Prácticas y saberes de excombatientes de las FARC-EP sobre el tratamiento de la leishmaniasis cutánea / Practices and knowledge of ex-combatents of the FARC-EP on the treatment of cutaneous leishmaniasis

RESUMEN Introducción: La Leishmaniasis es una enfermedad infecciosa parasitaria zoonótica que afecta la piel, las mucosas y las vísceras. Es endémica en 98 países y hay más de 350 millones de personas en riesgo de transmisión. En Colombia, los campamentos de las antiguas Fuerzas Armadas Revolucionarias de Colombia, se ubicaban en zonas selváticas donde la enfermedad está presente. El objetivo del presente trabajo está dirigido a describir las prácticas y saberes de los excombatientes de las FARC-EP sobre la Leishmaniasis cutánea y su manejo en escenarios de combate al convivir con esta enfermedad. Métodos: El estudio es cualitativo/exploratorio, donde se abordaron los conocimientos sobre la enfermedad y su forma de transmisión, como también aquellas prácticas relacionadas con el uso de medicamentos para su tratamiento. Resultados: En el análisis de las entrevistas se encontró que los excombatientes conocen el ciclo de la enfermedad desde sus vivencias y por transmisión oral, como también de prácticas curativas propias adaptadas al contexto del conflicto armado, esta experiencia los llevó a desarrollar estrategias de gestión del conocimiento basado en la evidencia. Discusión: Las entrevistas dan cuenta del conocimiento empírico y clínico de los excombatientes sobre el ciclo de la enfermedad; no existe un registro documental, ni manuales de procedimientos realizados en la selva por las FARC-EP sobre tratamiento de enfermedades; los miembros de las FARC-EP a desarrollar estrategias de gestión del conocimiento basados en la evidencia; el contexto de conflicto afectó de manera importante el tiempo y los recursos técnicos para manejar la Leishmaniasis, esto posibilitó las respuestas alternativas a la enfermedad documentadas en este trabajo.

ABSTRACT Introduction: Leishmaniasis is a zoonotic parasitic infectious disease that affects the skin, mucous membranes and viscera. It is endemic in 98 countries and there are more than 350 million people at risk of transmission. In Colombia, the camps of the former Revolutionary Armed Forces of Colombia were located in jungle areas where the disease is present. The objective of this work is aimed at describing the practices and knowledge of ex-combatants of the FARC-EP about cutaneous Leishmaniasis and its management in combat scenarios when living with this disease. Methods: The study is qualitative/exploratory, where knowledge about the disease and its form of transmission were addressed, as well as those practices related to the use of medications for its treatment. Results: In the analysis of the interviews it was found that the ex-combatants know the cycle of the disease from their experiences and by oral transmission, as well as their own healing practices adapted to the context of the armed conflict, this experience led them to develop knowledge management strategies based on the evidence. Discussion: The interviews give an account of the empirical and clinical knowledge of the ex-combatants about the cycle of the disease; There is no documentary record, nor manuals of procedures carried out in the jungle by the FARC-EP on the treatment of diseases; the members of the FARC-EP to develop evidence-based knowledge management strategies; the context of conflict significantly affected the time and technical resources to manage Leishmaniasis, this made possible the alternative responses to the disease documented in this work.

Evaluación del perfil metabólico y prevalencia de enfermedad cardiovascular en los ex combatientes de la guerra de Malvinas / Evaluation of the metabolic profile and prevalence of cardiovascular disease in former combatants of the Malvinas war

Resumen Introducción: Se ha informado que los veteranos de guerra están más expuestos a factores de riesgo cardiovascular. El objetivo del presente trabajo fue establecer los factores de riesgo, el perfil cardiometabólico y la prevalencia de enfermedad cardiovascular de un grupo de excombatientes de la Guerra de Malvinas (HdeM). Métodos: En un diseño caso-control se analizaron los datos de 799 HdeM y se compararon 799 controles de misma edad. La muestra se seleccionó de los participantes del Programa de Prevención de Salud Cardiovascular de la Fundación Favaloro, entre enero de 2017 y diciembre de 2019. Resultados: La edad promedio fue 56.9 ± 3.9 años. Se observó un aumento del peso entre los HdeM (91.3 ± 16.6 kg vs. 88.2 ± 14.7 kg; p = 0.0001). Se observó mayor frecuencia de hipertensión arterial en HdeM (42% vs. 34%; p < 0.001) y diabetes mellitus (15.1% vs. 10.4%; p < 0.005). El síndrome metabólico fue más prevalente en HdeM (49.2% vs. 39.7%; p = 0.0001). Se observó que el antecedente de infarto agudo de miocardio fue más frecuente entre los HdeM (3.6% vs. 2%; p < 0.05), con similar prevalencia de ACV (1.2% vs. 1%; p = ns), angioplastia corona ria (3.2% vs. 2.1%; p = ns) o cirugía de revascularización miocárdica (0.8% vs. 0.4%; p = ns). Discusión: Los HdeM mostraron mayor prevalencia de factores de riesgo, síndrome metabólico e infarto agudo de miocardio. Es importante tener en cuenta este aumento de riesgo para maximizar las estrategias de prevención cardiovascular en los excombatientes.

Abstract Introduction: It has been reported in different parts of the world that war veterans are more exposed to cardio vascular risk factors. The objective of this study was to establish the risk factors, the cardiometabolic profile and the prevalence of cardiovascular disease in a group of ex-combatants of the Malvinas War (HdeM). Methods: In a case-control design, data from 799 HdeM were analyzed and compared with 799 controls matched by age. The sample was selected from the participants of the Cardiovascular Health Prevention Program of the Favaloro Foundation, between January 2017 and December 2019. Results: The average age was 56.9 ± 3.9 years. An increase in weight was observed among the HdeM (91.3 ± 16.6 kg vs. 88.2 ± 14.7 kg; p = 0.0001). A higher frequency of arterial hypertension (42% vs. 34%; p < 0.001) and diabetes mellitus (15.1% vs. 10.4%; p < 0.005) was observed in HdeM. Metabolic syndrome was also more prevalent in HdeM (49.2% vs. 39.7%; p = 0.0001). It was observed that the history of acute myocardial infarction was more frequent among the HdeM (3.6% vs. 2%; p < 0.05), with a similar prevalence of stroke (1.2% vs. 1%; p = ns), coronary angioplasty (3.2% vs. 2.1%; p = ns) or myocardial revascularization surgery (0.8% vs. 0.4%; p = ns). Discussion: The HdeM showed an increase in the frequency of risk factors, metabolic syndrome and acute myocardial infarction. It is important to take this increased risk into account in order to maximize cardiovascular prevention strategies in ex-combatants.

Nursing Professionals within the Intergenerational Context during the 20th and 21st Centuries: an Integrative Review / Los profesionales de enfermería en el contexto intergeneracional durante los siglos XX y XXI: una revisión integradora / Profissionais de enfermagem no contexto intergeracional durante os séculos XX e XXI: uma revisão integrativa

Objective. To describe the generational differences and similarities existing among nursing professionals of the 20th and 21st centuries and how these have influenced on the evolution of the profession. Methods. Integrative review according to the methodology by Whittemore and Knafl. The key words used for the search were: nurses, intergenerational relations, Veterans, Baby Boom, X generation, and Millennials. Results. The electronic search process yielded 10 documents (eight articles and two theses), all within the Anglo-Saxon environment (4 in Canada, 5 in the United States, and 1 in Australia). The documents recovered determined three principal themes: the intergenerational nursing workforce (n = 7), recruiting and retention within an intergenerational workforce (n = 2), and tutoring within an intergenerational nursing workforce (n = 1). The four generations of nursing professionals (X, Y, Baby Boomers, and Veterans) have different aptitudes, social and cultural setting, that coexist within the same work staff. Conclusion. This study establishes the legitimacy of the intergenerational differences as an important variable of social categorization. The findings have the potential to improve generational comprehension and promote a more cohesive culture in clinical practice settings, besides conserving the legacy of the four generations of nursing professionals contributing to outline the identity of the nurses through the conservation of social, cultural, and professional experiences.

Objetivo. Describir las diferencias y similitudes generacionales existentes entre los profesionales de enfermería del siglo XX y XXI y cómo han influido en la evolución de la profesión. Métodos. Revisión integradora según la metodología de Whittemore y Knafl. Las palabras clave utilizadas para la búsqueda fueron: enfermeras, relaciones intergeneracionales, Veteranos, Baby Boom, generación X y Millennials. Resultados. El proceso de búsqueda electrónica dio como resultado un total de 10 documentos (8 artículos y dos tesis), todos ellos en el ámbito anglosajón (4 en Canadá, 5 en Estados Unidos y 1 en Australia). En los documentos recuperados se determinaron tres temas principales: la fuerza de trabajo de enfermería intergeneracional (n = 7), el reclutamiento y la retención dentro de una fuerza de trabajo intergeneracional (n = 2) y la tutoría dentro de una fuerza laboral de enfermería intergeneracional (n = 1). Las cuatro generaciones de profesionales de enfermería (X, Y, Baby Boomers y Veteranos) tienen diferentes aptitudes, entorno social y cultural, que conviven dentro de un mismo equipo de trabajo. Conclusión. Este estudio establece la legitimidad de las diferencias intergeneracionales como una importante variable de categorización social. Los hallazgos tienen el potencial de mejorar la comprensión generacional y fomentar una cultura más cohesiva en entornos de práctica clínica, además de conservar el legado de las cuatro generaciones de profesionales de enfermería lo que contribuye a perfilar las señas de identidad de las enfermeras mediante la conservación de experiencias sociales, culturales y profesionales.

Objetivo. Descreva as diferenças e semelhanças geracionais entre os profissionais de enfermagem dos séculos XX e XXI e como elas influenciaram a evolução da profissão. Métodos. Revisão integrativa segundo a metodologia Whittemore e Knafl. As palavras-chave utilizadas para a busca foram: Enfermeiros, relações intergeracionais, Veteranos, Baby Boom, Geração X e Millennials. Resultados. O processo de busca eletrônica resultou em um total de 10 documentos (8 artigos e duas teses), todos da área anglo-saxônica (4 no Canadá, 5 nos Estados Unidos e 1 na Austrália). Três temas principais foram identificados nos documentos recuperados: a força de trabalho de enfermagem intergeracional (n = 7), recrutamento e retenção dentro de uma força de trabalho intergeracional (n = 2) e tutoria dentro de uma força de trabalho de enfermagem intergeracional (n = 1). As quatro gerações de profissionais de enfermagem (X, Y, Baby Boomers e Veteranos) possuem diferentes aptidões, meio social e cultural, que convivem dentro de uma mesma equipe de trabalho. Conclusão. Este estudo estabelece a legitimidade das diferenças intergeracionais como uma importante variável de categorização social. Os resultados têm potencial para melhorar a compreensão geracional e fomentar uma cultura mais coesa no cenário da prática clínica, além de preservar o legado das quatro gerações de profissionais de enfermagem, ajudando a moldar a identidade do enfermeiro por meio da preservação de experiências sociais, culturais e profissional.

Experiência e sabedoria em campo: uma representação social positiva sobre o processo de envelhecimento dos "veteranos" no "campo" futebolístico amador de Ponta Grossa­Paraná (2014-2017) / Experience and wisdom in the field: a positive social representation of the aging process of the "veterans" in the amateur football "field" in Ponta Grossa, Paraná (2014-2017)

O objetivo do presente estudo foi analisar o processo de construção e manutenção de uma representação social positiva sobre os jogadores veteranos, presentes no campo futebolístico amador existente na cidade de Ponta Grossa (PR). Para tanto, optou-se pelos direcionamentos metodológicos da etnografia, pois eles guiam os pesquisadores no processo interpretativo da "visão sobre o mundo" dos indivíduos pertencentes ao grupo social investigado, através das interpretações de suas práticas simbólicas. As representações revelaram que mesmo no campo esportivo em que, tradicionalmente, o rendimento técnico-físico é o que determina a visão sobre os diferentes agentes; na análise em questão descobriu-se que através de ancoragens compensatórias, tais como não se tem vigor físico mas tem sabedoria/experiência, somado ao capital simbólico adquirido historicamente os idosos foram representados como figuras centrais deste espaço social. Conclui-se que em Ponta Grossa o futebol amador veterano apresenta-se como uma manifestação sociocultural, que tensiona o olhar negativo que comumente é estabelecido para o processo de envelhecimento e para a velhice. (AU)

The objective of the present study was to analyze the process of building and maintaining a positive social representation about the veteran players of the amateur football field in the city of Ponta Grossa, PR. In order to do so, we chose the methodological orientations of ethnography, since they guide the researchers in the interpretative process of the "world view" of the individuals belonging to the social group investigated, through the interpretations of their symbolic practices. It is concluded that in Ponta Grossa football presents itself as a sociocultural manifestation, which makes it possible to hold the negative eye on the process of aging and old age. The social representations revealed that even in the sports field, where it is aprioristically imagined that the performance is what determines the vision on the different agents, in the analysis in question it was discovered that through compensatory anchorages (there is no physical force, but has intelligence) and the acquired symbolic capital, legitimize the elderly as nuclear figures of the field. (AU)

Prevalence and Severity of Fecal Incontinence in Veterans

BACKGROUND/AIMS: Fecal incontinence (FI) is a common complaint that increases in prevalence with age. Our aim was to determine the prevalence of FI and assess its severity by self-report in a male-predominant Veteran outpatient clinic setting. METHODS: An anonymous 28 item questionnaire was administered to a convenience sample of veterans awaiting appointments. FI was defined as a loss of liquid or solid stool at least monthly. Multivariable logistic and linear models were used to identify predictors of FI prevalence and severity. RESULTS: One hundred thirty-three gastroenterology (GI) participants and 126 primary care (PC) participants completed the survey. Ninety-four of 259 participants (36.3%, 95% confidence interval [CI]: 30.4–42.5) reported an episode of FI (41.4% GI participants vs 31.0% PC participants; P = 0.078) with 33.6% having FI within the last 30 days (36.8% GI participants vs 30.2% PC participants; P = 0.122). Participants with more bowel movements per week (P = 0.005) and per day (P < 0.001) and with a higher Bristol Stool Scale form (P = 0.010) were more likely to have FI. Of participants with FI, mean Fecal Incontinence Severity Index score was 23.0 ± 9.5 with a significantly higher symptom score in GI participants compared to PC participants (25.2 ± 10.0 vs 20.1 ± 8.2; P = 0.011). Few participants had ever been asked by (35.0%) or evaluated by (18.0%) a doctor for FI symptoms. CONCLUSIONS: FI is a common complaint and under-recognized problem in the male-dominant Veteran population. Despite its prevalence, relatively few participants were asked about FI, with even less being treated. Due to the possible effects and implications on quality of life, more should be done to recognize this condition and arrange treatment.

Especial y marginal: hacia una problematización de la intervención estatal en la salud de los veteranos de Malvinas (1984-2000) / Special and marginal: towards a problematization of the state intervention regarding the health of Malvinas veterans (1984-2000)

RESUMEN El objetivo de este artículo es dar cuenta de las modalidades en que fue instituida la salud del veterano argentino de la guerra de Malvinas como un problema de intervención estatal entre 1984 y 2000. Para ello nos centramos en el concepto de problematización como un modo de análisis de las prácticas y el pensamiento político. El texto consta de tres apartados: en el primero se presentan las bases metodológicas para el análisis de las políticas públicas, mientras que el segundo y el tercero están destinados al análisis de una serie de leyes, proyectos de ley, decretos, informes, etc., producidos por diferentes esferas estatales en torno al veterano de guerra y su situación sanitaria. La hipótesis de lectura que proponemos es que el veterano o excombatiente de Malvinas fue problematizado como un segmento poblacional marginal, aunque la estabilización de un tratamiento específico tardó más de quince años en materializarse.

ABSTRACT The aim of this paper is to account for the modalities in which Malvinas veterans' health was constituted as a problem requiring state intervention between 1984 and 2000. In order to do so, we have focused on the concept of problematization as a way to analyze practices and political thought. The text consists of three sections: the first one presents the methodological basis of the analysis of public policies, whereas the second and third ones intend to analyze a series of laws, bills, decrees, reports and other documents produced by different state spheres about war veterans and their health situation. The hypothesis that we propose is that the Malvinas veterans were problematized as a marginal segment of the population, although the stabilization of a specific treatment took more than fifteen years to materialize

Efficacy of equine-assisted psychotherapy in veterans with posttraumatic stress disorder / 中西医结合学报

BACKGROUND@#Posttraumatic stress disorder (PTSD) is a common and debilitating disorder among war veterans. Although complementary and alternative therapies are gaining acceptance in the treatment of PTSD, the efficacy of animal-based therapies in this disorder is unknown. The goal of equine-assisted psychotherapy (EAP) is to improve the social, emotional, and/or cognitive functions of individuals with PTSD.@*OBJECTIVE@#This study aims to explore the effects of EAP on PTSD symptoms. We hypothesized that veterans with PTSD who participate in a standardized EAP program for 1 h per week for 6 weeks would experience decreased PTSD symptoms and would demonstrate increased resilience as compared with individuals who do not receive EAP intervention.@*DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS@#We conducted a sequentially assigned, two-arm parallel group trial comparing 6 weeks of EAP with standard, previously established, ongoing PTSD therapy. Therapy was conducted at a community EAP facility in conjunction with an academic University Hospital. Twenty adult veterans with symptomatic PTSD completed the study. Ten adult veterans with previously diagnosed PTSD were assigned to EAP and received directed interaction with trained horses for one hour a week in groups of 3 or 4 individuals, while also continuing their previously established therapies. A certified therapist supervised the sessions, and a professional horse handler was also present. Results were compared with those from 10 adult veterans who only received their standard previously established PTSD care as prescribed by their provider.@*MAIN OUTCOME MEASURES@#Changes in salivary cortisol, scores for the PTSD Check List-Military Version (PCL-M) and the Connor-Davidson Resilience Scale (CD-RISC) after 6 weeks of study were measured.@*RESULTS@#Of the 20 enrolled patients, 10 served in Afghanistan, 5 served in Iraq, and 3 served in Vietnam. Subjects were (47 ± 14) years old, were predominantly male, and had a body mass index of (29 ± 7) kg/m. They had (9.2 ± 6.1) years of military service and carried 66% ± 37% service-connected disability. PCL-M scores declined significantly in both groups and CD-RISC scores increased significantly in the EAP group. There was no difference between the groups with respect to the magnitude of change.@*CONCLUSION@#As compared to the control group, a 6-week EAP program did not produce a statistically significant difference with respect to PCL-M and CD-RISC scores, or salivary cortisol. However, our results suggest that EAP may work as well as standard therapy with respect to these parameters. This study supports further inquiry into EAP as a potentially efficacious alternative for veterans suffering from PTSD.@*TRIAL REGISTRATION@#ClinicalTrials.gov NCT #03039361.

A Pilot study on the prevalence of Post-Traumatic Stress Disorder (PTSD) among Veterans Memorial Medical Center (VMMC) Department Of Psychiatry Patients with combat experience from January 2013 - January 2015

Objectives@#The objectives of this pilot study was to establish the preliminary data on the prevalence of Post-Traumatic Stress Disorder (PTSD) among VMMC Department of Psychiatry In-Patients and Out-Patients with combat experience.@*Methodology@#It is a cross sectional study conducted by reviewing patients' charts. Case definition was based on the standardized ClinicianAdministered PTSD Scale (CAPS) - Filipino Version. In -patients were recruited directly while new and old OPD patients were recruited through chart review and invitations. Adequate combat exposure was measured with the United States Veterans Affairs Combat Exposure Scale (USVACES). Data was presented as lifetime and current prevalence among the exposed population.@*Results@#The study showed that 17.85% of the subjects (n=28) of this pilot study had a lifetime diagnosis of PTSD. None of the subjects reached the symptom threshold for a current diagnosis of PTSD. Three out of 19 subjects (15.78%) diagnosed with Schizophrenia had a lifetime diagnosis of PTSD while two out of five subjects (40%) with Bipolar I Disorder had comorbid lifetime diagnosis of PTSD. The number of subjects needed to power the study using Daniel's (1999) formula was N= 225.@*Conclusion@#The pilot study showed that the lifetime prevalence rate of PTSD among VMMC Psychiatry patients (17.85%) was comparable to worldwide trends. The study did not report any new occurrences of PTSD.

Trends and Appropriateness of Outpatient Prescription Drug Use in Veterans

OBJECTIVE: This study analyzed the national claims data of veterans to generate scientific evidence of the trends and appropriateness of their drug utilization in an outpatient setting. METHODS: The claims data were provided by the Health Insurance Review & Assessment (HIRA). Through sampling and matching data, we selected two comparable groups; Veterans vs. National Health Insurance (NHI) patients and Veterans vs. Medical Aid (MAID) patients. Drug use and costs were compared between groups by using multivariate gamma regression models to account for the skewed distribution, and therapeutic duplication was analyzed by using multivariate logistic regression models. RESULTS: In equivalent conditions, veteran patients made fewer visits to medical institutions (0.88 vs. 1), had 1.86 times more drug use, and paid 1.4 times more drug costs than NHI patients (p < 0.05); similarly, veteran patients made fewer visits to medical institutions (0.96 vs. 1), had 1.11 times more drug use, and paid 0.95 times less drug costs than MAID patients (p < 0.05). The risk of therapeutic duplication was 1.7 times higher (OR=1.657) in veteran patients than in NHI patients and 1.3 times higher (OR=1.311) than in MAID patients (p < 0.0001). CONCLUSION: Similar patterns of drug use were found in veteran patients and MAID patients. There were greater concerns about the drug use behavior in veteran patients, with longer prescribing days and a higher rate of therapeutic duplication, than in MAID patients. Efforts should be made to measure if any inefficiency exists in veterans' drug use behavior.

Androgen deprivation therapy is associated with decreased second primary lung cancer risk in the United States veterans with prostate cancer / 한국역학회지

OBJECTIVES: We investigated whether androgen deprivation therapy (ADT) in prostate cancer patients was associated with a decreased risk for second primary lung cancer in US veterans.METHODS: Prostate cancer diagnoses in the US Veterans Affairs Cancer Registry between 1999 and 2008 were identified. Use of hormonal therapy and diagnoses of second primary lung cancer were determined from the registry. Synchronous prostate and lung cancers, defined as 2 diagnoses made within 1 year, were excluded from the analysis. Cancer-free survival was estimated using the Kaplan-Meier method and hazard ratios were estimated using Cox proportional hazard models.RESULTS: Among the 63,141 identified patients with prostate cancer, 18,707 subjects were eligible for the study. Hormonal therapy was used in 38% of patients and the median follow-up period was 28 months. ADT use was associated with longer lung cancer-free survival in prostate cancer patients (log-rank p=0.01). After adjusting for age, race, smoking and prostate cancer stage, ADT use was associated with decreased lung cancer risk by 15, 21, and 24% after 1, 2, and 3 years, respectively.CONCLUSIONS: ADT in prostate cancer patients may be associated with decreased second primary lung cancer risk among US veterans.

Androgen deprivation therapy is associated with decreased second primary lung cancer risk in the United States veterans with prostate cancer / 한국역학회지

OBJECTIVES: We investigated whether androgen deprivation therapy (ADT) in prostate cancer patients was associated with a decreased risk for second primary lung cancer in US veterans. METHODS: Prostate cancer diagnoses in the US Veterans Affairs Cancer Registry between 1999 and 2008 were identified. Use of hormonal therapy and diagnoses of second primary lung cancer were determined from the registry. Synchronous prostate and lung cancers, defined as 2 diagnoses made within 1 year, were excluded from the analysis. Cancer-free survival was estimated using the Kaplan-Meier method and hazard ratios were estimated using Cox proportional hazard models. RESULTS: Among the 63,141 identified patients with prostate cancer, 18,707 subjects were eligible for the study. Hormonal therapy was used in 38% of patients and the median follow-up period was 28 months. ADT use was associated with longer lung cancer-free survival in prostate cancer patients (log-rank p=0.01). After adjusting for age, race, smoking and prostate cancer stage, ADT use was associated with decreased lung cancer risk by 15, 21, and 24% after 1, 2, and 3 years, respectively. CONCLUSIONS: ADT in prostate cancer patients may be associated with decreased second primary lung cancer risk among US veterans.

One-year Survival Rates and Functional Recovery in Veterans Who Suffer from Hip Fractures: Evaluation of Commissioned Hospitals' System through Comparison between Veterans Hospitals and Commissioned Hospitals / 대한고관절학회지

PURPOSE: This study was performed to compare the: i) 1-year survival rate of patients with hip fractures, ii) factors affecting mortality in patients with hip fractures, and iii) results of functional recovery at commissioned hospitals (CH) and veterans hospitals (VH) to characterize the quality of care provided in the Korean commissioned hospital system. MATERIALS AND METHODS: The study population consisted of 183 veteran patients (84 and 99 treated at a single VH and 39 CH, respectively) who underwent hip fracture surgery between January 2010 and February 2015. This study compared baseline characteristics (i.e., age, comorbidities, fracture types and surgical treatment approaches) of the two groups vs. clinical outcomes, and evaluated the waiting time, length of hospital stay, total medical expenses, mortality rate within one year, and functional recovery at last follow up. RESULTS: There were no significant differences in age, fracture types, comorbidities, ambulatory status before fracture, waiting time, or length of hospital stay between the two groups, however, the total medical cost was higher in the CH group (P=0.009). There was no significant difference in mortality within one year after hip fracture (P=0.224) or functional recovery at last follow-up (P=0.463) between the two groups. CONCLUSION: The results of this study confirm that the Korean commissioned hospitals system is operating in accordance with its purpose. However, further studies are needed to better characterize the medical expenses of CHs vs. veterans hospitals.

Combat surfers: a narrative study of veterans, surfing, and war trauma / Surfistas de combate: um estudo narrativo de veteranos, surfing e trauma de guerra / Surfistas de combate: un estudio narrativo de veteranos, surfing y trauma de guerra

We use narrative inquiry to illustrate the complex lives and experiences of combat veterans who go surfing to deal with the traumatic aftermath of war. The stories we collected reveal the rich and varied qualities of veterans' surfing experiences. These stories are several things at once. They are personal, revealing the body in motion as it negotiates the natural environment. They are social and cultural, shaped as they are by dominant societal narratives about veterans and masculinity. And, importantly, they are also actors, shaping the ways in which veterans experience themselves, each other, and the world around them(AU)

Usamos a investigação narrativa para ilustrar as vidas complexas e experiências de veteranos de combate que vão surfar para lidar com as conseqüências traumáticas da guerra. As histórias que coletamos revelam as qualidades ricas e variadas das experiências de surf dos veteranos. Essas histórias são várias coisas ao mesmo tempo. Eles são pessoais, revelando o corpo em movimento como ele negocia o ambiente natural. Eles são sociais e culturais, moldados como eles são por narrativas societal dominantes sobre veteranos e masculinidade. E, o mais importante, eles também são atores, moldando as maneiras pelas quais os veteranos experimentam a si mesmos, uns aos outros e ao mundo à sua volta(AU)

Utilizamos la investigación narrativa para ilustrar las complejas vidas y experiencias de los veteranos de combate que van a surfear para tratar las consecuencias traumáticas de la guerra. Las historias que recopilamos revelan las cualidades ricas y variadas de las experiencias de surf de los veteranos. Estas historias son varias cosas a la vez. Son personales, revelando el cuerpo en movimiento mientras que negocia el ambiente natural. Son sociales y culturales, conformados por las narrativas dominantes de la sociedad sobre los veteranos y la masculinidad. Y, lo que es más importante, también son actores, moldeando las maneras en que los veteranos se experimentan a sí mismos, entre ellos, y el mundo que los rodea(AU)

What Is Important in Selecting a Designated Hospital for the Korean Veterans with Hip Fractures? / 대한고관절학회지

PURPOSE: The Korea Veterans Health Service (KVHS) implemented the ‘designated hospital system’ so that veterans can receive prompt medical attention at hospitals near their residences when experience medical emergencies, including hip fractures. We analyzed the hospital-selection process of Korean veterans following a hip fracture. We then evaluated (the validity and considerations) for choosing designated hospitals. MATERIALS AND METHODS: The study population consisted of 183 veteran patients (84 treated at a single veterans hospital and the remaining 99 treated at 39 designated hospitals) who underwent hip fracture between January 2010 and February 2015 in the Honam region of South Korea. The subjects were divided into the ‘nearest group’ (those who chose the hospital closest to their residences) and the ‘non-nearest group’ (those who did not choose the hospital closest to their residences). We compared the age, ambulatory status, combined disease and fracture type, factors that we speculated may impact hospital choice. RESULTS: Although the patients had difficulty moving due to hip fractures, 116 (63.4%) patients choose hospitals that were not closest to their residences. Patients with three or more comorbidities (P=0.028) and older ages (P=0.046) were statistically more likely to fall into the non-nearest group. Ambulatory status and fracture type were shown not to significantly impact choice between nearest and non-nearest hospital. Patients in the non-nearest group tended to seek care at larger hospitals. CONCLUSION: Korean veterans with hip fractures tended to seek care at larger hospitals, regardless of distance. We must therefore consider the number of beds and departments when choosing designated hospitals.

Application of Mobile App and Paper Survey of PTSD Checklist in the Elderly Korean Veterans of the Vietnam War / 신경정신의학

OBJECTIVES: The posttraumatic stress disorder (PTSD) checklist (PCL) is currently the most popular self-report scale employed in screening PTSD. This study was conducted 1) to test the reliability and validity of PCL in veterans of the Vietnam War and 2) to compare the results when using a conventional paper survey and mobile app survey. METHODS: Participants included 186 Korean veterans of the Vietnam War. Mini Mental Status Examination, PTSD module of Structured Clinical Interview for DSM-IV (SCID), and Life Event Checklist were administered. PCL was administered in either written format or mobile app. Diagnostic validity of the PCL was compared using the PTSD module of SCID. Other psychometric properties of PCL were also calculated. RESULTS: PCL results using different methods, paper and mobile app, showed no significant difference in each item and total score. Cronbach's coefficient of PCL was 0.95, optimal cut-off 49.5, sensitivity 91.7%, and specificity 93.5%. CONCLUSION: PCL showed excellent internal reliability, sensitivity, specificity, and validity. There was no statistically significant difference between survey methods. These results suggest that PCL is a reliable self-report scale in veterans. In addition, PCL with mobile app can be helpful in screening PTSD.

El uso de los mecanismos de defensacomo herramientas de afrontamientopor veteranos israelíes deprimidos y con TEPT / The use of defense mechanisms as coping tools by PTSD and depressed Israeli veterans

Objetivo: detectar los mecanismos de defensa correspondientes a veteranos con TEPT (Trastorno por Estrés Post-Traumático), deprimidos y controles. Muestra: 155 participantes: grupo control (N = 55), veteranos deprimidos (N=39), veteranos con TEPT (N=61). Instrumentos: cuestionario de TEPT versión para civiles, escala Hamilton, Cuestionario de Experiencias Depresivas (CED), Índice de Estilo de Vida (LSI). Resultado: se detectaron diferentes combinatorias de mecanismos de defensa en cada uno de los grupos estudiados. El grupo de deprimidos reporta un mayor uso de la regresión y la proyección que el grupo control. Los individuos con TEPT utilizan la proyección, regresión y formación reactiva más que el grupo control. Por consiguiente, los grupos diagnosticados utilizan mecanismos de defensa diferentes de los del grupo control, lo cual confirma la hipótesis. Los individuos con TEPT utilizan la intelectualización más que los deprimidos y, entonces, la hipótesis de que existen diferencias entre estos dos grupos también se sostiene.

Objective: to detect the defense mechanisms corresponding to PTSD (Post traumatic stress disorder) and depressed Israeli veterans and control group. Sample: 155 participants: control group (N=55), depressed veterans (N=39). veterans suffering from PTSD (N=61). Instruments: PTSD questionnaire, version for civilians, Hamilton scale. Questionnaire of Depressive Experiences (QDE), Life style index (LSI). Result: different combinations of defense mechanisms were detected in each of the studied groups. The group of the depressed reports greater use of regression, projection and reaction formation than the control group. Accordingly, the diagnosed groups use different defense mechanisms from those of the control group, therefore confirming the hypothesis. The individuals manifesting TEPT use intellectualization more than the depressed ones, so the hypothesis that there are differences between these two groups can be maintained.

EEG analysis of army recruits and veterans and the relationship of the frequency spectrum with depression scale scores / 中华物理医学与康复杂志

Objective To explore the characteristics of EEG frequency in recruits and veterans and their relationship with depression scale scores.Methods Fifty-five newly enlisted soldiers formed the recruits group and 68 demobilized soldiers the veterans group.A general information survey,EEGs and the Hamilton depression scale (HAMD) were administered to all of the subjects.According to the HAMD scores,35 of the 123 were designated as the abnormal group,while 88 formed the normal one.Eighteen of the 35 with EEG abnormalities served as a doubleabnormal group to be compared with the remaining 17 cases with abnormal HAMD scores and normal EEGs (the single-abnormal group),and 9 of the 18 with higher HAMD scores as the higher group,and the other 9 cases as the lower group.The EEG frequency spectrum and the power percentages from the δ to γ frequency bands were calculated as δ:0.5-4 Hz,(o):4-8 Hz,α:8-13 Hz,β:13-25 Hz,γ:25-40 Hz.Results Forty-six of the subjects (37.4％) had abnormal EEG results,35 had abnormal HAMD scores,and 18 (51.4％ of the soldiers with abnormal HAMD scores) had both abnormalities.The veterans had lower δ band power percentage in all channels than the recruits,but in the (0) band it was the reverse.In the left channels the veterans had lower α and γ band power percentages than the recruits.Compared with the normal,all channels in the EEGs of subjects with abnormal HAMD scores had significantly higher δ band power percentages.The higher the δ band power percentage a subject had,the higher his HAMD score.Conclusion There is some correlation between changes in EEG power percentages and the possibility and severity of depression.Objective and subjective EEG evaluation can help improve the positive rate of diagnosis,and thus the management of the army.

Cancer Incidence in Korean Vietnam Veterans During 1992-2003: The Korean Veterans Health Study / 예방의학회지

OBJECTIVES: The aim of this study was to investigate the association between Vietnam experience including exposure to military herbicides and cancer incidence in Korean Vietnam War veterans. METHODS: The cancer cases of 185 265 Vietnam veterans from January 1, 1992 to December 31, 2003 were confirmed from the Korea National Cancer Incidence Database. The age-adjusted incidence and standardized incidence ratios (SIRs) were calculated using the male population during 1992 to 2003 as a standard population. RESULTS: The age-adjusted overall cancer incidence per 100 000 person-years was 455.3 in Vietnam veterans. The overall cancer incidence was slightly yet significantly lower in veterans (SIR, 0.97; 95% confidence interval, 0.95 to 0.99) than in the general population. The overall cancer incidence in enlisted soldiers was not lower (SIR, 1.00), whereas that in officers was significantly lower (SIR, 0.87) than in the general population. The incidences of prostate cancer and T-cell lymphoma in all veterans, and lung cancer and bladder cancer in enlisted soldiers, and colon cancer and kidney cancer in non-commissioned officers, and colon cancer, kidney cancer, and prostate cancer in officers, were higher than in the general population. The SIR for overall cancer among Vietnam veterans rose from 0.92 for 1992-1997 to 0.99 for 1998-2003. CONCLUSIONS: The overall cancer incidence in Vietnam veterans was not higher than in the general male population. Vietnam veterans and military rank subcohorts experienced a higher incidence of several cancers, including prostate cancer, T-cell lymphoma, lung cancer, bladder cancer, kidney cancer, and colon cancer than the general population. The SIR for overall cancer increased over time in Vietnam veterans.

Agent Orange Exposure and Prevalence of Self-reported Diseases in Korean Vietnam Veterans / 예방의학회지

OBJECTIVES: The aim of this study was to evaluate the association between Agent Orange exposure and self-reported diseases in Korean Vietnam veterans. METHODS: A postal survey of 114 562 Vietnam veterans was conducted. The perceived exposure to Agent Orange was assessed by a 6-item questionnaire. Two proximity-based Agent Orange exposure indices were constructed using division/brigade-level and battalion/company-level unit information. Adjusted odds ratios (ORs) for age and other confounders were calculated using a logistic regression model. RESULTS: The prevalence of all self-reported diseases showed monotonically increasing trends as the levels of perceived self-reported exposure increased. The ORs for colon cancer (OR, 1.13), leukemia (OR, 1.56), hypertension (OR, 1.03), peripheral vasculopathy (OR, 1.07), enterocolitis (OR, 1.07), peripheral neuropathy (OR, 1.07), multiple nerve palsy (OR, 1.14), multiple sclerosis (OR, 1.24), skin diseases (OR, 1.05), psychotic diseases (OR, 1.07) and lipidemia (OR, 1.05) were significantly elevated for the high exposure group in the division/brigade-level proximity-based exposure analysis, compared to the low exposure group. The ORs for cerebral infarction (OR, 1.08), chronic bronchitis (OR, 1.05), multiple nerve palsy (OR, 1.07), multiple sclerosis (OR, 1.16), skin diseases (OR, 1.05), and lipidemia (OR, 1.05) were significantly elevated for the high exposure group in the battalion/company-level analysis. CONCLUSIONS: Korean Vietnam veterans with high exposure to Agent Orange experienced a higher prevalence of several self-reported chronic diseases compared to those with low exposure by proximity-based exposure assessment. The strong positive associations between perceived self-reported exposure and all self-reported diseases should be evaluated with discretion because the likelihood of reporting diseases was directly related to the perceived intensity of Agent Orange exposure.

Serum 2,3,7,8-Tetrachlorodibenzo-p-dioxin Levels and Their Association With Age, Body Mass Index, Smoking, Military Record-based Variables, and Estimated Exposure to Agent Orange in Korean Vietnam Veterans / 예방의학회지

OBJECTIVES: The aim of this study was to examine the levels of serum 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) and evaluate their association with age, body mass index, smoking, military record-based variables, and estimated exposure to Agent Orange in Korean Vietnam veterans. METHODS: Serum levels of TCDD were analyzed in 102 Vietnam veterans. Information on age, body mass index, and smoking status were obtained from a self-reported questionnaire. The perceived exposure was assessed by a 6-item questionnaire. Two proximity-based exposures were constructed by division/brigade level and battalion/company level unit information using the Stellman exposure opportunity index model. RESULTS: The mean and median of serum TCDD levels was 1.2 parts per trillion (ppt) and 0.9 ppt, respectively. Only 2 Vietnam veterans had elevated levels of TCDD (>10 ppt). The levels of TCDD did not tend to increase with the likelihood of exposure to Agent Orange, as estimated from either proximity-based exposure or perceived self-reported exposure. The serum TCDD levels were not significantly different according to military unit, year of first deployment, duration of deployment, military rank, age, body mass index, and smoking status. CONCLUSIONS: The average serum TCDD levels in the Korean Vietnam veterans were lower than those reported for other occupationally or environmentally exposed groups and US Vietnam veterans, and their use as an objective marker of Agent Orange exposure may have some limitations. The unit of deployment, duration of deployment, year of first deployment, military rank, perceived self-reported exposure, and proximity-based exposure to Agent Orange were not associated with TCDD levels in Korean Vietnam veterans. Age, body mass index and smoking also were not associated with TCDD levels.