Calidad de vida de la población de 50-80 años, participantes del conflicto político-militar, Guarjila, Chalatenango, marzo-agosto 2019 / Quality of life of the population aged 50-80 years, participants in the political-military conflict, Guarjila, Chalatenango, March-August 2019

Propósito: establecer mecanismos y estrategias de promoción y prevención para que contribuyan a mejorar la calidad de vida de la población del Cantón Guarjila, donde las instituciones responsables aborden esta problemática identificada. Material y método: investigación de tipo descriptivo, corte transversal con enfoque cuantitativo, se realizó trabajo de campo y revisión documental. Resultados: en cuanto a los resultados más relevantes se encuentran: lo relacionado con las características sociodemográficas, identificándose que en la distribución de edades destacan que la población de 50 a 60 años predomina con 54%, el género femenino prevalece en un 59%,y un 38% no poseen ningún grado de escolaridad. En cuanto a las condiciones de salud, el 56% de la población padece una enfermedad o secuela del cual el 43% manifestó sentir un grado de afectación por las lesiones físicas sufridas durante el conflicto político militar, el 99% de la población expresó haber sido víctima de violación a sus derechos humanos durante los 12 años del conflicto, el 94% expresó que no tienen buena salud mental, el 55% manifestó no recibir invitación para participar en los grupos de autoayuda. Lo relacionado con la atención en salud, el 60% de la población siempre recibir atención especializada en la unidad de salud familiar u hospital, al 65% le proporcionan sus medicamentos en los establecimientos antes mencionados, el 60% de los encuestados refirió no pertenecer a ningún grupo de autoayuda. Conclusiones: un porcentaje significativo de la población no pertenecen a ningún grupo de autoayuda, por la carencia de apoyo de las instituciones de la comunidad, esto disminuye la motivación de las personas mayores para buscar ayuda profesional y perjudica su estado de salud en general. Recomendaciones: promover el fortalecimiento y creación de grupos de autoayuda para mejorar la autoestima, motivación, desarrollo personal y sobre todo tener en cuenta la opinión de la persona sobre su estado de salud

Especial y marginal: hacia una problematización de la intervención estatal en la salud de los veteranos de Malvinas (1984-2000) / Special and marginal: towards a problematization of the state intervention regarding the health of Malvinas veterans (1984-2000)

RESUMEN El objetivo de este artículo es dar cuenta de las modalidades en que fue instituida la salud del veterano argentino de la guerra de Malvinas como un problema de intervención estatal entre 1984 y 2000. Para ello nos centramos en el concepto de problematización como un modo de análisis de las prácticas y el pensamiento político. El texto consta de tres apartados: en el primero se presentan las bases metodológicas para el análisis de las políticas públicas, mientras que el segundo y el tercero están destinados al análisis de una serie de leyes, proyectos de ley, decretos, informes, etc., producidos por diferentes esferas estatales en torno al veterano de guerra y su situación sanitaria. La hipótesis de lectura que proponemos es que el veterano o excombatiente de Malvinas fue problematizado como un segmento poblacional marginal, aunque la estabilización de un tratamiento específico tardó más de quince años en materializarse.

ABSTRACT The aim of this paper is to account for the modalities in which Malvinas veterans' health was constituted as a problem requiring state intervention between 1984 and 2000. In order to do so, we have focused on the concept of problematization as a way to analyze practices and political thought. The text consists of three sections: the first one presents the methodological basis of the analysis of public policies, whereas the second and third ones intend to analyze a series of laws, bills, decrees, reports and other documents produced by different state spheres about war veterans and their health situation. The hypothesis that we propose is that the Malvinas veterans were problematized as a marginal segment of the population, although the stabilization of a specific treatment took more than fifteen years to materialize

Combat surfers: a narrative study of veterans, surfing, and war trauma / Surfistas de combate: um estudo narrativo de veteranos, surfing e trauma de guerra / Surfistas de combate: un estudio narrativo de veteranos, surfing y trauma de guerra

We use narrative inquiry to illustrate the complex lives and experiences of combat veterans who go surfing to deal with the traumatic aftermath of war. The stories we collected reveal the rich and varied qualities of veterans' surfing experiences. These stories are several things at once. They are personal, revealing the body in motion as it negotiates the natural environment. They are social and cultural, shaped as they are by dominant societal narratives about veterans and masculinity. And, importantly, they are also actors, shaping the ways in which veterans experience themselves, each other, and the world around them(AU)

Usamos a investigação narrativa para ilustrar as vidas complexas e experiências de veteranos de combate que vão surfar para lidar com as conseqüências traumáticas da guerra. As histórias que coletamos revelam as qualidades ricas e variadas das experiências de surf dos veteranos. Essas histórias são várias coisas ao mesmo tempo. Eles são pessoais, revelando o corpo em movimento como ele negocia o ambiente natural. Eles são sociais e culturais, moldados como eles são por narrativas societal dominantes sobre veteranos e masculinidade. E, o mais importante, eles também são atores, moldando as maneiras pelas quais os veteranos experimentam a si mesmos, uns aos outros e ao mundo à sua volta(AU)

Utilizamos la investigación narrativa para ilustrar las complejas vidas y experiencias de los veteranos de combate que van a surfear para tratar las consecuencias traumáticas de la guerra. Las historias que recopilamos revelan las cualidades ricas y variadas de las experiencias de surf de los veteranos. Estas historias son varias cosas a la vez. Son personales, revelando el cuerpo en movimiento mientras que negocia el ambiente natural. Son sociales y culturales, conformados por las narrativas dominantes de la sociedad sobre los veteranos y la masculinidad. Y, lo que es más importante, también son actores, moldeando las maneras en que los veteranos se experimentan a sí mismos, entre ellos, y el mundo que los rodea(AU)

What Is Important in Selecting a Designated Hospital for the Korean Veterans with Hip Fractures? / 대한고관절학회지

PURPOSE: The Korea Veterans Health Service (KVHS) implemented the ‘designated hospital system’ so that veterans can receive prompt medical attention at hospitals near their residences when experience medical emergencies, including hip fractures. We analyzed the hospital-selection process of Korean veterans following a hip fracture. We then evaluated (the validity and considerations) for choosing designated hospitals. MATERIALS AND METHODS: The study population consisted of 183 veteran patients (84 treated at a single veterans hospital and the remaining 99 treated at 39 designated hospitals) who underwent hip fracture between January 2010 and February 2015 in the Honam region of South Korea. The subjects were divided into the ‘nearest group’ (those who chose the hospital closest to their residences) and the ‘non-nearest group’ (those who did not choose the hospital closest to their residences). We compared the age, ambulatory status, combined disease and fracture type, factors that we speculated may impact hospital choice. RESULTS: Although the patients had difficulty moving due to hip fractures, 116 (63.4%) patients choose hospitals that were not closest to their residences. Patients with three or more comorbidities (P=0.028) and older ages (P=0.046) were statistically more likely to fall into the non-nearest group. Ambulatory status and fracture type were shown not to significantly impact choice between nearest and non-nearest hospital. Patients in the non-nearest group tended to seek care at larger hospitals. CONCLUSION: Korean veterans with hip fractures tended to seek care at larger hospitals, regardless of distance. We must therefore consider the number of beds and departments when choosing designated hospitals.

Culture, history and traumatic memory: an interpretation / Cultura, historia y memoria traumática: una interpretación / Cultura, história e memória traumática: uma interpretação

Efforts to investigate psychiatric disorders across cultures routinely ignore a pervasive cultural influence, namely the culture of psychiatry. This article focuses on how the culture of psychiatry affects our understanding of posttraumatic stress disorder (PTSD). PTSD is diagnosed by means of standardized symptom criteria and scales. Yet it is a heterogeneous phenomenon. The illusion of homogeneity is fostered by a categorical conception of traumatic memory that homogenizes posttraumatic memories and erects an obstacle to investigating the disorder's historical nature, clinical phenomenology, and neuro-physiology and neuro-anatomy. I illustrate this process, via an epidemic of PTSD that now affects a quarter of a million American war veterans.

Los esfuerzos para investigar trastornos psiquiátricos a través de las culturas, por lo general ignoran una frecuente influencia cultural, que es la propia cultura de psiquiatría. Este artículo se enfoca en cómo la cultura de psiquiatría afecta nuestro entendimiento del trastorno de estrés post-traumático (TEPP). El TEPP se diagnostica mediante criterios de síntomas y escalas. No obstante, es un fenómeno heterogéneo. La ilusión de homogeneidad es fomentada por una concepción categórica de memoria de trauma que homogeneiza las memorias post-trauma y crea un obstáculo para investigar la historia natural del trastorno, la fenomenología clínica, neurofisiología y neuroanatomía. Ilustro este proceso por medio de una epidemia de TEPP que afecta a un cuarto de millón de veteranos de guerra en Norteamérica.

Os esforços para investigar transtornos psiquiátricos em diferentes culturas rotineiramente ignoram a difusa influência cultural, principalmente a cultura da psiquiatria. Este artigo enfoca como a cultura da psiquiatria afeta a nossa compreensão do transtorno de estresse pós-traumático (PTSD). PTSD é diagnosticado por meio de critérios de sintomas padronizados e escalas. No entanto, é um fenômeno heterogêneo. A ilusão de homogeneidade é fomentada por uma concepção categórica da memória traumática que homogeniza as memórias pós-traumáticas e erige um obstáculo para investigar a natureza da desordem histórica, a fenomenologia clínica, e a neurofisiologia e neuroanatomia. Explico este processo por meio de uma epidemia de PTSD que atualmente afeta um quarto de um milhão de veteranos de guerra americanos.

Prevalencia de la fragilidad en adultos mayores del municipio La Lisa / Prevalence of fragility in elderly in La Lisa municipality

Introducción: el síndrome de fragilidad es consecuencia de disminución de la resistencia y reservas fisiológicas del anciano, que los hace vulnerables a efectos adversos para la salud. Objetivo: estimar la prevalencia de fragilidad en adultos mayores, veteranos de la defensa, residentes en el municipio La Lisa. Método: estudio descriptivo, de corte transversal, puerta a puerta. Para el diagnóstico del síndrome se utilizaron criterios validados en una investigación previa, que aplicó el método Delphi. Resultados: edad promedio: 70,4 años. Predominó el sexo masculino (88,2 por ciento). El 47,6 por ciento fue miembro del Ejército Rebelde. Las comorbilidades estuvieron presentes en 61,6 por ciento, la polifarmacia en el 43,8 por ciento y 64,8 por ciento mostró alteraciones en la flexibilidad y movilidad. En 8,9 por ciento se halló déficit cognitivo y depresión leve en 13,7 por ciento. El 25,7 por ciento de la población sufrió discapacidad. El 7,6 por ciento autopercibió su salud de mala. La mayoría (81,0 por ciento) no necesitaba cuidador permanente y poseía apoyo familiar (81,0 por ciento). Se obtuvo una prevalencia de fragilidad de 42,9 por ciento. Conclusiones: la prevalencia de fragilidad es alta y se halló entre los valores esperados para ancianos que habitan en Latinoamérica y el Caribe(AU)

Introduction: The fragility syndrome is a consequence of a decrease in resistance and physiological reserves of the elderly, which makes them vulnerable to adverse health effects. Objective: Estimate the prevalence of frailty in elderly, veterans of the defense, living in La Lisa municipality. Method: A descriptive, cross-sectional, door-to-door study was conducted. Validated criteria in a previous investigation, which applied the Delphi method, were used for this syndrome diagnosis. Results: Mean age: 70.4 years. The male sex predominated (88.2 percent). 47.6 percent were members of the Rebel Army. Comorbidities were present in 61.6 percent, polypharmacy in 43.8 percent and 64.8 percent showed alterations in flexibility and mobility. 8.9 percent had cognitive deficit. 13.7 percent of the subject studied had mild depression were found. 25.7 percent of the population suffered disability. 7.6 percent self-perceived poor health. The majority (81.0 percent) did not need permanent caregivers and had family support (81.0 percent). A prevalence of fragility was 42.9 percent. Conclusions: The prevalence of fragility is high and was among the expected values for the elderly living in Latin America and the Caribbean(AU)

Depressive Symptoms on the Geriatric Depression Scale and Suicide Deaths in Older Middle-aged Men: A Prospective Cohort Study / 예방의학회지

OBJECTIVES: Prospective evaluations of the associations between depressive symptoms and suicide deaths have been mainly performed in high-risk populations, such as individuals with psychiatric disorders or histories of self-harm. The purpose of this study was to prospectively examine whether more severe depressive symptoms assessed using the Geriatric Depression Scale (GDS) were associated with a greater risk of death from suicide in a general-risk population. METHODS: A total of 113 478 men from the Korean Veterans Health Study (mean age, 58.9 years) who participated in a postal survey in 2004 were followed up for suicide mortality until 2010. RESULTS: Over 6.4 years of follow-up, 400 men died by suicide (56.7 deaths per 100 000 person-years). More severe depressive symptoms were associated with greater risk of suicide death (p for trend <0.001). The unadjusted hazard ratios (HRs) in comparison to the absence of depression were 2.18 for mild depression, 2.13 for moderate depression, 3.33 for severe depression, and 3.67 for extreme depression. After adjusting for potential confounders, men with a potential depressive disorder had an approximate 90% higher mortality from suicide (adjusted HR, 1.92; 95% confidence interval [CI], 1.38 to 2.68; p<0.001) than men without depression. Each five-point increase in the GDS score was associated with a higher risk of death by suicide (adjusted HR, 1.22; p<0.001). The value of the area under the receiver operating characteristics curve of GDS scores for suicide deaths was 0.61 (95% CI, 0.58 to 0.64). CONCLUSIONS: Depressive symptoms assessed using the GDS were found to be a strong independent predictor of future suicide. However, the estimate of relative risk was weaker than would be expected based on retrospective psychological autopsy studies.

Low Systolic Blood Pressure and Mortality From All Causes and Vascular Diseases Among Older Middle-aged Men: Korean Veterans Health Study / 예방의학회지

OBJECTIVES: Recently, low systolic blood pressure (SBP) was found to be associated with an increased risk of death from vascular diseases in a rural elderly population in Korea. However, evidence on the association between low SBP and vascular diseases is scarce. The aim of this study was to prospectively examine the association between low SBP and mortality from all causes and vascular diseases in older middle-aged Korean men. METHODS: From 2004 to 2010, 94 085 Korean Vietnam War veterans were followed-up for deaths. The adjusted hazard ratios (aHR) were calculated using the Cox proportional hazard model. A stratified analysis was conducted by age at enrollment. SBP was self-reported by a postal survey in 2004. RESULTS: Among the participants aged 60 and older, the lowest SBP (<90 mmHg) category had an elevated aHR for mortality from all causes (aHR, 1.9; 95% confidence interval [CI], 1.2 to 3.1) and vascular diseases (International Classification of Disease, 10th revision, I00-I99; aHR, 3.2; 95% CI, 1.2 to 8.4) compared to those with an SBP of 100 to 119 mmHg. Those with an SBP below 80 mmHg (aHR, 4.5; 95% CI, 1.1 to 18.8) and those with an SBP of 80 to 89 mmHg (aHR, 3.1; 95% CI, 0.9 to 10.2) also had an increased risk of vascular mortality, compared to those with an SBP of 90 to 119 mmHg. This association was sustained when excluding the first two years of follow-up or preexisting vascular diseases. In men younger than 60 years, the association of low SBP was weaker than that in those aged 60 years or older. CONCLUSIONS: Our findings suggest that low SBP (<90 mmHg) may increase vascular mortality in Korean men aged 60 years or older.

Do Positive Surgical Margins Predict Biochemical Recurrence in All Patients Without Adjuvant Therapy After Radical Prostatectomy?

PURPOSE: The objective was to study whether positive surgical margins (PSMs) predict biochemical recurrence (BCR) in all patients without adjuvant therapy after radical prostatectomy (RP). MATERIALS AND METHODS: We retrospectively reviewed the medical records of patients who underwent RP for prostate cancer at Veterans Health Service Medical Center from 2005 to 2011. BCR was defined by a prostate-specific antigen (PSA) value > or =0.2 ng/mL. The clinicopathological factors of the PSM group were compared with those of the negative surgical margin (NSM) group, and the predictive impact of a PSM for BCR-free survival were evaluated. In addition, we analyzed the prognostic difference for BCR-free survival between solitary and multiple PSMs. RESULTS: A PSM was noted in 167 patients (45.5%). BCR was reported in 101 men in total (27.5%). The BCR-free survival rate of the PSM group was lower than that of the NSM group (p<0.001). In a multivariate analysis for the total patients, PSM was significantly associated with BCR-free survival (p<0.001). After stratification by pathological T stage, Gleason score (GS), and preoperative PSA value, PSM was significantly predictive for BCR-free survival in men with pT2 and/or GS < or =6 or 7 and/or a PSA value <10 or 10-20 ng/mL (all p<0.05). Multiple PSMs were more predictive of BCR-free survival than was a solitary PSM (p=0.001). CONCLUSIONS: A PSM is a significant predictor of postoperative BCR in patients with pT2 and/or GS < or =7 and/or preoperative PSA <20 ng/mL. Multiple PSMs are considered a stronger prognostic factor for prediction of BCR than is a solitary PSM.