This Week in JAMA FREE

A JAMA THEME ISSUE Edited by Annette Flanagin, RN, MA and Thomas B. Cole, MD, MPH

Two articles in this issue of THE JOURNAL examine the psychiatric morbidity associated with wartime conditions of physical trauma, nutritional deprivation, and social disruption. In a cross-sectional survey of Bosnian adult refugees living in a refugee camp in Varaždin, Croatia, Mollica and colleagues found that 39% reportedArticle symptoms meeting diagnostic criteria for depression and 26%, for posttraumatic stress disorder. Twenty-one percent reported symptoms comorbid for both disorders, which was associated with an increased risk of disability compared with asymptomatic refugees. Neugebauer and coworkers reportArticle an increased risk of antisocial personality disorder among men at age 18 years who were the offspring of women who experienced severe nutritional deficiency during the first and/or second trimesters of pregnancy when Germany blockaded food supplies to the Netherlands in the winter of 1944-1945. In an editorialArticle, Iacopino and Waldman trace the evolution of physician involvement in humanitarian relief activities originating in the care of those injured in war to include preventive and mental health care for refugee populations and documentation of human rights violations.

In this analysis of data from 4 biennial Youth Risk Behavior surveys of nationally representative samples of US adolescents in grades 9 through 12 conducted between 1991 and 1997, Brener and colleagues found significant linear decreases in the percentages of students who reported carrying a weapon, engaging in a physical fight, and being injured in a physical fight. Little change occurred, however, in the percentages of students reporting feeling too unsafe to go to school, being threatened or injured with a weapon on school property, or having property stolen or deliberately damaged at school.

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Using data from multiple sources, Cook and coworkers estimated the medical costs for acute care and follow-up treatment of gunshot injuries in 1994 in the United States and identified sources of payment. Estimated lifetime medical costs for treatment of the 134,445 patients with gunshot injuries that occurred during 1994 were $2.3 billion, of which $1.1 billion (49%) was paid by US taxpayers via government programs.

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To ascertain the true incidence of fatal child abuse, Herman-Giddens and colleagues researched possible cases identified in a search of the North Carolina Medical Examiner Information System between 1985 and 1995. Two hundred twenty (85%) of the 259 cases of homicide among children aged 10 years or younger were attributed to child abuse, 3 times more than the number of cases recorded in the state vital records system.

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Primary care physicians may be missing opportunities to identify intimate partner abuse. Based on the results of a cross-sectional survey of 400 California physicians in family medicine, general internal medicine, and obstetrics/gynecology, Rodriguez and colleagues estimated that 79% of California primary care physicians screen injured patients for intimate partner abuse, but only 10% routinely screen noninjured patients. Reported routine screening of new patients was highest among obstetricians/gynecologists (17%) and among physicians practicing in public clinic settings (37%) and lowest among physicians practicing in health maintenance organizations (1%).

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"In caring for patients, I have been confronted with a variety of human conflicts. But none of it had prepared me for dealing with this man." From "A Case of Mutual Distrust."

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A report on one physician who volunteered overseas; a new Directory of Volunteer Agencies; plus, medicine′s efforts to help survivors of violence.

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Wintemute reviews interventions that have been associated with recent reductions in firearm-related violence.

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Results of a survey of forensic physicians on their experiences with and attitudes toward virginity examinations.

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For your patients: Child abuse.

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