The association of delivery during a war with the risk for postpartum depression, anxiety and impaired maternal-infant bonding, a prospective cohort study.

OBJECTIVE: To examine the impact of war conditions on maternal mental health postpartum outcomes, specifically depression and anxiety, as well as on maternal-infant bonding (MIB). STUDY DESIGN: A prospective cohort study was performed on women who gave birth in a tertiary medical center during (October-November 2023) and before (March-May 2020) the Israel-Hamas War. All participants completed validated self-reported questionnaires: The Edinburgh Postnatal Depression Scale (EPDS ≥ 10), State-Trait Anxiety Inventory (STAI > 39) and the Postpartum Bonding Questionnaire (PBQ ≥ 26). RESULTS: A total of 502 women were included in the study, with 230 delivering during the war and 272 delivered before. The rates of postpartum depression (PPD) were higher in women delivering during the war (26.6% vs. 12.4%, p < 0.001), while multivariable regression revealing a two-fold higher risk (adjusted OR 2.35, 95% CI 1.16-4.74, p = 0.017). The rate of postpartum anxiety (PPA) risk was also higher (34.3% vs 17.0%, p < 0.001), reaching a trend towards significance when accounting for other risk factors (adjusted OR 2.06, 95% CI 0.97-4.36, p = 0.058). Additionally, delivery during the war was associated with specific factors of impaired maternal-infant bonding (MIB), although it did not increase the overall impaired MIB (PBQ ≥ 26) (10.2 ± 14.1 vs 8.3 ± 6.9, p = 0.075). CONCLUSION: The study revealed an increased risk of PPD, a marginally risk for PPA, and some aspects of impaired MIB among women delivering during the war. Maternal mental illness in the postpartum period has negative impacts on the entire family. Therefore, comprehensive screening and adequate resources should be provided for women delivering in war-conflict zones.

Risk of Dementia in Korean Vietnam War Veterans.

BACKGROUND: The number of cases of all types of dementia is increasing, and a significant increase in prevalence has been noted among veterans. Evidence of an association between dementia and exposure to chemicals such as Agent Orange from the Vietnam War is still limited, and there is a reported lack of awareness. OBJECTIVE: This study aimed to investigate the risk of dementia among Vietnam War veterans in Korea. DESIGN: This retrospective longitudinal study compared the incidence of dementia between Vietnam War veterans and the general population. SETTING: This study used data from the nationally representative Korean Vietnam War Veterans' Health Study Cohort, a combined dataset sourced from the Ministry of Patriots and Veterans Affairs in Korea and the National Health Insurance Sharing Service database. PARTICIPANTS: There were 191,272 Vietnam War veterans and 1,000,320 people of different ages, sexes, and residences. matched control in 2002. The total number of person-years were 18,543,181. MEASUREMENTS: The dementia group included participants who had visited a medical facility with any of the following ICD-10 codes in the follow-up periods: "F00 Dementia in Alzheimer's disease," "F01 Vascular dementia," "F02 Dementia in other diseases classified elsewhere," or "F03 Unspecified dementia." RESULTS: The incidence rate ratio for all types of dementia was 1.16, with higher ratios observed for vascular and unspecified dementia, particularly in the younger age groups. There was a significant increase in the risk of dementia, Alzheimer's disease, vascular dementia, and unspecified dementia. CONCLUSION: Vietnam War veterans showed an increased risk for all types of dementia. These findings are hypothesized to be due to the effects of the chemicals used during the Vietnam War, which can cause a variety of neurodegenerative diseases. Further studies are warranted to investigate the potential health determinants related to the Vietnam War, focusing on the neurodegenerative effects.

Enhancing trauma care in Ukraine amid conflict: A successful implementation of the modified advanced trauma life support course in an active war zone.

BACKGROUND: Following the 2022 Russian invasion, Ukraine's healthcare system suffered extensive damage, with over 1000 medical facilities destroyed, exacerbating the trauma care crisis. The absence of standardized trauma training left Ukrainian healthcare providers ill-equipped to manage the surge in trauma cases amid conflict. To bridge this gap, we implemented advanced trauma life support (ATLS) courses in Ukraine amid active warfare, aiming to enhance trauma care expertise among healthcare professionals. METHODS: A consortium, including the International Medical Corps, Harvard Humanitarian Initiative, and others, responded to a request from the Ukrainian Ministry of Health. The ATLS curriculum, translated into Ukrainian, guided the training, with US-based instructors sent to Ukraine for teaching. Despite logistical challenges, such as missile attacks and curfews, the courses ran in multiple Ukrainian cities over 3 months. Course effectiveness was evaluated through pre- and post-course knowledge tests, self-efficacy surveys, and satisfaction assessments. RESULTS: Ten ATLS courses trained 213 Ukrainian healthcare providers across five deployments. Significant improvements in knowledge scores (p < 0.05) and enhanced self-reported confidence in trauma management were observed. Notably, no casualties were reported among instructors or students, highlighting program safety despite security challenges. CONCLUSIONS: Our study demonstrates successful ATLS course implementation in an active war zone, filling a critical gap in trauma education in Ukraine. Despite challenges, the program significantly enhanced participants' trauma care knowledge and confidence. Collaboration between international and local partners was pivotal. This model can serve as a valuable framework for trauma education globally, improving outcomes in conflict zones and resource-limited settings.

Developing the Scale of the Social Health Impact of War.

Background/Aim: This study was conducted to develop the "Scale of the Effects of War on Social Health" to better understand the effects that news of have on individuals. Method: 389 adult individuals participated in the study. The scale was developed using exploratory and confirmatory factor analyses to test its structural validity.Results: As a result of exploratory and confirmatory factor analyses, the scale was found to consist of four dimensions: "worry and despair", "concentration", "shame and guilt" and "anger and control". The scale consists of a total of 16 statements. The calculated CR and AVE values show that the scale has a reliable structure. Conclusion: This study, conducted to determine the effect of war news on the social health of individuals, provides a scientific tool to identify and measure the potential effects of the frames reflected in mass media news during wartime on the social health status of individuals. The scale developed can contribute to a more comprehensive understanding of the effects of war news on the people who are not directly involved in the war but listen or read the news.

High rates of probable PTSD among Ukrainian war refugees: the role of intolerance of uncertainty, loss of control and subsequent discrimination.

Background: Intolerance of uncertainty is a well-known predictor of post-traumatic stress symptoms following a traumatic event. At the same time, it is relatively unknown whether intolerance of uncertainty amplifies the effects of other adverse life events on PTSD symptoms among traumatized individuals.Objective: This article addresses this problem in a study of Ukrainian war refugees' experiences with post-migration discrimination and powerlessness (loss of control).Method: 4972 forced immigrants from Ukraine took part in the study (90.2% women, Mage = 40.4, SD = 12.5) completing the PTSD-8 scale, measures of post-migration discrimination and loss of control experiences, and intolerance of uncertainty.Results: Almost half of respondents (47.5%) have probable PTSD. Regression analysis confirmed that war-related experiences, as well as intolerance of uncertainty, post-migration loss of control and experiences of discrimination were significant predictors of self-reported PTSD symptoms. Also, intolerance of uncertainty weakly moderated the effects of experienced discrimination and control deprivation on self-reported PTSD symptoms, so that the effects of adverse post-migration experiences were more pronounced among individuals high in intolerance of uncertainty.Conclusions: Understanding the effect of post-migration experiences on war refugees' mental health is crucial for developing improved acculturation policies and fostering a supportive environment for forced migrants.

Ukrainian forced migrants have high levels of probable PTSD symptoms.Post-migration experiences increase the probability of self-reported post-traumatic stress symptoms.IU weakly moderates the effects of discrimination and loss of control on self-reported post-traumatic stress symptoms.

Challenges of a regional trauma center in treating combat and civilian casualties. The experience of Assuta Ashdod Hospital in the Iron Swords War.

INTRODUCTION: Assuta Ashdod Hospital is a regional trauma center. The hospital received casualties on the first day of the civilian massacre of October 7th and thereafter. The Assuta Ashdod Hospital was designated as an emergency landing site only for unstable or deteriorating patients who would not survive longer flights to a central trauma center. The aim of this study is to share our experience and challenges as a new regional trauma center in a war zone. METHODS: A descriptive cohort study consisting of all trauma patients admitted in the Emergency Department, between October 7, 2023, and December of the same year. The data is part of the Israel National Trauma Registry. RESULTS: A total of 397 heavily wounded patients were admitted, of which 3 were declared dead on arrival, 95 were hospitalized and 299 were discharged from the emergency department after initial care. Of the 95 wounded patients hospitalized, 60 (63.1 %) had a single mechanism of injury, of which, 35.7 % were penetrating injuries. The most frequent injury was to the extremities (60 %) followed by chest and abdomen, 35.7 % and 14.7 % respectively. Multi-trauma injuries were present in 40 % of the wounded patients. The average ISS was 15 (median=9). Of all patients, 10.5 % of patients were considered to have severe and 23.1 % to have profound (very-severe) injuries by the ISS classification. Twelve patients received whole blood transfusions, fourteen received the Massive Transfusion Protocol. Sixty-one of the 95 (64 %) patients underwent surgery, with a total of 137 surgeries performed. Sixty-seven percent of surgical procedures were orthopedic and 16.7 % were of general surgery. The average length of stay was 6.5 days (median=6). We transferred 14 patients to central trauma centers, 3 of which did not survive. CONCLUSION: The outcomes of patients admitted to the Assuta Ashdod Hospital were good in treating major trauma patients in a mass casualty event, reaffirming its capabilities as an excellent regional trauma center. Therefore, we suggest that the guidelines for evacuation of battle or major casualty events victims only to central trauma centers unless patients are unstable should be reconsidered, and regional trauma centers could effectively share the burden of the treatment of those patients.

Father-separation and well-being in forcibly displaced Syrian children.

Forcibly displaced children often face separation from their parents, particularly fathers. These children endure the hardships of war, displacement, and the loss of a key attachment figure. Despite the critical role of attachment in children's well-being during periods of heightened stress, the impact of separation due to war and displacement has received little attention in empirical work. Findings from 1544 Syrian refugee children (Mage = 10.97, SD = 2.27) living in informal settlements in Lebanon with their mothers (Mage = 38.07, SD = 8.49), including 367 father-separated children, show that father-separated children experienced more war-related events and worse refugee environments. Structural equation modelling showed that beyond the direct relation of war exposure and quality of the refugee environment on well-being, father separation was uniquely related to more depressive symptoms and worse self-development, but not to anxiety, PTSD, or externalising problems in children. Maternal parenting did not explain these outcomes, though it had a protective function for children's well-being.

RP squeeze U-SegNet model for lesion segmentation and optimization enabled ShuffleNet based multi-level severity diabetic retinopathy classification.

In Diabetic Retinopathy (DR), the retina is harmed due to the high blood pressure in small blood vessels. Manual screening is time-consuming, which can be overcome by using automated techniques. Hence, this paper proposed a new method for classifying the multi-level severity of DR. Initially, the input fundus image is pre-processed by Non-local means Denoising (NLMD). Then, lesion segmentation is carried out by the Recurrent Prototypical-squeeze U-SegNet (RP-squeeze U-SegNet). Next, feature extraction is effectuated to mine image-level features. DR is categorized as abnormal or normal by ShuffleNet and it is tuned by Fractional War Royale Optimization (FrWRO), and later, if DR is detected, severity classification is performed. Furthermore, the FrWRO-SqueezeNet obtained the maximum performance with sensitivity of 97%, accuracy of 93.8%, specificity of 95.1%, precision of 91.8%, and F-Measure of 94.3%. The devised scheme accurately visualizes abnormal regions in the fundus images. Also, it has the ability to identify the severity levels of DR effectively, which avoids the progression risk to vision loss and proliferative disease.

Longitudinal evaluation of structural brain alterations in two established mouse models of Gulf War Illness.

Gulf War Illness (GWI) affects nearly 30% of veterans from the 1990-1991 Gulf War (GW) and is a multi-symptom illness with many neurological effects attributed to in-theater wartime chemical overexposures. Brain-focused studies have revealed persistent structural and functional alterations in veterans with GWI, including reduced volumes, connectivity, and signaling that correlate with poor cognitive and motor performance. GWI symptomology components have been recapitulated in rodent models as behavioral, neurochemical, and neuroinflammatory aberrations. However, preclinical structural imaging studies remain limited. This study aimed to characterize the progression of brain structural alterations over the course of 12 months in two established preclinical models of GWI. In the PB/PM model, male C57BL/6 J mice (8-9 weeks) received daily exposure to the nerve agent prophylactic pyridostigmine bromide (PB) and the pyrethroid insecticide permethrin (PM) for 10 days. In the PB/DEET/CORT/DFP model, mice received daily exposure to PB and the insect repellent DEET (days 1-14) and corticosterone (CORT; days 7-14). On day 15, mice received a single injection of the sarin surrogate diisopropylfluorophosphate (DFP). Using a Varian 7 T Bore MRI System, structural (sagittal T2-weighted) scans were performed at 6-, 9-, and 12-months post GWI exposures. Regions of interest, including total brain, ventricles, cortex, hippocampus, cerebellum, and brainstem were delineated in the open source Aedes Toolbox in MATLAB, followed by brain volumetric and cortical thickness analyses in ImageJ. Limited behavioral testing 1 month after the last MRI was also performed. The results of this study compare similarities and distinctions between these exposure paradigms and aid in the understanding of GWI pathogenesis. Major similarities among the models include relative ventricular enlargement and reductions in hippocampal volumes with age. Key differences in the PB/DEET/CORT/DFP model included reduced brainstem volumes and an early and persistent loss of total brain volume, while the PB/PM model produced reductions in cortical thickness with age. Behaviorally, at 13 months, motor function was largely preserved in both models. However, the GWI mice in the PB/DEET/CORT/DFP model exhibited an elevation in anxiety-like behavior.

Coping Mechanisms and Posttraumatic Stress Exhibited by Children in Areas of Yemen's Armed Conflict in Southern Saudi Arabia.

This study is an attempt to explore war-related trauma, its stressful effects, and the coping strategies of Saudi schoolchildren. The authors hypothesized that children exposed to war-related trauma will show higher levels of PTSD, and that those with higher levels of PTSD symptoms use more maladaptive coping strategies. The study describes the correlation between traumatic events and posttraumatic stress disorder (PTSD) as well as coping strategies. Five hundred twenty-seven intermediate and high school students, 12 to 18 years old, living in the conflict zone in southern Saudi Arabia completed three standardized self-reported scales: the War Zone Traumatic Events Checklist, the Child PTSD Symptom Scale, and the Children's Coping Strategies Checklist. Each participating student was randomly chosen. Analysis was based on two groups: the high-PTSD symptoms group (182 children) and the low-PTSD symptoms group (345 children). The study was conducted between September 2020 and April 2022 while the war was ongoing as part of an ongoing larger study. Children exposed to war-related traumatic events exhibited greater prevalence rates for PTSD. The children reported high levels of PTSD symptoms and applied a variety of coping strategies to manage related stress. Participants rarely reported that psychological or educational interventions had been used to manage the war-related traumatic experiences and PTSD or to improve related coping styles. The results are discussed in the context of mental health services needed for children in the conflict zone. To bridge the gap between health care services and the needs of children with PTSD, and for better understanding and interventions, health professionals are invited to develop a biopsychosocial model that identifies the risks of PTSD related to exposure to war-related traumatic events in school-aged children and, hence, provide a multidisciplinary intervention program that educates, encourages, and supports teachers and parents in following medical recommendations and goals.

Time-series satellite remote sensing reveals gradually increasing war damage in the Gaza Strip.

War-related urban destruction is a significant global concern, impacting national security, social stability, people's survival and economic development. The effects of urban geomorphology and complex geological contexts during conflicts, characterized by different levels of structural damage, are not yet fully understood globally. Here we report how integrating deep learning with data from the independently developed LuoJia3-01 satellite enables near real-time detection of explosions and assessment of different building damage levels in the Israel-Palestine conflict. We found that the damage continually increased from 17 October 2023 to 2 March 2024. We found 3747 missile craters with precision positions and sizes, and timing on vital infrastructure across five governorates in the Gaza Strip on 2 March 2024, providing accurate estimates of potential unexploded ordnance locations and assisting in demining and chemical decontamination. Our findings reveal a significant increase in damage to residential and educational structures, accounting for 58.4% of the total-15.4% destroyed, 18.7% severely damaged, 11.8% moderately damaged and 12.5% slightly damaged-which exacerbates the housing crisis and potential population displacement. Additionally, there is a 34.1% decline in the cultivated area of agricultural land, posing a risk to food security. The LuoJia3-01 satellite data are crucial for impartial conflict monitoring, and our innovative methodology offers a cost-effective, scalable approach to assess future conflicts in various global contexts. These first-time findings highlight the urgent need for an immediate ceasefire to prevent further damage and support the release of hostages and subsequent reconstruction efforts.

Peer conformity and competition shape how business managers evaluate withdrawals from Russia amid the Ukraine War.

States have long used economic sanctions in response to violations of international law as a strategy to restore order. Increasingly, firms also reject doing business with violators. In response to the war in Ukraine, hundreds of multinational corporations voluntarily withdrew from Russia, even when policymakers were still debating the extent of sanctions. How did firm managers evaluate whether to withdraw from the Russian market? Using a survey experiment with Japanese firm managers conducted three months after the Russian invasion of Ukraine in 2022, we explore how peer effects-information on what other firms are doing in response to the crisis-influence support for withdrawal of business activity with Russia. Our findings show that information about withdrawal by other firms from a diverse set of countries promotes peer conformity that increases support. In contrast, information about ongoing business with Russia by Chinese firms fosters competition that reduces support. Market exposure moderates these reactions, although the concern about peer behavior does not appear to be driven by a reputation mechanism. Our research provides insight into how business actors perceive the strategic interplay of peer influence and market dynamics in the context of geopolitical conflicts.

William Bateson, black slavery, eugenics and speciation: The relative roles of politics and science.

The peace of the world is challenged by societal confrontations that can often be labeled "racial" or "ethnic." Emblematic of this is discrimination based on skin colour. William Bateson's background suggests sympathy with the black emancipation movement. Yet the movement's success is attributed more to battles between political figures than between scientists with contending views on the biology of racial differences. However, in the long term, Bateson's contributions to slavery and eugenic issues may be seen as no less important than those of politicians. Mendel's discovery of what we now know as "genes" languished until seized upon by Bateson in 1900. For six exhausting years he struggled to win scientific acceptance of these biological character-determining units. Later, he pressed the Mendelian message home to the general public, opposing simplistic applications of Mendelian principles to human affairs, and arguing that minor genic differences that distinguished "races" - e.g. skin colour - do not initiate new species. Bateson praised the "physiological selection" speciation hypothesis of Darwin's young research associate, George Romanes. This enthusiasm was rekindled by Robert Lock and formulated in modern terms with C. R. Crowther. Thus, the spark that initiates a divergence into two species can be non-genic. This normal form of hybrid sterility, based on genome-wide DNA sequence differences, operates on, but has not succeeded in dividing, the human species. It should not be labeled "idiopathic," and be clearly distinguished both from pathological sterility and undiagnosed sterilities that may prove to be pathological. We are one reproductively isolated population, the human species.

Antimicrobial susceptibility to last-resort antibiotics in carbapenemase-producing bacteria from Ukrainian patients.

Since March 2022, an increase was observed in multidrug-resistant microorganisms (MDRO), associated with the hospital transfer of Ukrainian patients. The goal was to collect phenotypic susceptibility data and assess clinical implications. Carbapenemase-producing Enterobacterales (CPE, n = 96), Pseudomonas aeruginosa (CPPA, n = 20), and carbapenem-resistant Acinetobacter baumannii-calcoaceticus (CRAB, n = 6) from Ukrainian patients were obtained from March to December 2022 from the Dutch MDRO surveillance. Antimicrobial susceptibility testing was performed using broth microdilution (BMD) when available, fosfomycin agar dilution, disk diffusion (DD) for cefiderocol, and diverse gradient strips. All isolates were sequenced with Illumina next-generation sequencing. For meropenem, aminoglycosides, ceftazidime-avibactam, ceftolozane-tazobactam, and imipenem-relebactam, susceptibility rates were low (0%-30%), due to the high number of blaNDM-positive isolates (79/122; 65%). For cefiderocol, results depended on reading with or without microcolonies, applying EUCAST or CLSI breakpoints, and whether DD or BMD was used; e.g., for Klebsiella pneumoniae, 30%-97% were susceptible. For colistin, 103/111 (93%) non-intrinsically resistant CPE/CPPA/CRAB isolates were susceptible. For most CPE, a low minimal inhibitory concentration (MIC) of <0.5 mg/L was measured for tigecycline and ceftazidime-avibactam-aztreonam. For CPPA, cefiderocol tested susceptible in 65%-100% of isolates. For CRAB, ampicillin-sulbactam MICs were ≥128 mg/L; for sulbactam-durlobactam, 1-2 mg/L. Admission in a Ukrainian hospital in the last year was a risk factor for MDRO, and majority were screening isolates (79%). There is extensive phenotypic resistance to last-resort antibiotics in MDRO from Ukrainian patients. Interpretation of cefiderocol susceptibility results depends on several variables. When treating patients recently admitted in Ukraine, suspected for Gram-negative bacterial infection, this should be taken into consideration. IMPORTANCE: Since March 2022, multidrug-resistant microorganisms associated with Ukrainian patients have been detected in national surveillance systems of several European countries. We studied the phenotypic antimicrobial susceptibility to last-resort antibiotics of multidrug-resistant microorganisms from Ukrainian patients in the Netherlands and assessed clinical implications. Our research revealed that there was extensive phenotypic resistance to last-resort antibiotics. Healthcare professionals should be aware of multidrug-resistant microorganisms when treating patients recently admitted in Ukraine, suspected for Gram-negative bacterial infection.

Parental Resilience in Contexts of Political Violence: A Systematic Scoping Review of 45 Years of Research.

Families suffer in particular ways during the violence and targeted deprivation of freedom and resources within political violence (PV), which includes wars, armed conflicts, and military occupations-all part of political violence (PV). While evidence is accumulating about the disproportionate impacts of PV on parents and children, we lack a clear, globally integrated understanding of how families suffer-and survive-PV. There is an urgent need to synthesize existing work to refine our understanding of parental experiences within PV-with particular attention to both how PV creates suffering for parents, and how parents strategize, caring for their families within the most horrendous of circumstances. In this systematic scoping review, authors explore how political violence impacts parenting. Using predetermined search strategies and inclusion criteria (peer-reviewed, empirical articles, published in English), searches within multiple databases, and tests of interrater reliability, 112 articles (quantitative, qualitative, and mixed method) were identified. Authors organized and coded findings, determined common themes, and built a conceptual model connecting and integrating findings. Findings point to two crucial areas of parenting within PV: parenting efficacy and parenting practices, demonstrating how these are simultaneously compromised by and amplified within PV. Results uncover how much parenting within PV is intertwined with parental psychological and social well-being, and that parents cope with a variety of internal and external resources, including culture, community, religion, activism, flight, and emotional and logistical reconfiguration. Implications include that, within and after PV, interventions must focus on parental well-being, as well as the social and political situatedness of parents.

Humanitarianism as a tool of statecraft: contested authority, sovereign violence, and humanity in the Syrian civil war.

This research explores the dynamics of interaction between the sovereign state and international humanitarian organisations in alleviating human suffering in the Syrian civil war. Considering civil wars as a rupture in sovereignty, its focus is on the practices of the sovereign state within its social context and the resulting implications for aid organisations. I argue that the Syrian regime has employed state violence, in tandem with administrative and bureaucratic impediments, to reassert its sovereign authority in humanitarian decision-making processes. This exercise of sovereign power is intertwined with the actions of aid organisations, thereby reshaping power dynamics among the state, aid organisations, and vulnerable populations. Through a qualitative method, I show that the deployment of state violence concomitantly pushes aid organisations, specifically the United Nations, towards enforcing the state sovereignty defined by the regime. As an effect of assertive sovereignty, interpretations of humanitarian principles and practices are continuously negotiated and constructed differently by aid organisations, even though they share a common overarching goal.

The Prevalence and Correlates of Anxiety, Stress, Mood Disorders, and Sleep Disturbances in Poland after the Outbreak of the Russian-Ukrainian War 2022.

BACKGROUND: The conflict of the Russian-Ukrainian War that began on 24 February 2022 has profoundly changed Europe. The primary objective of this study was to assess the prevalence of anxiety, stress, depression, and insomnia among a group of surveyed Poles in the first months after the outbreak of war in 2022. The secondary goal was to analyze potential risk factors for these mental disorders. METHODS: A cross-sectional survey-based study was conducted. An anonymous questionnaire was created using Google Forms and distributed through social media from March 2022 to June 2022. The questionnaire included the Depression, Anxiety and Stress Scale (DASS-21) and an evaluation of the Insomnia Severity Index (ISI). RESULTS: Overall, 11.26% of 311 participants had depression, 10.29% had anxiety, and 24.12% experienced stress. Further, 62.05% of them declared sleep disturbances, and about 60% of them reported experiencing fears associated with the war. The outcomes of the assessment of psychiatric symptoms (depression, anxiety, stress and sleep disturbance) were associated with following factors: self-reported health status, fear of Russian invasion of Ukraine, and fear of the war extending to Poland. When the results for psychiatric symptoms were categorized into two groups, severe and non-severe, logistic regression analysis was only feasible for the insomnia variable. For this variable, multivariate logistic regression identified key potential factors: age, stress, and fear of Russian invasion of Ukraine. CONCLUSIONS: The respondents were found to be highly concerned about the war. In total, almost half of them manifested symptoms of anxiety, depression, and/or stress. Slightly less than two-thirds had sleep disorders. This study confirms that in a crisis situation, mental health screening is necessary.

Lessons from 9/11 for Supporting Veterans Exposed to Military Environmental Hazards: Veterans' Issues in Focus.

Exposure to environmental hazards exacerbates the risks inherent in military service, but many veterans do not experience the health consequences until many years later. The 2022 Sergeant First Class Heath Robinson Honoring Our Promise to Address Comprehensive Toxics (PACT) Act tasked the U.S. Department of Veterans Affairs with streamlining benefits and health care eligibility for certain veterans who have been exposed to military hazards. However, questions and concerns remain about the equitability, scientific robustness, and timeliness of the associated decisionmaking processes. There are opportunities to use structures from existing programs-specifically, the World Trade Center Health Program-as a template to improve engagement with veterans and their families, caregivers, providers, and advocates to ensure that their experiences and needs are heard, understood, and an integral part of the PACT Act's implementation.

A rare case of endoscopic removal of the metal fragment from the segmental bronchus after gunshot injury to the chest in combat patient injured in the war in Ukraine.

INTRODUCTION AND IMPORTANCе: Russo-Ukrainian war is associated with severe injuries to the chest. Isolated chest injuries are associated with high mortality or advanced invalidization due to the severity of the trauma. The aim of the study was to demonstrate the experience and the challenges in diagnosis and management of the combat patient with gunshot injury to the lungs with subsequent migration of the shrapnel projectile to the segmental bronchus and its bronchoscopic removal by using forceps. CASE PRESENTATION: A male patient 44 years of age was injured at an artillery strike in East Ukraine. The patient was evacuated to the Forward Surgical Team (Role 1) facility within one hour after the injury. The bronchoscopy was performed and to our surprise, the metal fragment in the lumen of the right segmental S2 bronchi was visualized at bronchoscopy, indicating its migration from the first place. The decision was made to attempt to remove the metal fragment endoscopically. At bronchoscopy, the metal fragment was caught by the endoscopic forceps and therefore removed endoscopically. The time of endoscopic removal of the metal fragment was 8 min. CLINICAL DISCUSSION: Removal of a foreign body (metal fragment) of gunshot origin from the lumen of a segmental bronchus by using bronchoscopy with endoscopic forceps is a rare phenomenon. CONCLUSIONS: The use of minimally invasive technologies in the treatment of gunshot blind penetrating wounds of the chest contributes to the reduction of operative trauma and shortens the time of operative treatment.