Consequences of Untreated Posttraumatic Stress Disorder Following War in Former Yugoslavia: Morbidity,Subjective Quality of Life,and Care Costs

Aim

To assess long-term mental health outcomes in people who suffer from war-related posttraumatic stress disorder (PTSD) but do not receive appropriate treatment.

Methods

We interviewed 264 subjects from former Yugoslavia, who lived in Croatia, Serbia, Germany, and the United Kingdom. All of them had suffered from PTSD at some point following the war, but never received psychiatric or psychological treatment. The interviews took place on average 10.7 ± 3.0 years after the war-related trauma. Outcomes were current PTSD on the Clinician Administered PTSD Scale for Diagnostic and Statistical Manual of Mental Disorders-IV, subjective quality of life (SQOL) on the Manchester Short Assessment of Quality of Life, and care costs. Socio-demographic characteristics, the level of traumatic war-events, and aspects of the post-war situation were tested for association with outcomes.

Results

Current PTSD was diagnosed in 83.7% of participants, the mean SQOL score was 4.0 ± 0.9, and mean care costs in the last 3 months exceeded €1100 in each center. Older age, more traumatic war-events, lower education, and living in post-conflict countries were associated with higher rates of current PTSD. Older age, combat experience, more traumatic war-events, being unemployed, living alone, being housed in collective accommodation, and current PTSD were independently associated with lower SQOL. Older age and living in Germany were linked to higher costs of formal care.

Conclusion

People with untreated war-related PTSD have a high risk of still having PTSD a decade after the traumatic event. Their SQOL is relatively low, and they generate considerable care costs. Factors that have been reported as influencing the occurrence of PTSD also appear relevant for recovery from PTSD. Current PTSD may impair SQOL independently of social factors.Posttraumatic stress disorder (PTSD) is one of the most frequently reported mental health consequences of exposure to war experience, although studies on both refugees and war veterans yielded inconsistent findings on the exact prevalence rates (1-5). Some evidence suggests that a higher degree of exposure to both war-related traumatic events and the pressures of the post-migration environment can lead to higher rates of PTSD over many years (6-9). Evidence based treatments for PTSD exist and are – at least to some extent – available in most post conflict contexts in the Western world. In such contexts, it can be assumed that a significant number of people with war-related PTSD receive treatment from psychiatrists or psychologists or are prescribed anti-depressants by their general practitioner.For various reasons, however, many people with serious and distressing levels of PTSD following war do not receive psychiatric or psychological treatment (10), and not much is known about their long term outcomes. It is not clear whether most of them recover from PTSD without treatment or the symptoms are likely to take a persistent course. Another question is what their subjective quality of life (SQOL) is, and what costs of formal and informal care they generate. Finally, it is not clear what factors are associated with more or less favorable outcomes in such populations, and whether current PTSD is associated with poorer SQOL.The present study addressed these questions and assessed long term outcomes in people who suffered from PTSD at some point of time following the war in former Yugoslavia in the 1990s, but never received psychiatric or psychological treatment in either primary or secondary care. Current PTSD, SQOL, and care costs were assessed as outcomes in refugees in Western Europe and in people who stayed in the area of conflict. Socio-demographic characteristics, the level of exposure to war stressors, and aspects of the post-war situation were tested for their association with more or less favorable outcomes.     

Mechanism of tetracycline phototoxicity

Studies were made to determine factors important in the phototoxicity mechanism of 7 clinically used tetracyclines (TC). The clinical phototoxicity, the rates of photochemical degradation, and the in vitro phototoxicity of the TCs were qualitatively but not quantitatively correlated. Phototoxicity in vitro was partially oxygen-dependent and possibly singlet oxygen is involved. The contribution of photoproducts to the phototoxic process may be the basis for the reported differences between the in vivo action spectrum and the absorption spectrum of demethylchlorotetracycline. A mechanistic model for in vivo phototoxicity is proposed where the absorption of UVA radiation by TC leads to at least two main processes: (i) photosensitization by the drug of biologic molecules to cause phototoxicity; (ii) production of one or more photoproducts which photosensitize by absorption of visible radiation.     

Modifiable and Non-modifiable Factors Associated with Low Awareness of Hypertension Treatment in Indonesia: A Cross-Sectional Population-Based National Survey

Introduction:Low awareness about hypertension treatment is recognized as a significant cause of treatment failure. Therefore, identifying its underlying factors is essential for developing effective intervention strategies. This study aims to identify the modifiable and non-modifiable factors associated with low awareness about hypertension treatment.Method:This national, cross-sectional, population-based survey used publicly available data from the Indonesian Family Life Survey (IFLS-5) for 2014 among respondents with hypertension aged ≥15 years. Depression and insomnia, as modifiable factors, were assessed using the Centre for Epidemiologic Studies—Depression (CES-D) and the Patient-Recorded Outcomes Measurement Information System (PROMIS) questionnaire, respectively. Non-modifiable factors, such as sociodemographic information, were obtained from self-reported data. Logistic regression analysis was used to assess the association between these factors and low awareness about hypertension treatment. Odds ratios (ORs) with 95% confidence intervals (CIs) were reported.Result:The study recruited 7,920 respondents, the majority of whom were female (53.8%) and aged <60 years (71.1%). The prevalence of low awareness of hypertension treatment was 87.1% (51.8% in women and 48.2% in men). Being an elderly (OR: 1.60, 95%CI 1.36–1.88), being irregularly blood pressure control (OR: 4.40, 95% CI 3.78–5.13), having depressive symptoms (OR: 1.35, 95% CI 1.12–1.62), having insomnia (OR: 1.31, 95% CI 1.11–1.53), and having low satisfaction with health care (OR: 1.28, 95% CI 1.08–1.51) were associated with low awareness of hypertension treatment. Surprisingly, respondents with strong religiosity (OR: 1.62; 95% CI 1.25–2.09) were more likely to display low awareness of hypertension treatment.Conclusion:The main factors associated with low awareness of hypertension treatment are modifiable. Thus, health care professionals should integrate more patient-specific factors when designing tailored interventions.     

In silico modification of oseltamivir as neuraminidase inhibitor of influenza A virus subtype H1N1

This research focused on the modification of the functional groups of oseltamivir as neuraminidase inhibitor against influenza A virus subtype H1N1.Interactions of three of the best ligands were evaluated in the hydrated state using molecular dynamics simulation at two different temperatures.The docking result showed that AD3BF2 D ligand(N-[(1S,6R)-5-amino-5-{[(2R,3S,4S)-3,4-dihydroxy-4-(hydroxymethyl) tetrahydrofuran-2-yl]oxy}-4-formylcyclohex-3-en-1-yl]acetamide-3-(1-ethylpropoxy)-1-cyclohexene-1-carboxylate) had better binding energy values than standard oseltamivir.AD3BF2 D had several interactions,including hydrogen bonds,with the residues in the catalytic site of neuraminidase as identified by molecular dynamics simulation.The results showed that AD3BF2 D ligand can be used as a good candidate for neuraminidase inhibitor to cope with influenza A virus subtype H1N1.     

Analysis of Socioeconomic,Utilization of Maternal Health Services,and Toddler’s Characteristics as Stunting Risk Factors

Stunting prevalence in South Kalimantan has been higher than the national figure and is the sixth highest in Indonesia. Not many studies in South Kalimantan have analysed the risk factors for stunting comprehensively that combine sociodemographic factors, utilization of maternal health services, and characteristics of children. Therefore, the purpose of this study was to analyse sociodemographic factors, utilization of maternal health services, and characteristics of children under 5 as determinants of stunting in South Kalimantan Province. This study used an analytic observational method with a cross-sectional design. Data collection used secondary data from the results of South Kalimantan Baseline Health Research 2018. The total population of toddlers obtained from South Kalimantan Baseline Health Research 2018 data was 1218 toddlers, and all of them were taken as samples. Data analysis used a chi square test for bivariate test and Logistic Regression for multivariate test. There is a relationship between mother’s education level (p = 0.001), father’s education (p = 0.002), toddler age (p < 0.001), low birth weight (p = 0.05), exclusive breastfeeding (p = 0.008), and underweight (p = 0.000) with stunting. The data were continued with the Logistics Regression test and the dominant variables related to stunting were underweight (p < 0.001 with OR 18,241), under-five age (p < 0.001, with OR value for ages 24–35 months 9511), and premature birth (p = 0.027 with an OR of 2187). The conclusion of this study is that the most important factor in the incidence of stunting in South Kalimantan is underweight nutritional status.     

Emotional intelligence and its impacts on the clinical performance of nurses in general public hospitals

Objectives: The nursing profession is considered to be at a high risk of workplace stress, workload, and burnout due to the high job demands. The nurses require the appropriate and prompt coping mechanisms to relieve the effects of stress. The nurses have to be emotionally intelligent to overcome the work-related stress to meet the clinical-based duties. But there is a paucity of the effect of emotional intelligence (EI) on the clinical performance of nurses in the literature. Therefore, the role of dimensions of EI in the improvement of clinical performance of nurses was explored in this study.Methods: A total of 194 nurses with different education levels and experiences were included from various clinical departments and shifts of public hospitals in Iraqi Kurdistan.Results: The mean age of the nurses was 29.44 years, with ages ranging from 23 years to 36 years. The nurses were men (56.70％),married (53.10％), non-smokers (86.10％), physically active (55.70％), and irregular physically active (63.90％). Nurses were able to appraise their own emotions but not the emotions of other nurses. They regulated their own emotions but were weak in regulating the emotions of other nurses. They did not utilize emotions in coming up with new ideas and facing obstacles in clinical settings. Generally,the nurses reported that a little clinical performance is required in medical settings. The levels of interpersonal communication and problem solving were improved with an increasing appraisal and regulating own emotions. The level of problem solving was improved with appraising own emotions and utilizing emotions in facing obstacles.Conclusions: Nurses need to know how to regulate others' emotions and utilize these emotions in coming up with new ideas and facing the obstacles positively in medical settings.     

Regional collaboration in reconstruction of mental health services in Bosnia and Herzegovina

The war in the former Yugoslavia between 1991 and 1995 destroyed the mainly hospital-based mental health care system in Bosnia and Herzegovina. This report summarizes the situation before and after the war and describes efforts to rebuild and reform mental health services under politically and economically challenging conditions. As a result of these efforts, there are now 39 multidisciplinary community mental health centers that are linked to primary care and that aim to provide prevention, treatment, and rehabilitation of mental disorders. The reform process has been supported by international initiatives and is now continuing in collaboration with other countries in South Eastern Europe.     

Production of urokinase by HT 1080 human kidney cell line

Studies were carried out in T-flasks and bioreactor to produce urokinase enzyme using HT 1080 human kidney cell line. While growing the cell line it has been observed that the lag phase is reduced considerably in the bioreactor as compared to T-flask culture. The HT 1080 cell adhesion rate and urokinase production were observed to be the function of serum concentration in the medium. The maximum urokinase activity of 3.1 x 10(-4) unit ml(-1) was achieved in the bioreactor at around 65 h of batch culture. Since HT 1080 is an anchorage dependent cell line, therefore, the hydrodynamic effects on the cell line were investigated.