Military medicine
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Comparative Study
Reproductive health in eight navies: a comparative report on education, prevention services, and policies on pregnancy, maternity/paternity leaves, and childcare.
As occupational cultures, navies are remarkable for an ability to achieve far-reaching cultural and behavioral effects by both sweeping and incremental policy changes. Therefore, navy policies for reproductive health education and services, childcare, and maternity and paternity leaves have potential to be at the vanguard of gender parity efforts to successfully integrate women into once male-only occupations. This article provides summaries of reproductive health education programs, pregnancy prevention services, and policies currently in effect in eight navies where women work alongside male peers as sailors and officers. ⋯ The results are quotations from completed questionnaires and policies sent from the navies of Germany, Latvia, the Netherlands, Norway, South Africa, Spain, the United Kingdom, and the United States. Policies under review include sexual conduct, pregnancy, and maternity and paternity leaves. We also report the latest available statistical data regarding women in these navies, such as numbers of women, percentages of navy women vs. total military women, and dates of women's inclusion as naval personnel.
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We present 4 cases of talus dislocation. In one case we had open total lateral dislocation of the talus and in 3 other cases we had closed subtalar dislocation (disruption of the talocalcaneal and talonavicular joints). Reposition of the dislocation was made and talocalcaneal transfixation completed with 3 Kirschner wires, placed like a spread fan, under fluoroscopic control. Reoccurring dislocations were not experienced nor were there signs of avascular necrosis in these 4 cases.
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To assess risk of disability discharge in U. S. Navy and Marine Corps personnel receiving waivers of medical accession standards for mental health, we retrospectively identified a cohort of 22,960 waiver recipients from February 2001 to November 2005. ⋯ Because of the high per-case compensation cost for mental health disability, this excess risk represents an estimated 32% higher disability compensation cost. We recommend further analysis of the waiver cohort to identify disqualifying conditions without excess disability risk. Targeting these conditions for policy changes could increase manpower without incurring long-term disability costs.
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Neurosurgeons at David Grant Medical Center (DGMC) have had low surgeon case volumes. Meanwhile, veterans have had long waits because of inadequate neurosurgical coverage. DGMC and Department of Veteran Affairs (VA) agreed to share resources to treat an underserved VA patient population. We analyzed number of cases, admissions, relative weighted product (RWP), and outpatient visits before and after this unique military-VA agreement. ⋯ The sharing agreement resulted in 1.7-fold increase in operative cases. This military-VA venture provides military neurosurgeons with more surgical cases and provides neurosurgical care to a previously underserved patient population.
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Military personnel deployed to Iraq and Afghanistan witnessed decreased numbers of soldiers killed in action and increased numbers of soldiers wounded in action. Medical personnel attribute these changes to use of improved body armor, rapid evacuation to medical treatment facilities, and use of medical technology. ⋯ This study uses modeling and simulation (M&S) to produce combat casualties, incorporate the projected benefits of field tourniquets and bandages, and examine their effects on wounded soldiers in a realistic simulated combat setting. The results show the positive benefit of using M&S to support analysis of medical technology and to inform medical research decisions.