Impairments, disabilities and needs assessment among non-fatal war injuries in south Lebanon, Grapes of Wrath, 1996. (25/803)

STUDY OBJECTIVE: To examine the impact of non-fatal war related injuries on physical disability in a group of war wounded civilians and to assess their needs. DESIGN: Cross sectional study. Home interviews were conducted using a structured interview schedule around one month after the injury, to assess impairments, disabilities, and needs. STUDY POPULATION AND SETTING: War wounded persons in towns and villages in South Lebanon during the attack "Grapes of Wrath" in 1996. RESULTS: The majority of the study population were young and in their productive age, mostly injured in the street or while hiding in open shelters. Around half of the injuries resulted in impairments, but, there were no age, gender or geographical differentials by severity of impairment. Almost one third (29%) of the students enrolled in schools at the time of the injury reported failure to continue their education and 42% of the working members lost their jobs with no potential for 34% of them to resume their former jobs. The impact of the injury on impairments, motor disabilities and physical independence was highest for injuries to the lower limbs (age and sex adjusted risk ratio (RR) 1.62, 95% confidence intervals (CI) 1.25, 2.10; 2.98, 95% CI 2.09, 4.23; and 2.13, 95% CI 1.39, 3.27, respectively). Despite the acute and early relief services provided by all those concerned at the time of the injury, when asked about unmet needs, the majority of the impaired (66%) reported the need for additional services, mostly medical in nature. The degree of disability was a salient factor for the need for rehabilitative services but not for medical services. CONCLUSIONS: The chronic and diverse needs of people with war injuries are often neglected and underestimated by the governmental institutions and relief agencies. Research funds as well as services should be allocated to tackle the long term and continuous health and social needs of those injured and their families.  (+info)

The effect of economic sanctions on the mortality of Iraqi children prior to the 1991 Persian Gulf War. (26/803)

OBJECTIVES: This study examined the effect of sanctions on mortality among Iraqi children. METHODS: The effects of economic sanctions on health are not well known. Past studies on the effect of economic sanctions on mortality have suffered from unreliable data sources and the collinearity of sanctions with other negative economic events. We overcame these weaknesses by using individual child records from a retrospective survey of mothers conducted after the 1991 Persian Gulf War to examine the effect of sanctions on mortality among Iraqi children. Multivariate proportional hazards analysis was used to assess the effect of economic sanctions prior to war (from August through December 1990). RESULTS: We found that after controlling for child and maternal characteristics, when economic sanctions were entered into the proportional hazards equation, the risk of dying increased dramatically. This increase was highly significant statistically. CONCLUSIONS: Innovative application of robust epidemiologic research tools can contribute to assessments of health and well-being even under the methodological and practical constraints of comprehensive economic sanctions, but more research is needed.  (+info)

Joining together to combat poverty. (27/803)

The International Poverty and Health Network (IPHN) was created in December 1997 following a series of conferences organized by the World Health Organization, with the aim of integrating health into plans to eradicate poverty. Around 1.3 billion people live on less than US$1 per day. Of the 4.4 billion people in developing countries nearly 60% lack access to sanitation, 30% do not have clean water, 20% have no health care, and 20% do not have enough dietary energy and protein. Even among rich nations there are gross socioeconomic inequalities. Many children are robbed of their physical and mental potential through poverty. Expressed in constant 1963 US dollars, an average Croatian family needed the annual income of US$894 to meet the poverty line in 1960 and US$9,027 in 1995. Accordingly, 9-25% of Croatian households were below the poverty line between 1960 and 1995. The increase in the poverty rate after 1991 was compounded by the war that destroyed almost a third of industrial capacity and infrastructure. Dissipation of the communist economy and inadequate privatization have contributed to the increase in unemployment rate, corruption, and other social ills. IPHN invited Croatian Medical Journal to publish this editorial to help push the issue of poverty up political and medical agendas on a global level. We argue that a factor contributing to the failure of most large-scale programs against poverty to date is the excessive emphasis on material and infrastructure assistance at the expense of spiritual, moral, and intellectual development.  (+info)

Retrospective analysis of pectoralis major myocutaneous flap surgeries performed under war conditions. (28/803)

AIM: To present our experiences in using a pectoralis major myocutaneous flap in the reconstruction of surgically created defects of the neck and lower part of the head during the war in Bosnia and Herzegovina. METHODS: Retrospective analysis of medical records from 15 patients treated at the ENT Department, Tuzla University Hospital, between January 1992 and December 1996. RESULTS: Ten flaps were prepared during basic operation ("one step reconstruction of defect") and five flaps three weeks after the removal of tumor (postoperative pharyngocutaneous fistula was the reason for secondary flap preparation). The necessary time for flap preparation and its accommodation in the defect was 2 hours. The most frequent complications included seroma of donor site (6/13), fistula (3/13), partial necrosis of the flap (2/13), and total necrosis of the flap (2/13). Three patients died in the postoperative period because of a cardiac arrest but the flaps accepted correctly. CONCLUSION: The pectoralis major myocutaneous flap is a good solution for covering defects of the neck and lower region of the head. Military blockade with extremely difficult conditions and lack of experience were the reason of the higher complication rate than those from literature.  (+info)

Eradication of poliomyelitis in countries affected by conflict. (29/803)

The global initiative to eradicate poliomyelitis is focusing on a small number of countries in Africa (Angola, Democratic Republic of the Congo, Liberia, Sierra Leone, Somalia, Sudan) and Asia (Afghanistan, Tajikistan), where progress has been hindered by armed conflict. In these countries the disintegration of health systems and difficulties of access are major obstacles to the immunization and surveillance strategies necessary for polio eradication. In such circumstances, eradication requires special endeavours, such as the negotiation of ceasefires and truces and the winning of increased direct involvement by communities. Transmission of poliovirus was interrupted during conflicts in Cambodia, Colombia, El Salvador, Peru, the Philippines, and Sri Lanka. Efforts to achieve eradication in areas of conflict have led to extra health benefits: equity in access to immunization, brought about because every child has to be reached; the revitalization and strengthening of routine immunization services through additional externally provided resources; and the establishment of disease surveillance systems. The goal of polio eradication by the end of 2000 remains attainable if supplementary immunization and surveillance can be accelerated in countries affected by conflict.  (+info)

Mine blast injuries: ocular and social aspects. (30/803)

BACKGROUND/AIMS: Landmines have long been used in conventional warfare. These are antipersonnel mines which continue to injure people long after a ceasefire without differentiating between friend or foe, soldier or civilian, women or children. This study focuses on Afghan non-combatants engaged in mine clearing operations in Afghanistan in the aftermath of the Russo-Afghan war. The patterns and types of injuries seen are described and experiences in their management, ways, and means to prevent them, and recommendations for the rehabilitation of the affected individuals are given. METHODS: It is a retrospective and analytical study of 84 patients aged 19-56 years who sustained mine blast injuries during mine clearing operations in Afghanistan from November 1992 to January 1996. The study was carried out at a military hospital with tertiary care facilities. The patients were divided into three groups on the basis of their injuries. Group 1 required only general surgical attention, group 2 sustained only ocular injuries, while group 3 had combined ocular and general injuries. Patients in groups 2 and 3 were treated in two phases. The first phase aimed at immediate restoration of the anatomy, while restoration of function wherever possible was done in subsequent surgical procedures in the second phase. RESULTS: It was observed that 51 out of 84 patients (60.7%) had sustained ocular trauma of a variable degree as a result of the blasts. The mean age of the victims was 29 years and they were all male. A total of 91 eyes of 51 patients (89.2%) had been damaged. Bilaterality of damage was seen in 40 (78.4%) patients. Most, 34 (37.3%), eyes became totally blind (NPL). Only a few escaped with injury mild enough not to impair vision. Foreign bodies, small and multiple, were found in the majority of eyes; most, however, were found in the anterior segment, and posterior segment injuries were proportionally less. CONCLUSIONS: The prevalence of blindness caused by mine blast injuries is quite high. The resulting psychosocial trauma to the patients and their families is tremendous and has not been adequately highlighted. These injuries are a great drain on the country's resources. Enforcement of preventive measures and the use of protective gear and sophisticated equipment by the mine clearing personnel would prove to be far more economical in terms of human life as well as medical and economic resources. There is also need for greater attention towards the establishment of support groups and rehabilitation programmes for these individuals.  (+info)

Medical services of Croat people in Bosnia and Herzegovina during 1992-1995 war: losses, adaptation, organization, and transformation. (31/803)

During the 1992-1995 war in Bosnia and Herzegovina (BH), Croatian people in BH had 19,600 (2.6%) killed and 135,000 (17.6%) displaced persons, and 222,500 (28.9%) refugees. They lost around two thirds of both physicians and other health personnel, and were left with 8. 5% of prewar patient beds. Fortunately, the organized defence against Serbs was initiated in time and Croats defended the territories where they formed majority. The first defense unit established was the Medical Corps Headquarters (MCH), caring for soldiers and civilians alike. The MCH was soon incorporated in the Croatian Defense Council (CDC, armed forces of Croatian people in BH). The MCH had two chains of command. One went through the district commanders of medical services and their subordinated physicians to paramedics in military units, and the other directly to the commanders of 14 war hospitals. After its formation in 1993, the Ministry of Health took the jurisdiction over the civilian medical services and after the Washington Peace Agreement (April 1994) over the war hospitals, too, whereas the medical services within military units remained under control of the Ministry of Defense. Dayton Peace Agreement divided BH into the Federation of BH and Republic Srpska, each with their own army. The Federation of BH Army is composed of the CDC and Bosniac-controlled Army of BH, with overall numerical ratio 1:2.3 for Bosniacs, and organized in accordance with NATO standards. Military medical services are provided by the Logistics Sector of both Ministry of Defense and Military Corps Headquarters (Joint Command).  (+info)

Comorbidity of posttraumatic stress disorder and alcohol dependence in displaced persons. (32/803)

AIM: To investigate in displaced persons a) the prevalence rate of current posttraumatic stress disorder (PTSD) and alcohol dependence; b) the relationship of alcohol dependence and current PTSD; and c) trauma exposure in relation to alcohol dependence comorbid to PTSD. METHODS: A group of displaced persons (157 men and 211 women) was interviewed using structured clinical interview based on DSM-III-R criteria for diagnosing PTSD and alcohol dependence, Watson's PTSD Questionnaire, and CAGE Questionnaire. RESULTS: Men showed higher prevalence rate of a current PTSD (50.3% of men vs. 36.5% of women, p=0.011), alcohol dependence (60.5% of men vs. 8.1% of women, p<0. 001), and alcohol dependence comorbid with PTSD (69.6% of men vs. 11. 7% of women, p<0.001). The rate of alcohol dependence increased in relation to current PTSD in men but not in women. Comorbidity of alcohol dependence and PTSD in women was influenced by alcohol-related problems before the war, whereas in men it was not influenced by any of the pre-war variables. The highest number of traumas was experienced by the displaced persons with a current PTSD only, followed by those with PTSD and alcohol dependence. The lowest number of war traumas was experienced by displaced persons with alcohol dependence, but without current PTSD. CONCLUSION: War traumas may have a role in the development of alcohol dependence in displaced men with current PTSD. The number of war traumas had a strong effect on the development of PTSD. Sex is a relevant factor in studying comorbidity of current PTSD and alcohol dependence.  (+info)