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1.  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.
PMCID: PMC3547281  PMID: 23330058
Children; war; disasters; evidence-based interventions
2.  Symptoms and medical conditions in Australian veterans of the 1991 Gulf War: relation to immunisations and other Gulf War exposures 
Aims: To investigate whether Australian Gulf War veterans have a higher than expected prevalence of recent symptoms and medical conditions that were first diagnosed in the period following the 1991 Gulf War; and if so, whether these effects were associated with exposures and experiences that occurred in the Gulf War.
Methods: Cross-sectional study of 1456 Australian Gulf War veterans and a comparison group who were in operational units at the time of the Gulf War, but were not deployed to that conflict (n = 1588). A postal questionnaire was administered and the likelihood of the diagnosis of self-reported medical conditions was assessed and rated by a medical practitioner.
Results: Gulf War veterans had a higher prevalence of all self-reported health symptoms than the comparison group, and more of the Gulf War veterans had severe symptoms. Increased symptom reporting was associated with several exposures, including having more than 10 immunisations, pyridostigmine bromide tablets, anti-biological warfare tablets, pesticides, insect repellents, reportedly being in a chemical weapons area, and stressful military service experiences in a strong dose-response relation. Gulf War veterans reported psychological (particularly post-traumatic stress disorder), skin, eye, and sinus conditions first diagnosed in 1991 or later more commonly than the comparison group. Over 90% of medical conditions reported by both study groups were rated by a medical practitioner as having a high likelihood of diagnosis.
Conclusion: More than 10 years after the 1991 Gulf War, Australian veterans self-report all symptoms and some medical conditions more commonly than the comparison group. Further analysis of the severity of symptoms and likelihood of the diagnosis of medical conditions suggested that these findings are not due to over-reporting or to participation bias.
PMCID: PMC1740679  PMID: 15550607
3.  Remains of War: Walt Whitman, Civil War Soldiers, and the Legacy of Medical Collections 
Museum history journal  2012;5(1):7-28.
The National Museum of Health and Medicine holds a collection of anatomical specimens from nearly 2,000 soldiers injured during the American Civil War. Originally collected as part of a study of trauma and disease during war, these specimens have been museum artifacts for over 140 years. During this time, they have been displayed and utilized in an array of interpretative strategies. They have functioned as medical specimens documenting the effects of gunshot wounds and infection to the human body, as mementos mori symbolizing the refuse of a nation divided by war, and as objects of osteological and forensic interest. The museum’s curators recently discovered four of these specimens from soldiers who the poet and essayist Walt Whitman nursed in the wartime hospitals of Washington, DC. Uniting these remains with Whitman’s words yields a new interpretation that bears witness to individual histories during a time of unprecedented conflict in American history.
PMCID: PMC3381362  PMID: 22741042
4.  Social and environmental factors in lung cancer mortality in post-war Poland. 
Poland and other Eastern European countries have undergone heavy industrial development with marked increases in air pollution and occupational exposure in the nearly 50 years since World War II. These countries have also experienced substantial increases in chronic disease mortality in the past three decades. While it is tempting to assume a direct association between these phenomena, more detailed analyses are called for. Poland offers a potentially rich opportunity for comparing geographical patterns of disease incidence and of industrial change. In this paper we 1) elucidate the prospects for attributing lung cancer mortality to industrial emissions in Poland, using an ecological approach based on the hitherto unaddressed geographic differences, and accounting for regional differences in cigarette consumption; 2) propose explanatory hypotheses for the observed geographic heterogeneity of lung cancer; 3) begin systematic testing of the widely accepted but not well-scrutinized notion that pollution in Poland is a major contributor to declining life expectancy. Regions with the highest fraction of cancer that cannot be explained by smoking appear to be highly urbanized, have high population exposure to occupational carcinogens, experience the highest rates of alcoholism and crime, and are associated with the post- World War II population resettlement. Although the analysis does not rule out pollution as a significant contributor to lung cancer mortality, it indicates that other factors such as occupational exposures and various social factors are of at least comparable importance.(ABSTRACT TRUNCATED AT 250 WORDS)
PMCID: PMC1519032  PMID: 7628428
5.  Compensating for cold war cancers. 
Environmental Health Perspectives  2002;110(7):A404-A407.
Although the Cold War has ended, thousands of workers involved in nuclear weapons production are still living with the adverse health effects of working with radioactive materials, beryllium, and silica. After a series of court battles, the U.S. government passed the Energy Employees Occupational Illness Act in October 2000 to financially assist workers whose health has been compromised by these occupational exposures. Now work is underway to set out guidelines for determining which workers will be compensated. The National Institute for Occupational Safety and Health has been assigned the task of developing a model that can scientifically make these determinations, a heavy task considering the controversies that lie in estimating low-level radiation risks and the inadequate worker exposure records kept at many of the plants.
PMCID: PMC1240926  PMID: 12117658
6.  Gulf war illness—better, worse, or just the same? A cohort study 
BMJ : British Medical Journal  2003;327(7428):1370.
Objectives Firstly, to describe changes in the health of Gulf war veterans studied in a previous occupational cohort study and to compare outcome with comparable non-deployed military personnel. Secondly, to determine whether differences in prevalence between Gulf veterans and controls at follow up can be explained by greater persistence or greater incidence of disorders.
Design Occupational cohort study in the form of a postal survey.
Participants Military personnel who served in the 1991 Persian Gulf war; personnel who served on peacekeeping duties to Bosnia; military personnel who were deployed elsewhere (“Era” controls). All participants had responded to a previous survey.
Setting United Kingdom.
Main outcome measures Self reported fatigue measured on the Chalder fatigue scale; psychological distress measured on the general health questionnaire, physical functioning and health perception on the SF-36; and a count of physical symptoms.
Results Gulf war veterans experienced a modest reduction in prevalence of fatigue (48.8% at stage 1, 43.4% at stage 2) and psychological distress (40.0% stage 1, 37.1% stage 2) but a slight worsening of physical functioning on the SF-36 (90.3 stage 1, 88.7 stage 2). Compared with the other cohorts Gulf veterans continued to experience poorer health on all outcomes, although physical functioning also declined in Bosnia veterans. Era controls showed both lower incidence of fatigue than Gulf veterans, and both comparison groups showed less persistence of fatigue compared with Gulf veterans.
Conclusions Gulf war veterans remain a group with many symptoms of ill health. The excess of illness at follow up is explained by both higher incidence and greater persistence of symptoms.
PMCID: PMC292982  PMID: 14670878
7.  Ontario's accelerated war against Medicare misuse another sign of leaner health care times. 
A special-investigations unit is helping the Ontario Health Insurance Plan (OHIP) curb the fraud and abuse that has been draining millions of health care dollars from the province. The government is taking a tougher line on foreigners who use friends' or relatives' OHIP cards, people who use misplaced, stolen or counterfeit cards, and on snowbirds who deliberately bend residency requirements as they try to hang on to medicare benefits. In 1994-95, Ontario spent $74 million on health care for Ontarians travelling or living abroad.
PMCID: PMC1487640  PMID: 8630844
8.  Promoting Darfuri women’s psychosocial health: developing a war trauma counsellor training programme tailored to the person 
The EPMA Journal  2013;4(1):10.
Women are considered special groups who are uniquely vulnerable in the context of war exposures. To effectively target the resources aimed at mitigating mental health consequences and optimising and maximising the use of mental health provisions, culturally relevant war trauma counsellor training is required. The objectives of this study are to promote a new philosophy in the Sudanese mental health care by introducing an integrative approach for targeted prevention and tailored treatments to the Darfuri person in a cost-effective way. Furthermore, the study provides evidence- and theory-based guidelines for developing a war trauma counsellor training programme in Sudan, mainly based on qualitative and quantitative studies among war-affected Darfuri female students. Cultural conceptualisations such as gender roles and religious expectations as well as theories that emphasise resilience and other psychosocial adaptation skills have been operationalised to reflect the totality of the Darfuri women’s experiences. Furthermore, the results of four interrelated studies among war-traumatised undergraduate Darfuri women who are internally displaced provide the basis that guides an outline for qualification development, capacity building and skills consolidation among Sudanese mental health care providers. Explicit war-related psychosocial needs assessment tools, specific war-related trauma counsellor training and particular counsellor characteristics, qualities and awareness that pertain to strengthening the efficacy of war trauma Sudanese counsellors are recommended. The aim is to produce expertly trained war trauma counsellors working with war-affected Darfuri women in particular and with regards to their helpfulness in responding to the psychosocial needs of war-exposed Sudanese in general.
PMCID: PMC3623904  PMID: 23531430
Darfuri women; Psychosocial war-related needs assessment; Counsellor training; Trauma counsellor characteristics; Contextual-theoretical framework; Targeted prevention; Tailored therapy
9.  The challenges of exposure assessment in health studies of Gulf War veterans 
A variety of exposures have been investigated in Gulf War veterans' health studies. These have most commonly been by self-report in a postal questionnaire but modelling and bio-monitoring have also been employed. Exposure assessment is difficult to do well in studies of any workplace environment. It is made more difficult in Gulf War studies where there are a number and variety of possible exposures, no agreed metrics for individual exposures and few contemporary records associating the exposure with an individual. In some studies, the exposure assessment was carried out some years after the war and in the context of media interest. Several studies have examined different ways to test the accuracy of exposure reporting in Gulf War cohorts. There is some evidence from Gulf War studies that self-reported exposures were subject to recall bias but it is difficult to assess the extent. Occupational exposure-assessment methodology can provide insights into the exposure-assessment process and how to do it well. This is discussed in the context of the Gulf War studies. Alternative exposure-assessment methodologies are presented, although these may not be suitable for widespread use in veteran studies. Due to the poor quality of and accessibility of objective military exposure records, self-assessed exposure questionnaires are likely to remain the main instrument for assessing the exposure for a large number of veterans. If this is to be the case, then validation methods with more objective methods need to be included in future study designs.
PMCID: PMC1569629  PMID: 16687267
Gulf war veterans; exposure; chemical warfare; uranium
10.  Influence of personal and environmental factors on mental health in a sample of Austrian survivors of World War II with regard to PTSD: is it resilience? 
BMC Psychiatry  2013;13:47.
War-related traumata in childhood and young-adulthood may have long-lasting negative effects on mental health. The focus of recent research has shifted to examine positive adaption despite traumatic experiences, i.e. resilience. We investigated personal and environmental factors associated with resilience in a sample of elderly Austrians (N = 293) who reported traumatic experiences in early life during World War II and subsequent occupation (1945–1955).
After reviewing different concepts of resilience, we analysed our data in a 3-phased approach: Following previous research approaches, we first investigated correlates of PTSD and non-PTSD. Secondly, we compared a PTSD positive sample (sub-threshold and full PTSD, n = 42) with a matched control sample regarding correlates of resilience and psychometrically assessed resilience (CD-RISC). Thirdly, we examined factors of resilience, discriminating between psychologically healthy participants who were exposed to a specific environmental stressor (having lived in the Soviet zone of occupation during 1945–1955) from those who were not.
A smaller number of life-time traumata (OR = 0.73) and a medium level of education (OR = 2.46) were associated with better outcome. Matched PTSD and non-PTSD participants differed in psychometrically assessed resilience mainly in aspects that were directly related to symptoms of PTSD. Psychologically healthy participants with an environmental stressor in the past were characterized by a challenge-oriented and humorous attitude towards stress.
Our results show no clear picture of factors constituting resilience. Instead, most aspects of resilience rather appeared to be concomitants or consequences of PTSD and non-PTSD. However, special attention should be placed on a challenge-oriented and humorous attitude towards stress in future definitions of resilience.
PMCID: PMC3598938  PMID: 23379932
11.  Tobacco wars: the bloody battle between good health and good politics 
A battle to introduce new antitobacco legislation in Canada has caused political battles within the Liberal Party. While one side is worried about the need to protect people's health, another is worried about the potential loss of jobs within the tobacco industry--many of which are located in politically volatile Quebec. Charlotte Gray writes about the machinations that led to the introduction of new smoking legislation in the House of Commons in November.
PMCID: PMC1226917  PMID: 9012729
12.  Perspectives of Radioactive Contamination in Nuclear War 
The degrees of risk associated with the medical, industrial and military employment of nuclear energy are compared. The nature of radioactive contamination of areas and of persons resulting from the explosion of nuclear weapons, particularly the relationship between the radiation exposure and the amount of physical debris, is examined.
Some theoretical examples are compared quantitatively. It is concluded that the amount of radio-activity that may be carried on the contaminated person involves a minor health hazard from gamma radiation, compared to the irradiation arising from contaminated areas.
PMCID: PMC1936905  PMID: 6015741
13.  Iatrogenic Blood-borne Viral Infections in Refugee Children from War and Transition Zones 
Emerging Infectious Diseases  2013;19(6):892-898.
Pediatric infectious disease clinicians in industrialized countries may encounter iatrogenically transmitted HIV, hepatitis B virus, and hepatitis C virus infections in refugee children from Central Asia, Southeast Asia, and sub-Saharan Africa. The consequences of political collapse and/or civil war—work migration, prostitution, intravenous drug use, defective public health resources, and poor access to good medical care—all contribute to the spread of blood-borne viruses. Inadequate infection control practices by medical establishments can lead to iatrogenic infection of children. Summaries of 4 cases in refugee children in Australia are a salient reminder of this problem.
PMCID: PMC3713815  PMID: 23739597
HIV; hepatitis B virus; hepatitis C virus; iatrogenic; children; war; pathogenesis; viruses; infections; transfusions
14.  Health care in Bosnia and Herzegovina before, during, and after 1992–1995 war: a personal testimony 
Market-based health care reform during democratic transition in Bosnia and Herzegovina was complicated by the 1992–1995 war, that devastated the country and greater part of its health care infrastructure. The course of the transition and consequences of war for the health system and health professionals are presented here from the perspective of the author. The description of real-life situations and their context is used to illustrate the problems physicians, as well as international community, were faced with and how they tried to cope with them during and after the war. Speaking openly about the mistakes that were made in those times is the first step in preventing them from happening again and an invitation for exchange of opinions and open academic discussion.
PMCID: PMC1890277  PMID: 17535419
15.  In the face of war: examining sexual vulnerabilities of Acholi adolescent girls living in displacement camps in conflict-affected Northern Uganda 
Adolescent girls are an overlooked group within conflict-affected populations and their sexual health needs are often neglected. Girls are disproportionately at risk of HIV and other STIs in times of conflict, however the lack of recognition of their unique sexual health needs has resulted in a dearth of distinctive HIV protection and prevention responses. Departing from the recognition of a paucity of literature on the distinct vulnerabilities of girls in time of conflict, this study sought to deepen the knowledge base on this issue by qualitatively exploring the sexual vulnerabilities of adolescent girls surviving abduction and displacement in Northern Uganda.
Over a ten-month period between 2004–2005, at the height of the Lord’s Resistance Army insurgency in Northern Uganda, 116 in-depth interviews and 16 focus group discussions were held with adolescent girls and adult women living in three displacement camps in Gulu district, Northern Uganda. The data was transcribed and key themes and common issues were identified. Once all data was coded the ethnographic software programme ATLAS was used to compare and contrast themes and categories generated in the in-depth interviews and focus group discussions.
Our results demonstrated the erosion of traditional Acholi mentoring and belief systems that had previously served to protect adolescent girls’ sexuality. This disintegration combined with: the collapse of livelihoods; being left in camps unsupervised and idle during the day; commuting within camp perimeters at night away from the family hut to sleep in more central locations due to privacy and insecurity issues, and; inadequate access to appropriate sexual health information and services, all contribute to adolescent girls’ heightened sexual vulnerability and subsequent enhanced risk for HIV/AIDS in times of conflict.
Conflict prevention planners, resettlement programme developers, and policy-makers need to recognize adolescent girls affected by armed conflict as having distinctive needs, which require distinctive responses. More adaptive and sustainable gender-sensitive reproductive health strategies and HIV prevention initiatives for displaced adolescent girls in conflict settings must be developed.
PMCID: PMC3536565  PMID: 23270488
Adolescent girls; Conflict; Sexual vulnerability; Displacement camps; Northern Uganda; Acholi; Qualitative; HIV/AIDS
Some hypothetical conclusions bearing on the evolution of cicatricial tissue can be suggested. The arterial circulation deposits in the wound chemical substances necessary for contraction of the wound and for epithelial proliferation. When the biologic process is not hindered by any special or severe bacterial infection this deposit is as regular as the circulation itself, and enables us to determine in advance the date of cicatrization. It even seems as though when the epidermization process is retarded by a slight infection the substances necessary for epidermization are stored up in the wound, and when the delay due to infection is removed the epithelium finds an accumulation of nutritive substances, and, so to speak, makes up the lost time. Moreover, when an infection entirely or partially stops epidermization, we have observed (Experiments 3, 4, and 5) that after the infection has disappeared the progress of new epidermization is much more rapid than normally; it even passes the calculated curve. The infection apparently destroyed only the epithelium and left in the wound the chemical substances which activate epidermization. The existence of these physical or chemical activating agents has been indicated again by two anatomical clinical facts. In treating a scalp wound in which there had been practically no epidermization for many months, we applied over the entire surface of the sterile wound dermo-epidermic grafts of fetal skin. After apparently taking, the grafts were absorbed and disappeared, but epidermization of the periphery of the wound, which hitherto had not progressed, took place abundantly, almost a hundred times as much as before. We believe that by mathematical measurements we can solve the problem of the action of various organic fluids on the cicatrization of wounds.
PMCID: PMC2125938  PMID: 19868199
17.  Cholera Epidemics, War and Disasters around Goma and Lake Kivu: An Eight-Year Survey 
During the last eight years, North and South Kivu, located in a lake area in Eastern Democratic Republic of Congo, have been the site of a major volcano eruption and of numerous complex emergencies with population displacements. These conditions have been suspected to favour emergence and spread of cholera epidemics.
Methodology/Principal Findings
In order to assess the influence of these conditions on outbreaks, reports of cholera cases were collected weekly from each health district of North Kivu (4,667,699 inhabitants) and South Kivu (4,670,121 inhabitants) from 2000 through 2007. A geographic information system was established, and in each health district, the relationships between environmental variables and the number of cholera cases were assessed using regression techniques and time series analysis. We further checked for a link between complex emergencies and cholera outbreaks. Finally, we analysed data collected during an epidemiological survey that was implemented in Goma after Nyiragongo eruption. A total of 73,605 cases and 1,612 deaths of cholera were reported. Time series decomposition showed a greater number of cases during the rainy season in South Kivu but not in North Kivu. Spatial distribution of cholera cases exhibited a higher number of cases in health districts bordering lakes (Odds Ratio 7.0, Confidence Interval range 3.8–12.9). Four epidemic reactivations were observed in the 12-week periods following war events, but simulations indicate that the number of reactivations was not larger than that expected during any random selection of period with no war. Nyiragongo volcanic eruption was followed by a marked decrease of cholera incidence.
Our study points out the crucial role of some towns located in lakeside areas in the persistence of cholera in Kivu. Even if complex emergencies were not systematically followed by cholera epidemics, some of them enabled cholera spreading.
Author Summary
With the number of cholera cases up to 73,000 during the last eight years and successive wars that have persisted for fifteen years, the North and South Kivu provinces of the Democratic Republic of Congo are currently heavily hit by both cholera outbreaks and war-related population displacements. Prior to this study, no research had been done to identify the sources of epidemics and the pathways used by cholera to spread throughout the Kivu provinces. Here we show that a few cities located on the lakeshore of Lake Kivu and Lake Tanganyika act as the main sources of cholera epidemics and that the number of cholera cases tends to increase during the rainy season. We also found that only a minority of population displacements were followed by cholera outbreaks. Finally, we think that the low number of cholera cases recorded after the Nyiragongo eruption is one more argument to implement programs aiming at restoring, and if possible improving, drinking water access following natural disasters
PMCID: PMC2677153  PMID: 19436726
18.  Effect of civil war on medical education in Liberia 
From 1980 to 2003 Liberia entered into a period of conflict and civil wars. During this time Liberia's health and educational services were severely disrupted. Equipment and supplies were stolen from the Medical School and the buildings damaged severely. A majority of health care workers, university faculty, and hospital and medical school administrators fled the country.
The objective of this study was to evaluate the impact of civil war on the training of medical students and physicians, and to identify a feasible intervention.
The authors compiled data from three sources at an Emergency Medicine symposium held at the A.M. Dogliotti School of Medicine, in Monrovia, Liberia, in September 2007. These were (1) data from 13 anonymous surveys completed by symposium participants who were physicians or physicians in training, and (2) answers from six open discussion groups at the symposium concerning perceived barriers to medical training. (3) Supporting documents volunteered by the Dean from interviews in 2002, 2007 and 2009 or published on line in 2002 and 2006 were incorporated, and a focused literature review was performed.
The 12 medical students and 1 physician who returned completed surveys and attended the symposium all reported a delay in their training, with 75% of respondents citing a past and current lack of Clinical and Basic Science faculty as a major delaying factor. The six open discussion groups at the symposium and the information provided by the Dean substantiated these findings.
Volunteer Basic Science and Clinical faculty for the medical school and teaching hospitals from a coalition of concerned partnering institutions would be a targeted intervention to assist in re-building the medical educational capacity of Liberia.
PMCID: PMC3051893  PMID: 21408002
19.  Wars and Child Health: Evidence from the Eritrean-Ethiopian Conflict * 
Journal of development economics  2012;99(2):330-340.
Conflict between and within countries can have lasting health and economic consequences, but identifying such effects can be empirically challenging. This paper uses household survey data from Eritrea to estimate the effect of exposure to the 1998–2000 Eritrea-Ethiopia war on children’s health. The identification strategy exploits exogenous variation in the conflict’s geographic extent and timing and the exposure of different birth cohorts to the fighting. The unique survey data include details on each household’s migration history, which allows us to measure a child’s geographic location during the war and without which war exposure would be incorrectly classified. War-exposed children have lower height-for-age Z-scores, with similar effects for children born before or during the war. Both boys and girls who are born during the war experience negative impacts due to conflict. Effects are robust to including region-specific time trends, alternative conflict exposure measures, and mother fixed effects.
PMCID: PMC3433062  PMID: 22962514
Child health; Conflict; Africa
20.  Rape in war: the humanitarian response 
Women and children are vulnerable to sexual violence in times of conflict, and the risk persists even after they have escaped the conflict area. The impact of rape goes far beyond the immediate effects of the physical attack and has long-lasting consequences. We describe the humanitarian community's response to sexual violence and rape in times of war and civil unrest by drawing on the experiences of Médecins Sans Frontières/Doctors Without Borders and other humanitarian agencies. Health care workers must have a keen awareness of the problem and be prepared to respond appropriately. This requires a comprehensive intervention protocol, including antibiotic prophylaxis, emergency contraception, referral for psychological support, and proper documentation and reporting procedures. Preventing widespread sexual violence requires increasing the security in refugee camps. It also requires speaking out and holding states accountable when violations of international law occur. The challenge is to remain alert to these often hidden, but extremely destructive, crimes in the midst of a chaotic emergency relief setting.
PMCID: PMC80250  PMID: 11079062
21.  The Scientific Conferences Organized During War Time (1992-1995) in Sarajevo 
Materia Socio-Medica  2011;23(4):238-248.
Author of this paper spent 1479 days in the siege of Sarajevo, during the period of war time in Bosnia and Herzegovina (B&H). This siege, lasting from 1992 to 1995 (e.g. Dayton Piece agreement was signed in November, 1995) represents the longest siege in the history of the world. Besides usual daily work, as the associate professor of Health education, Medical deontology and Medical informatics for the students of the Faculty of medicine, Faculty of dental medicine, Faculty of Pharmacy and Nursing college of University of Sarajevo, the author organized by himself and contributors, 10 scientific conferences in a sieged Sarajevo. All presented papers at those conferences are published in Proceedings abstract books, as the proof of continuing scientific work, in Sarajevo and other cities in B&H. Additionally, the author continued to publish, in that time, unique PubMed/MedLine indexed journal, - Medical Archives, (i.e. established in 1947) and, in 1993 formed a new journal named - “Acta Informatica Medica” (AIM) , as the Journal of the Bosnian Society of Medical informatics. Bosnian Society of Medical Informatics, thus became the first scientific association from Bosnia and Herzegovina, included in 1994, in the European Federation of Medical Informatics (EFMI) and the International Medical Informatics Assiciation (IMIA) , which was “miracle” from the besieged Sarajevo and war time result of aggression on Bosnia and Herzegovina. It should be noted that the importance of maintaining these academic gatherings, in the circumstances of war, was multifaceted. First of all, thanks to these meetings, the continuity of scientific meetings and activities in the besieged city of Sarajevo was not broken, as well as the continuity of scientific publication, which was crucial for the maintenance of the teaching staff at the university and, finally, in the expansion of the “scientific truth” about what happened in Sarajevo and B&H in these difficult times. All of this was critical to the “survival” of B&H and its people. Some of the published articles, especially in the Medical Archives journal, which even in difficult war conditions did not break the continuity of its publication, and then it was the only scientific journal indexed in B&H, having been consequently cited in the major biomedical data bases in the world. Many scientists abroad have had the opportunity to learn about some of the wonders of Sarajevo “war medicine”, thanks to this journal. Finally, despite the fact that it is another way of expressing its resistance to the aggression on B&H, the organized symposia in the war represented the continuity of the scientific research activities. Bosnia and Herzegovina and Sarajevo under siege, in this way, kept in touch with the civilized world and modern achievements, despite the fact that they were victims of medieval barbarism. In addition, these meetings sent a powerful message to the world about the willingness to register and systematize all the war experiences, especially those related to medicine and medical practice, in terms of what Europe has not known, since the Second World War. Partially, we succeeded in that. The total number of 286 presentations were presented in seven war Conferences, as quantitative and qualitative contribution to the scientific activities, despite the inhuman conditions, in which these articles emerged. These presentations and Conferences testify to the enthusiasm of B&H community and academic institutions that have collaborated with it. Authors and co-authors presented the “war” articles that deserve to be mentioned in the monograph “1479 days of the siege of Sarajevo”. Unfortunately, many of these brave authors are not alive and cannot read this. The task for us remains to remember them by their own good. Old Persian proverb says; “The event which is not recorded is as like it had never happened”. Sapienti sat.
PMCID: PMC3633541  PMID: 23678305
Bosnia and Herzegovina; siege; scientific meetings during wartime.
22.  Retrospective exposure assessment to airborne asbestos among power industry workers 
A method of individually assessing former exposure to asbestos fibres is a precondition of risk-differentiated health surveillance. The main aims of our study were to assess former levels of airborne asbestos exposure in the power industry in Germany and to propose a basic strategy for health surveillance and the early detection of asbestos related diseases.
Between March 2002 and the end of 2006, we conducted a retrospective questionnaire based survey of occupational tasks and exposures with airborne asbestos fibres in a cohort of 8632 formerly asbestos exposed power industry workers. The data on exposure and occupation were entered into a specially designed computer programme, based on ambient monitoring of airborne asbestos fibre concentrations. The cumulative asbestos exposure was expressed as the product of the eight-hour time weighted average and the total duration of exposure in fibre years (fibres/cubic centimetre-years).
Data of 7775 (90% of the total) participants working in installations for power generation, power distribution or gas supply could be evaluated. The power generation group (n = 5284) had a mean age of 56 years, were exposed for 20 years and had an average cumulative asbestos exposure of 42 fibre years. The occupational group of "metalworkers" (n = 1600) had the highest mean value of 79 fibre years. The corresponding results for the power distribution group (n = 2491) were a mean age of 45 years, a mean exposure duration of 12 years and an average cumulative asbestos exposure of only 2.5 fibre years. The gas supply workers (n = 512) had a mean age of 54 years and a mean duration of exposure of 15 years.
While the surveyed cohort as a whole was heavily exposed to asbestos dust, the power distribution group had a mean cumulative exposure of only 6% of that found in the power generation group. Based on the presented data, risk-differentiated disease surveillance focusing on metalworkers and electricians from the power generating industry seems justified. That combined with a sensitive examination technique would allow detecting asbestos related diseases early and efficiently.
PMCID: PMC2901364  PMID: 20579364
23.  Iraq War mortality estimates: A systematic review 
In March 2003, the United States invaded Iraq. The subsequent number, rates, and causes of mortality in Iraq resulting from the war remain unclear, despite intense international attention. Understanding mortality estimates from modern warfare, where the majority of casualties are civilian, is of critical importance for public health and protection afforded under international humanitarian law. We aimed to review the studies, reports and counts on Iraqi deaths since the start of the war and assessed their methodological quality and results.
We performed a systematic search of 15 electronic databases from inception to January 2008. In addition, we conducted a non-structured search of 3 other databases, reviewed study reference lists and contacted subject matter experts. We included studies that provided estimates of Iraqi deaths based on primary research over a reported period of time since the invasion. We excluded studies that summarized mortality estimates and combined non-fatal injuries and also studies of specific sub-populations, e.g. under-5 mortality. We calculated crude and cause-specific mortality rates attributable to violence and average deaths per day for each study, where not already provided.
Thirteen studies met the eligibility criteria. The studies used a wide range of methodologies, varying from sentinel-data collection to population-based surveys. Studies assessed as the highest quality, those using population-based methods, yielded the highest estimates. Average deaths per day ranged from 48 to 759. The cause-specific mortality rates attributable to violence ranged from 0.64 to 10.25 per 1,000 per year.
Our review indicates that, despite varying estimates, the mortality burden of the war and its sequelae on Iraq is large. The use of established epidemiological methods is rare. This review illustrates the pressing need to promote sound epidemiologic approaches to determining mortality estimates and to establish guidelines for policy-makers, the media and the public on how to interpret these estimates.
PMCID: PMC2322964  PMID: 18328100
24.  Raising the dead: war, reparation, and the politics of memory. 
BMJ : British Medical Journal  1995;311(7003):495-497.
All societies attach a different range of meanings to war than to natural disasters, and questions of societal recognition, reparation, and justice are generally central. Most modern conflict has been grounded in the use of terror to control and silence whole populations. Those abusing power typically refuse to acknowledge their dead victims, as if they had never existed and were mere wraiths in the memories of those left behind. This denial, and the impunity of those who maintain it, must be challenged if survivors are to make sense of their losses and the social fabric is to mend. For the names and fate of the dead to be properly lodged in the public record of their times also illuminates the costs that may flow from the philosophies and practices of the Western led world order, ones which health workers should be in a position to influence.
PMCID: PMC2550549  PMID: 7647648
25.  Health Belief Systems and the Psychobiology of War 
Western Journal of Medicine  1984;140(6):964-968.
Belief systems overlie powerful biological and psychological forces that are root causes of war. Much as in medicine where an appreciation of health belief systems is necessary in the control of illness and disease, so the paths to the control of war may lie in an understanding of belief systems and ways to circumvent them. Such understanding gives strong theoretical support to many time-honored but underutilized international initiative and educational ventures. The effort of the medical community to educate the public about biomedical aspects of nuclear war should gain more balance and sophistication with an appreciation of belief systems in the psychobiology of war.
PMCID: PMC1011158  PMID: 6741137

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