A literature review of medical aspects of post-cold war UN peacekeeping operations: trends, lessons learnt, courses of action and recommendations.

OBJECTIVE: Post-Cold War United Nations Peace Keeping Operations (UN PKOs) have been increasingly involved in dangerous areas with ill-defined boundaries, harsh and remote geographies, simmering internecine armed conflict and disregard on the part of some local parties for peacekeepers' security and role. In the interest of 'force protection' and optimising operations, a key component of UN PKOs is healthcare and medical treatment. The expectation is that UN PKO medical support will conform to the general intent and structure of UN PKOs. To do so requires effective policies and planning informed by a review of medical aspects crucial to UN PKOs. The intent of this article is to report on a review of principal medical aspects practical to post-Cold War UN PKOs. METHODS: This review was assembled through a comprehensive, grounded, systematic iterative inquiry of open-source articles. RESULTS: This inquiry revealed that the principal medical aspects in post-Cold War UN missions were the following: (1) the changed nature of UN PKOs, (2) new challenges in terms of proximity and distance to medical care, (3) expanded need for preventive medicine and disease contagion prevention and (4) increased propensity for psychological morbidity and need for intervention. CONCLUSIONS: Post Cold War, the dramatically changed nature of UN PKOs has resulted in new challenges mainly in terms of medical logistics, preventive medicine and psychiatry. The changed nature of post-Cold War UN PKOs altered the character of medical support most notably regarding (1) a need for emphasis on immediate response proximate to medical events and rapid transport over long distances and traversing barriers to higher levels of care, (2) proactive contagion and hazard identification and prevention and (3) interventions designed to reduce psychological morbidity. Recommendations are offered about possible courses of action in terms of addressing trends found in identified medical aspects of PKOs.

Mutations in smooth muscle alpha-actin (ACTA2) cause coronary artery disease, stroke, and Moyamoya disease, along with thoracic aortic disease.

The vascular smooth muscle cell (SMC)-specific isoform of alpha-actin (ACTA2) is a major component of the contractile apparatus in SMCs located throughout the arterial system. Heterozygous ACTA2 mutations cause familial thoracic aortic aneurysms and dissections (TAAD), but only half of mutation carriers have aortic disease. Linkage analysis and association studies of individuals in 20 families with ACTA2 mutations indicate that mutation carriers can have a diversity of vascular diseases, including premature onset of coronary artery disease (CAD) and premature ischemic strokes (including Moyamoya disease [MMD]), as well as previously defined TAAD. Sequencing of DNA from patients with nonfamilial TAAD and from premature-onset CAD patients independently identified ACTA2 mutations in these patients and premature onset strokes in family members with ACTA2 mutations. Vascular pathology and analysis of explanted SMCs and myofibroblasts from patients harboring ACTA2 suggested that increased proliferation of SMCs contributed to occlusive diseases. These results indicate that heterozygous ACTA2 mutations predispose patients to a variety of diffuse and diverse vascular diseases, including TAAD, premature CAD, ischemic strokes, and MMD. These data demonstrate that diffuse vascular diseases resulting from either occluded or enlarged arteries can be caused by mutations in a single gene and have direct implications for clinical management and research on familial vascular diseases.

Use of Tactile Contact Accompanying Health Prmotion Messages During Routine Health & Physical Examinations: A Technique for Improving Compliance.

A daunting challenge for health providers and medical practitioners is communicating the vital importance of health promotion and medical treatment adherence and compliance. This article is an evidence-based, best-practices commentary advocating the use of touch-accompanied verbal suggestions during the touching portions of routine, near-universal Health & Physical examinations. Notional case examples are presented; based on the professional literature, underlying Behavioral Mechanics are discussed. Touch-accompanied verbal health promotion messages skillfully deployed in routine Health & Physical examinations offer a non-harmful and efficient technique to synergistically and substantially enhance the probability of patient compliance with health improvement and medical treatment regimens. Though it is not a magic panacea, the public health applications, extensions and benefits are incalculable in terms of healthy behavior adoption. Additionally, if deftly conducted in accordance with best practices, it has the potential to greatly improve practitioner-patient relations and increase patient satisfaction. Further avenues of research inquiry are considered.

Tactile Contact as a Marketing Tool for Improving an HIV/STD Education Program's Compliance / Retention with Crack Cocaine Users.

BACKGROUND: This research brief reports results from an exploratory pilot study on the use of socially acceptable touch in a public setting that accompanies a request to improve program compliance with "street level" crack cocaine users. METHODS: Study participants consisted of 120 crack cocaine-using participants in a larger community-based HIV/STD prevention and research program targeting at-risk African-Americans. They were required to return for a series of four booster health education sessions over 2-5 days and 6 month and 1 year follow-up assessments. The most difficult aspect of this program was no-shows for the second booster session; study participants who attended at least two sessions were much more likely to attend all sessions and complete the entire lengthy program. The program director randomly approached some participants after the first visit in a public setting and briefly touched them as part of a handshake; then, the director asked them to return for their follow-up sessions. Whether they were approached or not was random. Analysis comprised descriptive and non-parametric statistics. RESULTS: Ninety-three percent of participants who were asked to return and were touched returned for the second session; only 75% returned who had been asked to do so but were not touched. A statistically significant difference favored being touched and complying, as measured by second-session returning participants (p < .01), though it appeared the touch / request had more of a preventive than a promotional effect. Extraneous demographic and background factors were ruled out with the exception of age (older participants), which contributed slightly. CONCLUSIONS: Results suggest that a request "anchored" to a socially acceptable public touch is promising in terms of improving program participation and engagement. Limitations and implications for future research are discussed.

Paramilitary Provision of Adequate Disaster Response and Advancement of Public Health: The Case of the Texas State Guard and Operation Lone Star.

OBJECTIVE: This article reports on State Defense Forces (SDFs) as tools for providing coordinated, disciplined, trained, and uniformed volunteers to augment civilian disaster response and advance public health. METHODS: This report draws on and describes the example of the Texas State Guard's Medical Brigade and its Operation Lone Star. RESULTS: Although SDFs have downsides, since they are largely self-sufficient, they are far less expensive and burdensome yet nonetheless effective alternatives. CONCLUSIONS: Future avenues for further inquiry are suggested. (Disaster Med Public Health Preparedness. 2017;11:412-416).

Post-cold war United Nations peacekeeping operations: a review of the case for a hybrid level 2+ medical treatment facility.

Post-Cold War, UN peacekeeping operations (UN PKOs) have become larger, more mobile, multi-faceted and conducted over vast areas of remote, rugged, and harsh geography. They have been increasingly involved in dangerous areas with ill-defined boundaries, simmering internecine armed conflict, and disregard on the part of some local parties for peacekeepers' security and role. Yet progressively there have been expectations of financial restraint and austerity. Additionally, UN PKOs have become more "robust," that is, engaged in preemptive, assertive operations. A statistically positive and significant relationship exists between missions' size, complexity, remoteness, and aggressive tenor and a higher probability of trauma or death, especially as a result of hostile actions or disease. Therefore, in the interest of "force protection" and optimizing operations, a key component of UN PKOs is health care and medical treatment. The expectation is that UN PKO medical support must conform to the general intent and structure of current UN PKOs to become more streamlined, portable, mobile, compartmentalized, and specialized, but also more varied and complex to address the medical aspects of these missions cost-efficiently. This article contends that establishing a hybrid level 2-a level 2 with level 3 modules and components (i.e., level 2+)-is a viable course of action when considering trends in the medical aspects of Post-Cold War UN PKOs. A level 2 medical treatment facility has the potential to provide needed forward mobile medical treatment, especially trauma care, for extended, complex, large-scale, and comprehensive UN PKOs. This is particularly the case for missions that include humanitarian outreach, preventive medicine, and psychiatry. The level 2 treatment facility is flexible enough to expand into a hybrid level 2+ with augmentation of modules based on changes in mission requirements and variation in medical aspects.