Physical signs of torture may be slight and easily overlooked.
Between February 1998 and June 1999, Serbian forces in Kosovo conducted
an intense campaign of ethnic cleansing against the majority Albanian population.
Lopes Cardozo and colleaguesArticle surveyed Albanian adults in Kosovo between August
and October 1999 after NATO forces took control of Kosovo and Albanian refugees
began returning to the country. Most respondents reported having experienced
traumatic events, and 17.1% met diagnostic criteria for posttraumatic stress
disorder. Salama and colleaguesArticle, in a survey of Serbian adults in Kosovo conducted
at about the same time, found that Serbian adults had poorer outcomes on measures
of social dysfunction and severe depression than Kosovar Albanian adults.
In an editorial, WestermeyerArticle points out how correlates of psychiatric morbidity
in these populations differ from what is observed in stable society.
See and and editorial
When the Brady Handgun Prevention Act was implemented in February 1994,
it required background checks and waiting periods for the purchase of handguns
from federally licensed firearm dealers in 32 states, exempting states that
already had similar legislation. Ludwig and CookArticle found that reductions in
firearm homicide and suicide rates in the 32 Brady Act states (treatment states)
after the Brady Act were similar to reductions in the exempt (control) states;
only the rate of firearm suicides among adults aged 55 years or older decreased
significantly more in treatment states. In an editorial, RosenfeldArticle considers
how the flow of guns between treatment and control states through unlicensed
sources in the secondary gun market might influence the results of this study
and asserts that these findings do not warrant relaxation of any of the Brady
Act restrictions on handgun purchases.
Evidence suggests that central nervous system corticotropin-releasing
factor systems may mediate the association between stress early in life and
the development of mood and anxiety disorders in adulthood. Heim and colleagues
found that adrenocorticotropic hormone and cortisol levels and heart rate
responses to a standardized psychosocial stress protocol were significantly
higher among women with a history of childhood abuse than among women with
no history of childhood abuse or psychiatric disorder.
The safety of UN peacekeeping forces has become an increasing concern.
Seet and Burnham report that more deaths occurred among UN peacekeeping forces
during the past decade than during the previous 40 years, but because the
number and scale of UN peacekeeping missions have increased since 1990, crude
death rates and relative risk of death have not significantly changed. Risk
of death was significantly associated with the number of deployed peacekeepers
and duration of the peacekeeping mission.
Policies in developed countries to deter the number of asylum seekers,
persons who seek protection refugee status after entering another country
rather than prior to arrival, have become increasingly restrictive. Silove
and coauthors review research on stress during the asylum process and the
mental health of asylum seekers.
The number of articles on human rights published in biomedical journals
has steadily increased since the 1970s. Submissions are invited for next year's JAMA
theme issue on violence and human rights scheduled for August 2001.
"The world is a bigger place than any US hospital can possibly convey,
poverty and disease are a way of life in many parts of the world, and as physicians,
we and our skills can make a big difference." From "The Cardboard Box."
Clinical assessment of survivors of torture.
Do screening programs prevent domestic violence? How should physicians
deal with violent patients? What can be done about violence in families?
The importance of recognizing genocide as a public health issue.
Clinical signs as prognostic indicators of mortality among severely
malnourished adults and adolescents during famine.
For your patients: Information on helping children cope with traumatic
This Week in JAMA. JAMA. 2000;284(5):529. doi:10.1001/jama.284.5.529