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This Week in JAMA
August 6, 2003

This Week in JAMA

JAMA. 2003;290(5):567. doi:10.1001/jama.290.5.567

Edited by Annette Flanagin, RN, MA, and Thomas B. Cole, MD, MPH

Posttraumatic Stress Among Children

Children exposed to violence may experience symptoms of posttraumatic stress disorder and other adverse psychological and behavioral sequelae. Stein and colleaguesArticle conducted a randomized trial to test the effectiveness of a school-based program of cognitive-behavioral therapy among sixth-grade students at 2 schools in Los Angeles who reported exposure to violence and had symptoms of posttraumatic stress disorder (PTSD). Compared with students who did not receive the intervention during the first 3 months of the trial, students in the early intervention group had significantly lower scores on symptoms of PTSD, depression, and psychosocial dysfunction after the 10-session intervention. Winston and colleaguesArticle report on the development and performance of a brief screening tool for clinicians to use during trauma care to identify children with acute injuries and their parents who are at risk for serious, persistent posttraumatic stress symptoms.

Mental Health Sequelae of Political and Civil Violence

Three articles in this issue of THE JOURNAL report on the mental health of populations exposed to war-related violence, political violence, or persistent terrorism. In a telephone survey in Israel after 19 months of terrorist attacks, Bleich and colleaguesArticle found that although most respondents reported at least 1 traumatic stress–related symptom and a decreased sense of safety, the rate of those meeting symptom criteria of posttraumatic stress disorder (PTSD) was relatively low (9.4%). Eisenman and colleaguesArticle conducted a survey of a sample of Latino immigrant adults in 3 community-based primary care clinics in Los Angeles and found a high rate of exposure to political violence in the country of origin, which was associated with PTSD and symptoms of depression and panic disorder. In a survey of residents of 5 Mayan refugee camps in Chiapas, Mexico, who fled civil conflict in Guatemala 20 years ago, Sabin and colleaguesArticle found that 54.4% reported anxiety symptoms, 38.8% reported depression symptoms, and 11.8% had all symptom criteria for PTSD.

Inflicted Brain Injury in North Carolina Children

Physical abuse is the leading cause of serious head injury and death in infants and toddlers in the United States. In this analysis of prospectively collected data from North Carolina resident children aged 2 years or younger in whom a serious or fatal traumatic brain injury occurred between January 1, 2000, and December 31, 2001, Keenan and colleagues found that the incidence of inflicted traumatic brain injury in the first 2 years of life was 17 per 100 000 person-years, and the incidence of noninflicted traumatic brain injury was 15.3 per 100 000 person-years. Compared with all children born in North Carolina in 2000, increased risk for inflicted traumatic brain injury was associated with minority race/ethnicity, younger maternal age, male sex, and multiple birth.

Casualties From Landmines in Afghanistan

Afghanistan had the most reported landmine and unexploded ordnance casualties in the world during 2000 and 2001. In this analysis of data collected by the International Committee of the Red Cross on landmine and unexploded ordnance casualties from March 2001 through June 2002, Bilukha and colleagues found that 81% of the 1636 individuals injured were civilians, 91.6% were men and boys, and 45.9% were younger than 16 years. Children were more likely to be injured by unexploded ordnance; most injuries among adults were caused by landmines. The most common risk behaviors for injury due to landmines and unexploded ordnance among children were playing and tending animals; for adults, the most common risk behaviors were military activity and activities of economic necessity, such as farming and traveling.

Medical News & Perspectives

Physicians and public health experts are playing a new role in curbing gun violence.

Communicable Disease Control in Iraq

Surveillance and control of communicable diseases in southern Iraq in April through June 2003.


Toxicology, clinical manifestations, and treatment of sarin nerve gas exposure.

Exhumation of Mass Graves in Iraq

Recovery of remains from mass graves in Iraq requires forensic, psychosocial, and logistical support to preserve evidence for future trials and meet humanitarian needs.

Posttraumatic Stress Responses

Kroll discusses factors that influence the expression and experience of posttraumatic stress responses.

JAMA Patient Page

For your patients: Information about inflicted brain injury in children.