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PubMed2002

Chemical and biological weapons. Implications for anaesthesia and intensive care.

In the wake of recent atrocities there has been renewed apprehension regarding the possibility of chemical and biological weapon (CBW) deployment by terrorists. Despite various international agreements that proscribe their use, certain states continue to develop chemical and biological weapons of mass destruction. Of greater concern, recent historical examples support the prospect that state-independent organizations have the capability to produce such weapons. Indeed, the deliberate deployment of anthrax has claimed several lives in the USA since September 11, 2001. In the event of a significant CBW attack, medical services would be stretched. However, victim survival may be improved by the prompt, coordinated response of military and civil authorities, in conjunction with appropriate medical care. In comparison with most other specialties, anaesthetists have the professional academic background in physiology and pharmacology to be able to understand the nature of the injuries caused by CBWs. Anaesthetists, therefore, play a vital role both in the initial resuscitation of casualties and in their continued treatment in an intensive care setting. This article assesses the current risk of CBW deployment by terrorists, considers factors which would affect the severity of an attack, and discusses the pathophysiology of those CBWs most likely to be used. The specific roles of the anaesthetist and intensivist in treatment are highlighted.

Anesthesia↗

PubMed1989

Patterns of mortality in Armenian parish records from eleven countries.

A study of the trends and distributions of mortality in parish records of Armenian churches from 11 countries spanning over 242 years is the basis of this report. In all parishes, the relative proportion of deaths in the older age groups gradually increased over the study period. Following a review of the most important causes of death, an effort was made to identify clusters and outbreaks of specific causes of death. Thus, in the 19th century, five epidemics of cholera were identified in one parish in Kutahya, Turkey (1831, 1848, 1865, 1871, and 1893). A review of the deaths due to the 1918 influenza pandemic revealed a major peak in October-December 1918 in Cairo, and deaths due to the same cause recorded in November-December 1918 in Rangoon, Dacca, and Calcutta. As observed elsewhere in the classic pattern of this pandemic, the largest number of these deaths were in persons who were in their twenties. In September-December 1942, in Thessaloniki, Greece, 31 deaths of all age groups were ascribed to a fever that was described as "toxic." The nature of this epidemic could not be explained. The observation that large numbers of recorded deaths occurred through violence and hunger during the First and Second World Wars as a result of the atrocities to which these communities were exposed sheds further light on historical events in those years.

Adolescent↗

PubMed2002

Children's trauma and adjustment reactions to violent and nonviolent war experiences.

OBJECTIVE: According to most studies, more than half of children exposed to war meet criteria for posttraumatic stress disorder (PTSD). Although we know that children are adversely affected by atrocities of war, we do not know which specific war events are associated with children's stress reactions. For example, it is unclear whether differences exist in response to violent versus nonviolent war-trauma experiences. This study examined the relationship of violent and nonviolent war experiences to children's trauma reactions and adjustment in a group of children from Bosnia. METHOD: During the 1994 siege in Sarajevo, 791 children aged 6 to 16 years participated in a study of trauma experience and response, in which assessment questionnaires (Impact of Event Scale, PTSD Reaction Index, Children's Depression Inventory, Child Behavior Checklist, and War Experience Questionnaire) were completed by children and their teachers. RESULTS: In this sample 41% had clinically significant PTSD symptoms. Children were adversely affected by exposure to both violent and nonviolent war-traumas. An additive effect of trauma exposure on trauma reactions was also found. However, many war experiences were not associated with children's adjustment and trauma reactions. CONCLUSIONS: Additive effects of violence and deprivations during war may overwhelm the coping skills of children and leave them vulnerable to externalizing and internalizing adjustment difficulties and symptoms of PTSD.

Adaptation, Psychological↗

PubMed1996

Malignant Post-Vietnam Stress Syndrome revisited.

Malignant Post-Vietnam Stress Syndrome describes a severe form of combat-related posttraumatic stress disorder. We update the concept of Malignant Post-Vietnam Stress Syndrome, considering the effects of repeated severe traumatization, exposure to atrocities, and a variety of comorbid conditions. An illustrative case report demonstrates an interdisciplinary treatment approach, combining case management, brief hospitalizations, symptom-directed use of medications, and supportive psychotherapy.

Case Management↗

PubMed1998

Fifty years after the Nuremberg Nazi Doctors' Trial: reviewing how the laws of the Third Reich applied to individuals with oral clefts.

The Nazi Doctors' Trial, held in the city of Nuremberg 50 years ago, is a landmark in the history of medicine and science. For the first time, the horrors inflicted by a group of German scientists on innocent victims became widely known. Most of the defendants received sentences that ranged from relatively short imprisonment to death. The Trial also provided elements to develop standards for permissible medical experimentation, known as the Nuremberg Code. The atrocities judged in the Nazi Doctors' Trial, however, were not isolated. They were part of an overall eugenic system that encouraged euthanasia, compulsory sterilization, and selective marriages based on "genetic health" and "racial hygiene." Individuals with oral clefts were considered subject to these laws and suffered their consequences. This paper describes the main features of the Trial, reviews the state of knowledge on oral clefts in the 1930s and 1940s, presents how the laws of the Third Reich impacted the lives of individuals with oral clefts, and speculates on the implications of past and present eugenic policies in the future of humankind.

Child↗

PubMedDate not supplied

The impact of war upon the pupils' growth in southern Croatia.

In order to assess the influence of war calamities on the pupils' growth rate, the height, weight, and relative weight of children from Split at the time of entering two major elementary schools (age about 6.5 years) and some 10 months later, during the two pre-war years (i.e. 1988/1989 and 1989/1990) and the two years of the war against Croatia (i.e. 1990/1991 and 1991/1992) were compared. A notable increase in body weight, ranging from 12.24 to 14.50% (compared with 8.57-11.93%; t = 1.23, P > 0.05), but not in height was observed in the first, and a significant acceleration in the longitudinal growth (4.53-4.73% as compared with 3.38-4.24%; t = 4.01, P < 0.01) but not in weight gain was noted in the second war year. These unexpected findings lead to a conclusion that the war atrocities may affect the children's growth rate differently, depending on the amount and quality of the consumed food, on the level of energy expenditure, and possibly on the variable impact of emotional stress.

Anthropometry↗

PubMed1995

Research ethics--a widening of the scope and extrapolation into the future.

Until recently, the concept of research ethics covered only the safety of, and the respect for, the research subject, i.e. the trial patient and the healthy volunteer. The reason was obviously that human research subjects are the most vulnerable of all key persons involved in biomedical research, and the fact that this vulnerability was made tragically visible through the atrocities of World War II. Not in any way to detract importance from this part of research ethics these years experience a widening of the conceptual scope, involving not only the researcher and his or her honesty but also society as a whole, not just duties and rights considered unilaterally but bilaterally. And further, including perspectives as science freedom and a given generation's responsibility for its global fellow-men and for future generations.

Ethics, Medical↗

PubMed2006

Cosmopolitanism and violence: difficulties of judgment.

This paper addresses the difficult relation of cosmopolitan ideas to the existence of war and violence. It explores the ambivalences within the cosmopolitan outlook as it seeks to reconcile its attentiveness to the actuality of violence in the modern age with its normative vision of perpetual peace. I address these ambivalences through a discussion of a) what it is to learn from the catastrophes of the twentieth century; b) the contribution Kant's theory of cosmopolitan law to the solution to contemporary problems of violence; c) the reconstruction of cosmopolitan thinking in the wake of the Holocaust as an attempt to take atrocities seriously; d) the application of cosmopolitan criteria to the justification and authorization of humanitarian military intervention; and e) the attempt on the part of Habermas and Derrida to address the ambivalence involved in reconciling cosmopolitanism and violence in Kosovo and Iraq. While cosmopolitanism is usually understood as a reference to a worldly legal and institutional order, the cosmopolitan outlook is also a mode of understanding the world, an ethic of responsibility and an ongoing exercise of political judgment in the face of violence.

Altruism↗

PubMed1996

Human guinea pigs and the ethics of experimentation: the BMJ's correspondent at the Nuremberg medical trial.

Though the Nuremberg medical trial was a United States military tribunal, British forensic pathologists supplied extensive evidence for the trial. The BMJ had a correspondent at the trial, and he endorsed a utilitarian legitimation of clinical experiments, justifying the medical research carried out under Nazism as of long term scientific benefit despite the human costs. The British supported an international medical commission to evaluate the ethics and scientific quality of German research. Medical opinions differed over whether German medical atrocities should be given publicity or treated in confidence. The BMJ's correspondent warned against medical researchers being taken over by a totalitarian state, and these arguments were used to oppose the NHS and any state control over medical research.

Editorial Policies↗

PubMed1997

The one child family policy: the good, the bad, and the ugly.

Rapid population growth in China during the 1950s and '60s led to the "late, long, few" policy of the 1970s and a dramatic reduction in the total fertility rate. However, population growth remained too high for the economic targets of Deng Xiao Ping's reforms, so the one child family policy was introduced in 1979 and has remained in force ever since. The strategy is different in urban and rural areas, and implementation varies from place to place depending on local conditions. The policy has been beneficial in terms of curbing population growth, aiding economic growth, and improving the health and welfare of women and children. On the negative side there are concerns about demographic and sex imbalance and the psychological effects for a generation of only children in the cities. The atrocities often associated with the policy, such as female infanticide, occur rarely now. China may relax the policy in the near future, probably allowing two children for everyone.

Attitude↗

PubMed2006

Critical care delivery: the experience of a civilian terrorist attack.

It has been recognised for some time that a terrorist incident was threatened in the U.K. and it has been noted previously in the JRAMC that the locations for terrorist atrocities are likely to be more diverse than previously experienced. July 7th 2005 witnessed the first terrorist suicide bombing on the U.K. mainland, targeting the public transport system in London. These attacks were unprecedented in both scale and intensity but they were anticipated in London. However there were clear difficulties, relating to multiple sites, their location underground and early problems with communication (2). This article highlights some of the experiences and learning points of the Intensive Care Medicine Service at the Royal London Hospital (RLH) in the wake of the July 7th bombings. The RLH was the single biggest receiver of casualties (195); seven of whom were admitted to the Intensive Care Unit. The Defence Medical Services have tri-service representation (both regular and reserve) at the RLH in Emergency Medicine and Pre-hospital Care, Surgical Services and Intensive Care Medicine.

Adult↗

PubMed1987

Posttraumatic stress disorder: the etiologic specificity of wartime stressors.

The authors examined the effects of wartime stressors in a sample of 69 Vietnam veterans who were psychiatric inpatients in a Veterans Administration hospital. Participation in atrocities and the cumulative exposure to combat stressors, each independently of the other, conferred a significant risk for posttraumatic stress disorder. In contrast, the effect of these war experiences on the onset of panic, major depression, and mania was not significant. The results indicate that extreme stressors are uniquely linked with posttraumatic stress disorder's characteristic cluster of symptoms but challenge DSM-III's implicit assumption that the reexperienced trauma is the stressor responsible for posttraumatic stress disorder.

Adult↗

PubMed1992

Symptoms of PTSD in 124 survivors of the Holocaust.

OBJECTIVE: Survivors of the Holocaust are expected to be at risk for posttraumatic stress disorder (PTSD), but few empirical data are available. This study investigated PTSD symptoms in Holocaust survivors with well-documented exposure to trauma. METHOD: The German files of 124 Jewish Holocaust survivors who were judged to be free from bipolar affective disorder, obsessive-compulsive disorder, and organic brain syndrome were selected from those of 145 applicants to West German compensation boards. The psychiatric assessments were reexamined for explicit descriptions of current PTSD symptoms according to the DSM-III-R diagnostic criteria. A subgroup of 20 Auschwitz survivors with tattooed identification numbers were also compared with the 45 survivors who had not been in concentration camps. RESULTS: Sixty-three percent of the total sample had been detained in concentration camps, and an average of 78% of their first-degree relatives were reported killed in the Holocaust. Forty-six percent of the total sample met the DSM-III-R criteria for PTSD. The most common symptoms were sleep disturbance, recurrent nightmares, and intense distress over reminders. The tattooed Auschwitz survivors had significantly more symptoms and were three times more likely to meet diagnostic criteria for PTSD than the survivors who had not been in concentration camps. CONCLUSIONS: The results suggest a greater risk of chronic PTSD in survivors who were exposed to atrocities. Most survivors had not received adequate psychiatric care.

Adult↗

PubMed2001

Dissociative flashbacks after right frontal injury in a vietnam veteran with combat-related posttraumatic stress disorder.

A Vietnam veteran with a combat-related posttraumatic stress disorder developed recurrent dissociative flashbacks (related to the atrocities of a specific war incident) several months after suffering a traumatic brain injury. CT disclosed a small lesion in the right dorsolateral prefrontal cortex. SPECT demonstrated more extensive functional changes in prefrontal and anterior paralimbic brain regions, mainly in the right hemisphere. This case further implicates the provocative effect of physical stimuli (brain damage) in reawakening old dormant memories and the preferential role of the right hemisphere for the storage of traumatic memories.

Brain Mapping↗

PubMed2003

War, exile, moral knowledge and the limits of psychiatric understanding: a clinical case study of a Bosnian refugee in London.

BACKGROUND: This paper describes a Bosnian refugee, a survivor of war and ethnic cleansing, during a 3-year follow-up in a psychiatry clinic. DISCUSSION: This case throws light on the tension between medicotherapeutic and sociomoral ways of understanding the effects of such experiences, and of the limitations of morally and politically neutral psychiatric categories and technologies. Suffering always invokes questions of values: in this case the clinical picture represented a moral protest at what had been done with such impunity, and a refusal to accommodate to a world which now seemed unintelligible. The clinical picture also embodied the collective outrage, and sense of unfinished business, which many back in Bosnia itself were carrying in the wake of the 1995 Dayton peace accords which effectively legitimised the lines of ethnic cleansing. CONCLUSIONS: DSM or ICD diagnoses of depressive disorder or post-traumatic stress disorder turned out to lack validity and explanatory power. Claims that victims of war and atrocity typically have an unmet need for mental health services are overstated. Recovery from the effects of war may depend on reestablishing a sense of intelligibility, a task that must primarily go on in social space rather than mental space.

Bosnia and Herzegovina↗

PubMed1996

Psychological trauma and its influence on genuine and false complaints of sexual assault.

Events that cause fear leave effects, both physical and psychological. In the last 20 years, it has been recognized that criminal assaults are also fearful events which, like war atrocities and civilian disasters, can have profound effects upon the psychological health of victims. In this paper, some of the research describing the psychological effects of crime will be reviewed, with particular emphasis on allegations of sexual assault. The impact of trauma on crime victims in relation to the prosecution process will be discussed, including the relevance of trauma to the issue of false allegations of sexual assault. The paper will conclude with some recommendations for research.

Adult↗

PubMed2005

Psychiatry in the Nazi era.

OBJECTIVES: To update Canadian psychiatrists on recent information from newly discovered Berlin archives about the actions of physicians, especially psychiatrists, during the era of National Socialism in Germany and to encourage introspection about the role of the medical profession, its relationship with government, and its vulnerability to manipulation by ideology and economic pressures. METHOD: This is a selective review of the literature on the collaboration of physicians, especially psychiatrists, in the sterilization, experimentation, and annihilation of patients with mental illness before and during World War II. RESULTS: Directed to value the health of the nation over the care of individual patients and convinced that a hierarchy of worth distinguished one person from another, German psychiatrists were enlisted to commit atrocities during the Nazi period. CONCLUSIONS: The values of care and compassion can be eroded; this knowledge demands constant vigilance.

Adolescent Psychiatry↗

PubMed1994

Torture survivors: a challenge to nursing practice.

Why should all nurses and student nurses receive instruction in the subject of torture, its purpose, methods and sequelae on body and soul? One reason is because torture is an atrocity, the most perverted and digusting act that exists. Some nurses meet torture survivors and their families in their private lives and at work. Many countries have ratified codes and declarations in relation to torture, and are therefore obliged to educate some professional groups in the subject. This article describes how the subject 'Torture' is dealt with at the School of Nursing in Aalborg, Denmark. Aspects of how the course is planned, the placement of the subject, teaching objectives, content of the lessons, teaching methods and teaching materials are mentioned. This article also underlines why it is so important to educate student and qualified nurses about torture. The conclusion is that nurses can help to alleviate the effects of torture in a merciless and unfeeling world.

Curriculum↗