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PubMed2004

Dental emergency rates at two expeditionary medical support facilities supporting operations enduring and Iraqi Freedom.

This study reports dental emergency rates and distribution of causes of dental emergencies at two expeditionary medical support facilities supporting operations Enduring Freedom/ Iraqi Freedom. A retrospective cohort analysis of 9948 soldiers deployed to Prince Sultan Air Base, Kingdom of Saudi Arabia, and 1467 soldiers at Baghdad International Airport, Iraq, was accomplished from a phased deployment from January 2003 to September 2003. Procedures were divided into 11 categories: endodontic, extraction of teeth other than third molars, extraction of third molar teeth, restoration of teeth (caries), restoration of broken teeth (not caries), orthodontic bracket/wire problem, sensitive teeth, temperomandibular pain, periodontal, oral pathology, and prosthodontic. The dental emergency rates for Prince Sultan Air Base and Baghdad International Airport were 153 and 145 dental emergencies per 1000 soldiers per year, respectively. Most of the emergencies were because of dental caries. Pain from third molars was the second most common reason for visiting the dental clinic.

Dental Service, Hospital↗
PubMed2005

The 274th Forward Surgical Team experience during Operation Enduring Freedom.

The 274th Forward Surgical Team (FST) was deployed in support of Operation Enduring Freedom from October 14, 2001 to May 8, 2002. During this period, the FST was asked to perform many nondoctrinal missions. The FST was tasked with functioning as a mini-combat support hospital during the earlier phases of Operation Enduring Freedom, performing in-flight surgical procedures and resuscitation of combat wounded, conducting split operations with surgical coverage of both Karshi and Khanabad, Uzbekistan, and Bagram, Afghanistan, and leading the multinational medical coalition assembled for Operation Anaconda and other combat operations staged from Bagram. Overall, the 274th FST took care of approximately 90% of U.S. combat casualties during this period and treated a total of 221 combat casualties. The FST treated 103 total surgical cases, including 73 with combat wounds. At the time, this experience with combat casualties and the surgical care of combat wounds was the largest since the Persian Gulf War. More importantly, this account describes the flow, frequency, and type of combat casualties seen in a low-intensity conflict like that being waged currently in Afghanistan. It is hoped that this depiction will aid in the preparation, equipping, and overall utilization of surgical assets in similar future conflicts.

Afghanistan↗
PubMed2005

Clinical case series: the use of Prazosin for combat-related recurrent nightmares among Operation Iraqi Freedom combat veterans.

OBJECTIVE: Increased central nervous system norepinephrine outflow and alpha1-adrenergic receptor responsiveness appear to be involved in the pathophysiologic processes of trauma-related nightmares in post-traumatic stress disorder. On the basis of reports that the brain-accessible alpha1-adrenergic antagonist Prazosin substantially reduced chronic combat-related nightmares among Vietnam War veterans, we evaluated Prazosin effects on combat-related nightmares among combat soldiers returning from Operation Iraqi Freedom. METHODS: Twenty-eight soldiers who self-reported distressing combat trauma-related nightmares on a postdeployment questionnaire were prescribed low-dose Prazosin before bedtime. RESULTS: Of the 23 soldiers for whom follow-up evaluations were available, 20 experienced marked improvement (complete elimination of nightmares), 2 experienced moderate improvement (reduced nightmare frequency or intensity), and 1 experienced no change. Prazosin was well tolerated. CONCLUSIONS: Prazosin appeared highly beneficial for combat-related nightmares characteristic of post-traumatic stress disorder among troops recently returned from Operation Iraqi Freedom. These findings provide a rationale for a placebo-controlled trial to establish efficacy in this population.

Adrenergic alpha-Antagonists↗
PubMed1982

"Freedom of choice" laws: empirical evidence of their contribution to competition in mental health care delivery.

Freedom of Choice laws have been forwarded as laws which enhance consumer choice and efficient functioning of markets for mental health services. The name of these laws constitute a misnomer, because they serve to force consumers to buy a specific type of insurance coverage. Nevertheless, under a specific set of markets conditions, the implementation of Freedom of Choice laws may increase competition and improve efficiency in the market. Empirical estimates are reported of the effect on prices of this legislation.

Community Participation↗
PubMed1998

Pathological T3 and/or margin positive prostate adenocarcinoma with undetectable postoperative PSA - to irradiate or not?: analysis of freedom from PSA failure.

We retrospectively analyzed 48 patients with pathological T3 (PT3) and/or margin positive disease who had undetectable or unknown postoperative serum prostate specific antigen (PSA) following radical prostatectomy. Twenty-nine patients received postoperative adjuvant radiotherapy (RT) while 19 did not. Follow-up ranged from 0.5 to 6.9 years with a median of 3.4 years for the irradiated group and 2.9 years for the surgery alone group. PSA outcome was available on all patients. Freedom from failure was defined as the maintenance of a serum PSA level of < 0.2 ng/ml and the absence of clinical local recurrence and distant metastasis. Actuarial overall survival was 92% for the entire group and showed no difference between the irradiated and non-irradiated groups. However, the 5-year actuarial disease free survival including freedom from PSA failure was statistically better in those treated with adjuvant RT than that in the surgery alone group (88% vs 46%, p=0.0035). The morbidity of adjuvant RT was acceptable with only 2 patients developing Grade 3 genitourinary complication.

Journal Article↗
PubMedDate not supplied

Large-scale study of freedom from smoking clinics--factors in quitting.

The American Lung Association's Freedom From Smoking Clinics are widely available in the community and at the worksite for smokers who wish the help of a formal group program in quitting the habit. Little has been published on their outcomes. A study of 494 smokers attending 42 Freedom From Smoking Clinics in western New York State showed that 29 percent reported not smoking about 1 year after attending the clinic sessions. There was a wide range of quit rates over different clinics, but the rates were similar for men and women and for different age groups. Those initially smoking less than one pack per day were more likely to be successful in quitting than heavier smokers. Quit rates were similar in work site groups and in the community clinics. Perceptions of having received group support at the clinic were also related to higher success rates. Research on group composition and process might be a fruitful road to raising what seems to be a ceiling on the success of current techniques.

Adolescent↗
PubMed1991

A health maintenance facility for space station freedom.

We describe a health care facility to be built and used on an orbiting space station in low Earth orbit. This facility, called the health maintenance facility, is based on and modeled after isolated terrestrial medical facilities. It will provide a phased approach to health care for the crews of Space Station Freedom. This paper presents the capabilities of the health maintenance facility. As Freedom is constructed over the next decade there will be an increase in activities, both construction and scientific. The health maintenance facility will evolve with this process until it is a mature, complete, stand-alone health care facility that establishes a foundation to support interplanetary travel. As our experience in space continues to grow so will the commitment to providing health care.

Ambulatory Care Facilities↗
PubMed1990

Further experience with the Delmed Freedom Set and the Flush Drain/Fill sequencing.

Presented in February 1989 from this program was data that reflected our departure from the then recommended procedure of Drain/Flush/Fill sequencing with the Delmed Freedom Set. Our procedure was changed to the now accepted Flush/Drain/Fill sequencing in this Y-configured, manual disconnect system. The improvement in the incidence of peritonitis was reflected in the data that demonstrated 1 episode of peritonitis (EOP)/12.4 patient months with the Drain/Flush/Fill (D/F/F) sequencing and the improved incidence of 1 EOP/30.4 patient months Flush/Drain/Fill (F/D/F). Presented here is the cumulative data with an additional 144 patient months experience with the F/D/F sequencing of the Delmed Freedom Set and its Safelock connectology. The incidence of peritonitis remains relatively low, and not significantly different from that initial 1 year data, being 1 EOP/29.6 patient months (current) vs. 1 EOP/30.4 patient months (1 year data).

Catheters, Indwelling↗
PubMed1988

[A pen-injector of insulin in young diabetics: freedom and excessive weight gain].

This study was undertaken to evaluate the use of a pen injector (Novopen) in 23 type I diabetic adolescents and young adults between 14 and 28 years of age. All patients were diabetic before age 15 and the duration of diabetes varied from 5 to 23 years. All patients were previously treated with a conventional regimen of Actrapid HM and Monotard HM or Protaphane HM twice daily (0.98 +/- 0.24 U/kg/day). The patients used Novopen to inject Actrapid HM in a bolus regimen with Ultratard HM as basal insulin, administered before bedtime. The mean duration of the Novopen experience was 8.1 months [1-12]. During the first 4 months after transfer to Novopen, the total daily dosage of insulin was higher than 1 U/kg; afterwards the insulin needs decreased to 0.8 U/kg (at 12 months). On the other hand, the weight/height ratio increased significantly from the 4th month. After one year, the mean increase was 14%. The "objective" determination of metabolic control was obtained by measuring total glycosylated haemoglobin, the mean level of which was unchanged after the transfer to Novopen. The patients' self evaluation of the therapy was documented by asking them to fill in a questionnaire. Results were as follows: 91% of the patients considered the use of Novopen more pleasant than the previous injection therapy; 87% reported a greater freedom regarding diet; 83% found Novopen easier to handle than syringes; 74% experienced greater freedom in everyday life; 70% found the injection by Novopen less painful; 61% considered that their metabolic control improved; 39% experienced minor signs of hypoglycaemia more frequently; 100% wanted to continue on Novopen.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1988

[Life and freedom as a compulsion? Considerations of the relation of the phenomenology of life and analysis of existence].

The phenomenon of compulsion, unless it is seen as purely pathological, discloses in a peculiar way by an analysis of the situation in connexion with the immanence of life. Challenged by a given situation man must react immediately whereas the first origin of human existence is a state of passivity without any possible escapes. In so far freedom rests on a inevitableness, that reactualizes with every challenge by the daily situation. This "compulsion" to answer permits at the same time real freedom; for the clever and synthesic questions to life give way to the real tasks, that have to be settled at the moment.

Adaptation, Psychological↗
PubMedDate not supplied

Rabies in Ireland: a precarious freedom.

The prolonged freedom from rabies enjoyed by Ireland is based on both its island location and the rigid enforcement of national legislation. The yachting tourist and the increased level of shipping activity in ports and harbours are a major threat of disease introduction. Mass media publicity and public awareness are the main safeguards necessary to protect the freedom of our island.

Animals↗
PubMed1986

[Risk of suicide in the psychiatric clinic in relation to compulsory security guarantees and freedom as adjunct to therapy].

Whereas doctors and nurses in a psychiatric hospital are compelled, on the one hand, to prevent a mental patient from committing suicide (which may entail quite considerable restriction of freedom of movement and action), they may find it necessary on the other hand to grant him a certain amount of freedom as an adjuvant to therapy. It has been said that one may well fear that the compulsion to prevent suicide completely over rules therapy as such, and hence that official legislation is an obstacle to full utilisation of existing chances of cure, since it requires doctors and nurses to prevent suicide as the first and foremost consideration. This fear, however, is unfounded. Rather, the psychiatrist is called upon to weight the suicide risk against the chances of cure under less strict supervision in individual cases that appear suitable for following such a procedure. This conclusion is based on legal theoretical deliberations and is in line with judgements pronounced by Federal German Supreme Courts.

Germany, West↗
PubMed1981

The Freedom of Information Act and Medicare costs reports.

Health care providers must submit cost reports to the Department of Health and Human Services or its designated intermediary before they can be reimbursed for their services by the Medicare system. These reports closely detail the financial operations of the provider. Whenever third parties have requested copies of the cost reports pursuant to the Freedom of Information Act and the Department of Health, Education and Welfare (now HHS) has declared its intention to comply with the request, the providers have sued to enjoin disclosure. This Note evaluates whether the cost reports are confidential and therefore exempt from mandatory disclosure under Exemption 4 of the Freedom of Information Act. It concludes that they should not be exempt, but that even if they are, disclosure is mandated by a validly promulgated HEW regulation. This regulation was enacted in compliance with the Administrative Procedure Act, and should not be considered on abuse of the HEW Secretary's discretion.

Confidentiality↗
PubMedDate not supplied

Professional freedom of government leprosy personnel.

BACKGROUND: Government employment in India is known for its lack of flexibility. We studied whether this also involved professional freedom among health personnel working for the National Leprosy Eradication Programme. METHODS: The sample population consisted of National Leprosy Eradication Programme employees from Tamil Nadu and Andhra Pradesh and 8 health professional groups. A questionnaire was developed for each of them to elicit information on 5 aspects of their autonomy. They were studied individually and as homogeneous groups so that comparisons were possible both within and between groups in different regions who were conducting similar health programmes. RESULTS: National Leprosy Eradication Programme personnel enjoy a high degree of autonomy within the organization. This autonomy was evident in both states investigated, despite different administrations and it was not connected with the professional positions they held. Professional freedom correlated with the training activities, promotional prospects and commitment to the organization. CONCLUSIONS: The National Leprosy Eradication Programme job is not rigid because the organization is small and the intellectual needs of the professionals are met within it.

Adult↗
PubMedDate not supplied

[Does restriction of sexual freedom according to article 169 of the Penal Code serve the mentally ill?].

Article 169 of the penal code imposes a ban on sexual contacts with a person, who is fully or to a significant degree deprived of the ability to recognize the meaning of his/her actions or to control his/her behaviour. A partner of a mentally retarded or mentally ill person, who engages fully in biologically and culturally appropriate sexual activity, can become criminally liable, receiving up to 10 years of freedom loss. The freedom of the insane and persons with strongly diminished mental ability is supposed to be a protected "good". The Polish Psychiatric Society tabled a motion in favour of abolishing this regulation, but the penal code reform committee did not accept this postulate. It is worth noting that sexual partnership constitutes both for men and women an irreplaceable human right. Nature itself does not exclude the mentally ill from the mystery of life which is unpredictable in its destiny. It should be added that some of the mentally ill identify hope for further living with the hope of keeping an intimate partnership.

Female↗
PubMed1976

A psychoanalytic model for human freedom and rationality.

The nature and scope of freedom and rationality in man are explored in light of the problems posed by a deterministic framework for understanding and explaining human though, feeling, and behavior. It is argued that the sort of explanation afforded by a psychodynamic theory is fully compatible with attributing freedom and rationality to persons. In particular, psychoanalytic theory is able to account for the existence of causal laws governing all aspects of human behavior, while providing a schema by which we can distinguish rational from irrational behavior, and free acts from those that are unfree.

Behavior↗
PubMed1991

Consent to mental health treatment: a theoretical analysis of coercion, freedom, and control.

Research has shown that substantial numbers of mental health patients may be coerced into 'voluntary' treatment. This article examines the concept of coercion to address the concerns of social scientists, treatment providers, and policy makers to know when coercion into treatment has occurred. This logically takes precedence over the second important question of whether or not coercion is desirable in some situations. A review of the scientific research on coercion and related topics of freedom, control, and choice leads to a theoretical framework in which coercion is defined in terms of opportunities to choose among courses of action. Implications of this analysis are drawn for mental health service delivery, mental health policy, and mental health research.

Choice Behavior↗