Non-medical aspects of civilian-military collaboration in management of major incidents.

PURPOSE: Disasters and major incidents demand a multidisciplinary management. Recent experiences from terrorist attacks worldwide have resulted in a search for better assessment of the needs, resources, and knowledge in the medical and non-medical management of these incidents and also actualized the need for collaboration between civilian and military healthcare. The aim of this study was to evaluate the impact of the civilian-military collaboration in a Swedish context with the main focus on its non-medical management. METHOD: An exercise, simulating a foreign military attack centrally on Swedish soil, was designed, initiated, and conducted by a team consisting of civilian and military staff. Data were collected prospectively and evaluated by an expert team. RESULTS: Specific practical and technical issues were presented in collaboration between civilian and military staffs. In addition, shortcomings in decision-making, follow-up, communication, and collaboration due to prominent lack of training and exercising the tasks and positions in all managerial levels of the hospital were identified. CONCLUSION: Current social and political unrests and terror attacks worldwide necessitate civilian-military collaboration. Such collaboration, however, needs to be synchronized and adjusted to avoid preventable medical and non-medical consequences. Simulation exercises might be one important source to improve such collaboration.

Adverse health events and late mortality after pediatric allogeneic hematopoietic SCT-two decades of longitudinal follow-up.

Treatment-related late toxicities after pediatric allogeneic hematopoietic SCT (allo-HSCT) are increasingly important as long-term survival has become an expected outcome for many transplanted children and adolescents. In a retrospective cohort study, we assessed long-term health outcomes in 204 allo-HSCT survivors transplanted in childhood or adolescence (<20 years) between 1978 through 2000 after a median follow-up time of 12 (range 4-28) years. Data on conditioning regimen, adverse health events (AE) and growth and hormonal substitutions (hormone replacement therapies (HRTs)) were obtained from medical records. AEs were graded retrospectively according to Common Terminology Criteria for Adverse Events v3.0. Late deaths (⩾48 months after allo-HSCT) were evaluated separately. Multivariate analysis demonstrated that chronic GVHD (P<0.000) and longer follow-up time (P<0.05) correlated with AEs, whereas CY-based conditioning was inversely correlated (P<0.002). TBI and longer follow-up duration predicted more severe AEs (P<0.001 and P<0.001, respectively). HRTs were more frequent after TBI. Diabetes type II, dyslipidemia and hypertension were detected in 9, 7 and 7% of the survivors, respectively. Late deaths (n=22) were most frequently due to pulmonary failure (n=7), followed by secondary malignancy (n=5). The occurrence of AEs after pediatric allo-HSCT is high and likely to increase during extended follow-up, particularly in patients who have received TBI.

Ovarian function after allogeneic hematopoietic stem cell transplantation in childhood and adolescence.

OBJECTIVE: The aim of the study was to evaluate long-term ovarian function after allogeneic hematopoietic stem cell transplantation (HSCT) in childhood and adolescence. SUBJECTS AND METHODS: Predictive factors for ovarian function were evaluated among 92 adult or pubertal female survivors transplanted at Huddinge and Helsinki University Hospital during 1978-2000, at a mean age of 9±4.3 years (range 1-19). At the time of the study a mean±s.d. of 13±5.5 years (range 6-27) had elapsed since the HSCT and the mean age of the participants was 22±6.3 years (range 9-41). RESULTS: Spontaneous puberty based on breast development occurred in 40 and menarche in 30 of the 70 girls who were prepubertal at transplantation. Six out of 20 girls who received HSCT after initiation of pubertal development recovered their ovarian function. Younger age at HSCT, conditioning without total body irradiation (TBI), and a non-leukemia diagnosis predicted the spontaneous menarche. The incidence of menarche was higher after fractioned vs single fraction TBI (P<0.05), cyclophosphamide (Cy) vs busulfan (Bu)-based conditioning (P<0.05), and among leukemia patients transplanted at first remission vs later remissions (P<0.01) and with no cranial irradiation (cranial radiotherapy, CRT) vs given CRT (14-24 Gy) (P<0.01). The majority of recipients conditioned with only Cy vs TBI (P<0.001) or vs Bu-based regimens (P<0.01) showed preserved ovarian function and required no estrogen replacement at their latest follow-up visit at a mean age of 23±6.3 years (range 15-41). Ten women became pregnant. CONCLUSIONS: Patients conditioned with TBI or Bu-based regimes are at high risk of ovarian failure. Intensive anti-leukemia therapy before HSCT including CRT especially among relapsed patients may further decrease the possibility of spontaneous menarche.

An attempt at distinguishing subgroups of women with anorexia nervosa and bulimia nervosa by means of the Defense Mechanism Technique modified (DMTm) and the Eating Disorder Inventory (EDI).

In an attempt to identify diagnostically meaningful subgroups in a group of sixty women 18-34 years of age, 19 of them having a DSM-IV diagnosis of anorexia nervosa and 41 of bulimia nervosa, a hierarchical cluster analysis was performed on their data obtained from the Defense Mechanism Technique modified (DMTm) and the Eating Disorder Inventory (EDI). Variables also taken into account in the cluster analysis were those of the main diagnosis, depression, personality disorder, binge eating, purging, Body Mass Index (BMI), and exercise. Five distinct clusters were found. Six of the eight EDI variables and fourteen of the twenty DMTm variables were represented in the description of the clusters. One anorexic and one bulimic cluster included DMTm signs previously found in patients with fibromyalgia. Two bulimic clusters included DMTm signs previously observed in patients with either distal or total ulcerative colitis. Hysteria was linked with the remaining anorexic cluster. On both EDI and DMTm the two main groups of anorexic and bulimic patients displayed few differences. It was mainly the various constellations of DMTm variables, interpreted in terms of the Andersson developmental and psychodynamic model of the mind, that were crucial for understanding the five clusters obtained.

Ultrasound examination of soft tissue injury of the lower limb in athletes.

We performed ultrasonography on 32 athletes complaining of intense pain in a swollen and tender thigh or calf after a contusion or stretching trauma. The ultrasonogram was used to visualize the presence and size of a suspected hematoma. The findings included the following: 7 patients with a circumscribed, anechoic lesion compatible with a liquefied hematoma; 10 patients with a circumscribed lesion of mixed echogenicity compatible with areas of liquefied hematoma, coagulated blood, and edema; and 15 patients with a diffuse change in echogenicity of the whole muscle. The circumscribed liquefied, and mixed hematoma were more common after contusion trauma, while the diffuse type was more common after injury caused by stretching. Ultrasonography is useful in localizing the hematoma and in characterizing the different types. Differentiation is important in diagnosis and choice of treatment.

Genetical control of phosphoglucose isomerase isozymes in the Japanese quail erythrocytes.

Three phenotypes of phosphoglucose isomerase (PGI) from the Japanese quail erythrocytes were observed by horizontal starch gel electrophoresis. Population and family data from one laboratory population of quail was consistent with the theory that PGI polymorphism was controlled by two codominant, autosomal alleles designated PGIF and PGIS with gene frequency values 0.25 and 0.75, respectively. The study supported the earlier view that the Japanese quail is highly polymorphic with regard to biochemical variation.