PMCC PMCC

Search tips
Search criteria

Advanced
Results 1-25 (195131)

Clipboard (0)
None

Related Articles

1.  Appetitive Aggression as a Resilience Factor against Trauma Disorders: Appetitive Aggression and PTSD in German World War II Veterans 
PLoS ONE  2012;7(12):e50891.
Background
Repeated exposure to traumatic stressors such as combat results in chronic symptoms of PTSD. However, previous findings suggest that former soldiers who report combat-related aggression to be appetitive are more resilient to develop PTSD. Appetitive Aggression should therefore prevent widespread mental suffering in perpetrators of severe atrocities even after decades.
Methods and Findings
To test the long-term relationship between trauma-related illness and attraction to aggression, we surveyed a sample of 51 German male World-War II veterans (age: M = 86.7, SD = 2.8). War-related appetitive aggression was assessed with the Appetitive Aggression Scale (AAS). Current- and lifetime PTSD symptoms were assessed with the PSS-I. In a linear regression analysis accounting for 31% of the variance we found that veterans that score higher on the AAS show lower PSS-I symptom severity scores across their whole post-war lifetime (β = − .31, p = .014). The effect size and power were sufficient (f2 = 0.51, (1-β) = .99). The same was true for current PTSD (β = − .27, p = .030).
Conclusions
Appetitive Aggression appears to be a resilience factor for negative long-term effects of combat experiences in perpetrators of violence. This result has practical relevance for preventing trauma-related mental suffering in Peace Corps and for designing adequate homecoming reception for veterans.
doi:10.1371/journal.pone.0050891
PMCID: PMC3521013  PMID: 23251398
2.  Post-combat syndromes from the Boer war to the Gulf war: a cluster analysis of their nature and attribution 
BMJ : British Medical Journal  2002;324(7333):321.
Objectives
To discover whether post-combat syndromes have existed after modern wars and what relation they bear to each other.
Design
Review of medical and military records of servicemen and cluster analysis of symptoms.
Data sources
Records for 1856 veterans randomly selected from war pension files awarded from 1872 and from the Medical Assessment Programme for Gulf war veterans.
Main outcome measures
Characteristic patterns of symptom clusters and their relation to dependent variables including war, diagnosis, predisposing physical illness, and exposure to combat; and servicemen's changing attributions for post-combat disorders.
Results
Three varieties of post-combat disorder were identified—a debility syndrome (associated with the 19th and early 20th centuries), somatic syndrome (related primarily to the first world war), and a neuropsychiatric syndrome (associated with the second world war and the Gulf conflict). The era in which the war occurred was overwhelmingly the best predictor of cluster membership.
Conclusions
All modern wars have been associated with a syndrome characterised by unexplained medical symptoms. The form that these assume, the terms used to describe them, and the explanations offered by servicemen and doctors seem to be influenced by advances in medical science, changes in the nature of warfare, and underlying cultural forces.
What is already known on this topicService in the Gulf war is associated with an increased rate of reported symptoms and worsening subjective healthPost-combat syndromes have been described after most modern conflicts from the US civil war onwardsWhat this study addsThere seems to be no single post-combat syndrome but a number of variations on a themeThe ever changing form of post-combat syndromes seems to be related to advances in medical understanding, the developing nature of warfare, and cultural undercurrentsBecause reported symptoms are subject to bias and changing emphasis related to advances in medical science or the discovery of new diseases, the characterisation of individual syndromes has to be treated with cautionAttributions by servicemen are generally consistent with symptom characteristics, though there seems to be a growing reluctance to consider the stress of military service as a cause
PMCID: PMC65292  PMID: 11834557
3.  Antarctica’s Protected Areas Are Inadequate, Unrepresentative, and at Risk 
PLoS Biology  2014;12(6):e1001888.
Global comparisons show that Antarctica's terrestrial biodiversity is poorly protected. Existing protected areas are inadequate, unrepresentative, and threatened by increasing human activity.
Antarctica is widely regarded as one of the planet's last true wildernesses, insulated from threat by its remoteness and declaration as a natural reserve dedicated to peace and science. However, rapidly growing human activity is accelerating threats to biodiversity. We determined how well the existing protected-area system represents terrestrial biodiversity and assessed the risk to protected areas from biological invasions, the region's most significant conservation threat. We found that Antarctica is one of the planet's least protected regions, with only 1.5% of its ice-free area formally designated as specially protected areas. Five of the distinct ice-free ecoregions have no specially designated areas for the protection of biodiversity. Every one of the 55 designated areas that protect Antarctica's biodiversity lies closer to sites of high human activity than expected by chance, and seven lie in high-risk areas for biological invasions. By any measure, including Aichi Target 11 under the Convention on Biological Diversity, Antarctic biodiversity is poorly protected by reserves, and those reserves are threatened.
doi:10.1371/journal.pbio.1001888
PMCID: PMC4060989  PMID: 24936869
4.  Good Fences: The Importance of Setting Boundaries for Peaceful Coexistence 
PLoS ONE  2014;9(5):e95660.
We consider the conditions of peace and violence among ethnic groups, testing a theory designed to predict the locations of violence and interventions that can promote peace. Characterizing the model's success in predicting peace requires examples where peace prevails despite diversity. Switzerland is recognized as a country of peace, stability and prosperity. This is surprising because of its linguistic and religious diversity that in other parts of the world lead to conflict and violence. Here we analyze how peaceful stability is maintained. Our analysis shows that peace does not depend on integrated coexistence, but rather on well defined topographical and political boundaries separating groups, allowing for partial autonomy within a single country. In Switzerland, mountains and lakes are an important part of the boundaries between sharply defined linguistic areas. Political canton and circle (sub-canton) boundaries often separate religious groups. Where such boundaries do not appear to be sufficient, we find that specific aspects of the population distribution guarantee either sufficient separation or sufficient mixing to inhibit intergroup violence according to the quantitative theory of conflict. In exactly one region, a porous mountain range does not adequately separate linguistic groups and that region has experienced significant violent conflict, leading to the recent creation of the canton of Jura. Our analysis supports the hypothesis that violence between groups can be inhibited by physical and political boundaries. A similar analysis of the area of the former Yugoslavia shows that during widespread ethnic violence existing political boundaries did not coincide with the boundaries of distinct groups, but peace prevailed in specific areas where they did coincide. The success of peace in Switzerland may serve as a model to resolve conflict in other ethnically diverse countries and regions of the world.
doi:10.1371/journal.pone.0095660
PMCID: PMC4029557  PMID: 24847861
5.  Real Time Dynamic Imaging and Current Targeted Therapies in the War on Cancer: A New Paradigm 
Theranostics  2013;3(6):437-447.
In biology, as every science student is made to learn, ontology recapitulates phylogeny. In medicine, however, oncology recapitulates polemology, the science of warfare: The medical establishment is transitioning from highly toxic poisons that kill rapidly dividing normal and malignant cells with little specificity to tailored therapies that target the tumors with the lethality of the therapeutic warhead. From the advent of the information age with the incorporation of high-tech intelligence, reconnaissance, and surveillance has resulted in "data fusion" where a wide range of information collected in near real-time can be used to redesign most of the treatment strategies currently used in the clinic. The medical community has begun to transition from the 'black box' of tumor therapy based solely on the clinical response to the 'glass box' of dynamic imaging designed to bring transparency to the clinical battlefield during treatment, thereby informing the therapeutic decision to 'retreat or repeat'. The tumor microenvironment is dynamic, constantly changing in response to therapeutic intervention, and therefore the therapeutic assessment must map to this variable and ever-changing landscape with dynamic and non-static imaging capabilities. The path to personalized medicine will require incorporation and integration of dynamic imaging at the bedside into clinical practice for real-time, interactive assessment of response to targeted therapies. The application of advanced real time imaging techniques along with current molecularly targeted anticancer therapies which alter cellular homeostasis and microenvironment can enhance therapeutic interventions in cancer patients and further improve the current status in clinical management of patients with advanced cancers.
doi:10.7150/thno.5658
PMCID: PMC3677414  PMID: 23781290
Cancer; microRNA; cancer therapy; imaging; drug delivery.
6.  War of Ontology Worlds: Mathematics, Computer Code, or Esperanto? 
PLoS Computational Biology  2011;7(9):e1002191.
The use of structured knowledge representations—ontologies and terminologies—has become standard in biomedicine. Definitions of ontologies vary widely, as do the values and philosophies that underlie them. In seeking to make these views explicit, we conducted and summarized interviews with a dozen leading ontologists. Their views clustered into three broad perspectives that we summarize as mathematics, computer code, and Esperanto. Ontology as mathematics puts the ultimate premium on rigor and logic, symmetry and consistency of representation across scientific subfields, and the inclusion of only established, non-contradictory knowledge. Ontology as computer code focuses on utility and cultivates diversity, fitting ontologies to their purpose. Like computer languages C++, Prolog, and HTML, the code perspective holds that diverse applications warrant custom designed ontologies. Ontology as Esperanto focuses on facilitating cross-disciplinary communication, knowledge cross-referencing, and computation across datasets from diverse communities. We show how these views align with classical divides in science and suggest how a synthesis of their concerns could strengthen the next generation of biomedical ontologies.
doi:10.1371/journal.pcbi.1002191
PMCID: PMC3182873  PMID: 21980276
7.  The China PEACE (Patient-centered Evaluative Assessment of Cardiac Events) Retrospective Study of Acute Myocardial Infarction: Study Design China PEACE-Retrospective AMI Study Design 
Background
Cardiovascular diseases are rising as a cause of death and disability in China. To improve outcomes for patients with these conditions, the Chinese government, academic researchers, clinicians, and more than 200 hospitals have created China Patient-centered Evaluative Assessment of Cardiac Events (China-PEACE), a national network for research and performance improvement. The first study from China PEACE, the Retrospective Study of Acute Myocardial Infarction (China PEACE-Retrospective AMI Study), is designed to promote improvements in AMI quality of care by generating knowledge about the characteristics, treatments, and outcomes of patients hospitalized with acute myocardial infarction (AMI) across a representative sample of Chinese hospitals over the last decade.
Methods and Results
The China PEACE-Retrospective AMI Study will examine more than 18,000 patient records from 162 hospitals identified using a 2-stage cluster sampling design within economic-geographic regions. Records were chosen from 2001, 2006, and 2011 to identify temporal trends. Data quality will be monitored by a central coordinating center and will, in particular, address case ascertainment, data abstraction, and data management. Analyses will examine patient characteristics, diagnostic testing patterns, in-hospital treatments, in-hospital outcomes, and variation in results by time and site of care. In addition to publications, data will be shared with participating hospitals and the Chinese government to develop strategies to promote quality improvement.
Conclusions
The China PEACE-Retrospective AMI Study is the first to leverage the China PEACE platform to better understand AMI across representative sites of care and over the last decade in China. The China PEACE collaboration between government, academicians, clinicians and hospitals is poised to translate research about trends and patterns of AMI practices and outcomes into improved care for patients.
doi:10.1161/CIRCOUTCOMES.113.000441
PMCID: PMC4054693  PMID: 24221838
myocardial infarction; epidemiology; morbidity; mortality
8.  Age-specific mortality patterns in Central Mozambique during and after the end of the Civil War 
Background
In recent years, vigorous debate has developed concerning how conflicts contribute to the spread of infectious diseases, and in particular, the role of post-conflict situations in the epidemiology of HIV/AIDS. This study details the age-specific mortality patterns among the population in the central provincial capital of Beira, Mozambique, during and after the Mozambican civil war which ended in 1992.
Methods
Data was collected from the death register at Beira's Central Hospital between 1985 and 2003 and descriptively analyzed.
Results
The data show two distinct periods: before and after the peace agreements in 1992. Before 1992 (during the civil war), the main impact of mortality was on children below 5 years of age, including still births, accounting for 58% of all deaths. After the war ended in 1992, the pattern shifted dramatically and rapidly to the 15-49 year old age group which accounted for 49% of all deaths by 2003.
Conclusions
As under-5 mortality rates were decreasing at the end of the conflict, rates for 24-49 year old adults began to dramatically increase due to AIDS. This study demonstrates that strategies can be implemented during conflicts to decrease mortality rates in one vulnerable population but post-conflict dynamics can bring together other factors which contribute to the rapid spread of other infectious diseases in other vulnerable populations.
doi:10.1186/1752-1505-5-8
PMCID: PMC3118347  PMID: 21615947
9.  Preventing Nuclear War: What Physicians Can Achieve 
Canadian Family Physician  1986;32:163-166.
On its fifth anniversary, the International Physicians for the Prevention of Nuclear War was awarded the Nobel Peace Prize. The organization was conceived by two Boston cardiologists who joined with some Soviet colleagues to create an international forum for considering the medical consequences of and means for preventing nuclear war. This article by the organization's archivist documents its difficult progress yet remarkable growth. Overcoming serious obstacles has added to its strength and credibility: now involving organizations with 145,000 members in 41 countries, IPPNW has become the international voice of medicine's concern about nuclear war.
PMCID: PMC2327601  PMID: 21274253
Nuclear war; prevention; physicians
10.  Comparative audit of blood transfusion during war and peace in Sarajevo. 
A comparative study was made between 146 patients receiving blood transfusion at the State Hospital, Sarajevo, in a 3-month period of peace (group 1) and 250 patients receiving transfusions in a 3-month period of war (group 2). In group 1, trauma accounted for only 7% of transfusions while it accounted for 99% in group 2. The threshold for transfusion was increased in war and the mean pretransfusion haematocrit in group 2 was 21%, compared with 27% in group 1 (P < 0.001). Less blood was also transfused per patient in war with a mean transfusion volume of 1.1 units in group 2 compared with 2.6 units in group 1 (P < 0.001). The reasons and justification for such a conservative transfusion practice in a besieged city are discussed.
PMCID: PMC2502681  PMID: 8659976
11.  Physical and Mental Health Costs of Traumatic War Experiences Among Civil War Veterans 
Archives of general psychiatry  2006;63(2):193-200.
Context
Hundreds of thousands of soldiers face exposure to combat during wars across the globe. The health impact of traumatic war experiences has not been adequately assessed across the lifetime of these veterans.
Objective
Identify the role of traumatic war experiences in predicting post-war nervous and physical disease and mortality using archival data from military and medical records of veterans from the Civil War.
Design
An archival examination of military and medical records of Civil War veterans was conducted. Degree of trauma experienced (POW experience, percentage of company killed, being wounded, early age at enlistment), signs of lifetime physician-diagnosed disease, and age at death were recorded.
Setting and Participants
US Pension board surgeons conducted standardized medical examinations of Civil War veterans over their post-war lifetimes. Military records of 17,700 Civil War veterans were matched to post-war medical records.
Main Outcome Measures
Signs of physician-diagnosed disease including cardiac, gastrointestinal (GI), and nervous disease, and number of unique ailments within each disease; mortality.
Results
Military trauma was related to signs of disease and mortality. Greater percentage of company killed was associated with signs of post-war cardiac and GI disease (IRR=1.34, p<.02), co-morbid nervous and physical disease (IRR=1.51, p<.005), and greater number of unique ailments within each disease (IRR=1.14, p<.01). Younger soldiers (≤18 years old), compared to older enlistees (> 30 years old), showed higher mortality risk (HR=1.52, p<.005), signs of co-morbid nervous and physical disease (IRR=1.93, p<.005), and a greater number of unique ailments within each disease (IRR=1.32, p<.005), controlling for length of time lived and other covariates.
Conclusions
Greater exposure to death of military comrades and younger exposure to war trauma was related to signs of physician-diagnosed cardiac, GI and nervous disease, and a greater number of unique disease ailments across the life of Civil War veterans. Physiological mechanisms by which trauma might result in disease are discussed.
doi:10.1001/archpsyc.63.2.193
PMCID: PMC1586122  PMID: 16461863
combat exposure; Civil War Veterans; war trauma; physical health; mental health
12.  Children and war: the work of the Children and War Foundation 
European Journal of Psychotraumatology  2013;4:10.3402/ejpt.v4i0.18424.
The Children and War Foundation was established after the authors’ experiences following the civil war in former Yugoslavia in the mid-1990s. Many organizations tried to mitigate the effects of the war on children but few interventions were based on evidence and fewer were properly evaluated. The Foundation was established in Norway with the aim of promoting better evidence-based interventions to help children after wars and natural disasters.
The Foundation has developed a number of empirically grounded manuals that aim to help children learn strategies that will lessen the stress reactions that they have developed. The manuals are designed to be delivered by personnel who are not necessarily very experienced in child mental health. They are aimed at groups of children using a public health approach to reach large numbers in a short space of time. The strategies are not intended as individual therapy.
The Teaching Recovery Techniques manual has been used following a number of earthquakes and other natural disasters and data from a number of these will be discussed. A Writing for Recovery manual is aimed at helping adolescents and is based on the seminal work of James Pennebaker. It is currently being evaluated in three separate studies. A group-based manual to help children bereaved by war or disaster has recently been developed.
doi:10.3402/ejpt.v4i0.18424
PMCID: PMC3547281  PMID: 23330058
Children; war; disasters; evidence-based interventions
13.  Prevalence of Gulf war veterans who believe they have Gulf war syndrome: questionnaire study 
BMJ : British Medical Journal  2001;323(7311):473-476.
Objectives
To determine how many veterans in a random sample of British veterans who served in the Gulf war believe they have “Gulf war syndrome,” to examine factors associated with the presence of this belief, and to compare the health status of those who believe they have Gulf war syndrome with those who do not.
Design
Questionnaire study asking British Gulf war veterans whether they believe they have Gulf war syndrome and about symptoms, fatigue, psychological distress, post-traumatic stress, physical functioning, and their perception of health.
Participants
2961 respondents to questionnaires sent out to a random sample of 4250 Gulf war veterans (69.7%).
Main outcome measure
The proportion of veterans who believe they have Gulf war syndrome.
Results
Overall, 17.3% (95% confidence interval 15.9 to 18.7) of the respondents believed they had Gulf war syndrome. The belief was associated with the veteran having poor health, not serving in the army when responding to the questionnaire, and having received a high number of vaccinations before deployment to the Gulf. The strongest association was knowing another person who also thought they had Gulf war syndrome.
Conclusions
Substantial numbers of British Gulf war veterans believe they have Gulf war syndrome, which is associated with psychological distress, a high number of symptoms, and some reduction in activity levels. A combination of biological, psychological, and sociological factors are associated with the belief, and these factors should be addressed in clinical practice.
What is already known on this topicThe term Gulf war syndrome has been used to describe illnesses and symptoms experienced by veterans of the 1991 Gulf warConcerns exist over the validity of Gulf war syndrome as a unique entityWhat this study adds17% of Gulf war veterans believe they have Gulf war syndromeHolding the belief is associated with worse health outcomesKnowing someone else who believes they have Gulf war syndrome and receiving more vaccinations were associated with holding the belief
PMCID: PMC48129  PMID: 11532836
14.  ‘Peace’ and ‘life worthwhile’ as measures of spiritual well-being in African palliative care: a mixed-methods study 
Background
Patients with incurable, progressive disease receiving palliative care in sub-Saharan Africa experience high levels of spiritual distress with a detrimental impact on their quality of life. Locally validated measurement tools are needed to identify patients’ spiritual needs and evaluate and improve spiritual care, but up to now such tools have been lacking in Africa. The African Palliative Care Association (APCA) African Palliative Outcome Scale (POS) contains two items relating to peace and life worthwhile. We aimed to determine the content and construct validity of these items as measures of spiritual wellbeing in African palliative care populations.
Methods
The study was conducted at five palliative care services, four in South Africa and one in Uganda. The mixed-methods study design involved: (1) cognitive interviews with 72 patients, analysed thematically to explore the items’ content validity, and (2) quantitative data collection (n = 285 patients) using the POS and the Spirit 8 to assess construct validity.
Results
(1) Peace was interpreted according to the themes ‘perception of self and world’, ‘relationship to others’, ‘spiritual beliefs’ and ‘health and healthcare’. Life worthwhile was interpreted in relation to ‘perception of self and world’, ‘relationship to others’ and ‘identity’. (2) Conceptual convergence and divergence were also evident in the quantitative data: there was moderate correlation between peace and Spirit 8 spiritual well-being (r = 0.46), but little correlation between life worthwhile and Spirit 8 spiritual well-being (r = 0.18) (both p < 0.001). Correlations with Spirit 8 items were weak to moderate.
Conclusions
Findings demonstrate the utility of POS items peace and life worthwhile as distinct but related measures of spiritual well-being in African palliative care. Peace and life worthwhile are brief and simple enough to be integrated into routine practice and can be used to measure this important but neglected outcome in this population.
doi:10.1186/1477-7525-11-94
PMCID: PMC3687576  PMID: 23758738
Outcome measurement; Spiritual well-being; Content validity; Construct validity; Sub-Saharan Africa; Palliative care
15.  Incidence of weapon injuries not related to interfactional combat in Afghanistan in 1996: prospective cohort study 
BMJ : British Medical Journal  1999;319(7207):415-417.
Objective
To examine the descriptive epidemiology of weapon injuries not directly attributable to combat during armed conflict.
Design
Prospective cohort study.
Setting
Nangarhar region of Afghanistan, which experienced effective peace, intense fighting, and then peace over six months in 1996.
Subjects
608 people admitted to Jalalabad hospital because of weapon injuries.
Main outcome measures
Estimated incidence of injuries from combat or otherwise (non-combat injury) before, during, and after the fall of Kabul.
Results
Incidence of non-combat injury was initially 65 per 100 000. During the intense military campaign for Kabul the incidence declined dramatically, and then differentially increased dependent on injury subcategory—that is, whether injuries were accidental or intentional and whether they were inflicted by firearms or fragmenting munitions. Non-combat injuries accounted for 51% of weapon injuries observed over the study period. Civilians were more likely to have non-combat injuries than combat injuries.
Conclusions
Weapon injuries that are not attributable to combat are common. Social changes accompanying conflict and widespread availability of weapons may be predictive of use of weapons that persists independently of conflict.
Key messagesA region in Afghanistan experienced peace, intense combat, and then peace in 1996During peace the incidence of injury from weapons was high, the incidence of injury from firearms being similar to that in the United StatesOver half of all weapon injuries were not attributable to interfactional combatWeapon availability and social breakdown accompanying conflict may be important factors in the occurrence of weapon injuries that persist independently of conflict
PMCID: PMC28196  PMID: 10445923
16.  Spiritual Well-Being and Depression in Patients with Heart Failure 
Background
In patients with chronic heart failure, depression is common and associated with poor quality of life, more frequent hospitalizations, and higher mortality. Spiritual well-being is an important, modifiable coping resource in patients with terminal cancer and is associated with less depression, but little is known about the role of spiritual well-being in patients with heart failure.
Objective
To identify the relationship between spiritual well-being and depression in patients with heart failure.
Design
Cross-sectional study.
Participants
Sixty patients aged 60 years or older with New York Heart Association class II–IV heart failure.
Measurements
Spiritual well-being was measured using the total scale and 2 subscales (meaning/peace, faith) of the Functional Assessment of Chronic Illness Therapy—Spiritual Well-being scale, depression using the Geriatric Depression Scale—Short Form (GDS-SF).
Results
The median age of participants was 75 years. Nineteen participants (32%) had clinically significant depression (GDS-SF > 4). Greater spiritual well-being was strongly inversely correlated with depression (Spearman’s correlation −0.55, 95% confidence interval −0.70 to −0.35). In particular, greater meaning/peace was strongly associated with less depression (r = −.60, P < .0001), while faith was only modestly associated (r = −.38, P < .01). In a regression analysis accounting for gender, income, and other risk factors for depression (social support, physical symptoms, and health status), greater spiritual well-being continued to be significantly associated with less depression (P = .05). Between the 2 spiritual well-being subscales, only meaning/peace contributed significantly to this effect (P = .02) and accounted for 7% of the variance in depression.
Conclusions
Among outpatients with heart failure, greater spiritual well-being, particularly meaning/peace, was strongly associated with less depression. Enhancement of patients’ sense of spiritual well-being might reduce or prevent depression and thus improve quality of life and other outcomes in this population.
doi:10.1007/s11606-006-0044-9
PMCID: PMC1829421  PMID: 17372795
heart failure; spirituality; depression; palliative care
17.  The Peaceful Mind Program: A Pilot Test of a CBT-Based Intervention for Anxious Patients with Dementia 
Objectives
To assess feasibility and to conduct a preliminary evaluation of outcomes following Peaceful Mind, a CBT-based intervention for anxiety in dementia, relative to usual care (UC).
Design
Pilot randomized controlled trial including assessments at baseline, 3 and 6 months
Setting
Houston, TX
Participants
32 outpatients diagnosed with mild (47%) or moderate (53%) dementia receiving care through outpatient clinics at the Veterans Affairs medical center, Baylor College of Medicine, Harris County Hospital District and community day centers for dementia, and their collaterals, who spent at least 8 hours a week with them.
Intervention
Peaceful Mind included up to 12 weekly in-home sessions (mean = 8.7, SD = 2.27) during the initial 3 months and up to eight brief telephone sessions (mean = 5.4, SD = 3.17) during months 3 to 6, involving self-monitoring for anxiety, deep breathing, and optional skills (coping self-statements, behavioral activation and sleep management). Patients learned skills, and collaterals served as coaches. In UC, patients received diagnostic feedback; and providers were informed of inclusion status.
Measurements
Neuropsychiatric Inventory-Anxiety subscale, Rating Anxiety in Dementia scale, Penn State Worry Questionnaire-Abbreviated, Geriatric Anxiety Inventory, Geriatric Depression Scale, Quality of Life in Alzheimer’s disease, Patient Health Questionnaire, Client Satisfaction Questionnaire
Results
Feasibility was demonstrated with regard to recruitment, attrition, and treatment characteristics. At 3 months, clinicians rated patients receiving Peaceful Mind as less anxious, and patients rated themselves as having higher quality of life; collaterals reported less distress related to loved ones’ anxiety. Although significant positive effects were not noted in other outcomes or at 6-month follow-up, the pilot nature of the trial prohibits conclusions about efficacy.
Conclusions
Results support that Peaceful Mind is ready for future comparative clinical trials.
doi:10.1016/j.jagp.2013.01.007
PMCID: PMC3411894  PMID: 23567399
anxiety; dementia; cognitive behavioral therapy; self-ratings; proxy ratings
18.  Spiritual Well-Being and Depression in Patients with Heart Failure 
Background
In patients with chronic heart failure, depression is common and associated with poor quality of life, more frequent hospitalizations, and higher mortality. Spiritual well-being is an important, modifiable coping resource in patients with terminal cancer and is associated with less depression, but little is known about the role of spiritual well-being in patients with heart failure.
Objective
To identify the relationship between spiritual well-being and depression in patients with heart failure.
Design
Cross-sectional study.
Participants
Sixty patients aged 60 years or older with New York Heart Association class II–IV heart failure.
Measurements
Spiritual well-being was measured using the total scale and 2 subscales (meaning/peace, faith) of the Functional Assessment of Chronic Illness Therapy—Spiritual Well-being scale, depression using the Geriatric Depression Scale—Short Form (GDS-SF).
Results
The median age of participants was 75 years. Nineteen participants (32%) had clinically significant depression (GDS-SF > 4). Greater spiritual well-being was strongly inversely correlated with depression (Spearman’s correlation −0.55, 95% confidence interval −0.70 to −0.35). In particular, greater meaning/peace was strongly associated with less depression (r = −.60, P < .0001), while faith was only modestly associated (r = −.38, P < .01). In a regression analysis accounting for gender, income, and other risk factors for depression (social support, physical symptoms, and health status), greater spiritual well-being continued to be significantly associated with less depression (P = .05). Between the 2 spiritual well-being subscales, only meaning/peace contributed significantly to this effect (P = .02) and accounted for 7% of the variance in depression.
Conclusions
Among outpatients with heart failure, greater spiritual well-being, particularly meaning/peace, was strongly associated with less depression. Enhancement of patients’ sense of spiritual well-being might reduce or prevent depression and thus improve quality of life and other outcomes in this population.
doi:10.1007/s11606-006-0044-9
PMCID: PMC1829421  PMID: 17372795
heart failure; spirituality; depression; palliative care
19.  Treatment of chronic hepatitis C in Croatian war veterans: experiences from Croatian reference center for viral hepatitis 
Croatian Medical Journal  2011;52(1):35-40.
Aim
To examine the risk factors, comorbidity, severity of liver disease, treatment course, and outcome in Croatian war veterans with chronic hepatitis C, especially those suffering from posttraumatic stress disorder (PTSD).
Methods
We collected medical records of 170 adult men diagnosed with chronic hepatitis C who started treatment with a combination of pegylated interferon-alpha and ribavirin between January 2003 and June 2009 at the Croatian Reference Centre for Viral Hepatitis.
Results
Participants’ mean age was 43 ± 9 years. Among 170 participants, there were 37 war veterans (22%). The main risk factor in veteran patients were operative procedures with transfusions (46% vs 5% in non-veterans; P < 0.001) and in non-veteran patients intravenous drug use (42.1% vs 13%; P < 0.001). The average duration of infection was longer in war veterans (14.5 ± 3.4 vs 12.2 ± 7.2 years; P = 0.020). The percentage of PTSD comorbidity in the whole group was 11% (18/170) and in the war veterans group 49% (18/37). The prevalence of sustained virological response in patients with PTSD was 50% and in patients without PTSD 56%. Treatment reduction in patients with PTSD (33%) was higher than in patients without PTSD (12%;P = 0.030).
Conclusion
Croatian war veterans are a group with high risk of chronic hepatitis C infection because many of them were wounded during the Croatian War 1991-1995. Considerations about PTSD as a contraindication for interferon treatment are unjustified. If treated, patients with PTSD have an equal chance of achieving sustained virological response as patients without PTSD.
doi:10.3325/cmj.2011.52.35
PMCID: PMC3046494  PMID: 21328718
20.  War-related stress exposure and mortality: a meta-analysis 
Background Domestic and international wars continue to be pervasive in the 21st century. This study summarizes the effects of war-related stress on all-cause mortality using meta-analyses and meta-regressions.
Methods A keyword search was performed, supplemented by extensive iterative hand-searches for observational studies of war-related stress and mortality. Two hundred and twenty mortality risk estimates from 30 studies were extracted, providing data on more than 9 million persons.
Results The mean hazard ratio (HR) was 1.05 [95% confidence interval (CI) 0.98–1.13] among HRs adjusted for age and additional covariates. The mean effect for men was 1.14 (CI 1.00–1.31), and for women it was 0.92 (CI 0.66–1.28). No differences were found for various follow-up durations or for various types of war stress. Neither civilians nor military personnel had an elevated mortality risk. Those exposed to a combat zone during the Vietnam War had a slightly higher chance of death (HR 1.11; 95% CI 1.00–1.23).
Conclusions The results show that, over all, exposure to war-stress did not increase the risk of death when studies were well controlled. Effects were small when found. This lack of substantial effect may be the result of selection processes, developed resiliency and/or institutional support.
doi:10.1093/ije/dyq132
PMCID: PMC2992629  PMID: 20724455
Meta-analysis; systematic review; psychological stress; combat-neurosis; mortality determinants
21.  Do childhood cognitive ability or smoking behaviour explain the influence of lifetime socio-economic conditions on premature adult mortality in a British post war birth cohort?☆ 
Social Science & Medicine (1982)  2009;68(9):1565-1573.
Poor childhood and adult socio-economic conditions, lower childhood cognitive ability and cigarette smoking are all associated with adult mortality risk. Using data on 4458 men and women aged 60 years from a British birth cohort study, we investigated the extent to which these risk factors are part of the same pathway linking childhood experience to adult survival. Compared with women from non-manual origins, men from non-manual origins, women and men from manual origins, and those with missing data on father's social class had about double the risk of mortality between 26 and 60 years. Cox proportional hazards models showed that these differences were reduced but remained significant after adjusting for childhood cognitive ability, adult socio-economic conditions and smoking. Higher childhood ability increased survival chances by securing better adult socio-economic conditions, such as home ownership, which was strongly associated with survival. These findings were similar for cardiovascular and cancer mortality.
doi:10.1016/j.socscimed.2009.02.006
PMCID: PMC3504657  PMID: 19269077
Mortality; Socio-economic conditions; Childhood cognitive ability; Cigarette smoking; Birth cohort study; Life course; UK
22.  The real war on cancer: the evolutionary dynamics of cancer suppression 
Evolutionary Applications  2012;6(1):11-19.
Cancer is a disease of multicellular animals caused by unregulated cell division. The prevailing model of cancer (multistage carcinogenesis) is based on the view that cancer results after a series of (generally somatic) mutations that knock out the genetic mechanisms suppressing unregulated cell growth. The chance of these mutations occurring increases with size and longevity, leading to Peto's paradox: why don't large animals have a higher lifetime incidence of cancer than small animals? The solution to this paradox is evolution. From an evolutionary perspective, an increasing frequency of prereproductive cancer deaths results in natural selection for enhanced cancer suppression. The expected result is a prereproductive risk of cancer across species that is independent of life history. However, within species, we still expect cancer risk to increase with size and longevity. Here, I review the evolutionary model of cancer suppression and some recent empirical evidence supporting it. Data from humans and domestic dogs confirm the expected intraspecific association between size and cancer risk, while results from interspecific comparisons between rodents provide the best evidence to date of the predicted recruitment of additional cancer suppression mechanisms as species become larger or longer lived.
doi:10.1111/eva.12018
PMCID: PMC3567467  PMID: 23396311
adaptation; comparative biology; evolutionary medicine; evolutionary theory
23.  Chemotherapy and Oncolytic Virotherapy: Advanced Tactics in the War against Cancer 
Frontiers in Oncology  2014;4:145.
Cancer is a traitorous archenemy that threatens our survival. Its ability to evade detection and adapt to various cancer therapies means that it is a moving target that becomes increasingly difficult to attack. Through technological advancements, we have developed sophisticated weapons to fight off tumor growth and invasion. However, if we are to stand a chance in this war against cancer, advanced tactics will be required to maximize the use of our available resources. Oncolytic viruses (OVs) are multi-functional cancer-fighters that can be engineered to suit many different strategies; in particular, their retooling can facilitate increased capacity for direct tumor killing (oncolytic virotherapy) and elicit adaptive antitumor immune responses (oncolytic immunotherapy). However, administration of these modified OVs alone, rarely induces successful regression of established tumors. This may be attributed to host antiviral immunity that acts to eliminate viral particles, as well as the capacity for tumors to adapt to therapeutic selective pressure. It has been shown that various chemotherapeutic drugs with distinct functional properties can potentiate the antitumor efficacy of OVs. In this review, we summarize the chemotherapeutic combinatorial strategies used to optimize virally induced destruction of tumors. With a particular focus on pharmaceutical immunomodulators, we discuss how specific therapeutic contexts may alter the effects of these synergistic combinations and their implications for future clinical use.
doi:10.3389/fonc.2014.00145
PMCID: PMC4052116  PMID: 24967214
oncolytic virotherapy; cancer immunotherapy; cancer vaccines; combination therapy; drug therapy; combination; oncolytic viruses
24.  The Falklands war--triage. 
In order to provide first class treatment for casualties in the recent Falklands war it was necessary to apply rigid rules. Those who required treatment most urgently received earlier resuscitative and surgical care to give the best possible chance of good quality survival. The concept of Triage was applied at every level of medical care but was found to be most crucial at surgical centres. The dynamic nature of the Triage system was noted. Patients required constant reassessment and updating by experienced well trained teams. The system worked well. The success in employing resuscitation trained dental officers in the Triage role was particularly worth noting.
PMCID: PMC2492553  PMID: 6721408
25.  The Global Coherence Initiative: Creating a Coherent Planetary Standing Wave 
ABSTRACT
The much anticipated year of 2012 is now here. Amidst the predictions and cosmic alignments that many are aware of, one thing is for sure: it will be an interesting and exciting year as the speed of change continues to increase, bringing both chaos and great opportunity. One benchmark of these times is a shift in many people from a paradigm of competition to one of greater cooperation. All across the planet, increasing numbers of people are practicing heart-based living, and more groups are forming activities that support positive change and creative solutions for manifesting a better world. The Global Coherence Initiative (GCI) is a science-based, co-creative project to unite people in heart-focused care and intention. GCI is working in concert with other initiatives to realize the increased power of collective intention and consciousness.
The convergence of several independent lines of evidence provides strong support for the existence of a global information field that connects all living systems and consciousness. Every cell in our bodies is bathed in an external and internal environment of fluctuating invisible magnetic forces that can affect virtually every cell and circuit in biological systems. Therefore, it should not be surprising that numerous physiological rhythms in humans and global collective behaviors are not only synchronized with solar and geomagnetic activity, but disruptions in these fields can create adverse effects on human health and behavior.
The most likely mechanism for explaining how solar and geomagnetic influences affect human health and behavior are a coupling between the human nervous system and resonating geomagnetic frequencies, called Schumann resonances, which occur in the earth-ionosphere resonant cavity and Alfvén waves. It is well established that these resonant frequencies directly overlap with those of the human brain and cardiovascular system. If all living systems are indeed interconnected and communicate with each other via biological, electromagnetic, and nonlocal fields, it stands to reason that humans can work together in a co-creative relationship to consciously increase the coherence in the global field environment, which in turn distributes this information to all living systems within the field.
GCI was established to help facilitate the shift in global consciousness from instability and discord to balance, cooperation, and enduring peace. A primary goal of GCI is to test the hypothesis that large numbers of people when in a heart-coherent state and holding a shared intention can encode information on the earth's energetic and geomagnetic fields, which act as carrier waves of this physiologically patterned and relevant information. In order to conduct this research, a global network of 12 to 14 ultrasensitive magnetic field detectors specifically designed to measure the earth's magnetic resonances is being installed strategically around the planet. More important is GCI's primary goal to motivate as many people as possible to work together in a more coherent and collaborative manner to increase the collective human consciousness.
If we are persuaded that not only external fields of solar and cosmic origins but also human attention and emotion can directly affect the physical world and the mental and emotional states of others (consciousness), it broadens our view of what interconnectedness means and how it can be intentionally utilized to shape the future of the world we live in. It implies that our attitudes, emotions, and intentions matter and that coherent, cooperative intent can have positive effects.
GCI hypothesizes that when enough individuals and social groups increase their coherence baseline and utilize that increased coherence to intentionally create a more coherent standing reference wave in the global field, it will help increase global consciousness. This can be achieved when an increasing number of people move towards more balanced and self-regulated emotions and responses. This in turn can help facilitate cooperation and collaboration in innovative problem solving and intuitive discernment for addressing society's significant social, environmental, and economic problems. In time, as more individuals stabilize the global field and families, workplaces, and communities move to increased social coherence, it will lead to increased global coherence. This will be indicated by countries adopting a more coherent planetary view so that social and economic oppression, warfare, cultural intolerance, crime, and disregard for the environment can be addressed meaningfully and successfully.
doi:10.7453/gahmj.2012.1.1.013
PMCID: PMC3833489  PMID: 24278803
Global Coherence Initiative; geomagnetic; Schumann resonances; coherence; heart-based living; global health

Results 1-25 (195131)