The psychological and medical sequelae of war in Central American refugee mothers and children.

OBJECTIVE: To investigate the physical and mainly psychological sequelae of exposure to war in Central American children and their mothers who immigrated to the United States on average 4 years before the study began. DESIGN: Interview study. PARTICIPANTS: Twenty-two immigrant Central American women caretakers and 1 of their children aged 5 to 13 years. MAIN OUTCOME MEASURES: Standardized and new measures were administered to assess children's physical and mental health symptoms and exposure to political violence. RESULTS: Eighteen of the 22 children had chronic health problems. Fifteen children and all of the adults had observed traumatic events, including bombings and homicides. Thirteen of the children showed mental health symptom profiles above established norms, although only 2 met the criteria for posttraumatic stress disorder according to their own reports. Many of the caretakers were unaware of their child's psychological distress. Four of the mothers exhibited posttraumatic stress disorder, and their symptoms predicted their child's mental health. CONCLUSIONS: Pediatricians are sometimes the first and only contacts these families have with health care providers. Caretakers' reports of children's mental health are often incomplete. It is therefore important for physicians to probe for "hidden" symptoms in refugee children. These family members may need referrals to social and psychological services, and pediatricians can open the gates to existing community networks of support. Because we found that maternal mental health influences the child's, the child's interests are well served when pediatricians also encourage the mother to contact services for herself if she confides that she is experiencing some of the severe psychological sequelae reported by the women in this study.

Stress in pediatric faculty. Results of a national survey.

OBJECTIVES: To determine current levels of pediatric faculty stress experienced by pediatric faculty and to examine contributors to and consequences of this stress. DESIGN: Random survey, using attitude questionnaire. SETTING: Twenty-six medical school-based pediatric programs nationwide. PARTICIPANTS: Two hundred fifty-two full-time pediatric faculty members. MAIN OUTCOME MEASURES: Stress level; importance of specific sources of stress and fulfillment; satisfaction with time allotted to various activities; social support; satisfaction with career choices. RESULTS: The return rate was 64%. Forty-six percent of respondents reported "high" or "very high" levels of usual stress; 64% were stressed beyond a "comfortable" level at least "frequently." Women (P < .05), assistant or associate professors (P < .001), and faculty on the tenure track (P < .006) reported feeling "overstressed" more often. Major sources of stress were pressure to do research, family needs (48%), and lack of personal time (40%). About half (51%) agreed that the recent emphasis on reducing resident stress has led to increased pressure on faculty members. Frequency of feeling overstressed was reduced if respondents felt valued by their chairperson (P < .001) and by other faculty (P < .01). Within the last year, 47% had considered moving to another medical school. Another 43% had considered leaving academia. The more frequently the respondent felt overstressed, the more likely he or she was to have considered such changes (P < .001). CONCLUSIONS: The stress currently experienced by pediatric faculty is substantial and seems to affect long-term commitment to academic medicine. Creative solutions to this issue should be explored.

Bystander cardiopulmonary resuscitation. Concerns about mouth-to-mouth contact.

BACKGROUND: Bystander cardiopulmonary resuscitation (CPR) is performed on only a small percentage of patients who suffer cardiac arrest. We conducted a study to elucidate attitudes toward and potential obstacles to performance of bystander CPR. METHODS: Attitude survey of 975 people on the University Heart Center, University of Arizona, Tucson, mailing list. Participants were asked about their willingness to perform CPR under four conditions, with varying relationships (stranger vs relative or friend) and CPR techniques (chest compressions plus mouth-to-mouth ventilation [CC+V] vs chest compressions alone [CC]). RESULTS: Participants rated willingness to perform CPR and concern about disease transmission. Both relationship and CPR technique affected willingness to respond. Only 15% would "definitely" provide CC+V with strangers compared with 68% who would "definitely" perform CC. Even with relatives or friends, only 74% would "definitely" provide CC+V compared with 88% who would "definitely" provide CC. Eighty-two percent of participants were at least "moderately" concerned about disease transmission. CONCLUSION: Concerns regarding mouth-to-mouth ventilation appear to create substantial barriers to performance of bystander CPR. Intensified educational efforts and investigations of new approaches to bystander CPR are warranted.