performed in New York City in 1884. An aggressive operative approach to all forms of abdominal trauma till the establishment of formal trauma centers (where data were analyzed) resulted in extraordinarily high rates of nontherapeutic laparotomies from the 1880s to the 1960s. More selective operative approaches to patients with abdominal stab wounds (1960s), blunt trauma (1970s), and gunshot wounds (1990s) were then developed. Current adjuncts to the diagnosis of abdominal trauma when serial physical examinations are unreliable include the following: 1) diagnostic peritoneal tap/lavage, 2) surgeon-performed ultrasound examination; 3) contrast-enhanced CT of the abdomen and pelvis; and 4) diagnostic laparoscopy. Operative techniques for injuries to the liver, spleen, duodenum, and pancreas have been refined considerably since World War II. These need to be emphasized repeatedly in an era when fewer patients undergo laparotomy for abdominal trauma. Finally, abdominal trauma damage control is a valuable operative approach in patients with physiologic exhaustion and multiple injuries.

Lay and peer counsellors to reduce leprosy-related stigma--lessons learnt in Cirebon, Indonesia.

PubMed

Lusli, Mimi; Peters, Ruth M H; Zweekhorst, Marjolein B M; Van Brakel, Wim H; Seda, Francisia S S E; Bunders, Joske F G; Irwanto

2015-03-01

Counselling has been identified as a promising strategy to reduce stigma. Lay and peer counsellors have provided counselling in various fields, but this has not yet been studied in the field of leprosy. The Stigma Assessment and Reduction of Impact (SARI) project in Cirebon District, Indonesia took up this endeavour. This paper describes the initial experiences based on the perspectives of the lay and peer counsellors and aims to provide lessons learnt for future initiatives. The selection of lay and peer counsellors was based upon pre-defined criteria such as completed junior high school and level of confidence. This study draws on the notes of seven monitoring and evaluation meetings and 21 group discussions the main researcher facilitated with the lay and peer counsellors and the notes written by the lay and peer counsellors on the sessions with their clients. In total, 198 people affected by leprosy were offered counselling by the 11 lay and 12 peer counsellors; 145 accepted this offer. The other 53 either did not need counselling or did not want to participate for example due to worries about disclosure. Effective communication skills such as listening and asking effective questions were important, but also difficult to acquire for the lay and peer counsellors. Sharing personal experiences was highly appreciated by clients and stimulated a deepened reflection. Challenges related to concealment and effective skills exist, but some people affected by leprosy and others can become effective counsellors making it at the outset a challenging but nevertheless promising intervention.

The Vancouver Elementary Schools Area Counsellor Services and the Area Counsellor Training Program. A Study Prepared for the Vancouver School Board. Research Report No. 75-03.

ERIC Educational Resources Information Center

Kitley, Philip J.

This study is concerned with an examination of the area counsellor services in Vancouver elementary schools and the support program of training for area counsellors. Information, opinions and suggestions were sought from a wide number of individuals and agencies having some connection with or interest in the services. It is recognized first of all…

Survey of trauma registry data on tourniquet use in pediatric war casualties.

PubMed

Kragh, John F; Cooper, Arthur; Aden, James K; Dubick, Michael A; Baer, David G; Wade, Charles E; Blackbourne, Lorne H

2012-12-01

Previously, we reported on the use of emergency tourniquets to stop bleeding in war casualties, but virtually all the data were from adults. Because no pediatric-specific cohort of casualties receiving emergency tourniquets existed, we aimed to fill knowledge gaps on the care and outcomes of this group by surveying data from a trauma registry to refine device designs and clinical training. A retrospective review of data from a trauma registry yielded an observational cohort of 88 pediatric casualties at US military hospitals in theater on whom tourniquets were used from May 17, 2003, to December 25, 2009. Of the 88 casualties in the study group, 72 were male and 16 were female patients. Ages averaged 11 years (median, 11 years; range, 4-17 years). There were 7 dead and 81 survivor outcomes for a trauma survival rate of 93%. Survivor and dead casualties were similar in all independent variables measured except hospital stay duration (median, 5 days and 1 day, respectively). Six casualties (7%) had neither extremity nor external injury in that they had no lesion indicating tourniquet use. The survival rate of the present study's casualties is similar to that of 3 recent large nonpediatric-specific studies. Although current emergency tourniquets were ostensibly designed for modern adult soldiers, tourniquet makers, perhaps unknowingly, produced tourniquets that fit children. The rate of unindicated tourniquets, 7%, implied that potential users need better diagnostic training. Level 4; case series, therapeutic study.

Counsellors in primary care in Southampton: a questionnaire survey of their qualifications, working arrangements, and casemix.

PubMed Central

Clark, A; Hook, J; Stein, K

1997-01-01

BACKGROUND: There has been an upsurge of interest in counselling in primary care over the past five years. This has been stimulated by a growing demand for non-drug treatment of emotional disorders and by the extension of reimbursement for the costs of counsellors. Continued calls for careful evaluation have been largely unheeded in the face of heady growth. AIM: To establish the prevalence of counselling services in the 67 general practices in the Southampton and South West Hampshire Health District, and to describe in detail their qualifications, working arrangements, and casemix. METHOD: A questionnaire enquiring about counselling services was sent to all the general practices in the district. A second questionnaire was then posted to all the counsellors identified as working in these practices. RESULTS: Twenty-six (39%) practices employed one or more counsellors. Fundholding practices were four times more likely than non-fundholders to employ a counsellor. Most of the counselling work was short term (4-20 sessions). The most common presenting complaints were relationship problems, depression, anxiety, and bereavement. CONCLUSION: This descriptive study highlights the wide variation in the qualifications and training of counsellors. Until the issue of effectiveness is resolved through further research, the best safeguard of quality is to ensure that counsellors meet the appropriate training standards laid down by the British Association of Counsellors. Monitoring standards is a legitimate task for those commissioning health care who are increasingly responsible for reimbursement of a counsellor's salary. Counsellors who meet appropriate training criteria should be encouraged to pursue accreditation with the British Association of Counsellors. Those who do not meet these criteria should be encouraged to undergo additional training. PMID:9474822

Post-conflict struggles as networks of problems: A network analysis of trauma, daily stressors and psychological distress among Sri Lankan war survivors.

PubMed

Jayawickreme, Nuwan; Mootoo, Candace; Fountain, Christine; Rasmussen, Andrew; Jayawickreme, Eranda; Bertuccio, Rebecca F

2017-10-01

A growing body of literature indicates that the mental distress experienced by survivors of war is a function of both experienced trauma and stressful life events. However, the majority of these studies are limited in that they 1) employ models of psychological distress that emphasize underlying latent constructs and do not allow researchers to examine the unique associations between particular symptoms and various stressors; and 2) use one or more measures that were not developed for that particular context and thus may exclude key traumas, stressful life events and symptoms of psychopathology. The current study addresses both these limitations by 1) using a novel conceptual model, network analysis, which assumes that symptoms covary with each other not because they stem from a latent construct, but rather because they represent meaningful relationships between the symptoms; and 2) employing a locally developed measure of experienced trauma, stressful life problems and symptoms of psychopathology. Over the course of 2009-2011, 337 survivors of the Sri Lankan civil war were administered the Penn-RESIST-Peradeniya War Problems Questionnaire (PRPWPQ). Network analysis revealed that symptoms of psychopathology, problems pertaining to lack of basic needs, and social problems were central to the network relative to experienced trauma and other types of problems. After controlling for shared associations, social problems in particular were the most central, significantly more so than traumatic events and family problems. Several particular traumatic events, stressful life events and symptoms of psychopathology that were central to the network were also identified. Discussion emphasizes the utility of such network models to researchers and practitioners determining how to spend limited resources in the most impactful way possible. Copyright © 2017 Elsevier Ltd. All rights reserved.

War-related trauma exposure and multiple risk behaviors among school-going adolescents in Northern Uganda: the mediating role of depression symptoms.

PubMed

Okello, James; Nakimuli-Mpungu, Etheldreda; Musisi, Seggane; Broekaert, Eric; Derluyn, Ilse

2013-11-01

The relationship between war-related trauma exposure, depressive symptoms and multiple risk behaviors among adolescents is less clear in sub-Saharan Africa. We analyzed data collected from a sample of school-going adolescents four years postwar. Participants completed interviews assessing various risk behaviors defined by the Youth Self Report (YSR) and a sexual risk behavior survey, and were screened for post-traumatic stress, anxiety and depression symptoms based on the Impact of Events Scale Revised (IESR) and Hopkins Symptom Checklist for Adolescents (HSCL-37A) respectively. Multivariate logistic regression was used to assess factors independently associated with multiple risk behaviors. The logistic regression model of Baron and Kenny (1986) was used to evaluate the mediating role of depression in the relationship between stressful war events and multiple risk behaviors. Of 551 participants, 139 (25%) reported multiple (three or more) risk behaviors in the past year. In the multivariate analyses, depression symptoms remained uniquely associated with multiple risk behavior after adjusting for potential confounders including socio-demographic characteristics, war-related trauma exposure variables, anxiety and post-traumatic stress symptoms. In mediation analysis, depression symptoms mediated the associations between stressful war events and multiple risk behaviors. The psychometric properties of the questionnaires used in this study are not well established in war affected African samples thus ethno cultural variation may decrease the validity of our measures. Adolescents with depression may be at a greater risk of increased engagement in multiple risk behaviors. Culturally sensitive and integrated interventions to treat and prevent depression among adolescents in post-conflict settings are urgently needed. © 2013 Elsevier B.V. All rights reserved.

The role of the counsellor in a medical centre.

PubMed

Harray, A S

1975-12-10

The counsellor is one member of the para-medical team being used more and more frequently by doctors. His role is allied to, but distinct from the doctor. He is not an authority figure who diagnoses and prescribes, but acts so as to help the patient diagnose the nature of his own dysfunction and assist him to draw on his own resources for growth and change. The methods the counsellor uses vary, but his goal harmonises with the doctor--the removal of disease from the psychosomatic unity of the patient.

The Psychometric Properties of the Counselor Burnout Inventory in Greek School Counsellors

ERIC Educational Resources Information Center

Kounenou, Kalliopi; Gkemisi, Sofia; Nanopoulos, Panagiotis; Tsitsas, George

2018-01-01

The present study aimed at testing and exploring the psychometric properties of the Counselor Burnout Inventory (CBI) in Greek school counsellors. Two hundred school counsellors from all over Greece participated in the study. The confirmatory study revealed four dimensions of the Greek version of CBI; namely, exhaustion, deterioration in personal…

The Route to "Inclusive Counselling": Counsellors' Perceptions of Disability Inclusion in Turkey

ERIC Educational Resources Information Center

Sakiz, Halis; Woods, Charlotte; Sart, Hande; Ersahin, Zehra; Aftab, Raiha; Koç, Nizamettin; Sariçam, Hakan

2015-01-01

The present research highlights new challenges and opportunities faced by counsellors in relation to the movement to include students with disabilities within mainstream schools launched by the Ministry of Education in Turkey. The main purpose of the study was to examine perceptions of counsellors in relation to this movement. Interviews were…

War traumas in the Mediterranean area.

PubMed

Carta, Mauro Giovanni; Moro, Maria Francesca; Bass, Judith

2015-02-01

The purpose is to explore the consequences of war and its impact on mental health with attention to the Mediterranean area. Narrative review of consequences of war on mental health and on the mental health of the communities in the current crises in the Mediterranean region. A series of outbreaks of war are still raging in the Mediterranean region and producing horrible effects with a considerable number of refugees with unsatisfied needs. Studies relating to conflicts of the past suggest that the mental health consequences of these wars may affect future generations for many years. While violations of human rights are not new, what is new are attacks on medical institutions perceived to be traditionally Western. The scientific community has to fight violence through mediation of conflicts. The idea that science can improve lives is a concept that is found in the history of all Mediterranean cultures. The Greek and Roman medical tradition was saved thanks to doctors of the Arab courts when Christian fundamentalism fought science in the Middle Ages. Health institutions are the product of the great Islamic medical tradition as well as Western culture. © The Author(s) 2014.

Optimizing lay counsellor services for chronic care in South Africa: a qualitative systematic review.

PubMed

Petersen, Inge; Fairall, Lara; Egbe, Catherine O; Bhana, Arvin

2014-05-01

To conduct a qualitative systematic review on the use of lay counsellors in South Africa to provide lessons on optimizing their use for psychological and behavioural change counselling for chronic long-term care in scare-resource contexts. A qualitative systematic review of the literature on lay counsellor services in South Africa. Twenty-nine studies met the inclusion criteria. Five randomized control trials and two cohort studies reported that lay counsellors can provide behaviour change counselling with good outcomes. One multi-centre cohort study provided promising evidence of improved anti-retroviral treatment adherence and one non-randomized controlled study provided promising results for counselling for depression. Six studies found low fidelity of lay counsellor-delivered interventions in routine care. Reasons for low fidelity include poor role definition, inconsistent remuneration, lack of standardized training, and poor supervision and logistical support. Within resource-constrained settings, adjunct behaviour change and psychological services provided by lay counsellors can be harnessed to promote chronic care at primary health care level. Optimizing lay counsellor services requires interventions at an organizational level that provide a clear role definition and scope of practice; in-service training and formal supervision; and sensitization of health managers to the importance and logistical requirements of counselling. Copyright © 2014 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

Cultural shift in mental illness: a comparison of stress responses in World War I and the Vietnam War.

PubMed

Skinner, Rasjid; Kaplick, Paul M

2017-12-01

Post-traumatic stress disorder is an established diagnostic category. In particular, over the past 20 years, there has been an interest in culture as a fundamental factor in post-traumatic stress disorder symptom manifestation. However, only a very limited portion of this literature studies the historical variability of post-traumatic stress within a particular culture. Therefore, this study examines whether stress responses to violence associated with armed conflicts have been a culturally stable reaction in Western troops. We have compared historical records from World War I to those of the Vietnam War. Reference is also made to observations of combat trauma reactions in pre-World War I conflicts, World War II, the Korean War, the Falklands War, and the First Gulf War. The data set consisted of literature that was published during and after these armed conflicts. Accounts of World War I Shell Shock that describe symptom presentation, incidence (both acute and delayed), and prognosis were compared to the observations made of Vietnam War post-traumatic stress disorder victims. Results suggest that the conditions observed in Vietnam veterans were not the same as those which were observed in World War I trauma victims. The paper argues that the concept of post-traumatic stress disorder cannot be stretched to cover the typical battle trauma reactions of World War I. It is suggested that relatively subtle changes in culture, over little more than a generation, have had a profound effect on how mental illness forms, manifests itself, and is effectively treated. We add new evidence to the argument that post-traumatic stress disorder in its current conceptualisation does not adequately account, not only for ethnocultural variation but also for historical variation in stress responses within the same culture.

Surgical Management of the Recent Orbital War Injury.

PubMed

Riyadh, Safaa; Abdulrazaq, Saif Saadedeen; Zirjawi, Ali Mhana Sabeeh

2018-05-08

Maxillofacial trauma affects sensitive and essential functions for the human being such as smell, breathing, talking, and the most importantly the sight. Trauma to the orbit may cause a vision loss especially if this trauma yields a high kinetic energy like that encountered during wars. The purpose of the study was to evaluate the surgical outcomes of the orbital war trauma, enriching the literature with the experience of the authors in this field. A total of 16 patients were injured, evacuated, and managed, between June 2014 and June 2017, from the fight between the Iraqi army and the Islamic State of Iraq and Syria (ISIS) in different areas of Iraq. Two-stage protocol was adopted, that is debridement and reconstruction. There were 14 military patients and 2 civilians. The cause of trauma was either bullet or shrapnel from an explosion. In the battlefield, delayed evacuation of the casualties led to increase the morbidity and mortality. Wearing a protective shield over the eye during the war along with fast evacuation highly improved the survival rates.

Career Counsellors and Suicide Risk Assessment

ERIC Educational Resources Information Center

Popadiuk, Natalee Elizabeth

2013-01-01

Recent discussions suggest that career counsellors need to be trained in more holistic frameworks in order to deal with the career and psychological issues of their clients. In particular, research shows a strong connection between employment and suicidality, including changes in socioeconomic status, disruption in employment, sudden unemployment,…

Alberta High School Counsellors' Knowledge of Homosexuality and Their Attitudes toward Gay Males

ERIC Educational Resources Information Center

Alderson, Kevin G.; Orzeck, Tricia L.; McEwen, Scott C.

2009-01-01

In this study we investigated Alberta high school counsellors' knowledge about homosexuality and their attitudes toward gay males. Three questionnaires were mailed to 648 high school counselling centres; 223 individuals returned the completed questionnaires. Most counsellors attained low scores in measured homo-negativity and high scores regarding…

Psychopharmacology Training and Canadian Counsellors: Are We Getting What We Want and Need?

ERIC Educational Resources Information Center

Schaefer, David; Wong-Wylie, Gina

2008-01-01

The psychopharmacology training experiences and attitudes of Canadian counsellors were the focus of our national Internet-based survey. This study was part of a larger investigation on Canadian counsellors' attitudes, practices, and training experiences related to clients on antidepressants. Results of the current study indicate Canadian…

[The hardest battles begin after the war].

PubMed

Sodemann, Morten; Svabo, Arndis; Jacobsen, Arne

2010-01-11

While psychic effects of war trauma are well-described, the somatic long-term consequences of war trauma have not previously been described. In three clinical cases from the Migrant Health Clinic at Odense University Hospital, we describe the complicated somatic problems which can be associated with a refugee status. The cross disciplinary team chose three cases that describe the long-term effects of war trauma. Post-traumatic stress disorder (PTSD) can appear 10-20 years after a primary war-related trauma and secondary trauma after the arrival in Denmark trigger and prolong post-traumatic stress symptoms with a range of somatic symptoms. Warning signs of an underlying PTSD disorder have often been present for many years, but overlooked or ignored. Many patients with PTSD and somatic symptoms loose previously acquired language skills, disintegrate and drop out of the labour market after 3-4 years in Denmark. Somatic symptoms along with PTSD can develop into a seriously complicated condition that requires skilled cross-disciplinary management. Experience from the Cross Disciplinary Migrant Health Clinic shows that by investing time in obtaining a full clinical and social history it is possible to increase the quality of life of these patients. Early screening and early specialized cross disciplinary and cross sectorial management are crucial to secure and maintain integration, but unfortunately the long waiting list to institutions that treat PTSD contributes to the high level of disintegration.

Torture and war trauma survivors in primary care practice.

PubMed Central

Weinstein, H M; Dansky, L; Iacopino, V

1996-01-01

Close to 1 million refugees from around the world have entered the United States, fleeing repression, war, terrorism, and disease. It has been estimated that among these are thousands who have experienced torture. Many refugees and immigrants will appear in the offices of health care professionals with symptoms that may be related either directly or indirectly to torture. Both physical and psychological torture may result in long-term sequelae. Physical effects may be found in every organ system, but psychological effects are most commonly manifest in the symptoms of the post-traumatic stress disorder. For physicians to recognize how torture can affect health status, it is important to understand that history taking may be difficult and that little information may emerge that would explain the origins of scars, fractures, or disabilities. Recognizing the clues to a torture history allows physicians to assist patients in describing the trauma. In addition, knowing the subacute and chronic signs and symptoms of torture enables physicians to diagnose and treat often obscure symptoms with a much clearer understanding of the sources of the difficulty. Paying special attention to the interview process will support torture survivors in detailing often horrific events. PMID:8909162

Factors associated with posttraumatic stress disorder and depression in war-survivors displaced in Croatia

PubMed Central

Letica-Crepulja, Marina; Salcioglu, Ebru; Frančišković, Tanja; Basoglu, Metin

2011-01-01

Aim To examine the role of perceived stressfulness of trauma exposure and economic, social, occupational, educational, and familial adaptation after trauma in posttraumatic stress disorder (PTSD) and depression in displaced war survivors. Methods A cross-sectional survey was conducted between March 2000 and July 2002 with a sample of 173 internally displaced persons or refugees and 167 matched controls in Croatia. Clinical measures included Structured Clinical Interview for DSM-IV and Clinician-Administered PTSD Scale. Results Displaced war survivors reported the exposure to a mean ± standard deviation of 13.1 ± 8.3 war stressors, including combat, torture, serious injury, death of close persons, and loss of property. Compared to controls, they reported higher rates of marked to severe impact of war on family (16.2% vs 51.6%), social (7.2% vs 43.5%), economic (12.6% vs 55.4%), occupational (1.8% vs 15.9%), and educational (2.4% vs 8.8%) adaptation. In two logistic regression analyses, the strongest predictor of PTSD and depression was high level of perceived distress during trauma exposure. PTSD but not depression was associated with economic, social, occupational, educational, and familial adaptation after trauma. Conclusion Displaced survivors who experienced multiple war events perceived greater negative impact of war on their life domains compared to individuals who lived in a war setting but had no trauma exposure. The most important determinant of psychological outcomes was perceived stressfulness of war stressors. Although post-trauma adaptation in different life spheres had an impact, its effect was not robust and consistent across disorders. These findings suggest that it would be effective to use a trauma-focused approach in rehabilitation of war survivors. PMID:22180270

The association between attachment and mental health symptoms among school-going adolescents in northern Uganda: the moderating role of war-related trauma.

PubMed

Okello, James; Nakimuli-Mpungu, Etheldreda; Musisi, Seggane; Broekaert, Eric; Derluyn, Ilse

2014-01-01

The association between attachment and mental health symptoms in adolescents in a post-conflict low resource setting has not been documented. We investigated the relationship between parent and peer attachment and posttraumatic stress, depression and anxiety symptoms in a sample of 551 adolescents aged 13-21 years old. Attachment quality was assessed using the Inventory of Parent and Peer Attachment (IPPA). Post-traumatic stress, depression and anxiety symptoms were assessed using the Impact of Events Scale Revised (IESR) and Hopkins Symptom Checklist for Adolescents (HSCL-37A) respectively. Gender differences in attachment relationships were determined using independent t-tests. Multivariate logistic regression was used to assess whether attachment relationships were independently associated with posttraumatic stress, depression and anxiety symptoms. Hierarchical linear regression analyses were conducted to explore the moderating role of war-related trauma. Our analyses revealed gender differences in attachment to parents, with males reporting stronger attachment than females. Parental attachment was protective against depression and anxiety symptoms but not posttraumatic stress symptoms after adjusting for potential confounders. Alienation by parents was independently associated with an increase in these mental health symptoms while peer attachment was not associated with any of these symptoms. However, in situations of severe trauma, our analyses showed that peer attachment was significantly protective against post-traumatic stress symptoms. Secure parental attachment is associated with better psychosocial adjustment in adolescents affected by war. Further, adolescents with secure peer attachment relationships in situations of severe war trauma may be less likely to develop posttraumatic stress symptoms. Interventions to enhance peer support in this post conflict setting would benefit this vulnerable population.

The Association between Attachment and Mental Health Symptoms among School-Going Adolescents in Northern Uganda: The Moderating Role of War-Related Trauma

PubMed Central

Okello, James; Nakimuli-Mpungu, Etheldreda; Musisi, Seggane; Broekaert, Eric; Derluyn, Ilse

2014-01-01

Background The association between attachment and mental health symptoms in adolescents in a post-conflict low resource setting has not been documented. Methods We investigated the relationship between parent and peer attachment and posttraumatic stress, depression and anxiety symptoms in a sample of 551 adolescents aged 13–21 years old. Attachment quality was assessed using the Inventory of Parent and Peer Attachment (IPPA). Post-traumatic stress, depression and anxiety symptoms were assessed using the Impact of Events Scale Revised (IESR) and Hopkins Symptom Checklist for Adolescents (HSCL-37A) respectively. Gender differences in attachment relationships were determined using independent t-tests. Multivariate logistic regression was used to assess whether attachment relationships were independently associated with posttraumatic stress, depression and anxiety symptoms. Hierarchical linear regression analyses were conducted to explore the moderating role of war-related trauma. Results Our analyses revealed gender differences in attachment to parents, with males reporting stronger attachment than females. Parental attachment was protective against depression and anxiety symptoms but not posttraumatic stress symptoms after adjusting for potential confounders. Alienation by parents was independently associated with an increase in these mental health symptoms while peer attachment was not associated with any of these symptoms. However, in situations of severe trauma, our analyses showed that peer attachment was significantly protective against post-traumatic stress symptoms. Conclusions Secure parental attachment is associated with better psychosocial adjustment in adolescents affected by war. Further, adolescents with secure peer attachment relationships in situations of severe war trauma may be less likely to develop posttraumatic stress symptoms. Interventions to enhance peer support in this post conflict setting would benefit this vulnerable population. PMID

Historical Trends in Counsellor Education Dissertations

ERIC Educational Resources Information Center

Richards, Judith; Dykeman, Cass; Bender, Sara

2016-01-01

There exists a dearth of literature on the content, research method and research design trends of dissertations in education. Within one large subfield of education (i.e. counsellor education), an online and full-text archive of dissertations has become available. This archive contains over 200 dissertations produced in Oregon State University's…

Mental health among older refugees: the role of trauma, discrimination, and religiousness.

PubMed

Mölsä, Mulki; Kuittinen, Saija; Tiilikainen, Marja; Honkasalo, Marja-Liisa; Punamäki, Raija-Leena

2017-08-01

The aim of this study was to examine, first, how past traumatic stress and present acculturation indices, and discrimination are associated with mental health; and, second, whether religiousness can buffer the mental health from negative impacts of war trauma. Participants were 128 older (50-80 years) Somali refugees living in Finland. They reported experiences of war trauma and childhood adversities, and filled-in questionnaires of perceived ethnic discrimination, religiousness (beliefs, attendance, and observance of Islamic faith), and symptoms of posttraumatic stress disorder (PTSD), depressive (BDI-21), psychological distress (GHQ-12), and somatization (SCL-90). Symptom-specific regression models showed that newly arrived refugees with non-permanent legal status and severe exposures to war trauma, childhood adversity, and discrimination endorsed greater PTSD symptoms, while only war trauma and discrimination were associated with depressive symptoms. Results confirmed that high religiousness could play a buffering role among older Somalis, as exposure to severe war trauma was not associated with high levels of PTSD or somatization symptoms among highly religious refugees. Health care should consider both unique past and present vulnerabilities and resources when treating refugees, and everyday discrimination and racism should be regarded as health risks.

Psychosocial rehabilitation after war trauma with adaptive disclosure: Design and rationale of a comparative efficacy trial.

PubMed

Yeterian, Julie D; Berke, Danielle S; Litz, Brett T

2017-10-01

Posttraumatic stress disorder (PTSD) from warzone exposure is associated with chronic and disabling social and occupational problems. However, functional impairment is rarely assessed or targeted directly in PTSD treatments, which instead focus on symptom reduction. Trauma-related contributors to diminished functioning, including guilt, shame, and anger resulting from morally compromising or loss-based war experiences, are also underemphasized. The goal of this clinical trial is to fill a substantial gap in the treatment of military-related PTSD by testing a modified Adaptive Disclosure (AD) therapy for war-related PTSD stemming from moral injury and traumatic loss focused on improving psychosocial functioning AD. This paper describes the rationale and design of a multi-site randomized controlled trial comparing AD to Present-Centered Therapy (PCT). We will recruit 186 veterans with PTSD, who will be assessed at baseline, post-treatment, and 3- and 6-months post-treatment. Primary outcomes are functional changes (i.e., functioning/disability and quality of life). Secondary outcomes are mental health variables (i.e., PTSD, depression, guilt, shame). We hypothesize that veterans treated with AD will experience greater improvements in all outcomes compared to those treated with PCT. This trial will advance knowledge in rehabilitation research by testing the first therapy specifically designed to address psychosocial functioning among veterans with war-related PTSD. The results may improve the quality of mental health care for veterans by offering an ecologically sound treatment for experiences that are uniquely impactful for war veterans. Published by Elsevier Inc.

Disaster Workers: Trauma and Social Support

DTIC Science & Technology

1992-05-01

coming back, the smell of dead flesh." "I think about the disaster quite a bit. I think about the 6 year old girl I had helpe and of her family. The...estimated 7% of the U.S. population is exposed to traumas/disasters each year . In the military, traumatic events caused by training, war, and combat, are...exposed to traumas and disasters each year . In the military, traumatic events caused by training, as well as war and combat, are an expected part of

Venous trauma in the Lebanon War--2006.

PubMed

Nitecki, Samy S; Karram, Tony; Hoffman, Aaron; Bass, Arie

2007-10-01

Reports on venous trauma are relatively sparse. Severe venous trauma is manifested by hemorrhage, not ischemia. Bleeding may be internal or external and rarely may lead to hypovolemic shock. Repair of major extremity veins has been a subject of controversy and the current teaching is to avoid venous repair in an unstable or multi-trauma patient. The aim of the current paper is to present our recent experience in major venous trauma during the Lebanon conflict, means of diagnosis and treatment in a level I trauma center. All cases of major venous trauma, either isolated or combined with arterial injury, admitted to the emergency room during the 33-day conflict were reviewed. Out of 511 wounded soldiers and civilians who were admitted to our service over this period, 12 (2.3%) sustained a penetrating venous injury either isolated (5) or combined with arterial injury (7). All injuries were secondary to high velocity penetrating missiles or from multiple pellets stored in long-range missiles. All injuries were accompanied by additional insult to soft tissue, bone and viscera. The mean injury severity score was 15. Severe external bleeding was the presenting symptom in three cases of isolated venous injury (jugular, popliteal and femoral). The diagnosis of a major venous injury was made by a CTA scan in five cases, angiography in one and during surgical exploration in six cases. All injured veins were repaired: three by venous interposition grafts, four by end to end anastomosis, three by lateral suture and two by endovascular techniques. None of the injuries was treated by ligation of a major named vein. Immediate postoperative course was uneventful in all patients and the 30-day follow-up (by clinical assessment and duplex scan) has demonstrated a patent repair with no evidence of thrombosis. Without contradicting the wisdom of ligating major veins in the setup of multi-trauma or an unstable patient, our experience indicates that a routine repair of venous trauma can

Pathological narcissism and acute anxiety symptoms after trauma: a study of Israeli civilians exposed to war.

PubMed

Besser, Avi; Zeigler-Hill, Virgil; Pincus, Aaron L; Neria, Yuval

2013-01-01

Diathesis-stress models of posttraumatic stress disorder (PTSD) hypothesize that exposure to trauma may interact with individual differences in the development of PTSD. Previous studies have not assessed immediate responses to a proximate stressor, but the current "natural laboratory" study was designed to empirically test the role that individual differences in pathological narcissism may play in the development of acute anxiety symptoms among civilians facing rocket and missile fire. We assessed demographic features, trauma exposure severity, narcissistic personality features, and acute anxiety symptoms (PTSD and General Anxiety Disorder [GAD]) among 342 Israeli female adults during the November 2012 eruption of violence in the Middle East. Results demonstrate an association between exposure severity and acute anxiety symptoms (both PTSD and GAD) for individuals with high levels of pathological narcissism but not for those with low levels of pathological narcissism. These results suggest that individuals with narcissistic personality features are at high risk for the development of acute anxiety symptoms following exposure to uncontrollable and life-threatening mass trauma. The findings underscore the role of intra-personal resources in the immediate psychological aftermath of war by highlighting the increased risk associated with narcissistic personality features. Theoretical and clinical implications of the findings are discussed.

Intraoperative fluorescence angiography: a review of applications and outcomes in war-related trauma.

PubMed

Green, J Marshall; Sabino, Jennifer; Fleming, Mark; Valerio, Ian

2015-03-01

In the recent Iraq and Afghanistan conflicts, survival rates from complex battlefield injuries have continued to improve. The resulting war-related wounds are challenging, with confounding issues making assessment of tissue perfusion subjective and variable. This review discusses the utility of intraoperative fluorescence angiography, and its usefulness as an objective tool to evaluate the perfusion of tissues in the face of complex war-related injuries. A retrospective review of all war-related traumatic and reconstructive cases employing intraoperative indocyanine green laser angiography (ICGLA) was performed. Data analyzed included indication for use, procedure success/failure rates, modifications performed, and perfusion-related complications. Anatomical regions assessed were extremity, head and neck, truncal, and intra-abdominal viscera. The endpoint of specific interest involved the decision for additional debridement of poorly perfused tissue, as based on the ICGLA findings. Over a 3-year period, this study examined 123 extremity soft tissue flaps, 41 extremity injuries including amputation and/or amputation revision cases, 13 craniofacial flaps, and 9 truncal/abdomen/gastrointestinal cases in which ICGLA was utilized to assess tissue perfusion and viability. A total of 35 (18.8%) of cases employing ICGLA required intraoperative modifications to address perfusion-related issues. Intraoperative fluorescent angiography is an objective, useful tool to assess various war-related traumatic injuries. This study expands on prior cited indications for ICGLA to include (1) guiding debridement in heavily contaminated wounds, (2) providing improved assessment of avulsion soft tissue injuries, (3) allowing for rapid detection of vascular and/or microvascular compromise in soft tissue and osseous flap reconstructions, (4) reducing and preventing perfusion-related complications in trauma, amputation closures, and reconstruction procedures, (5) contributing to better

Trauma-related Infections in Battlefield Casualties From Iraq

PubMed Central

Petersen, Kyle; Riddle, Mark S.; Danko, Janine R.; Blazes, David L.; Hayden, Richard; Tasker, Sybil A.; Dunne, James R.

2007-01-01

Objective: To describe risks for, and microbiology and antimicrobial resistance patterns of, war trauma associated infections from Operation Iraqi Freedom. Background: The invasion of Iraq resulted in casualties from high-velocity gunshot, shrapnel, and blunt trauma injuries as well as burns. Infectious complications of these unique war trauma injuries have not been described since the 1970s. Methods: Retrospective record review of all trauma casualties 5 to 65 years of age evacuated from the Iraqi theatre to U.S. Navy hospital ship, USNS Comfort March to May 2003.War trauma-associated infection was defined by positive culture from a wound or sterile body fluid (ie, blood, cerebrospinal fluid) and at least two of the following infection-associated signs/symptoms: fever, dehiscence, foul smell, peri-wound erythema, hypotension, and leukocytosis. A comparison of mechanisms of injury, demographics, and clinical variables was done using multivariate analysis. Results: Of 211 patients, 56 met criteria for infection. Infections were more common in blast injuries, soft tissue injuries, >3 wound sites, loss of limb, abdominal trauma, and higher Injury Severity Score (ISS). Wound infections accounted for 84% of cases, followed by bloodstream infections (38%). Infected were more likely to have had fever prior to arrival, and had higher probability of ICU admission and more surgical procedures. Acinetobacter species (36%) were the predominant organisms followed by Escherichia coli and Pseudomonas species (14% each). Conclusions: Similar to the Vietnam War experience, gram-negative rods, particularly Acinetobacter species, accounted for the majority of wound infections cared for on USNS Comfort during Operation Iraqi Freedom. Multidrug resistance was common, with the exception of the carbapenem class, limiting antibiotic therapy options. PMID:17457175

Problematic Internet Use: Perceptions of Addiction Counsellors

ERIC Educational Resources Information Center

Acier, Didier; Kern, Laurence

2011-01-01

Despite a growing number of publications on problematic Internet use (PIU), there is no consensus on the nature of the phenomenon, its constituent criteria, and its clinical threshold. This qualitative study examines the perceptions of addiction counsellors who have managed individuals with PIU in Quebec (Canada). Four focus groups were conducted…

The economics of employing a counsellor in general practice: analysis of data from a randomised controlled trial.

PubMed Central

Friedli, K; King, M B; Lloyd, M

2000-01-01

BACKGROUND: Counselling is currently adopted in many general practices, despite limited evidence of clinical and cost effectiveness. AIM: To compare direct and indirect costs of counsellors and general practitioners (GPs) in providing care to people with emotional problems. METHOD: We carried out a prospective, randomized controlled trial of non-directive counselling and routine general practice care in 14 general practices in north London. Counsellors adhered to a Rogerian model of counselling. The counselling sessions ranged from one to 12 sessions over 12 weeks. As reported elsewhere, there were no differences in clinical outcomes between the two groups. Therefore, we conducted a cost minimisation analysis. We present only the economic outcomes in this paper. Main outcome measures were cost data (service utilisation, travel, and work absence) at baseline, three months, and nine months. RESULTS: One hundred and thirty-six patients with emotional problems, mainly depression, took part. Seventy patients were randomised to the counsellors and 66 to the GPs. The average direct and indirect costs for the counsellor was 162.09 Pounds more per patient after three months compared with costs for the GP group; however, over the following six months the counsellor group was 87.00 Pounds less per patient than the GP group. Over the total nine-month period, the counsellor group remained more expensive per patient. CONCLUSIONS: Referral to counselling is no more clinically effective or expensive than GP care over a nine-month period in terms of direct plus indirect costs. However, further research is needed to establish indirect costs of introducing a counsellor into general practice. PMID:10897510

Narratives of Developing Counsellors' Preferred Theories of Counselling Storied through Text, Metaphor, and Photographic Images

ERIC Educational Resources Information Center

Wong-Wylie, Gina

2006-01-01

Reflective practice is integral for developing counsellors to maintain self-awareness and to recognize influences upon ones personal theory of counselling. In this exploratory narrative inquiry research, four doctoral level counselling psychologists participated to uncover "What are the personal stories of developing counsellors and in what…

Counsellor Education as Humanist Colonialism: Seeking Post-Colonial Approaches to Educating Counsellors by Exploring Pathways to an Indigenous Aesthetic

ERIC Educational Resources Information Center

Bowers, Randolph

2008-01-01

This narrative reflection emerged during a time of personally reconnecting with Mi'kmaq First Nation culture and heritage while working in the mainstream roles of counsellor educator and educationalist in Australia. The essay expresses turning points along a path of increasing political and social discomfort with the status quo in counsellor…

Surveying the Extent of, and Attitudes Towards, the Use of Prayer as a Spiritual Intervention among British Mainstream Counsellors

ERIC Educational Resources Information Center

Gubi, Peter M.

2004-01-01

A questionnaire was sent to 578 BACP Accredited Counsellors and 122 CMCS Approved Counsellors to survey the use, and attitudes to the use, of prayer as a spiritual intervention in British mainstream counselling. The data reveal that prayer influences the practice of a significant number of mainstream counsellors at a philosophical, a covert and an…

Trauma-induced dissociative amnesia in World War I combat soldiers. II. Treatment dimensions.

PubMed

Brown, P; van der Hart, O; Graafland, M

1999-06-01

This is the second part of a study of posttraumatic amnesia in World War I (WW I) soldiers. It moves beyond diagnostic validation of posttraumatic amnesia (PTA), to examine treatment findings, and relates these to contemporary treatment of dissociative amnesia, including treatment of victims of civilian trauma (e.g. childhood sexual abuse). Key WW I studies are surveyed which focus on the treatment of PTA and traumatic memories. The dissociation-integration and repression-abreaction models are contrasted. Descriptive evidence is cited in support of preferring Myers' and McDougalls' dissociation-integration treatment approach over Brown's repression-abreaction model. Therapeutic findings in this paper complement diagnostic data from the first report. Although effective treatment includes elements of both the dissociative-integrative and abreactive treatment approaches, cognitive integration of dissociated traumatic memories and personality functions is primary, while emotional release is secondary.

An investigation of war trauma types, symptom clusters, and risk-factors associated with post-traumatic stress disorder: where does gender fit?

PubMed

Farhood, Laila; Fares, Souha; Hamady, Carmen

2018-05-25

The female-male ratio in the prevalence of post-traumatic stress disorder (PTSD) is approximately 2:1. Gender differences in experienced trauma types, PTSD symptom clusters, and PTSD risk factors are unclear. We aimed to address this gap using a cross-sectional design. A sample of 991 civilians (522 women, 469 men) from South Lebanon was randomly selected in 2007, after the 2006 war. Trauma types were grouped into disaster and accident, loss, chronic disease, non-malignant disease, and violence. PTSD symptom clusters involved re-experiencing, avoidance, negative cognitions and mood, and arousal. These were assessed using parts I and IV of the Arabic version of the Harvard Trauma Questionnaire (HTQ). Risk factors were assessed using data from a social support and life events questionnaire in multiple regression models. Females were twice as likely as males to score above PTSD threshold (24.3 vs. 10.4%, p ˂ 0.001). Total scores on all trauma types were similar across genders. Females scored higher on all symptom clusters (p < 0.001). Social support, social life events, witnessed traumas, and domestic violence significantly were associated with PTSD in both genders. Social support, social life events, witnessed traumas and domestic violence were significantly associated with PTSD in both genders. Conversely, gender difference in experienced traumas was not statistically significant. These findings accentuate the need to re-consider the role of gender in the assessment and treatment of PTSD.

Lessons of War: Combat-related Injury Infections during the Vietnam War and Operation Iraqi and Enduring Freedom

PubMed Central

Blyth, Dana M.; Yun, Heather C.; Tribble, David R.; Murray, Clinton K.

2015-01-01

Summary In over a decade of war, numerous advancements have been made to improve overall combat-related mortality, but infectious complications remain a leading cause of both morbidity and mortality in combat-related injured personnel. Here we will attempt to compare the challenges and lessons of combat-related injuries and infections from the Vietnam War with those of OIF/OEF. Throughout the Vietnam War and OIF/OEF, there have been similar infection-related challenges faced in caring for combat-related trauma patients. Both conflicts reinforced the importance of rapid medical evacuation and definitive surgical management of war wounds. They revealed the constant evolution of infecting organisms and the challenge of increasing antimicrobial resistance. We have also seen that with decreased mortality of severely injured personnel new morbidities must be addressed. Using the foundation of fragmented research from the Vietnam War, previously successful models were assembled into joint service research institutions which have allowed these questions to be addressed. However, many questions regarding measures to reduce infectious complications in our combat-injured personnel remain unanswered. Continued research building on established knowledge is critical for continued improvements in the care of combat-related trauma patients. PMID:26406435

An Holistic Approach for Counsellors: Embracing Multiple Intelligences

ERIC Educational Resources Information Center

Booth, Rosslyn; O'Brien, Patrick John

2008-01-01

This paper explores a range of therapeutic modalities used by counsellors of children and positions those modalities within Gardner's theory of multiple intelligences. Research by O'Brien ("Gardner's theory of multiple intelligence and its implications for the counselling of children." Unpublished doctoral dissertation, Queensland University of…

The Impact of Counsellor Training on Emotional Intelligence

ERIC Educational Resources Information Center

Pearson, Anne; Weinberg, Ashley

2017-01-01

This study evaluated the impact of counsellor training on emotional intelligence (EI) in 45 undergraduates and 58 postgraduates. Significant improvements were recorded by students on completion of both programmes, suggesting that these were attributable to training which enhanced intra- and interpersonal aspects of emotional functioning. As a…

Systemic trauma.

PubMed

Goldsmith, Rachel E; Martin, Christina Gamache; Smith, Carly Parnitzke

2014-01-01

Substantial theoretical, empirical, and clinical work examines trauma as it relates to individual victims and perpetrators. As trauma professionals, it is necessary to acknowledge facets of institutions, cultures, and communities that contribute to trauma and subsequent outcomes. Systemic trauma-contextual features of environments and institutions that give rise to trauma, maintain it, and impact posttraumatic responses-provides a framework for considering the full range of traumatic phenomena. The current issue of the Journal of Trauma & Dissociation is composed of articles that incorporate systemic approaches to trauma. This perspective extends conceptualizations of trauma to consider the influence of environments such as schools and universities, churches and other religious institutions, the military, workplace settings, hospitals, jails, and prisons; agencies and systems such as police, foster care, immigration, federal assistance, disaster management, and the media; conflicts involving war, torture, terrorism, and refugees; dynamics of racism, sexism, discrimination, bullying, and homophobia; and issues pertaining to conceptualizations, measurement, methodology, teaching, and intervention. Although it may be challenging to expand psychological and psychiatric paradigms of trauma, a systemic trauma perspective is necessary on both scientific and ethical grounds. Furthermore, a systemic trauma perspective reflects current approaches in the fields of global health, nursing, social work, and human rights. Empirical investigations and intervention science informed by this paradigm have the potential to advance scientific inquiry, lower the incidence of a broader range of traumatic experiences, and help to alleviate personal and societal suffering.

Empowering Lay-Counsellors with Technology: Masivukeni, a Standardized Multimedia Counselling Support Tool to Deliver ART Counselling.

PubMed

Gouse, H; Robbins, R N; Mellins, C A; Kingon, A; Rowe, J; Henry, M; Remien, R H; Pearson, A; Victor, F; Joska, J A

2018-05-19

Lay-counsellors in resource-limited settings convey critical HIV- and ART-information, and face challenges including limited training and variable application of counselling. This study explored lay-counsellors and Department of Health (DoH) perspectives on the utility of a multimedia adherence counselling program. Masivukeni, an mHealth application that provides scaffolding for delivering standardized ART counselling was used in a 3-year randomized control trail at two primary health care clinics in Cape Town, South Africa. In this programmatic and descriptive narrative report, we describe the application; lay-counsellors' response to open-ended questions regarding their experience with using Masivukeni; and perspectives of the City of Cape Town and Western Cape Government DoH, obtained through ongoing engagements and feedback sessions. Counsellors reported Masivukeni empowered them to provide high quality counselling. DoH indicated strong support for a future implementation study assessing feasibility for larger scale roll-out. Masivukeni has potential as a counselling tool in resource-limited settings.

The protective role of maternal posttraumatic growth and cognitive trauma processing among Palestinian mothers and infants.

PubMed

Diab, Safwat Y; Isosävi, Sanna; Qouta, Samir R; Kuittinen, Saija; Punamäki, Raija-Leena

2018-02-01

War survivors use multiple cognitive and emotional processes to protect their mental health from the negative impacts of trauma. Because mothers and infants may be especially vulnerable to trauma in conditions of war, it is urgent to determine which cognitive and emotional processes are effective for preventing negative trauma impacts." This study examined whether mothers' high posttraumatic growth (PTG) and positive posttraumatic cognitions (PTC) protected (a) their own mental health and (b) their infants' stress regulation and sensorimotor and language development from the effects of war trauma. The participants were 511 Palestinian mothers and their infants living in the Gaza strip. The mothers were interviewed in their second trimester of pregnancy (T1) as well as when the infant was four months (T2) and twelve months (T3). Mothers reported posttraumatic growth (PTG; Tedeschi & Calhoun, 1996) at T1 and posttraumatic cognitions (PTCI; Foa et al., 1999) at T2. They also reported their exposure to traumatic war events both at T1 and T3 and described their mental health conditions (e.g., PTSD and/or depressive and dissociation symptoms) at T3. The Infant Behaviour Questionnaire (IBQ) was used to measure infants' stress regulation at T2 and sensorimotor and language development at T3. The results, based on regression analyses with interaction terms between trauma and PTG, showed that high levels of traumatic war events were not associated with high levels of PTSD, depressive, or dissociation symptoms among mothers showing high levels of PTG. This suggests that PTG may protect maternal mental health from the effects of trauma. In turn, positive maternal PTCs appeared to protect the infants' stress regulation from the effects of war trauma. The study concludes by discussing ways to develop and implement preventive interventions for mother-infant dyads in war conditions. Copyright © 2017 Elsevier Inc. All rights reserved.

Will the war for the Croatian Homeland War veterans ever end?

PubMed

Rak, Davor; Matić, Aldenita; Rak, Benedict

2014-12-01

The aim of this paper is to show the psychological consequences of participation in the Homeland War and experienced trauma which can indirectly be seen through drawing even after more than 15 years after the war had ended. The research was conducted on a sample of 125 patients of both genders treated in the Daily Hospital program of University Hospital Dubrava, Psychiatry Clinics. All the tested had trauma in their medical history and all of them met the PTSD diagnostic criteria, 75 examinees participated in the Homeland War and they represent the veteran group, and 50 examinees went through a stressful situation during peacetime and they represent the civilian group. All the examinees had to make two individual drawings, and the task was to portray feelings of term "love" (first drawing) and term "hate" (second drawing). They could choose motifs and colors freely. When portraying the term love, choice of motifs between the civilian and the veteran group wasn't considerably different, and only a small number of male veteran population (6.6%) drawings hinted at the connection with the Homeland War. The results between two groups are completely different in portraying the term hate. As much as 76% examinees from the veteran group have unequivocally and directly decided to portray wartime motifs, unlike the civilian group whose use of wartime motifs was just 10%. When choosing color, nearly 90% of the veteran group used neutral and cool colors to portray the term hate.

Two war-torn soldiers: combat-related trauma through an intersubjective lens.

PubMed

Carr, Russell B

2013-01-01

The author, himself an Iraq war veteran, presents a contemporary psychodynamic understanding, known as intersubjective therapy, of combat-related Post-traumatic Stress Disorder (PTSD). At the onset of this case example, the patient was highly suicidal and his PTSD symptoms had not responded to a first-line treatment: manualized cognitive processing therapy. Robert Stolorow's intersubjective, psychodynamic approach to traumatic emotional experiences was then selected for treatment, and illustrates how combat in Afghanistan shattered this soldier's world and self experience. Therapeutic action arises from this intersubjective perspective by providing a relational home so that unendurable emotions can be borne, processed, and integrated to achieve a more constant and individualized sense of self. Being a two-person model of therapy, the author also describes how his work with this traumatized soldier affected him, ultimately contributing to his own sense of authentic existing. The author discusses the need for therapists to recognize and acknowledge to traumatized patients their shared finitude and the ubiquity of trauma. In the Postscript, the patient describes what he felt was therapeutic and contrasts this to his previous experiences with manualized cognitive processing therapy.

Are injuries from terror and war similar? A comparison study of civilians and soldiers.

PubMed

Peleg, Kobi; Jaffe, Dena H

2010-08-01

To compare injuries and hospital utilization and outcomes from terror and war for civilians and soldiers. Injuries from terror and war are not necessarily comparable, especially among civilians and soldiers. For example, civilians have less direct exposure to conflict and are unprepared for injury, whereas soldiers are psychologically and physically prepared for combat on battlefields that are often far from trauma centers. Evidence-based studies distinguishing and characterizing differences in injuries according to conflict type and population group are lacking. A retrospective study was performed using hospitalization data from the Israel National Trauma Registry (10/2000-12/2006). Terror and war accounted for trauma hospitalizations among 1784 civilians and 802 soldiers. Most civilians (93%) were injured in terror and transferred to trauma centers by land, whereas soldiers were transferred by land and air. Critical injuries and injuries to multiple body regions were more likely in terror than war. Soldiers tended to present with less severe injuries from war than from terror. Rates of first admission to orthopedic surgery were greater for all casualties with the exception of civilians injured in terror who were equally likely to be admitted to the intensive care unit. In-hospital mortality was higher among terror (7%) than war (2%) casualties, and particularly among civilians. This study provides evidence that substantial differences exist in injury characteristics and hospital resources required to treat civilians and soldiers injured in terror and war. Hospital preparedness and management should focus on treating combat injuries that result from specific causes-terror or war.

Posttraumatic Stress Among Syrian Refugees: Trauma Exposure Characteristics, Trauma Centrality, and Emotional Suppression.

PubMed

Chung, Man Cheung; Shakra, Mudar; AlQarni, Nowf; AlMazrouei, Mariam; Al Mazrouei, Sara; Al Hashimi, Shurooq

2018-01-01

This study revisited the prevalence of posttraumatic stress disorder (PTSD) and examined a hypothesized model describing the interrelationship between trauma exposure characteristics, trauma centrality, emotional suppression, PTSD, and psychiatric comorbidity among Syrian refugees. A total of 564 Syrian refugees participated in the study and completed the Harvard Trauma Questionnaire, General Health Questionnaire (GHQ-28), Centrality of Event Scale, and Courtauld Emotional Control Scale. Of the participants, 30% met the cutoff for PTSD. Trauma exposure characteristics (experiencing or witnessing horror and murder, kidnapping or disappearance of family members or friends) were associated with trauma centrality, which was associated with emotional suppression. Emotional suppression was associated with PTSD and psychiatric comorbid symptom severities. Suppression mediated the path between trauma centrality and distress outcomes. Almost one-third of refugees can develop PTSD and other psychiatric problems following exposure to traumatic events during war. A traumatized identity can develop, of which life-threatening experiences is a dominant feature, leading to suppression of depression with associated psychological distress.

Counsellors' perspectives on the experience of providing HIV counselling in Kenya and Tanzania: the Voluntary HIV-1 Counselling and Testing Efficacy Study.

PubMed

Grinstead, O A; van der Straten, A

2000-10-01

Demand for HIV counselling services is increasing in developing counties, but there have been few previous studies that describe counsellors' roles and experiences providing HIV-related counselling in developing countries. Such information can be used to better supervise and support counsellors and thereby improve counselling services. As a sub-study of the Voluntary Counseling and Testing Efficacy Study, we conducted focus groups and individual interviews with 11 counsellors and counselling supervisors providing HIV counselling services in Kenya and Tanzania. Counsellors told us that their jobs were both rewarding and stressful. In addition to their obligations in the counselling relationship (providing information, protecting confidentiality and being non-judgemental), they perceived pressure to provide information and be good role models in their communities. Additional stresses were related to external (economic and political) conditions, 'spillover' of HIV issues from their personal lives and providing counselling in a research setting. Counsellor stress might be reduced and their effectiveness and retention improved by (1) allowing work flexibility; (2) providing supportive, non-evaluative supervision; (3) offering alternatives to client behaviour change as the indication of counsellor performance; (4) acknowledging and educating about 'emotional labour' in counselling; (5) providing frequent information updates and intensive training; and (6) encouraging counsellor participation in the development of research protocols.

Counsellors' Focus on Competitive Employment for People with Severe Mental Illness: An Application of the Theory of Planned Behaviour in Vocational Rehabilitation Programmes

ERIC Educational Resources Information Center

Knaeps, Jeroen; Neyens, Inge; van Weeghel, Jaap; Van Audenhove, Chantal

2016-01-01

Although the evidence-based Individual Placement and Support programme highlights the importance of the vocational rehabilitation (VR) counsellors' focus on competitive employment during career counselling, studies have shown that counsellors do not always target such jobs. This study examines which determinants affect the counsellors' intentions…

Peer counsellors' views on the collegial support scheme for doctors.

PubMed

Rø, Karin Isaksson; Aasland, Olaf Gjerløw

2016-02-23

The health condition and health-related behaviour of doctors are important to the doctors themselves as well as for their treatment of patients. The collegial support scheme is a county-based and easily accessible health and care service for doctors. We therefore wanted to describe the framework and functions of this scheme and examine its utility. Fourteen focus-group interviews with a total of 61 peer counsellors from all the counties were conducted. The interviews were recorded, transcribed and analysed with the aid of systematic text condensation. The framework--easy accessibility, a readily available offer of up to three sessions, a high degree of confidentiality and informal contact--was emphasised as crucial for doctors to make use of the scheme. The peer counsellors described their role as that of a listener and supportive helper. They helped bring clarity and discuss possible needs for further follow-up or treatment of numerous different and frequently complex issues. The peer counsellors highlighted three benefits in particular: the scheme helps raise awareness by legitimising help-seeking behaviour among doctors, it is a contingency scheme, and it eases the burden by lowering the threshold to seeking out further advice and treatment. A systematic evaluation of the collegial support scheme is important for an understanding of the totality of the collegial health and care services. The collegial support scheme may lower the threshold to seeking help, and encourage some doctors to seek necessary treatment.

Assessment in the Digital Age: An Overview of Online Tools and Considerations for School Psychologists and School Counsellors

ERIC Educational Resources Information Center

Jellins, Laura

2015-01-01

With recent developments in technology, online tests and digital tools offer school psychologists and school counsellors alternate modes of assessment. These new technologies have the potential to increase accessibility to tests (through greater portability), allow school psychologists and school counsellors to service more students (through…

Religiosity Gap Reversed: How Religious Counsellors' Belief System Presents When Working with Clients in a Non-Religious Environment

ERIC Educational Resources Information Center

Motalová, Katarína; Rihácek, Tomáš

2016-01-01

Most studies exploring the religiosity gap are concerned with non-religious counsellors and religious clients. Approaching this phenomenon from a reversed perspective, this study explores how counsellors' religiosity presents when working with clients in a predominantly non-religious environment. Semi-structured interviews with 11 Czech…

Attentional bias for trauma-related words: exaggerated emotional Stroop effect in Afghanistan and Iraq war veterans with PTSD.

PubMed

Ashley, Victoria; Honzel, Nikki; Larsen, Jary; Justus, Timothy; Swick, Diane

2013-03-14

Post-traumatic stress disorder (PTSD) involves debilitating symptoms that can disrupt cognitive functioning. The emotional Stroop has been commonly used to examine the impact of PTSD on attentional control, but no published study has yet used it with Afghanistan and Iraq war veterans, and only one previous study has compared groups on habituation to trauma-related words. We administered the emotional Stroop, the Beck Depression Inventory (BDI), and the PTSD Checklist (PCL) to 30 veterans with PTSD, 30 military controls, and 30 civilian controls. Stroop word types included Combat, Matched-neutral, Neutral, Positive and Negative. Compared to controls, veterans with PTSD were disproportionately slower in responding to Combat words. They were also slower and less accurate overall, did not show interference on Negative or Positive words relative to Neutral, and showed a trend for delayed but successful habituation to Combat words. Higher PCL and BDI scores also correlated with larger interference effects. Because of its specificity in detecting attentional biases to trauma-related words, the emotional Stroop task may serve as a useful pre- and post task with intervention studies of PTSD patients.

The Teaching and Learning of Psychological Trauma -- A Moral Dilemma

ERIC Educational Resources Information Center

Farrell, Derek; Taylor, Charlotte

2017-01-01

This article addresses the global burden of psychological trauma caused by both natural disasters and wars. Trauma and traumatic stress exact a human and socio-economic toll that is vast in its magnitude and immense in its consequences. Given the massive prevalence of trauma, this then raises an important pedagogic question: how do you educate and…

The Libyan civil conflict: selected case series of orthopaedic trauma managed in Malta in 2014.

PubMed

Ng, Colin; Mifsud, Max; Borg, Joseph N; Mizzi, Colin

2015-11-20

The purpose of this series of cases was to analyse our management of orthopaedic trauma casualties in the Libyan civil war crisis in the European summer of 2014. We looked at both damage control orthopaedics and for case variety of war trauma at a civilian hospital. Due to our geographical proximity to Libya, Malta was the closest European tertiary referral centre. Having only one Level 1 trauma care hospital in our country, our Trauma and Orthopaedics department played a pivotal role in the management of Libyan battlefield injuries. Our aims were to assess acute outcomes and short term mortality of surgery within the perspective of a damage control orthopaedic strategy whereby aggressive wound management, early fixation using relative stability principles, antibiotic cover with adequate soft tissue cover are paramount. We also aim to describe the variety of war injuries we came across, with a goal for future improvement in regards to service providing. Prospective collection of six interesting cases with severe limb and spinal injuries sustained in Libya during the Libyan civil war between June and November 2014. We applied current trends in the treatment of war injuries, specifically in damage control orthopaedic strategy and converting to definitive treatment where permissible. The majority of our cases were classified as most severe (Type IIIB/C) according to the Gustilo-Anderson classification of open fractures. The injuries treated reflected the type of standard and improved weaponry available in modern warfare affecting both militants and civilians alike with increasing severity and extent of damage. Due to this fact, multidisciplinary team approach to patient centred care was utilised with an ultimate aim of swift recovery and early mobilisation. It also highlighted the difficulties and complex issues required on a hospital management level as a neighbouring country to war zone countries in transforming care of civil trauma to military trauma.

Counsellors' Personal Experience and Appraisal of "My Career Chapter"

ERIC Educational Resources Information Center

McIlveen, Peter

2007-01-01

This study investigated a qualitative career assessment and counselling procedure that was founded upon a constructivist, narrative approach to career counselling, "My Career Chapter: A Dialogical Autobiography" (McIlveen, 2006). Counsellors were trained in the use of the procedure and then applied it to themselves in an intensive…

BNDF methylation in mothers and newborns is associated with maternal exposure to war trauma.

PubMed

Kertes, Darlene A; Bhatt, Samarth S; Kamin, Hayley S; Hughes, David A; Rodney, Nicole C; Mulligan, Connie J

2017-01-01

The BDNF gene codes for brain-derived neurotrophic factor, a growth factor involved in neural development, cell differentiation, and synaptic plasticity. Present in both the brain and periphery, BDNF plays critical roles throughout the body and is essential for placental and fetal development. Rodent studies show that early life stress, including prenatal stress, broadly alters BDNF methylation, with presumed changes in gene expression. No studies have assessed prenatal exposure to maternal traumatic stress and BDNF methylation in humans. This study examined associations of prenatal exposure to maternal stress and BDNF methylation at CpG sites across the BDNF gene. Among 24 mothers and newborns in the eastern Democratic Republic of Congo, a region with extreme conflict and violence to women, maternal experiences of war trauma and chronic stress were associated with BDNF methylation in umbilical cord blood, placental tissue, and maternal venous blood. Associations of maternal stress and BDNF methylation showed high tissue specificity. The majority of significant associations were observed in putative transcription factor binding regions. This is the first study in humans to examine BDNF methylation in relation to prenatal exposure to maternal stress in three tissues simultaneously and the first in any mammalian species to report associations of prenatal stress and BDNF methylation in placental tissue. The findings add to the growing body of evidence highlighting the importance of considering epigenetic effects when examining the impacts of trauma and stress, not only for adults but also for offspring exposed via effects transmitted before birth.

Let’s talk about sex: helping substance abuse counsellors address HIV prevention with men who have sex with men

PubMed Central

Spector, Anya Y.; Pinto, Rogério M.

2012-01-01

Integrating HIV prevention into substance abuse counselling is recommended to ameliorate the health outcomes of men who have sex with men. However, culture-based countertransferences (CBCs) may hamper this effort. Using a case illustration, this paper will explain the manifestation of CBCs held among substance abuse counsellors and how they hinder counsellors’ work with men who have sex with men. The following CBCs will be explored: distancing, topic avoidance, heteronormativity, assumptions and denying client strengths. These CBCs allow counsellors to avoid discussions about sexual practices and curtail HIV prevention counselling, while undermining the counsellor-client relationship. Based on the empirical literature on HIV and substance abuse prevention with men who have sex with men, we provide recommendations to help counsellors overcome CBCs and integrate HIV prevention consistently with men who are in treatment for substance abuse. PMID:21308577

Children exposed to war/terrorism.

PubMed

Shaw, Jon A

2003-12-01

This paper reviews the prevalence of psychological morbidities in children who have been exposed to war-related traumas or terrorism as well as the diversity of war-related casualties and their associated psychological responses. The psychological responses to war-related stressors are categorized as (1) little or no reaction, (2) acute emotional and behavioral effects, and (3) long-term effects. Specific categories of war-related casualties discussed include refugee status, traumatic bereavement, effects of parental absence, and child soldiers. Psychological responses associated with terrorism and bioterrorism are presented. Lastly, mediators of the psychological response to war-related stressors are discussed, to include exposure effects, gender effects, parental, family and social factors, and child-specific factors. Children exposed to war-related stressors experience a spectrum of psychological morbidities including posttraumatic stress symptomatology, mood disorders, externalizing and disruptive behaviors, and somatic symptoms determined by exposure dose effect. Specific questions for future research are identified.

The Evolution of Military Trauma and Critical Care Medicine: Applications for Civilian Medical Care Systems

DTIC Science & Technology

2008-01-01

evidence - based medicine . Like great leaders in medicine such as Ibn Sina, war and conflict have also been credited with advances in medical and surgical therapy throughout the centuries. Like in previous conflicts, many authors note that innovations in trauma and critical care evolving from the current global war on terrorism may significantly impact civilian trauma care, critical

The hidden effects of child maltreatment in a war region: correlates of psychopathology in two generations living in Northern Uganda.

PubMed

Olema, David Kani; Catani, Claudia; Ertl, Verena; Saile, Regina; Neuner, Frank

2014-02-01

Adverse life experiences are a major risk factor for psychopathology. Studies from industrialized countries have consistently shown the detrimental effects of child maltreatment on the mental health of the victims. Research in war-affected populations, however, has mostly been restricted to the psychological damage caused by the war. Both war trauma and child maltreatment have rarely been studied simultaneously. In a comparative study of 2 generations living in severely war-affected regions in Northern Uganda, we determined the relationship between both trauma types and posttraumatic stress disorder (PTSD), anxiety, depression, and suicide ideation. A total of 100 adolescents, 50 with and 50 without a history of abduction by the rebel army with both their parents (100 mothers and 100 fathers) living in camps in northern Uganda were interviewed. The study showed that both generations were severely affected by war and child maltreatment. Both trauma types were independently correlated with psychological disorders in the adolescent group. Only child maltreatment, however, not war violence, accounted for PTSD symptoms in the parent group (β = .253, p = .002). We conclude that, even in the context of severe war, the impact of child maltreatment on psychological disorders surpasses the damage of war trauma. Copyright © 2014 International Society for Traumatic Stress Studies.

A process evaluation exploring the lay counsellor experience of delivering a task shared psycho-social intervention for perinatal depression in Khayelitsha, South Africa.

PubMed

Munodawafa, Memory; Lund, Crick; Schneider, Marguerite

2017-07-01

Task sharing of psycho-social interventions for perinatal depression has been shown to be feasible, acceptable and effective in low and middle-income countries. This study conducted a process evaluation exploring the perceptions of counsellors who delivered a task shared psycho-social counselling intervention for perinatal depression in Khayelitsha, Cape Town together with independent fidelity ratings. Post intervention qualitative semi-structured interviews were conducted with six counsellors from the AFrica Focus on Intervention Research for Mental health (AFFIRM-SA) randomised controlled trial on their perceptions of delivering a task shared psycho-social intervention for perinatal depression. Themes were identified using the framework approach and were coded and analysed using Nvivo v11. These interviews were supplemented with fidelity ratings for each counsellor and supervision notes. Facilitating factors in the delivery of the intervention included intervention related factors such as: the content of the intervention, ongoing training and supervision, using a counselling manual, conducting counselling sessions in the local language (isiXhosa) and fidelity to the manual; counsellor factors included counsellors' confidence and motivation to conduct the sessions; participant factors included older age, commitment and a desire to be helped. Barriers included contextual factors such as poverty, crime and lack of space to conduct counselling sessions and participant factors such as the nature of the participant's problem, young age, and avoidance of contact with counsellors. Fidelity ratings and dropout rates varied substantially between counsellors. These findings show that a variety of intervention, counsellor, participant and contextual factors need to be considered in the delivery of task sharing counselling interventions. Careful attention needs to be paid to ongoing supervision and quality of care if lay counsellors are to deliver good quality task shared

Demotivating infant feeding counselling encounters in southern Africa: do counsellors need more or different training?

PubMed

Buskens, I; Jaffe, A

2008-03-01

Ethnographic research was conducted in eleven low-resource settings across Swaziland, Namibia and South Africa to explore how the perceptions and experiences of counselling health workers, pregnant women and recent mothers could be used to improve infant feeding counselling in the context of mother to child transmission (MTCT) of HIV. We found many counselling encounters to be demotivating. Mothers often reported feeling judged, stigmatised and shamed. Counsellors complained of mothers' poor compliance and passive resistance and reported suffering from stress, depression and burnout. We observed a rift between the mothers and counselling nurses, with both parties holding opposing agendas grounded in conflicting realities, expectations, experiences and needs. While the clients framed the visit as a consultation, counsellors framed it as health education, towards one exclusive purpose; to save the baby. Two communication modes prevailed in the counselling encounter: in theory, the counselling format was non-directive and client-centred but, in practice, most encounters reverted to information-based health education. Neither counselling format enabled the counsellors to acknowledge the reality of the two opposing agendas in the conversation and manage its dynamics. In order to achieve success - which, for the health service, is framed as persuading mothers to test for HIV and disclose the result - counsellors often felt compelled to be prescriptive and authoritative and reverted at times to confronting, judging and shaming mothers. Yet to adhere to their feeding choice consistently, mothers need to be motivated towards the significant behaviour change that this implies: to change their traditional roles and identities as women. For infant feeding counselling in the context of HIV/AIDS to become effective in southern Africa, a different format is therefore required; one that can acknowledge and manage these opposing agendas and conflicting realities and also enable

A field test of group based exposure therapy with 102 veterans with war-related posttraumatic stress disorder.

PubMed

Ready, David J; Thomas, Kaprice R; Worley, Virginia; Backscheider, Andrea G; Harvey, Leigh Anne C; Baltzell, David; Rothbaum, Barbara Olasov

2008-04-01

Group-based exposure therapy (GBET) was field-tested with 102 veterans with war-related posttraumatic stress disorder (PTSD). Nine to 11 patients attended 3 hours of group therapy per day twice weekly for 16-18 weeks. Stress management and a minimum of 60 hours of exposure was included (3 hours of within-group war-trauma presentations per patient, 30 hours of listening to recordings of patient's own war-trauma presentations and 27 hours of hearing other patients' war-trauma presentations). Analysis of assessments conducted by treating clinicians pre-, post- and 6-month posttreatment suggests that GBET produced clinically significant and lasting reductions in PTSD symptoms for most patients on both clinician symptoms ratings (6-month posttreatment effect size delta = 1.22) and self-report measures with only three dropouts.

Resilience-promoting factors in war-exposed adolescents: an epidemiologic study.

PubMed

Fayyad, John; Cordahi-Tabet, C; Yeretzian, J; Salamoun, M; Najm, C; Karam, E G

2017-02-01

Studies of war-exposed children have not investigated a comprehensive array of resilience-promoting factors, nor representative samples of children and adolescents. A representative sample of N = 710 adolescents was randomly selected from communities recently exposed to war. All those who had experienced war trauma were administered questionnaires measuring war exposure, family violence, availability of leisure activities, school-related problems, interpersonal and peer problems, socialization, daily routine problems, displacement, availability of parental supervision and contact and medical needs as well as coping skills related to religious coping, denial, self-control, avoidance and problem solving. Mental health was measured by the Strengths and Difficulties Questionnaire (SDQ) and the Child-Revised Impact of Events Scale (CRIES). Resilient adolescents were defined as those who experienced war trauma, but did not manifest any symptoms on the SDQ or CRIES. Resilience was related to being male, using problem-solving techniques, having leisure activities, and having parents who spent time with their adolescents and who supported them with school work. Interventions designed for war-traumatized youth must build individual coping skills of children and adolescents, yet at the same time target parents and teachers in an integrated manner.

Maternal pre- and postnatal mental health and infant development in war conditions: The Gaza Infant Study.

PubMed

Punamäki, Raija-Leena; Diab, Safwat Y; Isosävi, Sanna; Kuittinen, Saija; Qouta, Samir R

2018-03-01

Women and their infants need special protection in war context, as traumatic events can risk maternal mental and obstetric health and compromise infant development. This prospective study examined, first, how exposure to war trauma is associated with maternal mental health in pregnancy and postpartum, obstetric and newborn health, and infant development. Second, it tested the role of maternal mental health and obstetric risks in mediating between war trauma and infant development. Palestinian women (N = 511) from the Gaza strip participated during pregnancy (T1) and at 4 (T2) and 12 (T3) months postpartum. They reported PTSD, depressive, anxiety, and dissociative symptoms, as well as pregnancy complications, newborn health risks such as prematurity, and infant sensorimotor and language development. First, exposure to war trauma was associated with high levels of maternal mental health and complications at pregnancy, and with increased postpartum mental health symptoms, but exposure was not directly associated with newborn health risks or problems in infant development. Second, maternal mental health both in pregnancy and postpartum, but not pregnancy complications or newborn health, mediated the negative impact of war trauma on infant sensorimotor and language development at 12 months. Interventions to protect early child development in war conditions should be tailored to support maternal mental health. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

School Counsellors' Perceptions on Working with Student High-Risk Behaviour

ERIC Educational Resources Information Center

Harris, Gregory E.; Jeffery, Gary

2010-01-01

The current exploratory-descriptive study used a survey design method to examine guidance counsellors' and educational psychologists' perceptions of their preparation, motivation, and effectiveness in preventing, assessing, and intervening into student high-risk behaviour. The study also explored training associated with addressing high-risk…

Peer Collaboration: A Model to Support Counsellor Self-Care

ERIC Educational Resources Information Center

Barlow, Constance A.; Phelan, Anne M.

2007-01-01

In the context of a larger case study on how continuous learning in the workplace could be achieved through the implementation of peer collaboration, the process of how counsellors engaged in self-care within a large health care organization became clearer. This article is based on data derived from a qualitative analysis of nine transcribed…

Attentional bias for trauma-related words: exaggerated emotional Stroop effect in Afghanistan and Iraq war veterans with PTSD

PubMed Central

2013-01-01

Background Post-traumatic stress disorder (PTSD) involves debilitating symptoms that can disrupt cognitive functioning. The emotional Stroop has been commonly used to examine the impact of PTSD on attentional control, but no published study has yet used it with Afghanistan and Iraq war veterans, and only one previous study has compared groups on habituation to trauma-related words. Methods We administered the emotional Stroop, the Beck Depression Inventory (BDI), and the PTSD Checklist (PCL) to 30 veterans with PTSD, 30 military controls, and 30 civilian controls. Stroop word types included Combat, Matched-neutral, Neutral, Positive and Negative. Results Compared to controls, veterans with PTSD were disproportionately slower in responding to Combat words. They were also slower and less accurate overall, did not show interference on Negative or Positive words relative to Neutral, and showed a trend for delayed but successful habituation to Combat words. Higher PCL and BDI scores also correlated with larger interference effects. Conclusions Because of its specificity in detecting attentional biases to trauma-related words, the emotional Stroop task may serve as a useful pre- and post task with intervention studies of PTSD patients. PMID:23496805

Youth and trauma: terror, war, murder, incest, rape, and suicide.

PubMed

Halligan, Fredrica R

2009-09-01

College students in the United States post-9/11 face a different world than did their predecessors. In short vignettes this article reveals some of the numerous traumas that have been reported in a full-service counseling center at a small state university. Exploration of the impact of traumas past and present is interwoven with commentary on the impact of systems dynamics. A brief theoretical exploration is included of post-trauma resilience and the ongoing sense of threat that many traumatized persons experience.

World War I psychoneuroses: hysteria goes to war.

PubMed

Tatu, Laurent; Bogousslavsky, Julien

2014-01-01

During the First World War, military physicians from the belligerent countries were faced with soldiers suffering from psychotrauma with often unheard of clinical signs, such as camptocormia. These varied clinical presentations took the form of abnormal movements, deaf-mutism, mental confusion, and delusional disorders. In Anglo-Saxon countries, the term 'shell shock' was used to define these disorders. The debate on whether the war was responsible for these disorders divided mobilized neuropsychiatrists. In psychological theories, war is seen as the principal causal factor. In hystero-pithiatism, developed by Joseph Babinski (1857-1932), trauma was not directly caused by the war. It was rather due to the unwillingness of the soldier to take part in the war. Permanent suspicion of malingering resulted in the establishment of a wide range of medical experiments. Many doctors used aggressive treatment methods to force the soldiers exhibiting war neuroses to return to the front as quickly as possible. Medicomilitary collusion ensued. Electrotherapy became the basis of repressive psychotherapy, such as 'torpillage', which was developed by Clovis Vincent (1879-1947), or psychofaradism, which was established by Gustave Roussy (1874-1948). Some soldiers refused such treatments, considering them a form of torture, and were brought before courts-martial. Famous cases, such as that of Baptiste Deschamps (1881-1953), raised the question of the rights of the wounded. Soldiers suffering from psychotrauma, ignored and regarded as malingerers or deserters, were sentenced to death by the courts-martial. Trials of soldiers or doctors were also held in Germany and Austria. After the war, psychoneurotics long haunted asylums and rehabilitation centers. Abuses related to the treatment of the Great War psychoneuroses nevertheless significantly changed medical concepts, leading to the modern definition of 'posttraumatic stress disorder'.

PTSD prevalence among Polish World War II survivors.

PubMed

Lis-Turlejska, Maja; Łuszczyńska, Aleksandra; Szumiał, Szymon

2016-10-31

Over the past decade research has been published in several Western European countries on the prevalence of PTSD among World War II survivors, mostly civilians. Prevalence rates ranged from 1.9% to 10.8 %. The aim of the study was to measure the frequency of PTSD occurrence among Polish WWII survivors. Data from 96 persons: 59 women and 37 men, aged 70-96 were analyzed. All participants were born before 1945. They completed Polish adaptations of: Posttraumatic Diagnostic Scale (PDS), Impact of Events Scale (IES), Beck's Depression Inventory (BDI) and WWII trauma related questionnaire. Prevalence rate of potential PTSD was 32,3% Mean values of both number and severity of symptoms of PTSD were significantly higher for respondents with at least one war related trauma comparing to the participants who did note relate any such trauma. Comparing to other studies on WWII related PTSD the prevalence rate of possible PTSD was very high. Looking for possible explanation of such results seems to be an important challenge.

The utility of focused assessment with sonography for trauma as a triage tool in multiple-casualty incidents during the second Lebanon war.

PubMed

Beck-Razi, Nira; Fischer, Doron; Michaelson, Moshe; Engel, Ahuva; Gaitini, Diana

2007-09-01

The purpose of this study was to evaluate the role of focused assessment with sonography for trauma (FAST) as a triage tool in multiple-casualty incidents (MCIs) for a single international conflict. The charts of 849 casualties that arrived at our level 1 trauma referral center were reviewed. Casualties were initially triaged according to the Injury Severity Score at the emergency department gate. Two-hundred eighty-one physically injured patients, 215 soldiers (76.5%) and 66 civilians (23.5%), were admitted. Focused assessment with sonography for trauma was performed in 102 casualties suspected to have an abdominal injury. Sixty-eight underwent computed tomography (CT); 12 underwent laparotomy; and 28 were kept under clinical observation alone. We compared FAST results against CT, laparotomy, and clinical observation records. Focused assessment with sonography for trauma results were positive in 17 casualties and negative in 85. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of FAST were 75%, 97.6%, 88.2%, 94.1%, and 93.1%, respectively. A strong correlation between FAST and CT results, laparotomy, and clinical observation was obtained (P < .05). In a setting of a war conflict-related MCI, FAST enabled immediate triage of casualties to laparotomy, CT, or clinical observation. Because of its moderate sensitivity, a negative FAST result with strong clinical suspicion demands further evaluation, especially in an MCI.

Emotional Intelligence Levels and Counselling Skills of Prospective Psychological Counsellors

ERIC Educational Resources Information Center

Odaci, Hatice; Degerli, Fatma Irem; Bolat, Neslihan

2017-01-01

This research aimed to determine the correlation between emotional intelligence (EI) and counselling skills of Turkish prospective psychological counsellors and to investigate differences in both EI and counselling skills in terms of sex, previous experience of group studies, and class levels. Within a correlational pattern, the sample of the…

[Influence of Counsellor- and Intervention Variables on Motivation to Change Following a Brief Motivational Intervention to Reduce Risky Alcohol Use].

PubMed

Diestelkamp, Silke; Wartberg, Lutz; Arnaud, Nicolas; Thomasius, Rainer

2016-09-01

Influence of Counsellor- and Intervention Variables on Motivation to Change Following a Brief Motivational Intervention to Reduce Risky Alcohol Use Brief interventions are recommended for prevention and early intervention of risky alcohol use. However, evidence of their effectiveness, in particular for children and adolescents, is heterogeneous. Analysis of counsellor and intervention variables may provide insights into mechanisms of action in brief interventions and thereby contribute to an enhanced effectiveness. We analyzed data of N = 141 children and adolescents who were treated for acute alcohol intoxication in the emergency department. Study participants received a brief motivational intervention to reduce risky alcohol use during hospitalization. We applied multiple regression analysis to examine counsellor variables (empathy, affirmation, competence, congruence) and intervention variables (readiness and confidence ruler, decisional balance, goal agreement) as predictors of motivation to change. Higher scores on the basic therapeutic skill "positive affirmation" (R2 = 7.1 %; p < .01), finishing the intervention with a written goal agreement (R2 = 2.9 %; p < .05) and younger age were associated with greater readiness to change (R2 = 10.2 %; p < .01). Therefore, a special focus should be put on the counsellor skill "positive affirmation" when training new counsellors. Results also indicate that younger patients respond stronger to a brief intervention in this context.

The lifelong struggle of Finnish World War II veterans.

PubMed

Nivala, Sirkka; Sarvimäki, Anneli

2015-01-01

In many countries veterans from World War II are growing old. Research has shown that war experiences continue to impact those who have been involved in war for a long time. The present study targets old injured war veterans from World War II in Finland. The aim of this study was to produce knowledge of the impact of war experiences and injuries on the lifespan of Finnish war veterans. The method used was grounded theory. Data were collected by interviewing 20 aged war veterans in their homes. The analysis resulted in four categories, with also subcategories: (1) lost childhood and youth; (2) war traumas impacting life; (3) starting life from scratch; and (4) finding one's own place. A substantive theory of war veterans' lifelong struggle for freedom throughout the lifespan was outlined. The war overshadowed the whole lifespan of the veterans, but in old age they finally felt free. Since war experiences vary depending on historical context, a formal theory would require additional research.

The study of psychic trauma.

PubMed

Bacciagaluppi, Marco

2011-01-01

This article starts from the DSM definition of psychic trauma. A central source in this field is the 1992 book by Judith Herman. One line of investigation is the sexual abuse of women and children. In an early phase, both Janet and Freud described dissociation as a reaction to trauma. In 1897, Freud disputed the reality of sexual trauma, a position countered later by Ferenczi. In a later phase, this subject was investigated by the American feminist movement. Studies of physical abuse are then described, followed by mental abuse and neglect. Another line of investigation is combat neurosis. The two lines converged in the definition of PTSD and its incorporation into the DSM in 1980. The views on trauma of John Bowlby and Alice Miller are also discussed. The integration of the relational model in psychoanalysis with the trauma literature is presented. The most recent advances are located in neurobiology. The discussion makes a preliminary investigation of the remote causes of war and sexual violence.

Professional Characteristics of Canadian Counsellors: Results of a National Survey

ERIC Educational Resources Information Center

Gazzola, Nicola; Smith, J. David; Kearney, M. Kate; King-Andrews, Heather L.

2010-01-01

With statutory regulation of mental health professions clearly at the forefront in many Canadian jurisdictions, counselling appears to be experiencing internal tensions regarding its vision and direction. The goal of this study was to collect data directly from Canadian counsellors to more clearly define the current practices of counselling in…

Assisting Problem Gamblers in the Gaming Venue: A Counsellor Perspective

ERIC Educational Resources Information Center

Hing, Nerilee; Nuske, Elaine

2011-01-01

Governments now recognise gambling as a social and public health issue that invites a collaborative approach to responsible gambling and help-seeking involving the gambling industry, gambling help agencies and the wider community. In this paper, we report on findings from interviews with 23 counsellors working in Queensland Gambling Help agencies…

Gastrointestinal problems in modern wars: clinical features and possible mechanisms.

PubMed

Wang, Wei-Feng; Guo, Xiao-Xu; Yang, Yun-Sheng

2015-01-01

Gastrointestinal problems are common during wars, and they have exerted significant adverse effects on the health of service members involved in warfare. The spectrum of digestive diseases has varied during wars of different eras. At the end of the 20th century, new frontiers of military medical research emerged due to the occurrence of high-tech wars such as the Gulf War and the Kosovo War, in which ground combat was no longer the primary method of field operations. The risk to the military personnel who face trauma has been greatly reduced, but disease and non-battle injuries (DNBIs) such as neuropsychological disorders and digestive diseases seemed to be increased. Data revealed that gastrointestinal symptoms such as constipation, diarrhea, dyspepsia, and noncardiac chest pain are common among military personnel during modern wars. In addition, a large number of deployed soldiers and veterans who participated in recent wars presented with chronic gastrointestinal complaints, which fulfilled with the Rome III criteria for functional gastrointestinal disorders (FGIDs). It was also noted that many veterans who returned from the Gulf War suffered not only from chronic digestive symptoms but also from neuropsychological dysfunction; however, they also showed symptoms of other systems. Presently, this broad range of unexplained symptoms is known as "Gulf War syndrome". The mechanism that underlies Gulf War syndrome remains unclear, but many factors have been associated with this syndrome such as war trauma, stress, infections, immune dysfunction, radiological factors, anthrax vaccination and so on. Some have questioned if the diagnosis of FGIDs can be reached given the complexity of the military situation. As a result, further studies are needed to elucidate the pathogenesis of gastrointestinal disease among military personnel.

Practical Strategies for School Counsellor Leadership: The Leadership Challenge Model

ERIC Educational Resources Information Center

Shillingford, Margaret

2013-01-01

It is crucial to the progression of the school counselling profession that counsellors-in-training receive the training, knowledge, and practice in leadership that they need to counter systemic challenges that they may face. Effective leadership practices have been shown in research to be instrumental in promoting program delivery success in the…

Overcoming the Trauma of War: Literacy Challenges of Adults Learners

ERIC Educational Resources Information Center

Magro, Karen

2007-01-01

Increasingly, urban and rural centers in Canada are receiving immigrants and refugees from countries affected by war. While it is important not to pathologize the effects that war and other catastrophes may have on individuals, it is also vital not to underestimate their impact on the ability of individuals to adjust to life in a new society. The…

Internal and external factors in professional burnout of substance abuse counsellors in Croatia.

PubMed

Tatalović Vorkapić, Sanja; Mustapić, Jelena

2012-01-01

In this study, burnout and its internal and external factors were investigated among substance abuse counsellors (no. = 68) who worked in Centres for Prevention and Substance Abuse Treatment (no. = 18) in Croatia. Maslach Burnout Inventory was used which measured three burnout dimensions: emotional exhaustion, depersonalization and personal accomplishment; and questionnaire of internal and external burnout factors. The higher levels of emotional exhaustion and depersonalization, and the higher level of personal accomplishment were determined. Factors such as work conditions, emotions about us and work, work organization and certain personality traits showed significant relationship with three burnout dimensions. Overall, findings implicated a certain specificity of professional burnout in substance abuse counsellors, and the need for specific design of mental health care for them.

PTSD symptoms lead to modification in the memory of the trauma: a prospective study of former prisoners of war.

PubMed

Dekel, Sharon; Solomon, Zahava; Ein-Dor, Tsachi

2016-03-01

With the growing interest in the role of trauma memory in posttraumatic stress disorder (PTSD), this prospective study examined long-term changes in memory and the bidirectional relationship between symptoms of PTSD and trauma memory. A sample of Israeli former prisoners of the 1973 Yom Kippur War (N = 103) was assessed in 1991 and in 2008. Participants' PTSD symptom clusters, measured by the PTSD Inventory, and recollections of subjective and objective exposure during captivity, measured by a self-report questionnaire, were assessed at both times. Data on prewar and postwar negative life events and psychotherapy were also collected. Repeated-measures analysis revealed that participants' recollections were increasingly negative over time (P < .001). Applying an autoregressive cross-lagged modeling strategy showed that the PTSD symptoms of hyperarousal facilitated subsequent amplifications in their recollections (P < .01). These findings challenge the accuracy of reports of traumatic experiences and show that PTSD symptoms, in part, lead to the formation of more negative recollections over time. The findings suggest that the original memory is repeatedly updated under the influence of the individual's emotional state. The findings are discussed in the context of the reconsolidation theory of memory. © Copyright 2016 Physicians Postgraduate Press, Inc.

School Counsellor Training, Attitudes, and Perceptions of Preparedness to Provide Services to Students with Disabilities in Inclusive Schools in Turkey

ERIC Educational Resources Information Center

Cimsir, Elif; Carney, JoLynn V.

2017-01-01

The purpose of this study was to investigate the role of school counsellors' attitudes and training on their perceptions of preparedness to provide services to students with disabilities (SWD). Participants were 105 practicing school counsellors who completed the Attitudes toward Disabled Persons Scale Form-O (ATDP-O) as well as the School…

War’s long shadow: masculinity, medicine, and the gendered politics of trauma, 1914-1939.

PubMed

Humphries, Mark

2010-01-01

War is an inherently traumatizing experience, and during the First World War more than 15,000 Canadian soldiers were diagnosed with some form of war-related psychological wounds. Many more went unrecognized. Yet the very act of seeking an escape from the battlefield or applying for a postwar pension for psychological traumas transgressed masculine norms that required men to be aggressive, self-reliant, and un-emotional. Using newly available archival records, contemporary medical periodicals, doctors' notes, and patient interview transcripts, this paper examines two crises that arose from this conflict between idealized masculinity and the emotional reality of war trauma. The first came on the battlefield in 1916 when, in some cases, almost half the soldiers evacuated from the front were said to be suffering from emotional breakdowns. The second came later, during the Great Depression, when a significant number of veterans began to seek compensation for their psychological injuries. In both crises, doctors working in the service of the state constructed trauma as evidence of deviance, in order to parry a larger challenge to masculine ideals. In creating this link between war trauma and deviance, they reinforced a residual conception of welfare that used tests of morals and means to determine who was deserving or undeserving of state assistance. At a time when the Canadian welfare state was being transformed in response to the needs of veterans and their families, doctors' denial that "real men" could legitimately exhibit psychosomatic symptoms in combat meant that thousands of legitimately traumatized veterans were left uncompensated by the state and were constructed as inferior, feminized men.

Reconsidering Sexual Identities: Intersectionality Theory and the Implications for Educating Counsellors

ERIC Educational Resources Information Center

Cheshire, Liane C.

2013-01-01

Counselling programs in Canada provide minimal training relating to lesbian, gay, and bisexual (LGB) issues and cultures. This article presents a theoretical argument proposing that counselling programs move away from educating counsellors about LGB issues through specialized courses based on multicultural approaches of difference and diversity…

Playgroups as Protective Environments for Refugee Children at Risk of Trauma

ERIC Educational Resources Information Center

Jackson, Dianne

2006-01-01

Refugee families in Australia generally have a dual challenge--dealing with past traumatic experiences while facing the struggles of integrating with a new and unfamiliar society. For children and their families who have experienced war-related trauma and disruption, the resettlement process is being referred to as "secondary trauma" to…

Child sexual abuse in Lebanon during war and peace.

PubMed

Usta, J; Farver, J

2010-05-01

Child sexual abuse (CSA) is rarely addressed in the Arab world. This study examined the prevalence, risk factors and consequences associated with CSA in Lebanese children before, during and after the 2006 Hezbollah-Israeli war. A total of 1028 Lebanese children (556 boys; 472 girls) were administered an interview questionnaire that included the International Child Abuse Screening Tool, the Trauma Symptom Checklist and the Family Functioning in Adolescence Questionnaire. In total, 249 (24%) children reported at least one incident of CSA; 110 (11%) occurred before the war, 90 (8%) took place in the 1-year period after the war to the time of the data collection and 49 (5%) occurred during the 33-day war. There were no gender differences in CSA reports before or after the war, but boys reported more incidents during the war than did girls. Girls who reported CSA had higher trauma-related symptoms for sleep disturbance, somatization, Post Traumatic Stress Disorder (PTSD) and anxiety than did boys. There were geographic differences in the reports of abuse that may be associated with poverty and living standards. Logistic regression analyses correctly classified 89.9% of the cases and indicated that children's age, family size, fathers' education level and family functioning significantly predicted CSA during the period following the war. The prevalence of CSA in the current study is within the reported international range. Given the increase in the incidents of CSA during the war and the significant findings for family-related risk factors, there is an urgent need to provide multi-component culturally appropriate interventions that target the child and the family system in times of peace and conflict.

War exposure and post-traumatic stress as predictors of Portuguese colonial war veterans' physical health.

PubMed

Maia, Angela; McIntyre, Teresa; Pereira, M Graça; Ribeiro, Eugènia

2011-05-01

The relationship between war exposure and post-traumatic stress disorder (PTSD) has been largely investigated but the impact of the combat experience on physical health has only recently merited attention. The authors investigated the relationship between war exposure and psychological and physical health among 350 Portuguese colonial war veterans. The role of current PTSD symptoms as a mediator of these relationships was also investigated. The results showed that 39% of the veterans met criteria for current PTSD diagnosis and psychological distress was present in half of the sample. Pain, fatigue, and sleep problems were the most reported physical symptoms and mental health and gastro-intestinal problems, the most reported illnesses. Combat exposure variables were significant predictors of current health. The results indicated that veterans with higher exposure to war trauma maintained higher current levels of psychological distress and presented more physical health problems and physical symptoms than those less exposed. Mediation analyses showed that current PTSD was a full mediator of the relationship between war exposure and physical health outcomes.

The Role of School Counsellors and Psychologists in Supporting Transgender People

ERIC Educational Resources Information Center

Riggs, Damien W.; Bartholomaeus, Clare

2015-01-01

As growing numbers of transgender people--including students, parents, and educators--become visible within schools, so comes with this the requirement that schools ensure their full inclusion. This article suggests that school counsellors and psychologists have an important role to play in supporting transgender people within schools. As an…

Physical and Mental Health Consequences of War-related Stressors Among Older Adults: An Analysis of Posttraumatic Stress Disorder and Arthritis in Northern Vietnamese War Survivors.

PubMed

Korinek, Kim; Loebach, Peter; Teerawichitchainan, Bussarawan

2017-10-01

We examine the impacts of trauma exposures and family stressors associated with the Vietnam War on musculoskeletal health and posttraumatic stress disorder (PTSD) outcomes in elderly Vietnamese who were widely impacted by the war as young adults. Noting that wars' impacts extend beyond male veterans in most survivor populations, we give attention to male and female war survivors placed in a variety of roles vis-a-vis the war. Utilizing data from the 2010 Vietnam Health and Aging Pilot Study (N = 405), we use logistic and Poisson regression models to estimate the effect of wartime trauma exposures and family stressors on disabling arthritis and PTSD symptoms in male and female northern Vietnamese adults aged 55 and older. The odds of experiencing recent PTSD symptoms are greater in respondents who report involvement in killing/causing severe injury and who observed war atrocities. In women, PTSD is positively correlated with war era child death and spousal separation. Arthritis also exhibits a significant, positive association with killing/causing severe injury. Our study provides insights into the burden of conflict upon health among populations of the global south that survived war and are now entering older adulthood. The pattern of results, indicating greatest suffering among those who inflicted or failed to prevent bodily harm or loss of life, is consistent with the concept of moral injury. © The Author 2016. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Physical Activity on Prescription with Counsellor Support: A 4-Year Registry-Based Study in Routine Health Care in Sweden.

PubMed

Andersen, Pia; Holmberg, Sara; Lendahls, Lena; Nilsen, Per; Kristenson, Margareta

2018-04-16

Background : Public health gains from physical activity on prescription (PAP) depend on uptake in routine care. We performed an evaluation of the implementation, in a Swedish county council, of counsellors who give personalized support to PAP recipients aimed at facilitating PAP delivery. The aim was to compare characteristics between PAP recipients and the health care population as well as between PAP recipients who used and did not use counsellor support. We also investigated professional belonging and health care setting of health care professionals who prescribed PAP. Methods: All patients’ ≥18 years who received PAP during 2009–2012 in primary and secondary care in the County Council of Kronoberg were included ( n = 4879). Data were retrieved from electronic medical records. Main outcome measures were patient and professional characteristics. Results: A third of the PAP recipients had diseases in ≥5 diagnostic groups and more than half had ≥11 office visits the year before receiving PAP. Counsellor support was used by one-third and PAP recipients who used counsellor support had more multiple diagnoses and office visits compared with non-users. Physicians issued 44% of prescriptions and primary care was the predominant setting. The amount of PAP did not change over time, but the proportion of physicians’ prescriptions decreased while the proportion of nurses’ prescriptions increased. Conclusions: PAP recipients had high morbidity and were frequent health care attenders, indicating that PAP was predominantly used for secondary or tertiary prevention. PAP rates did not increase as intended after the implementation of counsellor support.

Media triggers of post-traumatic stress disorder 50 years after the Second World War.

PubMed

Hilton, C

1997-08-01

Post-traumatic stress disorder (PTSD) may present many years after the original trauma. Case studies of two elderly patients are described. Both had experienced life-threatening combat situations and witnessed intense suffering during the Second World War. Marked distress was triggered by the media commemorating the fiftieth anniversary of the end of the war. PTSD patients often avoid talking of their traumatic experiences because of associated distress. Without taking a military and trauma history from elderly patients the diagnosis is likely to be missed.

Innovation and new trends in critical trauma disease.

PubMed

Chico-Fernández, M; Terceros-Almanza, L L; Mudarra-Reche, C C

2015-04-01

The management of critical trauma disease (CTD) has always trends the trends in military war experiences. These conflicts have historically revolutionized clinical concepts, clinical practice guidelines and medical devices, and have marked future lines of research and aspects of training and learning in severe trauma care. Moreover, in the civil setting, the development of intensive care, technological advances and the testing of our healthcare systems in the management of multiple victims, hasve also led to a need for innovation in our trauma care systems. Copyright © 2014 Elsevier España, S.L.U. and SEMICYUC. All rights reserved.

Post-War Research on Post-Traumatic Stress Disorder. Part I. Research before 1989.

PubMed

Rutkowski, Krzysztof; Dembińska, Edyta

2016-10-31

The paper presents the post-war history of post-traumatic research conducted at the Department of Psychiatry of the Jagiellonian University and the analysis of the main research approaches and selected publications. The time after World War II passed in Poland in two directions: coping with the finished war trauma and simultaneously the experience of communist persecution trauma. First scientific publications appeared in the fifties and were focused on the research of former concentration camps prisoners (KZ-Syndrome). Between 1962 and 1989 a special edition of Przegląd Lekarski, which concentrated entirely on war trauma research, was published. The journal was nominated for the Peace Nobel Prize twice. The research team from the Department of Psychiatry headed by Professor Antoni Kępiński made a very extensive description of KZ-Syndrome issues. The paper summarizes the most important contemporary research findings on psychopathology of KZ-Syndrome (Szymusik), reaction dynamics (Teutsch), after camp adjustment (Orwid), paroxysmal hypermnesia (Półtawska), somatic changes (Gatarski, Witusik). The result of the study was the basis for the development of a methodology and a new look at the classification of the consequences of post-traumatic stress disorder, as well as the development of ethical attitudes towards patients.

The Comparison of the Effects of a Didactic Stress Management Program and Group Counselling on the Coping Strategies of School Counsellors

ERIC Educational Resources Information Center

Coban, Aysel Esen; Hamamci, Zeynep

2009-01-01

The aim of this study was to compare the effects of a didactic stress management program, group counselling, and a control group on school counsellors' stress coping strategies. Thirty-four school counsellors were randomly assigned to either a didactic stress management group, group counselling, or a control group. The didactic stress management…

MATERNAL TRAUMA AFFECTS PRENATAL MENTAL HEALTH AND INFANT STRESS REGULATION AMONG PALESTINIAN DYADS.

PubMed

Isosävi, Sanna; Diab, Safwat Y; Kangaslampi, Samuli; Qouta, Samir; Kankaanpää, Saija; Puura, Kaija; Punamäki, Raija-Leena

2017-09-01

We examined how diverse and cumulated traumatic experiences predicted maternal prenatal mental health and infant stress regulation in war conditions and whether maternal mental health mediated the association between trauma and infant stress regulation. Participants were 511 Palestinian mothers from the Gaza Strip who reported exposure to current war trauma (WT), past childhood emotional (CEA) and physical abuse, socioeconomic status (SES), prenatal mental health problems (posttraumatic stress disorder and depression symptoms), and perceived stress during their secondtrimester of pregnancy as well as infant stress regulation at 4 months. While all trauma types were associated with high levels of prenatal symptoms, CEA had the most wide-ranging effects and was uniquely associated with depression symptoms. Concerning infant stress regulation, mothers' CEA predicted negative affectivity, but only among mothers with low WT. Against hypothesis, the effects of maternal trauma on infant stress regulation were not mediated by mental health symptoms. Mothers' higher SES was associated with better infant stress regulation whereas infant prematurity and male sex predisposed for difficulties. Our findings suggest that maternal childhood abuse, especially CEA, should be a central treatment target among war-exposed families. Cumulated psychosocial stressors might increase the risk for transgenerational problems. © 2017 Michigan Association for Infant Mental Health.

Posttraumatic stress disorder in war veterans: a discussion of the Neuroevolutionary Time-depth Principle.

PubMed

Braquehais, María Dolores; Sher, Leo

2010-09-01

Trauma is a universal phenomenon. Violence is a type of trauma and war is one of the ways in which violence is expressed. The "Neuroevolutionary Time-depth Principle" of innate fears, based on prevalence data, suggests that high rates of posttraumatic stress disorder (PTSD) after combat exposure can be due to the fact that this fear-stress response appeared as a reaction to inter-group male-to-male and intra-group killings after the rising of population densities in the Neolithic period. Studies of PTSD prevalence available in MEDLINE, Institute for Scientific Information Databases (Science Citation Index Expanded, Social Sciences Citation Index, and Arts and Humanities Citation Index), EMBASE, and Cochrane Library were identified and reviewed. Prevalence data of PTSD deeply vary from one country to another, even in groups exposed to similar stressors. Moreover, war is not a uniform and unchanged phenomenon and not all war stressors are similar because some of them are known to lead to PTSD more than others. We argue that psychosocial narratives deeply influence our biological response to trauma and violence, shaping the genotypical response to trauma. Great differences in prevalence may be in part due to this fact. We also suggest that personal preconceptions and socio-cultural interests may also be playing a critical role in the theories developed to explain the nature of our response to violence. A comprehensive model for war-related PTSD should integrate both genotypical and phenotypical findings. 2009 Elsevier B.V. All rights reserved.

Towards a New Way of Healing: Experienced Counsellors' Perceived Influences of Ch'i-Related Experiences on Counselling Practice in Taiwan

ERIC Educational Resources Information Center

Liou, Chin-Ping

2018-01-01

This narrative study explored how the experienced counsellors utilised the idea and practice of "ch'i" during counselling sessions. The data were co-constructed between the researcher and 12 senior counsellors with substantial "ch'i"-related experiences using a semi-structured in-depth interview method and were analysed…

Rated casemix of general practitioner referrals to practice counsellors and clinical psychologists: A retrospective survey of a year's caseload.

PubMed

Cape, John; Parham, Alan

2001-06-01

Although evidence-based guidelines are beginning to be produced as to which psychological therapies might be appropriate for which patients, little is known about how general medical practitioners (GPs) in practice distribute referrals between different psychological therapy services. In a retrospective survey, 19 practice counsellors and 10 clinical psychologists from the same geographical area rated a year's caseload of GP referrals using identical data collection methods. Rated casemix was found to be broadly similar, although practice counsellors rated relationship and bereavement problems as more common in their caseloads (totalling 986 patients), and clinical psychologists rated panic disorder, phobias, and obsessive-compulsive problems as more common in their caseloads (totalling 320 patients). Depression and anxiety reactions were the most common problems rated in both groups, but the clinical psychologist cases of depression were rated as more severe and complex. Where differences were found, they may have reflected the different ways that counsellors and clinical psychologists conceptualize cases rather than actual differences in casemix. The results are discussed in relation to evidence-based guideline recommendations about cases appropriate to be seen by practice counsellors and by clinical psychologists in primary and secondary care, and the need to adapt such guidance to local services and skills of practitioners.

Rated casemix of general practitioner referrals to practice counsellors and clinical psychologists: a retrospective survey of a year's caseload.

PubMed

Cape, J; Parham, A

2001-06-01

Although evidence-based guidelines are beginning to be produced as to which psychological therapies might be appropriate for which patients, little is known about how general medical practitioners (GPs) in practice distribute referrals between different psychological therapy services. In a retrospective survey, 19 practice counsellors and 10 clinical psychologists from the same geographical area rated a year's caseload of GP referrals using identical data collection methods. Rated casemix was found to be broadly similar, although practice counsellors rated relationship and bereavement problems as more common in their caseloads (totalling 986 patients), and clinical psychologists rated panic disorder, phobias, and obsessive-compulsive problems as more common in their caseloads (totalling 320 patients). Depression and anxiety reactions were the most common problems rated in both groups, but the clinical psychologist cases of depression were rated as more severe and complex. Where differences were found, they may have reflected the different ways that counsellors and clinical psychologists conceptualize cases rather than actual differences in casemix. The results are discussed in relation to evidence-based guideline recommendations about cases appropriate to be seen by practice counsellors and by clinical psychologists in primary and secondary care, and the need to adapt such guidance to local services and skills of practitioners.

[Analysis of long-term sequelae of the trauma of war on the mental health of Bosnian army veterans].

PubMed

Ljubović, Senadin

2003-01-01

This paper wants to point out at the serious long-term consequences of the psychological trauma of the war on the mental health of a big number of Bosnian Army veterans: At the same time, the author is trying to identify crucial psychosocial and political reasons that have led to this situation and describe this specific psychopathology presented by this group of patients. Although nearly eight years has passed since the end of the war, the number of veterans who are seeking psychiatric assistance is still not decreasing because they find it more and more difficult to cope with their anxiety, irritability, anger and fury, inner bitterness, depression, pessimism, insecurity, loneliness and isolation, and the permanent feeling of emptiness, helplessness and inability to find and give meaning to their very existence. (They seem to be living only by default.) A significant number of patients in this group have already been diagnosed with serious somatic disorders, most frequently the disorders where traumatic stress plays significant role as a causative factor. The author of this paper has been actively involved in providing psychiatric assistance to this population of patients during the aggression. At that time, this group was permanently exposed to nearly all kinds of traumatic events that are known in the war. Paradoxically, a very small number of severe breakdowns have been noted at that time, and most of them were reversible by nature. The main reason for this incredible psychological resilience of our soldiers lies probably in their high motivation, because they were involved in defense that had no alternative. The end of the war that was unjust (it was ended by an agreement, but the fascism was not extinguished), as well as overall societal neglect for the need of this heavenly traumatized population in the post-war period, (they live in permanent insecurity, deprived of their rights, neglected and often even humiliated), present two key reasons that have led

[Psychogenic Disorders in German soldiers during World War I and II].

PubMed

Zimmermann, P; Hahne, H-H; Biesold, K-H; Lanczik, M

2005-02-01

In the First and Second World War German soldiers frequently suffered from psychogenic disorders. By comparison a change in the prevalences can be noted: in the First World War dissociative disorders dominated the clinical impression ("shell shock"), in the Second World War they could rarely be seen but were replaced by somatoform and psychosomatic diseases. The discussion about numerous reasons for this development has not been completed yet and is still not free from political attitudes. To achieve a more scientific point of view, the perspective of psychotraumatology might be helpful. According to psychotraumatic research, dissociative and somatoform disorders can emerge in a close relation to a Posttraumatic Stress Disorder. The choice of symptoms depends on personality traits of the victim, but also on specific factors that characterise the situation in which the trauma appears. The mixture of pathogenetic and protective influences includes e. g. the possibility of flight- or fight reactions, feelings of trauma-associated guilt and group cohesion in the military unit. These factors can be useful to help explain the change of symptoms between both wars. In addition the analysis of situational conditions in former wars can give hints to actual planning and prophylaxis strategies in modern military psychiatry, that has to adjust to very different military operation fields.

The role of sexual assault on the risk of PTSD among Gulf War veterans.

PubMed

Kang, Han; Dalager, Nancy; Mahan, Clare; Ishii, Erick

2005-03-01

The 1991 Gulf War was the first major military deployment where female troops were integrated into almost every military unit, except for combat ground units. We evaluated the impact of reported sexual trauma during this deployment on the risk of post-traumatic stress disorder (PTSD) after the war. A nested case-control analysis was conducted using the data collected in a population-based health survey of 30,000 Gulf War era veterans. A total of 1381 Gulf War veterans with current PTSD were compared with 10,060 Gulf veteran controls without PTSD for self-reported in-theater experiences of sexual harassment/assault and combat exposure. The adjusted odds ratio (aOR) for PTSD associated with a report of sexual assault was 5.41 (95% confidence interval [CI], 3.19-9.17) in female veterans and 6.21 (95% CI, 2.26-17.04) in male veterans. The aOR for PTSD associated with "high" combat exposure was also statistically significant (aOR, 4.03 [95% CI, 1.97-8.23] for females; aOR, 4.45 [95% CI, 3.54-5.60] for males). Notwithstanding a possibility of recall bias of combat and sexual trauma, for both men and women, sexual trauma as well as combat exposure appear to be strong risk factors for PTSD.

Vascular Shunts in Civilian Trauma

PubMed Central

Abou Ali, Adham N.; Salem, Karim M.; Alarcon, Louis H.; Bauza, Graciela; Pikoulis, Emmanuel; Chaer, Rabih A.; Avgerinos, Efthymios D.

2017-01-01

Experience with temporary intravascular shunts (TIVS) for vessel injury comes from the military sector and while the indications might be clear in geographically isolated and under resourced war zones, this may be an uncommon scenario in civilian trauma. Data supporting TIVS use in civilian trauma have been extrapolated from the military literature where it demonstrated improved life and limb salvage. Few non-comparative studies from the civilian literature have also revealed similar favorable outcomes. Still, TIVS placement in civilian vascular injuries is uncommon and by some debatable given the absence of clear indications for placement, the potential for TIVS-related complications, the widespread resources for immediate and definitive vascular repair, and the need for curtailing costs and optimizing resources. This article reviews the current evidence and the role of TIVS in contemporary civilian trauma management. PMID:28775985

Psychotherapeutic Intervention in the Demobilization Process: Addressing Combat-related Mental Injuries with Narrative Exposure in a First and Second Dissemination Stage.

PubMed

Köbach, Anke; Schaal, Susanne; Hecker, Tobias; Elbert, Thomas

2017-07-01

Depending on the exposure to traumatic stressors and combat, 20% to 50% of ex-combatants present with trauma-related disorders, and more than half of the members of armed groups have a proclivity to violence. Therefore, psychotherapeutic assistance should address both, trauma-related suffering and the lowered threshold for aggressive behaviour. Supporting the demobilization process of ex-combatants in the eastern DR-Congo, we implemented a version of Narrative Exposure Therapy adapted for Forensic Offender Rehabilitation (FORNET). In two successive dissemination stages (DS), local counsellors conducted FORNET. In DS1, they were trained by clinical experts, and in DS2, the by then experienced counsellors trained and supervised a second group of local counsellors (DS2). The training consisted of a 3-week workshop covering theoretical concepts and practical therapeutic skills. In DS1 and DS2, a total of 98 demobilizing combatants received an intervention; treatment-as-usual served as the control condition. Posttraumatic stress disorder, appetitive aggression, depression severity and drug dependence were assessed prior to the intervention and 6 and 12 months later; additionally, we assessed reintegration success. Six months post-intervention, FORNET significantly reduced Posttraumatic stress disorder symptoms but had less effect on the trait of appetitive aggression; moreover, beneficial effects were found for depression severity and drug dependence as well as for reintegration indices. Treatment gains were retained at 12 months. Individuals without previous training in psychotherapy can learn to effectively apply the brief intervention FORNET and support the demobilization process in ongoing conflicts. The study suggests that it is possible to pass down psychotherapeutic techniques over generations of counsellors. © 2015 The Authors. Clinical Psychology & Psychotherapy published by John Wiley & Sons Ltd. Posttraumatic stress symptoms, depression and clinically

"I Feel Like I do Not Exist:" A Study of Dissociative Experiences Among War-Traumatized Refugee Youth.

PubMed

Gušić, Sabina; Malešević, Andrea; Cardeña, Etzel; Bengtsson, Hans; Søndergaard, Hans Peter

2017-11-20

War-traumatized refugee children and adolescents have been overlooked in research on trauma-related dissociation, and whatever research has been conducted has relied almost exclusively on questionnaires. The present study was an exploration of dissociative experiences in multitraumatized war-refugee youth. In this study, we used a mixed-method approach by grouping participants according to a Western-based dissociation measure (the Adolescent Dissociative Experiences Scale; Armstrong, Putnam, Carlson, Libero, & Smith, 1997), and conducting qualitative and quantitative analyses of their verbal descriptions of mental experiences related to dissociation in the aftermath of war and resettlement. The sample included 40 refugee youth, ages 13 to 21, 19 girls and 21 boys resettled in Sweden because of war and persecution. Severe trauma-related dissociation was a problem for a considerable subgroup of the sample. Some dissociative experiences were present in all the sample; others were restricted to the most dissociative group. The correlates of severe dissociation included high frequency and severity of emotional dysregulation and intensity, negative self- and body-perception, depressive mood, and experiences of detachment. Clinicians are urged to be aware of and assess trauma-related dissociation in war-refugee youth, and consider not only dissociative phenomena, but also other important processes such as emotional dysregulation. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Trauma, shame and psychotic depression experienced by ex-POWs after release.

PubMed

Urlić, Ivan; Strkalj-Ivezić, Sladana; John, Nada

2009-09-01

Modern societies are growing ever more sensitive to the various sources and many kinds of psychic traumas, resulting even in psychotic reactions or states of functioning. Especially the war captivity situation represents the prolonged basis for chronic severe psychic stress and traumatisation, that may become deleterious even for the core self of the person. Severely psychotraumatized war veterans, or ex-POWs in the aftermath of the war captivity situation, survivors of extreme forms of violence and humiliation, are very reluctant to recall traumas. This avoidant behaviour is many times one of the most prominent symptoms that should be recognised and confronted in order to start the retraumatising process of healing the previously unthinkable traumas. The authors believe that shameful feelings are at the very basis of the psychotraumatised persons' withdrawal, depression, suicidal attempts, and even psychotic answers. The main feature of the first phase of any therapeutic work with these patients is the mourning process that should be gradually unfolded. The clinical examples will illustrate therapeutic work with these patients. The authors will expose some basic psychodynamic approaches and concepts regarding shame. This difficult feeling will be put in relationship with the psychotic answers. In that frame of reference the concept of 'near psychosis' will be described.

Risk and resilience trajectories in war-exposed children across the first decade of life.

PubMed

Halevi, Galit; Djalovski, Amir; Vengrober, Adva; Feldman, Ruth

2016-10-01

Although the effects of early-onset trauma on susceptibility to psychopathology are well-acknowledged, no study to date has followed risk and resilience trajectories in war-exposed young children over lengthy periods and charted predictors of individual pathways. In this prospective longitudinal study, we followed 232 children, including 148 exposed to repeated wartime trauma and 84 controls, at three time points: early childhood (1.5-5 years), middle childhood (5-8 years), and late childhood (9-11 years). Children were diagnosed at each time point and four trajectories defined: children exhibiting no pathology at any time point, those displaying early pathology that later remitted, those showing initial resilience followed by late pathology, and children presenting chronic pathology across the entire first decade. Maternal behavioral containment during trauma evocation and child social engagement during free play were observed in early childhood and maternal emotional distress self-reported across time. War-exposed children showed significantly higher rates of psychopathology, with 81% exhibiting pathology at some point during childhood. In middle childhood, exposed children displayed more posttraumatic stress disorders (PTSD), anxiety disorders, and attention-deficit/hyperactivity disorders (ADHD), and in late childhood more PTSD, conduct/oppositional defiant disorders, and ADHD. War-exposed children had more comorbid psychopathologies and number of comorbidities increased with age. Notably, war-exposure increased prevalence of chronic pathology by 24-fold. Maternal factors, including mother's uncontained style and emotional distress, increased risk for early and chronic psychopathology, whereas reduced child social engagement augmented risk for late pathology. Early-onset chronic stress does not heal naturally, and its effects appear to exacerbate over time, with trauma-exposed children presenting a more comorbid, chronic, and externalizing profile as they

Negative Social Relationships Predict Posttraumatic Stress Symptoms Among War-Affected Children Via Posttraumatic Cognitions.

PubMed

Palosaari, Esa; Punamäki, Raija-Leena; Peltonen, Kirsi; Diab, Marwan; Qouta, Samir R

2016-07-01

Post traumatic cognitions (PTCs) are important determinants of post traumatic stress symptoms (PTS symptoms). We tested whether risk factors of PTS symptoms (trauma, demographics, social and family-related factors) predict PTCs and whether PTCs mediate the association between risk factors and PTS symptoms among war-affected children. The participants were 240 Palestinian children 10-12 years old, half boys and half girls, and their parents. Children reported about psychological maltreatment, sibling and peer relations, war trauma, PTCs, PTS symptoms, and depression. Parents reported about their socioeconomic status and their own PTS symptoms. The associations between the variables were estimated in structural equation models. In models which included all the variables, PTCs were predicted by and mediated the effects of psychological maltreatment, war trauma, sibling conflict, and peer unpopularity on PTS symptoms. Other predictors had statistically non-significant effects. Psychological maltreatment had the largest indirect effect (b* = 0.29, p = 0.002) and the indirect effects of war trauma (b* = 0.10, p = 0.045), sibling conflict (b* = 0.10, p = 0.045), and peer unpopularity (b* = 0.10, p = 0.094) were lower and about the same size. Age-salient social relationships are potentially important in the development of both PTCs and PTS symptoms among preadolescents. Furthermore, PTCs mediate the effects of the risk factors of PTS symptoms. The causality of the associations among the variables is not established but it could be studied in the future with interventions which improve the negative aspects of traumatized children's important social relationships.

Psychological trauma, physical health and somatisation.

PubMed

Ng, V; Norwood, A

2000-09-01

The aim of this review is to examine the relationship between trauma, physical health and somatisation. A search was made on the Procite Database at the Department of Psychiatry at the Uniformed Services University of the Health Sciences for research articles with the following key words: posttraumatic stress disorder, somatisation, trauma (the Procite Database holds more than 15,000 articles related to trauma and disaster). A review of the current research findings show a link between prior exposure to traumatic events (such as war, disaster, motor vehicles and industrial accidents, crime and sexual assault, domestic violence and child abuse) and subsequent physical heath and medical care utilisation. Possible mechanisms and conceptualisations which may explain the association between trauma and physical health, such as high-risk health behaviours, neurobiology, alexithymia and culture are discussed. Because traumatised persons show high medical utilisation, good screening, thorough assessment, empirically-based treatment and appropriate referral of such patients are essential.

Devising work schedules for a collective: favouring intergenerational collaboration among counsellors in a shelter for female victims of conjugal violence.

PubMed

Chatigny, Céline

2011-01-01

The work activity of counsellors in shelters for female victims of conjugal violence is explored. The consortium of shelters requested the study because of complaints of worker stress, difficulties in management and high employee turnover. This qualitative and participatory community study involved a team of specialists in ergonomics and social work from the Centre de recherche interdisciplinaire sur la biologie, la santé, la sociélté et l'environnement (CINBIOSE), brought together by the Community Outreach Service of Université du Québec à Montréal (UQAM). Presented here are the study findings pertaining to training. Twenty-two semi-structured interviews and 80 hours of observation of work and training were conducted with counsellors from two contrasting shelters. Observations revealed an intense collaborative activity involving communication by many means. Nonetheless, young counsellors interviewed complained of having few opportunities to develop their counselling skills because they were isolated on evening, night and weekend shifts. In collaboration with the ergonomists, one shelter experimented with new ways of devising the work schedule to favour learning and training. By transforming the training mechanism, job status and work schedules, the shelter made the conditions more conducive to the development of counsellors' skills and health, while eliminating turnover for at least the two following years.

Follow-up studies of world war II and Korean conflict prisoners. III. Mortality to January 1, 1976.

PubMed

Keehn, R J

1980-02-01

Mortality through 1975 in US Army veterans released from prisoner-of-war camps following World War II (Europe, Pacific) and the Korean conflict and in several non-prisoner groups is compared using death rates and standard mortality ratios. The World War II Pacific and Korean conflict experience reveal increased risk of dying among former prisoners which, though diminishing with time, persist for 9 and 13 years, respectively. Mortality from tuberculosis and from trauma contributes to the increase among Pacific ex-prisoners, while for Korea the increase is limited to trauma. An excess of deaths due to cirrhosis of the liver in all three former prisoner groups appeared from about the 10th follow-up year. While the reported mortality experience for World War II spans 30 calendar years and for Korea 22 years, no evidence of increased aging among former prisoners of war is seen in mortality from the chronic and degenerative diseases.

The acceptability, feasibility and impact of a lay health counsellor delivered health promoting schools programme in India: a case study evaluation

PubMed Central

2012-01-01

Background Studies in resource-limited settings have shown that there are constraints to the use of teachers, peers or health professionals to deliver school health promotion interventions. School health programmes delivered by trained lay health counsellors could offer a cost-effective alternative. This paper presents a case study of a multi-component school health promotion intervention in India that was delivered by lay school health counsellors, who possessed neither formal educational nor health provider qualifications. Methods The intervention was based on the WHO’s Health Promoting Schools framework, and included health screening camps; an anonymous letter box for student questions and complaints; classroom-based life skills training; and, individual psycho-social and academic counselling for students. The intervention was delivered by a lay school health counsellor who had attained a minimum of a high school education. The counsellor was trained over four weeks and received structured supervision from health professionals working for the implementing NGO. The evaluation design was a mixed methods case study. Quantitative process indicators were collected to assess the extent to which the programme was delivered as planned (feasibility), the uptake of services (acceptability), and the number of students who received corrective health treatment (evidence of impact). Semi-structured interviews were conducted over two years with 108 stakeholders, and were analysed to identify barriers and facilitators for the programme (feasibility), evaluate acceptability, and gather evidence of positive or negative effects of the programme. Results Feasibility was established by the high reported coverage of all the targeted activities by the school health counsellor. Acceptability was indicated by a growing number of submissions to the students’ anonymous letter-box; more students self-referring for counselling services over time; and, the perceived need for the

The acceptability, feasibility and impact of a lay health counsellor delivered health promoting schools programme in India: a case study evaluation.

PubMed

Rajaraman, Divya; Travasso, Sandra; Chatterjee, Achira; Bhat, Bhargav; Andrew, Gracy; Parab, Suraj; Patel, Vikram

2012-05-25

Studies in resource-limited settings have shown that there are constraints to the use of teachers, peers or health professionals to deliver school health promotion interventions. School health programmes delivered by trained lay health counsellors could offer a cost-effective alternative. This paper presents a case study of a multi-component school health promotion intervention in India that was delivered by lay school health counsellors, who possessed neither formal educational nor health provider qualifications. The intervention was based on the WHO's Health Promoting Schools framework, and included health screening camps; an anonymous letter box for student questions and complaints; classroom-based life skills training; and, individual psycho-social and academic counselling for students. The intervention was delivered by a lay school health counsellor who had attained a minimum of a high school education. The counsellor was trained over four weeks and received structured supervision from health professionals working for the implementing NGO. The evaluation design was a mixed methods case study. Quantitative process indicators were collected to assess the extent to which the programme was delivered as planned (feasibility), the uptake of services (acceptability), and the number of students who received corrective health treatment (evidence of impact). Semi-structured interviews were conducted over two years with 108 stakeholders, and were analysed to identify barriers and facilitators for the programme (feasibility), evaluate acceptability, and gather evidence of positive or negative effects of the programme. Feasibility was established by the high reported coverage of all the targeted activities by the school health counsellor. Acceptability was indicated by a growing number of submissions to the students' anonymous letter-box; more students self-referring for counselling services over time; and, the perceived need for the programme, as expressed by principals

Empathy and Emotional Intelligence among Eastern and Western Counsellor Trainees: A Preliminary Study

ERIC Educational Resources Information Center

Young Kaelber, Kara A.; Schwartz, Robert C.

2014-01-01

This study explored degree of empathy and emotional intelligence among Thai (n?=?48) and American (n?=?53) counsellor trainees to determine if differences in Eastern and Western cultural orientations (e.g., interdependent versus independent self-construals) affect foundational counselling skills. Results indicated that Western trainees showed…

War on fear

PubMed Central

Burney, Ian

2012-01-01

This article examines the processes through which civilian fear was turned into a practicable investigative object in the inter-war period and the opening stages of the Second World War, and how it was invested with significance at the level of science and of public policy. Its focus is on a single historical actor, Solly Zuckerman, and on his early war work for the Ministry of Home Security-funded Extra Mural Unit based in Oxford’s Department of Anatomy (OEMU). It examines the process by which Zuckerman forged a working relationship with fear in the 1930s, and how he translated this work to questions of home front anxiety in his role as an operational research officer. In doing so it demonstrates the persistent work applied to the problem: by highlighting it as an ongoing research project, and suggesting links between seemingly disparate research objects (e.g. the phenomenon of ‘blast’ exposure as physical and physiological trauma), the article aims to show how civilian ‘nerve’ emerged from within a highly specific analytical and operational matrix which itself had complex foundations. PMID:23626409

Mental health of Somali adolescent refugees: the role of trauma, stress, and perceived discrimination.

PubMed

Ellis, B Heidi; MacDonald, Helen Z; Lincoln, Alisa K; Cabral, Howard J

2008-04-01

The primary purpose of this study was to examine relations between trauma exposure, post-resettlement stressors, perceived discrimination, and mental health symptoms in Somali adolescent refugees resettled in the U.S. Participants were English-speaking Somali adolescent refugees between the ages of 11 and 20 (N = 135) who had resettled in the U.S. Participants were administered an interview battery comprising self-report instruments that included the UCLA Posttraumatic Stress Disorder (PTSD) Index, the War Trauma Screening Scale, the Every Day Discrimination scale, the Adolescent Post-War Adversities Scale, and the Acculturative Hassles Inventory. Results indicated that cumulative trauma was related to PTSD and depression symptoms. Further, post-resettlement stressors, acculturative stressors, and perceived discrimination were also associated with greater PTSD symptoms after accounting for trauma, demographic, and immigration variables. Number of years since resettlement in the US and perceived discrimination were significantly related to depressive symptoms, after accounting for trauma, demographic, and immigration variables. Further research elucidating the relations between post-resettlement stressors, discrimination, and mental health of refugee adolescents may inform intervention development. PsycINFO Database Record (c) 2008 APA, all rights reserved.

Vascular Surgery in World War II: The Shift to Repairing Arteries.

PubMed

Barr, Justin; Cherry, Kenneth J; Rich, Norman M

2016-03-01

Vascular surgery in World War II has long been defined by DeBakey and Simeone's classic 1946 article describing arterial repair as exceedingly rare. They argued ligation was and should be the standard surgical response to arterial trauma in war. We returned to and analyzed the original records of World War II military medical units housed in the National Archives and other repositories in addition to consulting published accounts to determine the American practice of vascular surgery in World War II. This research demonstrates a clear shift from ligation to arterial repair occurring among American military surgeons in the last 6 months of the war in the European Theater of Operations. These conclusions not only highlight the role of war as a catalyst for surgical change but also point to the dangers of inaccurate history in stymieing such advances.

Counselling teenage girls on problems related to the 'protection of family honour' from the perspective of school nurses and counsellors.

PubMed

Alizadeh, Venus; Törnkvist, Lena; Hylander, Ingrid

2011-09-01

Approximately 1,500 young immigrant women living in Sweden sought help from various public organisations during 2004 due to problems related to Protection of Family Honour (PFH). Often they seek help from school nurses and counsellors. Information on how the school nurses and counsellors manage this complex PFH phenomenon is limited in Sweden. The aim was to generate a theoretical model that illuminates the experiences of school counsellors and school nurses counselling teenage girls, who worry about problems related to protection of family honour. Data were collected through individual interviews of the school welfare staff. The study subjects included welfare staff from six upper-secondary schools consisting of four nurses and six counsellors. Grounded theory methods were used to generate new knowledge as this is a new field of research. The staff's main goal was to provide the best support and help for the teenage girls. In addition, they wanted to be true to their professional ethics and values. However, this was difficult and created professional dilemmas because some teenage girls prevented them from doing what they thought was needed to support the teenage girls and protect them from violence. As a result, staff sometimes felt hampered, unable to help or able to help only in ways hidden from the teenage girls' families. © 2011 Blackwell Publishing Ltd.

Education as Catalyst for Intergenerational Refugee Family Communication about War and Trauma

ERIC Educational Resources Information Center

Lin, Nancy J.; Suyemoto, Karen L.; Kiang, Peter Nien-chu

2009-01-01

This article describes influences on intergenerational communication within refugee families about sociocultural trauma and explores how education may positively affect this communication process. Drawing on qualitative research and grounded theory through a larger study concerning intergenerational effects of and communication about trauma in…

Do counsellors in general practice surgeries and clinical psychologists in the National Health Service see the same patients?

PubMed Central

Burton, M V; Sadgrove, J; Selwyn, E

1995-01-01

An audit was conducted of a counsellor's work over the period 1989-1993 at two general practice surgeries in Coventry. Comparative data were available for general practitioner (GP)-referred patients seen in the district clinical psychology department in Coventry during 1988-1992. The counsellor saw significantly more patients referred with anxiety, depression, marital problems, child management and physical illness than did psychologists, whilst psychologists saw significantly more patients with relationship problems and personality disorders. To the question, 'Are these services effective?' the answer is yes, both services are effective, but they are treating different patient populations. PMID:7769604

Diversifying Counsellor Education: A Case Study of U.S. Students of Colour

ERIC Educational Resources Information Center

Hipolito-Delgado, Carlos P.; Estrada, Diane; Garcia, Marina

2017-01-01

Due to limited research on the experiences of students of colour in counselling programmes, counsellor educators are ill-equipped to implement strategies to promote the graduation of students of colour. In this case study, we explored the protective and risk factors for students of colour enrolled in a counselling programme in the Western U.S.…

"It's important to take your medication everyday okay?" An evaluation of counselling by lay counsellors for ARV adherence support in the Western Cape, South Africa.

PubMed

Dewing, S; Mathews, C; Schaay, N; Cloete, A; Louw, J; Simbayi, L

2013-01-01

There is growing interest in standard care programmes for antiretroviral (ARV) adherence support. In South Africa, individual counselling following ARV initiation is a main strategy for supporting adherence in the public sector. Egan's client-centred "Skilled Helper" counselling model is the predominant model used in HIV counselling in this context. This study evaluated counselling delivered by lay ARV adherence counsellors in Cape Town in terms of adherence to Egan's model. Thirty-eight transcripts of counselling sessions with non-adherent patients were analysed based on the methods of content analysis. These sessions were conducted by 30 counsellors. Generally counsellors' practice adhered neither to Egan's model nor a client-centred approach. Inconsistent with evidence-based approaches to counselling for ARV adherence support, counsellors mainly used information-giving and advice as strategies for addressing clients' non-adherence. Recommendations for improving practice are made. The question as to how appropriate strategies from developed countries are for this setting is also raised.

War on fear: Solly Zuckerman and civilian nerve in the Second World War.

PubMed

Burney, Ian

2012-12-01

This article examines the processes through which civilian fear was turned into a practicable investigative object in the inter-war period and the opening stages of the Second World War, and how it was invested with significance at the level of science and of public policy. Its focus is on a single historical actor, Solly Zuckerman, and on his early war work for the Ministry of Home Security-funded Extra Mural Unit based in Oxford's Department of Anatomy (OEMU). It examines the process by which Zuckerman forged a working relationship with fear in the 1930s, and how he translated this work to questions of home front anxiety in his role as an operational research officer. In doing so it demonstrates the persistent work applied to the problem: by highlighting it as an ongoing research project, and suggesting links between seemingly disparate research objects (e.g. the phenomenon of 'blast' exposure as physical and physiological trauma), the article aims to show how civilian 'nerve' emerged from within a highly specific analytical and operational matrix which itself had complex foundations.

Support and Self-Care: Professional Reflections of Six New Zealand High School Counsellors

ERIC Educational Resources Information Center

Evans, Yvonne A.; Payne, Monica A.

2008-01-01

In many Western societies there is increasing demand for counselling; in turn, heightened levels of support needs have been identified for counsellors themselves. Despite calls for practitioners to adopt a more proactive approach to self-care, research suggests many still pay insufficient attention to alleviating on-the-job stress or achieving…

Effects of war exposure on Air Force personnel’s mental health, job burnout and other organizational related outcomes

PubMed Central

Vinokur, Amiram D.; Pierce, Penny F.; Lewandowski-Romps, Lisa; Hobfoll, Stevan E.; Galea, Sandro

2011-01-01

Longitudinal data from a stratified representative sample of U.S. Air Force personnel (N = 1009) deployed to the wars in Iraq, Afghanistan, and other locations were analyzed in this study. Using structural equation models, we examined the effects of war exposure on traumatic experiences, Post Traumatic Stress (PTS) symptoms, resource loss, and on subsequent functioning, perceived health, and on job and organizationally relevant outcomes. The job and organizational outcomes included job burnout, job involvement, job strain, job satisfaction, work-family conflict, organizational commitment, deployment readiness, and intention to reenlist. We found that deployment to the theater of the war increased risk of exposure to trauma, which in turn, predicted elevated PTS symptoms and resource loss. PTS symptoms predicted later loss of resources and deterioration in perceived health and functioning. In turn, resource loss predicted negative job and organizational outcomes. Exposure to trauma fully mediated the effects of deployment to the theater of war on PTS symptoms and resource loss and had additional significant indirect effects on several job and organizational relevant outcomes. For returning veterans, deployment to the theater of war, exposure to trauma, PTS symptoms, and resource loss represents a ‘cascading’ chain of events that over time results in a decline of health and functioning as well as in adverse job and organizationally relevant outcomes that may affect organizational effectiveness. PMID:21280941

Can guilt lead to psychological growth following trauma exposure?

PubMed

Dekel, Sharon; Mamon, Daria; Solomon, Zahava; Lanman, Olivia; Dishy, Gabriella

2016-02-28

With the growing interest in posttraumatic growth (PTG) and its predictors, this study examined the relationship between trauma-related guilt and PTG in a sample of veterans over time. Self-reported guilt, PTG, and posttraumatic stress disorder (PTSD) symptoms were measured in combat veterans and prisoners of war (POWs). Positive correlations were found between guilt, PTSD, and PTG levels. Hierarchical regression revealed that initial guilt levels predicted subsequent PTG controlling for initial PTSD in combat veterans but not in POWs. The findings suggest that posttraumatic growth can be facilitated by trauma-related guilt, underscoring the complex relationship between positive and negative trauma outcomes. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

[Epidemiology of war injuries, about two conflicts: Iraq and Afghanistan].

PubMed

Pasquier, P; de Rudnicki, S; Donat, N; Auroy, Y; Merat, S

2011-11-01

Since March 2003, military operations in Iraq "Operation Iraqi Freedom" (OIF) and in Afghanistan "Operation Enduring Freedom" (OEF), have made many wounded and killed in action (KIA). This article proposes to highlight the specific epidemiology of combat casualties, met in these both non-conventional and asymmetric conflicts. Personal protective equipments, Kevlar helmet and body armor, proved their efficiency in changing features of war injuries. Health Force Services organized trauma care system in different levels, with three main objectives: immediate basic medical care in battalion aid station, forward surgery and early aeromedical evacuation. The Joint Theater Trauma Registry (JTTR), a war injury registry, provides medical data, analyzed from the combat theater to the military hospital in United States. This analysis concluded that during modern conflicts, most injuries are caused by explosive devices; injuries are more severe and interestingly more specifically the head region and extremities than the trunk. Hemorrhage is the first cause of death, leading to the concept of avoidable death. Specific databases focused on mechanisms and severity of injuries, diagnostic and treatment difficulties, outcomes can guide research programs to improve war injuries prevention and treatment. Copyright © 2011 Elsevier Masson SAS. All rights reserved.

Journalists and trauma: a brief overview.

PubMed

Czech, Ted

2004-01-01

In the past decade, journalism experts realized what those in the fields of emergency response and management have known for much longer: That journalists could be psychologically affected by the traumatic events they covered. Although a fledging field of study, groups such as the Dart Center for Journalism and Trauma, based at the University of Washington, in Seattle, WA, have dedicated themselves to advocating the ethical and thorough reporting of trauma, educating working journalists about trauma and serving as a forum for journalists to discuss topics related to covering traumatic events. The three major studies conducted on the subject--focusing on print journalists, photojournalists, and war journalists--have discovered that journalists can suffer sleeplessness, flashbacks, and in most extreme cases, posttraumatic stress disorder. According to Dr. Roger Simpson, director of the Dart Center, there is much work still to be done on the subject.

Posttraumatic stress symptoms among Polish World War II survivors: the role of social acknowledgement.

PubMed

Lis-Turlejska, Maja; Szumiał, Szymon; Drapała, Iwona

2018-01-01

Background : There is growing evidence of the important role played by socio-interpersonal variables on the maintenance of PTSD. Many World War II survivors in Poland could, as a result of political circumstances during the aftermath of the war, have experienced a lack of social recognition of their war-related trauma. Objective : The main aim of the study was to examine the association between perceived social reactions and the level of posttraumatic stress symptoms (PTSD) and depression. Method : Participants ( N  = 120) were aged 71-97 years ( M  = 82.44; SD  = 6.14). They completed a WWII trauma-related questionnaire, the Posttraumatic Diagnostic Scale (PDS), the Impact of Events Scale (IES) and Beck's Depression Inventory (BDI). The Social Acknowledgement Questionnaire (SAQ) was used to measure participants' perception of others' acknowledgement and disapproval of their war trauma. Results : The rate of probable PTSD, diagnosed according to DSM-IV, was 38.3%. PTSD symptoms and General Disapproval were significantly correlated for all three PTSD symptom groups (Pearson's r ranged from .25 to .41). The structural equation modelling results also demonstrated the importance of General Disapproval with regard to the level of PTSD symptoms. It explained both the intensity of PTSD symptoms (13.4% of variance) and the level of depression (12.0% of variance). Conclusion : In addition to confirming the high rate of PTSD among WWII survivors in Poland, the results indicate the importance of social reactions to survivors' traumatic experiences.

Reporting Military Sexual Trauma: A Mixed-Methods Study of Women Veterans' Experiences Who Served From World War II to the War in Afghanistan.

PubMed

Wolff, Kristina B; Mills, Peter D

2016-08-01

Since 2004, there has been increased effort to reduce military sexual trauma (MST) in the U.S. military. Although MST covers a range of inappropriate behaviors, the majority of research, treatment, and outreach are focused on sexual assault and the experiences of individuals serving in Afghanistan and Iraq. During a study on veterans' involvement in a national peace organization, participants were asked about their military experiences. Veterans served from World War II to current conflicts in Iraq and Afghanistan. Emerging out of the responses were descriptions of women's experiences with MST, barriers to reporting incidents of sexual misconduct and sexual assault, and the challenges they faced when seeking care. Data were gathered using anonymous questionnaires and semi-structured interviews. Out of 52 female veterans, the majority (90%) was subjected to at least one form of MST, and 15% (8) attempted to report the incident(s). Over half of the assailants were of a higher rank than the survivors. The majority of veterans remained silent due to lack of options to report, the status of perpetrators, and fear of retaliation. These data provide a glimpse into the challenges many women veterans faced when seeking assistance reporting incidents or obtaining health care for their MST. Reprint & Copyright © 2016 Association of Military Surgeons of the U.S.

And I Shot Her: On War, and the Creation of Inequities in the Development of Youths' Moral Capacities.

PubMed

Wainryb, Cecilia; Bourne, Stacia

War creates a multifaceted web of inequities that encompass most levels of the ecology of youth development. These include psychosocial inequities bearing on war-exposed youth's limited access to medical and educational services and job-training and employment opportunities, as well as some of the unique psychological sequelae of trauma exposure. In this chapter we put forth a twofold argument. First, we argue that the protracted hardships of war also create enduring psychological inequities that go beyond the well-documented psychosocial needs and psychological trauma, and encompass other aspects of youths' healthy development; these are inequities inasmuch as they represent profound alterations of the developmental pathways available to war-affected youth. Second, we maintain that the psychological sciences must strive to understand such longstanding developmental inequities even if we do not, at this time, have the tools to fully address them. © 2016 Elsevier Inc. All rights reserved.

Youth mental health after civil war: the importance of daily stressors

PubMed Central

Newnham, Elizabeth A.; Pearson, Rebecca M.; Stein, Alan; Betancourt, Theresa S.

2015-01-01

Background Recent evidence suggests that post-conflict stressors in addition to war trauma play an important role in the development of psychopathology. Aims To investigate whether daily stressors mediate the association between war exposure and symptoms of post-traumatic stress and depression among war-affected youth. Method Standardised assessments were conducted with 363 Sierra Leonean youth (26.7% female, mean age 20.9, s.d. = 3.38) 6 years post-war. Results The extent of war exposures was significantly associated with post-traumatic stress symptoms (P<0.05) and a significant proportion was explained by indirect pathways through daily stressors (0.089, 95% CI 0.04–0.138, P<0.001). In contrast, there was little evidence for an association from war exposure to depression scores (P = 0.127); rather any association was explained via indirect pathways through daily stressors (0.103, 95% CI 0.048–0.158, P<0.001). Conclusions Among war-affected youth, the association between war exposure and psychological distress was largely mediated by daily stressors, which have potential for modification with evidence-based intervention. PMID:25497299

Youth mental health after civil war: the importance of daily stressors.

PubMed

Newnham, Elizabeth A; Pearson, Rebecca M; Stein, Alan; Betancourt, Theresa S

2015-02-01

Recent evidence suggests that post-conflict stressors in addition to war trauma play an important role in the development of psychopathology. To investigate whether daily stressors mediate the association between war exposure and symptoms of post-traumatic stress and depression among war-affected youth. Standardised assessments were conducted with 363 Sierra Leonean youth (26.7% female, mean age 20.9, s.d. = 3.38) 6 years post-war. The extent of war exposures was significantly associated with post-traumatic stress symptoms (P<0.05) and a significant proportion was explained by indirect pathways through daily stressors (0.089, 95% CI 0.04-0.138, P<0.001). In contrast, there was little evidence for an association from war exposure to depression scores (P = 0.127); rather any association was explained via indirect pathways through daily stressors (0.103, 95% CI 0.048-0.158, P<0.001). Among war-affected youth, the association between war exposure and psychological distress was largely mediated by daily stressors, which have potential for modification with evidence-based intervention. Royal College of Psychiatrists.

Investigating Trauma in Narrating World War I: A Psychoanalytical Reading of Pat Barker's "Regeneration"

ERIC Educational Resources Information Center

Sadjadi, Bakhtiar; Esmkhani, Farnaz

2016-01-01

The present paper seeks to critically read Pat Barker's "Regeneration" in terms of Cathy Caruth's psychoanalytic study of trauma. This analysis attempts to trace the concepts of latency, post-traumatic stress disorders, traumatic memory, and trauma in Barker's novel in order to explore how trauma and history are interrelated in the…

Plastic Surgery Challenges in War Wounded I: Flap-Based Extremity Reconstruction

PubMed Central

Sabino, Jennifer M.; Slater, Julia; Valerio, Ian L.

2016-01-01

Scope and Significance: Reconstruction of traumatic injuries requiring tissue transfer begins with aggressive resuscitation and stabilization. Systematic advances in acute casualty care at the point of injury have improved survival and allowed for increasingly complex treatment before definitive reconstruction at tertiary medical facilities outside the combat zone. As a result, the complexity of the limb salvage algorithm has increased over 14 years of combat activities in Iraq and Afghanistan. Problem: Severe poly-extremity trauma in combat casualties has led to a large number of extremity salvage cases. Advanced reconstructive techniques coupled with regenerative medicine applications have played a critical role in the restoration, recovery, and rehabilitation of functional limb salvage. Translational Relevance: The past 14 years of war trauma have increased our understanding of tissue transfer for extremity reconstruction in the treatment of combat casualties. Injury patterns, flap choice, and reconstruction timing are critical variables to consider for optimal outcomes. Clinical Relevance: Subacute reconstruction with specifically chosen flap tissue and donor site location based on individual injuries result in successful tissue transfer, even in critically injured patients. These considerations can be combined with regenerative therapies to optimize massive wound coverage and limb salvage form and function in previously active patients. Summary: Traditional soft tissue reconstruction is integral in the treatment of war extremity trauma. Pedicle and free flaps are a critically important part of the reconstructive ladder for salvaging extreme extremity injuries that are seen as a result of the current practice of war. PMID:27679751

"If the patients decide not to tell what can we do?"- TB/HIV counsellors' dilemma on partner notification for HIV

PubMed Central

2011-01-01

Background There is a global consensus towards universal access to human immunodeficiency virus (HIV) services consequent to the increasing availability of antiretroviral therapy. However, to benefit from these services, knowledge of one's HIV status is critical. Partner notification for HIV is an important component of HIV counselling because it is an effective strategy to prevent secondary transmission, and promote early diagnosis and prompt treatment of HIV patients' sexual partners. However, counsellors are often frustrated by the reluctance of HIV-positive patients to voluntarily notify their sexual partners. This study aimed to explore tuberculosis (TB)/HIV counsellors' perspectives regarding confidentiality and partner notification. Methods Qualitative research interviews were conducted in the Northwest Region of Cameroon with 30 TB/HIV counsellors in 4 treatment centres, and 2 legal professionals between September and December 2009. Situational Analysis (positional map) was used for data analysis. Results Confidentiality issues were perceived to be handled properly despite concerns about patients' reluctance to report cases of violation due to apprehension of reprisals from health care staffs. All the respondents encouraged voluntary partner notification, and held four varying positions when confronted with patients who refused to voluntarily notify their partners. Position one focused on absolute respect of patients' autonomy; position two balanced between the respect of patients' autonomy and their partners' safety; position three wished for protection of sexual partners at risk of HIV infection and legal protection for counsellors; and position four requested making HIV testing and partner notification routine processes. Conclusion Counsellors regularly encounter ethical, legal and moral dilemmas between respecting patients' confidentiality and autonomy, and protecting patients' sexual partners at risk of HIV infection. This reflects the complexity of

The Syrian civil war: The experience of the Surgical Intensive Care Units.

PubMed

Ozdogan, Hatice Kaya; Karateke, Faruk; Ozdogan, Mehmet; Cetinalp, Sibel; Ozyazici, Sefa; Gezercan, Yurdal; Okten, Ali Ihsan; Celik, Muge; Satar, Salim

2016-01-01

Since the civilian war in Syria began, thousands of seriously injured trauma patients from Syria were brought to Turkey for emergency operations and/or postoperative intensive care. The aim of this study was to present the demographics and clinical features of the wounded patients in Syrian civil war admitted to the surgical intensive care units in a tertiary care centre. The records of 80 trauma patients admitted to the Anaesthesia, General Surgery and Neurosurgery ICUs between June 1, 2012 and July 15, 2014 were included in the study. The data were reviewed regarding the demographics, time of presentation, place of reference, Acute Physiology and Chronic Health Evaluation II (APACHE II) score and Injury Severity Score (ISS), surgical procedures, complications, length of stay and mortality. A total of 80 wounded patients (70 males and 10 females) with a mean age of 28.7 years were admitted to surgical ICUs. The most frequent cause of injury was gunshot injury. The mean time interval between the occurrence of injury and time of admission was 2.87 days. Mean ISS score on admission was 21, and mean APACHE II score was 15.7. APACHE II scores of non-survivors were significantly increased compared with those of survivors (P=0.001). No significant differences was found in the age, ISS, time interval before admission, length of stay in ICU, rate of surgery before or after admission. The most important factor affecting mortality in this particular trauma-ICU patient population from Syrian civil war was the physiological condition of patients on admission. Rapid transport and effective initial and on-road resuscitation are critical in decreasing the mortality rate in civil wars and military conflicts.

Experiences of Burnout, Self-Care, and Recovery of Female University Counsellors in Taiwan

ERIC Educational Resources Information Center

Lin, Yii-Nii

2012-01-01

The purpose of this study was to describe the burnout, self-care, and recovery experiences of female university counsellors working at a university counselling centre in Taiwan. The 9 participants had an average age of 42.44 years and had worked at the centre for an average of 11.3 years. A qualitative method of phenomenology with in-depth…

The protective role of maternal post-traumatic growth and cognitive trauma processing in Palestinian mothers and infants: a longitudinal study.

PubMed

Diab, Safwat Y; Isosävi, Sanna; Qouta, Samir R; Kuittinen, Saija; Punamäki, Raija-Leena

2018-02-21

Women at pre partum and post partum are especially susceptible to war trauma because they struggle to protect their infants from danger. Trauma research suggests increased problems in maternal mental health and infant development. Yet many cognitive-emotional processes affect the trauma survivors' mental health, such as post-traumatic growth and post-traumatic cognition. The aim of this study was to examine whether a mother's high post-traumatic growth and optimal post-traumatic cognition could protect their own mental health and their infant's stress regulation from the effects of traumatic war experiences. This three-wave prospective study involved Palestinian women living in the Gaza Strip who were at the second trimester of pregnancy (T1), women with infants aged 4 months (T2), and women with children aged 12 months (T3) months. The participants reported their war experiences in a 30-item checklist of losses, destruction, and atrocities in the 2008-09, 2012, and 2014 military offensives. Post-traumatic growth was assessed by a 21-item scale and post-traumatic cognition by a 36-item scale. Maternal mental health was assessed by post-traumatic stress disorder (PTSD), depressive, anxiety, and dissociation symptoms at T1 and T3, and infants' stress regulation was assessed with the Infant Behaviour Questionnaire at T2 and T3. We included 511 women at T1, 481 women at T2, and 454 women at T3. High maternal post-traumatic growth and post-traumatic cognition had protective roles. Post-traumatic growth had a protective effect on maternal mental health since severe exposure to traumatic war experiences was not associated with maternal PTSD, depression, and dissociation if women showed high post-traumatic growth, as indicated by the significant interaction effect between post-traumatic growth and war trauma on each of the three symptoms. Post-traumatic cognition had a protective effect on infant development since severe exposure was not associated with dysfunctional

Rates and impact of trauma and current stressors among Darfuri refugees in Eastern Chad.

PubMed

Rasmussen, Andrew; Nguyen, Leanh; Wilkinson, John; Vundla, Sikhumbuzo; Raghavan, Sumithra; Miller, Kenneth E; Keller, Allen S

2010-04-01

Darfur refugees face hardships associated with chronic displacement, including lack of basic needs and safety concerns. Psychiatric research on refugees has focused on trauma, but daily stressors may contribute more to variance in distress. This article reports rates of past trauma and current stressors among Darfur refugees and gauges the contribution of each to psychological distress and functional impairment. A representative sample of 848 Darfuris in 2 refugee camps were interviewed about traumatic events, stressors faced in the camps, psychological distress, and functional impairment. Basic needs and safety concerns were more strongly correlated with measures of distress (rs = .19-.31) than were war-related traumatic events (rs = .09-.20). Hierarchical regression supported models in which effects of trauma on distress were mediated by current stressors. Although war-related traumatic events are the initial causes of refugees' hardship, findings suggest that the day-to-day challenges and concerns in camps mediate psychological distress associated with these events.

Rates and Impact of Trauma and Current Stressors Among Darfuri Refugees in Eastern Chad

PubMed Central

Rasmussen, Andrew; Nguyen, Leanh; Wilkinson, John; Vundla, Sikhumbuzo; Raghavan, Sumithra; Miller, Kenneth E.; Keller, Allen S.

2010-01-01

Darfur refugees face hardships associated with chronic displacement, including lack of basic needs and safety concerns. Psychiatric research on refugees has focused on trauma, but daily stressors may contribute more to variance in distress. In this article we report rates of past trauma and current stressors among Darfur refugees and gauge the contribution of each to psychological distress and functional impairment. A representative sample of 848 Darfuris in two refugee camps were interviewed about traumatic events, stressors faced in the camps, psychological distress and functional impairment. Basic needs and safety concerns were more strongly correlated with measures of distress (r's = .19–.31) than were war-related traumatic events (r's = .09–.20). Hierarchical regression supported models in which effects of trauma on distress were mediated by current stressors. Although war-related traumatic events are the initial causes of refugees' hardship, findings suggest that the day-to-day challenges and concerns in camps mediate psychological distress associated with these events. PMID:20553516

Keeping a healthy distance: Self-differentiation and perceived health among ex-prisoners-of-war's wives.

PubMed

Lahav, Yael; Stein, Jacob Y; Solomon, Zahava

2016-10-01

War captivity may affect spouses of former-prisoners-of-war (ex-POWs) in many ways, including posttraumatic stress symptoms (PTSS) and somatic difficulties manifested in negative perceived health. This is generally known as secondary traumatization. Theory suggests that development of secondary traumatization occurs through the relationship with the primary trauma survivor Figley (1986) , thus implying that the ability to keep balanced emotional distance in the relationship may play a pivotal role. Notwithstanding, the contribution of self-differentiation to secondary somatic disturbances remains largely uninvestigated. The current study fills this gap. Ex-POWs' wives (n=143) and control former-combatants' wives (n=102), were assessed prospectively 30 (T1) and 38 (T2) years after the 1973 Yom Kippur War. Self-differentiation and PTSS were assessed at both time-points, while perceived health measures were assessed at T2. Wives of ex-POWs endorsed higher PTSS, lower self-differentiation and negative perceived health, compared to control wives. Indirect exposure to war captivity was related to low self-differentiation and elevated PTSS, which predicted negative perceived health. Furthermore, self-differentiation characterized by fusion-with-others fully mediated the relation between indirect exposure to war captivity and perceived health, beyond the effects of PTSS as a mechanism. Results suggest that tendencies towards fusion-with-others within the marital relationship, act as a risk factor not only for psychological distress but also for somatic distress among secondary trauma survivors. Hence, clinical interventions may seek to improve indirect trauma survivor's self-differentiation capacities, thus potentially facilitating the prevention of secondary somatic distress. Copyright © 2016 Elsevier Inc. All rights reserved.

Management of colorectal trauma: a review.

PubMed

Cheong, Ju Yong; Keshava, Anil

2017-07-01

Traumatic colorectal injuries are common during times of military conflict, and major improvements in their care have arisen in such periods. Since World War II, many classification systems for colorectal trauma have been proposed, including (i) Flint Grading System; (ii) Penetrating Abdominal Trauma Index; (iii) Colonic/Rectal Injury Scale; and (iv) destructive/non-destructive colonic injuries. The primary goal of these classifications was to aid surgical management and, more particularly, to determine whether a primary repair or faecal diversion should be performed. Primary repair is now the preferred surgical option. Patients who have been identified as having destructive injuries have been found to have higher anastomotic leak rates after a primary repair. Damage control principles need to be adhered to in surgical decision-making. In this review, we discuss the mechanisms of injury, classifications, clinical presentation and current recommendations for the management of colorectal trauma. © 2017 Royal Australasian College of Surgeons.

Point-of-injury Use of Reconstituted Freeze Dried Plasma as a Resuscitative Fluid: A Special Report for Prehospital Trauma Care

DTIC Science & Technology

2013-01-01

Point-of-injury use of reconstituted freeze dried plasma as a resuscitative fluid: A special report for prehospital trauma care Elon Glassberg, MD...in- jury as part of the multidisciplinary efforts to improve trauma victims’ outcome. BACKGROUND Trauma is the leading cause of death among adults be...diabetes.1 Managing the burden of injuries from decades of wars has underscored the importance of trauma research aimed at reducing morbidity and

A community long-term hotline therapeutic intervention model for coping with the threat and trauma of war and terror.

PubMed

Gelkopf, Marc; Haimov, Sigal; Lapid, Liron

2015-02-01

Long-term tele-counseling can potentially be a potent intervention mode in war- and terror-related community crisis situations. We aimed to examine a unique long-term telephone-administered intervention, targeting community trauma-related crisis situations by use of various techniques and approaches. 142 participants were evaluated using a non-intrusive by-proxy methodology appraising counselors' standard verbatim reports. Various background measures and elements in the intervention were quantitatively assessed, along with symptomatology and functioning at the onset and end of intervention. About 1/4 of the wide variety of clients called for someone else in addition to themselves, and most called due to a past event rather than a present crisis situation. The intervention successfully reduced posttraumatic stress symptoms and improved functioning. Most interventions included psychosocial education with additional elements, e.g., self-help tools, and almost 60% included also in-depth processes. In sum, tele-counseling might be a viable and effective intervention model for community-related traumatic stress.

African Refugees in Egypt: Trauma, Loss, and Cultural Adjustment

ERIC Educational Resources Information Center

Henry, Hani M.

2012-01-01

This study examined the influence of pre-immigration trauma on the acculturation process of refugees, as reflected in the manifestations of their continuing bonds with native cultures. Six African refugees who sought refuge in Egypt because of wars and political persecution were interviewed about the circumstances of their departure from their…

Posttraumatic stress symptoms among Polish World War II survivors: the role of social acknowledgement

PubMed Central

Lis-Turlejska, Maja; Szumiał, Szymon; Drapała, Iwona

2018-01-01

ABSTRACT Background: There is growing evidence of the important role played by socio-interpersonal variables on the maintenance of PTSD. Many World War II survivors in Poland could, as a result of political circumstances during the aftermath of the war, have experienced a lack of social recognition of their war-related trauma. Objective: The main aim of the study was to examine the association between perceived social reactions and the level of posttraumatic stress symptoms (PTSD) and depression. Method: Participants (N = 120) were aged 71–97 years (M = 82.44; SD = 6.14). They completed a WWII trauma-related questionnaire, the Posttraumatic Diagnostic Scale (PDS), the Impact of Events Scale (IES) and Beck’s Depression Inventory (BDI). The Social Acknowledgement Questionnaire (SAQ) was used to measure participants’ perception of others’ acknowledgement and disapproval of their war trauma. Results: The rate of probable PTSD, diagnosed according to DSM-IV, was 38.3%. PTSD symptoms and General Disapproval were significantly correlated for all three PTSD symptom groups (Pearson’s r ranged from .25 to .41). The structural equation modelling results also demonstrated the importance of General Disapproval with regard to the level of PTSD symptoms. It explained both the intensity of PTSD symptoms (13.4% of variance) and the level of depression (12.0% of variance). Conclusion: In addition to confirming the high rate of PTSD among WWII survivors in Poland, the results indicate the importance of social reactions to survivors’ traumatic experiences. PMID:29410775

Reconsidering American Indian historical trauma: lessons from an early Gros Ventre war narrative.

PubMed

Gone, Joseph P

2014-06-01

Professional clinicians and human services providers are increasingly attributing the mental health problems of American Indians (AIs) to historical trauma (HT). As an alternative to established psychiatric disorders, AI HT was formulated to explain enduring mental health disparities as originating in tribal experiences of Euro-American colonization. As a result, AI HT has been described as the collective, cumulative, and intergenerational psychosocial disability resulting from massive group-based oppression, such as forced relocation, political subjugation, cultural domination, and genocide. One objective of the HT construct is to frame AI distress and dysfunction in social and historical terms. Given widespread indigenous experiences of colonization, the debilitating effects of HT are presumed to affect most AI communities today. With this background in mind, I explore AI HT with specific reference to a "war narrative" obtained by an anthropologist in 1901 from an elderly Gros Ventre woman. In this account, Watches All described her participation in a historic intertribal battle, and her subsequent captivity and escape from the enemy during the late 1860s. This historical narrative references many first-hand experiences that would today be identified as traumatogenic. Interestingly, however, this account complicates several assumptions underlying AI HT, leading to vexing questions of whether Watches All's ordeal actually qualifies as an instance of AI HT. No matter how one answers these questions, such ambiguity highlights serious theoretical confusions requiring elaboration and refinement if AI HT is to remain a useful construct in the behavioral health sciences. © The Author(s) 2013 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

Managing Mental Health Disorders Resulting from Trauma through Yoga: A Review

PubMed Central

Telles, Shirley; Singh, Nilkamal; Balkrishna, Acharya

2012-01-01

There are many and varied types of trauma. The extent to which trauma influences the mental health of an individual depends on the nature of trauma, as well as on the individual's coping capabilities. Often trauma is followed by depression, anxiety, and PTSD. As the pharmacological remedies for these conditions often have undesirable side-effects, nonpharmacological remedies are thought of as a possible add-on treatment. Yoga is one such mind-body intervention. This paper covers eleven studies indexed in PubMed, in which mental health disorders resulting from trauma were managed through yoga including meditation. The aim was to evaluate the use of yoga in managing trauma-related depression, anxiety, PTSD and physiological stress following exposure to natural calamities, war, interpersonal violence, and incarceration in a correctional facility. An attempt has also been made to explore possible mechanisms underlying benefits seen. As most of these studies were not done on persons exposed to trauma that had practiced yoga, this is a definite area for further research. PMID:22778930

The Syrian civil war: The experience of the Surgical Intensive Care Units

PubMed Central

Ozdogan, Hatice Kaya; Karateke, Faruk; Ozdogan, Mehmet; Cetinalp, Sibel; Ozyazici, Sefa; Gezercan, Yurdal; Okten, Ali Ihsan; Celik, Muge; Satar, Salim

2016-01-01

Objective: Since the civilian war in Syria began, thousands of seriously injured trauma patients from Syria were brought to Turkey for emergency operations and/or postoperative intensive care. The aim of this study was to present the demographics and clinical features of the wounded patients in Syrian civil war admitted to the surgical intensive care units in a tertiary care centre. Methods: The records of 80 trauma patients admitted to the Anaesthesia, General Surgery and Neurosurgery ICUs between June 1, 2012 and July 15, 2014 were included in the study. The data were reviewed regarding the demographics, time of presentation, place of reference, Acute Physiology and Chronic Health Evaluation II (APACHE II) score and Injury Severity Score (ISS), surgical procedures, complications, length of stay and mortality. Results: A total of 80 wounded patients (70 males and 10 females) with a mean age of 28.7 years were admitted to surgical ICUs. The most frequent cause of injury was gunshot injury. The mean time interval between the occurrence of injury and time of admission was 2.87 days. Mean ISS score on admission was 21, and mean APACHE II score was 15.7. APACHE II scores of non-survivors were significantly increased compared with those of survivors (P=0.001). No significant differences was found in the age, ISS, time interval before admission, length of stay in ICU, rate of surgery before or after admission. Conclusion: The most important factor affecting mortality in this particular trauma-ICU patient population from Syrian civil war was the physiological condition of patients on admission. Rapid transport and effective initial and on-road resuscitation are critical in decreasing the mortality rate in civil wars and military conflicts. PMID:27375683

Relationship among Perceived Parental Trauma, Parental Attachment, and Sense of Coherence in Southeast Asian American College Students

ERIC Educational Resources Information Center

Han, Meekyung

2005-01-01

There are nearly 2 million Southeast Asians (SEAs) currently living in the United States. The overwhelming majority are refugees from the Southeast Asian wars and political turmoil in the latter half of the 20th century. While an abundance of literature has documented the significant war-related traumas that SEA refugees have suffered, very little…

Incidence and severity of ocular and adnexal injuries during the Second Lebanon War among Israeli soldiers and civilians.

PubMed

Barak, Adiel; Elhalel, Amir; Pikkel, Joseph; Krauss, Eli; Miller, Benjamin

2011-12-01

To analyze the incidence and severity of ocular and adnexal injuries in the Second Lebanon War among Israeli soldiers and civilians. Retrospective cohort study. All patients recorded in the Israeli National Trauma Registry during the Second Lebanon War (July-August, 2006). Retrieval of all data relevant to ocular and adnexal injuries sustained during the study period, and differentiation between those associated with combat/terrorist and other events. Analysis of data according to the severity of trauma , anatomical location of the injury, and whether the patients were military personnel or civilians. A total of 69 war-related ocular trauma patients (58 military personnel and 11 civilians) were registered during the 34 days of war. The injuries involved the anterior segment injury (n = 25), posterior segment (n = 29) and the periocular region (n = 15, all severe). Twenty-seven of the patients had open-globe injuries, of which 18 involved intraocular foreign bodies, and 27 patients had closed-globe injuries. The rate of ocular injuries was 7% among all registered wounded military personnel and 1.2% among all injured civilians. The incidence and severity of ocular and adnexal injuries among military personnel during the Second Lebanon War were consistent with previous reports from American sources of ocular injuries sustained in Iraq and Afghanistan. The rates of ocular injury associated with wartime events sustained by civilians has not been investigated before, and it was relatively low, probably as a result of stringent government-mandated building regulations for passive defense that are discussed.

African refugees in Egypt: trauma, loss, and cultural adjustment.

PubMed

Henry, Hani M

2012-08-01

This study examined the influence of pre-immigration trauma on the acculturation process of refugees, as reflected in the manifestations of their continuing bonds with native cultures. Six African refugees who sought refuge in Egypt because of wars and political persecution were interviewed about the circumstances of their departure from their home countries, as well as their life experiences in Egypt. All participants kept continuing bonds with their native cultures, but these bonds manifested differently depending on their ability to assimilate pre-immigration trauma and cultural losses. Participants who successfully assimilated both pre-immigration trauma and cultural losses developed continuing bonds with their native cultures that helped them (a) integrate the Egyptian culture into their life experiences and (b) tolerate difficult political conditions in Egypt. Participants who could not assimilate their pre-immigration trauma and cultural losses also developed continuing bonds with their native culture, but these bonds only provided them with solace.

The experience of collective trauma in Australian Indigenous communities.

PubMed

Krieg, Anthea

2009-08-01

The concept of collective trauma has predominantly been applied in the context of natural and human disasters. This paper seeks to explore whether collective trauma offers a respectful way in which to explore and respond to mental health and wellbeing issues for Aboriginal families and communities. A review of the international literature was undertaken in order to determine the elements of collective and mass trauma studies which may have relevance for Indigenous communities in Australia. Findings support the proposition that the patterns of human responses to disasters, particularly in protracted traumas such as war-zones, shows strong parallels to the contemporary patterns of experience and responses articulated by Aboriginal people affected by colonization and its sequelae in Australia. Adopting evidence-informed principles of family and community healing developed internationally in disaster situations may provide helpful ways of conceptualizing and responding in a coordinated way to mental health and wellbeing issues for Indigenous people within Australia.

Observations of a pediatric surgeon in the Persian Gulf War.

PubMed

Reyna, T M

1993-02-01

In Third-World countries, infectious disease is the principal cause of childhood death and disability. During the Persian Gulf War trauma became the leading cause of death in children, prompting this review of experience with the delivery of pediatric trauma care to noncombatant children at a military hospital. Eight hundred seventy-seven patients were admitted to the 410th Evacuation Hospital from January to April 1991. Fifty of the patients (6%) were children, and 40 of the 50 were admitted for trauma. The mean age of the children was 9 years. Sixty-five percent of pediatric patients sustained penetrating injuries; mechanisms of injury included shrapnel wounds, gunshot wounds, burns, motor vehicle accidents, crush injuries, and falls. The overall mortality rate for children admitted to the hospital was 12%, but no injured child died as a result of trauma. Complications of dehydration or malnutrition in infants accounted for all the deaths.

Cephalic region war injuries in children: Experience in French NATO hospital in Kabul Afghanistan.

PubMed

Chehab, Hussam El; Agard, Emilie; Dot, Corinne

2018-06-09

The NATO KAIA Hospital (Kabul International Airport), under French command, provided medical support for NATO forces in the Kabul region from 2009 to 2014. Medical assistance to civilians was an additional mission which included support for children who were war injured. The objective of this study was to analyze characteristics of cephalic injuries in children victims of war trauma. A retrospective study was conducted and commenced with the hospital opening (July 2009) to March 2012 on all children (<15years) with war trauma. We distinguished cephalic lesions in cranial (neuro-surgical), ophthalmological and neck regions. We analyzed mechanism, region, severity score, surgeries and resuscitation efforts. 217 children were operated on with 81 war traumas (mean age 10.2years). 36 children (44.4%) had a cephalic injury. 52.9% of the injured had an ophthalmological injury, 38.2% a cranial region injury and 29.4% a neck lesion. Mortality rate was 5.6% (1 hemorrhagic shock and 1 cerebral wound) in this cephalic lesion group. Ophthalmic injuries were the most common of cephalic injuries; 19 children of which 7 had a bilateral injury (26 eyes). In this group, fragmentary injuries were the most frequent (64% of eyes). In cerebral lesion group, the lesions were linked to a bullet or a shrapnel in 9 of 13 children. This mechanism systematically caused a crania-cerebral wound. Explosion (fragmentary and shrapnel) was the most important in the neck lesions (7 children of 10). The cephalic lesions were the second most common region in children during our experience in Afghanistan. Lack of protection (helmet) in children may explain the frequency of cephalic wounds. Copyright © 2018 Elsevier Ltd. All rights reserved.

The neurological manifestations of trauma: lessons from World War I.

PubMed

Linden, Stefanie C; Hess, Volker; Jones, Edgar

2012-04-01

Changes in the clinical presentation of functional disorders and the influence of social and cultural factors can be investigated through the historical case notes from mental hospitals. World War I (WWI) was a potent trigger of functional disorders with neurological or psychiatric symptoms. We analysed 100 randomly selected case files of German servicemen admitted to the Department of Psychiatry of the Charité Medical School of Berlin University during WWI and classified them according to contemporaneous and retrospective modern diagnoses. We compared the clinical presentations with accounts in the German and British medical literature of the time. Most patients obtained the contemporaneous diagnosis of 'psychopathic constitution' or hysteria reflecting the general view of German psychiatrists that not the war but an individual predisposition was the basis for the development of symptoms. The clinical picture was dominated by pseudoneurological motor or sensory symptoms as well as pseudoseizures. Some soldiers relived combat experiences in dream-like dissociative states that partly resemble modern-day post-traumatic stress disorder. Most servicemen were classified as unfit for military service but very few of them were granted compensation. Severe functional disorders of a neurological character could develop even without traumatic exposure in combat, which is of interest for the current debate on triggers of stress disorders. The high incidence of pseudoseizures accords with the psychiatric literature of the time and contrasts with accounts of war-related disorders in Britain. The tendency of German psychiatrists not to send traumatised servicemen back to active duty also distinguished between German and British practice. Our data contribute to the debate on the changing patterns of human responses to traumatic experience and their historical and social context.

Faith to move mountains: religious coping, spirituality, and interpersonal trauma recovery.

PubMed

Bryant-Davis, Thema; Wong, Eunice C

2013-11-01

Interpersonal trauma is pervasive globally and may result in long-term consequences physically, cognitively, behaviorally, socially, and spiritually (Bryant-Davis, 2005b). One of the protective factors that have emerged in the literature is religious coping. Religious coping, spirituality, and faith-based approaches to trauma recovery include endorsement of beliefs, engagement in behaviors, and access to support from faith communities. Compared with negative religious coping, spirituality and positive religious coping have been associated with decreased psychological distress, a finding established with survivors of child abuse, sexual violence, intimate partner violence, community violence, and war. This article focuses on spiritual and religious coping among survivors of child abuse, sexual violence, and war; however, research demonstrates increased use of positive religious coping among some survivors with higher rates of posttraumatic stress disorder. Much of the scholarship in this area includes qualitative studies with populations who face increased vulnerability to interpersonal trauma. Research in this area covers the life span from childhood to later adulthood and encompasses both domestic and international studies. The implications of research findings are explored, and future research needs are described. This line of research supports the American Psychological Association (2010) ethical standards that note the recognition of spiritual and religious faith traditions as important aspects of the provision of ethical treatment. Researchers, clinicians, and advocates for trauma survivors are encouraged to attend to the faith traditions and beliefs of persons confronting the potential devastation of traumatic events.

Lessons learned from the casualties of war: battlefield medicine and its implication for global trauma care

PubMed Central

Boyle, Peter; Autier, Philippe; van Wees, Sibylle Herzig; Sullivan, Richard

2015-01-01

Summary According to the Global Burden of Disease, trauma is now responsible for five million deaths each year. High-income countries have made great strides in reducing trauma-related mortality figures but low–middle-income countries have been left behind with high trauma-related fatality rates, primarily in the younger population. Much of the progress high-income countries have made in managing trauma rests on advances developed in their armed forces. This analysis looks at the recent advances in high-income military trauma systems and the potential transferability of those developments to the civilian health systems particularly in low–middle-income countries. It also evaluates some potential lifesaving trauma management techniques, proven effective in the military, and the barriers preventing these from being implemented in civilian settings. PMID:25792616

[Alberic Pont, the great war and the "broken faces"].

PubMed

Sigaux, N; Amiel, M; Piotrovitch d'Orlik, S; Breton, P

2017-12-01

The First World War and the number of facial injuries made specialized trauma centers necessary. Alberic Pont was trained both in medicine and dentistry. He founded in Lyon one of the first French specialized wards, which received more than 7000 soldiers overall. Through his charisma, his skills, his creativity and his generosity, he must be considered as a symbol among the pioneers of maxillo-facial surgery, which was then at its early stage. The centenary of World War I is the occasion to shed light on this man who dedicated his career to those who were renamed "broken faces". Copyright © 2017 Elsevier Masson SAS. All rights reserved.

High school students' posttraumatic symptoms, substance abuse and involvement in violence in the aftermath of war.

PubMed

Schiff, Miriam; Pat-Horenczyk, Ruth; Benbenishty, Rami; Brom, Danny; Baum, Naomi; Astor, Ron Avi

2012-10-01

This study examined one-year after effects of exposure to war events on adolescents' Posttraumatic Stress Symptoms (PTS) and risk behaviors (substance use and involvement in school violence). In addition, it addressed two potential vulnerability factors: at the micro level, it examined whether childhood trauma raised the vulnerability of Israeli adolescents to PTS and risk behaviors when exposed to war events. At the macro level, we explored whether ethnicity, i.e., being an Israeli Arab, is a vulnerability factor to PTS and risk behaviors. We used a representative sample of 7th to 11th grade students from the north of Israel that included 4151 students: 1800 Jewish (54.4% boys) and 2351 Arab (41.5% boys). We assessed exposure to war events and childhood traumatic events, PTS and PTSD, substance use (alcohol, cannabis, Ecstasy) and involvement in school violence. The findings revealed extensive exposure to war events among both Jewish and Arab students. A year after the war, its effects on adolescents were still manifested in PTS, and involvement in school violence and substance use. Exposure to child physical abuse was associated with higher levels of PTS symptoms, substance use and involvement in violence. Exposure to other traumatic events was also associated with greater PTS symptoms and involvement in violence but not with greater substance use. Arab students were a more vulnerable population. They reported higher PTS symptoms, more cannabis use and greater involvement in school violence than Jewish students. However, exposure to war events had similar effects on both Arab and Jewish students. We conclude that war effects include a broad range of psychological distress and risk behaviors that last long after the war ends, especially among youth who have experienced childhood trauma and high exposure to war-related stressors. Copyright © 2012 Elsevier Ltd. All rights reserved.

Psycho-Educational Assessment of Specific Learning Disabilities: Views and Practices of Australian Psychologists and Guidance Counsellors

ERIC Educational Resources Information Center

Meteyard, John D.; Gilmore, Linda

2015-01-01

This article reports an investigation of the views and practices of 203 Australian psychologists and guidance counsellors with respect to psycho-educational assessment of students with specific learning disabilities (SLDs). Results from an online survey indicated that practitioners draw upon a wide range of theoretical perspectives when…

Incidence and severity of maxillofacial injuries during the Second Lebanon War among Israeli soldiers and civilians.

PubMed

Levin, Liran; Zadik, Yehuda; Peleg, Kobi; Bigman, Galya; Givon, Adi; Lin, Shaul

2008-08-01

To analyze the incidence and severity of maxillofacial injuries in the Second Lebanon War, that occurred during the summer of 2006, among Israeli soldiers and civilians. This is a retrospective cohort study of patients recorded in the Israel National Trauma Registry during the Second Lebanon War. Data refer to all general hospitals throughout the country. Data were analyzed according to the etiology of the injury, severity of trauma using the Injury Severity Score, trauma location, and duration of hospital stay. Cases with multiple injuries that included maxillofacial injuries were separated and further analyzed according to the above parameters. Patients with only dental injuries and superficial facial soft tissue lacerations were excluded because they were referred to the military dental clinics and not to general hospitals. Maxillofacial injuries were found in 36 (6.4%) of the 565 wounded. Patients with maxillofacial injuries ranged in age from 20 to 44 years (mean age, 25.5 +/- 5.7 years). Greater than 50% of the injuries required more than 3 hospitalization days. Mortality rate of the maxillofacial injured was 2.8%. Most of the maxillofacial injuries (33; 91.7%) were combined with other organ injuries; 9 (25%) patients also had dental injuries. In the Second Lebanon War, the incidence and severity of true maxillofacial injuries, without dental injuries alone, were relatively low compared with previous reports of other conflicts. However, because most injuries involved multiple organs, special attention is required when planning and providing emergency, as well as secondary and tertiary medical care to war wounded.

Role of neuroinflammation and sex hormones in war-related PTSD.

PubMed

Mendoza, Cristhian; Barreto, George E; Ávila-Rodriguez, Marco; Echeverria, Valentina

2016-10-15

The susceptibility to develop posttraumatic stress disorder (PTSD) is greatly influenced by both innate and environmental risk factors. One of these factors is gender, with women showing higher incidence of trauma-related mental health disorders than their male counterparts. The evidence so far links these differences in susceptibility or resilience to trauma to the neuroprotective actions of sex hormones in reducing neuroinflammation after severe stress exposure. In this review, we discuss the impact of war-related trauma on the incidence of PTSD in civilian and military populations as well as differences associated to gender in the incidence and recovery from PTSD. In addition, the mutually influencing role of inflammation, genetic, and sex hormones in modulating the consequences derived from exposure to traumatic events are discussed in light of current evidence. Published by Elsevier Ireland Ltd.

Personality Traits and Socio-Demographic Variables as Correlates of Counselling Effectiveness of Counsellors in Enugu State, Nigeria

ERIC Educational Resources Information Center

Onyekuru, Bruno U.; Ibegbunam, Josephat

2015-01-01

Quality personality traits and socio-demographic variables are essential elements of effective counselling. This correlational study investigated personality traits and socio-demographic variables as predictors of counselling effectiveness of counsellors in Enugu State. The instruments for data collection were Personality Traits Assessment Scale…

The perceived impact of the European registration system for genetic counsellors and nurses.

PubMed

Paneque, Milena; Moldovan, Ramona; Cordier, Christophe; Serra-Juhé, Clara; Feroce, Irene; Pasalodos, Sara; Haquet, Emmanuelle; Lambert, Debby; Bjørnevoll, Inga; Skirton, Heather

2017-09-01

The aim of the European Board of Medical Genetics has been to develop and promote academic and professional standards necessary in order to provide competent genetic counselling services. The aim of this study was to explore the impact of the European registration system for genetic nurses and counsellors from the perspectives of those professionals who have registered. Registration system was launched in 2013. A cross-sectional, online survey was used to explore the motivations and experiences of those applying for, and the effect of registration on their career. Fifty-five Genetic Nurses and Counsellors are registered till now, from them, thirty-three agreed to participate on this study. The main motivations for registering were for recognition of their work value and competence (30.3%); due to the absence of a registration system in their own country (15.2%) and the possibility of obtaining a European/international certification (27.3%), while 27.3% of respondents registered to support recognition of the genetic counselling profession. Some participants valued the registration process as an educational activity in its own right, while the majority indicated the greatest impact of the registration process was on their clinical practice. The results confirm that registrants value the opportunity to both confirm their own competence and advance the genetic counselling profession in Europe.

The Voice of the Innocent: Propaganda and Childhood Testimonies of War

ERIC Educational Resources Information Center

de La Ferrière, Alexis Artaud

2014-01-01

Childhood testimonies have become a familiar component of war reporting and peace advocacy through the publication of children's drawings, oral descriptions of wartime trauma and wartime writing. While such practices have the merit of publicising children's experiences, it is also the case that the selection and distribution of these materials is…

Working with Clients Who Engage in Self-Harming Behaviour: Experiences of a Group of Counsellors

ERIC Educational Resources Information Center

Fox, Claudine

2011-01-01

This study aimed to explore the experiences of a group of counsellors regarding working with clients who engage in self-harming behaviour, in order to gain an understanding of what it is like to work with this client group. A series of six individual, semi-structured qualitative interviews were carried out, which were then transcribed and analysed…

Physical comorbidities of post-traumatic stress disorder in Australian Vietnam War veterans.

PubMed

McLeay, Sarah C; Harvey, Wendy M; Romaniuk, Madeline Nm; Crawford, Darrell Hg; Colquhoun, David M; Young, Ross McD; Dwyer, Miriam; Gibson, John M; O'Sullivan, Robyn A; Cooksley, Graham; Strakosch, Christopher R; Thomson, Rachel M; Voisey, Joanne; Lawford, Bruce R

2017-04-03

To determine whether the prevalence of physical comorbidities in Australian Vietnam War veterans with post-traumatic stress disorder (PTSD) is higher than in trauma-exposed veterans without PTSD. Cross-sectional analysis of the health status (based on self-reported and objective clinical assessments) of 298 Australian Vietnam War veterans enrolled by the Gallipoli Medical Research Institute (Brisbane) during February 2014 - July 2015, of whom 108 were confirmed as having had PTSD and 106 served as trauma-exposed control participants.Main outcomes and measures: Diagnostic psychiatric interview and psychological assessments determined PTSD status, trauma exposure, and comorbid psychological symptoms. Demographic data, and medical and sleep history were collected; comprehensive clinical examination, electrocardiography, spirometry, liver transient elastography, and selected pathology assessments and diagnostic imaging were performed. Outcomes associated with PTSD were identified; regression analysis excluded the effects of potentially confounding demographic and risk factors and comorbid symptoms of depression and anxiety. The mean total number of comorbidities was higher among those with PTSD (17.7; SD, 6.1) than in trauma-exposed controls (14.1; SD, 5.2; P < 0.001). For 24 of 171 assessed clinical outcomes, morbidity was greater in the PTSD group, including for conditions of the gastrointestinal, hepatic, cardiovascular, and respiratory systems, sleep disorders, and laboratory pathology measures. In regression analyses including demographic factors, PTSD remained positively associated with 17 adverse outcomes; after adjusting for the severity of depressive symptoms, it remained significantly associated with ten. PTSD in Australian Vietnam veterans is associated with comorbidities in several organ systems, independent of trauma exposure. A comprehensive approach to the health care of veterans with PTSD is needed.

Effects of a Sexual Health Education Programme on School Psychological Counsellor Candidates' Sexism Tendencies in Turkey

ERIC Educational Resources Information Center

Kahraman, Hanife

2017-01-01

This study examined the effects of a sexual health curriculum developed for school psychological counsellors in Turkey on the sexual health knowledge of the participating candidates, their beliefs in sexual myths and their tendencies towards ambivalent sexism and sexism in romantic relationships. The study adopted a semi-experimental design. Study…

Spirituality and Counselling: Are Counsellors Prepared to Integrate Religion and Spirituality into Therapeutic Work with Clients?

ERIC Educational Resources Information Center

Plumb, Alison M.

2011-01-01

An online survey of 341 Registered Clinical Counsellors in British Columbia was used to understand how therapists view and integrate spirituality and religion in their practice. Therapists were asked about their education and training in this realm, and about their perceived abilities, comfort, and competence when working with religious and/or…

Collective trauma in northern Sri Lanka: a qualitative psychosocial-ecological study.

PubMed

Somasundaram, Daya

2007-10-04

Complex situations that follow war and natural disasters have a psychosocial impact on not only the individual but also on the family, community and society. Just as the mental health effects on the individual psyche can result in non pathological distress as well as a variety of psychiatric disorders; massive and widespread trauma and loss can impact on family and social processes causing changes at the family, community and societal levels. This qualitative, ecological study is a naturalistic, psychosocial ethnography in Northern Sri Lanka, while actively involved in psychosocial and community mental health programmes among the Tamil community. Participatory observation, key informant interviews and focus group discussion with community level relief and rehabilitation workers and government and non-governmental officials were used to gather data. The effects on the community of the chronic, man-made disaster, war, in Northern Sri Lanka were compared with the contexts found before the war and after the tsunami. Fundamental changes in the functioning of the family and the community were observed. While the changes after the tsunami were not so prominent, the chronic war situation caused more fundamental social transformations. At the family level, the dynamics of single parent families, lack of trust among members, and changes in significant relationships, and child rearing practices were seen. Communities tended to be more dependent, passive, silent, without leadership, mistrustful, and suspicious. Additional adverse effects included the breakdown in traditional structures, institutions and familiar ways of life, and deterioration in social norms and ethics. A variety of community level interventions were tried. Exposure to conflict, war and disaster situations impact on fundamental family and community dynamics resulting in changes at a collective level. Relief, rehabilitation and development programmes to be effective will need to address the problem of

Collective trauma in northern Sri Lanka: a qualitative psychosocial-ecological study

PubMed Central

Somasundaram, Daya

2007-01-01

Background Complex situations that follow war and natural disasters have a psychosocial impact on not only the individual but also on the family, community and society. Just as the mental health effects on the individual psyche can result in non pathological distress as well as a variety of psychiatric disorders; massive and widespread trauma and loss can impact on family and social processes causing changes at the family, community and societal levels. Method This qualitative, ecological study is a naturalistic, psychosocial ethnography in Northern Sri Lanka, while actively involved in psychosocial and community mental health programmes among the Tamil community. Participatory observation, key informant interviews and focus group discussion with community level relief and rehabilitation workers and government and non-governmental officials were used to gather data. The effects on the community of the chronic, man-made disaster, war, in Northern Sri Lanka were compared with the contexts found before the war and after the tsunami. Results Fundamental changes in the functioning of the family and the community were observed. While the changes after the tsunami were not so prominent, the chronic war situation caused more fundamental social transformations. At the family level, the dynamics of single parent families, lack of trust among members, and changes in significant relationships, and child rearing practices were seen. Communities tended to be more dependent, passive, silent, without leadership, mistrustful, and suspicious. Additional adverse effects included the breakdown in traditional structures, institutions and familiar ways of life, and deterioration in social norms and ethics. A variety of community level interventions were tried. Conclusion Exposure to conflict, war and disaster situations impact on fundamental family and community dynamics resulting in changes at a collective level. Relief, rehabilitation and development programmes to be effective will

A modern combat trauma.

PubMed

Popivanov, Georgi; Mutafchiyski, V M; Belokonski, E I; Parashkevov, A B; Koutin, G L

2014-03-01

The world remains plagued by wars and terrorist attacks, and improvised explosive devices (IED) are the main weapons of our current enemies, causing almost two-thirds of all combat injuries. We wished to analyse the pattern of blast trauma on the modern battlefield and to compare it with combat gunshot injuries. Analysis of a consecutive series of combat trauma patients presenting to two Bulgarian combat surgical teams in Afghanistan over 11 months. Demographics, injury patterns and Injury Severity Scores (ISS) were compared between blast and gunshot-injured casualties using Fisher's Exact Test. The blast victims had significantly higher median ISS (20.54 vs 9.23) and higher proportion of ISS>16 (60% vs 33.92%, p=0.008) than gunshot cases. They also had more frequent involvement of three or more body regions (47.22% vs 3.58%, p<0.0001). A significantly higher frequency of head (27.27% vs 3.57%), facial (20% vs 0%) and extremities injuries (85.45% vs 42.86%) and burns (12.72% vs 0%) was noted among the victims of explosion (p<0.0001). Based on clinical examination and diagnostic imaging, primary blast injury was identified in 24/55 (43.6%), secondary blast injury in 37 blast cases (67.3%), tertiary in 15 (27.3%) and quaternary blast injury (all burns) in seven (12.72%). Our results corroborate the 'multidimensional' injury pattern of blast trauma. The complexity of the blast trauma demands a good knowledge and a special training of the military surgeons and hospital personnel before deployment.

Characterization of Midface Fractures Incurred in Recent Wars

DTIC Science & Technology

2012-11-01

reconstruction . Key Words: Maxillofacial, facial fractures, early rigid fixation, blast injury (J Craniofac Surg 2012;23: 1587 1591) The percentage of...evaluated by a facial trauma expert that some of these findings are made. Conversely, it is not uncommon to find fractures that are incorrectly...þ Robert G. Hale, DDS,þ and Rodney K. Chan, MDþ Background: Facial injuries sustained by US military personnel during the wars in Iraq and

Political violence, ethnic conflict, and contemporary wars: broad implications for health and social well-being.

PubMed

Pedersen, Duncan

2002-07-01

Ethnic conflict, political violence and wars that presently shape many parts of world have deep-seated structural causes. In poor and highly indebted countries, economic and environmental decline, asset depletion, and erosion of the subsistence base lead to further impoverishment and food insecurity for vast sectors of the population. Growing ethnic and religious tensions over a shrinking resource base often escort the emergence of predatory practices, rivalry, political violence, and internal wars. The nature of armed conflict has changed substantially over time and most strategic analysts agree that in the second half of the 20th century, contemporary wars are less of a problem of relations between states than a problem within states. Despite the growing number of armed conflicts and wars throughout the world, not enough attention has been paid to the local patterns of distress being experienced and the long-term health impact and psychosocial consequences of the various forms of political violence against individuals, communities, or specific ethnic groups. The short or long-term impact assessment on civilian populations of poor countries affected by war have been scarce, and studies focussing on experiences of collective suffering and trauma-related disorders among survivors are beginning to emerge in the scientific literature. The medicalization of collective suffering and trauma reflects a poor understanding of the relationships among critically important social determinants and the range of possible health outcomes of political violence.

Acute brain trauma

PubMed Central

Martin, GT

2016-01-01

In the 20th century, the complications of head injuries were controlled but not eliminated. The wars of the 21st century turned attention to blast, the instant of impact and the primary injury of concussion. Computer calculations have established that in the first 5 milliseconds after the impact, four independent injuries on the brain are inflicted: 1) impact and its shockwave, 2) deceleration, 3) rotation and 4) skull deformity with vibration (or resonance). The recovery, pathology and symptoms after acute brain trauma have always been something of a puzzle. The variability of these four modes of injury, along with a variable reserve of neurones, explains some of this problem. PMID:26688392

Humiliation: the invisible trauma of war for Palestinian youth.

PubMed

Giacaman, Rita; Abu-Rmeileh, Niveen M E; Husseini, Abdullatif; Saab, Hana; Boyce, William

2007-08-01

To investigate the influence of exposure to humiliation in war-like conditions on health status in 10th- and 11th-grade students living in the Ramallah District, West Bank, Occupied Palestinian Territory. A stratified single-stage cluster sample of 3415 students from cities, towns, villages and refugee camps of the Ramallah District. Survey questions were derived from the World Health Organization's Health Behaviour in School-aged Children Survey, the Gaza Community Mental Health Programme Traumatic Event Checklist, and focus group discussions with young people. The survey questionnaire was completed by students in their classrooms, under the supervision of a trained field worker. There was a significant association between a high number of subjective health complaints and demographic variables, particularly for females compared with males, and refugee camp dwellers compared with village dwellers. In addition, exposure to humiliation was significantly associated with an increased number of subjective health complaints. Students experiencing three forms of humiliation were found to be 2.5 times more likely to report a high number of subjective health complaints compared with those who had never been exposed to humiliation (52% vs 21%), while those experiencing four forms of humiliation were three times more likely to report a high number of subjective health complaints (62% vs 21%). A multiple logistic regression model revealed that humiliation was significantly associated with a high number of subjective health complaints, even after adjusting for sex, residence and other measures of exposure to violent events. The odds ratio of reporting a high number of subjective health complaints increased as the number of forms of humiliation increased, with values of 1.69, 2.67, 4.43 and 7.49 for reporting a high number of subjective health complaints when exposed to one, two, three or four forms of humiliation, respectively, compared with those who had never been exposed to

Medical costs of war in 2035: long-term care challenges for veterans of Iraq and Afghanistan.

PubMed

Geiling, James; Rosen, Joseph M; Edwards, Ryan D

2012-11-01

War-related medical costs for U.S. veterans of Iraq and Afghanistan may be enormous because of differences between these wars and previous conflicts: (1) Many veterans survive injuries that would have killed them in past wars, and (2) improvised explosive device attacks have caused "polytraumatic" injuries (multiple amputations; brain injury; severe facial trauma or blindness) that require decades of costly rehabilitation. In 2035, today's veterans will be middle-aged, with health issues like those seen in aging Vietnam veterans, complicated by comorbidities of posttraumatic stress disorder, traumatic brain injury, and polytrauma. This article cites emerging knowledge about best practices that have demonstrated cost-effectiveness in mitigating the medical costs of war. We propose that clinicians employ early interventions (trauma care, physical therapy, early post-traumatic stress disorder diagnosis) and preventive health programs (smoking cessation, alcohol-abuse counseling, weight control, stress reduction) to treat primary medical conditions now so that we can avoid treating costly secondary and tertiary complications in 2035. (We should help an amputee reduce his cholesterol and maintain his weight at age 30, rather than treating his heart disease or diabetes at age 50.) Appropriate early interventions for primary illness should preserve veterans' functional status, ensure quality clinical care, and reduce the potentially enormous cost burden of their future health care.

Self-efficacy, male rape myth acceptance, and devaluation of emotions in sexual trauma sequelae: Findings from a sample of male veterans.

PubMed

Voller, Emily; Polusny, Melissa A; Noorbaloochi, Siamak; Street, Amy; Grill, Joseph; Murdoch, Maureen

2015-11-01

Sexual trauma is an understudied but regrettably significant problem among male Veterans. As in women, sexual trauma often results in serious mental health consequences for men. Therefore, to guide potential future interventions in this important group, we investigated associations among self-efficacy, male rape myth acceptance, devaluation of emotions, and psychiatric symptom severity after male sexual victimization. We collected data from 1,872 Gulf War era Veterans who applied for posttraumatic stress disorder (PTSD) disability benefits using standard mailed survey methods. The survey asked about history of childhood sexual abuse, sexual assault during the time of Gulf War I, and past-year sexual assault as well as Veterans' perceived self-efficacy, male rape myth acceptance, devaluation of emotions, PTSD, and depression symptoms. Structural equation modeling revealed that self-efficacy partially mediated the association between participants' sexual trauma history and psychiatric symptoms. Greater male rape myth acceptance and greater devaluation of emotions were directly associated with lower self-efficacy, but these beliefs did not moderate associations between sexual trauma and self-efficacy. In this population, sexual trauma, male rape myth acceptance, and devaluation of emotions were associated with lowered self-efficacy, which in turn was associated with more severe psychiatric symptoms. Implications for specific, trauma-focused treatment are discussed. (c) 2015 APA, all rights reserved).

Does counsellor's attitude influence change in a request for a caesarean in women with fear of birth?

PubMed

Halvorsen, Lotta; Nerum, Hilde; Sørlie, Tore; Oian, Pål

2010-02-01

the attitudes of two counsellors towards women requesting a caesarean section due to fear of birth were identified. One emphasised the ability to overcome any emotional obstacle to vaginal birth ('coping attitude'), and the other emphasised that the ultimate choice of mode of birth was the womans' ('autonomy attitude'). Two research questions were asked: (1) What are the predictors of change in a wish for a caesarean and of vaginal birth in women with fear of birth? (2) Does a change from an 'autonomy attitude' to a 'coping attitude' increase the number of women who change their request for a caesarean and who give birth vaginally? the study population consisted of two samples of pregnant women with fear of birth and concurrent request for a caesarean, referred for crisis-oriented counselling at the antenatal clinic, University Hospital of North Norway between 2000-2002 (n=86) and 2004-2006 (n=107). Data were gathered from referral letters, counseling and antenatal, intra- and postpartum records. a coping attitude of the counsellor was positively associated with change in the request for a caesarean and with vaginal birth. A change from an autonomy attitude to a coping attitude was associated with a significant increase in the percentage of women who changed their desire for a caesarean from 77 to 93, and who had a vaginal birth from 42 to 81. a coping attitude was strongly associated with change in the desire for a caesarean and giving birth vaginally. A coping attitude can be learned through critical reflection and awareness of the counsellor's attitude, with measurable clinical results. Copyright 2008 Elsevier Ltd. All rights reserved.

Management of severe open ankle-foot trauma by a simple external fixation technique: an alternative during war and in resource-poor and low-technology environments.

PubMed

Pedrini, Gianpaolo; Cardi, Maurizio; Landini, Alberto; Strada, Gino

2011-03-01

Severe open foot and ankle injuries are still a challenge for the orthopaedic surgeon. Their treatment is even more difficult in third world countries and in war settings where high-energy trauma with severe soft tissue damage is more frequent. Lack of equipment, poor resources and hygiene, and different cultural systems make most of the standard proposed treatments difficult to apply. The authors describe an inexpensive, rapid, minimally invasive, and easy-to-apply external fixation technique for the treatment of severe open ankle-foot fractures. With the main goal of soft tissue management rather than definitive treatment of any bony injuries, this technique was developed over time during many consecutive missions in Sierra Leone and Afghanistan as an alternative to more appropriate treatments with surprisingly satisfactory short- and long-term results.

Digital Divide in the Utilization of Information and Communication Technology (ICT) in Counsellor Education in Nigerian Universities

ERIC Educational Resources Information Center

Eyo, Mfon

2014-01-01

This study investigated digital divide in the utilization of Information and Communication Technology (ICT) in counsellor education in Nigerian universities. It had two research questions and two hypotheses tested at 0.05 level of significance. It adopted a survey design and used ICT Utilization Questionnaire (IUQ) in gathering data from the…

[The "war neurosis"-- an early model of a pluridimensional outlined trauma-theory in psychiatry].

PubMed

Tölle, Rainer

2005-10-01

The war neurosis, mainly observed during the first World War, caused a lively debate on its origin and etiology. In psychiatric history this debate is often portrayed in a somewhat simplifying manner. Namely Oppenheim was considered as the leading exponent of the organic etiology of traumatic neurosis, while others, with growing interest in psychodynamic theories, were thought to favor exclusively psychogenesis of this condition. However, only discussing matters in this way would be too simple. Rather, the controversy was much more differentiated and led to important insights: First, it turned out to be impossible to explain any psychopathological syndrome exclusively in terms of neuropathological, i. e. structural alterations, in particular, a syndrome presenting with a sudden onset of dissociative and conversion symptoms. Secondly, the psychiatric theory of hysteria of Charcot and Freud was developed and extended further. And, last, the etiology of war neurosis was recognized to be multifactorial. Thus, the discourse on this issue was not one-dimensional and favoring a single explanation for a complex disorder, but revealed "pluridimensional" features. Subsequently psychotherapy, for the first time, was widely introduced into clinical practice with a clear indication and well-defined methodological approach. In summary, war neuroses can be addressed as an early model of traumatic stress disorder, such as acute stress disorder or post-traumatic stress disorder.

Exposures to war-related traumatic events and post-traumatic stress disorder symptoms among displaced Darfuri female university students: an exploratory study.

PubMed

Badri, Alia; Crutzen, Rik; Van den Borne, H W

2012-08-03

With the deaths of hundreds of thousands and the displacement of up to three million Darfuris, the increasingly complex and on-going war in Darfur has warranted the need to investigate war-related severity and current mental health levels amongst its civilian population. The purpose of this study is to explore the association between war-related exposures and assess post-traumatic stress disorder (PTSD) symptoms amongst a sample of Darfuri female university students at Ahfad University for Women (AUW) in Omdurman city. An exploratory cross-sectional study among a representative sample of Darfuri female university students at AUW (N = 123) was conducted in February 2010. Using an adapted version of the Harvard Trauma Questionnaire (HTQ), war-related exposures and post-traumatic stress disorder (PTSD) symptoms were assessed. Means and standard deviations illustrated the experiential severity of war exposure dimensions and PTSD symptom sub-scales, while Pearson correlations tested for the strength of association between dimensions of war exposures and PTSD symptom sub-scales. Approximately 42 % of the Darfuri participants reported being displaced and 54 % have experienced war-related traumatic exposures either as victims or as witnesses (M = 28, SD = 14.24, range 0 - 40 events). Also, there was a strong association between the experiential dimension of war-related trauma exposures and the full symptom of PTSD. Moreover, the refugee-specific self-perception of functioning sub-scale within the PTSD measurement scored a mean of 3.2 (SD = .56), well above the 2.0 cut-off. This study provides evidence for a relationship between traumatic war-related exposures and symptom rates of PTSD among AUW Darfuri female students. Findings are discussed in terms of AUW counseling service improvement.

Behavioral Problems and Emotional Difficulties at Children and Early Adolescents of the Veterans of War with Post-Traumatic Stress Disorder.

PubMed

Selimbasic, Zihnet; Sinanovic, Osman; Avdibegovic, Esmina; Brkic, Maja; Hamidovic, Jasmin

2017-02-01

Behavioral problems and emotional difficulties at children of the veterans of war with post-traumatic stress disorder (PTSD) have not been researched entirely. In our country, which has a lot of persons suffering from some psychological traumas, this trauma seems to continue. The aim of this study was to determine the exposure, manifestations of behavioral problems and emotional difficulties at children and early adolescents, whose fathers were the veterans of war demonstrating post-traumatic stress disorder symptoms. The analyzed group comprised 120 school age children (10-15 years of age), whose parents/fathers were the veterans of war. The children were divided into two groups, and each group into the following two age sub-groups: 10-12 (children) and 13-15 (early adolescents) according to PTSD presence at their fathers - veterans of war. PTSD symptoms at fathers, veterans of war, were assessed using the Harvard Trauma Questionnaire-Bosnia and Herzegovina version and MKB-10 - audit of criteria. To assess the behavioral problems of children, the Child Behavior Checklist for parents was used, and to evaluate the neuroticism at children Hanes-Scale of neuroticism-extraversion was used while the depression level was evaluated using the Depression self-rating scale (DSRS). To analyze the obtained results, SPSS 17 program was used. The value p <0. 05 is considered significant. Children of fathers, the veterans of war, demonstrating the PTSD symptoms show more problems in activity, social and school conduct as well as in symptoms of behavioral problems compared to the children whose fathers do not demonstrate the PTSD symptoms (p<0. 001). Children of the war veterans demonstrating the symptoms of the post-traumatic stress disorder show significant difference at neuroticism sub-scales (p<0.001). Negative correlation between PTSD and activity, social and school conduct has been determined (p <0. 01), while positive correlation was determined between PTSD of war veterans

[Medical indoor environment counsellor (MIEC) in Burgundy: evaluation by physicians and patients].

PubMed

Vagner, A; Reboux, G; Nicoullaud, V; Blanchon, L; Scherer, P; Collet, E; Camus, P; Foglia, T; Gardin, G; Bonniaud, P

2013-11-01

Since December 2009, chest physicians and allergologists in Burgundy have been able to call upon a medical indoor environment counsellor (MIEC). The consultations are free for the patient and are undertaken following a medical referal after systematic cutaneous prick tests. To describe the indications, the distribution of prescriptions and to measure the impact of the counsellor's visits on the first 100 patients at 6 months and on the physicians at 18 months. Telephone interviews with the 67 physicians (whether prescribers or not) concerning their motivation and/or expectations, and with the first 100 patients concerning follow up of the recommendations. Seventy percent of the physicians replied (n=47). The satisfaction of prescribers (n=22) was 8.42/10. The indications were rhinitis and a poorly controlled asthma. The requests concerned the search for dust mite (50%) and moulds (46%). Eighty-four percent of the physicians discussed the MIEC's report with the patients. The patients' symptoms were rhinitis (79%), asthma (57%) and conjunctivitis (33%). The Acarex test(®), performed in cases of positive prick tests to house dust mites (n=72), was strongly positive for 67 patients. Sixteen mould samples out of 21 were above the standard concentrations. Sixty-nine patients had followed the recommendations of the MIEC. The impact of the MIEC visits was perceived as positive by the physicians and the patients. The medico-economic impact warrants further evaluation. Copyright © 2013 SPLF. Published by Elsevier Masson SAS. All rights reserved.

"Have You Talked with a Teacher Yet?": How Helpline Counsellors Support Young Callers Being Bullied at School

ERIC Educational Resources Information Center

Danby, Susan; Butler, Carly W.; Emmison, Michael

2011-01-01

When seeking help and support about being bullied, children and young people weigh up the benefits and risks of talking to their friends, parents, teachers and counsellors about their experiences. The focus of this article is calls to an Australian helpline for children and young people where the strategy of "talking to the teacher" is…

The American Home Front: Revolutionary War, Civil War, World War I, World War II

DTIC Science & Technology

1983-01-01

ledgm ents ................................................... xvii WAR AND SOCIETY IN AMERICA: SOME QUESTIONS ..... I 1. THE AMERICAN REVOLUTION 5 The...Price of War ...................................... 6 A Revolutionary Society at War ............................ 8 The Revolutionary Economy...obilizing the Union for War .................................... 67 Civil War and American Society . ................................ 71 O rganizing the

Suicide among war veterans.

PubMed

Rozanov, Vsevolod; Carli, Vladimir

2012-07-01

Studies aiming to identify if war veterans are at higher risk of suicide have often produced inconsistent results; this could be due to the complexity of comparisons and different methodological approaches. It should be noted that this contingent has many risk factors, such as stressful exposures, wounds, brain trauma and pain syndrome. Most recent observations confirm that veterans are really more likely to die of suicide as compared to the general population; they are also more likely to experience suicidal ideation and suffer from mental health problems. Suicides are more frequent in those who develop PTSD, depression and comorbid states due to war exposure. Combat stress and its' frequency may be an important factor leading to suicide within the frame of the stress-vulnerability model. According to this model, the effects of stress may interact with social factors, interpersonal relations and psychological variables producing suicidal tendencies. Modern understanding of stress-vulnerability mechanisms based on genetic predispositions, early life development, level of exposure to stress and stress-reactivity together with interpersonal aspects may help to build more effective suicide prevention programs based on universal/selective/indicated prevention principles.

Suicide among War Veterans

PubMed Central

Rozanov, Vsevolod; Carli, Vladimir

2012-01-01

Studies aiming to identify if war veterans are at higher risk of suicide have often produced inconsistent results; this could be due to the complexity of comparisons and different methodological approaches. It should be noted that this contingent has many risk factors, such as stressful exposures, wounds, brain trauma and pain syndrome. Most recent observations confirm that veterans are really more likely to die of suicide as compared to the general population; they are also more likely to experience suicidal ideation and suffer from mental health problems. Suicides are more frequent in those who develop PTSD, depression and comorbid states due to war exposure. Combat stress and its’ frequency may be an important factor leading to suicide within the frame of the stress-vulnerability model. According to this model, the effects of stress may interact with social factors, interpersonal relations and psychological variables producing suicidal tendencies. Modern understanding of stress-vulnerability mechanisms based on genetic predispositions, early life development, level of exposure to stress and stress-reactivity together with interpersonal aspects may help to build more effective suicide prevention programs based on universal/selective/indicated prevention principles. PMID:22851956

Responding to Self-Harm in the School Setting: The Experience of Guidance Counsellors and Teachers in Ireland

ERIC Educational Resources Information Center

Dowling, Susan; Doyle, Louise

2017-01-01

School-based studies identify that while 1 in 10 young people engages in self-harm, only a small minority seek professional help. School counsellors and teachers are potentially the only professionals who may be aware of a young person's self-harm; however, little is known about how this impacts on them and how they might be best supported to…

Dispositional optimism and self-esteem as competing predictors of acute symptoms of generalized anxiety disorders and dissociative experiences among civilians exposed to war trauma.

PubMed

Weinberg, Michael; Besser, Avi; Zeigler-Hill, Virgil; Neria, Yuval

2015-01-01

Although previous studies have rarely examined predictors of acute emotional responses to war trauma, this "natural laboratory" study aimed to examine the role that individual differences in dispositional optimism and self-esteem play in the development of acute symptoms of generalized anxiety disorder (GAD) and dissociative experiences. A sample of 140 female adults exposed to missile and rocket fire during an eruption of violence in the Middle East in November 2012 was assessed during real-time exposure. The results demonstrate inverse associations between dispositional optimism and acute symptoms of GAD and dissociation. The associations were accounted for by individual differences in self-esteem. In addition, individuals with low levels of dispositional optimism demonstrated a higher risk for acute GAD and dissociative experiences, in part because of their low levels of self-esteem. Theoretical and clinical implications of the findings are discussed. (c) 2015 APA, all rights reserved).

Mental- and physical-health effects of acute exposure to media images of the September 11, 2001, attacks and the Iraq War.

PubMed

Silver, Roxane Cohen; Holman, E Alison; Andersen, Judith Pizarro; Poulin, Michael; McIntosh, Daniel N; Gil-Rivas, Virginia

2013-09-01

Millions of people witnessed early, repeated television coverage of the September 11 (9/11), 2001, terrorist attacks and were subsequently exposed to graphic media images of the Iraq War. In the present study, we examined psychological- and physical-health impacts of exposure to these collective traumas. A U.S. national sample (N = 2,189) completed Web-based surveys 1 to 3 weeks after 9/11; a subsample (n = 1,322) also completed surveys at the initiation of the Iraq War. These surveys measured media exposure and acute stress responses. Posttraumatic stress symptoms related to 9/11 and physician-diagnosed health ailments were assessed annually for 3 years. Early 9/11- and Iraq War-related television exposure and frequency of exposure to war images predicted increased posttraumatic stress symptoms 2 to 3 years after 9/11. Exposure to 4 or more hr daily of early 9/11-related television and cumulative acute stress predicted increased incidence of health ailments 2 to 3 years later. These findings suggest that exposure to graphic media images may result in physical and psychological effects previously assumed to require direct trauma exposure.

Joint Global War on Terror (GWOT) Vascular Injury Study 2

DTIC Science & Technology

2016-02-01

Iraq. This study proposes to link acute injury and clinical management information from the Joint Theater Trauma Registry (JTTR) to authentic patient...of patient based outcomes following extremity vascular injury in the wars in Afghanistan and Iraq. This study proposes to link acute injury and...deployment, training 3. ACCOMPLISHMENTS: What were the major goals of the project?  Study Phase I ( Acute and Mid-Term Data Collection): o

Analysis of the First 100 Patients From the Syrian Civil War Treated in an Israeli District Hospital.

PubMed

Biswas, Seema; Waksman, Igor; Baron, Shay; Fuchs, David; Rechnitzer, Hagai; Dally, Najib; Kassis, Shokrey; Hadary, Amram

2016-01-01

An analysis of the injuries and treatment of the first 100 patients from the Syrian civil war was conducted to monitor quality of care and outcome. As reports of the collapse of health care systems in regions within Syria reach the media, patients find themselves crossing the border into Israel for the treatment of war injuries. Among these patients are combatants, noncombatants, women, and children. Treatment, that is free at the point of care, is a humanitarian imperative for war wounded, and this paper reports the care in an Israeli district hospital of the first 100 patients received. With ethics committee approval, data from the Trauma Registry and electronic patient records were collected and analyzed. No identifying data are presented. Most patients (94) were male. Seventeen patients were younger than the age of 18 years; 52 patients were in their twenties. Most injuries were the results of gunshot or blast injury (50 and 29 patients, respectively). Two multiple-trauma patients died, 8 were transferred for specialist care, and 90 patients returned from Ziv Hospital to Syria after discharge. The experience of the care of patients across a hostile border has been unprecedented. Hospital protocols required adjustment to deliver quality clinical and social care to patients suffering from both the acute and chronic effects of civil war.

Female Veterans of Iraq and Afghanistan seeking care from VA specialized PTSD Programs: comparison with male veterans and female war zone veterans of previous eras.

PubMed

Fontana, Alan; Rosenheck, Robert; Desai, Rani

2010-04-01

Differences in the characteristics and mental health needs of female veterans of the Iraq/Afghanistan war compared with those of veterans of other wars may have useful implications for VA program and treatment planning. Female veterans reporting service in the Iraq/Afghanistan war were compared with women reporting service in the Persian Gulf and Vietnam wars and to men reporting service in the Iraq/Afghanistan war. Subjects were drawn from VA administrative data on veterans who sought outpatient treatment from specialized posttraumatic stress disorder (PTSD) treatment programs. A series of analyses of covariance (ANCOVA) was used to control for program site and age. In general, Iraq/Afghanistan and Persian Gulf women had less severe psychopathology and more social supports than did Vietnam women. In turn, Iraq/Afghanistan women had less severe psychopathology than Persian Gulf women and were exposed to less sexual and noncombat nonsexual trauma than their Persian Gulf counterparts. Notable differences were also found between female and male veterans of the Iraq/Afghanistan war. Women had fewer interpersonal and economic supports, had greater exposure to different types of trauma, and had different levels of diverse types of pathology than their male counterparts. There appear to be sufficient differences within women reporting service in different war eras and between women and men receiving treatment in VA specialized treatment programs for PTSD that consideration should be given to program planning and design efforts that address these differences in every program treating female veterans reporting war zone service.

Exposures to war-related traumatic events and post-traumatic stress disorder symptoms among displaced Darfuri female university students: an exploratory study

PubMed Central

2012-01-01

Background With the deaths of hundreds of thousands and the displacement of up to three million Darfuris, the increasingly complex and on-going war in Darfur has warranted the need to investigate war-related severity and current mental health levels amongst its civilian population. The purpose of this study is to explore the association between war-related exposures and assess post-traumatic stress disorder (PTSD) symptoms amongst a sample of Darfuri female university students at Ahfad University for Women (AUW) in Omdurman city. Methods An exploratory cross-sectional study among a representative sample of Darfuri female university students at AUW (N = 123) was conducted in February 2010. Using an adapted version of the Harvard Trauma Questionnaire (HTQ), war-related exposures and post-traumatic stress disorder (PTSD) symptoms were assessed. Means and standard deviations illustrated the experiential severity of war exposure dimensions and PTSD symptom sub-scales, while Pearson correlations tested for the strength of association between dimensions of war exposures and PTSD symptom sub-scales. Results Approximately 42 % of the Darfuri participants reported being displaced and 54 % have experienced war-related traumatic exposures either as victims or as witnesses (M = 28, SD = 14.24, range 0 – 40 events). Also, there was a strong association between the experiential dimension of war-related trauma exposures and the full symptom of PTSD. Moreover, the refugee-specific self-perception of functioning sub-scale within the PTSD measurement scored a mean of 3.2 (SD = .56), well above the 2.0 cut-off. Conclusions This study provides evidence for a relationship between traumatic war-related exposures and symptom rates of PTSD among AUW Darfuri female students. Findings are discussed in terms of AUW counseling service improvement. PMID:22863107

Dimensions of Cognitive Dissonance and the Level of Job Satisfaction among Counsellors in Delta and Edo States, Nigeria

ERIC Educational Resources Information Center

Oduh, William Akporobaroh

2016-01-01

This study examined the dimensions of cognitive dissonance and the extent to which cognitive dissonance could influence the level of job satisfaction of guidance counsellors. The study was guided by three research questions and one null hypothesis. The design of the study was correlational survey. The population of the study was 158 practising…

Posttraumatic stress disorder in women with war missing family members.

PubMed

Baraković, Devla; Avdibegović, Esmina; Sinanović, Osman

2014-12-01

Research in crisis areas indicate that survivors' responses to the forced disappearance of family members are similar to reactions to other traumatic events. The aim of this study was to determine the presence of symptoms of posttraumatic stress disorder (PTSD) in women with war missing family members in Bosnia and Herzegovina 18 years after the war in this region (1992-1995). The study included 160 women aged 47.1±14.0 from three regions of Bosnia and Herzegovina. It was carried out in the period from April 2010 to May 2011. Of the 160 participants, 120 women had a war missing family member and 40 women had no war missing family members. The Harvard Trauma Questionnaire (HTQ), the Beck Depression Inventory (BDI) and the Hamilton Anxiety Rating Scale (HAMA) were used for data collection. Basic socio-demographic data and data concerning the missing family members were also collected. Women with war missing family members experienced significantly more traumatic war experiences (18.43±5.27 vs 6.57±4.34, p<0.001). There was a significant difference between the two groups in the total PTSD score (2.48±0.59 vs 1.79±0.53, p<0.001), as well as in the intensity of depression (26.63±13.05 vs 10.32±6.58, p<0.001) and anxiety (21.0±10.69 vs 11.27±7.93, p<0.001). Anxiety and traumatic war experiences were significant predictors of PTSD in the group with war missing family members. Women with war missing family members showed significantly more severe PTSD symptoms. Based on the results of this study, it was determined that the forced disappearance of a family member is an ambiguous situation that can be characterized as a traumatic experience.

Effectiveness of psychosocial intervention enhancing resilience among war-affected children and the moderating role of family factors.

PubMed

Diab, Marwan; Peltonen, Kirsi; Qouta, Samir R; Palosaari, Esa; Punamäki, Raija-Leena

2015-02-01

The study examines, first, the effectiveness of a psychosocial intervention based on Teaching Recovery Techniques (TRT) to increase resiliency among Palestinian children, exposed to a major trauma of war. Second, it analyses the role of family factors (maternal attachment and family atmosphere) as moderating the intervention impacts on resilience. School classes in Gaza were randomized into intervention (N=242) and control (N=240) groups. The percentage of girls (49.4%) and boys (50.6%) were equal, and the child age was 10-13 years in both groups. Children reported positive indicators of their mental health (prosocial behaviour and psychosocial well-being) at baseline (T1), post-intervention (T2) and at a six-month follow-up (T3). At T1 they accounted their exposure to war trauma. Mothers reported about their willingness to serve as an attachment figure, and the child reported about the family atmosphere. Resilience was conceptualized as a presence of positive indications of mental health despite trauma exposure. Against our hypothesis, the intervention did not increase the level of resilience statistically significantly, nor was the effect of the intervention moderated by maternal attachment responses or family atmosphere. Copyright © 2014 Elsevier Ltd. All rights reserved.

Trauma and the state with Sigmund Freud as witness.

PubMed

Danto, Elizabeth Ann

Just before and after the end of World War I, Sigmund Freud took on an activist role and in his writings and speeches, redirected the concept of war trauma from individual failure to a larger issue of community responsibility. Testifying in Vienna as an expert witness for the state, Freud said that the military psychiatrists-not the soldiers-had "acted like machine guns behind the front" and were the "immediate cause of all war neurosis." Freud was called on by the legal community when Julius Wagner-Jauregg, a future Nobel Prize winner (and also future Nazi Party adherent), head of the municipal Clinic for Psychiatry and Nervous Diseases, was accused of the lethal use of electrotherapy on shell-shocked soldiers. As sociological as psychoanalytic in his responses, Freud's withering critique came just 2years after he avowed that "it is possible to foresee that the conscience of society will awake." That speech on the human right to mental health care affirmed Freud's alliance to the social democratic position and inspired the second generation of psychoanalysts to develop community-based clinics throughout Europe where treatment was free of cost, for war neurosis and beyond. Copyright © 2016 Elsevier Ltd. All rights reserved.

Blast injury prevalence in skeletal remains: Are there differences between Bosnian war samples and documented combat-related deaths?

PubMed

Dussault, Marie Christine; Hanson, Ian; Smith, Martin J

2017-11-01

Court cases at the International Criminal Tribunal for the Former Yugoslavia (ICTY) have seen questions raised about the recognition and causes of blast-related trauma and the relationship to human rights abuses or combat. During trials, defence teams argued that trauma was combat related and prosecutors argued that trauma was related to executions. We compared a sample of 81 cases (males between 18 and 75) from a Bosnian mass grave investigation linked to the Kravica warehouse killings to published combat-related blast injury data from World War One, Vietnam, Northern Ireland, the first Gulf War, Operation Iraqi Freedom and Afghanistan. We also compared blast fracture injuries from Bosnia to blast fracture injuries sustained in bombings of buildings in two non-combat 'civilian' examples; the Oklahoma City and Birmingham pub bombings. A Chi-squared statistic with a Holm-Bonferroni correction assessed differences between prevalence of blast-related fractures in various body regions, where data were comparable. We found statistically significant differences between the Bosnian and combat contexts. We noted differences in the prevalence of head, torso, vertebral area, and limbs trauma, with a general trend for higher levels of more widespread trauma in the Bosnian sample. We noted that the pattern of trauma in the Bosnian cases resembled the pattern from the bombing in buildings civilian contexts. Variation in trauma patterns can be attributed to the influence of protective armour; the context of the environment; and the type of munition and its injuring mechanism. Blast fracture injuries sustained in the Bosnian sample showed patterns consistent with a lack of body armour, blast effects on people standing in enclosed buildings and the use of explosive munitions. Copyright © 2017 The Chartered Society of Forensic Sciences. Published by Elsevier B.V. All rights reserved.

Internationally Minded: A Phenomenological Exploration of School Counsellors' Experiences Working in U.S. Schools with Internationally Themed Missions

ERIC Educational Resources Information Center

Ostvik-de Wilde, Marte; Na, GoEun

2018-01-01

School counsellors are uniquely equipped to impact school culture due to their expertise in adopting a systemic perspective while facilitating culturally competent services. This study sought to understand the school culture that places importance on developing U.S. students' appreciation for world cultures and emerging global mindsets. The…

International Registry of Counsellor Education Programs: CACREP's Contribution to the Development of Counseling as a Global Profession

ERIC Educational Resources Information Center

Stanard, Rebecca Powell

2013-01-01

This article addresses the issues and challenges involved in the development of the counseling profession internationally and the role that quality assurance plays in its development. It chronicles the development of the International Registry for Counsellor Education Programs and its contributions, a critical analysis of the strengths and…

Psychological Disturbances of War-traumatized Children from Different Foster and Family Settings in Bosnia and Herzegovina

PubMed Central

Hasanović, Mevludin; Sinanović, Osman; Selimbašić, Zihnet; Pajević, Izet; Avdibegović, Esmina

2006-01-01

Aim To assess the psychological health of war-traumatized children in different foster settings and compare them with children living with one or both parents, 7 years after the 1992-1995 war in Bosnia and Herzegovina. Method The study was carried out in Tuzla, Bosnia and Herzegovina, in March 2002. We assessed 186 (93 girls and 93 boys) elementary school children aged 12.7 ± 1.8 years for war trauma, presence of posttraumatic stress disorder (PTSD), and depression. There were 38 (14 girls) children from the government orphanage, 48 (24 girls) children from the non-governmental organization (NGO) SOS Children’s Village, 50 (24 girls) children who lost a parent in the war but lived with the surviving parent, and 50 (31 girls) children who lived with both parents. For data collection, we used Children’s Posttraumatic Stress Reaction Index and Children’s Depression Inventory. Basic sociodemographic data were also collected. Results Of 186 children, 90 (48.4%) had been forced into refuge because of the war. Loss of a family member was most frequent among children in the SOS Children’s Village, who also experienced the highest number of other types of trauma. PTSD was present in 51.6% of 186 children, with the highest prevalence among children in the SOS Children’s Village (39/48). PTSD prevalence was higher among children who lost a parent but lived with the surviving parent (29/50) then among children in the orphanage (15/38) or children living with both parents (13/50) (χ23 = 33.075, P<0.001). Depression was present in 42 of 186 (22.6%) children, but with no statistical difference among the groups (χ23 = 6.337, P = 0.096). The prevalence of PTSD and depression was similar in boys and girls. Loss of a parent was associated with higher frequency of PTSD and depression. The loss of both parents was associated with high prevalence of PTSD, but not depression. Prevalence of PTSD was positively correlated with the prevalence of depression

The Complexity of Trauma Response: A 4-Year Follow-up of Adolescent Cambodian Refugees

ERIC Educational Resources Information Center

Rousseau, Cecile; Drapeau, Aline; Rahimi, Sadeq

2003-01-01

Objective: The objective of this study was to document the psychosocial adjustment of young refugees during their adolescence and its association with the war-related trauma experienced by their family before migration. Method: Data were collected on 57 young Khmer resettled in Montreal and followed from early to late adolescence. The associations…

Two faces of death: fatalities from disease and combat in America's principal wars, 1775 to present.

PubMed

Cirillo, Vincent J

2008-01-01

Throughout America's first 145 years of war, far more of the country's military personnel perished from infectious diseases than from enemy action. This enduring feature of war was finally reversed in World War II, chiefly as a result of major medical advances in prevention (vaccines) and treatment (antibiotics). Safeguarding the health of a command is indispensable for the success of any campaign. Wars are lost by disease, which causes an enormous drain on the military's resources and affects both strategy and tactics. Disease and combat mortality data from America's principal wars (1775-present) fall into two clearly defined time periods: the Disease Era (1775-1918), during which infectious diseases were the major killer of America's armed forces, and the Trauma Era (1941-present), in which combat-related fatalities predominated. The trend established in World War II continues to the present day. Although there are currently more than 3,400 U.S. military fatalities in Iraq, the disease-death toll is so low that it is exceeded by the number of suicides.

Intergenerational transmission of biased information processing in posttraumatic stress disorder (PTSD) following displacement after World War II.

PubMed

Wittekind, Charlotte E; Jelinek, Lena; Kellner, Michael; Moritz, Steffen; Muhtz, Christoph

2010-12-01

An attentional bias for trauma-related stimuli has been demonstrated in individuals with posttraumatic stress disorder (PTSD). However, few studies have investigated how biological relatives of individuals with PTSD process trauma-relevant information. To investigate whether parental PTSD is associated with an attentional bias for trauma-related stimuli in adult offspring, we compared performance of individuals displaced after World War II with (n=22) and without PTSD (n=24) to a non-displaced healthy control group (n=11) and their respective offspring as to their processing of trauma-related stimuli in an emotional Stroop task. Evidence for biased information processing was neither found in individuals with PTSD nor their offspring. Possible explanations for the findings and implications for future studies are discussed. Copyright © 2010 Elsevier Ltd. All rights reserved.

Role of focused assessment with sonography for trauma as a screening tool for blunt abdominal trauma in young children after high energy trauma.

PubMed

Tummers, W; van Schuppen, J; Langeveld, H; Wilde, J; Banderker, E; van As, A

2016-06-01

The objective of the study was to review the utility of focused assessement with sonography for trauma (FAST) as a screening tool for blunt abdominal trauma (BAT) in children involved in high energy trauma (HET), and to determine whether a FAST could replace computed tomography (CT) in clinical decision-making regarding paediatric BAT. Children presented at the Trauma Unit of the Red Cross War Memorial Children's Hospital, Cape Town, after HET, and underwent both a physical examination and a FAST. The presence of free fluid in the abdomen and pelvis was assessed using a FAST. Sensitivity, specificity, and positive and negative predictive values (PPV and NPV) for identifying intraabdominal injury were calculated for the physical examination and the FAST, both individually and when combined. Seventy-five patients were included as per the criteria for HET as follows: pedestrian motor vehicle crashes (MVCs) ( n = 46), assault ( n = 14), fall from a height ( n = 9), MVC passenger ( n = 4) and other ( n = 2). The ages of the patients ranged from 3 months to 13 years. The sensitivity of the physical examination was 0.80, specificity 0.83, PPV 0.42 and NPV 0.96. The sensitivity of the FAST was 0.50, specificity 1.00, PPV 1.00 and NPV 0.93. Sensitivity increased to 0.90 when the physical examination was combined with the FAST. Nonoperative management was used in 73 patients. Two underwent an operation. A FAST should be performed in combination with a physical examination on every paediatric patient involved in HET to detect BAT. When both are negative, nonoperative management can be implemented without fear of missing a clinically significant injury. FAST is a safe, effective and easily accessible alternative to CT, which avoids ionising radiation and aids in clinical decision-making.

Surgical advances during the First World War: the birth of modern orthopaedics.

PubMed

Ramasamy, Arul; Eardley, W G P; Edwards, D S; Clasper, J C; Stewart, M P M

2016-02-01

The First World War (1914-1918) was the first truly industrial conflict in human history. Never before had rifle fire and artillery barrage been employed on a global scale. It was a conflict that over 4 years would leave over 750,000 British troops dead with a further 1.6 million injured, the majority with orthopaedic injuries. Against this backdrop, the skills of the orthopaedic surgeon were brought to the fore. Many of those techniques and systems form the foundation of modern orthopaedic trauma management. On the centenary of 'the War to end all Wars', we review the significant advances in wound management, fracture treatment, nerve injury and rehabilitation that were developed during that conflict. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Extremity War Injuries X: Return to Health and Function.

PubMed

Davila, Col Jeffrey N; Swiontkowski, Marc F; Andersen, Col Ret Romney C

2016-09-01

The symposium Extremity War Injuries X: Return to Health and Function, presented by the American Academy of Orthopaedic Surgeons, the Orthopaedic Trauma Association, the Society of Military Orthopaedic Surgeons, and the Orthopaedic Research Society, was held in Washington, DC, on January 27 and 28, 2015. Course chairs Marc F. Swiontkowski, MD, and COL Jeffrey N. Davila, MD, presided over 2 days of general session lectures focusing on war/trauma-related musculoskeletal injuries resulting in service member disability, followed by small group discussions, with a goal of identifying knowledge gaps in the treatment of these injuries. Recognized civilian and military clinicians and researchers summarized the current state of knowledge in their topic areas and led these discussion groups with meeting participants. Musculoskeletal conditions discussed included posttraumatic osteoarthritis of the knee, foot, and ankle and their relationship to chronic ligament injuries; back disability; peripheral nerve injury; hand transplantation updates; the role of biologics; and prosthetic acceptance and function. A scientific program highlighting research presented by 12 investigators was led by COL (Ret) Romney C. Andersen, MD. Keynote speaker LT GEN Douglas J. Robb, MD, discussed the future of military research funding and the anticipated consolidation of medical care among the three military branches. Additional presentations referencing the impact of military medical care and the government's continued commitment to funding medical research occurred throughout the symposium and were given by five congressional representatives.

Biomechanics of penetrating trauma.

PubMed

Yoganandan, N; Pintar, F A

1997-01-01

It is well known that injuries and deaths due to penetrating projectiles have become a national and an international epidemic in Western society. The application of biomedical engineering to solve day-to-day problems has produced considerable advances in safety and mitigation/prevention of trauma. The study of penetrating trauma has been largely in the military domain where war-time specific applications were advanced with the use of high-velocity weapons. With the velocity and weapon caliber in the civilian population at half or less compared with the military counterpart, wound ballistics is a largely different problem in today's trauma centers. The principal goal of the study of penetrating injuries in the civilian population is secondary prevention and optimized emergency care after occurrence. A thorough understanding of the dynamic biomechanics of penetrating injuries quantifies missile type, caliber, and velocity to hard and soft tissue damage. Such information leads to a comprehensive assessment of the acute and long-term treatment of patients with penetrating injuries. A review of the relevant military research applied to the civilian domain and presentation of new technology in the biomechanical study of these injuries offer foundation to this field. Relevant issues addressed in this review article include introduction of the military literature, the need for secondary prevention, environmental factors including projectile velocity and design, experimental studies with biological tissues and physical models, and mathematical simulations and analyses. Areas of advancement are identified that enables the pursuit of biomechanics research in order to arrive at better secondary prevention strategies.

Image Making and Personal Narratives with Japanese-American Survivors of World War II Internment Camps

ERIC Educational Resources Information Center

Yates, Carleen; Kuwada, Kali; Potter, Penelope; Cameron, Danielle; Hoshino, Janice

2007-01-01

This qualitative study explored the verbal and art making responses of Japanese-American elders who experienced the trauma of internment during World War II. Six Nisei (second generation Japanese-Americans) were asked to recall memories of their experiences during and immediately following internment; 3 of the participants also created art images…

Returning Veterans on Campus with War Related Injuries and the Long Road Back Home

ERIC Educational Resources Information Center

Church, Thomas E.

2009-01-01

This article reviews the growing numbers of returning military personnel attending higher education based on emerging national trends, including the new GI Educational Bill, amendments to the ADA, and the rising unemployment rate. The trauma of war and the high survival rate have resulted in a high percentage of veterans returning from the Global…

Psychological distress of parents in conflict areas: the mediating role of war atrocities, normative stressors and family resources.

PubMed

Khamis, Vivian

2017-04-01

Despite the ongoing controversy regarding which types of stressors or resources contribute to psychological distress, there has been little research examining the relationship between war trauma, normative stressors, family resources for management and psychopathology. This study investigated the differences between mothers and fathers in psychological distress, normative stressors and war atrocities experienced, and family's resources for management. It was hypothesized that a combination of risk variables and protective variables would be predictive of psychological distress in parents. Questionnaires were used with 205 Palestinian parents from Gaza Strip. Mothers had more psychiatric disorders than did fathers. Although, mothers and fathers were exposed to comparable levels of normative stressors, mothers concerns about intrafamily strains, and family legal violations were greater than they were for fathers. Results revealed that fathers possess a larger repertoire of resources for management when compared to mothers reflected in esteem and communication, mastery and health, extended family social support and financial well-being. However, mastery and health seem to buffer the effect of war traumas and normative stressors on neuroticism in both parents. The different patterns of predictor-outcome relations have practical as well as theoretical implications.

Trajectories of attachment in older age: interpersonal trauma and its consequences.

PubMed

Bachem, Rahel; Levin, Yafit; Solomon, Zahava

2018-06-04

Previous studies suggest that attachment insecurities may increase after trauma exposure, an effect documented only at a group level. This study explores the heterogeneity of changes over time and examines the associations of the nature of the traumatic event (interpersonal and nonpersonal), and its consequences (posttraumatic stress disorder [PTSD] and loneliness) with attachment trajectories. Two groups of Israeli veterans participated: 164 former prisoners-of-war and 185 combat veterans. Attachment was assessed at four points (1991-2015). Risk factors were evaluated in 1991. Using latent growth mixture modeling, trajectories of attachment insecurities were explored. Three avoidance trajectories (stability, decrease, inverse u-shaped) and two anxiety trajectories (stability, decrease) were identified. The inverse u-shaped avoidance trajectory was associated with captivity, humiliation, loneliness, and PTSD, and stable avoidance was associated with loneliness. Stable anxiety was associated with captivity and loneliness. Attachment insecurities can change during aging and persist decades after a trauma. Trauma-related risk factors are related to more deleterious trajectories.

War-related stressors are associated with asthma risk among older Kuwaitis following the 1990 Iraqi invasion and occupation.

PubMed

Wright, R J; Fay, M E; Suglia, S Franco; Clark, C J; Evans, J S; Dockery, D W; Behbehani, J

2010-07-01

Contemporary warfare involving civilian populations is a growing public health concern. In addition to the psychological impact, war-related trauma may result in physiological alterations and even broader health effects. Associations were examined between war-related stressors and incident asthma in elderly Kuwaiti civilians following the Iraqi invasion. A random sample of all Kuwaiti nationals aged 50-69 years on the day prior to the invasion were identified. Among the 7873 meeting eligibility criteria, 5567 (71%) agreed to participate and 5028 completed the questionnaire (91% of those eligible). Of these, 3759 were in Kuwait during the invasion, of whom 2294 were alive at follow-up. After exclusions for prevalent asthma or missingness on covariates, 2066 were available for analysis. War-related experiences were summarised into a continuous score using Rasch modelling. Relative Cox proportional hazard rates (HR) were calculated for asthma adjusting for covariates. Over 13 years of follow-up, physician-diagnosed asthma was reported by 66/996 (6.6%) men and 104/1070 (9.7%) women. In models adjusted for gender, socioeconomic status, smoking, BMI, and air pollution related to burning oil fires, those reporting highest stress exposure were more than twice as likely to report asthma (HR 2.3, 95% CI 1.3, 3.9) compared to civilians reporting no stressors. Experiences were more salient when anchored to fear for loss of life. War-related trauma is associated with increased asthma risk in these elderly civilians. Although prior research has documented the significant and persistent psychological toll of war, these findings implicate even broader health effects.

Cultural Trauma and Christian Identity in the Late Medieval Heroic Epic, The Siege of Jerusalem.

PubMed

DeMarco, Patricia A

2015-01-01

This essay examines scenes of violence in the late medieval poem The Siege of Jerusalem in order to reveal the ways in which trauma is used as the grounds upon which Christian/Jewish difference is established. In particular, I argue that this poem serves as an example of a widespread element in Christian chivalric identity, namely the need to manage the repetitive invocation of Christ's crucifixion (ritually repeated through liturgical and poetic invocation) as a means of asserting both the bodily and psychic integrity of the Christian subject in contrast to the violently abjected figure of the Jewish body. The failure of The Siege protagonist, Wespasian, to navigate the cultural trauma of the crucifixion is contrasted to the successful management of trauma by the martial hero, Tancred, in Tasso's epic, Gerusalemme Liberata, illustrating the range of imaginative possibilities for understanding trauma in pre-modern war literature.

Women and War

PubMed Central

Murdoch, Maureen; Bradley, Arlene; Mather, Susan H; Klein, Robert E; Turner, Carole L; Yano, Elizabeth M

2006-01-01

Most of today's 1.7 million women veterans obtain all or most of their medical care outside the VA health care system, where their veteran status is rarely recognized or acknowledged. Several aspects of women's military service have been associated with adverse psychologic and physical outcomes, and failure to assess women's veteran status, their deployment status, and military trauma history could delay identifying or treating such conditions. Yet few clinicians know of women's military history—or of military service's impact on women's subsequent health and well being. Because an individual's military service may be best understood within the historical context in which it occurred, we provide a focused historical overview of women's military contributions and their steady integration into the Armed Forces since the War for Independence. We then describe some of the medical and psychiatric conditions associated with military service. PMID:16637946

As They Like It--Culture-Centred Counsellor Education in the Context of Aotearoa New Zealand: A Play on Bicultural Pluralism

ERIC Educational Resources Information Center

Lang, Steve K. W.; Gardiner, Brent D.

2014-01-01

Against a backdrop of social struggles to rebalance power between colonisers and indigenous peoples, counsellor education at a university in Aotearoa New Zealand is undergoing a transformation. This article explores the creation and application of a framework that results from listening to the voices of indigenous peoples and counselling…

"Doomed to go in company with miserable pain": surgical recognition and treatment of amputation-related pain on the Western Front during World War 1.

PubMed

Edwards, Dafydd S; Mayhew, Emily R; Rice, Andrew S C

2014-11-08

The principal feature of injuries from World War 1 was musculoskeletal trauma and injury to peripheral nerves as a result of damage to the upper and lower limbs caused by gunshot wounds and fragments of artillery munitions. Amputation was used as a treatment in field hospitals to save lives; limb conservation was a secondary consideration. A century later, the principal feature of injuries to soldiers in today's wars in Iraq and Afghanistan is also musculoskeletal trauma and injury to the peripheral nerves caused by improvised explosive devices. Common to both types of injury is postamputation pain. We searched The Lancet's archives in this Series paper to show the efforts of surgeons in World War 1 to understand and treat postamputation pain in its own right both during and immediately after the war. Despite unprecedented patient numbers and levels of civilian medical expertise, little progress was made in providing relief from this type of pain, a grave concern to the surgeons treating these soldiers. Today postamputation pain is understood beyond a surgical context but remains a complex and poorly understood condition with few effective treatments. Copyright © 2014 Elsevier Ltd. All rights reserved.

Croatian war veterans in print media in 1996 and in 2006.

PubMed

Frančišković, Tanja; Stevanović, Aleksandra; Blažić, Danijela; Petrić, Daniela; Suković, Zoran; Tovilović, Zdravko; Moro, Iva Nemčić

2011-06-01

The media have an important role in maintaining and creating social relations and social environment. This especially refers to the war and post-war period in which the media can form a part of the prevention context, i.e., the media can facilitate the process of recovery from war trauma, but they can also contribute to stigmatization and retraumatization. Our aim was to analyze Croatian newspaper reports about Croatian war veterans and to determine the differences in ways of dealing with the subject during 1996 and 2006. The data were gathered by reviewing two daily papers, Novi list and Ve?ernji list and Globus weekly. The analysis included newspaper reports related to the subject of Croatian war veterans, published in the first six months of 1996 and 2006. Quantitative and qualitative methods were used to analyze both the form and the content of the reports. A total of 538 newspaper reports were published in the above-stated periods. In the first half of 2006 the number of reports related to the subject of Croatian war veterans dropped 6.5 percent compared to the first half of 1996. Topics prevalent at the end of the war were different from those ten years later. The 1996 articles mostly reported on activities organized by various associations, medal-awarding ceremonies, military operations etc. Ten years later the topics focused on war crimes, trials of Croatian war generals and dissatisfaction with veterans' rights and legislation. Moreover, articles relating to crime and reports about suicides and attempts of suicide increased significantly in 2006. During the ten-year period, the media image of Croatian war veterans significantly changed, which was expected owing to different social circumstances immediately after the war and ten years later. The prevalence of topics negative in tone and a lack of proactive stories reflect, but also create, a social context which can affect the process of recovery from traumatization.

Disentangling Sense of Coherence and Resilience in case of multiple traumas.

PubMed

Fossion, Pierre; Leys, Christophe; Kempenaers, Chantal; Braun, Stéphanie; Verbanck, Paul; Linkowski, Paul

2014-05-01

Depressive and anxiety disorders (DAD) are a major public health problem. Trauma endured during childhood is known to increase the risk of DAD in adulthood. We investigate the hypothesis that Sense of Coherence (SOC) is a mediator between childhood trauma and depressive and anxious symptoms (DAD) in adulthood. We also explore the nature (personality trait or aptitude) of SOC and attempt to disentangle the concepts of resilience and SOC. Former hidden children (FHC), the Jewish youths who spent World War II in various hideaway shelters across Nazi-occupied Europe, were compared with a control group. In each group we measured the presence of multiple traumas, the resilience with the Resilience Scale for Adults, the DAD with the Hopkins Symptoms Checklist and the SOC with the SOC-13 self-report questionnaire. We tested a mediated moderation model with childhood Trauma as the predictor; Adulthood trauma as the moderator; SOC as the mediator; and DAD as the outcome variable. Results were consistent with a sensitization model of DAD partially mediated by SOC. A first component of SOC was similar to an aptitude and another part of SOC was more similar to a personality trait. We are unable to differentiate if the sensitization process is a consequence of the nature of the trauma endured by FHC (long-standing exposure to extreme external events) or a consequence of the fact that this first trauma occurred during childhood. Our results could account for the controversial debate regarding the life time stability of SOC. Copyright © 2014 Elsevier B.V. All rights reserved.

Post-Traumatic Stress Disorder and Childhood Trauma: A Proposed Addition to the APA DSM-IV-R.

ERIC Educational Resources Information Center

Quinn, Kathleen L.

Literature exists to support the statement that children suffer from Post Traumatic Stress Disorder (PTSD). The diagnosis is not one that is commonly made in children and is generally considered occurring in returning war veterans or adult victims of trauma, including incest. The American Psychological Association (APA) Diagnostic and Statistical…

Emergency Physicians at War.

PubMed

Muck, Andrew E; Givens, Melissa; Bebarta, Vikhyat S; Mason, Phillip E; Goolsby, Craig

2018-05-01

Operation Enduring Freedom (OEF-A) in Afghanistan and Operation Iraqi Freedom (OIF) represent the first major, sustained wars in which emergency physicians (EPs) fully participated as an integrated part of the military's health system. EPs proved invaluable in the deployments, and they frequently used the full spectrum of trauma and medical care skills. The roles EPs served expanded over the years of the conflicts and demonstrated the unique skill set of emergency medicine (EM) training. EPs supported elite special operations units, served in medical command positions, and developed and staffed flying intensive care units. EPs have brought their combat experience home to civilian practice. This narrative review summarizes the history, contributions, and lessons learned by EPs during OEF-A/OIF and describes changes to daily clinical practice of EM derived from the combat environment.

Primary care management of non-English-speaking refugees who have experienced trauma: a clinical review.

PubMed

Crosby, Sondra S

2013-08-07

Refugees are a vulnerable class of immigrants who have fled their countries, typically following war, violence, or natural disaster, and who have frequently experienced trauma. In primary care, engaging refugees to develop a positive therapeutic relationship is challenging. Relative to care of other primary care patients, there are important differences in symptom evaluation and developing treatment plans. To discuss the importance of and methods for obtaining refugee trauma histories, to recognize the psychological and physical manifestations of trauma characteristic of refugees, and to explore how cultural differences and limited English proficiency affect the refugee patient-clinician relationship and how to best use interpreters. MEDLINE and the Cochrane Library were searched from 1984 to 2012. Additional citations were obtained from lists of references from select research and review articles on this topic. Engagement with a refugee patient who has experienced trauma requires an understanding of the trauma history and the trauma-related symptoms. Mental health symptoms and chronic pain are commonly experienced by refugee patients. Successful treatment requires a multidisciplinary approach that is culturally acceptable to the refugee. Refugee patients frequently have experienced trauma requiring a directed history and physical examination, facilitated by an interpreter if necessary. Intervention should be sensitive to the refugee's cultural mores.

Stress Coping Strategies among Guidance Counsellors in the Performance of Their Jobs in Secondary Schools Delta North Senatorial District

ERIC Educational Resources Information Center

Onoyase, Anna

2015-01-01

The study was set out to investigate stress coping strategies among Guidance Counsellors in the performance of their jobs. One research question and four hypotheses were formulated to guide the study. Two instruments were used to collect data for the study. One hundred and ten copies of the instruments were administered on one hundred and ten…

Comorbidity of PTSD and depression in Korean War veterans: prevalence, predictors, and impairment.

PubMed

Ikin, Jillian F; Creamer, Mark C; Sim, Malcolm R; McKenzie, Dean P

2010-09-01

Rates of PTSD and depression are high in Korean War veterans. The prevalence and impact of the two disorders occurring comorbidly, however, has not been investigated. This paper aims to investigate the extent to which PTSD and depression co-occur in Australian veterans of the Korean War, the symptom severity characteristics of comorbidity, the impact on life satisfaction and quality, and the association with war-related predictors. Veterans (N=5352) completed self-report questionnaires including the Posttraumatic Stress Disorder Checklist, the Hospital Anxiety and Depression Scale, the Life Satisfaction Scale, the brief World Health Organisation Quality of Life questionnaire and the Combat Exposure Scale. Seventeen percent of veterans met criteria for comorbid PTSD and depression, 15% had PTSD without depression, and a further 6% had depression without PTSD. Compared with either disorder alone, comorbidity was associated with impaired life satisfaction, reduced quality of life, and greater symptom severity. Several war-related factors were associated with comorbidity and with PTSD alone, but not with depression alone. The reliance on self-reported measures and the necessity for retrospective assessment of some deployment-related factors renders some study data vulnerable to recall bias. Comorbid PTSD and depression, and PTSD alone, are prevalent among Korean War veterans, are both associated with war-related factors 50 years after the Korean War, and may represent a single traumatic stress construct. The results have important implications for understanding complex psychopathology following trauma. 2010 Elsevier B.V. All rights reserved.

Victimization and adversity among children experiencing war-related parental absence or deployment in a nationally representative US sample.

PubMed

Turner, Heather A; Finkelhor, David; Hamby, Sherry; Henly, Megan

2017-05-01

This study compares children and youth who have experienced lifetime war-related parental absence or deployment with those having no such history on a variety of victimization types, non-victimization adversity, trauma symptoms, and delinquency; and assesses whether cumulative adversity and victimization help to explain elevated emotional and behavioral problems among children of parents who have experienced war-related absence or deployment. The National Surveys of Children's Exposure to Violence (NatSCEV) are comprised of three cross-sectional telephone surveys conducted in 2008, 2011, and 2014. Data were collected on the experiences of children aged one month to seventeen years. In each survey, interviews were conducted with youth 10-17 years old and with caregivers of children 0-9 years old. The analyses use pooled data from all three U.S. nationally-representative samples (total sample size of 13,052). Lifetime parental war-related absence or deployment was a marker for elevated childhood exposure to a wide array of victimization and adversity types. Cumulative past year exposure to multiple forms of victimization and adversity fully explained elevated trauma symptoms and delinquency in this population of children. Given the breadth of victimization and adversity risk, children with histories of parental war-related absence or deployment, as well as their families, represent important target groups for broad-based prevention and interventions to reduce exposure and ameliorate consequences when it does occur. Copyright © 2017 Elsevier Ltd. All rights reserved.

Fairy Tales and Other Stories as Spiritual Guides for Children of War: An Auto-Ethnographic Perspective

ERIC Educational Resources Information Center

Feuerverger, Grace

2010-01-01

This article dares to suggest that the use of fairy tales as a pedagogical tool for children in and out of classrooms is and always will be about uplifting the human spirit: a way to survive; a pathway toward hope, especially for vulnerable children suffering from the trauma of war. (Contains 1 note.)

The psychodynamic treatment of combat neuroses (PTSD) with hypnosis during World War II.

PubMed

Watkins, J G

2000-07-01

In a large Army hospital during World War II, a full-time program in hypnotherapy for battle trauma cases was developed. Symptoms included severe anxiety, phobias, conversions, hysterias, and dissociations. Many hypnoanalytic techniques were used, especially including abreactions. Good therapeutic results were frequent, as demonstrated by typical cases. There was no evidence that the abreactive procedure tended to retraumatize patients or initiate psychotic reactions.

What are the risk factors for the comorbidity of posttraumatic stress disorder and depression in a war-affected population? A cross-sectional community study in South Sudan.

PubMed

Ayazi, Touraj; Lien, Lars; Eide, Arne H; Ruom, Majok Malek; Hauff, Edvard

2012-10-19

Limited data exists on the association of war trauma with comorbid posttraumatic stress disorder (PTSD)-depression in the general population of low-income countries. The present study aimed to evaluate socioeconomic and trauma-related risk factors associated with PTSD, depression, and PTSD-depression comorbidity in the population of Greater Bahr el Ghazal States, South Sudan. In this cross-sectional community study (n=1200) we applied the Harvard Trauma Questionnaire (HTQ) and MINI International Neuropsychiatric Interview (MINI) to investigate the prevalence of PTSD, depression, and PTSD-depression comorbidity. Multinomial logistic regression analyses were conducted to examine the association between these disorders, previous trauma exposure, sociodemographic, and socioeconomic factors. PTSD only was found in 331 (28%) and depression only in 75 (6.4%) of the study population. One hundred and twelve (9.5%) of the participants had PTSD-depression comorbid diagnosis. Exposure to traumatic events and socioeconomic disadvantage were significantly associated with having PTSD or PTSD-depression comorbidity but not with depression. Participants with a comorbid condition were more likely to be socioeconomic disadvantaged, have experienced more traumatic events, and showed higher level of psychological distress than participants with PTSD or depression alone. In individuals exposed to war trauma, attention should be given to those who may fulfill criteria for a diagnosis of both PTSD and depression.

Trauma- and Stressor Related Disorders in the Tuareg Refugees of a Camp in Burkina Faso

PubMed Central

Carta, M.G.; Oumar, F. Wallet; Moro, M.F.; Moro, D.; Preti, A.; Mereu, A.; Bhugra, D.

2013-01-01

Background: Post-traumatic stress disorder (PTSD) is reported to be common among refugees. We set out to explore risk of Trauma- and Stress-or-Related Disorders and the associated burden of psychological distress in a refugee camp of Malian Refugees in Burkina Faso. Methods: One out of five persons living in the camp was selected randomly and interviewed using the French version of the Short Screening Scale for PTSD and the validated K6 scale to measure psychiatric morbidity. Results: Around 60% of the interviewed sample (N=408) met the criteria for Trauma- and Stress-or-Related Disorders and also reported severe mental distress on K6 scores. Women aged 40 and over were found to be at higher risk of Trauma- and Stress-or-Related Disorders whereas young people (39 or younger) scored higher on K6 ratings. Around 83% of the surveyed subjects had a family member killed in the war, 91% a relative in the war, more than 80% had a family member suffering from physical injuries, and 90% reported problems with food and housing. The frequency of these life events was not surprisingly higher in persons with Trauma- and Stress-or-Related Disorders, with the death of a family member and severe problems with food being specifically related to them.Conclusion: These results point to important psychological suffering in a population that is often ignored by the media and international political authorities. Immediate steps are required to provide urgent legal and humanitarian protection to those who are forced to flee their homes and cross international borders because of disasters. PMID:24285982

Cultural Trauma and Christian Identity in the Late Medieval Heroic Epic, The Siege of Jerusalem.

PubMed

DeMarco, Patricia A

2015-01-01

This essay examines scenes of violence in the late medieval poem The Siege of Jerusalem in order to reveal the ways in which trauma is used as the grounds upon which Christian/Jewish difference is established. In particular, I argue that this poem serves as an example of a widespread element in Christian chivalric identity, namely the need to manage the repetitive invocation of Christ's crucifixion (ritually repeated through liturgical and poetic invocation) as a means of asserting both the bodily and psychic integrity of the Christian subject in contrast to the violently abjected figure of the Jewish body. The failure of The Siege protagonist, Wespasian, to navigate the cultural trauma of the crucifixion is contrasted to the successful management of trauma by the martial hero, Tancred, in Tasso's epic, Gerusalemme Liberata, illustrating the range of imaginative possibilities for understanding trauma in pre-modern war literature.

Military-to-civilian translation of battlefield innovations in operative trauma care.

PubMed

Haider, Adil H; Piper, Lydia C; Zogg, Cheryl K; Schneider, Eric B; Orman, Jean A; Butler, Frank K; Gerhardt, Robert T; Haut, Elliott R; Mather, Jacques P; MacKenzie, Ellen J; Schwartz, Diane A; Geyer, David W; DuBose, Joseph J; Rasmussen, Todd E; Blackbourne, Lorne H

2015-12-01

Historic improvements in operative trauma care have been driven by war. It is unknown whether recent battlefield innovations stemming from conflicts in Iraq/Afghanistan will follow a similar trend. The objective of this study was to survey trauma medical directors (TMDs) at level 1-3 trauma centers across the United States and gauge the extent to which battlefield innovations have shaped civilian practice in 4 key domains of trauma care. Domains were determined by the use of a modified Delphi method based on multiple consultations with an expert physician/surgeon panel: (1) damage control resuscitation (DCR), (2) tourniquet use, (3) use of hemostatic agents, and (4) prehospital interventions, including intraosseous catheter access and needle thoracostomy. A corresponding 47-item electronic anonymous survey was developed/pilot tested before dissemination to all identifiable TMD at level 1-3 trauma centers across the US. A total of 245 TMDs, representing nearly 40% of trauma centers in the United States, completed and returned the survey. More than half (n = 127; 51.8%) were verified by the American College of Surgeons. TMDs reported high civilian use of DCR: 95.1% of trauma centers had implemented massive transfusion protocols and the majority (67.7%) tended toward 1:1:1 packed red blood cell/fresh-frozen plasma/platelets ratios. For the other 3, mixed adoption corresponded to expressed concerns regarding the extent of concomitant civilian research to support military research and experience. In centers in which policies reflecting battlefield innovations were in use, previous military experience frequently was acknowledged. This national survey of TMDs suggests that military data supporting DCR has altered civilian practice. Perceived relevance in other domains was less clear. Civilian academic efforts are needed to further research and enhance understandings that foster improved trauma surgeon awareness of military-to-civilian translation. Copyright © 2015

[The war at home: "war amenorrhea" in the First World War].

PubMed

Stukenbrock, Karin

2008-01-01

In 1917, the Göttingen gynaecologist Dietrich published a short article about a phenomenon which he called "war amenorrhea" ("Kriegsamenorrhoe"). The article attracted the attention of his colleagues. While the affected women did not pay much attention to their amenorrhea, the physicians considered the phenomenon a new disease which was mainly caused by the war. This new disease gave the gynaecologists the opportunity to present their specialty as a discipline with high relevance for medicine in times of war. Nevertheless, there was no consensus about the importance, the incidence, the diagnostic criteria, the causes and the appropriate therapy of"war amenorrhea". Although the gynaecologists failed to define a uniform clinical syndrome, they maintained the construction of "war amenorrhea" after the war and subsumed it under well known types of amenorrhea. We can conclude that under the conditions of war a new disease emerged which was not sharply defined.

Competence training in evidence-based medicine for patients, patient counsellors, consumer representatives and health care professionals in Austria: a feasibility study.

PubMed

Berger, Bettina; Gerlach, Anja; Groth, Sylvia; Sladek, Ulla; Ebner, Katharina; Mühlhauser, Ingrid; Steckelberg, Anke

2013-01-01

Informed and shared decision-making require competences for both partners - healthcare professionals and patients. There is a lack of training courses in evidence-based medicine for patients and counsellors. We investigated feasibility, acceptability and the potential effects of a 2 x 2.5 days training course on critical health competences in patients, patient counsellors, consumer representatives and healthcare professionals in Austria. We adapted a previously developed curriculum for patient and consumer representatives. The adaptation comprised the specific needs of our target group in Austria and was founded on Carl Rogers' theory of person-centred education. For the formative evaluation a questionnaire was applied to address the domains: 1) organisational conditions (time and duration of the course, location, and information given in advance, registration); 2) assistance outside the courses; 3) teaching methods (performance of lecturers, teaching materials, structure of modules and blocks) and 4) satisfaction; 5) subjective assessment of competences. Participants evaluated the course, using a 5-point Likert scale. Long-term implementation was assessed using semi-structured interviews three to six months after the course. To estimate the increase in critical health competences we used the validated Critical Health Competence Test (CHC test). Eleven training courses were conducted including 142 participants: patients (n=21); self-help group representatives (n=17); professional counsellors (n=29); healthcare professionals (n=10); psychologists (n=8); teachers (n=10) and others (n=29). 97 out of 142 (68 %) participants returned the questionnaire. On average, participants strongly agreed or agreed to 1) organisational conditions: 71 % / 23 %; 2) assistance outside the courses: 96 % / 10 %; 3) teaching methods: 60 % / 28 %; and 4) satisfaction: 78 % / 20 %, respectively. Interviews showed that the training course raised awareness, activated and empowered

Low levels of posttraumatic stress symptoms and psychiatric symptomatology among third-generation Holocaust survivors whose fathers were war veterans.

PubMed

Zerach, Gadi; Solomon, Zahava

2016-02-01

There is an ongoing debate regarding the intergenerational transmission of Holocaust trauma to the third generation (TGH). However, due to the rareness of this population, there are no studies that have examined TGH individuals whose fathers were also victims of war-related trauma and captivity. This prospective study aimed to assess the role of parents' Holocaust background, fathers' posttraumatic stress symptoms (PTSS), and adult offspring's anxiety sensitivity (AS) in adult offspring's PTSS and psychiatric symptomatology. A sample of 123 Israeli father-child dyads (42 TGH and 71 non-TGH), that included 80 former prisoners of war (ex-POWs) dyads and a comparison group of 44 veteran dyads, completed AS, PTSS and psychiatric symptomatology self-report measures. Fathers were assessed 17 years following the Yom Kippur War (T1: 2008) while offspring took part in T2 (2013-2014). Surprisingly, results show that TGH participants reported lower levels of PTSS and psychiatric symptomatology than non-TGH participants, regardless of their fathers' captivity status. Interestingly, a moderated mediation analysis indicated that offspring's AS mediated the association between Holocaust background and participants' PTSS and psychiatric symptomatology, only among ex-POWs' offspring. This study provides evidence for relatively lower levels of PTSS and psychiatric symptomatology among TGH individuals whose fathers were war veterans. Ex-POWs' adult offspring who are grandchildren of Holocaust survivors reported lower levels of AS that was related to lower levels of PTSS and psychiatric symptomatology. Copyright © 2015 Elsevier Ltd. All rights reserved.

[Neuropsychological sequelae of deportation to the Nazi concentration camps during the Second World War].

PubMed

Abalan, F; Martínez-Gallardo, R; Bourgeois, M

1989-01-01

The essential neuropsychic consequences of the deportation to the nazi concentration camps of adults during the second world war are the "KZ syndrome", the survival syndrome (or persecution syndrome) and reactive schizophrenias. The "KZ syndrome" puts together a psychic asthenia, a progressive intellectual deterioration, anxiety, depressive mood and vegetative disturbances. It is brought about as a consequence of malnutrition and the psychic traumas suffered by those deported. It shows up mainly in the non-jewish deported. The survival syndrome is chronic, puts together anxiety, insomnia and nightmares, repetitive memories relative to the period of persecution, depressive symptoms, somatic complaints, neurovegetative disturbances and hypervigilance. It is observed mainly in those deported that are jewish. It is produced as a consequence of very severe psychic traumas suffered by the jewish deportees. Some reactive schizophrenias described in deported jews seem to be the direct consequence of psychic traumas of an extreme intensity.

Risk factors for injury acute renal in patients with severe trauma and its effect on mortality.

PubMed

Baitello, André Luciano; Marcatto, Gustavo; Yagi, Roberto Kaoru

2013-01-01

The studies which associated acute kidney injury (AKI) and trauma emerged during the Second World War, and since then we have seen a progressive evolution of healthcare aiming at AKI prevention. However, establishing the risk factors for post-trauma AKI development remains crucial and may help reduce this complication. This study aims at identifying risk factors vis-à-vis the development of AKI in patients with severe trauma and its impact on mortality. This is a retrospective study of 75 patients with severe trauma. Six were taken off because they arrived at the hospital past the point of resuscitation. The variables considered were age, gender, trauma severity according to the Injury Severity Score (ISS) and the Glasgow Coma Scale (GCS), trauma mechanism, mean blood pressure upon admission, fluid replacement in the first 24 hours, serum creatinine levels, use of nephrotoxic antibiotics, length of hospital stay, need for ICU admission and mortality. The prevalence of AKI in severe trauma patients was 17.3%, and the factors associated with ARF in this sample were Head Injury and GCS < 10. Mortality, length of hospital stay and the need for ICU were significantly higher in patients who developed AKI. The identification of these risk factors is of paramount importance for the development of care strategies for patients suffering from severe trauma, for the prevention of acute kidney injury and the associated high mortality.

New Phenomenon of Abnormal Auditory Perception Associated with Emotional and Head Trauma: Pathological Confirmation by SPECT Scan

ERIC Educational Resources Information Center

Stephane, Massoud; Hill, Thomas; Matthew, Elizabeth; Folstein, Marshal

2004-01-01

We report the case of an immigrant who suffered from death threats and head trauma while a prisoner of war in Kuwait. Two months later, he began to hear conversations that had taken place previously. These perceptions occurred spontaneously or were induced by the patient's effortful concentration. The single photon emission computerized tomography…

Quality of life in caregivers of severely disabled war survivors.

PubMed

Mousavi, Batool; Seyed Hoseini Davarani, Seyed Hosein; Soroush, Mohammadreza; Jamali, Arsia; Khateri, Shahriar; Talebi, Morteza; Montazeri, Ali

2015-01-01

To evaluate quality of life (QOL) of caregivers of severely disabled war survivors and identify variables threatening caregivers' QOL. A cross-sectional study was performed on 532 caregivers of Iran-Iraq war related injured survivors by using Persian version of 36-item Short Form Health Survey (SF-36). Caregivers had lower QOL compared to the Iranian female population (p < .001). Caregivers of amputees had better SF-36 scores compared to caregivers of two groups of chemical warfare survivors (p ranging from .01 to <.001). Caregiving to chemical warfare and being married at the time of trauma were the independent predictors of poor QOL in both the physical component summary (OR = 5.08, 95% CI = 3.35-7.7; OR = 0.57, 95% CI = 0.37-0.89) and the mental component summary (OR = 4.12, 95% CI = 2.68-6.32; OR = 0.63, 95% CI = 0.40-0.98). Caregivers of war veterans suffer from poor QOL. Chemical warfare agents contribute to more persistent poor QOL in caregivers than the injuries caused by conventional weapons. © 2014 Association of Rehabilitation Nurses.

The epidemiology of vascular injury in the wars in Iraq and Afghanistan.

PubMed

White, Joseph M; Stannard, Adam; Burkhardt, Gabriel E; Eastridge, Brian J; Blackbourne, Lorne H; Rasmussen, Todd E

2011-06-01

Blood vessel trauma leading to hemorrhage or ischemia presents a significant cause of morbidity and mortality after battlefield injury. The objective of this study is to characterize the epidemiology of vascular injury in the wars of Iraq and Afghanistan, including categorization of anatomic patterns, mechanism, and management of casualties. The Joint Theater Trauma Registry was interrogated (2002-2009) for vascular injury in US troops to identify specific injury (group 1) and operative intervention (group 2) groups. Battle-related injuries (nonreturn to duty) were used as the denominator to establish injury rates. Mechanism of injury was compared between theaters of war and the management strategies of ligation versus revascularization (repair and interposition grafting) reported. Group 1 included 1570 Troops injured in Iraq (OIF) (n = 1390) and Afghanistan (OEF) (n = 180). Mechanism included explosive (73%), gunshot (27%), and other (<1%) with explosive more common in OIF than OEF (P < 0.05). During this period, 13,076 battle-related injuries occurred resulting in a specific rate of 12% (1570 of 13,076), which was higher in OIF than OEF (12.5% vs 9% respectively; P < 0.05). Of group 1, 60% (n = 940) sustained injury to major or proximal vessels and 40% (n = 630) to minor or distal vessels (unknown vessel, n = 27). Group 2 (operative) comprised 1212 troops defining an operative rate of 9% (1212 of 13,076) and included ligation (n = 660; 54%) or repair (n = 552; 46%). Peak rates in OIF and OEF occurred in November 2004 (15%) and August 2009 (11%), respectively and correlated with combat operational tempo. The rate of vascular injury in modern combat is 5 times that reported in previous wars and varies according to theater of war, mechanism of injury and operational tempo. Methods of reconstruction are now applied to nearly half of the vascular injuries and should be a focus of training for combat surgery. Selective ligation of vascular injury remains an important

Quality of care after early childhood trauma and well-being in later life: child Holocaust survivors reaching old age.

PubMed

van der Hal-Van Raalte, Elisheva; Van Ijzendoorn, Marinus H; Bakermans-Kranenburg, Marian J

2007-10-01

The link between deprivation and trauma during earliest childhood and psychosocial functioning and health in later life was investigated in a group of child Holocaust survivors. In a nonconvenience sample 203 survivors, born between 1935 and 1944, completed questionnaires on Holocaust survival experience and several inventories on current health, depression, posttraumatic stress, loneliness, and attachment style. Quality of postwar care arrangements and current physical health independently predicted lack of well-being in old age. Loss of parents during the persecution, year of birth of the survivors (being born before or during the war), and memories of the Holocaust did not significantly affect present well-being. Lack of adequate care after the end of World War II is associated with lower well-being of the youngest Holocaust child survivors, even after an intervening period of 60 years. Our study validates Keilson's (1992) concept of "sequential traumatization," and points to the importance of aftertrauma care in decreasing the impact of early childhood trauma.

Hearing loss in former prisoners of war of the Japanese.

PubMed

Grossman, T W; Kerr, H D; Byrd, J C

1996-09-01

To describe the prevalence, degree, and types of hearing loss present in a group of older American veterans who had been prisoners of war of the Japanese. A descriptive study. A Veterans Affairs university hospital. Seventy-five male veterans, mean age 68 (+/- 3.6) years. Hearing aids were prescribed for eight veterans. Subjects were examined, and pure tone air and bone conduction, speech reception threshold, and speech discrimination were determined. Results were compared with age- and sex-matched controls from the largest recent American population study of hearing loss. 95% of subjects had been imprisoned longer than 33 months. Starvation conditions (100%), head trauma (85%), and trauma-related loss of consciousness (23%) were commonly reported. A total of 73% complained of hearing loss, and 29% (22/75) dated its onset to captivity. Most of those with the worst losses in hearing and speech discrimination were found in this subgroup. When the entire group was compared with published age- and sex-matched controls from the Framingham Study, no significant differences were found. We advocate screening examinations and long-term follow-up of populations with similar histories of starvation, head trauma, and torture.

Posttraumatic Stress Disorder in Infants and Young Children Exposed to War-Related Trauma

ERIC Educational Resources Information Center

Feldman, Ruth; Vengrober, Adva

2011-01-01

Objective: Although millions of the world's children are growing up amidst armed conflict, little research has described the specific symptom manifestations and relational behavior in young children exposed to wartime trauma or assessed factors that chart pathways of risk and resilience. Method: Participants included 232 Israeli children 1.5 to 5…

Follow-up care by a genetic counsellor for relatives at risk for cardiomyopathies is cost-saving and well-appreciated: a randomised comparison.

PubMed

Nieuwhof, Karin; Birnie, Erwin; van den Berg, Maarten P; de Boer, Rudolf A; van Haelst, Paul L; van Tintelen, J Peter; van Langen, Irene M

2017-02-01

Increasing numbers of patient relatives at risk of developing dilated or hypertrophic cardiomyopathy (DCM/HCM) are being identified and followed up by cardiologists according to the ACC/ESC guidelines. However, given limited healthcare resources, good-quality low-cost alternative approaches are needed. Therefore, we have compared conventional follow-up by a cardiologist with that provided at a cardiogenetic clinic (CGC) led by a genetic counsellor. Phenotype-negative first-degree relatives at risk for DCM/HCM were randomly assigned to see either a cardiologist or to attend a CGC. Uptake and resource use were recorded. For 189 participants, we evaluated quality of care experienced, patient satisfaction and perceived personal control (PPC) using validated questionnaires and estimated the average cost difference of these two modes of care. Maximum patient satisfaction scores were achieved more frequently at the CGC (86% vs 45%, P<0.01). In terms of follow-up care provided, the genetic counsellor did not perform worse than the cardiologist (95% vs 59%, P<0.01). The genetic counsellor more often enquired about the relative-at risk's health (100% vs 65%, P<0.01) and family health (97% vs 33%, P<0.01), measured blood pressure (98% vs 29%, P<0.01) and gave disease-specific information (77% vs 52%, P<0.01). Although PPC scores were equal in both groups, the average cost per patient of CGC follow-up was 25% lower. Follow-up of phenotype-negative relatives at risk for DCM/HCM at a CGC led to greater patient satisfaction and is well-appreciated at lower cost. CGC care is a good alternative to conventional cardiological follow-up for this growing group of patients.

Trauma care at rural level III trauma centers in a state trauma system.

PubMed

Helling, Thomas S

2007-02-01

Although much has been written about the benefits of trauma center care, most experiences are urban with large numbers of patients. Little is known about the smaller, rural trauma centers and how they function both independently and as part of a larger trauma system. The state of Missouri has designated three levels of trauma care. The cornerstone of rural trauma care is the state-designated Level III trauma center. These centers are required to have the presence of a trauma team and trauma surgeon but do not require orthopedic or neurosurgical coverage. The purpose of this retrospective study was to determine how Level III trauma centers compared with Level I and Level II centers in the Missouri trauma system and, secondly, how trauma surgeon experience at these centers might shape future educational efforts to optimize rural trauma care. During a 2-year period in 2002 and 2003, the state trauma registry was queried on all trauma admissions for centers in the trauma system. Demographics and patient care outcomes were assessed by level of designation. Trauma admissions to the Level III centers were examined for acuity, severity, and type of injury. The experiences with chest, abdominal, and neurologic trauma were examined in detail. A total of 24,392 patients from 26 trauma centers were examined, including all eight Level III centers. Acuity and severity of injuries were higher at Level I and II centers. A total of 2,910 patients were seen at the 8 Level III centers. Overall deaths were significantly lower at Level III centers (Level I, 4% versus Level II, 4% versus Level III, 2%, p < 0.001). Numbers of patients dying within 24 hours were no different among levels of trauma care (Level I, 37% versus Level II, 30% versus Level III, 32%). Among Level III centers 45 (1.5%) patients were admitted in shock, and 48 (2%) had a Glasgow Coma Scale score <9. Twenty-six patients had a surgical head injury (7 epidural, 19 subdural hematomas). Twenty-eight patients (1%) needed

Shared War reality effects on the professional quality of life of mental health professionals.

PubMed

Pruginin, Itay; Segal-Engelchin, Dorit; Isralowitz, Richard; Reznik, Alexander

2016-01-01

To date, studies on the outcomes of a shared war reality among mental health professionals (MHPs) in southern Israel have focused only on those residing and working in Otef Gaza. The aim of this study is to determine the impact of different exposure levels to shared trauma on the professional quality of life of MHPs in southern Israel. This study compares the level of secondary traumatic stress, burnout, and compassion satisfaction of social workers from Otef Gaza to social workers living and working in the Beer-Sheva area who experience occasional missile attacks. The Professional Quality of Life Scale was used to examine the level of secondary traumatic stress, burnout, and compassion satisfaction of 125 social workers living and working in the Negev: 72 from Beer-Sheva and 53 from the regional councils of Otef Gaza. No statistically significant differences were found in the three professional quality of life variables between the Otef-Gaza and Beer-Sheva groups. The lack of secondary traumatic stress and burnout differences between the study groups, despite the chronic exposure to terror attacks among the Otef Gaza social workers, may be explained by the strong sense of belonging and support evidenced by many Otef Gaza residents as well as by the comprehensive trauma training MHPs receive for work in the region. The results of this study are important for health policy geared to trauma prevention efforts, moderating the effects of work under shared war reality, and promoting the professional quality of life of MHPs in conflict areas.

When the war was over, little changed: women's posttraumatic suffering after the war in Mozambique.

PubMed

Igreja, Victor; Kleijn, Wim; Richters, Annemiek

2006-07-01

This article explores the psychosocial effects of women's prolonged exposure to civil war in the center of Mozambique. Using a combination of quantitative and qualitative methods, 91 women were assessed for posttraumatic stress symptoms and psychosocial indicators of ill health. The results indicate that for the majority of the women in this study, traumatic experiences are sequential processes. Their ill health ranges from symptoms of posttraumatic stress to episodes of spirit possession (gamba), affecting women's capacities to conceive and raise children, and marginalizing their social position. A careful analysis of the specific problems and needs of women in postwar contexts is recommended, along with a systematic examination of the effectiveness of the available resources that may play a role in boosting trauma recovery in this group of women.

Military Trauma and Social Development: The Moderating and Mediating Roles of Peer and Sibling Relations in Mental Health

ERIC Educational Resources Information Center

Peltonen, Kirsi; Qouta, Samir; El Sarraj, Eyad; Punamaki, Raija-Leena

2010-01-01

We first examined how war-related traumatic events impact on peer and sibling relations, and how the quality of these relations in turn are associated with children's mental health, indicating a mediation model. Second, we tested the moderating (protective) effects of good peer and sibling relations in attenuating the link between trauma and…

Patterns of trauma and violence in 19th-century-born African American and Euro-American females.

PubMed

de la Cova, Carlina

Trauma and violence has been a topic of interest to biological anthropologists. This study examined the presence of trauma, including interpersonal violence, in a sample (n=256) of African American and Euro-American females of low socioeconomic status, born from 1800 to 1877, from the Terry Collection. Individuals were statistically analyzed according to ancestry (African American and Euro-American), birth (Antebellum, Civil War, Reconstruction), and birth status (Enslaved Black, Pre-Reconstruction White, Liberated Black, Reconstruction White) cohorts to determine if differences in trauma and fracture patterning existed between African Americans and Euro-Americans. Results indicated that there were significant differences. African American females had higher rates of cranial, nasal, and hand phalanx trauma and Euro-Americans had larger frequencies of hip and radial fractures. This variation in fracture patterning could have been the result of intimate partner violence, interpersonal violence, osteoporosis, or accidental injury. Historical research revealed that many of these women were inmates in mental hospitals, further suggesting that the observed trauma may have been the result of interpersonal and structural violence induced by institutionalization. Copyright © 2012 Elsevier Inc. All rights reserved.

Trauma systems and the costs of trauma care.

PubMed Central

Goldfarb, M G; Bazzoli, G J; Coffey, R M

1996-01-01

OBJECTIVE. This study examines the cost of providing trauma services in trauma centers organized by publicly administered trauma systems, compared to hospitals not part of a formal trauma system. DATA SOURCES AND STUDY SETTING. Secondary administrative discharge abstracts for a national sample of severely injured trauma patients in 44 trauma centers and 60 matched control hospitals for the year 1987 were used. STUDY DESIGN. Retrospective univariate and multivariate analyses were conducted to examine the impact of formal trauma systems and trauma center designation on the costs of treating trauma patients. Key dependent variables included length of stay, charge per day per patient, and charge per hospital stay. Key impact variables were type of trauma system and level of trauma designation. Control variables included patient, hospital, and community characteristics. DATA COLLECTION/EXTRACTION METHODS. Data were selected for hospitals based on (1) a large national hospital discharge database, the Hospital Cost and Utilization Project, 1980-1987 (HCUP-2) and (2) a special survey of trauma systems and trauma designation undertaken by the Hospital Research and Educational Trust of the American Hospital Association. PRINCIPAL FINDINGS. The results show that publicly designated Level I trauma centers, which are the focal point of most trauma systems, have the highest charge per case, the highest average charge per day, and similar or longer average lengths of stay than other hospitals. These findings persist after controlling for patient injury and health status, and for demographic characteristics and hospital and community characteristics. CONCLUSIONS. Prior research shows that severely injured trauma patients have greater chances of survival when treated in specialized trauma centers. However, findings here should be of concern to the many states developing trauma systems since the high costs of Level I centers support limiting the number of centers designated at this

A review of blood transfusions in a trauma unit for young children.

PubMed

Salverda, M; Ketharanathan, N; Van Dijk, M; Beltchev, E; Buys, H; Numanoglu, A; Van As, A B

2017-02-27

Trauma is the leading cause of mortality and morbidity worldwide. Blood transfusions play an incremental role in the acute phase, yet practice varies owing to variations in transfusion thresholds and concerns about potential complications, especially in children. To evaluate protocol adherence to blood transfusion thresholds in paediatric trauma patients and determine the degree of blood product wastage, as defined by discarded units. A retrospective, descriptive study of trauma patients (age 0 - 13 years) who received a blood transfusion in the trauma unit at Red Cross War Memorial Children's Hospital, Cape Town, South Africa, over a 5.5-year period (1 January 2009 - 1 July 2014). Haemoglobin (Hb) transfusion thresholds were defined as 10 g/dL for neurotrauma patients and patients requiring skin grafting or a musculocutaneous flap (group 1). All other trauma patients had an Hb transfusion threshold of 7 g/dL (group 2). A total of 144 patients were included (mean age 5.2 years (standard deviation (SD) 3.3), 68.1% male). The mean Hb increase after transfusion was 3.5 g/dL (SD 1.7). Adherence to the transfusion Hb threshold protocol was 96.7% for group 1 v. 34.0% for group 2. No complications were reported. Average blood wastage was 3.5 units per year during the study period. Adherence to paediatric blood transfusion protocol was low in the Hb threshold group <7 g/dL. However, transfusion-related complications and wastage were minimal. Further prospective research is required to determine optimal blood transfusion guidelines for paediatric trauma patients.

Aggression in war veterans suffering from posttraumatic stress disorder with co-morbid alcoholism.

PubMed

Babić, Dragan; Martinac, Marko; Bjelanović, Vedran; Babić, Romana; Sutović, Alija; Sinanović, Osman

2010-03-01

For thousands of years it has been known that aggression as a symptom appears in numerous psychiatric disorders and diseases. During the last decade the appearance of the aggressive behavior related to the posttraumatic stress disorder (PTSD) has been frequently investigated, often associated with war trauma. The goal of this study is to analyze the impact of alcoholism on a way war veterans suffering from chronic PTSD express and control aggression. The sample included 240 war veterans with chronic PTSD. The subjects were divided in two groups. PTSD group (n=147) and controlled group composed of those suffering from alcoholism in addition to PTSD (n=93). In this study, the following psychological instruments were used: The Harvard trauma questionnaire for PTSD diagnosis (HTQ); the questionnaire for self-evaluation of aggression (STAXI); The Profile Index Emotion (PIE); questionnaire for auto-diagnosis of alcoholism (CAGE). The obtained results indicate that subjects who have PTSD with co-morbid alcoholism are more deprived, aggressive (p < 0.001) and oppositional (p < 0.05) in comparison to subjects whose PTSD is not combined with alcoholism (PIE). The aggression is statistically more expressed in subjects with PTSD who have also been diagnosed with alcoholism on all subscales in comparison to subjects with PTDS who have not been diagnosed with alcoholism: the current state of aggression, the general state of aggression, aggression towards an unfair treatment, aggression directed inwards and outwards (p < 0.001); aggression towards nonspecific provocation and a general way of expressing aggression (p < 0.05) (STAXI). Subjects that had PTSD combined with alcoholism show a higher degree of aggression in comparison to subjects with PTDS who are not diagnosed with alcoholism.

From shell shock and war neurosis to posttraumatic stress disorder: a history of psychotraumatology

PubMed Central

Crocq, Marc-Antoine; Crocq, Louis

2000-01-01

The term posttraumatic stress disorder (PTSD) has become a household name since its first appearance in 1980 in the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-lll) published by the American Psychiatric Association, In the collective mind, this diagnosis is associated with the legacy of the Vietnam War disaster. Earlier conflicts had given birth to terms, such as “soldier's heart, ” “shell shock,” and “war neurosis.” The latter diagnosis was equivalent to the névrose de guerre and Kriegsneurose of French and German scientific literature. This article describes how the immediate and chronic consequences of psychological trauma made their way into medical literature, and how concepts of diagnosis and treatment evolved over time. PMID:22033462

Mental health consequences of war: a brief review of research findings

PubMed Central

MURTHY, R. SRINIVASA; LAKSHMINARAYANA, RASHMI

2006-01-01

Among the consequences of war, the impact on the mental health of the civilian population is one of the most significant. Studies of the general population show a definite increase in the incidence and prevalence of mental disorders. Women are more affected than men. Other vulnerable groups are children, the elderly and the disabled. Prevalence rates are associated with the degree of trauma, and the availability of physical and emotional support. The use of cultural and religious coping strategies is frequent in developing countries. PMID:16757987

"At Risk of Harm"? An Exploratory Survey of School Counsellors in the UK, Their Perceptions of Confidentiality, Information Sharing and Risk Management

ERIC Educational Resources Information Center

Jenkins, Peter; Palmer, Joanne

2012-01-01

The primary objective of this study was to explore perceptions of UK school counsellors of confidentiality and information sharing in therapeutic work with children and young people, using qualitative methods. The research design employed a two-stage process, using questionnaires and follow-up interviews, with a small, non-random sample of school…

Numbing and Dysphoria Symptoms of Posttraumatic Stress Disorder among Iraq and Afghanistan War Veterans: A Review of Findings and Implications for Treatment

ERIC Educational Resources Information Center

Hassija, Christina M.; Jakupcak, Matthew; Gray, Matt J.

2012-01-01

Iraq and Afghanistan war veterans experience significant rates of posttraumatic stress disorder (PTSD) and other trauma-related mental health conditions. Understanding how specific PTSD symptomatology affects physical health and psychosocial functioning may be useful in improving the conceptualization of PTSD nosology and informing treatment…

Iraqi adolescents: self-regard, self-derogation, and perceived threat in war.

PubMed

Carlton-Ford, Steve; Ender, Morten G; Tabatabai, Ahoo

2008-02-01

A year into the 2003 US-Iraq war, how were adolescents in Baghdad faring? Conflict-related events typically lower psychological well-being; in contrast, investment in and protection of threatened identities should lead to self-esteem striving and, presumably, better well-being. How threatened do Iraqi adolescents feel? Is their self-esteem related to their sense of threat? Do age, religion, ethnicity, and gender alter the link between perceived threat and self-esteem? We use data from 1000 randomly selected adolescents living in Baghdad during July 2004. Iraqi adolescents reported high levels of threat; those feeling more threatened reported higher levels of self-esteem. Social background correlates with both self-esteem and perceived threat, but controlling for social background does not eliminate the relationship between self-esteem and perceived threat. We interpret our results in light of theory and research concerning social identity, mortality threats, and war trauma.

Civilians in World War II and DSM-IV mental disorders: results from the World Mental Health Survey Initiative.

PubMed

Frounfelker, Rochelle; Gilman, Stephen E; Betancourt, Theresa S; Aguilar-Gaxiola, Sergio; Alonso, Jordi; Bromet, Evelyn J; Bruffaerts, Ronny; de Girolamo, Giovanni; Gluzman, Semyon; Gureje, Oye; Karam, Elie G; Lee, Sing; Lépine, Jean-Pierre; Ono, Yutaka; Pennell, Beth-Ellen; Popovici, Daniela G; Ten Have, Margreet; Kessler, Ronald C

2018-02-01

Understanding the effects of war on mental disorders is important for developing effective post-conflict recovery policies and programs. The current study uses cross-sectional, retrospectively reported data collected as part of the World Mental Health (WMH) Survey Initiative to examine the associations of being a civilian in a war zone/region of terror in World War II with a range of DSM-IV mental disorders. Adults (n = 3370) who lived in countries directly involved in World War II in Europe and Japan were administered structured diagnostic interviews of lifetime DSM-IV mental disorders. The associations of war-related traumas with subsequent disorder onset-persistence were assessed with discrete-time survival analysis (lifetime prevalence) and conditional logistic regression (12-month prevalence). Respondents who were civilians in a war zone/region of terror had higher lifetime risks than other respondents of major depressive disorder (MDD; OR 1.5, 95% CI 1.1, 1.9) and anxiety disorder (OR 1.5, 95% CI 1.1, 2.0). The association of war exposure with MDD was strongest in the early years after the war, whereas the association with anxiety disorders increased over time. Among lifetime cases, war exposure was associated with lower past year risk of anxiety disorders (OR 0.4, 95% CI 0.2, 0.7). Exposure to war in World War II was associated with higher lifetime risk of some mental disorders. Whether comparable patterns will be found among civilians living through more recent wars remains to be seen, but should be recognized as a possibility by those projecting future needs for treatment of mental disorders.

Civilians in World War II and DSM-IV mental disorders: Results from the World Mental Health Survey Initiative

PubMed Central

Frounfelker, Rochelle; Gilman, Stephen E.; Betancourt, Theresa S.; Aguilar-Gaxiola, Sergio; Alonso, Jordi; Bromet, Evelyn J.; Bruffaerts, Ronny; de Girolamo, Giovanni; Gluzman, Semyon; Gureje, Oye; Karam, Elie G.; Lee, Sing; Lépine, Jean-Pierre; Ono, Yutaka; Pennell, Beth-Ellen; Popovici, Daniela G.; Have, Margreet ten; Kessler, Ronald C.

2018-01-01

Purpose Understanding the effects of war on mental disorders is important for developing effective post-conflict recovery policies and programs. The current study uses cross-sectional, retrospectively reported data collected as part of the World Mental Health (WMH) Survey Initiative to examine the associations of being a civilian in a war zone/region of terror in World War II with a range of DSM-IV mental disorders. Methods Adults (n= 3,370)who lived in countries directly involved in World War II in Europe and Japan were administered structured diagnostic interviews of lifetime DSM-IV mental disorders. The associations of war-related traumas with subsequent disorder onset-persistence were assessed with discrete-time survival analysis (lifetime prevalence) and conditional logistic regression (12-month prevalence). Results Respondents who were civilians in a war zone/region of terror had higher lifetime risks than other respondents of major depressive disorder (MDD; OR 1.5, 95% CI 1.1, 1.9) and anxiety disorder (OR 1.5, 95% CI 1.1, 2.0). The association of war exposure with MDD was strongest in the early years after the war, whereas the association with anxiety disorders increased over time. Among lifetime cases, war exposure was associated with lower past year risk of anxiety disorders. (OR 0.4, 95% CI 0.2, 0.7). Conclusions Exposure to war in World War II was associated with higher lifetime risk of some mental disorders. Whether comparable patterns will be found among civilians living through more recent wars remains to be seen, but should be recognized as a possibility by those projecting future needs for treatment of mental disorders. PMID:29119266

The social, cultural and political dimensions of contemporary war.

PubMed

Summerfield, D

1997-01-01

There have been more than 160 wars and armed conflicts since 1945, almost all in the Third World, and more than 50 currently. More than 90% of these are internal rather than between sovereign states. There has been a sixfold increase in the number of war refugees worldwide since 1970, who now number 1% of the global population. Ninety per cent of all casualties are civilians. A key element of modern political violence is the creation of states of terror to penetrate the entire fabric of grassroots social relations as a means of control. The valued institutions and ways of life of whole populations are routinely targeted for destruction. In the 1980s many such wars were played out on a terrain of subsistence economies. The back-drop is of environmental degradation, poverty, embedded social injustice, pressure on the nation-state, a global rise in food insecurity and a widening gulf between the wealthiest 20% and the poorest 20% in the world. The World Health Organization is warning of a health catastrophe, with life expectancy in the world's poorest countries falling by the year 2000 and one-third of the world's children undernourished. Understanding a complex and evolving set of causes and effects surrounding war is a considerable challenge to the international humanitarian field, not least the health professions. In recent years there has been a burgeoning interest in the psychological impact of the atrocities of war, and in trauma programmes based on Western psychological concepts and techniques. This individualistic focus risks neglecting the core issue: the role of a social world, invariably targeted in war and yet still embodying the capacity of survivor populations to manage their suffering, adapt and recover on a collective basis. Using the example of Mozambique, Guatemala and others, this paper will discuss the way in which contemporary war damages social and cultural forms, and the range of traditions, values and understandings which these carry. However

Pathological spirit possession as a cultural interpretation of trauma-related symptoms.

PubMed

Hecker, Tobias; Barnewitz, Eva; Stenmark, Hakon; Iversen, Valentina

2016-07-01

Spirit possession is a phenomenon frequently occurring in war-torn countries. It has been shown to be an idiom of distress entailing dissociative symptoms. However, its association with trauma exposure and trauma-related disorders remains unclear. This study aimed to explore subjective disease models and the relationship between pathological spirit possession and trauma-related disorders in the Eastern Democratic Republic of the Congo. Seventy-three (formerly) possessed persons (74% female, mean age = 34 years), referred by traditional and spiritual healers, were interviewed about their experiences of pathological spirit possession, trauma exposure, posttraumatic stress disorder (PTSD) symptoms, depressive symptoms, shame and guilt, psychotic symptoms, somatic complaints, and the impairment of psychosocial functioning. The most common disease model for pathological spirit possession was another person having sent the spirit, mostly a family member or a neighbor, out of jealousy or conflict over resources. Significant correlations were found between spirit possession over lifetime and PTSD symptom severity, feelings of shame and guilt, depressive symptoms, somatic complaints, and psychotic symptoms. Spirit possession during the preceding 4 weeks was associated with PTSD symptom severity, impairment of psychosocial functioning, and psychotic symptom severity. The results of this study indicate that pathological spirit possession is a broad explanatory framework for various subjectively unexplainable mental and physical health problems, including but not limited to trauma-related disorders. Understanding pathological spirit possession as a subjective disease model for various mental and physical health problems may help researchers and clinicians to develop culturally sensitive treatment approaches for affected individuals. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

Secondary growth among former prisoners of war's adult children: The result of exposure to stress, secondary traumatization, or personality traits?

PubMed

Zerach, Gadi

2015-07-01

The long-term toll of war captivity on secondary traumatization (ST) on adult children has recently been exemplified. Several studies have also revealed that indirect exposure to trauma might be accompanied by positive psychological changes. This study examined secondary posttraumatic growth (SG) among adult children of former prisoners of war (ex-POWs' children) who were compared with adult children of comparable veterans (controls' children). Furthermore, we examined the role of five-factor personality traits in the associations between exposure to stress stemming from fathers' behaviors, ST symptoms, and SG. Participants were Israeli ex-POWs' children (N = 98) and controls' children (N = 90), whose fathers fought in the 1973 Yom Kippur War. Results show that ex-POWs' children reported higher levels of SG compared with controls' children. ST symptoms were found to mediate the association between research group and SG, and the direct effect was found to be conditioned at the levels of participants' extroversion. Furthermore, among ex-POWs' children, extroversion and openness to the experience personality traits, as well as exposure to stress, were found to predict SG. Forty years after the war ended, the experience of living with ex-POWs is associated with ex-POWs' children SG that might be more related to their exposure to stress and personality traits than their ST symptoms. Clinical interventions aiming to increase the levels of SG among indirect victims of captivity should consider the influence of pretrauma resources, trauma characteristics, and posttrauma factors. (PsycINFO Database Record (c) 2015 APA, all rights reserved).

Extracorporeal Organ Support following Trauma: The Dawn of a New Era in Combat Casualty Critical Care

DTIC Science & Technology

2013-01-01

course may confer a survival benefit for trauma patients if started before fulminate renal failure.54 During the wars in Afghanistan and Iraq, RRT...effects, such that any subsequent insult, particularly infectious, can lead to fulminant systemic inflam- matory response syndrome and death.68,69...detoxifi- cation and synthesis of proteins) and increased capacity. In addition, refinements in mechanisms and engineering of extra- corporeal organ support

The impact of psychological trauma on wages in post-conflict Bosnia and Herzegovina.

PubMed

Searing, Elizabeth A M; Rios-Avila, Fernando; Lecy, Jesse D

2013-11-01

In the last three decades, armed conflict has increasingly been fought among civilian populations, resulting in greater physical and mental tolls. Soldiers returning from combat with psychological trauma are now receiving medical and policy attention for reintegration into the workforce. However, there is little attention on the impacts and options available to civilians who may face similar problems achieving labor force success after exposure to war-related trauma. Using the Bosnia and Herzegovina Living Standards Measurement Survey for years 2001-2004, we study wage attainment for 7659 respondents in relation to a series of psychological trauma measures which correspond to those used in PTSD diagnosis. In standard OLS regression, all subcomponents of PTSD have a negative impact; however, once unobserved individual heterogeneity is taken into account, some of the individual elements of psychological trauma have positive impacts on wage attainment. This is one of the first studies to find evidence of Posttraumatic Growth using information beyond psychometric instruments. The impact of the PTSD condition itself is insignificant in both models, and we do not find evidence of selection bias. We determine that the traditional means of predicting wages in labor economics are relevant in a post-conflict environment. Copyright © 2013 Elsevier Ltd. All rights reserved.

Mobile mental health interventions following war and disaster

PubMed Central

Kuhn, Eric; Jaworski, Beth K.; Owen, Jason E.; Ramsey, Kelly M.

2016-01-01

Mobile technologies offer potentially critical ways of delivering mental health support to those experiencing war, ethnic conflict, and human-caused and natural disasters. Research on Internet interventions suggests that effective mobile mental health technologies can be developed, and there are early indications that they will be acceptable to war and disaster survivors, and prove capable of greatly increasing the reach of mental health services. Promising mhealth interventions include video teleconferencing, text messaging, and smartphone-based applications. In addition, a variety of social media platforms has been used during and immediately after disasters to increase agility in responding, and strengthen community and individual resilience. Globally, PTSD Coach has been downloaded over 243,000 times in 96 countries, and together with large-scale use of social media for communication during disasters, suggests the potential for reach of app technology. In addition to enabling improved self-management of post-trauma problems, mobile phone interventions can also enhance delivery of face-to-face care by mental health providers and increase the effectiveness of peer helpers and mutual aid organizations. More research is needed to establish the efficacy of mhealth interventions for those affected by war and disaster. Research should also focus on the identification of active elements and core processes of change, determination of effective ways of increasing adoption and engagement, and explore ways of combining the various capabilities of mobile technologies to maximize their impact. PMID:28293610

Mobile mental health interventions following war and disaster.

PubMed

Ruzek, Josef I; Kuhn, Eric; Jaworski, Beth K; Owen, Jason E; Ramsey, Kelly M

2016-01-01

Mobile technologies offer potentially critical ways of delivering mental health support to those experiencing war, ethnic conflict, and human-caused and natural disasters. Research on Internet interventions suggests that effective mobile mental health technologies can be developed, and there are early indications that they will be acceptable to war and disaster survivors, and prove capable of greatly increasing the reach of mental health services. Promising mhealth interventions include video teleconferencing, text messaging, and smartphone-based applications. In addition, a variety of social media platforms has been used during and immediately after disasters to increase agility in responding, and strengthen community and individual resilience. Globally, PTSD Coach has been downloaded over 243,000 times in 96 countries, and together with large-scale use of social media for communication during disasters, suggests the potential for reach of app technology. In addition to enabling improved self-management of post-trauma problems, mobile phone interventions can also enhance delivery of face-to-face care by mental health providers and increase the effectiveness of peer helpers and mutual aid organizations. More research is needed to establish the efficacy of mhealth interventions for those affected by war and disaster. Research should also focus on the identification of active elements and core processes of change, determination of effective ways of increasing adoption and engagement, and explore ways of combining the various capabilities of mobile technologies to maximize their impact.

Anthropological analysis of the Second World War skeletal remains from three karst sinkholes located in southern Croatia.

PubMed

Jerković, Ivan; Bašić, Željana; Bečić, Kristijan; Jambrešić, Gordana; Grujić, Ivan; Alujević, Antonio; Kružić, Ivana

2016-11-01

Although in the cases of war crimes the main effort goes to the identification of victims, it is crucial to consider the execution event as a whole. Thus, the goal of the research was to determine the trauma type and probable cause of death on skeletal remains of civilians executed by partisans from WWS found in the three karst sinkholes and to explain the context in which the injuries occurred. We determined biological profiles, pathological conditions, traumas, and assessed their lethality. Nineteen skeletons were found, 68.4% had, at least, one perimortem trauma, classified as lethal/lethal if untreated in 69.2% cases. The type of execution and administered violence showed to be age and health dependent: elderly and diseased were executed with the intention to kill, by the gunshot facing victims, whilst the more violent behavior expressed towards younger and healthy individuals was indicated by the higher frequency of blunt force trauma. Copyright © 2016 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

The influence of sense of coherence and mindfulness on PTSD symptoms and posttraumatic cognitions in a sample of elderly Austrian survivors of World War II.

PubMed

Glück, Tobias M; Tran, Ulrich S; Raninger, Simone; Lueger-Schuster, Brigitte

2016-03-01

Sense of Coherence (SOC) and mindfulness are known protective factors against psychopathology, also in older age. We set out to investigate the influence of SOC and mindfulness on posttraumatic symptoms and cognitions in the context of lifetime trauma in elderly persons with a history of childhood war-experiences. Elderly Austrians (N = 97) filled in questionnaires on traumatic lifetime experiences and posttraumatic symptoms (ETI), posttraumatic cognitions (PTCI), SOC (SOC-13) and mindfulness (FFMQ). We expected the influence of SOC scores on posttraumatic symptoms and cognitions to be on one hand influenced by mindfulness. On the other hand, we expected that both aspects would uniquely explain fewer posttraumatic symptoms and cognitions. Participants reported various lifetime traumas (M = 2.42), including experiences during World War II (WWII) as children and adolescents. Mindfulness partially mediated the association of SOC scores with posttraumatic cognitions, but not with posttraumatic symptoms. However, in a two-stage mediation model, mindfulness significantly predicted posttraumatic symptoms via its effects on posttraumatic cognitions. Although SOC was the strongest predictor of posttraumatic symptoms, mindfulness influenced the severity of posttraumatic symptoms via its effects on posttraumatic cognitions. We discuss implications for mindfulness-based interventions on trauma-related cognitions in the elderly.

[Combined burn trauma in the array of modern civilian and combat burns].

PubMed

Ivchenko, E V; Borisov, D N; Golota, A S; Krassiĭ, A B; Rusev, I T

2015-02-01

The current article positions the combined burn and non-burn injuries in the general array of civilian and combat burns. For that purpose the official state statistics and scientific medical publications, domestic as well as foreign, have been analyzed. It has been shown that in peace time the combined burn/trauma injuries are infrequent. But the same type of injury becomes routine especially among the civilian population in the conditions of the modern so called "hybrid war". And the medical service should be prepared for it.

Management of penetrating extraperitoneal rectal injuries: An Eastern Association for the Surgery of Trauma practice management guideline.

PubMed

Bosarge, Patrick L; Como, John J; Fox, Nicole; Falck-Ytter, Yngve; Haut, Elliott R; Dorion, Heath A; Patel, Nimitt J; Rushing, Amy; Raff, Lauren A; McDonald, Amy A; Robinson, Bryce R H; McGwin, Gerald; Gonzalez, Richard P

2016-03-01

The management of penetrating rectal trauma invokes a complex decision tree that advocates the principles of proximal diversion (diversion) of the fecal stream, irrigation of stool from the distal rectum, and presacral drainage based on data from World War II and the Vietnam War. This guideline seeks to define the initial operative management principles for nondestructive extraperitoneal rectal injuries. A systematic review of the MEDLINE database using PubMed was performed. The search retrieved English language articles regarding penetrating rectal trauma from January 1900 to July 2014. Letters to the editor, case reports, book chapters, and review articles were excluded. Topics of investigation included the management principles of diversion, irrigation of stool from the distal rectum, and presacral drainage using the GRADE methodology. A total of 306 articles were screened leading to a full-text review of 56 articles. Eighteen articles were used to formulate the recommendations of this guideline. This guideline consists of three conditional evidence-based recommendations. First, we conditionally recommend proximal diversion for management of these injuries. Second, we conditionally recommend the avoidance of routine presacral drains and distal rectal washout in the management of these injuries.

Scanning and War: Utility of FAST and CT in the Assessment of Battlefield Abdominal Trauma.

PubMed

Smith, Iain M; Naumann, David N; Marsden, Max E R; Ballard, Mark; Bowley, Douglas M

2015-08-01

To determine utilization and accuracy of focused assessment with sonography for trauma (FAST) and computed tomography (CT) in a mature military trauma system to inform service provision for future conflicts. FAST and CT scans undertaken by attending radiologists contribute to surgical decision making for battlefield casualties at the Joint Force, Role 3 Medical Treatment Facility at Camp Bastion (R3), Afghanistan. Registry data for abdominally injured casualties treated at R3 from July to November 2012 were matched to radiological and surgical records to determine diagnostic accuracy for FAST and CT and their influence on casualty management. A total of 468 casualties met inclusion criteria, of whom 85.0% underwent FAST and 86.1% abdominal CT; 159 (34.0%) had abdominal injuries. For detection of intra-abdominal injury, FAST sensitivity (Sn) was 0.56, specificity (Sp) 0.98, positive predictive value (PPV) 0.87, negative predictive value (NPV) 0.90, and accuracy (Acc) 0.89. For CT, Sn was 0.99, Sp 0.99, PPV 0.96, NPV 1.00, and Acc 0.99. Forty-six solid organ injuries were identified in 38 patients by CT; 17 were managed nonoperatively. A further 61 patients avoided laparotomy after CT confirmed extra-abdominal wounds only. The negative laparotomy rate was 3.9%. FAST and CT contribute to triage, guide surgical management, and reduce nontherapeutic laparotomy. When imaging is available, these data challenge current doctrine about inadvisability of nonoperative management of abdominal injury after combat trauma.

Prophylactic antibiotics for penetrating abdominal trauma.

PubMed

Brand, Martin; Grieve, Andrew

2013-11-18

Penetrating abdominal trauma occurs when the peritoneal cavity is breached. Routine laparotomy for penetrating abdominal injuries began in the 1800s, with antibiotics first being used in World War II to combat septic complications associated with these injuries. This practice was marked with a reduction in sepsis-related mortality and morbidity. Whether prophylactic antibiotics are required in the prevention of infective complications following penetrating abdominal trauma is controversial, however, as no randomised placebo controlled trials have been published to date. There has also been debate about the timing of antibiotic prophylaxis. In 1972 Fullen noted a 7% to 11% post-surgical infection rate with pre-operative antibiotics, a 33% to 57% infection rate with intra-operative antibiotic administration and 30% to 70% infection rate with only post-operative antibiotic administration. Current guidelines state there is sufficient class I evidence to support the use of a single pre-operative broad spectrum antibiotic dose, with aerobic and anaerobic cover, and continuation (up to 24 hours) only in the event of a hollow viscus perforation found at exploratory laparotomy. To assess the benefits and harms of prophylactic antibiotics administered for penetrating abdominal injuries for the reduction of the incidence of septic complications, such as septicaemia, intra-abdominal abscesses and wound infections. Searches were not restricted by date, language or publication status. We searched the following electronic databases: the Cochrane Injuries Group Specialised Register, CENTRAL (The Cochrane Library 2013, issue 12 of 12), MEDLINE (OvidSP), Embase (OvidSP), ISI Web of Science: Science Citation Index Expanded (SCI-EXPANDED), ISI Web of Science: Conference Proceedings Citation Index- Science (CPCI-S) and PubMed. Searches were last conducted in January 2013. All randomised controlled trials of antibiotic prophylaxis in patients with penetrating abdominal trauma versus no

Analyses of demographical and injury characteristics of adult and pediatric patients injured in Syrian civil war.

PubMed

Er, Erhan; Çorbacıoğlu, Şeref Kerem; Güler, Sertaç; Aslan, Şahin; Seviner, Meltem; Aksel, Gökhan; Bekgöz, Burak

2017-01-01

Aimed to analyze demographical data and injury characteristics of patients who were injured in the Syrian Civil War (SCW) and to define differences in injury characteristics between adult and pediatric patients. Patients who were injured in the SCW and transferred to our emergency department were retrospectively analyzed in this study during the 15-month period between July 2013 and October 2014. During the study period, 1591 patients who were the victims of the SCW and admitted to our emergency department due to war injury enrolled in the study. Of these patients, 285 were children (18%). The median of the injury severity score was 16 (interquartile range [IQR]: 9-25) in all patients. The most frequent mechanism of injury was blunt trauma (899 cases, 55%), and the most frequently-injured region of the body was the head (676 cases, 42.5%). Head injury rates among the children's group were higher than those of the adult group (P < .001). In contrast, injury rates for the abdomen and extremities in the children's group were lower than those in the adult group (P < .001, P < .001). The majority of patients were adults, and the most frequent mechanism of injury was blunt trauma. Similarly, the children were substantially affected by war. Although the injury severity score values and mortality rates of the child and adult groups were similar, it was determined that the number of head injuries was higher, but the number of abdomen and extremity injuries was lower in the children's group than in the adult group. Copyright © 2016 Elsevier Inc. All rights reserved.

Death on a Napoleonic battlefield - Peri-mortem trauma in soldiers from the Battle of Aspern 1809.

PubMed

Binder, Michaela; Quade, Leslie

2018-06-07

On the 21 st -22 nd of May1809 Napoleon Bonaparte saw his first major defeat on land at the Battle of Aspern, just north-east of Vienna. Of the 167,000 soldiers who fought for the French and Austrian armies, a total of 55,000 died on the battlefield. Salvage excavations prior to the construction of large urban development project (2008-2016) have revealed several burial sites related to the Battle of Aspern. The skeletal remains of 30 soldiers were excavated and underwent a detailed bioarchaeological study to elucidate both the impact of 19th-century military conditions on soldiers in life, as well as how they died on the battlefield. This paper presents the analysis of peri-mortem trauma observed in 21 of the 30 skeletons (70.0%) excavated from the battlefield of Aspern. Following standard criteria in forensic and palaeopathological trauma studies, this study revealed a predominance of ballistic trauma (20 cases in 17 individuals), while only nine individuals (eleven cases) displayed evidence of blunt force trauma. By contrast, no evidence of sharp force trauma was identified in the skeletal remains. These results are discussed within the historic context of the Napoleonic Wars to reconstruct causes of injury and circumstances of death. Copyright © 2018 Elsevier Inc. All rights reserved.

How to quantify exposure to traumatic stress? Reliability and predictive validity of measures for cumulative trauma exposure in a post-conflict population.

PubMed

Wilker, Sarah; Pfeiffer, Anett; Kolassa, Stephan; Koslowski, Daniela; Elbert, Thomas; Kolassa, Iris-Tatjana

2015-01-01

While studies with survivors of single traumatic experiences highlight individual response variation following trauma, research from conflict regions shows that almost everyone develops posttraumatic stress disorder (PTSD) if trauma exposure reaches extreme levels. Therefore, evaluating the effects of cumulative trauma exposure is of utmost importance in studies investigating risk factors for PTSD. Yet, little research has been devoted to evaluate how this important environmental risk factor can be best quantified. We investigated the retest reliability and predictive validity of different trauma measures in a sample of 227 Ugandan rebel war survivors. Trauma exposure was modeled as the number of traumatic event types experienced or as a score considering traumatic event frequencies. In addition, we investigated whether age at trauma exposure can be reliably measured and improves PTSD risk prediction. All trauma measures showed good reliability. While prediction of lifetime PTSD was most accurate from the number of different traumatic event types experienced, inclusion of event frequencies slightly improved the prediction of current PTSD. As assessing the number of traumatic events experienced is the least stressful and time-consuming assessment and leads to the best prediction of lifetime PTSD, we recommend this measure for research on PTSD etiology.

Perceived current needs, psychological distress and functional impairment in a war-affected setting: a cross-sectional study in South Sudan.

PubMed

Ayazi, Touraj; Swartz, Leslie; Eide, Arne H; Lien, Lars; Hauff, Edvard

2015-08-19

To examine the current perceived needs of the general population in a war-affected setting, and to study the influence of perceived needs on the participants' mental health status and functional impairment across genders. A cross-sectional community survey (n=464) was conducted in war-affected South Sudan. Three regression models were analysed. Perceived needs were assessed with the Humanitarian Emergency Settings Perceived Needs Scale. Psychological distress was measured with the General Health Questionnaire and level of functioning by the Short Form Health Survey (SF-12). The most frequently expressed needs were related to drinking water, alcohol and drug use in the community and access to sanitation facilities. No gender differences were found regarding the level of perceived needs or the number of traumatic events. Higher level of perceived needs significantly predicted psychological distress and lower level of functioning even when numbers of experienced trauma events were taken into account. The associations of higher level of needs and trauma experiences, on the one hand, and negative health outcomes on the other, necessitate a greater integration of interventions directed towards the population's perceived needs and mental health, particularly for those who have been exposed to trauma. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Multidisciplinary trauma team care in Kandahar, Afghanistan: current injury patterns and care practices.

PubMed

Beckett, Andrew; Pelletier, Pierre; Mamczak, Christiaan; Benfield, Rodd; Elster, Eric

2012-12-01

Multidisciplinary trauma care systems have been shown to improve patient outcomes. Medical care in support of the global war on terror has provided opportunities to refine these systems. We report on the multidisciplinary trauma care system at the Role III Hospital at Kandahar Airfield, Afghanistan. We reviewed the Joint Trauma System Registry, Kandahar database from 1 October 2009 to 31 December 2010 and extracted data regarding patient demographics, clinical variables and outcomes. We also queried the operating room records from 1 January 2009 to 31 December 2010. In the study period of 1 October 2009 to 31 December 2010, 2599 patients presented to the trauma bay, with the most common source of injury being from Improvised Explosive Device (IED) blasts (915), followed by gunshot wounds (GSW) (327). Importantly, 19 patients with triple amputations as a result of injuries from IEDs were seen. 127 patients were massively transfused. The in-hospital mortality was 4.45%. From 1 January 2010 to 31 December 2010, 4106.24 operating room hours were logged to complete 1914 patient cases. The mean number of procedures per case in 2009 was 1.27, compared to 3.11 in 2010. Multinational, multidisciplinary care is required for the large number of severely injured patients seen at Kandahar Airfield. Multidisciplinary trauma care in Kandahar is effective and can be readily employed in combat hospitals in Afghanistan and serve as a model for civilian centres. Published by Elsevier Ltd.

The Impact of Trauma on Drug Users' Identities

ERIC Educational Resources Information Center

Etherington, Kim

2007-01-01

This article addresses drug users' identity construction, and invites counsellors, psychotherapists, researchers and others who work with drug misusers to notice how cultural and societal discourses can shape drug misusers' stories, and the positions from which helpers listen and respond to them. By representing and analysing parts of two life…

Injury patterns of soldiers in the second Lebanon war.

PubMed

Schwartz, Dagan; Glassberg, Elon; Nadler, Roy; Hirschhorn, Gil; Marom, Ophir Cohen; Aharonson-Daniel, Limor

2014-01-01

In the second Lebanon war in 2006, the Israeli Defense Forces fought against well-prepared and well-equipped paramilitary forces. The conflict took place near the Israeli border and major Israeli medical centers. Good data records were maintained throughout the campaign, allowing accurate analysis of injury characteristics. This study is an in-depth analysis of injury mechanisms, severity, and anatomic locations. Data regarding all injured soldiers were collected from all care points up to the definitive care hospitals and were cross-referenced. In addition, trauma branch physicians and nurses interviewed medical teams to validate data accuracy. Injuries were analyzed using Injury Severity Score (ISS) (when precise anatomic data were available) and multiple injury patterns scoring for all. A total of 833 soldiers sustained combat-related injury during the study period, including 119 fatalities (14.3%). Although most soldiers (361) sustained injury only to one Abbreviated Injury Scale (AIS) region, the average number of regions per soldier was 2.0 but was 1.5 for survivors versus 4.2 for fatalities. Current war injury classifications have limitations that hinder valid comparisons between campaigns and settings. In addition, limitation on full autopsy in war fatalities further hinders data use. To partly compensate for those limitations, we have looked at the correlation between fatality rates and number of involved anatomic regions and found it to be strong. We have also found high fatality rates in some "combined" injuries such as head and chest injuries (71%) or in the abdomen and an extremity (75%). The use of multiinjury patterns analysis may help understand fatality rates and improve the utility of war injury analysis. Epidemiologic study, level III.

[Coping skills and social support in German long-time survivors of rape in the end of World War II].

PubMed

Eichhorn, Svenja; Klauer, Thomas; Grundke, Elena; Freyberger, Harald J; Brähler, Elmar; Kuwert, Philipp

2012-05-01

The aim of the study was to document perceived social support in a sample of German war-raped women in World War II. Furthermore the impact of this potential resource on today's posttraumatic symptoms should be pointed out. 27 women (M = 80.3 years, SD = 3.1 years) answered each a semi-structured interview and several questionnaires. Perceived social support shows clearly lower values than in the comparative samples. The measured degree of the variable in the present sample bears negative relationship to the actual posttraumatic symptoms of the women. In World War II sexually traumatized women could profit only few from the examined resource. The found negative relationship between perceived social support and posttraumatic symptoms shows additionally the potentially long-lasting impact of these form of coping on psychological health in trauma victims. © Georg Thieme Verlag KG Stuttgart · New York.

Trauma rehabilitation for war-affected persons in northern Uganda: a pilot evaluation of the EMPOWER programme.

PubMed

Sonderegger, Robi; Rombouts, Sacha; Ocen, Benson; McKeever, Reyelle Sarah

2011-09-01

OBJECTIVES. This study evaluated the impact of a culturally sensitive cognitive behaviour therapy (CBT)-based intervention (the EMPOWER programme) for war-affected persons in northern Uganda. DESIGN. The study conducted a pilot evaluation with a convenience sample of participants from internally displaced persons (IDPs) camps (i.e., a treatment camp and waitlist control camp). This was done to avoid treatment effects spreading from the intervention to control conditions. METHODS. A total of 202 participants (N= 90 treatment participants and N= 112 control participants) were included as a convenience sample. The Acholi Psychosocial Assessment Instrument (APAI), a culturally appropriate measure of psychosocial functioning, was administered to participants residing in two IDP camps at pre-treatment, post-treatment, and at 3-month follow-up. Participants in the treatment camp received the EMPOWER programme--a culturally sensitive CBT-based intervention teaching emotional resiliency and promoting forgiveness. RESULTS. Participants in the treatment condition reported (a) significantly lower scores on the depression-like syndromes and the anxiety-like syndrome and (b) significantly more prosocial behaviours, than participants in the control condition. CONCLUSIONS. The results of this study provide initial support for the application of structured CBT interventions in war-affected areas, illustrating that the EMPOWER programme could be utilized by humanitarian agencies to address the psychosocial needs of war-affected displaced persons. ©2010 The British Psychological Society.

Trauma-Focused CBT for Youth who Experience Ongoing Traumas

PubMed Central

Cohen, Judith A.; Mannarino, Anthony P.; Murray, Laura A.

2011-01-01

Many youth experience ongoing trauma exposure, such as domestic or community violence. Clinicians often ask whether evidence-based treatments containing exposure components to reduce learned fear responses to historical trauma are appropriate for these youth. Essentially the question is, if youth are desensitized to their trauma experiences, will this in some way impair their responding to current or ongoing trauma? The paper addresses practical strategies for implementing one evidence-based treatment, Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) for youth with ongoing traumas. Collaboration with local therapists and families participating in TF-CBT community and international programs elucidated effective strategies for applying TF-CBT with these youth. These strategies included: 1) enhancing safety early in treatment; 2) effectively engaging parents who experience personal ongoing trauma; and 3) during the trauma narrative and processing component focusing on a) increasing parental awareness and acceptance of the extent of the youths’ ongoing trauma experiences; b) addressing youths’ maladaptive cognitions about ongoing traumas; and c) helping youth differentiate between real danger and generalized trauma reminders. Case examples illustrate how to use these strategies in diverse clinical situations. Through these strategies TF-CBT clinicians can effectively improve outcomes for youth experiencing ongoing traumas. PMID:21855140

Impact of the Gulf war on congenital heart diseases in Kuwait.

PubMed

Abushaban, L; Al-Hay, A; Uthaman, B; Salama, A; Selvan, J

2004-02-01

There has been concern over the increase in the number of babies born with congenital heart diseases (CHD) in Kuwait after the Gulf War. We evaluated retrospectively the number of Kuwaiti infants who were diagnosed to have CHD within the first year of life. The comparison was made between those presented from January 1986 to December 1989 (preinvasion) and those presented after the liberation of Kuwait (from January 1992 to December 2000). The number of cases was considered per 10,000 live births in that year. The numbers of cases were 2704 (326 before the invasion and 2378 after liberation). The mean annual incidence of CHD was 39.5 and 103.4 (per 10,000 live births) before and after the Gulf War, respectively (P<0.001). There was an increase in the number of babies with CHD during the immediate 3 years postliberation with a relative reduction in the trend from 1995 to 2000, in some types of CHD. In our series, there was an increased incidence of CHD almost immediately following the end of the Gulf War period. The cause of this increase remains relatively obscure. Environmental pollution may be a contributing factor; others such as possible psychological trauma remain subject to speculation.

Beyond Pathologizing Harm: Understanding PTSD in the Context of War Experience.

PubMed

Benner, Patricia; Halpern, Jodi; Gordon, Deborah R; Popell, Catherine Long; Kelley, Patricia W

2018-03-01

An alternative to objectifying approaches to understanding Post-traumatic Stress Disorder (PTSD) grounded in hermeneutic phenomenology is presented. Nurses who provided care for soldiers injured in the Iraq and Afghanistan wars, and sixty-seven wounded male servicemen in the rehabilitation phase of their recovery were interviewed. PTSD is the one major psychiatric diagnosis where social causation is established, yet PTSD is predominantly viewed in terms of the usual neuro-physiological causal models with traumatic social events viewed as pathogens with dose related effects. Biologic models of causation are applied reductively to both predisposing personal vulnerabilities and strengths that prevent PTSD, such as resiliency. However, framing PTSD as an objective disease state separates it from narrative historical details of the trauma. Personal stories and cultural meanings of the traumatic events are seen as epiphenomenal, unrelated to the understanding of, and ultimately, the therapeutic treatment of PTSD. Most wounded service members described classic symptoms of PTSD: flashbacks, insomnia, anxiety etc. All experienced disturbance in their sense of time and place. Rather than see the occurrence of these symptoms as decontextualized mechanistic reverberations of war, we consider how these symptoms meaningfully reflect actual war experiences and sense of displacement experienced by service members.

Obsessive-compulsive and posttraumatic stress symptoms among civilian survivors of war.

PubMed

Morina, Naser; Sulaj, Vita; Schnyder, Ulrich; Klaghofer, Richard; Müller, Julia; Martin-Sölch, Chantal; Rufer, Michael

2016-04-27

Several psychological sequelae have been identified in civilian war survivors. However, little is known about the prevalence of obsessive-compulsive symptoms and their relationship to trauma in this population. Fifty-one adult civilian survivors of the Kosovo War (28 males) who had immigrated to Switzerland completed the Revised Obsessive-Compulsive Inventory Scale, the Posttraumatic Stress Diagnostic Scale and the Hopkins Symptom Checklist. Data were analysed using multiple regression analyses. Overall, 35 and 39% of the sample scored above the cut-offs for likely obsessive-compulsive disorder and posttraumatic stress disorder, respectively. Participants with high levels of posttraumatic stress symptoms were significantly more likely to have obsessive-compulsive symptoms, and vice versa. In multiple regression analysis, gender and severity of posttraumatic stress symptoms were predictors of obsessive-compulsive symptoms, whereas number of traumatic life event types and depressive symptoms were not. Given the small sample size, the results of this study need to be interpreted cautiously. Nevertheless, a surprisingly high number of participants in our study suffered from both obsessive-compulsive and posttraumatic stress symptoms, with obsessive-compulsive symptoms tending to be more pronounced in women. It remains, therefore, critical to specifically assess both obsessive-compulsive and posttraumatic stress symptoms in civilian war survivors, and to provide persons afflicted with appropriate mental health care.

Posttraumatic stress in aging World War II survivors after a fireworks disaster: a controlled prospective study.

PubMed

Bramsen, Inge; van der Ploeg, Henk M; Boers, Maarten

2006-04-01

Little is known about the effects of cumulative trauma and whether traumatized individuals are more vulnerable. In 2000, a fireworks disaster created the possibility to examine this issue among World War II survivors who were part of an ongoing longitudinal study. Between 1998 and 2000 posttraumatic stress increased in disaster exposed respondents as opposed to the control group. War-related reexperiencing and avoidance also increased. The strongest increase occurred in disaster-exposed respondents who had low levels of wartime stress and a slight decrease occurred in those who had high wartime exposure. This unique controlled observation suggests that disasters do increase the levels of posttraumatic stress, and that reactivation of previous traumatic events generally occurs. However, the vulnerability hypothesis was not supported.

Meaning as a mission: a review of empirical studies on appraisals of war and peacekeeping experiences.

PubMed

Schok, Michaela L; Kleber, Rolf J; Elands, Martin; Weerts, Jos M P

2008-03-01

The aim of this article is to review the scientific literature on making sense of war and peacekeeping experiences, and it includes an analysis of empirical studies that examine appraisals of military deployment experiences among veterans. Veterans reported more positive than negative effects in the studies of this review. Furthermore, construing positive meaning from war and peacekeeping experiences, especially related to combat exposure or high perceived threat, is associated with better psychological adjustment. More insight on "normal" psychological processing of stressful and traumatic experiences is obtained when the concept of meaning is used in research. This perspective emphasizes the perception of individuals and focuses on beliefs and attitudes in making sense of threatening events instead of pathologizing the response to trauma.

Position statement on opportunistic genomic screening from the Association of Genetic Nurses and Counsellors (UK and Ireland).

PubMed

Middleton, Anna; Patch, Chris; Wiggins, Jennifer; Barnes, Kathy; Crawford, Gill; Benjamin, Caroline; Bruce, Anita

2014-08-01

The American College of Medical Genetics and Genomics released recommendations for reporting incidental findings (IFs) in clinical exome and genome sequencing. These suggest 'opportunistic genomic screening' should be available to both adults and children each time a sequence is done and would be undertaken without seeking preferences from the patient first. Should opportunistic genomic screening be implemented in the United Kingdom, the Association of Genetic Nurses and Counsellors (AGNC), which represents British and Irish genetic counsellors and nurses, feels strongly that the following must be considered (see article for complete list): (1) Following appropriate genetic counselling, patients should be allowed to consent to or opt out of opportunistic genomic screening. (2) If true IFs are discovered the AGNC are guided by the report from the Joint Committee on Medical Genetics about the sharing of genetic testing results. (3) Children should not be routinely tested for adult-onset conditions. (4) The formation of a list of variants should involve a representative from the AGNC as well as a patient support group. (5) The variants should be for serious or life-threatening conditions for which there are treatments or preventative strategies available. (6) There needs to be robust evidence that the benefits of opportunistic screening outweigh the potential harms. (7) The clinical validity and utility of variants should be known. (8) There must be a quality assurance framework that operates to International standards for laboratory testing. (9) Psychosocial research is urgently needed in this area to understand the impact on patients.

Korean Survivors of the Japanese "Comfort Women" System: Understanding the Lifelong Consequences of Early Life Trauma.

PubMed

Park, Jee Hoon; Lee, KyongWeon; Hand, Michelle D; Anderson, Keith A; Schleitwiler, Tess E

2016-01-01

Prior to and during World War II, thousands of girls and young women were abducted from Korea and forced into sexual slavery by the Japanese government. Termed comfort women, these girls and young women suffered extreme sexual, physical, and emotional abuse and trauma. Research on this group is not well-developed and people know little of the impact of this early life trauma on the lives of these women who are now in later life. Using snowball sampling, 16 older adult survivors of the comfort women system participated in semistructured qualitative interviews. Thematic analysis was conducted to gain an understanding of the trauma that these women suffered and how it impacted their lives. Results revealed the depths of the abuse these women suffered, including repeated rapes, physical beatings, humiliation, forced surgery and sterilization, and social exclusion. These early traumatic experiences appeared to reverberate throughout their lives in their family relations, their inability to marry and to conceive children, and their emotional and physical well-being throughout the life course and into later life. The experiences of these survivors illustrate the lasting impact of early-life trauma and can guide interventions with current survivors of sexual abuse or trafficking.

Assuring optimal trauma care: the role of trauma centre accreditation

PubMed Central

Simons, Richard; Kirkpatrick, Andrew

2002-01-01

Optimal care of the injured patient requires the delivery of appropriate, definitive care shortly after injury. Over the last 30 to 40 years, civilian trauma systems and trauma centres have been developed in the United States based on experience gained in military conflicts, particularly in Korea and Vietnam. A similar process is evolving in Canada. National trauma committees in the US and Canada have defined optimal resources to meet the goal of rapid, appropriate care in trauma centres. They have introduced programs (verification or accreditation) to externally audit trauma centre performance based on these guidelines. It is generally accepted that implementing trauma systems results in decreased preventable death and improved survival after trauma. What is less clear is the degree to which each facet of trauma system development contributes to this improvement. The relative importance of national performance guidelines and trauma centre audit as integral steps toward improved outcomes following injury are reviewed. Current Trauma Association of Canada guidelines for trauma centres are presented and the process of trauma centre accreditation is discussed. PMID:12174987

Beyond Trauma: Post-resettlement Factors and Mental Health Outcomes Among Latino and Asian Refugees in the United States.

PubMed

Kim, Isok

2016-08-01

War-related traumas impact refugees' mental health. Recent literature suggests that structural and sociocultural factors related to the resettlement also become critical in shaping refugees' mental health. So far, there is limited empirical evidence to support this claim among resettled refugees. Resettlement contextual factors that influence mental health outcomes were examined using Latino and Asian refugees (n = 656) from a nationally representative survey. Linear and logistic regressions predicted factors associated with the study's outcomes (self-reported mental health, mood disorders, and anxiety disorders). Post-resettlement traumas were significantly associated with mental health outcomes, but pre-resettlement traumas were not. Unemployment, everyday discrimination, and limited English were significantly associated with mental health outcomes among both Latino and Asian refugees. The outcomes indicate that resettlement contextual factors have a significant association with refugees' mental health. Therefore, future studies with refugees must pay closer attention to structural and sociocultural factors after resettlement.

The evolution of pain management in the critically ill trauma patient: Emerging concepts from the global war on terrorism.

PubMed

Malchow, Randall J; Black, Ian H

2008-07-01

The evolution of military medical care to manage polytrauma, critically ill-wounded warriors from the greater war on terrorism has been accompanied by significant changes in the diagnosis, management, and modulation of acute and chronic trauma-related pain. A paradigm shift in pain management includes early treatment of pain at the point of injury and throughout the continuum of care with a combination of standard and novel therapeutic interventions. These concepts are important for all critical care providers because they translate to most critically ill patients, including those resulting from natural disasters. Previous authors have reported a high incidence of moderate to severe pain and poor analgesia in intensive care units associated with sleep disturbances, tachycardia, pulmonary complications, increased stress response with thromboembolic incidents, and immunosuppression, increased intensive care unit and hospital stays, and needless suffering. Although opioids have traditionally been the cornerstone of acute pain management, they have potential negative effects ranging from sedation, confusion, respiratory depression, nausea, ileus, constipation, tolerance, opioid-induced hyperalgesia as well as potential for immunosuppression. Alternatively, multimodal therapy is increasingly recognized as a critical pain management approach, especially when combined with early nutrition and ambulation, designed to improve functional recovery and decrease chronic pain conditions. Multimodal therapy encompasses a wide range of procedures and medications, including regional analgesia with continuous epidural or peripheral nerve block infusions, judicious opioids, acetaminophen, anti-inflammatory agents, anticonvulsants, ketamine, clonidine, mexiletine, antidepressants, and anxiolytics as options to treat or modulate pain at various sites of action. With a more aggressive acute pain management strategy, the military has decreased acute and chronic pain conditions, which may

The Nervous Flyer: Nerves, Flying and the First World War.

PubMed

Shaw Cobden, Lynsey

2018-02-02

This is not an article about 'shell-shock'. It explores the military medical response to nervous disorders in the Royal Flying Corps. The First World War exposed the propensity of pilots to the nervous and psychological rigours of aerial warfare, but their unique experiences have been overlooked in favour of 'trauma' in infantrymen. This represents a critical lacuna in the historiography of military medicine, for flying personnel were studied apart from 'shell-shocked' soldiers. This article will show that flyers were believed to be medically different, and what set them apart from men in the trenches was their unique employment. The war necessitated, and provided the conditions for, the study of the medical problems of flying, including the significant nervous strains. Medical officers quickly established that flying not only affected bodily functions, but also 'wore down' the nerves that regulated psychological responses. This article will therefore present the medical view. It will study the research of air-minded medical officers and the conclusions reached on the nervous disorders of flying personnel.

War-related penile injuries in Libya: Single-institution experience.

PubMed

Etabbal, Abdalla M; Hussain, Fathi F; Benkhadoura, Mohamed O; Banni, Abdalla M

2018-06-01

To report on our initial experience in the management of war-related penile injuries; proper diagnosis and immediate treatment of penile injuries is essential to gain satisfactory results. Besides treating primary wounds and restoring penile function, the cosmetic result is also an important issue for the surgeon. The study was conducted in the Department of Urology at Benghazi Medical Center and comprised all patients who presented with a shotgun, gunshot or explosive penile injury between February 2011 and August 2017. The patient's age, cause of injury, site and severity of injuries, management, postoperative complications, and hospital stay, were recorded. In all, 29 males with war-related penile injuries were enrolled in the study. The mean (SD) age of these patients was 31.3 (10.5) years. The glans, urethra, and corporal bodies were involved in four (13.7%), 10 (34.4%), and 20 (68.9%) of the patients, respectively. According to the American Association for the Surgery of Trauma Penis Injury Scale, Grade III penile injuries were the most common (11 patients, 37.9%). The most common post-intervention complications were urethral stricture with or without proximal urethrocutaneous fistula (eight patients, 27.5%), followed by permanent erectile dysfunction (five patients, 17.2%). In patients who sustain war-related penile injuries the surgeon's efforts should not only be directed to restoring normal voiding and erectile function but also on the cosmetic appearance of the penis.

Prevalence of war-related mental health conditions and association with displacement status in postwar Jaffna District, Sri Lanka.

PubMed

Husain, Farah; Anderson, Mark; Lopes Cardozo, Barbara; Becknell, Kristin; Blanton, Curtis; Araki, Diane; Vithana, Eeshara Kottegoda

2011-08-03

Nearly 2.7 million individuals worldwide are internally displaced (seeking refuge in secure areas of their own country) annually by armed conflict. Although the psychological impact of war has been well documented, less is known about the mental health symptoms of forced displacement among internally displaced persons. To estimate the prevalence of the most common war-related mental health conditions, symptoms of posttraumatic stress disorder (PTSD), anxiety, and depression, and to assess the association between displacement status and these conditions in postwar Jaffna District, Sri Lanka. Between July and September 2009, a cross-sectional multistage cluster sample survey was conducted among 1517 Jaffna District households including 2 internally displaced persons camps. The response rate was 92% (1448 respondents, 1409 eligible respondents). Two percent of participants (n = 80) were currently displaced, 29.5% (n = 539) were recently resettled, and 68.5% (n = 790) were long-term residents. Bivariable analyses followed by multivariable logistic regression models were performed to determine the association between displacement status and mental health. Symptom criteria of PTSD, anxiety, and depression as measured by the Harvard Trauma Questionnaire and the Hopkins Symptom Checklist-25. The overall prevalences of symptoms of PTSD, anxiety, and depression were 7.0% (95% confidence interval [CI], 5.1%-9.7%), 32.6% (95% CI, 28.5%-36.9%), and 22.2% (95% CI, 18.2%-26.5%), respectively. Currently displaced participants were more likely to report symptoms of PTSD (odds ratio [OR], 2.71; 95% CI, 1.28-5.73), anxiety (OR, 2.91; 95% CI, 1.89-4.48), and depression (OR, 4.55; 95% CI, 2.47-8.39) compared with long-term residents. Recently resettled residents were more likely to report symptoms of PTSD (OR, 1.96; 95% CI, 1.11-3.47) compared with long-term residents. However, displacement was no longer associated with mental health symptoms after controlling for trauma exposure

Effects of War, Terrorism and Armed Conflict on Young Children: A Systematic Review.

PubMed

Slone, Michelle; Mann, Shiri

2016-12-01

Millions of children have been maimed, displaced, orphaned and killed in modern warfare that targets civilian populations. Several reviews have documented the impact of political trauma on children's mental health but none has focused specifically on young children (ages 0-6). Since developmental factors influence the young child's perception and experience of traumatic events, this developmental period is characterized by a unique spectrum of responses to political trauma. This systematic review, comprising 35 studies that included a total of 4365 young children, examined the effects of exposure to war, conflict and terrorism on young children and the influence of parental factors on these effects. Results showed that effects include PTSD and post-traumatic stress symptoms, behavioral and emotional symptoms, sleep problems, disturbed play, and psychosomatic symptoms. Correlations emerged between parental and children's psychopathology and, additionally, family environment and parental functioning emerged as moderators of the exposure-outcome association for children.

Long-term treatment effect of trauma-affected refugees with flexible cognitive behavioural therapy and antidepressants.

PubMed

Buhmann, Caecilie Böck; Nordentoft, Merete; Ekstroem, Morten; Carlsson, Jessica; Mortensen, Erik Lykke

2018-04-04

Few studies exist on the long-term effect of treatment of trauma-affected refugees. The purpose of this study was to estimate the long-term treatment effects of cognitive behavioural therapy and antidepressants (sertraline and mianserin) in trauma-affected refugees. Follow-ups were conducted 6 and 18 months after a randomised controlled clinical trial. The included patients were refugees with war-related traumatic experiences, PTSD and without psychotic disorders. We found a small improvement over time in PTSD, depression and anxiety symptoms and level of functioning, but the improvement was not associated with any specific treatment. Personality change after catastrophic experiences and life events influenced the symptom level at all follow-ups while depression at completion of treatment was associated with a steeper decline in symptom load at the follow-ups. In spite of the limited decline in symptom scores and treatment effects immediately after treatment, the condition of the treated trauma-affected refugees was significantly improved 6 and 18 months after treatment although the improvement was small. Copyright © 2018 Elsevier B.V. All rights reserved.

Physical Trauma among Refugees: Comparison between Refugees and Local Population Who Were Admitted to Emergency Department-Experience of a State Hospital in Syrian Border District.

PubMed

Duzkoylu, Yigit; Basceken, Salim Ilksen; Kesilmez, Emrullah Cem

2017-01-01

Hundreds of thousands of people have fled to Turkey since the civil war started in Syria in 2011. Refugees and local residents have been facing various challenges such as sociocultural and economic ones and access to health services. Trauma exposure is one of the most important and underestimated health problems of refugees settling in camps. We aimed to evaluate refugee admissions to emergency department because of trauma in means of demographics of patients and mechanism of trauma and compare the results with the local population. Retrospective evaluation of results and comparison with the results of local population. We determined that the ratio of emergency admission of refugee patients because of trauma was significantly higher than the local population for most types of trauma. Further studies with more refugee participants are needed to fully understand the underlying reasons for this high ratio to protect refugees as well as for planning to take caution to attenuate the burden on healthcare systems.

Impact of war, religiosity and ideology on PTSD and psychiatric disorders in adolescents from Gaza Strip and South Lebanon.

PubMed

Khamis, Vivian

2012-06-01

This study investigated the extent to which differences in the types of war trauma, economic pressure, religiosity and ideology accounted for variation in PTSD and psychiatric disorders among adolescents from Gaza Strip and South Lebanon. Participants were 600 adolescents aged 12-16 years. They were selected from the public school system in the highly war exposed areas. Questionnaires were administered in an interview format with adolescents at school by two trained psychologists. Results indicated that the various types of trauma had differential effects on the psychological status of adolescents in both countries. Economic pressure was more predictive of PTSD and psychological distress in adolescents from Gaza. Differences in religiosity and ideology did not account for similar variation in stress response among adolescents from Gaza and South Lebanon. While higher levels of religiosity evidenced the greatest levels of depression and anxiety in adolescents from Gaza, religiosity had an attenuated effect on adolescents from South Lebanon. Ideology was negatively associated with depression and anxiety in Gaza strip adolescents, whereas it did not play a role for adolescents from South Lebanon. The clinical and research implications of these conclusions are discussed. Copyright © 2012 Elsevier Ltd. All rights reserved.

Cultural patterns of trauma among 19th-century-born males in cadaver collections.

PubMed

De La Cova, Carlina

2010-01-01

Comprehending violence among bioarchaeological and historical groups is a topic of recent interest among biological anthropologists. This research examines trauma among African American and Euro-American males of low socioeconomic status born between 1825 and 1877. A total of 651 male skeletons from the Cobb, Terry, and Hamann-Todd anatomical collections were macroscopically evaluated for skeletal trauma, based on the presence of fractures and weapon-related wounds, and statistically analyzed according to ancestry, birth (Antebellum, Civil War, Reconstruction), combined ancestry - birth, and collection cohorts. Results indicated that African Americans and Euro-Americans expressed ethnic differences in regard to interpersonal violence. To interpret these disparities, documentary data were used to reconstruct the socioeconomic and cultural environment of these individuals. This research emphasizes the importance of evaluating skeletal data within the context of class, culture, and environment so that behavioral patterns observed in the skeleton can be better understood.

Assisting Australians with mental health problems and financial difficulties: a Delphi study to develop guidelines for financial counsellors, financial institution staff, mental health professionals and carers.

PubMed

Bond, Kathy S; Chalmers, Kathryn J; Jorm, Anthony F; Kitchener, Betty A; Reavley, Nicola J

2015-06-03

There is a strong association between mental health problems and financial difficulties. Therefore, people who work with those who have financial difficulties (financial counsellors and financial institution staff) need to have knowledge and helping skills relevant to mental health problems. Conversely, people who support those with mental health problems (mental health professionals and carers) may need to have knowledge and helping skills relevant to financial difficulties. The Delphi expert consensus method was used to develop guidelines for people who work with or support those with mental health problems and financial difficulties. A systematic review of websites, books and journal articles was conducted to develop a questionnaire containing items about the knowledge, skills and actions relevant to working with or supporting someone with mental health problems and financial difficulties. These items were rated over three rounds by five Australian expert panels comprising of financial counsellors (n = 33), financial institution staff (n = 54), mental health professionals (n = 31), consumers (n = 20) and carers (n = 24). A total of 897 items were rated, with 462 items endorsed by at least 80 % of members of each of the expert panels. These endorsed statements were used to develop a set of guidelines for financial counsellors, financial institution staff, mental health professionals and carers about how to assist someone with mental health problems and financial difficulties. A diverse group of expert panel members were able to reach substantial consensus on the knowledge, skills and actions needed to work with and support people with mental health problems and financial difficulties. These guidelines can be used to inform policy and practice in the financial and mental health sectors.

Blood transfusion at the time of the First World War--practice and promise at the birth of transfusion medicine.

PubMed

Boulton, F; Roberts, D J

2014-12-01

The centenary of the start of the First World War has stirred considerable interest in the political, social, military and human factors of the time and how they interacted to produce and sustain the material and human destruction in the 4 years of the war and beyond. Medical practice may appear distant and static and perhaps seems to have been somewhat ineffectual in the face of so much trauma and in the light of the enormous advances in medicine and surgery over the last century. However, this is an illusion of time and of course medical, surgical and psychiatric knowledge and procedures were developing rapidly at the time and the war years accelerated implementation of many important advances. Transfusion practice lay at the heart of resuscitation, and although direct transfusion from donor to recipient was still used, Geoffrey Keynes from Britain, Oswald Robertson from America and his namesake Lawrence Bruce Robertson from Canada, developed methods for indirect transfusion from donor to recipient by storing blood in bottles and also blood-banking that laid the foundation of modern transfusion medicine. This review explores the historical setting behind the development of blood transfusion up to the start of the First World War and on how they progressed during the war and afterwards. A fresh look may renew interest in how a novel medical speciality responded to the needs of war and of post-war society. © 2015 British Blood Transfusion Society.

Communicative Empowerment of People with Intellectual Disability

ERIC Educational Resources Information Center

van Nijnatten, Carolus; Heestermans, Marianne

2012-01-01

Background: Personal narratives are conditional for victims of sexual abuse to overcome their trauma. Counsellors can help victims with intellectual disability to take an active position in conversations about sexuality and to co-construct a personal narrative. Method: Using discourse and conversational analysis, we studied 4 conversations between…

Drugs, Violence, and Trauma in Mexico and the USA

PubMed Central

Puyana, Juan Carlos; Puyana, Juan Carlos Jacob; Rubiano, Andres Mariano; Montenegro, Jorge Hernan; Estebanez, Glyn O.; Sanchez, Alvaro Ignacio; Vega-Rivera, Felipe

2017-01-01

The impact of illicit drug markets on the occurrence of violence varies tremendously depending on many factors. Over the last years, Mexico and the USA have increased security border issues that included many aspects of drug-related trade and criminal activities. Mexico experienced only a small reduction in trauma deaths after the enforcement of severe crime reinforcement policies. This strategy in the war on drugs is shifting the drug market to other Central American countries. This phenomenon is called the ballooning effect, whereby the pressure to control illicit drug-related activities in one particular area forces a shift to other more vulnerable areas that leads to an increase in crime and violence. A human rights crisis characterized by suffering, injury, and death related to drug trafficking continues to expand, resulting in the exorbitant loss of lives and cost in productivity across the continent. The current climate of social violence in Central America and the illegal immigration to the USA may be partially related to this phenomenon of drug trafficking, gang violence, and crime. A health care initiative as an alternative to the current war approach may be one of the interventions needed to reduce this crisis. PMID:28329741

The impact of specialist trauma service on major trauma mortality.

PubMed

Wong, Ting Hway; Lumsdaine, William; Hardy, Benjamin M; Lee, Keegan; Balogh, Zsolt J

2013-03-01

Trauma services throughout the world have had positive effects on trauma-related mortality. Australian trauma services are generally more consultative in nature rather than the North American model of full trauma admission service. We hypothesized that the introduction of a consultative specialist trauma service in a Level I Australian trauma center would reduce mortality of the severely injured. A 10-year retrospective study (January 1, 2002-December 31, 2011) was performed on all trauma patients admitted with an Injury Severity Score (ISS) > 15. Patients were identified from the trauma registry, and data for age, sex, mechanism of injury, ISS, survival to discharge, and length of stay were collected. Mortality was examined for patients with severe injury (ISS > 15) and patients with critical injury (ISS > 24) and compared for the three periods: 2002-2004 (without trauma specialist), 2005-2007 (with trauma specialist), and 2008-2011 (with specialist trauma service). A total of 3,869 severely injured (ISS > 15) trauma patients were identified during the 10-year period. Of these, 2,826 (73%) were male, 1,513 (39%) were critically injured (ISS > 24), and more than 97% (3,754) were the victim of blunt trauma. Overall mortality decreased from 12.4% to 9.3% (relative risk, 0.75) from period one to period three and from 25.4% to 20.3% (relative risk, 0.80) for patients with critical injury. A 0.46% per year decrease (p = 0.018) in mortality was detected (odds ratio, 0.63; p < 0.001). For critically injured (ISS > 24), the trend was (0.61% per year; odds ratio, 0.68; p = 0.039). The introduction of a specialist trauma service decreased the mortality of patients with severe injury, the model of care should be considered to implement state- and nationwide in Australia. Epidemiologic study, level III.

Epidemiology of moderate-to-severe penetrating versus closed traumatic brain injury in the Iraq and Afghanistan wars.

PubMed

Orman, Jean A; Geyer, Dennis; Jones, John; Schneider, Eric B; Grafman, Jordan; Pugh, Mary Jo; Dubose, Joseph

2012-12-01

US combat operations in Iraq and Afghanistan have resulted in a greater proportion of service members with head and neck wounds caused by explosions compared with that of previous wars. Although penetrating traumatic brain injury (TBI) is frequently associated with these wounds, the epidemiology of penetrating TBI from these conflicts has not been well described. The Joint Theater Trauma Registry was queried for January 2003 through December 2010 to identify all patients with moderate-to-severe brain injury with a maximum Abbreviated Injury Scale (AIS) score of the head of 3 or greater and a diagnosis of penetrating or closed TBI in accordance with the Department of Defense Traumatic Brain Injury Surveillance definition. The epidemiology of these injuries was examined, including demographics, TBI severity, overall injury severity, and surgical interventions provided. A total of 1,255 TBI patients (774 penetrating, 481 closed) meeting criteria were identified. Penetrating brain injuries were more severe, more likely to be battle related, and less likely to be isolated injuries than a group of moderate-to-severe closed TBIs within the same range of anatomic injury severity. During the 5-year period of the Iraq war with the largest numbers of TBIs (2004-2008), the numbers of penetrating TBIs exceeded closed TBIs by a ratio of 2:1. During the 3-year period of the Afghanistan war with the greatest numbers of TBIs (2008-2010), the ratio of penetrating to closed TBIs was substantially lower, approximately 1.3:1. This study represents the first comprehensive report on the epidemiology of moderate-to-severe penetrating and closed TBIs resulting from the wars in Iraq and Afghanistan using Joint Theater Trauma Registry data. With the maturing theater of conflicts, penetrating TBIs were substantially less predominant compared with closed TBIs. While this finding may reflect changes in the use of protective measures and tactics or improvements in diagnosis of closed TBIs

Trauma center staffing, infrastructure, and patient characteristics that influence trauma center need.

PubMed

Faul, Mark; Sasser, Scott M; Lairet, Julio; Mould-Millman, Nee-Kofi; Sugerman, David

2015-01-01

The most effective use of trauma center resources helps reduce morbidity and mortality, while saving costs. Identifying critical infrastructure characteristics, patient characteristics and staffing components of a trauma center associated with the proportion of patients needing major trauma care will help planners create better systems for patient care. We used the 2009 National Trauma Data Bank-Research Dataset to determine the proportion of critically injured patients requiring the resources of a trauma center within each Level I-IV trauma center (n=443). The outcome variable was defined as the portion of treated patients who were critically injured. We defined the need for critical trauma resources and interventions ("trauma center need") as death prior to hospital discharge, admission to the intensive care unit, or admission to the operating room from the emergency department as a result of acute traumatic injury. Generalized Linear Modeling (GLM) was used to determine how hospital infrastructure, staffing Levels, and patient characteristics contributed to trauma center need. Nonprofit Level I and II trauma centers were significantly associated with higher levels of trauma center need. Trauma centers that had a higher percentage of transferred patients or a lower percentage of insured patients were associated with a higher proportion of trauma center need. Hospital infrastructure characteristics, such as bed capacity and intensive care unit capacity, were not associated with trauma center need. A GLM for Level III and IV trauma centers showed that the number of trauma surgeons on staff was associated with trauma center need. Because the proportion of trauma center need is predominantly influenced by hospital type, transfer frequency, and insurance status, it is important for administrators to consider patient population characteristics of the catchment area when planning the construction of new trauma centers or when coordinating care within state or regional

Practitioner Review: Assessment and Treatment of Refugee Children and Adolescents Who Have Experienced War-Related Trauma

ERIC Educational Resources Information Center

Ehntholt, Kimberly A.; Yule, William

2006-01-01

Background: Increasingly clinicians are being asked to assess and treat young refugees, who have experienced traumatic events due to war and organised violence. However, evidence-based guidance remains scarce. Method: Published studies on the mental health difficulties of refugee children and adolescents, associated risk and protective factors, as…

Surgical outcomes of a civil war in a neighbouring country.

PubMed

Akkucuk, Seckin; Aydogan, A; Yetim, I; Ugur, M; Oruc, C; Kilic, E; Paltaci, I; Kaplan, A; Temiz, M

2016-08-01

The civil war in Syria began on 15 March 2011, and many of the injured were treated in the neighbouring country of Turkey. This study reports the surgical outcomes of this war, in a tertiary centre in Turkey. 159 patients with civilian war injuries in Syria who were admitted to the General Surgery Department in the Research and Training Hospital of the Medical School of Mustafa Kemal University, Hatay, Turkey, between 2011 and 2012 were analysed regarding the age, sex, injury type, history of previous surgery for the injury, types of abdominal injuries (solid or luminal organ), the status of isolated abdominal injuries or multiple injuries, mortality, length of hospital stay and injury severity scoring. The median age of the patients was 30.05 (18-66 years) years. Most of the injuries were gunshot wounds (99 of 116 patients, 85.3%). Primary and previously operated patients were transferred to our clinic in a median time of 6.28±4.44 h and 58.11±44.08 h, respectively. Most of the patients had intestinal injuries; although a limited number of patients with colorectal injuries were treated with primary repair, stoma was the major surgical option due to the gross peritoneal contamination secondary to prolonged transport time. Two women and 21 men died. The major cause of death was multiorgan failure secondary to sepsis (18 patients). In the case of civil war in the bordering countries, it is recommended that precautions are taken, such as transformation of nearby civilian hospitals into military ones and employment of experienced trauma surgeons in these hospitals to provide effective medical care. Damage control procedures can avoid fatalities especially before the lethal triad of physiological demise occurs. Rapid transport of the wounded to the nearest medical centre is the key point in countries neighbouring a civil war. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Incremental cost-effectiveness of trauma service improvements for road trauma casualties: experience of an Australian major trauma centre.

PubMed

Dinh, Michael M; Bein, Kendall J; Hendrie, Delia; Gabbe, Belinda; Byrne, Christopher M; Ivers, Rebecca

2016-09-01

Objective The aim of the present study was to estimate the cost-effectiveness of trauma service funding enhancements at an inner city major trauma centre. Methods The present study was a cost-effectiveness analysis using retrospective trauma registry data of all major trauma patients (injury severity score >15) presenting after road trauma between 2001 and 2012. The primary outcome was cost per life year gained associated with the intervention period (2007-12) compared with the pre-intervention period (2001-06). Incremental costs were represented by all trauma-related funding enhancements undertaken between 2007 and 2010. Risk adjustment for years of life lost was conducted using zero-inflated negative binomial regression modelling. All costs were expressed in 2012 Australian dollar values. Results In all, 876 patients were identified during the study period. The incremental cost of trauma enhancements between 2007 and 2012 totalled $7.91million, of which $2.86million (36%) was attributable to road trauma patients. After adjustment for important covariates, the odds of in-hospital mortality reduced by around half (adjusted odds ratio (OR) 0.48; 95% confidence interval (CI) 0.27, 0.82; P=0.01). The incremental cost-effectiveness ratio was A$7600 per life year gained (95% CI A$5524, $19333). Conclusion Trauma service funding enhancements that enabled a quality improvement program at a single major trauma centre were found to be cost-effective based on current international and Australian standards. What is known about this topic? Trauma quality improvement programs have been implemented across most designated trauma hospitals in an effort to improve hospital care processes and outcomes for injured patients. These involve a combination of education and training, the use of audit and key performance indicators. What does this paper add? A trauma quality improvement program initiated at an Australian Major Trauma Centre was found to be cost-effective over 12 years with

Anaesthetic and other treatments of shell shock: World War I and beyond.

PubMed

McKenzie, A G

2012-03-01

Post-traumatic stress disorder (PTSD) is an important health risk factor for military personnel deployed in modern warfare. In World War I this condition (then known as shell shock or 'neurasthenia') was such a problem that 'forward psychiatry' was begun by French doctors in 1915. Some British doctors tried general anaesthesia as a treatment (ether and chloroform), while others preferred application of electricity. Four British 'forward psychiatric units' were set up in 1917. Hospitals for shell shocked soldiers were also established in Britain, including (for officers) Craiglockhart War Hospital in Edinburgh; patients diagnosed to have more serious psychiatric conditions were transferred to the Royal Edinburgh Asylum. Towards the end of 1918 anaesthetic and electrical treatments of shell shock were gradually displaced by modified Freudian methods psychodynamic intervention. The efficacy of 'forward psychiatry' was controversial. In 1922 the War Office produced a report on shell shock with recommendations for prevention of war neurosis. However, when World War II broke out in 1939, this seemed to have been ignored. The term 'combat fatigue' was introduced as breakdown rates became alarming, and then the value of pre-selection was recognised. At the Maudsley Hospital in London in 1940 barbiturate abreaction was advocated for quick relief from severe anxiety and hysteria, using i.v. anaesthetics: Somnifaine, paraldehyde, Sodium Amytal. 'Pentothal narcosis' and 'narco-analysis' were adopted by British and American military psychiatrists. However, by 1945 medical thinking gradually settled on the same approaches that had seemed to be effective in 1918. The term PTSD was introduced in 1980. In the UK the National Institute for Health and Clinical Excellence (NICE) guidelines for management (2005) recommend trauma-focussed Cognitive Behavioural Therapy and consideration of antidepressants.

History of the Innovation of Damage Control for Management of Trauma Patients: 1902-2016.

PubMed

Roberts, Derek J; Ball, Chad G; Feliciano, David V; Moore, Ernest E; Ivatury, Rao R; Lucas, Charles E; Fabian, Timothy C; Zygun, David A; Kirkpatrick, Andrew W; Stelfox, Henry T

2017-05-01

To review the history of the innovation of damage control (DC) for management of trauma patients. DC is an important development in trauma care that provides a valuable case study in surgical innovation. We searched bibliographic databases (1950-2015), conference abstracts (2009-2013), Web sites, textbooks, and bibliographies for articles relating to trauma DC. The innovation of DC was then classified according to the Innovation, Development, Exploration, Assessment, and Long-term study model of surgical innovation. The "innovation" of DC originated from the use of therapeutic liver packing, a practice that had previously been abandoned after World War II because of adverse events. It then "developed" into abbreviated laparotomy using "rapid conservative operative techniques." Subsequent "exploration" resulted in the application of DC to increasingly complex abdominal injuries and thoracic, peripheral vascular, and orthopedic injuries. Increasing use of DC laparotomy was followed by growing reports of postinjury abdominal compartment syndrome and prophylactic use of the open abdomen to prevent intra-abdominal hypertension after DC laparotomy. By the year 2000, DC surgery had been widely adopted and was recommended for use in surgical journals, textbooks, and teaching courses ("assessment" stage of innovation). "Long-term study" of DC is raising questions about whether the procedure should be used more selectively in the context of improving resuscitation practices. The history of the innovation of DC illustrates how a previously abandoned surgical technique was adapted and readopted in response to an increased understanding of trauma patient physiology and changing injury patterns and trauma resuscitation practices.

The Role of Cumulative Trauma, Betrayal, and Appraisals in Understanding Trauma Symptomatology.

PubMed

Martin, Christina Gamache; Cromer, Lisa Demarni; Deprince, Anne P; Freyd, Jennifer J

2013-03-01

Poor psychological outcomes are common among trauma survivors, yet not all survivors experience adverse sequelae. The current study examined links between cumulative trauma exposure as a function of the level of betrayal (measured by the relational closeness of the survivor and the perpetrator), trauma appraisals, gender, and trauma symptoms. Participants were 273 college students who reported experiencing at least one traumatic event on a trauma checklist. Three cumulative indices were constructed to assess the number of different types of traumas experienced that were low (LBTs), moderate (MBTs), or high in betrayal (HBTs). Greater trauma exposure was related to more symptoms of depression, dissociation, and PTSD, with exposure to HBTs contributing the most. Women were more likely to experience HBTs than men, but there were no gender differences in trauma-related symptoms. Appraisals of trauma were predictive of trauma-related symptoms over and above the effects explained by cumulative trauma at each level of betrayal. The survivor's relationship with the perpetrator, the effect of cumulative trauma, and their combined impact on trauma symptomatology are discussed.

The Role of Cumulative Trauma, Betrayal, and Appraisals in Understanding Trauma Symptomatology

PubMed Central

Martin, Christina Gamache; Cromer, Lisa DeMarni; DePrince, Anne P.; Freyd, Jennifer J.

2012-01-01

Poor psychological outcomes are common among trauma survivors, yet not all survivors experience adverse sequelae. The current study examined links between cumulative trauma exposure as a function of the level of betrayal (measured by the relational closeness of the survivor and the perpetrator), trauma appraisals, gender, and trauma symptoms. Participants were 273 college students who reported experiencing at least one traumatic event on a trauma checklist. Three cumulative indices were constructed to assess the number of different types of traumas experienced that were low (LBTs), moderate (MBTs), or high in betrayal (HBTs). Greater trauma exposure was related to more symptoms of depression, dissociation, and PTSD, with exposure to HBTs contributing the most. Women were more likely to experience HBTs than men, but there were no gender differences in trauma-related symptoms. Appraisals of trauma were predictive of trauma-related symptoms over and above the effects explained by cumulative trauma at each level of betrayal. The survivor’s relationship with the perpetrator, the effect of cumulative trauma, and their combined impact on trauma symptomatology are discussed. PMID:23542882

Preparing Global Trauma Nurses for Leadership Roles in Global Trauma Systems.

PubMed

Muñiz, Sol Angelica; Lang, Richard W; Falcon, Lisa; Garces-King, Jasmine; Willard, Suzanne; Peck, Gregory L

Trauma leads to 5.7 million annual deaths globally, accounting for 25%-33% of global unintentional deaths and 90% of the global trauma burden in low- and middle-income countries. The Lancet Commission on Global Surgery and the World Health Organization assert that emergent and essential surgical capacity building and trauma system improvement are essential to address the global burden of trauma. In response, the Rutgers Global Surgery program, the School of Nursing and Medicine, and the Robert Wood Johnson University Hospital faculty collaborated in the first Interprofessional Models in Global Injury Care and Education Symposium in June 2016. This 2-week symposium combined lectures, high-fidelity simulation, small group workshops, site visits to Level I trauma centers, and a 1-day training course from the Panamerican Trauma Society. The aim was to introduce global trauma nurses to trauma leadership and trauma system development. After completing the symposium, 10 nurses from China, Colombia, Kenya, Puerto Rico, and Uruguay were surveyed. Overall, 88.8% of participants reported high levels of satisfaction with the program and 100% stated being very satisfied with trauma lectures. Symposia, such as that developed and offered by Rutgers University, prepare nurses to address trauma within system-based care and facilitate trauma nursing leadership in their respective countries.

The "War Poets": Evolution of a Literary Conscience in World War I.

ERIC Educational Resources Information Center

Galambos, Ellen

1983-01-01

Pre-World War I poetry often used picturesque images which blinded people to the actual horrors of war. The war poets, who experienced the destruction of World War I, led the way in expressing new images of the devastation and death of war, rather than focusing on honor and glory. (IS)

Trauma-focused CBT for youth with complex trauma

PubMed Central

Mannarino, Anthony P.; Kliethermes, Matthew; Murray, Laura A.

2013-01-01

Objectives Many youth develop complex trauma, which includes regulation problems in the domains of affect, attachment, behavior, biology, cognition, and perception. Therapists often request strategies for using evidence-based treatments (EBTs) for this population. This article describes practical strategies for applying Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) for youth with complex trauma. Methods TF-CBT treatment phases are described and modifications of timing, proportionality and application are described for youth with complex trauma. Practical applications include a) dedicating proportionally more of the model to the TF-CBT coping skills phase; b) implementing the TF-CBT Safety component early and often as needed throughout treatment; c) titrating gradual exposure more slowly as needed by individual youth; d) incorporating unifying trauma themes throughout treatment; and e) when indicated, extending the TF-CBT treatment consolidation and closure phase to include traumatic grief components and to generalize ongoing safety and trust. Results Recent data from youth with complex trauma support the use of the above TF-CBT strategies to successfully treat these youth. Conclusions The above practical strategies can be incorporated into TF-CBT to effectively treat youth with complex trauma. Practice implications Practical strategies include providing a longer coping skills phase which incorporates safety and appropriate gradual exposure; including relevant unifying themes; and allowing for an adequate treatment closure phase to enhance ongoing trust and safety. Through these strategies therapists can successfully apply TF-CBT for youth with complex trauma. PMID:22749612

Pediatric trauma at an adult trauma center.

PubMed

Siram, Suryanarayana; Oyetunji, Tolulope A; Khoury, Amal L; Walker, Sonya R; Bolorunduro, Oluwaseyi B; Chang, David C; Greene, Wendy R; Cornwell, Edward E; Frederick, Wayne A I

2010-08-01

Accidental traumatic injury is the number 1 cause of morbidity and mortality in the pediatric population. In this study, we aim to prove that certain pediatric patients can be treated with good outcomes at an adult level 1 trauma center. Retrospective analysis using the Howard University Hospital trauma registry identified 71 patients treated at Howard University Hospital between the ages of 1 and 17 years old. Specific variables were identified and collected for each patient. The majority of pediatric traumas treated at Howard University Hospital between June 2004 and May 2005 had high survival rates (93%). The patients who did not survive (7%) included 3 patients who were dead on arrival and 2 who died shortly after arrival to the hospital. Certain pediatric populations who present with minor and/or isolated injuries can be treated in an adult level 1 trauma center with similar outcomes to treatment in a pediatric level 1 trauma center.

Psychosocial effects of war experiences among displaced children in southern Darfur.

PubMed

Morgos, Dorothy; Worden, J William; Gupta, Leila

were measured in these children. Although trauma, depression, and grief often exist as co-morbid disorders, the mechanisms and pathways of these is less understood. In this study we used Structural Equation Modeling to better understand the complex interaction and trajectories of these three symptoms evolving from war exposure and loss. This study is the first of its kind to assess the psychosocial effects of war experiences among children currently living in war zone areas within Sudan. It identifies some of the most prevalent war-related atrocities and their varying impact on the children's psychological well-being and overall adjustment. Implications for planning mental health interventions are discussed.

Trauma Fact Sheet

MedlinePlus

... News & Meetings Science Education About NIGMS NIGMS Home > Science Education > Physical Trauma Physical Trauma Tagline (Optional) Middle/Main Content Area PDF Version (420 KB) Other Fact Sheets What is physical trauma? Physical trauma is ...

School Counsellors and Cultural Diversity Management in Spanish Secondary Schools: The Role of Relations with Other Educators and Intervention Models Used in Care of Immigrant Students

ERIC Educational Resources Information Center

González-Falcón, Inmaculada; Coronel, José M.; Correa, R. Ignacio

2016-01-01

During the last 20 years, the influx of immigrant pupils in Spanish schools has taken up much of school counsellors' agendas. This leads us to reflect upon the status and role of educational guidance in terms of cultural diversity management, particularly focusing on two elements that may potentially help understand the situation: relations with…

Group crisis intervention for children during ongoing war conflict.

PubMed

Thabet, Abdel Aziz; Vostanis, Panos; Karim, Khalid

2005-08-01

The aim of this study was to evaluate the short-term impact of a group crisis intervention for children aged 9-15 years from five refugee camps in the Gaza Strip during ongoing war conflict. Children were selected if they reported moderate to severe posttraumatic stress reactions, and were allocated to group intervention (N=47) encouraging expression of experiences and emotions through storytelling, drawing, free play and role-play; education about symptoms (N=22); or no intervention (N=42). Children completed the CPTSD-RI and the CDI pre- and post-intervention. No significant impact of the group intervention was established on children's posttraumatic or depressive symptoms. Possible explanations of the findings are discussed, including the continuing exposure to trauma and the non-active nature of the intervention.

Nepali concepts of psychological trauma: the role of idioms of distress, ethnopsychology and ethnophysiology in alleviating suffering and preventing stigma.

PubMed

Kohrt, Brandon A; Hruschka, Daniel J

2010-06-01

In the aftermath of a decade-long Maoist civil war in Nepal and the recent relocation of thousands of Bhutanese refugees from Nepal to Western countries, there has been rapid growth of mental health and psychosocial support programs, including posttraumatic stress disorder treatment, for Nepalis and ethnic Nepali Bhutanese. This medical anthropology study describes the process of identifying Nepali idioms of distress and local ethnopsychology and ethnophysiology models that promote effective communication about psychological trauma in a manner that minimizes stigma for service users. Psychological trauma is shown to be a multifaceted concept that has no single linguistic corollary in the Nepali study population. Respondents articulated different categories of psychological trauma idioms in relation to impact on the heart-mind, brain-mind, body, spirit, and social status, with differences in perceived types of traumatic events, symptom sets, emotion clusters and vulnerability. Trauma survivors felt blamed for experiencing negative events, which were seen as karma transmitting past life sins or family member sins into personal loss. Some families were reluctant to seek care for psychological trauma because of the stigma of revealing this bad karma. In addition, idioms related to brain-mind dysfunction contributed to stigma, while heart-mind distress was a socially acceptable reason for seeking treatment. Different categories of trauma idioms support the need for multidisciplinary treatment with multiple points of service entry.

Nepali Concepts of Psychological Trauma: The Role of Idioms of Distress, Ethnopsychology, and Ethnophysiology in Alleviating Suffering and Preventing Stigma

PubMed Central

Hruschka, Daniel J.

2013-01-01

In the aftermath of a decade-long Maoist civil war in Nepal and the recent relocation of thousands of Bhutanese refugees from Nepal to Western countries, there has been rapid growth of mental health and psychosocial support programs, including posttraumatic stress disorder (PTSD) treatment, for Nepalis and ethnic Nepali Bhutanese. This medical anthropology study describes the process of identifying Nepali idioms of distress and local ethnopsychology and ethnophysiology models that promote effective communication about psychological trauma in a manner that minimizes stigma for service users. Psychological trauma is shown to be a multi-faceted concept that has no single linguistic corollary in the Nepali study population. Respondents articulated different categories of psychological trauma idioms in relation to impact upon the heart-mind, brain-mind, body, spirit, and social status, with differences in perceived types of traumatic events, symptom sets, emotion clusters, and vulnerability. Trauma survivors felt blamed for experiencing negative events, which were seen as karma transmitting past life sins or family member sins into personal loss. Some families were reluctant to seek care for psychological trauma because of the stigma of revealing this bad karma. In addition, idioms related to brain-mind dysfunction contributed to stigma while heart-mind distress was a socially acceptable reason for seeking treatment. Different categories of trauma idioms support the need for multidisciplinary treatment with multiple points of service entry. PMID:20309724

Increase in the incidence of type 1 diabetes in Israeli children following the Second Lebanon War.

PubMed

Zung, Amnon; Blumenfeld, Orit; Shehadeh, Naim; Dally Gottfried, Orna; Tenenbaum Rakover, Yardena; Hershkovitz, Eli; Gillis, David; Zangen, David; Pinhas-Hamiel, Orit; Hanukoglu, Aaron; Rachmiel, Marianna; Shalitin, Shlomit

2012-06-01

Type 1 diabetes is an autoimmune disease occurring in genetically susceptible individuals. The precipitating cause is unclear. Recently, the Second Lebanon War exposed a large civilian population in northern Israel to significant psychological stress in the form of repeated barrages of missile attacks. We hypothesized that trends in regional incidence of type 1 diabetes before and after the war would reflect an association with stress. All type 1 diabetes patients aged 0-17 yr who were reported to the Israel Juvenile Diabetes Register (n = 1822) in the four pre-war (2002-2005) and two post-war years (2006-2007) were included in the study. The patients were stratified by gender, age, ethnicity, family history of type 1 diabetes, season at diagnosis, and region of residency, namely, those who lived in the northern regions that were attacked and those in other regions. The post-war incidence of type 1 diabetes was increased in the northern regions (rate ratio, RR = 1.27; p = 0.037), with no change in the other regions. This change was more prominent in males (RR = 1.55; p = 0.005) but similar in summer and winter, in different ages, and in different ethnic groups. There was no change in the proportion of new patients with a family history of the disease. For the first time in a large population, we found a positive association between the trauma of war and an increase in the incidence of type 1 diabetes in children and adolescents. The increase in incidence was not associated with genetic susceptibility to the disease. © 2011 John Wiley & Sons A/S.

The role of the trauma nurse leader in a pediatric trauma center.

PubMed

Wurster, Lee Ann; Coffey, Carla; Haley, Kathy; Covert, Julia

2009-01-01

The trauma nurse leader role was developed by a group of trauma surgeons, hospital administrators, and emergency department and trauma leaders at Nationwide Children's Hospital who recognized the need for the development of a core group of nurses who provided expert trauma care. The intent was to provide an experienced group of nurses who could identify and resolve issues in the trauma room. Through increased education, exposure, mentoring, and professional development, the trauma nurse leader role has become an essential part of the specialized pediatric trauma care provided at Nationwide Children's Hospital.

The trauma ecosystem: The impact and economics of new trauma centers on a mature statewide trauma system.

PubMed

Ciesla, David J; Pracht, Etienne E; Leitz, Pablo T; Spain, David A; Staudenmayer, Kristan L; Tepas, Joseph J

2017-06-01

Florida serves as a model for the study of trauma system performance. Between 2010 and 2104, 5 new trauma centers were opened alongside 20 existing centers. The purpose of this study was to explore the impact of trauma system expansion on system triage performance and trauma center patients' profiles. A statewide data set was queried for all injury-related discharges from adult acute care hospitals using International Classification of Diseases, Ninth Revision (ICD-9) codes for 2010 and 2014. The data set, inclusion criteria, and definitions of high-risk injury were chosen to match those used by the Florida Department of Health in its trauma registry. Hospitals were classified as existing Level I (E1) or Level II (E2) trauma centers and new E2 (N2) centers. Five N2 centers were established 11.6 to 85.3 miles from existing centers. Field and overall trauma system triage of high-risk patients was less accurate with increased overtriage and no change in undertriage. Annual volume at N2 centers increased but did not change at E1 and E2 centers. In 2014, Patients at E1 and E2 centers were slightly older and less severely injured, while those at N2 centers were substantially younger and more severely injured than in 2010. The injured patient-payer mix changed with a decrease in self-pay and commercial patients and an increase in government-sponsored patients at E1 and E2 centers and an increase in self-pay and commercial patients with a decrease in government-sponsored patients at N2 centers. Designation of new trauma centers in a mature system was associated with a change in established trauma center demographics and economics without an improvement in trauma system triage performance. These findings suggest that the health of an entire trauma system network must be considered in the design and implementation of a regional trauma system. Therapeutic/care management study, level IV; epidemiological, level IV.

[Emergence of early childhood trauma in adult psychiatric symptomatology].

PubMed

Bouras, G; Lazaratou, E

2012-06-01

Trauma comes as a result of the subject's exposure to extremely negative and stressful events, such as natural or human-provoked catastrophes, wars, serious injuries, violent deaths, tortures, terrorist attacks, rapes and other sexual crimes. A child's exposure to traumatic circumstances of this level during the crucial period of self-structuring creates rather difficult conditions for its development. Moreover, if the child does not have the opportunity to elaborate and analyze all these stressful conditions and put them into words, serious consequences, both psychological and somatic, may occur in adult life. Specific factors and child characteristics, namely, the age, the developmental stage within which the trauma occurs, its type (physical or sexual abuse, neglect or traumatic social events), frequency, duration and intensity, have been proved to seriously affect the trauma's consequences. The immediate emotional impact of trauma may include isolation, fear, feeling of weakness or loss of the sense of confidence. Moreover, mood disorders such as depression and withdrawal, negative effects on cognitive ability, language development and academic performance, difficulties in creating a secure link and post-traumatic stress disorder (PTSD) are also observed. The long-term consequences for the individual's mental health can be expressed through the following: post-traumatic stress disorder (PTSD) combined or not with depression and anxiety disorder, mood disorders, personality disorders, poor control of impulsions, dissociation disorder, psychotic disorder. Finally, apart from the dramatic impact of trauma on the person itself, there is also a high social cost to be paid as a result of the individual's poor adjustment and dysfunction in the community. Early support and intervention in the child's environment may significantly minimize the negative effects of trauma. Beyond the expression of genes, good maternal care as well as psychological support, lead to normal

Long-term mental health of war-refugees: a systematic literature review.

PubMed

Bogic, Marija; Njoku, Anthony; Priebe, Stefan

2015-10-28

three disorders, whilst a poor post-migration socio-economic status was particularly associated with depression. There is a need for more methodologically consistent and rigorous research on the mental health of long-settled war refugees. Existing evidence suggests that mental disorders tend to be highly prevalent in war refugees many years after resettlement. This increased risk may not only be a consequence of exposure to wartime trauma but may also be influenced by post-migration socio-economic factors.

Battle for the mind: World War 1 and the birth of military psychiatry.

PubMed

Jones, Edgar; Wessely, Simon

2014-11-08

The 100th anniversary of the outbreak of World War 1 could be viewed as a tempting opportunity to acknowledge the origins of military psychiatry and the start of a journey from psychological ignorance to enlightenment. However, the psychiatric legacy of the war is ambiguous. During World War 1, a new disorder (shellshock) and a new treatment (forward psychiatry) were introduced, but the former should not be thought of as the first recognition of what is now called post-traumatic stress disorder and the latter did not offer the solution to the management of psychiatric casualties, as was subsequently claimed. For this Series paper, we researched contemporary publications, classified military reports, and casualty returns to reassess the conventional narrative about the effect of shellshock on psychiatric practice. We conclude that the expression of distress by soldiers was culturally mediated and that patients with postcombat syndromes presented with symptom clusters and causal interpretations that engaged the attention of doctors but also resonated with popular health concerns. Likewise, claims for the efficacy of forward psychiatry were inflated. The vigorous debates that arose in response to controversy about the nature of psychiatric disorders and the discussions about how these disorders should be managed remain relevant to the trauma experienced by military personnel who have served in Iraq and Afghanistan. The psychiatric history of World War 1 should be thought of as an opportunity for commemoration and in terms of its contemporary relevance-not as an opportunity for self-congratulation. Copyright © 2014 Elsevier Ltd. All rights reserved.

Drugs, Violence, and Trauma in Mexico and the USA.

PubMed

Puyana, Juan Carlos; Puyana, Juan Carlos Jacob; Rubiano, Andres Mariano; Montenegro, Jorge Hernan; Estebanez, Glyn O; Sanchez, Alvaro Ignacio; Vega-Rivera, Felipe

2017-01-01

The impact of illicit drug markets on the occurrence of violence varies tremendously depending on many factors. Over the last years, Mexico and the USA have increased security border issues that included many aspects of drug-related trade and criminal activities. Mexico experienced only a small reduction in trauma deaths after the enforcement of severe crime reinforcement policies. This strategy in the war on drugs is shifting the drug market to other Central American countries. This phenomenon is called the ballooning effect, whereby the pressure to control illicit drug-related activities in one particular area forces a shift to other more vulnerable areas that leads to an increase in crime and violence. A human rights crisis characterized by suffering, injury, and death related to drug trafficking continues to expand, resulting in the exorbitant loss of lives and cost in productivity across the continent. The current climate of social violence in Central America and the illegal immigration to the USA may be partially related to this phenomenon of drug trafficking, gang violence, and crime. A health care initiative as an alternative to the current war approach may be one of the interventions needed to reduce this crisis. © 2017 S. Karger AG, Basel.

Trauma-Focused CBT for Youth Who Experience Ongoing Traumas

ERIC Educational Resources Information Center

Cohen, Judith A.; Mannarino, Anthony P.; Murray, Laura K.

2011-01-01

Many youth experience ongoing trauma exposure, such as domestic or community violence. Clinicians often ask whether evidence-based treatments containing exposure components to reduce learned fear responses to historical trauma are appropriate for these youth. Essentially the question is, if youth are desensitized to their trauma experiences, will…

[The present level of post-traumatic stress symptoms in a sample of child survivors of World War II].

PubMed

Lis-Turlejska, Maja; Szumiał, Szymon; Okuniewska, Hanna

2012-01-01

The aim of the study was to estimate the prevalence of PTSD and level of symptoms more broadly considered as post-traumatic e.g. depression among Polish child survivors of World War II. Data were collected from 218 individuals aged 63-78. a list of questions regarding exposure to a range of war related traumas; PDS (Foa, 1995); IES (Horowitz et al., 1976) to measure PTSD symptoms and BDI (Beck et al., 1961) for depression symptoms. Exposure to potentially traumatic events related to the WWII varied from 1.83% to 47.25%. The prevalence of PTSD symptoms at a diagnostic level according to PDS was 29.4%. The mean values B, C and D-category symptoms were respectively: 2.08 (SD=1.74), 2.34 (SD=1.98) and 2.40 (SD=1.69). Greater age, parental loss and exposure to at least one traumatic war-related event (this variable was close to the level of statistical significance, however) were all predictors of a diagnostic level of PTSD symptoms. 60 years after WW II about one-third of respondents manifest a clinical level of PTSD symptoms. Taking into consideration the results of the research on the child survivors of the modern wars, psychosocial and cultural factors should also be examined as causes of this phenomenon.

Resurrecting Limited War Theory

DTIC Science & Technology

2008-05-01

indirectly with an appreciation of the principles and guidelines for limited war. 15. SUBJECT TERMS Limited War, Political Objectives, Total War...conflict between other nations may require the United States to act indirectly with an appreciation of the principles and guidelines for limited war...in war, echoing Clausewitz’s principle of political primacy. Like Clausewitz, he was also a student of

Facial trauma.

PubMed

Peeters, N; Lemkens, P; Leach, R; Gemels B; Schepers, S; Lemmens, W

Facial trauma. Patients with facial trauma must be assessed in a systematic way so as to avoid missing any injury. Severe and disfiguring facial injuries can be distracting. However, clinicians must first focus on the basics of trauma care, following the Advanced Trauma Life Support (ATLS) system of care. Maxillofacial trauma occurs in a significant number of severely injured patients. Life- and sight-threatening injuries must be excluded during the primary and secondary surveys. Special attention must be paid to sight-threatening injuries in stabilized patients through early referral to an appropriate specialist or the early initiation of emergency care treatment. The gold standard for the radiographic evaluation of facial injuries is computed tomography (CT) imaging. Nasal fractures are the most frequent isolated facial fractures. Isolated nasal fractures are principally diagnosed through history and clinical examination. Closed reduction is the most frequently performed treatment for isolated nasal fractures, with a fractured nasal septum as a predictor of failure. Ear, nose and throat surgeons, maxillofacial surgeons and ophthalmologists must all develop an adequate treatment plan for patients with complex maxillofacial trauma.

PTSD and trauma in Austria's elderly: influence of wartime experiences, postwar zone of occupation, and life time traumatization on today's mental health status—an interdisciplinary approach

PubMed Central

Glück, Tobias M.; Tran, Ulrich S.; Lueger-Schuster, Brigitte

2012-01-01

Background While in recent years epidemiological studies on World War (WW) II-related traumatization and prevalence of posttraumatic stress disorder (PTSD) in elderly persons have been conducted for various European countries, for Austria, these numbers are unknown. Objective The focus of this epidemiologic study was to picture the current mental health status and prevalence of PTSD and lifetime traumatic events in Austria's elderly with respect to WWII and subsequent occupation. Method In an interdisciplinary approach of psychologists and historians, 316 elderly Austrians (born before 1946) were interviewed for symptoms of PTSD and lifetime traumatization (Traumatic Life Events Questionnaire, PTSD Checklist-Civilian Version), current mental health (Brief Symptom Inventory), wartime-related trauma, and traumatic experiences with occupational forces. These factors were also compared regarding the zone of occupation (Allied vs. Soviet). Data were collected between March and September 2010. Results 97.5% of the sample reported at least one lifetime trauma. War-related traumata were reported by 92.7% and non-war-related traumata by 82.3%; 40.2% experienced traumatic events with occupational forces. PTSD was present in 1.9% of the sample and up to 13.9% taking subthreshold PTSD into account. Both, the presence of symptoms indicative of PTSD and subthreshold PTSD implied weaker current mental health (regarding General Distress: odds ratios up to 25.51; 95% CI = 9.82 to 66.27). Independent of PTSD diagnosis persons from the Soviet occupied zone showed higher levels of Interpersonal Sensitivity, Global Distress, and Phobic Anxiety. Prevalence of PTSD was independent of gender. Conclusions Our results corroborate findings from other European countries that PTSD is a common disorder in the elderly due to WWII experience and that PTSD and trauma affect mental health even across long periods of time. Postwar distressing conditions also pose a further risk factor for

Cumulative trauma and midlife well-being in American women who served in Vietnam: effects of combat exposure and postdeployment social support.

PubMed

Park, Crystal L; Wachen, Jennifer Schuster; Kaiser, Anica Pless; Mager Stellman, Jeanne

2015-01-01

Research increasingly demonstrates that trauma exposure can have cumulative effects, yet much remains to be learned about effects of cumulative trauma, particularly regarding longer term adjustment. One such trauma, combat exposure, is insufficiently understood, especially for women, who are increasingly engaged in professional combat activities. The study comprised a cross-sectional survey assessing multiple aspects of current well-being in women approximately 25 years after their service in Vietnam during the Vietnam War. Participants were 1374 women (78% military and 22% nonmilitary; mean age = 59.7). This study investigated the relations between three separate categories of trauma exposure (childhood, adulthood, and combat) and well-being and examined whether perceived social support at return from Vietnam moderated the association between combat exposure and well-being. While both childhood and adulthood trauma exposure related to midlife well-being, combat exposure still uniquely predicted outcomes. Further, postdeployment perceived social support moderated the association of combat and well-being: recollected higher perceived social support at homecoming buffered participants from the links between combat exposure and well-being. These results may have important implications for interventions to reduce the impact of traumatic experiences, particularly in light of the increasing exposure of women to direct combat events.

How Much War Should Be Included in a Course on World War II?

ERIC Educational Resources Information Center

Schilling, Donald G.

1993-01-01

Contends that end of Cold War increases need for students to understand causes and aftermath of World War II. Recommends spending less time on military aspects of the war and more time on the economic, social, and cultural impact of total war. Provides a selected list of resources to be used in a college level course on the war. (CFR)

United Campuses to Prevent Nuclear War: Nuclear War Course Summaries.

ERIC Educational Resources Information Center

Journal of College Science Teaching, 1983

1983-01-01

Briefly describes 46 courses on nuclear war available from United Campuses to Prevent Nuclear War (UCAM). These courses are currently being or have been taught at colleges/universities, addressing effects of nuclear war, arms race history, new weapons, and past arms control efforts. Syllabi (with assignments/reading lists) are available from UCAM.…

Responses of mental health professionals to man-made trauma: the Israeli experience.

PubMed

Solomon, Z

1996-09-01

The reactions and responses of mental health professionals in the area of armed conflict is the focus of this paper. It examines the way the therapeutic community has dealt with the survivors of two catastrophes-the Holocaust and warfare. A parallel process of a gradual change of attitudes towards the survivors was observed: emotional detachment, lack of recognition in the early stages and, eventually, social acceptance and empathy. The origins of these attitudes will be discussed, and three explanations will be offered. Israel is a small, stress-ridden country that has known seven full-scale wars and countless hostilities during its 47 years of existence. Our national history over 2000 years has been beset with persecution, programs and deportations, culminating in the Nazi Holocaust. The establishment of the State of Israel brought with it the hope of a secure existence. Unfortunately, this has not been achieved, and Israel is a natural laboratory of war stress. The reactions and responses of mental health professionals in areas of armed conflict is the focus of this paper. Presented here will be this author's analysis of the way the Israeli society and the helping professions in Israel have dealt with two kinds of man-made catastrophic events: the Nazi Holocaust and seven Arab-Israeli wars. In these different events of human violence, a parallel process of a gradual change of attitude towards the survivors was observed. This remarkable parallel presents emotional detachment, lack of recognition and at times blaming the victims in the early stages and, eventually, social acceptance and empathy. The process of social change becomes complex when the agents of change are themselves members of the social entity undergoing the change. This paper shall demonstrate that therapists and mental health planners had considerable difficulties in transcending public attitudes toward survivors of the Holocaust and psychiatric casualties of the Israeli-Arab conflict. As a result

Correlating weather and trauma admissions at a level I trauma center.

PubMed

Rising, William R; O'Daniel, Joseph A; Roberts, Craig S

2006-05-01

Popular emergency room wisdom touts higher temperatures, snowfall, weekends, and evenings as variables that increase trauma admissions. This study analyzed the possible correlation between trauma admissions and specific weather variables, and between trauma admissions and time of day or season. Trauma admission data from a Level I trauma center database from July 1, 1996 to January 31, 2002 was downloaded and linked with local weather data from the Archives of the National Oceanic and Atmospheric Administration website, and then analyzed. There were 8,269 trauma admissions over a total of 48,984 hours for an average of one admission every 6 hours. Daily high temperature and precipitation were valid predictors of trauma admission volume, with a 5.25% increase in hourly incidents for each 10-degree difference in temperature, and a 60% to 78% increase in the incident rate for each inch of precipitation in the previous 3 hours. Weather and seasonal variations affect admissions at a Level I trauma center. Data from this study could be useful for determining staffing requirements and resource allocation.

World War I: an air war of consequence.

PubMed

Hallion, Richard P

2014-06-01

On December 17, 1903, the brothers Wilbur and Orville Wright flew the world's first successful airplane, following this with the first military airplane in 1908. (The 1908 Flyer was built by the brothers in response to a 1907 requirements specification for a 2-place aircraft capable of flying at 40 mph and able to be broken down and transported in a horse-drawn wagon. Technically, since it crashed during its demonstration program and was not formally delivered to the Army, it never became Army property. But the trials had been so impressive that the Army ordered a second, delivered in 1909.) Just six years later, Europe erupted in a general war. Often portrayed as a sideshow to the war on land and sea, the air war heralded the advent of mechanized warfare, the airplane being one of four great technological advances--the submarine, the tank, and radio communication--that, together, revolutionized military affairs. Aircraft reconnaissance influenced the conduct of military operations from the war's earliest days, and airborne observers routinely governed the fall of artillery barrages, crucially important in an artillery-dominant war. Copyright © 2014. Published by Elsevier Ltd.

Rebuilding community resilience in a post-war context: developing insight and recommendations - a qualitative study in Northern Sri Lanka.

PubMed

Somasundaram, Daya; Sivayokan, Sambasivamoorthy

2013-01-11

Individuals, families and communities in Northern Sri Lanka have undergone three decades of war trauma, multiple displacements, and loss of family, kin, friends, homes, employment and other valued resources. The objective of the study was understanding common psychosocial problems faced by families and communities, and the associated risk and protective factors, so that practical and effective community based interventions can be recommended to rebuild strengths, adaptation, coping strategies and resilience. This qualitative, ecological study is a psychosocial ethnography in post-war Northern Sri Lanka obtained through participant observation; case studies; key- informant interviews; and focus groups discussions with mental health and psychosocial community workers as well as literature survey of media and organizational reports. Qualitative analysis of the data used ethnography, case studies, phenomenology, grounded theory, hermeneutics and symbolic interactionism techniques. Quantitative data on suicide was collected for Jaffna and Killinochchi districts. Complex mental health and psychosocial problems at the individual, family and community levels in a post-war context were found to impair recovery. These included unresolved grief; individual and collective trauma; insecurity, self-harm and suicides; poverty and unemployment; teenage and unwanted pregnancies; alcoholism; child abuse and neglect; gender based violence and vulnerability including domestic violence, widows and female headed-household, family conflict and separation; physical injuries and handicap; problems specific for children and elderly; abuse and/or neglect of elderly and disabled; anti-social and socially irresponsible behaviour; distrust, hopelessness, and powerlessness. Protective factors included families; female leadership and engagement; cultural and traditional beliefs, practices and rituals; and creative potential in narratives, drama and other arts. Risk factors that were impeding

Rebuilding community resilience in a post-war context: developing insight and recommendations - a qualitative study in Northern Sri Lanka

PubMed Central

2013-01-01

Background Individuals, families and communities in Northern Sri Lanka have undergone three decades of war trauma, multiple displacements, and loss of family, kin, friends, homes, employment and other valued resources. The objective of the study was understanding common psychosocial problems faced by families and communities, and the associated risk and protective factors, so that practical and effective community based interventions can be recommended to rebuild strengths, adaptation, coping strategies and resilience. Methods This qualitative, ecological study is a psychosocial ethnography in post-war Northern Sri Lanka obtained through participant observation; case studies; key- informant interviews; and focus groups discussions with mental health and psychosocial community workers as well as literature survey of media and organizational reports. Qualitative analysis of the data used ethnography, case studies, phenomenology, grounded theory, hermeneutics and symbolic interactionism techniques. Quantitative data on suicide was collected for Jaffna and Killinochchi districts. Results Complex mental health and psychosocial problems at the individual, family and community levels in a post-war context were found to impair recovery. These included unresolved grief; individual and collective trauma; insecurity, self-harm and suicides; poverty and unemployment; teenage and unwanted pregnancies; alcoholism; child abuse and neglect; gender based violence and vulnerability including domestic violence, widows and female headed-household, family conflict and separation; physical injuries and handicap; problems specific for children and elderly; abuse and/or neglect of elderly and disabled; anti-social and socially irresponsible behaviour; distrust, hopelessness, and powerlessness. Protective factors included families; female leadership and engagement; cultural and traditional beliefs, practices and rituals; and creative potential in narratives, drama and other arts. Risk

DefenseLink Special: World War I - The Great War Remembered

Science.gov Websites

Us The War That Didn't End All Wars By Jim Garamone American Forces Press Service They called it , and the U.S. Congress declared war. The first American troops journeyed to France in June 1917 phrase that gave heart to the Allies. Army Gen. John J. Pershing commanded the American Expeditionary

Do trauma type, stressful life events, and social support explain women veterans' high prevalence of PTSD?

PubMed

Lehavot, Keren; Goldberg, Simon B; Chen, Jessica A; Katon, Jodie G; Glass, Joseph E; Fortney, John C; Simpson, Tracy L; Schnurr, Paula P

2018-06-23

To examine factors that account for women veterans' higher prevalence of past-year DSM-5 posttraumatic stress disorder (PTSD) compared to women civilians and men veterans. Cross-sectional analyses of the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III). Face-to-face interviews with 379 women veterans, 20,007 women civilians, and 2740 men veterans were conducted. Trauma type (child abuse, interpersonal violence, combat or war zone, and other), number of trauma types, past-year stressful life events, current social support, and DSM-5 PTSD were assessed using the Alcohol Use Disorder and Associated Disabilities Interview Schedule-5. Generalized linear models were used that accounted for the complex survey design. Women veterans had a higher unadjusted prevalence of past-year PTSD (11.40%) compared to their civilian (5.96%) and male (5.19%) counterparts. Individual predictor models indicated that the difference between women veterans' and civilians' prevalence of PTSD was attenuated when adjusting for number of trauma types, whereas the difference between men and women veterans was attenuated when adjusting for child abuse, interpersonal violence, and stressful life events. Nonetheless, while full adjustment in a multiple predictor model accounted for the difference in PTSD between women veterans and civilians, gender differences between men and women veterans remained. Number of trauma types, type of trauma, and social factors may together help explain women veterans' higher PTSD prevalence compared to women civilians, but do not fully account for differences between men and women veterans. Results highlight a need to explore additional explanatory factors and evaluate associations with longitudinal data.

Post-Traumatic Stress Disorder in Adolescents in Lebanon as Wars Gained in Ferocity: A Systematic Review

PubMed Central

Shaar, Khuzama Hijal

2013-01-01

Significance for public health Post traumatic stress disorder (PTSD) in adolescents has been implicated in developmental impairments, mental and scholastic problems, alcohol and drug abuse, and antisocial behavior in its victims among others. Absence of review studies regarding the prevalence of PTSD in adolescents in Lebanon, a country plagued by decades of civil strife and external occupation and invasion, is noted. Such information may reinforce the need to develop national public health policies to identify PTSD in children and adolescents, provide them with counseling and treatment, and formulate prevention strategies to protect vulnerable youth from devastations of war. For decades, Lebanon was war-torn by civil strife, and occupation and invasion by neighboring countries. In time, these wars have escalated in intensity from sniping, barricading streets and random shelling of residential quarters to the use of rockets, aerial bombing, and heavy artillery. Adverse mental health effects are noted in times of war with post traumatic stress disorder (PTSD) as a main outcome. The aim of this study was to carry out a systematic review of published studies documenting the prevalence of PTSD in the adolescent population of Lebanon, to investigate the increase in these rates with the escalation of war intensity, and to examine PTSD determinants. A search strategy was developed for online databases (PubMed and Google Scholar) between inception to the first week of January 2013. Search terms used were PTSD, adolescents and Lebanon. Eleven studies reporting PTSD in adolescents met the inclusion criteria for a total number of 5965 adolescents. Prevalence rates of PTSD ranged from 8.5% to 14.7% for the civil war, 3.7% for adolescents with sensory disabilities, 21.6% for the Grapes of Wrath War, and 15.4% to 35.0% for the 2006 July War. Some increase in PTSD rates in time is noted. Type of trauma such as bereavement, injury, house destruction, and economic problems, low

Prevalence of Gulf war veterans who believe they have Gulf war syndrome: questionnaire study

PubMed Central

Chalder, T; Hotopf, M; Unwin, C; Hull, L; Ismail, K; David, A; Wessely, S

2001-01-01

Objectives To determine how many veterans in a random sample of British veterans who served in the Gulf war believe they have “Gulf war syndrome,” to examine factors associated with the presence of this belief, and to compare the health status of those who believe they have Gulf war syndrome with those who do not. Design Questionnaire study asking British Gulf war veterans whether they believe they have Gulf war syndrome and about symptoms, fatigue, psychological distress, post-traumatic stress, physical functioning, and their perception of health. Participants 2961 respondents to questionnaires sent out to a random sample of 4250 Gulf war veterans (69.7%). Main outcome measure The proportion of veterans who believe they have Gulf war syndrome. Results Overall, 17.3% (95% confidence interval 15.9 to 18.7) of the respondents believed they had Gulf war syndrome. The belief was associated with the veteran having poor health, not serving in the army when responding to the questionnaire, and having received a high number of vaccinations before deployment to the Gulf. The strongest association was knowing another person who also thought they had Gulf war syndrome. Conclusions Substantial numbers of British Gulf war veterans believe they have Gulf war syndrome, which is associated with psychological distress, a high number of symptoms, and some reduction in activity levels. A combination of biological, psychological, and sociological factors are associated with the belief, and these factors should be addressed in clinical practice. What is already known on this topicThe term Gulf war syndrome has been used to describe illnesses and symptoms experienced by veterans of the 1991 Gulf warConcerns exist over the validity of Gulf war syndrome as a unique entityWhat this study adds17% of Gulf war veterans believe they have Gulf war syndromeHolding the belief is associated with worse health outcomesKnowing someone else who believes they have Gulf war syndrome and receiving

Preparing the Field for Feasibility Testing of a Parenting Intervention for War-Affected Mothers in Northern Uganda.

PubMed

Wieling, Elizabeth; Mehus, Christopher; Yumbul, Cigdem; Möllerherm, Julia; Ertl, Verena; Laura, Achan; Forgatch, Marion; Neuner, Frank; Catani, Claudia

2017-06-01

In this article, we discuss the successful implementation of an adapted evidence-based parenting intervention for families affected by two decades of war in Northern Uganda. The adaptation and adoption of such interventions to support mental health and family functioning is widely endorsed by prevention scientists and considered a priority in global mental health. The preparation and early adoption phases of engaging with a highly vulnerable community affected by war trauma are documented in this paper along with a discussion of the steps taken to adapt a parenting intervention for cultural and contextual fit. This study is a component of an overall program of research aimed at reducing the long-term negative effects of war on parenting practices and childhood outcomes, which have considerable implications for preventing mental, neurological, and substance-use disorders. The processes described here cover a 4-year period culminating in the implementation of the nine-session Enhancing Family Connection intervention piloted with a group of 14 mothers. The lessons in cultural adaptation have been valuable and the feasibility results promising for further testing the intervention. © 2015 Family Process Institute.

Recovery from Posttraumatic Stress Symptoms: A Qualitative Study of Attributions in Survivors of War

PubMed Central

Ajdukovic, Dean; Ajdukovic, Dea; Bogic, Marija; Franciskovic, Tanja; Galeazzi, Gian Maria; Kucukalic, Abdulah; Lecic-Tosevski, Dusica; Schützwohl, Matthias; Priebe, Stefan

2013-01-01

Objective The study explored factors to which people traumatized by war attribute their recovery from posttraumatic symptoms and from war experiences. Methods : In-depth interviews were conducted with two groups of participants with mental sequelae of the war in the former Yugoslavia: 26 people who had recovered from posttraumatic stress disorder (PTSD) and 17 people with ongoing symptoms of PTSD. Participants could attribute their recovery to any event, person or process in their life. The material was subjected to thematic analysis. Results Eight themes covered all factors to which participants attributed their recovery. Six themes described healing factors relevant for both groups of participants: social attachment and support, various strategies of coping with symptoms, personality hardiness, mental health treatment, received material support, and normalization of everyday life. In addition to the common factors, recovered participants reported community involvement as healing, and recovered refugees identified also feeling safe after resolving their civil status as helpful. Unique to the recovered group was that they maintained reciprocal relations in social attachment and support, employed future-oriented coping and emphasised their resilient personality style. Conclusions The reported factors of recovery are largely consistent with models of mental health protection, models of resilience and recommended interventions in the aftermath of massive trauma. Yet, they add the importance of a strong orientation towards the future, a reciprocity in receiving and giving social support and involvement in meaningful activities that ensure social recognition as a productive and valued individual. The findings can inform psychosocial interventions to facilitate recovery from posttraumatic symptoms of people affected by war and upheaval. PMID:23950965

Geriatric trauma.

PubMed

Adams, Sasha D; Holcomb, John B

2015-12-01

The landscape of trauma is changing due to an aging population. Geriatric patients represent an increasing number and proportion of trauma admissions and deaths. This review explores recent literature on geriatric trauma, including triage criteria, assessment of frailty, fall-related injury, treatment of head injury complicated by coagulopathy, goals of care, and the need for ongoing education of all surgeons in the care of the elderly. Early identification of high-risk geriatric patients is imperative to initiate early resuscitative efforts. Geriatric patients are typically undertriaged because of their baseline frailty being underappreciated; however, centers that see more geriatric patients do better. Rapid reversal of anticoagulation is important in preventing progression of brain injury. Anticipation of difficult disposition necessitates early involvement of physical therapy for rehabilitation and case management for appropriate placement. Optimal care of geriatric trauma patients will be based on the well established tenets of trauma resuscitation and injury repair, but with distinct elements that address the physiological and anatomical challenges presented by geriatric patients.

International trauma teleconference: evaluating trauma care and facilitating quality improvement.

PubMed

Parra, Michael W; Castillo, Roberto C; Rodas, Edgar B; Suarez-Becerra, Jose M; Puentes-Manosalva, Fabian E; Wendt, Luke M

2013-09-01

Evaluation, development, and implementation of trauma systems in Latin America are challenging undertakings as no model is currently in place that can be easily replicated throughout the region. The use of teleconferencing has been essential in overcoming other challenges in the medical field and improving medical care. This article describes the use of international videoconferencing in the field of trauma and critical care as a tool to evaluate differences in care based on local resources, as well as facilitating quality improvement and system development in Latin America. In February 2009, the International Trauma and Critical Care Improvement Project was created and held monthly teleconferences between U.S. trauma surgeons and Latin American general surgeons, emergency physicians, and intensivists. In-depth discussions and prospective evaluations of each case presented were conducted by all participants based on resources available. Care rendered was divided in four stages: (1) pre-hospital setting, (2) emergency room or trauma room, (3) operating room, and (4) subsequent postoperative care. Furthermore, the participating institutions completed an electronic survey of trauma resources based on World Health Organization/International Association for Trauma and Surgical Intensive Care guidelines. During a 17-month period, 15 cases in total were presented from a Level I and a Level II U.S. hospital (n=3) and five Latin American hospitals (n=12). Presentations followed the Advanced Trauma Life Support sequence in all U.S. cases but in only 3 of the 12 Latin American cases. The following deficiencies were observed in cases presented from Latin America: pre-hospital communication was nonexistent in all cases; pre-hospital services were absent in 60% of cases presented; lack of trauma team structure was evident in the emergency departments; during the initial evaluation and resuscitation, the Advanced Trauma Life Support protocol was followed one time and the Clinical

Long-term outcomes of war-related death of family members in Kosovar civilian war survivors.

PubMed

Morina, Nexhmedin; Reschke, Konrad; Hofmann, Stefan G

2011-04-01

Exposure to war-related experiences can comprise a broad variety of experiences and the very nature of certain war-related events has generally been neglected. To examine the long-term outcomes of war-related death of family members, the authors investigated the prevalence rates of major depressive episode (MDE), anxiety disorders, and quality of life among civilian war survivors with or without war-related death of first-degree family members 9 years after the war in Kosovo. Compared to participants without war-related death of family members, those who had experienced such loss had signficantly higher prevalence rates of MDE, posttraumatic stress disorder, and generalized anxiety disorder, and reported a lower quality of life 9 years after the war. These results indicate that bereaved civilian survivors of war experience significant mental health problems many years after the war.

War and Children's Mortality.

ERIC Educational Resources Information Center

Carlton-Ford, Steve; Houston, Paula; Hamill, Ann

2000-01-01

Examines impact of war on young children's mortality in 137 countries. Finds that years recently at war (1990-5) interact with years previously at war (1946-89) to elevate mortality rates. Religious composition interacts with years recently at war to reduce effect. Controlling for women's literacy and access to safe water eliminates effect for…

Vietnam: Historians at War

ERIC Educational Resources Information Center

Moyar, Mark

2008-01-01

Although the Vietnam War ended more than thirty years ago, historians remain as divided on what happened as the American people were during the war. Mark Moyar maps the ongoing battle between "orthodox" and "revisionist" Vietnam War historians: the first group, those who depict Vietnam as a bad war that the United States should…

Suicide and war: the mediating effects of negative mood, posttraumatic stress disorder symptoms, and social support among army National Guard soldiers.

PubMed

Griffith, James

2012-08-01

The mediating effects of posttraumatic stress disorder (PTSD) symptoms, negative mood, and social support on the relationship of war experiences to suicidality were examined. The research literature suggested a sequence among study scales representing these constructs, which was then tested on survey data obtained from a sample of National Guard soldiers (N=4,546). Results from structural equation modeling suggested that war experiences may precipitate a sequence of psychological consequences leading to suicidality. However, suicidality may be an enduring behavioral health condition. War experiences showed no direct effects on postdeployment suicidality, rather its effect was indirect through PTSD symptoms and negative mood. War experiences were, however, predictive of PTSD symptoms, as would be expected. PSTD symptoms showed no direct effect on postdeployment suicidality, but showed indirect effects through negative mood. Results also suggested that suicidality is relatively persistent, at least during deployment and postdeployment. The percentage of those at risk for suicide was low both during and after deployment, with little association between suicidality and time since returning from deployment. Additionally, few soldiers were initially nonsuicidal and then reported such symptoms at postdeployment. Implications of relationships of both negative mood and combat trauma to suicidality are discussed, as well as possible mediating effects of both personal dispositions and social support on relationships of war experiences to PTSD, negative mood, and suicidality. © 2012 The American Association of Suicidology.

Group Trauma-Focused Cognitive-Behavioural Therapy with Former Child Soldiers and Other War-Affected Boys in the DR Congo: A Randomised Controlled Trial

ERIC Educational Resources Information Center

McMullen, John; O'Callaghan, Paul; Shannon, Ciaran; Black, Alastair; Eakin, John

2013-01-01

Background: The Democratic Republic of Congo (DRC) has been home to the world's deadliest conflict since World War II and is reported to have the largest number of child soldiers in the world. Despite evidence of the debilitating impact of war, no group-based mental health or psychosocial intervention has been evaluated in a randomised controlled…

Cardiac Trauma.