Comparing post-deployment mental health services utilization in soldiers deployed to Balkan, Iraq and Afghanistan

OBJECTIVE

Insight on how different missions have impacted rates of mental health service (MHS) utilization is unexplored. We compared postdeployment MHS utilization in a national cohort of first-time deployed to missions in Balkan, Iraq, and Afghanistan respectively.

METHODS

A prospective national cohort study of 13 246 first-time deployed in the period 1996 through 2012 to missions in Balkan area, Iraq, or Afghanistan respectively. Soldiers 'MHS utilization was also compared with a 5:1 sex-, age-, and calendar year-matched never-deployed background population. Postdeployment utilization of MHS was retrieved from national coverage registers. Using Cox survival analyses, participants were followed and compared with regard to receiving three different types of psychiatric services: (i) admission to psychiatric hospital, (ii) psychiatric outpatient contact, and (iii) prescriptions of psychotropics.

RESULTS

Utilizing of psychiatric outpatient services and psychotropics was significantly higher in first-time deployed to Iraq and Afghanistan compared with deployed to Balkan. However, the rate of postdeployment admission to psychiatric hospital did not differ between missions. Postdeployment rates of psychiatric admission and psychiatric outpatient treatment were significantly higher in Afghanistan-deployed personnel compared with the background population.

CONCLUSIONS

Utilization of MHS differed significantly between mission areas and was highest after the latest mission to Afghanistan.

Trauma treatment in a role 1 medical facility in Afghanistan

BACKGROUND

Most of the emergency care delivered in Afghanistan is currently provided by the military sector and non-governmental organisations. Main Operating Base (MOB) Price in Helmand Province has a small medical centre and due to its location provides critical care to civilians and military casualties and this article describes the patterns in trauma patient care at the MOB Price medical centre regarding the types of patients and injuries.

MATERIALS AND METHODS

The study population consists of 64 consecutive critically injured patients treated in MOB Price during a 4-month period from September to December 2010. The outcomes were battle-related injuries, treatment received before arriving to MOB Price, types of injury and treatment.

RESULTS

There were 35 civilians (12 children and 23 adults), 28 Afghan National Security Forces and one International Security Assistance Force soldier; they were divided into three groups (civilian adults, civilian children and military). 22% of the patients suffered fragmentation injuries and civilians were more likely to incur fragment injury than military personnel (OR (95% CI) 7.04 (1.4 to 34.8)). Regarding intubation, there was a trend towards more civilians needing it than military personnel and significantly more children than adults underwent intubation (OR (95% Cl) 51 (5.2 to 498.5)). Gunshot wounds (GSW) occurred in 30% of the patients. Civilians patients had a lower OR for GSWs than military patients (OR (95% CI) 0.35 (0.1 to 1.1)). Other trends in injury types and treatment were apparent but did not reach significance due to the small number of patients.

CONCLUSIONS

Both civilians and military personnel benefitted from the in-theatre Role 1 medical facility treatment. The most frequent injuries were fragmentation damage and GSW.

Protection of dehydrated chicken meat by natural antioxidants as evaluated by electron spin resonance spectrometry

Dehydrated chicken meat (a(w) = 0.20-0.35) made from mechanically deboned chicken necks can be protected against oxidative deterioration during storage by rosemary extract (at a sensory acceptable level of 1000 ppm, incorporated prior to drying). The efficiency of the rosemary extract was similar to that obtained by synthetic antioxidants in a reference product (70 ppm butylated hydroxyanisole and 70 ppm octyl gallate). Tea extract and coffee extract were less efficient than rosemary and synthetic antioxidants. Among the natural antioxidants tested, grape skin extract provided the least protection against oxidative changes in dehydrated chicken meat. Radicals in the product, quantified by direct measurement by electron spin resonance (ESR) spectrometry, developed similarly to headspace ethane, pentane, and hexanal, and to oxygen depletion both in unprotected and protected products. The ESR signal intensity and headspace hexanal both correlated with the sensory descriptor "rancidity" as evaluated by a trained sensory panel. Hexanal, as a secondary lipid oxidation product, showed an exponential dependence on the level of radicals in the product in agreement with a chain reaction mechanism for autoxidation, and direct ESR measurement may be used in quality control of dehydrated food products.

Synthetic zeolites as amendments for sewage sludge-based compost

The effects of incorporating a synthetic zeolite (Zeolite P) in a range of concentrations (0.1-1.0 w:w) into an experimental horticultural compost, derived from sewage sludge, have been investigated. The impact of zeolite treatment on time-related changes of the labile zinc, copper, iron and manganese pools within the compost was compared to lime incorporation (5% w:w) and to a proprietary unamended peat-based compost. Addition of 0.5% and 1.0% zeolite significantly reduced labile zinc over a 90 day period. The highest zeolite treatment was more effective than liming; 0.5% zeolite was as effective as lime. Plant growth trials measuring transfer of metals to ryegrass (Lolium perenne L. cv Elka) in successive harvests demonstrated that both 1.0% zeolite and 5% lime treatment caused significant reduction in total metal transfer from soil-plant over a 116 day growth period. It is concluded that the use of synthetic zeolite as an amendment for compost of this type significantly reduces potential for soil metal mobility and soil-plant transfer.

[Prevalence of Chlamydia trachomatis among conscripts. A comparative study of urine samples and urethral swabs]

The purpose of the investigation was 1) to determine the prevalence of C. trachomatis among young men and women enrolled in military service, 2) to compare enzyme-immunoassay (EIA) of a urethral swab with a sample of first voided morning urine, 3) to determine frequency of earlier venereal diseases (VD) and actual symptoms of urethritis and cervicitis. EIA positive specimens were confirmed by immunofluorescent microscopy. The investigation comprised 831 men and 80 women (17-26 years). The prevalence was 5.7% (95% confidence limits 4.2-7.4%) and 15% (8-25%) for men and women, respectively (p < 0.005, chi 2). The agreement between the results of the urethral swab and the urine sample was low. Sensitivity and positive predictive value for urethral swab was better than for urine. The handling of urine specimens was more laborious and confirmation more difficult. The percentage of actual symptoms among Chlamydia positive men was 6. The frequency of earlier VD was 7.5% and 10% among men and women, respectively. Treatment with tetracycline was effective, which makes control of eradication unnecessary. We conclude that genital chlamydial infection among young asymptomatic people is common and screening would be desirable. We still recommend urethral swabbing as the routine method until simpler and/or more reliable assays for urine specimens are developed.

[Low-energy laser therapy in medial tibial stress syndrome]

The effect of low-energy laser therapy on shin splints was examined in a randomized study with an unblinded design. Constripts from the Jutland Dragoon regiment with shin splints were given either active laser treatment (40 mW in 60 sec per cm tender tibia edge) or placebo laser. All patients were exempted from normal duty concerning activities like running and march. Forty-nine patients participated in the study, 23 in the laser group and 26 in the control group. From the start the study was designed to be double-blind, but by accident the code was broken towards the end of the study. We found no significant differences between the groups regarding pain visual analog score and readiness to return to active duty after 14 days.

Postanaesthetic arousal time in elderly patients. A double-blind study of glycopyrrolate and atropine

Postanaesthetic arousal time was studied in elderly patients given either glycopyrrolate 0.01 mg kg-1 or atropine 0.02 mg kg-1 before antagonism of neuromuscular blockade. Forty patients (age greater than or equal to 65 yr) undergoing elective hip replacement were included in a double-blind study. Arousal was scored for 2 h after recovery using a modified scoring system. No difference in arousal time was found between the two groups.

Fosfomycin-ampicillin versus gentamicin-ampicillin in the treatment of critically ill patients with pneumonia

Thirty-two patients with severe pneumonia (22 on assisted ventilation) were entered into a prospective randomised trial, in which fosfomycin plus ampicillin (17 patients) was compared with gentamicin plus ampicillin (15 patients). Treatment was either 4 g fosfomycin or 80 mg gentamicin every 8 h and 1 g ampicillin every 6 h. Complete or partial clinical success was attained in 94% (16/17) in the fosfomycin group and in 80% (12/15) in the gentamicin group. Bacteriological success was 87.5% with fosfomycin-ampicillin and 90% with gentamicin-ampicillin. An intermediary sensitive Klebsiella pneumoniae strain developed complete resistance in the fosfomycin group, and an in vitro sensitive Pseudomonas aeruginosa strain was resistant in vivo in the gentamicin group. Two of three patients in the fosfomycin group receiving the infusion through a peripheral vein developed thrombophlebitis. No other side-effects were observed. We conclude that fosfomycin is at least as effective as gentamicin. Since fosfomycin is widely atoxic and may be given in large doses, irrespective of kidney function, it is considered to have advantages over gentamicin in the combined therapy of pneumonia.