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1.  Causes of Death of Prisoners of War during the Korean War (1950-1953) 
Yonsei Medical Journal  2013;54(2):480-488.
This study aimed at analyzing the causes of death of prisoners of war (POWs) during the Korean War (1950-1953) who fought for the Communist side (North Korea and the People's Republic of China). In 1998, the United States Department of Defense released new information about the prisoners including, 7,614 deaths of the POW during the Korean War. The data on the causes of death of the POWs during the Korean War provides valuable information on the both the public health and history of the conflict.
Materials and Methods
To analyze the causes of death of the POWs, we classified the clinical diagnosis and findings on 7,614 deaths into 22 chapters, as outlined in the International Statistical Classification of Diseases and Related Health Problems-10th Revision (ICD-10). Second, we traced changes in the monthly death totals of POWs as well as deaths caused by common infectious diseases and external causes of death including injury over time from August 1950 to September 1953.
The most common category of causes of deaths of POWs was infectious disease, 5,013 (65.8%) out of 7,614 deaths, followed by external causes including injury, 817 (10.7%). Overall, tuberculosis and dysentery/diarrhea were the most common causes of death. Deaths caused by acute and chronic infection, or external causes showed different patterns of increases and decline over time during the Korean War.
The information and data on POWs' deaths during the Korean War reflects the critical impact of the POWs' living conditions and the effect of public health measures implemented in POW camps during the war.
PMCID: PMC3575971  PMID: 23364985
Prisoners of war (POW); Korean War; causes of deaths; infectious diseases
2.  Ross E. Baker, DC: A Canadian chiropractic survivor 
This paper is an historical biography of a fortunate man. It begins with a glimpse of Ross E. Baker’s origins in south-western Ontario, watches him going to school and working in Hamilton before joining the Canadian Army and shipping off to Europe to fight in the Second World War. At War’s end, the article picks up Dr. Baker as he comes home, starts a family, becomes a chiropractor and sustains a viable practice. Now in the twilight of life, the good doctor is last seen content with his retirement, spending days at his cottage property, reviewing his memoirs and reflecting on the tumult, terror and eventual triumph of the D-Day landing at Normandy.
PMCID: PMC3924507  PMID: 24587499
Baker; history; chiropractor; Baker; histoire; chiropraticien
3.  Exposure to the Holocaust and World War II Concentration Camps during Late Adolescence and Adulthood is not Associated with Increased Risk for Dementia at Old Age 
Holocaust and Nazi concentration camp survivors were subjects to prolonged and multi-dimensional trauma and stress. The aim of the present study was to assess the association between exposure to such trauma during late adolescence and adulthood with dementia at old age. In 1963, approximately 10,000 male civil servants aged 40–71 participated in the Israel Ischemic Heart Disease (IIHD) study. Of them, 691 reported having survived Nazi concentration camps [concentration Camp Survivors (CCS)]. Additional 2316 participants were holocaust survivors but not concentration camp survivors (HSNCC) and 1688 were born in European countries but not exposed to the Holocaust (NH). Dementia was assessed in 1999–2000, over three decades later, in 1889 survivors of the original IIHD cohort; 139 of whom were CCS, 435 were HSNCC, and 236 were NH. Dementia prevalence was 11.5% in CCS, 12.6% in HSNCC, and 15.7% in NH. The odds ratio of dementia prevalence, estimated by age adjusted logistic regression, for CCS as compared to HSNCC was 0.97 (95% CI: 0.53–1.77), approximate Z =−0.10; p = 0.92. Further adjustment for socioeconomic status, diabetes mellitus, and other co-morbidity at midlife (coronary heart disease, lung, and kidney disease), and height did not change the results substantially. Thus, in subjects who survived until old age, late adolescence and adulthood exposure to extreme stress, as reflected by experiencing holocaust and Nazi concentration camps, was not associated with increased prevalence of dementia. Individuals who survived concentration camps and then lived into old age may carry survival advantages that are associated with protection from dementia and mortality.
PMCID: PMC3157888  PMID: 21157030
Adolescence; adulthood; dementia; Holocaust; Nazi concentration camps
4.  Low prevalence of byssinotic symptoms in 12 flax scutching mills in Normandy, France. 
The concentrations of airborne dust and bacteria were determined in 12 flax scutching mills and in two milk processing plants in Normandy, France. A total of 308 of 340 flax workers and 111 of 113 milk processors volunteered to answer a respiratory questionnaire. Personal exposure to airborne dust in the scutching mills varied from 22.2 mg/m3 to 144 mg/m3 and areal concentrations from 8.92 mg/m3 to 47.1 mg/m3. The concentration of Gram negative bacteria ranged from 3970 (colony forming units) cfu/m3 to 67,900 cfu/m3 and that of total bacteria from 12,900 cfu/m3 to more than 600,000 cfu/m3. In all, 20% of the flax scutchers were found, on the basis of the questionnaire, to suffer from persistent cough and 25% from chronic phlegm production. The corresponding figures among milk processors were 3.6% and 4.5%. Unexpectedly, only 12.5% of the scutchers appeared to suffer from byssinotic symptoms even though they were heavily exposed to airborne dust and bacteria. The low prevalence of byssinosis might be due to self selection of the workforce or a relatively low concentration of the causative agent despite high airborne contamination.
PMCID: PMC1008003  PMID: 3378012
5.  Origins of the Spanish Influenza pandemic (1918–1920) and its relation to the First World War 
The virus which was responsible for the first benign wave of the Spanish Influenza in the spring of 1918, and which was to become extremely virulent by the end of the summer of 1918, was inextricably associated with the soldiers who fought during the First World War. The millions of young men who occupied the military camps and trenches were the substrate on which the influenza virus developed and expanded. Many factors contributed to it, such as: the mixing on French soil of soldiers and workers from the five continents, the very poor quality of life of the soldiers, agglomeration, stress, fear, war gasses used for the first time in history in a massive and indiscriminate manner, life exposed to the elements, cold weather, humidity and contact with birds, pigs and other animals, both wild and domestic. Today, this combination of circumstances is not present and so it seems unlikely that new pandemics, such as those associated with the avian influenza or swine influenza, will emerge with the virulence which characterized the Spanish Influenza during the autumn of 1918.
PMCID: PMC2805838  PMID: 20076789
Pandemic influenza; Spanish influenza; Word War I; influenza A; H1N1
6.  The association of state per capita income and military service deaths in the Vietnam and Iraq wars 
In the United States, social burdens including war casualties are often distributed unequally across groups of individuals, communities, and states. The purpose of this report was to examine the association between war deaths and per capita income in the 50 states and District of Columbia during the Vietnam and Iraq wars.
The numbers of deaths by the home state of record for each conflict were obtained from Department of Defense records on the Internet as were key variables including age at death, gender, race, branch of service, rank, circumstances of death, home state of record and the ratio of wounded to dead. In addition, we obtained state per capita income and state population for the relevant times.
Characteristics of decedents in the 2 conflicts were very similar with young, white enlisted men accounting for the majority of deaths. However, in the Iraq war, women accounted for a 2.4% of casualties. Also of note was the higher ratio of wounded to dead in Iraq. At the level of the state, the correlation between the ratio of deaths per 100,000 and per capita income was -0.51 (p < 0.0001) for Vietnam and -0.52 for Iraq (p < 0.0001). In both eras, states with lower per capita income tended to have higher ratios of deaths per population.
For military service members serving in the Vietnam and Iraq conflicts, there were many more women who died in the latter war. Whether war deaths resulted in lower per capita income cannot be determined from these cross sectional data; we simply note a strong association between per capita income and war casualty rates for both wars.
PMCID: PMC2621124  PMID: 19126218
7.  Activity of daily living and its associated factors in war survivors with no visual acuity 
War is a known cause of tremendous physical injuries to different body organs, and eyes are not exceptions. War-related no visual acuity (NVA) affects both the victim and the family. Activity of daily living (ADL) can display personal life independency and is considered as a morbidity index. This study was designed to investigate the ADL profile of war survivors with NVA.
This cross-sectional study was conducted in 2007 in Iran. In this study, 500 Iranian people with war related NVA were invited to take part in a camp in Mashhad city. ADL was evaluated using Barthel Index and demographic data were collected using a data sheet. Stepwise linear regression was used to determine the associates of ADL.
The overall response rate to the invitation was 50%. From the total 250 participants 96.5% were male with a mean age of 43 ± 8 years. Only 8.3% had no dependency in ADL and other 91.7% had some ranges of dependency in at least one of the daily living activities. ADL score was higher in highly educated participants, those younger than 50 years old, those with less co-morbid physical problems (hearing loss) and those with regular physical exercises. According to regression analysis, age and duration of war related NVA were significant predictors of ADL.
According to the results, both age and the time passed from war related NVA increase the dependency of people with war related NVA.
PMCID: PMC3082812  PMID: 21526082
War; No Visual Acuity; Activity of Daily Living
8.  German Battle Casualties: The Treatment of Functional Somatic Disorders during World War I 
World War I witnessed the admission of large numbers of German soldiers with neurological symptoms for which there was no obvious organic cause. This posed a considerable challenge for the military and medical authorities and resulted in an active discussion on the etiology and treatment of these disorders. Current historiography is reliant on published physician accounts, and this represents the first study of treatment approaches based on original case notes. We analyzed patient records from two leading departments of academic psychiatry in Germany, those at Berlin and Jena, in conjunction with the contemporaneous medical literature. Treatment, which can be broadly classified into reward and punishment, suggestion, affective shock, cognitive learning, and physiological methods, was developed in the context of the emerging fields of animal learning and neurophysiology. A further innovative feature was the use of quantitative methods to assess outcomes. These measures showed good response rates, though most cured patients were not sent back to battle because of their presumed psychopathic constitution. While some treatments appear unnecessarily harsh from today's perspective and were also criticized by leading psychiatrists of the time, the concentration of effort and involvement of so many senior doctors led to the development of psychotherapeutic methods that were to influence the field of psychiatric therapy for decades to come.
PMCID: PMC3792648  PMID: 22492735
World War I; military psychiatry; treatment; trauma; functional disorders; etiology; case records; hysteria; war neurosis
9.  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.
To discover whether post-combat syndromes have existed after modern wars and what relation they bear to each other.
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.
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.
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
10.  Changes in Immune Parameters Seen in Gulf War Veterans but Not in Civilians with Chronic Fatigue Syndrome 
The purpose of this study was to evaluate immune function through the assessment of lymphocyte subpopulations (total T cells, major histocompatibility complex [MHC] I- and II-restricted T cells, B cells, NK cells, MHC II-restricted T-cell-derived naive and memory cells, and several MHC I-restricted T-cell activation markers) and the measurement of cytokine gene expression (interleukin 2 [IL-2], IL-4, IL-6, IL-10, IL-12, gamma interferon [IFN-γ], and tumor necrosis factor alpha [TNF-α]) from peripheral blood lymphocytes. Subjects included two groups of patients meeting published case definitions for chronic fatigue syndrome (CFS)—a group of veterans who developed their illness following their return home from participating in the Gulf War and a group of nonveterans who developed the illness sporadically. Case control comparison groups were comprised of healthy Gulf War veterans and nonveterans, respectively. We found no significant difference for any of the immune variables in the nonveteran population. In contrast, veterans with CFS had significantly more total T cells and MHC II+ T cells and a significantly higher percentage of these lymphocyte subpopulations, as well as a significantly lower percentage of NK cells, than the respective controls. In addition, veterans with CFS had significantly higher levels of IL-2, IL-10, IFN-γ, and TNF-α than the controls. These data do not support the hypothesis of immune dysfunction in the genesis of CFS for sporadic cases of CFS but do suggest that service in the Persian Gulf is associated with an altered immune status in veterans who returned with severe fatiguing illness.
PMCID: PMC95652  PMID: 9874656
11.  Protective Factors and Risk Modification of Violence in Iraq and Afghanistan War Veterans 
The Journal of Clinical Psychiatry  2012;73(6):e767-e773.
After returning home, a subset of Iraq and Afghanistan War Veterans report engaging in aggression toward others. This study is the first to identify variables empirically related to decreased risk of community violence among Veterans.
The authors conducted a national survey from July 2009 to April 2010 in which participants were randomly drawn from over one million U. S. military service members who served after September 11, 2001. Data were colleceted from a total of 1388 Iraq and Afghanistan War era and theater veterans. The final sample included veterans from all 50 states and all military branches.
One-third of survey respondents self-identified committing an act of aggression toward others during the past year, mostly involving minor aggressive behavior. Younger age, criminal arrest record, combat exposure, probable posttraumatic stress disorder, and alcohol misuse were positively related to violence toward others. Multivariate analyses showed that stable living situation and the perception of having control over one’s life were associated with reduced odds of severe violence. Greater resilience, perceiving positive social support, and having money to cover basic needs were linked to reduced odds of other physically aggression.
The study identifies aggression as a problem for a subset of Iraq and Afghanistan War Veterans who endorsed few protective factors. Data revealed that protective factors added incremental value to statistical modeling of violence, even when controlling for robust risk factors. The data indicate that, in addition to clinical interventions directed at treating mental health and substance abuse problems, psychosocial rehabilitation approaches aimed at improving domains of basic functioning and psychological well-being may also be effective in modifying risk and reducing violence among veterans.
PMCID: PMC3399731  PMID: 22795217
12.  Impact of civil war on emotion recognition: the denial of sadness in Sierra Leone 
Studies of children with atypical emotional experience demonstrate that childhood exposure to high levels of hostility and threat biases emotion perception. This study investigates emotion processing, in former child soldiers and non-combatant civilians. All participants have experienced prolonged violence exposure during childhood. The study, carried out in Sierra Leone, aimed to examine the effects of exposure to and forced participation in acts of extreme violence on the emotion processing of young adults war survivors. A total of 76 young, male adults (38 former child soldier survivors and 38 civilian survivors) were tested in order to assess participants' ability to identify four different facial emotion expressions from photographs and movies. Both groups were able to recognize facial expressions of emotion. However, despite their general ability to correctly identify facial emotions, participants showed a significant response bias in their recognition of sadness. Both former soldiers and civilians made more errors in identifying expressions of sadness than in the other three emotions and when mislabeling sadness participants most often described it as anger. Conversely, when making erroneous identifications of other emotions, participants were most likely to label the expressed emotion as sadness. In addition, while for three of the four emotions participants were better able to make a correct identification the greater the intensity of the expression, this pattern was not observed for sadness. During movies presentation the recognition of sadness was significantly worse for soldiers. While both former child soldiers and civilians were found to be able to identify facial emotions, a significant response bias in their attribution of negative emotions was observed. Such bias was particularly pronounced in former child soldiers. These findings point to a pervasive long-lasting effect of childhood exposure to violence on emotion processing in later life.
PMCID: PMC3760028  PMID: 24027541
childhood; violence exposure; emotion recognition; young adults; war survivors; denial of sadness; Sierra Leone
13.  Cutaneous Melioidosis in a Man Who Was Taken as a Prisoner of War by the Japanese during World War II 
Journal of Clinical Microbiology  2005;43(2):970-972.
Melioidosis, an infection caused by the gram-negative bacillus Burkholderia pseudomallei, is endemic to Southeast Asia and Northern Australia. Human infection is acquired through contact with contaminated water via percutaneous inoculation. Clinical manifestations range from skin and soft tissue infection to pneumonia with sepsis. We report a case of a man who was taken as a prisoner of war by the Japanese during World War II who presented with a nonhealing ulcer on his right hand 62 years after the initial exposure.
PMCID: PMC548040  PMID: 15695721
14.  Global Comparison of Warring Groups in 2002–2007: Fatalities from Targeting Civilians vs. Fighting Battles 
PLoS ONE  2011;6(9):e23976.
Warring groups that compete to dominate a civilian population confront contending behavioral options: target civilians or battle the enemy. We aimed to describe degrees to which combatant groups concentrated lethal behavior into intentionally targeting civilians as opposed to engaging in battle with opponents in contemporary armed conflict.
Methodology/Principal Findings
We identified all 226 formally organized state and non-state groups (i.e. actors) that engaged in lethal armed conflict during 2002–2007: 43 state and 183 non-state. We summed civilians killed by an actor's intentional targeting with civilians and combatants killed in battles in which the actor was involved for total fatalities associated with each actor, indicating overall scale of armed conflict. We used a Civilian Targeting Index (CTI), defined as the proportion of total fatalities caused by intentional targeting of civilians, to measure the concentration of lethal behavior into civilian targeting. We report actor-specific findings and four significant trends: 1.) 61% of all 226 actors (95% CI 55% to 67%) refrained from targeting civilians. 2.) Logistic regression showed actors were more likely to have targeted civilians if conflict duration was three or more years rather than one year. 3.) In the 88 actors that targeted civilians, multiple regressions showed an inverse correlation between CTI values and the total number of fatalities. Conflict duration of three or more years was associated with lower CTI values than conflict duration of one year. 4.) When conflict scale and duration were accounted for, state and non-state actors did not differ. We describe civilian targeting by actors in prolonged conflict. We discuss comparable patterns found in nature and interdisciplinary research.
Most warring groups in 2002–2007 did not target civilians. Warring groups that targeted civilians in small-scale, brief conflict concentrated more lethal behavior into targeting civilians, and less into battles, than groups in larger-scale, longer conflict.
PMCID: PMC3167835  PMID: 21915272
15.  Cross-sectional Biomonitoring of Metals in Adult Populations in Post-war Eastern Croatia: Differences Between Areas of Moderate and Heavy Combat 
Croatian Medical Journal  2010;51(5):451-460.
To determine differences in metal and metalloid exposure between residents of areas in eastern Croatia exposed to heavy fighting during the war in Croatia and residents of areas exposed to moderate fighting.
Concentrations of aluminum (Al), arsenic (As), barium (Ba), cadmium (Cd), chromium (Cr), copper (Cu), iron (Fe), nickel (Ni), lead (Pb), uranium (U), vanadium (V), and zinc (Zn), reported to be associated with military operations, were determined in hair, serum, and urine samples using inductively-coupled plasma mass spectroscopy. A total of 127 and 46 participants from areas of heavy and moderate fighting, respectively, were included.
Compared with participants from areas exposed to moderate fighting, participants from areas exposed to heavy fighting had significantly higher serum concentrations of Al (87.61 vs 42.75 μg/L, P = 0.007), As (5.05 ± 1.79 vs 4.16 ± 1.55 μg/L, P = 0.003), Ba (7.12 vs 6.01 μg/L, P = 0.044), and V (17.98 vs 16.84 μg/L, P = 0.008); significantly higher urine concentrations of As (43.90 vs 11.51 μg/L, P < 0.001) and Cd (0.67 vs 0.50 μg/L, P = 0.031); and significantly higher hair concentrations of Al (12.61 vs 7.33 μg/L, P < 0.001), As (0.32 vs 0.05 μg/L, P < 0.001), Cd (0.03 vs 0.02 μg/L, P = 0.002), Fe (22.58 vs 12.68 μg/L, P = 0.001), Pb (1.04 vs 0.69 μg/L, P = 0.006), and V (0.07 vs 0.03 μg/L, P < 0.001).
Differences between populations from eastern Croatian areas exposed to heavy and populations exposed to moderate fighting point to the need for extensive monitoring of metal and metalloid exposure, emphasizing the role of biomonitoring through ecologic and preventive activities.
PMCID: PMC2969140  PMID: 20960595
16.  Management of war-related vascular injuries: experience from the second gulf war 
To study the biomechanism, pattern of injury, management, and outcome of major vascular injuries treated at Mubarak Al-Kabeer Teaching Hospital, Kuwait during the Second Gulf War.
This is a descriptive retrospective study. War-related injured patients who had major vascular injuries and were treated at Mubarak Al-Kabeer Teaching Hospital from August 1990 to September 1991 were studied. Studied variables included age, gender, anatomical site of vascular injury, mechanism of injury, associated injuries, type of vascular repair, and clinical outcome.
36 patients having a mean (SD) age of 29.8 (10.2) years were studied. 32 (89%) were males and 21 (58%) were civilians. Majority of injuries were caused by bullets (47.2%) and blast injuries (47.2%). Eight patients (22%) presented with shock.
There were 31 arterial injuries, common and superficial femoral artery injuries were most common (10/31). Arterial repair included interposition saphenous vein graft in seven patients, thrombectomy with end-to-end / lateral repair in twelve patients, vein patch in two patients, and arterial ligation in four patients. Six patients had arterial ligation as part of primary amputation. 3/21 (14.3%) patients had secondary amputation after attempted arterial vascular repair of an extremity. There were a total of 17 venous injuries, 13 managed by lateral suture repair and 4 by ligation. The median (range) hospital stay was 8 (1–76) days. 5 patients died (14%).
Major vascular injuries occurred in 10% of hospitalized war-related injured patients. Our secondary amputation rate of extremities was 14%. The presence of a vascular surgeon within a military surgical team is highly recommended. Basic principles and techniques of vascular repair remain an essential part of training general surgeons because it may be needed in unexpected wars.
PMCID: PMC3700839  PMID: 23816260
Injury; Management; Trauma; Vascular; War
17.  The risk to the United Kingdom population of zinc cadmium sulfide dispersion by the Ministry of Defence during the "cold war" 
Objectives: To estimate exposures to cadmium (Cd) received by the United Kingdom population as a result of the dispersion of zinc Cd sulfide (ZnCdS) by the Ministry of Defence between 1953 and 1964, as a simulator of biological warfare agents.
Methods: A retrospective risk assessment study was carried out on the United Kingdom population during the period 1953–64. This determined land and air dispersion of ZnCdS over most of the United Kingdom, inhalation exposure of the United Kingdom population, soil contamination, and risks to personnel operating equipment that dispersed ZnCdS.
Results: About 4600 kg ZnCdS were dispersed from aircraft and ships, at times when the prevailing winds would allow large areas of the country to be covered. Cadmium released from 44 long range trials for which data are available, and extrapolated to a total of 76 trials to allow for trials with incomplete information, is about 1.2% of the estimated total release of Cd into the atmosphere over the same period. "Worst case" estimates are 10 µg Cd inhaled over 8 years, equivalent to Cd inhaled in an urban environment in 12–100 days, or from smoking 100 cigarettes. A further 250 kg ZnCdS was dispersed from the land based sites, but significant soil contamination occurred only in limited areas, which were and have remained uninhabited. Of the four personnel involved in the dispersion procedures (who were probably exposed to much higher concentrations of Cd than people on the ground), none are suspected of having related illnesses.
Conclusion: Exposure to Cd from dissemination of ZnCdS during the "cold war" should not have resulted in adverse health effects in the United Kingdom population.
PMCID: PMC1740210  PMID: 11836463
18.  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
19.  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
20.  Caenorhabditis elegans: a model to monitor bacterial air quality 
BMC Research Notes  2011;4:503.
Low environmental air quality is a significant cause of mortality and morbidity and this question is now emerging as a main concern of governmental authorities. Airborne pollution results from the combination of chemicals, fine particles, and micro-organisms quantitatively or qualitatively dangerous for health or for the environment. Increasing regulations and limitations for outdoor air quality have been decreed in regards to chemicals and particles contrary to micro-organisms. Indeed, pertinent and reliable tests to evaluate this biohazard are scarce. In this work, our purpose was to evaluate the Caenorhaditis elegans killing test, a model considered as an equivalent to the mouse acute toxicity test in pharmaceutical industry, in order to monitor air bacterial quality.
The present study investigates the bacterial population in dust clouds generated during crop ship loading in harbor installations (Rouen harbor, Normandy, France). With a biocollector, airborne bacteria were impacted onto the surface of agar medium. After incubation, a replicate of the colonies on a fresh agar medium was done using a velvet. All the replicated colonies were pooled creating the "Total Air Sample". Meanwhile, all the colonies on the original plate were isolated. Among which, five representative bacterial strains were chosen. The virulence of these representatives was compared to that of the "Total Air Sample" using the Caenorhaditis elegans killing test. The survival kinetic of nematodes fed with the "Total Air Sample" is consistent with the kinetics obtained using the five different representatives strains.
Bacterial air quality can now be monitored in a one shot test using the Caenorhaditis elegans killing test.
PMCID: PMC3279514  PMID: 22099854
21.  A mating method accounting for inbreeding and multi-trait selection in dairy cattle populations 
Selection in dairy cattle populations usually takes into account both the breed profiles for many traits and their overall estimated breeding values (EBV). This can result in effective contributions of breeding animals departing substantially from contributions optimised for saving future genetic variability. In this work, we propose a mating method that considers not only inbreeding but also the detailed EBV of progeny or the EBV of sires in reference to acceptance thresholds. Penalties were defined for inbreeding and for inadequate EBV profiles. Relative reductions of penalties yielded by any mating design were expressed on a scale ranging from 0 to 1. A value of 0 represented the average performance of random matings and a value of 1 represented the maximal reduction allowed by a specialized, single-penalty, mating design. The core of the method was an adaptative simulated annealing, where the maximized function was the average of both ratios, under the constraints that both relative penalty reductions should be equal and that the within-herd concentration criterion should be equal to a predefined reasonable value. The method was tested on two French dairy cattle populations originating from the same AI organization. The optimised mating design allowed substantial reductions of penalty: 70% and 64% for the Holstein and the Normandy populations, respectively. Thus, this mating method decreased inbreeding and met various demands from breeders.
PMCID: PMC3225904  PMID: 19284690
22.  Mortality in adults aged 26-54 years related to socioeconomic conditions in childhood and adulthood: post war birth cohort study 
BMJ : British Medical Journal  2002;325(7372):1076-1080.
To examine premature mortality in adults in relation to socioeconomic conditions in childhood and adulthood.
Nationally representative birth cohort study with prospective information on socioeconomic conditions.
England, Scotland, and Wales.
Study members
2132 women and 2322 men born in March 1946 and followed until age 55 years.
Main outcome measures
Deaths between 26 and 54 years of age notified by the NHS central register.
Study members whose father's occupation was manual at age 4, or who lived in the worst housing, or who received the poorest care in childhood had double the death rate during adulthood of those living in the best socioeconomic conditions. All indicators of socioeconomic disadvantage at age 26 years, particularly lack of home ownership, were associated with a higher death rate. Manual origins and poor care in childhood remained associated with mortality even after adjusting for social class in adulthood or home ownership. The hazard ratio was 2.6 (95% confidence interval 1.5 to 4.4) for those living in manual households as children and as adults compared with those living in non-manual households at both life stages. The hazard ratio for those from manual origins who did not own their own home at age 26 years was 4.9 (2.3 to 10.5) compared with those from non-manual origins who were home owners.
Socioeconomic conditions in childhood as well as early adulthood have strongly influenced the survival of British people born in the immediate post war era.
What is already known on this topicAssociations between socioeconomic conditions in childhood and mortality in adulthood suggest that risks to survival begin in early lifeStudies have been generally retrospective, been unrepresentative, used only one marker of childhood conditions, controlled inadequately for adult conditions, or not included womenWhat this study addsThe death rate for women and men between 26 and 54 years living in poor socioeconomic conditions in childhood was double that of those living in the best conditionsThose for whom socioeconomic disadvantage continued into early adulthood were between three and five times more likely to die than those in the most advantageous conditions
PMCID: PMC131184  PMID: 12424168
23.  Prevalence and association of perceived stress, substance use and behavioral addictions: a cross-sectional study among university students in France, 2009–2011 
BMC Public Health  2013;13:724.
University students face multiple stressors such as academic overload, constant pressure to succeed, competition with peers as well as concerns about the future. Stress should not be considered on its own, but should be associated with potential risk behaviors leading to onset of substance use and related problems heightened during the university period. The aim of this study was to determine the prevalence of main substance use and behavioral addictions among students in higher education in France and to examine the relationship with perceived stress.
A self-administered questionnaire was filled out by university student volunteers from Upper Normandy (France) either by anonymous online questionnaire or by paper questionnaire. Data collected included socio-economic characteristics, Perceived Stress Scale (PSS), substance use (tobacco, alcohol, and cannabis) and hazardous behaviors: alcohol abuse problems, smoking, consumption of cannabis, eating disorders, and cyber addiction.
A total of 1876 students were included. Mean PSS score was 15.9 (standard deviation = 7.2). Highly stressed students (4th quartile) were compared with lesser stressed students (1st quartile). A positive relation was observed between female gender, regular smokers, alcohol abuse problems, risk of cyberaddiction and especially eating disorders (AOR = 5.45, 95% CI = 3.42-8.69), and increasing PSS score. PSS score however, was not significantly related to the curriculum, regular alcohol use, drunkenness or binge drinking even after additional controlling for use of other substances. We found a significant negative association between stress and practice of sport: students with the most physical activity were less likely to report perceived stress (4th quartile: AOR = 0.57, 95% CI = 0.39-0.80).
This cross-sectional study among university students in France revealed that perceived stress was associated not only with known risks such as alcohol misuse, but also with new risks such as eating disorders and cyber addiction. These results could help to develop preventive interventions focussing on these risk behaviors and subsequently improving stress coping capacity in this high-risk population.
PMCID: PMC3750571  PMID: 23919651
24.  Vulnerability to high risk sexual behaviour (HRSB) following exposure to war trauma as seen in post-conflict communities in eastern uganda: a qualitative study 
Conflict and Health  2011;5:22.
Much of the literature on the relationship between conflict-related trauma and high risk sexual behaviour (HRSB) often focuses on refugees and not mass in-country displaced people due to armed conflicts. There is paucity of research about contexts underlying HRSB and HIV/AIDS in conflict and post-conflict communities in Uganda. Understanding factors that underpin vulnerability to HRSB in post-conflict communities is vital in designing HIV/AIDS prevention interventions. We explored the socio-cultural factors, social interactions, socio-cultural practices, social norms and social network structures that underlie war trauma and vulnerability to HRSB in a post-conflict population.
We did a cross-sectional qualitative study of 3 sub-counties in Katakwi district and 1 in Amuria in Uganda between March and May 2009. We collected data using 8 FGDs, 32 key informant interviews and 16 in-depth interviews. We tape-recorded and transcribed the data. We followed thematic analysis principles to manage, analyse and interpret the data. We constantly identified and compared themes and sub-themes in the dataset as we read the transcripts. We used illuminating verbatim quotations to illustrate major findings.
The commonly identified HRSB behaviours include; transactional sex, sexual predation, multiple partners, early marriages and forced marriages. Breakdown of the social structure due to conflict had resulted in economic destruction and a perceived soaring of vulnerable people whose propensity to HRSB is high. Dishonour of sexual sanctity through transactional sex and practices like incest mirrored the consequence of exposure to conflict. HRSB was associated with concentration of people in camps where idleness and unemployment were the norm. Reports of girls and women who had been victims of rape and defilement by men with guns were common. Many people were known to have started to display persistent worries, hopelessness, and suicidal ideas and to abuse alcohol.
The study demonstrated that conflicts disrupt the socio-cultural set up of communities and destroy sources of people's livelihood. Post-conflict socio-economic reconstruction needs to encompass programmes that restructure people's morals and values through counselling. HIV/AIDS prevention programming in post-conflict communities should deal with socio-cultural disruptions that emerged during conflicts. Some of the disruptions if not dealt with, could become normalized yet they are predisposing factors to HRSB. Socio-economic vulnerability as a consequence of conflict seemed to be associated with HRSB through alterations in sexual morality. To pursue safer sexual health choices, people in post-conflict communities need life skills.
PMCID: PMC3213062  PMID: 22011647
25.  Pro-Anorexia and Pro-Recovery Photo Sharing: A Tale of Two Warring Tribes 
There is widespread use of the Internet to promote anorexia as a lifestyle choice. Pro-anorexia content can be harmful for people affected or at risk of having anorexia. That movement is actively engaged in sharing photos on social networks such as Flickr.
To study the characteristics of the online communities engaged in disseminating content that encourages eating disorders (known as “pro-anorexia”) and to investigate if the posting of such content is discouraged by the posting of recovery-oriented content.
The extraction of pro-anorexia and pro-recovery photographs from the photo sharing site Flickr pertaining to 242,710 photos from 491 users and analyzing four separate social networks therein.
Pro-anorexia and pro-recovery communities interact to a much higher degree among themselves than what is expected from the distribution of contacts (only 59-72% of contacts but 74-83% of comments are made to members inside the community). Pro-recovery users employ similar words to those used by pro-anorexia users to describe their photographs, possibly in order to ensure that their content appears when pro-anorexia users search for images. Pro-anorexia users who are exposed to comments from the opposite camp are less likely to cease posting pro-anorexia photographs than those who do not receive such comments (46% versus 61%), and if they cease, they do so approximately three months later. Our observations show two highly active communities, where most interaction is within each community. However, the pro-recovery community takes steps to ensure that their content is visible to the pro-anorexia community, both by using textual descriptions of their photographs that are similar to those used by the pro-anorexia group and by commenting to pro-anorexia content. The latter activity is, however, counterproductive, as it entrenches pro-anorexia users in their stance.
Our results highlight the nature of pro-anorexia and pro-recovery photo sharing and accentuate the need for clinicians to be aware of such content and its effect on their patients. Our findings suggest that some currently used interventions are not useful in helping pro-anorexia users recover. Thus, future work should focus on new intervention methods, possibly tailored to individual characteristics.
PMCID: PMC3510717  PMID: 23134671
Medical Informatics; Internet; Photo; Eating Disorder; Anorexia Nervosa; Social Network

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