Mental health status of vulnerable tsunami-affected communities: a survey in Aceh Province, Indonesia

The authors determined the prevalence of severe emotional distress and depressive symptoms using the Hopkins Symptoms Checklist-25 (HSCL; Derogatis, Lipman, Rickels, Uhlenhuth, & Covi, 1974) in tsunami-affected communities that had experienced armed conflict arising from the ongoing independence movement in Aceh Province, Indonesia. We also evaluated determinants of severe emotional distress. The data were collected for the purposes of a mental health assessment. In our sample (N = 262), 83.6% demonstrated severe emotional distress, and 77.1% demonstrated depressive symptoms. In multivariate regression models, severe emotional distress was positively associated with the number of tsunami-related deaths among household members. Our data suggests a need for effective interventions in this vulnerable population.

Elderly destitution in Ile-Ife community of Osun State, Nigeria

Many studies have been conducted on the elderly, but none has ever paid particular attention to the increasing rate of destitution in the rural communities, where the elderly serve as agents for sustenance and transmission of culture. This study is descriptive in nature and has adopted qualitative perspective in order to identify and examine the factors that have contributed to the state of elderly in destitution in Ile-Ife, Nigeria. It has also examined the feelings and reactions of the subjects of the study and has documented how their lifestyles affect their health status. Sixteen elderly people in destitution were traced and interviewed in Ile-Ife community. At each location, where an elderly in destitution was located, at least an elderly chief and a resident were located for interview. Data collected were analysed using Textbase Beta package for qualitative analysis. The study found that communal feud, violence and conflicts were factors that created unhappiness for the elderly, and the lack of adequate support from the immediate households consequently led to their homelessness. The study documented that the elderly in destitution lack good hygiene and nutrition, and equally suffer self-neglect and mental confusion. The study concludes that peaceful coexistence, communal security, and familial care and support are important factors that promote happiness and successful ageing. It also maintains that focused health education is highly essential for the households and caregivers of the elderly in rural community.

Hospital services for children in the Solomon Islands: rebuilding after the civil conflict

AIMS

The Solomon Islands health service, infrastructure and economy were severely affected by the civil conflict that occurred between 1998 and 2003. In 2002 plans to rebuild health services for children, especially those provided in provincial hospitals, were developed by paediatricians, in collaboration with the World Health Organization. We aimed to inform this process by an assessment of the strengths and weaknesses of the child health service, particularly in provincial hospitals.

METHODS

A systematic assessment of the quality of hospital care for children in Solomon Islands was conducted in November 2003. The study used a WHO assessment tool, modified for use in the Asia-Pacific region.

RESULTS

The assessment highlighted several problems in clinical care, human resources, health financing, referral systems, and training, and has been used as a basis for several interventions for improving the quality of paediatric care.

CONCLUSION

This study and the initiatives that have followed it demonstrate the link between such assessments, child health policy and quality improvement activities. Such programs can be implemented even where resources are very limited. Sustaining initiatives based on this assessment will be important for the Solomon Islands if it is to achieve the Millennium Development Goals for child survival by 2015.

A high prevalence of HIV-1 infection among pregnant women living in a rural district of north Uganda severely affected by civil strife

This study aims at estimating the recent trends in HIV-1 prevalence and the factors associated with infection among pregnant women in the Gulu District of north Uganda, a rural area severely affected by civil strife. In 2000-2003, a total of 4459 antenatal clinic attendees of Lacor Hospital were anonymously tested for HIV-1 infection. The overall and age-specific prevalence did not show any significant trend over time. The age-standardized prevalence slightly declined, from 12.1% in 2000 to 11.3% in 2003. Increased age [20-24 years: adjusted odds ratio (AOR) 1.63; 95% CI 1.18-2.25; >or=25 years: AOR 2.56; 95% CI 1.91-3.44], residence in urban areas (AOR 1.76; 95% CI 1.41-2.18), being unmarried (AOR 1.60; 95% CI 1.27-2.01), increased age of partner (25-34 years: AOR 1.87; 95% CI 1.29-2.73; >or=35 years: AOR 2.68; 95% CI 1.72-4.16), modern occupation of partner (AOR 1.98; 95% CI 1.53-2.58), and short time of residence at the current address (AOR 1.36; 95% CI 1.05-1.76) were associated with infection. The HIV-1 prevalence in this rural district is high and similar to that observed in urban antenatal clinics, probably reflecting the effect of the last 18 years of civil strife.

Need for "conflict version" of primary surgery: war surgery in the era of low-intensity conflicts

The conventional wars between nations have widely been replaced by low-intensity conflicts within nations today, resulting in different patterns of injuries and practice of surgical care. A blurred front line, protracted durations of violence, indiscriminant fighting, and the emergence of specific surgical problems characterize low-intensity conflicts. In protracted conflicts with limited resources, surgical outcomes depend on many factors other than surgical skills, such as social/cultural values and economical feasibility. This paper examines how the characteristics of current conflicts affect surgical practice and will address key issues to evolve care to adapt to these changes. Key issues are (1) need for comprehensive surgical skills, (2) importance of improving local capacities, (3) long-term impact of trauma, and (4) limited access to information required to improve surgical skills.

Israelis' Attitudes toward the Disengagement Plan, Perceived Risk, and Knowledge of Biblical Events

A sample of 73 Israeli students perceived current risks related to the disengagement plan but showed low awareness of Biblical civil wars and political assassinations. Attitude toward disengagement did not correlate with current perceived risks or awareness of Biblical violence. Left-leaning subjects were more supportive of disengagement and perceived greater risk of political assassination in its wake.

Emotional impact of exposure to terrorism among young-old and old-old Israeli citizens

OBJECTIVE

Since September 2000, continuous terrorist attacks have exposed Israeli society to trauma, and the impact of these events on the mental health of the elderly Israeli population remains unclear. The authors sought to assess the prevalence of posttraumatic stress-related symptoms of distress, depression, optimism, self-efficacy, and sense of safety of the young-old and old-old Jewish population after 19 months of intense terrorism in Israel, in order to identify correlates of the psychological sequelae and compare symptoms and coping methods of these populations with those of younger adults.

METHODS

Authors did a telephone survey using stratified sampling with a national sample of young-old (65-74 years old), old-old (>74 years old) and a comparison group of younger adults (18-64 years old).

RESULTS

No difference was found in the level of exposure, traumatic stress symptoms, including probable PTSD, except for a nonsignificant tendency toward more depersonalization and emotional numbness in the elderly group, a tendency toward more sleeplessness, more re-experiencing of unwanted thoughts, hyperarousal, fewer avoidance symptoms, and less disengagement-coping in the old-old group. Younger adults were found to be significantly more optimistic. Young-old and old-old people used cigarettes/alcohol and tranquilizers more often to cope with the situation, and old-old people who used disengagement-coping felt less helped by it.

CONCLUSIONS

Young-old and old-old people do not differ significantly from the younger adult population with regard to their response to 19 months of intense and recurrent terrorism.

Development of family medicine in Kosovo

Many eastern European countries are expanding primary care. Experience in Kosovo shows how some of the difficulties can be overcome

Back to basics: managing gunshot injuries in East Timor

BACKGROUND

The management of patients following severe trauma requires a combination of skills. Among these are accurate clinical assessment, basic resuscitation measures, basic general surgical skills and techniques, good decision making and team leadership. More technically advanced imaging and investigations are often useful and can enhance clinical assessment but should not replace the basic elements. In situations where more advanced investigations are not available good outcomes can be achieved by application of the basic principles in trauma management and surgery. This article describes a mass casualty situation of gunshot wounds managed with limited resources and the outcomes.

METHODS

A series of gunshot wounds managed in a single day at Dili National Hospital, Dili, East Timor is described. The presentation of the patients, initial assessment of injuries and haemodynamic stability are detailed in addition to the subsequent surgical treatment, complications and outcomes. The information was obtained from hospital records and personal recollection of the treating doctors. All injuries were documented with digital photography. All patients were managed by two surgeons who also supervised their postoperative course and reported on their outcomes. Surgical procedures on all of the patients were performed by the named two consultant surgeons and one basic surgical trainee.

RESULTS

Fourteen patients were treated for gunshot injuries. All were single bullet injuries. Six trajectories involved the thoracic or abdominal cavity (one trajectory traversed both). Eight injuries were to limbs or soft tissue of the pelvis and included four compound fractures. Surgical intervention was needed for all patients ranging from emergency laparotomy for haemodynamic instability through to wound debridements. Thirteen patients survived and were discharged from hospital within 3 weeks. One patient died of uncontrolled haemorrhage.

CONCLUSIONS

In the present series of gunshot injuries managed with limited resources a good outcome was achieved with the application of basic principles. The present series emphasizes the importance of basic trauma management as outlined in courses such as Emergency Management of Severe Trauma and the use of basic surgical techniques as taught during the Advanced Surgical training program.

Pre-election insecurity in Afghanistan hampers health service delivery

It's three years since the fall of the Taliban; now, with an election looming, Afghanistan's battle is for better health