Greetings from the National Library of Medicine and MedlinePlus.gov

I’m Rob Logan, PhD. Senior Staff, US. National Library of Medicine substituting this week for Donald Lindberg, M.D, the Director of the U.S. National Library of Medicine.

Here is what’s new in MedlinePlus this week.

The recent shootings at Virginia Polytechnic Institute and State University, or Virginia Tech, are a reminder (among other things) of life’s fragility, how to respond when someone is brandishing a weapon on campus and how to cope with stress after an unexpected, emotional, mass tragedy.

The injuries and deaths at Virginia Tech hit home; many employees at the National Library of Medicine live in the same communities surrounding Washington D.C. as some of the victims.

We offer our heartfelt condolences to Virginia Tech students, faculty, staff, alumni and friends. The tragedy in Blacksburg additionally reminds us of the necessity for all of us to have information to be prepared for – and cope with -- an unexpected tragedy.

We divert a little this week from our focus on medical research or developments to acquaint you with some of the information on MedlinePlus that helps you prepare and cope with the type of calamity that occurred at Virginia Tech and similar incidents at other U.S. schools and college campuses in recent years.

Two websites from the Nemours Foundation are especially pertinent to recent events at Virginia Tech. One site, which is titled, ‘Should you worry about school violence’ helps all of us put the risk of school shootings in perspective. This website underscores that it still much safer to be in school than in a car. Twice as many 15-19 year olds die in motor accidents than in all shootings (and less than one percent of all shootings occur on school grounds or when someone is on the way to or from school). So, the probability of shootings on campus remains very low -- and perhaps this explains our collective shock and disbelief when it occurs.

Another website from the Nemours Foundation, available in MedlinePlus, provides clear advice about what to do if someone at school has a weapon. These tips include:

• Contact a trusted faculty member, counselor, coach or similar authority immediately
• If you do not trust a person to maintain your anonymity, call the school’s administrative office (such as the dean’s or principal’s office) and report the incident. Another option is to call 911 and ask them to keep your identify confidential
• Try to note if the weapon is a knife, hand gun, rifle or something else
• Explain whether the weapon was being shown off or used to threaten other students, or anyone else
• Keep a written record of what you saw, including the time and date. To borrow a journalistic axiom, try to remember and write down: who (was involved), what happened, where an incident occurred, and when it happened.  

The Nemours Foundation website also lists some of the warning signs that may tip off when a young person, who seems upset, may turn violent. These behavioral signs include: 

• cruelty to pets and other animals
• talking about weapons and violence
• a fascination with violent video games, television and movies
• threatening or bullying others
• isolation from family or friends.

You can access both the aforementioned websites by typing in ‘Teen violence’ in the search box on MedlinePlus’ home page. Then, click on ‘Teen violence (National Library of Medicine).’ You will find the links to “Should you worry about school violence’ and ‘Someone at school has a weapon’ under the ‘Teenagers‘ section on this page.

The American Psychological Association (APA) also has a page on MedlinePlus that provides tips for college and university students to manage their distress in the aftermath of the events at Virginia Tech -- but the APA’s counsel seems relevant to many tragic events where there are sudden, unexpected deaths and injuries.

The APA immediately reminds us that it is normal to experience shock, sorrow, numbness, fear, anger, disillusionment, grief and related emotions following a traumatic event. The APA site adds it is common to have problems sleeping, eating, concentrating and  remembering to do simple tasks. They add that is normal to experience intense stress, similar to the effects of a physical injury, after a traumatic event.

To strengthen your resilience after a traumatic event, the APA suggests you should:

• Talk about it: ask for support from people who care about you or those who will listen to your concerns
• Strive for balance: to compensate for a normal negative or pessimistic reaction, the APA suggests you should remind yourself of people and events which are meaningful, comforting and even encouraging
• Turn off the news coverage for a while and take a break. The APA warns everyone not to overdo news coverage, or overexposure to email and internet blogs. Instead, try to do something else that lifts your spirits
• Honor your feelings: on Virginia Tech’s drill field, or the campus’ common ground, students were encouraged to express their feelings by writing notes, placing flowers, signing condolence cards and letters or similar activities
• Help others, or do something productive, such as volunteering to help neighbors
• Give grief some time to work its way through
• If you survive a traumatic event without injury, or are in the vicinity of a tragic event without going through it personally, remember that ‘survivor guilt’ is a normal type of grief.

To find the APA’s helpful website, type ‘Coping with disaster’ on MedlinePlus’ front page. Then, click on ‘Coping with disasters (National Library of Medicine)’ The link to the American Psychological Association’s website is in the ‘Related issues’ section. Another option is to type, ‘APA college distress’ in Google’s search box. The site is the first one listed.

The APA information is a good introduction to coping with stress. A helpful website from the U.S. Department of Veterans Affairs further differentiates between common reactions and more problematic responses in coping with stress.   

The Veterans Affairs website divides post-trauma stress into four categories: emotional, cognitive, physical, and interpersonal effects.

Besides shock, anger, guilt, grief and numbing noted above, the Veterans Affairs site explains other common emotional responses include: terror, irritability, and helplessness.

In addition to impaired concentration noted above, the Veterans Affairs site explains other normal cognitive effects include: confusion, nightmares, intrusive thoughts, and memories.

Besides fatigue and insomnia noted above, the Veterans Affairs site explains other common physical effects include: headaches, and increased physical pain.

In addition to disillusionment noted above, the Veterans Affairs site explains other normal interpersonal effects include: distrust, externalization of blame, feeling others are suddenly more vulnerable to violence or tragedy, and decreased satisfaction.

To repeat, all these types of reactions are normal and are to be expected at times -- and differ from person to person -- following a traumatic event.

However, the Veterans Affairs website adds the following responses are among those that are less common. These types of responses suggest a person needs help from a medical or mental-health professional. They include:

• Substance use (such as abuse or dependency on prescription medications, illegal drugs or alcoholic beverages)
• Debilitating anxiety (severe phobias, unshakable obsessions, paralyzing nervousness, fear of losing control or going crazy and ruminative worry)
• Severe intrusive re-experiencing (flashbacks, terrifying screen memories, repetitive reenactment).

The Veterans Affairs site also provides an introduction to post-traumatic stress disorder, which is usually more associated with military combat veterans than students or other civilians. But the Veterans Affairs site notes there are similarities in emotional reactions to severely traumatic events regardless of location.

To find the Veterans Affairs website, type “post-traumatic stress’ or ‘PTSD’ on MedlinePlus’ home page. Then, click on ‘Post-traumatic stress disorder (National Library of Medicine). The Veterans Affairs link is within the ‘Related issues’ section.

To mention two other helpful resources, the U.S. Centers for Disease Control and a number of other federal agencies, including the National Library of Medicine, sponsor a clearinghouse of information on prevention of youth violence. The url is: safeyouth.org

The National Center for School Crisis and Bereavement provides a clearinghouse for information and research about violence in schools, sponsored by the Cincinnati Children's Hospital Medical Center.  The site is best accessed by typing “School crisis and bereavement’ in Google’s search box.

Before I go, this reminder……. MedlinePlus.gov is authoritative,….. free…. does not accept advertising …and is written to help you.    

To find MedlinePlus.gov, just type in “MedlinePlus.gov’ in any web browser, such as Firefox, Safari, Netscape, or Explorer.

We encourage you to use MedlinePlus and please recommend it to your friends. MedlinePlus is available in English and Spanish.

Your comments about this or any of our podcasts are always welcome. Please email Dr. Lindberg anytime at: NLMDirector@nlm.nih.gov     That’s NLMDirector (one word) @nlm.nih.gov

A written transcript of recent podcasts is available. Just click on the ‘Director’s comments’ link on MedlinePlus’ home page.

The National Library of Medicine is one of 27 institutes and centers within the National Institutes of Health. The National Institutes of Health is part of the U.S. Department of Health and Human Services.

It was nice to be with you….

Dr. Lindberg returns in the near future