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Farhat T, Nahouli H, Hajjar M, Abdul-Sater Z, Kobeissi E, Menassa M, Chaya BF, Elamine A, El Sheikh WG, Tamim H, Hettiaratchy S, Abu-Sittah G. Characteristics of injuries during the 2006 Lebanon conflict: a three-center retrospective study of survivors, 16 years after the conflict. Front Public Health 2024; 12:1382514. [PMID: 38864014 PMCID: PMC11165059 DOI: 10.3389/fpubh.2024.1382514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 05/03/2024] [Indexed: 06/13/2024] Open
Abstract
Background Armed conflict injury is a growing public health concern, particularly in regions like the Middle East and North Africa (MENA). The protracted conflicts and political unrest in this region have led to a substantial number of injuries. Despite this, there is still limited understanding of the specific injury patterns stemming from conflicts, such as the 2006 Lebanon conflict. This study aimed to assess the characteristics and burdens of injuries resulting from this conflict, which occurred 16 years prior to this research. Methods This retrospective study analyzed data of individuals affected by the 2006 Lebanon conflict, across three tertiary care centers. Demographics, injuries, complications, injury management, and hospitalization expenses were extracted from medical records and analyzed using SPSS version 29.0. Categorical variables were presented as counts and proportions, and continuous variables as mean ± standard deviation (SD). Hospital comparisons utilized chi-square or Fisher's exact tests for categorical variables, and one-way ANOVAs for continuous variables. Analysis was conducted from September to November 2023. Results Across three hospitals, 341 patients were studied, comprising 73.6% males and 26.4% females. Among them, a notable proportion (57.3% males and 34.1% females) fell within the 18-39 age range. Children and adolescents under 18 years accounted for 15.9% of males and 25.9% of females. Blast-related injuries predominated, with 24.5% resulting from direct damage caused by explosive parts and 33.3% from blast wave forces. Extremity trauma occurred in 49.0% of patients, and head/neck trauma in 24.9%. Common injuries, including penetrating, musculoskeletal, and traumatic brain injuries affected 34.9%, 31.1, and 10.0% of patients, respectively. Wound repair, fracture treatment, and debridement were the most performed procedures on 15.5, 13.5 and 9.7% of the patients, respectively. The total cost of care was USD 692,711, largely covered by the Ministry of Public Health (95.9%). Conclusion Conflict-related injuries significantly contribute to the global burden of disease. Therefore, there is a pressing need to improve national guidelines to prioritize life-threatening cases and potential long-term disabilities. Furthermore, enhancing electronic registry systems to collect clinical data on injured patients is essential for conducting research and better understanding the needs of conflict casualties.
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Affiliation(s)
- Theresa Farhat
- Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Hasan Nahouli
- Division of Orthopedic Surgery, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Marwan Hajjar
- Division of Plastic Surgery, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Zahi Abdul-Sater
- Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Elsa Kobeissi
- Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Marilyne Menassa
- Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Bachar F. Chaya
- Division of Plastic Surgery, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ahmad Elamine
- Division of Plastic Surgery, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Walaa G. El Sheikh
- Clinical Research Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Hani Tamim
- Clinical Research Institute, American University of Beirut Medical Center, Beirut, Lebanon
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Shehan Hettiaratchy
- Centre for Blast Injury Studies, Imperial College London, London, United Kingdom
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
- Imperial College Healthcare NHS Trust, London, United Kingdom
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Osmanov B, Chepurnyi Y, Snäll J, Kopchak A. Delayed reconstruction of the combat-related mandibular defects with non-vascularized iliac crest grafts: Defining the optimal conditions for a positive outcome in the retrospective study. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2024; 125:101794. [PMID: 38331217 DOI: 10.1016/j.jormas.2024.101794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 02/03/2024] [Accepted: 02/05/2024] [Indexed: 02/10/2024]
Abstract
BACKGROUND Reconstruction of mandibular defects caused by combat injuries is challenging for clinicians due to soft tissue defects and high complication risk. This study evaluated the outcomes of mandibular continuous defects reconstruction with non-vascularized iliac crest graft (NVICG) in patients with combat injuries. MATERIAL AND METHODS Patients with continuous mandibular defects acquired by high-velocity agents, who received NVICG reconstruction with or without microvascular-free soft tissue or regional flaps, were included in the study. The outcome variable was graft loss due to postoperative complications or full (more than 90 %) resorption. The primary predictor variable was soft tissue defect in the recipient area. The secondary predictor variable was the length of the defect. Variables related to patients, defect site, surgery, and other complications were also evaluated. Statistical analysis was performed with the usage of independent sample t-test, Pearson's chi-squared and Fisher's exact tests with a significance level of P < 0.05 RESULTS: The study included 24 patients with 27 mandibular defects. Overall, the general success rate of reconstructions was 59.3 %. Soft tissue defects were significantly associated with graft failure and other complications (p < 0.05), which were mostly related to soft tissue defects. The graft success rate was only 14.3 % even in minor soft tissue defects. In turn, in reconstructions with sufficient soft tissue coverage, the graft survived in 75.0 % of the cases. In addition, patients with more delayed reconstruction had significantly fewer graft failures than those with earlier surgery (p < 0.05). No associations were found between defect size and complications. CONCLUSION The sufficient soft tissue coverage is essential in the reconstruction of mandibular defects caused by combat injuries. Also, minor soft tissue defects should be covered with soft tissue flaps to avoid complications and graft loss in these specific injuries. Even large defects can be reconstructed with NIVICG if the soft tissue coverage is sufficient.
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Affiliation(s)
- Bekir Osmanov
- Department of Maxillofacial Surgery and Innovative Dentistry, Bogomolets National Medical University, Kyiv, Ukraine.
| | - Yurii Chepurnyi
- Department of Maxillofacial Surgery and Innovative Dentistry, Bogomolets National Medical University, Kyiv, Ukraine
| | - Johanna Snäll
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Andrii Kopchak
- Department of Maxillofacial Surgery and Innovative Dentistry, Bogomolets National Medical University, Kyiv, Ukraine
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Aguirre AS, Rojas K, Torres AR. Pediatric traumatic brain injuries in war zones: a systematic literature review. Front Neurol 2023; 14:1253515. [PMID: 37745670 PMCID: PMC10511749 DOI: 10.3389/fneur.2023.1253515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 08/11/2023] [Indexed: 09/26/2023] Open
Abstract
Background Pediatric casualties in war zones are a devastating consequence of armed conflicts, causing significant challenges for affected children, especially in the context of poor access to care. This study aimed to understand traumatic brain injuries (TBIs) in this high-risk population and to identify and provide information for the stakeholders, as well as to recognize severe long-term consequences and develop strategies to prevent them, thus minimizing their burden while aiding in the management of these cases. Methods We carried out a systematic literature review following PRISMA guidelines to identify publications discussing traumatic brain injuries in children in the context of war zones, and we analyzed all the collected data. Results Our study showed that head injuries were the most common casualty in war zones; male and female children were affected, and the mean age was 8-10 years. Most children were reported to be from Afghanistan, and blasts were the most common mechanism of injury. The mortality fluctuated from 3 to 47%. Conclusion There is a lack of evidence-based information regarding the characterization, approach, and management of children with TBI in conflict zones. While the world finds ways to live in peace, there is an urgency to research, train, and deploy enough specialists to these areas, if governments are serious about improving outcomes for this population.
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Affiliation(s)
| | | | - Alcy R. Torres
- Division of Pediatric Neurology, Department of Pediatrics, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States
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Talmy T, Cohen-Manheim I, Radomislensky I, Gelikas S, Tsur N, Benov A, Koler T, Glassberg E, Almog O, Gendler S. Implications for future humanitarian aid missions: Lessons from point-of injury and hospital care for Syrian refugees. Injury 2023; 54:110752. [PMID: 37142481 DOI: 10.1016/j.injury.2023.04.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 04/01/2023] [Accepted: 04/19/2023] [Indexed: 05/06/2023]
Abstract
BACKGROUND Warzone humanitarian medical aid missions are infrequent and applying lessons from these missions is vital to ensuring preparedness for future crises. Between 2013-2018, the Israel Defense Forces Medical Corps (IDF-MC) provided humanitarian medical aid to individuals injured in the Syrian Civil War who chose to seek medical assistance at the Israeli-Syrian border. Patients requiring care surgical or advanced care were transferred to civilian medical centers within Israel. This study aims to describe the injury characteristics and management of hospitalized Syrian Civil War trauma patients over a five-year period. METHODS Retrospective cohort analysis cross-referencing data from the IDF trauma registry, documenting prehospital care, and the Israel National Trauma Registry, documenting in-hospital care, between 2013 and 2018. Syrian trauma patients hospitalized in Israeli hospitals were cross-referenced between the two registries. Multivariable logistic regression was applied to identify independent factors associated with in-hospital mortality. RESULTS Overall, 856 hospitalized trauma patients were included following definitive cross-matching. The median age was 23 years, and 93.3% were males. Blast (n = 532; 62.1%) and gunshot (n = 241; 28.2%) were the most common injury mechanisms. Injury Severity Score was ≥25 for 28.8% of patients and most common body regions with severe injury (Abbreviated Injury Scale≥3) were the head (30.7%) and thorax (25.0%). Intensive care unit admission was required for 40.1% of patients, and the median hospital stay was 13 days. In-hospital mortality was recorded for 73 (8.5%). Signs of shock upon emergency department admission and severe head injury were significantly associated with mortality in the adjusted model whereas age of <18 years was associated with decreased odds for in-hospital mortality. CONCLUSIONS Trauma patients hospitalized in Israel following injuries sustained in the Syrian Civil War were characterized by a high prevalence of blast injuries with concomitant involvement of several body regions. Future missions should ensure preparedness for complex multi-trauma, often involving the head, and ensure high intensive care and surgical capacities.
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Affiliation(s)
- Tomer Talmy
- Israel Defense Forces Medical Corps, Surgeon General's Headquarters, Ramat Gan, 5265601, Israel; Department of Military Medicine, Hebrew University of Jerusalem, Faculty of Medicine, Jerusalem 9112102, Israel.
| | - Irit Cohen-Manheim
- Israel National Center for Trauma & Emergency Medicine Research, The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, 5265601, Israel
| | - Irina Radomislensky
- Israel National Center for Trauma & Emergency Medicine Research, The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, 5265601, Israel
| | - Shaul Gelikas
- Israel Defense Forces Medical Corps, Surgeon General's Headquarters, Ramat Gan, 5265601, Israel; Sheba Medical Center Hospital, Tel Hashomer, Ramat Gan, Israel
| | - Nir Tsur
- Israel Defense Forces Medical Corps, Surgeon General's Headquarters, Ramat Gan, 5265601, Israel; Department of Otolaryngology-Head and Neck Surgery, Rabin Medical Center, Tel Aviv University, Petach Tiqva, Israel
| | - Avi Benov
- Israel Defense Forces Medical Corps, Surgeon General's Headquarters, Ramat Gan, 5265601, Israel; The Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Tomer Koler
- Israel Defense Forces Medical Corps, Surgeon General's Headquarters, Ramat Gan, 5265601, Israel
| | - Elon Glassberg
- Israel Defense Forces Medical Corps, Surgeon General's Headquarters, Ramat Gan, 5265601, Israel; The Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel; The Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Ofer Almog
- Israel Defense Forces Medical Corps, Surgeon General's Headquarters, Ramat Gan, 5265601, Israel; Department of Military Medicine, Hebrew University of Jerusalem, Faculty of Medicine, Jerusalem 9112102, Israel
| | - Sami Gendler
- Israel Defense Forces Medical Corps, Surgeon General's Headquarters, Ramat Gan, 5265601, Israel
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Hanafi I, Munder E, Ahmad S, Arabhamo I, Alziab S, Badin N, Omarain A, Jawish MK, Saleh M, Nickl V, Wipplinger T, Wipplinger C, Nickl R. War-related traumatic brain injuries during the Syrian armed conflict in Damascus 2014-2017: a cohort study and a literature review. BMC Emerg Med 2023; 23:35. [PMID: 36977988 PMCID: PMC10053936 DOI: 10.1186/s12873-023-00799-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 02/24/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND The decade-long Syrian armed conflict killed or injured more than 11% of the Syrian population. Head and neck injuries are the most frequent cause of war-related trauma, about half of which are brain injuries. Reports about Syrian brain trauma victims were published from neighboring countries; However, none are available from Syrian hospitals. This study aims to report war-related traumatic brain injuries from the Syrian capital. METHODS We conducted a retrospective cohort study between 2014 and 2017 at Damascus Hospital, the largest public hospital in Damascus, Syria. Target patients were the victims of combat-related traumatic brain injuries who arrived alive and were admitted to the neurosurgery department or to another department but followed by the neurosurgery team. The collected data included the mechanism, type, and site of injury based on imaging findings; types of invasive interventions; intensive-care unit (ICU) admissions; as well as neurological status at admission and discharge including several severity scales. RESULTS Our sample consisted of 195 patients; Ninety-six of them were male young adults, in addition to 40 females and 61 children. Injuries were caused by shrapnel in 127 (65%) cases, and by gunshots in the rest, and most of them (91%) were penetrating. Sixty-eight patients (35%) were admitted to the ICU, and 56 (29%) underwent surgery. Neurological impairment was reported in 49 patients (25%) at discharge, and the mortality rate during hospitalization was 33%. Mortality and neurological impairment associated significantly with higher values on clinical and imaging severity scores. CONCLUSIONS This study captured the full spectrum of war-related brain injuries of civilians and armed personnel in Syria without the delay required to transport patients to neighboring countries. Although the clinical presentation of injuries at admission was not as severe as that in previous reports, the inadequate resources (i.e., ventilators and operation rooms) and the lack of previous experience with similar injuries might have resulted in the higher mortality rate. Clinical and imaging severity scales can provide a handy tool in identifying cases with low probability of survival especially with the shortage of personal and physical resources.
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Affiliation(s)
- Ibrahem Hanafi
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Damascus University, Mazzah, Damascus, Syria.
| | - Eskander Munder
- Faculty of Medicine, Syrian Private University, Mazzah, Damascus, Syria
| | - Sulafa Ahmad
- Faculty of Medicine, Damascus University, Mazzah, Damascus, Syria
| | - Iman Arabhamo
- Faculty of Medicine, Syrian Private University, Mazzah, Damascus, Syria
| | - Suzan Alziab
- Faculty of Medicine, Damascus University, Mazzah, Damascus, Syria
| | - Noor Badin
- Faculty of Medicine, Damascus University, Mazzah, Damascus, Syria
| | - Ahmad Omarain
- Faculty of Medicine, Damascus University, Mazzah, Damascus, Syria
| | | | - Muhannad Saleh
- Division of Neurosurgery, Department of Surgery, Damascus Hospital, Damascus, Syria
| | - Vera Nickl
- Department of Neurosurgery, Würzburg University, Würzburg, Germany
| | - Tamara Wipplinger
- Department of Neurosurgery, Würzburg University, Würzburg, Germany
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, USA
| | | | - Robert Nickl
- Department of Neurosurgery, Würzburg University, Würzburg, Germany
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Hunili T, Erden S. Effect of TENS on Vacuum Pain in Acute Soft Tissue Trauma. Pain Manag Nurs 2023:S1524-9042(23)00029-2. [PMID: 36907690 DOI: 10.1016/j.pmn.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 01/27/2023] [Accepted: 02/04/2023] [Indexed: 03/12/2023]
Abstract
BACKROUND In the literature, the effect of TENS on acute pain has been investigated, and no study has been found on its effect on pain associated with VAC application. This randomized controlled trial was designed to assess the efficacy of TENS application in pain caused by vacuum applied in acute soft tissue trauma of the lower extremity. DESIGN AND SETTINGS The study included 40 patients: 20 in the control group, and 20 in the experimental group and was carried out in a university hospital's plastic and reconstructive surgery clinic. Data for the study were gathered using the Patient Information form and the Pain Assessment form. Conventional TENS lasting 30 minutes was applied to the experimental group patients 1 hour before vacuum (vacuum assisted closure [VAC]) insertion and removal by the researcher, and TENS was not applied to the control group. The "Numerical Pain Scale" was used to assess pain in both groups before and after TENS application. In the statistical analysis of the data, the SPSS 23.0 package program was used. In all tests, p < .005 was considered statistically significant. RESULTS The experimental and control groups of the patients included in the study were homogeneous in terms of demographic characteristics (p > .05). Furthermore, when the pain levels of the groups were compared over time, it was discovered that the pain levels of the control group were significantly higher than the experimental group at the times of VAC insertion (T3) and VAC removal (T6) (p < .05). Bonferroni test, one of the post hoc tests, was used to determine in-group significance in both the experimental and control groups, and it was discovered that the difference was between T6 and all other times (T6-T1, T2, T3, T4, T5). CONCLUSIONS The results obtained from our study showed that TENS reduced the pain caused by vacuum applied in acute soft tissue trauma of the lower extremity. It is thought that TENS may not replace traditional analgesics but may help reduce the level of pain and contribute to healing by increasing comfort during painful procedures.
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Affiliation(s)
- Tuğba Hunili
- From the Cukurova University, Balcalı Hospital, Plastic Surgery Department, Turkey
| | - Sevilay Erden
- Faculty of Health Sciences, Department of Nursing Adana, Turkey.
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Mohamed AY, Ibrahim HS, Taşkoparan H, Ibrahim YB. Epidemiological characteristics and comparative outcome of blast versus gunshot injuries of the extremities in Somalia. J Orthop Surg Res 2023; 18:44. [PMID: 36647060 PMCID: PMC9843833 DOI: 10.1186/s13018-023-03527-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 01/10/2023] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND War conflicts and terror-related injuries constitute a significant public health problem in Somalia. We aim to characterize and compare the injury characteristics of gunshot and blast injuries of the extremities. METHODS The data of 333 patients with gunshot and blast injuries of the extremities over three years were retrospectively reviewed. The demographics, injury characteristics, and outcomes were analyzed. RESULTS Most of the patients had injuries due to gunshot casualties compared with blast victims (n = 222, 66.7% vs. n = 111, 33.3%). Patients with gunshot wounds (GSW) had a more significant proportion of males than those with blast wounds (BW) (95.5% vs. 85.6%, P < 0.001). There were more open extremity fractures in GSW casualties (96.4% vs. 81.1%). The BW victims had significantly higher associated injuries (52.3% vs. 18.5%, P < 0.001). The BW group had a higher injury severity score (ISS ≥ 16 in 55%, P < 0.001). The need for an intensive care unit (ICU) admission was significantly higher in the BW patients (18% vs. 6.3%, P < 0.001); as well as the length of hospital stay (LOS) was higher in the BW group compared with the GW patients (> 2-week hospital stay in 31% vs. 19%, P < 0.04). About a 2.7% mortality rate was observed in BW (P < 0.014). CONCLUSION Gunshot and explosion injuries comprise the majority of war and terror-related trauma of the extremities. These injury mechanisms differ in the body regions involved, the severity of the injury, duration of hospital stay, need for ICU admission, and mortality. Assessment and management of such devastating casualties require a complex and multidisciplinary approach.
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Affiliation(s)
- Abdullahi Yusuf Mohamed
- Department of Orthopedics and Traumatology, Mogadishu Somali Turkish Training and Research Hospital, Nasib-Bundo Street, Shibis District, Mogadishu, Somalia
| | - Hassan Salad Ibrahim
- Department of Orthopedics and Traumatology, Mogadishu Somali Turkish Training and Research Hospital, Nasib-Bundo Street, Shibis District, Mogadishu, Somalia
| | - Hüseyin Taşkoparan
- Department of Orthopedics and Traumatology, Mogadishu Somali Turkish Training and Research Hospital, Nasib-Bundo Street, Shibis District, Mogadishu, Somalia
| | - Yasin Barkhad Ibrahim
- Department of Orthopedics and Traumatology, Mogadishu Somali Turkish Training and Research Hospital, Nasib-Bundo Street, Shibis District, Mogadishu, Somalia
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Latifeh Y, Jaredh MW, Nasri L, Shriedy D, Al-Mahdi A, Murtada MW. Knowledge, stigma, and beliefs toward mental illnesses among schoolteachers in Damascus. Int J Soc Psychiatry 2022; 68:1054-1062. [PMID: 33969746 PMCID: PMC9310142 DOI: 10.1177/00207640211015701] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Teachers have an important role in promoting the mental wellbeing of their students, hence their knowledge and attitudes toward mental health disorders should be assessed. A very few studies regarding this topic were conducted in Syria, but due to the recent events which have had occurred the country, it is essential to deal with students who suffer from mental illnesses professionally especially that such disorders may be stigmatized by the society. AIMS This paper aims to investigate knowledge, beliefs, and attitudes toward mental disorders in a sample of Syrian schoolteachers. METHOD A cross-sectional study using self-administered questionnaire was conducted in Damascus and Refdimashq, involving 400 teachers from 16 schools. RESULTS The results showed that the prevalence of stigmatizing positions toward psychiatric illnesses was low among teachers. The contributors did not state a correlation between spiritual beliefs and psychological disorders. It was also found that teachers were neutral in their knowledge about mental illnesses and psychiatric treatment or interventions along with their mental health resources. However, 42.5% of the participants use the internet for such purposes. CONCLUSION In general, teachers of Damascus and its Refdimashq had a reasonable degree of awareness about mental disorders and treatments. Furthermore, neither stigma nor the relation between religious thoughts and mental disorders had been ascertained.
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Affiliation(s)
- Youssef Latifeh
- Syrian Private University, Syria.,Faculty of Medicine, Damascus University, Damascus, Syria, Syrian Arab Republic
| | - Mhd Wael Jaredh
- Faculty of Medicine, Damascus University, Damascus, Syria, Syrian Arab Republic
| | - Lulia Nasri
- Faculty of Medicine, Damascus University, Damascus, Syria, Syrian Arab Republic
| | - Duaa Shriedy
- Faculty of Medicine, Damascus University, Damascus, Syria, Syrian Arab Republic
| | - Ayat Al-Mahdi
- Faculty of Medicine, Damascus University, Damascus, Syria, Syrian Arab Republic
| | - Mhd Wasim Murtada
- Faculty of Medicine, Damascus University, Damascus, Syria, Syrian Arab Republic
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Alrashid Alhiraki O, Fahham O, Dubies HA, Abou Hatab J, Ba'Ath ME. Conflict-related excess mortality and disability in Northwest Syria. BMJ Glob Health 2022; 7:bmjgh-2022-008624. [PMID: 35589154 PMCID: PMC9121437 DOI: 10.1136/bmjgh-2022-008624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 05/08/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction The Syrian conflict that started in 2011 has been ongoing for over a decade without an end in sight. Estimates regarding excess mortality and conflict-related disability vary widely, and little field research has been done to address this topic. Methods A population-based field survey was conducted from 10 to 18 November 2020 in Northwest Syria. Forty-nine clusters were selected using staged sampling based on predefined population distribution maps. Data were collected for the period from 2000 to 2020 and were divided into pre-conflict (2000–2010) and conflict (2011–2020) periods. Mortality rates were compared using the Mann-Whitney U test, and p<0.05 was considered statistically significant. Results A total of 1483 households were surveyed, for a population of 12 268 people. The crude mortality rate increased 3.55 times between the two periods (p>0.001). In total, 54.3% of war-related deaths were caused by aerial attacks. Despite the continued increase in mortality rates during the conflict period, most deaths from 2017 onwards were related to non-violent causes. Overall, directly and indirectly, the conflict seems to have caused approximately 874 000 excess deaths. A total of 14.9% of households reported having at least one substantial violence-related disability since 2011. Conclusion The conflict caused the tripling of mortality rates in Syria. The estimated excess mortality in our study is higher than previous estimates. From 2017 onwards, most conflict-related deaths were due to non-violent causes. There is a high prevalence of violence-related disabilities in the studied communities. Our data could prove useful for health policymakers.
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Affiliation(s)
- Omar Alrashid Alhiraki
- Department of Surgery, Bab Al-Hawa Hospital, Idlib, Northwest Syria, Syrian Arab Republic .,Syria Research Group (SyRG), co-hosted by the London School of Hygiene and Tropical Medicine and Saw Swee Hock School of Public Health, London, UK
| | - Ola Fahham
- Syria Research Group (SyRG), co-hosted by the London School of Hygiene and Tropical Medicine and Saw Swee Hock School of Public Health, London, UK.,Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
| | - Hussam Alden Dubies
- Department of Surgery, Idlib University, Faculty of Medicine, Idlib, Northwest Syria, Syrian Arab Republic
| | - Jawad Abou Hatab
- Faculty of Medicine, Free Aleppo University, Aleppo, Northwest Syria, Syrian Arab Republic
| | - Muhammad Eyad Ba'Ath
- Department of Surgery, Bab Al-Hawa Hospital, Idlib, Northwest Syria, Syrian Arab Republic
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Gizatullin SK, Stanishevskiy AV, Svistov DV. [Combat gunshot skull and brain injuries]. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2021; 85:124-131. [PMID: 34714013 DOI: 10.17116/neiro202185051124] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
UNLABELLED There have been over 15 ended and ongoing armed conflicts in the world between 2014 and 2020. The total number of irrecoverable losses in these conflicts exceeded 800 000 people. In modern conflicts, gunshot head wounds account for 37.4% of sanitary losses of surgical profile. These injuries are characterized by high mortality rate. Changes in fighting nature entail changes in structure of wounds and treatment approaches. OBJECTIVE To analyze treatment strategy and features of surgical interventions for combat gunshot head injuries considering literature data for the period from 2014 to 2020. MATERIAL AND METHODS We analyzed the PubMed and eLibrary databases using the following keywords: head gunshot wound, traumatic brain injury, head trauma, combat trauma, wartime injury. We selected the reviews, original articles and case reports devoted to head gunshot wound management for the period 2014-2020. Manuscripts in Russian, Ukrainian and English with available abstract and/or full-text article were reviewed. Data on the incidence and structure of craniocerebral injuries, mortality and treatment strategy were analyzed. RESULTS We found 24 publications matching searching criteria. The majority of manuscripts were devoted to craniocerebral wounds received by combatants and civilians during the hostilities in the south-east of Ukraine (7 manuscripts), in Iraq and Afghanistan (4 manuscripts), as well as in the Syrian Arab Republic (12 manuscripts). Craniocerebral wounds occupy a leading position in overall structure of gunshot wounds and result the highest mortality compared to other wounds. There is a tendency towards the prevalence of bullet wounds over splinter wounds. CONCLUSION Modern wars and armed conflicts are characterized by changes in the structure of gunshot wounds. Craniocerebral injuries are ones of the most severe and characterized by high mortality. Data on their incidence and structure of gunshot craniocerebral wounds are advisable to be used in planning and organizing care for the wounded, as well as for development of preventive measures.
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Affiliation(s)
| | | | - D V Svistov
- Kirov Military Medical Academy, St. Petersburg, Russia
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