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Cultural-societal roots of violence. The examples of genocidal violence and of contemporary youth violence in the United States.

Widespread violence in a society must have its origins in cultural characteristics, current societal conditions, or both. In this article, the cultural, societal, and psychological origins of two very different forms of violence are examined. A conception of the origins of genocide and mass killing is briefly presented, with the Holocaust and the violence in the former Yugoslavia as supporting evidence. Difficult life conditions give rise to scapegoating, destructive ideologies, and the evolution of increasing violence against a designated enemy. Cultural characteristics that make this process more or less probable are described. This is followed by a presentation of the socialization experiences of children that generate youth violence. To explain the increase in youth violence, the presence of difficult life conditions in the United States is noted (due primarily to substantial social change). The effects of difficult life conditions, cultural characteristics, and social conditions such as poverty and discrimination against minority groups on family life and parenting are described. Similarities and differences in the origins of the two forms of violence are examined. The role of unfulfilled or frustrated basic human needs in generating violence is stressed, and conditions and actions required to reduce violence are proposed.

Adolescent↗

Trauma treatment training for Bosnian and Croatian mental health workers.

Trauma treatment training programs were conducted in the former Yugoslavia for Bosnian and Croatian mental health workers. A method was developed for measuring and evaluating compassion fatigue and burnout among the trainees, and an efficient system of international supervision and consultation was implemented. Plans for development of this system to support future training and consultation programs are discussed.

Behavior Therapy↗

Case-control study of risk factors for prostate cancer.

One hundred and one patients with histologically confirmed prostate cancer and 202 hospital controls individually matched by age (+/- 2 years), hospital admittance and place of residence, were interviewed during the period 1990-94 in two towns in central Serbia (Yugoslavia). In an analysis using multivariate logistic regression, the followng factors were significantly related to prostate cancer: (1) occupational physical activity during the year preceding the disease [odds ratio (OR)=3.87, 95% confidence interval (95% CI)=2.09-7.16]; (2) occupational exposure to asbestos, steel, dyes and lacquers, bitumen, pitch, iron, nickel, lead, fertilizer and certain other agents (OR=2.13, 95% CI=1.05-4.32); (3) nephrolithiasis (OR=4.52, 95% CI=1.34-15.30); (4) 'other' diseases in medical history such as chronic bronchitis, chronic rheumatic diseases, hypertension, cardiomyopathy, diabetes mellitus, renal diseases, eye diseases and tuberculosis (OR=3.14, 95% CI=1.56-6.33); (5) a greater number (> or = 3) of brothers (OR=2.08, 95% CI=1.35-3.22); and (6) greater numbers (> or = 8) of sexual partners (OR=2.24, 95% CI=1.13-4.44). Marital status, age at first marriage, educational level, age at first sexual intercourse, frequency of sexual intercourse, venereal diseases, tonsillectomy, appendectomy, hernia inguinale and hydrocele, anthropometric characteristics, smoking history, sport and recreational activities and family history of prostatic neoplasms were not found to be independently related to prostate cancer.

Adult↗

The crisis in Bosnia: breaking down barriers.

Since the outbreak of war in the former Yugoslavia, the British Government has accepted a number of people with special humanitarian needs from Bosnia. In October 1992, seven families, comprising of ten adults aged between 24 and 42 years old and 13 children aged between 18 months and 15 years old, arrived in Surrey having sought the status of 'war refugee' by the Home Office.

Adolescent↗

Nutritional habits in the Mediterranean Basin. The macronutrient composition of diet and its relation with the traditional Mediterranean diet. Multi-centre study of the Mediterranean Group for the Study of Diabetes (MGSD).

OBJECTIVE: To compare the nutritional habits among six Mediterranean countries and also with the various official recommendations and the 'Mediterranean diet' as originally described. DESIGN: Cross-sectional study. SETTINGS: Three centres in Greece, two in Italy and one in Algeria, Bulgaria, Egypt and Yugoslavia. SUBJECTS: Randomly selected non-diabetic subjects from the general population, of age 35-60, not on diet for at least 3 months before the study. INTERVENTIONS: A dietary questionnaire validated against the 3-Day Diet Diary was used. Demographic data were collected and anthropometrical measurements done. RESULTS: All results were age adjusted. Energy intake varied in men, from 1825 kcal/day in Italy-Rome to 3322 kcal/day in Bulgaria and in women, from 1561 kcal/day in Italy-Rome to 2550 kcal/day in Algeria. Protein contribution (%) to the energy intake varied little, ranging from 13.4% in Greece to 18.5% in Italy-Rome, while fat ranged from 25.3% in Egypt to 40.2% in Bulgaria and carbohydrates from 41.5% in Bulgaria to 58.6% in Egypt. Fibre intake, g/1000 kcal, ranged from 6.8 in Bulgaria to 13.3 in Egypt and the ratio of plant to animal fat from 1.2 in Bulgaria to 2.8 in Greece. The proportion of subjects following the WHO and the Diabetes and Nutrition Study Group (DNSG) of the EASD recommendations for carbohydrates, fat and protein ranged from 4.2% in Bulgaria to 75.7% in Egypt. Comparison with the Mediterranean diet, as defined in the seven Country Study, showed significant differences especially for fruit, 123-377 vs 464 g/day of the Mediterranean diet, meat, 72-193 vs 35 g/day, cheese, 15-79 vs 13 g/day, bread, 126-367 vs 380 g/day. CONCLUSIONS: (a) Dietary habits of the 'normal' population vary greatly among the Mediterranean countries studied. (b) Egypt is closest to the DNSG recommendations. (c) Significant differences from the originally described Mediterranean diet are documented in most Mediterranean countries, showing a Westernization of the dietary habits.

Adult↗

B chromosomes and developmental homeostasis in the yellow-necked mouse, Apodemus flavicollis (Rodentia, Mammalia): effects on nonmetric traits.

B chromosomes are found in almost all populations of the yellow-necked mouse, Apodemus flavicollis (Rodentia, Mammalia). Their effects on developmental homeostasis in this species were analyzed using morphological nonmetric traits (number of foramina) in a sample of 218 animals from locality Mt Jastrebac in the former Yugoslavia. Variations of the parameters of developmental homeostasis (the degree of fluctuating asymmetry--FA, the number of asymmetrical characters per individual--NA, and the total phenotypic variability--PV) were examined in three groups: in animals without Bs, with one B chromosome, and with more than one B chromosome. Significant differences in the level of FA between groups of animals were found for two characters. Carriers of one B chromosome displayed the highest level of phenotypic variability. Parameters of developmental stability (DS) were monitored in the population in which significant variations in the frequency of animals with Bs (fB) were established during the season earlier. The FA levels for four foramina out of a total of 12 examined followed the changes of frequencies of animals with Bs. Furthermore, a significant seasonal correlation between NA and fB was found. The presence of B does not cause a disturbance of homeostasis in a way that allows changes in homeostasis to be directly related to B chromosome's presence. However, carriers of B react differently to environmental changes than do noncarriers.

Animals↗

Hereditary, focal, transgressive palmoplantar keratoderma with associated clinical findings: a new entity?

We report on a 24-year-old male originating from Yugoslavia with a focal, transgressive palmoplantar keratoderma presumably inherited as an autosomal recessive trait. Associated clinical findings were hyperkeratotic lichenoid papules on the knees and elbows, psoriasis-like lesions in the groins and on the scalp, a spotty or reticulate hyperpigmentation of the face, trunk and extremities and a partial alopecia of the left eyebrow and eyelashes. The patient's sister was affected by similar but less pronounced cutaneous changes. Although our case shares some similarities with other hereditary palmoplantar keratodermas there remain substantial differences. We therefore believe this case to represent a new entity.

Adult↗

Somatic hypotheses of war syndromes.

Since the end of the American Civil War, unexplained symptoms in military personnel arising after a war or peace mission have frequently been described. The pattern of symptoms is highly similar for all of the various war syndromes although the conditions of each war or peace mission are widely different. Many somatic hypotheses have been formulated to explain these syndromes; a considerable proportion of them are already outdated. In the last few years much attention has been given to Gulf War Syndrome and to unexplained symptoms of military personnel who were sent to Cambodia, Rwanda, Burundi, Zaire, or the former Yugoslavia. In this review the symptoms of war syndromes will be considered in more detail and the suggested somatic explanations will be discussed. During the last decade the following somatic causes have been suggested as possible explanations for these symptoms: (persistent) infection, abnormal immune response, administration of multiple vaccinations within a short period of time, use of malaria chemoprophylaxis, neurological abnormalities, exposure to toxicological substances and environmental factors. The various investigations performed to study these hypotheses are discussed. The fact that bias regularly occurs in the course of these investigations is pointed out. For the future, a reliable investigation of a war syndrome should be a prospective multidisciplinary study and should distinguish between causative and sustaining factors.

Combat Disorders↗

Psychostimulants, adult attention deficit hyperactivity disorder and morbid jealousy.

OBJECTIVE: This paper aims to discuss the relationship between morbid jealousy, stalking behaviour, and psychodynamic issues. Comment will be made on the risk associated with diagnosis of adult attention deficit hyperactivity disorder (ADHD) and use of psychostimulants. CLINICAL PICTURE: A man born in the former Yugoslavia charged with stalking was referred for assessment. He presented with a history of treatment for ADHD with dexamphetamine and delusions regarding his wife's fidelity. TREATMENT: The patient was treated with neuroleptics and counselling for himself and his family. OUTCOME: The patient was returned to the community. He separated from his wife but retains the abnormal belief. CONCLUSIONS: The diagnosis of adult ADHD appears to be increasing in Western Australia. Treatment with stimulants is common. The misdiagnosis of ADHD and consequent misuse of stimulants, can lead to the development of morbid jealousy, stalking behaviour and arrest.

Adult↗

A review of the validity of the General Health Questionnaire in adolescent populations.

OBJECTIVE: To comprehensively review the validity of the General Health Questionnaire (GHQ) [1] with adolescents (aged 12-19). Although the GHQ has been extensively used and validated with adults and has been frequently used with adolescents, the validity data for this group are sporadic. METHOD: Systematic review of the English language peer-reviewed literature. RESULTS: Eight studies were identified validating the GHQ with young people of which four included only adolescents and four studies involved young adults and adolescents. Of these eight studies, four used an English language version of the GHQ and four used a translated version. CONCLUSION: The GHQ has demonstrated validity with older adolescents (17 + years) from the UK and Hong Kong (Chinese translation) and with girls aged 15 in the UK, but there are few data for either gender, aged less than 15 years. Studies in Australia and Italy reported a high proportion of misclassified cases while the studies in Spain and Yugoslavia included some older subjects (20 + years). Therefore, the validity of the GHQ for adolescents in populations other than the UK and Hong Kong remains to be demonstrated. IMPLICATIONS: Psychiatrists and other mental health professionals need to be aware of the above limitations when using the GHQ as a screening instrument with adolescents. Further studies are required to: (i) determine the minimum age at which it can be employed, (ii) compare the use of adult versus adolescent criterion interviews, (iii) assemble relevant normative data, and (iv) establish the validity of translated versions.

Adolescent↗

Importance of sodium dodecyl sulfate pore-graduated polyacrylamide gel electrophoresis in the differential diagnostic of Balkan nephropathy.

Balkan nephropathy (BN) is an endemic disease, which leads to end-stage renal failure and artificial renal replacement therapy. Pathologically it is characterized by progressive interstitial nephritis in a large population of villages situated in the proximity of a bend of the Danube up to a distance of 100 km from the river in several parts of Bulgaria, Romania, and the former Yugoslavia. The urinary proteins of 19 patients with BN from the region of Vratza, Bulgaria were examined using ultrathin layer sodium dodecyl sulfate (SDS) pore-graduated polyacrylamide gel electrophoresis (PAGE) and silver staining. The documentation of urinary proteins pattern was performed using laser densitometry and consecutive electronic processing for the purpose of characterizing and quantifying protein excretion. Our results show that the proteinuria of BN is predominantly tubular, consisting of low molecular weight species (10-65 kilodaltons). The amount of tubular protein changes with the progression of the disease. SDS-polyacrylamide gel electrophoresis (PAGE) is a diagnostic method for early diagnosis of tubular failure in BN. Using our method of SDS-PAGE, tubular failure can be detected even at a total protein concentration below 0.1 g/L and when the serum creatinine concentration is normal. Additionally, our method of SDS-PAGE supports the differentiation of BN from glomerular disease.

Aged↗

Liver transplantation in Eastern Europe.

The aim of this report is to evaluate the development of liver transplantation in eastern Europe until mid-1998. Representatives of gastroenterological and hepatological societies of the respective countries answered a questionnaire about the most descriptive items of the issue of liver transplantation. The Baltic countries, together with 6 southern Balkan countries, Moldovia, and Belarus, have not developed a program of liver transplantation. In Ukraine, 7 transplantations were performed, with 3 early deaths. In Russia, 31 liver transplantations were performed, with 8 of the last 12 patients surviving short term. In Slovenia, 1 of 2 patients, and in Yugoslavia, 8 of 9 patients survived. In Croatia and Slovakia, 2 patients each died immediately after surgery. The number of liver transplantations is increasing in both Hungary and Poland. In Hungary, 63 transplantations were performed, with a 1-year survival rate reaching 85%; in Poland, 55 adults and 29 children underwent transplantation, with an actuarial 1-year survival rate of 70%. In former East Germany, 4 centers developed their programs since 1992. A total of 196 transplantations were performed, with 1-year survival rates varying from 80% to 89%. The total spectrum of indications for transplantation was standard, with a greater proportion of hepatocellular cancer compared with Eurotransplant statistics. In the Czech Republic, the first liver transplantation was performed in 1983, but it was not until 1994 that the number of procedures increased steeply. Until mid-1998, a total of 182 transplantations were performed. At the Prague Institute for Clinical and Experimental Medicine, we performed 94 transplantations, with a 1-year patient survival rate of 90.6%. There has been rapid development over the last 3 years in the 3 countries of Central Europe. The progress is influenced by the sweeping political and economic changes.

Adult↗

[Visceral kala-azar disease in a child (author's transl)].

Repeated blood cultures were negative in a six-year-old boy with high septic temperature. Rheumatoid arthritis, typhoid and brucellosis were excluded. There was no evidence of leukaemia (bone-marrow tests). There was hepatomegaly with increased transaminase activity. Cortisone treatment was begun for suspected collagen disease. Several liver needle biopsies at first revelaed increasingly severe necrotising changes, predominantly in the centres of the acini. There were no parasites demonstrable histologically. The spleen was increased in the isotope scan but, covered by the liver, not definitely palpable. Diagnosis of mediterranean Kala-Azar disease was then suspected (the parents reporting a camping holiday in Yugoslavia) and finally proven serologically. The previously treatment-resistant disease improved dramatically after administration of trivalent antimony (Fuadin).

Alanine Transaminase↗

[A small outbreak of trichinosis caused by imported smoked ham].

Three patients fell ill with diarrhoea 14 to 15 days after eating smoked ham. All had an increased white cell count (up to 16,200 microliters), eosinophilia (14 to 38%) and increased creatinkinase activity (357 up to 1905 U/l). Patient 1 (a 21-year-old woman) also had fever of around 40 degrees C; patient 2 (32-year-old woman) had a fever up to 39 degrees C, with muscle pains and swellings in the face. Patient 3 (38-year-old man) had no other symptoms. Because of eosinophilia and as five other family members in former Yugoslavia whence the ham had been imported, also had had fevers, trichinosis was soon considered as the cause. Serology in patients 1 and 2 was positive on admission, in patient 3 after one week. Mebendazole was administered, initially 50 mg/kg in three doses for 2 days. Drug blood levels were determined 1 and 4 hours after start of treatment and the dosage was then increased to 80-100 mg/kg daily. Duration of treatment ranged from 11 to 14 days. All patients were discharged symptom-free and there have been no sequelae. In Germany trichinosis typically occurs in small outbreaks. It is assuming increasing importance as an imported disease.

Adult↗

[Leishmaniasis with multiple cutaneous nodules].

Six weeks after a holiday trip to Yugoslavia, a previously well 48-year-old man developed a reddish-livid, firm nodule, 0.5 cm in diameter, on the proximal joint of the right thumb. A similar nodule appeared nearby, as well as over the left patella. Eleven additional nodules occurred over the next 4 months. His general health remained good and physical examination merely noted the liver edge palpable 3 cm below the costal margin. The histology of one of the nodules showed a tuberculoid, plasma-rich inflammatory reaction reminiscent of leishmaniasis or brucellosis. No organisms were seen. Immunohistochemistry of a frozen section demonstrated Leishmania-associated antigens, and the Western-blot test was characteristic for leishmaniasis. No systemic treatment was undertaken because of likely alcoholic toxic liver damage. On local treatment with paromomycin-containing ointment the cutaneous nodules healed without scar within 3 months.

Animals↗

[The combination of atrial myxoma and multiple skin myxomas: a characteristic symptom complex?].

In 1980, a then 7-year-old boy from Yugoslavia had an atrial myxoma removed. Since then there have been no abnormal cardiac signs or symptoms. Between 1982 and 1986 five cutaneous myxomas in the trunk region were removed. None of the tumours had histological signs of malignancy. These observations can be fitted into the symptom complex (described in 1985 by Carney et al.) of cardiac myxoma, cutaneous myxoma, changes in skin pigmentation, and abnormal endocrine functions--although not all signs need be present together. A disposition towards the development of myxomatous tumours is to be assumed in these patients. One should, therefore, always suspect an occult cardiac myxoma in the presence of multiple cutaneous myxomas. Appropriate diagnostic measures need to be taken before the typical and sometimes lethal consequences of a cardiac myxoma have occurred.

Child↗

Balkan endemic nephropathy and associated urinary tract tumours: a review on aetiological causes and the potential role of mycotoxins.

A series of publications in the 1950s described a kidney disease in Bulgaria, the former Yugoslavia and Romania that became known as Balkan endemic nephropathy (BEN). The disease was qualified by World Health Organisation (WHO) experts as 'progressive and very gradually developing renal failure with insidious onset.... The last stage shows marked fibrosis...'. BEN is characterized by tubular degeneration, interstitial fibrosis and hyalinization of glomeruli accompanied by enzymuria and impaired renal function without nephrotic syndrome. Later, an association between BEN and tumours of the kidney pelvis and ureter was recognized, so that the problem of BEN became not only nephrological, but also oncological. There may also be an association with increased urinary bladder cancer incidence, although many confounding factors may interfere in the analysis of data for this organ. In view of the very intimate association between BEN and the urinary tract tumours (UTT), the term 'endemic uropathy' has been proposed. Several hypothesis concerning the aetiology of these diseases has been investigated, which include: predisposing genes factors, environmental factors (heavy metals, minerals, bacteria, leptospira, viruses, fungal toxins and, most recently, pliocene lignites). This paper reviews the different hypotheses about the aetiology of endemic uropathy and pays particular attention to the role of fungal toxins.

Balkan Nephropathy↗

Determination of pesticide residues in wine using gas chromatography with nitrogen-phosphorus and electron capture detection.

A multiresidue method employing an extraction step with ethyl acetate followed by clean-up using an Isolute silica column and determination using gas chromatography with nitrogen-phosphorus and electron capture detection was validated for a wide range of pesticide residues in white and red wine. Recoveries between 70 and 110% and relative standard deviations below 20% were obtained for nearly all target analytes using matrix-matched standards. Limits of detection based on three times the signal-to-noise ratio were in the range 0.002-0.01 mg l(-1) for most compounds. The chromatograms were generally free of interference peaks resulting from co-extractives, although a few were noted for red wine with nitrogen-phosphorus detection. Ninety-two wine samples collected in Greece and Yugoslavia during 2 consecutive years were screened for residues of 84 pesticides, 71% of which were registered for use on vines in one or both countries. A total of 20% of the samples were obtained from field trials, and of these, one Greek wine contained iprodione 0.3 mg l(-1) and six Yugoslavian wines, for which vinclozolin had been added to the must as part of a different study, contained residues of this pesticide. No residues were detected in any of the other samples.

Chromatography, Gas↗