Peace through health: traditional medicine meditation in the prevention of collective stress, violence, and war.

In the midst of global armed conflicts, notably the Israel-Hamas and Ukraine-Russia wars, there is an urgent need for innovative public health strategies in peacebuilding. The devastating impact of wars, including mortality, injury, disease, and the diversion of healthcare resources, necessitates effective and durable interventions. This perspective aligns with WHO recommendations and examines the role of evidence-based meditation from Ayurveda and Yoga in public health to mitigate collective stress and prevent collective violence and war. It highlights the Transcendental Meditation program, recognized for reducing stress, with contemporary evidence supporting its effectiveness in mental health, mind-body disorders, cardiovascular disease, and public health. Empirical studies with cross-cultural replications indicate that these Traditional Medicine meditation practices can reduce collective stress and prevent collective violence and war activity while improving quality of life. The mechanisms of group meditation in mitigating collective violence are explored through public health models, cognitive neuroscience, population neuroscience, quantum physics principles, and systems medicine. This perspective suggests that Transcendental Meditation and the advanced TM-Sidhi program, as a component of Traditional Medicine, can provide a valuable platform for enhancing societal well-being and peace by addressing brain-based factors fundamental to collective stress and violence.

Exploring the health consequences of armed conflict: the perspective of Northeast Ethiopia, 2022: a qualitative study.

BACKGROUND: Conflict is a complicated topic with a multidimensional consequences for community health. Its effects have a broad pattern, starting from direct war-related morbidity and mortality caused by bullets and bombs to indirect consequences due to the interruption of the delivery of preventive and curative health services. This study aimed to explore the health consequences of the northern Ethiopian conflict in the North Wollo zone, northeast Ethiopia, in 2022. METHODS: This descriptive qualitative study was conducted from May to June 2022 on six conflict-affected Woredas in the north Wollo zone. A total of 100 purposively selected participants, which included patients, pregnant women, elders, community and religious leaders, and health professionals, were interviewed using IDI and FGD. The data was entered, coded, and analyzed using Open Code version 4.03. Thematic analysis approach employed to conduct the interpretation. Data was presented using descriptive statistics in the form of texts and tables. RESULTS: The findings indicate that the conflict has caused a profound consequence on population health. It has resulted in a wide range of direct and indirect consequences, ranging from war-related casualties, famine, and disruptions of supply chains and forced displacement to instances of violence and rape associated with insecurity. The conflict also caused a breakdown in the health system by causing distraction of health infrastructure, fleeing of health workers and shortage of medication, together with insecurity and lack of transportation, which greatly affected the provision and utilization of health services. Additionally, the conflict has resulted in long-term consequences, such as the destruction of health facilities, interruption of immunization services, posttraumatic stress disorders, and lifelong disabilities. The coping strategies utilized were using available traditional medicines and home remedies, obtaining medications from conflict-unaffected areas, and implementing home-to-home healthcare services using available supplies. CONCLUSION: The Northern Ethiopian conflict has an impact on community health both directly and indirectly through conflict-related causalities and the breakdown of the health system and health-supporting structures. Therefore, this study recommends immediate rehabilitation interventions for damaged health infrastructure and affected individuals.

Impact of armed conflict on health professionals' education and training in Syria: a systematic review.

OBJECTIVES: To provide an overview of the holistic impact of the armed conflict on medical education and health professionals' training (MEHPT) in Syria. SETTING: Syria is a country which underwent an armed conflict for 10 years and suffered from the weaponisation of health. METHODS: A mixed-methods systematic review including quantitative, qualitative, mixed-methods and textual literature between 2011 and 2021 including papers on the Syrian MEHPT undergraduate and postgraduate education and training personnel (including medicine, dentistry, pharmacy, nursing, midwifery and allied health professionals). The electronic search was conducted in October 2018 in Embase, Global Health, Medline, PsycINFO, Web of Science, PubMed, Scopus, CINAHL and grey literature. And an update to the search was conducted in August 2021 in PubMed, Google Scholar and Trip database. OUTCOMES: The impact of conflict on the MEHPT system, personnel, experiences, challenges and channels of support. RESULTS: Of the 5710 citations screened, 70 met the inclusion criteria (34 quantitative, 3 qualitative, 1 mixed-method, and 32 reports and opinion papers). The two major cross-cutting themes were attacks on MEHPT and innovations (present in 41% and 44% of the papers, respectively), followed by challenges facing the MEHPT sector and attitudes and knowledge of trainees and students, and lastly health system and policy issues, and narrating experiences. CONCLUSION: Conflict in Syria has politicised all aspects of MEHPT. Influenced by political control, the MEHPT system has been divided into two distinguished geopolitical contexts; government-controlled areas (GCAs) and non-GCAs (NGCAs), each having its characteristics and level of war impact. International and regional academic institutes collaboration and coordination efforts are needed to formulate educational platforms using innovative approaches (such as online/blended/store-and-forward/peer-training/online tutoring) to strengthen and build the capacity of the health workforce in conflict-affected areas.

Alabaos and Currulaos: Resignification of Afro-Pacific Cultural and Identity Practices in the Framework of the Armed Conflict / Alabaos y currulaos: resignificación de prácticas identitarias y culturales afropacíficas en el marco del conflicto armado

RESUMEN Este artículo presenta una revisión crítica en torno a la resignificación de dos prácticas culturales, identitarias y literarias, alabaos y currulaos, rostros de la palabra cantada, en el contexto del conflicto armado que ha afectado desproporcionalmente a las comunidades afrocolombianas. Método: La investigación sigue la perspectiva de lo que nombro la hermenéutica del retorno, une perspectiva interpretativa crítica sobre la presencia histórica de las comunidades afro en perspectiva de la descolonización. En primer lugar, se introduce una discusión respecto al carácter literario de estas dos creaciones afro. Luego se procede a la contextualización de estas prácticas como agencias de la identidad étnico-racial y cultural afro. Después, me adentro en el reconocimiento de los impactos del conflicto armado en los territorios a partir de la lectura y escucha detenida de las líricas, principalmente tres canciones a ritmo de currulao, de la agrupación de chirimía Rancho Aparte, Esteban Copete y su Kinteto, Canalón de Timbiquí y la orquesta Herencia de Timbiquí. Asimismo, se retomarán algunos alabaos del álbum titulado Voces de resistencia, apoyado por la Universidad ICESI y la Fundación Ford, y realizado por las Cantaoras de Pogue. Finalmente, mediante este escrito pretendo visibilizar la capacidad de reinvención de las comunidades para hacer de estas prácticas dispositivos de memoria, proceso de concienciación, denuncia y sanación mental.

ABSTRACT This paper presents a critical review about resignification of two identitarian, literary, and cultural practices, alabaos and currulaos, faces of the sung word, in the framework of the armed conflict that has disproportionally impacted Afro-Colombian communities. Method: the research follows the perspective of what I call the hermeneutics of return, a critical interpretive perspective on the historical presence of Afro communities in the perspective of decolonization. First, it introduces a discussion regarding the literary character of these Afro-Colombian creations. Then, these cultural practices are contextualized as agencies of Afro ethno-racial and cultural identity. After that, I focus on the recognition of the armed conflict effects in the territories, considering careful reading and listening of some lyrics, particularly three currulao songs of the following groups: Rancho Aparte, Esteban Copete y su Kinteto, Canalón de Timbiquí, and Herencia de Timbiquí. Furthermore, some alabaos from the album Voces de resistencia will be analyzed in terms of the transformations this cultural practice suffered in the middle of the war experiences. This album was interpreted by Las Cantaoras de Pogue and sponsored by ICESI University and the Ford Foundation. In conclusion, Ipretend, through this article, to visualize the reinvention capacity of communities to transform these cultural practices into memory, sensibilizing, denouncing, and mental healing tools.

Pandemics throughout the centuries.

Pandemics have ravished the globe periodically, often associated with war, at times commencing as fever and rash, beginning in recorded history in the crowded walled city of Athens during the Peloponnesian War as described in great detail by the Athenian historian and military general Thucydides in 430 BCE. As the world now faces the first major pandemic of the 21st century, we focus on the "plague" commencing in Athens in 430 BCE and the 2 pandemics of the more recent century, which killed more than one million, the Spanish flu of 1918 and the Asian flu of 1957. The latter linked with successful vaccine development thanks to the heroic efforts of microbiologist Maurice Hilleman. We now look back and then forward to the viral infection coronavirus disease 2019 now devastating the world.

[The potato in hospital nutrition as an approach to its introduction in the urban diet: the case of Vitoria (Alava, Spain)]. / La patata en la nutrición hospitalaria como aproximación a su introducción en la dieta urbana: el caso de Vitoria (Álava, España).

INTRODUCTION: Introduction: given the lack of historical documentary sources about the beginning of potato effective consumption in Vitoria (Alava, Spain), its introduction in the urban diet is estimated from cultivation and production data. This only allows asserting the introduction of the cultivation at the end of the 18th century, the recognition of two quantitative jumps during the Independence and First Carlist Wars, and that it was the second cultivation in quantity by 1857. Objective/method: from the hypothesis of a good correspondence between hospital diet and ordinary urban diet, evidenced in other studies for Vitoria, it is proposed to document the chronology of potato introduction in the urban diet from its analysis in the city hospital, as well as to contextualize concurrent historical events, through the review and analysis of primary and secondary documentary sources. Results: the hospital keeps a record of food acquisitions since 1743. The first purchase of potatoes was paid on September 17, 1834. Acquisitions continue in very variable quantities and dates, which are normalized from 1844. Contextually, there is a major subsistence crisis with cholera as the most immediate and necessary cause in synergy with the first carlist war and the devastation of crops in a summer storm. In 1854 the potato was established in the urban diet. Conclusions: the first acquisition of potatoes was made in September 1834 in the immediate context of cholera together with the carlist war and catastrophic weather effects.

INTRODUCCIÓN: Introducción: dada la carencia de fuentes documentales históricas sobre el inicio del consumo efectivo de patata en Vitoria (Álava, España), su introducción en la dieta urbana se estima a partir de los datos de cultivo y producción. Ello solo permite aseverar la introducción del cultivo a finales del siglo XVIII, el reconocimiento de dos saltos cuantitativos durante las guerras de independencia y primera carlista, y que era el segundo cultivo en cantidad en 1857. Objetivo/método: desde la hipótesis de una buena correspondencia entre la dieta hospitalaria y la dieta ordinaria urbana, evidenciada en otros estudios para Vitoria, se propone documentar la cronología de la introducción de la patata en la dieta urbana a partir de su análisis en el hospital de la ciudad, así como contextualizar los acontecimientos históricos concurrentes mediante la revisión y el análisis de fuentes documentales primarias y secundarias. Resultados: el hospital conserva el registro de alimentos adquiridos desde 1743. La primera compra de patatas se abona el 17 de septiembre de 1834. Se continúa con adquisiciones en cantidades y fechas muy variables que se normalizan a partir de 1844. Contextualmente, existe una crisis mayor de subsistencia con el cólera como causa más inmediata y necesaria en sinergia con la primera guerra carlista y la devastación de cultivos en una tormenta veraniega. En 1854 la patata está asentada en la dieta urbana. Conclusiones: la primera adquisición de patatas se realizó en septiembre de 1834 en el contexto inmediato del cólera junto a la guerra carlista y efectos catastróficos meteorológicos.

The holistic transformative street-street gang intervention impact and its association with homicide rates in Cali, Colombia / El efecto holístico transformador de la intervención de las pandillas y su asociación con la tasa de homicidios en Cali, Colombia / O efeito transformador holístico da intervenção das gangues e sua associação com a taxa de homicídios em Cali, Colômbia

Abstract Cali is one of the cities in Colombia and Latin America with the highest rate of homicides, with around one third of homicides being attributed to street gang-related violence. In 2016, the Mayor's office from Santiago the Cali - Colombia, the Police Department and the Cisalva institute from Universidad del Valle worked together to develop an holistic intervention, "TIP -Youth without frontiers", to reduce street gang-related violence in Cali's communes. The intervention comprised six components focusing on developing personal/emotional skills, improving access to health and other public services, reducing substance use, connecting youth with employment and educational opportunities, promoting participation in sports and recreational activities, and improving the restitution of citizen rights to street gang members. This study aimed to describe the characteristics and implementation of this transformative street gang program and to describe changes in street gang-related homicides that could be associated with the implementation of this program. The program started contacting street gangs in January 2016, recruiting the first street gang members in August 2016. As of December 2018, 2.107 youth (from 84 Police identified street gangs) have participated in the program. A reduction in street gang-related homicides was observed in Cali's communes from 2015 to 2018. In intervened communes these homicides decreased on average by 80%, suggesting that the program could have contributed to the reduction of street gang-related violent behavior in these areas.

Resumen Cali es una de las ciudades de Colombia y de Latinoamérica con la tasa de homicidios más alta, con alrededor de un tercio de los homicidios atribuidos a la violencia entre pandillas. En 2016, la Alcaldía de Santiago de Cali - Colombia, la Policía Nacional y el Instituto Cisalva de la Universidad del Valle trabajaron juntos para desarrollar una intervención holística, "TIP - Jóvenes sin fronteras", con el fin de reducir la violencia relacionada con las pandillas en las comunas de Cali. La intervención abarcó seis componentes centrados en desarrollar habilidades personales/emocionales, mejorar el acceso a los servicios de salud y otros servicios públicos, reducir el consumo de sustancias, conectar a los jóvenes con oportunidades laborales y educativas, fomentar la participación en actividades deportivas y recreativas, y restituir los derechos cívicos a integrantes de las pandillas. El objetivo de este estudio era describir las características y la implementación de este programa de transformación de pandillas, y describir los cambios en la tasa de homicidios relacionados con pandillas que podrían estar asociados con la implementación de este programa. El programa comenzó contactando a las pandillas en enero del 2016, reclutando a los primeros miembros de estas en agosto del 2016. A diciembre del 2018, 2.107 jóvenes (de 84 pandillas identificadas por la policía) han participado en el programa. Se observó una reducción de los homicidios relacionados con pandillas en las comunas de Cali entre 2015 y 2018. En las comunas intervenidas, estos homicidios disminuyeron en promedio un 80%, lo que sugiere que el programa podría haber contribuido a la reducción del comportamiento violento relacionado con las pandillas en estas áreas.

Resumo Cali é uma das cidades da Colômbia e da América Latina com a maior taxa de homicídios, com cerca de um terço dos homicídios atribuídos à violência de gangues. Em 2016, a Prefeitura de Santiago de Cali - Colômbia, a Polícia Nacional e o Instituto Cisalva da Universidad del Valle trabalharam juntos para desenvolver uma intervenção holística, "TIP - Jovens sem fronteiras", a fim de reduzir a violência das gangues nas comunas de Cali. A intervenção abrangeu seis componentes focados no desenvolvimento de habilidades pessoais/emocionais, melhoria do acesso aos serviços de saúde e outros serviços públicos, redução do uso de substâncias, conexão dos jovens com oportunidades de emprego e educação, incentivo à participação em atividades esportivas e recreativas, e a restauração dos direitos cívicos para os membros das gangues. O objetivo deste estudo foi descrever as características e a implementação do programa de transformação de gangues e descrever as mudanças na taxa de homicídios por gangues que poderiam estar associadas à implementação deste programa. O programa começou contatando as gangues em janeiro de 2016 e foram recrutados os primeiros membros das gangues em agosto de 2016. Em dezembro de 2018, participaram do programa 2.107 jovens (de 84 gangues identificadas pela polícia). Uma redução dos homicídios relacionados a gangues nas comunas de Cali foi observada entre 2015 e 2018. Nas comunas intervencionadas, esses homicídios diminuíram em média 80%, sugerindo que o programa possa ter contribuído para a redução do comportamento violento relacionado a gangues nessas áreas.

Medicine in Extreme Environments: A New Medical Student Elective Class for Wilderness, Aerospace, Hyperbaric, Exercise, and Combat Medicine.

We developed an elective course titled Medicine in Extreme Environments (MEE) at the University of Texas Southwestern Medical Center for first- and second-year medical students. This course covered physiology, research, clinical practice, and career guidance regarding the fields of wilderness, space, hyperbaric, combat, and exercise medicine. The primary aim was to generate interest in and awareness of these seldom covered fields of medicine by exposing medical students to these disciplines during their preclinical years. A postcourse questionnaire was implemented to investigate whether the MEE course increased awareness of, interest in, and knowledge in the fields of medicine included in the curriculum. Through 2 iterations of the class, a total of 67 students enrolled in the course, and 38 students completed the questionnaire. After course completion, 95% felt they better understood the work and lifestyle of the fields covered, 100% learned more about concepts of each field, and 74% agreed that the elective influenced the direction of their future careers to include some part of the fields emphasized. Although only a limited number of students enrolled in this course, these initial findings suggest that the MEE curriculum may have some utility in promoting awareness of and interest in these medical disciplines among students who attend the course. With continued student and faculty support, this course will likely be continued annually at our institution. We believe that certain aspects of this course may be useful in helping develop similar courses at other medical schools.

Two probable cases of mastoiditis in a cemetery from the Warring States to Han Dynasty (475 BCE-220 CE) in Qufu, Shandong Province, China.

In modern clinical medical practice, middle-ear infection is a frequently reported condition. If untreated, persistent inflammation caused by infection may lead to perforation of the mastoid process or other portions of the temporal bone. When the middle-ear abscess penetrates the surrounding bone and invades the mastoid process, it causes mastoiditis. Abnormal osseous fistulae were observed on the temporal bones of individuals M137 and M199, which were unearthed in Qufu Olympic Sports Center Cemetery in Qufu City, Shandong Province, and date to the Warring States to the Han Dynasty (475 BCE-220 CE). Microscopic observation and CBCT were used to examine the lesions. A differential diagnosis suggests that the lesions were related to mastoiditis, and based on reference studies, burial information, and paleopathological observation, pollution in the living environment and poor living conditions may be potential factors that caused individuals M137 and M199 to suffer from mastoiditis. The two examples from Qufu are the earliest reported cases of mastoiditis from China; however, infections in the middle ear often go unnoticed in archaeological samples.

Factors Associated With Posttraumatic Stress Disorder Among Veterans of Recent Wars Receiving Veterans Affairs Chiropractic Care.

OBJECTIVES: Post-traumatic stress disorder (PTSD) is thought to complicate pain management outcomes, which is consistent with the impact of other psychosocial factors in the biopsychosocial model of pain. This study aimed to identify patient sociodemographic and clinical characteristics associated with PTSD prevalence among veterans of Operations Enduring Freedom/Iraqi Freedom/New Dawn (OEF/OIF/OND) who received Veterans Affairs (VA) chiropractic care. METHODS: A cross-sectional analysis of electronic health record data from a national cohort study of OEF/OIF/OND veterans with at least 1 visit to a VA chiropractic clinic from 2001 to 2014 was performed. The primary outcome measure was a prior PTSD diagnosis. Variables including sex, race, age, body mass index, pain intensity, alcohol and substance use disorders, and smoking status were examined in association with PTSD diagnosis using logistic regression. RESULTS: We identified 14,025 OEF/OIF/OND veterans with at least 1 VA chiropractic visit, with a mean age of 38 years and 54.2% having a diagnosis of PTSD. Male sex (adjusted odds ratio [OR] = 1.23, 95% CI = 1.11-1.37), younger age (OR = 0.99, CI = 0.98-0.99), moderate-to-severe pain intensity (numerical rating scale ≥ 4) (OR = 1.72, CI = 1.59-1.87), body mass index ≥ 30 (OR = 1.34, CI = 1.24-1.45), current smoking (OR = 1.32, CI = 1.20-1.44), and having an alcohol or substance use disorder (OR = 4.51, CI = 4.01-5.08) were significantly associated with a higher likelihood of PTSD diagnosis. CONCLUSION: Post-traumatic stress disorder is a common comorbidity among OEF/OIF/OND veterans receiving VA chiropractic care and is significantly associated with several patient characteristics. Recognition of these factors is important for the appropriate diagnosis and management of veterans with PTSD seeking chiropractic treatment for pain conditions.

Conflict-related sexual violence: a review.

Conflict-related sexual violence (CRSV) is a concerning yet prevalent feature of historical and current conflict. The term encompasses any form of sexual violence associated with conflict, including rape, sexual assault and forced marriage or prostitution. Acts of CRSV have been perpetrated by both military personnel and civilians against men, women and children. The aetiology of CRSV is complex and unique to each conflict and circumstance. It may arise as a deliberate tactic of war or as opportunistic criminal acts at times of the relative lawlessness resulting from conflict. CRSV can also be related to certain sociocultural attitudes surrounding conflict.CRSV can result in profound medical, psychological and social sequelae for victims and management requires a holistic approach to address these. The global political response to CRSV has been gaining momentum in recent decades. Although the practical reaction to political stances has been limited at times, some consistent messages have arisen from collaborative work between the United Nations and other multinational bodies. Advances have also been made in the judicial response to CRSV.Due to the widespread nature of the issue, there is the potential for the exposure of Defence Medical Services (DMS) personnel to CRSV. This may occur while operating in a conflict zone or when participating in humanitarian operations. DMS personnel should maintain an awareness of the prevalence of CRSV and of any current political measures in place to tackle it. When appropriate, CRSV should feature in operational medical planning and pre-deployment training to assist personnel in managing any cases they encounter.

Physical and elemental analysis of Middle East sands from recent combat zones.

Objective: The lungs are uniquely exposed to the external environment. Sand and dust exposures in desert regions are common among deployed soldiers. A significant number of Veterans deployed to the Middle East report development of respiratory disorders and diseases.Materials and methods: Sand collected from Fallujah, Iraq and Kandahar, Afghanistan combat zones was analyzed and compared to a sand sample collected from an historic United States (U.S.) battle region (Fort Johnson, James Island, SC, Civil War battle site). Sand samples were analyzed to determine the physical and elemental characteristics that may have the potential to contribute to development of respiratory disease.Results: Using complementary scanning electron microscopy (SEM) imaging and analysis, and inductively coupled plasma mass spectrometry (ICP-MS), it was determined that Iraq sand contained elevated levels of calcium and first row transition metals versus Afghanistan and U.S. sand. Iraq sand particle texture was smooth and round, and particles were considerably smaller than Afghanistan sand. Afghanistan sand was elevated in rare earth metals versus Iraq or U.S. sands and had sharp edge features and larger particle size than Iraq sand.Conclusions: These data demonstrate significant differences in Iraq and Afghanistan sand particle size and characteristics. Middle East sands contained elevated levels of elements that have been associated with respiratory disease versus control site sand, suggesting the potential of sand/dust storm exposure to promote adverse respiratory symptoms. Data also demonstrate the potential for variation based on geographical region or site of exposure. The data generated provide baseline information that will be valuable in designing future exposure studies.

Psychosocial impacts among adolescents disengaged from Colombian illegal armed groups and challenges to their attention.

OBJECTIVES: Our study focused on the impacts on health among adolescents who became members of illegal armed groups in Colombia and their attention within the specialized government programme as seen by the professionals who work directly with them. Previous research indicates that those victims of armed violence are usually highly affected on their emotional and social health, but with appropriate and timely support more serious mental health problems can be prevented. Therefore, the care provided to them should be based on broader and holistic approaches. METHODS: This cross-sectional study used the qualitative method based on semi-structured interviews with 42 professionals, and internal reports on the health condition of 165 adolescents, 57 (34.5%) females and 108 (65.5%) males, as a secondary source of information. All information was anonymous and confidential. RESULTS: The interviews with professionals and their reports demonstrated that about a half of the 165 adolescents, 35 of 57 (61.4%) females and 48 of 108 (44.4%) males, suffered from serious symptoms requiring therapeutic and psychiatric attention. About 20% of the adolescents presented clinically important post-traumatic stress symptoms, 27% admitted sexual abuse and 29% psychoactive substance abuse. The professionals stressed various obstacles to the attention of these multiple impacts related both to the administrative and institutional issues and the particular characteristics of this population. CONCLUSIONS: Our findings show the complexity of the psychosocial impacts among adolescent victims of the Colombian armed conflict and their attention. Highly trained professionals and alternative strategies including active listening, observation and art therapy activities seem to be vital for an effective care. The lessons learned from the Colombian reintegration programme serve as important inputs to be considered when attending children and adolescents from conflict-stricken areas also in other contexts.

Enfermería durante la guerra civil española y su posguerra (1936-1949): olvido e inhabilitación / Nursing during the Spanish Civil War and its post-war period (1936-1949): forgetting and disabling / Enfermagem durante a Guerra Civil Espanhola e seu período pós-guerra (1936-1949): esquecendo e incapacitando

Marco contextual: El modelo de salud en la Segunda República española (1931-1939) y las prácticas asistenciales desarrolladas por el personal enfermero transformaron las condiciones sanitarias del país. Sin embargo, durante la Guerra Civil (1936-1939), los cuidados sociosanitarios fueron desiguales. Objetivo: Analizar la influencia sanitaria durante la Guerra Civil y la posguerra española. Metodología: Investigación histórico-descriptiva, relacionada con la sanidad durante la guerra civil española y la posguerra. Recopilación de información: documentos enfermeros; análisis: periódicos, libros, leyes. Se realizó un análisis interpretativo por fechas y acontecimientos del periodo de estudio. Resultados: Entre 1939 y 1949, las leyes promulgadas revisaron el trabajo realizado por los sanitarios, lo que llevó a la represión y eliminación de funcionaros sanitarios ajenos a las ideas políticas imperantes, y supuso un proceso de purificación y descalificación. Conclusión: El Gobierno de la Segunda República española atribuyó importancia a la higiene en el ámbito sanitario y doméstico. Llegada la Guerra Civil, España sufrió carencias de cuidados sanitarios a nivel civil y militar. Durante la posguerra, la identidad de parte de la enfermería fue omitida y olvidada.

Background: The health model during the Second Spanish Republic (1931-1939) and the care practices developed by the nursing staff transformed the health conditions of the country. During the civil war (1936-1939), social and health care was unequal. Objective: Analyse the influence of health care during and after the Spanish Civil War. Methodology: Historical-descriptive research related to health care during the Civil War. Compilation of information: nursing documents, newspapers, books, laws. Interpretative analysis by dates and events of the period of study. Results: Between 1939 and 1949, the laws enacted revised the work carried out by the health workers, leading to the repression and elimination of the health workers who were alien to the prevailing political ideas, which meant a process of purification. Conclusion: The government of the Second Republic attributed importance to hygiene in the sanitary and domestic field. After the Civil War, Spain suffered from a lack of health care at both civil and military levels. During the post-war the identity of part of the nursing profession was forgotten.

Enquadramento: O modelo de saúde durante a Segunda República Espanhola (1931-1939) e as práticas assistenciais desenvolvidas pelos enfermeiros transformaram as condições de saúde do país.Durante a Guerra Civil (1936-1939), a assistência social e sanitária foi desigual. Objetivo: Analisar a influência dos cuidados de saúde durante a Guerra Civil Espanhola e período pós-guerra. Metodologia: Investigação histórico-descritiva sobre os cuidados de saúde durante a Guerra Civil. Compilação de informação: documentos de enfermagem, jornais, livros, leis. Análise interpretativa por datas e eventos do período em estudo. Resultados: Entre 1939 y 1949, as leis promulgadas reviram o trabalho realizado pelos trabalhadores da saúde, levando à repressão e eliminação de muitos que eram alheios às idéias políticas predominantes, o que implicava um processo de purificação e desqualificação. Conclusão: O Governo da Segunda República atribuiu importância à higiene no campo sanitário e doméstico. Após a Guerra Civil, a Espanha sofreu com a falta de cuidados de saúde. Durante o período pós-guerra, a identidade de parte da profissão de enfermagem foi omitida e esquecida.

How Did the War Affect Organ Transplantation in Syria?

Since 2011, the Syrian conflict has destroyed much of the country's infrastructure. The deteriorating humanitarian situation has involved health workers and facilities. In 2010, before the war, 385 kidney transplants were performed in Syria. This number declined to 154 in 2013 (60% less) before increasing to 251 transplants in 2018, which is still 35% less than the number of transplants performed before the war. In addition, the number of operational kidney transplant centers has decreased from 8 in 2010, distributed over 3 cities, to only 4 in 2013, all located in Damascus, which increased to 6 centers in 2019. Interestingly, with regard to type of living donor, the percentage of unrelated kidney donors has decreased by 20% for unclear reasons. Another alarming statistic is that more than 50% of kidney transplant physicians and surgeons are no longer practicing transplant medicine in their centers, either because they have left the country or because their centers had become nonoperational. Since the war, free and timely provision of immunosuppressive drugs for all patients in all provinces has been a leading challenge for health authorities and transplant patients. This difficulty has led to adverse medical consequences for patients. A project to initiate liver transplant came to a halt because of complex reasons but mainly because foreign trainers could not visit Syria. Although the autologous bone marrow transplant program had slowed until recently, it has become more active, involving both autologous and allogeneic transplants. The deceased-donor program is still not available in Syria; the war has just reinforced the many reasons that prevented the start of this program before the conflict. The commitment of transplant teams despite these large challenges continues to be extraordinary. The Syrian conflict has affected all aspects of organ transplant, paralyzing new projects and negatively affecting existing programs.

APPLICATION OF ART THERAPY FOR CORRECTION OF PERSONAL DISORDERS OF PSYCHOEMOTIONAL STATE OF CHILDREN - INHABITANTS OF RADIATION POLLUTED TERRITORIES AND CHILDREN DISPLACED FROM THE ARMED CONFLICT ON THE SOUTHERN EAST OF UKRAINE. / ZASTOSUVANNIa ART-TERAPIÏ DLIa KOREKTsIÏ PORUShEN' PSYKhOEMOTsIY̆NOGO STANU DITEY̆-MEShKANTsIV RADIOAKTYVNO ZABRUDNENYKh TERYTORIY̆ TA DITEY̆, PEREMIShchENYKh IZ ZONY ZBROY̆NOGO KONFLIKTU NA PIVDENNOMU SKhODI UKRAÏNY.

OBJECTIVE: to identify the psycho-emotional state of children - residents of radioactively contaminated territories and children displaced from the zone of armed conflict in the south-east of Ukraine, and evaluate the effectiveness of art therapy application to correct its disturbances. MATERIALS AND METHODS: The psycho-emotional state was determined in 113 children, of which 57 children from radioactively contaminated territories with 137Cs content in the body from 269 Bq to 7024 Bq (group I) and 56 chil- dren displaced from the zone of military conflict in the Southeast of Ukraine (group II). The age of children ranged from 10 to 17 years. The children were hospitalized to the childrens' clinics of the NRCRM because of functional dis- orders and chronic somatic pathology. The psycho-emotional state of children was evaluated using the «non-exis- tent animal¼ test. It was analyzed for three symptoms - anxiety, aggressiveness and neuropsychiatric exhaustion and was evaluated by scoring points. Correction of the psychoemotional condition was carried out by the method of art therapy in the form of a serial drawing. Psychological testing was performed twice: at admission to the hospital and after the end of the art therapy. RESULTS: The results of the primary examination of the psycho-emotional state of children by the «non-existent ani- mal¼ test showed that in children - residents of radioactively contaminated territories the state of anxiety was reg- istered in all 57 children (100 %), the state of aggression - in 38 children (66.7%); exhaustion - in 37 children (64.9 %). In children who have been displaced from the zone of armed conflict in the south-east of Ukraine, the state of anxiety was also registered in all 56 children (100 %), the status of aggression was determined in 53 chil- dren (94.6 %), and the state of exhaustion - in 44 children (78.6 %). It was established that in children displaced from the combat zone in the Southeast of Ukraine, the quantitative indices of anxiety and aggression states were sig- nificantly higher than in children living in radioactively contaminated territories (p < 0.001), whereas nor by frequen- cy, nor by the degree of severity of exhaustion state they did not clearly differ (p > 0.05). Correlation analysis with the definition of Spearman's criterion did not reveal likely association between the content of 137Cs in the body of children - residents of radioactively contaminated territories and the peculiarities of their psycho-emotional state. CONCLUSIONS: The use of the art therapy method in the form of a serial drawing for children - residents of radioac- tively contaminated territories and children moved from the combat zone in the south-east of Ukraine, led to a sig- nificant positive effect, which was characterized by a decrease in the manifestations of symptoms of anxiety and aggressiveness. The state of exhaustion was less well corrected and its indices only had a tendency to improve. Thus, the method of art therapy in the form of a serial drawing is characterized by efficiency, simplicity of execution, low cost, it can be widely used in children's teams to correct disorders of the psycho-emotional state.

Results from one-year use of an electronic Clinical Decision Support System in a post-conflict context: An implementation research.

BACKGROUND: In 2017, the Adamawa State Primary Healthcare Development Agency introduced ALMANACH, an electronic clinical decision support system based on a modified version of IMCI. The target area was the Federal State of Adamawa (Nigeria), a region recovering after the Boko Haram insurgency. The aim of this implementation research was to assess the improvement in terms of quality care offered after one year of utilization of the tool. METHODS: We carried out two cross-sectional studies in six Primary Health Care Centres to assess the improvements in comparison with the baseline carried out before the implementation. One survey was carried out inside the consultation room and was based on the direct observation of 235 consultations of children aged from 2 to 59 months old. The second survey questioned 189 caregivers outside the health facility for their opinion about the consultation carried out through using the tablet, the prescriptions and medications given. RESULTS: In comparison with the baseline, more children were checked for danger signs (60.0% vs. 37.1% at baseline) and in addition, children were actually weighed (61.1% vs. 27.7%) during consultation. Malnutrition screening was performed in 35.1% of children (vs. 12.1%). Through ALMANACH, also performance of preventive measures was significantly improved (p<0.01): vaccination status was checked in 39.8% of cases (vs. 10.6% at baseline), and deworming and vitamin A prescription was increased to 46.5% (vs. 0.7%) and 48.3% (vs. 2.8%) respectively. Furthermore, children received a complete physical examination (58.3% vs. 45.5%, p<0.01) and correct treatment (48.4% vs. 29.5%, p<0.01). Regarding antibiotic prescription, 69.3% patients received at least one antibiotic (baseline 77.7%, p<0.05). CONCLUSIONS: Our findings highlight major improvements in terms of quality of care despite many questions still pending to be answered in relation to a full integration of the tool in the Adamawa health system.

Increase of precuneus metabolism correlates with reduction of PTSD symptoms after EMDR therapy in military veterans: an 18F-FDG PET study during virtual reality exposure to war.

PURPOSE: The prevalence of posttraumatic stress disorder (PTSD) is higher among veterans, and can lead to disastrous consequences such as suicide. Eye movement desensitization and reprocessing (EMDR) is recommended in first-line psychotherapies for PTSD. Virtual reality exposure (VRE) coupled with 18F-FDG PET imaging can highlight the activated brain regions during stress exposure. The objective of this study is to identify, after EMDR therapy, the regions of brain metabolism that evolve during the stress exposure of a war scene with symptomatic remission in a group of military veterans suffering from PTSD, and to secondarily search for predictive metabolic features. METHODS: We recruited 15 military veterans suffering from PTSD who performed an 18F-FDG PET sensitized by the exposure to a virtual war scene, before (T0) and after (T1) EMDR therapy. Statistical parametric mapping was used to compare brain metabolism before and after treatment and to study correlations between metabolism and evolution scores on PTSD clinical scales (PTSD Checklist Scale, PCLS; Clinician-Administered PTSD Scale, CAPS). RESULTS: The metabolic activity of the precuneus was increased after EMDR therapy (p < 0.005 uncorrected, k > 180) and correlated with clinical improvement with the CAPS scale (r = -0.73 and p < 0.001). Moreover, the precuneus metabolic value before therapy predicted the clinical improvement on the PCLS scale (T1-T0) after EMDR (r = -0.667 and p < 0.006). CONCLUSION: The clinical improvement in military patients with PTSD after EMDR is related to increased precuneus metabolism upon VR stress exposure.

The historical process of the masonry city walls construction in China during 1st to 17th centuries AD.

Masonry city walls were common defense facilities in the cities of the Eurasian before the industrial revolution. However, they were not widespread in China until the Ming Dynasty (1368-1644). Limited in research methods, previous studies failed to make convincing arguments on this phenomenon. We collected, organized and analyzed relevant historical documents to reconstruct the spatio-temporal process of the construction of masonry walls from 1st to 17th century in China. We conducted a time series analysis primarily based on factors such as wars, garrisons, economy, and natural disasters. Analysis of the correlation among the construction of masonry walls and these factors provides insights into this process. From the 1st to 14th century, only 125 masonry city walls were built in China and the annual average number was below 0.1. While in the Ming Dynasty, a total of 1,493 masonry walls were built, with an annual average of 5.41. The construction activities in 1368-1456 spread throughout the country, but mainly appeared in the high-grade administrative cities and garrisons, as a result of the planned implementation of the central government. The construction activities in 1457-1644 had corresponding cluster areas during different periods, mainly at county-level. We found that the wall construction was stimulated by external factors such as wars and disasters. We believe that the mass construction of masonry walls in the Ming Dynasty is a phenomenon of cultural diffusion. The central government plan, the complex interactions between local governments and community, and the stimulation of external factors worked together to contribute to the diffusion of masonry city walls in the Ming Dynasty.

Barriers to Breastfeeding in Disasters in the Context of Iran.

IntroductionNatural disasters have many effects on vulnerable groups, especially infants and children. Protecting breastfeeding in disasters is important, because artificial feeding puts a lot of risk to the child. In disasters, artificial nutrition is dangerous to children and its supplementation requires special equipment. There is little information on the nutritional status of infants after disasters in Iran.ProblemThe purpose of this study was to explore the barriers to appropriate lactation after disasters in Iran. METHOD: This was a qualitative study using a content analysis method. A total of 19 midwives with disaster-relief experiences were approached for interview. Data were collected using semi-structured interviews. Data analysis was performed using the Graneheim's approach. RESULTS: The categories of maternal factors, neonatal factors, management factors, and context-base factors were extracted from the data. CONCLUSION: The challenges of social support, mothers' self-efficacy, educated staff for disasters, and privacy for breastfeeding can be considered as important barriers to breastfeeding in disasters. Training programs, as well as health system support, can help overcome the breastfeeding barriers in disasters. MirMohamadaliIeM, Khani JazaniR, SohrabizadehS, Nikbakht NasrabadiA. Barriers to breastfeeding in disasters in the context of Iran. Prehosp Disaster Med. 2019;34(1):20-24.