Experience of the Air Medical Evacuation Team of Serbian Armed Forces in the United Nations Mission in the Democratic Republic of Congo--Deployment stress and psychological adaptation.

BACKGROUND/AIM: Wars of the nineties in former Yugoslavia, Somalia, Rwanda imposed new tasks to the United Nations (UN) forces, such as providing humanitarian aid, protection of civilians, peacekeeping, and in many instances providing armed enforcement of peace. The aim of this study was an observational analysis of Serbian participation in the UNs Mission in the Democratic Republic of Congo with the emphasis on stress and coping techniques. METHODS: Serbian contribution in this mission dates back to April 2003 till the present days with a military contingent consisting of six members as a part of Air Medical Evacuation Team. The observed stressogenous factors acted before arrival to the mission area and in the mission area. In this paper we analysed ways to overcome them. RESULTS: The productive ways of overwhelming stress used in this mission were: honesty and openness in interpersonal communications, dedication to work, maintaining discipline and order, strict following of appropriate regime of work, diet, rest and recreation; regular communication with family and organizing and participation in various social, cultural and sports manifestations. CONCLUSION: This analysis indicates that out of all the observed factors, the most important is appropriate selection of personnel.

Re-evaluating disability assessment in war veterans with posttraumatic stress disorder.

Background/Aim: Sametimes war veterans may resort to such strategies as preducing exaggerated symptoms and malingerating in order to obtain material compensation rights. The aim of this study was to assess the accuracy of the diagnosis of posttraumatic stress disorder (PTSD) on the basis of which war veterans were entitled to a financial compensation due to their disability. Methods: The diagnoses of 259 war veterans were re-evaluated. Veterans were previously diagnosed by a psychiatrist on local level, while regional state medical commission determined the degree of disability and the right to a financial compensation. A team of experts, consisting of psychiatrists with research experience in the field of traumatic stress and who were trained to use a structured interview for PTSD, conducted the evaluation of medical data from veterans' military records. The diagnostic process was conducted using the standardized diagnostic interview (Clinician-Administered PTSD Scale ­ CAPS), after which the diagnosis was reaffirmed or reviewed. This influenced disability status and consequential financial compensation. Results: There was a remarkable difference between the first diagnostic assessment of PTSD, conducted by the psychiatrists on local level, and the second evaluation conducted by the team of experts. In more than half of 259 veterans (52.1%) diagnosed with PTSD in the first assessment the diagnosis was not confirmed. The diagnosis was confirmed in 31.7% of veterans. Those veterans who were diagnosed with lifetime PTSD (7.3%) should also be treated as accuratelly diagnosed. This means that a total of 39% of the diagnoses were accurate. The rest (8.9%) were diagnosed with other diagnoses, but not PTSD, as was the case in the initial assessment. Conclusion: The possibility for war veterans to obtain the right to disability and financial compensation due to a diagnosis of PTSD might interfere with the proper diagnostic assessment and thus the treatment outcome. During the procedures for the obtention of these rights, exaggeration or simulation of symptoms are common. The quality of the diagnostic assessment of PTSD can be improved by applying evidence based standardized procedures.

Anthropometric assessment of crane cabins and recommendations for design: A case study.

BACKGROUND: Work of crane operators is very difficult and demanding. Therefore, it is very important that the cabin of a crane be designed on the basis of relevant anthropometric data. However, it is very difficult to find a research that considers anthropometric convenience of crane cabins. OBJECTIVE: From the theoretical viewpoint, it is important to perceive and to classify effects of the anthropometric incompatibility of crane cabins. Globally, the objective is to consider the anthropometric convenience of existing crane cabins, and possibilities for improvements of their design from the ergonomic point of view. In this regard, it is significant to detect constraints that impede or hinder the work of the crane operators, which could be overcome with certain anthropometric solutions. The main objective is to examine whether and to what extent is justifiable to use anthropometric data that are obtained on the basis of general (national) population, during designing the crane cabins. METHODS: For the assessment of existing crane cabins and the work of operators, four methods were used: observation of the work of the operators and design solutions of the cabins, the checklist approach, interviewing of operators and the experimental research based on obtaining the data on the population of crane operators. RESULTS: Results of the analysis based on the method of observation, analysis based on the application of the checklist, as well as interviewing of the operators indicate that certain construction constraints of the components in the cabins are the main reasons of reduced visibility and improper working postures of operators. All this has caused the emergence of continuous musculoskeletal loading of the crane operators. The results of the anthropometric research that were obtained on the population of crane operators in this case study suggest that there is a statistically significant difference, when compared data of this population of workers with anthropometric data from the general population. CONCLUSIONS: Analyzed workplaces in crane cabins do not correspond to the majority of operators from the anthropometric standpoint. The conducted anthropometric analysis has been indicated that could be made the mistake, if dimensions of the cabin and layout of equipment would be relied on data derived from the general population of citizens. In order to achieve greater precision in the design and configuration of equipment, it is recommended using the data that are obtained directly on the population of the crane operators when designing the cabin.

Atypical case of Wilson's disease with psychotic onset, low 24 hour urine copper and the absence of Kayser-Fleischer rings.

INTRODUCTION: Wilson's disease is typically manifested in two clinical forms, neurological and hepatic and in rare cases it starts with psychiatric symptoms exclusively. We presented a rare atypical case of Wilson's disease with psy- chotic onset. CASE REPORT: A 22-year-old male patient was initially presented with predominant signs and symptoms of psychiatric disorder and then later with the development of neurological signs and symptoms. Neuroimaging, detected metal deposits in central nervous system (CNS) but not in peripheral organs, while serum analysis excluded pantothenate-kinase associated neurodegeneration and aceruloplasminemia. In favor of the diagnosis of Wilson's disease there were reduced concentrations of copper and ceruloplasmin concentrations and metal deposits in CNS, but other pathognomonic signs and symptoms were absent: increased copper in urine, Kayser-Fleischer rings in Descemet's corneal membrane and deposits of copper in liver. Introduction of penicillamine treatment resulted in improvement in mental and general health of the patient. Molecular genetic analysis definitely confirmed the diagnosis of Wilson's disease. CONCLUSION: Wilson's disease can remain undetected for a long period of time if masked with dominant or exclusive psychiatric symptoms. If clear clinical symptoms and signs, and unambiguous laboratory findings are not present, it is necessary to perform molecular genetic analysis to confirm the definitive diagnosis.

[Pregnancy outcome during the bombing of Yugoslavia from March 24 to June 9, 1999].

BACKGROUND/AIM: The aim of this study was to evaluate pregnancy outcome during the bombing of Yugoslavia in the period from March 24 to June 9, 1999. METHODS: A retrospective study included a total of 81 spontaneous abortion following XII gestation week, and 1448 deliveries, hospitalized in the regional hospital. The analyzed were: the incidence of spontaneous abortion, Cesarean section, post-term delivery, vaginal delivery following the previous Cesarean section within the period from March 24 to June 9, 1999, and compared to the same periods in 1998 and 2000 by the use of chi2 and Kolgomorov-Smirnov tests. RESULTS: Under the conditions of a three-month stress imposed by the bombing, significantly increased were the incidence of spontaneous abortion and vaginal delivery following the previous Cesarean section, while the incidence of Cesarean section and post-term delivery were decreased, but the incidence of perinatal outcome was paradoxically improved. The analysis of findings on admittance revealed that iterative Cesarean section was performed electively, close to the expected term of delivery, and vaginal delivery following the previous Cesarean section mainly two weeks before that term with the admittance finding confirming a high active stage pregnancy. CONCLUSIONS: Within the bombing, statistically significantly was increased the percentage of abortions after XII gestation week, and the biological duration of pregnancy was reduced. The reduced duration of pregnancy complete with the accelerated fetal mutation (also caused by the stress) resulted in better perinatal outcome, and statistically significantly lower percentage of Cesarean section.

[Histochemical detection of primary shell residue mixture in the entry of gunshot wounds]. / Histohemijsko dokazivanje rezidua inicijalne smese kapisle u ulaznom otvoru strelne rane.

Alizarin red S, a commonly used organic dye in the histologic identification of calcium deposits, also forms colored reaction products with other metal ions, such as barium and lead, which are present in primer residue. The possibility was presented of using this histochemical technique in determination of firing distance based on the results in experimentally made close-range gunshot wounds (up to 1 m) by using several types of firearms.