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Background: Immigrants who have sustained war-related injuries face unique challenges within the healthcare systems of their new countries. This study aimed to explore the health service experiences of war-injured immigrant populations in Richmond Hill, Ontario, with a focus on identifying the barriers they encounter and the aspects of healthcare that effectively meet their needs. Methods: This qualitative study utilized semi-structured interviews to collect data from 26 war-injured immigrants with severe physical injury residing in Richmond Hill, Ontario from June to October 2023. Participants were selected to represent a diverse range of ages, genders, and countries of origin. Data were analyzed using thematic analysis to extract patterns and insights related to the healthcare experiences of the participants. The qualitative software NVivo, version 15, was utilized to assist in the organization and analysis of the data. Results: Four main themes emerged from the data: Access to health services, quality of care, patient-provider relationship, and health outcomes and satisfaction. Subthemes identified included initial contact, navigation challenges, financial barriers, waiting times, professional competence, patient-centered care, communication, trust building, cultural competence, communication quality, continuity of care, patient advocacy, recovery experience, satisfaction with care, and improvement in health status. Participants expressed significant challenges related to navigating the healthcare system, language barriers, financial constraints, and long waiting times. Positive experiences were often linked to high-quality communication, cultural competence of providers, and continuous care. Conclusion: This study underscores the need for targeted interventions to improve access and quality of care for this vulnerable population, including enhancing cultural competence and communication strategies among healthcare providers.

Background: Plastic Surgery originated in war and still has an important role in the management of war wounds and their sequelae. Since June 2022 the Plastic Surgery department of Zaragoza's Miguel Servet University Hospital has been involved in the management of patients with injuries secondary to the Russo-Ukrainian War. In this paper we describe the activity of the plastic surgeons involved and the types of injuries and procedures performed. Methods: We included patients injured in the Russo-Ukrainian conflict transferred for multidisciplinary care to the General Defence Hospital in Zaragoza from June 2022 until December 2023. We gathered epidemiological data, mechanism of injury, anatomical location, types of plastic surgery performed, number of interventions and complications. Results: In the period from June 2022 to December 2023 the multidisciplinary team provided care for a total of 59 patients. Plastic surgeons were involved in the care of 16 patients with a total of 34 plastic surgery procedures: 7 microsurgical free flaps, 6 regional flaps, 4 grafts, 8 debridements, 3 flap remodelings, 4 Targeted Muscle Reinervations, 1 amputation and 1 hand surgery. Three patients suffered from major complications in the form of infections of the surgical wound. Conclusions: Our study showed the crucial role of Plastic Surgery in the management of war injuries and the high proportion of high-complexity microsurgical procedures needed to take care of this type of injury. Level of evidence: Level IV, Therapeutic. [ABSTRACT FROM AUTHOR]

Introduction. Colombia is a country that has had armed conflict as part of its history. For more than 50 years, different types of weapons have been used in internal warfare. From 1999 to 2010, more than 15,000 people injured in combat were treated at the Central Military Hospital, Bogotá, D.C., Colombia. The objective of this study was to describe the surgical approaches carried out for the treatment of injuries generated in military combat, by the General Surgery service at the Central Military Hospital, between 2016 and 2021. Methods. A cross-sectional descriptive observational study was conducted, where information was collected from the database of the Trauma group of the Central Military Hospital on patients with injuries during combat treated by the General Surgery service. Results. A total of 203 patients were admitted, 99% were male, 87% belonged to the Army. The department from which the most wounded were received was Arauca (20.7%). High-velocity firearms were the injury-related weapons in more than half of the cases. The most common surgical interventions performed were foreign body extraction (28%), vascular exploration (25.5%), and thoracostomy or thoracoscopy (20.6%). Conclusion. Surgical procedures for the management of military trauma continue to be varied with respect to location and approach, which is why the general surgeon's knowledge must be extensive to be qualified for its management. [ABSTRACT FROM AUTHOR]

BackgroundNoncompressible torso hemorrhage is a leading cause of preventable death on the battlefield. Intra-aortic balloon occlusion was first used in combat in the 1950s, but military use was rare before Operation Iraqi Freedom and Operation Enduring Freedom. During these wars, the combination of an increasing number of deployed vascular surgeons and a significant rise in deaths from hemorrhage resulted in novel adaptations of resuscitative endovascular balloon occlusion of the aorta (REBOA) technology, increasing its potential application in combat. We describe the background of REBOA development in response to a need for minimally invasive intervention for hemorrhage control and provide a detailed review of all published cases (n = 47) of REBOA use for combat casualties. The current limitations of REBOA are described, including distal ischemia and reperfusion injury, as well as ongoing research efforts to adapt REBOA for prolonged use in the austere setting.Level of evidenceLevel V.

The Walker Dip refers to the cycle of the improvement of care for the battle injured soldier over the course of a conflict, followed by the decline in the skills needed to provide this care during peacetime, and the requisite need to relearn those skills during the next conflict. As the operational tempo of the conflicts in Afghanistan and Iraq has declined, concerns have arisen regarding whether US military surgeons are prepared to meet the demands of future conflicts. This problem is not unique to the US military, and allied nations have taken creative steps to address the Walker Dip in their own surgical communities. A panel entitled "Military and Civilian Trauma System Integration: Where Have We Come; Where Are We Going and What Can We Learn from Our International Partners" at the 2018 American Association for the Surgery of Trauma meeting brought together a cadre of civilian and military surgeons with experience in this area. The efforts described involved the creation of a new trauma training program in Doha, Qatar, the military civilian partnership in the Netherlands, and the steps taken to address the deficit of penetrating trauma in Sweden. This article focuses on the lessons that can be learned from our allied partners to assure readiness for deployment among military surgeons. LEVEL OF EVIDENCE: Economic and Value Based Evaluations, level V.

Copyright of Rocznik Bezpieczeństwa Międzynarodowego is the property of University of Lower Silesia / Dolnoslaska Szkola Wyzsza and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of HNO is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: The ongoing war in Ukraine leads to the destruction of critical infrastructure and the displacement of millions of civilians while the necessity for neurosurgical care has increased tremendously. The consequences of this armed conflict on the practice of neurosurgery are uncertain to date. Methods: A cloud-based questionnaire including 10 single- and multiple-choice questions was sent through the email distribution list of the Ukrainian Neurosurgical Society and the Association of Neurosurgeons of Ukraine. Results: Between June 2022 and July 2022, a link to the online survey was distributed to a total of 134 (100%) departments of neurosurgery across Ukraine. After 21 days of being available, a total of 96 questionnaires (72%) returned. Conclusions: The survey highlights the field of activity as well as the severe impact on professional and personal life of Ukrainian neurosurgeons during the ongoing war. [ABSTRACT FROM AUTHOR]

Family medicine is well-established in Israel and serves as the foundation of the Israeli health care system. On October 7, 2023, Israel experienced a profound shock and trauma when over 1,200 Israelis, including Jews, Christians, and Muslims of all ages, were brutally murdered, tortured, raped, burned alive, or taken hostage by Hamas terrorists from Gaza. This essay provides a contextual view from the vantage point of an Israeli family physician. It touches on the horror of the conflict while proposing that family physicians can stand as beacons of hope, offering healing and solace to all in need. Annals Early Access article., (© 2024 Annals of Family Medicine, Inc.)

Introduction: The management of infections in war wounds is a problem aggravated by the presence of multiresistant bacteria and requires a combined approach with surgery. Literature has identified the risks and patterns of antibiotic resistance in previous armed conflicts, but the Russian-Ukrainian conflict has required the study of specific bacterial resistance patterns., Methods: We included war-injured patients from the Russian-Ukrainian conflict transferred for treatment to the General Defense Hospital of Zaragoza from May 2022 to October 2023. Epidemiological data, factors related to the injury, presence of infection and microbiological results were collected; These data were subsequently analyzed statistically., Results: Fifty-three patients were included in the study, with a mean age of 35.6 years; 83% were injured by an explosive mechanism and all received antibiotic therapy prior to transfer. Seventeen patients had skin, soft tissue or joint infection. Correlation was demonstrated with the presence of bone lesion (p 0.03), skin coverage defect (p 0.000) and presence of foreign bodies (p 0.006). Nine patients had monomicrobial cultures, and the most frequently isolated microorganisms were Gram negative bacilli (GNB) and Staphylococcus aureus. Virtually all GNB presented some resistance mechanism., Conclusion: Our work shows the correlation of war wound infection with the presence of foreign bodies and affected tissues. Likewise, the presence of polymicrobial wounds is emphasized, with a predominance of GNB and multidrug-resistant S. aureus., (Copyright © 2024 Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. Published by Elsevier España, S.L.U. All rights reserved.)

Service members with amputations experience numerous challenges, yet few studies have examined patient-reported outcomes, including physical functional status, mental-health screening status, and quality of life (QOL) or the relationship between these outcomes. Service members with combat-related lower extremity amputations (N = 82) and participants in the Wounded Warrior Recovery Project were included. Patient-reported outcomes of physical functional status, posttraumatic stress disorder (PTSD), depression screening status, and QOL were compared, while accounting for amputation level. Linear regression assessed relationships between physical functional status and QOL, as well as mental-health screening status. Higher physical functioning scores were associated with better QOL, and lower physical functioning scores were associated with screening positive for PTSD or depression. When stratified by mental-health screening, a significant relationship was observed between mean physical functioning scores and amputation level with a negative PTSD or depression screen only. Additionally, those with bilateral amputation reported lower physical functioning. Physical functioning was associated with patient-reported outcomes, including QOL and mental-health screening. Screening positive for PTSD or depression was associated with worsened self-reported physical function and may outweigh the impact of amputation severity on physical functioning. Successful rehabilitation requires the integration of physical and mental health domains in order to achieve optimal functioning. The current study shows that physical functioning in participants with combat-related amputation is related to the amputation level, quality of life, and mental-health symptom screening. Good mental health is crucial to optimal functioning, as presence of adverse mental-health symptoms may exacerbate physical functional limitations among those with combat-related amputations. Assessing variables related to adverse mental-health symptoms and ultimate physical functioning outcomes is critical for clinicians to optimize rehabilitative strategies and outcomes. [ABSTRACT FROM AUTHOR]

Objective: The high number of limb injuries among Post-9/11 Veterans and their long-term care pose significant challenges to clinicians. Current follow-up for extremity arterial vascular injury (EVI) is based on guideline-concordant care for treatment of peripheral vascular disease (GCC-PVD), including anticoagulant/antiplatelet or statin therapy and duplex ultrasound. No best practices exist for arterial EVI. Our goal was to determine correlates of GCC-PVD and other care among Post-9/11 Veterans with combat-related arterial EVI.Materials and Methods: We identified Post-9/11 Veterans with arterial EVI who underwent initial limb salvage repair or ligation (e.g., for single-vessel injury) attempt per DoD Trauma Registry validated by chart abstraction. Veterans Health Administration (VHA) data characterized the cohort in the first five years of VHA care. Models predicted (a) GCC-PVD, (b) pain clinic use, (c) mental/behavioral health care, (d) long-term opioid use, and (e) time to complication, controlling for injury severity and type, mental health parameters, and demographics.Results: The 490-Veteran cohort with validated arterial injury was 77% White averaging 25.2 years at injury (range: 18-56). Mechanism of injury was primarily explosive (63%). Veterans had Injury Severity Scores classified as mild (60%), moderate (25%) and severe (15%). Approximately 25% received at least one component of VHA GCC-PVD including 8% arterial ultrasounds, 5% statins, and 11% anticoagulants/antiplatelets; 77% had mental/behavioral healthcare. GCC-PVD, as well as PTSD and substance use disorders, were associated with receipt of mental/behavioral health care. Complications affected 46% of the cohort and were more common among those prescribed 90+ days of opioids or receiving GCC-PVD.Conclusion: Despite injury severity (40% moderate/severe), only 25% of cohort patients received VHA GCC-PVD, and nearly half had complications from their arterial injury. Receiving GCC-PVD appeared to potentiate receiving care for mental and behavioral disorders.Impact: The treatment gap in Veterans with arterial EVI may be due to lack of appropriate guidelines, lack of vascular specialists in VHA or accessing care outside the VHA. Focused study of care options and their outcomes will help define optimal care processes for combat Veterans with arterial EVI. [ABSTRACT FROM AUTHOR]

Background: Gunshots and bomb blasts are important causes of extremity injuries in conflict zones, yet little research exists on the characteristics and outcomes of these injuries in civilian populations., Methods: We performed a prospective cohort analysis utilizing data from a randomized trial conducted at two civilian hospitals in Jordan and Iraq in 2015-2019. Adults who presented ≤72 h of sustaining an extremity injury were included. We used mechanism of injury (gunshot/bomb blast) as the exposure and wound closure by day 5 as the primary outcome measure., Results: The population predominantly comprised young men (n = 163, 94% male, and median age 29 years) injured by gunshots (61%) or bomb blasts (39%). Compared with the gunshot group, more participants in the bomb blast group had concomitant injuries (32/63 [51%] vs. 11/100 [11%], p < 0.001) and vascular injuries (9/63 [14%] vs. 4/100 [4%], p = 0.02). The wounds were larger in the bomb blast group compared with the gunshot group (median area 86 cm 2 [IQR 24-161] vs. 21 cm 2 [IQR 7-57], p < 0.001). Compared with the bomb blast group, significantly more participants in the gunshot group achieved wound closure by day 5 (74/100 [74%] vs. 16/63 [25%], p < 0.001). This difference remained after controlling for confounding factors (odds ratio 4.7, 95% confidence interval 1.6-13.7)., Conclusions: In civilians with conflict-related extremity injuries, bomb blast wounds had a lower likelihood of achieving closure within 5 days than gunshot wounds, independent of other factors, such as wound size and vascular injuries., Trial Registration: ClinicalTrials.gov, NCT02444598. Registered 14-05-2015, https://classic., Clinicaltrials: gov/ct2/show/NCT02444598., (© 2024 The Author(s). World Journal of Surgery published by John Wiley & Sons Ltd on behalf of International Society of Surgery/Société Internationale de Chirurgie (ISS/SIC).)

The treatment of war injuries represents a continuing and recurrent challenge in modern reconstructive surgery. Previously, tumor resections and sepsis-related resections were mainly responsible for lengthy bone defects in Germany. In recent years another picture has increasingly emerged, particularly caused by the medical support of Ukraine. Aspects of military surgery are also becoming more important in civil hospitals, especially in the treatment of gunshot and explosion injuries. In Germany, war injuries are currently secondarily treated, as the distribution of patients is carried out according to the cloverleaf principle, weeks or months after the occurrence of the primary injury. In addition to complex bone and soft tissue defects of the extremities following such injuries, which often affect neural and vascular structures, reconstruction is often complicated by an increasing spectrum of multidrug-resistant pathogens. The definition of microbiological terms, such as contamination, colonization, critical colonization, local and systemic infections are important in the clinical routine in order to initiate a targeted treatment, especially in treatment with antibiotics. Wound swabs for determination of the spectrum of pathogens and the optimal testing of resistance are important for selecting the appropriate antibiotic agents. The concept of antibiotic stewardship (ABS) is established in many hospitals to improve the quality of antibiotic treatment and to minimize the formation of resistance. The selection of the method of reconstruction depends on the condition of the patient, the overall clinical constellation and the function to be expected after completion of treatment. The treatment of injuries due to violence and terrorism necessitates clear concepts and an interdisciplinary approach, especially with respect to microbiological challenges and increasing resistance situations., (© 2024. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

The degree of irreversible pathophysiological changes in traumatic shock has no early clinical manifestations, since in 16.7 % of cases the anatomical assessment of the severity of the injury and the severity of the condition of the injured is determined, which is related to the peculiarity of the body compensatory capacity, timeliness and quality of quality of anti-shock measures. The aim of the work is to conduct, on the basis of clinical and statistical analysis of changes in the indicators of functional disorders of the cardiovascular system, a pathophysiological justification of the general condition of the wounded with combat trauma of the extremities at the levels of medical support. Materials and methods. An array of studies consisted of 378 wounded with combat injuries to their extremities. Pathophysiological assessment of homeostasis in the comparison groups was performed according to 14 indicators determined immediately after the admission of the wounded to the anti shock ward by the method of tetrapolar rheography. The Admission trauma scale (AdTS) was used to assess the severity of the injuries. Results. In the wounded with severe and extremely severe trauma, starting from the second level of medical support, during the sequential implementation of countermeasures during the stages of medical evacuation, there was a positive dynamics of changes in the indicators of the cardiovascular system status to a mild degree. With the reduction of stages, there was a tendency to deterioration of the general condition of the wounded and decrease of indicators by 41.8–53.6 % to irreversible values (Pα < 0.05). Dynamic changes in the severity of functional disorders of the cardiovascular system confirmed the benefits of a sequential evacuation scheme for the wounded with severe and extremely severe injuries. In patients with mild trauma, reducing the levels did not worsen the general condition, and functional disorders were moderate. Conclusions. Consistent providing of traumatological care to the wounded at the levels of medical support, due to timely performed surgical interventions, carrying out countermeasures and maintaining the reserve forces of the body of the wounded with extremely severe and severe combat injuries of the extremities (5 points or more) allows to achieve a gradual change of the functional state of the cardiovascular system from severe to moderate. Assistance to the injured with a minor trauma (

Objective: The ongoing Russian-Ukrainian war has been linked to mental health problems in the Ukrainian general population. To date, however, scarce research has examined the mental health of psychosocial support workers (PSWs) in Ukraine who have a burdensome workload in the context of ongoing conflict. This study aimed to examine the prevalence and correlates of burnout, posttraumatic stress disorder (PTSD), and suicidal ideation (SI) in PSWs in Ukraine during the Russian-Ukrainian war., Methods: One hundred seventy-eight PSWs in Ukraine completed a survey assessing war exposure, mental health, and psychosocial characteristics., Results: A total 59.6% of PSWs screened positive for burnout, 38.2% for PTSD, and 10.7% for current SI. Lower optimism was associated with greater odds of burnout. Greater distress from witnessing war-related destruction, lower optimism, lower presence of meaning in life, and lower levels of close social relationships were associated with greater odds of burnout. Lower presence of meaning in life was associated with greater odds of SI., Conclusions: Results of this study highlight the mental health challenges faced by PSWs in Ukraine during the ongoing Russian-Ukrainian war. They further suggest that interventions to foster meaning in life and promote social connectedness may "help the helpers" during this ongoing conflict.

Autoimmune hepatitis (AIH), primary biliary cirrhosis/cholangitis (PBC), primary sclerosing cholangitis (PSC) and autoimmune cholangiopaties are the autoimmune liver diseases. These diseases are rare and remain under-explored, therefore difficult for understanding and conducting even by specialists. Aim. To provide a comprehensively modern view of autoimmune liver diseases and their features. It is important to clearly distinguish AIG, PBH, and PSC between each other. Epidemiological data indicate low prevalence of these diseases, but its growth is noted. Most of the patients are young and middle age, prevalence of the AIH and PBC is higher in women, for PSC - in men. Etiologic factors remain unknown; the role of viral-bacterial, toxic, drugs that change the immune system with forming of autoantibodies is examined. Genetic factors also may play role in pathogenesis of these diseases. Diagnostics of autoimmune liver diseases are based on specific signs. AIH can proceed as acute or chronic hepatitis, cirrhosis or fulminant hepatic-cellular insufficiency, but also can be asymptomatic for a long time. For PBC and PSC, the clinic of cholestasis is characterized by skin itch, jaundice, skin changes. In later stages, a picture of cirrhosis develops. Hepatic tests in patients with AIH are characterized by predominance of cytolysis that can reach high values, and for PBC and PSC – cholestasis with high alkaline phosphatase and GGTP. Diagnostics with specific markers of autoimmune liver diseases are crucial for our country. AIH is characterized by detection of ANA, SMA, anti-LKM, anti-SLA, anti-LP anti-LC1, ASGP-R, and increased level of IgG. A highly specific PBC marker is AMA-M2, while p-ANCA can be determined in PSC. Among the visualizing methods of the hepatobiliary system, MRCP was identified as an accurate method for evaluating the duct system in PSC and liver elastography for evaluating the degree of fibrosis.Treatment of autoimmune liver diseases, according to the latest EASL recommendations, includes immunosuppressive therapy with hormones, azathioprine, other cytostatics, UDCA. Since the data of evidence-based medicine are limited, it is believed that an expert opinion can be crucial for the treatment of such patients. Clinical examples showing the features of management of autoimmune liver diseases are given in this article. Conclusions. Diagnosis and treatment of autoimmune liver diseases are a complex process. In this case, the latest modern recommendations can considerably help, at the same time, the clinical experience of the doctor and the patient’s individual data still matter.

Abstract Background War-related traumas can lead to orthopedic and neurological disorders in victims. However, the scope of such disorders may expand months or even years after the trauma. Orthotic treatment as a rehabilitation process aims to enable people with disabilities to reach and maintain their optimal physical, sensory, intellectual, psychological, and social functional levels. This study aimed to investigate the rate of using orthoses among Iranian veterans with neuromuscular and skeletal disorders of the ankle and foot. Furthermore, the priorities of orthotic treatment in those veterans were explored. Methods This qualitative study was a national health needs assessment conducted in 11 provinces of Iran during 2011–2016. A stakeholder research group was established to survey the veterans in respect to their demographic variables, activities of daily living, current health conditions, and rate of using orthoses. Results Overall, 907 of the 1124 veteran participants completed the survey (response rate: 80.7%). Most of the veterans were men (97.7%), and their age and disability rate were 52.07 ± 8.13 years and 31.92% ± 14.93%, respectively. Nearly 42% of the veterans had experience in using orthoses on a daily and weekly basis. As physical ambulation was the main problematic activity in veterans, most of them were using medical shoes and foot orthoses. Nearly 37% of veterans were in need of some type of lower limb orthoses on the contralateral side to compensate for their hip inequality. In sequential order, the most in need orthoses for veterans were foot orthoses (n = 538), medical shoes (n = 447), lower limb orthoses on the contralateral side (n = 320), spinal orthoses (n = 273), and upper limb orthoses (n = 86). Conclusions In spite of the high demands for orthoses among Iranian veterans with ankle and foot disorders, the use of orthoses is insufficient. Hence, there is a discrepancy between the current rate of orthoses use and its ideal situation, and more resources should be provided for service providers to be able to serve veterans. Moreover, veterans should be educated regarding orthoses, their use, and their impacts on the user’s health status. The findings of a needs assessment of orthoses can be used in strategic planning and decision making to improve health care services for Iranian veterans.

The aim. To investigate the level and structure of combat trauma among servicemen of the Armed Forces of Ukraine in conditions of military operations. Materials and methods. The results of the analysis of the structure and character of the modern combat trauma in 954 soldiers – participants of the anti-terrorist operation, who were treated in the Military Medical Clinical Center of the Western Region (MMCC of the WR), are presented. Results It was found that the largest proportion among the injuries is injury of extremities – 52 % (496 wounded). In most of the wounded – 583 (61 %) – the state at the time of admission to the MMCC of the WR was rated as of mild severity. 94 wounded (10 %) received treatment in severe condition. In 277 wounded (29 %) state at the time of admission was assessed as of average severity. The longest treatment period was observed in patients with severe injuries – it was 36.6 days on the average. Duration of treatment in patients with injury of moderate severity was 21.8 days. In case of mild injury the duration of treatment for patients was 24.2 days. 6 (0.6 %) patients of the total number of treated patients (954 persons) died. These lethal consequences were caused by serious injuries: a mine-explosive injury of a severe degree (2 patients), a combined gunshot wound (3 patients), a gunshot wound of the head (1 patient). 604 patients (63.3 %) returned to military service without treatment without changing the category of suitability; 344 (36.1 %) patients are considered unsuitable for military service. Conclusions. Summarizing the results obtained, we can say that in the structure of wounds the greatest part was wound of extremities – 52 %. Among these the upper extremities were injured in 41.12 %, wounds of the lower extremities were 58.8 %. Modern combat trauma requires a long period of treatment and rehabilitation, which in the case of serious injuries is 36.6 days on the average. Treatment of modern combat trauma cannot be separated from rehabilitation measures. Therefore, treatment and rehabilitation of servicemen is a topical issue that today faces not only military but also civilian medicine and social protection services.

Epidemiology can be considered as a responsible public health science the aim of which is to control health problems. One of the most important public health problems is "war". The aim of the present paper, therefore, is threefold: firstly, to determine to what extent war has been investigated from an epidemiological point of view; secondly, what the definition and scope of "war epidemiology" would be; and thirdly, if it would be possible to introduce a new branch of epidemiology entitled "peace epidemiology". In the present study, I have tried to fulfill the aims of the study based on my experiences in war and peace epidemiology and also by reviewing the most relevant websites, documents and papers. Evidence suggests that enough epidemiological studies have not been carried out to determine the sheer public health consequences of war. "War epidemiology" can be defined as "the study of the distribution and determinants of war-related events in specified populations, and the application of this study to the control of war". "Peace epidemiology" is a new branch of epidemiology which "highlights how peace could positively shape our world". Epidemiologists need to produce more scientific evidence about the negative public health consequences of wars and also the positive public health consequences of peace. The ultimate aim of "war epidemiology" is to control war, usually by secondary and tertiary prevention activities. However, the ultimate aim of "peace epidemiology" is to reinforce peace by primary and/or primordial prevention activities. [ABSTRACT FROM AUTHOR]

Background: War causes more death and disability than many major diseases. There are few studies in the context of the deleterious impact of war on fertility potential; therefore, in this study, we tried to review articles about the adverse effects of war on male/ female fertility potential Methods: In this study, a total of 183 articles related to the effects of war on fertility potential were examined by a systematic search using known international medical databases. Results: Among these studies, there were limited studies on the effects of war on female infertility and most studies examined the effects of war on sperm parameters and male infertility. The physical and psychological trauma of war can increase the risk of infertility in men and women. Presence of reproductive system toxins in weapons, stressful periods of war and direct damage to the reproductive system can impair the fertility of men and women. The way war affects male fertility is not clear, but the higher degree of stress during wartime seems to play an important role. Using reproductive toxicants during the war also increases the risk of impairment in reproductive function in men. Some studies have shown the harmful effects of Sulfur mustard as a war chemical toxin especially on sperm quality and male infertility. Oxidative stress induced by free radicals is a major mechanism for the direct effects of Sulfur mustard on male infertility. Conclusion: The study of past research suggests that exposure to war may be an independent risk factor for reproductive disorders and infertility in men. For female infertility, war leads to menstrual dysfunction. [ABSTRACT FROM AUTHOR]

Competing Interests: Competing interests: None declared.

The use of tourniquets for life-threatening limb hemorrhage is standard of care in military and civilian medicine. The United States (U.S.) Department of Defense (DoD) Committee on Tactical Combat Casualty Care (CoTCCC) guidelines, as part of the Joint Trauma System, support the application of tourniquets within a structured system reliant on highly trained medics and expeditious evacuation. Current practices by entities such as the DoD and North Atlantic Treaty Organization (NATO) are supported by evidence collected in counter-insurgency operations and other conflicts in which transport times to care rarely went beyond one hour, and casualty rates and tactical situations rarely exceeded capabilities. Tourniquets cause complications when misused or utilized for prolonged durations, and in near-peer or peer-peer conflicts, contested airspace and the impact of high-attrition warfare may increase time to definitive care and limit training resources. We present a series of cases from the war in Ukraine that suggest tourniquet practices are contributing to complications such as limb amputation, overall morbidity and mortality, and increased burden on the medical system. We discuss factors that contribute to this phenomenon and propose interventions for use in current and future similar contexts, with the ultimate goal of reducing morbidity and mortality.

Background: The Army Medical Department (AMEDD) Military-Civilian Trauma Team Training (AMCT3) Program was developed to enhance the trauma competency and capability of the medical force by embedding providers at busy civilian trauma centers. Few reports have been published on the outcomes of this program since its implementation., Methods: The medical and billing records for the two AMCT3 embedded trauma surgeons at the single medical center were retrospectively reviewed for care provided during August 2021 through July 2022. Abstracted data included tasks met under the Army's Individual Critical Task List (ICTL) for general surgeons. The Knowledge, Skills, and Abilities (KSA) score was estimated based on previously reported point values for procedures. To assess for successful integration of the embedded surgeons, data were also abstracted for two newly hired civilian trauma surgeons., Results: The annual clinical activity for the first AMCT3 surgeon included 444 trauma evaluations and 185 operative cases. The operative cases included 80 laparotomies, 15 thoracotomies, and 15 vascular exposures. The operative volume resulted in a KSA score of 21 998 points. The annual clinical activity for the second AMCT3 surgeon included 424 trauma evaluations and 194 operative cases. The operative cases included 92 laparotomies, 8 thoracotomies, and 25 vascular exposures. The operative volume resulted in a KSA score of 22 799 points. The first civilian surgeon's annual clinical activity included 453 trauma evaluations and 151 operative cases, resulting in a KSA score of 16 738 points. The second civilian surgeon's annual clinical activity included 206 trauma evaluations and 96 operative cases, resulting in a KSA score of 11 156 points., Conclusion: The AMCT3 partnership at this single center greatly exceeds the minimum deployment readiness metrics established in the ICTLs and KSAs for deploying general surgeons. The AMEDD experience provided a deployment-relevant case mix with an emphasis on complex vascular injury repairs., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

The history of warfare has shown that children are vulnerable group who have suffered various types of violence during armed conflicts. The United Nation Convention on the Rights of the Child from 1989 pointed to the necessity of children's protection during armed conflicts. 20th and 21th century have been marked by terrible suffering of children in armed conflicts worldwide. Severe suffering of children also marked Balkan wars during the nineties, especially in surrounded enclaves during aggression on Bosnia and Herzegovina. Except for killed and wounded children, invisible victims of the war were preterm and sick infants, without possibilities for survival due to lack of basic healthcare conditions. Children who have survived violence and cruelty during war conflicts worldwide suffer fro m posttraumatic stress disorder. Current war conflicts in the Middle East have brought a new mass phenomenon: migrations of the families with their children or children alone, without parental care. There are hundreds and thousands children refugees and migrants on Mediterranean route toward Europe which lasts for several years, without possibilities of schooling; investigations indicate that they show signs of deep psychologic trauma as a consequence of suffering experienced on their refugee route. Physicians can do a lot to ensure that children in the future have more chance for normal and fulfilled childhood, independent of birth place. Regardless of the fact that the triumph of pediatric medicine mostly refers to reduction of child mortality, eradication of some diseases like poliomyelitis, an important pediatric practice has been and will remains the care for children, war victims. [ABSTRACT FROM AUTHOR]

Objectives: Non-compressible torso hemorrhage remains a high mortality injury, with difficulty mobilizing resources before exsanguination. Previous studies reported on a retrievable stent graft for damage control and morphometric algorithms for rapid placement, yet fluoroscopy is impractical for the austere environment. We hypothesized that magnetic sensors could be used to position stents relative to an external magnet placed on an anatomic landmark, whereas an electromagnet would allow self-calibration to account for environmental noise., Methods: A magnetic sensor alone (MSA) and with integrated stent (MSIS) were examined in a porcine model under anesthesia. A target electromagnet was placed on the xiphoid process (position 0 cm). Sensors were placed in the aorta and measurements obtained at positions 0 cm, +4 cm, and +12 cm from the magnet and compared with fluoroscopy. Sensors were examined under conditions of tachycardia/hypertension, hypotension, vibration, and metal shrapnel to simulate environmental factors that might impact accuracy. General linear models compared mean differences between fluoroscopy and sensor readings., Results: Both sensors were compatible with a 10 French catheter system and provided real-time assessment of the distance between the sensor and magnetic target in centimeters. Mean differences between fluoroscopy and both magnetic sensor readings demonstrated accuracy within ±0.5 cm for all but one condition at 0 cm and +4 cm, whereas accuracy decreased at +12 cm from the target. Using the control as a reference, there was no significant difference in mean differences between fluoroscopy and both MSA or MSIS readings at 0 cm and +4 cm for all conditions. The system retained effectiveness if the target was overshot., Conclusion: Magnetic sensors achieved the highest accuracy as sensors approached the target. Oscillation of the electromagnet on and off effectively accounts for environmental noise.This approach is promising for rapid and accurate placement of damage control retrievable stent grafts when fluoroscopy is impractical., Level of Evidence: Not applicable., Competing Interests: Competing interests: An invention disclosure was submitted for the device detailed in this article., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

In the most austere combat conditions, Yugoslav guerillas of World War II (WWII) demonstrated an innovative and effective hospitalization system that saved countless lives. Yugoslav Partisans faced extreme medical and logistical challenges that spurred innovation while waging a guerrilla war against the Nazis. Partisans used concealed hospitals ranging between 25 to 215 beds throughout the country with wards that were often subterranean. Concealment and secrecy prevented discovery of many wards, which prototypically contained two bunk levels and held 30 patients in a 3.5 × 10.5-meter space that included storage and ventilation. Backup storage and treatment facilities provided critical redundancy. Intra-theater evacuation relied on pack animals and litter bearers while partisans relied on Allied fixed wing aircraft for inter-theater evacuation., (2023.)

Introduction: Until recently, female U.S. service members (SMs) have not been permitted to serve in direct combat roles. However, during Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF), a large number of female SMs have been wounded while serving in combat support roles. This included an unprecedented number of women with genitourinary (GU) injuries. No previous studies have reported either the incidence or clinical picture of these injuries. The objective of this study is to describe the epidemiology of GU injuries among female U.S. SMs during OIF/OEF and understand the potential for increased female GU injuries in future conflicts and the long-term sequelae from these injury patterns.Materials and Methods: The Department of Defense Trauma Registry was reviewed to identify all U.S. SMs diagnosed with GU injury from 2001 to 2013. The Department of Defense Trauma Registry includes data for wounded SMs treated at any U.S. combat support hospital, the in-theater equivalent of a civilian trauma center. Female SMs with ICD-9-CM diagnosis codes and/or Abbreviated Injury Scale codes for GU injury were included. Data on all females with GU injury were reviewed, including battle injury (BI) and non-BI. Basic demographic and injury characteristics were reported.Results: Among the 1,463 U.S. SMs diagnosed with GU injury while deployed to OIF/OEF, 20 (1.4%) were female (median age: 25 yr; interquartile range 21-27 yr). Of these, nine were BI (45%) and 11 were non-BI (55%). The distribution of injury location was as follows: renal injuries (n = 12), vulvar injuries (n = 3), vaginal injuries (n = 3), perineal injury (n = 1), and bladder injury (n = 1). Median Injury Severity Score was in the severe range of 21 (interquartile range 6-32), and four women (20%) died of their wounds. Important associated injuries included colorectal (n = 5) and lower extremity amputation(s) (n = 2). The most common mechanism of injury among the nine women with GU BI was improvised explosive device blast (n = 6), followed by other explosions (n = 2) and gunshot wound (n = 1). Mechanisms of GU non-BI varied, including gunshot wound (n = 2), fall (n = 2), fire/flame (n = 1), knife wound (n = 1), unintentional machine injury (n = 1), motor vehicle accident (n = 1), sports injury (n = 1), fight (n = 1), and pedestrian injury (n = 1).Conclusion: Female GU injuries comprise a small portion of all GU injuries sustained during OIF/OEF with the most predominant being renal injury. Now that the ground combat exclusion policy has been lifted, these data can be used as a model for the expected injury patterns in future female combatants. Long-term applications for these data include research and development for personal protective equipment and development of a multidisciplinary approach to long-term comprehensive care following GU trauma. [ABSTRACT FROM AUTHOR]

BACKGROUND: A link between moral injury (i.e., the psychological distress caused by perceived moral transgressions) and adverse mental health outcomes (AMHO) has been recently proposed. However, the prevalence of exposure to morally injurious events and the associated risk of experiencing AMHO remains understudied. METHOD: The impact of exposure to potentially morally injurious experiences (PMIEs) was explored in relation to past-year PTSD and MDD, using the 2013 Canadian Armed Forces Mental Health Survey dataset of Afghanistan mission deployed regular force and reserve personnel. A series of logistic regressions were conducted, controlling for relevant sociodemographic, military, deployment, and trauma-related variables. RESULTS: Over half of the deployed personnel endorsed at least one PMIE. Several demographic and military variables were associated with exposure to PMIEs. Those exposed to PMIEs demonstrated a greater likelihood of having past-year PTSD and MDD; feeling responsible for the death of Canadian or ally personnel demonstrated the strongest association with PTSD and MDD. Mental health training was not a moderator for PMIE exposure and AMHO. CONCLUSIONS: Exposure to PMIEs during deployments is common and represents an independent risk factor for past-year PTSD and MDD. Improved training that targets moral-ethical dilemmas and treatment interventions that address moral injury expressions is warranted. © Her Majesty the Queen in Right of Canada 2018. Reproduced with the permission of the Minister of Defence. [ABSTRACT FROM AUTHOR]