Late-onset stress symptomatology (LOSS) scale – short form: development and validation

Objectives: Late-onset stress symptomatology (LOSS) is a phenomenon observed in older combat veterans who experience increased combat-related thoughts, feelings, and reminiscences corresponding with the changes and challenges of aging. Previously, we developed the LOSS Scale to assess LOSS. This paper describes the development and validation of a LOSS Scale short form (LOSS-SF) to screen veterans in various settings who may be actively re-examining their past wartime experiences.

Method: Three studies examined the reliability and validity of the LOSS-SF in separate samples of male combat veterans age 55 and older (total N = 346). Veterans were administered measures via telephone and mail survey. Correlation and regression analyses examined the reliability and validity of the LOSS-SF.

Results: The LOSS-SF exhibited strong internal consistency (alpha = .93), test-retest reliability (2 week interval on average; r = .88), and good concurrent validity with the LOSS Scale (r = .81). Convergent and divergent validity were supported by the pattern of correlations between the LOSS-SF and other construct measures.

Conclusion: The LOSS-SF is a reliable and valid measure to quickly assess thoughts, feelings, and reminiscences about past combat experiences in older veterans and identify those veterans in distress who may benefit from psychological interventions..     

Targeting sirtuin activity with nicotinamide riboside reduces neuroinflammation in a GWI mouse model

Gulf War Illness (GWI) affects 30% of veterans from the 1991 Gulf War (GW), who suffer from symptoms that reflect ongoing mitochondria dysfunction. Brain mitochondria bioenergetics dysfunction in GWI animal models corresponds with astroglia activation and neuroinflammation. In a pilot study of GW veterans (n = 43), we observed that blood nicotinamide adenine dinucleotide (NAD) and sirtuin 1 (Sirt1) protein levels were decreased in the blood of veterans with GWI compared to healthy GW veterans. Since nicotinamide riboside (NR)-mediated targeting of Sirt1 is shown to improve mitochondria function, we tested whether NR can restore brain bioenergetics and reduce neuroinflammation in a GWI mouse model. We administered a mouse diet supplemented with NR at 100μg/kg daily for 2-months to GWI and control mice (n = 27). During treatment, mice were assessed for fatigue-type behavior using the Forced Swim Test (FST), followed by euthanasia for biochemistry and immunohistochemistry analyses. Fatigue-type behavior was elevated in GWI mice compared to control mice and lower in GWI mice treated with NR compared to untreated GWI mice. Levels of plasma NAD and brain Sirt1 were low in untreated GWI mice, while GWI mice treated with NR had higher levels, similar to those of control mice. Deacetylation of the nuclear-factor κB (NFκB) p65 subunit and peroxisome proliferator-activated receptor gamma coactivator 1-α (PGC-1α) was an increase in the brains of NR-treated GWI mice. This corresponded with a decrease in pro-inflammatory cytokines and lipid peroxidation and an increase in markers of mitochondrial bioenergetics in the brains of GWI mice. These findings suggest that targeting NR mediated Sirt1 activation restores brain bioenergetics and reduces inflammation in GWI mice. Further evaluation of NR in GWI is warranted to determine its potential efficacy in treating GWI.     

The medical life of Henry Norman Bethune

BACKGROUND:

Henry Norman Bethune is one of the most exciting and incredible surgeons that Canada has ever produced. Indeed, he is often characterized as one of the world’s best-known surgeons. He was an innovator and his scientific contributions have stood the test of time. In Canada, he will forever be remembered as a social activist committed to the welfare of the poor and to the reform of the health care system. In the People’s Republic of China, he is idolized and remains the only foreigner to ever become a national hero.

OBJECTIVE:

To detail the numerous and significant achievements of Henry Norman Bethune in the field of thoracic surgery and as a social activist and describe his heroic war-time actions on the battlefields of both Spain and China.

METHOD:

Information was gathered through the reading of the numerous publications written about the life and work of Bethune, interviews with knowledgeable people from Canadian and Chinese universities, analysis of Bethune’s own publications, and extensive experience of one of the authors in China.

RESULTS:

In the social sense, Henry Norman Bethune had a difficult personality, but he was deeply caring about the plight of his patients, especially the poor. As a thoracic surgeon, he could be ingenious, thoughtful and effective but he could also be abrasive, restless and temperamental. His scientific contributions were sound and, at the time, gained worldwide attention. As an activist, he led a crusade to reform the Canadian health care system, demanding free health care for all. His outstanding work during the Spanish Civil War, where he organized the first ever mobile blood transfusion unit, and during the Sino-Japanese war, where he was totally committed to the welfare of both soldiers and civilian population, were deliberate acts of resistance against Fascist onslaught and enthusiasm for the Communist cause.

CONCLUSIONS:

Henry Norman Bethune was unconventional and a revolutionary, but he was brilliant. He will forever be remembered as an innovative thoracic surgeon and outstanding humanitarian.     

The influence of war stress on the prevalence of signs and symptoms of temporomandibular disorders

The aim of this study was to determine the prevalence of signs and symptoms of temporomandibular disorders in patients with post-traumatic stress disorder (PTSD) occurring as a consequence of exposure to war stress. The examined group consisted of 100 male subjects, aged from 25 to 50 years, who had taken part in the War in Croatia, and in whom PTSD had previously been diagnosed. The control group comprised 100 subjects, without PTSD, of the same sex and age group, who had not taken part in the War. A functional evaluation of the stomatognathic system was performed using the Helkimo Anamnestic and Clinical Dysfunction Index. Eighty-two per cent of the group with PTSD had at least one symptom, and 98% at least one sign of dysfunction. Eight per cent reported mild symptoms and 74% severe symptoms. Twenty-eight per cent showed mild clinical signs, 22% had signs of moderate, and 48% of severe dysfunction. Twenty-four per cent of the control group of subjects had at least one symptom, and 52% at least one clinical sign of dysfunction. Twenty-two per cent reported mild and 2% severe symptoms. Mild clinical signs of dysfunction were found in 50% of subjects in the control group, moderate in 2% and none exhibited severe clinical signs. It is concluded that correlation exists between war stress and temporomandibular disorders.     

The lifelong struggle of Finnish World War II veterans

Objectives: In many countries veterans from World War II are growing old. Research has shown that war experiences continue to impact those who have been involved in war for a long time. The present study targets old injured war veterans from World War II in Finland. The aim of this study was to produce knowledge of the impact of war experiences and injuries on the lifespan of Finnish war veterans.

Method: The method used was grounded theory. Data were collected by interviewing 20 aged war veterans in their homes.

Results: The analysis resulted in four categories, with also subcategories: (1) lost childhood and youth; (2) war traumas impacting life; (3) starting life from scratch; and (4) finding one's own place. A substantive theory of war veterans’ lifelong struggle for freedom throughout the lifespan was outlined.

Conclusion: The war overshadowed the whole lifespan of the veterans, but in old age they finally felt free. Since war experiences vary depending on historical context, a formal theory would require additional research.     

Levels of combatant control and the patterns of non-incumbent/insurgent violence experienced by civilians living in Sunni–Arab communities in Iraq (2004–2009)

This study explores how one social-structural variable, control over Sunni–Arab communities during the Iraq civil war, affected the types of violence used by insurgent/non-government actors that killed and injured civilians in these communities from January 2004 to December 2009. The study classifies three levels of control: (1) incumbent (government-supported) control, (2) insurgent control and (3) actively contested control. It uses Iraq Body Count (IBC) fatality data to characterize two general types of violence (selective and indiscriminate) evident during the Iraq conflict. It demonstrates that the type of violence committed by non-government actors was significantly (P > .01) different as related to the level of control insurgents had over territory. Primarily, insurgents/non-governmental actors used more selective forms of violence when insurgents controlled territory and more indiscriminate violence when incumbent (government-supported) forces controlled territory. Also, acts of indiscriminate violence cause considerably more injuries and death per act as compared to selective violence. Importantly, if control over territory has broadly generalizable effects on the types of violence that civilian’s experience during civil war, than understanding this relationship could be useful when determining the types of medical assistance, medical supplies and training most needed in combat zones.     

Long-term effects on adult attachment in German occupation children born after World War II in comparison with a birth-cohort-matched representative sample of the German general population*

Background: Children born of war are a phenomenon of every conflict. At the end of World War II and thereafter, approximately 400,000 children were fathered by foreign soldiers and born to local women in Germany. Quantitative research on psychosocial consequences of growing up as German occupation child (GOC) has been missing so far.

Methods: This study examines adult attachment and its association with current depression in GOC (N = 146) using self-report instruments: Adult Attachment Scale, Patient Health Questionnaire. Data were compared to a birth-cohort-matched representative sample of the German population (BCMS; N = 786).

Results: GOC differ in both attachment dimensions (less comfortable with closeness/intimacy, lowered ability to depend on others) and adult attachment (more dismissive and fearful) compared to BCMS. Insecure adult attachment is associated with current depression.

Conclusion: GOC grew up under difficult circumstances (e.g. poverty, adverse events, and stigmatization). Even decades later they display more insecure attachment in current relationships. Findings underline the complex and long-term impact of their developmental conditions on attachment and current mental health.     

间接腹内压监测在基层部队腹部战创伤救治中的应用

目的探讨间接腹内压(intra-abdominal pressure,IAP)监测技术在基层部队腹部战创伤救治中的应用。方法 2015年1-9月,便利抽样法选取解放军第303医院所属基层部队收治的腹部损伤患者78例为研究对象,以是否存在腹内高压(intra-abdominal hypertension,IAH)将患者分为IAH组(n=46)和非IAH组(n=32)。动态观察两组患者IAP变化趋势,比较其入住监护病房时间、总住院时间、输血量、手术探查率、并发症发生率和病死率,并将腹腔内积血量与IAP的关系进行直线回归分析。结果IAH组和非IAH组患者入住监护病房时间分别为(6.28±4.5)d和(3.1±1.94)d,总住院时间分别为(48.3±25.9)d和(32.3±17.4)d,输血量分别为(3304.3±985.2)ml和(618.75±220.3)ml,手术探查率分别为93.5%和75.0%,差异均有统计学意义(均P0.05)。IAP随腹腔内出血量的增多而增高(R2=0.786,P0.05)。结论间接IAP测定准确、及时,能反映伤员腹部创伤病情变化,具有操作简单、无创和动态监测的优点,适合在基层部队腹部战创伤救护中的应用。