US Air Force Behavioral Health Optimization Program: team members' satisfaction and barriers to care.

BACKGROUND: Research has shown significant contribution of integrated behavioural health care; however, less is known about the perceptions of primary care providers towards behavioural health professionals. OBJECTIVE: The current study examined barriers to care and satisfaction with integrated behavioural health care from the perspective of primary care team members. DESIGN: This study utilized archival data from 42 treatment facilities as part of ongoing program evaluation of the Air Force Medical Service's Behavioral Health Optimization Program. SETTING: This study was conducted in a large managed health care organization for active duty military and their families, with specific clinic settings that varied considerably in regards to geographic location, population diversity and size of patient empanelment. STUDY PARTICIPANTS: De-identified archival data on 534 primary care team members were examined. RESULTS: Team members at larger facilities rated access and acuity concerns as greater barriers than those from smaller facilities (t(533) = 2.57, P < 0.05). Primary Care Managers (PCMs) not only identified more barriers to integrated care (ß = -0.07, P < 0.01) but also found services more helpful to the primary care team (t(362.52) = 1.97, P = 0.05). Barriers to care negatively impacted perceived helpfulness of integrated care services for patients (ß = -0.12, P < 0.01) and team members, particularly among non-PCMs (ß = -0.11, P < 0.01). CONCLUSIONS: Findings highlight the potential benefits of targeted training that differs in facilities of larger empanelment and is mindful of team members' individual roles in a Patient Centered Medical Home. In particular, although generally few barriers were perceived, given the impact these barriers have on perception of care, efforts should be made to decrease perceived barriers to integrated behavioural health care among non-PCM team members.

[Military aviation dentistry].

The aim of this article is to introduce the concepts of military aviation dentistry, including facial barotraumas (external otitic barotrauma, barosinusitis and barotitis- media), dental barotrauma, barodontalgia, and dental care for aircrews. Special considerations have to be made when planning restorative, endodontic, prosthodontic and surgical treatment to an aircrew patient. The article supplies the military dental officer with diagnostic and treatment guidelines, and the principles of prevention, periodic examination, and dental-related flight restriction.

[Stages of development of flight medical expertise in Russia].

Flight medical expertise (FME) in military aviation is one of the most important areas of medical support of flight crews manning, maintaining of aircrew health and flight safety. The authors analyse the main stages of development of this area of medical practice. The priority in creation of FME system belongs to our country. Domestic scientists, prominent organizers of military medicine and a large group of aviation physicians developed organizational and methodological basis for studying different impacts of flight factors on the health of flight personnel, development of criteria for admission to flight operations, principles of organization of the examination, implementation of effective methods of disease diagnosis. At the present stage FME development is determined by the needs of medical, technical and psycho-physiological support of supersonic aircraft, the need to adjust to the requirements of aircrew health, advanced diagnostics of the functional state and the search for means to improve the stability of his body to flight factors. The main principles of the FME remains the complexity of the study of the human body in terms of its professional and individual approach to a medical examination, a thorough clinical, clinical and physiological and psychological examinations, regular medical supervision of the health of flight crews.

[Scientific and research experimentation center of aviation and space medicine and human engineeing celebrates 80th anniversary].

The article is devoted to the history of the Research Test Center Aviation and Space Medicine and military ergonomics, now included in the Central Research Institute of the Air Force Defense Ministry. The center throughout 80 years history is a leding research organization in the country for the integrated study of the human factor in aviation and problems connected with it. The world-famous scientific schools in aviation physiology, hygiene and radiolorgy, emergency medicine, aviation psychology and ergonomics have been grounded on the basis of this center. With a high qualified scientific staff and laboratory-and-bench-scale base including unique seminatural airplanes and helicopters complexes, posters and installation simulating the impact of flight factors (centrifuge, hyperbaric chambers, shakenr vestibulyar-WIDE stands, etc.) the center has. successfully slved tasks concerning an improvement of flight crews protection from occupational hazards, ergonomic demands to capabilities of aircraft, professional and psycho-physiological training. Automatic systems of medical decision-making on assessment of the health status in the medical-flight expertise and dynamic medical supervision, planning, treatment and preventive and remedial actions aircrew training are currently 'being developed

[Medical Service of the Finnish Defence Forces].

Thee article is a brief description of the current state of the Finnish Defence Forces medical service and is based on the study of the open access foreign sources. At the beginning, the general information about Finland, the Finnish Defence Forces, and their medical service is presented. Then some particular features are described with more detail, namely, the organization of the inpatient and outpatient treatment, medical supply, scientific research, combat medicine, medical staff education and training, medical , service personnel income.

[Marine, aviation and space physician, psychologist and physiologist (To the 90th anniversary of the birth of G. M. Zarakovskii)].

In the current paper authors discuss problems of marine and aerospace medicine and psychophysiology, which Georgii Zarakovskii (1925-2014), a prominent domestic experts in the field of military medicine, psychology and ergonomics, solved. Authors focused on methodological approaches and results of the study of psychophysiological characteristics and human capabilities took into account for design of tools and organization of flight crews, astronauts and military experts. Authors marked the contribution to the creation of a system integrating psychophysiological features and characteristics of the person neccessary for development, testing and maintenance of aerospace engineering and organization of its professional activities. The possibilities of using the methodology of psychophysiological activity analysis in order to improve the reliability of psychophysiological military specialists, are shown.

[Actual problems of medical care of aviation specialists in the Arctic region].

The article considers the influence of geographic and climatic conditions of the Arctic on a functional condition of aviation professionals. Marked possible effects of aggressive environmental factors on the health of the personnel. Studied the dynamics of the recovery functions of the cardio-respiratory system and of the indicators of general clinical blood test in a period of adaptation to the conditions of the middle latitudes after the return of the personnel from the Arctic. Identified the main activities to preserve the health of aviation specialists, depending on the length of stay in the Arctic region and age.

[The main ways of improvement of medical support of the Air Forces in modern conditions].

Blaginin A.A., Grebenyuk A.N., Lizogub LN. - The main ways of improvement of medical support of the Air Forces in modern conditions. Aircrew conducting active hostilities suffers from the whole spectrum of factors and conditions of the combat situation. The main task for the medical service of the Air Force is to carry out preventive and curative action for aviation specialists who are responsible for the combat capability of aircraft formations. The medical service of the Air Force must have forces and facilities for planning, organization and implementation of the treatment of lightly wounded and sick aviation professionals with short periods of recovery, medical rehabilitation of aircrew qfter suffering injuries, diseases, sanatorium therapy of aircrew with partial failure of health, outpatient and inpatient medical examination aircrew - flight commissions, preventive rest of aviation specialists with symptoms of chronic fatigue. Should be trained aviation physicians, including both basic military medical education and in-depth study of the medical aspects of various fields of personnel of the Air Force.

[Suppositions for development of preventive military air medicine].

It is shown that on the basis of scientific concepts for regenerative medicine and organizational principles of prevention as a result of the research were revealed fundamental laws of life of the organism in an unusual environment. It is concluded that the need to integrate the methodology of research and testing aircraft and medical equipment on a single scientific basis. This will enable more productive use of research results in the field of ergonomics, ecology, and computer science in order to preserve the life and health of military personnel and maintain their combat capability.

[Professional psychological selection system in the Air Force - 50 years].

Given the data about the establishment of the professional psychological selection system in the Air Force in 1958-1964 in the NIIIAM Air Force by the team psychological department under the leadership of K.K.Platonova. Given the names of the developers of this system and given the results of their research. The result of all made work the order of Air Force Commander about the introduction of the psychological selection in Higher Military Aviation School of Pilots, starting from a set of 1964 became. Recommendations for professional psychological selection of a wide range of aviation professionals in various fields, and in the future - and other professionals of the Armed Forces, became the results of future work.

[Flight and altitude medicine for anesthetists-part 3: emergencies on board commercial aircraft]. / Flug- und Höhenmedizin für Anästhesisten - Teil 3: Notfälle an Bord von Verkehrsflugzeugen.

The demographic trend of industrialized societies is also reflected in commercial airlines' passengers: passengers are older nowadays and long-haul flights are routine mode of transport despite considerable chronic and acute medical conditions. Moreover, duration of non-stop flight routes and the number of passengers on board increase. Thus, the probability of a medical incident during a particular flight event increases, too.Due to international regulations minimum standards for medical equipment on board, and first aid training of the crews are set. However, it is often difficult to assess whether a stopover at a nearby airport can improve the medical care of a critically ill passenger. Besides flight operations and technical aspects, the medical infrastructure on the ground has to be considered carefully.Regardless of the amount of experience of a physician medical emergencies on board an aircraft usually represent a particular challenge. This is mainly due to the unfamiliar surroundings, the characteristics of the cabin atmosphere, the often existing cultural and language barriers and legal liability concerns.

[Enhancement of the medical care system for crews on space missions].

An overview of structural, operational and research aspects of the Russian system of medical support to health and performance of cosmonauts on the International space station (ISS) is presented. The backbone of the current tactics of cosmonauts' health maintenance is the original Russian medical care system developed for long-term piloted space fights. Over 12 years of its existence, the ISS has been operated by 33 main crews. The ISS program entrusted the established multilateral medical boards and panels with laying down the health standards as well as the generic and specific medical and engineering requirements mandatory to all international partners. Due to the program international nature, MedOps planning and implementation are coordinated within the network of working level groups with members designated by each IP. The article sums up the experiences and outlines future trends of the Russian medical care system for ISS cosmonauts. The authors pay tribute to academician Anatoli I. Grigoriev for his contribution to creation of the national system of medical safety in long-term piloted space missions, setting the ISS health and environmental standards and uniform principles of integrated crew health management, and gaining consensus on medical policy and operational issues equally during the ISS construction and utilization.

[Founder of domestic bioastronautics (to the 100th anniversary of the birth of V.I. Yazdovskiy)].

The article is concerned to the anniversary of the founder of domestic bioastronautics, leader and organizer of realization of biomedical programs, preparations and supply of the first space flights in our country, V.I. Yazdovskiy. The authors underlined significancy of his shining merits, which helped to develop domestic bioastronautics. In cooperation with S.P. Korolyov, V.I. Yazdovskiy launched the first manned spaceflight. With this flight our country became a leader in space exploration.

[Main concepts of preventive health care for the air staff of sea-based aviation].

The authors researched the air-stuff and complex of adverse factors uncharacteristic for the air-staff of land-based aircraft. It was determined that adverse factors affect the air-staff foremost in 4-5 months of a blue-water sailing, except cardiovascular system diseases. In a month of a blue-water sailing was registered a hypotonic state. Systolic blood pressure varied from 100-105 mm Hg and lower, dystolic blood pressure varied from 60-65 mm Hg and lower. The lowest ranges of blood pressure were registered in three months after the beginning of the sailing. In the following, the hypotonic state, registered during the monthly medical examinations, remained till the end of the sailing. Normal averages of blood pressure were restored in two weeks after the end of sailing. Low red cell count (for more than 1100 points) was registered in 61.5% of patients, (for more than 550 points) in 38.4% of patients. Low white cell count (for more than 4800 points) was registered in 33.3% of patients, (for more than 3300 points) in 41% of patients, (for more than 1330 points) in 25% of patients. Input data was: red cell count--4250 points, white cell count--7300 points in 1 ml of blood. After the sailing haematological indices were restored. The authors suggested guidelines for primary and secondary disease prevention.

[Aviation medicine: yesterday, today and tomorrow].

The article describes the history and current state of medical support of the Air Force. On December 1, 2009 Air Force Medical Service was renamed into the service of aviation medicine of Command Air Forces, and many of the functions of medical support of the Air Force transferred to the newly formed Air Force Center of Aviation Medicine. April 29, 2011 office of Aviation Medicine of the High Command of the Air Force has stepped 95-year milestone. The changes affected all structures entrusted with the issues of medical support of the Air Force. Today, the medical service of the Air Force faces challenges--ensuring safety, the study of flight conditions and their impact on health, job performance and psychological characteristics of flight personnel.

[The contribution of military aviation and space medicine to the biomedical support of the first flight into space].

April 12, 2011 Humanity celebrated 50 years of one of the greatest achievements of the twentieth century--the legendary flight of Y. Gagarin into space. In this study are highlighted the role and importance of military aviation and space medicine, and in particular, the State Scientific Research Testing Institute of Aviation and Space Medicine, Ministry of Defence of the USSR (now--the State Scientific Research Testing Institute of Military Medicine, Military Medical Academy named after S.M. Kirov) in the preparation and conduct of flight of Yu.A.Gagarin.

MEDEVAC miscategorization.

OBJECTIVE: To assess the effectiveness of an education program designed to improve medical evacuation (MEDEVAC) categorization. METHODS: To remedy the MEDEVAC miscategorization rates identified in the southern region of Afghanistan, the MEDEVAC medical director for that area created an education program to improve the situation. This education program was implemented through the region by the 14 NATO countries serving in southern Afghanistan and adopted by the Canadian Army as part of the training for Canadian medics. RESULTS: The education program yielded statistically significant improvement in the MEDEVAC miscategorization rate. CONCLUSIONS: Education concerning the categorization of MEDEVAC patients is essential for efficient use of Army MEDEVAC. Further investigation is warranted concerning the accuracy of categorization among an Army-only population.

[Some approaches to the countermeasure system for a mars exploration mission].

In article discussed physiological and methodical principles of the organization of training process and his (its) computerization during Martian flight in conditions of autonomous activity of the crew, providing interaction with onboard medical means, self-maintained by crew of the their health, performance of preventive measures, diagnostic studies and, in case of necessity, carrying out of treatment. In super long autonomous flights essentially become complicated the control of ground experts over of crew members conditions, that testifies to necessity of a computerization of control process by a state of health of crew, including carrying out of preventive actions. The situation becomes complicated impossibility of reception and transfer aboard the necessary information in real time and emergency returning of crew to the Earth. In these conditions realization of problems of physical preventive maintenance should be solved by means of the onboard automated expert system, providing management by trainings of each crew members, directed on optimization of their psychophysical condition.

[On-board medical support system (MSS) of flights of promising aerospace sets (design)].

It was suggested as the main compositive fractions MSS to consider the base system of automated evaluation of blood redistribution (BR) in body means of crew members protection and prophylaxis (CMPP) of unfavourable effects of flight factors to organism and also the automated circuit of CMPP' control. The advanced MSS includes 4 original measuring channels for registration of the base physiologic indices (electrocardiogram, venous-arterial pulsegram of neck vessels, reogram of head, earlap vessels pulsegram) the dynamic of which allows to determine with the help of computer the BR-integral parameter. The CMPP automated control circuit unites the separate protecting means in common system and executes the individual selection of regimes and CM PP-composition in accord with, first of all, body reactions manifestation and, secondly, individual physiologic status of spaceman. As CMPP was selected the negative pressure production around lower body part. Approlation of constructed active laboratory engineering mock-up MSS has performed investigations with participation of 29 subjects (Volunteers) under the modeling of hemodynamic shifts, developing in human body in short-term antiorthostatic hypokinesia (-10 degrees), as well as, in combined effect of antiorthostatic hypokinesia (-10 degrees), Coriolis acceleration and optokinetic stimulation. Results of investigations have showed, that the use of advanced MSS gives the indices of operator professional activity on the average of 17-32% under the decrease of hemodynamic stressful.

[Famous scientist and organizer of the surgical service of military air forces].

The article is concerned with the biography of professor, Doctor of Medicine Petr Lazarevich Seltsovsky (1898-1961), who was surgeon-in-chief of Air Force during the Great Patriotic War. He enunciated suggestions about the problems of surgery during his service in Air Force in his scientific works "Head injury of aircraft personnel of Air Force", "Traumatism of aircraft personnel", "Traumatism in Air Force". During the 30-year period of academic and research practice professor P. L. Seltsovsky published more than 120 scientific works including 7 monographs and 2 manuals.