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1.
Confl Health ; 12: 16, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29686727

RESUMO

Evidence of use of toxic gas chemical weapons in the Syrian war has been reported by governmental and non-governmental international organizations since the war started in March 2011. To date, the profiles of victims of the largest chemical attacks in Syria remain unknown. In this study, we used descriptive epidemiological analysis to describe demographic characteristics of victims of the largest chemical weapons attacks in the Syrian war. We analysed conflict-related, direct deaths from chemical weapons recorded in non-government-controlled areas by the Violation Documentation Center, occurring from March 18, 2011 to April 10, 2017, with complete information on the victim's date and place of death, cause and demographic group. 'Major' chemical weapons events were defined as events causing ten or more direct deaths. As of April 10, 2017, a total of 1206 direct deaths meeting inclusion criteria were recorded in the dataset from all chemical weapons attacks regardless of size. Five major chemical weapons attacks caused 1084 of these documented deaths. Civilians comprised the majority (n = 1058, 97.6%) of direct deaths from major chemical weapons attacks in Syria and combatants comprised a minority of 2.4% (n = 26). In the first three major chemical weapons attacks, which occurred in 2013, children comprised 13%-14% of direct deaths, ranging in numbers from 2 deaths among 14 to 117 deaths among 923. Children comprised higher proportions of direct deaths in later major chemical weapons attacks, forming 21% (n = 7) of 33 deaths in the 2016 major attack and 34.8% (n = 32) of 92 deaths in the 2017 major attack. Our finding of an extreme disparity in direct deaths from major chemical weapons attacks in Syria, with 97.6% of victims being civilians and only 2.4% being combatants provides evidence that major chemical weapons attacks were indiscriminate or targeted civilians directly; both violations of International Humanitarian Law (IHL). Identifying and quantifying chemical weapons violations requires inter-disciplinary collaboration to inform international policy, humanitarian intervention and legal action.

2.
Lancet Glob Health ; 6(1): e103-e110, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-29226821

RESUMO

BACKGROUND: Since March, 2011, the Syrian civil war has lowered life expectancy by as much as 20 years. We describe demographic, spatial, and temporal patterns of direct deaths of civilians and opposition combatants from conflict-related violence in 6 years of war. METHODS: We analysed conflict-related violent deaths with complete information on date, place, and cause of death and demographic group occurring from March 18, 2011, to Dec 31, 2016, recorded by the Violation Documentation Center (VDC). We included civilian and combatant deaths in all Syrian governorates, excluding government-controlled areas. We did not include detainees and missing persons, nor deaths from siege conditions or insufficient medical care. We categorised deaths based on VDC weapon type. We used χ2 testing to compare deaths from different weapons in civilian men, women, boys, and girls and adult and child combatants. We analysed deaths by governorate and over time. FINDINGS: The VDC recorded 143 630 conflict-related violent deaths with complete information between March 18, 2011, and Dec 31, 2016. Syrian civilians constituted 101 453 (70·6%) of the deaths compared with 42 177 (29·4%) opposition combatants. Direct deaths were caused by wide-area weapons of shelling and air bombardments in 58 099 (57·3%) civilians, including 8285 (74·6%) civilian women and 13 810 (79·4%) civilian children, and in 4058 (9·6%) opposition combatants. Proportions of children among civilian deaths increased from 8·9% (388 of 4254 civilian deaths) in 2011 to 19·0% (4927 of 25 972) in 2013 and to 23·3% (2662 of 11 444) in 2016. Of 7566 deaths from barrel bombs, 7351 (97·2%) were civilians, of whom 2007 (27·3%) were children. Of 20 281 deaths by execution, 18 747 (92·4%) were civilians and 1534 (7·6%) were opposition combatants. Compared with opposition child soldiers who were male (n=333), deaths of civilian male children (n=11 730) were caused more often by air bombardments (39·2% vs 5·4%, p<0·0001) and shelling (37·3% vs 13·2%, p<0·0001) and less often by shooting (12·5% vs 76·0%, p<0·0001). INTERPRETATION: Aerial bombing and shelling rapidly became primary causes of direct deaths of women and children and had disproportionate lethal effects on civilians, calling into question the use of wide-area explosive weapons in urban areas. Increased reliance on aerial bombing by the Syrian Government and international partners is likely to have contributed to findings that children were killed in increasing proportions over time, ultimately comprising a quarter of civilian deaths in 2016. The inordinate proportion of civilians among the executed is consistent with deliberate tactics to terrorise civilians. Deaths from barrel bombs were overwhelmingly civilian rather than opposition combatants, suggesting indiscriminate or targeted warfare contrary to international humanitarian law and possibly constituting a war crime. FUNDING: None.


Assuntos
Mortalidade da Criança/tendências , Mortalidade/tendências , Violência/estatística & dados numéricos , Guerra , Adulto , Criança , Bases de Dados Factuais , Feminino , Humanos , Masculino , Síria/epidemiologia
3.
Child Adolesc Ment Health ; 18(3): 171-179, 2013 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32847249

RESUMO

OBJECTIVE: To survey Iraqi primary school teachers' beliefs and attitudes about mental health and behavioural problems of children. METHODS: From 10 primary schools in Baghdad, 148 teachers were surveyed using a closed-response questionnaire to assess beliefs and attitudes regarding students' mental health and behavioural problems, needs, resources and limitations to teaching. RESULTS: Disruptive behaviours were rated as main problems by the largest proportions of teachers. In-service training on 'identifying students with social, emotional, or behavioural problems' and 'effective behaviour management' was rated very important by 70% of teachers. Most teachers received no training on mental health during their teaching career. There was low reported availability of a wide range of school-based mental health resources. CONCLUSIONS: Teachers in Iraq report substantial mental health and behavioural problems in primary school children and identify high unmet need for school-based mental health programmes and training.

4.
PLoS One ; 6(9): e23976, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-21915272

RESUMO

BACKGROUND: Warring groups that compete to dominate a civilian population confront contending behavioral options: target civilians or battle the enemy. We aimed to describe degrees to which combatant groups concentrated lethal behavior into intentionally targeting civilians as opposed to engaging in battle with opponents in contemporary armed conflict. METHODOLOGY/PRINCIPAL FINDINGS: We identified all 226 formally organized state and non-state groups (i.e. actors) that engaged in lethal armed conflict during 2002-2007: 43 state and 183 non-state. We summed civilians killed by an actor's intentional targeting with civilians and combatants killed in battles in which the actor was involved for total fatalities associated with each actor, indicating overall scale of armed conflict. We used a Civilian Targeting Index (CTI), defined as the proportion of total fatalities caused by intentional targeting of civilians, to measure the concentration of lethal behavior into civilian targeting. We report actor-specific findings and four significant trends: 1.) 61% of all 226 actors (95% CI 55% to 67%) refrained from targeting civilians. 2.) Logistic regression showed actors were more likely to have targeted civilians if conflict duration was three or more years rather than one year. 3.) In the 88 actors that targeted civilians, multiple regressions showed an inverse correlation between CTI values and the total number of fatalities. Conflict duration of three or more years was associated with lower CTI values than conflict duration of one year. 4.) When conflict scale and duration were accounted for, state and non-state actors did not differ. We describe civilian targeting by actors in prolonged conflict. We discuss comparable patterns found in nature and interdisciplinary research. CONCLUSIONS/SIGNIFICANCE: Most warring groups in 2002-2007 did not target civilians. Warring groups that targeted civilians in small-scale, brief conflict concentrated more lethal behavior into targeting civilians, and less into battles, than groups in larger-scale, longer conflict.


Assuntos
Guerra , Humanos , Militares/estatística & dados numéricos
5.
Lancet ; 378(9794): 906-14, 2011 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-21890055

RESUMO

BACKGROUND: Suicide bombs in Iraq are a major public health problem. We aimed to describe documented casualties from suicide bombs in Iraq during 2003-10 in Iraqi civilians and coalition soldiers. METHODS: In this descriptive study, we analysed and compared suicide bomb casualties in Iraq that were documented in two datasets covering March 20, 2003, to Dec 31, 2010--one reporting coalition-soldier deaths from suicide bombs, the other reporting deaths and injuries of Iraqi civilians from armed violence. We analysed deaths and injuries over time, by bomb subtype and victim demographics. FINDINGS: In 2003-10, 1003 documented suicide bomb events caused 19% (42,928 of 225,789) of all Iraqi civilian casualties in our dataset, 26% (30,644 of 117,165) of injured civilians, and 11% (12,284 of 108,624) of civilian deaths. The injured-to-killed ratio for civilians was 2·5 people injured to one person killed from suicide bombs. Suicide bombers on foot caused 43% (5314 of 12,284) of documented suicide bomb deaths. Suicide bombers who used cars caused 40% (12,224 of 30,644) of civilian injuries. Of 3963 demographically identifiable suicide bomb fatalities, 2981 (75%) were men, 428 (11%) were women, and 554 (14%) were children. Children made up a higher proportion of demographically identifiable deaths from suicide bombings than from general armed violence (9%, 3669 of 40,276 deaths; p<0·0001). The injured-to-killed ratio for all suicide bombings was slightly higher for women than it was for men (p=0·02), but the ratio for children was lower than it was for both women (p<0·0001) and men (p=0·0002). 200 coalition soldiers were killed in 79 suicide bomb events during 2003-10. More Iraqi civilians per lethal event were killed than were coalition soldiers (12 vs 3; p=0·004). INTERPRETATION: Suicide bombers in Iraq kill significantly more Iraqi civilians than coalition soldiers. Among civilians, children are more likely to die than adults when injured by suicide bombs. FUNDING: None.


Assuntos
Bombas (Dispositivos Explosivos) , Guerra do Iraque 2003-2011 , Militares/estatística & dados numéricos , Suicídio/estatística & dados numéricos , Terrorismo/estatística & dados numéricos , Ferimentos e Lesões/epidemiologia , Adulto , Criança , Feminino , Humanos , Iraque/epidemiologia , Masculino , Ferimentos e Lesões/etiologia , Ferimentos e Lesões/mortalidade
6.
Transcult Psychiatry ; 48(1-2): 37-52, 2011 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-21511845

RESUMO

This article contributes to the Transcultural Psychiatry special issue of autobiographical articles on: ''The Personal and the Professional: Lives and Careers of Cultural Psychiatrists.'' The author describes influences and themes in her professional development as a cross-cultural psychiatrist and academic. Growing up as a part-Chinese, part-white child in rural Midwestern America resulted in frequently being asked: ''What are you?'' This abrupt, bald, but essential question eventually became a useful tool in the productive, repeated re-working of identity, values, and goals throughout her personal and professional life. Experiences of being an outsider, family histories, and early observations of racism are linked to later interests in cross-cultural psychiatry, ethics, and the protection of vulnerable populations. She describes her research on cross-cultural measurement, depression, suicidality, domestic violence and violence in war. Issues of career advancement and internal conflict are described for women academics who occupy three simultaneous, primary roles: academic, doctor and mother. The theme of ''crossing,'' as in ''cross-cultural,'' indicates the effort and intention required to move between races, cultures, classes, intellectual disciplines, personal and professional identities, clinical and academic roles, and social roles allocated to men and women.


Assuntos
Americanos Asiáticos/psicologia , Escolha da Profissão , Etnopsicologia/tendências , Papel do Médico/psicologia , Mobilidade Ocupacional , Diversidade Cultural , Violência Doméstica/etnologia , Violência Doméstica/psicologia , Etnopsicologia/educação , Docentes de Medicina , Previsões , Identidade de Gênero , Humanos , Liderança , Transtornos Mentais/etnologia , Transtornos Mentais/psicologia , Médicas/psicologia , Preconceito , Refugiados/psicologia , Pesquisa/tendências , Fatores de Risco , Valores Sociais , Suicídio/etnologia , Suicídio/psicologia , Estados Unidos , Guerra
8.
PLoS Med ; 8(2): e1000415, 2011 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-21358813

RESUMO

BACKGROUND: Armed violence is a major public health and humanitarian problem in Iraq. In this descriptive statistical analysis we aimed to describe for the first time Iraqi civilian deaths caused by perpetrators of armed violence during the first 5 years of the Iraq war: over time; by weapon used; by region (governorate); and by victim demographics. METHODS AND FINDINGS: We analyzed the Iraq Body Count database of 92,614 Iraqi civilian direct deaths from armed violence occurring from March 20, 2003 through March 19, 2008, of which Unknown perpetrators caused 74% of deaths (n = 68,396), Coalition forces 12% (n = 11,516), and Anti-Coalition forces 11% (n = 9,954). We analyzed the subset of 60,481 civilian deaths from 14,196 short-duration events of lethal violence to link individual civilian deaths to events involving perpetrators and their methods. One-third of civilian violent death was from extrajudicial executions by Unknown perpetrators; quadratic regression shows these deaths progressively and disproportionately increased as deaths from other forms of violence increased across Iraq's governorates. The highest average number of civilians killed per event in which a civilian died were in Unknown perpetrator suicide bombings targeting civilians (19 per lethal event) and Coalition aerial bombings (17 per lethal event). In temporal analysis, numbers of civilian deaths from Coalition air attacks, and woman and child deaths from Coalition forces, peaked during the invasion. We applied a Woman and Child "Dirty War Index" (DWI), measuring the proportion of women and children among civilian deaths of known demographic status, to the 22,066 civilian victims identified as men, women, or children to indicate relatively indiscriminate perpetrator effects. DWI findings suggest the most indiscriminate effects on women and children were from Unknown perpetrators using mortar fire (DWI  = 79) and nonsuicide vehicle bombs (DWI  = 54) and from Coalition air attacks (DWI  = 69). Coalition forces had higher Woman and Child DWIs than Anti-Coalition forces, with no evidence of decrease over 2003-2008, for all weapons combined and for small arms gunfire, specifically. CONCLUSIONS: Most Iraqi civilian violent deaths during 2003-2008 of the Iraq war were inflicted by Unknown perpetrators, primarily through extrajudicial executions that disproportionately increased in regions with greater numbers of violent deaths. Unknown perpetrators using suicide bombs, vehicle bombs, and mortars had highly lethal and indiscriminate effects on the Iraqi civilians they targeted. Deaths caused by Coalition forces of Iraqi civilians, women, and children peaked during the invasion period, with relatively indiscriminate effects from aerial weapons. Please see later in the article for the Editors' Summary.


Assuntos
Homicídio/estatística & dados numéricos , Violência/estatística & dados numéricos , Armas , Causas de Morte , Feminino , Humanos , Iraque/epidemiologia , Masculino , Ferimentos e Lesões/epidemiologia
9.
Psychiatry Res ; 175(3): 227-32, 2010 Feb 28.
Artigo em Inglês | MEDLINE | ID: mdl-20006386

RESUMO

Previous studies of the Center for Epidemiologic Studies Depression Scale (CES-D) in Chinese Americans describe internal reliability and factor structure. We report CES-D construct validity and diagnostic validity for major depression in a probability sample of 168 community-dwelling Chinese American women. Internal consistency was satisfactory (Cronbach's alpha=0.86). Good construct validity was indicated by significantly higher mean CES-D scores for respondents who reported lower social support, worse self-perceived general health, or stressful life events, including intimate partner violence. Cultural response bias was found, with positively-stated CES-D items (e.g. "I was happy") producing higher depression scores in immigrants and subjects who preferred to speak Chinese. Diagnostic validity for major depression was assessed using the Composite International Diagnostic Interview. A CES-D cut-off score of 16 had sensitivity of 100% (95% CI: 44% to 100%), specificity of 76% (95% CI: 69% to 82%), PPV of 7% (95% CI: 3% to 19%) and NPV of 100% (95% CI: 97% to 100%). Our findings suggest that the CES-D is useful for screening out non-depressed subjects in a first-stage assessment. However, it should be followed by a diagnostic tool in Chinese American women with scores above the cut-off in order to identify those with clinical depression.


Assuntos
Viés , Cultura , Transtorno Depressivo Maior , Inquéritos e Questionários , Adulto , Americanos Asiáticos , Transtorno Depressivo Maior/diagnóstico , Transtorno Depressivo Maior/epidemiologia , Transtorno Depressivo Maior/psicologia , Análise Fatorial , Feminino , Humanos , Escalas de Graduação Psiquiátrica , Reprodutibilidade dos Testes , Fatores Socioeconômicos , Adulto Jovem
12.
Lancet ; 369(9556): 101-2; author reply 103-4, 2007 Jan 13.
Artigo em Inglês | MEDLINE | ID: mdl-17223463
13.
J Interpers Violence ; 21(10): 1249-69, 2006 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-16940395

RESUMO

A community probability-sampled survey was done of 181 Chinese American women to investigate the prevalence and nature of intimate partner violence (IPV) in Chinese Americans. Of participants, 42% knew a Chinese woman who had experienced IPV. Also, 14% had experienced IPV themselves in their lifetime (8% severe and 6% minor), 3% in the previous year, and 2% currently. In Chinese American women who were ever married, the lifetime prevalence of IPV was 17%. IPV resulted in physical injuries for 31% of women and affected their work and education. Exploratory analysis suggests that relationship problems and partner's alcohol use may be risk factors for IPV in this group.


Assuntos
Americanos Asiáticos/estatística & dados numéricos , Mulheres Maltratadas/estatística & dados numéricos , Maus-Tratos Conjugais/estatística & dados numéricos , Saúde da Mulher , Adulto , Análise de Variância , Características Culturais , Feminino , Humanos , Pessoa de Meia-Idade , Prevalência , Fatores Socioeconômicos , Inquéritos e Questionários , Violência/estatística & dados numéricos
14.
BMC Fam Pract ; 7: 39, 2006 Jun 22.
Artigo em Inglês | MEDLINE | ID: mdl-16792812

RESUMO

BACKGROUND: A bill to legalize physician-assisted suicide in the UK recently made significant progress in the British House of Lords and will be reintroduced in the future. Until now there has been little discussion of the clinical implications of physician-assisted suicide for the UK. This paper describes problematical issues that became apparent from a review of the medical and psychiatric literature as to the potential effects of legalized physician-assisted suicide. DISCUSSION: Most deaths by physician-assisted suicide are likely to occur for the illness of cancer and in the elderly. GPs will deal with most requests for assisted suicide. The UK is likely to have proportionately more PAS deaths than Oregon due to the bill's wider application to individuals with more severe physical disabilities. Evidence from other countries has shown that coercion and unconscious motivations on the part of patients and doctors in the form of transference and countertransference contribute to the misapplication of physician-assisted suicide. Depression influences requests for hastened death in terminally ill patients, but is often under-recognized or dismissed by doctors, some of whom proceed with assisted death anyway. Psychiatric evaluations, though helpful, do not solve these problems. Safeguards that are incorporated into physician-assisted suicide criteria probably decrease but do not prevent its misapplication. SUMMARY: The UK is likely to face significant clinical problems arising from physician-assisted suicide if it is legalized. Terminally ill patients with mental illness, especially depression, are particularly vulnerable to the misapplication of physician-assisted suicide despite guidelines and safeguards.


Assuntos
Papel do Médico , Suicídio Assistido/legislação & jurisprudência , Idoso , Coerção , Depressão , Pessoas com Deficiência , Idoso Fragilizado/psicologia , Humanos , Motivação , Relações Médico-Paciente , Doente Terminal/psicologia , Transferência Psicológica , Reino Unido
15.
Psychiatr Serv ; 55(7): 827-9, 2004 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-15232026

RESUMO

South Asian women suffer disproportionately high rates of suicide and attempted suicide. Yet few intervention studies on this group have been done. A total of 180 British South Asian women were sampled to pilot test an educational pamphlet about depression and suicidality. After reading the pamphlet, significantly more women assessed themselves as willing to confide in their clinicians, friends, and spouses if they felt depressed or suicidal, rather than not telling anyone. Also, more women reported that they felt that antidepressants were helpful for depression after they read the pamphlet. These changes remained four to six weeks later. The pamphlet was feasible for use in primary care and community settings and highly acceptable among British South Asian women and professionals.


Assuntos
Atitude Frente a Saúde , Depressão/etnologia , Comportamentos Relacionados com a Saúde , Educação em Saúde , Promoção da Saúde , Folhetos , Aceitação pelo Paciente de Cuidados de Saúde , Tentativa de Suicídio/etnologia , Adulto , Ásia/etnologia , Atitude Frente a Saúde/etnologia , Depressão/epidemiologia , Estudos de Viabilidade , Feminino , Seguimentos , Humanos , Masculino , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Projetos Piloto , Suicídio/etnologia , Tentativa de Suicídio/estatística & dados numéricos , Inquéritos e Questionários , Reino Unido
16.
J Nerv Ment Dis ; 191(11): 722-9, 2003 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-14614339

RESUMO

This cross-sectional, retrospective study used epidemiological and anthropological methods toward two aims: 1) to examine associations between partner violence and major depression in a community probability sample of women and 2) to provide new data on partner violence in Chinese Americans. In this study, 181 Chinese American women were interviewed, with 178 completing structured sections on CIDI 2.1 major depression and on partner violence history. Results indicate that a history of partner violence is associated with significantly higher rates of lifetime, 12-month, and current major depression in this community population. This effect is specific and independent of other factors. Partner violence also has a dose-response relationship with the severity of major depression episodes, increasing risk for severe and moderate episodes. The strength and specificity of this association, its dose-response effect, and its commonality across different populations suggest a possible causal role for partner violence needing further investigation in research on major depression in women.


Assuntos
Americanos Asiáticos/psicologia , Transtorno Depressivo Maior/etnologia , Transtorno Depressivo Maior/psicologia , Maus-Tratos Conjugais/etnologia , Maus-Tratos Conjugais/psicologia , Cônjuges/psicologia , Adulto , Estudos Transversais , Transtorno Depressivo Maior/diagnóstico , Feminino , Humanos , Prevalência , Estudos Retrospectivos , Índice de Gravidade de Doença , Inquéritos e Questionários , Estados Unidos/epidemiologia
17.
Am J Orthopsychiatry ; 73(4): 455-62, 2003 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-14609407

RESUMO

Perceived causes of suicide attempts were examined in 180 ethnic South Asian women living in the London area. The 3 factors endorsed most frequently and strongly as causes of suicide attempts in South Asian women were violence by the husband, being trapped in an unhappy family situation, and depression.


Assuntos
Depressão/psicologia , Violência Doméstica , Tentativa de Suicídio/etnologia , Tentativa de Suicídio/psicologia , Adulto , Ásia Sudeste/etnologia , Estudos Transversais , Relações Familiares , Feminino , Felicidade , Humanos , Fatores de Risco , Reino Unido
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