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Piñeros-Ortíz SE, Urrego-Mendoza ZC, Garzón-Orjuela N, Eslava-Schmalbach J. Social determinants, symptoms and mental problems in adults internally displaced by armed conflict. Soacha, Colombia, 2019. Rev Colomb Psiquiatr (Engl Ed) 2024:S2530-3120(24)00022-5. [PMID: 38677942 DOI: 10.1016/j.rcpeng.2022.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 08/08/2022] [Indexed: 04/29/2024]
Abstract
OBJECTIVE To characterise social determinants of health, mental health problems and potentially problematic symptoms in the adult population displaced by internal armed conflict in Colombia. METHODS Cross-sectional descriptive study with a random sample of 98 adults forcefully displaced to Soacha, Colombia, due to internal armed conflict. The Self Report Questionnaire to detect potentially problematic mental health problems and symptoms, and a structured questionnaire on social determinants of health were applied. RESULTS The median age was 38 [interquartile range, 28-46] years, and women predominated (69.39%). The median time since displacement was 36 [16-48] months, and time since settlement in Soacha, 48 [5-48] months. 86.32% survived on less than the minimum wage per month and 93.87% did not have an employment contract. 42.86% and 7.14% reported being owners of their homes before and after displacement, respectively. Upon arriving in Soacha, 79.60% went to primary support networks and 3% to institutions. Before displacement, 16.33% lacked health insurance and 27.55% afterwards. Regarding mental health problems; there were possible depressive or anxious disorders in 57.29%; possible psychosis in 36.73%; and potentially problematic symptoms in 91.66%, being more prevalent and serious in women (p = 0.0025). CONCLUSIONS A deterioration in living conditions and a higher prevalence of potentially problematic mental health problems and symptoms was reported in displaced adult populations settled in Soacha compared to other regions of the country. Analyses with complementary perspectives are required to evaluate these differences.
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Jolof L, Rocca P, Carlsson T. Women's experiences of trauma-informed care for forced migrants: A qualitative interview study. Heliyon 2024; 10:e28866. [PMID: 38596047 PMCID: PMC11002685 DOI: 10.1016/j.heliyon.2024.e28866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 03/11/2024] [Accepted: 03/26/2024] [Indexed: 04/11/2024] Open
Abstract
Introduction Forced migration affect the health and wellbeing of millions of women. The aim was to explore experiences of trauma-informed care among women who are forced migrants. Methods This was an exploratory qualitative study. Eleven women who had concluded treatment at multidisciplinary trauma centers in Sweden were interviewed, recruited through consecutive sampling. Audio-recorded interviews were transcribed and analyzed with systematic text condensation. Results Women dealt with mental and physical manifestations in a challenging psychosocial situation. Various structural and individual barriers were addressed that hindered access to adequate health services. Women appreciated various benefits of the treatment and recalled the care as supportive and compassionate. However, undergoing treatment was considered demanding, requiring significant determination and energy. Participants suggested that peer support could enhance the support. Conclusions Migrant women experience a range of health-related burdens and encounter barriers to trauma-informed care. While demanding, treatment has the potential to alleviate symptoms. Health professionals and stakeholders providing trauma-informed care need to ensure that their services are accessible and culturally sensitive towards the unique needs of women. Peer support has the potential to enhance support further, which need further evaluation.
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Affiliation(s)
- Linda Jolof
- The Red Cross Treatment Center for Persons Affected by War and Torture, Malmö, Sweden
| | - Patricia Rocca
- The Red Cross Treatment Center for Persons Affected by War and Torture, Malmö, Sweden
| | - Tommy Carlsson
- The Department of Health Sciences, The Swedish Red Cross University, Huddinge, Sweden
- The Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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Ortega-Narváez A, Muñoz-Manquillo DM, Guzmán-Lopez CP, Cabra-Bautista G. Profiles of suicide attempted in children and adolescents. J Pediatr (Rio J) 2024:S0021-7557(24)00034-2. [PMID: 38615698 DOI: 10.1016/j.jped.2024.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 01/10/2024] [Accepted: 01/21/2024] [Indexed: 04/16/2024] Open
Abstract
OBJECTIVE Suicide attempt (SA) is the strongest predictive variable for completed suicide. The Department of Cauca in Colombia has an SA rate higher than the national average, but the factors are unknown. The objective was to identify the profiles of SA in children and adolescents of Cauca. METHODS Cross-sectional study, which included all SA (Event-356) records from the SIVIGILA platform in children under 18 years of age between 2016 and 2019. The authors described the variables and multiple correspondence analysis (MCA) with the Burt method, according to the completeness of the data to establish the possible SA profiles using STATA 15.1, and R. The Ethics Committee at Universidad del Cauca approved it. RESULTS The study found 977 SA during this period, 72.4% female, 97.1% adolescent, 74.4% mestizo, 19.3% indigenous, 45.3% resided in municipalities exposed to the armed conflict, 32.3% expressed ideation and previous attempts, and 15.5% prior attempts. The MCA included 810 SA and identified three profiles: "Classic", which had mestizo adolescents with a history of prior SA, mental illness, or psychoactive substance use problems; "Related to the armed conflict", which included female adolescents with a first SA and residents in municipalities exposed to the armed conflict; "Ethnic" represented by male indigenous, with housing in a rural area. CONCLUSION The SA profiles found in Cauca were "Classic", "Related to the armed conflict", and "Ethnic"; these can be considered to implement prevention strategies from a cross-cultural, mental health, and gender perspective, with the presence of the state in the territories.
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Affiliation(s)
- Alicia Ortega-Narváez
- Universidad del Cauca, Department of Pediatrics, Popayán, Colombia; Hospital Susana López de Valencia, Pediatric Emergency, Popayán, Colombia.
| | - Diana Marcela Muñoz-Manquillo
- Universidad del Cauca, Department of Pediatrics, Popayán, Colombia; Hospital San José, Pediatric Emergency, Popayán, Colombia
| | | | - Ginna Cabra-Bautista
- Universidad del Cauca, Department of Pediatrics, Popayán, Colombia; Hospital Susana López de Valencia, Pediatric Emergency, Popayán, Colombia
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Granata G, Petersen E, Capone A, Donati D, Andriolo B, Gross M, Cicalini S, Petrosillo N. The impact of armed conflict on the development and global spread of antibiotic resistance: a systematic review. Clin Microbiol Infect 2024:S1198-743X(24)00160-5. [PMID: 38556213 DOI: 10.1016/j.cmi.2024.03.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 03/19/2024] [Accepted: 03/24/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND Scant data are available on the link between armed conflicts and the development and spread of antimicrobial resistance. OBJECTIVES We performed a systematic review with the aim to summarize the available data on the prevalence and features of antibiotic resistance and the causes of antibiotic resistance development during armed conflicts in the 21st century. METHODS Data sources: PubMed and SCOPUS databases were searched from 1 January 2000 to 30 November 2023. STUDY ELIGIBILITY CRITERIA Original articles reporting data on armed conflicts and antimicrobial resistance were included in this systematic review. No attempt was made to obtain information from unpublished studies. No language restriction was applied. Methods of data synthesis: Both quantitative and qualitative information were summarized by means of textual descriptions. PARTICIPANTS Patients or soldiers deployed in armed conflict zones. TESTS culture-dependent antibiotic sensitivity testing or molecular detection of the genetic determinants of antibiotic resistance after a confirmed diagnosis of bacterial infection. Assessment of risk of bias: To evaluate the quality of the included studies, we adapted the tool recommended by the Joanna Briggs Institute. RESULTS Thirty-four studies were identified, published between November 2004 and November 2023. The quality of included studies was high and medium in 47% and 53% of the studies, respectively. The included studies reported high infection and colonization rates of multidrug-resistant bacteria. Studies performed during the Eastern Ukraine conflict reported high rates of New Delhi metallo-β-lactamase producers. DISCUSSION Our findings confirm that wars lead to a large pool of multidrug-resistant infections that could potentially spread. Infection control in healthcare facilities in conflict zones and proper antimicrobial stewardship are crucial.
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Affiliation(s)
- Guido Granata
- Systemic and Immune Depression-Associated Infection Unit, National Institute for Infectious Diseases "L. Spallanzani", Istituto di Ricovero e Cura a Carattere Scientifico, Roma, Italy.
| | - Eskild Petersen
- PandemiX Center of Excellence, Roskilde University, Roskilde, Denmark; European Society for Clinical Microbiology and Infectious Diseases Emerging Infections Subcommittee. European Society of Clinical Microbiology and Infectious Diseases, Basel, Switzerland
| | - Alessandro Capone
- Systemic and Immune Depression-Associated Infection Unit, National Institute for Infectious Diseases "L. Spallanzani", Istituto di Ricovero e Cura a Carattere Scientifico, Roma, Italy
| | - Daniele Donati
- Infection Prevention & Control/Infectious Disease Service, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Benedetta Andriolo
- Systemic and Immune Depression-Associated Infection Unit, National Institute for Infectious Diseases "L. Spallanzani", Istituto di Ricovero e Cura a Carattere Scientifico, Roma, Italy
| | - Maya Gross
- Systemic and Immune Depression-Associated Infection Unit, National Institute for Infectious Diseases "L. Spallanzani", Istituto di Ricovero e Cura a Carattere Scientifico, Roma, Italy
| | - Stefania Cicalini
- Systemic and Immune Depression-Associated Infection Unit, National Institute for Infectious Diseases "L. Spallanzani", Istituto di Ricovero e Cura a Carattere Scientifico, Roma, Italy
| | - Nicola Petrosillo
- Infection Prevention & Control/Infectious Disease Service, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy; European Society for Clinical Microbiology and Infectious Diseases International Affairs SubCommittee. European Society of Clinical Microbiology and Infectious Diseases, Basel, Switzerland
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Abed Alah M. Echoes of conflict: the enduring mental health struggle of Gaza's healthcare workers. Confl Health 2024; 18:21. [PMID: 38481328 PMCID: PMC10938685 DOI: 10.1186/s13031-024-00577-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 02/25/2024] [Indexed: 03/17/2024] Open
Abstract
The conflict in Gaza presents distinct difficulties that significantly impact the psychological well-being of healthcare workers (HCWs) making it imperative to understand and address their mental health needs in this specific context. This article highlights the unique challenges of the ongoing Gaza conflict and its critical impact on the mental health of HCWs. Observations in the paper revealed that HCWs in Gaza face extraordinary challenges, including the targeting of medical facilities, severe shortages of medical supplies, and the ethical dilemmas of providing care in such constrained conditions. These factors contribute to heightened stress, anxiety, and a pervasive sense of helplessness among HCWs. The paper also notes the compounded emotional burden due to the loss of colleagues and the need to navigate complex interactions with patients' families under extreme conditions. Furthermore, the lack of basic needs like adequate nutrition and safe drinking water for HCWs themselves further compromises their ability to provide care effectively, contributing further to worsened mental health. The paper also notes the lack of sufficient media coverage and support for these workers, contributing to a sense of isolation and neglect. HCWs in Gaza find themselves in a uniquely challenging situation, one that is marked not only by the immediate stresses of the ongoing conflict but also by the deep-seated psychological scars from past wars. The circumstances in Gaza are clinically relevant as they directly affect the HCWs' ability to provide care and maintain their well-being. These findings highlight the need for targeted mental health interventions and support tailored to the specific challenges faced by HCWs in Gaza. Addressing these issues is crucial for their well-being and ability to provide effective healthcare under such demanding and traumatic circumstances.
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Affiliation(s)
- Muna Abed Alah
- Clinical Effectiveness Department, Primary Health Care Corporation, Doha, Qatar.
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Cappelli F, Costantini V, D'Angeli M, Marin G, Paglialunga E. Local sources of vulnerability to climate change and armed conflicts in East Africa. J Environ Manage 2024; 355:120403. [PMID: 38428181 DOI: 10.1016/j.jenvman.2024.120403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 10/13/2023] [Accepted: 02/13/2024] [Indexed: 03/03/2024]
Abstract
While socioeconomic and institutional factors are crucial in explaining the onset and evolution of conflicts, recent research suggests that climate change is a further indirect driver acting as a "threat multiplier". This paper focuses on the concept of vulnerability to both climate change and conflicts to explain why some locations are more likely to engage in armed conflicts than others in the presence of a similar level of exposure to climatic changes. In particular, by means of a Spatial Autoregressive Model, we identify a set of local-specific vulnerability factors that increase conflict risk in East Africa. We employ a georeferenced database with a resolution of 25 × 25 km, covering the period 1997-2016. Results from our analysis provide some interesting insights: first, climate change does not increase conflict risk per se, but only in the presence of pre-existing vulnerabilities. Second, resource access and socioeconomic factors play a key role in driving the climate-conflict nexus especially in urban areas. In particular, vulnerability is increased whenever power is not distributed in such a way as to ensure an equitable distribution of resources. Overall, our findings suggest that, by addressing vulnerability factors that prevent adaptive capacity and an equitable distribution of resources, societies may benefit in terms of both diminished conflict risk and alleviation of climate change impacts.
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Affiliation(s)
- Federica Cappelli
- Department of Economics and Management, University of Ferrara, via Voltapaletto, 11 - 44121, Ferrara, Italy.
| | - Valeria Costantini
- Department of Economics, University of Roma Tre, Via Silvio D'Amico 77, 00145, Rome, Italy.
| | - Mariagrazia D'Angeli
- Department of Economics, University of Roma Tre, Via Silvio D'Amico 77, 00145, Rome, Italy.
| | - Giovanni Marin
- Department of Economics, Society, Politics, University of Urbino Carlo Bo, Via Aurelio Saffi, 42, 61029, Urbino, Italy.
| | - Elena Paglialunga
- Department of Economics, University of Roma Tre, Via Silvio D'Amico 77, 00145, Rome, Italy.
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Jolof L, Rocca P, Carlsson T. Support interventions to promote health and wellbeing among women with health-related consequences following traumatic experiences linked to armed conflicts and forced migration: a scoping review. Arch Public Health 2024; 82:8. [PMID: 38225672 PMCID: PMC10790529 DOI: 10.1186/s13690-023-01235-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 12/28/2023] [Indexed: 01/17/2024] Open
Abstract
BACKGROUND Women exposed to armed conflicts and forced migration face significant health-related risks and consequences. Consequently, there is a need to identify and develop effective interventions that provide tailored support for them. The aim of this scoping review was to examine research evaluating support interventions promoting the health and well-being among women with traumatic experiences linked to armed conflict and/or forced migration. METHODS A scoping review of empirical studies evaluating non-pharmacologic/non-surgical interventions promoting health and well-being among adult women with traumatic experiences linked to armed, torture, and/or forced migration, identified through systematic searches in February 2022 within five databases (AMED, CINAHL, Cochrane Library, PsycINFO, and PubMed). Methodological characteristics and results were extracted and analyzed with narrative analysis using tabulations, descriptive statistics, text-based summaries, and thematization. RESULTS Assessment of 16 748 records resulted in 13 included reports. The methodological approaches were quantitative (n = 9), qualitative (n = 2), and mixed methods (n = 2), with most reports being feasibility/pilot studies (n = 5) and/or randomized controlled trials (n = 4). The most common recruitment strategy was non-probability sampling (n = 8). Most interventions were conducted in North America (n = 4), Asia (n = 3) or Middle East (n = 3). Thirteen intra-intervention techniques and five categories of components utilized within the interventions were identified, the most common being skill building (n = 12). Ten developed the interventions through theoretical frameworks or manuals/therapy, while five developed interventions through public or stakeholder involvement. Eleven studies evaluated outcomes related to psychological health, disorders, or distress. A large proportion of the investigated outcomes showed post-exposure improvements and improvements when compared with controls. Qualitative findings highlighted improved mental and physical health, empowerment and stigma reduction, and enhanced knowledge. CONCLUSION Few studies have developed and evaluated tailored support interventions for this population, containing a range of components and intra-intervention techniques. No clear focus was identified regarding outcome measures, and most studies used non-probability sampling. Few developed interventions through public contribution in collaboration with women. While limited studies show promising effects on women's mental health, more empirical intervention research that closely corresponds to women's needs are needed.
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Affiliation(s)
- Linda Jolof
- The Red Cross Treatment Center for Persons Affected by War and Torture, Malmö, Sweden
| | - Patricia Rocca
- The Red Cross Treatment Center for Persons Affected by War and Torture, Malmö, Sweden
| | - Tommy Carlsson
- The Department of Health Sciences, The Swedish Red Cross University, Huddinge, Sweden.
- The Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
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Mani ZA, Kuhn L, Plummer V. Emergency care in the context of armed conflict: Nurses' perspectives of the essential core competencies. Int Nurs Rev 2023; 70:510-517. [PMID: 37534434 DOI: 10.1111/inr.12870] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 07/23/2023] [Indexed: 08/04/2023]
Abstract
AIM To identify nurses' perspectives of their core competencies for emergency care in the context of armed conflict. INTRODUCTION Emergency department's (ED) capacity is frequently overwhelmed by a sudden surge of patients when located near armed conflict. Although emergency nurses are key frontline responders, evidence detailing core competencies needed to work in these areas remains limited. METHOD The study used a cross-sectional survey design and is reported using STROBE guidelines. A validated questionnaire was administered in hospitals near the southern Kingdom of Saudi Arabia and Yemen border, where emergency nurses regularly manage large numbers of patients from armed conflict. RESULT A total of 163 questionnaires were returned (68% response rate). Most participants were female and had more than six years of ED experience. The core competencies for emergency nurses working near armed conflict were identified and highly rated by participants: the highest mean value was 9.47/10 and the lowest was 8.89/10. Analysis revealed regular education, training and drills were needed to provide quality emergency nursing care for victims of armed conflict. CONCLUSION AND IMPLICATIONS FOR NURSING AND HEALTH POLICY This study provides new evidence regarding core competencies in emergency nursing care in the context of armed conflict. The identified competencies should be incorporated into future education, curricula, training programmes and evaluations to enable emergency nurses to function effectively in the context of armed conflict. The findings will assist decision-makers to develop plans and strategies for mitigating risk and improving the future nursing response in similar contexts.
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Affiliation(s)
- Zakaria A Mani
- School of Nursing and Midwifery, Monash University, Frankston, Australia
- College of Nursing, Jazan University, Jazan, Saudi Arabia
| | - Lisa Kuhn
- School of Nursing and Midwifery, Monash University, Frankston, Australia
- Monash Health, Clayton, Australia
| | - Virginia Plummer
- School of Nursing and Midwifery, Monash University, Frankston, Australia
- Federation University Australia, Victoria, Australia
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Mani ZA, Kuhn L, Plummer V. Core competencies of emergency nurses for the armed conflict context: Experiences from the field. Int Nurs Rev 2023. [PMID: 37953625 DOI: 10.1111/inr.12902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 10/17/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND Armed conflicts are usually associated with high mortality and morbidity rates, with unpredictable workload, injuries and illnesses. Identifying emergency nurses' views of the core competencies required to enable them to work effectively in hospitals in areas of armed conflict is critical. It is important to inform the requisite standards of care and facilitate the translation of knowledge into safe, quality care. AIM The aim of this study was to identify emergency nurses' perceptions of core competencies necessary to work in hospitals in the context of armed conflict. METHOD A descriptive qualitative phase of a mixed-method study using semi-structured interviews with participants was conducted from June to July 2019. The COREQ guideline for reporting qualitative research was followed. FINDINGS A sample of 15 participants was interviewed. The participant perceptions provided a different perspective of core competencies required for emergency nurses in the context of armed conflict, culminating in four main areas: (i) personal preparedness , (ii) leadership, (iii) communication and (iv) assessment and intervention. CONCLUSION This study identified emergency nurses' perceptions of their core competencies. Personal preparedness, leadership, communication, assessment and intervention were identified as contributing to calmness of character, confidence in care and cultural awareness for care in this setting and were essential for them to work effectively when managing victims of armed conflict in emergency departments. IMPLICATIONS FOR NURSING PRACTICE AND HEALTH POLICY The findings of this study are important and novel because the researchers sought the perspectives of emergency nurses who have experience in receiving patients from armed conflict firsthand. The findings will inform policymakers in those settings regarding standard of care, education and drills for hospital nurses in optimizing armed conflict care response outcomes.
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Affiliation(s)
- Zakaria A Mani
- School of Nursing and Midwifery, Monash University, Frankston, Australia
- College of Nursing, Jazan University, Jazan, Saudi Arabia
| | - Lisa Kuhn
- School of Nursing and Midwifery, Monash University, Frankston, Australia
- Monash Health, Clayton, Australia
| | - Virginia Plummer
- School of Nursing and Midwifery, Monash University, Frankston, Australia
- Federation University Australia, Ballarat, Australia
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Kemajou Njatang D, Bouba Djourdebbé F, Adda Wadou ND. Climate variability, armed conflicts and child malnutrition in sub-saharan Africa: A spatial analysis in Ethiopia, Kenya and Nigeria. Heliyon 2023; 9:e21672. [PMID: 38027550 PMCID: PMC10656247 DOI: 10.1016/j.heliyon.2023.e21672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/01/2023] Open
Abstract
Background Sub-Saharan Africa (SSA) has one of the highest prevalence of malnutrition among children under 5 in the world. It is also the region most vulnerable to the adverse effect of climate change, and the one that records the most armed conflicts. The chains of causality suggested in the literature on the relationship between climate change, armed conflict, and malnutrition have rarely been supported by empirical evidence for SSA countries. Methods This study proposes to highlight, under the hypothesis of spatial non-stationarity, the influence of climatic variations and armed conflicts on malnutrition in children under 5 in Ethiopia, Kenya, and Nigeria. To do this, we use spatial analysis on data from Demographic and Health Surveys (DHS), Uppsala Conflict Data Program Georeferenced Event Dataset (UCDP GED), Climate Hazards center InfraRed Precipitation with Station data (CHIRPS) and Moderate Resolution Imaging Spectroradiometer (MODIS). Results The results show that there is a spatial autocorrelation of malnutrition measured by the prevalence of underweight children in the three countries. Also, local geographically weighted analysis shows that armed conflict, temperature and rainfall are positively associated with the prevalence of underweight children in localities of Somali in Ethiopia, Mandera and Turkana of Wajir in Kenya, Borno and Yobe in Nigeria. Conclusion In conclusion, the results of our spatial analysis support the implementation of conflict-sensitive climate change adaptation strategies.
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García AM, Gutiérrez J, Villamil E, Sánchez W, Villarreal L, Lozada-Martinez ID, Picón-Jaimes YA, Pérez M, Cabrera-Vargas LF. Predictors for limb amputation in war vascular trauma: A 20-years retrospective analysis from the Colombian armed conflict. Am J Surg 2023; 225:787-792. [PMID: 36220700 DOI: 10.1016/j.amjsurg.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 09/27/2022] [Accepted: 10/05/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND The Latin American military vascular trauma is virtually unknown. The aim of this study was to describe severe war vascular trauma during the last 20 years of the Colombian armed conflict, and to identify predictors of limb amputation. METHODS Retrospective analysis of a follow-up cohort from 1999 to 2019 of patients with associated severe vascular injuries (ISS >15) in the Colombian armed conflict treated at the Hospital Militar Central. RESULTS Out of 5948 patients, 243 had military vascular trauma with 430 vascular injuries. The most frequent trauma mechanisms were gunshot wounds (n = 153; 63%). The most common injured vessels were femoral. 24 (10%) patients required amputations. Mortality was 4.1%. Amputation was associated with arteriovenous lesions (RR 4.82, p = 0.025), compartment syndrome (RR 4.2, p = 0.007), arteriovenous femoropopliteal injuries (RR 3.5, p = 0.0026), multiple arterial injuries (RR 3.35, p = 0.0218), associated fractures (RR 3.1, p = 0.0032). CONCLUSIONS Concomitant arteriovenous injuries in popliteal and femoropopliteal lesions, multiple arterial lesions, bone fractures, and compartment syndrome are associated with amputation in severe vascular injury.
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Affiliation(s)
- Ana Maria García
- Department of Surgery, Hospital Militar Central, Universidad Militar Nueva Granada, Bogotá, Colombia
| | - Jorge Gutiérrez
- Department of Surgery, Hospital Militar Central, Universidad Militar Nueva Granada, Bogotá, Colombia; Department of Surgery, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Edwin Villamil
- Department of Surgery, Hospital Militar Central, Universidad Militar Nueva Granada, Bogotá, Colombia
| | - William Sánchez
- Department of Surgery, Hospital Militar Central, Universidad Militar Nueva Granada, Bogotá, Colombia
| | - Laura Villarreal
- Department of Surgery, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Ivan David Lozada-Martinez
- Medical and Surgical Research Center, Future Surgeons Chapter, Colombian Surgery Association, Bogotá, Colombia; International Coalition on Surgical Research, Universidad Nacional Autónoma de Nicaragua, Managua, Nicaragua.
| | | | - Mauricio Pérez
- Department of Surgery, Universidad El Bosque, Bogotá, Colombia
| | - Luis Felipe Cabrera-Vargas
- Medical and Surgical Research Center, Future Surgeons Chapter, Colombian Surgery Association, Bogotá, Colombia; Department of Surgery, Universidad El Bosque, Bogotá, Colombia
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Zhang Z, Ding J, Zhao W, Liu Y, Pereira P. The impact of the armed conflict in Afghanistan on vegetation dynamics. Sci Total Environ 2023; 856:159138. [PMID: 36191719 DOI: 10.1016/j.scitotenv.2022.159138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 09/27/2022] [Accepted: 09/27/2022] [Indexed: 06/16/2023]
Abstract
Armed conflicts disturb the environment and impair land productivity. Afghanistan has been submerged in conflict for >20 years, affecting the environment dramatically. In this study, we used the Normalised difference vegetation index (NDVI) to investigate vegetation's spatial and temporal changes and the potential underpinned mechanisms. We found a 16.44 % increase in NDVI in Afghanistan from 2000 to 2021. The average NDVI growth rate was 11.33 % (within 5 km distance from the armed conflict), higher in the conflict group than in the non-conflict group. People migration may have reduced the human impacts on the environment. The relative contribution of armed conflict to vegetation growth was 3.17 %. Our results showed that the vegetation in Afghanistan increased, confirming the idea that depopulation increase greenness. Despite the reduced variance explained by the war (R2 values around 0.3), our study provides empirical evidence on the linkages between the war and vegetation change in Afghanistan.
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Affiliation(s)
- Zhijie Zhang
- State Key Laboratory of Earth Surface Processes and Ecology, Faculty of Geographical Science, Beijing Normal University, Beijing 100875, China; Institute of Land Surface System and Sustainable Development, Faculty of Geographical Science, Beijing Normal University, Beijing 100875, China; Zhuhai Branch of State Key Laboratory of Earth Surface Processes and Resource Ecology, Advanced Institute of Natural Sciences, Beijing Normal University at Zhuhai, Zhuhai 519087, China
| | - Jingyi Ding
- State Key Laboratory of Earth Surface Processes and Ecology, Faculty of Geographical Science, Beijing Normal University, Beijing 100875, China; Institute of Land Surface System and Sustainable Development, Faculty of Geographical Science, Beijing Normal University, Beijing 100875, China
| | - Wenwu Zhao
- State Key Laboratory of Earth Surface Processes and Ecology, Faculty of Geographical Science, Beijing Normal University, Beijing 100875, China; Institute of Land Surface System and Sustainable Development, Faculty of Geographical Science, Beijing Normal University, Beijing 100875, China.
| | - Yue Liu
- State Key Laboratory of Earth Surface Processes and Ecology, Faculty of Geographical Science, Beijing Normal University, Beijing 100875, China; Institute of Land Surface System and Sustainable Development, Faculty of Geographical Science, Beijing Normal University, Beijing 100875, China
| | - Paulo Pereira
- Environmental Management Center, Mykolas Romeris University, Ateities g. 20, 08303 Vilnius, Lithuania
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13
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Jolof L, Rocca P, Mazaheri M, Okenwa Emegwa L, Carlsson T. Experiences of armed conflicts and forced migration among women from countries in the Middle East, Balkans, and Africa: a systematic review of qualitative studies. Confl Health 2022; 16:46. [PMID: 36071504 PMCID: PMC9450290 DOI: 10.1186/s13031-022-00481-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 09/01/2022] [Indexed: 11/10/2022] Open
Abstract
Background A significant proportion of the global population is displaced, many being women. Qualitative studies can generate in-depth findings that will contribute to an understanding of their experiences, but there is a need for further synthetization efforts. The aim was to provide a comprehensive perspective about adult women’s experiences of armed conflicts and forced migration, focusing on women in or from countries in the Middle East, Balkans, or Africa. Methods Systematic review of English reports presenting empirical qualitative studies published in scientific journals 1980 or later, utilizing searches performed in September 2021 within three databases combined with manual screening. Of the 3 800 records screened in total, 26 were included. Methodological details and quality were appraised using pre-specified extraction and appraisal tools. The findings within the included reports were analyzed with thematic analysis. Results Most reports utilized interviews, including in total 494 participants, and were appraised as having insignificant methodological limitations. The first theme concerns changed living conditions, involving reduced safety, insufficient access to resources meeting basic needs, forced migration as a last resort, and some positive effects. The second theme concerns the experienced health-related consequences, involving psychological distress, risks during pregnancy and childbirth, exposure to violence and discrimination as a woman, as well as a lack of adequate healthcare services and social support. The third theme concerns the resources and strategies that enhance resilience, involving social support and family life, as well as utilization of internal resources and strategies. Conclusion When experiencing armed conflicts and forced migration, women face significant challenges related to changed living conditions and are exposed to health-related consequences. Consistently, women are targets of severe structural and personal violence, while lacking access to even the most basic healthcare services. Despite facing considerable hardships, these women display extraordinary resilience and endurance by finding strength through social support and internal resources. Synthesized qualitative research illustrates that women value social support, including peer support, which is a promising intervention that needs to be evaluated in future experimental studies. Supplementary Information The online version contains supplementary material available at 10.1186/s13031-022-00481-x.
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Affiliation(s)
- Linda Jolof
- The Red Cross Treatment Center for Persons Affected By War and Torture, Malmö, Sweden
| | - Patricia Rocca
- The Red Cross Treatment Center for Persons Affected By War and Torture, Malmö, Sweden
| | - Monir Mazaheri
- Department of Nursing Science, Sophiahemmet University, Stockholm, Sweden.,Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Huddinge, Sweden
| | - Leah Okenwa Emegwa
- The Department of Health Sciences, The Swedish Red Cross University, Huddinge, Sweden
| | - Tommy Carlsson
- The Department of Health Sciences, The Swedish Red Cross University, Huddinge, Sweden. .,The Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
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14
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Stauch G, Raoufi R, Sediqi A, Dalquen P, Fritz P, Aichmüller C, Aichmüller-Ratnaparkhe M, Hubler M. [Experiences with telepathology in northern Afghanistan : A 10-year success story]. Pathologie (Heidelb) 2022; 43:303-310. [PMID: 35238979 DOI: 10.1007/s00292-022-01060-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/13/2022] [Indexed: 06/14/2023]
Abstract
Afghanistan is in a military conflict lasting more than 20 years and according to recent political development, in a downhill spiral towards a failed society. This scenario faces the question of the usefulness of international medical aid, especially morphological diagnostics in crisis situations. On the basis of ten years of experience from a telemedicine project, need, feasibility and results in Afghanistan will be discussed. General and country-specific problems and the sustainability of an international partnership are discussed. In summary our experience is: (1) Telemedicine is possible and necessary even in countries with high conflict potential. It is integrated into routine care by local medical care taker, (2) Accompanying video conferences are a significant improvement in telemedical diagnostics, (3) "High level" consultations can bridge the gap between sophisticated western diagnostics and medicine in the partner country in selected cases and (4) Scientific work is possible on the basis of the medical data collected on site and the image material generated.
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Affiliation(s)
- Gerhard Stauch
- iPath Telemedicine Network gGmbH, 26603, Aurich, Deutschland.
- Institut für Pathologie Aurich/Westerstede, Wallinghausener Str. 8-12, 26603, Aurich, Deutschland.
| | - Rokai Raoufi
- Abu Ali Sina Hospital, Masar-e-Scharif, Afghanistan
| | - Atiq Sediqi
- Abu Ali Sina Hospital, Masar-e-Scharif, Afghanistan
| | - Peter Dalquen
- Institut für Pathologie, Universitätsspital Basel, 4031, Basel, Schweiz
| | - Peter Fritz
- Institut für Pathologie, Robert-Bosch-Krankenhaus, 70341, Stuttgart, Deutschland
| | | | | | - Monika Hubler
- Administration iPath Telemedicine Network gGmbH, 79576, Weil am Rhein, Deutschland
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15
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Muhrbeck M, Wladis A, Lampi M, Andersson P, Junker JPE. Efficacy of topical honey compared to systemic gentamicin for treatment of infected war wounds in a porcine model: A non-inferiority experimental pilot study. Injury 2022; 53:381-392. [PMID: 34756413 DOI: 10.1016/j.injury.2021.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 10/11/2021] [Accepted: 10/18/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND In armed conflicts, infected wounds constitute a large portion of the surgical workload. Treatment consists of debridements, change of dressings, and antibiotics. Many surgeons advocate for the use of honey as an adjunct with the rationale that honey has bactericidal and hyperosmotic properties. However, according to a Cochrane review from 2015 there is insufficient data to draw any conclusions regarding the efficacy of honey in treatment of wounds. We, therefore, decided to evaluate if honey is non-inferior to gentamicin in the treatment of infected wounds in a highly translatable porcine wound model. MATERIAL AND METHODS 50 standardized wounds on two pigs were infected with S. aureus and separately treated with either topically applied Manuka honey or intramuscular gentamicin for eight days. Treatment efficacy was evaluated with quantitative cultures, wound area measurements, histological, immunohistochemical assays, and inflammatory response. RESULTS Topically applied Manuka honey did not reduce bacterial count or wound area for the duration of treatment. Intramuscular gentamicin initially reduced bacterial count (geometric mean 5.59*¸0.37 - 4.27*¸0.80 log10 (GSD) CFU/g), but this was not sustained for the duration of the treatment. However, wound area was significantly reduced with intramuscular gentamicin at the end of treatment (mean 112.8 ± 30.0-67.7 ± 13.2 (SD) mm2). ANOVA-analysis demonstrated no variation in bacterial count for the two treatments but significant variation in wound area (p<0.0001). The inflammatory response was more persistent in the pig with wounds treated with topically applied Manuka honey than in the pig treated with intramuscular gentamicin. CONCLUSION At the end of treatment S. aureus count was the same with topically applied Manuka honey and intramuscular gentamicin. The wound area was unchanged with topically applied Manuka honey and decreased with intramuscular gentamicin. Topically applied Manuka honey could consequently be non-inferior to intramuscular gentamicin in reducing S. aureus colonization on the wound's surface, but not in reducing wound size. The use of Manuka honey dressings to prevent further progression of a wound infection may therefore be of value in armed conflicts, where definite care is not immediately available.
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Affiliation(s)
- Måns Muhrbeck
- Department of Surgery in Norrköping, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden; Department of Biomedical and Clinical Sciences, Center for Disaster Medicine and Traumatology, Linköping University, Linköping, Sweden.
| | - Andreas Wladis
- Department of Biomedical and Clinical Sciences, Center for Disaster Medicine and Traumatology, Linköping University, Linköping, Sweden; Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Maria Lampi
- Department of Biomedical and Clinical Sciences, Center for Disaster Medicine and Traumatology, Linköping University, Linköping, Sweden
| | - Peter Andersson
- Department of Biomedical and Clinical Sciences, Center for Disaster Medicine and Traumatology, Linköping University, Linköping, Sweden; Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Johan P E Junker
- Department of Biomedical and Clinical Sciences, Center for Disaster Medicine and Traumatology, Linköping University, Linköping, Sweden; Department of Biomedical and Clinical Sciences, Laboratory of Experimental Plastic Surgery, Linköping University, Linköping, Sweden
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16
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Méndez F, Zapata-Rivera AM. Armed conflict, pollution, and health risks: A risk evaluation of three sources of environmental exposure associated with the conflict in Colombia. Biomedica 2021; 41:660-675. [PMID: 34936252 PMCID: PMC8759577 DOI: 10.7705/biomedica.5928] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 06/21/2021] [Indexed: 11/24/2022]
Abstract
Introduction: Armed conflicts affect territories rich in resources and biodiversity. As a result of the environmental damage caused by violent actions, the health of populations can be affected. Objectives: To assess the risks to human health due to environmental degradation associated with three violent actions in the context of the Colombian armed conflict: Pipeline bombing, informal mining with mercury, and spraying of illicit crops with glyphosate. Materials and methods: We conducted a quantitative evaluation of the risks to individual health associated with armed conflict activities using methodologies focused on the routes of pollutants dispersion, their concentrations in the environment, the exposure of the individuals, and the risks of carcinogenic and non-carcinogenic effects. Results: The risk assessment of the armed conflict-related actions under study evidenced intolerable carcinogenic risk and unacceptable non-carcinogenic risk due to the consumption of water and fish contaminated by polycyclic aromatic hydrocarbons (PAH), mercury, and glyphosate. Conclusions: The study reiterates the inextricable connections existing among the environment, society, and health, as well as the implications of environmental violence for the public health of vulnerable population groups and, in general, for the well-being of all living beings affected by the armed conflict.
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Affiliation(s)
- Fabián Méndez
- Escuela de Salud Pública, Universidad del Valle, Cali, Colombia.
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17
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Muhrbeck M, Osman Z, von Schreeb J, Wladis A, Andersson P. Predicting surgical resource consumption and in-hospital mortality in resource-scarce conflict settings: a retrospective study. BMC Emerg Med 2021; 21:94. [PMID: 34380419 PMCID: PMC8359038 DOI: 10.1186/s12873-021-00488-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 07/30/2021] [Indexed: 11/14/2022] Open
Abstract
Background In armed conflicts, civilian health care struggles to cope. Being able to predict what resources are needed is therefore vital. The International Committee of the Red Cross (ICRC) implemented in the 1990s the Red Cross Wound Score (RCWS) for assessment of penetrating injuries. It is unknown to what extent RCWS or the established trauma scores Kampala trauma Score (KTS) and revised trauma score (RTS) can be used to predict surgical resource consumption and in-hospital mortality in resource-scarce conflict settings. Methods A retrospective study of routinely collected data on weapon-injured adults admitted to ICRC’s hospitals in Peshawar, 2009–2012 and Goma, 2012–2014. High resource consumption was defined as ≥3 surgical procedures or ≥ 3 blood-transfusions or amputation. The relationship between RCWS, KTS, RTS and resource consumption, in-hospital mortality was evaluated with logistic regression and adjusted area under receiver operating characteristic curves (AUC). The impact of missing data was assessed with imputation. Model fit was compared with Akaike Information Criterion (AIC). Results A total of 1564 patients were included, of these 834 patients had complete data. For high surgical resource consumption AUC was significantly higher for RCWS (0.76, 95% CI 0.74–0.78) than for KTS (0.53, 95% CI 0.50–0.56) and RTS (0.51, 95% CI 0.48–0.54) for all patients. Additionally, RCWS had lower AIC, indicating a better model fit. For in-hospital mortality AUC was significantly higher for RCWS (0.83, 95% CI 0.79–0.88) than for KTS (0.71, 95% CI 0.65–0.76) and RTS (0.70, 95% CI 0.63–0.76) for all patients, but not for patients with complete data. Conclusion RCWS appears to predict surgical resource consumption better than KTS and RTS. RCWS may be a promising tool for planning and monitoring surgical care in resource-scarce conflict settings. Supplementary Information The online version contains supplementary material available at 10.1186/s12873-021-00488-2.
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Affiliation(s)
- Måns Muhrbeck
- Department of Surgery in Norrköping, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden. .,Center for Disaster Medicine and Traumatology, University Hospital, Linköping, Sweden.
| | - Zaher Osman
- International Committee of the Red Cross, Geneva, Switzerland
| | - Johan von Schreeb
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Andreas Wladis
- Department of Surgery in Norrköping, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.,Center for Disaster Medicine and Traumatology, University Hospital, Linköping, Sweden
| | - Peter Andersson
- Department of Surgery in Norrköping, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.,International Medical Programme, Center for Disaster Medicine and Traumatology, University Hospital, Linköping, Sweden
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18
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Robinson E, Lee L, Roberts LF, Poelhekke A, Charles X, Ouabo A, Vyncke J, Ariti C, Gbanzi MCA, Ouakouma MT, Gray N, Daly M, White K, Templeman S, Hejdenberg M, Hersevoort M, Pena SJ, Kuehne A. Mortality beyond emergency threshold in a silent crisis- results from a population-based mortality survey in Ouaka prefecture, Central African Republic, 2020. Confl Health 2021; 15:50. [PMID: 34193238 PMCID: PMC8243074 DOI: 10.1186/s13031-021-00385-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 06/14/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Central African Republic (CAR) suffers a protracted conflict and has the second lowest human development index in the world. Available mortality estimates vary and differ in methodology. We undertook a retrospective mortality study in the Ouaka prefecture to obtain reliable mortality data. METHODS We conducted a population-based two-stage cluster survey from 9 March to 9 April, 2020 in Ouaka prefecture. We aimed to include 64 clusters of 12 households for a required sample size of 3636 persons. We assigned clusters to communes proportional to population size and then used systematic random sampling to identify cluster starting points from a dataset of buildings in each commune. In addition to the mortality survey questions, we included an open question on challenges faced by the household. RESULTS We completed 50 clusters with 591 participating households including 4000 household members on the interview day. The median household size was 7 (interquartile range (IQR): 4-9). The median age was 12 (IQR: 5-27). The birth rate was 59.0/1000 population (95% confidence interval (95%-CI): 51.7-67.4). The crude and under-five mortality rates (CMR & U5MR) were 1.33 (95%-CI: 1.09-1.61) and 1.87 (95%-CI: 1.37-2.54) deaths/10,000 persons/day, respectively. The most common specified causes of death were malaria/fever (16.0%; 95%-CI: 11.0-22.7), violence (13.2%; 95%-CI: 6.3-25.5), diarrhoea/vomiting (10.6%; 95%-CI: 6.2-17.5), and respiratory infections (8.4%; 95%-CI: 4.6-14.8). The maternal mortality ratio (MMR) was 2525/100,000 live births (95%-CI: 825-5794). Challenges reported by households included health problems and access to healthcare, high number of deaths, lack of potable water, insufficient means of subsistence, food insecurity and violence. CONCLUSIONS The CMR, U5MR and MMR exceed previous estimates, and the CMR exceeds the humanitarian emergency threshold. Violence is a major threat to life, and to physical and mental wellbeing. Other causes of death speak to poor living conditions and poor access to healthcare and preventive measures, corroborated by the challenges reported by households. Many areas of CAR face similar challenges to Ouaka. If these results were generalisable across CAR, the country would suffer one of the highest mortality rates in the world, a reminder that the longstanding "silent crisis" continues.
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Affiliation(s)
- Eve Robinson
- Médecins sans Frontières, Bangui, Central African Republic
| | - Lawrence Lee
- Médecins sans Frontières, Bangui, Central African Republic
| | | | | | - Xavier Charles
- Médecins sans Frontières, Bangui, Central African Republic
- Médecins sans Frontières, London, UK
| | - Adelaide Ouabo
- Médecins sans Frontières, Bangui, Central African Republic
| | | | - Cono Ariti
- Centre for Trials research, Cardiff University Medical School, Cardiff, UK
| | - Mariette Claudia Adame Gbanzi
- Directorate of Family and Population Health, Ministry of Health and of the Population, Bangui, Central African Republic
| | - Martial Tanguy Ouakouma
- Central African Institute for Statistics and Social and Economic Studies, Bangui, Central African Republic
| | - Nell Gray
- Médecins sans Frontières, London, UK
| | - Maura Daly
- Médecins sans Frontières, Amsterdam, The Netherlands
| | - Kate White
- Médecins sans Frontières, Amsterdam, The Netherlands
| | - Sam Templeman
- Médecins sans Frontières, Amsterdam, The Netherlands
| | | | | | | | - Anna Kuehne
- Médecins sans Frontières, London, UK
- Médecins sans Frontières, Berlin, Germany
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19
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Avendaño-Vásquez CJ, Reina-Gamba NC, Daza-Castillo LA, Quarantini L. Nursing Interventions in Children Living Under Armed Conflict Situations and Quality of Life: A Scoping Review. J Pediatr Nurs 2021; 58:44-52. [PMID: 33316614 DOI: 10.1016/j.pedn.2020.11.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 11/22/2020] [Accepted: 11/22/2020] [Indexed: 10/22/2022]
Abstract
PROBLEM Today, one in four children in the world lives in an area of conflict or disaster, and more than 30 million have been displaced, enslaved or trafficked, abused, and exploited. However, there is little recognition of nursing interventions in this context and their impact on the quality of life. ELIGIBILITY CRITERIA Studies that (1) Described nursing interventions in children under situations of armed conflict. (2) Identified the impact of the interventions in the Quality of Life. (3) identify research trends in the field by nursing professionals. (4) Summarized concepts associated and nursing interventions proposed in armed conflict to address this problem. SAMPLE From June to November 2019, electronic databases such as Embase, MEDLINE, LILACS, BIREME library, CINAHL, and ProQuest were accessed. Eleven papers were included in the review. RESULTS The studies described the positive effects of nursing interventions on mental health and mortality. No studies were found reporting the impact of the interventions on quality of life. The topics of significant research in nursing focus on mental health. Care practices based on leadership, health management, advocacy, and intermediation in public policies should be a matter of interest for nurses. CONCLUSIONS Future research is required to generate a comprehensive and accurate understanding of the nursing interventions in children under armed conflict situations. IMPLICATIONS Recognizing the applied interventions and proposing a frame of reference justifies present and future research to children's attention under armed conflict situations.
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Affiliation(s)
| | | | | | - Lucas Quarantini
- Medicine Post-graduated program. (PPgMS), Federal University of Bahia, Brazil; Neurosciences, and the Mental Health Department, School Medicine. The Federal University of Bahia, Brazil
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20
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Horev A, Edan-Reuven S, Eshel R, Novack L. Utilization of health services for skin disorders during military operations. A population- based study. Dermatol Reports 2020; 12:8648. [PMID: 33408840 PMCID: PMC7772756 DOI: 10.4081/dr.2020.8648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 10/18/2020] [Indexed: 11/23/2022] Open
Abstract
In addition to the immediate casualties of armed conflicts, their indirect impact may bring even more damage by causing malfunctioning of health systems and impaired access to diagnosis and treatment. We conducted a population-based study, to assess the utilization rates of health services due to skin disorders, among civilians exposed to missile attacks and siren alarms during three military operations in Israel. The study was designed as a natural experiment, whereas periods of military operations were compared to the non-military times. During the military operations, when sirens and missiles were an everyday experience, the number of visits to dermatologists was 1.07-1.16 times lower [Relative Risk (RR)=0.86-0.92] as compared to the non-military periods, especially evident for patients residing closer to the military zone, where it dropped almost 2- folds (RR=0.52). Although perceived nonurgent in their majority, the routine care should not be delayed to prevent more serious skin conditions.
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Affiliation(s)
- Amir Horev
- Pediatric Dermatology Service, Soroka University Medical Center, Beer-Sheva.,Faculty of Health Sciences, Ben-Gurion University of the Negev
| | | | - Ron Eshel
- Faculty of Health Sciences, Ben-Gurion University of the Negev
| | - Lena Novack
- Faculty of Health Sciences, Ben-Gurion University of the Negev.,Negev Environmental Health Research Institute, Soroka University Medical Center, Beer-Sheva, Israel
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Abstract
This Letter to the Editor is in reference to the article by Murphy M, Ellsberg M and Contreras-Urbina M, "Nowhere to go: disclosure and help-seeking behaviors for survivors of violence against women and girls in South Sudan," published on 12 February 2020. The authors have to be lauded to study this important topic in South Sudan where data are scarce and the problem is less understood. In such a context, actions by various actors to address sexual violence, a major public health concern and a serious international humanitarian law and human rights violation, must be well thought of to avoid causing more harm and compound the suffering of survivors.
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Affiliation(s)
- Dilshad Jaff
- Maternal and Child Health Department, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, NC 27599 USA
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22
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Rezaeian M. "War Epidemiology" Versus "Peace Epidemiology": A Personal View. Arch Iran Med 2020; 23:S38-S42. [PMID: 32349507 DOI: 10.34172/aim.2020.s8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 10/12/2019] [Indexed: 01/12/2023]
Abstract
Epidemiology can be considered as a responsible public health science the aim of which is to control health problems. One of the most important public health problems is "war". The aim of the present paper, therefore, is threefold: firstly, to determine to what extent war has been investigated from an epidemiological point of view; secondly, what the definition and scope of "war epidemiology" would be; and thirdly, if it would be possible to introduce a new branch of epidemiology entitled "peace epidemiology". In the present study, I have tried to fulfill the aims of the study based on my experiences in war and peace epidemiology and also by reviewing the most relevant websites, documents and papers. Evidence suggests that enough epidemiological studies have not been carried out to determine the sheer public health consequences of war. "War epidemiology" can be defined as "the study of the distribution and determinants of war-related events in specified populations, and the application of this study to the control of war". "Peace epidemiology" is a new branch of epidemiology which "highlights how peace could positively shape our world". Epidemiologists need to produce more scientific evidence about the negative public health consequences of wars and also the positive public health consequences of peace. The ultimate aim of "war epidemiology" is to control war, usually by secondary and tertiary prevention activities. However, the ultimate aim of "peace epidemiology" is to reinforce peace by primary and/or primordial prevention activities.
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Affiliation(s)
- Mohsen Rezaeian
- Epidemiology and Biostatistics Department, Occupational Environmental Research Center, Rafsanjan Medical School, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
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23
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Abstract
BACKGROUND Due to the increasing threat of terrorist attacks and assassinations even in Europe, the interest in management of severe vascular injuries, which, with an increased incidence of 10% are to be expected with such penetrating wounds, is also growing; however, with increasing subspecialization in surgery there is a threat that the know-how in vascular surgery will become lost among non-vascular surgical specialists. Therefore, the Germany military established an educational program, the so-called DUOplus concept, to ensure that future military surgeons acquire and retain the experience and skills to fulfill the demanding role of a deployed surgeon. OBJECTIVE The DUOplus concept of the German Medical Forces is introduced with a special focus on vascular surgery training. RESULTS All trainee German military surgeons attain a second specialization alongside general surgery. This residency includes several courses in various surgical specialties as well as a 12-month rotation in a vascular surgery department. The core elements of vascular trauma training are two practical courses on life-like models. In these courses, which were developed especially for the needs of non-vascular surgeons in hands-on training, open surgical techniques and damage control measures including resuscitative endovascular balloon occlusion of the aorta (REBOA) are taught on suitable models and intensively practiced. CONCLUSION All surgeons potentially confronted with traumatic and iatrogenic vascular injuries should have some basic competence in the management of vascular trauma. Especially the courses in vascular surgery for non-vascular surgeons offer such a skill set for every surgeon. Next to the German military surgeons, the courses are attended more and more by civilian and military surgeons from different surgical specialties and nationalities.
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Abstract
PURPOSE OF REVIEW This paper reviews recent research on the depression in young people following exposure to catastrophic stresses such as disasters, terrorism and political violence. RECENT FINDINGS Depression is one of the commonest outcomes following mass trauma, for all ages including children and adolescents. Recent articles continue to report high prevalence of depression which often continues for years. It is often comorbid with other psychiatric disorders, especially PTSD. Post-traumatic depression in children and adolescence affects purpose of life, impairs scholastic achievements, increases suicidality and has extensive comorbidity. Besides the trauma, individual constructs, personality factors, social support, exposure to other traumatic events are some of the predicting factors. Biological and genetic basis of post-traumatic depression has been reported. Studies suggest some benefit to psychotherapeutic interventions such as trauma-focussed cognitive behavioural therapy and web-based therapy. A considerable proportion of youths develop depression following mass traumatic events. More research is required regarding the effectiveness of interventions in this population.
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Affiliation(s)
- Nilamadhab Kar
- Black Country Partnership NHS Foundation Trust, Steps to Health, Showell Circus, Low Hill, Wolverhampton, WV10 9TH, UK.
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25
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Abstract
Background Pediatric chest injuries were infrequent in our practice, but the outbreak of the Syrian crisis resulted in an increase in number and a change in the pattern of thoracic trauma incidents. We compared our experience of pediatric chest injuries before and during the crisis. Methods We reviewed the records of 256 children aged 12.8 ± 5 years who were admitted to our hospital with the diagnosis of chest trauma over a 12-year period. Collected data included mechanism of injury, associated injuries, method of management, length of hospital stay, complications, and mortality. Results The incidence of pediatric chest injuries increased significantly following the outbreak of the crisis, and penetrating injuries prevailed, mainly due to shrapnel, bullets, and stab wounds. Forty percent of patients with blunt injuries and 20% of those with penetrating injuries were managed conservatively, whereas urgent thoracotomies were indicated in 10%, mostly in patients with penetrating injuries. Associated injuries were more frequent in patients with blunt injuries and resulted in a longer hospital stay and an increased mortality rate. The overall mortality rate was 7.8% and it was higher in children younger than 7 years of age and in patients who had been subjected to blunt injuries. Conclusions There has been a recent substantial upsurge in the incidence of pediatric thoracic trauma, with a predominance of penetrating injuries. Most patients could be managed nonoperatively, but a small subset required an open thoracotomy. The presence of associated injuries constitutes the main determinant of prognosis in this group of patients.
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Affiliation(s)
- Bassam Darwish
- Department of Surgery, Faculty of Medicine, Damascus University, Damascus, Syria
| | - Mohammad Z Mahfouz
- Department of Surgery, Faculty of Medicine, Damascus University, Damascus, Syria
| | - Saeed Al-Nosairat
- Department of Surgery, Faculty of Medicine, Damascus University, Damascus, Syria
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26
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Meiqari L, Hoetjes M, Baxter L, Lenglet A. Impact of war on child health in northern Syria: the experience of Médecins Sans Frontières. Eur J Pediatr 2018; 177:371-380. [PMID: 29255951 PMCID: PMC5816770 DOI: 10.1007/s00431-017-3057-y] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 11/06/2017] [Accepted: 11/09/2017] [Indexed: 11/26/2022]
Abstract
UNLABELLED Few data are available to evaluate the impact of Syrian war on civilian population; to describe this impact on child health, this article uses data from Médecins Sans Frontières-Operational Centre Amsterdam's activities in Tal-Abyad and Kobane cities, northern Syria (2013-2016). Data were obtained from routine medical datasets and narrative reports, for out-patient clinics, immunisation, nutritional monitoring and assessments, and in-patient care, and were analysed quantitatively and qualitatively. Infections were the largest contributor to morbidity. The proportion of < 5 year out-patient consultations of infectious diseases that are listed for outbreak monitoring in emergencies was 15% in 2013, 51% in 2014, 75% in 2015 and 70% in 2016. Thalassemia was recorded in 0.5% of 2014 < 5 year out-patient consultations and 3.4% of 2013-2014 < 18-year in-patient admissions. Measles immunisation activities and routine Extended Programme for Immunisation were re-activated across northern Syria; however, immunisation coverage could not be calculated. Results from our routine data must be compared cautiously, due to differences in settings and disease categories. CONCLUSION With such scattered interventions, routine data are limited in providing a quantified evidence of emergency's health impact; however, they help in drawing a picture of children's health status and highlighting difficulties in providing curative and preventive services, in order to reflect part of population's plight. What is Known • Few data exist to evaluate the impact of the Syrian war on the health of children; • Médecins Sans Frontières (MSF-OCA) has worked in northern Syria during different times since 2013. What is New • Quantitative and qualitative analysis of MSF's routine medical data and situtation reports show that one fifth of all consultations in children < 5 years in MSF health facilities in northern Syria 2013-2016 were due to communicable diseases; • The analysis also highlights the burden of chronic conditions that were prevalent in Syria before the war, e.g. thalassemia.
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Affiliation(s)
- Lana Meiqari
- Médecins Sans Frontières, Operational Centre Amsterdam (MSF-OCA), Plantage Middenlaan 14, 1018 DD, Amsterdam, The Netherlands. .,Athena Institute for Research on Innovation and Communication in Health and Life Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
| | - Maartje Hoetjes
- grid.452780.cMédecins Sans Frontières, Operational Centre Amsterdam (MSF-OCA), Plantage Middenlaan 14, 1018 DD Amsterdam, The Netherlands
| | - Louisa Baxter
- grid.57981.32Public Health England (PHE), London, UK
| | - Annick Lenglet
- grid.452780.cMédecins Sans Frontières, Operational Centre Amsterdam (MSF-OCA), Plantage Middenlaan 14, 1018 DD Amsterdam, The Netherlands
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