A JAMA THEME ISSUE Edited by Annette Flanagin, RN, MA and Thomas B.
Cole, MD, MPH
Two articles in this issue of THE JOURNAL examine the psychiatric morbidity
associated with wartime conditions of physical trauma, nutritional deprivation,
and social disruption. In a cross-sectional survey of Bosnian adult refugees
living in a refugee camp in Varaždin, Croatia, Mollica and colleagues
found that 39% reportedArticle symptoms meeting diagnostic criteria for depression
and 26%, for posttraumatic stress disorder. Twenty-one percent reported symptoms
comorbid for both disorders, which was associated with an increased risk of
disability compared with asymptomatic refugees. Neugebauer and coworkers reportArticle
an increased risk of antisocial personality disorder among men at age 18 years
who were the offspring of women who experienced severe nutritional deficiency
during the first and/or second trimesters of pregnancy when Germany blockaded
food supplies to the Netherlands in the winter of 1944-1945. In an editorialArticle,
Iacopino and Waldman trace the evolution of physician involvement in humanitarian
relief activities originating in the care of those injured in war to include
preventive and mental health care for refugee populations and documentation
of human rights violations.
In this analysis of data from 4 biennial Youth Risk Behavior surveys
of nationally representative samples of US adolescents in grades 9 through
12 conducted between 1991 and 1997, Brener and colleagues found significant
linear decreases in the percentages of students who reported carrying a weapon,
engaging in a physical fight, and being injured in a physical fight. Little
change occurred, however, in the percentages of students reporting feeling
too unsafe to go to school, being threatened or injured with a weapon on school
property, or having property stolen or deliberately damaged at school.
Using data from multiple sources, Cook and coworkers estimated the medical
costs for acute care and follow-up treatment of gunshot injuries in 1994 in
the United States and identified sources of payment. Estimated lifetime medical
costs for treatment of the 134,445 patients with gunshot injuries that occurred
during 1994 were $2.3 billion, of which $1.1 billion (49%) was paid by US
taxpayers via government programs.
To ascertain the true incidence of fatal child abuse, Herman-Giddens
and colleagues researched possible cases identified in a search of the North
Carolina Medical Examiner Information System between 1985 and 1995. Two hundred
twenty (85%) of the 259 cases of homicide among children aged 10 years or
younger were attributed to child abuse, 3 times more than the number of cases
recorded in the state vital records system.
Primary care physicians may be missing opportunities to identify intimate
partner abuse. Based on the results of a cross-sectional survey of 400 California
physicians in family medicine, general internal medicine, and obstetrics/gynecology,
Rodriguez and colleagues estimated that 79% of California primary care physicians
screen injured patients for intimate partner abuse, but only 10% routinely
screen noninjured patients. Reported routine screening of new patients was
highest among obstetricians/gynecologists (17%) and among physicians practicing
in public clinic settings (37%) and lowest among physicians practicing in
health maintenance organizations (1%).
"In caring for patients, I have been confronted with a variety of human
conflicts. But none of it had prepared me for dealing with this man." From
"A Case of Mutual Distrust."
A report on one physician who volunteered overseas; a new Directory
of Volunteer Agencies; plus, medicine′s efforts to help survivors of
Wintemute reviews interventions that have been associated with recent
reductions in firearm-related violence.
Results of a survey of forensic physicians on their experiences with
and attitudes toward virginity examinations.
For your patients: Child abuse.
This Week in JAMA. JAMA. 1999;282(5):407. doi:10.1001/jama.282.5.407