Magnitude of psychological distress and associated factors among war survivor women in Northern, Ethiopia, 2022: a community-based cross-sectional survey.

BACKGROUND: Civilian war and internal conflicts increase the incidences of mental health conditions among war survivors. It is crucial to assess war-related psychological consequences in war-affected areas in Ethiopia to intervene in the future. Thus, this study aimed to determine the magnitude of psychological distress and associated factors of psychological distress among war survivor women in Northern, Ethiopia. METHODS: A community-based cross-sectional survey was conducted, and 1596 war survivor women were recruited to participate using a face-to-face interviews with a census sampling technique from May 1-30, 2022. The psychological distress was assessed using a Kessler psychological distress scale (K10). Bi-variable and multi-variable logistic regression analyses were used, and variables with a p-value less than 0.05 in the multivariable analyses were considered statistically significant. RESULT: In this study, the response rate was 100% and the prevalence of psychological distress was 44.90% at a 95% CI: (42.40, 47.40). Psychological distress was significantly associated with the education of ability to read and write (AOR = 2.92; 95% CI: 2.12, 4.01), primary education and above (AOR = 3.08; 95% CI: 2.09, 4.54), housewife (AOR = 5.07; 95%CI: 2.64, 9.74), farmer (AOR = 8.92; 95%CI: 4.03, 19.70), emotional violence (AOR = 1.52; 95%CI: 1.05, 2.18), physical violence (AOR = 3.85; 95%CI: 2.37, 6.26) and sexual violence (AOR = 3.25; 95%CI: 1.98, 5.33) whereas being separate was protective for psychological distress (AOR = 0.38; 95%CI: 0.16, 0.92). CONCLUSION: The prevalence of psychological distress was found to be high. Therefore, women who are housewives, married, farmers, educated, and who have experienced violence must be the focus of governmental and private collaborative interventions to prevent war-related psychological morbidity and mortality.

Impact of the War in Ukraine on the Ability of Children to Recognize Basic Emotions.

Objectives: This study assessed emotion recognition skills in school-age children in wartime conditions in Ukraine. Methods: An online survey based on the concept of basic emotions was administrated to a sample of 419 schoolchildren from Ukraine and a control group of 310 schoolchildren from the Czech Republic, aged 8 to 12. Results: There is no difference in judging the intensity of anger and fear by Ukrainian children, compared with the control group. There is no evidence that the emotions of anger, fear, and sadness were better recognized in the Ukrainian group. Children from Ukraine were better at recognizing positive emotions than Czech children. Conclusion: Increased risks of threats and wartime experience do not impair the accuracy of identification of emotions like fear or the assessment of intensity of basic emotions by children who experience war in Ukraine. Still, it is important to continue studying the long-term consequences of military conflicts in order to deepen the understanding of their impact on human mental functioning.

Understanding posthumous sperm retrieval during war through a terror management theory perspective.

Terror Management Theory (Tmt, solomon et al., 1991) claims that individuals use three anxiety buffer mechanisms to regulate their death awareness - cultural worldviews, self-esteem, and proximity seeking. In this article, we use these three TMT anxiety buffers to explain the phenomenon of posthumous sperm retrieval, requested by spouses or parents, usually of young soldiers who died during their military service. Whereas this phenomenon has been known for some time, it increased dramatically in the initial days following the massacre conducted by the Hamas terrorist organization in Israel on October 7, 2023. We claim that this was an immediate reaction to this terror event, which posed a direct, existential threat to those who were exposed to the massacre and the soldiers who defended the country, but also to the entire Israeli society, as well as for Jews around the globe. We use interpretive phenomenology to qualitatively examine the phenomenon of retrieving sperm from dead young men, analyzing the requests to retrieve sperm posthumously as a sign of the need to provide these young men with symbolic immortality, on both personal and national levels. We integrate this explanation with the military ethos and the tendency of Israeli society to endorse familyist and pronatalist values to expand our understanding of this contemporary phenomenon in Israel.

"Sonhei que morri": guerra e morte nos sonhos de jovens que cumprem medida socioeducativa de privação de liberdade / "Soñé que moría" guerra y muerte en los sueños de jóvenes que se encuentran en medidas socioeducativas / "I dreamed I died" war and death on adolescents' dreams who are subjected to socio-educational measures / "J'ai rêvé que je mourais" guerre et mort dans les rêves des jeunes en mesures socio-éducatives

Este artigo apresenta reflexões acerca da experiência com as Rodas de Sonhos, um dispositivo clínico-político construído em meio aos trabalhos de pesquisa-intervenção do NUPPEC junto aos adolescentes que cumpriam medida socioeducativa de privação de liberdade. Destacamos a temática da guerra e da morte presente nos relatos dos sonhos dos meninos em enlace com o desejo de morte que a sociedade brasileira dirige a esses jovens. Explicitamos o contexto violento da juventude brasileira em situação de vulnerabilidade social, sustentado pela lógica dos discursos capitalistas e neoliberais. Compartilhamos algumas narrativas oníricas, nas quais problematizamos os efeitos das políticas de morte e da violência dirigidas aos jovens negros e pobres do país. Entendemos que as Rodas de Sonhos oferecem um modo de resistência frente aos discursos mortíferos dirigidos a esses jovens

Este artículo presenta reflexiones sobre la experiencia con Rodas de Sonhos, un dispositivo clínico-político, construido en medio del trabajo de investigación-intervención del NUPPEC, con adolescentes que cumplían una medida socioeducativa de privación delibertad. Destacamos el tema de la guerra y la muerte presente en los relatos de los sueños de los chicos en relación con el deseo de muerte que la sociedad brasileña dirige a estos jóvenes. Explicamos el contexto violento de la juventud brasileña en situación de vulnerabilidad social, apoyados en la lógica de los discursos capitalista y neoliberal. Compartimos algunas narrativas oníricas, en las que problematizamos los efectos de las políticas de muerte y violencia dirigidas a los jóvenes negros y pobres del país. Entendemos que las Rodas de Sonhos ofrecen una forma de resistir los discursos mortíferos dirigidos a estos jóvenes

This article presents the reflections about the experience with Wheels of Dreams (Rodas dos Sonhos), a clinical-political device, developed around the research-intervention work of NUPPEC, with teenagers who are on depravation of liberty on detention centers for juvenile offenders. We emphasize the theme of war and death present in the narration of the dreams of teenagers in association with the desire for death that Brazilian society directed to these young people. We explicit the violent context of Brazilian youth in social vulnerability situation, sustained by the logic of capitalist and neoliberal discourses. We share some oneiric narratives, in which we problematized the effects of death policies and violence towards the country's young black and poor people. We understand that the Wheels of Dreams offer a mode of resistance in the face of deadly discourses directed at these young people

Cet article expose des réflexions sur l'expérience avec les Roues de Rêves, un dispositif clinique-politique, construit parmi aux travaux de recherche-intervention du NUPPEC, avec des adolescents qui purgeaient une mesure socio-éducatif de privation de liberté. Nous soulignons le thème de la guerre et de la mort présent dans les rapports des rêves des garçons combinés avec le souhait de mort que la société brésilienne apporte à ces jeunes. Nous explicitons le contexte violent de la jeunesse brésilienne en situation de vulnérabilité sociale, soutenu par la logique des discours capitalistes et néolibéraux. Nous partageons quelques récits oniriques, dans lesquels nous problématisons les effets des politiques de mort et de violence destinées à les jeunes noirs et pauvres du pays. Nous comprenons que les Roues de Rêves proposent une manière de résistance aux discours mortels destinés à ces jeunes

Encontro com a guerra no Brasil: entre psicanálise, Clausewitz e Foucault / Meeting the war in Brazil: between psychoanalysis, Clausewitz and Foucault / La rencontre avec la guerre au Brésil: entre psychanalyse, Clausewitz et Foucault / Encuentro con la guerra en Brasil: entre el psicoanálisis, Clausewitz y Foucault

Resumo A guerra do tráfico de drogas no Brasil tem ganhado destaque nas pesquisas dentro da psicologia pelo significativo número de mortes relacionadas a este fenômeno. Partindo da descrição dos cinco primeiros dias de encontro entre pesquisadores e adolescentes envolvidos com o fenômeno descrito, pretende-se apontar alguns pontos de aproximação e diferença entre ele e o que é chamado pelo significante "guerra" na filosofia de Clawsewitz e Foucault. Para tanto, foi feita uma descrição do campo, seguida pela problematização, retomando três aportes teóricos: a tese da guerra como continuação da política, de Clausewitz; a inversão feita por Foucault que sustenta o Racismo de Estado; e um aprofundamento psicanalítico sobre as diversas modalidades dos conflitos sob o nome de guerra. Concluindo, essa análise resultou na tese de que existe uma guerra no Brasil como consequência do sistema político excludente, denunciada pelos jovens envolvidos com o tráfico de drogas.

Abstract The 'war on drugs' promoted in Brazil has gained prominence in psychology research due to the ensuing significant number of deaths. By describing the five first meetings held with teenagers, the researchers highlight some similarities and differences between the described phenomenon and what Clausewitz and Foucault call 'war.' To this end, after describing the field research, the paper discusses three theoretical points: Clausewitz's thesis that war is the continuation of politics; Foucault's inversion, which sustain state racism; and an in-depth psychoanalysis of the various forms of conflict under the umbrella-term 'war.' In conclusion, this analysis point out the war going on in Brazil as a consequence of the exclusionary political system, denounced by youths involved in drug trafficking.

Résumé La guerre au trafic de drogues promue au Brésil a pris de l'importance dans la recherche en psychologie en raison du nombre important des décès qu'elle a entraîné. En décrivant les cinq premières réunions tenues avec des adolescents, les chercheurs souligne certaines similitudes et différence entre le phénomène décrit et ce que Clausewitz et Foucault appellent la « guerre ¼. Pour cela, après avoir décrit la recherche, l'article discute de trois points théoriques : la thèse de Clausewitz, selon laquelle la guerre est le prolongement de la politique; l'inversion faite par Foucault, qui soutient le racisme d'État ; et une psychanalyse approfondie des différentes formes de conflit sous le terme générique de « guerre ¼. En conclusion, cette analyse met en évidence la guerre qui se déroule au Brésil comme une conséquence du système politique d'exclusion dénoncé par les jeunes impliqués dans le trafic de drogue.

Resumen La guerra en contra del tráfico de drogas en Brasil ha ganado atención en la investigación en psicología debido al número significativo de muertes relacionadas a este fenómeno. Partiendo de la descripción de los cinco primeros días de encuentro entre investigadores y adolescentes envueltos en el fenómeno descrito, se pretende señalar algunos puntos de aproximación y diferencia entre este y lo que es llamado por el significante "guerra" en la filosofía de Clausewitz y Foucault. Para esto, se llevó a cabo una descripción de campo, seguida por la problematización con tres aportes teóricos: la tesis de la guerra como extensión de la política de Clausewitz; la inversión hecha por Foucault que sustenta el Racismo de Estado; y una profundización psicoanalítica sobre las diversas modalidades de los conflictos bajo el nombre de guerra. En conclusión, este análisis constató la tesis de que existe una guerra en Brasil como consecuencia de un sistema político excluyente, denunciada por los jóvenes envueltos con tráfico de drogas.

Using clinical expertise and empirical data in constructing networks of trauma symptoms in refugee youth.

Background: In recent years, many adolescents have fled their home countries due to war and human rights violations, consequently experiencing various traumatic events and putting them at risk of developing mental health problems. The symptomatology of refugee youth was shown to be multifaceted and often falling outside of traditional diagnoses. Objective: The present study aimed to investigate the symptomatology of this patient group by assessing the network structure of a wide range of symptoms. Further, we assessed clinicians' perceptions of symptoms relations in order to evaluate the clinical validity of the empirical network. Methods: Empirical data on Post-Traumatic Stress Disorder (PTSD), depression and other trauma symptoms from N = 366 refugee youth were collected during the routine diagnostic process of an outpatient centre for refugee youth in Germany. Additionally, four clinicians of this outpatient centre were asked how they perceive symptom relations in their patients using a newly developed tool. Separate networks were constructed based on 1) empirical symptom data and 2) clinicians' perceived symptom relations (PSR). Results: Both the network based on empirical data and the network based on clinicians' PSR showed that symptoms of PTSD and depression related most strongly within each respective cluster (connected mainly via sleeping problems), externalizing symptoms were somewhat related to PTSD symptoms and intrusions were central. Some differences were found within the clinicians' PSR as well as between the PSR and the empirical network. Still, the general PSR-network structure showed a moderate to good fit to the empirical data. Conclusion: Our results suggest that sleeping problems and intrusions play a central role in the symptomatology of refugee children, which has tentative implications for diagnostics and treatment. Further, externalizing symptoms might be an indicator for PTSD-symptoms. Finally, using clinicians' PSR for network construction offered a promising possibility to gain information on symptom networks and their clinical validity.

Antecedentes: En los últimos años, muchos adolescentes han huido de sus países de origen debido a la guerra y a violaciones contra los derechos humanos experimentando, como consecuencia, diversos eventos traumáticos y situándose en riesgo de desarrollar problemas de salud mental. La sintomatología de los refugiados jóvenes mostró ser multifacética y, por lo general, quedando fuera de los diagnósticos tradicionales.Objetivos: Este estudio tiene por objetivo investigar la sintomatología de este grupo de pacientes evaluando la estructura de redes de un amplio rango de síntomas. Además, evaluamos la percepción de los clínicos respecto a la relación de los síntomas para evaluar la validez clínica del trabajo de redes empírico.Métodos: Se recolectaron datos empíricos sobre el trastorno de estrés postraumático (TEPT), la depresión y otros síntomas de trauma de N = 366 jóvenes refugiados durante los procesos diagnósticos de rutina de un centro ambulatorio para refugiados jóvenes en Alemania. Además, a cuatro clínicos de este centro ambulatorio se les preguntó sobre cómo percibían las relaciones de los síntomas de sus pacientes empleando una herramienta recientemente desarrollada. Se construyeron redes separadas sobre la base de 1) datos empíricos de síntomas y 2) la percepción de la relación de los síntomas (PRS) de los clínicos.Resultados: Tanto las redes basadas en datos empíricos como las redes basadas en la PRS de los clínicos mostraron que los síntomas del TEPT y de la depresión se relacionaban con más fuerza con cada racimo respectivo de síntomas (conectados principalmente a través de los problemas de sueño). Los síntomas externalizantes estaban algo relacionados con los síntomas asociados al TEPT mientras que las intrusiones se constituyeron en algo central. Se encontraron algunas diferencias entre las propias PRS's de los clínicos, así como entre la PRS y las redes empíricas. Aun así, la restructura general de redes basadas en la PRS mostró una correspondencia moderada a buena con los datos empíricos.Conclusión: Nuestros resultados sugieren que los problemas de sueño y las intrusiones tienen un papel central en la sintomatología de los niños refugiados, lo que tiene implicancias tentativas para el diagnóstico y el tratamiento. Además, los síntomas externalizantes podrían ser un indicador de síntomas asociados al TEPT. Finalmente, empleando la PRS de los clínicos para la construcción de redes brindó una posibilidad prometedora para obtener información sobre las redes de síntomas y su validez clínica.

Adaptive coping during protracted political conflict, war and military blockade in Gaza.

Identifying culturally-relevant concepts and coping mechanisms can help protect civilian wellbeing. This study explores how seven professional Palestinian university graduates in the Gaza Strip (occupied Palestinian territories) cope with war, military occupation, military blockade and the challenges of living in a conflict-affected area. Participants were interviewed to determine whether culturally specific modes of coping were used. Thematic analysis was applied. The use of resistance and more specifically sumud, 1 being steadfast and persevering, were identified alongside the motivation to persevere and other adaptive responses to living conditions. Coping strategies identified in this study include adapting, problem-solving, accepting reality, exercising patience, utilising social support, and faith in God (iman) and religion. The implications of this study and the relevance of the findings to mental health and disaster relief are considered.

A systematic review of psychological training or interventions given to UK military personnel prior to deployment.

INTRODUCTION: Predeployment stress management/mental health training is routinely delivered in an effort to mitigate potential adverse psychological effects. Little is known about the effectiveness of such interventions. METHODS: A systematic literature review explored research outcomes related to this subject, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guidelines. An electronic database search using key terms identified studies published between January 2007 and March 2019. Comprehensive inclusion/exclusion criteria were applied and study quality was appraised by two reviewers using 12 criteria adapted from the Critical Appraisal Skills Programme (CASP) checklist. Papers were excluded if they were allocated CASP scores ≤10 out of 24. RESULTS: 2003 references were identified; 15 papers fulfilled inclusion criteria and quality threshold requirements. Included studies were randomised controlled trial design (n=8), quasi-experimental (n=5), case report (n=1) and cross-sectional (n=1). Duration of follow-up assessment varied from immediately postintervention to 24 months. The included studies were heterogeneous so clear recommendations relating to predeployment training for military personnel could not be made. Although somewhat disparate, predeployment interventions shared the aim of promoting prior to, during and after deployment health and well-being. Social benefits such as improved cohesion and improved stress management skills were identified in some studies, although substantial mental health and well-being benefits were not found. CONCLUSIONS: Evidence for the effectiveness of predeployment psychological interventions is scant. Every attempt should be made to use methods and measures to facilitate comparisons across studies, to attempt a longer follow-up timescale and to clarify key trainer characteristics.

Caring for Child Psychotrauma: Lessons from Bosnia.

The war in Bosnia and Herzegovina (1992-1995) was an extremely hard traumatic event with different losses, separations of people, injuries, hard physical and psychical suffering of everyone. Children were especially in difficult conditions. One of the most remarkable things about children, as anyone who works with them soon finds out, is their resilience. While children are vulnerable to psychic damage and, if the damage is deep enough, to delays in emotional and even physical growth, they also have an astonishing capacity to bounce back. This is one of the most rewarding things about treating traumatized children. For many children, it takes very little, perhaps only some words of understanding, to help them tap into their own ability to heal. Taking care of child war psycho-trauma was a difficult task for me, as the war-time head of Department of psychiatry, without enough knowledge in child psycho-trauma and as person with a high responsibility, to organize together with other psychological caretakers of children, especially refugee children. This presentation will be some kind of my remembrance of period of 20-25 years ago when we, I think did good work of what we could and what we knew.

War Atrocities and Growing Up: Risks We Have to Think About.

The establishment of the United Nations after World War II raised hopes of a new era of peace. This was over-optimistic. Between 1945 and 1992, there were 149 major wars, killing more than 23 million people. Recent developments in warfare have significantly heightened the dangers for children. During the last decade child war victims have included: 2 million killed; 4-5 million disabled; 12 million left homeless; more than 1 million orphaned or separated from their parents; some 10 million psychologically traumatized. Researches indicate that children do develop PTSD after experiencing very stressful, life-threatening events such as happen in war. Wars of 21st century are often guerrilla-type civil wars in which women and children are not only the main victims, but are deliberately targeted. Thousands are displaced both internally and across borders. Wars at the end of nineties of 20th century in the region of ex Yugoslavian countries brought all the cruelty of war vivid again on European ground. Population were exposed to death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence. During the War in Bosnia and Herzegovina 1992-1995 there were about 100 000 people killed (20% woman and 3.5% children) and about 18 000 children were orphaned because of war. Children are not capable to regulate their emotions and hyper-arousal on their own. It depends of the way how their parents (caretaker) regulate her/his own emotions. During the war weak child's ego is paralyzed with intensive stimuli and floating anxiety, it does not manage to make constructive solution for traumatic experiences in such a short time. Mothers with small children are especially vulnerable group during the war time: they are supposed to take care about children and feel happiness, what is almost impossible Severe war experiences could cause depressive symptoms in mothers, what reduce their emotional disposability and could lead in different form of the child's neglecting. PTSD symptoms were lasting longer in children if their mothers have had functioning problems. Traumatization of mothers is connected with different behavior problems in their children. Wars are continuing all over the world and there is a continuity of researches about their consequences on children. Any programs that intend to mitigate the psychological effects of such trauma need to adopt a public health approach aimed at reaching many thousands.

Could Combat Stress Affect Journalists' News Reporting? A Psychophysiological Response.

Covering war conflicts may compromise the psychological and physical health of journalists because chronic exposure to these environments has been related to depression, memory dissociative processes, and post-traumatic stress disorder; however, acute effects have not been studied yet. Thus, a combat simulation was carried out replicating actual warfare scenarios, including personnel and equipment. Psychophysiological response, memory, and information-processing were analysed of 40 professional soldiers (21 males and 19 females) and 19 journalists (12 males and 7 females) with international experience in current conflict areas such as Afghanistan, Iraq, Bosnia and Herzegovina, and Kosovo, in relation to their experience of a combat intervention. A significant increase (p < 0.05) in metabolic, muscular, cardiovascular, and cortical and psychological anxiety response, as well as a decrease in memory accuracy directly after and 24 h and 72 h post-combat were found; these modifications were modulated by the nature of the stimulus. Journalists presented higher cognitive and memory impairment than soldiers, resulting in a press reporting of real events accuracy of only 27%.

Syria's Devastating Legacy of War.

Nearly a decade of conflict leaves health and housing systems in shambles.

Social suffering and the psychological impact of structural violence and economic oppression in an ongoing conflict setting: The Gaza Strip.

Structural violence and economic oppression (e.g. control over resources, politically engineered poverty and unemployment) are common features of warfare, yet there is a lack of research exploring the impact this has on civilian wellbeing in conflict-affected areas. This study, embedded within a human rights and community liberation psychology framework, aims to address this need by studying young Palestinian university graduates living under military blockade and occupation in the Gaza Strip. Semi-structured interviews were conducted. Thematic analysis indicated that economic and political domains adversely affected multiple aspects of civilian life and wellbeing. The findings revealed the deleterious effects of structural violence and economic oppression which created: human insecurity; poor psychological wellbeing and quality of life; existential, psychological and social suffering; humiliation; injuries to dignity; multiple losses; and led to life being experienced as 'on hold'. Local expressions and idioms to express distress were identified. The findings contributed to unique insights regarding how continual, systemic, and structural oppression can be potentially more psychologically detrimental than specific incidents of conflict and violence. The implications and the relevance of the findings to mental health and disaster relief are considered. Interventions providing human security and economic security should be prioritised.

Parental Wartime Deployment and Socioemotional Adjustment in Early Childhood: The Critical Role of Military Parents' Perceived Threat During Deployment.

Infants, toddlers, and preschool-aged children have unique developmental needs that render them vulnerable to challenges associated with parental military service. We used a sample of military-connected families with 3-6-year-old children (N = 104) to examine associations among children's socioemotional development and fathers' trauma-related deployment experiences, including perceived threat during deployment and exposure to combat and the aftermath of battle. Of these potential stressors, only paternal perceived threat during deployment was significantly associated with measures of mother-reported child adjustment. Fathers' perceived threat during deployment was associated with child behavior problems even after accounting for demographic variables and current paternal symptoms of posttraumatic stress, depression, and anxiety, ß = .36, p = .007. The association between fathers' perceived threat during deployment and child behavior problems was mediated by several family processes related to emotion socialization, including father-reported sensitive parenting, indirect effect (IE) B = 0.106, 95% CI [0.009, 0.236]; parent-child dysfunctional interaction, IE B = 0.119, 95% CI [0.014, 0.252]; and mother-reported family emotional responsiveness, IE B = 0.119, 95% CI [0.011, 0.258]. Implications for future research on the intergenerational transmission of traumatic stress as well as prevention and intervention efforts for military-connected families with young children are discussed.

A community-based system dynamics approach for understanding factors affecting mental Health and Health seeking behaviors in Beirut and Beqaa regions of Lebanon.

BACKGROUND: Available evidence on mental health and psychosocial problems in Lebanon is limited. Recent quantitative data suggests a high prevalence among Syrian refugees and their Lebanese host communities, with significant treatment gaps in both populations. This study aims to determine how Lebanese host and Syrian refugee communities perceive mental health, and identify health seeking behaviors and barriers to health access in two contrasting contexts of fragility. METHODS: A comparative qualitative study design was adopted whereby a total of 36 semi-structured interviews with Lebanese host and Syrian refugees' community members were conducted, followed by a series of four participatory group model building (GMB) sessions. Participants were recruited from two contrasting fragility contexts: Beirut and Beqaa regions. During these sessions, causal loop diagrams were elicited depicting shared understandings of factors prompting the onset of mental health and psychosocial issues; health seeking behaviors, pathways and elements affecting the rate of health improvement and maintenance were also identified. RESULTS: Community members in both settings had similar perceptions of factors contributing to mental health. Participants named long-term effects of exposure to wars, political and social effects of conflicts, and financial constraints at the household level as precipitating factors prompting the onset of mental health and psychosocial stressors. Gender and integration related challenges between communities were identified as factors that affect condition onset and associated care seeking. Pathways for health seeking were found to be shaped by trust, the advice and support of loved ones, and the need to ensure confidentiality of affected individuals. Recurrent themes in discussion highlighted major barriers to healthcare access including significant delays in health care seeking from the formal health system, widespread social stigma, prohibitive service costs, lack of health coverage, limited awareness of mental health service availability and limited trust in the quality of services available. CONCLUSION: Mental health and psychosocial support strategies need to be gender- and integration-sensitive, primarily focused on condition prevention and awareness raising in order to strengthen health-seeking behaviors.

Miniaturization optimized weapon killing power during the social stress of late pre-contact North America (AD 600-1600).

Before Europeans arrived to Eastern North America, prehistoric, indigenous peoples experienced a number of changes that culminated in the development of sedentary, maize agricultural lifeways of varying complexity. Inherent to these lifeways were several triggers of social stress including population nucleation and increase, intergroup conflict (warfare), and increased territoriality. Here, we examine whether this period of social stress co-varied with deadlier weaponry, specifically, the design of the most commonly found prehistoric archery component in late pre-contact North America: triangular stone arrow tips (TSAT). The examination of modern metal or carbon projectiles, arrows, and arrowheads has demonstrated that smaller arrow tips penetrate deeper into a target than do larger ones. We first experimentally confirm that this relationship applies to arrow tips made from stone hafted onto shafts made from wood. We then statistically assess a large sample (n = 742) of late pre-contact TSAT and show that these specimens are extraordinarily small. Thus, by miniaturizing their arrow tips, prehistoric people in Eastern North America optimized their projectile weaponry for maximum penetration and killing power in warfare and hunting. Finally, we verify that these functional advantages were selected across environmental and cultural boundaries. Thus, while we cannot and should not rule out stochastic, production economizing, or non-adaptive cultural processes as an explanation for TSAT, overall our results are consistent with the hypothesis that broad, socially stressful demographic changes in late pre-contact Eastern North America resulted in the miniaturization-and augmented lethality-of stone tools across the region.

Medical Ethics in Extreme and Austere Environments.

American society has a history of turning to physicians during times of extreme need, from plagues in the past to recent outbreaks of communicable diseases. This public instinct comes from a deep seated trust in physician duty that has been earned over the centuries through dedicated and selfless care, often in the face of personal risks. As dangers facing our communities include terroristic events physicians must be adequately prepared to respond, both medically and ethically. While the ethical principles that govern physician behavior-beneficence, nonmaleficence, autonomy, and social justice-are unchanging, fundamental doctrines must change with the new risks inherent to terroristic events. Responding to mass casualty disasters caused by terrorists, natural calamities, and combat continue to be challenging frontiers in medicine. Preparing physicians to deal with the consequences of a terroristic disease must include understanding the ethical challenges that can occur.

The sex ratio at birth, the 10/17 Las Vegas shooting and the 01/18 Hawaii false missile alert.

INTRODUCTION: Males are born usually in excess of females and the ratio is often expressed as M/T (male divided by total births). Many acute and stressful factors have been shown to influence M/T, and these transiently lower M/T for a one month period, three to five months after such events. This study was carried out in order to ascertain whether the Las Vegas shooting (10/2017) and the Hawaii false missile alert (01/2018) influenced M/T in the respective populations. METHODS: Monthly live births by gender for the states of Nevada and Hawaii for 2016-2018 were obtained from the website of the Centers for Disease Control and Prevention (CDC). RESULTS: There were no significant dips in M/T for any of the relevant months (3-5 months) following these events. DISCUSSION: Research to date has shown M/T dips following catastrophic or tragic events. Equivalent dips were not noted in this study. The reasons for this may be one or a combination of the following. The population size was not sufficiently large in order to detect an M/T dip. Alternatively, the events were not felt to be sufficiently momentous by the populace such that an M/T dip was not produced. Yet another possibility is that these particular populations are somehow hardier and more resistant to such influences. Not all acute events may result in a visible/significant reduction in M/T.