Dental cost of deploying a National Guard unit to Bosnia

OBJECTIVES: To examine the dental readiness of a National Guard (NG) unit mobilizing to Bosnia, to estimate the civilian comparable cost for the necessary treatment to make the unit deployable, and to examine the effect on the active component (AC) dental readiness. MATERIALS AND METHODS: This study was a retrospective cohort analysis of dental fitness classifications (DFCs) and treatment provided for the 48th IN BDE (Mech) upon mobilization for a 6-month deployment to Bosnia. The NG unit mobilized through Fort Stewart, Georgia, from December 2000 through February 2001 en route to a 6-month deployment starting in February 2001. All soldiers received dental examinations and were classified in one of four DFCs. DFC 1 implies that the soldier has no dental treatment needs; DFC 2 indicates that the soldier needs dental treatment, but the condition is not expected to cause an emergency in the next 12 months; DFC 3 indicates that significant oral conditions present are expected to cause an emergency in the next 12 months; DFC 4 indicates that the soldier is in need of a dental examination. Dental treatment was provided for all DFC 3 soldiers. A database was created of DFCs of deploying soldiers upon arrival at the mobilization site and dental procedures performed. RESULTS: This retrospective review identified 1,378 soldiers who processed through the dental station at the mobilization site. Soldiers DFCs were as follows: DFC 1, 7.8%; DFC 2, 50.1%; DFC 3, 35.8%; DFC 4, 6.2%. Direct costs to the Fort Stewart Dental Activity were $95,602. The services provided to treat the DFC 3 patients are valued at $441,471. CONCLUSIONS: The dental readiness of this NG unit was greatly inferior to that of the AC, and there is a significant cost in personnel, dollars, and AC readiness to provide the needed dental treatment before mobilization.     

Q fever outbreak during the Czech Army deployment in Bosnia

An epidemic of Q fever was identified among soldiers from the Czech Republic serving in the U.N. Stabilization Force in Bosnia and Herzogovina in 1997. There were 26 serologically confirmed infections, or 4.6% of those exposed. There were 14 cases of febrile illness and 12 subclinical infections. Prodromal symptoms of malaise, headache, backache, and fatigue were followed by fever > or = 39 degrees C with an intermittent course. Physical findings were unremarkable except in five cases with radiographically confirmed pneumonia. Cases were treated with doxycycline, trimethoprim-sulfamethoxazole, or ceftriaxone and supportive care. Q fever occurred at four U.N. Stabilization Force bases with the highest incidence at Dolna Ljubija (attack rate 9.4% vs. 2.3% at other locations (risk ratio = 4.0; 95% confidence interval [CI] = 2.7-5.9; p < 0.05). A sheep farm with active lambing was located 100 m from the base. Helicopter operations at a nearby landing zone may have generated infectious environmental aerosols and may have been a cause of the Q fever outbreak.     

Traumatic experiences and psychological reactions among women in Bosnia during the war

Internally displaced women (N = 77) in Bosnia were interviewed before and after participating in group psychotherapy during the war in 1994 and 1995 to gain background information and assess stress exposure and stress reactions. Nearly all the women had experienced loss of family members, many acts of violence and mental health impairment. The participants had high scores on a symptom scale, in terms of intrusive, avoidance and arousal symptoms and somewhat lower on depression/powerlessness items. After participating in short-term group therapy they reported significant reduction in symptoms. The women who had experienced most traumatic events and had most symptoms, reported greatest reduction in symptomatology. Some of the implications of the findings are discussed and it is concluded that group therapy may be helpful in war conditions, even though traditional preconditions for psychotherapy are not present.     

Traumatic experiences and psychological reactions among women in Bosnia during the war

Internally displaced women (N = 77) in Bosnia were interviewed before and after participating in group psychotherapy during the war in 1994 and 1995 to gain background information and assess stress exposure and stress reactions. Nearly all the women had experienced loss of family members, many acts of violence and mental health impairment. The participants had high scores on a symptom scale, in terms of intrusive, avoidance and arousal symptoms and somewhat lower on depression/powerlessness items. After participating in short‐term group therapy they reported significant reduction in symptoms. The women who had experienced most traumatic events and had most symptoms, reported greatest reduction in symptomatology. Some of the implications of the findings are discussed and it is concluded that group therapy may be helpful in war conditions, even though traditional preconditions for psychotherapy are not present.     

Hospitalization of British troops during Operation Joint Endeavor (Bosnia).

Of 414 recorded hospitalizations among British troops during Operation Joint Endeavor (Bosnia) in 1996, 2% were attributable to battle injuries, 46% to routine injuries, and 52% to disease; most injuries were to the lower limbs, and most diseases were of the skin and musculoskeletal system. The median length of inpatient stay was 4 days for injury (range, 1-146 days) and 3 days for disease (range, 1-60 days). Correcting for uncaptured data, the number of hospitalizations attributable to both injury and disease was significantly lower than the number predicted from the NATO planning figures (p < 0.0001). The NATO planning estimates for expected hospitalizations need to be revised. The electronic recording at source of all patient information should be introduced during military deployments to optimize data capture, facilitate the audit of clinical activity, and inform future medical planning. All hospitalizations occurring during military missions should be recorded, and surgical interventions during deployments should be coded at source. Ineffective paper-based morbidity surveillance procedures such as Jefferson 97 (or J97) must be discontinued and replaced by an electronic, fully integrated, NATO-wide clinical information system. This clinical information system should encompass primary care, secondary care, medical training, and medical supply. It should be built on a Microsoft Office platform and should be capable of interfacing electronically with existing civilian databases. Important clinical outcomes should be structured hierarchically within the data set. The database should be configured so that it can be accessed locally by clinicians and remotely by epidemiologists and planners.     

Croatian Medical Corps in Bosnia and Herzegovina during the 1992-1995 war

OBJECTIVE: The purpose of this study was to review the establishment and operation of the Croatian Medical Corps in Bosnia and Herzegovina in the 1992-1995 war. METHODS: We analyzed pertinent documents available to one of the authors (B.I.) who served on the Headquarter of the Corps, the study of the 17 published articles describing medical activities in various parts of Bosnia and Herzegovina during the war, as well as other relevant medical-military literature. RESULTS: The Corps functioned effectively and, in fact, served as a new health care system for the Croats in Bosnia and Herzegovina. It was initiated, planned, and operated voluntarily by members of the medical community, established before the defense forces, and later incorporated within them, but retaining its autonomy. CONCLUSIONS: The development of the Corps represents a unique phenomenon in the history of military medicine.     

Biogenic amine/metabolite response during in-flight emergencies

Urine excretion of epinephrine (E), norepinephrine (NE), dopamine (DA), serotonin (5HT) and the metabolites vanillylmandelic acid (VMA), 4-hydroxy-3 methoxyphenylglycol (MHPG), homovanillic acid (HVA), 3, 4-dihydroxyphenylacetic acid (DOPAC), and 5-hydroxyindoleacetic acid (5-HIAA) was determined for students (n = 19) and instructors (n = 21) involved in flying training in-flight emergencies. Timed urine samples were analyzed using high-performance liquid chromatography with electrochemical detection. Basal excretion rates were determined at a later date. Four indices showed significant alteration during the emergencies. Epinephrine and the sum of epinephrine plus norepinephrine increased, the ratio dopamine/norepinephrine decreased and the ratio norepinephrine/serotonin increased. Instructors and students differed only in that VMA and the sum VMA plus MHPG were higher in students. Among the emergencies monitored, smoke and fumes in the cockpit and mechanical problems caused the greatest stress responses.     

Pediatric emergencies: thoracic emergencies

Emergencies always require rapid diagnosis and an urgent or semi-urgent medical, interventional, or surgical action. In most cases radiology plays an essential role in making an accurate diagnosis. Reviewing the causes of acute respiratory pathology in the different pediatric age groups, we thought it would be interesting to divide the pathologies into two main parts: one part concerning pathologies involving the air flow and the other part concerning pathology affecting the pulmonary parenchyma. We acknowledge, however, that both conditions can occur concomitantly. The esophagus is another anatomic structure in the thorax that can be responsible for acute pathology in children. Acute pathology predominantly involving the air flow can be intrinsic and/or extrinsic, affecting the upper airways, trachea, main and segmental bronchi, and the small airways. Acute lung pathology can be congenital, infectious, or less frequently, tumoral or traumatic in children. Pleural pathology and cardiogenic emergencies are discussed also. Acute esophageal pathology is discussed briefly. Electronic Publication     

Response capability during civil air carrier inflight medical emergencies

Expanded civil aircraft medical emergency kits have been mandated on U.S. carriers since August 1986. Airlines provided the Federal Aviation Agency reports on medical kit usage and outcomes of the associated medical emergencies; 1,016 inflight medical events during the period August 1, 1986, through July 31, 1987, were available for review. Physicians responded to the emergencies in over 63% of the occurrences; the two most prevalent presenting situations were chest pain and syncopal episodes. Nine passengers died on board aircraft, and at least three deaths occurred postlanding. A minimum of 89 of the total cases resulted in flight diversions. The sphygmomanometer (739 cases) and stethoscope (734 cases) were the most frequently used kit items; oropharyngeal airways were utilized in 14 cases. Since standardized reporting formats are not required, evaluation of response capability remains incomplete.     

The lessons learned from the canadian forces physiotherapy experience during the peacekeeping operations in Bosnia

The musculoskeletal injuries and soldiers' demographic profiles observed by physiotherapy (PT) officers during the Canadian Forces peacekeeping mission Op-Palladium in Bosnia between 2000 and 2004 were characterized. The number of PT visits (N = 4,167; range, 310-974) and gender distribution (N = 2,558 cases; male, 80.8%-91%; female, 9.0%-16.4%) varied between tours. On average, >30% of the entire Canadian Forces contingent required PT services. Lower limb injuries were the single leading reason for PT treatment (41.8%) followed by the spine (28.5%) and the upper limb (21.5%). The most commonly affected joints were the knee (17.2%) and ankle (16.1%), the shoulder (14.4%), and the lumbar spine (14.4%). The 26 to 35 age group and combat arms showed the highest incidence of musculoskeletal injuries (p < 0.001). The majority of cases seen were subacute and chronic (68%). Primary prevention activities and the capacity to provide the full scope of PT services were identified as two key factors contributing to the maintenance of operational readiness of the troops.     

Paediatric emergencies: non-traumatic abdominal emergencies

Presentation with acute abdominal pain or abdominal symptopathology is a very common cause of presentation of children to hospital. The causes are dependent in part on the age of the child, in part on the presence of previous surgery, and can be divided into those that relate to congenital abnormalities at whatever age they present, acquired disease and infection. Children, particularly young children are often poor historians, and therefore the clinical examination and the laboratory investigations are important in helping to come to a diagnosis. Primary imaging of abdominal emergencies in childhood is a radiograph of the abdomen, followed by ultrasound. Further imaging depends on the results of these studies. An ordered review of the abdomen radiograph is important if the salient features on X-ray are not to be missed. Practitioners should be competent with abdominal ultrasound in children and know where to seek the causes of disease, as these are different from those that are obtained in many instances in adults. Familiarity with the likely causes is important. The three commonest causes of acute abdominal pain in childhood are, in young infants, intussusception, appendicitis and mesenteric adenitis. In older children, inflammatory bowel disease and ovarian pathology are also included. This article details the approach to imaging and the salient features of some of the conditions. Electronic Publication     

Dental malpractice cases in Turkey during 1991-2000

OBJECTIVES: Doctors can face punitive and legal consequences if patients are not satisfied with the medical treatment. The purpose of this study is to provide a database for dental malpractice cases in Turkey. METHODS: This study is based on the decisions of High Health Council (HHC) in medical malpractice cases. Between 1991 and 2000, 1548 decisions were made by the HHC. 14 (0.9%) of these decisions were related to dentistry. This study examines the 8 decisions under which the dentists are found to be at fault. RESULTS: As three of these cases are based on the same facts they are examined together. Of the dentists consulted on 11 decisions, nine were male and two were female. In four cases the HHC gave its expert opinion before the trial, in five cases during criminal trial and in two cases during compensation trial. In five cases patients received surgical treatment, in four cases prosthetic treatment and in two cases endodontic treatment. Nine of these treatments were carried out at private dental practice. In eight reported decisions negligence and inadequate treatment were identified. Most of negligence was caused during surgical intervention. In two cases, treatments resulted in death. CONCLUSIONS: Like all other medical staff dentists are under the obligation to comply with the legal rules in the country they practice. They also have to consider ethical principles as well as the acceptable standards and protocols of diagnosis and treatment.     

Ultrasonography in abdominal emergencies

From February 1986 to March 1988 113 abdominal US exams were performed in emergency situation to evaluate the accuracy of this methodology: 13 were blunt traumas, 18 postoperative complications. A real-time scanner with a linear probe of 5 MHz was employed. The results were confirmed by surgical and/or clinical and instrumental evaluation. In 81% of the examinations, ultrasonography allowed a diagnosis to be made. Gallbladder and biliary pathologies were the most common findings. The results (sensibility 96%, specificity 88%, accuracy 95%) confirm the reliability of ultrasonography in abdominal emergencies, as shown in literature.     

Intestinal emergencies in newborns

Summary Imaging plays a major role in most neonatal gastrointestinal emergencies. The role may vary from helping to establish a diagnosis, to the evaluation of associated abnormalities, to surgical planning, or to therapy for some conditions like meconium ileus or meconium plug syndrome. Plain radiographs and ultrasound serve a primary imaging modalities with bowel contrast examinations, CT scan, and MR imaging playing roles in more complex cases. Eingegangen am 30. Dezember 1996 Angenommen am 15. M?rz 1997