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Peña-Galo EM, Wurzelmann D, Alcedo J, Peña R, Cortes L, Morgan D. Enduring association between irritable bowel syndrome and war trauma during the Nicaragua civil war period: A population-based study. World J Gastroenterol 2023; 29:5953-5961. [PMID: 38130999 PMCID: PMC10731151 DOI: 10.3748/wjg.v29.i45.5953] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 09/13/2023] [Accepted: 11/27/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Psychosocial and physical trauma are known risk factors for irritable bowel syndrome (IBS), including in war veterans, whereas war exposure in civilians is unclear. Nicaragua experienced two wars, 1970-1990: The Sandinistas Revolution (1970s) and The Contra War (1980s). Our aim was to investigate the role of exposure to war trauma in the subsequent development of IBS in the context of an established health surveillance system (11000 households). AIM To investigate in a civilian population the relationship between exposure to war trauma and events and the subsequent development of IBS in the context of an established public health and demographic surveillance system in western Nicaragua. METHODS We conducted a nested population-based, cross-sectional study focused on functional gastrointestinal disorders based on Rome II criteria. 1617 adults were randomly selected. The Spanish Rome II Modular Questionnaire and Harvard Trauma Questionnaire were validated in Nicaragua. War exposure was assessed with 10 measures of direct and indirect war trauma and post-war effects. Multiple exposures were defined by ≥ 3 measures. RESULTS The prevalence of IBS was 15.2% [Female (F) 17.1%, Male (M) 12.0%], war exposure 19.3% (F 9.3%, M 36.7%), and post-traumatic stress disorder (PTSD) 5.6% (F 6.4%, M 4.3%). Significant associations with IBS in the civilian population were observed (adjusted by gender, age, socioeconomic status, education): physical and psychological abuse [adjusted odds ratio (aOR): 2.25; 95% confidence interval: 1.1-4.5], witnessed execution (aOR: 2.4; 1.1-5.2), family member death (aOR: 2.2; 1.2-4.2), and multiple exposures (aOR: 2.7; 1.4-5.1). PTSD was independently associated with IBS (aOR: 2.6; 1.2-5.7). CONCLUSION An enduring association was observed in the Nicaragua civilian population between specific civil war-related events and subsequent IBS. Civilian populations in regions with extended armed conflict may warrant provider education and targeted interventions for patients.
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Affiliation(s)
- Edgar M Peña-Galo
- Department of Digestive Diseases, Miguel Servet University Hospital, Zaragoza 50009, Aragon, Spain
- Aragon Health Research Institute, IIS Aragon, Zaragoza 50009, Aragon, Spain
| | - Daniel Wurzelmann
- Department of Mental Health, Carolina Partners, Durham, NC 27707, United States
| | - Javier Alcedo
- Department of Digestive Diseases, Miguel Servet University Hospital, Zaragoza 50009, Aragon, Spain
- Aragon Health Research Institute, IIS Aragon, Zaragoza 50009, Aragon, Spain
| | - Rodolfo Peña
- Department of Data Analysis, CIDE (Research, Development and Epidemiology Center), Tegucigalpa 11101, Francisco Morazán, Honduras
| | - Loreto Cortes
- School of Medicine, National Autonomous University of Nicaragua, Leon 21000, Leon, Nicaragua
| | - Douglas Morgan
- Department of Gastroenterology and Hepatology, UAB University of Alabama Birmingham, Birmingham, AL 35233, United States
- School of Medcine, The University of North Carolina, Chapel Hill, NC 9500, United States
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Hutaif M, Al Moaish A, Soliman M, Al-Fadliy A. The hidden toll of war: a comprehensive study of orthopedic injuries in Yemen. Confl Health 2023; 17:55. [PMID: 38037162 PMCID: PMC10691014 DOI: 10.1186/s13031-023-00551-8] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 11/01/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND Yemen has been experiencing a protracted civil war and humanitarian crisis since 2015, which has resulted in many war-related injuries. However, there is a lack of data on the epidemiology, characteristics, and outcomes of these injuries, especially the orthopedic ones. This study aimed to describe the war-related orthopedic injuries in Yemen and their impact on the patients' health and function. METHODS This was a retrospective study based on medical records and trauma registries of 3930 patients who were admitted to three major trauma centers in Sana'a city with war-related orthopedic injuries from January 2015 to December 2020. We collected data on demographics, injury mechanisms, injury types and locations, surgical procedures, complications, mortality, and functional outcomes using the Musculoskeletal Function Assessment questionnaire. We used descriptive and inferential statistics to analyze the data and performed a logistic regression analysis to identify the factors associated with mortality. RESULTS Most of the patients were young males and civilians who suffered from complex and severe injuries involving multiple body regions, especially the lower extremities. The main mechanisms of injury were gunshot wounds, blast injuries, and landmine explosions. The patients required multiple surgical procedures and implants, and had high rates of complications and mortality. The most common complications were infection, nonunion, malunion, and amputation. The most common cause of death was sepsis. The functional outcomes were poor, as indicated by the high mean MFA score. The logistic regression analysis showed that older age, blast injuries, spine injuries, vascular injuries, and infection were significant predictors of mortality. CONCLUSION This study provides valuable information on the war-related orthopedic injuries in Yemen and their impact on the patients' health and function. It also identifies some areas for future research, such as exploring the risk factors for infection and nonunion/malunion, evaluating the effectiveness and cost-effectiveness of different surgical procedures and implants, assessing the long-term outcomes and quality of life of the patients, and developing novel strategies to enhance bone and soft-tissue healing.
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Affiliation(s)
- Mohammad Hutaif
- Sana'a University School of Medicine, Vice Dean, Sana'a, Yemen.
| | | | - Mosleh Soliman
- Sana'a University School of Medicine, Vice Dean, Sana'a, Yemen
| | - Anwar Al-Fadliy
- Sana'a University School of Medicine, Vice Dean, Sana'a, Yemen
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Azhar A, Zainab A, Ghaffar RA. Battered by Cyclone Mocha and the civil war: The ignored mental health of the Burmese. Asian J Psychiatr 2023; 89:103791. [PMID: 37812999 DOI: 10.1016/j.ajp.2023.103791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 09/22/2023] [Accepted: 09/25/2023] [Indexed: 10/11/2023]
Affiliation(s)
- Ayesha Azhar
- Department of Internal Medicine, Dow University of Health Sciences, Karachi 74200, Pakistan.
| | - Asra Zainab
- Department of Internal Medicine, Dow University of Health Sciences, Karachi 74200, Pakistan
| | - Rimmel Abdul Ghaffar
- Department of Internal Medicine, Dow University of Health Sciences, Karachi 74200, Pakistan
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Wintemute GJ, Robinson SL, Crawford A, Tancredi D, Schleimer JP, Tomsich EA, Reeping PM, Shev AB, Pear VA. Views of democracy and society and support for political violence in the USA: findings from a nationally representative survey. Inj Epidemiol 2023; 10:45. [PMID: 37770994 PMCID: PMC10540371 DOI: 10.1186/s40621-023-00456-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 07/03/2023] [Accepted: 08/31/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND Current conditions in the USA suggest an increasing risk for political violence. Little is known about the prevalence of beliefs that might lead to political violence, about support for and personal willingness to engage in political violence, and about how those measures vary with individual characteristics, lethality of violence, political objectives that violence might advance, or specific populations as targets. METHODS This cross-sectional US nationally representative survey was conducted on May 13 to June 2, 2022, of adult members of the Ipsos KnowledgePanel. Outcomes are weighted, population-representative proportions of respondents endorsing selected beliefs about American democracy and society and violence to advance political objectives. RESULTS The analytic sample included 8620 respondents; 50.5% (95% confidence interval (CI) 49.3%, 51.7%) were female; and weighted mean (± standard deviation) age was 48.4 (± 18.0) years. Nearly 1 in 5 (18.9%, 95% CI 18.0%, 19.9%) agreed strongly or very strongly that "having a strong leader for America is more important than having a democracy"; 16.2% (95% CI 15.3%, 17.1%) agreed strongly or very strongly that "in America, native-born white people are being replaced by immigrants," and 13.7% (95% CI 12.9%, 14.6%) agreed strongly or very strongly that "in the next few years, there will be civil war in the United States." One-third of respondents (32.8%, 95% CI 31.7%, 33.9%) considered violence to be usually or always justified to advance at least 1 of 17 specific political objectives. Among all respondents, 7.7% (95% CI 7.0%, 8.4%) thought it very or extremely likely that within the next few years, in a situation where they believe political violence is justified, "I will be armed with a gun"; 1.1% (95% CI 0.9%, 1.4%) thought it very or extremely likely that "I will shoot someone with a gun." Support for political violence and for the use of firearms in such violence frequently declined with increasing age, education, and income. CONCLUSIONS Small but concerning proportions of the population consider violence, including lethal violence, to be usually or always justified to advance political objectives. Prevention efforts should proceed urgently based on the best evidence available.
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Affiliation(s)
- Garen J Wintemute
- UC Davis Violence Prevention Research Program, Sacramento, CA, USA.
- Department of Emergency Medicine, UC Davis, Sacramento, CA, USA.
- California Firearm Violence Research Center, Sacramento, CA, USA.
| | - Sonia L Robinson
- UC Davis Violence Prevention Research Program, Sacramento, CA, USA
- Department of Emergency Medicine, UC Davis, Sacramento, CA, USA
- California Firearm Violence Research Center, Sacramento, CA, USA
| | - Andrew Crawford
- UC Davis Violence Prevention Research Program, Sacramento, CA, USA
- Department of Emergency Medicine, UC Davis, Sacramento, CA, USA
- California Firearm Violence Research Center, Sacramento, CA, USA
| | - Daniel Tancredi
- UC Davis Violence Prevention Research Program, Sacramento, CA, USA
- Department of Emergency Medicine, UC Davis, Sacramento, CA, USA
- California Firearm Violence Research Center, Sacramento, CA, USA
- Department of Pediatrics, UC Davis, Sacramento, CA, USA
| | - Julia P Schleimer
- UC Davis Violence Prevention Research Program, Sacramento, CA, USA
- Department of Emergency Medicine, UC Davis, Sacramento, CA, USA
- California Firearm Violence Research Center, Sacramento, CA, USA
| | - Elizabeth A Tomsich
- UC Davis Violence Prevention Research Program, Sacramento, CA, USA
- Department of Emergency Medicine, UC Davis, Sacramento, CA, USA
- California Firearm Violence Research Center, Sacramento, CA, USA
| | - Paul M Reeping
- UC Davis Violence Prevention Research Program, Sacramento, CA, USA
- Department of Emergency Medicine, UC Davis, Sacramento, CA, USA
- California Firearm Violence Research Center, Sacramento, CA, USA
| | - Aaron B Shev
- UC Davis Violence Prevention Research Program, Sacramento, CA, USA
- Department of Emergency Medicine, UC Davis, Sacramento, CA, USA
- California Firearm Violence Research Center, Sacramento, CA, USA
| | - Veronica A Pear
- UC Davis Violence Prevention Research Program, Sacramento, CA, USA
- Department of Emergency Medicine, UC Davis, Sacramento, CA, USA
- California Firearm Violence Research Center, Sacramento, CA, USA
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Al-Samhari GA, Al-Mushiki GM, Tamrakar R, Lin YD, Al-Shaebi F, Akroot MA, Al-Nahari SA, Li GJ, Tang XY. Prevalence, aetiology, vaccination coverage and spatio-temporal pattern among patients admitted with acute bacterial meningitis to the sentinel hospital surveillance network in Yemen, 2014-20, before and during the civil war. Int J Epidemiol 2023:7147619. [PMID: 37128839 PMCID: PMC10396411 DOI: 10.1093/ije/dyad047] [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: 02/05/2022] [Accepted: 04/02/2023] [Indexed: 05/03/2023] Open
Abstract
BACKGROUND Acute bacterial meningitis (ABM) is a serious health issue in Yemen where civil war, which continues unabated, has crippled the healthcare system. We conducted a nationwide retrospective observational study in Yemeni sentinel hospitals to identify the prevalence, aetiology, vaccination coverage and spatio-temporal pattern of ABM in children aged <5 years before and during the civil war, 2014-20. METHODS Cerebrospinal fluid samples were collected from hospitalized children and were analysed macroscopically for appearance and microscopically by Gram stain and white blood cell count. Culture and latex agglutination tests were performed. Data on the prevalence of and vaccination coverage for ABM were obtained from the Ministry of Health. Joinpoint regression was used to assess the annual percent change (APC) of ABM prevalence and vaccination coverage. Pearson's correlation was used to evaluate the association between ABM prevalence and vaccination coverage. RESULTS In total, 11 339 hospitalized children had suspected cases of ABM (prevalence, 40.07/100 000 of the whole Yemeni population) and 2.6% (293/11 339) of suspected ABM cases were confirmed (prevalence, 1.04/100 000 of the whole Yemeni population). The dominant pathogens were Streptococcus pneumoniae, Neisseria meningitidis and Haemophilus influenzae type b (Hib). The civil war reduced the Hib and pneumococcal vaccination coverage (APC = -1.92), reaching its lowest (79.5%) in 2018. The prevalence of suspected ABM increased (APC = 3.46), reaching its maximum (6.08/100 000 of the whole Yemeni population) in 2019. The conflict inversely correlated with the ABM prevalence and vaccination coverage (Pearson correlation coefficient (r), -0.69 to -0.53). Ta'izz region, which was severely affected by the civil war, had the highest prevalence of suspected ABM (120.90/100 000 of the whole Yemeni population) and lowest vaccination coverage (60%). CONCLUSIONS The civil war had a negative impact on vaccination coverage and coincided with increasing prevalence of ABM in Yemen. Streptococcus pneumoniae is the dominant causative pathogen.
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Affiliation(s)
- Galal A Al-Samhari
- Department of Epidemiology and Biostatistics, School of Public Health, Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, P.R. China
- Department of Community Medicine, Faculty of Medicine and Health Sciences, Thamar University, Dhamar, Yemen
| | - Gaber M Al-Mushiki
- Department of Epidemiology and Biostatistics, School of Public Health, Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, P.R. China
- Department of Community Medicine, Faculty of Medicine and Health Sciences, Thamar University, Dhamar, Yemen
| | - Rashi Tamrakar
- Department of Endocrinology, Internal Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, P. R. China
| | - Yue-Dong Lin
- Department of Epidemiology and Biostatistics, School of Public Health, Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, P.R. China
- Acute Infectious Disease Prevention and Control Branch, Xiamen Center for Disease Control and Prevention, Xiamen, Fujian, P. R. China
| | - Fadhl Al-Shaebi
- Department of Community Medicine, Faculty of Medicine and Health Sciences, Thamar University, Dhamar, Yemen
- Department of Immunology & Key Laboratory of Immune Mechanism and Intervention on Serious Disease in Hebei Province, Hebei Medical University, Shijiazhuang, China
| | - Mohammed A Akroot
- Department of Microbiology, National Program for Bacterial Meningitis Investigation, Dhamar General Hospital, Dhamar, Yemen
| | - Saddam A Al-Nahari
- Department of Central Supervision, Expanded Program on Immunization, Ministry of Public Health Population, San'a, Yemen
| | - Guan-Jie Li
- Department of Epidemiology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Xian-Yan Tang
- Department of Epidemiology and Biostatistics, School of Public Health, Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, P.R. China
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Reeves A, Sochas L. When do democratic transitions reduce or increase child mortality? Exploring the role of non-violent resistance. Soc Sci Med 2022; 314:115459. [PMID: 36302297 PMCID: PMC10926273 DOI: 10.1016/j.socscimed.2022.115459] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 09/29/2022] [Accepted: 10/11/2022] [Indexed: 11/06/2022]
Abstract
What explains variation across countries in the effect of democratization on child mortality rates? Democratic transitions, on average, improve health outcomes but there is substantial variation across countries in whether democratization leads to lower-than-expected child mortality post-transition. As yet, there is no convincing quantitative explanation for this variation. In this paper, we argue that whether you have a protest-led or violence-led democratic transition alters the trajectory of child mortality post-transition. Our paper makes two contributions. First, we offer a more detailed account of how the type of resistance movement promoting regime change affects health post-transition. We also draw on novel data to categorise the movements producing democratic transitions as violent or peaceful, moving beyond earlier work which operationalised peaceful democratizations in terms of battle-related deaths. Second, we extend earlier research by examining whether the nature of the democratization movement constitutes a necessary cause of higher or lower-than-expected child mortality following democratization. Across 51 transitions, countries that have a protest-led transition have lower-than-expected child mortality rates after the transition to democracy than countries with other kinds of movements (β = -0.17, p = 0.003). Countries with violence-led transitions, meanwhile, have, on average, higher-than-expected child mortality rates after their transition (β = 0.20, p = 0.001). These associations hold when we adjust for covariates (including all possible combinations of various confounding variables). We also find evidence that protest-led transitions may be a necessary condition for avoiding increased child mortality post-transition. Finally, we conduct a deviant case analysis of transitions that appear to be contrary to our theory, finding that these cases are likely instances of measurement error. Democratization may not always improve health, but such health improvements are more likely when regime change is protest-led. This is because such movements are more likely to build broad coalitions committed to consensual politics post-transition, a critical feature of successful democracies.
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Affiliation(s)
- Aaron Reeves
- Department of Social Policy and Intervention, University of Oxford, United Kingdom.
| | - Laura Sochas
- Department of Social Policy and Intervention, University of Oxford, United Kingdom.
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Shesterinina A. Civil war as a social process: actors and dynamics from pre- to post-war. Eur J Int Relat 2022; 28:538-562. [PMID: 35971376 PMCID: PMC9373192 DOI: 10.1177/13540661221095970] [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] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
What accounts for overarching trajectories of civil wars? This article develops an account of civil war as a social process that connects dynamics of conflict from pre- to post-war periods through evolving interactions between nonstate, state, civilian, and external actors involved. It traces these dynamics to the mobilization and organization of nascent nonstate armed groups before the war, which can induce state repression and in some settings escalation of tensions through radicalization of actors, militarization of tactics, and polarization of societies, propelled by internal divisions and external support. Whether armed groups form from a small, clandestine core of dedicated recruits, broader networks, social movements, and/or fragmentation within the regime has consequences for their internal and external relations during the war. However, not only path-dependent but also endogenous dynamics shape overarching trajectories of civil wars. During the war, armed groups develop cohesion and fragment in the context of evolving internal politics, including socialization of fighters, institution-building in the areas that they control, which civilians can collectively resist, competition and cooperation with other nonstate and state forces, and external influence. After the war, armed groups transform to participate in continuing conflict and violence in different ways in interaction with multiple actors. This analysis highlights the contingency of civil wars and suggests that future research should focus on how relevant actors form and transform as they relate to one another to understand linkages between conflict dynamics over time and on continuities and discontinuities in these dynamics to grasp overarching trajectories of civil wars.
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Affiliation(s)
- Anastasia Shesterinina
- Anastasia Shesterinina, Department
of Politics and International Relations, The University of Sheffield,
Elmfield Building, Northumberland Road, Sheffield S10 2TU, UK.
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Hashim HT. Yemen's triple emergency: Food crisis amid a civil war and COVID-19 pandemic. Public Health Pract (Oxf) 2021; 2:100082. [PMID: 34494006 PMCID: PMC8411833 DOI: 10.1016/j.puhip.2021.100082] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 12/23/2020] [Revised: 01/08/2021] [Accepted: 01/12/2021] [Indexed: 11/30/2022] Open
Abstract
Yemen has been termed as the world’s worst humanitarian crisis by the United Nations. About 20.1 million (more than 50% of population) Yemenis are facing hunger and 10 million are severely food insecure according to reports by the World Food Programme. With the spread of COVID-19, the situation in Yemen has worsened and humanitarian aid from other countries has become the basis of life for hundreds of thousands of Yemenis after the threat of famine. Yemen is practically one of the poorest countries in the world. It has structural vulnerabilities that have developed over a protracted period of conflict and poor governance and more than 50% live in starving, they suffer for getting one meal a day. To prevent a total collapse of Yemen’s food crises, the government and the international community should act now more decisively.
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Bara C, Deglow A, van Baalen S. Civil war recurrence and postwar violence: Toward an integrated research agenda. Eur J Int Relat 2021; 27:913-935. [PMID: 34512100 PMCID: PMC8427816 DOI: 10.1177/13540661211006443] [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] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Violence after civil war is a challenge to sustainable peace. Many armed conflicts today are recurrences of previous wars and much of the literature on violence after war explains why armed groups return to the battlefield. But even if peace prevails, many other types of violence take place in postwar environments. This postwar violence is likewise subject to a growing multidisciplinary literature. Using citation network analysis, we show that research on war recurrence and postwar violence has developed in relative isolation from each other-although these phenomena are interrelated. This compartmentalization leads us to overlook important similarities and differences in the drivers of different forms of violence after war. We demonstrate this by reviewing the literature in both of these closely related fields. While war recurrence and postwar violence share a set of common risk factors, some factors can have opposite effects on the two outcomes. Because these insights only emerge when systematically comparing the two strands of literature, we propose a novel framework for the study of violence after wars that aims at overcoming the compartmentalization of research within these two fields. The framework serves both as a conceptual lens and an analytical tool to categorize and compare different forms of violence after war. We then outline how the framework aids scholars in pursuing an integrated research agenda, with concrete suggestions for research questions that should be studied to expand our understanding of violence after wars.
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Affiliation(s)
- Corinne Bara
- Corinne Bara, Uppsala Universitet, Gamla Torget 3, Uppsala, 751 20, Sweden.
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Brownlee BJ, Ghiabi M. The Mythological Machine in the Great Civil War (2001-2021): Oikos and Polis in Nation-Making. Middle East Crit 2021; 30:127-148. [PMID: 34122729 PMCID: PMC7610966 DOI: 10.1080/19436149.2021.1911460] [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] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The article revisits 'sectarianism' as an epistemic venue within the context of a Great Civil War in the Middle East (2001-2021), a label that includes the overarching narratives of political life in the aftermath of 9/11 up to the aftermath of the so-called 'Arab Spring.' By introducing the notion of the 'mythological machine,' it argues that 'sectarianism' is a myth, something that does not exist in real terms, but which has real world effects. The mythological machine is a device that produces epiphanies and myths; it is a gnoseological process, which has cultural, social and political effects through the generation of mythological facts and, as a machine, it does so through both guiding and automatized mechanisms. Through this interpretive shift, the article proceeds through several theoretical steps using a variety of cases from across West Asia and North Africa, contextualizing them within global political events. Firstly, the article argues that it is 'civil war,' shaped by the work of the mythological machine that governs state-society relations and transnational politics in the Middle East. Then, the article discusses how the mythological machine incorporates a semantic othering via mythological thinking, speak and practice that shapes the perception and experience of civil wars. To conclude, the article discusses how the mythological machine displaces people's status in the context of civil wars leading to the emergence of new forms of belonging and nation-making. Ultimately, the mythological machine creates what Giorgio Agamben defines as a state without people, a condition exhausting the value of citizenship and the political.
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Abstract
OBJECTIVE The data collected by the Global Burden of Disease 2016 project indicate that migraine ranks second in high-income countries with very competitive and flexible labour markets, and first in low- and middle-income countries suffering from civic unrest and conflict. This raises the question whether external stress factors may be correlated with migraine years lived with disability per 100,000 inhabitants (YLD). The objective of this exploratory study is to test the hypothesis that external stress factors are correlated with the prevalence and severity of migraine at the country level. The analysis uses two country groups: developed and developing countries. For the first group, the proxy variables for stress are labour productivity and unemployment rate. For the second group, the proxy variables measure conflict-related deaths and share of migrant/refugee population. RESULTS The results show a positive relationship between the stress variables on the one hand and migraine YLD on the other hand for both country groups. Almost all results are statistically significant at p < 0.01. These exploratory findings suggest that societal stress factors may be potential candidates for modifiable factors for the prevalence and/or severity of migraine at the country level.
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Affiliation(s)
- Irene van Staveren
- Institute of Social Studies, Erasmus University Rotterdam, Kortenaerkade 12, 2518 AX, The Hague, The Netherlands.
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Abstract
This article studies the impact of COVID-19 on armed conflict. The pandemic has significant health, economic and political effects. These can change the grievances and opportunity structures relevant for armed conflicts to either increase or decrease conflict risks. I analyse empirical evidence from Afghanistan, Colombia, India, Iraq, Libya, Pakistan, the Philippines, Thailand and Yemen from the first six months of 2020. Results suggest that COVID-19 provides little opportunities for health diplomacy and cooperation, but it also has not yet driven grievances to a level where they became relevant for armed conflicts. Four countries have encountered temporary declines in armed conflicts, mostly due to strategic decisions by governments or rebels to account for impeded logistics and to increase their popular support. Armed conflict levels have increased in five countries, with conflict parties exploiting either state weakness or a lack of (international) attention due to the COVID-19 pandemic. This is a worrisome trend given the tremendous impacts of armed conflict on human security and on the capabilities of countries to deal with health emergencies.
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Affiliation(s)
- Tobias Ide
- School of Geography, The University of Melbourne, 221 Bouverie St, Carlton, VIC 3053, Australia
- Institute of International Relations, Brunswick University of Technology, Bienroder Weg 97, 38106 Brunswick, Germany
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Acero C, Machuca D. The substitution program on trial: progress and setbacks of the peace agreement in the policy against illicit crops in Colombia. Int J Drug Policy 2021; 89:103158. [PMID: 33618988 DOI: 10.1016/j.drugpo.2021.103158] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 05/31/2020] [Revised: 01/27/2021] [Accepted: 02/02/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND In 2016 the Colombian government and the country's most important guerrilla group - the FARC - signed a peace agreement that included the "definitive solution to the problem of illicit crops". That solution has not arrived. METHODS We tracked the design and implementation of the substitution program (PNIS) included in the peace agreement using an original set of in-depth interviews, press reviews and archival material, all of which were collected in different rounds of fieldwork between 2018 and 2020 in Bogotá and three coca growing regions. RESULTS We show that, as a product of several political pressures, the peace agreement introduced modifications to the standing policy against illicit crops that were favorable to peacebuilding, but also retained regressive aspects of that policy. However, following a shift in the balance of power, the policy returned to what it was during the war period. CONCLUSION We conclude by discussing the importance of developing a research agenda that explores both resistances to change in illicit crops policy, and the political coalitions needed to make change sustainable.
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Affiliation(s)
- Camilo Acero
- Universidad Nacional de Colombia, Carrera 30 # 45-03, Bogotá, Colombia; Observatory of Restitution and Regulation of Agrarian Property Rights, Carrera 7 # 12B-41, Bogotá, Colombia.
| | - Diana Machuca
- Universidad Nacional de Colombia, Carrera 30 # 45-03, Bogotá, Colombia; Observatory of Restitution and Regulation of Agrarian Property Rights, Carrera 7 # 12B-41, Bogotá, Colombia
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Alsheikh Ali ASS. Efficiency of Intervention Counseling Program on the Enhanced Psychological Well-being and Reduced Post-traumatic Stress Disorder Symptoms Among Syrian Women Refugee Survivors. Clin Pract Epidemiol Ment Health 2020; 16:134-141. [PMID: 33029190 PMCID: PMC7536727 DOI: 10.2174/1745017902016010134] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 02/06/2020] [Revised: 05/01/2020] [Accepted: 06/11/2020] [Indexed: 11/22/2022]
Abstract
Background: The number of individuals displaced from their original countries due to civil wars, hunger, disasters, and international wars is increasing worldwide day by day. These refugees are more vulnerable to Post-Traumatic Stress Disorder (PTSD). Objective: The present study aimed to examine the effectiveness of the intervention program in improving the well-being and reducing Post-Traumatic Stress Disorder (PTSD) among a sample of Syrian refugee women in Jordan who had been displaced due to civil wars in Syria. Methods: The study recruited 40 Syrian refugee females in Jordan who were psychologically challenged, with high PTSD symptoms (assessed by PCL) and a psychological well-being impairment (assessed by PWD). The culture of Jordanian society discriminates and affects the Syrian refugee women, rendering them vulnerable to PTSD. Quasi-experimental design was used, wherein the participants were randomly distributed in experimental and control groups (n=20/group). The control group members did not receive any services related to psychological support or psychiatric medications, while the experimental group underwent a counseling program. Results: The present study demonstrated that the intervention program improves the well-being and reduces PTSD among the Syrian refugee women who constituted the experimental group. The intervention program and the PTSD manifestation were not affected by age. The present study recommended that the program be applied to the refugees in Jordan to improve the well-being of the women in the residential areas. Conclusion: Furthermore, an intervention on the Jordanian cultural impact on the refugee camps was also essential if the condition for the female refugees worsened. Lastly, the effect of Jordanian culture on Syrian refugees should be investigated since the literature presented a negative impact.
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Elhadi M, Msherghi A, Elgzairi M, Alhashimi A, Bouhuwaish A, Biala M, Abuelmeda S, Khel S, Khaled A, Alsoufi A, Elmabrouk A, Alshiteewi FB, Alhadi B, Alhaddad S, Gaffaz R, Elmabrouk O, Hamed TB, Alameen H, Zaid A, Elhadi A, Albakoush A. Psychological status of healthcare workers during the civil war and COVID-19 pandemic: A cross-sectional study. J Psychosom Res 2020; 137:110221. [PMID: 32827801 PMCID: PMC7428743 DOI: 10.1016/j.jpsychores.2020.110221] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 08/10/2020] [Accepted: 08/13/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Healthcare workers, particularly those working in departments that provide care for patients with coronavirus disease 2019 (COVID-19), are at a higher risk of this contagious disease than those who work in other departments. The aim of this study was to assess the psychological status of healthcare workers during the COVID-19 outbreak, which has compounded Libya's existing civil war-related problems. METHODS A multi-center cross-sectional survey on depressive symptoms, anxiety symptoms, and abuse was conducted. The Hospital Anxiety and Depression Scale (HADS) was used to measure the prevalence of anxiety and depressive symptoms among healthcare workers. RESULTS The data of 745 eligible healthcare workers from 15 hospitals were analyzed. Depressive and anxiety symptoms were compared to the basic characteristics of the participants to determine the association. A total of 420 (56.3%) participants had depressive symptoms, while 348 (46.7%) had anxiety symptoms. Age, residency status, department, stigmatization, and living in a conflict zone were significantly associated with depressive symptoms. Age, department, years of experience, working hours per week, internal displacement, stigmatization, living in a conflict zone, and verbal abuse were significantly associated with anxiety symptoms. CONCLUSION Our study presents important findings regarding depressive, anxiety symptoms, and abuse among physicians providing care during the COVID-19 outbreak and civil war in Libya. It also demonstrates several factors that can be associated with depressive and anxiety symptoms in this population.
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Affiliation(s)
- Muhammed Elhadi
- Faculty of Medicine, University of Tripoli, University Road, Furnaj, 13275 Tripoli, Libya.
| | - Ahmed Msherghi
- Faculty of Medicine, University of Tripoli, University Road, Furnaj, 13275 Tripoli, Libya
| | | | - Ayiman Alhashimi
- Faculty of Medicine, Al-Jabal Al Gharbi University, Gherian, Libya
| | | | - Marwa Biala
- Faculty of Medicine, University of Tripoli, University Road, Furnaj, 13275 Tripoli, Libya
| | - Seraj Abuelmeda
- Faculty of Medicine, University of Tripoli, University Road, Furnaj, 13275 Tripoli, Libya
| | - Samer Khel
- Faculty of Medicine, University of Tripoli, University Road, Furnaj, 13275 Tripoli, Libya
| | - Ala Khaled
- Faculty of Medicine, University of Tripoli, University Road, Furnaj, 13275 Tripoli, Libya
| | - Ahmed Alsoufi
- Faculty of Medicine, University of Tripoli, University Road, Furnaj, 13275 Tripoli, Libya
| | - Amna Elmabrouk
- Faculty of Medicine, University of Tripoli, University Road, Furnaj, 13275 Tripoli, Libya
| | - Fatimah Bin Alshiteewi
- Faculty of Medicine, University of Tripoli, University Road, Furnaj, 13275 Tripoli, Libya
| | - Bushray Alhadi
- Faculty of Medicine, University of Tripoli, University Road, Furnaj, 13275 Tripoli, Libya
| | - Sarah Alhaddad
- Faculty of Medicine, University of Tripoli, University Road, Furnaj, 13275 Tripoli, Libya
| | - Rwanda Gaffaz
- Faculty of Medicine, University of Tripoli, University Road, Furnaj, 13275 Tripoli, Libya
| | - Ola Elmabrouk
- Faculty of Medicine, University of Tripoli, University Road, Furnaj, 13275 Tripoli, Libya
| | - Tasneem Ben Hamed
- Faculty of Medicine, University of Tripoli, University Road, Furnaj, 13275 Tripoli, Libya
| | - Hind Alameen
- Faculty of Medicine, University of Tripoli, University Road, Furnaj, 13275 Tripoli, Libya
| | - Ahmed Zaid
- Faculty of Medicine, University of Tripoli, University Road, Furnaj, 13275 Tripoli, Libya
| | - Ahmed Elhadi
- Faculty of Medicine, University of Tripoli, University Road, Furnaj, 13275 Tripoli, Libya
| | - Ahmed Albakoush
- Faculty of Medicine, University of Tripoli, University Road, Furnaj, 13275 Tripoli, Libya
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Biçen Ç, Akdemir M, Ekin A. Management of orthopaedic injuries in Libyan civil war: experiences of a distant hospital. Int Orthop 2020; 44:1639-46. [PMID: 32728929 DOI: 10.1007/s00264-020-04755-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 07/24/2020] [Indexed: 10/23/2022]
Abstract
AIM OF THE STUDY In this study, we aimed to evaluate the musculoskeletal injury types, infections, and treatments of the patients injured in Libyan civil war. METHODS A total of 291 patients (288 male, 3 female) treated in our clinic, between November 2011 and April 2020, were included in our retrospective study. Patients' age, injury severity score (ISS), injury type, mechanism, location, accompanying traumas, infection, and operations in Libya and in our clinic were evaluated. RESULTS Injuries were caused by gunshots in 172 patients, by explosives in 56, by missiles in eight, and by different mechanisms in the remaining 55 patients. Injuries were located mostly in lower extremities, followed by upper extremities and by both extremities. The most common fracture was tibial fractures, followed with femur and humerus. Plate-screw fixation was performed for 82 cases, intramedullary nailing for 42, external fixator for 41, K-wire fixation for 27, foreign body excisions for 26, arthrodesis for 15, amputation for , arthroplasty for 11, and soft tissue operations for 78. Infection was present among 50 (% 17.2) patients. Complications were seen in five patients. Three patients needed implant removal due to infection, one patient had a plate fracture, and one patient died because of sepsis. DISCUSSION Difficulties in the treatment of war injuries begin in the battlefield. Patients' transfers and treatments may not be provided properly due to unsuitable conditions. Hospitals in neighbouring and distant countries can be helpful for supporting the treatment of increased numbers of injured patients. CONCLUSION Wars cause excessive numbers of injuries. In this study, we want to show that hospitals far from war zones can be considered as alternatives for treatment of these injuries.
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Naaman O, Yulevich A, Sweed Y. Syria civil war pediatric casualties treated at a single medical center. J Pediatr Surg 2020; 55:523-9. [PMID: 30902455 DOI: 10.1016/j.jpedsurg.2019.02.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 02/07/2019] [Accepted: 02/18/2019] [Indexed: 11/23/2022]
Abstract
PURPOSE We describe the medical and surgical treatment outcomes of Syrian civil war pediatric casualties admitted to our tertiary medical center in northern Israel and compare them to reports of pediatric war victims in Iraq and Afghanistan. METHODS 117 pediatric casualties up to age 18 (median age: 12 years, 91 males) were admitted from 2013 to 2016. We measured demographics, injury mechanism, wound type, injury severity, surgical interventions, morbidity, and mortality. RESULTS Injury mechanisms were penetrating injuries (n = 87, 74%), blunt (n = 34, 29%) and blast (n = 13, 11%) injuries, caused by fragments (56, 48%), blasts (51, 44%), and gunshot wounds (24, 21%). Most common injuries were head trauma (n = 66, 56%) and lower extremities injury (n = 45, 38%). 51 children (44%) had Injury Severity Score > 25. Surgical procedures, most commonly orthopedic (n = 35) and neurosurgical (n = 27), were performed on 81 children (69%). Average number of procedures per patient was 2 ± 2.5; average hospitalization time was 25.8 days. Mortality rate was 3.4% (four children). Injury characteristics were different from those reported for pediatric war casualties in Iraq and Afghanistan. CONCLUSIONS Head trauma was associated with serious injury and mortality; most injuries were penetrating and complex. Collaboration of various hospital departments was often necessary for efficient and successful treatment. LEVEL OF EVIDENCE III Retrospective comparison study.
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Martínez JC, Eng B. Stifling stateness: The Assad regime's campaign against rebel governance. Secur Dialogue 2018; 49:235-253. [PMID: 30034121 PMCID: PMC6041736 DOI: 10.1177/0967010618768622] [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] [Indexed: 06/08/2023]
Abstract
This article assesses the impact of the Assad regime's aerial bombardment campaign on a frequently neglected component of Syria's ongoing civil war: rebel governance. While analysis of the military and humanitarian ramifications of such attacks has been extensive, these perspectives fail to consider how the Assad regime's counter insurgency efforts subvert governance practices by Syria's diverse rebel groups. Drawing on performative approaches to the 'state', we argue that opposition groups' daily enactments of 'stateness' via two key welfare services - bread and healthcare provision - constitute a historically inflected and locally grounded critique of the incumbent. When executed successfully, such enactments can stabilize relations between rulers and ruled while offering a vision of an alternative polity. They can also attract the attention of rivals. The Assad regime's aerial bombing campaign of rebel-held areas is thus neither a haphazard military strategy nor simply the product of long-standing sectarian hatreds, but a deliberate tactic through which it seeks to destroy a key threat to its authority.
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Affiliation(s)
| | - Brent Eng
- University of California Berkeley, USA
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Poulson SC, Burke KA. Levels of combatant control and the patterns of non-incumbent/insurgent violence experienced by civilians living in Sunni-Arab communities in Iraq (2004-2009). Med Confl Surviv 2018; 34:95-120. [PMID: 30016122 DOI: 10.1080/13623699.2018.1493820] [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] [Indexed: 10/28/2022]
Abstract
This study explores how one social-structural variable, control over Sunni-Arab communities during the Iraq civil war, affected the types of violence used by insurgent/non-government actors that killed and injured civilians in these communities from January 2004 to December 2009. The study classifies three levels of control: (1) incumbent (government-supported) control, (2) insurgent control and (3) actively contested control. It uses Iraq Body Count (IBC) fatality data to characterize two general types of violence (selective and indiscriminate) evident during the Iraq conflict. It demonstrates that the type of violence committed by non-government actors was significantly (P > .01) different as related to the level of control insurgents had over territory. Primarily, insurgents/non-governmental actors used more selective forms of violence when insurgents controlled territory and more indiscriminate violence when incumbent (government-supported) forces controlled territory. Also, acts of indiscriminate violence cause considerably more injuries and death per act as compared to selective violence. Importantly, if control over territory has broadly generalizable effects on the types of violence that civilian's experience during civil war, than understanding this relationship could be useful when determining the types of medical assistance, medical supplies and training most needed in combat zones.
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Affiliation(s)
- Stephen C Poulson
- a Department of Sociology , James Madison University , Harrisonburg , VA , USA
| | - Kelly A Burke
- b Virginia Tech Carilion School of Medicine and Research Institute , Blacksburg , VA , USA
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Dagnelie O, Luca GDD, Maystadt JF. Violence, selection and infant mortality in Congo. J Health Econ 2018; 59:153-177. [PMID: 29753197 DOI: 10.1016/j.jhealeco.2018.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 11/22/2016] [Revised: 06/12/2017] [Accepted: 02/04/2018] [Indexed: 06/08/2023]
Abstract
This paper documents the effects of the recent civil war in the Democratic Republic of Congo on mortality both in utero and during the first year of life. It instruments for conflict intensity using a mineral price index, which exploits the exogenous variation in the potential value of mineral resources generated by changes in world mineral prices to predict the geographic distribution of the conflict. Using estimates of civil war exposure on mortality across male and female newborn to assess their relative health, it provides evidence of culling effect (in utero selection) as a consequence of in utero shocks.
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Affiliation(s)
| | - Giacomo Davide De Luca
- Department of Economics, University of York, YO10 5DD Heslington, UK; LICOS KU Leuven, Belgium.
| | - Jean-François Maystadt
- Department of Economics, Lancaster University Management School, Lancaster LA1 4YX, UK; LICOS KU Leuven, Belgium.
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Gorbaty B. The Lauramann Howe Russell Papers: a Window into Critical Care Medicine during the American Civil War. J Anesth Hist 2017; 3:117-121. [PMID: 29275802 DOI: 10.1016/j.janh.2017.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 07/19/2017] [Revised: 09/28/2017] [Accepted: 11/08/2017] [Indexed: 11/25/2022]
Abstract
The Civil War influenced all aspects of American society and culture, including the field of medicine and critical care. Union physician Lauramann Howe Russell's letter to his daughter, Ellen Howe, written on October 19, 1862, illustrates the changes in hospital construction, gender roles in healthcare and medical treatments which revolutionized healthcare during the Civil War. This letter offers a glimpse of the medical care of wounded soldiers during the early years of the Civil War. In describing his conversion hospital, he reveals the precursor to the new hospital construction which would greatly influence hospital design for decades to come. His description of women volunteers hints at the evolving role and growing importance of women in healthcare. Finally, the advancements in surgical and medical practice which developed during the Civil War are embodied in Russell's descriptions of his patients. His letter freezes a moment in medical history, bridging the gap between archaic medical practice and modern critical care.
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Affiliation(s)
- Benjamin Gorbaty
- Anesthesia Resident, Rutgers-Robert Wood Johnson University Medical School, Piscataway, NJ, USA.
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22
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Soydan L, Demir AA, Tunaci A. Frequency of abnormal pulmonary computed tomography findings in asylum seeking refugees in Turkey. Int Health 2017; 9:118-123. [PMID: 28100704 DOI: 10.1093/inthealth/ihw057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 06/27/2016] [Accepted: 12/14/2016] [Indexed: 11/13/2022] Open
Abstract
Background Lungs are particularly vulnerable to both acute infections, including TB, and chronic diseases such as chronic obstructive pulmonary disease, as well as to malignancies, all of which require particular attention during war times in which health conditions are far from optimal. Methods This retrospective cross-sectional study included 1149 refugees that underwent thoracic computed tomography (CT) for respiratory symptoms between March 2013 and February 2015 in Turkey. Results At least one positive CT finding was seen in 231 (20.1%) of the patients. The most common findings were chronic pulmonary changes (n=197, 17.2%), followed by findings suggestive of infections (n=39, 3.4%), and mass/nodular lesions (n=16, 1.4%). The rates of the lesions suggestive of active TB and malignancy were 1.0% (n=11) and 0.7% (n=8), respectively. Age 55-64 years was an independent significant predictor for any CT lesion, chronic changes, mass lesions, and lesions suggestive of malignancy. Age>65 years was predictive of any CT lesion and chronic changes. Conclusions The findings of this study indicate the need for implementation of cost-effective screening strategies in refugees, particularly during war times. Screening for TB would improve disease control among both refugees and the host populations. Middle aged and older individuals, in particular, would benefit from more proactive screening tools and strategies for the early diagnosis of pulmonary malignancies and chronic lung diseases.
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Affiliation(s)
- Levent Soydan
- Department of Radiology, Haydarpasa Numune Research and Training Hospital, 34668, Istanbul, Turkey
| | - Ali Aslan Demir
- Department of Radiology, Capa Medical Faculty, Istanbul University, 34093, Istanbul, Turkey
| | - Atadan Tunaci
- Department of Radiology, Capa Medical Faculty, Istanbul University, 34093, Istanbul, Turkey
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Al-Salem W, Herricks JR, Hotez PJ. A review of visceral leishmaniasis during the conflict in South Sudan and the consequences for East African countries. Parasit Vectors 2016; 9:460. [PMID: 27549162 PMCID: PMC4994383 DOI: 10.1186/s13071-016-1743-7] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [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: 02/22/2016] [Accepted: 08/08/2016] [Indexed: 01/24/2023] Open
Abstract
Background Visceral leishmaniasis (VL), caused predominantly by Leishmania donovani and transmitted by both Phlebotomus orientalis and Phlebotomus martini, is highly endemic in East Africa where approximately 30 thousands VL cases are reported annually. The largest numbers of cases are found in Sudan - where Phlebotomus orientalis proliferate in Acacia forests especially on Sudan’s eastern border with Ethiopia, followed by South Sudan, Ethiopia, Somalia, Kenya and Uganda. Long-standing civil war and unrest is a dominant determinant of VL in East African countries. Here we attempt to identify the correlation between VL epidemics and civil unrest. Objective and methodology In this review, literature published between 1955 and 2016 have been gathered from MSF, UNICEF, OCHA, UNHCR, PubMed and Google Scholar to analyse the correlation between conflict and human suffering from VL, which is especially apparent in South Sudan. Findings Waves of forced migration as a consequence of civil wars between 1983 and 2005 have resulted in massive and lethal epidemics in southern Sudan. Following a comprehensive peace agreement, but especially with increased allocation of resources for disease treatment and prevention in 2011, cases of VL declined reaching the lowest levels after South Sudan declared independence. However, in the latest epidemic that began in 2014 after the onset of a civil war in South Sudan, more than 1.5 million displaced refugees have migrated internally to states highly endemic for VL, while 800,000 have fled to neighboring countries. Conclusion We find a strong relationship between civil unrest and VL epidemics which tend to occur among immunologically naïve migrants entering VL-endemic areas and when Leishmania-infected individuals migrate to new areas and establish additional foci of disease. Further complicating factors in East Africa’s VL epidemics include severe lack of access to diagnosis and treatment, HIV/AIDS co-infection, food insecurity and malnutrition. Moreover, cases of post-kala-azar dermal leishmaniasis (PKDL) can serve as important reservoirs of anthroponotic Leishmania parasites.
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Affiliation(s)
| | - Jennifer R Herricks
- Department of Pediatrics and Molecular Virology and Microbiology, National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, USA.,James A. Baker III Institute for Public Policy, Rice University, Houston, TX, USA
| | - Peter J Hotez
- Department of Pediatrics and Molecular Virology and Microbiology, National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, USA.,James A. Baker III Institute for Public Policy, Rice University, Houston, TX, USA.,Sabin Vaccine Institute and Texas Children's Hospital Center for Vaccine Development, Houston, TX, USA.,Department of Biology, Baylor University, Waco, TX, USA
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Mansaray LR, Huang J, Kamara AA. Mapping deforestation and urban expansion in Freetown, Sierra Leone, from pre- to post-war economic recovery. Environ Monit Assess 2016; 188:470. [PMID: 27418077 DOI: 10.1007/s10661-016-5469-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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: 12/20/2015] [Accepted: 07/04/2016] [Indexed: 06/06/2023]
Abstract
Freetown, the capital of Sierra Leone has experienced vast land-cover changes over the past three decades. In Sierra Leone, however, availability of updated land-cover data is still a problem even for environmental managers. This study was therefore, conducted to provide up-to-date land-cover data for Freetown. Multi-temporal Landsat data at 1986, 2001, and 2015 were obtained, and a maximum likelihood supervised classification was employed. Eight land-cover classes or categories were recognized as follows: water, wetland, built-up, dense forest, sparse forest, grassland, barren, and mangrove. Land-cover changes were mapped via post-classification change detection. The persistence, gain, and loss of each land-cover class, and selected land conversions were also quantified. An overall classification accuracy of 87.3 % and a Kappa statistic of 0.85 were obtained for the 2015 map. From 1986 to 2015, water, built-up, grassland, and barren had net gains, whereas forests, wetlands, and mangrove had net loses. Conversion analyses among forests, grassland, and built-up show that built-up had targeted grassland and avoided forests. This study also revealed that, the overall land-cover change at 2001-2015 was higher (28.5 %) than that recorded at 1986-2001 (20.9 %). This is attributable to the population increase in Freetown and the high economic growth and infrastructural development recorded countrywide after the civil war. In view of the rapid land-cover change and its associated environmental impacts, this study recommends the enactment of policies that would strike a balance between urbanization and environmental sustainability in Freetown.
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Affiliation(s)
- Lamin R Mansaray
- Magbosi Land, Water and Environment Research Center (MLWERC), Sierra Leone Agricultural Research Institute (SLARI), PMB 1313, Mile 91, Northern Province, Sierra Leone.
- Institute of Remote Sensing and Information Application, College of Environmental and Resource Sciences, Zhejiang University, Hangzhou, 310058, People's Republic of China.
- Key Laboratory of Agricultural Remote Sensing and Information Systems, Zhejiang Province, Hangzhou, 310058, People's Republic of China.
| | - Jingfeng Huang
- Institute of Remote Sensing and Information Application, College of Environmental and Resource Sciences, Zhejiang University, Hangzhou, 310058, People's Republic of China
- Key Laboratory of Agricultural Remote Sensing and Information Systems, Zhejiang Province, Hangzhou, 310058, People's Republic of China
| | - Alimamy A Kamara
- Magbosi Land, Water and Environment Research Center (MLWERC), Sierra Leone Agricultural Research Institute (SLARI), PMB 1313, Mile 91, Northern Province, Sierra Leone
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Ozdogan HK, Karateke F, Ozdogan M, Cetinalp S, Ozyazici S, Gezercan Y, Okten AI, Celik M, Satar S. The Syrian civil war: The experience of the Surgical Intensive Care Units. Pak J Med Sci 2016; 32:529-33. [PMID: 27375683 PMCID: PMC4928392 DOI: 10.12669/pjms.323.9529] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [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] [Indexed: 11/15/2022] Open
Abstract
Objective: Since the civilian war in Syria began, thousands of seriously injured trauma patients from Syria were brought to Turkey for emergency operations and/or postoperative intensive care. The aim of this study was to present the demographics and clinical features of the wounded patients in Syrian civil war admitted to the surgical intensive care units in a tertiary care centre. Methods: The records of 80 trauma patients admitted to the Anaesthesia, General Surgery and Neurosurgery ICUs between June 1, 2012 and July 15, 2014 were included in the study. The data were reviewed regarding the demographics, time of presentation, place of reference, Acute Physiology and Chronic Health Evaluation II (APACHE II) score and Injury Severity Score (ISS), surgical procedures, complications, length of stay and mortality. Results: A total of 80 wounded patients (70 males and 10 females) with a mean age of 28.7 years were admitted to surgical ICUs. The most frequent cause of injury was gunshot injury. The mean time interval between the occurrence of injury and time of admission was 2.87 days. Mean ISS score on admission was 21, and mean APACHE II score was 15.7. APACHE II scores of non-survivors were significantly increased compared with those of survivors (P=0.001). No significant differences was found in the age, ISS, time interval before admission, length of stay in ICU, rate of surgery before or after admission. Conclusion: The most important factor affecting mortality in this particular trauma-ICU patient population from Syrian civil war was the physiological condition of patients on admission. Rapid transport and effective initial and on-road resuscitation are critical in decreasing the mortality rate in civil wars and military conflicts.
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Affiliation(s)
- Hatice Kaya Ozdogan
- Hatice Kaya Ozdogan, MD. Dept. of Anaesthesiology and Reanimation, Adana Numune Training and Research Hospital, Adana, Turkey
| | - Faruk Karateke
- Faruk Karateke, MD. Dept. of General Surgery, Adana Numune Training and Research Hospital, Adana, Turkey
| | - Mehmet Ozdogan
- Mehmet Ozdogan, MD. Professor of Surgery, Dept. of General Surgery, Medline Hospital, Adana, Turkey
| | - Sibel Cetinalp
- Sibel Cetinalp, MD. Dept. of Anaesthesiology and Reanimation, Adana Numune Training and Research Hospital, Adana, Turkey
| | - Sefa Ozyazici
- Sefa Ozyazici, MD. Dept. of General Surgery, Adana Numune Training and Research Hospital, Adana, Turkey
| | - Yurdal Gezercan
- Yurdal Gezercan, MD. Dept. of Neurosurgery, Adana Numune Training and Research Hospital, Adana, Turkey
| | - Ali Ihsan Okten
- Ali Ihsan Okten, MD. Dept. of Neurosurgery, Adana Numune Training and Research Hospital, Adana, Turkey
| | - Muge Celik
- Muge Celik, MD. Dept. of Anaesthesiology and Reanimation, Adana Numune Training and Research Hospital, Adana, Turkey
| | - Salim Satar
- Salim Satar, MD. Associate Professor of Emergency Medicine, Dept. of Emergency Medicine, Adana Numune Training and Research Hospital, Adana, Turkey
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Tierney D, Bolton P, Matanu B, Garasu L, Barnabas E, Silove D. The mental health and psychosocial impact of the Bougainville Crisis: a synthesis of available information. Int J Ment Health Syst 2016; 10:18. [PMID: 26941835 PMCID: PMC4776395 DOI: 10.1186/s13033-016-0054-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 02/24/2016] [Indexed: 11/10/2022] Open
Abstract
Background The Bougainville Crisis (1988–1997) was the largest armed conflict in the Pacific since WW-II. Despite this, there has been no assessment of the Mental Health and Psychosocial (MHPS) impact of the war. The aim of this paper is to summarize the available data regarding the longer-term MHPS impact of the Bougainville Crisis. Methods A literature review and a sequence of consultations in Bougainville were conducted to identify the MHPS impact of the Bougainville Crisis and the capacity within Bougainville to address these issues. Results The Bougainville Crisis resulted in violence-related deaths; the displacement of more than half of the population; widespread human rights abuses; far-reaching societal impacts including undermining of the traditional authority of elders and women and damage to cultural values and relationships; property damage; and significant impacts on education and the economy. Conflict-related experiences continue to impact on mental health in the form of trauma-related symptoms, anger, complicated grief, alcohol and substance abuse, domestic violence including sexual assault, excessive alcohol use and a lack of engagement in purposeful activities. Other impacts include an increase in other forms of gender-based violence (including sexual assault), population displacement, and adverse trans-generational effects on children exposed to disturbed parental behaviours attributable to conflict exposure. In spite of the evident needs, there is limited capacity within Bougainville to address these pressing MHPS issues. Conclusions The Bougainville Crisis has had a significant MHPS impact at multiple levels in the society. There is a strong interest within Bougainville to draw on external expertise to build local capacity to address MHPS issues. Preliminary recommendations are made to assist the process of building the capacity in Bougainville to address MHPS needs.
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Affiliation(s)
- David Tierney
- St. John of God Frankston Rehabilitation Hospital, 255-265 Cranbourne Rd, Frankston, VIC Australia
| | - Paul Bolton
- Center for Refugee and Disaster Response, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Barnabas Matanu
- Buka Hospital, Autonomous Region of Bougainville, Buka, Papua New Guinea
| | - Lorraine Garasu
- Nazareth Treatment Centre, Chabi, Autonomous Region of Bougainville, Buka, Papua New Guinea
| | - Essah Barnabas
- Buka Hospital, Autonomous Region of Bougainville, Buka, Papua New Guinea
| | - Derrick Silove
- Psychiatry Research and Teaching Unit, Academic Mental Health Unit, University of New South Wales, Southwest Sydney Local Health District, Sydney, Australia
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Çelikel A, Karbeyaz K, Kararslan B, Arslan MM, Zeren C. Childhood casualties during civil war: Syrian experience. J Forensic Leg Med 2015; 34:1-4. [PMID: 26165650 DOI: 10.1016/j.jflm.2015.04.021] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [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: 02/16/2015] [Revised: 04/16/2015] [Accepted: 04/30/2015] [Indexed: 11/28/2022]
Abstract
In war areas a lot of children die as well as adults. According to UNICEF, almost 2 million children have died in the wars took place in the last 10 years. In this study, we aimed to evaluate demographical data and injury characteristics of Syrian children who were wounded in Syria Civil War and died while being treated in Turkey. Postmortem examination and autopsy reports of 985 forensic deaths from Hatay -a Syrian neighborhood city of Turkey-between January 2012 and August 2014 were analyzed retrospectively. Among 763 Syrian people who were wounded in the war and died while being treated in Turkey, 140 cases (18.3%) who were younger than 18 years of age were taken into the scope of this study. Among those cases 77.9% (n = 109) were male and 22.1% were female. Median ages of female cases are 14 (min-max: 2-18) and median age of female cases are 9 (min-max: 1-18). Frequency distribution is highest between 13 and 18 years of age (n: 71, 50.7%). In 70% (n: 98) of cases, cause of death is bombing and shrapnel injuries, 13.6% (19) of them were killed by gunshot wounds. According to injury sites most of the injuries were reported to be on multiple body parts (54.3%, n: 76) and only head and neck injuries (%30). Cause of death was intracranial bleeding and cerebral parenchymal injury in most of the cases (n: 66, %47.1) followed by vascular damage with external bleeding (n: 15, %10.7) and internal organ damage with internal bleeding (n: 15, %10.7). The cases had very high level Abbreviated Injury Scales and Injury Severity Sores. In conclusion, a lot of children have died in the Civil War of Syria. Their average abbreviated injury scale and injury severity score values reported very high. Children that we evaluated were mostly died of head and neck injuries predominantly caused by bombing attacks and Autopsies of them revealed fatal intracranial hemorrhages and parenchymal injuries.
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Affiliation(s)
- Adnan Çelikel
- Mustafa Kemal University, Medical Faculty, Department of Forensic Medicine, Hatay, Turkey.
| | | | - Bekir Kararslan
- Gaziosmanpaşa University, Medical Faculty, Department of Forensic Medicine, Tokat, Turkey.
| | - M Mustafa Arslan
- Mustafa Kemal University, Medical Faculty, Department of Forensic Medicine, Hatay, Turkey.
| | - Cem Zeren
- Mustafa Kemal University, Medical Faculty, Department of Forensic Medicine, Hatay, Turkey.
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Kerridge BT, Khan MR, Rehm J, Sapkota A. Terrorism, civil war and related violence and substance use disorder morbidity and mortality: a global analysis. J Epidemiol Glob Health 2014; 4:61-72. [PMID: 24534337 PMCID: PMC7320406 DOI: 10.1016/j.jegh.2013.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Revised: 10/10/2013] [Accepted: 10/11/2013] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION The purpose of this study is to examine associations between deaths owing to terrorism, civil war, and one-sided violence from 1994-2000 and substance use disorder disability-adjusted life years (DALYs). METHODS The relationship between terrorism, and related violence and substance use disorder morbidity and mortality among World Health Organization Member States in 2002, controlling for adult per capita alcohol consumption, illicit drug use, and economic variables at baseline in 1994. RESULTS Deaths as a result of terrorism and related violence were related to substance use disorder DALYs: a 1.0% increase in deaths as a result of terrorism, war and one-sided violence was associated with an increase of between 0.10% and 0.12% in alcohol and drug use disorder DALYs. Associations were greater among males and 15-44 year-old. CONCLUSION Terrorism, war and one-sided violence may influence morbidity and mortality attributable to substance use disorders in the longer-term suggests that more attention to be given to rapid assessment and treatment of substance use disorders in conflict-affected populations with due consideration of gender and age differences that may impact treatment outcomes in these settings. Priorities should be established to rebuild substance abuse treatment infrastructures and treat the many physical and mental comorbid disorders.
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Affiliation(s)
- Bradley T Kerridge
- Department of Epidemiology and Biostatistics, School of Public Health, University of Maryland, College Park, College Park, MD 20740, USA.
| | - Maria R Khan
- Department of Epidemiology, College of Public Health Professions, School of Medicine, University of Florida Health Services Center, University of Florida, Gainesville, FL 32610, USA
| | - Jürgen Rehm
- Centre for Addiction and Mental Health, 33 Russell Street, Toronto, Ontario M5S 2S1, Canada
| | - Amir Sapkota
- Maryland Institute for Applied Environmental Health, Department of Epidemiology and Biostatistics, School of Public Health, University of Maryland, College Park, College Park, MD 20742, USA
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Kerridge BT, Khan MR, Rehm J, Sapkota A. Conflict and diarrheal and related diseases: a global analysis. J Epidemiol Glob Health 2013; 3:269-77. [PMID: 24206798 PMCID: PMC4691541 DOI: 10.1016/j.jegh.2013.05.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Revised: 05/22/2013] [Accepted: 05/24/2013] [Indexed: 11/24/2022] Open
Abstract
The purpose of this study was to determine the association between deaths owing to terrorism, civil war and one-sided violence from 1994-2000 and disability-adjusted life years (DALYs) attributable to diarrheal and related diseases, schistosomiasis, trachoma and the nematode infections (DSTN diseases) in 2002 among World Health Organization Member States. Deaths resulting from terrorism, civil war and one-sided violence were significantly related to DSTN DALYs across the majority of sex-age subgroups of the populace, after controlling for baseline levels of improved water/sanitation and a variety of economic measures: overall, a 1.0% increase in deaths owing to terrorism and related violence was associated with an increase of 0.16% in DALYs lost to DSTN diseases. Associations were greatest among 0-to-4-year olds. The results of the present study suggest that DSTN disease control efforts should target conflict-affected populations with particular attention to young children who suffer disproportionately from DSTN diseases in these settings. In view of the evidence that terrorism and related violence may influence DSTN DALYs in the longer term, control strategies should move beyond immediate responses to decrease the incidence and severity of DSTN diseases to seek solutions through bolstering health systems infrastructure development among conflict-affected populations.
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Affiliation(s)
- Bradley T Kerridge
- Department of Epidemiology and Biostatistics, School of Public Health, University of Maryland, College Park, College Park, MD 20742, United States.
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